Do spinal adjustments impact inflammation and oxidative stress? #481

Foreign hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And on today's episode we are diving into a brand new research study and it is a good one. Around the adjustment, we take a look at some cutting edge research about how spinal manipulation therapy, as they call it, affects oxidative stress and inflammation markers in the body. Now, before we get started, I want to say a few words about neck care, the best objective assessment tool for the cervical spine. Out there, they provide you with reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. You can check it all out@neckcare.com and I'll drop a link down in the show notes as well as a host of videos I've put out on YouTube and my social channel. They have a awesome combo of software and technology. So today's episode we're talking all about how a spinal adjustment affects oxidative stress and inflammation markers. As always, we'll drop a link down to the study in the show notes. And this is hot off the press. This was published in chiropractic and manual therapies and it's really the first one to examine how different levels of force with the spinal adjustment is impact blood biomarkers related to oxidative stress and inflammation resolution. So in today's episode we'll talk about things like why does this study matter? What are some of the designs and methods, the key findings, as well as some clinical applications in your practice. So let's dive in with why this study matters. And it's pretty obvious, but musculoskeletal pain, especially chronic musculoskeletal pain, is the leading cause of disability worldwide. We also know that the World Health Organization has recently recommended spinal adjustments as part of non surgical and conservative care options for chronic low back pain. However, the physiological mechanisms behind the spinal adjustments are not fully understood. Questions like how does it impact inflammation? How does it affect oxidative stress? Remain unanswered. And this study sought to answer those questions by investigating how different again, force levels of a spinal adjustment impact key biomarkers of oxidative stress and inflammation. And this is a really, really big deal for a variety of different reasons. And number one is we talk about it often on this podcast. But number one is we continue to learn more about the mechanisms of action that take place during a spinal adjustment and even the spinal adjustment itself. There are different aspects to that, right. And different applications. In other words, techniques. Are you doing diversified? Are you doing gonstead I mean even there's such network. Are you using tools such as an activator or a pro adjuster or. All of these are quite different in terms of how the body intakes that input, so to speak. And part of that is the force, right rotation, not rotation, higher force, lower force, non touch. All of these are different physiologically. Now they have overlap and they have some things that are similar, but there also are some big differences. So I liked this study because it analyzes, or at least starts to analyze the hey, we apply different forces with how we go about things. And this study looked at two different levels of force. We'll get into it in a moment. And basically was trying to see what happens that's different, not that one is necessarily better or worse than the other at this point, but just are there any differences when different levels of force are applied? And specifically, I'm going to say not relative to just did your pain go down more or less. But they really were looking at some interesting biomarkers to determine how does the body, not the conscious mind, but how does the body react differently to different force levels. And to do this they had just about 20 healthy adults aged 18 to 45. And they basically split them up into three different groups, a control group. So they had preload, no thrust at all. Then they had. This is hard because we don't really think, I don't think about things in terms of Newtons, but They had a 400 Newton Spinal Adjusting Group which they called the moderate force. And then they had an 800 Newton Spinal Adjusting Group which was the higher force. And they did this pretty interestingly. They used a force sensing table to really, as precisely as possible measure those spinal adjustment forces. And then they collected blood samples before, after, immediately after and 20 minutes after the adjustment. And they analyzed a few different biomarkers. One, total oxidant status, a measure of oxidative stress. Two, lipid peroxidation, LPO and lipid hypoperoxides that they call looh, indicators of cell membrane damage. They also measured total antioxidant capacity, the body's ability to fight oxidative stress, and resolvin D1, an inflammation resolving molecule that plays a role in pain relief. So they measured all four of those different biomarkers via blood samples, again directly before for three different groups. Control, 400 Newton, 800 Newton directly after the adjustment and then 20 minutes after. And they basically are trying to figure out what's the difference and is there a difference at all? And there were some differences. So in the 400 Newton group. There was a reduction in total oxidative stress, meaning there was less oxidative damage. There was a reduction as well in lipid peroxidation and lipid hydroperoxide suggesting decreased inflammation related damage. There is no significant drop in antioxidant capacity or resolvin levels and what this suggested was a net positive effect on reducing oxidative stress and inflammation. Super interesting.

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Now let's take a look at the 800 Newton, the higher force group. There was actually an increased total oxidative stress by about 80% immediately after the adjustment and then that diminished to 75% 20 minutes later. There was also an increase in lipid peroxidation and lipid hydroperoxide, indicating that there could be some short term oxidative stress. There was a decrease in total antioxidant capacity and resolvent meaning the body's natural defenses took a temporary hit. And this suggests that high force adjustments may induce short term oxidative stress before recovery. So what does all that mean? Well, it means that moderate force reduced inflammation and oxidative stress. Higher force temporarily increased those stress markers before the body kind of readjusted or re acclimated. So what's really interesting will be the next study which showcases knowing that really what happens and how. Where do we go from here? Right. So I look at this data and it's just interesting data at this point in time. I'm a big fan of manual adjusting and I like to get adjusted. So this is in no way, shape or form. I'll be super clear. This is in no way, shape or form saying lighten up on your adjustments. That's not the case whatsoever. And I don't even know if. I certainly don't know myself. And I'm imagining you don't know how many newtons of force you're putting in when you adjust somebody. But this is the start of a story, meaning this research is starting a story that's about to tell us a lot more about the different techniques we utilize, the different application processes we have, and what we can expect is immediate reduction in oxidative stress better in the 400 Newton group? I don't know. Maybe, maybe not. Is a immediate slight increase better or worse in the highest higher force adjusting group? Maybe, maybe not. I know quite often it's the bounce back, so to speak, that can cause the most benefit. This might be an off the wall comparison, but I think about it like a sauna and a cold plunge. The benefit comes not just that you got hot or got cold, although there are benefits there. It comes from the body having to re acclimate to homeostasis. Now that doesn't mean you want to increase oxidative stress necessarily on purpose, but we don't know. Let's learn more about what that means and then get a better understanding of, well, which one is really what we're trying to accomplish and secondarily with which patient population because remember, these were all healthy individuals. Now when somebody comes in and they're in pain, maybe, maybe there's a different way to look at it, I don't know. But I think it's a really fascinating and interesting research study. I'm glad they're producing research like this and it does exactly what it's meant to do, which is stimulate more questions. So what does this mean for our patients? It means that spinal adjustments definitively as if this hasn't been proven, but there's many people out there that don't know, has systematic effects beyond the mechanical components alone. It also means that moderate force adjustments may be ideal for reducing oxidative stress and inflammation immediately. It highlights the fact that higher force adjustments aren't necessarily harmful, but, but they could cause a short term spike in oxidative stress before recovery. So this supports the continuing plethora and piles of research that highlight spinal adjustments have a neurobiological component. That it's actually a neurobiological care and treatment option, not just structural, doesn't take away the structural, but this is really the bridge between structure and function. So what does this mean for your practice? Not too much today, but I think it can really tell a story as time goes on. So as always, I think we want to be cognizant of patient tolerance when we're applying our different techniques. It also highlights that adjusting force levels could optimize inflammation reduction for patients with chronic conditions. Especially when you think about somebody that's sensitized, somebody in chronic pain, those individuals have a very low threshold before. It's like, I just think of it like a old fashioned carnival game where you're like swinging the hammer and the weight goes up and hits the bell. It's like the weight is already 90% up the pole towards the bell. Right? In a chronic pain patient, it doesn't take much. Just standing up, fear, avoidance, behavior, all of these things. It's like, ding, ding, ding. The most mundane touch. And we've all had these patients. You can't even touch them when they're on the table and they're practically jumping off the because of pain. And that doesn't mean that they're lying. They are just that sensitized. So understanding how you can tailor the treatments, tailor the techniques, tailor the care that you provide to the individual only helps them and only helps you. It only helps them get relief faster, better, more efficiently, and it only helps you because if they're receiving the benefit they came in for, whether that's pain relief performance or whatever it may be, if they're receiving that benefit in the fair exchange of value, they're more likely to stay. They're more likely to refer all of those benefits that come into your business. So what do you need to know from this study? I think there's just a couple different things. One is that, of course, as chiropractors, we don't impact just the spine. We do influence the body's biochemical responses. We influence biomarkers in the brain, in the body, in the blood, as we see here. That is really, really impactful. And a direct quote from the study is quote. A 400 Newton spinal adjustment appears to reduce total oxidant status and lipid peroxidation, while an 800 Newton SMT seems to temporarily increase these biomarkers in the systemic blood of healthy individuals. So, interesting research. It is the beginning of what I believe to be a long journey of research along this line. And I just think it's cool. Think about the fact that what you do as a chiropractor in your practice each and every day not only affects the structural components of what's going on, but it literally can impact the brain. It can impact biochemical markers in the blood instantaneously. That is massively powerful. No pharmaceuticals necessary. It just continues to highlight the depth of what you do each and every day with every single patient that walks into your practice. And you should stand up tall, push those shoulders back, and feel confident when you're delivering the care that you do each and every day. You are truly impacting every aspect of those individuals. That can't be overstated. And it needs to be remembered each and every day, because that is the start of understanding how to communicate those benefits to your patients. Now, before we wrap up today's episode, I wanna say a few words about TurnCloud. If you're not checked them out yet, do so turncloud.com TurnCloud's design was to was to find the most efficient path in the day in the life of a chiropractor. They've stripped away everything that's not essential and made everyday function simpler. They've created an awesome intuitive application where nobody needs a user manual. So if you've been frustrated or maybe you're just looking for a cool option that's easy to use, that is simple, simple, simple. Head over to turncloud and there's a lot of people out there that would love that. Head over to turncloud.com again. There's turncloud.com, i'll drop that link down down in the show Notes. Thank you so much for tuning into this podcast. Whether it's your first time listening or you've been on the ride for 480 plus episodes, thank you so much. I would love to hear from you. So if you would please, please scroll down, tap how many stars. If you're listening on your phone on Apple Podcasts, maybe leave some feedback, maybe leave one line of text to me, let me know how it's going, let me know how you're enjoying it. I would love that. If you have direct feedback for me, you can always reach out to me at jeffevidencebasedchiropractor.com Other than that, I hope you have a fantastic weekend practice and I will talk to you soon.

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