How a Lumbar Adjustment Affects Athletic Performance and Symmetry | Podcast Ep. 258

Foreign hello and welcome to the Evidence Based Chiropractor.

I am your host, Dr. Jeff Langmaid.

If you take care of athletes in.

Your practice, you're going to want to listen to this week's episode. It is all about lumbar adjustments, symmetry and performance. It's a randomized, controlled study. It was single blinded, came out just not too long ago. 2018 in BMJ we're going to break down this and showcase how it is clinically meaningful for you and your practice in today's episode. Before we get started, I will ask if you have not yet left us a rating or a review in itunes. Please scroll on down if you're listening on your phone and tap how many stars you think we earned and if you want to comment, even better. It helps more and more docs. Find out about this podcast and thank you for tuning in. If you could take that extra moment.

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20 to 25 minutes.

Comes out every Monday morning at 6am Eastern time.

And on this week's episode we're talking all about the effects of a single.

Session of lumbar spinal manipulative therapy in terms of physical performance Test symmetry in asymptomatic athletes. A single blinded randomized controlled study.

Again, this came out in BMJ Open.

Sport and Exercise Medicine Journal and it.

Came out in 2018.

So let's get the basics down. First, musculoskeletal disorders in athletes, including spinal biomechanical dysfunctions.

They're often asymptomatic, but they're believed to.

Negatively influence physical performance in terms of symmetry. So what they hypothesize is that asymmetrical.

Athletes could show a decrease in physical.

Performance, so suboptimal performance, or have an.

Increased risk of injury as a result of favoring one side of the body. I don't think that's too far fetched.

That's where a lot of this study is built off of those two sort of hypotheses that symmetry is good. Our bodies are designed to be symmetrical and in an asymptomatic athlete, if there is chronic or perpetual asymmetry going on, it could have an effect on their top level performance.

If you're an athlete, you're probably doing.

It for some level of performance, so that's important. Right.

And the kicker, not only might you.

Have suboptimal performance, but you could be more likely to, to have an injury. So is symmetry important? Well, in the context of what they're laying out, I would say the answer is absolutely yes. So let's see what they found. This study took 40 athletes, 20 males, 20 females from different fields of sport participation. And they got either a sham adjustment or spinal or an SMT of the lumbar spine. And then they were assessed. They were assessed after that statically. They were assessed doing sort of a.

Jump, so to speak, and they were assessed doing a squat. And the assessment took place. They used a motion capture system that was equipped with like 15 cameras, a bunch of force sensor platforms. So they used a lot of technology to really gain these symmetry indexes or indices, and that is how they based their baseline.

And that's how they looked at the.

Sham treatment against the adjustment or the spinal manipulation treatment.

Now, what they found is, could be surprising or not surprising, I guess, depending.

Upon who you are.

But they had participants that presented with bilateral asymmetry values in the static position. And after the adjustment, these values reduced.

Significantly, and reduction is equivalent to less.

Asymmetrical, so significant reduction where these individuals were becoming more symmetrical. The lumbar intervention produced immediate effects in static symmetry.

However, the same effects were not found in the dynamic test. So in the static test, hey, after an adjustment, symmetry improved dramatically in the dynamic test, the squat and the jump.

It did not work out that way.

There were not statistically significant changes. The sham group, incidentally, showed no statistically significant differences between pre and post measurements.

So what was the difference?

Well, of course, it was the SMT or the adjustment.

So before the interventions, the participants presented.

Asymmetry values with mean of around 16.

And a half percent. And in the sham group, it was.

Around about around 11%. So that's sort of where everybody started. Now, afterward, the asymmetry values range from 4 to 13%. So you could see when they're starting at 16%, some of these people got down to 4% and 13 was the high.

Yet that's a pretty significant change in.

Terms of percentage and the pictures that they showcase in this study, it's pretty clear what's going on. So the researchers here believe these findings seem to be useful in the clinical Context of rehabilitative programs for asymptomatic athletes. So when we think about prehab rehab and just, you know, activity, right, this could be very, very impactful. Again, these athletes, they were asymptomatic, they didn't have a ton of challenges, they weren't dealing with, you know, 8 out of 10 pain, they didn't have radiculopathy, they were healthy and probably feeling like, hey, I'm performing pretty well. So that's also an incredibly important piece of this because I know there are so many docs out there in the rehab, the sports, the evidence informed community that sort of have these gym spaces inside of your. Inside of your practices. And quite often I'm shocked because you'll use them for the care that you deliver, but then you'll let the patient go back and just go to the regular gym and kind of hope for the best. And if you've built out a rehab space, a clinic, gym, hybrid, whatever it might be, how you're positioning it. I always think about, man, what an.

Opportunity for those individuals that are coming.

In symptomatic, because many people do, right? Most people come in symptomatic, they're having.

Some sort of challenge, and they're looking.

To you to help guide them towards better health and wellness. Now once they get there, if they're an athlete, this start of this information starts to become really, really compelling in.

Terms of man, utilizing that gym space.

And when indicated, you know, adjusting the lumbar spine, making sure that their segmental biomechanics are as good as possible, could have a very positive effect in their ability to perform.

And I think the same holds true.

In the professional athlete circles. I mean, a lot of those guys and gals that are pro athletes are kind of beat up all the time. And I realize that they're not really the best case for asymptomatic people. There's probably not anybody that goes through an NFL season that's not hurt from what I hear. So probably not the best example. But if you think about how a chiropractor is utilized on a lot of these teams, it really is about really rehab, it's about proprioception, it's about ongoing care and maintenance. Not just simply let me toggle the atlas and that's the ongoing maintenance, but it's really working with the athletes through those three phases of motion that I always talk about and think about. Segmental motion, regional body motion, and whole body motion. Chiropractors are really uniquely positioned to impact all three of those in a way that almost nobody else is. So when we start to think about asymptomatic athletes and how can we help these individuals continue to progress, how can we have what I'll call ethical maintenance care? This study starts to lay the foundation for that. So the conclusion of this study was statistically significant. Differences were found in lumbar smt, but only for static symmetry.

These findings suggest that SMT was effective.

In producing immediate effects in symmetry in the static position, but none in the dynamic tests.

So future studies will be super interesting.

To see how adjustments, if they do or don't, if they impact any of the dynamic motion and dynamic tests over time. We'll have to wait and see and learn. But this initial study is incredibly impactful. When you can impact the potentially decrease the opportunity of injury, risk of injury, likelihood of injury. When you can improve the potential top end performance of an asymptomatic athlete, that's incredibly impactful. Again, if you think about the athlete that comes in hurt, you've already built the no trust and like factor with them. Theoretically, they're only asymptomatic at the point where you've already helped them get to that point. Of course, right? They came in symptomatic. You're working with them throughout what you do to get them asymptomatic. But if you have a rehab space, if you have a gym, I'm going to encourage you. Think about it in a new light. Think about it in terms of how you can have a relationship with somebody over time and how it doesn't have to be just transactional down to the care you give when they are at their most challenged, when they first present into the office. But there are opportunities and we've seen this sort of extend beyond the chiropractic space in what they're doing, for instance, with on Base U and professional athletics movement. Right. When we see what TPI and Greg and the team over there have been able to do in the golf world. What we do as chiropractors extends so far beyond. One of our most powerful tools is the adjustment itself. But really we are movement experts at heart. Again, segmentally, the adjustment falls right in line with that. But we're also experts in regional motion. We're also experts in movement assessments. Many of us are experts in whole body exercise, health and fitness. And don't shortchange your practice by becoming so myopic. I think there's a tendency in the evidence informed world to become very myopic to what's going on with the person. But, but one Thing that I see in the literature time and time again as I continue to study more, continue to try to learn more, is the emphasis on the dynamics of our bodies. Our bodies are super, super dynamic. And really almost every organ system is integrated into the other one. Now it's like, this is one of those things I think we all know and think about when we're a little kid. It's like, yeah, mind, body, connection, we're all one. It's a dynamic being. But as we go through our education process, and sometimes for many of us, as we get into really getting into these specific techniques or these specific protocols, it actually we start to become a little bit more myopic in terms of how we think about the body and less dynamic. So I'm gonna encourage you, take what you learned today, think about it, think about ways that it makes sense to apply in your practice, and take a peek via a movement assessment. You don't need to have 15 cameras to be able to tell the body symmetry of somebody that's walking in the practice. Do a movement assessment, take a look at how they are moving statically and dynamically. Assess whether there is asymmetry or not.

And if there's asymmetry and they're an.

Athlete, might be a great idea to have a conversation with them about what they can do to improve their performance, to potentially decrease their risk of injury. And you continue to help guide them to their best life, their highest quality of life. And for an athlete that typically is staying in the game, not injured and having the best performance but possible. So hopefully this study was enlightening to you as it was to me. I hope you have a fantastic week in practice and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to go faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.