How Chiropractic Adjustments Affect Biochemical Markers in Neck Pain | Podcast Ep. 174

Foreign hello and welcome to the evidence based chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with the research. It is about diving deep into how an adjustment works. And there's a brand new paper in the journal of manual and manipulative therapy that highlights changes in pain and specifically what biochemical markers change or are altered after an adjustment or a manipulation is given. This is an awesome piece of research. It's brand new and I cannot wait to dive in on this week's episode. Additionally, if you have not picked up your ticket to adjust your marketing 2019, I don't know what you're doing because time is running out. Adjust your marketing is my deep intensive dive June 7th through 9th here in beautiful sunny Tampa, Florida, where we're going to build, create, strategize and even start to implement a marketing plan for your practice. That's what it's all about. You can see all of the information at the evidence based chiropractor.com events and you can pick up a ticket there as well. Again, adjust your marketing is happening June 7th through June 9th here in Tampa, Florida. 20 docs maximum. I wanna work one on one with everybody there to help you grow your practice. That's what it's all about. If that interests you, then visit theevidencebasedchiropractor.com events and pick up your ticket today. But for today, specifically, the research we're touching on, as I said at the top, brand new study from the Journal of manual and manipulative Therapy. And the title is the immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute nonspecific mechanical neck pain. And it is an rct, a randomized clinical trial. I'm going to say that one more time and you can also find a link in the show. Notes the immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non specific mechanical neck pain. A randomized clinical trial. So the researchers come right out of the gate by emphasizing the role of spinal manipulation. It's a common technique for the treatment of neck pain and it has demonstrated various mechanical, neurophysiological and analgesic effects, which is awesome. They also touch on, which I think is really, really important. The opioid epidemic. And I did not know this stat, but listen to this. In 2016, 116 individuals died every day from an opioid related overdose. Can you believe that? Over 100 people died every single day from an opioid related overdose. So clearly a lot of this starts with spine or musculoskeletal complaints and clearly it needs to stop. So this research paper took a look at females with neck pain because neck pain is more common with females and it wasn't in. Sometimes we see studies like this and it's in asymptomatic people. This was in symptomatic people, people with non specific mechanical neck pain, specifically those people being females. So the researchers found a couple things, I will lay out a couple quotes, then we'll talk about. You can utilize this in your practice. The researchers found more recently there is moderate emerging evidence supporting a modulation of biochemical mechanisms as well, suggesting that a mechanical stimuli provided by manipulation can trigger changes in analgesic and anti inflammatory serum markers in asymptomatic individuals. Sort of similar to what we touched on in last week's episode to a certain degree. But this paper specifically because of that, they said, well, let's take a look at the symptomatic people and see what goes on there. And here's what they found. Our findings suggest that the mechanical stimuli from the manipulation may modify neuropeptide expression in symptomatic subjects by statistically significant increase in the serum concentration of neurotensin, oxytocin and orexin A in subjects with nonspecific mechanical cervical spine pain. So they break it out right there and then we'll dive a little bit deeper. They also found oxytocin plays an endocrine role in modulating pain by blocking the activity of A and C fibers without affecting nociceptive fibers. So important there, right? Oxytocin we know is an important component of how we experience pain. Also this neurotensin, this is a new one for me. The findings of this study show a significant increase in mean circulating serum neurotensin, a well recognized biochemical analgesic in the spinal manipulation group. While no significant change was noted in the sham group. So definitive differences between the people who were getting adjusted and the people who did not. So their conclusions were as follows. The results of the current study suggest that the mechanical stimuli provided through an adjustment may modify neuropeptide expression by immediately increasing the serum concentration of neurotensin oxytocin anorexin A in the blood of female subjects with mechanical neck pain. So this gets to be really, really exciting when I start to break this down. Number one, they are looking at as we know people with neck pain and we see that all the time in our practices, right? Probably second to low back. It's probably the Second most common reason people come in. And if you combine neck and headache, it might even overtake low back. Also great about this paper, randomized clinical trial. So it's an rct. It's kind of one of that top echelon pieces of research. Now the thing that gets pretty wild when I start to think about this is think about the mechanical nature of giving adjustment or manipulation, right? It's physical. You give an adjustment that way. And in most of the cases, these looked like they were just for reference. A supine diversified adjustment is what it looks like in the picture. And to change biochemical markers after giving a manual impulse like that is awesome. I mean, think about the power that that has. Often people are taking drugs, they're taking like literally things that affect their chemistry to get this result. And to think about the fact that an adjustment with your hands alone or an instrument, depending upon how you practice, you can get in there, put a force in on the spine, ultimately an adjustment to the cervical spine in this case, and have literal biochemical marker change in an individual along with decreased pain is absolutely mind blowing to me. And the really interesting part about it was they were looking at these really important biochemical markers as we talked about, right? They looked at oxytocin, they looked at cortisol levels. Ultimately they also looked at this neurotensin and this orexin, which were some new ones for me, specifically orexin. Obviously we've all heard of cortisol levels, we've all heard of oxytocin. But to think about the fact that an adjustment that you give in your practice can have an immediate impact and how I like to think about how that the physical nature of giving an adjustment impacts what we produce chemically within our bodies is just so powerful and so awesome. And it showcases again the further effect, right? This had nothing. I didn't say anything about gapping facets. I didn't say anything about, you know, changes or alterations of disc pressure, which is very, very mechanical, right? You're opening up a foraminal canal with an adjustment. This is strictly physics and mechanics. But when we look at the effects on how it can impact ultimately what has to be the nervous system to come out with biochemical marker changes, it is so, so powerful. So this is the type of research that gets me so excited about what's to come. I love the mechanical aspects of things. I think it's exceptionally interesting and there's a long way to go there before we. Everything there is that we can know. But understanding how pain is experienced, how biochemical markers tell the story of that. And how physical, mechanical things such as an adjustment or a manipulation can alter that and then decrease the pain, increase the range of motion, improve the function of individuals is just so, so important. And when we set that against the backdrop, as the researchers did, we set it against the backdrop of the opioid epidemic. This starts to become a very, very compelling piece of a larger body of research that substantiates what we do as chiropractors each and every day. I cannot help but think that this is building that cascading wave where we're going to go from utilizations of 10 and 15% to much, much, much higher. Now, the key is we need to be able to showcase this research in a way that's actionable. We need to be able to showcase the research not only to policymakers and legislators, we also need to showcase it to other healthcare providers and certainly the public needs to know about it as well. Now, I don't think the public is too concerned with biochemical markers. They're interested right in the benefits. What does that mean for me? What does that mean in terms of quality of life? But from a policymaker perspective and from a interdisciplinary communication and speaking with MDs, DOs and the like, having this body of research to stand on is just so crucially important to bridging the gap into growing our profession. So this is why research such as this gets me so jazzed. I think we are on the edge of what's going to be a massive amount. We've seen more chiropractic research published over the last 10 years than probably ever before. And I think we're at the tip of the iceberg to an avalanche. More research coming down the pipe. And if it keeps showing up as this, I think we're all gonna be in for a real treat. And again, to frame it back one more time, 100 people dying per day directly due to opioid related overdose. I have never seen anything in the literature to date that has even approached literally 1% of that as far as the risk associated with a chiropractic adjustment. So it's almost so on the other end of the spectrum that it doesn't make sense when we look at risk, reward and the ability to help people get well. But, and I, we need to continue to step on the gas, get information like this out to the people in our community, out to the policymakers in our states and counties, and also in the hands of other healthcare providers in our community. So if you have any questions about this paper, feel free to drop me a line. Jeff the evidence basedchiropractor.com I would super, super appreciate it if you have not left a rating or review on itunes for this podcast. It's what helps more and more docs find us. So I'd encourage you to do that and I hope you have a great week in practice and I will talk to you soon.

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