How Chiropractic Adjustments Work From the Inside Out | Live Talk

So normally our mutual friend Mark Mao has the best sneakers at the event. Matt Hubbard has the best sneakers at the event today. Well done, Matt. Thank you. I am super excited to be here. Thank you, Dr. Paul, and thank you for Dr. Al. Anybody know Dr. Alex Vadan? He's speaking tomorrow. Awesome chiropractor, great guy, and he's the one that hooked it up. So I am super happy to be here. And we are going to go through a massive amount of information. Fair warning, we're going to go through a lot of information over the next 26 minutes. And my goal, my hope is that you take some of this information and put it to use in your communication. Great presentation that just ended about communicating. We're going to dive into some of the information you can use to power those communications. So this picture I took two days ago at my house. I see a couple familiar gentlemen right here. That is my great grandfather, and he was at Palmer when this guy was teaching. He was one of the students there in the 1920s, so many, many moons ago. And I can guarantee you my great grandfather, CA Langmaid, Chester Arthur Langmaid, did not have the advantages that we have today. 100 years later, we now have credibility. We have better market penetration, we have a ton of research, and we have a lot of people that could use our help. 100 years ago, there were a lot of people that could use our help, but we did not have a lot of. He did not have a lot of the advantages that we have today. If you look in the bottom left hand corner, there's a $3 ticket and it's like, man, in the 20s, $3 was a lot for an adjustment. On the back of that, that's a six pack of adjustments. 50 cents each. 50 cents each back in the day. So I'm happy to come from that legacy and hopefully do my best to continue that legacy a little bit. As Dr. Matt said this a little bit about me, we're going to move on from this quick. That's my kind of portfolio of companies that I'm involved in on the bottom there. But if you are online, I would love to connect with you, whether it's through podcasts, LinkedIn, Instagram, whatever it might be. So let's get started. Who thinks back pain is kind of boring? All right, I agree with that. Who thinks we can help much more than strictly back pain in our practices? I 100% agree. So let's look into some stats, though. First and second, set the stage. So here is the truth. Ah, I'm going to suffer From a little bit of keynote to PowerPoint transition here with some of these slides. So here is the truth, and this is important to know. I don't say put this slide up to be like a downer, but I want to showcase the opportunity that we have. Currently in the United states, there's about 334 million people. That's a lot of people. About 100 million people at any given time have back pain. It's a 30% point prevalence. So that means 30% of the population, for every 100 people anywhere at any time, about 30 of them have back pain, right? Then that means if we had everybody that had just back pain alone, and we know we can do so much more than that. I'm not even talking about neck. I'm not talking about sports performance. I'm not talking about healthy lifestyle. I'm talking about the stuff we think is super boring. All of US would have 1538 patients continually in our practice, day after day, week after week, month after month. And if we were seeing them two times a week, you can see every single practice would have 3,000 visits per week. That is a big opportunity and one that is important. And here is why. I practiced in a few multidisciplinary groups throughout my career, and what I saw happen was this. And I can guarantee you, if you are in practice, this is happening in your community right now. And this is why, in my opinion, is back pain boring to take care of? Sometimes it is. But this is the truth of what people are dealing with. Somebody has radiculopathy, well, they go in and they don't see you, they go somewhere else. They're typically going to be prescribed a medication. That medication doesn't work because they have a structural issue. So then the patient sent for an mri. Well, the MRI shows foraminal compression. We would have picked that up immediately on the exam. But now they are already down the pipeline or the journey of what I call professional indifference. And now it is time for shots. And we don't mean Little John shots. We mean epidural steroid injections, which are the fast track to surgical intervention. I believe this sucks. I believe we can and should do better. And I believe people deserve better than this as their primary option. That means we need to understand and communicate at a level that we never have before, because we know that's just scratching the surface. Think about how much more we can do beyond this. But, man, there are hundreds of millions of people struggling with this type of thing going on right now. And that is a big, big Deal. How big of a deal? Let's go through some kind of nasty stats here. This talk is about how an adjustment works. But I want to set the stage first for what's actually going on, and then we can talk about how and why what we do matters so much. NSAIDs, they must be safe, right? Well, 100,000 hospitalizations and 3,000 deaths each year just due to NSAIDs. Anybody seen that on the news? I certainly haven't. That's a big deal. Opioids, they are back in worse than ever. There was some progress made previous to what happened in 2019. Since then, things are back and worse than ever. 125 has now become about 138 deaths each and every day. A majority of those start with neuromusculoskeletal issues. That's a big deal. A real big deal. Anybody know what ESI is? Epidural steroid injection. Anybody see a patient that gets. Have a patient come in that gets three a year? I get three a year. Nine million of these are shot up every single year. That is 25,000 epidural steroid injections per day. And if you know anything about them, you know that they are basically frowned upon in the literature, used off label, and completely non effective unless somebody is in abject pain and maybe it can help them for a very short period of time. What also do we need to know? You might not know this, but 21% increased risk of spinal fracture every time somebody gets an esi. Do people know that? I don't think so. And that they are, quote, unquote, generally successful for approximately 50% of patients. That is worse than placebo by definition. They're kind of successful some of the time, about 50% for some people. That's about the weakest statement ever created. Yet this is done 9 million times per year. And that is why we need to communicate at a higher and better level, because people deserve better than that. We can also look towards Dr. Ulrich at spine Health. Lumbar fusion surgery only works for specific conditions. Well, in about 90% of the time, we don't really know what that condition is. Okay. This is why communication and understanding of what's going on in your community. And I don't. I'm always tentative to say this, but, you know, it's like this is happening right now in Vancouver, in Portland, wherever you're coming in from, this is happening. This is real, and people are dealing with this. This is why I'm so passionate about us being able to communicate and understand how we can help People, because to me, it's the most important thing in the world. Because once you have structural change, there's no going back from that. And is there a time or a place? Maybe 1% of the time, but this is absolutely nuts what's been going on and continues to go on. So how do we fare head to head? So you might say, okay, that kind of looks bad, but how do we stack up against these types of things with what we do? Let's take a look. So this is a super long title to a study, by the way. I can't believe. Absolutely crazy. So basically what happened was this. Here's what this study title means. They took a bunch of people that had huge disc herniations on MRIs. There was no mistaking it. A huge disc herniation pressing into a foraminal canal causing foraminal stenosis. And half of those people, gut chiropractic care or spinal manipulation in the literature, half of those people got injections. And what did they find? They found that the spinal manipulative therapy cohort had a greater reduction in pain than the nerve root injection cohort. Why does that matter? They literally took steroids, injected it where the pain was. That should probably make somebody feel a little bit better. And then they took people and had a chiropractic adjustment and we outperformed that. That's insane. That is wild. That is the power of who we are and what we do at the boring level. We didn't even get into increasing cortical drive and strength, athletic performance, injury reduction, all of those other. This is the boring stuff. And we'll outperform every day, all day. What's going on? So the question is, if your practice is not full to the gills, it is a communication issue, it's not a clinical issue. 99.9% of the time, slide strikes again. What else do we have here? We have high velocity, low amplitude manipulation, low back pain, double blinded, randomized control. That's all the good stuff. Against Diclofenac. Anybody here? Diclofenac before? Basically it's prescription medication, pain reliever kind of thing. So has anybody ever looked at any YouTube videos that I've produced? Anybody out there? A couple, couple of hands go up. Do not look at the comments with your children around. It's a public. It's crazy. You will. People believe the craziest stuff, like chiropractic. Oh, there's no research. There's like a gazillion papers and oh, well, there's never been anything that's A random. There's a double blinded randomized control trial. Chiropractic is not better than placebo. No, injections aren't better than placebo. But people have no idea. They don't even know how to make a good decision. This is why understanding this and communicating is so critically important. In this study they had a double blind, randomized controlled trial that showed that we were clearly superior to placebo and clearly superior to NSAID. About 75% of the people that had standard medical care plus chiropractic had pain completely gone, as opposed to pretty much almost the complete opposite. And if you just had standard medical care, what did that look like? It looked like this. So on the right hand side, all the way. If you look at the diclofenac, basically it was like a crapshoot. Like you were just as likely to get better as not to get better as get worse. And, and if you look at the manipulation as they call it in the literature, if you look at the spinal adjustment group, you can see, ah, there's some of it missing on the bottom. The 19 was pain completely gone. The 0 was slightly worse. 0 people got worse. Everybody had improvement. Where if we look at the other way we can see it was middling at best. That is a big deal. Anybody have a crazy notion that maintained chiropractic care? Maintenance care is a good thing. Good. All right. Just making sure I was in the right room. So I could not agree more. There's no doubt about it that maintenance care and continued care is a good thing. Now what you might not know is there's actually literature out there to support that. It's not just like some thing that we thought was good and we think might be good and maybe we'll check it out in the future. This is like 13 years ago. It's been out there. How many people know about this? Far too little. So what did they find? There's a lot of alliteration in the last statement here, but periodic patient visits permit proper evaluation, a lot of peace, evaluation, detection and early treatment of an emerging problem, thus preventing future episodes. I like the idea of detection. I like the idea of early evaluation. I like the idea of preventing future episodes because I know that to get to top performance you, you can't be in abject pain. And the first step is to get somebody feeling and moving well and then you can get into performance. So you have to get the bases covered here. And what we see is that the literature supports the benefits of maintenance care. It does not take away from it. Now by the way, anybody think insurance companies read this lately? Whole nother talk for a different day. We'll leave that one alone. So this does not mean that it's going to change policy tomorrow, quote unquote, healthcare policy or how an insurance pays you. But that does not equal what's actually true in real life. So please understand and know that all of this is out there for you. What do we also see about opioids? This was a big one and I tried to draw the second half. As we get into the second half of this presentation, I really cherry picked some of what I thought was the best stuff from the last few years. So it wasn't like super old. So here we are, Chiropractic care in the use of opioids. So as we talked about at the beginning, we have a ton of opioid deaths. That's not good. And almost 60% of people taking opioids report having back pain. That's a high correlation. Super high correlation. Well, what do we know? Well, if somebody receives chiropractic care over a six year period, the likelihood that they fill an opioid is going to drop by over 50%. Why is that? Any guesses? I hear some mumbling going on. So one thing might be, well, we don't prescribe medications. 100% true, but that's not why. The reason why is because people get moving. People understand more about their health. People don't need it because they're beyond pain and into performance. This is a really, really big deal and this can impact everybody. At a community level. You have people struggling on these types of medications right now in your community. You probably have people in your practice that you don't even know that are struggling with this type of thing. But please be aware that you are making a material impact in this with every patient that comes in, especially those boring patients that come in with sciatica, those boring patients that come in with back pain, those boring patients that come in with radiculopathy. And you see them, I mean, we practically expect them to get well. It's not even a question. We're like, okay, great, let's get to work. Let's get to the fun stuff. After we get through this, you change their life, you change their life for them. Their spouse, their partner, their work, their family. How big of a mission is that? What's bigger? Nothing, in my opinion. So don't skip over the boring stuff. So how does an adjustment actually work? The keynote to PowerPoint gremlins strike again. How does an adjustment actually work? Let's dive in. We got 12 minutes. Everybody doing good? All right, cool. So it works in about a million ways. And this could be a 10 to 12 hour talk. It's going to be 12 minutes. So there is a lot of different ways and we continue to learn more each and every year about how an adjustment works. Who here cruises PubMed for fun? That's what I thought. So I thought, when I was in chiropractic school, I think I went one time to PubMed and I was like, I ain't never doing that again. Lo and behold, here I am. So I don't blame you. It's super complicated. It's hard to understand what research says. It seems like they never answer a question, which is kind of the point of research to ask a new question. So if you try to read anything, don't get stressed out. If you want to make it easy, this is what I talk about all the time. So let's talk about lateral thalamic neurons. Wow, this talk just got really boring. We're trying to make this somewhat more fun here. Chiropractic adjustments work through a variety of different mechanisms, including at the joint, at the brain, at the spinal cord, and through the peripheral. We're going to highlight some of those right here. The top line here, it's a little bit small, but there is a difference between. I'm not getting into technique wars here, but there is a difference between a slow mobilization and a high velocity adjustment with how the body inputs that information. That's what this top line says. When you deliver an adjustment, there is something that happens that is different. That high velocity as opposed to low velocity. Does it mean it's better? It depends on the application. But it is different and it is special. And that is really, really important. So several studies showcased that adjustments alter central processing of mechanical stimulus. Increasing pressure pain thresholds and decreasing pain sensitivity. That's a really good thing. Fear avoidance, when somebody is in discomfort is one of the primary challenges we need to overcome. Because everything I think of it like, if you ever, like, went to, like the fair, I'm not this old, but if you went to, like the fair in the 1940s, you'd like, hit the thing and the bell goes up and hits. So you want the threshold of pain, you want your little bell to not hit the top. That's. It hurts. It hurts, it hurts. And when somebody's been in pain, their bell is kind of like hanging out right here. So anything that they do, they're so sensitized. It just hurts immediately so what we do is we bring that bell down where they can do more and not feel pain. That's what they talk about when it's said that they increase the threshold level. And that's really, really important because we want to get people moving. Also, mechanoreceptors in the musculature, another important part about what we do. This ties into the Golgi tendon organs. As you can see here, we depress the flow of sensory information and excite the motor pathways. It's that pain gating type of thing. No really news there. But it's important to know. We've only talked about two things. We've already hit on central changes in the thalamics and also in the mechanoreceptors. Let's keep trucking. There was another study that came out just a couple years ago about changes in brain activity. It's always been nice to think, oh, we kind of change things. No, we do. There's not a question about that at this point in time. So we impact an area of the brain called the dmn. How does that happen? Well, you can see right here at the bottom, we see alterations after an adjustment, especially with people with chronic low back pain, changing how the DMN lights up when they're measuring things. What does that change mean? It's part of how the brain responds to pain, and we're literally altering that. Like this blows my mind when I think about hands on a human being and an adjustment being performed. And that input integrates into literally how their brain is processing information. That is wild. That is absolutely wild. I love it. Let's take a look at a couple more changes in H reflex and V waves. So here we go again at the. Which is the best one? Probably the top line here is the takeaway. Spinal manipulation changes various aspects of nervous system function, including reflexes, cognitive processing, reaction time, and the speed at which the brain processes information. All of those things are impacted when an adjustment is delivered. And yeah, your patient might get off the table and say, I can move a little bit better, thanks, which is great. But this is what's going on inside. To get that simple one line reaction or that simple smile after an adjustment. Super complex stuff at a very, very deep. At a very deep neurological level, all of that is happening. That is why what we do is so impactful without pharmaceuticals. That is incredible. And the impact by how we do that with our hands, with an instrument, if you choose, however your technique flows, is really wild. And as we talked about at the beginning, I know, I went through it super fast, but there are tons of people struggling. They need our care. What else are they going to do? What else are they going to do? They need to be moving, they need good segmental motion. That's what we help with, of course, with the adjustments themselves. They need to, they need good regional motion and they need good whole body motion. You cannot have good regional motion, adequate regional motion and great whole body motion. If segmentally you're jacked up, it's impossible. These things stack upon each other. So whether it is for performance sake, injury reduction in athletes and crossfitters in weekend warriors, whether it's helping people get out of abject pain, all of these things happen in such a multifaceted, incredibly dynamic way that is overlooked by 99.9% of the profession and 99.9999% of the people in the world. So I hope that today, with some of the studies that we've highlighted super quickly, we got a couple more to go. This starts to pique your interest. No, you don't need to go to PubMed on Monday and start doing research. But you should appreciate the impact of what you do because I know showing up and delivering care, as passionate as we are and as excited as we can be when we see somebody get up and move better, when we see those changes, I'll tell you, it's like the curse of chiropractic is that it works so well. We see people come in and we expect them to move better and feel better. We get bored with a challenge of back pain that's causing hundreds of deaths per day and people going down. I didn't have it in this slide, but if anybody guesses how many spinal surgeries are performed each and every year, it's about a million per year currently. A million per year. 80 to 90% of those that can't identify the pain generator think that's a problem. I do. And we've all seen people that come to us and say, I wish I would have came here first. That is where I tie it in and say, this is about communication. This is about absolutely showing up each and every day in your practice and not only helping people, but getting those referrals to come in, promoting, as the man himself would say, to my left, right here, early to bed, early to rise, work like hell and advertise absolutely critical. People will die without that. There are not enough chiropractors. If we looked at just the back pain thing and we're like, it'd be 3,000 visits a week. For every chiropractor, that's kind of a lot. That's not even like chiropractic practices. That's every doc themselves. So if you are into sports performance as well, if you're into lifestyle care, if you are into those other things, I can tell you you have no shortage of people. So it is incumbent upon you, us, all of us, to get out there and tell the story as often, as clearly and as impactfully as we can. Because otherwise people don't know how to make the right decision. If they did, we wouldn't be in the situation we are right now. And it's our job. Nobody's coming to save the day. It is everybody in this room. It is. All the onus is on us to get out there and do it. Golly, my slides got stepped on here. I apologize for that. So neurophysiological response to manual therapy and analgesic implication is any like, who titles these things, by the way? That's a whole nother story. So anyhow, let's take a look at what they found here. Multiple reviews have also investigated the pain modulating mechanisms and are in agreement that it is neurophysiological. Through the descending pain modulation circuit, they also found a small and statistically increase in B endorphin levels. And they saw decreases in neurotensin orexin A, whatever that is, and decreases in oxytocin after the adjustment. Long story short is that is all good stuff. And in many of the cases, this is what's really wild. Pharmaceuticals like, try to do this through chemical alteration. We do it through natural healing processes. That's wild. That's awesome. And that is one of the many reasons, as I've elaborated on, that it's so critical that we get out there and continue to tell this story. Pain sensitivity and spinal stiffness. The first line here, I just like it because if you haven't been paying attention to the literature almost every single study at this point, again, this is different. And I say this because it's so different than how people think or what every other healthcare provider in your community probably knows. They start out by just saying clinical guidelines recommend spinal manipulation not only for chronic low back pain, but for many other things in the literature. It's like this is like a 10 year old phenomenon. It's like, of course that's what the first line treatment should be. Now that hasn't correlated to referral habits very well and it hasn't correlated to decision making. But that foundation is all there for us. It is all there for us. Take a look at another one or two here. We got two minutes to go. Everybody still good? All right, cool. Inflammatory mediators with non specific low back pain. What do we have here? We have a significant reduction in IL6 and enhancement in IL2. Those are interleukins, which I don't even really know what that means, but it's a good thing when that happens and people feel a lot better at the end. So this is again what a lot of the pharmaceutical industry is trying to do. We do with our hands and as we highlighted at the beginning of this talk, and I agree with 100%, this is the boring stuff. Damn. Like that is the power of who we are and what we do. And we can provoke an anti inflammatory reflex again through the care that we deliver. I absolutely love that and I love to continue to see these studies. Just rack up one after the other after the other after the other and. And again, I can tell you 20 and 30 years ago this stuff was not there, but it is there now and it is there as deep and as many as you want to investigate and go after. So man, I'm going to be about one minute early right now. So thank you for being chiropractors. The world absolutely needs you, it needs all of us and we need to get out there and tell our story. I want to thank again Dr. Alex Vedan for making the recommendation to Dr. Paul to have me out here. It's my first time in the Pacific Northwest. It's absolutely awesome. I've seen a lot of familiar faces. I could point some of them out right now. And thank you for Matt Hubbard for making a fantastic introduction. Have an awesome day. Thank you for being a chiropractor and hopefully I'll see you soon. Thank you so much for watching this video on the evidence based Chiropractor channel. If you don't want to miss a single thing, please subscribe to our YouTube channel. Subscribe so you can get notifications of every video we put out. And we put out new content each and every week, so be sure to subscribe today.