Proof It’s Not Placebo: New Research on Adjustments & Lumbar Proprioception | #520

Foreign. Hello and welcome to the Evidence Based Chiropractor. I'm your host, Dr. Jeff Lingmaid. On today's episode, we're talking all about spinal adjustments and lumbar proprioception. Fantastic brand new study. We're going to highlight what the research says, how to implement it in your practice, and of course put it into the conversations you, you can and probably should have with your community. Before we get started, big shout out to two partners. NeckCare, the best objective assessment tool for the cervical spine on the market. They're willing to hook you up with 10% off. Check it all out@necare.com it is reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. In addition to that, Leander Tables, hooking you up for being a listener. $1,000 off their Series 950 table. You can use the code EBC2025 or or visit their page to learn more. Awesome, awesome. Flexion distraction tables. Check them out. Leander tables. I will drop that link down in the show notes. But as I said at the top, we're diving into a brand new randomized controlled trial. And it gives us, as chiropractors, you and me, something we absolutely love, which is hard data on what spinal adjustments actually do inside or influence or with the nervous system. So, so let's kick this off with a pretty bold statement that a single spinal adjustment can shift the body's balance towards or balance strategy, I should say, towards the lumbar spine. And that shift may help predict who gets the most pain relief. That type of statement is straight out of this 2025 randomized controlled trial. And today we're going to break it down again. Talk about what they did, what they found, and how you can use this in your practice. So this starts to answer the question, if you've wondered what exactly changes after an adjustment beyond the cavitation and the motion, this episode is gonna be a good one for you. So this study looked at something called proprioceptive waiting. Like W E I G H T I N G. Proprioceptive waiting. That's a new term for me, and here's what it means. Which body region your brain trusts more for balance control. Your ankles, your lumbar spine, whatever it might be. Now, why does this matter? Well, people with chronic low back pain often rely way too much on ankle proprioception and not enough on lumbar proprioception. And that mismatch can contribute to a host of things that might sound familiar to you, things like stiffness guarding, altered motor control, and continued ongoing pain. So the researchers in this study set out to answer, and they asked a really deceptively simple question. Does a single spinal adjustment change how the nervous system prioritizes proprioceptive input from the lumbar spine? And if it does, is that change linked to pain relief? So they randomized over 140 individuals, both healthy adults and, and people with chronic low back pain, which I love that they had both sides of that, into three primary groups. Group number one, lumbar spinal adjustments, hvla. Group number two, lumbar mobilization, grade three, Maitland style mobilization. And group number three was no intervention. So again, group one, spinal adjustments, group two, lumbar mobilization, and group three, no intervention. So before and after treatment, they used force plates and a 60 Hz vibration to measure how each person used their ankles versus their lumbar spine for proprioception when balancing. And here's the really cool part. Spinal adjustments produced a stronger lumbar steered proprioceptive response than either mobilization or doing nothing. Even better than that, patients with the strongest lumbar driven proprioception at baseline got the biggest pain relief after the adjustment. So this is really the first randomized control trial that I've ever seen, showing that spinal adjustments can immediately, I'll repeat, that can immediately shift proprioceptive weighting towards the lumbar spine, and that baseline proprioception may. May help predict who responds best to the care that we deliver. So let's hit some of these headline stats because I think they're really important. Number one, spinal adjustments, again, significantly shifted proprioceptive weighting toward the lumbar spine compared to no intervention. That was a P of.007 compared to mobilization.030 immobilization versus no intervention. No meaningful difference. So the numbers are a little hard to conceptualize there. But the big one there, mobilization versus no intervention, no difference. Adjustments versus mobilization, big difference. Adjustments versus no intervention, big difference. That shows us that adjustments or spinal manipulation uniquely, uniquely enhances how the brain relies on lumbar proprioception. This ties back to, I think, a number of studies that we've highlighted throughout the years on this podcast showing that there's just this unique mechanism, and it's almost like, hard to put your finger on because it's so much more than just one thing. But there is something different that happens between a mobilization and an adjustment or a manipulation getting into that paraphysiological space. And I'm not even sure it's technically as just biomechanic as getting into the space I think it's a host of different factors that really make a massive shift and a massive difference between. And mobilization can be very beneficial. I'm not dogging mobilization, but. But something different happens when you get in there with an adjustment. And I've very rarely seen that. That something different isn't meaningfully better than not doing it. And that's something I think is important for all of us to keep in mind as we look and review research like this, as we understand the differences between mobilization and manipulation. There's a time and a place for both. Not everybody can you get in there and deliver an adjustment. Sometimes mobilization is the best you can do and the best you should do. But when you can get in there with an adjustment, man, there just is, I hate to use the word magic, but there just is something a little bit different that happens. It takes the effects to the next level. It impacts our peripheral central nervous system differently than simply going through the mobilization alone. So another stat was, you know, pain relief after manipulation or adjustments depended on proprioception at baseline. Really interesting here. So in patients with chronic low back pain, there was a lower baseline proprioceptive weighted ratio, meaning stronger lumbar proprioception predicted greater pain relief after the adjustment. So this moderating effect important. Was not seen with no mobilization or no treatment. So what does this mean? It means that patients whose nervous systems, you know, already quote, unquote, listen to their lumbar spine benefit the most from that thrust or from that adjustment. Additionally, both healthy adults and chronic low back pain patients responded similarly. So no major baseline differences in proprioceptive strategy between those two groups and a single session produced immediate neurophysiological changes. So this is not placebo or expectation effects. This is really neuro data that is objective and that's pretty big because if you go on YouTube for about more than one second looking at any chiropractic related video, you're going to see plenty of trolls inside the comments claiming everything a chiropractor does is placebo. Everything is just about setting expectations and framing things, sales practically. And the data is just, we're talking, this is like a decade and a half in two decades. Now I remember the research from literally 15 to 20 years ago clearly stating the difference between placebo and what we're doing and that there is, there's no overlap, it's not a placebo effect. There is absolutely real data. Now the real interesting point, the irony of all of this is that quite often I look at what the results are with a lot of traditional medical care in a neuromusculoskeletal world, and it's practically worse than placebo. I'll let you do that with what you will. But it's important to note this is not a placebo or a expectation or influenced effect. This is actual data coming out of the research, highlighting before and after in a randomized control trial.

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Let's take a moment and kind of unpack what the adjustment changed. So the researchers looked at what they called the center of pressure, and they referred to these as center of pressure shifts during vibration of the ankle muscles or the lumbar paraspinal muscles. And when you vibrate those areas, you can kind of trick the proprioceptive system and watch how the body reacts. So you can kind of think of this like a stress test for proprioception. And what they found was that adjustments kind of upweighted lumbar proprioception. So after an adjustment, the individuals in the study, their bodies relied more on lumbar muscle spindle input and less on ankle input when maintaining balance. So this suggests a few different things. It suggests an adjustment can increase sensitivity of the lumbar muscle spindles. It suggests that there's an enhancement of interferon input into the central nervous system. It suggests that there's improvement in sensory motor integration both at the spinal and supraspinal levels. It also suggests that there's a shift in motor control to a more efficient and segmentally driven strategy. So mobilization did not produce this effect. So when somebody had just mobilization, nothing significantly changed compared to the rest. So this helps separate, I'm going to say, the mechanical input of an adjustment from the rhythmic or passive input of a mobilization. Another thing was that pain relief relief was not directly caused by proprioceptive change, but it was rather linked to that baseline state. And this is kind of interesting because changes in the proprioceptive weighting didn't correlate directly with changes in pain scores. And probably not surprising for us, as chiropractors often function and pain can be independent of each other or loosely connected. If not causative all the time. But baseline proprioceptive weighting did predict, so pain did not, but the baseline did. So this suggested that adjustments were more effective in central nervous systems that were already leaning towards lumbar driven motor strategies. So this opens up the door for future questions, future research, uh, and it showcases, hey, we're not there yet. But this is a big step in the right direction from a research perspective. So I think there's really a couple of clinically relevant highlights or insights that we can glean from this study. One is that spinal adjustments produce immediate neurophysiological changes. It's not just motion or cavitation, but it's actual paraspinal muscle spindle input, it's actual proprioceptive weighting, it's actual central nervous system integration and sensory feedback. Secondarily, that adjustments can help to restore a more efficient motor control strategy. So we can help to influence the improvement of balance, reduced guarding and stiffness, enhancing motor control. Now, these are dynamic things. It's not always A plus B equals C, but, but there's a tendency that the research shows and that tendency is important to lean into additionally, again, that baseline proprioception can really help predict who's gonna benefit the most. So patients with strong lumbar proprioception at baseline experience the largest pain reduction and when, again, when I say benefits specifically with this, it's related to pain relief. So this is great information, in my opinion, to make sure that you're considering during your report of findings, during table talk, during front desk, new patient education, whether it's your. I bring this up all the time. But social media videos, your workshops, your reactivation messaging, you know, all of this is really, really important because you can use proprioception as an enhancement to your explanations of care. And this helps differentiate what you do as a chiropractor from passive or solely mechanical. Oh, well, I do PT at home. I kind of stretch and do my exercises. That's awesome. But that's different than delivering an adjustment, right? Pain isn't just a tissue issue, it's often a proprioceptive issue. And that's important to highlight. Also, adding balance and proprioceptive testing to your initial visits. Probably already do this part of whether it's DNS, sfma, whatever assessment tools you're using on. But even simple assessments can really emphasize the neuromuscular part of chiropractic. Things like single leg stance, eyes closed stability, foam pad, balance test, Trendelenburg variations. You know, patients love to see these objective, objective changes. Excuse me. So you know, highlighting things during your evals and then your reovals during your exams and then during your re exams can really start to showcase the benefits that the patient's actually receiving. This is not again, it's not magic, it's actually showing them here's where you were at, here's where you're at today. But unless they're physically doing that, that's quite often lost on them. So getting them to go through those tasks, they take seconds, but they really can make a meaningful impact in helping somebody understand the benefits of the beyond just their activities of daily living. Additionally reinforcing that the adjustments you deliver, they influence the nervous system not in this opaque, vague way, but in a measurable, research supported way. When an adjustment is delivered, it modulates muscle spindle firing and enhances lumbar afferent input. It can improve proprioceptive weighting and it can help optimize motor control. Those are really important messages for every platform we just discussed, meaning newsletters, report of findings, social media videos, all of those things. So I loved this study. I think it's a great reference for more of what's to come. And it showcased at its heart that a single lumbar adjustment can immediately increase how much the brain relies on sensory input from the lumbar spine. It starts to tie together pain, motor control, proprioception, neurophysiology, all of that together. And it reinforces probably what you and I see each and every day, that people don't just move better after adjustment, their nervous system has the opportunity to function better. And this helps substantiate that one more step. Now as we wrap up, I want to give a special shout out to two more partners of this podcast, Blue Honest Lasers. They're going to hook you up with $2,500 off their Pro VX laser. We'll drop that link down below. If you are in the market for a Laser Pro. Excuse me, Blue Honest Pro VX Lasers, Full spectrum. They're awesome. I had an interview with Dr. Doug a few weeks ago. Listen back to that. If you haven't, you will learn more about lasers in that episode I did than I had learned in 20 years of practice. So check that out. And Shockwave Centers of America if you're looking to bring in Shockwave into your practice, Shockwave Centers of America will hook you up with $500 off and a free cart for being a listener to this podcast. I'll drop that link down below. Or you can connect with their team and let them know you heard about them on this podcast. Other than that, I want to say thank you for tuning in and listening. If you have not left a rating or review, I would appreciate it if you would take a moment and do. Thank you for tuning in. Thank you for being a chiropractor. Have a fantastic week in practice and I will talk to you soon.

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