Spinal Adjustments: The Surprising Forces at Play During Manipulation | Podcast Ep. 278

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we are exploring a fascinating piece of research that starts to break down the question of what's the difference between the forces of your hands when applied to the patient and. And the patient into the table Is a fascinating study. I've never seen anything like it. We're going to break down what these researchers found. It's brand new. It came out just last year in 2020 in chiropractic and manual therapies. I'll list the title and also drop a link down in the show notes if you want to check it out. And it is all about a study titled Assessing forces during Spinal manipulation and mobilization. Factors influencing the difference between forces at the patient table and clinician patient interfaces. That's a mouthful there. This came out just last year in 2020 in chiropractic and manual therapies. So as chiropractors, we probably deliver a lot of adjustments each day and each week. It's the hallmark of chiropractic care is a spinal adjustment. But you probably haven't thought too much in terms of the force difference between where your hands meet the patient and where the patient meets the table. It's a fascinating thing to think of. It's just not something I would normally consider, especially when we think of a prone thoracic adjustment or even an anterior thoracic adjustment. When somebody's leaning back, there is direct force that goes in from you to the patient and direct force into the table. And understanding some of those nuanced differences give us potentially the future opportunity to play with things a little bit, to be more specific, to be more accurate and to better understand how can we deliver the most effective adjustment possible. So the background for this study was they basically said, hey, spinal manipulative therapy and mobilization effects, they're believed to be related through their force characteristics. Most previous studies have measured the force at the patient table interface or at the clinician patient interface. The objectives of this study were to check out the differences between those two and to really get a better understanding of what's going on when that force is delivered. So we all know spinal manipulative therapy, spinal mobilization, commonly used by a few different healthcare professionals in the management of musculoskeletal conditions. Normally when we think of spinal manipulative therapy or spinal adjustments, that normally falls more towards what we do as chirofractors in the spinal mobilization realm, that's, I'm gonna say falls more towards what we would normally associate with physical therapists or back in the day, osteopaths. So there's some nuanced differences there. And predominantly when we talk about an adjustment or manipulation, it's getting into that paraphysical physiological space. Not just going through immobilization at the end point of range of motion, but pushing beyond that now. And incidentally, that's where I personally believe through the research that that's where a lot of the benefit happens is just beyond. We're not getting into injury territory, we're not getting into aggravation territory. What we are doing is getting beyond that classic range of motion into that paraphysiological space. That's where some of the quote unquote magic happens. In my opinion, with the chiropractic adjustment, it is that little bit extra that makes a lot of the difference. So spinal manipulation is characterized by the application of a dynamic force using high velocity and low amplitude thrust. Whereas immobilization is typically defined by the application of cyclic and rhythmic low velocity forces to an intervertebral joint. So again, you know, an adjustment, bam, you're getting in there, it is high speed, it is low, you know, it's high velocity, it is low amplitude, you are getting in there and it is over with in a mobilization, it's more of that pumping, it's more of that rhythm and flow. And that's a big difference, right? That ties back into our previous statements about the paraphysiological space. Now, forces from both of the interventions cause a mechanical deformation of the spinal region and the surrounding tissues. And both are believed to trigger neuromechanical responses that could potentially be relative in respective to their therapeutic effects. So no surprises there, right? The healing hands, right? It's the force that creates the benefit and the deformation of the joint actually creates benefit. The fundamentals of movement. As we think about segmental movement, regional movement and whole body, I just really like to think about movement in those three. They're not really planes by any stretch, but those three verticals. Segmental motion is the motion by which all other motion is built specifically relative to the spine. Of course, without proper segmental motion, you're not gonna. You'll have suboptimal regional motion and. But inherently you'll have suboptimal whole body motion. Whole body motion typically referred to as exercise. Right? Cardiovascular exercise. But it could be other things as well. It all starts with having adequate and optimal. Ideally adequate for sure, and ideally optimal segmental motion. That's what we focus on as chiropractors. That's where a lot of the benefits of what we do sit and reside. And that's what this study looked at. So they took about 35 ish patients. These were adults without thoracic pain. So asymptomatic individuals aged between 18 and 50. And interestingly, they were recruited through advertisement and social media, which is interesting to see studies study a few weeks ago that had text involved, now we're seeing social media. It's just fascinating to see the research world sort of adopt to new trends and utilizing new trends. Hopefully that helps us continue to get great pieces of research to expedite to a certain extent the publication of the research. And ultimately, I think what our job is, at least part of my job is as the evidence based chiropractor and with the smart chiropractor as well, is to help amplify the message of what we know to more and more people. That helps us get our word out there. It helps us get more eyes open to who we are and what we do. And it ultimately is going to result in more people coming in your front door and you being able to help them without drugs or surgery, which is my goal. So what were the results of this study? Well, the results showed that 93% of the spinal force and 84% of the mobilization force yielded greater total peak forces at the patient table interface. So get that it was not an overwhelming majority. Think about that. An adjustment. 93% of the time in this study, there were greater forces that were measured at the patient table interface other than the pisiform patient interface. Right. So when that chiropractor was getting in there and delivering that adjustment, there was actually greater force and resistance at the table than there were at the hands. Absolutely fascinating. So these researchers kind of posed the question, well, why do we measure increased forces at the patient table interface? They referenced a study that was released just before the turn of the century, which seems like an eon ago in 1999. And this study was the first to record simultaneously the magnitude of force vectors at the patient table interface and the perpendicular contact pressure and at the clinician patient interface. Now, the authors of this study hypothesized that due to the gravitational loads the clinician applied loadings and the accelerating patient's mass, the patient table interface force during the adjustment would be higher than the force applied at the clinician patient interface. But their results actually showed the opposite. This is where research always gets interesting. So this original study, done 20 some odd years ago, actually found the opposite of their hypothesis. And the opposite of this Study, because this study found that the greatest forces were at the patient table interface. A lot of nomenclature here, but the bottom line is that's an interesting thing as time goes on. And why is that? Well, there could be a few different reasons, as the authors of this study postulate. Could be due to spinal stiffness. Could have been due to a kyphosis or a biomechanical structural change that affects how forces and load is distributed. Excuse me. Now, with that, I want you to take that to heart, because think about the fact that it's very likely depending upon patient presentation, depending upon spinal stiffness, depending upon kyphosis, depending upon scoliosis, potentially, that there could be a difference in how force is transmitted during your adjustment based upon their structural challenges. Now, that probably is like, yeah, duh. If the patient's different, when I deliver an adjustment, my force might be a little bit different. I use different forces with different people. I totally get it. But if you think about this in terms of really applying it at a practical level, this is gonna really help inform future studies as we continue to, again, learn more about how is force dissipated in the spine. What's a good force? If you're not using an instrument, then the force you deliver, I'm gonna say, has more variation. If you're using instrument adjusting, the force is relatively fixed. Right. You could adjust your tool to a certain, you know, force application or a certain depth. Right. Many of these tools have the ability to set in maybe four different modes, but that's a heck of a lot different than you delivering an adjustment by hand, where I'm going to say the forces. Again, I'd be interested in the studies on this. But the forces could be wildly different. Now, does wildly different mean better or worse? It could mean either. That's the importance of better understanding how load is distributed, how forces are taken in by a patient receiving an adjustment, and what forces might be more beneficial than others. The more that we continue to understand that, the better and easier it is for us to get great results in our practice. So the conclusion from these researchers was, quote, this study revealed that during thoracic manual therapy, spinal manipulation and mobilization, forces measured at the patient table interface are most often great than forces applied at the clinician patient interface. Moreover, manual therapy characteristics, total peak force, thrust duration and rate of force application influence the difference of forces between the interfaces. Bottom line is there is a lot that goes into delivering what looks to be at the surface level, a simple adjustment. There's a lot of things that are dynamically in play between you between the patient and between the patient and the table. And all of those things should and can be kept in mind as you continue to get out there, take care of people in your community and help people live higher quality lives. And that is really what it's all about. I love this study because I think it ties very well into what we've been exploring over the last few months, which is a lot around how an adjustment works. We've seen those brain changes, we've seen those biochemical marker changes, we've seen the impact on Golgi tendon organs on muscle spindles. And now to understand more about how force application can play into that, continues to evolve our understanding of how we as chiropractors can make a bigger impact on and for the people in our communities. Which to me is what it is all about. And speaking of that making an impact in your community, if you have not checked out the Smart Chiropractor lately, please do so. We recently released or launched our official Smart Chiropractor store. What does that mean for you? It means that marketing can be difficult and we are here to make it easy. So we have created, created and for the first time ever are offering our a la carte content campaigns low back how an adjustment works Chiropractic care. If you want that content campaign built, download it, do it for yourself. You can go for it and get it. We have SEO tools there, we have email templates for onboarding, for reactivation protocols and we have all of the tools available that are a part of the smart Chiropractor available a la carte Chiro Emails, our flagship service done for you, personalized, all the automations, all the journeys, unlimited sending. We are talking significant ROI that is now available a la carte. If you only would like that. If you'd like Cairo Social, our social media posting service that hits Facebook and Instagram Daily, YouTube Weekly and I should say this quietly, Google my business coming very soon. If you want to drive more traffic and leads from your website with our opt in pop up boxes and our lead magnets you can check out Cairo emails and of course our streaming tv. Do not be playing that news in your reception area. Make sure that you have a fantastic streaming educational, beautiful chiropractic focused content going out all the time. You can pick up smart tv, streams wirelessly, updates wirelessly, all Amazon Fire stick empowered, you can check that out as well. Or if you want all of it together and save some bucks then you can of course become a member of the Smart Chiropractor. If you have any questions about that, you can hit me up. Jeff the evidencebasedchiropractor.com Otherwise, I hope you have a fantastic week in practice and I will talk to you soon.

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