Spinal Manipulative Therapy & Brain Activity in Lumbar Disc Herniation Patients | Podcast Ep. 358

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with research. It just came out September 2022 in Frontiers in Neuroscience. It is titled Spinal Manipulative Therapy, Altered brain activity in patients with Lumbar Disc herniation and a resting state Functional MRI study. This is a good one. We're talking brain changes relative to disc herniations relative to spinal adjustments. We take a look at what the latest research has to say on today's episode. Before we get started, I wanna say a few things about the smart chiropractor. If you have an email list of over about 300 and you think you have a new patient issue, you're probably incorrect. You actually have a retention and a reactivation issue. The symptom is that you consistently need more new patients. If you want to tighten that up, head over to thesmartchiropractor.com it is what we do. We are coming out with some really, really interesting data showcasing 3, 2, 1 return on investment for nearly every single doc that we service. So with that being said, we service over 300 docs around the world. If you want to learn more about how we get those results and how we can really fill the holes in your bucket, head over to the smart chirofractor.com but as I said at the top of this episode, we're talking research. This is all around functional MRI and how what we do as chiropractors when we provide a spinal adjustment, how does that impact the brain? For individuals that have a lumbar disc herniation, and there's probably a lot of people in your practice that do have lumbar disc herniations, whether symptomatic or not. So. So a lumbar disc herniation. Let's set the stage. We all know what it is, but in this study they defined it as a protrusion or prolapse of the nucleus pulposus in the posterior spinal canal and taking the form of a series of clinical symptoms such as pain, reflex loss and muscle weakness. So they're specifically relative to the posterior herniation. Makes a lot of sense whether it's directly central, whether it's in a lateral recess, whether it's more lateral, when it's impacting the nerves, we see a lot of anterior herniations on film. Fortunately, those don't cause any issues because there isn't nerve canals back there that are tight. There's not a lot of tight space. There's plenty of room up Front. So we're talking about posterior herniations that are affecting an individual's ability to function, whether that's pain, reflex again or muscle weakness. So this was an interesting point in the study that I thought it was about 10 years older than what they're citing here. But they highlight that studies have reported its prevalence is highest, I.e. lumbar disc herniation prevalence between the ages of 30 and 50. I thought it was about 40 to 60, but they're saying 30 to 50. So a little bit of a younger population there. Interesting to note. And additionally they highlight and I love this spinal manipulative therapy which is performed by trained physicians. Applying a controlled force to the spine with hands or other devices shows a higher cure and effective rate than other treatments and becomes the preferred complementary non surgical, conservative care treatment for lumbar disc herniation, according to the American College of Physicians, amongst others. So great data there. Again, I said it before, I'll say it again. I love it when I see a study and they're just putting the truth, shocker, the truth right up front. This is the preferred way to go about it. There's no question about it. Guidelines support what we do with spinal manipulative therapy or as I'll say, spinal adjustments. And it does show a really high cure rate and it's really, really effective. Movement based care works. It's just the way it goes. Now, some studies have suggested that chiropractic adjustments, spinal manipulation might influence spontaneous brain activities in patients with low back pain. Interesting there. And they say manual therapy could not only reduce clinical low back pain, but also increase functional connectivity between the salient network and the brain regions which are associated with the cognitive, affective and sensory motor processes of pain. This is where things start to like spider web out quite a bit. So we've highlighted a lot of studies on this podcast that talk about how multifactorial what we do is. And it's really important to continue to dig back to that because it sets the stage for the research. When we deliver a spinal adjustment, a lot of stuff happens. There's a lot of influence. There's influence segmentally on the biomechanics, on joint positioning. There's influence certainly in the peripheral nervous system, there's influence in the central nervous system, which includes spinal cord brain. There's also, there's sensitization changes, there's biochemical marker in the brain changes, there is potential reflex change. There's a lot that goes on. And this is a good, this is a double edged sword. The great News about that is it's one of the reasons why what we do is so effective at not only pain, but also performance. We look at every major sports team, most of their highest level athletes, these people have the most to lose, literally wicked short career spans. If something goes wrong, that's really bad for them. And almost every single high level athlete across every single major sport relies on chiropractic for performance. Because the medical team on these sports franchises are what control the pain and the rehab. And that's so important to keep in mind that we really can impact performance with people. Now, we're going to talk lumbar disc herniation and pain today, but it just goes to show the gamut of what we do and how it can impact people. And that's important to keep in mind. It makes it challenging from a research perspective because it's hard to nail it down to like just one thing in research. The more specific the question on a research paper, typically I'm not saying the better the paper in terms of qualifying the paper, but that's a good thing. When a researcher is saying, I'm trying to answer one specific question in one paper, it's a lot easier than I'm trying to answer 80 questions in one paper. It's just not the way it works in research. So that shouldn't make us frustrated. But it's why research papers sometimes like, man, I wish they would have went farther. Well, they're picking off specific questions one at a time. So after spinal manipulative therapy in this study, a couple things happen. What they refer to as the amplitude of low frequency fluctuations. So after smt, the amplitude of low frequency fluctuations of lumbar disc herniation patients was decreased compared to that that did not have a lumbar disc herniation. So pretty impactful there. We'll break that down in a moment. Compared with the healthy control group, they did have a control group without the disc herniation. So compared to the healthy control group, they found that lumbar disc herniation patients showed increased amplitude of low frequency fluctuations in the right lingual gyrus extending to the conventional band. The lingual gyri, as they say, is mainly located in the visual cortex and sends sensory information through sensory afferents to the thalamus, amygdala and hippocampus. So this is important because they also cite previous research that says the visual cortex has been involved in the processing of pain signals. So here's where the rubber meets the road with this and that visceral Pain was associated with hippocampus, fusiform gyrus, and a host of other areas. So when we're making influence there, that could be positive. There's no question about that. And the other thing that they cite is, until now, spinal manipulation has been utilized to restore structure of disordered spines and unstable spinal balance, improve the physiological properties of the muscles, moderate the internal stress of intervertebral discs, and alleviate intervertebral disc compression of the nerve root. Therefore, it could reach the goal of stopping pain and restoring the function of of the local spinal column. A systematic review has shown that spinal manipulation has a favorable effect on alleviating pain and speeding up the recovery compared with other interventions for people with lumbar disc herniations. So what does that all equate to as we go one step farther? Well, there's a couple of things that I want to just touch on and break down before we get to the conclusion. One is that it is unquestionable at this point in time. And anytime there's input into the body, it doesn't surprise me that there's alteration or influence to the brain, because that's where everything's being processed, right? So there's no question at this point in time that when a force, a spinal manipulation, spinal adjustment is given that that information is input into the brain. Now, what's interesting is, well, where does that information go? Because as the body receives the input, the output, or the result is gonna be pending what areas of the brain process that input. So it sounds overly simplistic and ridiculously complex at the same time, but when an input is given in the body, the brain is going to acknowledge that input. Where that input is acknowledged in the brain is going to determine to a certain degree what happens next. So understanding where influence in the brain is occurring is important to understand the process of how pain is mitigated and how function is improved. And that is really, I think, what this paper is trying to drive to. And that's the framework that I always think about it. So when we look at a study like this and we're talking about amplitude of low frequency fluctuations, that's super technical. But when I look at what they really cite, which is here are the areas of the brain that are impacted. In this case, it is the visual cortex, which sends sensory information through afferents to the thalamus, hippocampus, and others. And then we know that the visual cortex is involved in the processing of pain signals, that now we start to be able to put those puzzle pieces together. And say, okay, well that could have a correlation between what's going on with the individual and how what we do as chiropractors through responding manipulation is helping them improve their quality of life, helping them function better, helping them reduce pain. And to me, that's some of the most important bits of information we can gather from studies just like this. Because there's a lot that happens. So when the researchers take the time to isolate it down in this paper, if you check it out, we'll drop a link down in the show notes, it gets super complex. So if you want to dive like 10 layers deeper on this into, you know, areas of the brain and things that I've never heard of, quite frankly in my life, you can do so this, this paper is super, super detailed. I'm trying to keep it at a high level. So there's some take home messages here and some of the take home message that I gather from this is when an adjustment is delivered, there's influence in the brain. That influence in the brain is directly correlative to the areas that tie into how we experience pain. And that's a really, really good thing because without having to take a pill, without having to have a shot, without having to have surgery, we're able to influence some of the most important areas in the brain relative to pain processing. We're able to change those, influence those in a way that helps people find relief without having to chemically alter it. That is so important, it's so impactful and it's the heart of what we do as chiropractors. So the conclusion that they found was that the alff, the amplitude of low frequency fluctuations analysis deployed in this study revealed the altered regional activities in multiple frequency bands in lumbar disc herniation patients. And that is the take home message. So is this a little geeky in the research? Yes. Is there a long way to go before we really tie up these loose ends and have a super crystal clear understanding of quote, unquote cause and effect? Absolutely. But studies like this help us take one step closer towards that day. So kudos to everybody involved in this study. Hopefully that was good information for you to listen to and understand that what you're doing when you see somebody with a lumbar disc herniation, it is not only mechanical, what's going on? Yeah. Do you like to have imaging that showcases that the disc is reabsorbed, which the body's going to try its best to do so anyway? Yeah, of course. Do you want to see people feel and function better. Absolutely. But you can also know that it, it goes just beyond the biomechanics of only that segmental unit and you are able to make an impact. And citing previous research that we've looked at specifically when we're talking about lumbar disc herniations, there's so much fear associated behavior, there's sensitization. These things are all changed when people are able to move. And what we do is a movement based care, you know, option with chiropractic. When people are able to move, man, it makes such a substantial difference in their ability to, to heal and that some of the most important thing that we can do. So before we wrap up today's episode, if you have not gotten a free sample pair of power step orthotics, I don't know what you're doing. These are the orthotics that I use. They're what my father uses. I can't recommend them enough and they are willing, they want to support this podcast. So I'm going to ask you to support them and to do so, they're going to hook you up with a free sample pair. So pro.powerstep.com sample pro powerstep.com sample use the code EBC evidence based chiropractor. They'll hook you up with with a free sample pair. Additionally, we're getting into the fourth quarter of this year right now. 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If you're looking to hire a DC or a ca, even in the next year, it takes a little time, doesn't take a year, but it takes a little time. So start the conversation now. You're only going to be more prepared when you're ready to get going. And other than that, 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 to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.