The Link Between Fascia and Neck Pain: Research Breakdown | Podcast Ep. 413

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are talking fascia. On today's episode. I'll drop a link of course to the paper down in the show notes a brand new study that came out titled Effects of Fascia Therapy versus Fascia Manipulation on Pain, Range of Motion and Function in Patients with Chronic Neck Pain. Brand new study. We're going to dive into it and extract some clinical pearls along the way. Before we get started, I want to say a few words about Patient Pilot by the Smart Chiropractor. If you would like to see a listing of the patients, the names of your patients ready to reactivate into your practice each and every day, you're going to want to head over and do a demo@the smartchiropractor.com that's what we do with Patient Pilot. How do we do it? We send weekly email newsletters with big buttons as they click to schedule and call to schedule. Anytime somebody clicks on those, they obviously head over to your scheduler or to your telephone number. But we also track every one of those clicks and deliver them on a silver platter to you and your team every morning at 7am Anytime somebody clicks. So if you'd like to build more reactivations into your practice as we head into Q4, additionally, we got some HSA FSA campaigns lined up. There is easy money right there. Head over to thesmartchiropractor.com but as I said at the top on today's episode, we're talking research. And this is a study that came out in BMP Musculoskeletal Disorders. And again, the title is Effects of Fascia Therapy versus Fascial Manipulation on Pain, Range of Motion and Function in Patients with Chronic Neck Pain. So let's start right there. Neck pain is the fourth most common cause of neck disability and most people do recover from it. So that's the good news. The bad news is this is super common. It's one of the top three things that that draw people into a chiropractic practice to start. Low back headache, neck top three items on why people initially begin chiropractic care and the duration does matter. Of course it is acute if the period of neck pain is less than six weeks, subacute if less than three months and if it's three to six months, then it is considered chronic. And there are many, many factors that can cause neck pain or contribute to neck pain. Postural changes, just a female gender, you have a higher likelihood of neck pain, high job demands, older age, all of these things are correlative, in some cases causative to experiencing neck pain. Now, there are a plethora of treatments available, of course, tens units strengthening and stretching, mobilization of the neck. There is a host of things, just like the low back. There is about a product and a service. You can't get to the end of the list in terms of the amount of products and services that claim to heal neck pain. But you have to get to the cause. And we know of the causes of neck pain. Fascial tightness is one of the reasons that you can experience a painful range of motion of the neck. Now what is fascia? Technically, it's a form of connective tissue which encloses muscles, tendons and nerves. And it's responsible for holding organs together. And it does have its own blood, lymph and nerve supply. And it's divided into four different layers, depending upon kind of where it's located. Superficial fascia is linked with the skin. Deep fascia is connected to the tendons and vessels. Visceral and parietal fascia is attached to the internal organs. So those are a couple of the different types or subcategories. Now, fascial tightness or irritation, it can cause a host of different things, none of which we want, which are pain, decreased range of motion, reduced flexibility, and it can also contribute to shoulder, head and neck pain. So the bottom line is normal fascial mobility is critical for normal function. And anytime that we have disruption or challenges with fascia, we are very likely to have pain and dysfunction. So this study looked at a couple different techniques that they were putting head to head. One was called the DBM technique. It is a non manipulative soft tissue therapy technique that involves gentle pressure while stretching the body's connective tissue. The second technique in this study was related to the deep fascia and it was a bit different in terms of finding a pain point and then utilizing pressure on that pain point. And there's heat generated when you're putting that pressure in to ultimately, so to speak, release the fascia. So there's over 50 participants in this study that were included and the findings were pretty fascinating. Now, anytime I think of fascia, I think back to my good friend Dr. Steve Capo Bianco over at Rock Tape. He has been, in my opinion, at the forefront of fascial knowledge, from my point of view, for many, many years. I remember going to Rock stock their annual conference years ago and he had an entire class when we were Using ultrasound to examine fascial movement, fascial integrity, you were looking at the body in motion and statically determining what's going on with the fascia. And for many of us, I'll speak for myself, certainly, when I think of a segmental unit, fascia, like, totally goes over my head. Like, I think of the segmental unit of the spine, I'm thinking about disc, I'm thinking about bone, I'm thinking about tendon, I'm thinking about ligament, and I'm thinking about muscle and nerve. That's basically what I'm thinking about. Fascia intertwines, connects, and facilitates movement or hinders movement throughout all of these items. Yet for me, it's often overlooked. And I got a feeling for a lot of us out there, it's not something we think about each and every day. And in some cases, that's due to a lack of education on the topic. In my case, that's definitely true. In other cases, it's a lack of really having a great treatment option. So even if you were able to identify something, what are you going to do about it? And that's where some of the fascial tools, I believe that, for example, rock tape, have come up with, over time, just great tools for fascial mobility. But it is kind of a complex topic because if you think about fascia basically being in between intertwined and covering and everything else, every aspect of the human body, essentially, it's just a lot to take in. It's difficult to get an A plus B equals C when it's so dynamic and so intertwined with nearly every other type of tissue that we're super familiar with. So, to me, that's some of the challenges that we've had in terms of, I'm gonna say, fascial therapy as chiropractors. And I know there's some docs out there that are super tuned into it and doing an awesome job, But I got a feeling most of us maybe don't focus on the fascia as much as we do bone, ligament, nerve, and disc, specifically relative to the spine. So studies like this are super interesting because they start to highlight what are the different techniques out there, and based upon that technique, what are we seeing for an outcome? And that starts to frame it for me anyhow, in terms of, okay, now I can start putting these puzzle pieces and building blocks together in a way that makes meaningful sense, and I can take action on. So this study, specifically, the aim of it, was to compare these two different treatment techniques of fascial Therapy and fascial manipulation and fascia therapy did improve the cervical range of motion, extension and right sided bending, but there were no difference in any of the parameters. Fascial therapy and fascial manipulation techniques were equally effective in improving pain, range of motion and function in neck pain management. So, you know, this is harkening back as we think about chiropractic techniques. Generally speaking, the output of many chiropractic techniques, not every technique is right for every person. But when we look at them as a whole, kind of regardless of what technique you choose, we see across the literature decreases in pain, improvements in range of motion. We see the same thing with the fascial techniques here. So while this study doesn't come to the conclusion that I'm gonna say, I'll kind of throw it out there and say the technique might matter less than just getting in there and doing the work. So the specifics of the technique, maybe some techniques resonate with you as a clinician more than others. Definitely. Some techniques will work better and different on different people at different times because the input of that stimulus is going to have to be processed by the individual. In somebody that has a lot of, I'm gonna say, let's say comorbidities, quote unquote, meaning abject pain, fear of movement, maybe they're depressed. That's gonna, as with anything, they're gonna be affected differently by a touch based care modality, AKA you know, movement and hands on approach. That's gonna input somebody differently than somebody who maybe doesn't have any of that going on. The same thing as we see with the chiropractic care that we deliver. So I think there's a lot of correlatives here and we know based upon literature that fascial therapy and manipulation both positively affect tissues and muscles and relax the body physically and psychologically. This is also an important component for us as chiropractors to keep in mind. Because often if somebody is really, whether they're in acute pain or they're just like super scared of getting adjusted, you don't want to like fight through that. At least that's not the way that I go about it. So often you're gonna be looking for techniques to diminish the level of psychological stress on somebody as you're getting in there with some other techniques. So in this case, fascial therapy might be a great way to help somebody, you know, just get moving, so to speak. In other words, if they are super sensitive to touch and you're like, gosh, I'm not sure if I'm gonna be able to get in there and deliver an adjustment for this person. Maybe starting with some fascial therapy techniques will help, you know, decrease their sensitization a little bit, help get them more accustomed to who you are, get them comfortable with the procedure in the practice, get them comfortable with the fact that, hey, they can be touched and not go through the roof in pain. And fascial therapy might be a good opportunity to do that. So trigger points and tight muscles can lead to severe pain, but the myofascial release can benefit both acute and chronic cases. So as always, a combination of things, whether it's trigger points, whether it's fascial techniques, whether it's spinal adjustments or extremity adjustments for that matter, all are a really important part. And when we look at these different techniques, I'm going to say under the banner of movement based natural healthcare, it's all awesome. I mean, to me, I love looking at this study where it's like, hey, the techniques there were a little bit of difference in outcome, but generally speaking, everybody was moving a little bit better, everybody was feeling a little bit better. And that's a really, really good sign that we're on the right track with our approach and philosophy of care, which is this is about facilitating healing more than it's about pushing down symptomatology. And when we look at studies that continue to showcase improvements based upon hands on care, based upon movement, based upon not putting drugs and surgery into the body, but by using the body's natural healing mechanism and facilitating that healing through the treatment options that we choose, the care options that we choose, I just love seeing that and I think it tells us we are on the right direction. So their conclusion was, quote, according to the study findings, DBM fascia therapy shows more improvement in cervical extension and right side bending as compared to fascial manipulation, although there were no difference between the groups in the other parameters, range of motion, pain relief and functional improvement, both treatment types or techniques show clinical improvements in neck pain intensity, disability and range of motion. So a pretty cool study with some really interesting things. Again, I believe this. As always with studies, this is going to stimulate more questions than provide answers. But that's great because it leads us down the path of our body of knowledge. And showcasing that fascial therapy, regardless of technique, can improve pain, provide pain relief, decrease disability and improve range of motion is an awesome star and it's something we should all as clinicians take a look at, see if we have those tools in our tool belt. And if not, it might be something you want to look at at your next continuing education seminar. Now, before we wrap up, I want to say a few words about some really, really important pieces of my life right now. One is patients always have questions about what's the best pillow. Chiropractors always have questions about what's the best pillow. Align of Sleep is the best pillow I have seen to date, bar none. I met Dr. Michael £ a few weeks ago and I have a Alina pillow and in my house right now if you want to learn more. Alignasleep.com he sells direct to chiropractors so you're not going to get cost cut by, you know, big box stores or anything to that effect. Alinasleep.com I'll drop that link down below. If you are looking for what I consider to be the best pillow to either have for yourself and or ideally for both yourself and your patients, Align of Sleep is going to be where you want to go. Alignosleep.com, i'll drop that link down below. Head on over. Secondarily everybody's talking about Shockwave and everybody I see online is not sure what product and service to go with. I am a big Stem Wave fan. I have found Stem Wave in the practice that I own to be a absolute game changer. Top of the line product, top of the line results, top of the line service. And I'm going to drop a link down below if you want to connect with their team. They have some really really special opportunities for listeners of this podcast. I use this myself personally the practice I own go stemwave.com the evidence based chiropractor go stemwave.com the evidence Based Chiropractor I will drop that link down in the show Notes Connect with their team they have some really special things for listeners this podcast because they're trying to get out to evidence based chiropractor. So if you've been exploring and thinking about shockwave therapy in your practice, Stemwave is the brand that I recommend go stemwave.com the evidence based chiropractor and they will hook you up and happy just hop on the phone and answer some questions. See if it is right for you. So I hope you have had a great week in practice. I hope you have a fantastic week coming up. If you have not left a rating or review for this podcast I would love it if you would take a moment to do so. You can scroll on down, tap the amount of stars, leave some feedback. As always, if you want to reach out to me directly. I'm available, Jeff, at the evidencebasedchiropractor.com if you have a study you'd like to see highlighted in the future, or just a comment on what's going on in the podcast. I hope you have a fantastic week in practice and I will talk to you soon.

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