They Adjusted MS Patients' Spines — Here's What Happened to Their Immune System | #550

Hello and welcome to The Evidence Based Chiropractor. I'm your host, Dr. Jeff Langmaid. On today's episode, we are talking all about chiropractic, inflammation, and MS. This is a new look at the neuroimmune effects of spinal adjustments. It's kind of an early study, uh, but I think it sets the stage for some really cool research down the road. We're going to dive into it and much more. On today's episode. It's titled Effects of Thoracic Manipulation with Trigger Point Therapy on Inflammatory Cytokine Levels in Individuals with Multiple Sclerosis: A Pilot Study. So this is going to be a pretty cool study. And, uh, you know, for a long time and for many episodes on this podcast, we talk a lot about low back pain, about neck pain, about headaches, and they are all super important. Some of the biggest causes of disability out there, and they're a huge part of what we do as chiropractors to help people every single day. But I think we all know that's not really the full conversation because if you look at what happens when you deliver a chiropractic adjustment, spinal adjustment, um, I think there's a lot of researchers out there that are asking, I'm gonna say, more in-depth, better questions. Not just did the pain go down, but really what changed in the brain? What changed in the nervous system? What changed in the immune system? What changed in the movement, function, inflammation, physiology. And that's exactly why today's study I think is really so, so interesting. So this researchers— research, excuse me, looked at people with relapsing and remitting MS and asked whether thoracic, specifically thoracic spinal adjustments combined with trigger point therapy could influence inflammatory cytokines. So this is not saying that chiropractic cures MS or treats MS. That's not the point. The point is that a chiropractic, you know, style manual care, you know, may be able to produce— we're going to dive in— measurable changes in inflammatory signaling. And that it's in a pretty complex neurological population, those struggling with MS. So it's a really big deal because it moves the conversation from, well, chiropractic can help with low back pain. I think that's great and super important, but it moves it into, we might be able to influence physiology in ways that we're still working to understand. And in my mind, for our profession, that matters. I'll drop a link to the study down below, of course, so you can check it out. So today we're gonna talk about what the research did, what they found, what the fi— you know, why the findings, in my opinion, are so exciting, and how you can use this research in your practice, I'm gonna say, without overclaiming and also without overcomplicating it, because there's really a sweet spot between those two. It's not about hyping research that might not be there yet, but it also is not about apologizing for things that we're still learning. And to me, that's good science. So again, study title: Effects of Thoracic Manipulation with Trigger Point Therapy on Inflammatory Cytokine Levels in Individuals with MS. Uh, this was published in 2026, brand new one, and the researchers were wanting to explore— probably pretty self-evident at this point in time— whether chiropractic adjustments combined with trigger point therapy could influence those inflammatory biomarkers, whether they can influence neurodegenerative biomarkers, or clinical and/or, I guess I should say, clinical outcomes with relapsing and remitting MS. So they took people with MS, they provided chiropractic manual therapy, they compared it to a sham intervention at the base level. And then they looked at what happened in the blood, specifically with inflammatory signaling molecules. So that was the heart of the study. So if you're asking why MS, well, MS is a neurological condition, chronic, involving inflammation, demyelination, and, you know, neuroaxonal injury ultimately in the central nervous system. And in relapsing and remitting MS, people can experience symptom flare-ups followed by periods of complete recovery. So many of these individuals deal with fatigue, pain, sometimes cognitive changes even, mood challenges, sleep problems, motor dysfunction. Because inflammation, you know, plays such a major role in MS, cytokines and chemokines are really, really important. So you can think of these cytokines as kind of chemical messengers. You've probably heard of them before. They help the immune cells communicate and they can help regulate inflammatory activity and they can help also coordinate immune responses. Some are kind of generally pro-inflammatory, some are generally anti-inflammatory, and some of these can go either way depending upon the context. So instead of only asking, did the symptoms improve? This study asked a deeper question. Can spinal adjustments and trigger point therapy shift the inflammatory signaling in people with a pretty, pretty serious neurological condition? And it's a pretty smart question. And I think this is exactly the type of research I'd love to see more of come out because in my opinion, our profession is at, we're at our strongest when we're not only looking at outcomes, but we're also looking at the why, we're looking at the mechanisms, we're looking at, you know, what happens in the body after an adjustment is delivered? What systems are affected? What was the response? What was the physiology? And this study does not answer every one of those questions, but it contributes an important early piece to the puzzle. Brought to you by Care Plan Pro. Build care plans in seconds, present them with confidence, and grow your recurring revenue through memberships and concierge. See how at careplanpro.ai. So this was a pilot randomized sham-controlled trial. They had 66 people with MS, 26 met the inclusion criteria, a few withdrew or excluded. So there's 21 participants that completed. 11 were in the spinal adjustment group, 10 were in the sham adjustment group. So the participants had, again, relapsing and remitting MS. They were all between 18 and 55 years old. They were fully ambulatory without any aid. And they all, this is important, they all had been relapse-free for 30 days. And they were on FDA-approved disease-modifying therapy ultimately, so medication. This was not an unstable or a population in an acute flare-up. These were people that were stable enough to participate in the full protocol. So the intervention group received chiropractic adjustments, of course, trigger point therapy, and the adjustments were delivered actually by a licensed chiropractor. Sometimes we see this in, you know, manual therapies delivered by other people, and I'm always like, well, you know, depending upon how that was performed, you know, it might be different than a chiropractic adjustment. These were actually adjustments delivered by chiropractors twice a week for 4 weeks. So 8 visits total. So this was not a single adjustment and a blood draw. They looked at the response after the first intervention and again after a series of care. Now the sham group, they received thoracic palpation and a simulated adjustment using an activator with a zero force setting. So it made the click, it created the experience, it mimicked the clinical encounter, but it did not deliver the therapeutic thrust. So they were really trying to account for the human interaction, touch, expectation, etc. So no sham, you know, therapy, manual therapy is perfect. But I think this did a pretty good job. So the blood samples were collected actually at 5 individual time points at baseline, 20 minutes at— a lot of blood draws here— 20 minutes after the first intervention, 2 hours after the first intervention, 20 minutes after the final intervention, and 2 hours after the final intervention. So they were able to look at both short-term and cumulative changes, and they ended up measuring 21 inflammatory biomarkers. Uh, they measured 3 neurodegenerative biomarkers as well, and they looked at clinical and performance-based outcomes. They, of course, looked at pain, fatigue, depression, anxiety, sleep, walking speed, hand dexterity, and cognitive processing speed. So even though this was like a pretty small study overall, it was pretty robust in terms of what they looked at. And it was pretty, pretty interesting as well. So the researchers found that 6 of the 21 cytokines and chemokines demonstrated moderate to large effect sizes at multiple post-intervention time points, and all of it favored the spinal manipulation group. So that's a pretty big takeaway. In a small group of people with MS, thoracic adjustments combined with trigger point therapy were associated with measurable changes in inflammatory signaling compared with sham care. So that's really kind of the headline here, but there's more to be able to dive into as, as we continue to go through. So, uh, the pattern I think was really, really interesting. So the effect sizes did move based upon when the blood draw was done. And it actually indicated that repeated care may create a cumulative biological response. In other words, it wasn't just one intervention, then another one, but there could be a stacking cumulative response. So this doesn't mean we need to jump beyond it and say, "Well, that's exactly what we need to do." There's a lot of variable there. But this was a really cool study that started to showcase that there are changes. Now, on the neurodegenerative biomarker side of things, there was a decrease in the spinal adjustment or manipulation group with a smaller effect size approaching more moderate. So, and on the clinical and performance-based outcomes, most changes were pretty small. So this was primarily, I guess, like a mechanistic pilot study ultimately. And the most interesting part always was gonna be the bio— biomarker response. So, and that's exactly what made this, I'm gonna say, pretty exciting because they highlighted the fact, the big idea really is that spinal adjustments and manual therapy may be able to influence more than local pain pathways. That doesn't mean every adjustment carries this massive, you know, systemic shift, but it does mean that manual therapy into the spine and soft tissue can interact or at least has the opportunity to interact with the nervous and immune systems in really measurable ways. So that, to me is really, really exciting. The input that we're delivering can actually influence things like pain processing, muscle tone, movement, autonomic activity. And based on studies like this, it showcases there may be some influence also on immune signaling. Now, the cytokine results are, I'm gonna say, especially interesting because the standout biomarkers were primarily pro-inflammatory. So, At first glance, you may expect the goal would be to reduce all biomarkers, but the immune system, obviously, as we know, is complex. Inflammatory signaling is actually part of how the body heals, responds, adapts, and communicates. So the key finding is not just inflammation went down. It's a little, it's a little more nuanced than that. It's really that manual care appeared to alter inflammatory signaling, and that's much more nuanced, but it's actually more useful. Because it highlights that the body responded biologically, that ultimately there were measurable changes that were occurring and shifting as a result of the care given. Another key point was the timing. They measured these biomarkers again, 20 minutes and 2 hours, excuse me, after both the first and final interventions. And I think that's a pretty good design because biological responses are dynamic. If you only measure at one time point, could very easily miss the signals, as you can imagine. Some changes happen, you know, quickly, some happen later. So this study accounted for that timing, and it really highlighted the fact that these shifts happened, I'm going to say, in waves. And while the clinical outcomes were less dramatic— pain, weakness, etc.— it doesn't weaken the biomarker findings. It just tells us that the biological changes may occur before the obvious clinical changes show up, especially in a small, you know, kind of sample study such as this. So I like this study because I think it provides us a better way to talk about chiropractic care. It doesn't need to be, you know, for so long we, I think we've oversimplified what we do or sometimes been misunderstood. Well, we only help backs and joints, we're only helping people with pain. And research like this starts to support the broader, and I'll say adds to the literature showcasing You know, what we do really provides input into the spine and nervous system. Of course, there are segmental changes, but the changes can also include things like pain modulation, mobility, functional ability, and potential shifts in inflammatory signaling. And to me, this really matters because inflammatory signaling affects a variety of populations, people with chronic stress beyond MS, people with chronic stress, poor sleep patterns, fatigue, persistent inflammation, movement dysfunction, sedentary lifestyles, Yes, pretty much I've already said 99% of the population. So, and I believe that to be true. We can help a lot of people out there. It's a matter of how we are framing what we do, how we're going about the dynamics of our assessments, the care that we're delivering, and ultimately what the individual's goals are. Because not everybody, everybody has actually different goals. Many people might come in due to pain, but as you know, that's the life effect is deeper than that always. It's never about the pain. People will live in pain forever, for days, weeks, months, or years. It's only when that pain precludes them from doing something that they want to do that they say, "Let me make a change. Let me see if there's a better way." And quite often for you and I as chiropractors, they probably have tried other things quite often. So they've done some other things and that hasn't been successful, and they end up coming into our practices really looking for help. So the more that you can, I'm gonna say, not only understand that, but communicate that effectively, efficiently in patient language, I think is a really good thing. And to me, you know, if we take all of the deep science out of this, I think what this study showcases is, you know, chiropractors have the opportunity to influence inflammatory changes in the body. And if you are dealing with pain, if you're dealing with an inflammatory-based condition, if you are dealing with X, Y, and Z, that can be a really, really good thing. And when you partner that with some other things, in this case they had trigger point therapy, but think about, you know, exercise, think about strength training, think about overcoming fear avoidance behavior, all of those things is massive. So, you know, the future of chiropractic, while I like to become narrow in terms of thinking about individual topics, that doesn't mean chiropractic becomes smaller. It actually becomes bigger. Not because we're making like wild claims, but because the research is actually becoming more sophisticated. And we're moving from symptom conversations only into mechanism-based conversations, nervous system effects, immune signaling, pain modulation, sensory motor control, quality of life, functional outcomes. And that is where chiropractic and you can shine unequivocally because the body is integrated. Movement affects pain. All of, you know, the body is hyperdynamic. So when chiropractic care and how chiropractic care fits into that broader conversation is a really, really great thing. So I'll drop a link down to this, uh, in the show notes to the study. Quick, uh, shout out, uh, if you're looking for a new chiropractic table, Leander Table is going to hook you up with $750 off their Series 950. You can check that out as well as the NovoPulse OA Recovery Program. OA is a massive challenge— osteoarthritis, of course. If you don't have a specific recovery program, um, you're probably missing an opportunity to help people and generate revenue. NovoPulse has a fantastic Fantastic hardware and software option that gives you opportunities to attract those individuals in and the hardware. And they also just started a partner program where you can actually bring that in for zero out-of-pocket cost. So I'll drop a link down below. You can have a conversation with their team, check it out. Fantastic team over there. If you have not left a rating or review for this podcast, I would love it if you would take a moment and do so. Thank you so much 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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