Thoracic Adjustments for Neck Pain? What the Research Actually Shows | #529

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with more research, a fantastic study and one that I get really excited about because this is going to be discussing what happens when you adjust the thoracic spine and all of a sudden your patient experiences neck pain relief. So this is really the multifaceted aspect of what happens when you deliver care in your practice. I love this study. We're gonna dive into what the researchers found, what it says, how to apply it in your practice and much more, all on today's episode. Before we get started, big shout out to two partners of mine, Leander Tables save $1,000 off their Series 950 by using the code EBC2025 or click down in the show notes, connect with their team. They're gonna hook you up as a listener with $1,000 off. Additionally, diabetes reversal group, new partner, you're gonna click down below and learn about how you can add a diabetes reversal program, reversal. That's correct, not management reversal program, into your practice. They have made it turnkey super easy. They do all of the heavy lifting and you already have the patience in your practice. So it is super awesome program, super easy to implement into your practice. And we're gonna keep h with opportunities to connect with awesome sponsors, partners and vendors and discounts along the way just for being a listener. So thank you so much for taking time out of your day to tune into this podcast. But on today's episode, this is all about thoracic adjustments for neck pain. Is it overhyped? Is it not? What does the research say? The study is brand new. It's titled Effectiveness of Thoracic spine Manipulation for the Management of neck pain. A systematic umbrella review with with risk of bias and methodological and reporting quality. This is gonna be linked down in the show notes if you wanna check it out. But I am sure you've had this experience just as I have had many times in practice, which is that you've adjusted somebody's thoracic spine and all of a sudden their neck pain starts to feel better, right? You're palpating the mid thoracics. You deliver the adjustment, they sit up and they go, my neck feels a lot better. We have all seen this happen in practice where a thoracic adjustment resulted in neck pain relief. And it's basically a daily thing for most of us in practice. And it kind of feels like magic because you're adjusting one region, there's regional effects there and then there's adjacent regional effects. Right. So the question starts to become, is that actually supported by strong research or are we just seeing this in our clinical experience? Those aren't the same thing. Neither one is better or worse. But today's paper doesn't just ask the question, does thoracic adjustments work? It asks a question that's way more interesting and that is how good is the research that says it works? And what they found is pretty encouraging and probably a little uncomfortable in some ways as well. And that's the conversation I think we're going to have today. But it's also a conversation that we should have as a profession. So let's tackle the big picture of this study first. This is not a single trial. It is not even a systematic review. It's an umbrella review. And that means it's a review of all of the systematic reviews out there. So basically, the researchers stepped back and said, we're not going to just look at the studies, we're going to actually evaluate the quality, quality of these reviews themselves. And that's super important because if the systematic reviews are flawed, well, the conclusions might be flawed as well. So they took a look into PubMed Cochrane reviews from inception through 2025, and they included only systematic reviews that specifically studied thoracic spine adjustments, adults with mechanical neck pain and pain and or functional outcomes. So they excluded narrative reviews, scoping reviews, radiculopathy cases. So it's a pretty clean criteria that they were looking at. They ended up with seven systematic reviews, 27 unique clinical studies, and that encompassed just about 1,400 total patients aged 18 to 62. So not the biggest study in the world, not the smallest study in the world, but definitely meaningful. And when we start to look into some of the key findings and statistics, it's where things get really interesting because there are, I'm going to say, two layers of findings in this study. Layer one was does it help patients, meaning adjusting the thoracic spine for cervical spine relief. Layer two, how trustworthy is the evidence here? Now let's start with the clinical side, because every single systematic review said thoracic adjustments help neck pain. I'll say that again. Every single systematic review said thoracic adjustments help neck pain, specifically short term pain relief, short term disability improvements, and sometimes better range of motion as well. Some reviews had even showed that thoracic adjustments were superior to thoracic mobilization, that thoracic adjustments were superior to standard care, and that thoracic adjustments were superior to exercise alone, but usually equal to cervical adjustments. Probably no Surprise there. So thoracic adjustments work, cervical adjustments work. Both help. And that is what we see clinically, and I think you see clinically each and every day in your practice. So I really like how they're framing this study because it's not only framing it in terms of the results, but what else is out there. Right? Standard care is out there. Exercise alone is out there. People are doing it. Mobilization is out there. But when we can see that not only is a thoracic adjustment outperforming all of those modalities, but then you stack onto that, no surprise that of course a cervical adjustment is going to help with neck pain in the cervical spine, this starts to become pretty, pretty compelling. Now let's dive into some of the uncomfortable part. So here's what the researchers did that most people skip. They didn't just ask, did it work? Remember, they said, how good are the reviews themselves? And they used three quality assessment tools. They graded each review using Amstar 2, which is a methodological quality, a Robis, which is the risk of bias, and prism, prisma, excuse me, which is reporting quality. And basically all of these ask the question, how well was this review actually done?

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So over 85% of the systematic reviews were pretty low quality. And that means that the review methods were pretty flawed. So 4 out of the 7 reviews had a high risk of bias, 3 did have a low risk. So that's good. And there were common problems, like the protocols were different. Right. There were weak search strategies, there was a poor bias assessment and some inconsistent reporting. So a lot of them didn't follow best practices, let's say, for research design. So even though they said thoracic adjustments help, the confidence is not super strong. Now there is a detail that I want to touch on. The authors did try to combine everything into one kind of mega analysis, but. But they couldn't do it. The studies overlapped too much. So the same trials kept showing up in multiple reviews, which kind of artificially changes the numbers or influences the numbers. So they had to stick with the narratives. And that's a responsible way to go about it. So this, you know, let me be very clear. Those challenges with the reviews doesn't mean thoracic adjustments don't work. It means, hey, we need to do better research to prove how well it does work. And those are very, very different things. Clinically, we, we see this type of outcome in our practices each and every day. And the research does suggest that it works, at least in the short term. But the evidence quality is kind of meh. So the signals are there, but the studies are not as clean as we'd like. So this is a great study. As you've heard me say multiple times, this is a great study that should generate more studies, which is most of the time, what great research does. It doesn't necessarily perfectly answer a question, it stimulates more questions. And this does exactly the same thing. It's leading us down the path of understanding, which to me is some of the best things that research can do. So the big takeaway is that thoracic adjustments work. There is consistent evidence that shows at least short term benefits. And it's recommended in the clinical practice guidelines that is accurate, it's honest, it's defensible. And this supports something I think we all already know, which is an adjustment is not magic. It's part of a multimodal plan with multiple mechanisms of action. And that is a really, really important thing for you to understand yourself, but also for you to be able to articulate to your patient. So helping them understand your mid back and your neck are connected. Adjusting the thoracic spine often takes the stress off of your neck and can help you move better. It's a great statement. It's easy to say and it helps people understand. We've spoken on this podcast many, many times about always looking at the next joint, right? So if somebody comes in with a wrist issue, evaluating the elbow, somebody's coming in with a thoracic spine issue, evaluating the cervical and lumbar spine. If they're coming in with a cervical spine issue, evaluating the thoracic spine and taking the time to do that, it's really, really important. Don't become so myopic that you're only treating the area of pain because, because you're probably leaving some benefit on the table by not at least checking out the adjacent areas. It's also important to be able to communicate that, hey, research shows thoracic adjustments can help reduce neck pain and improve mobility, especially in the short term. This is a great way to help people understand, hey, I came in with A neck complaint. This guy's touching and feeling my mid back. What's going on here? You have to verbalize this so patients can understand it. And also helping them understand this is why we combine adjustments with exercise. We want both immediate relief and we want long term stability. I like to say the balance of stability and flexibility. That's a really strength and flexibility, I should say, over time. So that's a really, really, really great way to frame things. Whether it is during your report of findings, whether it is in your marketing and communication, whether it's with your table talk, all of those are great opportunities to get out there and help people better understand their body. At Patient Pilot by Smart Chiropractor, we talk about the weekly email that we send. We call it the journey to better health internally. Why do we call it that? Because it's supposed to be guiding the patient's journey to better health and that can happen through email. Email is a great automated way to do that on behalf of your practice to guide that patient's journey to better health. But it also comes about during every opportunity you have to interact with patients before they come into the practice again in your marketing and your communications. Maybe if you're shooting reels during their report of findings, during their examination again, don't forget about speaking your exam. Absolutely critical component of patient understanding and patient experience and often overlooked. And that is literally speaking exactly what you're doing as you're going through an exam and not just instructing them on what to do and notating it yourself, but actually verbalizing, just literally saying what you're thinking throughout that entire process helps people understand at a tremendously high level, higher level, what's going on, what you're doing, what we do as chiropractors, what you do each and every day is massively impressive. But nobody knows if you're not actually verbalizing it. So. So some simple steps you can take to ensure that people have a really good understanding. So the bottom line was, you know, the question, does thoracic adjustments, is it good for neck pain? Yes, absolutely. So. But it can work even better when you combine it with everything else you do in your practice exercise. When you combine it with mobilization, potentially when you combine it, combine it with acervical spine adjustment. And I'll just take a little bit of an aside here to also say if somebody. This is a really important component, had nothing to do with this study, but is really important clinically. Patients can come in with hardware in their neck. I don't want you to touch my neck. You know, there's a variety of things patients come in with where you're not going to adjust their cervical spine. If they have cervical spine pain, don't let them out your front door and say you can't help them. Get in there on the thoracic spine. Work the thoracic spine. Do everything you can in and around the challenged area in the cervical spine. But even if that is fused from occiput to c, get in there on the thoracic spine. Their thoracic spine is probably taking a beating if they have from a compensatory standpoint, if they have that much hardware. So don't sleep on the next region is my big big takeaway. So these are great conversations to have. I like this study. I'll drop a link down below in the show notes so you can check it out as your leisure and additionally shout out to two additional partners before we wrap up. Shockwave Centers of America as a listener, $500 off and a free cart. I'll drop that link down below if you're thinking about bringing Shockwave in. Great tool, super affordable pricing, awesome results and Novopulse, they have a full OA osteoarthritis recovery program that really enables you to build an entire system in affordably. You could check that link down below and connect with their team. If you have not left a rating review for this podcast. If you take a moment and do so, that would be absolutely awesome. It helps more and more docs. Find out about the podcast and and 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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