What Happens in the Brain After a Spinal Adjustment? (2026 fMRI Study) | #531

Hello and welcome to The Evidence-Based Chiropractor. I am your host, Dr. Jeff Langmaid. On today's episode, we are back with more brand new research, fantastic study around one of my favorite topics, which is what happens in the brain after you deliver an adjustment. Awesome study, lots of clinical pearls, some really cool stuff happening in the research realm. We're gonna dive into that on today's episode. Before we get started, big shout out to two partners of this podcast. One is Leander Tables. As a listener, I'm gonna hook you up with $1,000 off their Series 950 table using the code EBC2026 or connecting with their team. Let them know you came from this podcast and they're gonna hook you up with $1,000 off. Additionally, shockwave, you've heard of it. Many docs are adding it in. Shockwave Centers of America will give you $500 off and a free cart, all for being a listener of this podcast. So please keep tuning in as you're exploring adding things into your practice. Reach out to our partners. They're hooking you up with massive savings. Now, as I said at the top, today's episode, all about research. What happens in the brain? After a spinal adjustment. So what if, question for you, what if one of the biggest reasons your adjustments help patients actually have nothing to do with the joint itself and everything to do with the brain? At first, that might sound a little provocative depending upon your level of understanding in the research, but today we're gonna dive into a brand new study that looked at brain changes after an adjustment. In patients, specifically those patients with lumbar disc herniation and chronic low back pain. Now, if you've been following along on this podcast for a little while, you know this is one of my favorite topics. The breadth and depth of what happens when you deliver an adjustment to a patient is massive. It's one of the challenges because it's hard to like just say this one thing happens. A lot of different things happen segmentally, regionally, systemically, in the brain. There's a lot that happens biomechanically, et cetera. This study dives into one of my favorite topics, which is highlighting when you deliver that adjustment, what's happening. And in my opinion, the changes that are happening in the brain are some of, if not the most important changes that happen because the multifactorial nature of it provides a ton of benefit for the patients. So the adjustments that you deliver and were delivered in the study didn't just change pain scores. It actually changed brain activity. We're talking about measurable neuroplastic changes. So we're going to talk about in this study— excuse me, in this podcast episode— what the study looked at, what actually changed in the brain, why this matters for you, and how you can communicate it. So this paper that we're going to review was a 2026 scoping review published in Frontiers in Neurology, and I'm going to drop a link to that down in the show notes. So It was looking at brain functional changes after spinal adjustments, again, in patients specifically with lumbar disc herniation and chronic low back pain. So chronic, as you know, defined as being more than acute and subacute. It's been hanging around for at least a few months. So the purpose of this study, researchers were really trying to answer a very important question. How do spinal adjustments affect the central nervous system? Historically, most explanations of chiropractic care have focused on things like mechanical decompression, local muscle effects, blood flow changes. But as a chiropractor out there taking care of people, you probably know you've seen something deeper happening. Patients, after you deliver your care, they move different, they feel different, and some even emotionally respond to situations differently. So The authors in this study specifically noted that, that many patients continue to have chronic pain even after mechanical compression has resolved. So that suggests that there's some other thing going on here and that some other thing very likely, as we're gonna see, relates to the central nervous system. The goal of this review was a few things. One, summarize the clinical research. Two, identify those brain changes after an adjustment. Three, highlight any gaps in the research. And then four, guide future research. You probably heard me say this before, you know, most research doesn't specifically answer a question, it actually generates more questions. And that's why research is a journey, not a destination. And that can be frustrating when you first start to get into the research realm. You're like, isn't there an answer to anything? The answer is yes, but it's really more about the educational journey. So this study specifically was a scoping review, meaning that they systematically searched all of the literature out there. So they searched the 8 8 major databases. They looked through almost 170 articles, and they found 10 studies that met their criteria. These studies all used functional MRI to look at brain activity both before and after a spinal adjustment. So this was not theoretical. This is imaging-based evidence based upon multiple studies. So across those 10 studies, spinal adjustments were associated with a lot of good stuff. And there was significant modulation, as they highlight, were seen in the prefrontal cortex, in what they call the DMN, the default mode network, the visual network, the cerebellum, the angular gyrus, and the, and the cingulate regions as well. Now, that's a lot of technical stuff, but it's a really big deal because these are pain processing and regulation hubs in the brain. Multiple studies that they evaluated showed significant improvements in VAS pain scores, ODI disability scores, JOA function scores, and anxiety and depression measures. And even more interesting, in several of the studies, brain changes, of course, correlated with clinical improvement, meaning the more that the brain kind of normalized, so to speak, the better patients felt. And that's really powerful in I think we tend to see this again. I'll say some of our bias as chiropractors is actually the fact of what we do works so well. Many surgeons out there have the 33-33-33 rule. 33% of their patients get better after a certain spine surgery, 33% are about the same, and 33% get worse. You and I would like cringe and probably go hide under a table and maybe change professions if that was our shooting percentage. Because if I asked you, What percentage of patients see meaningful improvement in your practice? You're probably gonna tell me 90% plus, 80% plus minimum. So we're playing at such a high level that many times seeing benefits that patients receive due to our care can seem expected to us rather than a surprise. As opposed to 66% of our patients getting worse or staying the same, we're like, 85% get meaningfully better. So it's important to take a step back and understand that's unusual. That is not normal. The care and the result, the results that you see in your practice don't happen that way in many other healthcare providers' practices or offices. So it's important to recognize that, to respect that, and also to understand, okay, we see this, but what's going on? How is this working and how are we generating these incredible results, especially with chiropractors using various techniques, right?

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So one of the strongest parts of this review, getting back into it, was that there was a placebo-controlled study, uh, and it showed both groups— placebo, non-placebo— improved in pain, but only the group that received spinal adjustments improved functionally. And that functional improvement was significant. The adjustment group also showed distinct brain changes. So expectations, as I've always, I never lean away from placebo. I love placebo. It's amazing to me that there are some professions out there that actually their interventions do worse than placebo. That's a whole story for a different podcast episode. But in our situation, that's not the case. And I love it when a patient, I think we should all be encouraging placebo effect. That's, to me, that's great communication, a welcoming environment, and setting up expectations for relief. Not a guarantee, but expectations. And expectations do play a role in all healthcare. But adjustments show specific neurological effects beyond placebo. Specific neurological effects beyond placebo. And that's massive for our profession. So if we unpack some of what actually changed in the brain. 1, there were prefrontal cortex modulation that occurred. Several studies showed changes in the middle frontal gyrus and orbital frontal regions. So the prefrontal cortex is involved in things like pain interpretation, emotional regulation, cognitive control of pain. After adjustments, patients often showed normalized activity in these regions. Really, really good. Some studies even found correlations between prefrontal changes in VAS and ODI improvement. So this suggests that the adjustments you deliver may help the brain kind of turn down, if you want to think of it, the pain processing. Now, if we dive into those default mode network changes, the default mode network, DMN. It's involved in self-referential thinking, chronic pain rumination, and emotional processing. I'm sure you've seen a few patients that are struggling with this. Now, after an adjustment, studies did see increased connectivity in some of those DMN nodes and also a normalization of abnormal activity. And this is really fascinating because chronic pain patients very often have DMN dysregulation. So the adjustments that you deliver may help recalibrate that system. It's not gonna be 100% of the time for everybody, you know, works every time, 100% of the time. That's not the way it works, right? People are dynamic. They're coming in with their own baggage, emotionally, physically, previous injuries. How long is the chronicity? What was the initial challenge? What's still going on in their life? Those things matter tremendously. But man, I think that we've unders— As chiropractors, we take care of a lot of people with acute pain, right? People come in in acute pain. But I think there's a massive opportunity in the chronic pain space for these people that are going and getting, in many cases, I'll say, very poor care in a pain management practice. There's a massive opportunity to bite into that if you put out the messaging that you can help them. Not to talk trash on another profession, but the way you'll do that is to be able to highlight who you are and what you do. Highlight it as an opportunity for relief without drugs or medication. Massively meaningful. Third big thing was those angular gyrus findings. This is one of the standout regions because improvements in this region are associated and correlated with pain improvement and functional improvement. So this strengthens the, the case that brain changes are not random and that they're clinically meaningful. And then we can dive into the visual network and the cuneus changes. This is where things start to get really interesting. So you might think the visual cortex has absolutely nothing to do with low back pain, but after multiple adjustment sessions, the right cuneus showed decreased activity that strongly correlated with pain improvement. So why would that happen? Well, there's— the authors make a few suggestions. One could be attention to pain. Two, sensory integration. That would make a lot of sense with what we do. And then of course, pain modulation. And it's important to remember that pain is not just a tissue problem. It's very much an attention and perception problem. So that's where changes there make a big difference. Now, one of the things you might've caught at the top of this episode was I mentioned anxiety and depression scores. Some studies also showed improvements in both anxiety and depression scores. So along with connectivity changes, that happened along with connectivity changes in the temporal and limbic regions. So this supports why you might be seeing, when pain improves, mood improves also. It makes sense just from a human level. Of course, if you're not in abject pain, you're probably going to be happier. And if you're in a ton of pain all the time, chronic pain with the disc herniation, you're probably not going to have the best attitude. But tying it to the specific benefits delivered after the adjustment you give, massively meaningful, massively, massively, massively meaningful. So for years, there's been people you can look on any comment on any YouTube video I've ever put out and it's, you know, chiropractic is placebo. It's just mechanical. It doesn't do anything. And it's anytime somebody's saying that at this point in time with what research is out there, it shows their knowledge level. And I'm going to say it's not high, right? It's very clear this paper has added to an insanely growing body of evidence that showcases spinal adjustments have central nervous system effects. It's not just joint motion. It's not muscle tone only. It's not just local effects. We're seeing measurable neuroplastic changes. And that's a big deal, um, and, and it explains why imaging— it starts to explain, I should say— why imaging doesn't always match pain. You've probably seen, you know, big disc herniations, minimal pain, small budges, and people, you know, can't move, severe pain. And that's because pain is processed centrally. And this paper reinforces that chronic low back pain involves brain network reorganization, emotional components, and central sensitization, which really aligns perfectly with our modern pain science understanding. So this can help you as you discuss the why with patients. And you can explain why, why is your care helping? Well, it's impacting the nervous system, the brain, and the pain processing pathways. This can elevate the value of what you do dramatically. And I'm gonna say in a truthful fashion, it can actually describe better what you are currently doing. There's a couple things important here. The authors do emphasize that lumbar disc herniation pain involves a bidirectional pain-body process, right? It's not simple mechanical. So that supports things like also active care, behavioral strategies, movement education, in addition to the adjustment itself. So I loved this study. I think there's just so much to dive into. You hear me say this week in and week out, but using this in your report of findings, reframing pain neuroscience, explaining central sensitization, That just leads to better care plan acceptance. And I say that not in a salesy way, quote unquote, although I have no problem with that. But I mean, if you're giving a care plan, I assume it's what's best for the patient based upon your findings and their health goals. So if a patient doesn't complete that, that's a failure. That's not a benefit, right? So now you might choose to amend their care plan as time goes on, and maybe they don't, and that's a different story. But patients are far more compliant when they understand what's going on neurologically. Feeling better with an adjustment is really easy to do. Making the changes necessary for long-term benefit and decreased risk of reinjury, much harder. So utilizing this information in a report of findings, in your marketing, you know, that research supports neurologically focused care, brain-based pain relief, not overdoing it, but just telling the truth. Clinical decision-making, reactivation campaigns. This is just great information for you to get out there in your community. So the big takeaway in today's episode, spinal adjustments aren't just changing joints. It's associated with measurable changes in both brain function and connectivity in patients with chronic low back pain and disc herniation. And that is a powerful story to understand, and it's a powerful story to communicate. The future of chiropractic is not just mechanical, it's neuromechanical. And research like this certainly helps us tell that story with the dramatic degree of confidence. Now, before we wrap up, two more big shoutouts. One, NovoPulse's OA Recovery Program. I'll drop a link down below. Osteoarthritis walks into your practice each and every day, and if you don't have a program for it, you're missing an opportunity to help a ton of people and also for revenue in your practice. NovoPulse is a fantastic device, totally different than what's out there to get that job done. Additionally, The Diabetes Reversal Group, massively successful program, super easy to implement. I'm gonna drop a link down below. If you have people walking into your practice with type 2 diabetes, the Diabetes Reversal Group needs to be on your radar. You refer them out and it makes things super, super easy. They link, down in the link you can check a video, learn more, and see if it makes sense to bring into your practice. Other than that, 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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