Why Microglia May Hold the Key to Spinal Recovery and Neuroinflammation | #510

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Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Lengmaid. On today's episode, we are back with more brand new research. A little bit different and it is awesome. We're going to talk neuro inflammation. This is a great study. It again provides us answers and questions. I love it. We'll dive into it in just a moment. Before we get started, special shout out to Leander tables. If you're looking for a new table, they support this podcast and they're willing to support you by being a listener. They're willing to hook you up with $1,000 off their Series 950 table. You can visit down at the link below or connect directly with their team. But as I said at the top, we are talking research today. Title of the study, evolving insights on the role of microglia in neuroinflammation, plasticity and regeneration of the injured spinal cord. This was released just this year in the journal titled Frontiers on Immunology. Now, one thing that you may not know, the smallest cells in your spinal cord, those are those microglia might actually be the biggest players when it comes to recovery after an injury. These tiny cells are totally transforming and shaping how we understand inflammation, how we understand repair, and in some cases they might even be contributing or fueling problems like chronic pain and autonomic dysfunction. So on today's episode, we're gonna dive deep into this brand new research study. Again, I'll drop a link down below which is microglia and spinal cord injuries, and hopefully we'll uncover why this matters to you as a practicing chiropractor and me and how you can communicate this effectively with and to your patients. So the paper we're talking about, it was a mini review again published in Frontiers in immunology in August 2025. This thing is hot off the press. Now the authors, they were going to really trying to take us through an evolving understanding, I'll say, of microglia, the immune cells of the central nervous system and their specific role in spinal cord injury. Now, for decades, pretty much everybody lumped all immune cells in the spinal cord or involved in spinal cord injuries together, calling them, you probably have heard this term before. Macrophages, you probably have heard that before. But with better tools, things like genetic advancements, imaging, bioinformation, we can now distinguish between bloodborne macrophages and tissue resident microglia. Now, this distinction, while seems like technical, it is huge because these two groups do not at all behave the same way. In this review looks at how microglia respond after an injury, how their timing and their location affect outcomes, and how they can be harnessed, potentially therapeutically to improve recovery. So some of the big findings from this study, we'll start with early responders. Microglia are the first first immune cells, the first immune cells to respond within minutes of injury, while blood derived macrophages don't peak until around seven days later. That's a massive difference. Again, especially we're talking about an acute injury, a spinal cord injury. What shows up first and what happens in those early moments we know is so massively important to recovery. So microglia are actually the first responders there. Now, monocyte derived macrophages can often be harmful. They can drive axon and tissue damage, while microglia tend to be protective, promoting repair, releasing growth factors, excuse me, and coordinating scar formation. Additionally, it's important to remember that balance matters. Initially, after an injury, the balance between pro inflammatory M1 and anti inflammatory M2 immune activity is about 50, 50. But after two weeks, the M1, the harmful response, usually dominates. And this is really, really important. You have to remember, when an injury acutely occurs, inflammation can be a good thing early on. The real task is ensuring that chronic inflammation doesn't take place. And this is a delicate and nuanced balance, right, because too much inflammation even early is not good. So this is a real delicate balance. But ultimately, when there's an injury, some inflammation acutely and immediately is really important. It's actually the first step in the healing process. However, if acute inflammation sticks around, that becomes chronic inflammation. And chronic inflammation is not only linked to chronic pain, but it's linked to a whole plethora of additional challenges as well. So getting that balance right, and you know, I'm speaking not based upon this research study, but that balance can be a little bit different, in my opinion, depending upon the injury, depending upon what's the injury, where's the injury. So it's not one size fits all in terms of, well, how much early inflammation is, is optimal. The answer is, as most things in life, it depends. But having that balance be as ideal as possible is going to facilitate the best recovery, the fastest recovery, and the most complete recovery possible. When that gets out of balance, either inflammation early doesn't happen while the healing process doesn't start not good, or inflammation hangs around because of a host and variety of factors. That's chronic inflammation that can result in chronic pain and a whole again, plethora of problems as a result of that. So finding that balance, and I'm going to say more so than finding it empowering the body to maintain that balance is probably the best way to put it is really, really critical.

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Now back to the episode now, in newborn in all newborn animals, microglia, they coordinate scar free healing and axon regeneration. Didn't know that? Love to see the new things in studies now, in adults, that ability is greatly reduced. We all know in children and newborn animals, in young people, you heal a lot faster than if you start getting up there in age, right? And this study just emphasizes that. But I didn't know that the microglia are what coordinate that scar free healing and axon regeneration. But as adults, again, that is dramatically reduced. And that is a challenge. Now, it's also important to remember, microglia don't act only at the injury site itself. They also activate. Far from the challenge. They can actually reshape kind of the neuronal circuit, so to speak, and they can drive conditions like autonomic dysreflexia. Excuse me. Wow, mouthful there. And chronic pain. So as we go one step deeper with this, these researchers selectively depleted monocyte derived macrophages. And when they did that, the subjects had better recovery, they had more axon sparing, they had improved motion. Now, when the microglia were depleted, outcomes worsened, recovery slowed, more tissue is damaged, and inflammation kind of spiraled out of control. So this kind of goes into the thought that microglia are not just passive bystanders to injury, they're actually active coordinators of recovery. They release neurotropic factors like bdnf, cntf, and gdnf, which help neurons survive and also help axons regrow. They also supported the remyelination efforts and a lot of the factors surrounding that. So these microglia are really critically important both locally and systemically when we're talking about neuronal recovery. Another fascinating detail that I found was microgliation. They can kind of be primed, quote, unquote, before recovery. For example, in some experience, some experiments, excuse me, low doses of microglia given before a spinal cord injury actually protected against paralysis. And that's massively powerful. Now, I don't think they're going as far as to say that that's a proactive and preventative medicine type step, but it's important to notate and it highlights how important they are. Now, on the flip side, in some injuries, microglia in distant spinal regions can strip away synapses and fuel plasticity. This contributes to conditions like immune suppression and chronic neuropathic pain. So ultimately, these microglia are really important to have in the area of injury. They act systemically, but having them close to or in the area is critically important. So there's a little bit of a double edged sword. And the location, I'm gonna say the timing and the activation pathways of these microglia critically important to ultimately how they impact the recovery. So, you know, you might be thinking, this sounds interesting, but what the heck does this have to do day in and day out in my practice? And I think the answer is threefold. It's patient communication, it's understanding inflammation, and it's also just getting an insight into what might be coming down the pipeline in the future. So we'll start with patient communication. Patients, you might have patients that have had spinal cord injuries, they might have chronic pain or neuropathy. Chances are when I say all three of those, you have some of those patients. And they often ask, why is my body reacting this way? So this is an opportunity to sit down, take a moment and explain that their nervous system has its own immune cells called microglia, that sometimes help, but sometimes can contribute to pain as well. So again, balance, balance, balance, being proactive, getting motion, and all of those things, I think tie in just at a high level. You don't need to get into the deep science, but just most people have no clue, hey, your nervous system has its own immune cells. And it's really important that we do everything we can to enable them to do the best job that they can, because that's how you recover to the best of your body's ability. Also, just again, that basic understanding of inflammation, we talk a lot, a lot, a lot, a lot about systemic inflammation in chiropractic. Now this research highlights that within the central nervous system, inflammation is really nuanced. And again, some immune activity is protective by nature, some is harmful. And that's a powerful statement or analogy for the lifestyle choices and interventions we often discuss with our patients. Just help them get at basic understanding and then additionally, just keeping an eye on the future. This field is moving towards microglia targeted treatments that can go a variety of different directions. And while it might not be something you offer in Your practice. It's really important to be aware of these directions because if your patients start asking about them, you want to be able to guide and direct them in the best way possible. So patients with that, chronic pain, patients with neuropathy, you know, bringing this up in the report of findings, there are immune cells in your spinal cord that may be contributing to why this pain continues. Our job is aimed at balancing and calming your system and supporting the best healing environment possible. That's a great practical application for on what I call heavy research like this, in truthful, consumer friendly language. You know, reactivation campaigns. You know, I talk about this all the time with Patient Pilot, the best reactivation software out there by far. And the gist of it is keeping people aware of what's going on with their body. Even if your pain feels old, right, it's chronic pain, your body's immune system is still actively involved. So getting adjusted, seeking care, doing things, you know, balance of strength and flexibility, all of those things focusing on your health can still help to bring that balance back. Nothing. It's very rare that things are too far gone for any improvement. And specifically when we're talking about chronic pain and also differentiation. The healthcare market's never been more crowded than it is today. So understanding these concepts and being able to speak about them in plain English just helps you stand out. And patients really appreciate it. People appreciate it when you're up to date on the science and can connect it with their care. So in short, microglia, the smallest cells in your spinal cord, have some of the biggest impacts on recovery, pain and function. They can help or hinder the process, but that depends upon a few specific things, including timing, location and balance. And for us, it's just another reminder that the nervous system is never static. It's constantly adapting, it's constantly remodeling and constantly interacting with the immune system. And when we help patients, as we do lower systemic inflammation, move better, we're supporting the very principles that these researchers are continuing to uncover. So you are on task whether you knew this research or you didn't until today's episode. So before we wrap up today, I want to say special shout out again to neckcare, the best hardware and software package for cervical spine assessments out there. Necare.com let them know you heard about them through this podcast. They will hook you up with 10% off. We will drop that link down in the show notes. Additionally, if you did not get our founding member rates, we still have some specials going on with Velo AI Call Agent Services. I'm using it in all of my businesses. Call the evidence based Chiropractor right now and you will experience a Velo agent. Or you can head over to the evidencebasedchiropractor.com velocity or from the top line navigation Choose Fellow I don't want you missing calls when you're out of the practice and you are missing calls if you're using an answering answering machine. Ain't nobody leaving an answering machine message. There's nobody that's doing that for one person that does. 100 people hung up and called the next chiropractor. I don't want that to be the case with you. We actually use Velo AI call agents 24 7, 365 in my practice. You might choose to use them only off hours. That's great. The bottom line is Velo is the best AI call agent solution and I don't want you missing new patient calls, reschedule calls, or an opportunity to engage an answering machine. It's 2025, soon to be 2026. Answering machine just ain't good enough so check out Velo. 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