Blog, Live Events September 26, 2022

The Chiropractic Adjustment Mechanism Explained

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Hi, I’m Dr. Mark Studin and welcome today’s session and it’s an exciting one. But first I’d like to thank ChiroSecure for helping create the forum to get this information to you. And today we’re going to talk a lot. About the mechanism of the chiropractic spinal adjustment. And believe it or not, there’s so much confusion out there about what is it?

Is there a bone on nerve? How does it work? We’re gonna talk a lot about subluxation or what I call a patho neuromechanic lesion. There’s a lot of things about what we do to get to understand and believe it or. When you’re dealing with collaborative physicians, primary care doctors, specialists, or those neuro neurosurgeons, pain management by you, understanding this also helps you in the referral process.

It’s critically important. If you’re dealing with lawyers, it matters also because on the witness stand or in depositions, chiropractors are being asked, How does a chiropractic adjustment? What is it you’re diagnosing and you need to understand these things. So we’re going really delve into this, not a lot, because this is not going to be completely handled in a half an hour, and I want to ensure that you don’t practice what I call sound bite chiropractic.

In other words, you understand a sound. 10%, but you profess to know 200%. I call that the old chiro. One step, two step. So you need real education behind that. All right, let’s go to the let’s go to the slides and or the article actually, and actually the, we’re gonna discuss an article today.

And this particular article is on the US Chiropractic Directory. And I urge you all to go there and in the US chiropractic direct. If you look along the top ribbon, there’s research case reports and medical legal white papers and it’s all free. Unlike other folks in our industry who I think are demented to give you pro chiropractic information, they make you pay for it.

Guess what? This is all free, and I want you to know that we’ve had 21,502,531. Let’s refresh the. 541. Now, since the last four minutes, there were 10 hits, so this is a real number since 2012. This also probably is the most visited website in the chiropractic industry. So I, it’s just so important that everyone has this information.

Everyone understands it. And I just posted these two articles yesterday and each of ’em have gotten about 300 hits in a day. So let’s go to the article. We’re gonna be discuss. And it’s called, This is the chiropractic spinal adjustment Mechanism, explained chiropractic spinal adjustments, increases facet capping, facet gaping and functional outcomes.

And I’ve done that with Dr. Capari in conjunction with him. Now, this was also just published Actually, it’s being published this month in Dynamic Chiropractic so that you can you could look at, you could look it up there if you choose. But what this says, and by the way, you’re gonna see me, I’m a nerd.

I’m sitting in front of four screens. When I’m looking at the screen, I’m presenting is here. When I’m looking at the words and scrolling and using my pointer, I’m looking this way, so you’re gonna see a little bit of this side of my face. It says, The prevalence of neck pain is significant in a general population, affects almost half the population.

In in any 12 month period and a lifetime prevalence is 70%. So we’re talking something that’s in epidemic proportion. I work with many primary care medical doctors, many of them, and I consult for a bunch of them. I work with emergency departments and emergency rooms, and I could tell you that the fifth most prevalent diagnoses number.

Is back pain, musculoskeletal fifth most, and they tell me that. There’s one guy told me yesterday in a suburb of New York City, told me that he could actually refer 20 cases a day into a chiropractor’s office, but he doesn’t fully understand the mechanisms and how this happens. So because of that lack of knowledge, he refers to pt.

So stuff like this has a very. Big level of applicability to fully understand it. This article is focused on the effects of the chiropractic spinal adjustment, cervical spine outcomes regarding pain and biomechanical functional outcomes. Here’s the key folks. Everything is about spinal biomechanics. It’s not about, Oh, I’m picking a bone off an nerve, even though there is bone on the nerve.

And it’s not the nerve root. It’s not about your technique. Oh, I did a pita a I’m an Atlas orthogonal technique specialist. I’m a no one cares. The second you talk about your technique, you’ve lost everybody. You’ve lost the game. It’s not about, Remember these, This one word management, it’s about managing your case.

How do you manage your case? How do you diagnose your case? Because chiropractic medicine is diagnostic heavy and treatment short and chiropractic is the converse. It’s diagnostic short and treatment heavy. So what we’re going to do is meld those two things today and give you information. So when considering intervertebral kinematics, specifically joint movement and residual gaping manipulation is considered an effective treatment for neck pain.

Now, this is all based upon. Taking from literature, and I have all the references down below. I don’t like using the word manipulation. I don’t like it. And here’s why. The problem with the generalized descriptor, manipulation and a high velocity, low amplitude, quick thrust, conflates providers as physical therapists, osteopaths, and chiropractor.

All utilize similar descriptions in treatment. This is confusing when considering care paths and often misleaded. The medical doctor said to me, the primary care you all manipulate the spine. What difference does it make? Who I send it to? We don’t all manipulate the spine equally. A chiropractor runs a chiropractic spinal adjustment.

A physical therapist does level 1, 2, 3, or four joint mobilizations, and the evidence in the literature is clear. When physical therapy is the first provider, there’s upwards of a 313% incident of additional disability versus of a chiropractor Is the first person treating you now, I love physical therapy.

It’s wonder. But for spine, not as the first provider. So when I explained that to the physical, to the medical provider and I showed him the research article because it’s not about a soundbite, it’s about having full understanding of this. He goes, his eyes like bugged out of his head. Oh my goodness gracious.

I said, We do not do joint mobilizations. We do a high velocity, low amplitude thrust called a spinal chiropractic adjust. It matters tremendously. Your language, it matters tremendously in how you communicate, and it separates you from the pack. We do not do what they do. Not at all, and I’m not saying what they do is bad.

It’s just for spine. This is about functional outcomes. Functional outcomes. Here it is in a nutshell, that’s the winner. Because you wanna increase function. And when you increase function, or let me rephrase that, normalized function or create homeostasis. Now if you look at medicine and by the way, medicine’s gonna validate chiropractic, we’re not gonna validate ourselves.

It’s gonna happen in the research world, in medical academia, it’s already starting. I want to impress the medical community. How come? We’ve been in this game since 1895, so that’s 127 years We’ve been hovering for decades at around 7% utilization of the population. That’s it. Medicine sees probably 99% of the population.

Do I wanna keep doing the same thing and fighting for that 7% to get it to 8%, or do I want to tap in to this primary cares 20 a day that he could? It’s just, it’s incredible the number of people that could be in chiropractic offices that need to be, that are being mismanaged. So when you look at biomechanical functional outcomes, when you look at medicine, for instance, When you’re treating a high blood pressure patient, do they ever say, I’m gonna fix your high blood pressure, I’m gonna cure your high blood pressure or diabetes the same?

No, We’re gonna manage it. How long? For a lifetime. A lifetime. And it’s reality. And life expectancies have increased. And you know what? It’s okay. There’s a lot of people making a lot of money, but there’s a lot of people getting well and not suffering. So when we manage cases, it’s very different.

And here’s the key. We look at mechanics. If in fact, a vertebra is in the wrong position, we’re gonna talk about how it gets in the wrong position in a moment. If a verte. Is in a wrong position over a period of time. Let me make sure I’m not doing this later on. No. Okay. In a long period of time, the PAs of electric effect comes into the PA of electric effect. Comes into play. And then the bone starts to remodel, you’re gonna create first. And I’m not gonna go into the mechanism bone spurs. It’s gonna, it’s gonna leech calcium from the adjacent vertebra into the anterior posterior longitudal ligaments.

It’s gonna calcify, it’s gonna remodel the bone. Once that bone has been remodeled, it’s no longer a perfect square. Not that it’s, or a rectangle or whatever shape it should be, but it’s gonna be not a perfect square. So now the vertebra is going to be lined up, Aly constantly putting pressure on the facets.

As a result of that, you’re never going to be able to make a full correction if in fact you get the person under care. Provided there is no damage to the ligaments, which is a conversation for a whole different time. You can hopefully make as much correction as possible. But once that vertebra starts to remodel and you’re off even one degree, that spinal never stay in the right spot.

So now you’re managing that SP spine for that person’s lifetime. And I’m not saying you’re managing their pain, you’re managing their biomechanical abnormal. The original. Reporting of joint cap gaping by Kramer and more recent reporting by Anders in 2018, utilized the chiropractic spinal adjustment model by an experienced chiropractor.

Therefore, this article will be focused on, let’s get this over. We’ll be focused on chiropractic to prevent confusion when considering a care path based on an evidenced based model. It’s in the litera. Kramer reported in 2002, and again, it was confirmed in 2018 by using chiropractic only the thrust given to chiropractic procedure had the effective, increasing the gaping of the zigas joint, the facet joint, the average.

So you’re delivering a high velocity thrust when you do that in the facet joint. There is a a meniscal or a pleco, It’s a space. And when you have A macro trauma or repetitive microtraumas, car accidents, sports injuries falls or repetitive microtraumas walking with high heels that are, that cause you hip to till anything which causes repetitive trauma that spacer dislodges, It’s called a buckling effect that buckles and the spacer, this lodges and the facets now are aberly positioned and they app.

Especially if it’s a high velocity or a a macro trauma like a car agonist or sports injuries, it’s going to overstretch that joint ligament capsule and in those ligaments are no receptors. MEChA receptors, which are your pian core puzzles, which are your stretch receptors, your refin core muscles, which are your crimp receptors.

Receptors, your GOGI ligament organs, where it sends information also to the lateral horn and the no receptors. So in the joint capsule, there’s MEChA receptors and no receptors and myriad of information is going into the central nervous system at the facet level. You have no suscept that line, the facet.

So when that joint that gaping goes outta place, it does that and now it’s firing into the lateral horn. Why does it do that? It does that because when everything’s out of position, it’s bringing you off plum biomechanically. So the body wants to. So what’s happening is it goes up to the brain.

Everything is from the brain, everything. Then the brain shoots down information. You got mechanical receptors all over the body and it knows where it needs to be, and it has to create an analia. An analia is correcting to get you biomechanically, plump. That’s what analia is leaning from. The pain is one way, but it’s also creating other issues.

So the brain now sends e unfairly information to the muscles. Through the motor cortex and it says spasm. If you have a problem in the lumbar spine, which is taking you two degrees it’s gonna pull your cervical and thoracic spine to try to put curves in there to get you plum where you want to get your glabella, your epi stone not, and your pubic synthesis in line.

So the bodys gonna try to plum it. So what this says is the average difference between control subjects that receive the chiropractic adjust. And remained in the side Posture position was 1.33 millimeters and a difference of 0.71 found in the side posture group. So what they said was, is the facet gap increased?

Point nine to 0.4 millimeters and they retook imaging 20 minutes later and it persisted. They didn’t do after that. So what they’re saying is those little spacers, those mancos, those plecos similar name get reseated. Unfortunately, muscles are patterns sometimes and it goes back out. Or the ligaments are overstretched and it goes back out and it needs to be receded.

But once you put that menis back, It now separates. It’s a spacer, those facets, and it’s no longer firing. You’re relaxing that joint capsule. It’s no longer firing, and the whole rest of the body starts the plum and it actually decreases pain in all different areas of the body. In disparities, as the literature says, physical therapy doesn’t do that.

O osteopathy doesn’t do that. It does joint mobilization, stretching gliding. It doesn’t deliver that high velocity throws to create that gap in the evidence 16 years apart is consistent with the most current articles validating biomechanical changes as a result, a direct. Of a chiropractic spinal adjustment, but they also reported in 2018, the results suggest that clinical and functional improvement after a chiropractic spinal adjustment may as occur as a result of small increases of interal range of motion across multiple segments.

So what they’re saying is the study demonstrates the feasibility in characterizing the real time manual input and biological response. When you’re adjusting the spine in the cervical area or in the lumber area for cervical or cervical, for lumbar, it helps normalize the entire spine beyond post mri, which is unrealistic, and clinical PR clinical practice due to cost.

There are algorithms based on x-ray to help diagnose these changes and the normalization of the spine. Mu sang in 2022. The study of subsequent subject specific spinal loading could help further the understanding of cervical spinal biomechanics, degenerate mechanism and complications. This is what we discussed.

ABRA biomechanics causes degeneration the PAs of electric effect in complications from that because it remodels the bone. We also know, despite the political rhetoric, that diagnostic x-ray is safe and has no carcinogenic effect. X-ray does not cause cancer. X-rays are safe to be in 2009 reported among humans.

There is no evidence of a carcinogenic effect for acute radiation in a diagnostic x-ray as we use. And the numbers, and I’m just gonna give this to you briefly, they found that it takes a hundred milli serves, that’s a unit of radiation, a hundred millis in one setting, cuz it’s not cumulative to have less than one in 100,000.

Radiation effects less than one in 100,000, but still you don’t want to be that one in 100,000 a hundred milliseconds. A lumbar x-ray is five. Let me just get the numbers down exactly. I’m using a calculator. It’s approximately 1.79 millis. One lumbar x-ray is 1.79. Millis, you would have to do 56 lumbar x-rays at one.

To have any evidence of less than one and 100,000. When’s the, I’ve been in this game 41 years. I don’t know any chiropractor ever who took 56 x-rays at. That’s crazy. So it just backs up. Diagnostic X-rays have virtually no negative adverse health based adverse health sequela based upon this and the totality of everything in the literature.

But there is technology there is that renders pre and post biomechanics based upon x-ray and ligament pathology. To demonstratively document changes. It renders a visual. Renders demonstrative visual pattern. Now we use a piece of technology called Siver. S Y M V, Orates an x-ray digitizing platform and does a myriad of things and what it’s showing.

And by the way, today, the algorithm has been changed. But what this says, it’s a flexion extension, X-ray, cervical, lumbar. But what it does is it measures either translation forward and back. Or positive X movement and positive or Theta X actually, which is forward rotation or negative theta backwards rotation.

And it’s measuring the movements of their thresholds. So what this is saying is anytime a vertebra moves more than 0.6 millimeters, and by the way, that’s now changing to 0.78 plus or minus 0.22, based upon more recent evidence in the literature, there is ligament this path. And it’s gonna, And look at this.

Where would you adjust this patient? This is just easy. There’s pathology at C two C three. Not so much in c. C4 is normal. C five is a tiny bit, I’m not gonna really count that, but C six and C seven. And there are other views that you could see from this technology to tell you whether you were just infer superior or left to right.

So it’s telling you exactly where these issues are and these problems are. And when I go to the medical doctor and I sit with the neurosurgeon, the orthosurgeon, the primary, and they say it’s only non-specific back pain. I said Non-specific. Yeah. No fracture. No tumor infection, no herniation.

They can’t see it and find it. When I show them this technology, their eyes bug outta their head. I said, and what I share with them is I. Doctor, I appreciate that there is no anatomical pathology for you to treat, but there is biomechanical pathology and there is connective tissue pathology, which is secondary, strained sprain, and that’s exactly what this is.

There are significant tearing and sub failures, and I’m not gonna get into that right now. We don’t have the time, but when I show this, they say it’s very specific and here’s where the problem. Chiropractic needs to evolve with technology. It needs to evolve with the evidence of the literature. It needs to evolve in how we communicate, and it must be demonstrative.

When I show this to the medical doctor, surgeons now are saying, I need this on every patient. Because if there is a, If there is, this is 2.5, if there’s a significant amount of translation, I can’t use an artificial disc. If I’m doing a discectomy, it’s gonna change how I treat the. They want us to digitize their images and evaluate them, and then when they’re done with surgery, get them back in to treat the adjacent areas, because if not, you’re gonna get adjacent segment to generation, which happens in almost everyone.

And there’s a 22% of surgical incident because of adjacent issues. So it just works. There’s so much out there that’s changing Everyth. In conclusion, folks, Anders concluded the results of were demonstrate that target and adjacent motion segments undergo fent gaping during manipulation, which is a ChiroSecure spinal adjustment, and that interal range of motion is increased in all three plains of motion.

After adjusting the patient, the results suggest that clinical and. Clinical and functional improvements after a chiropractic spinal adjustment may occur as a result of small increases in interal range of motion across multiple motion segments. By putting those BLEs or mancos in the study demonstrates the feasibility of characterizing in real time.

The manual input and biological response that compromise cervical manipulation, including clinician applied for set, gaping, and increase. Interal range of motion, so we can go on and on. But analytical tools like SY Verta can assess the location of FEC Compromise for acute treatment, for accurate treatment planning folks creates an accurate treatment plan.

We’re starting to see carriers push back in lawsuits, and they call them predetermined treatment plans. Everyone gets the same treatment, everybody. Guess what? And I’ve seen that in a huge amount of cases. Guess what? Here it is, right? I’m adjusting the patient here, and here.

There’s no predetermined treatment plan, and I’m going to redo this in some instances, in almost every re eval, which is every month because there’s no negative x-ray effect. And I’m going to see where it gets better and change my treatment plan. And then when it stabilizes, I’m gonna MMI my patient. It’s just easy.

It’s just easy. We have doctors all around the country doing. And it’s evidenced based, Let me rephrase that. Demonstrative evidence based practice. It makes it simple. Are you changing what you do? No. Are you changing how you adjust your patient? No. All you’re changing is where and when to stop because the body will tell you.

And when you’ve reached mmi, I’m going to still treat the patient if the bones. That’s going to tell us a whole lot because I’m gonna still treat the patient if the bones remodel. Maybe for their lifetime because they need to be managed, but now not an acute or reconstructive setting, but that’s a conversation for another time.

So folks, wow. So much to unpack in such a short amount of time. I’d like to thank you so much again, ChiroSecure. Thank you for giving us the platform. Mike Miscoe will be here next week to share with you a whole lot of really cool information and I’ll see you next time. Thanks and have a great day.