A patients guide to the science behind Chiropractic manipulation

Chiropractic is over 100 years old (born in 1895) with an interesting history of big characters, gurus, experts, gifted and incredibly cleaver people. Not to mention the not so impeccable and down right unethical. Chiropractic started when medicine was in it's relative infancy, this was a time when medicine was given out by lay people or you could call them snake oil salesmen. They delived sometimes fatal doses of toxins for a price, often their life all for better health, unlike today where it is regarded as regulated. There was little research into what worked and what did not with physical medicine. It was mostly a theory based on what they knew then about the human body and how it worked. Saying that, physical therapy has been around for much longer than most people would think, dating back to 460BC around the time of Hippocrates where he documented using massage, manipulation and hydrotherapy therapy [1].

Daniel David Palmer was the Canadien and founder of chiropractic. He developed the popular theory that when the spine has a mis-alignment that this was the cause of dis-ease and contributed to the vast majority of illnesses. This is still believed by some and has been thrown out of the window by others as it is no longer scientifically evident that this is the case. Take this for an example: all spinal nerves exit the spine from the spinal cord and are sent to an organ, muscle, skin, cells and a host of other locations. If a spinal segment (spinal disc) is reduced or the nerve is being pinched at that level then the organ at that level should not be working correctly, right? Wrong, because how can you explain people who have been paralysed from the neck down after a traffic accident or tumour or injury and their organs work fine? It's because most of the nerves that supply organs are high up above the neck in the brain stem. The exception is in the lower spine with a condition known as cauda equina , where nerves are damaged, pinched or other reasons to stop nerve flow. When nerves are pinched in the way originally proposed it can cause problems like shooting pain, limb weakness, reflex loss and pain but is not going to give you a visceral illness like pneumonia.

When I was in Chiropractic school I knew there was a division in Chiropractic but had no idea of the scale. On one side there are the purists where chiropractic started out and then the mixers who wanted to know the who, how, why, where and when's. The mixers also believed there is more to offer than just cracking joints. The profession is at a crossroads and has been for some time because finding a common ground between the divisions is very difficult because of the conflicts of views. What we do know is that the original philosophy is scientifically flawed and this is due to the latest evidence coming from New Zealand where specific tests show what actually happens during spinal manipulation.

Chiropractic schools in Europe are fighting for an evidence based curriculum, still educating on chiropractic history and the philosophy but driving to be incorporated into the medical professions. We are taught in science, biology, neurology, anatomy and physiology, nutrition, pharmacology among many others using a patient centred approach. Chiropractors have for many years now, integrate soft tissue work, stretching techniques, instrument adjusting, acupuncture, shock-wave therapy and many other techniques that have shown to work in addition to the famous joint cracking that chiropractic is infamous for. Many chiropractors treat the whole body from top to toe as for example a bad ankle can lead to a bad back, by adjusting the back you are unlikely to improve the ankle. The one philosophy that joins the profession is we want to find the cause of pain and dysfunction, to help people come off pain medication and have long lasting effects. Chiropractic has come a long way but still has some way to go, many sports teams now use us, presidents, office workers, labourers and recently the NHS has been referring to chiropractors in England.

You may be thinking I am slandering my own profession, this is really not the case, I have seen my patients come in with chronic pain and have great results, I have had sports enthusiasts come in with injuries and have got them back on the field stonger, more stable and educated about their body. We help 95% of patients we see and it is due to knowing how the body works, using techniques that work and having research to back up what we do. It is all about teamwork, the patient has a say in their care, prescribed the right exercises and education, address their diet and feel empowered that they are involved in their own recovery. There is a shift in philosophy and the latest science is telling us what actually happens when we use spinal manipulation. And the results are great!

Dr Heidi Haavik is being called a pioneer in the field of chiropractic manipulation and neurophysiology. She has done in depth scientific experiments measuring brain activity during spinal manipulation and the results are very promising. When a spinal joint becomes restricted/stiff/subluxated we now know that this is a “central segment motor control” issue. Yes a fancy name which really means that the brain and spinal cord (central nervous system) is not controlling that problematic area of the spine very well. This leads to the muscles (para spinal) to over stretching sending signals back to the brain where pain is interpreted. These paraspinal muscles act as sensors, and when they are not sensing properly this is where pain and dysfunction can occur. This is a problem that does not happen straight away, it is usually a build up of dysfunction over time. Poor posture, sedentary lifestyle, injury, stress and even diet plays a role in the end product of pain interpretation. Your head is like a bowling ball (no offence but a good analogy for what's to come) and needs to be in the right position for stability, the centration of

joints and is also important for breathing and your mood. When you have sluggish posture with forward head carriage all of the muscles and ligaments are taking the weight of this bowling ball causing over stretching, ligament damage, tension headaches and is even evident it effects your mood also. This can lead to pain, stiffness and early onset of osteoarthritis.

When we deliver a manipulative thrust to the spine it helps improve the communications between that segment and the brain. When the spinal joints are moving as they should be, the muscles follow suit which helps the brain understand this information more easily. That is why manipulation helps with pain. Just sit there for a minute and close your eyes (read the next bit first), now raise your left hand up and out to the left (open after 5 seconds). Now have you ever wondered how you know where your hand and arm is in space and time with you eyes closed? It's called proprioception, we know where we are and what part of our body is at all times. We also have something called sensorimotor [2] integration, which in basic terms lets us grasp objects with our hands and understand he shape, helps with coordination, move our heads in the direction of sounds, enable postural stability and lets us engage with our environment. The nervous system is complex so explaining it is even harder when the reader knows little about what it does. I shall explain briefly with the good old bullet points!

The Nervous system

• Controls just about everything in the human body

• Nerves are like electricity cables sending signals up and down the body like a computer

• Nerves go up: These are sensory nerves and make us feel sensations like hot and cold, for smell, taste, basically our senses.

• Nerves go down: These control our muscles for movement and glands for hormone secretion

• Each of us have 90,000 miles of nerve if put together in one straight line, 100 billion neurone cells

• The nervous system can transmit signals at speeds of 100 meters (328 feet) per second

• Nerves work through electrochemical processes

The last section is about how we adapt and how that relates to the chiropractic adjustment. The word is Neuroplasticity [3] and is so important in everyday living that if we did not have it we would cease to exist.

Neuroplasticity can be described as any change in the structure or function of the central nervous system in response to altered input, in this case the input is the manipulation. The amazing thing is the brain is constantly changing, whether you are awake, asleep, thinking in deep thought or eating breakfast. We have the ability to never stop learning and our neuronal circuitry is constantly changing and rewiring. There is a myth that when we age these new connections stop, this is completely wrong [4]. We actually keep learning but if you stop using this ability then the process will slow quicker as we age. So the old saying which I use nearly every day is if you don't use it you will loose it. When we develop dysfunction and inevitably we all do at some point our lifes, the adaptive process of spinal coordination can become maladaptive. Dr Heidi Haavik's findings show that spinal manipulation can reverse this maladaptive processes by restoring function again between the spine and central nervous system.

It really does seem it's out with the old and in with the new, we always knew the benefits of chiropractic and the basic science behind manipulation, but with these studies and more to come it is an exciting time for Chiropractic, it's patients and other professions that use manipulative therapy.

You have reached the end! A lot to take in I know, but I believe in educating patients with wholesome information, even if it is in depth for those who know little about neurology or physiology. And now you also know the importance of good posture.

Until next time this is Corbin's Chiro Blog

Photos from open source

1. Wharton MA. Health Care Systems I; Slippery Rock University. 1991

2. http://www.chiro.org/research/FULL/Exploring_the_Neuromodulatory_Effects.pdf

3. http://www.podcastchart.com/podcasts/chiropractic-science/episodes/brain-adjustments-with-dr- heidi-haavik/pop

4. https://www.elsevier.com/connect/brain-and-behavior-are-modifiable-even-as-we-get-older