Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 289: Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery

Today we’re going to talk about Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery

But first, here‘s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.

We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together.

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail]

If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #289

Now if you missed last week’s episode, we talked about COVID delayed surgeries and lumbar stenosis. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

What a day and what a week. In trying to keep up with the work/life balance thing, my wife and I took our 16 year old daughter to the Taylor Swift show up in Denver last weekend. From here in Amarillo, TX, that’s about a 7 hour drive. Not terrible overall and for a big portion of the drive you have mountains to look at so it’s all good.

We found an app called Autio that is co-owned by Kevin Costner. Along your drive, certain things are marked on the app and there are stories about the area you’re driving through that you can listen to while you’re driving through it. Pretty cool and definitely adds another layer to your drive if you’re a traveler like we are.

TSwift brough in 73,000 screaming fans and it was the second night of a 2-night stand there in Denver. That’s just unreal, honestly. The numbers and money are just staggering when you think about it.

Now, beyond that, we’re just ramping up some new marketing ideas, working on updating my stats, and getting ready to go to Alaska. We’re going on a cruise in a week and a half or so. If I can, I’m going to pre-record some episodes. If I just don’t have time to do that, you’ll be out of an episode for a week or two and we’ll pick it back up on my return. .

Most of you know how it goes. It’s tough to be gone and it’s even tougher to catch up when you return. But I’ll do my very best.

Let’s hop in.

Item #1

The first one today is called “Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study” by Meisingset et. al. and published in BMC Musculoskeletal Disorders onMarch 17, 2015.

Why They Did It

Neck pain is associated with several alterations in neck motion and motor control. Previous studies have investigated single constructs of neck motor control, while few have applied a comprehensive set of tests to investigate cervical motor control. This comparative cross- sectional study aimed to investigate different motor control constructs in neck pain patients and healthy controls.

How They Did It

• A total of 166 subjects participated in the study,
• 91 healthy controls (HC) and
• 75 neck pain patients (NP) with long-lasting moderate to severe neck pain.
• Neck flexibility, proprioception, head steadiness, trajectory movement control, and postural sway were assessed using a 3D motion tracking system (Liberty).

What They Found

• Neck flexibility was lower in neck pain patients compared to healthy controls, indicated by reduced cervical ROM and conjunct motion.
• Movement velocity was slower in neck pain patients compared to healthy controls.
• Tests of head steadiness showed a stiffer movement pattern in neck pain patients compared to healthy controls, indicated by lower head angular velocity.
• Neck pain patients patients departed less from a predictable trajectory movement pattern (figure of eight) compared to healthy controls, but there was no difference for unpredictable movement patterns (the Fly test).
• No differences were found for postural sway in standing with eyes open and eyes closed.
• However, neck pain patients patients had significantly larger postural sway when standing on a balance pad.
• Proprioception did not differ between the groups.
• Largest effect sizes were found for neck and head steadiness.
• Neck flexibility was the only construct that showed a significant association with current neck pain, while peak velocity was the only variable that showed a significant association with kinesiophobia.

Wrap It Up

• Neck pain patients patients showed an overall stiffer and more rigid neck motor control pattern compared to healthy controls, indicated by lower neck flexibility, slower movement velocity, increased head steadiness and more rigid trajectory head motion patterns.
• Only neck flexibility showed a significant association with clinical features in neck pain patients

Before getting to the next one,

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Item #2

Our last one this week is called, “Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers” by Lindsay M. Gorrell,Andrew Sawatsky, W Brent Edwards & Walter Herzog and published in Taylor and Francis Online on 15 Nov 2022. Hot potato!

Why They Did It

The objective of this study was to measure VA length changes that occur during cervical spine manipulation and to compare these to the VA failure length.

How They Did It

• Piezoelectric ultrasound crystals were implanted along the length of the VA (C1 to C7) and were used to measure length changes during cervical spine manipulation of seven un-embalmed, post-rigor human cadavers.

• Arteries were then excised, and elongation from arbitrary in-situ head/neck positions to first force (0.1 N) was measured. Following this, VA were stretched (8.33 mm/s) to mechanical failure. Failure was defined as the instance when VA elongation resulted in a decrease in force.

What They Found

• From arbitrary in-situ head/neck positions, the greatest average VA length change during spinal manipulation was 5.1%

• From arbitrary in-situ head/neck positions, arteries were elongated on average 33.5% prior to first force occurrence and 51.3% to failure.

• Average failure forces were 3.4 N

Wrap It Up

• Measured in arbitrary in-situ head/neck positions, VA were slack. It appears that this slack must be taken up prior to VA experiencing tensile force.

• During cervical spine manipulations (using cervical spine extension and rotation), arterial length changes remained below that slack length, suggesting that VA elongated but were not stretched during the manipulation.

• However, in order to answer the question if cervical spine manipulation is safe from a mechanical perspective, the testing performed here needs to be repeated using a defined in-situ head/neck position and take into consideration other structures (e.g. carotid arteries).

Let’s get to the message. Same as it is every week.

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Meisingset I, Woodhouse A, Stensdotter AK, Stavdahl Ø, Lorås H, Gismervik S, Andresen H, Austreim K, Vasseljen O. Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study. BMC Musculoskelet Disord. 2015 Mar 17;16:56. doi: 10.1186/s12891-015-0517-2. PMID: 25888215; PMCID: PMC4377005.

Lindsay M. Gorrell, Andrew Sawatsky, W Brent Edwards & Walter Herzog (2023) Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers, Journal of Manual & Manipulative Therapy, 31:4, 261-269, DOI: 10.1080/10669817.2022.2148048

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