Top Research of 2018

Top Research of 2018

By: Dr. Jonathan Verderame

We love research, in part because it is a vital element to critical thinking, and critical thinking is important to making independent judgments. Axiom Seminar and its board have proposed that the solution to our profession’s problem of unity, legitimacy and utilization will inevitably and undoubtedly begin from the inside-out, whereas most solutions until now have been focused on outside in approaches.

We must be capable of actively and skillfully applying general principles, analyzing claims, and recognizing truth. A large component of this process is applying and evaluating research. This year has been a remarkable year for research, with groundbreaking discoveries, that have again reaffirmed how true the principles of chiropractic are. We have looked through hundreds of article over the year to find the most applicable and impacting articles. Here are the top research studies of 2018

10. Chiropractic spinal manipulation alters TMS induced I-wave excitability and shortens the cortical silent period. J Electromyogr Kinesiol. 2018 Oct;42:24-35.

This is the first of 3 articles included in our list that pertain to improving muscle strength. It is exciting and promising to see research that is not focused on pathological physiology, but adaptive physiology. The article states:

“These finding may have important clinical implications as they provide support that spinal manipulation can be used to strengthen muscles. This could be followed up on populations that have reduced muscle strength, such as stroke victims.”

9. Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study. J Manipulative Physiol Ther. 2018 Aug 15.

Following up to the previous article pertaining to stroke patients, this article states: “As a consequence of ventilatory disturbances, stroke patients develop inadequate respiratory function.”

Although the adjustments were performed “non specific T4-8 supine” it nonetheless improved 2 important functional parameters, including improved 6 minute walk test and pulmonary function values were both significantly enhanced.

8. The effects of a single session of lumbar spinal manipulative therapy in terms of physical performance test symmetry in asymptomatic athletes: a single-blinded, randomised controlled study. BMJ Open Sport Exerc Med. 2018 Nov 28;4(1)

What is the power of one chiropractic adjustment? “These findings suggest that SMT was effective in producing immediate effects in symmetry in the static position.” With only a single session!

7. Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study. Chiropr Man Therap. 2018 May 17;26:16

Gonstead would be happy. This is the first study showing that adjusting the SI joints produced statistically significant improvements of lumbar disc herniation. Of course we have seen this clinically for many years. The article states:  “Compared to common treatments for LDH (lumbar disc herniation), SMT is reported to be 37,000 to 148,000 times safer than non steroid antiinflammatory drugs and 55,500 to 444,000 times safer than surgery…The improved outcomes in our patients can be attributed to two main factors. Firstly, SIJ manipulation may improve normal functioning of the lumbar spine and related muscles [38]. Secondly, lumbar side-posture rotational manipulation can induce spinal muscle relaxation improve lumbar range of motion [36], and briefly decrease intradiscal pressure.”

6. The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique. J Altern Complement Med. 2018 Jan;24(1):90-98

With a large sample size of 343 pregnant patients (average age = 30.96 years) it was fascinating to see the demographics. “They were highly educated with 75% attaining a 2-year associate's degree or higher.” This is the second article in our list including the word vertebral subluxation! Both published in high indexed journals.

“This study adds to the growing evidence that suggests that chiropractic care may play a role in QoL (quality of life) and overall wellness, beyond MSK conditions. There is strong theoretical reason to believe that spinal adjustments and correction of vertebral subluxation improve nerve system function and therefore a function of the person as a whole. Studies have demonstrated that chronic pain contributes to disability, anxiety, depression, sleep disturbances, poor QoL, and healthcare costs.31 By relieving physical distress and restoring the body's natural way of functioning, chiropractic may play a key role in the improvement of QoL.”

5. Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation: A Nonrandomized Clinical Trial. Clin J Pain. 2018 Jan;34(1):68-75.

The chemistry of life!

Its always wise to read the entire article, not merely the abstract. I always wonder how many adjustments were provided in  given research article, especially if the results are subpar. As the article states ”Clearly, the 6 single SMT regime utilized in this study was insufficient to resolve any tissue irritation that might be associated with LBP.”

Nonetheless 2 weeks of care was enough to reduce the production of inflammatory chemokines.

4. Beliefs in the population about cracking sounds produced during spinal manipulation. Joint Bone Spine. 2018 Mar;85(2):239-242.

Sometimes we take for granted or don't realise just how little the general public understands about what we do and what is happening with the adjustment. This article shows just how important patient education is. This article asked 100 individuals their beliefs. Among them, 60 had no history of chiropractic. Only 9% of participants correctly ascribed the sound to the formation of a gas bubble in the joint. As the article states: “Certain beliefs have documented adverse effects. This study showed a high prevalence of unfounded beliefs regarding spinal manipulation.”

3. Role of C1 neurons in anti-inflammatory reflex: Mediation between afferents and efferents.

Neurosci Res. 2018 Nov;136:6-12

I often find some of the most compelling research outside of the chiropractic profession. In fact, most of the articles in this list are not from chiropractic journals. This article provides fascinating insight into the anatomical and neurophysiological importance of C1:

“Neuroimmune communication,the connection between the autonomic regulatory pathway and immune cells, has been implicated in the regulation of immune function and inflammation. The role of afferents (vagal afferent and somatic sensory nerves) and efferents (autonomic nervous and hypothalamicpituitary-adrenal systems) in the inflammatory reflex has been well studied; however, the central pathway remains unknown. it is possible that “good” stress-induced activation of the C1 neurons, through factors such as exercise and preventive therapy, might facilitate the anti-inflammatory response, and would contribute the promotion of health.”

2. The effects of a single session of spinal manipulation on strength and cortical drive in athletes. A single session of SM increased muscle strength and corticospinal excitability to ankle plantar flexor muscles in elite Taekwondo athletes. Eur J Appl Physiol. 2018 Apr;118(4):737-749.

Again, we ask just how powerful is 1 adjustment? It is great to see studies on patients with subclinical pain. Just imagine if they looked at these same parameters with a proper care plan. Nevertheless, the article found:

“Increased strength, reduced neuromuscular fatigue, and increased cortical drive are crucial factors to athletic performance, so by optimising these physiological factors athletic performance may improve.”

1. X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Dose Response. 2018 Jun 19;16(2).

Amidst the ACAs choosing not so wisely guidelines, and the WFCs recent statement, this incredible article from Dr. Deed E. Harrison sheds light on the issue. Yes, they are not afraid to use the word vertebral subluxation:

“Radiography reveals the true condition and alignment of the spine; it eliminates guesswork. Contemporary approaches to spinal rehabilitation, guided by accurate imaging, have demonstrated superiority over primitive treatments. Unfortunately, there are well-meaning but misguided activists who advocate elimination or minimization of exposures in spine radiography. The radiation dose employed for a plain radiograph is very low, about 100 times below the threshold dose for harmful effects. Rather than increasing risk, such exposures would likely stimulate the patient’s own protection systems and result in beneficial health effects.

Spinal deformities or “subluxations” resulting from various types of poor postures (eg, forward head translation, thoracic hyperkyphosis, etc) and spinal deformities (eg, scoliosis, cervical/lumbar kyphosis, etc) exert direct and indirect pressures onto the nerves and cord as well as onto the associated tissues including muscles, bone, ligaments, discs, and so on and thereby disrupt normal function to cause dysfunction or “dis-ease” and outright diagnosable pain and illness syndromes (eg, neck pain, low back pain, sciatica, tension headache, migraine, cervical myofascial pain syndrome, fibromyalgia, etc).”


Brain Sci. 2018 Apr 27;8(5). Chiropractic Manipulation Increases Maximal Bite Force in Healthy Individuals.

“Bite force in the chiropractic group increased significantly by 11.0% (±18.6%) post-intervention (p = 0.04) and remained increased by 13.0% (±12.9%, p = 0.04) at the 1 week follow up.”

PLoS One. 2018 Sep 12;13(9) The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain-A pragmatic randomized controlled trial.

Are you still merely treating symptoms? If so, stop! This study was massively important for Norway. The association even changed their guidelines to include maintenance care as a result of this study. The study included 328 subjects. It was conducted by 40 Swedish chiropractors with clinics across Sweden. Maintenance care resulted in a reduction in the total number of days per week with bothersome low back pain compared with symptom-guided treatment.

Health Outcomes of Pediatric Patients Undergoing Chiropractic Care Since Birth: A Retrospective Analysis Journal of Pediatric, Maternal & Family Health, Chiropractic ~ August 13, 2018 ~ Pages 90-98

Should we be checked from birth? Although a small sample size, this study found that “Parents in this study reported that their children experienced a higher level of health and quality of life than other children of the same age.”

Dr. Jonathan Verderame

Founder Axiom Seminar