It’s no secret that one of the biggest gaps in chiropractic as a healthcare approach is its paucity of research. Life University is committed to contribute to filling that gap with a $1M allocation to its Sid E Williams Center for Chiropractic Research.
To learn more about the direction and approach that research will take, please watch the video below or scroll down and read the transcript.
Dr. Riekeman: I want to bring up one of the people in chiropractic today that is literally transforming our research agenda, how we’re looking at the world and chiropractic’s role in that, the head of our research department, Dr. Stephanie Sullivan. I sort of have to tie this side of the room with Stephanie, with this side of the room with Wayne Wilson and Lou [Sportelli] and the foundation for NCMIC who is sponsoring a lot of this research along with the commitment that Dr. Scott and the university have made, over $1 million in research over the next few years, to be researching this thing. Are we real as a profession when we talk about this thing called subluxation and its neurological implications? That being said, Stephanie, the audience is yours.
Dr. Sullivan: Thank you. And I am so excited to talk to you today about my absolute favorite topic, which is neuroscience. So, and really that’s where it all began, right? When DD Palmer did that first adjustment to Harvey Lillard, he restored hearing. Well, when we look at the different theories for how this occurred, so maybe we’re looking at some facilitation of muscles that normally…dampen the hearing process, or we’re looking at some central facilitation theories, it all comes back to neuroscience, right? It all comes back to what’s going on in the nervous system that we change through chiropractic and really, therapies like chiropractic have been around for thousands of years. I mean, DD Palmer even says it’s been…around as long as the vertebrae, right? And while they didn’t always know that it was the nervous system or related to the nervous system, they did look to the spine for things that weren’t necessarily musculoskeletal in nature.
So they looked at things like mania and vertigo and colic and then they treated, so this here, The Spinal Irritation, was a book that was done by medical profession and they actually treated it with things like galvanic stimulation where they would actually zap the vertebrae or they would put leeches on the vertebrae or cause blisters in order to bring about these changes. But…they hadn’t really learned as much about the nervous system. Well, as professions like chiropractic began to gain in popularity, then the NIH came in and said, “Okay, wait, wait a minute. Okay, you’re getting great results, but how are you getting great results? What’s going on?” So then in 1975, they created a conference where they brought together scientific researchers, basic sciences researchers, chiropractors, and osteopaths to try and understand what’s going on, kind of behind the scenes and under the hood. And why are you getting these changes?
And this really spurred…a Renaissance of research from several different directions. And so did this conference that you get things like the Sharpless study, where they noticed that 10 millimeters of mercury of pressure on a dorsal root changed or decreased the action potential propagation of a nerve by 50%. And there were other studies showing that things like axonal degeneration. And so there were a whole host of studies. And then from this, you kind of evolve the science of chiropractic, things like Pickar’s work, this middle picture, where he’s able to show that chiropractic can change the proprioceptive system. And then you go…look at these different perspectives like Kramer, where he’s looking at these transforaminal ligaments, using cadaver models and MRIs to really look and try and see how are we influencing the nervous system, how are you changing the physiology?
And then from there the science of chiropractic evolved even further. And there were two main directions. So they had to look at it from a pain and disease model because that’s what was kind of prevalent at the time, which is basically, “Does chiropractic have an effect on X?” And you kind of insert that condition. And then there’s this expression of health model, this need to understand what’s the underlying mechanism and, “How is that going to play out?” And both are very important and very key to the science of chiropractic. Now, let’s look at the pain and disease model first. And what that’s allowed us to do is to really understand chiropractic’s effect and we’ll use pain, since that’s one of the more dominant, especially with the opioid crisis, that’s going on. So you can see that because of the scientific research, it’s shown like the American College of Physicians have recommended chiropractic as one of the non-pharmacological therapies.
So, it’s because of this research that we were able to have those statements in those positions. But please understand this has taken millions and millions of dollars, decades of research, and it’s also taken literally volumes of research that’s been produced. And I’m going to take off my scientific hat, or my researcher hat, for a second and I’m going to put on my clinician hat. And while I think these [pain studies] are very needed and they’re phenomenal, when you look at it and it says that we’re one of several options that shows some evidence of effectiveness, to me, that seems a little bit lackluster. I still think it’s phenomenal and it’s definitely moved our profession forward. But as a chiropractor, I think, “Oh, there’s more; there’s more I do for my patients.” So, I kind of view this research as if we’re looking through a keyhole and that’s the necessity of that type of research.
It has to be specific. It has to define exactly what it’s looking for. But it’s really just like looking through that keyhole. That’s a very lovely tree, if you can tell what it is, but it doesn’t give you the full picture. You’re not able to ask all these robust questions about the changes that chiropractic’s really having. So this is where I like the expression of health model and the expression of health perspective, because then you’re opening the door and you’re opening yourself up to all the grandeur of what’s really going on and what you see on a daily basis in your patients. So what we’ve decided to do at Life University is really look at the research from this particular [expression of health] perspective. And we’re not the only ones. So there are several. This expression of health model and understanding these mechanisms is becoming more and more dominant as researchers go on because they want to know more.
They want to understand the foundation. I mean, even organizations like the World Federation of Chiropractic, their public health division is asking questions, not just about the opioid epidemic, but healthy aging, and how is it influencing women’s and children’s health. And then there are other labs that are starting to do this type of research. So, in research we layer and we stand on each other’s shoulders, right? So, out of the New Zealand College of Chiropractic and Dr. Heidi Haavik’s lab, then she’s kind of layered on Joel Picard’s work and some of his to understand that we bring about proprioceptive change and then she wants to understand how is that changing the brain? What are we doing to the brain? Well, as Heidi is doing her work, kind of emerging at the same time over these past 20 years, are additional cognitive studies. So now it’s not only showing from a neurophysiology perspective, we’re changing the brain, but now it’s looking at it from the perspective and say, okay, we’re actually changing how the brain responds.
We’re changing attention, we’re changing reaction time, we’re changing things like spatial cognition and knowing where we are in space. So what’s going on? Why is this occurring? Well, here’s kind of how I think about it and why we’ve kind of chosen the direction of research that we’ve chosen. Think about it like this. If you’re driving a car, remember when you first started driving a car, what it was like. You had both hands on the wheel. You were focused. Like you [had] tunnel vision. You couldn’t hear anything else. If someone was talking, you weren’t listening because all you were focused on was on the road. Now as you went along, you developed patterns and now all of a sudden you’re a minivan mom driving along the road, you can stop the kids from fighting behind you. You can…eat your Chick-Fil-A, and you can talk on the phone, all while driving.
Well, so think about the subluxation in these aberrant motor patterns coming in, right? So if you have a subluxation or you’re getting misinformation, it’s like your brain is always in learning. It’s like your brain says, “Oh, I’ve got to put both hands on the wheel. I don’t have any other mental capacity,” because we only have so many neurons, right? Our brain is a limited resource, right? So if I’m getting wrong information, well now my higher cortical functions have to take…control. So, they’ve got to spend their resources to focus on what’s going on. So if you’re subluxated, if you’re getting the poor information in your higher brain structures are always having to make up for that. Meaning you don’t have enough mental capacity leftover to remember someone’s name when they just said it to you, to remember where you parked your car, or if you’ve got a list of ten things, what’s the right way really to kind of organize your day?
So, it’s those kinds of questions that we started looking at in our lab. And I’m excited to present to you some of our recent research that we finished. Now we took a different approach than the Haavik lab. We were looking at resting state EEG. So we wanted to know first, let me back up. So your resting state is kind of like you’re a runner starting at a starting block. So how the runner sets themselves up on the starting block determines how they’re going to finish the race. Your brain is the same way. So how your brain is resting and kind of sitting determines how it’s going to respond to the environment, to a cognitive task. Okay. So we were looking at resting state EEG and we had a chiropractic group, a sham – which is like our placebo – and then a control group.
First of all, there were no changes in the control group. But then when we started looking at the sham versus the chiropractic group, we had some amazing patterns…Now, in our sham, we touched the patient. We also did three time points: baseline, immediately post, and one week post. Right after the adjustment, to one week post, is where we got the greatest change in the sham, Notice, your sham is mostly in the posterior aspect of your brain. The arrows indicate the direction of information flow and the numbers of readings that we received. Okay. So with the sham, it’s coming from your somatosensory cortex going to your visual cortex.
Here’s what we think is happening. So whenever we touch the patients for the sham, whenever you touch someone or you get touched, your visual association areas dampen; your auditory areas dampen. So now you can focus in on that touch. So we think that’s what we’re seeing in our sham. So…It starts off, which was right after the adjustment, they’re attending to that sense of touch, and then when they came back one week later, which is this Time Point 2 image, well, no, we’re not touching them for our sham. So now their visual association is kind of driving the show. And also here’s the thing: the sham adjustment? So, baseline was here [Dr. Sullivan uses her hand at head level], then there was immediately post [uses hand to indicate chest height] and then there was one week later [uses hand to indicate head height again]. It was a rebound effect.
Now your chiropractic group, and I get goosebumps when I think about this one. So, your chiropractic changes are in yellow and then your prefrontal cortex, right? It’s where we noticed the changes. So your chiropractic changes were baseline [uses had to indicate chest height], immediately post [uses hand to indicate chin height], and one week post, [uses hand to indicate top of head height]. They followed this stair-step pattern. So, to me that makes sense from a neuroplasticity standpoint because neuroplasticity needs time. It needs sleep. So students, if you’re in here, don’t stay up all night. You need sleep to consolidate memories. And then it also needs repetition. So when you put a chiropractic adjustment into the body, then it needs them moving in space and moving around to really integrate that information. So, …here’s the exciting part. So the results before the adjustment, information flow was actually coming from your medial brain structures; after the adjustment and then going towards your prefrontal structures. After the adjustment, it reversed. Now it’s your prefrontal cortex is driving the information flow. And to me that’s powerful.
And let me give you some background information as to why, Your prefrontal cortex is in charge of executive function. Things like organizing, planning, attention, response inhibition. It can even dampen the pain response. So, this is powerful information and Dr. Heidi actually found the prefrontal cortex to be one of the generators for changes in her studies as well. So to me, this is really exciting. Now the question is, okay, as clinicians, we want to make sure that the research we do is relevant to you. So how does this mean anything for you? Well, so think about the typical daily lifestyle in America, right? You’ve got to get dinner, you’ve got to get your kids to practice. You’ve…maybe you’re going back to school, Oh, some time in there, you’ve got to clean your house and oh yeah, there’s work. So the typical American lifestyle causes a lot of stress.
And when you’re stressed, the number one region of the brain that’s affected is your prefrontal cortex. That’s kind of the target zero for whenever you’re experiencing stress. So think about the last time when you were in a really stressful environment or situation. Um, was it easier or harder to say no to those chocolate chip cookies? Was it easier or harder to take the clothes off the treadmill and actually exercise? And this is the big one. So, when you were stressed, was it easier or harder to stop Netflix, or did all of a sudden you look up and it’s two o’clock in the morning and you’ve watched the entire season of Stranger Things? So, stress has a profound impact and your prefrontal cortex is where that impact happens. So think about it, connect the dots from a chiropractic perspective.
So maybe one of the profound reasons why chiropractic has this kind of big picture effect on our patients is because we’re changing the prefrontal cortex, and we’re helping our patients say, no. We’re helping our patients get up and move. We’re helping them say, “Ah, okay, I’m just going to watch two episodes, really, of Netflix. So, we’re making those changes. Now, and I say, “maybe” because I always want to do, in full disclosure…, it requires a lot of research to make these changes and to really do those differences… So, what I really want you to know is, I want you to look at research like we are, from a different perspective. We want to see the bigger difference and the bigger change. We want to do go towards an expression of health model. And we’re doing that at Life University. So we’re developing what’s called the WHEEL, the Wellbeing and Health Expression Evaluation List. And this is being designed for you so that…we are creating easily deployable measures [that] you can use in your practice and that we’re doing basic science research behind, so that not only can you sit in front of your patients and show them the changes, you can say, “Okay, here’s how chiropractic influences the nervous system.”
So, and to me that’s strength and power. Thank you very much.
Possible images:
- Royalty-free stock photo ID: 1514884757 (St. Peter’s Basilica through keyhole arch).
- Royalty-free stock photo ID: 348086228: St. Peter’s from a distance
- Brain image: Royalty-free stock illustration ID: 86443981
- WHEEL graphic