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The Ageing Brain: Prevention of Neuro Decline with Dr. Damian Kristof and Dr. Kelly Holt

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The Ageing Brain: Prevention of Neuro Decline with Dr. Damian Kristof and Dr. Kelly Holt

In this episode we take a deep dive into the Chiropractic world in our latest podcast with Dr. Damian Kristof and Dr. Kelly Holt, the current President of the New Zealand College of Chiropractic, renowned clinical researcher and PhD recipient.

Damian and Kelly discuss the work Kelly is undertaking on the benefits of chiropractic treatments in the process of ageing for the prevention of falls through sensorimotor function improvement, prevention of neuro decline where we hear the familiar term “use it or lose it,” the differences between activator adjustments and manual techniques and his work on enhancing muscle strength in stroke recovery, demonstrating that chiropractic care is effective for more than back and neck pain and headaches. 

Join us to hear about Kelly's incredible research and fascinating anecdotes on the benefits of chiropractic practice for patients, both as a standalone modality and alongside other complementary modalities. 

Covered in this episode

[01:34] Welcoming Dr. Kelly Holt
[03:14] Kelly’s area of interest: nervous system function and quality of life
[05:25] Chiropractic care and the brain
[07:28] What happens to the brain as it ages?
[08:57] Approaching ageing from a movement perspective
[12:08] Reduction of falls in the elderly
[13:24] Differences in technique
[16:44] Kelly’s research on treating stroke patients with chiropractics
[26:34] Longer term effects of chiropractic on stroke patients
[29:46] Chiropractic care for brain injury
[36:28] Thanking Kelly and closing remarks

Key takeaways 

  • It is important to maintain movement throughout the ageing process to prevent falls and neuromuscular decline. 
  • Use it or lose it! A decline in physical activity can reduce mobility in the ageing process and increase the risk of falls and lower confidence. 
  • Irrespective of the techniques or adjustments used, patients of chiropractors found a benefit from treatment when compared with controls. 

Resources discussed in this episode

Dr. Kelly Holt
Podcast: Spinal Dysfunction and its Impacts on the Brain with Dr. Damian Kristof and Dr. Heidi Haavik
Study: The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial (Holt, et al., 2021)
Study: Chiropractic Spinal Adjustment Increases the Cortical Drive to the Lower Limb Muscle in Chronic Stroke Patients (Navid, et al., 2022)



Damian: This is FX Medicine, bringing you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr. Damian Kristof, a Melbourne based chiropractor and naturopath and joining us on the line today is Dr. Kelly Holt

Kelly is the current president of the New Zealand College of Chiropractic. He is a world-renowned researcher and Ph.D. recipient and his research includes the exploration into falls risk in the elderly, the effects of chiropractic care on patients post-stroke, amongst other great things. 

Today, he joins us from Auckland, New Zealand. And I know everyone will be fascinated with what we chat about today. Kelly, it's a real pleasure to have you joining us today.

Kelly: Always a pleasure to catch up with your Damian.

Damian: Kelly, there's a lot going on in your world. Obviously, from the introduction, people will know how busy you actually are. I don't even know how you find time to continue to do research. But I had the opportunity to interview Dr. Heidi Haavik. And, obviously, you've done a lot of work with her over the years. And, she's pulled out some unbelievable research, but so have you. You've done some incredible research too. And I want to talk a lot about what you've done today because it really opens the door and shines a light on what chiropractic can actually offer people that maybe people have never considered chiropractic could actually offer people. We discovered the impact of chiropractic on the brain and proprioception talking with Heidi. But, I think we can go deep diving with what you're talking about today.
And I think it's going to blow some people's minds, which I'm very excited about. And when, you know, when you started doing your research, there must have been some kind of impetus for you to kind of move in a particular direction, Kelly. 

And, I've always found it fascinating, you know, how do you know what to research? And how do you know where to go? What led you to the point where you would research what you're researching?

Kelly: Well, if you look at the very beginning of when I was getting into research, or really getting into research, that was probably about 15 years ago. And that's when Heidi started working at the college, we started collaborating. And, Heidi's focus was basic science research. 

Now, her big thing is, how does it work? So she's just convinced chiropractic care works, it makes a difference on the nervous system, brain-body communication. And she's really driven to find out how it works.
And for me, I come at it from a slightly different direction, where I have more of a clinical focus because Heidi's convinced that it works. So, why would I need to show that? For me, it's, I absolutely know that chiropractic care works. But so many people out there in society don't know it works. So, I wanted to come at it from a clinical focus. We were doing more of the clinical research, randomised control trials, just to see how well chiropractic care actually does work.

And, part of the idea there was, to begin with, Heidi and myself, we're pretty much a team of two. And we figured that if I had that clinical focus, it would complement what Heidi was doing with the basic science research. So, it was sort of building on what she had started to do already and looking at a clinically relevant population of people where we thought chiropractic care would make a difference to them. 
So, the focus that we look at is nervous system function. And one of the big problems we've got in society is falls in older people. And part of it comes down to function of the nervous system. They're things like balance, and gait, and those sorts of things. So, that's the direction I went down. I wanted to look at a clinically relevant population of people where improving their nervous system function could have a real impact on their health, wellness, and quality of life. So, that's really what took me in that direction.

Damian: Yeah, well, it was a big eye-opener for a lot of people when that research came out that you did, in terms of falls risk in the elderly. It was a huge moment for chiropractic worldwide, because chiropractors have, as you said, have always known that chiropractic works. We've not necessarily known how it works or why it works, but we've known that it works. 

But what was a great thing was it that you were able to demonstrate that, over a period of time, and from memory — and I'll get you to clarify this — so maybe only 12 weeks of chiropractic care that showed positive improvement, a significantly positive improvement and a decrease in risk of falls in the elderly. Is that correct, something along those lines?

Kelly: Yeah, something along those lines. What we looked at was really sensorimotor function that was related to falls risk, because the challenge is if you really want to show a decrease in falls risk, what you need to do was study people really over the course of about a year. And you'd need several hundred people in each group, which would be quite a big trial, it would cost a million bucks just to do that. 

And I was doing this research as a part of my Ph.D. And if I was going to do that, that major trial that would have been, we just couldn't have done it within the structure of my Ph.D. with time logistics, all of that sort of thing.

So, what we wanted to do was look at things like joint position seats. So, how the brain controls the joints and knows where you are in space. Another thing we looked at was choice efferent reaction time. So, how quickly you could take a step to try and prevent a fall from happening. So, we had these measures of sensorimotor function, where we know that if they improve, it means you're less likely to fall. So, that's what we used, it was more of the surrogate measures, sensorimotor function associated with falls risk, and therefore improvements in a bunch of these things, which were really cool.

Damian: Yeah, that's so cool. I remember that and was pretty exciting. 

But can I just ask a question here, Kelly? What do we know about the brain as it ages? What actually happens to the brain as it ages that maybe makes things more complicated for people as they do age?

Kelly: A pretty big question, there's so much that happens in the brain. It basically becomes less efficient, in a way, sort of slows down. Part of that is impacted by a breakdown in sensory function. So, the sensory information that's going into the brain from hearing, from vision, that takes a little bit of a hit, also proprioception, that takes a bit of a hit. So, as you have more, I suppose, garbage going in, getting the response in the brain decreases and becomes a little bit less accurate, I suppose you could say.

And then, throw in there a lot of people with an ageing brain, you end up with things like dementia or cognitive decline. So, as we get older, the facts are usually about a third of people don't have much impact as far as cognitive decline, or things like dementia. A third of people have some sort of mild dementia. And then, a third of people are really hit with things like Alzheimer's. 

Damian: Right.

Kelly: So, you do have an awful lot of changes in the ageing brain that have a big impact on how we live our lives and how we can perform our activities of daily living, how we can stay independent and mobile.

Damian: And so, obviously, as the population's ageing, we're seeing an increase in all these sorts of things. And quite often we find that people go, "Well, what sort of supplements can I take?" People are taking maybe fish oil, or having some extra magnesium, or maybe acetylcarnitine, or cysteine, or whatever supplement they're taking to try and decrease the speed or the rate of ageing, trying to decrease inflammation. They're approaching ageing from a nutritional perspective, but your research would suggest that if we approached ageing from a movement perspective, that might also be of benefit. And, that's kind of about right, isn't it?

Kelly: Yeah, absolutely. So, much of the decline that we have with ageing, it comes down to use it or lose it. And as we become less active, you can have a very quick decline, you become frail because you're actually not getting out there and doing the activities that you used to do. That was one of the things that was a part of my falls research, was you have a fall, and you lose that confidence to be out there in society and doing the things that are keeping you active, keeping your joints moving, keeping your muscles working. And you can have a very quick decline in function, leading to frailty and ultimately death just because you're not using your body the way that you used to. So, very much of a case of use it or lose it. So, as we age absolutely look after yourself when it comes to nutrition, but also do everything you can to keep active. When you stop moving, you lose the ability to move.

Damian: Yeah, yeah. And so I suppose we go through that period of synaptic pruning in our early years of teenagehood, where we lose massive amounts of neurons and synapses and all that sort of thing. And throughout our life, obviously, that slows down, but there is that continual loss and I think you're right. Or I know you're right, Kelly, because you're the researcher here.

As you stop moving, you stop feeding back feeding, feeding forward or feeding back, through the body, through the brain. And there's a decline in function, proprioception, your ability to find yourself in space. So, when you extend that out, that neurological loss in the brain, do we see the same sort of neurological deficit or decline in the peripheral nervous system? Or is this all confined to the central nervous system?

Kelly: Pretty much everything goes downhill as we age. We tend to talk more about the central nervous system, but across the board, we become less efficient within the nervous system. Now, you're talking more about the synapses and those types of things, which we associate more with central nervous system function. But even things like vibration sense, joint position sense, that have a certain amount of...well, they have the origin in the peripheral nervous system, they take a hit as well.

Damian: So, fascinating. And you know, people that are listening to this will be thinking, "Oh, my gosh, I've got patients that are getting old." And, "Oh, my gosh, what am I going to do for them? And yes, I've got their diet right. They're eating more cabbage and broccoli, and spinach, and alfalfa sprouts, they're doing all that, and they're taking their supplements, doing all that sort of stuff. But from a movement perspective, this is all really important as well."

And so, what was the essentially — and we'll move on from falls risk and the ageing brain and we'll move to a damaged brain shortly. But what were the takeaways? What's the key takeaway that you got from the research with regards to decreasing falls risk in the elderly?

Kelly: Well, my main focus was looking at chiropractic care. And that was really to try and work out whether chiropractic care had an impact on brain function that was going to be beneficial to these older people. Because we don't have a lot of clinical research relating to chiropractic care, one, in older people, but two, outside of things like back pain, neck pain, and headaches. So, really, what I was looking at was, when we adjust the spine, which can have an impact on proprioception, or the information coming from your body going into your brain, does that lead to better brain function?

And, really, the research that I did, it suggests that it does. It looks like when you have a spine that's moving better, that can have a positive impact on the way that your brain is working and on brain-body communication, which can be important for things like falls, or the way that you control your body in space.

Damian: Yeah, I love that. Now, one question that will come up with people, Kelly is the type of adjustment that somebody might actually get from a chiropractic can vary. So, it could be everything from a heavy Gonstead single segment type of adjustment, through to a drop piece adjustment, with Thomson technique, for example, where it might be SOT was a relatively light on using blocks and very light touch all the way through to a stick that clicks in activator.

Now, is there a big difference between technique that you found? Was there much of a change? Did you see that it needs to be a manual adjustment or could it have been a stick that goes click?

Kelly: No, we didn't set out to look at that. But I did spend a hell of a long time looking at all of the data that I did click, and did some subgroup analyses just to see whether there was an impact based on the types of adjustment or chiropractic care that people were getting. So, with older people we had a lot of the chiropractors who were providing the care, they could provide care like they were in practice. And there was a bunch of them who were using activator, instrument-assisted adjustments, a bunch of them using drop tables, a bunch of them using HVLA, the more manual sort of techniques.

And really, there was no difference when I broke those down into groups. Now, there's other research that's been done that has shown some small differences between, say, an activator and a manual adjustment with the impact that they have. But the study that I did looked pretty closely at it, there was no real difference. Across the board with the chiropractic care group, they had these positive changes. The control group, who wasn't receiving care, didn't have the positive changes. And it didn't have a big impact what sort of techniques that chiropractor was using, which was really interesting.

Damian: And I love that, Kelly. And the reason why I love that so much is because, every person on the planet responds to care in a different way. And every person on the planet will build relationships with their practitioner.

But I think that what we see is that people go to a chiropractor because of the type of care that they provide and the type of person that they are. And so, what it appears from your research and the things that you've read and that you report on and talk about is that regardless of the type of care that you're receiving, the impact of the care that you're receiving will benefit the person equally regardless of the type of care they're receiving, which I love. And that kind of means that whether you're a pretty light on adjuster or a pretty hardcore adjuster, you're going to be impacting the brain in a similar sort of way, which I love. I think that's a great thing.

Kelly: Yeah, that certainly came out of that study that I did. And we've got another study that we've done that we're sitting on, which is very different to the stroke one, but it was looking at using an activator adjusting instrument and how it impacted brain function. And we hadn't done that before. But in this study, we didn't know what to expect. We've done lots of studies. We have done the manual adjustments and looked at the way that it impacted brain function.

In this latest one, again, it's unpublished, but we used an activator adjustment instrument and we saw very similar changes in the brain to the ones that we did when we did the manual adjustments, which was really interesting.

Damian: It's unreal. Kelly, let's move on to some of the more recent research or the very most recent research that you've had published. And two papers that you've had recently published, one, outlining the effects of four weeks of chiropractic spinal adjustments on motor function in people with stroke using a randomised controlled trial model. That shows some incredibly positive information. Now, one of the things that I've loved about your research recently, and another paper that you wrote about is the effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients.

What I'm loving is that it's a multi-modality approach to care. So, you've teamed up, you've used physiotherapists, or physiotherapy in with your research. And it shows that chiropractic's part of a whole care model that could integrate with naturopaths, integrative general practitioners, physiotherapy, it could even be osteopaths, and so on and so forth. But the chiropractic part of it is so important. Can you tell us more about the research that you've recently had published, please, mate?

Kelly: You bring up a really good point, there, Damian. Because with the research we're doing, we're not just saying that chiropractic should replace all other forms of health care or other approaches from other people. But it absolutely can complement what other people are doing. So, that was one of the things that we took into that four-week trial. 

Actually, the second study you mentioned...that was the first one we did, we did these over in Pakistan. We've got a great team of researchers that we work with. And, one of the people we work with is called Imran Khan Niazi and this guy is an absolute legend. He has contacts all around the world in all sorts of different fields. And he managed to tee up for us to go and work in the hospital over in Pakistan, and work on one of the rehabilitative wards. So, we took off over there in 2015 or 2016, something like that, and worked on one of these wards with the stroke patients. So, people had had a stroke. And it was the first study that we've done with stroke patients.

And we were interested to know...we'd done previous work. We had seen if you adjust someone, we saw immediate changes in the muscle strength. And we've seen this in students, we've seen it in mainly healthy people, with some standard and elite athletes. But I don't think we'd collected that data at that stage. But we thought, “It's all well and good that we can see a change in muscle strength in a healthy student, but what does it really matter? It would really matter more if we could see a change in muscle strength in someone who's had a stroke and has muscle weakness.”

So, that's the study that we aimed to do when we went over there. And that study was pre and post a single adjustment, or pre and post just a control session, which was just passive movement. Interesting thing there was, we were dealing with people who had no idea what a chiropractor was. So, usually you have trouble with blinding of people. So, one of the criticisms we tend to have with chiropractic trials, is the patient knew they've been adjusted so they just tried harder. So, people in the control group that knew there hadn't been adjusted, they didn't try as hard. That's why you see the changes that you do.

But in that first study, one thing is the patients had no idea what a chiropractor was, whether they'd been adjusted or not really. But what we saw was about a 64% increase in strength in weak leg muscles after a single chiropractic adjustment or adjustment session. And in the control group, they actually had a decrease in muscle strength. Because the way we go about testing it, it's like a gym workout. We're getting them to push, push, push. And usually, we see fatigue, which is what we saw in the control group. But in the chiropractic group, we saw a 64% increase in strength, which was quite amazing, because we used to see around about a 15% increase in strength in most people. And that was a really cool finding. 

And the other thing we found is we were doing some other neurophysiological testing which showed that the change in strength was primarily driven by the brain. So, it didn't come down to some sort of reflex change going on in the spine. It was more the impact of adjusting the spine, how the brain function has been leading to that increase in muscle strength.

So, that was a really cool outcome. That blew us away, the outcome that we got. But again, you look at that's pre and post single adjustment, and you're just looking at strength in one single leg muscle. And so, then the next question is, “Does that really matter?" If someone's had a stroke, does it really matter if you have what's potentially just a short-term increase in muscle strength in a leg muscle to help it function?
So, that's what led us to that next study, which was the four-week one. And, again, we went back to Pakistan, same hospital wards, that was maybe 2019, I sort of lose track of time. And then we spent two or three months over there doing the study. And what we're really conscious of was, we know that physical therapy care does help people as far as rehab when they've had a stroke. So, it does help them with the muscle function. And we didn't want to withhold that care, which we know helps them and just give them chiropractic care just for the sake of seeing whether chiropractic care works or not.

So, in the control group, they actually received physical therapy care over the course of four weeks. And then, in the chiropractic group, they received the same physical therapy care, but we also adjusted them for four weeks as well. And the outcome measure that we looked at was called the Fugl-Meyer Assessment, which is pretty much a gold standard assessment of motor function that's used in people who've had a stroke. So, it takes about half an hour or whatever to do the Fugl-Meyer Assessment. It's a pretty comprehensive assessment of motor function.

And we had no idea what we were going to find, because we figured that we'd find an improvement in the physio group. But it's really hard to find an improvement on top of an improvement. So, we didn't know if we were going to get that by adding chiropractic care or not. Then, when the results came through, again, we were pretty blown away because we did find that improvement in everyone, but the patients who were receiving chiropractic care had a really good improvement on what they got from just the physio care alone. And, with the analysis we did, it may even be a clinically significant improvement on top of a clinically significant improvement, which was a pretty cool finding to have. 

So, I was just talking with Imran, I think it was yesterday or the day before, we're looking at how we can get back to Pakistan and do some longer-term studies over there. We did four weeks in that last study, we'd love to do a six-month study and a follow up these people for a longer period of time. That would be fantastic.

Damian: Yeah, absolutely. That's amazing. So, I think this is an interesting thing to also consider, and maybe you can tell us in terms of adjustments that these people received. Were they getting adjusted once a week, or was it twice a week? Was it every day? Because if you think about back into history, if you go back into, say, the Spears Chiropractic Hospital where we saw people go into the hospital with polio and spend weeks or months in there until they were recovered, and then they’d leave in pretty good shape. So, what were you doing in terms of an adjustment perspective with these patients?

Kelly: Most of them we were seeing three times a week. And, the reason we went with that is basically because that's what I would do in practice. So, three times a week, adjusted them as necessary during the time that they were there. And one of the really interesting things, Damian, was we were also seeing the people in the control group three times a week as well. And we were checking them and putting them through all the standard sort of setups that we would do as if we were adjusting them, but we weren't putting them in that adjusted thrust.

And what I noticed is very quickly the people who were in the experimental group, those that were receiving the chiropractic adjustments, I was noticing a change in their demeanour as they were coming in over the course of even a week. And, I started getting gifts and I'm invited to go and stay at people's houses. "Come and visit me in my holiday home. Here's some dinner," and all of these things were coming from the people in the chiropractic group. So, those poor people in the control group who weren't getting the same benefit, they weren't quite as nice to me. The ones who were really adjusting, you could see a change in their demeanour, which was really cool.

Damian: That is really cool. Because, look, I've helped quite a number of people, not lots of people, but a number of people who have had injuries from stroke, and there is definitely, there's...they come in very flat. People come in quite withdrawn and they're a little bit over everything and everything's kind of, life has been tough for them. But you do see that improvement in their overall mental health and their well-being. I love that you were able to see that. Was it good food, Kelly? Did they give you good food?

Kelly: The food was actually incredible. I actually loved the food over there.

Damian: That's amazing. Kelly, the research when I look at the little graphs that you've got in that paper where you’re tracking patients for four weeks, the stroke patients for four weeks, it looks like the results that these people got seem to last. There was a few people, maybe they got some decline that didn't last long. But, it seemed that after four weeks, people continue to have that same sort of improvement, or at the very worst, it maybe just plateaued out. So, they got it, got the care and then it stayed good. Is that what you found?

Kelly: Yeah, we did see… the study was eight weeks. So, we checked and adjusted them for four weeks. And then we followed them up four weeks later. And we had a reasonable dropout between the four and the eight weeks. And the reason for that, which I found out after the fact, is a lot of the people who were seen in the study had come from hundreds of kilometres away. And they had heard that we are doing the study so, they were coming from all over the district, the area. And, you know, their caregivers were bringing them and they were staying with friends and relatives, and they could only really stay for the four weeks.
And then we lost a few in that follow-up period. But the ones that we could follow up for the full eight weeks, and for most of them, the improvement lasted. So, even without any more care, we still saw that improvement after eight weeks. We didn't have the statistical significance after eight weeks, which probably, in my mind, was probably due to the dropout that we saw. But, if you look at the graphs, you can see that those improvements are still there, which was a really cool finding as well.

Damian: Yeah, that's really cool. And was that the same sort of finding that you found with falls risk? Did you find that when you provided the 12 weeks of care to the people that you're measuring with, central motor, or central — I can't remember what you said it was — but the 12 weeks of care, they got the care, did that last as well when they finished their care?

Kelly: We didn't really follow up with them. So, we just did the 12-week assessment and then didn't follow up any further. But I know that a bunch of them did continue under chiropractic care. And I keep getting these reports from these people about the ongoing improvements that they had. But we didn't do any follow up just to see how long the improvements lasted. It would have been great to do that, but it just wasn't feasible with the timeframe that we're working on the study. And also we didn't want to withhold care from them, so they decided to carry on until the study had finished. So, I can't really tell you for sure. I'm sure we would have seen a lasting result, but for how long, I don't really know.

Damian: Well we don't know at this stage. But it does highlight how much more research we could be doing in this space. But, even in the early days and, this is obviously a research paper that is going to lead to another research paper and further investigation, all that sort of thing, which is very, very exciting. And I think the listeners to this podcast will go, "Oh, my gosh. I had no idea that chiropractic was good for that because I thought that chiropractic was all headaches, neck pain, and back pain.” But from what we've heard from both yourself and Heidi, chiropractic's so much more than that. 

If we look at, I suppose, brain damage in this sense with regards to stroke, could we be thinking down the track, and maybe this could be something that gets researched, could be thinking like, TIAs or other forms of brain damage? I know that there's some great research being done in the U.S. with post-concussion syndrome patients, looking at whether or not chiropractic care can be of benefit to a degenerating brain as a result of injury. Could we be seeing the chiropractic might be playing a role in the way in which we're approaching patient care?

Kelly: Yeah, I hope so. Like you said, we've only really started scratching the surface here when it comes to brain function and chiropractic care, because so much of the effort of the profession over the last few decades has been focused on back pain, neck pain, and headaches. Because we see in practice that we have improvements there all the time. And that's a major problem for society as well.

So, we've started scratching the surface with older people looking at brain function, cognitive decline, those types of things. And you mentioned post-concussion syndrome. We've actually got an amazing researcher in our group, Ellis Cage, she's doing her Ph.D. at Auckland University, looking at people with concussion and chiropractic care. So, there should be some good stuff coming up here in the next year or two. And, if you look at the studies that we did over in Pakistan, we collected a lot of data there and we're in the process of analysing some data from groups of people who had Alzheimer's, and also another group who had Parkinson's disease.

Damian: Oh, wow.

Kelly: So, we are looking at what impact chiropractic care has in lots of different patient populations. What we've seen so far suggests that it's a fantastic idea to get your spine and nervous system adjusted by a chiropractor, particularly if you've got some sort of damage, like if you've had a stroke. But now we know in practice that anyone can benefit if your brain-body communication improves through adjustment of someone's spine, it's going to be beneficial all round. But we will have more research to back up the impact of chiropractic care in these different patient groups over the next few years, which will be cool.

Damian: When I was studying at the NZCC, one of our lecturers was a Carrick Institute graduate. And, Ted Carrick, as you know, is a world-renowned, I suppose, explorer and well-researched chiropractor in the field of neurology and neurorehabilitation. And, I recall when he was going into hospitals, obviously with permission, and in research sort of environments, that when he would look after stroke or brain-injured patients, that he would start a long way away from the brain.

And I always thought in my mind that you needed to provide less inputs to the spine for a brain that had been damaged. Is that still the case? Is that still the current thinking? Do we feel like you've got to adjust the little toe to be a long way away from the brain so as not to overload it or to overexcite it? Or is that kind of thinking changing, Kelly?

Kelly: I don't think it really has changed. I mean, I get the Carrick course many years ago was Randy Beck, who you're talking about there. And Ted is an absolute genius, very polarising figure, but still a genius.

Damian: Absolutely.

Kelly: And, the approach that he takes is talking about awakening the brain, I suppose, building plasticity and building resilience in the brain. And if you take someone who's had a brain injury, often the brain is functioning and it's on the edge of basically falling over. And, often it's the efferent input or sensory input that's coming into them that pushes them over the edge. Someone's got a migraine, it might be sights, or sounds or smells, and it's that efferent information that's coming in and pushing the brain over the edge so they can't cope anymore, and you basically end up with that migraine will end up going downhill.

And, certainly, if someone has had a concussion, they've got an issue with cerebellar function and we come in there and adjust and say upper cervically with manual adjustment. That's probably one of the biggest things we can do as far as an efferent barrage going into the brain. So, for some of those people that might be too much. And really, that's part of the art of chiropractic care, is working out what the appropriate care to provide them.

And we do that in practice. It might be that we are starting further away than in upper cervical, or not. But we quickly adapt to what we're doing if we find that we're not getting the results that we want. 

Damian: Yeah.

Kelly: So, absolutely, if you look at what Carrick was doing, starting away from sort of the upper cervical spine, I suppose, there's absolute merit in doing that. Most chiropractors or all chiropractors will come up with an approach that they feel works and modify if they're not getting the results that they're after.

Damian: Which I think is really important thing to consider is that, there are chiropractors and there are chiropractors. And it's important to say that because some people will be very well-versed and skilled, and some people in, say, managing stroke or brain injury, and there'll be other chiropractors who are very well versed and skilled looking after children, and other chiropractors are well-versed and skilled in looking after sporting injuries, for example. It's important, I suppose, to find someone who's not only interested in managing stroke, but someone who’s used to managing people with stroke, I suppose, to work in this sort of space. Would you agree with that?

Kelly: Yeah. I mean, absolutely a fair call. There's some chiropractors who I would get in touch with to see my kids over another chiropractor. We all have our own skillsets and specialist areas, I suppose, even though we're not really supposed to call ourselves specialists. But, absolutely. Some chiropractors I know, I'd rather go and see than others, for sure. That all comes down to time and practice, developing the skill sets, and also changing your approach based on the people that are in front of you, which every chiropractor should be doing as well.

Damian: Yeah, yeah, absolutely. All right, Kelly. It's been absolutely fascinating chatting with you. And I'm so excited about the research and the analysis of the research that you've done. I'm excited to find out more about what's actually going on. 

And I think that what a conversation like this does for the profession of chiropractic, but also...not only the profession of chiropractic, but also for all cares out there listening to this particular podcast, whether it be an integrative GP, whether it be a specialist, whether it be an osteopath, or a physiotherapist, or a naturopath, or whoever is listening to this particular podcast out there, I know there's thousands of you listening to this podcast. It's not just about filling a space that doesn't exist, we're working with you to help you get better outcomes. And I think that's been a great chat today and thank you for sharing with us your research.

Kelly: Always good to catch up, Damian. My pleasure.

Damian: To get more information head on over to chiropractic.ac.nz

Thanks, everyone for listening today. Don't forget that you can find all the show notes, transcripts, and other resources on the FX Medicine website. I'm Dr. Damian Kristof. Thank you for joining us.

About Dr. Kelly Holt

Dr. Kelly Holt was a member of the 1998 inaugural graduating class of the New Zealand College of Chiropractic. Besides his chiropractic degree he also holds a Bachelor of Science majoring in physiology and a PhD in Health Science from the University of Auckland. His PhD focused on the effects of chiropractic care on sensorimotor function and falls risk in older adults. He has published work in a number of peer reviewed journals that investigated the effects of chiropractic care on nervous system function and the reliability of vertebral subluxation indicators and has won a number of international research awards. Kelly worked in private practice as a chiropractor for 10 years following graduation and has taught at the New Zealand College of Chiropractic since 2000 and is currently the Dean of Research at the College.   Kelly was named ‘Chiropractor of the Year’ by the New Zealand College of Chiropractic Alumni Association in 2012 and by the New Zealand Chiropractors’ Association in 2014.


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