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Spinal Dysfunction and its Impacts on the Brain with Dr Heidi Haavik

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Spinal Dysfunction and its Impacts on the Brain with Dr Heidi Haavik

How can a dysfunctional spinal segment affect the brain, and by extension, the heath of the whole body?

Dr Damian Kristof is joined by chiropractor, neurophysiologist, and researcher Dr Heidi Haavik for an in-depth episode discussing the impact of movement in the spine on the brain and the nervous system. 
Heidi talks about her extensive research into the science of Chiropractic, getting deep into the mechanics of the movement of the spine and how it affects different areas of the brain, particularly the cerebellum and pre-frontal cortex. 

She also discusses how spinal health influences how the brain interprets input from our external senses, the connection between the brain and the nervous system, and her dream outcomes for the future of the Chiropractic profession and how it is viewed by other modalities. 

Covered in this episode

[00:09] Welcoming Dr Heidi Haavik
[02:23] Sensory input differs depending on how your spine is functioning
[07:45] How stress and fear affect the muscles of the spine
[10:02] How does moving the spine affect the brain’s ability to interpret data? 
[14:27] Dysfunction of the spine may not cause pain
[18:05] The Harvey Lillard story and what we’ve learned since then
[24:06] Connection between the spine and the digestive system
[29:07] The differences between basic science studies versus randomised controlled trials
[32:41] Pain is in the brain
[35:22] Changing the views on chiropractic
[38:02] Movement impacts the brain
[40:34] Heidi’s dream outcomes for the future
[43:17] Resources and further information on some of Heidi’s studies
[45:22] Thanking Heidi and closing remarks

Damian: Hi and welcome to FX Medicine, where we bring 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 all the way from New Zealand is Dr Heidi Haavik.

Heidi is a chiropractor and a neurophysiologist, who has worked in the area of human neuropsychology for over 15 years. As a researcher, she has investigated the effects of chiropractic adjustments of dysfunctional spinal segments on somatosensory processing, sensory-motor integration, and motor cortical output. And she's received numerous research awards and published a number of papers in chiropractic and neurophysiology journals. 

What a mouthful, she's here to talk about the impact of movement in the spine, on the brain and the nervous system. Welcome to FX Medicine, Heidi. How's sunny New Zealand going?

Heidi: Not too bad, we're heading into summer, it's quite nice. Lovely to speak to you again, Damian.

Damian: Heidi, you've been busy, you've had a lot on. Every time I'd jump on to find out what you're up to, you're up to new great things. And as I said in my intro, you are the most prolific preeminent researcher of our time, and people love your stuff. 

But the reason why they love your stuff, Heidi, is because it's so clinically relevant. I know that our listeners today are going to get a lot from what it is that you talk about. And the main thing in practice for me, what I love is the ability to talk to my patients using complicated research bits and pieces that you've come up with and that you've discovered and then explained, but in bite-sized chunks. 

So I'm excited about today's chat, and particularly about The Reality Check, because for me, for people to understand that the brain tells them a story or interprets the data, I think that's really exciting. And I think that people are going to want to know more.

Heidi: You know, I love talking about this topic, as you know. I've just been fascinated by how on earth chiropractors can adjust the spine, and it can change people so dramatically. Obviously, I've been a clinician myself for many, many years. So I've seen the changes and I realized quite early on how hard it is to explain this easily to patients. And so I figured “Who better to at least come up with some examples of how to explain it than us researchers that are doing the work?”

Damian: Yeah, and you do do a lot of work. One of the things that I've really loved, Heidi, in trying to explain this to my patients, is this perception of the environment. And this is great for all of our listeners to picture this and to consider this is that your brain is basically interpreting everything that's in your environment. I know that we talk about that. 

But when you stop to think about that your brain is interpreting billions of bits of information at any point in time and it's trying to get the message right. It's trying to make the right decision based on everything that it's learnt, everything that it's aware of, all the other factors that are happening within the body. It's trying to do this all at the same time. Sometimes it gets it wrong, and things go out of control. But most of the time it gets it right.

When I try to explain that to people, they kind of go, "Ah, that's quite an incredible experience or quite an incredible thing to think about." You have a little diagram on one of your brochures that has a checkerboard. And on the checkerboard, there's an A and a B and they appear to be on different colour background squares. But in reality, the colour squares are exactly the same.

Heidi: They are identical.

Damian: Identical. How does all that work? And can you explain that to us, how did you come up with that? And then, you know, what's really going on here?

Heidi: Well, I think most people, at least public people, are aware of the five key senses, right? But they're really only our external senses. So things like touch, smell, visual input, taste, and sound, they are your five external senses. 

But of course, we've got a whole lot of internal senses as well. So we've got temperature sensors, and chemoreceptors, and pain receptors, and emotions. And the way the brain can pick up on emotions, as well as proprioception, and kinaesthetic sensors.

And it's kind of interesting, because even just a week ago, the latest Nobel Prize winners in physiology were literally given their Nobel Prize because of their work to identify how things like temperature or proprioception actually is converted into brain signals. And that's part of those interoceptive signals. 

Whereas most of us, we don't walk around thinking about that. Your brain uses all of these internal signals, as well as those external signals. And you touched on it, that your brain also takes into account your past experiences. So you will actually interpret what you see, hear, touch, smell, and feel in a completely different way to someone else, because of their past experiences.

So it gets really...like even just explaining how your brain perceives your reality, it's kind of quite funky. On top of that, it even takes into account what you expect to happen in your future. And your thoughts and your feelings will colour how you interpret what's going on outside you and inside you. 

But this is when it gets really cool. And this is where chiropractic comes into it. Because all the work we've been doing for the last 20 years at the Centre for Chiropractic Research at the New Zealand College is showing us that the way your brain interprets… we've gone round and tested a lot of these different sensory inputs, and the way your brain interprets them is different depending on how your spine is functioning.

So for example, if you've got spinal dysfunction to the point that you've got aches and pains that reoccur, which is most of us, I presume, your brain interprets sound and visual information differently. And that's weird to think about, isn't it? Whereas if you get adjusted, so if we adjust that dysfunctional segment, again, many different names, many different people, but if you adjust that dysfunction, it improves the way your brain processes sound and visual information, which is weird. It's telling us that the way your spine is moving changes the way your brain interprets what you see and hear.

Or, again, a whole lot of other studies have shown it changes the way our brain processes proprioceptive information. So you're more accurately aware of where your arm and ankle, and how your spine is functioning when you get adjusted. Or if you have that spinal dysfunction, you're less able to accurately sense where your arm and your ankle or how your spine is moving.

And there's just been many, many studies like this over 20 years that's quite clearly showing us that the way your spine moves influences how your brain perceives not only the world around you - what you see, hear, taste, smell, and can feel - but also what's going on inside your body. So of course, this can have quite widespread significant implications on how we function in normal day life.

Damian: Totally. And I'm thinking about my golf game this morning and why it was so bad. I did wake up with a little ache this morning thinking, "Ah, gosh, I hope this doesn't affect my golf game." I wonder, yes, maybe I should have got adjusted at, you know, 6:30 this morning, but there was no chiropractors there to take care of me that time of the day.

Heidi: Funny enough, there actually is a golf study, I don't know if you're aware of that. But there's a clinical study showing that you can hit that ball a little bit further if you get adjusted. And it does make sense because if your brain is then more accurately aware of where you are, where your arms are, where your feet are and all movements of your arms and legs, including swinging the golf ball, or any other kind of sport really, requires your brain to know where you are. And the core of you is because all your arms and leg movements are obviously moved according to where they attach to the body, which is again your core.

Damian: I want to extrapolate that out a little bit because when I think about the patients that I see, Heidi, in my practice, and many of the people that are listening to this would interact with people from a nutritional space, in and around diet or lifestyle or whatever else. And quite often we meet people with fears and anxieties about their lifestyle, whether they've got chronic fatigue syndrome, whether they've had Lyme disease, some kind of dysfunction that's prefaced any kind of interaction that they're going to have with their practitioner or a new practitioner.

So, they come with the story of their life, they come with the symptomology, a symptom picture that could be as long as six people's arms. And you try to interpret all that data. And of course, they've interpreted that data in a particular way. And they might have already tried some of the things that you're going to suggest to them. 

How would that impact their ability to heal? In my mind, I think, “Well, even if the spine was properly aligned, let's say it had zero dysfunction in it. Their bias, the cognitive bias, and all those sorts of things, could that be playing havoc with the way in which they might be healing?

Heidi: Yeah well, even just the… I mean, as soon as you said fear, as soon as you said stress, I mean, people that have got health concerns usually have stress and fear. And we know, interestingly, that stress and fear normally has very detrimental effects on health, in general. But it's also linked with switching off of the small paraspinal muscles, those ones that are absolutely essential for your brain to know what's going on in the spine.

So I think the core of the spinal dysfunction, we think one of the main reasons that you actually end up with spinal dysfunction is stress, fear. And any sort of acute health condition would set that off immediately. So not only are you primed for fight and flight with the leg muscles being sort of pumped and ready to go, but you also actually switch off those little ones close to the spine and skull.

And as soon as you switch them off, that's when the brain cannot perceive what's going on in the spine and it can also have ongoing effects. Like, for instance, we particularly know that a part of the brain that we impact when we adjust dysfunctional spinal segments of the spine is the prefrontal cortex, which is another part of the brain that's actually switched off with stress. That's kind of interesting to see all these different interactions.

Damian: Yeah, absolutely. So, and one of the ways... I remember a speaker James Chestnut speaking many years ago, and you know James. I'm sure you know him very well.

Heidi: Yeah.

Damian: I'm sure you've shared a bottle of wine with him a few times, I'm sure of it, Heidi. James said something about the cerebellum, which has always stuck with me in that from a refinement of fine motor and the coordination of movement and how important great functioning cerebellum actually is, and how that impacts the prefrontal cortex, etc. When we're moving the spine or when we're moving in our day, how is that impacting our brain's ability to interpret the data?

Heidi: We actually, interestingly enough, have done several studies now as well, that shows that when we again adjust these dysfunctional segments in the spine, that we impact the way the cerebellum communicates with both the primary motor cortex and the primary sensory cortex. So again, it's going to impact the way the brain perceives what's going on. We know that this multimodal integration that takes place, when you perceive your reality, the two parts of the brain that are highly involved in creating that reality, of integrating all that multimodal input is the prefrontal cortex and the cerebellum. And interestingly, those chiropractic adjustments have shown to impact the processing of both those parts of the brain.

So it makes sense that we're seeing people are better able to perceive what's going on in their body, they're better able to know where their arm is, or their leg is. Or they're better able to perceive sound and visual information, how the sensorimotor functions change. So it actually makes a lot of sense when you start to look deeply into these mechanistic studies, these basic science studies that are showing us exactly why that spinal function is so important.

Damian: Heidi, it's a great thing that you just said there. And I'll come back to it because you mentioned basic science studies. And it's something that I hang on all the time because basic science studies are still so important. And everyone's looking for these elaborate studies into the treatment of conditions or into specific impacts of an adjustment to the C7 vertebra from the posterior lateral portion of the lateral condyle of C1. And, and they're trying to impact...you know, trying to work out how that's going to influence ADHD.

Heidi: Yeah, but if you don't know how an intervention actually works, how can you test what it does? You know what I mean?

Damian: Yes.

Heidi: And that's where you got to have these basic science mechanistic studies as well. But it gets interesting when we started to look at this, Damian, and I'm cutting you off here. But you know when we actually look at what a dysfunctional spinal segment is, we can see from research studies that over time, if you’ve injured a spinal segment - and we also know that similar changes happen under stress situations as well - but we know that the little muscles closest to the spine and skull, they can get neurologically inhibited, but they can get right through to atrophied. 

So they literally shrink, if you've ever seen a muscle in a cast, right? So that dysfunctional segment, there's more though, they get fibrotic, there's fatty infiltration, they change their fibre type. So there's a whole host of maladaptive functional changes that take place within these muscles deep in the spine. And those deep muscles, it's a stretch of them that literally allows the brain to know what's going on at the spinal level. And then it can tell the more superficial muscles, the bigger muscles, when to move and when to stiffen up. 

But if this whole process dysfunctions because of stress or injury, and this could have been like someone had a whiplash injury a year ago, and they've never sought any care for it. Or, by then we know that those little muscles around that area that they were injured, they've atrophied. They're fibrotic, they've got fatty infiltration, they are pretty much useless in being able to tell the brain what's going on at that level. So how on earth then can the brain control the spine, the arms, and the legs appropriately?

So not only now are you dealing with that injury, but you're dealing with the brain is now maybe causing microtrauma and the way it controls arms and legs. All of a sudden, they might end up with tennis elbow or golfer's elbow, and they're wondering, "Oh, how did that happen?" Well, maybe because your brain doesn't know what's going on, because you haven't taken care of your spine?

Damian: Yeah, totally. It's just so good. So what you're saying basically and I think this is a really important thing. Again, for the listeners, I'm going to keep on bringing the listeners back to this because this is a language that you and I are familiar with. But for many people who are listening to this, they may not be familiar with this particular language. 

But I want to keep bringing everybody back to this, for the listener, what we're saying here is these dysfunctions can occur in the spine that result in atrophy of the small muscles which alters the brain's ability to perceive your space where you are in space, and this may not cause pain. This is important, isn't it, right? Because you may not experience pain with the dysfunction, but you could have dysfunction without pain which results in deterioration.

Heidi: Most of our work has specifically been on people that have reoccurring spinal dysfunction. So for example, they have reoccurring ache, pain, or tension in the spine. But most importantly, we required our subjects to not be in pain on the day. Because most of our brain measures that we've been recording, they are influenced by the way your current pain levels. And I mean, most people know that if you go to a chiropractor, it reduces pain, right?

So if we adjusted someone and it reduced their pain, and they had these changes in the brain, I wouldn't know if it was because of the adjustment or because of the changes in their feelings of pain. So the studies started showing that you improve your ability to know where your ankle joint is or elbow joint is or your spinal function, or the sound-visual information, or multimodal integration, or all these other studies that we've done, have been done in people that haven't got pain on the day that we are testing them. So we know that this dysfunction is there, even on days that you have no pain. It can potentially be why people end up with injuries because the brain is less likely aware of where they are in space. So obviously, they're likely to be more clumsy. 

What fascinates me is those additional effects. For example, this massive big survey they did in Americans, and they looked at, you know, 35,000 people, and then asked if they'd ever been to a chiropractor, or they'd being to a chiropractor in the last year. And then they go into what kind of benefits do you feel chiropractic care has had for you? They only asked the people, obviously, that have been to chiropractors. And they were like, insane numbers, 70% felt better, they were coping better, 40% were sleeping better. Even like 13% of people felt like they were better able to communicate with other human beings, their interactions with other humans.

And these kinds of effects really scream at prefrontal cortex functions, which has been a study that, we've shown in several studies, that you actually change the process in the prefrontal cortex when we adjust people. Because we know that prefrontal cortex is a major inhibitor of emotions and mental health and hugely influential on our ability to think rationally. So that whole, being able to pick up on what you're talking about. If they're in fear, or they're in pain, when they're coming in to see you, chances are their prefrontal cortex has gone offline. And they're in their limbic emotional brain. They're probably subluxated as well.

Damian: Yes, totally.

Heidi: There are so many key ways that adjusting people is likely going to be helping them, it might even help them cope better. And if it's helping them to cope better, then all of a sudden, they're able to do more of those positive things like take supplements or start an exercise program. 

Damian: Eat a better diet.

Heidi: Or even things like impulse controls and addictions are linked with prefrontal cortex dysfunction. Prefrontal cortex is also highly linked with balancing the autonomic nervous system and our inflammation levels and therefore, vital for immune function. So it's really fascinating to start to pick apart just how important that spinal function really is, so much more than just, , “crunch a bone where you hurt.” There's a completely different picture coming out of the basic science research.

Damian: There really is, just don't only hit the high spots, that's what you're saying. I want to bring people back to and just consider this for a moment. 

And Heidi, actually, just as a number, how many research studies have you done so far on the impact of the spine and the brain? How many studies have you done so far?

Heidi: Oh, I don't know. I think I was up to about 65 last time I checked.

Damian: So we're talking lots, right? We're talking lots. So this isn't just new. And so let's just take it back to 1895 just for a second. Just a little bit of quick history here for the listener. 
In 1895 D.D. Palmer, who was the founder of chiropractic spoke with the janitor of his school. And I could get some of these things wrong, Heidi, if you feel like you want to correct me, then feel that you can do that, Harvey Lillard. And Harvey...

Heidi: You know this better than me, probably.

Damian: Maybe.

Heidi: Harvey Lillard. Yeah.

Damian: Harvey Lillard, yeah, he was deaf. Now, Harvey Lillard explained that the reason why he’d been deaf is because he'd bumped his head, and he'd felt something go out. And ever since that point, this thing had gone out. So then D.D. Palmer, who was a magnetic healer at the time, chiropractic wasn't invented at this point in time, found a bone out of place, racked it back into place. So the scripture says, I'll say the scripture, and it goes back into place, and lo and behold, Harvey Lillard's hearing is restored. And hence, D.D. then thought that he'd found the cure for deafness, jumped in horse and cart, went all around America horse and cart, “I've found the cure for deafness.” Thousands upon thousands of people came to have their deafness fixed, and this didn't happen. No one else had their hearing restored.

So we kind of go, "Ah, N equals one, that's not causative. That's, you know, it's this correlation maybe. Maybe it was a fluke, maybe, it had nothing to do with that." But what D.D. then found was that other people were getting improvements in their health and well-being as a result of being adjusted. But we didn't know why, back in 1895 we didn't know why.

Heidi: Exactly. Exactly.

Damian: So you're explaining now.

Heidi: And that's so interesting. Yeah.

Damian: Yeah. You're explaining now that this could be because of the cortical control at a brain level that...

Heidi: For so many years, we thought it was a squashed nerve root, right?

Damian: Yes, the bone on nerve. Yeah.

Heidi: And, I remember actually, I remember vividly, I was, must be about five or six years ago, now pre-COVID pandemic. I was in Istanbul, in the lab doing an experiment with one of the world's leading experts on dual function, so bite strength. And I was listening to...I think there was some sort of an interview over in Australia where I don't know medical doctors or someone was laughing at the fact that how could the spine possibly have anything to do with cranial nerve function. And they were laughing at this Harvey Lillard's story and how could it possibly have anything to do with deafness.

And I was sitting there, literally in front of the computer, watching and as we did our adjustments, bite strength increased. And I mean, facial control is controlled, again, by cranial nerves, bite, jaw strength, is a cranial nerve function. And I was watching it, and it was lasting like over a week, and that's in one of our publications as well, this jaw strength. There's so many studies showing us that we increase the efficiency by which the brain can produce force. But so we finally understand that what we're doing when we're adjusting the spine does not relieve pressure off a nerve root, which we used to think for many years.

What we're actually doing is we're finding those dysfunctional spinal segments, where those little muscles that tuck, the small deep muscles have probably atrophied and, you know, become fibrotic, and so forth, and so on. And then we rapidly, blasting the brain with proprioceptive input, because it is a rapid stretch of those deep muscles when we go in there with an HVLA adjustment. And that blast of proprioceptive information or counter-receptive information seems to have this massive central effect on the brain itself. And that's what's changing the way your brain is processing sound and visual information. Actually, it makes sense now, how Harvey Lillard could get his hearing back.

And since I've gone around presenting on this research, I've actually had multiple chiropractors come and tell me that similar stories to that Harvey Lillard story, that there are people that had an accident. So there's obviously an accident that's caused the dysfunction. And it could be upper cervically, but that's caused a dysfunction in the way the brain processes sound, or visual information, and then they get their function back. So it's quite remarkable. And it's very, very exciting to be piecing this puzzle piece together that we've wondered about for 125 odd years.

Damian: Absolutely, it's huge. It's so huge. And I want to... I suppose I'm going to just recap what we've just been saying before we keep on moving forward, because we are going at a rate of knots, and there's so much exciting stuff in here. 

What we're saying here is that people may present to the practitioner with some kind of dysfunction that could result in pain, but it could result in some other kind of dysfunction. It could be bowel dysfunction, it could be digestive discomfort or whatever else, and it may be responsive to medication.

Heidi: And we're not saying that we're a cure for anything.

Damian: No.

Heidi: But this new biological understanding of how that spine dysfunction can impact function, it can sort of explain how we could impact just about any system in the body. And that's interesting, because, again, chiropractors have been blamed of claiming that they fix everything. But I don't really think that's the case. And I don't even think chiropractors are claiming that. But they see remarkable changes in just about every system of the body. Because, of course, every system of the body relies on the brain being acutely aware of what's going on inside you or outside you. You mentioned one part of the body that doesn't need your brain to be aware of what's going on. And I'll probably challenge you to find one of those.

Damian: I remember when I was a naturopath, Heidi, and you know that I was a naturopath for a long time.

Heidi: Yeah, yeah.

Damian: Only a naturopath, and I say that only because that was the only thing that I did. And these days, I do chiropractic and naturopathy, right. 

So I think about, then I remember speaking to a great chiropractor in Traralgon, his name is Dr. Garry Coleman, and I said to Garry, I said, "You know, I do a lot of work with the digestive system." And he said, "Well, what controls the digestive system?" I said, "Well, I don't know, like the digestive system." He said, "It's the brain, ok,” “Yeah, yeah, it's the brain. Right." 

And then he said, "And the brain communicates through the spine and goes to the digestive." I said, "Yeah, of course, it does, Garry." And he said, "So you could do a lot of work with the digestive system like I do." And like a lot of the listeners do, just like 7,500 maybe 10,000 now, could be even 20,000 listeners to this podcast right now, going, "Yep, I do work with the digestive system."

And I used to find myself prescribing lots of supplements to help my patients get their digestive system right. And yes, I would get great results. And it was amazing, like, it was amazing. But what I also found was that when they saw Garry because I was a naturopath and I'd refer to a chiropractor, it could have been Garry, could be another chiropractor. When they were under care and doing chiropractic the way it was supposed to be, not just chasing pain, headaches, neck pain, back pain, that sort of thing, that it made it easier for me as a practitioner to be able to help my patients get great results because food appeared to work better. They seemed to be happier, they slept more efficiently, their movement was more profound, there seemed to be a whole lot more.

And it's really only through what you're finding in your research that I can explain all of that to my patients and to other practitioners that I work with, not only in my practice, but at the golf course or in social circles or in professional circles, explaining to them that it's not the chiropractor's cure, or fix or treat anything in particular, except that what they look at is these dysfunctional segments within the spine. And it's great that you're finding that this is why it works. And this is how it all happens.

Heidi: Yeah, and that's, you've raised a couple of things that I think are really interesting and worth touching on. Because there are probably multiple reasons why just, and I'm saying just chiropractic care because, like you, I would also use a lot of nutrition, supplementation the way I practice. But just doing chiropractic, because we know the effects that it's having.

But step back even further, let's just think about the gut. What's in the gut? There's actually more neural tissue in the gut, more neural tissue in the gut than there is in the spinal cord. So much so now that we consider that digestive system the nervous system, the nervous tissue in the gut, the second brain. So it's really an extension of the brain that happens to live in the digestive system, probably because it's so, so important that you get your digestion right, as you will probably also know as a naturopath.

Damian: But embryologically, that makes sense too, does like, you know, from an embryological perspective as the nuchal crest folds and forms, you know, the two ends of that, we've got the brain and the gut. So we're talking about basic embryology there.

Heidi: And it's also outside your body, right, skin and digestive tract is outside your body. That's what determines who you are from what's external to you. So, for one, I think it's extremely important that your brain needs to be aware of what's going on in your digestive system. That's probably why there's so much neural tissue there, to begin with. So being accurately able to perceive what's going on, and then control the gut in the most ideal way, number one. 

But we also see that the chiropractic adjustments can, if that's influencing the prefrontal cortex, it could also be influencing... We know that the prefrontal cortex directly activates the parasympathetic nervous system. And that's, of course, your digest, rest, healing, and reproductive system.

So we see quite a lot of people that get under chiropractic care, start reporting that their functional gastroenterology symptoms go away, right. So there's multiple, very interesting links, it's the direct neural links that the importance of the microbiome that skyrocketed in the last couple of decades, that research. But there's also this potential link that we have on the parasympathetic nervous system, through impacting the prefrontal cortex. Because if we are, therefore, activating the prefrontal cortex ability to activate the parasympathetic nervous system, that could be optimizing your healing, resting, digesting.

And again, if you go back to that big survey by Adams et al, I mean, it would appear, you know, if you look at those numbers, the 70%, coping better, feeling better. You know, all these improvements, they scream of prefrontal cortex improvements. It sounds very much to me like that prefrontal cortex is improved. We don't know that yet, that's again, we need to go in and do some more of these clinical trials. But now, there's just so many studies I need to do. It's like, it never ends. I open one door, and it's like now I've got to do 20 more studies.

Damian: You need more researchers, you need more researchers. That's what's going on, Heidi, you got to expand the nest, expand the nest.

Heidi: I know. I certainly don't need to lose them to become presidents.

Damian: Wow, that's a great point, Kelly Holt, that's right. 

So now, Heidi, I'm always aware that there's a lot of science going on and some stuff doesn't make it to the fore. And often, chiropractic has been accused of not having robust enough science, or robust enough studies. I'm often left lost in that sort of conversation because we often hear a statistic around “What's relevant?” or “What is a good study?” and “What is a bad study?” and “What's usable?” and all that sort of stuff. And sometimes people say only 70%, or maybe it's 20% of all medications that are used are actually researched to the standard that they want us to be researched to the standard.

We find this also with nutritional medicine and with herbal medicine, and all these other types of therapies. There's not a lot of incredibly robust information in around what they were called the “gold standard of research,” which is the double-blind, placebo-controlled study. Why would a double-blind, placebo-controlled study not be good for us?

Heidi: Can I... Just before... I wouldn't say that. That's the only gold standard for clinical science.

Damian: Right, okay.

Heidi: So like basic science is very, very different. So if you wanted the gold standard for basic science, you would be stupid to use a randomised control trial design. If you were doing basic science studies, you don't want the randomised control trial design, it's the wrong design.

Damian: Right.

Heidi: So it depends on what kind of studies you are doing. Ideally, we actually do many different types of studies, because the many different types of studies each provide you with different kinds of evidence. So if you're wanting to understand how something works, you've really got to do a really well-designed basic science study. If you're wanting to design a study to show you how effective an intervention is for a certain condition, that's when you want to do a really good clinical trial and preferably a randomized control trial.

And I mean, when it comes to chiropractic research, we do extremely well, when it comes to muscular-skeletal pain research. And I would never underestimate the value of that muscular-skeletal pain research, it’s phenomenal, especially like, for me as a basic scientist again, so I can't help myself, Damian. But I follow the basic science research on what pain is. And I don't know if you've followed that. In the last 20, 30 years, there's been an amazing development on what chronic pain truly is. We used to think it was, pain reflected some tissue pathology. Well, now we know chronic pain, that's not the case at all. Your tissue pathology could have healed years ago. But your brain has learned to live with the pain.

So it comes back to this brain driven response, you start looking into things that actually light up the pain matrix. It's not even the one part of the brain that causes feelings of pain, we know there's a whole multitude of parts of the brain, including the prefrontal cortex, is a major player in that pain matrix. And then you start looking at all the triggers that can cause the pain matrix to fire so that you feel pain.

All that comes down to all kinds of things, it's like, loneliness, isolation, you think of the stress that people are going through at the moment, sleep problems, exercising, lack of exercise. Inflammatory levels, your digestion, the food that you eat and don't eat, the supplements you take and don't take, your hormonal system, the amount of movement that you have every day, that your thought patterns, your emotions. Even things like inflammatory levels, it could be local inflammation or peripheral inflammation.

And again, you start to tie all these things together. And it actually makes perfect sense that, if as chiropractic, what we're probably doing is not necessarily fixing tissue pathology where you hurt, but we're probably turning off or down the feelings of pain in the brain itself, especially when it comes to our chronic pain. If you've had an acute injury, then you're probably talking a bit of that peripheral pain tissue pathology type thing. But I'd say most chronic pain patients' musculoskeletal chronic pain, it's a brain problem that we're actually affecting by adjusting the brain.

Damian: And I love that because you actually jumped my segue, I've got to tell you, Heidi. I was going to segue into that the pain is in the brain, which is where I was going to go, but you jumped to my segue, which I'm totally fine with. That's great. I love your enthusiasm. You could never be accused of not being enthusiastic, I'm going to tell you that, Heidi.

Heidi: No.

Damian: But so I love that. And so when we're perceiving this, and I think this is important to understand, too, because from a soft tissue healing perspective. And I know that everyone who's listening to this at the moment will be thinking, "Yeah, yeah, but I use turmeric for pain, or I use magnesium for pain, or I use Quercetin for inflammation" or whatever else it might be or fish oils.

Heidi: And that's wonderful.

Damian: It's so good. But if we're talking a chronic issue, it's highly likely, as you say, that the soft tissue has healed in the local area of where the pain might be felt. And so as a result...

Heidi: Or another probably quite common thing is that because the brain isn't accurately aware of what's going on, it's not controlling the movement patterns appropriately. So you're getting micro traumas.

Damian: Yes, tiny little micro traumas. That's right.

Heidi: So if you go to move your arm, yeah, in the wrong way all the time with the wrong muscles and the wrong order, you're not activating these feed forward protective reflexes that you're supposed to, you know, your core is supposed to switch on before you lift an arm and a leg. So people could be micro trauma-ing  their back or their neck or their arms or legs all day every day. If you don't clear out that movement patterns and get the right movement patterns, you can take all the turmeric you like. But I'm not saying don't take the turmeric or the good fish oils and things like that.

I think most practitioners that work with chiropractors find exactly what you say, that their patients just do better. They'll respond better to your supplementation, they'll respond better to the massage, they'll respond better to the acupuncture. Whatever you're doing, if you've got a brain that's more accurately aware of what's going on in its system, and it's more effectively and more efficiently controlling your system, whatever you do, as an alternative complementary or any kind of practitioner, your patients are likely to do better.

And that's one thing I'm hoping that I can achieve in my lifetime, Damian, is change this view on chiropractic. It shouldn't be viewed as one, or two, or three therapeutic doses. That does my head in. I would like it if we can start, because we're talking about the function of the deep paraspinal muscles. And when it comes to muscle function, I don't know about you, but you can't go to the gym three or four times and expect to be fit for life. I wish, but it doesn't work that way.

Damian: I thought I was just going there once. I thought I was just...I thought if I had a membership, I'd be fine.

Heidi: Yeah. Exactly. You know, “Oh, I've been to a chiropractor once in my life, and it didn't work.” What? That’s what chiropractors see. It's those people that get those regular adjustments to the point that you're holding your adjustments, meaning that the brain is able to control that segment in an appropriate way, meaning it will stiffen up when it should and move when it should. 

You know, that's literally the neurophysiological view now of that dysfunctional spinal segment. It's literally that the brain isn't able to control that segment in your spine appropriately. That it's not moving when it should, or it's stiffening up when it shouldn't. So obviously, that ends up tender to the touch, it has changes in its intersegmental range of motion, compared to the level above and below. That's what it takes.
That's why it takes five years for chiropractors to train to detect it very well. And then applying those thrusts and getting the whole spine as a functional unit, working as it should. So you've got your protective reflexes switching on, your bones are moving when they should, they're stiffening up when they should, when you lift, for example, versus running. It's that it's literally I see chiropractors, their role is to exercise the spine back into proper function. But, you know, it's still treated as a “Go see your chiropractor four, five times, because you've got back pain.” It does my head, it literally goes against the basic science mechanisms.

Damian: It really does.

Heidi: Even if you look at the clinical trials that have looked at benefits of maintenance care versus just symptomatic care, people have less symptoms overall in a year if they have the maintenance care, versus just turning up when they hurt. Which also makes sense if you start to understand what pain is, this chronic pain anyway, you know, and why that happens. But yeah, it's going to take a bit of time. And I think that's quite normal with new science that it always takes 20, 30, 40 years for a new understanding to become common knowledge. So it's kind of cool, I just got to learn to be patient.

Damian: Well, you know…

Heidi: Not my strong side.

Damian: You're more patient than most, I have to tell you, Heidi, you really are. 

I love that you say that movement can impact pain, right? So movement impacts pain. And the reason why it does that, and I'm bringing everybody back to understanding this because movement impacts pain because of the ascending messages to the brain, and then the brain's interpretation of the data. It's a better interpretation, more efficient interpretation of the data, as a result of the movement of the spine, the tiny little paraspinal muscles that are being triggered.

Heidi: Because they're the eyes, like, literally view those little deep muscles that go from one vertebra to another, because they're the ones that we stretch when we apply the adjustment to that subluxated segment. And they're the ones that we know atrophy, they literally shrink inside, they become fibrotic, they have fatty infiltration. A whole host of maladaptive plastic changes take place within them over time, after injury, or following long-term stress. So we know that happens. And again, we know that stress will trigger these, injuries will trigger these, even local inflammation can trigger these.

I don't know if you've ever seen those patients that like they have a tooth abscess, and they're continuously subluxated their upper cervical spine. I don't know if you've ever noticed that, or the person that's got a bowel inflamed bowl, that triggers their low back and vice versa. So it's...

Damian: Absolutely.

Heidi: They are the three things that we know, it's that local inflammation. Probably enough systemic can probably trigger things as well, but the stress and then the injury, and then the detrimental effect that has on those small muscles. We can almost view them like fuses blowing, it's a little bit like when your system's too overloaded, it blows the fuse -whether that's due to pain, an accident, injury, local inflammation, stress - you blow your fuse, and your body's kind of learnt a dysfunctional pattern.

And it can still function, your brain has been with you most of your life, so it can kind of guess where your spine is. And that might be like a survival compensation, that once you go into fight-or-flight, you need your bigger muscles to either fight or run away. And so it sort of focuses on them and just ignores the small intrinsic spinal muscles. Who knows? But for some reason, that's what happens. 

But over time that is unhelpful, just like chronic stress is unhelpful, where short-term stress is fantastic. I mean, that's like exercise, it's really a healthy thing, it boosts your immune system and immune function, but that chronic long-term stress is very, very detrimental.

Damian: Absolutely. Well, last month we spoke with Wayne Todd, who's a great communicator.

Heidi: Yeah, yeah, he's lovely, yeah.

Damian: Great communicator, around Sympathetic Dominance, and how all of what you're talking about feedback to exactly what Wayne was talking about. And what I wanted to ask him was, “If you were to ask Heidi a question, what would it be?” But I didn't get a chance to ask him that question.

Heidi: Well, I reckon he'd want to know that, I can say, say in another 10, 20 years, what would be my dream outcomes? It would literally be understanding better this impact that we have on the prefrontal cortex, clinically. Does that actually improve...? Is it through our impact on prefrontal cortex that the brain is better able to perceive where arms and legs and movement control? Do we influence its executive functions? If that's the case, then literally, we would be noticing that people literally have greater intelligence under care, that you get adjusted, and if you can activate the executive functions of the prefrontal cortex. If that's a clinical positive improvement, they will be literally smarter, they will have better emotional control, better mental health. I mean, every mental health disorder known to man is linked with prefrontal cortex dysfunction. And I don't know about you, but I used to get quite often that we have husbands coming in because their wife said that they needed the “grumpy bone adjusted.” I don't know if you ever heard that.

Damian: Yeah, that's right, and the kids. That's right. Yeah.

Heidi: But you know, they would get adjusted and they wouldn't be so grumpy anymore. I used to just laugh, but now I actually could explain why that might be, or the impulse control ing addictions or the pain processing. I'd just like to understand, are we improving people's chronic pain because we are affecting prefrontal cortex. Or, again, we could look at all the functions of the cerebellum, because the cerebellum isn't just about perceiving the body. Or aligning, the spine or motor control, or fine motor control, it's all about learning new motor skills. We've even found studies where there if you've got dysfunction, you are not retaining motor learning.

But this is where it's going, Damian. And this is probably why Wayne Todd would be extremely excited about the research because again, that prefrontal cortex is vitally involved in balancing the autonomic nervous system, in inhibiting the sympathetic nervous system and in turning on that parasympathetic healing, digesting reproduction system. 

So it makes so much sense. And I'm convinced that that's the effect that we have. But that's, because I've got over 20 years of clinical experience, as well as this basic science knowledge. There's too many. I've even written a big review on it actually.

Damian: Well, what I'm going to ask for, Heidi, is for as much information is what you can provide for us or links where people can actually get information from. Because I know that at the end of this podcast, which we will finish in a couple of minutes time, I know that people are going to be screaming for information. And, of course, everyone want to be able to find information in the show notes, etc. But if we were to send them by way of a link, would we just send them straight to your website, Heidi?

Heidi: There's multiple places to go actually so but I'll send you links to two free downloadable articles because one's an invited review from the European Journal of Applied Physiology. And what we wrote about was how the brain controls movements, and how the spine, both in dysfunction or through adjustments could impact that.

But I've also just recently - and I say I – we, my research team and I at the New Zealand College Chiropractic, we also wrote a review, because of the pandemic. And there was a lot of confusion about whether chiropractic care could boost the immune system or not. And we have no such clinical trials. So we can't make those claims. 

Damian: Right.

Heidi: But so many chiropractors see these changes in their patients. So they were like, "Well, how? How could an adjustment impact anything to do with the immune system?" So we did a review again, of the basic science literature, showing that that high velocity, low amplitude thrust to the spine can improve neurochemicals that are important for our neuroimmune function.

So we talked about, again, this link between how does the nervous system and the immune system talk to each other? What are the main routes? And obviously, the main routes are via the autonomic nervous system and the neuroendocrine system. So the HPA axis, and the prefrontal cortex's role in that, which is massive. But so, we couldn't explain why that was, but now we can.

So I'll send you links to those two reviews. I've also got a whole load on my own website now. I created a library because I get emails all the time saying “What's the evidence on this? And what's the evidence on that?” So we've got a whole Chiros Academy library online. So chirosacademy.com. I'll send you some links.

Damian: That'd be great. That'd be great. Heidi, you are unbelievable. And I reckon we could keep this podcast going for another couple of days. But Heidi, I just want to thank you so much for spending the time with us today. And thank you for all the great work you're doing in this area, sixty plus studies, I'm sure there's going to be hundreds of studies that you complete in the next decade that will shape and change the way people see health and well-being, and chiropractic role within the healthcare system, which I think is really, really important. 

Heidi, thank you so much for joining us, and I'm so grateful for your time.

Heidi: Thanks, Damian. It's been an absolute pleasure, anytime. Anytime. I could talk for days.

Damian: You could. Thanks, everyone for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the FX Medicine website, fxmedicine.com.au. I'm Dr Damian Kristof and thanks for joining us. We'll see you next time.

Resources Discussed in this Episode

Dr Heidi Haavik
The Reality Check
2021 Nobel Prize Winners in Physiology
Centre for Chiropractic Research at the New Zealand College of Chiropractic
ResearchThe Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey (Adams, et al, 2017)
Research: The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function (Haavik, et al. 2021)  
Research: The potential mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A narrative review (Haavik, et al., 2021)

About Dr Heidi Haavik

Dr Heidi Haavik is a chiropractor who has also gained a PhD in human neurophysiology. Dr Haavik graduated from the New Zealand College of Chiropractic in 1999 and has practiced for over 20 years. She was awarded her PhD degree by the University of Auckland in 2008. She is the Director of Research at the New Zealand College of Chiropractic where she established the Centre for Chiropractic Research. She is the author of the book ‘The Reality Check: A quest to Understand Chiropractic from the inside out’ (www.heidihaavik.com). This book describes in easy to understand language what happens in the brain when a chiropractor adjusts dysfunctional segments in the spine. Dr Haavik has used her neurophysiology expertise to study the effects of adjusting subluxations on the function of the central nervous system.

Dr Haavik is the director of Haavik Research Ltd, a company that enlightens the world about the science of chiropractic at www.therealitycheck.com, and she runs an online learning academy at www.chirosacademy.com. Dr Haavik was a member of the World Federation of Chiropractic’s Research Council for ten years. She has received numerous research awards and has published a number of papers in chiropractic and neurophysiology journals. She has presented her work to both chiropractic and neuroscience communities around Australasia, Africa, North America and Europe. She is on the Editorial Board of the Journal of Manipulative and Physiological Therapeutics and Journal of Chiropractic Education and is a Review Editor in Movement Science and Sport Psychology for Frontiers in Psychology and Sports Science. She was named Chiropractor of the year in 2007 by both the New Zealand Chiropractic Association and the New Zealand College of Chiropractic Alumni Association. 


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