A long awaited study on the effect of chiropractic care for stroke patients has been released, with the journal ‘Scientific Reports’ carrying Dr Kelly Holts latest offering. The study examined whether or not chiropractic care “could increase strength in weak plantar flexor muscles in chronic stroke patients .” Results are in and they are encouraging.
The topic of chiropractic and stroke risk has long been the topic of hot debate, but by and large, the focus of those conversations has been on the risk of stroke for chiropractic patients. While research found no evidence for causation when it comes to chiropractic and cervical artery dissection (a significant cause of stroke), debate and conversation around such topics wears on . However, very little discourse or research has been dedicated to how chiropractic care might help a patient recover. That is what makes this latest study so interesting.
Holt et al gathered 12 chronic stroke patients who were all experiencing plantar flexor muscle weakness. They used a randomized controlled crossover design, assessing participants’ pre and post chiropractic care, and measuring the differences (including cortical drive to the muscle) in order to ascertain the effect of a single session of chiropractic care on stroke patients.
While the study was not without its limitations (which included a small sample size and the inability to ascertain how long the effect might last), the study offered up some significant findings. It showed a significant increase in muscle strength and in the V-wave/Mmax ratio when compared with the control intervention.
“Plantar muscle strength increased in chronic stroke patients after a single session of chiropractic care. An increase in V-wave amplitude combined with no significant changes in H-reflex parameters suggests this increased strength is likely modulated at a supraspinal level,” wrote Holt et al.
We know that stroke contributes greatly to mortality and the burden of disease every year. We also know that recovery is a process that often employs many modalities including “physical therapy, motor re-learning, and brain computer interface-based approaches amongst others .” This evidence shows us that by adjusting the spine, we may help increase muscle strength and cortical drive to key muscles, thus indicating that the chiropractor may have a very real role in supporting stroke recovery. Of course, the impact, reach and effectiveness of this intervention is something that only further research can clarify.
This study is the latest in a growing line of research indicating an increase in cortical drive to the muscles post chiropractic adjustment. It also shows changes at a brain level rather than a spine level as evidenced by the increase in cortical drive. Other studies (non-stroke related) have indicated similar effects in leg muscles and bite force among others [3-6]. This is the first that looked specifically at the plantar flexor, but it illustrates a similar effect regardless of muscle group. This once again it illustrates the potential impact chiropractic has on the brain.
Full details can be accessed at the journal referenced below . Stay tuned for our interview with Dr Kelly Holt and Dr Imran Niazi where we discuss the clinical implications that have emerged from this study.
We congratulate Dr Kelly and the team on this study’s publication, and look forward to seeing more research on this important topic emerge.
- Holt K, Niazi IK, Nedergaar RW, Duehr J, Amjad I, Shafique M, Anwar MN, Ndetan H, Turker KS and Haavik H (2019), “The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients,” Scientific Reports, 9, Article Numbers: 2673(2019), https://www.nature.com/articles/s41598-019-39577-5 retrieved 26 February 2019
- Staff writer (2017), “Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation,” Australian Spinal Research Foundation, retrieved 26 February 2019, https://spinalresearch.com.au/chiropractic-care-cervical-artery-dissection-no-evidence-causation/
- Niazi, IK, Turker KS, Flavel S, Kinget M, Duehr J, Haavik H (2015), “Changes in H-reflex and V-waves following spinal manipulation,”Experimental Brain Research, April 2015, Volume 233, Issue 4, pp. 1165-1173, https://link.springer.com/article/10.1007/s00221-014-4193-5 retrieved 4 February 2019
- Staff Writer, (2016), “Greater Strength, Muscle Function and Less Fatigue,”Australian Spinal Research Foundation (Interview with Heidi Haavik), https://spinalresearch.com.au/research-project-h-reflex-and-v-waves-2/ retrieved 4 February 2019
- Haavik H, Ozyurt M, Niazi I, Holt K, Nedergaard R, Yilmaz G, Turker K (2018), “Chiropractic Manipulation Increases Maximal Bite Force in Healthy Individuals,”Brian Sciences, 2018, 8, 76; doi:10.3390/brainsci8050076
-  Haavik, H.; Niazi, I.K.; Jochumsen, M.; Sherwin, D.; Flavel, S.; Türker, K.S. Impact of spinal manipulation on cortical drive to upper and lower limb muscles.Brain Sci. 2017, 7, 2