Episode

069 – Dr. Walter Herzog – Biomechanics, Spinal Manipulation, Vertebral Artery and Gait

In this interview Dr. Herzog and I discuss his research including: 1) the biomechanics of spinal manipulation; 2) spinal manipulation and the biomechanics of the vertebral artery; 3) spinal manipulation and gait and; 4) the sarcomere, titin and muscle contraction. Dr. Walter Herzog did his undergraduate training in Physical Education at the Federal Technical Institute in Zurich, Switzerland (1979), completed his doctoral research in Biomechanics at the University of Iowa (USA) in 1985, and completed postdoctoral fellowships in Neuroscience and Biomechanics in Calgary, Canada in 1987.

Currently, he is a Professor of Biomechanics with appointments in Kinesiology, Medicine, Engineering, and Veterinary Medicine, holds the Dr. Benno Nigg Chair in Biomechanics, Mobility and Longevity. He was the Canada Research Chair for Cellular and Molecular Biomechanics from 2001 to 2022 and the Killam Memorial Chair for Inter-Disciplinary Research from 2011 to 2021 at the University of Calgary.

His research interests are in musculoskeletal biomechanics with emphasis on mechanisms of muscle contraction focusing on the role of the structural protein titin, and the biomechanics of joints focusing on mechanisms of onset and progression of osteoarthritis.

Dr. Herzog is the recipient of the Borelli Award from the American Society of Biomechanics, the Career Award from the Canadian Society for Biomechanics, the Dyson Award from the International Society of Biomechanics in Sports, the Muybridge Award from the International Society of Biomechanics, and received the Killam Prize in Engineering from the Canada Council for the Arts for his contributions to biomedical research. He is the past president of the International, American and Canadian Societies for Biomechanics. He was inducted into the Royal Society of Canada in 2013.

Here is the video for this episode.



Click here to view Dr. Herzog’s google scholar page.

Here are a few of the articles we discuss in this podcast episode.

1.
Strain of the vertebral artery during passive neck movements and spinal manipulation of the cervical spine: An observational study.
Fagundes C, Herzog W.
J Bodyw Mov Ther. 2024 Oct;40:569-574. doi: 10.1016/j.jbmt.2024.05.011. Epub 2024 May 18.

PMID: 39593645
2.
A low-cost 2-D sarcomere model to demonstrate titin-related mechanisms for force production.
Baptista de Oliveira Medeiros H, de Brito Fontana H, Herzog W.
Adv Physiol Educ. 2024 Mar 1;48(1):92-96. doi: 10.1152/advan.00090.2023. Epub 2023 Dec 7.

PMID: 38059284
3.
Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers.
Gorrell LM, Sawatsky A, Edwards WB, Herzog W.
J Man Manip Ther. 2023 Aug;31(4):261-269. doi: 10.1080/10669817.2022.2148048. Epub 2022 Nov 15.

PMID: 36382347 Free PMC article.
4.
Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation.
Gorrell LM, Kuntze G, Ronsky JL, Carter R, Symons B, Triano JJ, Herzog W.
Chiropr Man Therap. 2022 Jun 1;30(1):28. doi: 10.1186/s12998-022-00438-0.

PMID: 35650649 Free PMC article.
5.
Reflex Responses of Neck, Back, and Limb Muscles to High-Velocity, Low-Amplitude Manual Cervical and Upper Thoracic Spinal Manipulation of Asymptomatic Individuals-A Descriptive Study.
Gorrell LM, Conway PJ, Herzog W.
J Manipulative Physiol Ther. 2019 Oct;42(8):572-581. doi: 10.1016/j.jmpt.2018.11.025.

PMID: 31864518
6.
Quantifying strain in the vertebral artery with simultaneous motion analysis of the head and neck: a preliminary investigation.
Piper SL, Howarth SJ, Triano J, Herzog W.
Clin Biomech (Bristol). 2014 Dec;29(10):1099-107. doi: 10.1016/j.clinbiomech.2014.10.004. Epub 2014 Oct 23.

PMID: 25457973
7.
Biomechanical characterization of cervical spinal manipulation in living subjects and cadavers.
Symons B, Wuest S, Leonard T, Herzog W.
J Electromyogr Kinesiol. 2012 Oct;22(5):747-51. doi: 10.1016/j.jelekin.2012.02.004. Epub 2012 Mar 7.

PMID: 22402264
8.
The biomechanics of spinal manipulation.
Herzog W.
J Bodyw Mov Ther. 2010 Jul;14(3):280-6. doi: 10.1016/j.jbmt.2010.03.004.

PMID: 20538226 Review.
9.
Preliminary report: biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation.
Wuest S, Symons B, Leonard T, Herzog W.
J Manipulative Physiol Ther. 2010 May;33(4):273-8. doi: 10.1016/j.jmpt.2010.03.007.

PMID: 20534313
10.
The forces applied by female and male chiropractors during thoracic spinal manipulation.
Forand D, Drover J, Suleman Z, Symons B, Herzog W.
J Manipulative Physiol Ther. 2004 Jan;27(1):49-56. doi: 10.1016/j.jmpt.2003.11.006.

PMID: 14739874
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068- Dr. Felipe Duarte – Neurobiology related to chronic musculoskeletal conditions and spinal manipulation

Dr. Felipe C. K. Duarte graduated from Feevale University-Brazil in 2008. He has clinical experience as a chiropractor and three other degrees (postgrad dip: Exercise Physiology; MSc: Human Physiology; PhD: Neuroscience). Between 2019 and 2023, he held a research-intensive position at CMCC-Toronto as a postdoctoral fellow and research associate in a rehab research-focused hospital (KITE-Toronto Rehab Institute-UHN, Toronto). Since 2023 Felipe is a senior lecturer at the School of Health, Medical and Applied Sciences, Chiropractic Discipline, Central Queensland University, Australia. He also holds Adjunct professor status at the Canadian Memorial Chiropractic College.

His research interests aim to (1) investigate the neurobiological and neuromechanical mechanisms underlying highly prevalent disabling chronic musculoskeletal conditions, such as chronic spinal pain, neuropathic pain, fibromyalgia, myofascial pain syndrome, and osteoarthritis, which are of great concern to public health systems; (2) Investigate the underlying mechanisms of rehab strategies such as force-based mechanotherapy (e.g., spinal manipulation), focusing on the neurobiological and neuro-immune factors; (3) use these biological determinants to explore their potential for patient stratification in chronic MSK conditions and to spinal manipulation (e.g., responders x non-responders).

Felipe has experience in various methodologies and study designs to address his research interests, which range from molecular biology to neuroimaging and clinical epidemiology. Felipe also possesses direct teaching experience in Biochemistry, Physiology, Neuromusculoskeletal Anatomy, Neuroanatomy, and Clinical Neurological Assessment and Diagnosis at both undergraduate and postgraduate levels.

Visit Dr. Duarte’s research at researchgate.net and view his faculty page.

Here are the articles we discuss during this episode:

1.
Myofascial Pain as an Unseen Comorbidity in Osteoarthritis: A Scoping Review.
Duarte FCK, Chien R, Ghazinour G, Murnaghan K, West DWD, Kumbhare DA.
Clin J Pain. 2023 Apr 1;39(4):188-201. doi: 10.1097/AJP.0000000000001102.
PMID: 36943163 Review.
2.
Effects of Distinct Force Magnitude of Spinal Manipulative Therapy on Blood Biomarkers of Inflammation: A Proof of Principle Study in Healthy Young Adults.
Duarte FCK, Funabashi M, Starmer D, Partata WA, West DWD, Kumbhare DA, Injeyan S.
J Manipulative Physiol Ther. 2022 Jan;45(1):20-32. doi: 10.1016/j.jmpt.2022.03.012. Epub 2022 Jun 25.
PMID: 35760595 Clinical Trial.
3.
Re-Examining Myofascial Pain Syndrome: Toward Biomarker Development and Mechanism-Based Diagnostic Criteria.
Duarte FCK, West DWD, Linde LD, Hassan S, Kumbhare DA.
Curr Rheumatol Rep. 2021 Jul 8;23(8):69. doi: 10.1007/s11926-021-01024-8.
PMID: 34236529 Review.
4.
Spinal Manipulation Therapy Improves Tactile Allodynia and Peripheral Nerve Functionality and Modulates Blood Oxidative Stress Markers in Rats Exposed to Knee-Joint Immobilization.
Duarte FCK, Kolberg C, Riffel APK, Souza JA, Belló-Klein A, Partata WA.
J Manipulative Physiol Ther. 2019 Jul;42(6):385-398. doi: 10.1016/j.jmpt.2018.11.023. Epub 2019 Jul 30.
PMID: 31371096
5.
Spine-Adjusting Instrument (Impulse®) Attenuates Nociception and Modulates Oxidative Stress Markers in the Spinal Cord and Sciatic Nerve of a Rat Model of Neuropathic Pain.
da Silva FBO, Santos MDCQ, da Silva TCB, Facchini D, Kolberg A, Barros RR, Silveira EMS, Kroth A, Duarte FCK, Vassoler JM, Kolberg C, Partata WA.
Pain Med. 2022 Apr 8;23(4):761-773. doi: 10.1093/pm/pnab167.
PMID: 33993301


Here is a link to Clinical Compass.  While there, check out the Evidence Center, Clinical Guidelines, and various other resources!

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067- Dr. Caroline Fagundes Discusses Vertebral Artery Strain, Posture and Falls

Dr. Caroline Fagundes and I discuss vertebral artery strain, posture and falls in this episode of the chiropractic science podcast. Dr. Fagundes always knew that her professional field would be in healthcare, and when she read about chiropractic, there were no doubts about which profession to choose. She graduated from chiropractic school in 2008 but continued to seek answers, which led her to a graduate degree in kinesiology at the Federal University of Rio Grande do Sul (Brazil).  This is where she also had her first contact with the research of Professor Walter Herzog.

In 2017, she was awarded a scholarship for the Master’s Degree in Cultural Diversity and Social Inclusion, in the area of Health and Social Inclusion – Aging. Her research was about the relationship between static posture and falls in elderly. In her PhD, also carried out with a scholarship, she continued to study this relationship and in 2021 she was awarded a scholarship to study abroad. Dr. Fagundes embarked on a trip to Calgary, Canada in September to study the strain caused in the vertebral artery during cervical movements and cSMT with Professor Herzog. She returned to Brazil in February 2022, and then finished her PhD and currently works as a chiropractor and acupuncturist in her own office in the South of Brazil.

Find more studies by Dr. Caroline Fagundes at Researchgate.net.

Caroline Fagundes, Walter Herzog. Strain of the vertebral artery during passive neck movements and spinal manipulation of the cervical spine: An observational study, Journal of Bodywork and Movement Therapies, Volume 40, 2024, Pages 569-574, ISSN 1360-8592, https://doi.org/10.1016/j.jbmt.2024.05.011.
(https://www.sciencedirect.com/science/article/pii/S1360859224002882)

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065- Dr. Clinton Daniels Discusses Manipulation and Prior Spine Surgery, Medications for Back Pain and More

Dr. Daniels and I discuss some of his publications dealing with prior spine surgery, medications for low back pain, suicide prevention, and health promotion. Dr. Clint Daniels is chiropractic section chief at VA Puget Sound Health Care System in Tacoma, Washington where he supervises a team of 9 chiropractors and is a resident director. He serves on the VA chiropractic Field Advisory Committee as the Research Coordinator, is a scientific commission board member for Clinical Compass, and is appointed to the Washington State Health Technology Clinical Committee. He is a 2010 chiropractic graduate from Logan University, where he also received his Master of Science in Sports Science and Rehabilitation. He worked in private practice for 4 years, and then joined VA and was the first graduate of the St. Louis VA chiropractic integrated clinical practice residency program. He has authored and contributed to numerous scientific publications on the topics of chiropractic integration into veteran and military facilities, postsurgical spine pain, suicide prevention, chiropractic best practices, and numerous case reports on a variety clinical presentations.

Please find Dr. Daniel’s researchgate.net profile here.

Here are the articles we discuss in this episode.

1.Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review.Daniels CJ, Cupler ZA, Gliedt JA, Walters S, Schielke AL, Hinkeldey NA, Golley DJ, Hawk C.Complement Ther Clin Pract. 2021 Feb;42:101261. doi: 10.1016/j.ctcp.2020.101261. Epub 2020 Nov 17.PMID: 33276229
2.Systematic review of guideline-recommended medications prescribed for treatment of low back pain.Price MR, Cupler ZA, Hawk C, Bednarz EM, Walters SA, Daniels CJ.Chiropr Man Therap. 2022 May 13;30(1):26. doi: 10.1186/s12998-022-00435-3.PMID: 35562756 Free PMC article. Review.
3.The chiropractor’s role in primary, secondary, and tertiary prevention of suicide: a clinical guide.Cupler ZA, Daniels CJ, Anderson DR, Anderson MT, Napuli JG, Tritt ME.J Can Chiropr Assoc. 2021 Aug;65(2):137-155.PMID: 34658386 Free PMC article.
4.The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline.Hawk C, Amorin-Woods L, Evans MW , Jr, Whedon JM, Daniels CJ, Williams RD , Jr, Parkin-Smith G, Taylor DN, Anderson D, Farabaugh R, Walters SA, Schielke A, Minkalis AL, Crivelli LS, Alpers C, Hinkeldey N, Hoang J, Caraway D, Whalen W, Cook J, Redwood D.J Altern Complement Med. 2021 Oct;27(10):850-867. doi: 10.1089/acm.2021.0184. Epub 2021 Jul 26.PMID: 34314609
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064- Dr. Matt Fernandez Discusses Physical Activity, Exercise and Chiropractic

Dr. Matt Fernandez is a registered chiropractor in Australia and is currently a senior lecturer at Central Queensland University (CQU), where he teaches and supervises students in the Master of Chiropractic program. Prior to his CQU appointment, he was a lecturer at the Department of Chiropractic, Macquarie University. Matt is very passionate about research and following the completion of his PhD at the University of Sydney, he now leads various research projects and supervises research students. He also regularly presents his research at conferences in targeted areas that advances the knowledge and understanding of chiropractic through physical activity, exercise and patient education interventions. Matt is also a member of the inaugural CARL fellows.

In this episode, we discuss physical activity, exercise, practice guidelines, and the chiropractic profession.

Please find Dr. Fernandez’s researchgate.net profile here.

Here are the articles we discuss in this episode.

1.Physical activity promotion in chiropractic: a systematic review of clinician-based surveys.Fernandez M, Young A, Milton K, Pinhiero M, de Luca K, Ferreira P, Hebert J.Chiropr Man Therap. 2022 Dec 13;30(1):55. doi: 10.1186/s12998-022-00467-9.PMID: 36514061 Free PMC article. Review.
2.GLA:D® Back Australia: a mixed methods feasibility study for implementation.Fernandez M, Young A, Kongsted A, Hartvigsen J, Barton C, Wallis J, Kent P, Kawchuk G, Jenkins H, Hancock M, French SD.Chiropr Man Therap. 2022 Apr 7;30(1):17. doi: 10.1186/s12998-022-00427-3.PMID: 35392935 Free PMC article.
3.The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study.Fernandez M, Moore C, Eklund A, Swain M, de Luca K, Sibbritt D, Adams J, Peng W.Complement Ther Med. 2019 Aug;45:172-178. doi: 10.1016/j.ctim.2019.06.012. Epub 2019 Jun 18.PMID: 31331556
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063- Dr. Robert Trager Discusses Spinal Manipulation, Lumbar Discectomy and Case Reports

Dr. Robert Trager is a chiropractic physician and researcher at University Hospitals, in Cleveland, Ohio, in the United States. In this episode, we discuss his research covering a variety of clinically focused topics at the intersection of medicine and chiropractic, ranging from case reports to health service utilization. Dr. Trager first became interested in research when he was an undergraduate student at Northeastern University, where took part in a co-op program that got him hands-on experience in a research laboratory. He then attended Logan University, graduating in 2013, and has since practiced in an integrative healthcare setting.

Please find Dr. Trager’s researchgate.net profile here.

Here are the articles we discuss in this episode. We also talked about the article that Dr. Brian Anderson and I discussed on episode 61 of the podcast.

1.Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data.Trager RJ, Daniels CJ, Perez JA, Casselberry RM, Dusek JA.BMJ Open. 2022 Dec 16;12(12):e068262. doi: 10.1136/bmjopen-2022-068262.PMID: 36526306 Free PMC article.
2.Chiropractic case reports: a review and bibliometric analysis.Trager RJ, Dusek JA.Chiropr Man Therap. 2021 Apr 28;29(1):17. doi: 10.1186/s12998-021-00374-5.PMID: 33910610 Free PMC article. Review.
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062- Dr. Lindsay Gorrell Discusses Spinal Manipulation, the Vertebral Artery, Reporting of Adverse Events

Dr. Lindsay Gorrell and I discuss her research regarding spinal manipulation, the vertebral artery and reporting of adverse events. Lindsay Gorrell completed her clinical training in Chiropractic and a Master of Research (The effect of manual and instrument applied cervical spine manipulation on mechanical neck pain) at Macquarie University, Australia. She then completed a PhD (Musculoskeletal Biomechanical and Electromyographical Responses Associated with Spinal Manipulation) under the supervision of Drs Walter Herzog and Jay Triano at The University of Calgary, Canada. She is now working as an International Research Fellow at the Balgrist University Hospital, University of Zurich, Switzerland. Lindsay is also studying a Master of Science in Medical Education at The University of Oxford, England.

Lindsay’s research interests are centered on investigating: i) the delivery of spinal manipulation; ii) the physiological responses and clinical outcomes occurring in response to spinal manipulation; and iii) the safety of the manual therapy. This requires different experimental approaches depending on the research question of interest. Most recently, she has published on the relationship between the amount of strain experienced by the vertebral artery, the 3D movements of the head and neck and the forces applied by clinicians during cervical spine manipulation and physiological responses to cervical and upper thoracic spinal manipulation. Lindsay has maintained part-time clinical practice since graduation.  

View Dr. Gorrell’s researchgate page here.

Below are the research studies that we discuss in this episode.

1.The reporting of adverse events following spinal manipulation in randomized clinical trials-a systematic review.Gorrell LM, Engel RM, Brown B, Lystad RP.Spine J. 2016 Sep;16(9):1143-51. doi: 10.1016/j.spinee.2016.05.018. Epub 2016 May 27.PMID: 27241208 Review.
2.Differences in force-time parameters and electromyographic characteristics of two high-velocity, low-amplitude spinal manipulations following one another in quick succession.Gorrell LM, Conway PJ, Herzog W.Chiropr Man Therap. 2020 Dec 8;28(1):67. doi: 10.1186/s12998-020-00355-0.PMID: 33287851 Free PMC article.
3.Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation.Gorrell LM, Kuntze G, Ronsky JL, Carter R, Symons B, Triano JJ, Herzog W.Chiropr Man Therap. 2022 Jun 1;30(1):28. doi: 10.1186/s12998-022-00438-0.PMID: 35650649 Free PMC article.
4.Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers.Gorrell LM, Sawatsky A, Edwards WB, Herzog W.J Man Manip Ther. 2022 Nov 15:1-9. doi: 10.1080/10669817.2022.2148048. Online ahead of print.PMID: 36382347
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060- Dr. Brian Anderson Discusses Chiropractic, Treatment Escalation, Medical Services

Dr. Brian Anderson

Dr. Brian Anderson DC, MPH, MS, PhD is an Assistant Professor within the Palmer Center for Chiropractic Research (PCCR) at the Palmer College of Chiropractic, where his research is focused on evaluation of nonpharmacological spine care delivery in the US. His background includes 15 years of clinical experience as a licensed chiropractic physician in a variety of settings, including private practice, a hospital-based integrative medicine center, and a chiropractic academic teaching clinic. He has also been an educator for the past 15 years, teaching courses at the undergraduate, graduate, and post-graduate level. With a passion to better understand and contribute to conservative spine care research, he enrolled in a PhD program in Health Sciences in 2015 with a focus on Health Services Research. His dissertation was titled “A Secondary Analysis Of Insurance Claims Data To Determine The Association Between Provider Type And Treatment Escalation In Musculoskeletal Disorders”, which is a topic he continues to investigate currently. In this interview, we discuss his journey from chiropractor to researcher, and several of his publications.

After graduating with his PhD in 2019, he joined the faculty at the Palmer Center for Chiropractic Research, where he participated in a pilot clinical study as a treating clinician, developed relationships with several research collaborators, and made progress towards developing his own research program.

Dr. Anderson’s research has been presented at many academic conferences, for which he has received several best paper awards. He is currently a co-investigator and primary analyst on a R15 grant titled “Spinal Manipulative Therapy vs Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Neck Pain”. He was recently awarded a 2-year Loan Repayment Award through the National Center for Complementary & Integrative Health (NCCIH), and also participated in the Fall 2022 cohort of the US Bone & Joint Young Investigators Initiative.

View Dr. Anderson’s publications at researchgate.net.

Here are the articles we discuss in this episode:

1.Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims.Anderson BR, McClellan WS, Long CR.J Manipulative Physiol Ther. 2021 Jun;44(5):372-377. doi: 10.1016/j.jmpt.2021.03.001. Epub 2021 Aug 6.PMID: 34366149
2.The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults.Davis M, Yakusheva O, Liu H, Anderson B, Bynum J.J Manipulative Physiol Ther. 2021 Jun;44(5):353-362. doi: 10.1016/j.jmpt.2021.05.002. Epub 2021 Aug 8.PMID: 34376317 Free PMC article.
3.The Relationship Between Healthcare Provider Availability and Conservative Versus Non-conservative Treatment for Back Pain Among Older Americans.Anderson BR, Yakusheva O, Liu H, Bynum JPW, Davis MA.J Gen Intern Med. 2022 Mar;37(4):992-994. doi: 10.1007/s11606-021-06889-0. Epub 2021 May 24.PMID: 34031853 No abstract available.
4.Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims.Anderson BR, McClellan SW.J Manipulative Physiol Ther. 2021 Nov-Dec;44(9):683-689. doi: 10.1016/j.jmpt.2022.03.010. Epub 2022 Jun 24.PMID: 35753873
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059- Dr. Frank Scali – Upper Cervical Spine and Myodural Bridge

Dr Frank Scali

In this interview, Dr. Scali discusses with me the upper cervical spine and myodural bridge (connective tissue between suboccipital muscles and the cervical spinal dura mater). Dr. Frank Scali grew up in Valley Stream, Long Island, New York, and studied Neuroscience at Stony Brook University. In 2009, he received his Doctorate in Chiropractic at Logan University in Chesterfield, Missouri. During his time in medical school, Dr. Frank Scali professionally prosected cadaveric specimens for Gray’s Anatomy and illustrated for multiple journals and textbooks, including the Oxford Handbook of Bariatric Surgery. While attending medical school, he published multiple non-variant anatomical findings in the medical literature and served as an Ad Hoc Reviewer in Journals such as The Spine Journal, The Anatomical Record, Surgical and Radiological Anatomy, and others. In 2018, he graduated with his MD from AUC School of Medicine with fifty-four publications, including textbook contributions and a patent for a medical device.

Dr. Scali is board certified in Chiropractic and Medicine. His current title is Assistant Professor of Medical Education and Anatomy at the California University of Science and Medicine. At CUSM, Dr. Scali serves as the Director of the ATLAS Lab Center, is the Director of the USMLE Board Preparation, and is the Course Director for MSK/Derm, Surgical Anatomy, and the Step 1/2CK Board Prep course. He was inducted into the Sigma Xi Scientific Research & Honor Society in 2020 and serves on the Editorial Board for the Journal of Medicine since 2019. As Assistant Professor of Medical Education, Dr. Scali has achieved dozens of teaching awards in Medical Foundations, MSK/Derm, Neuroscience, Reproductive Medicine, and Medical Board Preparation courses. Because of his innovative teaching style, in 2021, Dr. Scali became the inaugural recipient of the Robert Suskind & Leslie Lewinter-Suskind Pre-Clinical Faculty of the Year award.

Visit Dr. Scali’s research at researchgate.net and view his faculty page.

Here are the articles we discuss during this episode:

1.Anatomical connection between the rectus capitis posterior major and the dura mater.Scali F, Marsili ES, Pontell ME.Spine (Phila Pa 1976). 2011 Dec 1;36(25):E1612-4. doi: 10.1097/BRS.0b013e31821129df.PMID: 21278628
2.Investigation of meningomyovertebral structures within the upper cervical epidural space: a sheet plastination study with clinical implications.Scali F, Pontell ME, Nash LG, Enix DE.Spine J. 2015 Nov 1;15(11):2417-24. doi: 10.1016/j.spinee.2015.07.438. Epub 2015 Jul 22.PMID: 26210227
3.Histological analysis of the rectus capitis posterior major’s myodural bridge.Scali F, Pontell ME, Enix DE, Marshall E.Spine J. 2013 May;13(5):558-63. doi: 10.1016/j.spinee.2013.01.015. Epub 2013 Feb 11.PMID: 23406969
4.The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures.Scali F, Ohno A, Enix D, Hassan S.Cureus. 2022 May 30;14(5):e25484. doi: 10.7759/cureus.25484. eCollection 2022 May.PMID: 35686279 Free PMC article.
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058- Dr. Carlos Gevers – Mechanisms of Spinal Manipulation, Pain, TNF-Alpha

Dr. Carlos Gevers

Dr. Carlos Gevers joins me to discuss mechanisms of spinal manipulation, particularly as they relate to central sensitization and neuroinflammation. He also shares a study on Tumor Necrosis Factor-Alpha in Urine Samples of Patients With Chronic Low Back Pain Undergoing Chiropractic Care.

Carlos Gevers Montoro is a second-generation chiropractor. He graduated from Life Chiropractic College West in 2003 as Valedictorian and the recipient of the Clinical Excellence Citation award. After practicing for a few years in Spain and France, he was instrumental in the opening of the Madrid College of Chiropractic (MCC), where he still lectures. His contributions at the MCC were mostly related to the clinical sciences. In parallel, he served for seven years as the President of the Spanish Chiropractic Association, being involved in chiropractic politics and policy at the national and international level.

In 2018 he decided to switch gears and take a completely new path in the research arena. He started his PhD in Pain Neurosciences at UQTR – University of Montreal joint program under the supervision of Prof. Mathieu Piché. His PhD studies are partially funded, by a prestigious grant from the Government of Quebec. His line of research and his first publications are mostly focused on mechanisms of spinal manipulation, particularly as they relate to central sensitization and neuroinflammation. These two phenomena seem to be strongly implicated in the development of chronic pain syndrome and other conditions.

Check out Dr. Carlos Gevers researchgate profile page.

Here are the articles we discuss in this episode:

1.Presence of Tumor Necrosis Factor-Alpha in Urine Samples of Patients With Chronic Low Back Pain Undergoing Chiropractic Care: Preliminary Findings From a Prospective Cohort Study.Gevers-Montoro C, Romero-Santiago M, Losapio L, Conesa-Buendía FM, Newell D, Álvarez-Galovich L, Piché M, Ortega-De Mues A.Front Integr Neurosci. 2022 Apr 12;16:879083. doi: 10.3389/fnint.2022.879083. eCollection 2022.PMID: 35492573 Free PMC article.
2.Chiropractic Spinal Manipulation Prevents Secondary Hyperalgesia Induced by Topical Capsaicin in Healthy Individuals.Gevers-Montoro C, Provencher B, Northon S, Stedile-Lovatel JP, Ortega de Mues A, Piché M.Front Pain Res (Lausanne). 2021 Jul 20;2:702429. doi: 10.3389/fpain.2021.702429. eCollection 2021.PMID: 35295504 Free PMC article.
3.Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain.Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M.Eur J Pain. 2021 Aug;25(7):1429-1448. doi: 10.1002/ejp.1773. Epub 2021 Apr 15.PMID: 33786932 Review.
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