Firstly, huge shout out to Ricardo Fujikawa for organising an amazing event!

Last time I went to an ECU it was London 2010, and it was drier than a roast dinner without the gravy.

One academic researcher told us all about his analysis of manipulation for acute low back pain and how he wasn’t sure it really worked, there wasn’t enough evidence to support it to say it definitely does work. 

Subsequently, during the panel discussion, an audience member asked the panel “If you had acute low back pain, what would you do?”

Is there an easier question for a Chiropractor?

And yet, another one of the panel members (also a chiropractor of some repute, though mainly in research), said, “I had back pain after shoveling snow last year, I took ibuprofen and it went away”.

But in 2024, Ricardo nailed it, and brought the ECU into the modern age with a series of great speakers.

The gut microbiome was up first, with the excellent Paul Krkal ND and also Faye Deane DC.

I talked about how neuro-inflamamtion (as a result of, for example gut microbiome issues or say low magnesium) was creating chronic pain, mood & behavior issues and fatigue. 

“I’ve had it up to here with academics telling me to deny reality…..”

Hanging out with lovely people on a roof top terrace in old town Valencia. 

Then on the Saturday, we had some great talks on sleep and how poor quality sleep or just very little sleep can lead to chronic pain.

This is why we have sleep as part of our phase 1 in our hierarchy of clinical interventions, along with food and the easy to fix deficiencies. 

If you do not sleep well, you are going to struggle to be well and your chronic patients will respond far less well to your care than they should.

But why would poor sleep make your hurt? 

Well, not to whang on about it again and again (and again), but it is the foundation of the Core Concepts in Chiropractic Nutrition, Neuro-inflammation. 

Thus, poor sleep can turn into a sustained low grade inflammatory response.

And that is part of why poor sleep makes us hurt. 

One night will do it: 

OK, but one night of no sleep, but what about 4 hours or maybe even lots of sleep but poor quality, say non REM sleep. 

Yup, that too. 

So, go to bed on time, and all is well?

Well, yes and no. 

The reality is, this is a vicious cycle. 

It might be that neuro-inflammation, made them hurt so they sleep less, so they hurt more. 

Or the neuro-inflammation, make it hard to get off to sleep, and then they lacked deep sleep, so they hurt even more from more inflammation from less sleep – thus insomnia is a symptom. 

Or maybe sleep issues from stress, present or past, (which is inherently inflammatory), made them inflamed and on and on.

With chronic patients, it often doesn’t really matter, you just have to break the vicious cycle. 

Sometimes, doing great neuro-mechanical care will be enough to reduce pain, reduce sympathetic stress and break the cycle. 

Other times you will need to add in sleep hygiene, and maybe add some Mag Duo Plus (magnesium citrate/glycinate with B6) through the day and before bed, to calm the fires of inflammation and calm your brain. 

You can check out an old newsletter on magnesium/B6 and sleep here: