Latest / In Tune Podcast / 11. Dr. Monique Andrews - Neuroscience and research in Chiropractic
Transcript
- Dr. Nick Harvey: Welcome to the In Tune Podcast. I'm your host, Dr. Nick Harvey a chiropractor from Australia. This podcast is focused on getting deep with chiropractors globally and understanding their journey, their why, and what shaped them to be the chiropractors they are today. So come with me as we interview some great people within our profession so we can push chiropractic forwards. My guest today is a chiropractor and a neuroscientist. She was a research scientist before she was a chiropractor, publishing on stress and the immune system. She's also been a press professor of neurology and chair of basic sciences at a chiropractic college. And she teaches chiropractors around the world about neuroscience behind what we actually do. Dr. Monique Andrews, welcome to Intune. Dr. Monique Andrews: Thanks, Nick. Thank you so much. One one important thing you missed was I had about twelve years in practice and my wife and I had a very successful practice together in Ottawa, Canada. And just wanted to make sure people know that too. Dr. Nick Harvey: course. And I want to hear all about that as we get into the podcast too. And where I start with all my guests, Dr. Mo is how did their journey begin into chiropractic? And I love to put forward the question of how did they find chiropractic or or better yet, how did chiropractic find them? So where did Dr. Monique Andrews: Yeah. Dr. Nick Harvey: your journey start? Dr. Monique Andrews: My journey started when I was a neuroscience researcher in Ottawa, Canada. And I met this incredible young woman and fell in love and literally followed her to chiropractic school. I didn't know anything about chiropractic. All I knew was I didn't want my life to be without her. And so I followed her off to Davenport, Iowa back in nineteen ninety seven, I think. we've been together ever since, myself and my wife, Doctor Tamir McIntyre, and myself in chiropractic. Dr. Nick Harvey: Beautiful. And and where did you study and how did that journey begin? And and what were the early years like of studying your expectations of chiropractic? Dr. Monique Andrews: Yeah, that's a great question. I, as I said, you know, I literally followed somebody else to chiropractic school. And so I had no idea. I thought I was gonna become a glorified physiotherapist. I I was a bench neuroscientist. and that was my plan. And so when I got to chiropractic school, I was like, well, this is interesting. and I really thought it was gonna be a I was gonna have a doctorate in manual medicine. And that whole thing shifted when I met Reggie Gold. I was at Palmer Davenport when Guy Reekman he became president after my first quarter there, first semester. And he opened up the doors to let everybody back on campus again, people that hadn't been allowed for a long time. So I was sitting about three months in, I'm sitting in a lecture hall and everybody's talking about this guy Reggie Gold. And at this point I thought, wow, these there's a lot of nuts in this profession. And so I'm like, I want to go and see what this particular nut is about. I'd heard a bit about him. And Honestly, my life turned on its axis that day when Reggie gave his chemistry of life talk. And I was just like, wow, I've been missing so much. You know, I've been studying neuroscience for so long that I was really interested in what was happening, really on the cellular level, the molecular level, more in the chemistry end of things than the behavior end. And he really turned me on to this idea that. Everything that we experience in life is driven by our nervous system. And so this framework of neuroscience, this lens that I had prior to becoming a chiropractor, really allowed me to go beyond looking from the granular to the complexities of our human lived experience beyond anything that I had imagined. And that's a really long answer to your question, I think, but that's the truth. Dr. Nick Harvey: No, that's fantastic. And what an amazing man, Reggie Gold. And I've I've heard he's influenced the lives of many people within chiropractic and outside of chiropractic too. And I'd love to hear more of you you touched on just briefly, but I would really love to hear what he went into that that started to change your ideas and your perception of of what you were looking at so differently. What what were the big things he mentioned? Dr. Monique Andrews: Yeah, I think for me, I had studying in the hard sciences, you have a very mechanistic, maybe even reductive idea of how this magic is designed. And I guess he really, for me, opened up the possibility, number one, of this idea of innate intelligence and that the body has this inborn wisdom that allows it to heal, to thrive, to grow. And I think. when I was a young person, I was always very spiritual. And I think it allowed me to see the possibility, maybe not that day, that I could have I could be a scientist and still also know that there was something beyond the physical, that metaphysics had a place that had just as much value as hard science had. And that for me was a big shift because I I think I guess before then I kind of thought you had to be one or the other. And now I realize that it's this such a beautiful confluence when you can bring them both together and speak from that lens, that it doesn't have to be this or that. It can be this and that. And I and I think that's been a struggle for this profession because they think they have to go one way or the other and in reality you don't. Dr. Nick Harvey: I couldn't agree more and I can't tell you how many times on this podcast we sit down with guests and they think they're one or the other, but they just they express the attributes of both and they're not all so different, the mechanistic and the vitalistic. The vitalistic, I believe, just has one really extra layer on top of the mechanistic belief. So it's not that vastly different. Dr. Monique Andrews: What's the layer, Nick? Dr. Nick Harvey: The layer, I believe, is is the ability, the understanding that there's the something bigger than self, that there's a a life force, the innate intelligence within the body that is governing all all of that function. And like you said, in a in a reductionistic model, it it becomes very hard to measure and articulate. It's a it's a very large concept. So that that's been my understanding now, and it's it's ever growing with with more people I talk to. But one of the people I started to learn that from was Dr. Dick Santo, listened to a lot of a lot of his stuff talking about vitalism versus mechanism. How Dr. Monique Andrews: Yeah. Dr. Nick Harvey: how would you touch on on the differences and the the the the extra layer? Dr. Monique Andrews: Well, I think there are different levels to vitalism as well. And you know, are you talking about it historically or a modern definition of vitalism? Which I can get behind. I think where things start to get murky for those super mechanistic folks is when they look at vitalism in its earlier context of being something almost magical, you know, which is not to say that Life isn't magical. But I think, you know, I think honestly I'll just say one of the biggest challenges for our profession is to be able to communicate in a way that is heard and accepted across the board. I'm not one of those people that's like, you know, we have to have a seat at the table. And we have a massive credibility gap. And I think the essence of that credibility gap comes from the fact that we've largely been a faith-based Profession. for a hundred years we said that when you adjust the spine, you create change in the nervous system. And the truth is we never had have any tangible evidence to say that was true. And now we do. You know, the last two decades of chiropractic has, I won't say brought us a deluge of science. It's brought us, you know, a few dozen really great papers. specifically and around chiropractic neuroscience and largely out of New Zealand Chiropractic College, but also the people at the Foundation for Vertebral Subluxation and ASRF do great, things. I think we need to start to be able to talk about that. I don't think it's it's in any way takes us away from our principles or our philosophy to be able to talk about the science. I f in fact, I think it's necessary. You know, we need to be able to communicate it in a way that convinces the skeptical patient and silences the self righteous medical doctor. That's not a failing. That's a that needs to be where we go. Or we're never gonna grow. Why are we still we're not even at ten percent? We're at nine point one percent. Why are we still at that number? Well, it's because we are doing a very poor message at actually conveying what it is that we have to offer. And that that doesn't negate any of our vitalistic underpinnings. It's just the reality of if we want this to grow, then we need to do something different. Dr. Nick Harvey: I couldn't agree more. I couldn't agree more. And then from your journey on from that into your early years of practice and obviously being in practice for thirteen years, how was that experience? Dr. Monique Andrews: I'd probably be clubbed by the principled chiropractors if I said I didn't love practice. And I did, and I left because I needed a new challenge. I felt like I had taken that as far as I was going to for me. And I was really curious about what teaching would feel like. You know, people say, those who can't do teach. I mean, number one, that's rubbish. And some of the best teachers in the world are People that have had incredible practices, and and I'm one of them. We had a very successful practice. But being able to teach means you know more than the people in front of you. And it's not just what's that quote? I forget the quote. Education's not the filling of a pail, it's the lighting of a fire. So my own personal challenge for me was: how can I help chiropractors do better? Because I'll be honest, when I was in the practice, I just saw what was being graduated the quality, the caliber of chiropractor that was graduating. I saw the struggles and what I was seeing at a time I think when Mac like not mass marketing, practice management really did something to chiropractic at that time that made it feel kind of like yucky. There was this real push in the early 2000s to see as many people as you can. And that was not couched in anything other than you should be rich too. And I think we started producing chiropractors that that was more important than changing lives. And that just I didn't like that. I felt it made me feel dirty. And I wanted to change what that looked like. And I felt like the only way I could do that is if I actually went back to the beginning. And how can we change the output? How can we change the caliber of chiropractor unless we change the education? And so that's what I attempted to do. Dr. Nick Harvey: Yeah, and I really loved one of your posts you put up recently. You mentioned and I I might not get this correct, but you said we've got chiropractors that are clinically they're incompetent. They don't know what they're doing, but they understand all the research, they understand the terminology, they understand the right words to say. And I think that's the the practice management element of they understand all the right words, but they can't deliver the goods. And th there's nothing wrong with understanding the research and being able to communicate effectively and inspire people into care. That's all fantastic. As long as you can deliver. Dr. Monique Andrews: Yeah, you have to have both. You can't be a great adjuster and a terrible communicator. And you can't be a terrible adjuster and a great communicator. you can be both of those things, but the bottom is going to fall out of it. And I think, rarely does we're rarely do we see people drop out of care because of a bad adjustment. It's usually because they either don't understand why they're there, or worse, they think they're there for you to put a bone back in place. And once that's done and the pain's gone, the patient's gone. So, really, it it lies on us. We have to be able to communicate right from the very first interaction. how we design our paperwork, what does our intake look like? What's the focus? What words do we use? I'm a big advocate of words matter. And so, yeah, you gotta have the full picture. Why are chiropractors failing? It's because the story's not complete, the picture's not full. You have to be technically beyond competent. You have to be efficient and well-rounded in your ability to communicate because that's what really drives people's behavior, right? You want to be able to explain things in a way that creates people to take action, to book the appointment, to refer their family, to, you know, have to communicate in a way that inspires people to take action. Dr. Nick Harvey: Yeah, I agree. I agree. And what is it that you're changing now within chiropractors? both clinically, what would you like to see change? What what are chiropractors missing? What where do they need to work on on their adjusting skills? And two, how do they need to change their language and their communication? Dr. Monique Andrews: Yeah, I would say I'm not sure changing adjusting skills is as important as making sure that you're measuring something. You know, you could have all the greatest adjusting skills in the world. If you don't do a thorough assessment, how do you even know that you're adjusting what needs to be adjusted? I literally just posted my article this month for my Dr. Mono's chiropractic research review was looking at specificity and what they did in this study. Was they looked at the brain's response to an adjustment, and specifically adjusting an area that was found by a chiropractor to be what they called relevant, i.e., adjusting a subluxated segment versus some chiropractors would say you can't adjust something that's not subluxated. But anyway, they put an HVLA thrust into a subluxated segment and they put an HVLA thrust into something that was found to be normal. And the only thing that caused significant change in how the brain processed that sensory input was if you adjusted. Subluxated segment. Specificity matters. Now, the only way you know that is if you assess somehow pre and post. You have to measure something. There's a saying that's like there, if there's no measurement, there's no value. I don't know if I agree with that a hundred percent, but we need to measure. We need to check pre and post something, preferably objective, that tells us, yep, hey, you know what, there's a subluxation here, and by the way, you've corrected it. that's a a must, and I know many. Chiropractors today who aren't focused so much on assessment and measurement. And I think more so than refining any technique is, well, the technique you need to refine is the your assessment. that was question number one. What was question number two? how do they need to communicate it differently? Well, they need to learn to communicate it in a way that a five-year-old nods their head or a five-year-old gets it, and the PhD still nods their head, right? Like it needs to be accessible, it needs to be complete. And it needs to inspire them to take action. And both of those things require practice and good mentorship and learning. It's you don't just get it from an Instagram post. I can sure as hell tell you that. Dr. Nick Harvey: That's really exciting that research, 'cause I know I I'll call them Instagram chiropractors. A lot of the the people going around bashing chiropractic, even even the ones within chiropractic, they love to get on and talk about how specificity doesn't matter and it's all just pain, no seception, and it doesn't matter where you put the force into the body, so and and that just goes completely past anything I've ever experienced. I know the adjustment is specific, it's intentional, and I know when I get adjusted in that way versus a broad manipulation. I feel different, so it's great to see the research is is showing that too. Dr. Monique Andrews: Yeah. Yeah. And if you're not taking care in your assessment and the application of, you know, the delivery, then of course you're gonna argue it doesn't matter. If you're a flying seven doc who just rattles the whole chain, of course you're gonna say specificity doesn't matter. well the research says otherwise. Dr. Nick Harvey: It does. And and what objective measurements do you like nowadays for for chiropractors to lean into and to start using? Dr. Monique Andrews: Well, I think that depends on a number of things. It depends on your style of practice. It depends on your budget. You know, can you afford equipment that costs several thousand dollars to look at things like heart rate variability, surface EMG, thermography? These are great objective tools used appropriately. I think also you have outcome assessment tools and screens, which are essentially free. you know, use an SF36 along with a resilience score. maybe a promise twenty-nine. There are many ways that we can evaluate objectively pre and post. And that can come through using a tool that you know measures that technologically. It can come from a tool that measures it through self-report. And both are valid measures, objective measures. Just measure something. I I don't honestly don't care what it is, as long as it's a validated instrument. That actually says does what you say it does. Dr. Nick Harvey: I agree. And and when we integrated the insight scans into our practice, it was it was game changing. It's been foundational. And it was the missing piece for me where I've been looking for this congruent style of chiropractic where I can communicate in such an effective way to to clients, not have to dumb it down and not have not have to use terminology that didn't feel right, that that's up to date with the research. So it's been super. Dr. Monique Andrews: And that takes practice, right? Because, you can have the best instrument in the world. And if you can't communicate what it means and why, for example, on one day the scan doesn't look like the pretty picture you want to see, right? You want you'd be able you can explain that actually we're looking at trends and the body's dynamic. You need to be able to communicate what the scans mean beyond a day where, you know, do a reassessment and Yeah, you wish the scan looked different too, probably. What does that mean, right? So you gotta make sure that you're communicating in a way that's true and valid and also meaningful to the person standing in front of you. Dr. Nick Harvey: I couldn't agree more. When when I first bought them, I'm just all guns blazing personality. So I put them in the practice, we got them ready, and yeah, as you said, if you if you can't communicate, if you can't understand why scans were changing, I was getting really frustrated because I was like, I I can feel you're getting better, but why aren't the scans showing that? So once we really sat down and did the learning, which takes takes a long period of time to understand trends, that Dr. Monique Andrews: Takes time. Yeah. Dr. Nick Harvey: was so helpful. And then you can start to explain the process of subluxation. how that can change and how things can actually look worse before they get better. I think that Dr. Monique Andrews: Yeah. And suddenly that technology forces you to talk about the nervous system, doesn't it? You can't get a you Dr. Nick Harvey: And also. Dr. Monique Andrews: can't get away from it. You can't be a pain, a back and neck pain doc, and use instruments like that that are focused on nervous system function and still be talking about a bone at a place. You're never gonna get to the place that you wanna get, and and they never will either, because they'll probably leave because they'll read through the bullshit story, right? Dr. Nick Harvey: Hey guys, I just wanted to quickly let you know I'm going to be running two-day adjusting seminars across Australia and New Zealand at the end of 2026 and into 2027. They're going to be two days of going deep into what I believe are the fundamental principles of adjusting: holding a high intention, getting deep with your presence, adjusting from positions of ease, and most of all, expressing the art at its highest form. If you're interested, there's a link below in the show notes, or you can go to www. inflowartistry.com.au. All right, back into it. Yep. Yep. And I think that would be a good segue to go down if there is any areas of research you've been diving into to explain why the subluxation process can often get worse or or not get worse but appear worse before it gets better. Dr. Monique Andrews: Yeah. Well, if you look at subluxation as a neurological adaptation, number one, right? The subluxation is a nervous system that gets stuck in a pattern that it wasn't able to release. So here's how I look at it. Everything that we experience in life, our nervous system takes in and it either learns from it and adapts to it, or it somehow gets stuck, gets locked in a pattern. And it's not like When you're subluxated, the brain just ignores that segment. It doesn't ignore it, it continues to take input, but what it does is it creates maladaptive changes because the input's distorted. So then what happens when we deliver the adjustment? We're literally providing new neural input to block the pattern, to tell the brain, we can you can now break that protective pattern that you've been stuck in because it was limiting us, right? And the more inputs that we get, the more consistent the new pattern can happen. Like any learning system, it can be a machine system or a biological system. Learning only happens in one way, and that is consistent and repeated exposures in the same regard. So that's why, for example, we need consistent care over a lifetime, not just one or two adjustments. You might feel better, which is why we don't ever only talk about symptoms, right? Because Yep, you might change symptomatically what the picture looks like. Now, why do we get to plateaus? Well, I think that the therapeutic relationship depends on a couple of things. Number one, the integrity of the input that you're putting into the neurospinal system. But also, what's the capacity the person has? If they eat garbage all day, if they're stressed out, if they don't sleep, if they work too much, if they don't exercise, then is that the same capacity? That we have in someone that has much less allostatic load. The person who, has a stress reduction practice, who eats clean, who exercises regularly, who's in a supportive, nurturing relationship. Surely the allostatic load of person A, the garbage eater, versus person B, who has a much less impactful allostatic load, their capacity, the capacity of the person with the lower allostatic load is going to be greater to accept the new information that you're giving. Now I'm not saying you blame everything on the patient, but really if we're tilling the soil, then the soil matters. And things happen. There's stressors in life. There's, things that are happening globally that makes this time in particular extremely stressful. So we just have an acknowledge that, There are limitations to of matter, going back to the principles, that impact our capacity to receive the healing input of an adjustment. And you're gonna see times when it feels like a setback or it feels like a plateau. And that's what it looks like if you even if you're measuring it. and that's normal, and that we'll see their trajectory continue to grow and elevate because it's not like you're stopping all the other inputs in your life. And that would be a problem in a whole other direction. Did I answer your question? Dr. Nick Harvey: You did. You did. That was great. That was fantastic. You mentioned one part in there which I really want to go into is the integrity of the input. Dr. Monique Andrews: Mm. Dr. Nick Harvey: What do you mean by the integrity? Dr. Monique Andrews: Well, what makes a good adjustment? Number one, assessment. So you have to make sure that you're adjusting a segment that's subluxated or into a subluxated area, however, that's a whole other conversation. So number one, are you actually adjusting the subluxation? Number two, where's your intention? Okay. number three, are are you is your system regulated? Because that person's neurosceptive brain, right? At all times our brain is surveilling its environment, its internal. An external environment to assess safety and danger. So what the brain wants as its most foundational need as a human being, we need safety. So if you're stressed out, if you're running behind, if the CA pissed you off, if whatever, guess what? That means your nervous system isn't regulated, then that person on the table, they're gonna co-regulate, but not in a direction you want them to, right? So you need to be grounded, you need to be regulated because if you're not, That person's brain is gonna tap into your less than optimal, poorly regulated nervous system and get the wrong message. And that too impacts the integrity of the input. Dr. Nick Harvey: Could not agree more. And and it's a lot of the concepts I like to teach too, specifically all starting with intention. Because there isn't there's more arguments around how intention doesn't matter and it doesn't change outcomes. And I talk about how it's the foundation. Intention is really the foundation. Do you Dr. Monique Andrews: Well, your brain doesn't know the difference between what is reality and what you tell it. So I think intention matters if you think it matters and maybe it matters less if you think it doesn't. But when we are in tune with our intent and the intent of the person on the table, when our nervous systems are co regulating in an elevated way, I think you're gonna get better outcomes every single time. Dr. Nick Harvey: And my argument is we always have intention. It's just whether we're conscious to it. Dr. Monique Andrews: Yeah, I agree with that too. Yeah. Dr. Nick Harvey: So I think I think it's it's much better to be conscious to your intention and to bring conscious awareness to what you're trying to co create. So in Dr. Monique Andrews: Yeah. I think you could stop at it's much better to be conscious. Dr. Nick Harvey: Yeah. Yeah. And and you go a lot into consciousness and chiropractic too. I just saw you speak at Neo in Melbourne, which was fantastic by the way. Dr. Monique Andrews: yeah, that was fun, wasn't it? Dr. Nick Harvey: It was great. It was really good. And you talked a lot about consciousness and chiropractic, which I love. what are the the new concepts coming out about consciousness and chiropractic that really excite you? Dr. Monique Andrews: Yes, so the New Zealand crew just came out with a new study looking at the triple brain network. So we talk about the default mode network, which is really when we reflect on self, when we think about our, you know, that whole uniting the physical and the spiritual, that's really the default mode network that we're talking about. This is where sort of, well, at least some of the theories around consciousness believe our concept of self and connection to source reside in the default mode network. And we often see that there's dysfunction in that regard when people are subluxated. And when we adjust them, the early study they did in 24 was that we were seeing changes where there was increased coherence in the default mode network. The new study from 2026 looks at the triple brain network. So, and this was this this the idea of the triple brain network was introduced a long time ago now by it's leaving my cold rattled brain. Anyway. Default mode network, which is reference to self, the salience network, which is like what you pay attention to. So if you want to create any learning, one of the primary factors we need is attention. And the salience network, what that does is it it focuses attention on something. Now, the salience network can become really dysregulated if people are have chronic pain, for example. And in what the brain does, what specifically what the salience network does, is it overfocuses on that. Okay. And then the third network is the central executive network, which is kind of like the top-down planning. It's what organizes, is what turns down other parts of the brain. and what so what this new study did, the 2026 study from New Zealand, was essentially they looked at what happened over 12 weeks of care within these three networks, because presumably the older studies dating all the way back to Lelick in twenty sixteen specifically say, look, when you adjust the spine, you're actually impacting the prefrontal cortex. And that's involved both in the default mode as well as in the central executive network, different parts of the prefrontal cortex. Anyway, I'm starting to nerd out. Let me get focused here. Here's what we know: when you adjust the spine, you're actually improving the functionality within the default mode. So you're enhancing That sense of connection to self, where maybe consciousness resides. And you're dampening output of both the or decreasing c connectivity within the salience network. So you're making the salience network and the central executive network more quiet. Now, why does that matter? Well, if you have chronic pain and the salience network is essentially overactive because you're obsessing, ruminating. Focused on this nagging chronic pain, then that takes a lot of energy and resources. And then also the central executive network, if it cannot turn down the salience network, if it cannot turn down noise in the system, any noise in the system gets determined, gets interpreted as input. And then that input again increases the allostatic load, and you're working in a system that that's you're not gonna be at your most elevated state. And so they didn't just look at what was happening within these three networks, they also looked at they did quality of life, they looked at what was happening with anxiety, depression, fatigue, sleep. They use Fitbit. And they saw improvements not only across every single one of these networks, but across each of these measures in the same people across the same time zone, using the same measures. That's really big. And they made a statement that basically said these changes are due to chiropractic. This is massive because normally in most studies they're never gonna say due to, because that means causation. And the fact that they could say that is just a really profound message that you get from research today, because it sh specifically showed that chiropractic was creating massive change across these factors. And certainly in these parts of the brain that are responsible for our sense of self. if you take a patient that's in chronic pain, you can imagine their sense of self is going to be altered. yeah, it's very exciting. And it was over a long period of time. So they did, you know, immediately post-adjustment, four weeks, 12 weeks. The care was for 12 weeks, three times a week for 12 weeks, and then they even checked it 16 weeks, and they still saw. That these changes were present. Now, this also gives us a ton of fuel for looking at, you know, everybody wants to talk about man care management. How many times a week? For how long? Well, most studies they have a finite amount of time they can be doing research for. So this study ended at 16 weeks, but we don't know if the if the positive results extended beyond that. And this is something that I spoke with Imra Imran Nia Nyazi over at New Zealand when I was there in August. or September and it's the direction that they're moving into in the new year to start to do longer term studies. And we need that because it's it's the c one of the most constant detractors of chiropractic research, right? Numbers too small, not long enough, not repeated. Dr. Nick Harvey: Yeah, I I hear that a lot. And that there's a part of me that unfortunately feels like they'll never be happy with the the research we we bring forwards, even no matter how good and how great it gets, but we we continue on from there too and Dr. Monique Andrews: Yeah, everybody doesn't have to be happy. We have to be happy, and then we have to be able to communicate it in a way that drives people to take action. Yeah. that's the nature Dr. Nick Harvey: Agreed. Agreed. In that I think Dr. Monique Andrews: of research. People are supposed to argue about it. let let's be real. it's normal for there to be discourse. I have discourse with people all the time about the state of research. What matters, and because you know what? Here's the reality. You can have one paper that says one thing and another one that says something entirely different, and then you get to have discourse about it. And then It was like, hey, well, maybe if we ask this question and do this study, we'll it'll tell us something else. It never ends. That's the story. Dr. Nick Harvey: Yep. Within that what I think would be really beneficial is for chiropractors to start because I I think widely there's this big th there's a lot of fear within chiropractors to tell people how much care they need and probably in a subluxation way they're over delivering, doing too much to the nervous system too early. if you understand where I'm coming from. Is there is there research talking about the number of adjustments At which stages of care and also the frequency and duration. Dr. Monique Andrews: It's spotty. We do have some research and It really a lot of it has is technique specific or it's way less than I think it should be. And the research that I just spoke about out of New Zealand is the closest, most relevant piece of research lately that says, Hey, look, seeing people three times a week and doesn't mean adjusting them three times a week, but they were seen and evaluated three times a week for twelve weeks created incredible changes in system wide brain level activity in a very positive direction. I don't think you can you we had this qu I was on a expert panel on the remarkable practice a couple of weeks ago, and that was a question was about overutilization versus underutilization. And I think it's a problem just in opposite directions. It's a miscalibration, right? If you underutilize There's no perfect number, by the way. If you underutilize, then what happens is people don't get the care they need. And, you know, if you stop when they no longer have pain, for example, or symptoms only, then they leave and the it's not done because they haven't had enough input neurologically to create adaptive neuroplastic change. We need consistent repeated exposure, right? and then overutilization. What does it even look like? Can you over-adjust if someone's not subluxated? If they're subluxated, they need an adjustment. But if we overutilize, then what often happens is you're not actually evaluating appropriately. Because if you did, if you were measuring and assessing for subluxation, then it's not even possible to overutilize because you cannot adjust a non-subluxated segment. It what's too much? Dr. Nick Harvey: I think within the chiropractic community, there's a lot of talk at the moment of and and I'd love to go into this with you too about the polyvagal stuff, of understanding what state someone's nervous system in is in. And then picking a priority for what to adjust. And I mean, this is very specific in the realm of kids and and my mentor, Dr. Tony Ebel, talks a lot about this of choosing what to adjust and what what frequency and how many adjustments you're gonna deliver based on that state and and and where the nervous system's at, which he talks a lot about within the kids framework and less is more approach, especially in an exhausted shutdown nervous system. That's super important that you're you're picking the most exhausted area and you're working, you know, from from less is more approach. That's that's where I'm really coming from. And then obviously into adults it gets a little more here there. You know, how much how much is too Dr. Monique Andrews: Yeah, that that's Dr. Nick Harvey: much? Dr. Monique Andrews: and in my mind that's not the same as Overutilization because that's a capacity issue. It goes back to what I was saying earlier, right? You of course, polyvagal is my thing. Of course, you it's depends on the state, it depends on the capacity. That therapeutic relationship, if the capacity's not there, there's no point putting in more input. The input has to be determined by a number of factors, one of which is what can this system tolerate today, which is when I say if you have a conscientious chiropractor doing intentional work, they're you're not gonna overdo it because if you're following the rules of care, you're not gonna do that. Then again, I think you're just trying to pad your numbers for your business plan, not a care plan. Dr. Nick Harvey: Mm. And and maybe that should have maybe I should have reframed my question initially too, because that's what I wanted to go into with you was explaining to chiropractors the polyvagal states and what to do with each person at at at different levels as well from from experience you've seen and what the research shows. Dr. Monique Andrews: Yeah. Well, that I have a whole four-hour class on that, so I'm not gonna be able to answer that in an hour-long podcast, but I will basically give you a quick overview of what's relevant. if people are interested and want to dive in, then here here's here's the theory in a nutshell. And that basically is pr arguably the most clinically relevant framework outside of chiropractic for understanding human nervous system behavior. Poor just developed polyvagal, announced it initially in nineteen ninety-four in Atlanta, and he said. that it was it it was a framework for helping us understand why people behave the way that they do in response to safety and in response to danger. And three of the main tenants. Actually before I get into the three of the main tenets, in the spring there was this new article by Grossman and a few cronies talking about how Polyvegel was debunked. how many times did we hear chiropractic was debunked pseudoscience? I I ask and implore people to to maybe invoke the same amount of reverence for studies like that as they do too when people tell us that what we do is pseudoscience. And essentially what Grossman and people said was, you know what, we don't know if the ventral vagus e myelinated specifically so that we could have social engagement. And the other thing they said was we can't use respiratory sinus rhythm in relationship to heart rate variability as a measure of ventrovagal tone. Even though we now know that Heart rate variability is a measure of vagal tone, but we don't know if it's specifically ventral. So, okay, I'll give them those two things. Porgis acknowledges it, I acknowledge it. Here's the three tenets of polyvagal. Number one, that there are three main states, although three also hybrid states: ventral vagal, sympathetic dorsal vagal. And these states are hierarchical, meaning they developed at a very baseline level of survival, which is dorsal vagal. Evolved into sympathetic, which is your fight or flight response. And then the newest, most adaptive, and probably most sensitive is the ventral vagal system. This is our freedom friends in Forage. so if dorsal vagal is freezer fawn, that means that when you well, I'll start at the top. Let's say you walk into a room and you see somebody that you know, what happens? You smile, right? Do you see them and then think, I should smile? No, you naturally just do it. That's your social engagement nervous system. Okay? So that's the ventral vagal. This is how we are connected with one another. This is how we feel amazing in the world. if you walk into a room and it doesn't quite feel safe and you're not sure, you might drop into fight or flight. There's your nervous system has sensed there's a threat. You drop into that fight or flight response, amygdala gets charged up. Activates the sympathetic nervous system for aggressive defense mobilization. Important terminology, aggressive defense mobilization. Something's not safe, you go into an aggressive stance and you mobilize fight or flight. You run or you fight. Third option is it's life threatening, and because of that, you drop into a passive defense immobilization. That is the dorsal vagal system. So what is passive defense of immobilization look like? It looks like freezer fun. What does a lizard do? It plays dead, literally plays dead because predators do not want dead prey because it's infected and who knows what, right? So that's the basic hierarchical system. And what Poor just says and what we see demonstrated in the behavioral literature and the neurophysiology literature is we literally move through those. The good news is they're all available to us at all times. People tend to hang out in one or the other though. Right? We all have those patients who are hyper-vigilant all the time. You can hardly do a leg check because they're so in a state of control. That's fight or flight. So that's the first one that there's a hierarchy within our nervous system platforms, that these platforms are available all the time. the second is neuroception, that your brain at all times is surveilling its environment to determine if it's safe or not. That happens below the level of conscious awareness. As soon as your brain determines there's a lack of safety. The amygdala gets fired up, sends signals to the hypothalamus, floods the body with hormones like cortisol, adrenaline, and it creates an active defense mobilization. Your nervous system is literally activated. That's normal. We want that to happen. If we're under threat, you want the body to go and fight or flight. we also want it to come back down, and there are many theories and reasons why it doesn't. This is what we see a lot when we go through like experimental global inoculations and things like that. and then the third one, co-regulation. And I talked about this earlier that you, even before the adjustment, are a clinical intervention because your nervous system state will automatically help the person on the table co-regulate. Now, can you co-regulate up, co-regulate down? Absolutely, which is why we want to be, you know, functioning at the highest level of regulation and adaptation that we can be getting checked regularly, doing all the right things. We always tell everybody else to do. So when we bring these three things together, it's a really powerful way to actually address care. And it even brings us back into care plans because what's our number one human need? Safety. You need to be regulated. And telling somebody 50 times this is a safe place is a load of rubbish. You cannot talk somebody into safety. You have to create that through your own nervous system. Through the layout of your office, through your CA, through your intake paperwork. It's not something you can skip. And there I think it's one of the main reasons why people leave care because their brain on an unconscious level does not feel safe. And if you're only driving your care plans based on, no, everyone gets seen three times a week for three months, then twice a week for three months, and then once, and if it it's anyway, you get the Dr. Nick Harvey: Yeah, Dr. Monique Andrews: drink. Dr. Nick Harvey: if you're a chiropractic student or a chiropractor and you're curious about how you might be able to improve your adjusting, I've created a free quiz on inflow artistry all about going deep into what I believe are the five most fundamental foundations of adjusting. It's completely free. It'll take you about 10 minutes to fill out, and it'll give you a detailed report of where you're doing well and where you might be able to improve. If you're interested, the link will be below in the show notes, or you can go to inflowartistry.com. dot-ayy-you slash quiz. I do. I do. And I I couldn't agree more that people want to feel safe, they wanna feel important, they wanna feel seen and heard. Dr. Monique Andrews: Yeah. Dr. Nick Harvey: And they wanna feel like the care that is tailored to them and that's that's the way we should practice in a congruent chiropractic model is that everything is individualized towards the client and Dr. Monique Andrews: Hundred percent. And it doesn't mean you don't have systems, but it means you acknowledge, you know, the unique masterpiece that person is and you move accordingly. Dr. Nick Harvey: And on the rarity that you just get someone coming in that's just regulating so well, which is is so hard for me to see nowadays. I just they're they're one in a hundred, one in a thousand, but you get them come in and you go, This is awesome. We Dr. Monique Andrews: Yeah. Dr. Nick Harvey: we only need to see you this frequently ongoing. You you you don't need to go through an intensive phase to begin with. Dr. Monique Andrews: Yeah, let's see what kind of inputs your nervous system needs. Let's see what comes up for you in life. This is how we manage. You're doing so great. This is how we manage care for you. And it's specifically based on what you're coming in with each visit. This is what I would recommend for us to begin. And even for everybody, even if at the ventral vagal person comes in and they're crushing it, I'm still gonna want to see them again in a few days in the beginning because let's see how your nervous system responds to input. But I think the key piece for people to recognize is number one, all however you present, like if we talk even about Porges's three nervous system states or platforms, all of them are available to you at all times. And we want to see people moving through them. We don't want to see them stuck. What we want to see is that there is flexible adaptability, that they're not getting stuck in a pattern. That's the biggest gift of chiropractic is to disrupt. maladaptive patterns. That's the whole point. Dr. Nick Harvey: Yeah. Could not agree more. And back on the element of safety, you spoke about something really interesting at NEO that just came through about the part of the brain that we we skip when we're doing hands-on chiropractic work. The the part that yes, yes. And I thought that was really interesting to understand that element of safety, but also that element of of how we can access parts of someone's nervous system that may be difficult to get into through things like talk therapy or or other Dr. Monique Andrews: Yeah. Dr. Nick Harvey: modalities. Dr. Monique Andrews: Yeah, top-down versus bottom-up care. I use the term embodied neuroscience, and I do some work specifically in that realm outside of chiropractic that is working through the body versus through talk therapy. Meditation is top-down too, right? there are many practices that are top-down, meaning it starts in the brain and and then it goes from there. So talk therapy, for example, is a very top Down cortex-driven word thought-based approach. And it's so complex and it's so slow that it's very difficult for us to be able to change what's happening, let's say, for example, in the limbic system. Like if you're emotionally, if there's a high level of emotional discharge, all the rational talking and thinking in the world is not gonna be able to change what's happening. Limbically. So that's the limitation of talk therapy. it's great for a reframe. if you're seeing the same talk therapist after three years, they must have a great schnick because, there's only so much talk can do. And unless you're in psychoanalysis, for example, in Jungian psychoanalysis, which is a whole other thing, talk therapy, it's not meant to be long term because anyway, when you work through the body. And we have those inputs, we have a much faster trajectory to get to the limbic system, to get to the subcortical structures. Because some of that input, we don't we're not trying to convince the cortex. And in fact, we go straight into limbic system structures in a way that is much faster and in a way that moves beyond the level of thoughts and words. nobody needs to be convinced. The amygdala just needs to. And well, not just the amygdala, the insula, the whole threat detection system, needs to be needs to feel safe. And that doesn't happen through words at all. Dr. Nick Harvey: It's really powerful. Dr. Monique Andrews: Unless you're talking to yourself. Telling yourself right here, right now, I feel safe is actually impactful, especially if you put your hands on your body. there's only three ways to feel safe. Number one, you tell yourself you feel safe. Number two, you have to trust your instinct. and number three, you have to dampen sympathetic output. Dr. Nick Harvey: Hmm. Really powerful. And on that, pardon me, on that too, where what's exciting you at the moment on where the chiropractic research is heading in the future and and what do you see coming through in the next five, ten, twenty years, especially for our profession? Dr. Monique Andrews: Yeah, I think we're gonna see more and more brain search. I love research. I love that, New Zealand is now diving into the realm of consciousness. And, in the early days, they and still today to a certain degree, you know, a lot of this research uses language that is ambiguous. Like a spinal manipulation is not the same as an adjustment. Lots of people can do a spinal manipulation, only a chiropractor can do an adjustment. But you know, 20 years ago, in order for us to get published. in those journals, that language was used. And it's nice to see that we're finally have have, you know, maybe earned enough credibility within the research community in some of those journals that we can start to use our own language again and talk about adjustment and subluxation and move it in that regard. And I love that we're finally getting to the place where we're starting to talk about people's subjective lived experience beyond pain. Because here's the reality, right? We live our whole lives through our nervous system, above, down, inside out. And the only way that life is meaningful is because we do have thoughts, because we do have consciousness. And if we can start to tap into that in a meaningful way, then I think that opens up a whole other conversation. I think it's a conversation we can already be having from the small amount of research that we do have, and it's a conversation we need to be having as chiropractors. Away from the whole pain and symptom conversation into talking about here's your about this is what's happening with your lived experience. Conversations about allostatic load, conversations about consciousness, adaptability, resilience. We're impacting all of these things. And it's just that, you know, our profession is so uneducated about what is there that they can't talk about it. So it requires some work. Do the work. Dr. Nick Harvey: I agree. I agree. And we'll and we'll touch on that just next, but just quickly, you mentioned a couple of things and I really want to hear from a neuroscientist perspective and how your understanding of this has evolved over the years to what's the understanding we now have about the innate intelligence of the body and and where that comes from also the universal intelligence too in in both your lens and a a scientific lens? Dr. Monique Andrews: Well, that's a difficult concept because what was that machine called? Encephaloment whatever. they tried to measure the mental impulse, right? And I and I love the concept of mental impulse, but it's not anything at this point that we've put into a cogent way of evaluating, as much as the innate intelligence. Here's what I know, and how in my mind I put it together, and that is that when you're subluxated, that creates a separation from innate. And when we adjust somebody. That allows for that separation to reunite. That's growth, by the way. When you're subluxated, that's information. And the body pays attention to that. And what is intentional becomes salient. And what is salient then is what allows for change. I think if we can find a way to take the concepts and bridge our understanding by using more contemporary language, I'm not saying abandon it, but that language, innate intelligence, mental impulse. This is really relevant and important to us in our own chiropractic philosophy. I don't think it necessarily matters for what we're doing in our conversations with the public. And in fact, maybe it creates some confusion. We never have to get rid of it, but it's for us. You know, it's our own f philosophy. we're certainly not measuring it in a way that we can say, look, here's we just measured the mental impulse. We measured innate intelligence. Can we? Use terms like adaptability and resilience, which I think really are. If we wanted to say, well, if you look at somebody's ability to prepare for, adapt to, and recover from challenge, that's an indicator of the body's innate wisdom or innate intelligence. But technically, are we measuring innate intelligence? No, can we know? Dr. Nick Harvey: Yeah. Dr. Monique Andrews: but we can measure the expressions of it. Dr. Nick Harvey: Yeah. And I guess that's in in my very short lived career where where I'm headed and what I've started to understand is looking at the th the theories and the concept of the thermodynamic subluxation Dr. Monique Andrews: Mm. Dr. Nick Harvey: and and the potential energy theory of of the subluxation too, in that the life force or the innate intelligence of the body has limitations. And when we are subluxated that that we know and understand that That takes more energy. That utilizes more energy. and Dr. Monique Andrews: Yeah, I don't know the life force has limitations or it meets with patterns that limits its expression. Because I think intelligence is infinite. and you know, I study with Sue Brown when I was a a student, and for her, subluxation is potential energy, you know, and it goes back to what I said at the very very beginning, which is everything we experience in life, whether it's physical, mental, chemical, the body takes that in. And it either learns and adapts or it stores it and it gets stuck as potential energy in the form of subluxation. again, I think so many of these concepts can be useful sometimes in explaining to the outside, and for the most part, they're for our own level of certainty more than they are for the publics. Dr. Nick Harvey: Yeah. And I think what I've even noticed in this podcast, what you do such a fantastic job of is really explaining the science in such a simple way. And I'm sure a lot of chiropractors are really gonna love hearing this and would love to know what work you do with chiropractors, what you teach them, how you help them implement this. I mean, if a chiropractor comes to you, what what have you got to offer? Dr. Monique Andrews: Yeah. Thanks for asking that. so there are two main ways that doctors learn with me. One is through my Dr. Mono's chiropractic neuroscience training program where we meet every month and do a live class. I'm not one of those speakers who like just keeps regurgitating the same old thing over and over. Every month we do a new topic very specific on something in chiropractic that's relevant from a principled, accessible way, just like how we're talking here today. Like my whole thing is this, right? I want chiropractors to be able to communicate what it is that they're doing with their hands, what's actually happening when you adjust somebody, and to communicate that in a way that the person in front of you gets it and it drives them to take action. And that's what we do in Dr. Monos. The other thing that I launched in 2025 was my chiropractic research review. So people subscribe and every month they get a new article. As well as my breakdown in three or four pages with clinical integration tips and patient education scripts. I always said I wouldn't do scripts, but so many people are like, but I just love the way you say it. So then I start I and now I do include scripts. And I'm but I still say, you know what, make this your own. Here's a great place to start. Yeah. And all everything is formatted in a way that is also really conscious about neuropriming, which means. You use the words not just to tell the story, but actually to create change below the level of conscious awareness. I think that's neuro linguistic programming, but just to say that I'm not just delivering the neuroscience, I'm delivering it in a neuroscientific way that is gonna get you better results ultimately. Dr. Nick Harvey: Yeah, I couldn't agree more. And the the new age of of science, people are more hungry than ever to understand what's actually happening from what I see. You know, they're they're sick of the old ways of of the simplicity of the explanation and and not even the simplicity, just the outright wrong ta ways we can communicate. Yeah. Dr. Monique Andrews: But it's so incomplete, right? We we used to talk about the foot on the hose. Like what a brilliant analogy. And damn, is it ever it's just falls so short because that's actually not what's happening. And it's so reliant on this bone out of place old biomechanical science. And we now have all this beautiful neuroscience that says, actually, you know what? There's something much more global happening here. And as we start to layer in more and more pieces, that story is just gonna get beautiful. But we're already out of place. Where the story that you tell people based on current research is really, really impactful. And I don't want anybody to underestimate the profundity of the impact of your words in your communication. Dr. Nick Harvey: I couldn't agree more. I could not agree more. And just before we finish up, thank you for your time, Doctor Mo. I'd love to hit you with one last question and and just put you on the spot a little bit here. I'm a new client walking into your clinic and I'd love to hear in a minute or less just how you would communicate what what chiropractic is and what we're gonna offer you today. Dr. Monique Andrews: Yeah. So chiropractic care is chiropractic care helps your brain and body communicate better so that your nervous system can adapt to the demands of life. What we do in this office is assess your nervous system for integrity and look for areas of subluxation, which are areas that your body starts to store as a pattern because of something it's learned. It's not a limitation, it's an adaptation. But we want to make sure is that your body does not get stuck in patterns that are limit you limiting you further. And when we adjust you, what we're doing is we're providing precise input to your nervous system so that we can break those patterns. And it's almost like I don't like the word reboot. I like the word re-recalibrating, right? We've all worked with computers before when a program gets frozen. We're recalibrating the information so that what happens is you're able to adapt to challenge. You become more resilient, more flexible. And that shows up in all areas of your life, whether it's better sleep, better sex, better movement. Less stress, you name it. the nervous system learns to let go of old patterns that didn't serve you so that you can live the most possibly elevated lived experience. Something like that. Something like that. You can sign up right now, Nick. Dr. Nick Harvey: That was beautiful. W when when can I get started? When can I get started? That was great. Dr. Monique Andrews: Drmonos.com. Dr. Nick Harvey: That was great. Thank you so much for your time today, Dr. Mo. It was really inspiring and I I really appreciate all the work you're doing from afar in in the profession and the impact you're having. I believe we've we've got so many different soldiers of chiropractic that are doing such great works and all super essential from different lenses. So thank you. We we appreciate you and the work you do. Dr. Monique Andrews: thank you, Nick. Thanks for having me. I appreciate it. Dr. Nick Harvey: That's all right. Until next time. Thank you for listening to the Intune podcast. If you made it this far, I appreciate you being here. And if you enjoyed this episode, I would really appreciate if you could leave us a five-star review and share this with a friend. We'll see you next time.