SPN

IN OLDER PATIENTS, PAIN RELIEF IS NOT ENOUGH

If an 80-year-old patient’s pain decreases from 8/10 to 3/10, have we succeeded?
Maybe.

But I think we need to ask better questions.
Can the patient get out of a chair without assistance?
Can they walk outside?
Can they climb stairs?
Can they turn quickly without losing balance?
Are they becoming stronger?
Are they less afraid of falling?
Can they return to the activities that make their life meaningful?
In older adults, function may be a far more meaningful clinical outcome than pain alone.

This is where chiropractic, rehabilitation and functional neurology can potentially speak the same language.
Movement.
Strength.
Proprioception.
Balance.
Sensory integration.
Autonomy.

The 2024 Lancet Commission on dementia prevention is particularly interesting in this context. Physical inactivity, untreated sensory impairment and several cardiovascular and metabolic factors are among the potentially modifiable factors associated with dementia risk.
This does not mean chiropractic prevents dementia.
We must be scientifically precise about that.
But it does reinforce something I strongly believe clinically:
Helping an older patient remain capable of moving and interacting with the world has value far beyond simply reducing back pain.
In SPN – Simplified Practical Neurology, I increasingly think of successful care as helping the nervous system interact more effectively with its environment.
Pain matters.
But function, adaptability and independence matter too.
Perhaps even more as we age.

📚 Reference:
Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024;404:572–628. PMID: 39096926.
PubMed

Learn more about SPN – Simplified Practical Neurology:
SPN Technique

Neurology ClinicalReasoning PatientCenteredCare

JOIN OUR SPN INTRODUCTORY ZOOM

This meeting is designed for the doctors attending the Michigan seminar, but it is also open to any chiropractor interested in discovering the principles of SPN.

📅 Thursday, September 24, 2026
🕢 7:30–8:30 PM Italy / 1:30–2:30 PM Eastern Time

🔗 Zoom link:
https://us06web.zoom.us/j/87614685032?pwd=zdVZa5KoFss1PrDbqUI8zdN1d4hN1u.1

Meeting ID: 876 1468 5032

We will introduce the philosophy, neurological principles, and clinical reasoning behind Simplified Practical Neurology.

The meeting will also be recorded and shared on our website and social media, so anyone interested in SPN will be able to watch it later.

JOIN OUR SPN INTRODUCTORY ZOOM

This meeting is designed for the doctors attending the Michigan seminar, but it is also open to any chiropractor interested in discovering the principles of SPN.

📅 Thursday, September 24, 2026
🕢 7:30–8:30 PM Italy / 1:30–2:30 PM Eastern Time

🔗 Zoom link:
https://us06web.zoom.us/j/87614685032?pwd=zdVZa5KoFss1PrDbqUI8zdN1d4hN1u.1

Meeting ID: 876 1468 5032

We will introduce the philosophy, neurological principles, and clinical reasoning behind Simplified Practical Neurology.

The meeting will also be recorded and shared on our website and social media, so anyone interested in SPN will be able to watch it later.

Thank you again to everyone joining us in Michigan. We can’t wait to work together.

SPN is not another technique. It is a neurological framework designed to enhance any other chiropractic approach.

🌐 www.spntechnique.com

THE PATIENT SHOULD NEVER HAVE TO ADAPT TO YOUR TECHNIQUE

The patient should never have to adapt to your technique.
Your technique should adapt to the patient.

I believe this becomes especially important when treating older adults.
Consider two 80-year-old patients.
One still plays tennis, walks several kilometers and has excellent balance.
The other has osteoporosis, sarcopenia, previous falls, limited mobility and significant fear of movement.
Same chronological age.

Completely different nervous systems, biomechanics, resilience and capacity to tolerate input.
Would it make sense to deliver the same adjustment to both?
I don’t believe so.
Aging is associated with changes in bone, muscle, sensory integration and postural control. This means that the dose, direction and intensity of our intervention matter.
Sometimes the most intelligent neurological input is not the strongest one.
It is the smallest appropriate stimulus capable of producing the desired response.

This idea became fundamental in the development of SPN – Simplified Practical Neurology.
SPN is not about abandoning chiropractic adjustments.
Quite the opposite.
It is about asking:
What does THIS patient need TODAY?
High force?
Low force?
Proprioceptive input?
Vestibular stimulation?
Movement?
Balance work?
Or sometimes simply less input?
Technique should be the consequence of assessment.
Never the starting point.

📚 Scientific context:
World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. Older adults benefit particularly from multicomponent physical activity emphasizing functional balance and strength.
WHO physical activity guidelines

Learn more about SPN – Simplified Practical Neurology:
SPN Technique

Neurology PatientCenteredCare

PAIN IS NOT THE SAME AS NEUROLOGICAL DEFICIT

One of the most important lessons in treating lumbar disc herniation is this: pain intensity and neurological impairment are not the same thing.
A patient may present with severe radicular pain while maintaining relatively good motor function.

Another patient may tell you:
“Actually, Doc, the pain is getting better...”
while strength is deteriorating.
Which patient concerns me more?
Often, the second one.
Especially in an older patient, our assessment cannot stop at:
“How much pain do you have today?”
We need to repeatedly assess neurological function:
motor strength, reflexes, sensation, gait and changes over time.
Progressive motor deficit, foot drop, saddle anesthesia or bladder/bowel dysfunction fundamentally change the clinical decision-making process.
The WFNS Spine Committee recommendations support conservative treatment as first-line management for lumbar disc herniation when cauda equina syndrome, motor deficit or other serious neurological deficits are absent.
This is also highly consistent with the philosophy behind SPN – Simplified Practical Neurology.
Before asking:
“What adjustment should I make?”
I believe we should ask:
“What is this nervous system telling me?”
Assessment determines intervention — not the other way around.

📚 Reference:
Yaman O, et al. The role of conservative treatment in lumbar disc herniations: WFNS Spine Committee recommendations. World Neurosurg X. 2024;22:100277.
PubMed

Learn more about SPN:
SPN Technique

DiscHerniation ClinicalReasoning

THE MRI IS NOT THE PATIENT

An 80-year-old patient is not simply an “elderly patient.”
And an MRI showing a lumbar disc herniation is not, by itself, a diagnosis of what is generating that patient’s symptoms.
In older adults, imaging frequently shows multiple findings at the same time:
disc degeneration, facet arthropathy, foraminal stenosis, central stenosis, spondylolisthesis and disc herniation.
The clinical question therefore becomes much more interesting:
Which finding is actually relevant to this patient?
This is where clinical reasoning must come before technique.

I want to know:
Is there a neurological deficit?
Is strength changing?
What are the reflexes telling me?
Is sensation altered?
How does the patient walk?
How is balance?
What happens under load?
And, most importantly, is the clinical picture consistent with the imaging?

A systematic review by Brinjikji et al. demonstrated just how common degenerative spinal imaging findings are in asymptomatic individuals — and how dramatically their prevalence increases with age.
This is one of the principles that has strongly influenced the development of SPN – Simplified Practical Neurology:
We don’t treat an MRI.
We don’t treat an age.
We assess the individual nervous system in front of us.
And then we choose the appropriate stimulus.

📚 Reference:
Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015;36:811–816. PMID: 25430861.
PubMed

Learn more about SPN – Simplified Practical Neurology:
SPN Technique

DiscHerniation HealthyAging

WHERE I RECHARGE… AND WHERE MANY PIECES OF SPN CAME TOGETHER 🌊🧠

This is Tavolara, Sardinia.

For me, it is much more than a beautiful island.

It is one of those magical places where I recharge my batteries, reconnect with nature, clear my mind, and somehow become more creative.

Over the years, I have spent many hours here studying and thinking.

I studied all the modules of Dr. Robert Melillo, whose work became an important part of the functional neurology framework that influences SPN.

But SPN has never come from one teacher, one technique, or one school.

Throughout more than 30 years of practice, I have had the privilege of learning from many extraordinary doctors and teachers.

Dr. Carrick, Dr. D’Onofrio, Dr. Mark Pick, whose knowledge of SOT deeply influenced me, and Dr. Seru, my personal mentor in what we used to call the San Rocco Method even before the San Rocco Method was invented 😜.

We spent countless hours working on the tension of the dura mater: how to evaluate it, how to influence it, and especially how to make those concepts simpler and more accessible to chiropractors who were not necessarily experts in AK.

I also learned from the work of Dr. Victor Frank, the father of TBM, Dr. Donald Epstein, Dr. Ted Morter and BEST, and Dr. George Gonzalez and Quantum Neurology.

Different teachers. Different models. Different ways of looking at the patient.

And not all these approaches have the same level of scientific evidence. Some are supported by stronger neurophysiological research; others come primarily from clinical models developed within different chiropractic schools.

But each of them made me ask questions, observe my patients differently, and continue searching.

Today I was discussing adjusting and functional neurology with Dr. Paul Bergamo from Australia, and we agreed on something that summarizes much of what I believe:

The patient should not adapt to the doctor.
The doctor should adapt to the patient.

Our responsibility is to keep learning.

To have as many tools as possible.

To understand the person in front of us and choose the most appropriate stimulation for that individual nervous system at that particular moment.

This is one of the fundamental ideas behind SPN – Simplified Practical Neurology.

SPN is not a collection of techniques.

It is my attempt to take what I have learned from great teachers, neuroscience, more than three decades of clinical experience, and most importantly from thousands of patients, and make it simpler, practical and clinically useful.

And somehow, looking at Tavolara again today, I realize how many of those pieces came together right here. 🌊

Never stop learning. Never stop questioning. And never force the patient to fit your technique.

🚀 Ready to elevate your clinical results?

I’m excited to share two important updates with you:

📄 The official agenda for our upcoming SPN Seminar
🌐 Our newly redesigned website: www.spntechnique.com

Take a few minutes to explore both and discover what makes SPN different.

SPN is not another technique it is a neurological framework designed to enhance any chiropractic approach.

Our mission is simple: help Doctors of Chiropractic improve clinical outcomes immediately while developing a deeper understanding of functional neurology and the autonomic nervous system.

Unlike many educational programs that require years of seminars before doctors feel confident applying what they’ve learned, our goal is different.

We have designed SPN to provide you with the essential concepts, clinical reasoning, and practical protocols you need to begin implementing SPN in your practice immediately after your very first seminar.

But our commitment doesn’t end there.

Learning SPN is much like caring for patients—every doctor learns differently.

Some master the concepts quickly, while others benefit from more guidance and individual coaching. That’s why we continue to support every participant throughout the entire year with:

✅ Live group Zoom coaching sessions
✅ Individual mentoring when needed
✅ Clinical case discussions
✅ Ongoing protocol updates as SPN continues to evolve
✅ Access to an international community of passionate chiropractors committed to clinical excellence

SPN is a living neurological framework.

Every week we continue refining our methods through clinical experience, neuroscience, and collaboration with our growing international community.

When you join SPN, you’re not simply attending a seminar.

You’re joining a family of chiropractors dedicated to becoming better clinicians and helping more patients every day.

The tuition reflects far more than two days of education.

It is an investment in long-term mentorship, continuous clinical support, and a community that genuinely wants every member to succeed.

We don’t just teach a seminar.

We build confident chiropractors. Together.

🌐 www.spntechnique.com

I hope to welcome you personally at our next SPN Seminar.

Dr. Manuel Mazzini
Founder – SPN (Simplified Practical Neurology)

Simplified Practical Neurology SPN – Simplified Practical Neurology Transform the way you practice. Transform the way you serve. Welcome to Simplified Practical Neurology (SPN) Simplified Practical Neurology (SPN) is an innovative approach designed to bridge the gap between advanced neurological concepts and their practical app...