|Chiropractic Reduces Falling Risk in the Elderly
Chiropractic Care Improves Senses and Reduces Risks of
Falling in the Elderly Population
By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
As our population ages, our most senior are being told that their heart diseases or cancers won’t be as likely to cause death as sequella from a fall. Therefore, doctors are urging that sect of population to rely more and more on canes, walkers and other devices to help offer greater support when balance issues become even slightly problematic. According to Holt et. Al (2016) “Falls account for more than 80% of injury related hospital admissions in people older than 65 years and they are the leading cause of injury related death in older adults. Approximately 30%-40% of community-dwelling older adults suffer from at least 1 fall per year.” (pg. 267)
Holt et. al. listed the following risks associated with falls
- Lower limb weakness
- Recent History of Falling
- Gait Deficits
- Deterioration of the sensorimotor system that occurs regularly with normal aging
The National Institute of Health (NIH) expanded the list of risk factors in older adults to include:
- Muscle weakness
- Balance and gait
- Blood pressure drops
- Postural hypotension
- Reflexes slower
- Foot problems
- Sensory problems
- Vision issues
Comparatively speaking, both the Holt et. Al. and the NIH are in agreement that falling can be a multifactorial issue with often no single cause or solution. However, if an older person, who has one or more of the above risk factors can minimize those risks, the likelihood of falling can be decreased and potentially extend their life. Holt et. al. continued “There is however, a growing body of basic science evidence that suggests that chiropractic care may influence sensory and motor systems that potentially have an impact on some of the neuromuscular risk factors associated with falling.” (pg. 268) In short, the evidence has suggested that chiropractic can reduce the risk of falling in older adults.
Holt et. al. found that the mechanisms where chiropractic may influence sensorimotor functions are:
- Neuroplastic processes in the central nervous system through altered afferent input.
- Pain and altered cognition as a result with respect to attention focus and physical function
- Muscle strength and muscle activity patters
- Deterioration of the sensorimotor system that occurs regularly with normal aging
Looking at those neuroplastic processes or effects of chiropractic on the central nervous system, Gay et al. (2014) reported, “…pain-free volunteers processed thermal stimuli applied to the hand before and after thoracic spinal manipulation (a form of MT). What they found was that after thoracic manipulation, several brain regions demonstrated a reduction in peak BOLD [blood-oxygen-level–dependent] activity. Those regions included the cingulate, insular, motor, amygdala and somatosensory cortices, and the PAG [periaqueductal gray regions]” (p. 615). In other words, thoracic adjustments produced direct and measureable effects on the central nervous system across multiple regions, which in the case of the responsible for the processing of emotion (cingulate cortex, aka limbic cortex) are regarding the insular cortex which also responsible for regulating emotion as well has homeostasis. The motor cortex is involved in the planning and execution of voluntary movements, the amygdala’s primary function is memory and decision making (also part of the limbic system), the somatosensory cortex is involved in processing the sense of touch (remember the homunculus) and, finally, the periaqueductal gray is responsible for descending pain modulation (the brain regulating the processing of painful stimuli).
This is a major step in showing the global effects of the chiropractic adjustment, particularly those that have been observed clinically, but not reproduced in large studies. “The purpose of this study was to investigate the changes in FC [functional changes] between brain regions that process and modulate the pain experience after MT [manual therapy]. The primary outcome was to measure the immediate change in FC across brain regions involved in processing and modulating the pain experience and identify if there were reductions in experimentally induced myalgia and changes in local and remote pressure pain sensitivity” (Gay et al., 2014, p. 615).
Coronado et al. (2012) reported that, “Reductions in pain sensitivity, or hypoalgesia, following SMT [spinal manipulative therapy or the chiropractic adjustment] may be indicative of a mechanism related to the modulation of afferent input or central nervous system processing of pain” (p. 752). “The authors theorized the observed effect related to modulation of pain primarily at the level of the spinal cord since (1) these changes were seen within lumbar innervated areas and not cervical innervated areas and (2) the findings were specific to a measure of pain sensitivity (temporal summation of pain), and no other measures of pain sensitivity, suggesting an effect related to attenuation of dorsal horn excitability and not a generalized change in pain sensitivity” (Coronado et al., 2012, p. 752).These findings indicate that a chiropractic spinal adjustment affects the dorsal horns at the root levels which are located in the central nervous system. This is the beginning of the “big picture” since once we identify the mechanism by which we can positively influence the central nervous system, we can then study that process and its effects in much more depth.
One of the main questions asked by Corando et al. (2012) “…was whether SMT (chiropractic adjustments) elicits a general response on pain sensitivity or whether the response is specific to the area where SMT is applied. For example, changes in pain sensitivity over the cervical facets following a cervical spine SMT would indicate a local and specific effect while changes in pain sensitivity in the lumbar facets following a cervical spine SMT would suggest a general effect. We observed a favorable change for increased PPT [pressure pain threshold] when measured at remote anatomical sites and a similar, but non-significant change at local anatomical sites. These findings lend support to a possible general effect of SMT beyond the effect expected at the local region of SMT application (p. 762).
The above mechanisms take the effects of chiropractic care out of the realm of theory and validates the processes through which chiropractic works based upon the scientific evidence (literature).
Holt et. Al found that outcomes measured for both sensorimotor and quality of life increased with chiropractic care. The primary outcomes of improvement choice stepping reaction time (CSRT)and sound-induced flash illusion. The CSRT involves feet placement in a timed scenario and sound-induced flash illusion involves multisensory processing to ascertain reaction to perceived illusions. Both have been significantly related to older populations and falling. Although the results of this study has its limitations, as many studies do. Holt concluded” The results of this trial indicated that aspects of sensorimotor integration and multisensory integration associated with fall risk improved in a group of community-dwelling older adults receiving chiropractic care. The chiropractic group also displayed small, statistically significant improvements in health-related quality of life related to physical health when compared with a “usual care” control. These results support previous research which suggests that chiropractic care may alter somatosensory processing and sensorimotor integration.” (pg. 277)
As with many of our articles from here forward, I would like to leave you with a last and seemingly unrelated statement. I felt it was important to add this at the end since many of our critics negatively portray the safety of chiropractic care. This statement shall put that to rest leaving only personal biases left standing. Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects and after the unqualified subjects had been removed from the study, the total patient number accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified” (Whedon et al., 2015, p. 5). This study supersedes all the rhetoric about chiropractic and stroke and renders an outcome assessment to help guide the triage pattern of mechanical spine patients.
- Holt K., Haavik H., Lee A., Murphy B., Elley C., (2016) Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated with Falls Risk in Older People: A Randomized Controlled Trial, Journal of Manipulative and Physiological Therapeutics, 39(4) 267-278
- Falls and Older Adults, Causes and Risk Factors (n.d.) National Institute of Health, retrieved from: http://nihseniorhealth.gov/falls/causesandriskfactors/01.html
- Gay, C. W., Robinson, M. E., George, S. Z., Perlstein, W. M., & Bishop, M. D. (2014). Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain.Journal of Manipulative and Physiological Therapeutics, 37(9), 614-627.
- Coronado, R. A., Gay, C. W., Bialosky, J. E., Carnaby, G. D., Bishop, M. D., & George, S. Z. (2012). Changes in pain sensitivity following spinal manipulation: A systematic review and meta-analysis, Journal of Electromyography Kinesiology, 22(5), 752-767.
- Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.
Author:Mark Studin DC, FASBE(C), DAAPM, DAAMLP and William J. Owens DC, DAAMLP
Source:US Chiropractic Directory
|National Chiropractic Health Month Starts October: Get Moving!
The American Chiropractic Association (ACA)
and chiropractors nationwide are promoting the benefits of movement to overall
health as well as the prevention of back pain during National Chiropractic
Health Month (NCHM) in October. This year’s theme, “Move 4 Life,” encourages
people to move more now so they will be able to move better later and avoid
chronic and painful conditions associated with sedentary lifestyles.
For information on the benefits of movement
and tips on how to stay active and prevent injury, visit www.acatoday.org/NCHM
and follow ACA on Facebook
--look for the hashtag
#Move4Life. (Those who would like to help promote NCHM can also find a campaign
with information and resources to share on social media and in their
Research shows there is a worldwide pandemic
of increasing inactivity. In the U.S., only about half of all adults get the
recommended amount of physical activity, putting them at greater risk of
cardiovascular disease and Type 2 diabetes as well as falls and low back pain.
“The bones, muscles and joints that make up
our body’s musculoskeletal system require regular movement to stay healthy and
function properly. As we age, we are more at risk of developing low back pain
and joint problems if we do not get enough physical activity,” said ACA
President N. Ray Tuck, Jr., DC. “With their non-drug approach, chiropractors
help people move better by relieving back and joint pain and improving joint
ACA offers additional information on how to
get and stay moving:
Doctors of chiropractic practice a hands-on, drug-free approach to
health care and pain relief that includes patient examination, diagnosis and
treatment. In addition to their expertise in spinal manipulation, chiropractors
have broad diagnostic skills and are trained to recommend therapeutic and
rehabilitative exercises, and to provide nutritional, dietary and lifestyle
counseling. For more information, visit www.acatoday.org/patients.
- Good nutrition, ergonomic workspaces and
proper lifting and movement techniques can go a long way in helping people to
strengthen their spines and avoid disabling injuries and chronic back pain,
which often prevent regular physical activity.
- Consider weight-bearing exercises, such as walking,
which help maintain bone density over a lifetime and keep our skeletal bones
healthy and strong.
- When busy schedules are the obstacle, a
re-examination of personal priorities is sometimes necessary to restore balance
in life; make time for healthy habits such as physical activity.
Back pain is one of the most common conditions
for which prescription opioids are prescribed. It was once believed that pain
medication and bed rest were the best course of action for low back pain, but
research today supports first trying non-drug options for pain management, while
remaining as active as possible, before moving on to other options.
Author:American Chiropractic Association
Source:Online, acatoday.com. September 25, 2018.
Copyright:American Chiropractic Association 2018
|Women: Want to Avoid Heart Failure? Try Walking
New research suggests that women who exercise regularly, including walking, may lower their risk for heart failure. The study from researchers at the University of Buffalo in New York looked at over 137,000 women aged 50-79, of which over one-third had high blood pressure and other heart disease risk factors such as smoking and diabetes. After a follow-up period of 14 years, researchers found that the women who got some form of physical activity were less likely to suffer from heart failure (11%). Women with the highest levels of physical activity, meanwhile, were the least likely to suffer from heart failure (35%), as compared to women who got no exercise at all. In addition, women who got the most physical activity were the least likely to develop a sub-type of heart failure called reduced ejection fraction (32%) as compared to women who never exercised. 33% of the same group of women were also the least likely to develop another sub-type of heart failure called a preserved ejection fraction. One of the biggest findings from the study, however, is that walking works just as well as other forms of exercise, including more vigorous types. To discover how much exercise the women got, researchers studied answers to a questionnaire about exercise that every participant completed. As it turns out, walking was the most common type of physical activity reported.
Source:JACC: Heart Failure, online September 5, 2018.
Copyright:ProfessionalPlanets.com LLC 2018
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