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» Chiropractic Reduces Falling Risk in the Elderly
» Latest Research Shows Chiropractic Decreases Need for Opioids for Lower Back Pain Up to 90%
» Skipping Breakfast May Lead to Essential Nutrient Shortfall
» Preventing Cognitive Decline with Mental Stimulation

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

  1. Lower limb weakness
  2. Recent History of Falling
  3. Gait Deficits
  4. 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:

  1. Muscle weakness
  2. Balance and gait
  3. Blood pressure drops
  4. Postural hypotension
  5. Reflexes slower
  6. Foot problems
  7. Sensory problems
  8. Vision issues
  9. Confusion
  10. Medications

(http://nihseniorhealth.gov/falls/causesandriskfactors/01.html)

 

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:

  1. Neuroplastic processes in the central nervous system through altered afferent input.
  2. Pain and altered cognition as a result with respect to attention focus and physical function
  3. Muscle strength and muscle activity patters
  4. 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.

 

References:

  1. 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
  2. Falls and Older Adults, Causes and Risk Factors (n.d.) National Institute of Health, retrieved from: http://nihseniorhealth.gov/falls/causesandriskfactors/01.html
  3. 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.
  4. 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.
  1. 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


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Latest Research Shows Chiropractic Decreases Need for Opioids for Lower Back Pain Up to 90%

A recently published five-year study published evaluated claims from patient visits, pharmacy claims, and inpatient and outpatient procedures. The study followed well over 200,00 patients across the USA, some of them seeing medical doctors while others sought natural alternative care, including doctors of chiropractic.

The end result? Those who initially sought chiropractic care for low back pain (LBP) needed up to 90% less opioid prescriptions.

The study explained that patients who received initial treatment from chiropractors decreased odds of short-term and long-term opioid use compared with those who received initial treatment from a primary care physician (PCP). Compared with PCP visits, initial chiropractic care was also associated with decreased odds of long-term opioid use, too.

Prescription opioid use has ballooned into an epidemic since the 1990s, according to the CDC. Overdose deaths have been on the rise since at least 1999 with spikes in 2010 and 2013. Over 191 million opioid prescriptions were dispensed to American patients in 2017. The CDC said on their website, "To reverse this epidemic, we need to improve the way we treat pain."

Chiropractic services can vary from clinic to clinic, but the common denominator is to effectively treat each patient without the use of drugs or having to resort to surgery. Core chiropractic care reduces pain and inflammation while helping you recover range of motion and increase flexibility.

Author: ChiroPlanet.com
Source: BMJ Open 2020;10:e028633corr1


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Skipping Breakfast May Lead to Essential Nutrient Shortfall

It is commonly held that breakfast is the most important meal of the day, but until recently the prevailing argument was simply that breakfast eaters started the day with sounder cognitive function and set themselves up for overall better performance and achievement as the day progressed.

However, a recent study out of Kings College London in the UK suggests that children who skip breakfast on a regular basis are likely missing out on all recommended essential nutrients throughout the day.

In general studies conducted over many years, skipping breakfast has been proven to increase the risk of diabetes, heart disease, reduced memory function, and weight gain. However, only recently have studies of nutrition shown the effects of missing out on micronutrients such as vitamins C, D, E, B-complex and K, folic acid and beta-carotene, and the correlation of obtaining these nutrients beginning with a meal at breakfast.

Iron and Calcium Deficiencies May Be Linked to Skipping Breakfast
Detailed statistics of participants in the Kings College study show that more than 30% of children who skip breakfast are low on iron, and more than 20% of the children are deficient in calcium. Comparatively, only 3% of children who eat breakfast regularly were low in iron and or calcium. Not surprisingly, fat intake throughout the day was higher when children did not eat breakfast.

Researchers determined that older children, those aged 11 to 18 years, were more likely than their younger peers (ages 4 -10 years) to skip breakfast. And girls were more likely than boys to begin their day without a meal. But the missing micronutrients in the younger breakfast skippers was greater than in the older group, indicating that the younger you are, the more important it is to eat breakfast so that your body can derive and process nutrition throughout the day.

Even children in the study who ate a nutritionally balanced diet despite not eating breakfast were still found, when tested, to be lacking in essential nutrients, further indicating that breakfast may be key to establishing efficient and balanced dietary intake. The study also indicated that children who did not eat breakfast ended up consuming the same number or fewer total calories as children who ate breakfast every day.

Author: ChiroPlanet.com
Source: British Journal of Nutrition, online August 17, 2017.


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Preventing Cognitive Decline with Mental Stimulation

With the increasing global concern surrounding dementia and related cognitive problems in the elderly, being able to successfully prevent these issues is of great importance. JAMA Neurology conducted a study to research the effects of various forms of mental stimulation on cognitive delays in elderly participants. The study found several forms of mental stimulation that can reduce the risks of cognitive problems in the elderly. For instance, playing games and participating in regular social events was found to decrease the risk of cognitive delay by more than 20%. While participating in crafting activities can lower the risk by 28%, and learning to use a computer can reduce the risk as much as 30%. Maintaining a healthy lifestyle by choosing to eat healthy and exercise regularly has also been proven in many studies to reduce cognitive delay. Combining this with regular mental stimulation is a great way to help reduce the risks even further. According to Dr. Denise Park of the University of Texas, participating in new activities or tasks may be more effective than the repetition of familiar activities in preventing cognitive problems. Overall, it is important for older adults to participate in mentally stimulating activities and try to maintain a healthy lifestyle through proper diet and exercise. This may prove to be their best defense against cognitive decline.

Author: ChiroPlanet.com
Source: JAMA Neurology, online January 30, 2017.


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