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» Chiropractic Reduces Falling Risk in the Elderly
» The Quality of Your Posture Is Linked to Fall Risk
» Obesity Grows Around The World
» Research Says Fitness Trackers May Not Be Accurate

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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The Quality of Your Posture Is Linked to Fall Risk

Whether your golden years are now or decades off, good posture is correlated to reduced fall risk. And the other good part? Your favorite chiropractor is a great resource for both achieving and maintaining good posture.†

The Link Between Posture and Fall Risk

Hereís the not-so-good part: not only does poor posture lead to back pain, it leads to an increased fall risk. Youíre twice as likely to fall if you have back pain, according to studies. And if youíre in pain, youíre less likely to move, which leads to weaker muscles for both movement and posture, which then lead to an even greater risk of falling. It can become quite the vicious cycle.† Back pain is not only linked to an increased risk of falling, itís often tied to poor posture. And if you have poor posture, your body is poorly balanced and you may also have hindered range of motion. For example, if you trip or slip, your poor, imbalanced posture makes it harder to get your feet back under you in time.

Falling Statistics

Falling statistics go beyond the number elderly of folks who take a tumble in any given year. Thereís associated injuries (broken hips and head injuries top the list), medical costs (falls incur over $50 billion annually), deaths and more.† The other problem is that all these numbers get worse year over year. The CDC projects that the fall death rate in the U.S. alone will rise to 7 deaths every hour by 2030. Part of that is due to our baby boomer generation entering the 65+ age group, and part of it is due to a life of sitting at computers and/or on couches. Statistics also show that youíre more likely to fall if you experience foot pain as well. Improper posture places uneven wear and tear on your feet, often leading to pain.

How Your Chiropractor Can Help With Posture

Chiropractors are trained to evaluate posture and aid in promoting correct posture. They can help in four powerful ways.

Quality Testing - Fixing posture is more than remembering to sit or stand straight. And to properly fix posture, it takes getting to know your unique case. Poor posture can stem from improper curvature in the neck or back, scoliosis, how you hold your head, injury, poor ergonomics and more. Chiropractors have various posture assessments and tests to correctly identify the root cause(s) of poor posture and the best approach to treating you and only you.

Ergonomics Evaluation - One of the best ways to avoid poor posture is to develop a lifestyle that promotes good posture. Your chiropractor can evaluate your workspace and home lifestyle, and give you guidance on how to adjust your lifestyle in a way that proper posture will come more easily.

Chiropractic Adjustments - Chronically poor posture reshapes your neck and spine, and changes how your muscles hold all those bones together. Chiropractic adjustments can coax your spine back into alignment, making it easier for your body to achieve and maintain correct posture.††

Muscle Work - Building off of adjustments, your muscles need rehabilitative work, too. For example, if youíre hunched forward, then muscles on your backside are going to be longer than they should be while muscles in front are shorter. Your chiropractor can guide you through carefully calculated stretches and rehabilitative work to balance your body out and hold correct posture.†

Good posture can protect you and potentially save your life. You donít have to live in fear of falling. You can work with your chiropractor to improve your posture, thus significantly reducing both pain levels and your risk of falling.

Author: ChiroPlanet.com
Source: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html


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Obesity Grows Around The World

In early 2016, the global population totaled more than 640 million obese people. These new totals now show that more than half the world is overweight. This increase in obesity means that one in seven women and one in 10 men are obese, with a body mass index of more than 30 (overweight is 25). During the last 40 years, the average male BMI has risen from 21.7 to 24.2 while females saw a rise from 22.1 to 24.4. That totals to an average of 3.3 pounds gained per decade. The study looked at almost 20 million adults worldwide. It's an epidemic that has seen worldwide attention as countries address food labeling practices, food pricing, taxes on unhealthy foods, and government nutrition recommendations. At the same time, many of the world's poorest are underweight, suffering from a lack of food. Obesity can have both health and economic effects. As healthcare costs rise, problems due to an unhealthy weight can affect the economic stability of millions of households. But it doesn't have to be this way. Leading a healthy lifestyle with plenty of exercise and a smart diet can allow you to live a longer and better life.

Author: ChiroPlanet.com
Source: Reuters, online March 31, 2016.


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Research Says Fitness Trackers May Not Be Accurate

Fitness trackers are exploding in popularity, tracking everything from heart rate to steps taken. But a new study from the National Institute of Health and Nutrition in Tokyo shows that this technology isn't always accurate at tracking energy expenditure. Researchers tested 12 fitness trackers against current methods of detecting energy expenditure. The results suggest that these trackers can both under and overestimate energy expenditure, sometimes by hundreds of calories. Some devices underestimated calories burned by almost 600 calories while others overestimated by around 200. Researchers say it is possible the trackers are inaccurate due to people taking them off during the day. For people who use fitness trackers to make health decisions based on fitness level, both over and underestimates can be harmful. Those trying to lose weight could be actually burning too few calories. Those watching their activity levels due to heart problems may be too active. Thereís not much research on trackers yet, and devices could vary from brand to brand. Either way, people using fitness trackers to make health decisions should be cautious about relying too much on device data.

Author: ChiroPlanet.com
Source: JAMA Internal Medicine, online March 21, 2016.


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