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Newsletter Archives > ChiroPlanet.com Monthly Health Newsletter: January 2020 Health Newsletter

January 2020 Health Newsletter


Current Articles

» Chiropractic Reduces Falling Risk in the Elderly
» Manual Therapy Providers Forge Closer Ties at Interprofessional Collaborative Spine Conference
» Screen Time and Inactivity Unacceptable In Adolescents
» Chiropractic - Safe and Sound
» How Pillow Height Affects Muscle Activity and Perceived Comfort

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
Copyright: 2016 2016


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Manual Therapy Providers Forge Closer Ties at Interprofessional Collaborative Spine Conference

More than 160 members of the chiropractic, physical therapy and osteopathic professions forged a new spirit of cooperation and understanding during the Interprofessional Collaborative Spine Conference (ICSC), which took place Nov. 8-9 in Pittsburgh, Pa.  Organizers of this first-of-its-kind event hope to enhance patient outcomes as well as increase integration of manual therapies for back pain in the wake of the ongoing opioid crisis.  ICSC was organized and hosted by the American Chiropractic Association (ACA) with the support of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) and the Academy of Orthopaedic Physical Therapy (AOPT), which represent three of the major provider groups of non-drug manual therapies for pain.     Manual therapies such as spinal manipulation, physical therapy modalities, massage and acupuncture have received increased attention and support in recent years by major health care organizations such as the Centers for Disease Control and Prevention and the American College of Family Physicians for their ability to effectively manage many cases of back pain and in some cases reduce or alleviate the need for prescription opioids.  Research shows that back pain is one of the most common conditions for which opioids are prescribed.  "The chiropractic profession was honored to take part in the Interprofessional Collaborative Spine Conference," said Michele Maiers, DC, MPH, PhD, vice president of the American Chiropractic Association. "We are committed to working together with our colleagues in physical therapy and osteopathy to raise awareness and promote integration of non-drug manual approaches."  "Providers of manual therapies have an unprecedented opportunity to positively impact the lives of millions of people who struggle with back pain. Together, we can find ways to improve what we do and to communicate better with patients.  The Interprofessional Collaborative Spine Conference was an important step in that direction," said Julie Fritz, PT, PhD, FAPTA, associate dean for research at the University of Utah College of Health, who helped plan the conference.

Author: American Chiropractic Association.
Source: Acatoday.com. November 12, 2019.
Copyright: American Chiropractic Association. 2020


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Screen Time and Inactivity Unacceptable In Adolescents

According to research conducted by the World Health Organization (WHO), the majority of adolescents are not getting adequate amounts of physical activity.  The WHO recommends adolescents participate in an hour of moderate to vigorous physical activity daily.  However, data obtained by the WHO from 1.6 million students between 2001 and 2016 found only 1 out of 5 children met the WHO’s recommendation for daily physical activity.  The WHO attributes this lack of physical activity to increase in home screen time which is replacing the time for physical activity.  While the data is extremely concerning and parents and educational leaders need to step up to create and implement solutions, the good news is that over the 15 years reviewed, the physical activity for boys has actually improved.  Unfortunately, over that same period of time, there has been no improvement for the physical activity in girls.

Author: ChiroPlanet.com
Source: The Lancet Child & Adolescent Health. November 21, 2019.
Copyright: ProfessionalPlanets.com LLC 2020


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Chiropractic - Safe and Sound

Every once in a while someone makes a comment suggesting chiropractic care might not be completely safe. They may claim that chiropractic care to the neck region might have associated risks of stroke. Make no mistake - chiropractic care is actually one of the most natural, safe and least invasive forms of health care available. Doctors of chiropractic are trained extensively to deliver their care in a safe, natural and non-invasive manner. Not only have millions of patients experienced the safety and effectiveness chiropractic care has to offer, numerous studies in existence back this up. One of the most recently published safety related studies evaluated the incidence of strokes in approximately 1.16 million 66 to 99 year old Medicare beneficiaries following visits to medical doctors vs. visits to doctors of chiropractic. Ironically according to researchers, their findings indicated that 7 days after their visits slightly more beneficiaries who visited a medical doctor as compared to a doctor of chiropractic ended up suffering from a stroke.

Author: ChiroPlanet.com
Source: JMPT. February 2015 Volume 38, Issue 2, Pages 93–101.
Copyright: ProfessionalPlanets.com LLC 2015


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How Pillow Height Affects Muscle Activity and Perceived Comfort

A recent report studied how using foam pillows of three different heights affected the comfort and electromyographic (EMG) activity of the neck and mid-upper back muscles of participants. The study was performed by a team of therapists and researchers in the University of São Paulo School of Medicine in São Paulo, Brazil. Performed in 2014 and published in 2015, the study revealed the associations among pillow height, EMG activity, and perceived comfort. Twenty-one asymptomatic adults were observed using three different foam pillows of 5 cm, 10 cm and 14 cm, or approximately 2 inches, 4 inches and 5 1/2 inches. Study participants rated their comfort using a 100-mm visual analog scale, while researchers calculated EMG activity of the neck and mid-upper back muscles, called the sternocleidomastoid and upper and middle trapezius muscles. Participants considered height 1 (approximately 2 inches) to be the least comfortable and height 2 (approximately 4 inches) the most comfortable. In addition, all muscle groups showed statistical differences in EMG activity between heights 1 and 2, but not between heights 2 and 3. Individuals who prefer sleeping with a flat pillow may want to think twice, as a four-inch pillow may be the best choice for perceived comfort and back and neck support.

Author: ChiroPlanet.com
Source: JMPT. Volume 38, Issue 6, Pages 375-381.
Copyright: ProfessionalPlanets.com LLC 2015


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