July 2019 Health Newsletter

Print-Friendly Newsletter

Current Articles

» Chiropractic Reduces Falling Risk in the Elderly
» Bill Introduced to Modernize Medicare Coverage of Chiropractic Services
» Chiropractic Care - Not Just For Back Problems
» Stay Cool For Better Exercise Performance and Safety

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


page toppage toppage top




Bill Introduced to Modernize Medicare Coverage of Chiropractic Services

A bill that would update Medicare by increasing its coverage of services provided by doctors of chiropractic within the full extent of their licensure was introduced today in the U.S. House of Representatives.  The legislation, H.R. 3654, known as the Chiropractic Medicare Coverage Modernization Act of 2019, would align Medicare’s coverage of chiropractic services with that of other federal health care providers as well as many private health plans.  The bipartisan legislation, introduced by Reps. Brian Higgins (D-N.Y.) and Tom Reed (R-N.Y.), would enable beneficiaries to more easily access the chiropractic profession’s broad-based, non-drug approach to pain management, which includes Medicare-covered services such as manual manipulation of the spine and extremities, evaluation and management services, diagnostic imaging  and utilization of other non-drug approaches that have become an important strategy in national efforts to stem the epidemic of prescription opioid overuse and abuse.  "The American Chiropractic Association (ACA) is encouraged that this bill would finally give Medicare beneficiaries access to the same safe and effective chiropractic services that members of our military, veterans, and federal employees now enjoy," said ACA President Robert C. Jones, DC.  "We applaud Rep. Higgins and Rep. Reed, who recognize the necessity of modernizing Medicare's chiropractic coverage to meet the needs of today's beneficiaries," added Keith Overland, DC, chairman of the ACA Legislative Advisory Board.  Since 1972, Medicare beneficiaries have been covered for only one chiropractic service—manual manipulation of the spine—forcing them to access additional medically necessary care from other types of providers or to pay out of pocket for the services from their chiropractor.  Chiropractors are the only physician-level providers in the Medicare program whose services are restricted in this manner.  The federal Medicare program currently serves more than 55 million individuals; various projections forecast the number of people age 65 or older increasing by about one-third over the next decade.

Author: ChiroPlanet.com
Source: Acatoday.com July 9, 2019.
Copyright: ProfessionalPlanets.com LLC 2019


page toppage toppage top




Chiropractic Care - Not Just For Back Problems

Chiropractors have always maintained that chiropractic care is not just for the treatment of back and neck pain, but is in fact effective for other conditions issues as well. A new case study, published in the Journal of Chiropractic Medicine backs these claims by examining the treatment of arm and hand pain. A 41-year-old female patient was experiencing alarming pain, numbness and weakness in her right arm and hand. Her symptoms had begun three weeks prior to treatment, when she woke up in the morning and assumed she had “slept wrong.” Medical assessments confirmed her pain, numbness and decreased grip strength. Treatment began immediately and included specific chiropractic manipulative therapy as well as myofascial therapy and elastic therapeutic taping. The patient was also assigned an active home care regimen which included postural exercises and workstation ergonomics education. The results—The patient showed immediate improvement of her numbness and weakness after just the first treatment. The case study’s authors noted that over a series of eleven treatments, her symptoms were completely resolved and she was able to return to work without pain. If you’re experiencing any sort of body pain, numbness or loss of strength, contact your local chiropractor today. Consultations are affordable, safe and chances are very good that chiropractic care may be able to help!

Author: ChiroPlanet.com
Source: Journal of Chiropractic Medicine. Volume 12, Issue 2; June 2013.
Copyright: ProfessionalPlanets.com LLC 2013


page toppage toppage top




Stay Cool For Better Exercise Performance and Safety

As the temperature rises so too does the risk for exercise related heat stroke and performance drop. The human body doesn't perform optimally when it becomes too hot. New research shows that using cooling techniques such as ice vests or cold water bathing/applications before and/or during workouts increases performance. Your body requires significant energy and blood flow to keep your body from overheating. Any external assistance with the cooling process provides the body with additional energy and blood flow to exercising muscles. Various cooling methods were studied including the use of cooling vests and cold packs, consumption of cold water or ice slurries, immersion in a cold water bath or a combination. Researchers also studied the effects on performance comparing pre-exercise applications vs. during exercise applications. Researchers found while pre-exercise and during exercise applications of cold increased performance, a combination of the two worked best. One of the most effective applications was wearing an ice chest during exercise along with a combination of pre-exercise techniques. Doing so improved athletic performance by close to 7 percent. In addition to the increased performance, cooling techniques reduce potential for heat stroke - a very common side effect of exercise, especially in the summer heat.

Author: ChiroPlanet.com
Source: British Journal of Sports Medicine, online April 19, 2014.
Copyright: ProfessionalPlanets.com LLC 2014


page toppage toppage top






Articles 1-4 of 4 << first < previous next > last >