April 2024 Health Newsletter

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.

5. 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.

For those individuals grappling with chronic back or neck pain, finding effective relief can be a daunting challenge. In the pursuit of alleviating discomfort and improving quality of life, chiropractic care should be at the top of the list. But what does the evidence say about its efficacy? Let's briefly review just some of the research to understand the role of chiropractic care in addressing musculoskeletal conditions such as back pain and neck pain.

Chiropractic care is founded on the principle that proper alignment of the spine is essential for overall health and well-being. Practitioners, known as doctors of chiropractic (DCs) or chiropractors, employ hands-on spinal manipulation and other manual techniques to adjust vertebral misalignments (subluxations) and restore proper function to the musculoskeletal system. While chiropractic treatment has been traditionally sought for back and neck pain relief, its effectiveness has been the subject of numerous studies and clinical trials.

One of the most comprehensive reviews of chiropractic care for back pain was conducted by the Agency for Healthcare Research and Quality ("Agency for Healthcare Research and Quality (AHRQ). (2017"). Noninvasive treatments for low back pain.). Their analysis of available evidence concluded that spinal manipulation—the primary treatment modality in chiropractic care—was effective in reducing acute low back pain and improving function. Additionally, the AHRQ found that chiropractic care was associated with fewer adverse effects compared to other treatments such as medication or surgery.

Furthermore, research published in reputable medical journals supports the efficacy of chiropractic care for both acute and chronic back pain. A study published in the Journal of Manipulative and Physiological Therapeutics found that patients with chronic low back pain who received chiropractic spinal manipulation experienced greater pain relief and functional improvement compared to those who received standard medical care.

Similarly, chiropractic care has shown effective in managing neck pain, which often stems from poor posture, muscle strain, or cervical spine misalignments. A systematic review published in the Journal of Manipulative and Physiological Therapeutics concluded that spinal manipulation performed by chiropractors was effective in reducing neck pain intensity and improving function. Moreover, a randomized controlled trial published in the Annals of Internal Medicine ("Annals of Internal Medicine, 156(1_Part_1), 1-10.") found that spinal manipulation combined with exercise was more effective in reducing neck pain than medication alone.

For those considering chiropractic care for back or neck pain relief, the evidence supporting its effectiveness is substantial and continues to grow. From reducing pain intensity to improving function and overall quality of life, chiropractic treatment offers a non-invasive and drug-free approach to managing back and neck pain and dysfunction as well as many other musculoskeletal conditions. By staying informed and seeking care from reputable chiropractic practitioners, prospective patients can take proactive steps towards finding lasting relief.


If you are in chronic pain from back problems, you may be tempted to try anything to keep the hurt at bay. This might include taking addictive opioid pain killers or analgesics that have negative side effects.  These prescription drugs can cause "adverse drug events," which refer to any sort of injury or side effect caused by a medication.  Even scarier, the mortality rate from adverse drug events has been rising dramatically.  No one wants to die from a pain pill or end up addicted to it.   The Good News: Adverse Drug Events Can Be Avoided The next time you are tempted to just medicate your back pain away, contact your chiropractor.  By getting comprehensive chiropractic care, you may be able to reduce or completely eliminate your dependence on prescription pain medication.  In fact, it's been proven to work.  One recent study showed that chiropractic patients had a 51% reduced likelihood of adverse drug events within 12 months compared to nonrecipients.  Comprehensive chiropractic care for back pain can include spinal manipulation and adjustments, pain relieving exercises, and other wellness protocols that are safe, non-invasive, and don’t have those pesky and often dangerous side effects of drugs.  Reduce Pain with Chiropractic Care Today There is no need to risk adverse drug events when there is a safer option with chiropractic care. Contact us today for a consultation!

The government wants to start encouraging more people to take their bike to work. No, this isn’t in response to efforts to halt the progression of global climate change and to save the environment. The reason the government is promoting this is because of the awesome health benefits. According to recent studies, riding to work can reduce a person’s chances of:

• Developing cancer
• Dying prematurely
• Being diagnosed with heart disease
  

The numbers are quite astonishing. According to the UK’s Telegraph, the risk of premature death fell by 41% among those who regularly rode to work. Forbes reports that the study was done at the University of Glasgow, where they evaluated the health of over 260,000 people during a five year period. Those who cycled to work had a:

• 46% lower risk of developing heart disease
• 52% lower risk of dying from heart disease
• 45% lower risk of developing cancer
• 40% lower risk of dying from cancer
  

Since cancer and heart disease are the leading causes of death in many countries – including the U.S. – it stands to reason that people would do anything they can to reduce their risks. Now they have proof that something as simple as cycling to work can lower the risk significantly. Why not give it a try for yourself? Start out slow – replacing your car with your bike as your mode of transport one day a week, then two, then three, and so on. With results like these, you’ll be happy you did!