March 2019 Health Newsletter

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» Chiropractic Reduces Falling Risk in the Elderly
» Reducing Risk of Recurring Low Back Pain for Office Workers
» New Study Finds Obese Seniors Can Improve Disability with Diet and Exercise
» Even Bad Cholesterol in the Moderate Range Can Spell Early Death

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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Reducing Risk of Recurring Low Back Pain for Office Workers

Are you an office worker who has experienced low back pain in the past?  If so, you are at a significantly greater risk of future low back pain.  According to a one-year study of 669 healthy office workers, people who had previous episodes of low back pain were more likely to experience low back pain again.  The amount of recurring low back pain was also influenced by the frequency of work rest breaks as well as psychological stresses.  This study gives some clues as to how to avoid getting low back pain while at the office.

Here are some tips:

  • Take Frequent Desk Breaks. We are not talking about taking advantage of your employer and “shirking off” during the day for long periods of time. A quick break could simply be to stand up for a minute or two and stretch before returning to your work.
  • Reduce Workplace Stress. While some of this is out of your control, you can take some positive steps to reduce workplace stress. Speak up and ask for an extended deadline if the task needs it. Try to work out problems with coworkers respectfully and proactively.
  • Chiropractic Care. A qualified chiropractor can help you reduce low back pain when it happens and prevent it. Contact our office today for a no commitment consultation!

Author: ChiroPlanet.com
Source: JMPT. June 2018 Volume 41, Issue 5, Pages 405–412
Copyright: ProfessionalPlanets.com LLC 2019


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New Study Finds Obese Seniors Can Improve Disability with Diet and Exercise

According to a new U.S. study, seniors age 65-79 may be able to improve their disability and lessen fatigue if they start exercising more.  Plus, if they cut calories, they may achieve overall improved health.  Researchers at Wake Forest School of Medicine in North Carolina conducted the study. The experiment involved 180 obese senior adults from the age of 65 to 79 years-old.  Each participant was randomly given a 20-week task: Regular aerobic activity, or regular aerobic activity combined with cutting calories.  All 180 seniors focused on treadmill exercises at least 4 days per week. However, the group assigned to cut calories also were instructed to eat at least 250-600 fewer calories per day, as well.  According to the study, the group who exercised and cut calories was able to increase their exercise capacity (the body’s ability to supply oxygen to muscles during longer exercise sessions) by 14-16%.  Meanwhile, the seniors who only focused on aerobic exercise increased their exercise capacity by nearly 8%.  The researchers concluded, in general, people who cut a moderate amount of calories from their diets and complete regular aerobic workouts will see good results.  You don’t have to slash calories drastically, because this is difficult to keep up.  Best of all, anyone at any stage of life, even people who are both obese and elderly, will see health benefits from getting active and eating less.

Author: ChiroPlanet.com
Source: The Journals of Gerontology Series B, online July 5, 2018.
Copyright: ProfessionalPlanets.com LLC 2019


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Even Bad Cholesterol in the Moderate Range Can Spell Early Death

Adults who don't keep their "bad cholesterol" numbers at bay, who are otherwise healthy, are far likelier to die early deaths from cardiovascular issues than those who keep their cholesterol in the "good" range.  A recent study from the University of Texas Southwestern Medical Center looked at data from over 36,000 patients with zero past incidences of diabetes or heart disease, including a low risk for heart attacks and strokes.  However, these patients had some level of LDL-C ("bad cholesterol" that can build up in your blood vessels), although it was low enough not to warrant prescription cholesterol medication, called statins.  The follow-up period for the study was around 27 years. During this time, over 1,000 people died from cardiovascular disease, while nearly 600 died from heart disease.  According to the study, the higher the person's LDL-C levels (ranging from 100 to 190 mg/DL), the higher their risk of dying from cardiovascular disease or complications.  Usually, physicians don't prescribe statins unless the patient's cholesterol level reaches a threshold of 190 mg/DL.  This means even moderate levels of LDL-C can put you at risk.  Researchers say that the biggest takeaway from the study data is that a low risk for 10-year cardiovascular events does not mean the risk posed by higher LDL-C levels is wiped out.

Author: ChiroPlanet.com
Source: Circulation, online August 20, 2018.
Copyright: ProfessionalPlanets.com LLC 2019


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