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» Chiropractic Reduces Falling Risk in the Elderly
» Chronic Back Pain Could Be Made Worse by Spouse Hostility
» Young and Hypertense: Do You Know if You Have High Blood Pressure?

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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Chronic Back Pain Could Be Made Worse by Spouse Hostility
According to a recent study, lower back pain may be heightened if a spouse is unsupportive or critical of their partner. Published in August, the report involved observing 71 couples during a 10-minute discussion. The researchers were looking to see how a spouseís perspective could influence a patientís ability to deal with pain when they were suffering from a herniated disc, spinal stenosis, or a degenerative disc. After the discussion, the patients suffering from chronic back pain were asked to do a 10-minute activity which involved stretching, bending, reclining, walking, standing, and sitting, while their partner watched on. The research team measured the levels of hostility and criticism from the spouse along with how much criticism was perceived by the patient. They also monitored the patientsí depressive symptoms, pain behaviors, and pain intensity.

How Negativity Can Intensify Chronic Back Pain
It was intended for the initial 10-minute discussion to create conflict, but the amount of hostility or criticism given wasnít manipulated. The researchers were successful in creating this conflict, with all patients reporting significant increases in their feelings of sadness, anger, and anxiety. Throughout the activity, the patients who experienced greater pain and were more likely to observe greater criticism from their spouses have been found to have higher depression scores.†

Combatting Chronic Back Pain†
Speaking about the study, John Burns who was their lead researcher suggested that until now, most studies have focused on how adequate social support can positively influence someone with chronic pain. However, this study has demonstrated how negative communication from a spouse can have a harmful effect on pain patients, with these negative responses often creating a vicious cycle. Spouse criticism can cause pain among patients as expressed by straining, groaning, and grimacing up to three hours later. This can also lead to further spouse criticism up to three hours later. When someone is experiencing back pain, itís very easy to criticize, dismiss them, or even act in a hostile manner toward them. However, when a patient is enduring pain, the best type of support is to help them lead the best life they can despite their pain. For back pain sufferers, this may also include getting the help of a chiropractor. As studies suggest, this noninvasive treatment is effective at relieving this type of pain. If youíve got chronic back pain, donít suffer in silence. Seek the professional advice and care of your local chiropractor.

Author: ChiroPlanet.com
Source: Pain 2017.
Copyright: ProfessionalPlanets.com LLC 2017


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Young and Hypertense: Do You Know if You Have High Blood Pressure?
If you are a male between the ages of 18 and 39, there is a good chance you have high blood pressure and may not know it. Research findings in eight national health surveys conducted between 1999 and 2014 suggest that only half of the 6.7 million young adults between the ages of 18 and 39 who actually have high blood pressure or hypertension received treatment for it.

Most High Blood Pressure Goes Undiagnosed

Approximately 75 million adults in the US, which is roughly 32% of the population, have high blood pressure.† While awareness of and treatment for hypertension and high blood pressure has improved in recent years, a significant number of people still go undiagnosed and untreated every year. And a large percentage of those people are men under the age of 39. Over 86% of women with high blood pressure have been diagnosed and sought treatment, compared with 44% of young men. High blood pressure and hypertension are the leading cause of stroke and heart attack, and contribute to one in 4 deaths every year in the US alone. High blood pressure can be caused by many factors, including obesity, smoking, stress, and genetics. In many cases the risk factors can be reduced or eliminated and the condition can be controlled.† However, failure to seek medical opinion and treatment can have serious consequences.

Reducing Stress With Chiropractic Care May Reduce Blood Pressure
Studies conducted at Harvard Medical School and Brigham & Womenís Hospital in Boston, MA show that individuals who have shown elevated blood pressure in adolescence and early adulthood are at greater risk for heart attacks later in life. Researches suggest that preventing high blood pressure in the first place by exercising, eating a healthy diet, and avoiding tobacco is one of the best ways to reduce the likelihood of hypertension or high blood pressure.† If medication I required to control the condition, patients tend to get better results when they are young. Chiropractic care can also help alleviate or eliminate sources of stress caused by chronic pain, which can contribute to an overall reduction in blood pressure. If you have a history of high blood pressure or heart disease in your family, or think you may be suffering from the condition, you are encouraged to seek a medical evaluation and treatment.

Author: ChiroPlanet.com
Source: Hypertension, online August 28, 2017.
Copyright: ProfessionalPlanets.com LLC 2017


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