Newsletter Archives > ChiroPlanet.com Monthly Health Newsletter: January 2017 Health Newsletter

January 2017 Health Newsletter


Current Articles

» Chiropractic Reduces Falling Risk in the Elderly
» Pediatric Chiropractic Care: Is It Safe?
» Opioid Pain Killers and Crash Risk in the Elderly
» What Mattress Is Best For Your Back Pain?

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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Pediatric Chiropractic Care: Is It Safe?

Chiropractors are no strangers to the question: "Is chiropractic care safe for children?" Extensive research on the subject of chiropractic care and techniques tailored to the unique bodies and needs of children indicates yes. One common concern regarding pediatric chiropractic care is based upon a misunderstanding that everyone, regardless of age, receives the same techniques and treatments. However, just as a child sees a pediatrician, receives child-appropriate doses of medications, and responds differently than adults to different medical treatments, so too do children require tailored chiropractic care. The field of pediatric chiropractic care is enormously large and effective, and has helped children across the globe. And just as different bodies young and old have different needs, chiropractors modify techniques depending on the age and development of the child. Childhood chiropractic care has resulted in high improvement of conditions from musculoskeletal pains to GI ailments, and has been employed to successfully treat childhood asthma as well as pain in the back, joints, and soft tissues. This summer, the Chiropractic Board of Australia and the American Chiropractic Association (ACA) released statements about the safety and efficacy of pediatric chiropractic care, asserting that the practice is gentle and effective. The ACA further cited over 115 years of scientific literature investigating adverse events in pediatric chiropractic care, and illustrated that such adverse events were "exceedingly rare." Pediatric chiropractic care has been demonstrated as an important component of childhood health care, and supports the wellbeing of young people through safe, gentle, and effective treatments.

Author: ChiroPlanet.com
Source: JMPT Volume 39, Issue 6, Pages 401Ė410
Copyright: ProfessionalPlanets.com LLC 2017


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Opioid Pain Killers and Crash Risk in the Elderly

Opioid use has been in the spotlight recently. From over-prescription, to abuse and addiction, to devastating long-term effects, the conversation about these controversial medications has even reached the federal level through opioid legislation. But the drug is now receiving attention in a new topic of discussion: motor vehicle accidents. A new study from the Oxford Journal Age and Ageing has demonstrated a possible link between opioid use and increased vehicle crash risk for individuals 50-80 years old. The results of this study demonstrated that older drivers using opioid medications doubled their risk of a single-vehicle crash against those using non-opioid analgesics. Previous studies have also suggested possible increased risk associated with driving while taking opioids, which further reinforces the known risks of opioid medications. For doctors of chiropractic, seeing patients who are taking opioid medications is all too familiar. This is because opioids are very commonly prescribed for back and neck pain, and are often taken long-term. However, these drugs can have devastating side effects such as depression, dependence, and even damage to the brain. Fortunately, chiropractic care presents a solution. Rather than prescribing long-term medications or invasive procedures, chiropractic care relies on non-invasive, sustainable, and effective treatment measures that don't just mask the symptoms of pain, but treat the actual source of discomfort. Particularly for the elderly, the understood risks of opioid usage are increasing. But chiropractic care presents a solution that is safe and effective for all ages, eliminating the risks associated with these medications, and resolving pain from the source. By minimizing or eliminating the need for pain medications, chiropractic care can effectively increase safety for elderly patients and increase their quality of life.

Author: ChiroPlanet.com
Source: Age and Aging, online July 26, 2016.
Copyright: ProfessionalPlanets.com LLC 2017


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What Mattress Is Best For Your Back Pain?
According to a recent study, waterbeds and body-conforming foam mattresses appear better for those individuals who suffer from back pain as compared with hard mattresses. The study included more than 100 subjects who were randomly assigned a waterbed, body-conforming mattress or hard mattress. Subjects slept on their assigned mattresses for 30-days and were evaluated by researchers before and after the 30-days. Things evaluated included the subjects' reported back pain levels, daily functioning and amount of sleep achieved per night. While researchers found no significant difference between those sleeping on waterbeds and those sleeping on foam mattresses, they did find them both superior to the hard mattress. And while everyone responds differently, those suffering from back pains who sleep on a hard mattress may wish to consider changing to a softer, less stiff foam containing mattress or perhaps even those once very popular waterbeds.

Author: ChiroPlanet.com
Source: Spine. 33(7):703-708, April 1, 2008.
Copyright: ProfessionalPlanets.com LLC 2008


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