Chiropractic Care Improves Senses and Reduces Risks of Falling in the Elderly Population
A report on the scientific literature
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
The National Institute of Health (NIH) expanded the list of risk factors in older adults to include:
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:
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.
Arthritis Prevention and Chiropractic
Chiropractic prevents arthritis in accident victims, the elderly and the sedentary
A report on the scientific literature
By Mark Studin DC, FASBE(C), DAAPM, DAAMLP
According to the Arthritis Foundation (2007), "Forty-six million [46,000,000] Americans are currently living with arthritis, the nation's leading cause of disability, and we are all paying a high price for it. The Centers for Disease Control and Prevention (CDC) announced that the annual cost of arthritis to the United States economy was $128 billion in 2003 and increased by $20 billion between 1997 and 2003.
CDC attributes the dramatic increase to the aging of the population, predominantly baby boomers, and increased prevalence of arthritis. CDC also estimates an additional 8 million new cases of arthritis will be diagnosed in the next decade" (http://www.arthritis.org/cost-arthritis.php).
Arthritis, A.D.A.M., Inc. (2010, February 5), "...is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. There are over 100 different types of arthritis...
Causes, incidence, and risk factors
Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.
You may have joint inflammation for a variety of reasons, including:
- An autoimmune disease (the body attacks itself because the body immune system believes a body part is foreign)
- Broken bone
- General wear and tear
- Infection (usually cause by bacteria or viruses)...
With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:
- Being overweight
- Previously injuring the affected joint
- Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers and construction workers are all at risk)
Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223). With hypomobility (less mobility or movement), adhesions occur in a joint (the region where 2 bones connect).
According to A.D.A.M., Inc. (2010, March 30), "Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together. As the body moves, tissues or organs inside are normally able to shift around each other. This is because these tissues have slippery surfaces.
Causes, incidence, and risk factors
Inflammation (swelling), surgery, or injury can cause adhesions to form almost anywhere in the body...Once they form, adhesions can become larger or tighter over time. Symptoms or other problems may occur if the adhesions cause an organ or body part to twist, pull out of position, or be unable to move as well.
Adhesions may form around joints such as the shoulder...or ankles, or in ligaments and tendons. This problem may happen:
- After surgery or trauma
- With certain types of arthritis
- With overuse of a joint or tendon
Adhesions in joints, tendons, or ligaments make it harder to move the joint and may cause pain...Adhesions in the pelvis may cause chronic or long-term pelvic pain.
Signs and tests
Most of the time, the adhesions cannot be seen using x-rays or imaging tests" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462).
Over time, with a sedentary lifestyle as seen in many portions of the population and increasingly with the elderly, joints become hypomobile. Hypomobility is also seen in trauma-related cases and repetitive use injuries, such as reading while looking down for extended periods, carrying heavy items, holding the phone between one's shoulder and ear, prolonged use of hands, wrists, back and neck, excessive use of computers, etc. As time progresses, internal scar tissue or adhesions continue to develop and further increases the loss of mobility.
Cramer, Henderson, Little, Daley and Grieve (2010), cite previous studies that have shown that adhesions have been found in numerous hypomobile (loss of normal movement) joints and that spinal adjusting separates the articular surfaces of the joint. The researchers inquired as to whether connective tissue adhesion developed in lumbar articular joints as a consequence to intervertebral hypomobility and utilized animal studies. They concluded that "...hypomobility results in time-dependent [adhesions]..." (Cramer et al., 2010, p. 508). In other words, internal scar tissue (arthritis) developed within the joints over time.
Cramer et al. (2010) sited previous studies that found the spinal adjustment separates the joints which could break up intra-articular adhesions. In other words, in their animal studies, spinal adjustments/manipulation increased the "Z gap" or spacing between the joints/bones and the mobility of the joints. If this applied in humans, the adjustments would then prevent further development of adhesions and degeneration and osteophytes, which is how the arthritic process progresses.
While arthritis affects approximately 1 in 7 Americans, the prevention of and/or correction of arthritis would relieve a great strain on our economy. While not all arthritis is a result of hypomobility, much of it is. If every person was under chiropractic care, we could not only positively affect the lives of every American, we could potentially rescue the economy of the United States and every other country and insurer in the world that assumes risk for an aging and hypomobile society.
1. Arthritis Foundation. (2007, January 17). Cost of arthritis increases to $128 billion annually. Retrieved from http://www.arthritis.org/cost-arthritis.php
2. A.D.A.M., Inc. (2010, February 5). Arthritis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223
3. A.D.A.M., Inc. (2010, March 30). Adhesion. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462
4. Cramer, G. D., Henderson, C. N. R., Little, J. W., Daley, C., & Grieve, T. J. (2010). Zygapophyseal joint adhesions after induced hypomobility. Journal of Manipulative and Physiological Therapeutics, 33(7), 508-518.
Balance and Movement and The Effect
of Chiropractic Care
Utilization with the Elderly, Cerebral Palsy, the Athlete
and the General Population
Chiropractic care reverses maladaptations in sensorimotor integration
and improves motor control
A report on the scientific literature
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
Sensorimotor is defined as our ability to feel and move. With infants, Piaget, the renowned researcher, categorized the first 2 years of an infant’s life as the sensorimotor stage. "During this period, infants are busy discovering relationships between their bodies and the environment. Researchers have discovered that infants have relatively well developed sensory abilities. The child relies on seeing, touching, sucking, feeling, and using their senses to learn things about themselves and the environment. Piaget calls this the sensorimotor stage because the early manifestations of intelligence appear from sensory perceptions and motor activities" (Anderson, n.d., http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html).
As we develop and our nervous systems have acquainted us to our surroundings, we need the neurological "hookups" to remain intact to function optimally and pain free. In addition, our sensory and motor systems need to work in tandem in order for us to function normally.
To further break it down, our sensory system is part of the nervous system that consists of receptors that receive stimuli from both our internal and external environments. These receptors, such as the ones located in our fingertips, sense external stimuli, such as hot or cold, or what we feel. An internal receptor may be found in the tendons (connect your muscles to your bones) and lets you know what your joints are doing, such as are my fingers sensing if they are relaxed or in a fist. The sensory system is also controlled by the brain that processes what we feel.
Pain is part of the sensory nervous system and to the surprise of many, pain is an important component to protecting yourself. Without pain, you could get seriously hurt, such as by keeping your finger on a hot stove too long or touching a sharp object too heavily and cutting your hand. Internally, pain is a warning sign that an organ or system is "sick" and alerts you to seek medical care.
All pain receptors are free nerve endings, meaning they only bring information to your brain and function as the "pain receptors." There are three types of pain receptors; mechanical, thermal and chemical. They are found in skin and on internal surfaces such as the coverings of the bone and joint surfaces. "Deep internal surfaces are only weakly supplied with pain receptors and will propagate sensations of chronic, aching pain if tissue damage in these areas is experienced. Pain receptors do not adapt to stimulus. In some conditions, excitation of pain fibres becomes greater as the pain stimulus continues, leading to a condition called hyperalgesia [commonly known as, "WOW, that hurts a lot!"]" (Global Oneness, n.d., http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137).
Your motor system is what allows you to move, maintain your posture and control your muscles. The motor system is controlled through nerves similar to the sensory system and like the sensory system, has a controlling element in the brain.
Functional tasks are defined as those things we do in our lives. Answering a telephone, putting a key in a door lock or picking up a fork to eat are all examples of functions. These functions, just like Piaget described in infants, are how we have a relationship with our body and the environment and require an integrated motor and sensory nervous system. Every functional task that we do involves both the motor and sensory components of our nervous system and while performing these tasks, we are protected by our ability to perceive pain.
Due to the development and integrategration of the world around us necessary to complete every task in our lives, as we get older, postural disturbances can arise and negatively affect how we integrate the sensorimotor information we are receiving both internally and externally and lead to significant balance disorders. Lord and Ward (1994) reported that, "All of the sensory, motor and balance system measures showed significant age-associated differences" (http://ageing.oxfordjournals.org/cgi/content/abstract/23/6/452). This means that as one gets older, his/her sensorimotor system often fails to integrate the internal and external environment as it once could.
A research study by Taylor and Murphy (2008) concluded that chiropractic care reverses maladaptations in sensorimotor integration and improving motor control. The study suggests that spinal dysfunction may lead to muscle specific alterations of the brain’s ability to process motor control. The "real-life" implications of this finding affect every facet of our lives and every person. Whether it be an older person who is starting to exhibit balance disorders, or a cerebral palsy victim who struggles on a daily basis with the simple tasks of life or a world class athlete looking to increase his/her fine motor skills just 1/10 of 1%, the results of chiropractic care can be dramatic.
From the clinical observation of Dr. Mark Studin, a co-author of this article and a practicing chiropractor for 30 years, "This now gives scientific evidence and validation to what patients have been sharing after receiving chiropractic care. The most common comment from patients post care is, 'I perceive my surroundings more acutely and feel straighter.'" Dr. Studin continues, "Although I have heard this from every age group, my first patient was a cerebral palsy patient who stated that without getting adjusted he could barely function. With care, he walked to and from the office, a distance of 3 miles."
These studies, along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions to increase integration between the motor and sensory systems of your body. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
1. Anderson, M. (n.d.). Sensorimotor stage. Jean Piaget's Theory of Development. Retrieved from http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html
2. Global Oneness. (n.d.). Pain - Physiology. Retrieved from http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137
3. Lord, S. R. & Ward, J. A. (1994). Age-associated differences in sensori-motor function and balance in community dwelling women. Age and Ageing. Retrieved from http://ageing.oxfordjournals.org/cgi/content/ abstract/23/6/452
4. Taylor, H. H. & Murphy, B. (2008). Altered sensorimotor integration with cervical spine manipulation. Journal of Manipulative and Physiological Therapeutics, 31(2), 115-126.