Chiropractic care for older people may reduce deaths and injuries from falls according to researchers taking part in a study by Auckland University and the Chiropractic Research Centre (CRC) at the New Zealand College of Chiropractic on the neurophysiological effects of chiropractic on the brain.
According to chiropractor, PhD candidate and principal investigator of the study Dr Kelly Holt, falls often occur due to a decline in nervous system function with advancing age. This can lead to a loss of balance, or poor control of the limbs, which dramatically increases the risk of falling.
Dr Holt says: `Already it is estimated that in New Zealand slips, trips and falls cost almost $300 million per year in treatment and rehabilitation costs and as the population ages this will likely get worse.’ He says that ‘falls result in approximately 450 deaths per year in New Zealand and for older adults in particular, a fall can lead to a downward spiral that involves a loss of confidence, a cessation of day to day activities and eventually increased frailty and even death.’
ABSTRACT: The Effects of Manual Therapy on Balance and Falls: A Systematic Review
Journal of Manipulative and Physiological Therapeutics March/April 2012, Holt et alObjective
The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.
Methods
This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.
Results
Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.
Conclusion
A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.
It would only make sense that spinal manipuation would help with the proprioception and mechanics that would improve balance. Athletes that utilized chiropractic will tell you receiving adjustments helps with their particular sport including balance.
The article says Manual Therapy, not Chiropractic. “a manual therapy component” only infers CMT. You’re stretching it John.
Dr. Stiglitz
If you have a subscription to JMPT, you can access the Full-Text article, to determine how many of the 11 articles they discuss may have been related to care provided by DCs vs. other manual providers.
Even so, the discussion is that improved joint function appears to improve balance. Chiropractors pride themselves on being the Masters of manipulation/adjusting, and the research bears that out nicely.
Although the RAND report is dated now, at least in the 90s they found that more than 90% of ALL SMT was being provided by DCs, so John is not really “stretching it”.
As usual Frank you manipulate what you read to favorable to us and when a topic comes up negative, it has to be the PT’s and DO’s doing the bad stuff. You’re quite the scientist Frank.
Basic research is like shooting an arrow into the air and, where it lands,
painting a target.
— Homer Burton Adkins (1892-1949, American organic chemist)
See My Reply Below
Hugo,
That was a rather caustic comment. If you are so scientific, why did you fail to offer any evidence of my ever having done that? (“manipulate what you read to (be) favorable to us”)
I’m also curious why you didn’t respond to my original comments to you?
You do not appear anywhere on Google, especially not as a DC practicing anywhere. Most curious.
Please respond to the e-mail I sent you, before you post here again. This is, after all, a Doctor’s forum.
I would like to see some more direct comparisons of proprioceptive function before and after manipulation – perhaps after a single manip, then after a series of manipulations over some time frame.
While we’ve correlated some clinical outcomes with manipulations with research, to my knowledge we’re not really sure WHY manipulation helps. The “bone-on-nerve” and “garden hose” hypotheses don’t hold much water for me, and the generic “to improve joint function” rationale, while it may be true, doesn’t really explain anything either.
CMT is a fast stretch of a joint, and thus can be objectively proven to increase joint ROM. Since both muscle spindles and golgi tendon organs report data about joint stretch, and therefore joint position, I think it makes sense to run some studies on whether CMT affects proprioception in any way.
Hi Daniel
I agree that joint neurology is the most interesting topic, and perhaps the best window for viewing the power of the chiropractic adjustment.
Here are some links to articles I have collected over the years:
http://www.chiro.org/research/ABSTRACTS/Exploring_the_Neuromodulatory_Effects.shtml
http://www.chiro.org/LINKS/ABSTRACTS/Neurophysiological_Effects_of_Spinal_Manipulation.shtml
http://www.chiro.org/LINKS/ABSTRACTS/Response_of_Muscle_Proprioceptors.shtml
http://www.chiro.org/research/ABSTRACTS/Preliminary_Morphological_Evidence.shtml
http://www.chiro.org/research/ABSTRACTS/Manual_Therapy_With_and_Without_Vestibular.shtml
http://www.chiro.org/research/ABSTRACTS/Improvement_in_Ataxia.shtml
http://www.chiro.org/research/ABSTRACTS/Cervicocephalic_Kinesthetic_Sensibility.shtml
http://www.chiro.org/research/ABSTRACTS/Cervical_Kinesthesia.shtml
http://www.chiro.org/research/ABSTRACTS/Vestibular_Diseases.shtml
http://www.chiro.org/research/ABSTRACTS/Reflex_Effects_of_Subluxation.shtml
http://www.chiro.org/ChiroZine/ABSTRACTS/Seaman_dysafferentiation.shtml
AND my personal all-time favorite:
http://www.chiro.org/research/ABSTRACTS/Visceral_Disease_Simulation.shtml
Wow — thanks for all the resources, Frank! I’m looking forward to reading these. 🙂
It really is no wonder that chiropractic can help lessen incidences of deaths and injuries among the elderly. Chiropractic, after all, helps improve balance and strength.
It amazes me how many of our elderly patients report having much better movement and balance as part of their health benefits of chiropractic yet we hear almost nothing from the medical profession about it as a preventative measure. I would be curious to see any articles about forward head posture and elderly people leading to a decrease of mechanoreception into the cerebellum.
It is fantastic that these studies are being followed and published. We need more of this to add to the collection of case studies to help the public become more aware of the benefits of chiropractic care. The improvement in balance and proprioception with older patients is such an incredible help to them. Good article!