Chiropractic Care, Balance, and Falls Prevention in an Ageing Population

By Dr Danica Newbold, B.HSci (Chiro), M.ClinChiro, Ad.Dip Myo. Certified Cox® Technic Chiropractor and Myotherapist.

As a nation, Australia is ageing.  As of June 30 2020, 4.2 million people (16% of Australia’s total population) are 65 and older(1). Ageing comes with its own unique set of issues, and falls, fall-related injuries and mortalities are prominent features. In 2018/19, 231,000 people were hospitalised due to falls, and it was reported that 5,300 people died due to fall incidences(2). The number of falls per year has shown a consistent increase of approximately 2% since 2009/10, and as the number of older Australians increases, these numbers too, are expected to grow.

Balance issues and falls can result from several physiological factors, including vision changes, vestibular (inner ear) problems and altered sensation in the feet. Some of these changes can be associated with certain spinal conditions, such as spinal stenosis. Lumbar spinal stenosis is the narrowing of spinal canal spaces that compromise the neurological structures, causing low back pain, leg pain, and paraesthesia (numbness). This neurological compromise can present a problem for older people and may increase the risk of falls. Poor balance has also been noted in the literature in relation to Low Back Pain (LBP) patients. The evidence continues to support the fact that patients who report LBP showed decreased postural sway and improved balance when treating their LBP condition(3,4,5).

Frailty is also a serious issue for the ageing population. The more frail one is, the more likely they are to have serious complications regarding their health and wellbeing. The level of frailty depends on 5 specific observable characteristics (phenotypes). If a person has 3 out of the 5 phenotypes, they are considered frail:

1. Weakness and Strength (Sarcopenia) – are usually measured by grip strength. Women should be able to demonstrate a minimum of 20kg of grip strength, and Men should be able to demonstrate a minimum of 30 kg of grip strength.
2. Slowness – Measure by how fast a person can walk. Should be able to demonstrate greater than 0.8m/s.
3. Low Level of Physical Activity
4. Self-reported exhaustion
5. Unintentional weight loss – Should be less than 4-5kg without even trying.

Sarcopenia is the involuntary loss of muscle mass and strength, usually due to age, another common feature associated with frailty. This can also be problematic concerning balance and falls. Without appropriate muscle strength, then the risk of falls is significantly increased. Sarcopenia and Osteoporosis may also be associated with each other. With decreased muscle mass and strength also comes reduced bone density. Reduced bone density can lead to fall-related fractures, which can be a significant complication of falls, impacting every aspect of your health and daily living.

Top 3 tips for falls prevention:

• EXERCISE: Exercise has many great health benefits. Incorporating group and/or home-based exercise programmes into your daily routines which focus on strength and balance (i.e., Tai Chi) can improve balance and walking speed and reduces the risk of falls. Dancing or rhythmic exercise trains our higher cognitive functions and enhances our gait and balance.
• NUTRITION: Incorporating supplements such as Vitamin D and Calcium have been shown to improve bone density and therefore reduce the risk of fall-related fractures(6). Speak to your Practitioner about the appropriate supplementation for your condition before commencing.
• SPINAL ASSESSMENT: Speak to one of the Cox® Flexion-Distraction Certified Chiropractors at Malvern Chiropractic Clinic and Melbourne Spine Clinic regarding your spinal pain conditions. During your consultation, your Chiropractor can also assess your fall risks and prescribe the exercises that would best suit your spinal condition.

The Chiropractors at Malvern Chiropractic Clinic and Melbourne Spine Clinic are highly qualified to assess spinal function and frailty and recommend an exercise treatment plan for the prevention of falls.  Speak to your Chiropractor today or at your next appointment about how you may benefit from falls prevention treatment.  Book online here or call (03) 9822 1835 and speak to our friendly staff.

REFERENCES: 

1. https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/summary
2. https://www.aihw.gov.au/reports/injury/falls
3. Ruhe, A., Fejer, R., Walker, B., Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain? BMC Musculoskelet Discor 12, 162 (2011). http://doi.org/10.1186/1471-2474-12-162
4. Ruhe, A., Fejer, R., Walker, B. Pain relief is associated with decreasing postural sway in patients with non-specific low back pain. BMC Musculoskelet Discor. 2012 Mar 21;13:39. doi: 10.1186/1471-2474-13-39. PMID: 22436337; PMCID:PMC3341188
5. Ge, L., Wang, C., Zhou, H., et al. Effects of low back pain on balance performance in elderly people: a systematic review and meta-analysis. Eur Rev Aging Phys Act 18, 8(2021). http://doi.org/10.1186/s11556-021-00263-z
6. Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial. JAMA.2019;322(8):736–745. doi:10.1001/jama.2019.11889

Dr Joel Dixon attends Cox® Honors Course with Dr James Cox in the USA

Dr Joel Dixon was very honoured to attend face to face training at the Cox® Technic Honors Spinal Decompression Course in Fort Wayne, Indiana. In conjunction with Dr James (Jim) Cox, he and several Cox® Certified Doctors, Surgeons and Instructors from across the USA presented a range of white papers which contribute to the worldwide body of research into how Cox ®Technic protocols provide proven, effective treatment for a range of spinal conditions.

Dr Cox presented his recent research findings on Spinal Disc /spinal nerve root compression syndromes and changes to conservative spinal management. Amongst the detail and presentations, Dr Dixon and the other attendees were also provided with an update on spinal surgery options for these conditions from Dr Troy Atkins, a Neurosurgeon based in the US.

Some of the topics that were discussed at the conference were:

• Comparative Cervical disc surgery, posterior versus anterior techniques
• Lumbar Disc surgical outcomes versus conservative (Cox therapy) 5-year comparisons.
• Health sector impact of conservative therapy /surgical therapy models
• Balance and Falls Prevention – see article below and our top tips on Chiropractic care, Balance and Falls Prevention in an ageing population.

We will be bringing you more research findings in upcoming newsletters and social media posts.

Cox Technic® is a world leader in conservative spinal management and with a commitment to research and proven outcomes, continues to advance and develop. There were several presentations on case management, journal abstracts and upcoming publications submitted by many of the Doctors at the conference.

Dr Dixon presented a case study on a large thoracic spine disc protrusion (Click here to read Dr Dixon’s case), and Dr George Joachim (a US Cox Technic® Instructor) presented Dr Danica Newbold’s case on a large L5/S1 disc protrusion (Click here to read Dr Newbold’s case), both successfully managed with significant improvement in outcomes for patients using Cox Technic® at Malvern Chiropractic Clinic and Melbourne Spine Clinic.

There was much focus on the increasing number of cases of spinal stenosis.  It was detailed that by 2025, 6 out of 10 Americans over the age of 65 will suffer from the effects of spinal stenosis. Dr Kurt Olding, a US Cox Technic® Instructor, presented his research on the impact of trips and falls on the elderly. He detailed the early detection signs, prevention and management, including self-management. This is world first research that endeavours to deal with the increasing personal and health system impact of an ageing population and an increase in falls can bring.

Dr Ralph Kruse (a US Cox Technic® Instructor) presented his research into Post-surgical continued pain or FBSS (Failed Back Surgery Syndromes) which you can read more about here.

Dr Dixon returned from the conference even more enthused and inspired by how Cox® Flexion-Distraction and Spinal Decompression Therapy continues to be the ‘gold standard’ to manage a range of  spinal conditions and give patients proven relief from pain using the most up to date research and treatment protocols available.  Dr Joel Dixon and Dr Danica Newbold are available for consultations at Malvern Chiropractic Clinic and Melbourne Spine Clinic. Book online here or call 9822 1835 to schedule your next appointment.

Top 3 Stretches for Winter

HAMSTRING STRETCH

Lying face-up on the floor, using a resistance band or towel loop it over the foot like a stirrup. Straighten the leg up to 90o (or the point of gentle stretch) while slightly pulling down on the resistance band/ towel towards the torso. Hold for 30-60 secs and repeat on the opposite leg.

BACK DRAPE

Position yourself over an Exercise Ball with the ball underneath the spine between the shoulders and mid-back. Relax the body and spine with the arms either above the head or out to the side. You should feel a gentle stretch through the mid-back, chest and shoulders. Hold for 30-60 secs.

FOAM ROLLER GLUTEALS

Using the Foam Roller position the body in a seated position (hand on the floor behind) on top of the roller with one cross one ankle onto the opposite knee while rotating the knee outwards. Roll backwards and forwards across the foam roller. Maintain a steady rhythm for 30-60 secs and repeat on the opposite side.