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In the upright positionA strategy for preventing falls in the elderly population.BY S T E V E N W E I N I G E R , D C

FALLS ARE THE LEADING CAUSE OF

DEATH AND INJURY AMONG THE

elderly, with a third of peopleover 65 suffering a fall each year.During the next 20 )ears, some 10,000baby boomers will turn 65 every day,creating an increasingly huge demo-graphic prone to this problem. What'smore, baby boomers are expected tooutlive their parents, which is whythe prevalence of falls will explode overthe coming decades. So how can DCshelp?

Falls are common, but they're notnecessarily a natural part of aging)According to experts, fall preventionbegins with heightening awareness ofthe problem, and then taking amultifactorial approach, which

includes looking at an individual'senvironment, psychology behavior,and physical functioning.'

Reflexes slow with age, so it's best tobegin any fall management inter-vention by looking at the patient'senvironment. Along with other fall-risk professionals, DCs should advisepatients over 65 to be aware of hometripping hazards, poorly fitting shoes,loose rugs, and electrical cords nearwalkways. Also, vision can be a factor,making regular eye assessments animportant part of prevention.

The psychological fear of falling isalso a component. Once someone falls,they're twice as likely to fall again inthe next six months.

A vicious spiral of decreased mobility

RESEARCH R ES U LIS

leads to inactivity and deconditioning,further increasing fall risk. And even ifit's only a friend who experiences thefall, awareness of the consequencescauses nearly half of older adults toworry

But while environment andpsychology are important, the greatestpotential to reduce falls is throughcountering frailty with physicalconditioning. There's potential forchiropractic here, too, as improving thebody's biomechanics on segmental aswell as global levels plays to chiro-practic's strengths.

For the mainstream healthcare fall-prevention team to include DCs,however, a clear value propositionmust be communicated to MDs, from

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geriatricians to gerontologists, as well as adult-care facilitypersonnel, administrators, the media, and the public.

A neglected part of conditioningBalance is one of the four aspects of fitness essential forgood health, the other three being strength, cardiovascularcondition, and flexibility And although in the past few yearsbalance has received more attention with the rising popularityof exercise balls, Pilates, and yoga, it's still a distant fourth inmost exercise programs.

While some DCs address balance, in practice most don'trealize (or communicate) the potential for an adjustment toimprove a patient's functional equilibrium. But some chiro-practic researchers who have looked at manual therapy andfalls have seen promising results.'

Osteopathic manipulation is now being investigated as atool to reduce falls, improve gait, and address balancedisorders.4 O n e d i z zi n es s s tu dy found " os te op at hic manip-

ulative treatment for spinal somatic dysfunction improvedbalance in patients with dizziness lasting at least three months:'s

Thus spinal manipulation can make unique contributionsin fall prevention. Anecdotally, many DCs who focus onbalance report observing significant improvement in one-legbalance time and stability after an adjustment.

A chiropractic model for fall management and preventioncan empower patients with practical recommendations, anddovetail with the research already being directed at fall-riskmitigation and injury prevention. For chiropractic involve-ment in fall prevention to be widely adopted, it mustintegrate the passive therapy it's known for (with anevidence-supported model of active rehab, balance, and gaittraining, and a focus on balance).

Posture for fall preventionClinical communication must come before action. Just asyou'd never tell a patient, "Let me work on you, and then I'lltell you what I did:' to work in the realm of fall prevention,it's imperative to explain the problem from a biomechanicalperspective, which includes the importance of the DC'ssignature contribution—the adjustment. And the key to thismodel is posture.

Balance and posture are two sides of the same coin. Tostand, the body must be in balance. And postural alignmentis relevant to falls. From bottom to top, the body's massesalign to balance forces and remain vertical.

Whether standing still or in dynamic gait, posture is howthe body's masses balance, align, and move. To commu-nicate this and other biomechanical concepts, you can usesuch phrases as "Posture is how you balance your body. Ifyou don't balance, you fall down."6 Body positioning errors are a significant cause of falls,and stability suffers when the building blocks of the body

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are poorly stacked.7 A r e c e n t s t u d y

looked at posture and low-back pain,finding little clinical relevance in highshoulders and low hips, but noted,"The orientation of gross bodysegments with respect to the gravityline seems superior to local spino-pelvic features in terms of clinicalimportance."'

To facilitate explanations of bodyposition, these body segment masses

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can be labeled "The four posturezones."9 The postural equilibrium ofbalancing (the legs support the pelvis,'upon which balances the torso, whichin turn supports the head) is maintainedwith a subtle interaction of forces.Equally subtle is the compensation thatoccurs from injuries and habits causingstructural asymmetries, which cancause the body to stand and move in

unintended ways.When a person's proprioception is

off, reality intercedes and stabilitysuffers—a major fall risk. Whenwalking, if you believe your foot isgoing to clear the ground—and itdoesn't—your foot catches but thebody continues to fall forward. Studiesindicate that, especially in men, whenthe head translates forward of the torso,it is a risk factor for injurious falls.10Assessing functional symmetryTo begin focusing on posture, observebody control and position by testingpatients' ability to maintain bodyposition while standing tall andbalancing on one leg, then the other.In addition to timing how long theindividual can support themselves,note the symmetry of control in howthey are maintaining balance as theylift one leg versus the other.

Waving arms or hopping revealsweakness or loss of control—or both.In other words, there is a discrepancybetween where they believe their bodyto be in space and the objective reality

Next, photograph the location of thebody against a background grid toobserve asymmetries and errorsbetween the patient's perceived posi-tion of head, torso, and pelvis, versusthe reality It may be subtle, but anydeviation from centerline must beaddressed for the individual to maintain

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RESEARCHRESU LIS

vertical position. For example: If thehead goes to the left of midline, themass must be compensated for byanother mass or force shifting thebody toward the right.

When you look carefully, you maysee correlations between a patient'spresenting symptoms with his or herpattern of compensation. During thereport of findings, if you can connectthe difference between a patient'sperceived postural alignment withphotographic evidence to the contrary,he or she will often make the sameconnection.

More people are exercising to stayactive; yet posture and balance tend todegenerate with age, and falls oftenprecipitate a slide toward diminishedfunction. You can make a meaningfuldifference with fall-risk education andbalance training.

Chiropractic can contribute to abetter culture of health for older

patients with fall prevention. Bypromoting postural awareness andhelping people regain and retrainsymmetry of motion, you can helppatients stand tall and move well. a

STEVEN WEINIGER, DC,teaches continuing educationseminars on integratingchiropractic and posture rehabexercise, and clinical posture

assessment and therapy. He is a managingpartner of BodyZone and posturezone.com,an online health resource and referraldirectory for posture-exercise professionals.He can be contacted at 866-443-8966,drweiniger@bodyzone.com, or throughbodyzone.com.

References1NlaineHealth. "A Matter of Balance" fall

prevention program. wwwmainehealthlearningcenter.orgiresourcesipreventing-falls. AccessedOctober 1, 2014.

2 Health Quality Ontario. Prevention of falls andfall-related injuries in community-dwellingseniors: An evidence-based analysis. Out Health

Wows.I didn't know it would do that too!Many doctors join ChiroHealthlISA just thinking they are solving a cash discouhi ploblern. Thenthey begin to see all the other ways to use it to help their practice, just like a multi-purpose tool.How will ChiroHealthUSA help you?

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3 0 C H I R O P R A C T I C E C O N O M I C S • N O V E M B E R 11, 2 0 1 4

Technol Assess Ser. 2008;8(2):1-78.3 Holt KR, Haavik H, Elley CR. The effects ofmanual therapy on balance and falls: Asystematic review J Manipulative Physiol Then2012;35(3):227-34.

'Noll DR. Management of falls and balancedisorders in the elderly. A m Osteopath Assoc.2013;113(1):17-22.

5Fraix NI, Gordon A, Graham V, Hurwitz E,

Seffinger MA. Use of the SMART balance masterto quantify the effects of osteopathic manipulativetreatment in patients with dizziness. I AmOsteopath Assoc. 2013;113(5)394-403.

6 Weiniger S. (2008). Stand Taller Live Longer: AnAnti-Aging Strategy Alpharetta, GA: BodyZonePress.

'Winter DA. Human balance and posturecontrol during standing and walking. GaitPosture. 1995;3(0:193-214.

8Dolphens M. Cagnie B. Coorevits P. et al.

Sagittal standing posture and its associationwith spinal pain: A school-based epidemiologicalstudy of 1196 Flemish adolescents before age atpeak height velocity. Spine. 2012,37(19):1657-66,

"Weiniger S. (2008). Stand Taller Live Longer: AnAnti-Aging Strategy. Alpharetta, GA: BodyZonePress.

'°Kada DM, Huang MI-I, Nguyen CB, Barrett-Connor E, Greendale GA. Hyperkyphoticposture and risk of injurious falls in olderpersons: The rancho bernardo study. GerontolA Rio! Sci Med Sci. 2007;62(6):652-7.

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With over 2,500 providers helping over 500,000 people, ChiroHealMUSA is the Network that Works for Chiropractic/ Have questions about how we can help grow and protect your practice? Call and see c h i r o H e a l t hJust how easy it is to implement ChiroHealthLISA and start practicing with more peace of mind/1-888-719-9990 / www.chirohealthusacom /info@chirohealthusa.com

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