Chiropractic Research

Auckland, New Zealand

The effects of manual therapy on balance and falls

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The effects of manual therapy on balance and falls: a systematic review

Kelly R. Holt, BSc (Chiro), PGDipHSc, Heidi Haavik, BSc (Chiro), PhD, and C. Raina Elley, MBChB, PhD

Objective: 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. (J Manipulative Physiol Ther 2012;35:227-234)

Fall risk profile

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Fall risk profile and quality-of-life status of older chiropractic patients

Kelly R. Holt, BSc (Chiro), PGDipHSc, Paul L. Noone, B.App.Sci (Chiro), PhD, Krystal Short, B.N RcpN,C. Raina Elley, MBChB, PhD, and Heidi Haavik, BSc (Chiro), PhD

Objectives: The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status.

Methods: A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older.

Results:One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for communitydwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with nonfallers (P = .04).

Conclusions: A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk

Subclinical neck pain

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Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense

Heidi Haavik, PhD, BSc (Chiro), and Bernadette Murphy, PhD

Objective: The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.

Method: Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in 4 positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a 5-minute rest period. Group JPS data were compared, and it was assessed pre and post interventions using 3 parameters: absolute, constant, and variable errors.

Results: At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group’s absolute error significantly improved after the cervical adjustments when the participants’ heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants’ JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.

Conclusion: These results suggest that asymptomatic people with a history of SCNP have reduced elbow JPS accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper limb JPS accuracy. (J Manipulative Physiol Ther 2011;34:88-97)

Study with Professor Türker

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One of the exciting studies that we are doing is a collaborative study with Professor Kemal Türker, Professor of Physiology at the Koc University School of Medicine in Turkey. The New Zealand College of Chiropractic, The Hamblin Trust and Spinal Research together made it possible for us to host Professor Türker in New Zealand for one month. He is one of the world’s leading neurophysiologists who specialises in spinal cord reflexes and is particularly interested in jaw function. Professor Türker, our NZ colleagues and we spent this month investigating how chiropractic care influences the way the brain controls motor neurons in the spine. While he was with us we were so excited with what we were seeing we completed a second study at the same time which is now in the publication process.

Professor Kamal Turker

This excitement resulted in us pursuing this line of research further. Dr Imran Khan Niazi and myself went to Professor Türker’s lab in Turkey earlier this year to perform a follow-up pilot study that looks at how spinal adjustments influence the cranial nerves, in particular how they influence jaw function. Considering how chiropractic was founded this particular project could be very enlightening for the profession! We’re now ready to run the full study using the protocol we have piloted and are ready to jump into action and get this under way as soon as we secure the funding we need to complete the study.

This collaboration has also resulted in two more projects that we hope to do that will look at the effects of chiropractic care on strength and proprioception for an upper limb (shoulder) muscle and the effects of long term chiropractic care on lower limb muscle function. Again these projects are designed, piloted, and just waiting for the required funding needed to conduct them!

Research Grants Needed

We have submitted this project to Spinal Research for a grant and it has been approved by both their clinical and scientific panels, however they do not yet have the funds to award us this grant. So as soon as we are able to raise enough money in conjunction with Spinal Research for this study then we will jump into action and get this under way immediately.

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  • 6 Harrison Road, Mount Wellington,
  • Auckland 1060
  • PO Box 113-044, Newmarket
  •  Mon to Fri 8:30am to 5:00pm
  •   +64 9 526 6789
  •  +64 9 526 6788
  •  info@chiropracticresearch.ac.nz