Chiropractic, posture and risk of falling

https://www.researchgate.net/publication/378090792_Risk_of_Fall_Cognition_and_Static_Posture_in_Aging

I came across this very interesting article while listening to one of my chiropractic research podcasts. It reminded me of a conversation I had with a patient and her adult daughter who drove her to her appointment last year. The mother, in her early 80s, had moved closer to her daughter’s family and was trying to reestablish chiropractic care on a more consistent basis. She was a lifelong chiropractic patient, for episodic neck injuries and later on decided to stay on a preventive checkup schedule because she felt overall better and more balanced when she did so. During the history, her daughter chimed in on her mother’s comment that “ she has a tendency to be more clumsy and trip “ when she has not had a chiropractic check and adjustment in a while. The daughter was unfamiliar with chiropractic and simply curious about the correlation between the two. At the time, I share my 30 years of clinical experience in observing that correlation and the biological mechanisms connecting the chiropractic treatment on the neurological adjustment of proprioception and reflex time. I wish I had had that piece of research to add to the conversation.

The research led by a lesser known Brazilian colleague showed a correlation between two key measures of sagittal posture and the risk of fall: the degree of anterior neck shifting in relationship to the trunk, and the anterior angle of the ankle. Both indicating that the body is off its center of gravity and thus has less time to respond to stay upright before hitting the ground. Both posture indicators are exam findings that we observe and report, and both are factors that we aim to improve/correct with manual therapy and guidance on home activities and corrective exercises. One little golden nugget for me to take away from this research is that I can use it in conversation with patients when they question why I work on their lower extremities, especially their ankles and feet, when their primary problem seems to lie elsewhere. I almost often look at the lower extremity alignment when doing my initial evaluation and I will adjust them if needed, something that makes some folks a little testy when I ask them to take off their shoes and poke at one more body area. Now I can remind them that when I take on that additional endeavor at 5 pm, when their footsies are a little more “ aromatic”, it is indeed solely for their own benefit and backed by solid scientific research

(photo courtesy Freepik)

Can I have a pinched blood vessel ?

Patients will often precede a question with the disclaimer “ this may be a dumb question, but I am wondering if….”. This disclaimer almost always guarantees that they are usually pretty astute in their observation and closing in on some matter of importance.

The latest “dumb question” that came up this week was interesting: could my symptoms be caused by a pinched blood vessel ?  The patient had some pins and needles sensations in the front of the shoulder, they had noticed that the skin on the front of the arm was a little darker and a little colder than on the other side. Good logic led them to wonder if there was decreased blood flow in the affected area.

The surprising answer to that question is not only: yes !, but the fact that most instances of pinched nerves probably have some degree of pinched vascular structures that go along with the pinched nerve. And there is a very simple reason for that: if you go back to basic anatomy, nerves, arteries and veins very often travel as a trio before splitting off prior to their final destination. Anyone who has done college level anatomy will recall the acronym NAV, standing for  nerve, artery and vein, describing the bundles of the three structures lumped together. And anyone who has done anatomy cadaver dissection recalls how difficult it was to separate the three structures from each other and tell them apart.

From a practical and clinical standpoint, there is a lot of overlap in the symptoms of nerve and vascular compression. Both can cause pain, and both can cause abnormal sensation like numbness and tingling, making it difficult to differentiate them based on symptoms alone. Physical examination can be helpful, but also somewhat limited. Mild vascular compression can cause subtle swelling, changes in color and temperature, but those can be difficult to differentiate from inflammation related edema, and most body areas have collateral circulation that can take over when there is mild vascular compression from one source. 

In day to day chiropractic practice, we tend not to aim our treatment to relieve mild vascular compression independent from relieving nerve compression, which is probably why we talk about this topic infrequently. Relieving nerve compression is the main goal, and vascular structures will basically benefit from that approach. Nerve tissue and vascular tissues have distinct features that makes nerves more vulnerable in NAV bundles: they lack collateral back up, and they are not as adaptable to move out of the way of compressive forces. But that is not to say that some patients will show up with unusually strong vascular compression symptoms that need to be taken into account when setting up a treatment plan, for example limiting the use cold pack therapy and compression

Caregiver injuries and transfer belts

https://www.youtube.com/watch?v=5GC_OETvnRc

This video is geared for a wide audience, not just for the professionals in the personal care industry. Many of us are finding ourselves in a season of life involving caring for loved ones at home with progressive leg weakness and balance issues. I have treated enough injuries sustained in that context to spur this brief video on how you can prevent many injuries using this simple tool and technique. If you are not sure on how to use a transfer belt, please bring your own to your appointment and I will be glad to give you a short tutorial