by Casey Chan, DC, QME
Today my patient asked me whether it becomes harmful or dangerous to use chiropractic as she gets older. She was particularly concerned about the arthritis she had in her spine. Like all forms of healthcare, there are benefits, risks and contraindications to chiropractic manipulation with patients with arthritis. There are many treatment methods I can use to help her with the pain and stiffness she feels from daily stresses.
You may have heard the saying that exercise is important for arthritis. This is because movement is important for the health and nutrition of joints. Chiropractic manipulation does the same for the health and nutrition of joints. A chiropractic manipulation is a low-amplitude high-velocity thrust into a specific, restricted, misaligned or stiff joint to induce movement into the joint. Stimulation of joint and muscle receptors through chiropractic manipulation also helps to reduce pain and muscle spasm/tension. Chiropractic manipulation is a very effective tool for the treatment of many musculoskeletal conditions ranging from general low back pain, neck pain, muscle strain, ligament sprain, arthritis and muscle spasm.
The caveat to both exercise and chiropractic manipulation, however, is that they both pose some risks. It is possible to sprain you hip while jogging or while overstretching. An improperly performed chiropractic manipulation may also cause a sprain to your joints.
There are other risks to chiropractic manipulation to the arthritic and elderly patient. In the case of moderate to severe arthritis, it is possible that a forceful manipulation can fracture bone spurs. Elderly with osteoporosis are also at risk of fracture with manipulation. If disc herniation is associated with the arthritis, chiropractic may be helpful or harmful depending on the severity of the herniation. Moderate and severe disc herniations often require gentler forms of treatment. Therefore, it is important for your chiropractic doctor to assess your condition and possible contraindications.
Every patient must be assessed individually to properly apply appropriate treatments that will be most beneficial while reducing the risks to the patient.
There are alternatives to the most common type of manual chiropractic manipulation for the care of arthritis. This includes Drop Table forms of chiropractic manipulation, joint mobilization (a gentle stretching movement to the joint), therapeutic massage, electrical stimulation (to reduce muscle tension, spasm and pain), rehabilitative exercise, and the use of an Activator instrument to stimulate the joint at joint receptors.
The Drop Table form of manipulation uses the design of the table to minimize the force applied to the patient. It is called a drop table because the table underneath the patient drops when a force is applied to the patient from above.
An Activator instrument is a triggered device that is used to tap at specific joints to stimulate joints. Joint receptors are stimulated, causing the joint to loosen up and pain to decrease. Because of the low-force of the Activator, there is low risk of injury to patients with conditions such as severe arthritis or osteoporosis.
I have many elderly patients, several of them even nearing 90 years old! A few of them are female and of petite build. I have to care for them individually using different treatment techniques depending on their overall health condition. Many patients are helped with skillfully applied chiropractic manipulation, causing no pain. For those who have contraindications to chiropractic manipulation, there are alternative options that I use. Activator or drop table forms of manipulation may be used as may joint mobilization. Most of my patients, elderly or not, also benefit from adjunct treatments such as therapeutic massage and rehabilitative exercise. Electrical stimulation is a form of physiotherapy that may be used at times to help with muscle spasm and pain. The ultimate goal in caring for elderly patients is to maximize benefits and minimize risks to help our patients live a long, happy and healthy life.