Is Chiropractic Care Safe and Effective for Older Adults?

Last updated: 06-29-2020

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Is Chiropractic Care Safe and Effective for Older Adults?

Chiropractic care represents a safe and effective treatment alternative for older adults, according to evidence-based recommendations published in the May issue of the Journal of Manipulative and Physiological Therapeutics. 

“The most important take-home point from this updated document is that given the growing need for evidence-based, cost-efficient care in the older adult population, chiropractic care is a very attractive alternative,” explained lead author Cheryl Hawk, DC, PhD, Professor at Texas Chiropractic College in Pasadena, Texas.

“Chiropractic care incorporates many different treatment modalities, as outlined in the document,” Dr. Hawk told SpineUniverse. “One of the key treatments that chiropractors deliver is spinal manipulative therapy (SMT). The evidence base for SMT continues to grow.”

Spinal Manipulation Is First-Line Treatment for Low Back Pain “The most important recent update is the new American College of Physicians clinical practice guideline, in which spinal manipulative therapy (SMT) is included as a first-line treatment for low back pain,” Dr. Hawk said. “In addition to SMT, these updated clinical practice guidelines also recommend other treatments commonly delivered by chiropractors, including exercise recommendations.”

The Best Practices paper lists considerations to apply when treating older adults with manual procedures (Table 1). In addition, the recommendations emphasize the need to incorporate the biopsychosocial model of pain in the assessment and management of older adults, including age-related changes in the neurologic and musculoskeletal systems of older adults that may require consideration during physical examination (eg, peripheral neuropathy, muscle loss, and decreased flexibility). “Health professionals caring for older adults must recognize that these patients may have cognitive issues, depression, substance use issues, or other factors that make their care complex,” Dr. Hawk said. “It is essential that providers caring for geriatric patients become fluent in evidence-based screening tools to assure that the entire clinical picture is being considered.”

How to Counsel Elderly Patients on the Safety of Chiropractic Care The updated recommendations include data from recently published randomized-controlled trials that provide additional support for the safety of SMT in older adults.

“The most valid studies suggest that about half of all patients will experience adverse events after SMT,” Dr. Hawk explained, adding that the events are usually mild (muscle soreness or stiffness) and transient (24-72 hours). “No reliable data exist about the incidence of serious adverse events, but they appear to be extremely rare.”

“Based on our review of the literature on safety, reported in our paper, the bottom line is that the risk for cerebrovascular accidents associated with SMT in the older adult is minimal given that even the small risk that exists is in a younger (


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