ECU 2010 David Byfield DC MPhil FBCA FCC FFEAC

Exercise for the Elderly

People the world over are living much longer due to a complex combination of economic development, social progress and advances in medicine. As a result of this global shift in the population demographics elderly patients present a clinical challenge for the chiropractor for many reasons particularly in terms of manual intervention and overall functional management. From a clinical perspective, pain in older people has been identified as the fifth vital sign which has been associated with poorer self rated health and higher morbidity and mortality. It has been reported that back pain and neck pain are extremely common, intermittent symptoms in the elderly, widely underestimated and associated with general poor physical health. In addition, neck pain and back pain of longer duration has been associated with significantly lower physical performance. Moreover, it has also been stated that strenuous physical activity for at least one session a week appeared to be provide a protective effect for developing low back pain in seniors which has significant social implications in terms of quality of life and independence. Without question, the single most important contributor to achieving optimal health is physical activity or exercise. The benefits of exercise are legion and include, for example, improved general health, functional capacity, improvements in cognitive brain function and memory, extending longevity. In addition, the data in support of exercise benefits is exhaustive. Not weak, equivocal or contentious but strong and irrefutable evidence. Nor are these benefits limited to the currently healthy or the young. A wealth of studies now show the effect extends to those already stricken with a variety of illnesses including chronic obstructive pulmonary disease, rheumatoid arthritis, multiple sclerosis, hypertension, heart failure, diabetes, Parkinson’s and the age related illnesses. This lecture will explore the benefits of exercise for the elderly and the overall importance of including a structured exercise programme to promote and maintain a healthy lifestyle.

What Will It Take to Gain Acceptance?

This lecture will attempt to identify a realistic strategy for the UK chiropractic profession to move towards gaining acceptance in the wider health care community. Apart from identifying a number of initiatives to achieve recognition, this lecture will also pinpoint what the profession should not do in order to gain approval but focus more on appropriate professional behaviour and patient centered care to realise these aspirations. The chiropractic profession needs to build on its obvious strengths and address its weaknesses in order to sustain a level of success. Statutory regulation and all the spin offs, including professional conduct/discipline and high standards of education are important building blocks to secure a sound future. Collaborative research initiatives supported by professional funding streams and developing inter-professional working relationships will also add value in this campaign. The profession desperately needs to create a vision for itself and establish a cultural authority as a musculoskeletal specialist providing model of care that is evidence based and coherent with and benchmarked against national health system governance and clinical care pathways. This presentation will also explore ways of closing the gap that clearly exists between chiropractic education and professional practice. Furthermore, dispelling professional myths and addressing inter-professional prejudice is high on the “to do” list. The chiropractic profession cannot ignore these issues and business as usual if it wants to be a respected member of the health care team. The chiropractic profession, if it wishes to be a part of mainstream healthcare, cannot be all things to all people. It must make serious choices about its identity and where it fits into the milieu of health care. This may necessitate narrowing the system(s) we treat and expanding our therapeutic scope, forcing us to reflect on and accept the limits of our professional influence. This view does not reduce, nor should it impact on, our aspirations regarding our primary contact role.

Chiropractic Care for the Elderly

This workshop will present a comprehensive review and practical application of a number of diversified manual skills adapted for managing the elderly patient for a variety of clinical conditions and mechanical pain syndromes. Emphasis will be placed upon the practicalities of reviewing and modifying a number of manual skills related to the care of the elderly, for all regions of the spine and pelvis including the hip and shoulder. The manipulative techniques will be primarily diversified in nature and underpinned by neuro-biomechanical principles that constitute one of a number of important models that defines chiropractic manipulative sciences. Information will also be drawn from the biopsychosocial, rehabilitation and exercise models regarding patient care and management. The aim of the workshop will be to present a best practice approach to the care of the elderly based upon current evidence and clinical experience and apply this to clinical management. A number of clinical scenarios will be presented exploring a range of issues that may influence care of the elderly including depression, anxiety and fear avoidance along with a number of other important conditions such as osteoarthritis and back pain and health outcomes. The workshop will emphasize the fact that management of this group is complex and involves consideration of a number of parameters which will be discussed in context with the theme of the workshop.

The primary theme of the workshop will be to describe relevant modifications of a variety of diversified manual skills to meet the needs of this ever-expanding cohort of patients. Clinical decisions regarding whether to deliver a manipulation (adjustment) and/or a mobilisation procedure will also be presented in light of various age related pathologies and degenerative conditions common to specific regions of the neuron-musculoskeletal system, frequently encountered in this age group. The implementation of other instrument based manual care options including: i) pelvic blocking techniques, ii) mechanical thrust devices, iii) drop piece mechanisms, iv) distraction protocols and v) various soft tissue procedures will be presented. These adjunctive techniques will also adhere to neuro-biomechanical principles and rationale. Emphasis will be placed upon the psychomotor performance and delivery of these diversified skills with a view of controlling important force and speed parameters in light of the patient’s needs with ageing joints and soft tissues. The workshop will also address both absolute and relative contraindications to manual intervention depending on the particular case details. A number of manipulative skill modifications will be highlighted in the workshop for a variety of manual skills including, for example:

1) Broad contacts over large area to disperse thrust
2) Patient positioning to decrease leverage (sitting, supine)
3) Varied pre-load (joint tension)
4) Multiple lighter (less force) thrusts/oscillations
5) Sustained pressure rather than quick thrust
6) Use of specific active/passive motion - specific contacts
7) Use of accessory equipment

The workshop will also explore the concept of joint preload and the implications with respect to this particular age group and the biomechanical alterations in the aging process which may influence selection of an appropriate manual intervention or tool.