Adjusting the Aging Patient

David I Graber, DC, DACBSP

Patient Gets Chiropractic Adjustment:

Chiropractors are seeing an increased number of older patients. It’s estimated that one in seven ( 14-16% ) of patients treated by doctors of chiropractic (DCs) are 65 and older. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%).

Research has shown that Chiropractic care has a number of benefits for the geriatric population.

  • Patients over age 65 that are under chiropractic care have a lower overall risk for an injury due to a neuromusculoskeletal problem.
  • Medicare beneficiaries treated by a chiropractor had slower declines in activities of daily living, disability, lifting, stooping, walking, self-rated health, and worsening health after 1 year, compared with patients receiving usual medical care.
  • Chiropractic care is effective for relieving acute and chronic spinal pain conditions, especially when used in conjunction with exercise.
  • Patients under chiropractic care report higher satisfaction than usual medical care.

Here are some considerations and rules of thumb for adjusting these “seasoned citizens”.

General Considerations:

  • The patient’s ability to move on the table. This includes how well they can get on and off the adjusting table (high-low tables can be helpful here), if they can get on or off it at all, and how well they can move and change positions on the table. Definitely minimize the chances of a patient falling off the table, especially those with orthostatic hypotension.
  • Use the least amount of thrust necessary. High-velocity low amplitude (HLVA) techniques need to take into account the health of the joints adjusted, the degree of joint degeneration and its accompanying limitations in range of motion and increased stiffness, the patient’s tolerance to these procedures, the presence of osteoporosis, and reduced muscle mass. Modify your techniques as needed. Many times mobilization, non-thrust techniques, or using adjusting instruments are more appropriate approaches, especially in the initial stages of care.
  • Using a chiropractic table with various drop sections is beneficial, as it allows you to use less force and is often more comfortable for elderly patients.
  • Care with soft-tissue and manual techniques with patients taking anti-coagulant or prolonged steroid medications to prevent bruising or bleeding. The same is true for patients with age-related increased capillary fragility.
  • Never force a technique on a patient. If a patient isn’t comfortable, physically or psychologically, with any procedure, use an alternative one.
  • Patients with conditions that increase the likelihood of potential injury have been shown to be a chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm, and dissection, or long-term use of anticoagulant therapy. These conditions are not absolute contraindications for SMT, but warrant consideration in the patient’s care plan.
  • Older patients frequently have touch hyperesthesia and are more sensitive to the pressures applied by any type of manual therapy. This is due to epidermal thinning, reduced muscle mass, increased nociception, and psychological factors.

Regional Considerations:

  • Cervical Spine:  Avoid excessive rotation and extension of patient’s cervical spine. While studies have shown cervical spine manipulation is safe for the geriatric population, the adjustive vectors of rotation and extension have been shown to be the most problematic if not carefully applied.
  • Thoracic Spine: The posterior-to-anterior (P-A) force of a chiropractic adjustment is unlikely to cause damage to the bodies of the thoracic vertebrae in an osteoporotic patient. To reduce the risk further, consider using lower force or light thrust manual techniques in the thoracic spine of osteoporotic patients.  Care needs to be taken with patients who have reduced mobility in the rib articulations, as costal joint sprains are possible.
  • Lumbopelvic Region: Make sure the patient is securely placed on the table. Many older patients have proprioceptive and balance issues, and these may exacerbate a fear of falling off the table. When performing side posture techniques, avoid using the femoral neck area as a fulcrum with frail patients, those with a history of hip injury, surgery, or instability. For patients who have had a hip replacement, the upside knee should never be forced to cross the patient’s midline to decrease the small potential risk of prosthesis dislocation or injury to the hip joint. Flexion distraction techniques are effective, especially if used with a table that allows multi-directional angles.

Chiropractic adjustments are effective and safe when applied wisely to geriatric patients. With our growing aging population, chiropractic care can help millions lead better and healthier lives.

Note: References are available on request:

About the Author:

Dr. David Graber is a nationally known presenter on chiropractic technique and is a member of the ANJC board of directors. He maintains a private practice in Parsippany, NJ. He blogs on chiropractic and clinical topics at:  He can be reached at:

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