Does Your Clinical Assessment Need an Update? Add Balance & Proprioception Testing

by Mark Sanna, DC, ACRB Level II, FICC • 

President & CEO Breakthrough Coaching • 

Chiropractors are constantly evolving their clinical assessments to meet the ever-growing needs of their patients. Today, we must ask ourselves: Are we doing enough to prevent falls and improve the quality of life for our middle-aged and elderly patients? The answer may be incorporating balance and proprioception testing into our standard assessments. The integration of balance assessments not only addresses immediate pain and mobility concerns but also promotes long-term health and safety, particularly for older adults who are at a higher risk of falls.

The Slip and Fall Crisis

Falls are a significant health risk for older adults, contributing to over 8 million emergency room visits annually in the United States. The consequences of a fall, especially for those over 65, are often severe, leading to fractures, hospitalization, and even death. In fact, falls are the second leading cause of injury-related death for individuals aged 65 to 84 and the leading cause for those aged 85 and older.

These alarming statistics underscore the need for chiropractors to play a proactive role in fall prevention. By incorporating balance assessments and proprioception testing into routine care, we can help identify patients at risk of falling and intervene early to prevent injuries.

Why Balance and Proprioception Matter

Balance is an integral part of physical health that deteriorates with age, significantly increasing the risk of falls. Proprioception, which refers to the body’s ability to perceive its position and movement in space, also declines as we get older. This decline not only affects balance but can impair a patient’s ability to perform daily tasks safely and independently.

Recent studies have shown a strong correlation between balance abilities and overall mortality. For instance, a study published in the British Journal of Sports Medicine found that the ability to complete a simple 10-second one-legged stance test was a predictor of all-cause mortality. Individuals who were unable to complete the test had nearly double the risk of death over the study’s follow-up period compared to those who could complete it. This makes balance testing a valuable, quick, and easy tool that can provide prognostic information about a patient’s overall health.

The Role of Balance Testing in Chiropractic Practice

For chiropractors, balance testing offers several key benefits:

• Early Detection of Fall Risk: Regular balance assessments allow you to identify patients who may be at risk of falls before an incident occurs. This proactive approach enables timely interventions, potentially preventing fall-related injuries and hospitalizations.
• Comprehensive Patient Care: Incorporating balance assessments demonstrates a commitment to holistic care. By addressing both immediate pain relief and long-term health risks, you can improve patient outcomes and enhance their overall quality of life.
• Improved Patient Outcomes: Balance training has been shown to improve stability, coordination, and strength, all of which are crucial for reducing fall risk. Studies have found that targeted interventions, such as proprioceptive exercises, can significantly enhance balance and decrease the likelihood of falls.

Implementing Balance and Proprioception Testing in Your Practice

Introducing balance and proprioception testing into your chiropractic practice doesn’t require a significant investment in time or resources. Here’s how to get started:

1. Routine Balance Tests: A simple test, such as the 10-second one-legged stance, is quick to administer and provides valuable insights into a patient’s balance capabilities. To conduct the test, ask your patient to stand on one leg with their arms at their sides. The patient should be able to hold this position for at least 10 seconds without needing additional support. If they cannot, it may indicate a higher risk of falls and warrant further intervention.
2. Tailored Balance Training Programs: Based on the results of your assessments, develop individualized balance and proprioception training programs for your patients. These programs can include exercises to improve core strength, flexibility, and proprioceptive awareness. Balance boards, foam pads, and simple one-legged exercises can all be used to enhance stability.
3. Patient Education: Educating patients about the importance of balance in daily life and fall prevention is crucial. Encourage them to practice balance exercises at home to maintain their independence and reduce the risk of injury.
4. Collaborate with Other Healthcare Providers: Fall prevention often requires a multidisciplinary approach. Work with physical therapists, occupational therapists, and other healthcare professionals to develop comprehensive care plans for patients at risk of falling.

The Importance of Updating Clinical Assessments

As healthcare providers, it’s our responsibility to stay current with research and incorporate new strategies that can improve patient outcomes. The addition of balance and proprioception testing to your chiropractic assessments can significantly enhance the care you provide. A study from Brazil found that those who could not perform a 10-second one-legged stance were 1.84 times more likely to die of any cause than those who could. These findings demonstrate the importance of balance as an indicator of overall health, particularly in middle-aged and older individuals.

Moreover, balance deteriorates rapidly after age 50, which means that early intervention is key. Identifying balance issues before they lead to a fall can prevent serious injuries and improve your patients’ long-term health.

Balance Testing in Action: Case Studies

Consider the case of a 68-year-old patient who came to your clinic complaining of chronic lower back pain. During your initial assessment, you include a 10-second one-legged stance test and discover that the patient struggles to maintain balance for more than a few seconds. This result, combined with their age and history of back pain, indicates that they may be at a higher risk of falls.

In addition to your standard chiropractic adjustments and mobility exercises, you prescribe a series of balance and proprioception exercises to improve the patient’s stability. Over the next few months, the patient’s balance improves, and they report feeling more confident in their movements and less fearful of falling. This simple intervention may have prevented a fall and subsequent injury, ultimately improving the patient’s quality of life.

Conclusion: Incorporating Balance Testing into Routine Care

The addition of balance and proprioception testing is not just about preventing falls—it’s about taking a more comprehensive approach to patient care. By including balance assessments in your routine examinations, you can identify at-risk patients, intervene before falls occur, and improve the overall health and safety of your patients.

As chiropractors, our goal is to provide the best care possible, and that includes addressing long-term health risks. Balance and proprioception testing should be a standard part of our clinical toolkit, ensuring that our patients remain active, independent, and healthy well into their later years.

By taking this proactive approach, we can help reduce fall-related injuries, improve patient outcomes, and ultimately enhance the quality of life for our patients. Let’s make balance testing a routine part of our practice, empowering patients to live healthier, safer lives.

Dr. Mark Sanna is the CEO of Breakthrough Coaching. He is a Board member of the Foundation for Chiropractic Progress, a member of the Chiropractic Summit, a member of the Chiropractic Future Strategic Plan Leadership Committee. To learn more, visit www.mybreakthrough.com. He is the author of Cracking the Code: Marketing Chiropractic—How Chiropractors Align Spines and Minds, available on Amazon.com.