Ransomware removal and the most common health care cyberattack

The cost, the hassles and the fines to DCs for ransomware attacks and ransomware removal

Every month the risk of having your office shut down forever (or a doctor of chiropractic or other health care organization having to spend an average of $158,000 in fines and repairs for ransomware removal) relative to a ransomware attack goes up and up. This year is already proving to be another record setter, with massive increases in attacks against small and medium-sized chiropractic and health care offices.

successful ransomware attack is a HIPAA violation

A ransomware attack is also an automatic HIPAA (Health Insurance Portability and Accountability Act) violation, as these attacks cannot be successful if you are following all HIPAA rules – including required documented and formalized policies, risk analysis and mitigation plans.

The only chance for protection against a ransomware attack is prevention. Having a complete HIPAA program in place and following it closely is the only way to help prevent these attacks. When I started traveling to teach HIPAA in 2010 (presently teaching for 40 state associations and four chiropractic colleges), there were major problems regarding HIPAA compliance on the horizon for chiropractors, but nothing like we see today.

At that time no one had heard of ransomware attacks, whereas now, I am often contacted by 2-4 chiropractors per month who have been hit by ransomware and are petrified regarding the practice devastation, ransomware removal, potential HIPAA fines and their required interactions with government enforcement agencies.

Cybersecurity = HIPAA

In the health care field, everything you hear on the news regarding cybersecurity — which is every time you turn on the news – must be changed, in your mind, to HIPAA, because in the health care world, HIPAA equals cybersecurity.

It is the law that dictates what we are required to do, as covered entities, under HIPAA, to prevent cyberattacks. The world has changed, and if you don’t change, you will get swallowed-up — unfortunately more and more chiropractors are experiencing this very phenomenon.

The national average cost to solve a ransomware attack is $158,000. Chiropractic offices and other primary care practitioners are typically on the smaller end of institutional size and the typical costs including ransomware removal are more in the area of $90k or less, but that can still shut down many practices. Prevention is the key.

Some take the attitude, ‘Let them come after me. If I get hit I will just close down and declare bankruptcy!’ Unfortunately, that may avoid some costs, but government fines are like IRS actions and are not typically discharged in a bankruptcy.

Ransomware removal, losses and violations

Approximately 89% of all cyberattacks are now ransomware. When you experience a ransomware attack you typically arrive at your office, you boot up your computer to get the new day going, and there’s nothing on your computer’s screen except a message that says, “We have your data.”

If it’s “weaponized ransomware” they have probably had that “worm” or virus in your hard drive for a long time, not just that day, and they have likely captured your back-up data as well — which is why backing up your data (and even keeping copies of old back-ups) is important.

They will also make a demand for a certain amount of money to get your data back and then give you a time limit to pay. Example: “Within the next five hours it will cost $10,000 to get your data back, and if you don’t pay within five hours it will go up to $20,000, and if you don’t provide that within 24 hours we will release/sell your data on the dark web and you will never see it again.”

‘Brick’-ing your computer

With weaponized ransom ware they may also have the ability to destroy your computer from a distance.

So, let’s say you decide to pay $15,000 to get your information back. That is the start of your money problems. This is HIPAA violation because, if you had a HIPAA program in place and were following the legally-required policies and rules, in all likelihood, you would not have succumb to a ransomware attack.

You are supposed to know this and therefore this type of violation can be declared “willful neglect,” and if it falls under willful neglect that’s a minimum $59,255 fine (they can also add punitive damages, if they choose). You may also be required to pay the expenses incurred by your patients to monitor their credit. If 1,000 patients were breached, at a cost to you of $10 per month for a year, that would equal $10,000 per month.

You will also face the costs of a forensic examination by IT experts to determine who and how many patients were breached, etc. This can easily cost $10-20K, and in regard to ransomware removal you will likely need new software and hardware replacements. You can easily see how fast costs can rise and how devastating such an attack can be if not prevented.

You are required to protect private patient information, especially when this information is going into cloud-based systems or somebody else’s server or somewhere other than in your office. You have to make sure this information does not get breached and create a reason for a patient to say, “Hey, I think you mishandled my information and I’m filing a complaint with the government.”

Watch your data associations

When you’re working with an EHR company’s electronic medical records storage (even if the information is stored onsite, or in your office), if the company has access to your data they are considered a business associate.

If said business associate does not protect the information that you give them, and something goes wrong and that information is breached, then you, the doctor, are liable, unless you have a BAA (Business Associate Agreement) in place. You are the one in charge of and responsible for protecting your data, so this is a critical requirement under HIPAA law.

There is always a human component when information is breached — someone did what they shouldn’t do, or didn’t do what they should do. We all want to protect our patient information, just like you want your data protected when you go to the dentist, etc. If you don’t have a solid HIPAA program in place, what will be your defensible position when the government comes knocking? “I didn’t know” does not work.

New CARES ACT, HIPAA regulation

As of the writing of this article there is a new CARES ACT law going into effect, along with a new HIPAA regulation. These mainly relate to new fines and requirements regarding blocking information from patients who have requested same — the point being, the requirements are continuously changing and you are required to keep up or be fined, and most offices need help doing this.

You have to have a defensible program in place or you will get fined to death. The government by law must investigate every complaint, and they are presently two years behind, which means you could be in trouble now and not know it for another two years.

Why do you want to lose sleep at night over that? Get a HIPAA program in place now.

I am constantly amazed by the increased ransomware attack numbers. They grow faster and faster and it is compounded by the fact that many who are attacked do not take massive, immediately steps to fix the problem — and once a practice is attacked, there is a 95% greater chance they will be attacked again.

I still travel the United States and, even in this day and age, find chiropractors, medical doctors and dentists who don’t do what they need to do to have their data security and HIPAA program in place. They think, “Well, I’m okay because I have training once a year where I talk about HIPAA and patients sign records releases and I think we’re probably okay.” It is time to face facts — hiding your head in the sand, in these modern times, just makes your practice a bigger target.

TY TALCOTT, DC, CHPSE, is a certified HIPAA Privacy and Security Expert (CHPSE) and president of HIPAA Compliance Services. He has consulted for thousands of health care practices relative to business development and protection. He can be contacted at (469) 371-8804 or at DrTyTheComplianceGuy.com.

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Student DC: The initial patient exam

The initial patient exam starts with the pedal foundation and how it is involved in spinal stability

The initial patient exam and doctor’s report I utilize with new patients evolved over a period of years after my graduation from chiropractic college in 1980. I had the incredibly fortunate opportunity of meeting and working for Monte Greenawalt, DC, DABCO, while I was a chiropractic college student in the late 1970s. Very early in my chiropractic education, Greenawalt taught me the importance of the pedal foundation and how it was involved in spinal stability.

So, with that in mind, I am going to outline the initial patient exam and briefly explain my treatment protocol of a typical chiropractic patient.

Patient history and the initial patient exam

Like every chiropractor, I have my patients fill out a HIPAA-compliant health history form. After that, I consult/interview the patient to obtain more details and clarify any questions I may have from the history. Then I administer the initial examination that I originally developed in the late 1980s when I practiced in Las Vegas, Nev.

One of the most important components in my initial patient exam is to examine the patient starting from the ground up. I begin my exam using a digital foot scan that will determine any degree of pronation or supination and whether it is symmetrical or asymmetrical. This is very important as this can directly relate to lower extremity and spinal dysfunction and symptomatology.

Since pronation of the feet is the most common pattern seen in adults, I also utilize a series of reliable visual indicators present in the patient with the typical pronation pattern. These include a foot flare/toe out stance, Achilles tendon bowing, calluses under the second, third, and fourth metatarsal heads, and posterior lateral heel wear on the patient’s shoes.

After that, I observe the patient in a standing posture to determine the levels of the feet, knees, hips, shoulders and head. I then perform the typical range-of-motion analysis on the cervical, thoracic and lumbar spine, noting any restrictions and/or pain.

I also use the typical appropriate orthopedic checks, which include Cervical Compression and Distraction, Jackson’s, Bechterew’s, Kemp’s, Nachlas, Ely’s, Hibb’s, Yeoman, Lasegue’s and FABER tests. I also check deep tendon reflexes for the cervical and lumbar areas.

I then take A/P and lateral X-ray views of the lumbopelvic and cervical areas unless contraindicated. As a chiropractic student, I was also influenced by Russell Erhardt, DC, DABCR, one of the first diplomats in radiology in the chiropractic profession. He had a saying, “To see is to know. To not see, is to guess.”

Radiographic measurements and report of findings

As we were all trained in radiology, I first rule out any pathologies, etc., that would be contraindications for chiropractic care. Then, I measure several chiropractic radiographic measurements. These include:

1) femur head height

2) lumbosacral angle

3) Ferguson’s Gravity line

4) measurement of cervical lordosis

Based on the information obtained in this initial patient exam, I create a report of findings in PowerPoint format. In this report to the patient, I present visually-based information on the patient’s unique combination of feet, knees, hips, pelvic, thoracic and cervical alignment.

I explain to the patient basic postural considerations and the ramifications of crossing the legs when sitting, slouching when sitting and sleeping on the stomach. I also discuss that when I adjust their feet, it will not “hold” for very long since the primary stability of the arches in the feet is ligamentous in nature.

We know that the plantar fascia will plastically deform and foot adjustments do not hold for very long. A functional support for the three arches of the feet that allows normal/optimal ranges of motion of the feet and blocks excessive motion is my recommendation to patients.

Presentation of recommendations

I then present my recommendations, which in most cases include flexible function orthotics, plus a series of chiropractic adjustments. A series of basic rehabilitative exercises is utilized on my patients to balance and strengthen areas of the spine and extremities.

My adjusting protocol involves full spine diversified adjustments along with an analysis of indictors and appropriate adjustment of the feet, knees, hips, wrists, elbows and shoulders. I explain to the patient that I am going to utilize a whole-body adjustment protocol based on indicators and not necessarily their symptoms.

Even the first chiropractor, D.D. Palmer, was well aware of the clinical significance of adjusting extra vertebral articulations, particularly the feet. In his book, “The Chiropractic Adjuster,” he states, “Chiropractors adjust any and all of the 300 joints of the body, more particularly the joints of the spinal column.” Along with, “Chiropractors are the first to adjust the bones of the foot for the relief of corns.” He also stated, in the same book, “Why adjust the lumbar for displacements of the foot?”1

MARK CHARRETTE, DC, is a graduate of Illinois State University and Palmer College of Chiropractic in Davenport, Iowa. He is the owner of Charrette Chiropractic in Flower Mound, Texas. He is the author of “Chiropractic Extremity Adjusting; Charrette Adjusting Protocols,” and has produced an instructional video series on extremity adjusting. As a member of the Foot Levelers Speakers Bureau, he has taught more than 2,000 seminars on chiropractic techniques. Learn more about upcoming events and other Foot Levelers speakers at footlevelers.com/continuing-education-seminars.

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The legal requirements of a multidisciplinary medical practice with chiropractic

The rewards are great, but chiropractors must adapt to new policies and procedures with a multidisciplinary medical practice

Emerging in the contemporary practice environment is the increased collaboration between health care professionals. MDs, PTs and DCs are converging for the purpose of delivering comprehensive services to patients whose conditions warrant a joint approach to care via a multidisciplinary medical practice.

Multidisciplinary practices (MDPs) offer patients a broader scope of coordinated services than those available in either a medical, physical therapy or chiropractic practice alone. They can also deliver these services in a more efficient and cost-effective manner. These are the steps to take (and those to avoid) that will help provide effective care in an efficient way in an MDP.

Multidisciplinary medical practice legal compliance

The decision to establish a MDP can be beneficial to chiropractors who have achieved a measure of success and are interested in taking their practice to the next level.

The creation of a MDP requires several preliminary steps starting with the recruiting of medical personnel, as well as the creation of the proper corporate structure. State corporate laws and scope of practice regulations control how multidisciplinary practices must be formed and operated. These requirements vary dramatically from state to state.

When establishing your multidisciplinary medical practice, it is best to retain local legal counsel familiar with the group practice health care laws and regulations of the state in which the practice will be established. Beware of “ghost” or “on-paper-only” physician ownership. In states that require an MD to own all or part of the stock in the MDP, the owning physician must have a documented and ongoing role in the practice. In addition, all stockholders of the MDP should make a financial contribution to that corporation as well as performing all other steps of corporate compliance.

While successfully operating a MDP can be rewarding, those rewards can quickly disappear should the chiropractor and other professionals involved not adhere to the most stringent policies and procedures. A MDP is not a method to change a chiropractic practice into a medical practice with a few legal sleights of hand. It is not a method of increasing reimbursement revenues by misrepresenting chiropractic services as medical, nor is it a method of fraudulently obtaining insurance coverage for chiropractic treatment that would otherwise not be covered. A MDP should be created for the benefit of its patients.

MDP billing procedures

In all practices, including MDPs, the provider that performs the service must be identified on the insurance claim form. Chiropractic services, those services and procedures performed by a DC, are never to be billed under an MD’s provider number. All chiropractic services are billed under the DC’s provider number. Chiropractic services are never billed incidentally to a medical license. MD and PT services are similarly identified.

A multidisciplinary medical practice is a group practice working under one tax ID number, and identifies services performed by the individual practice members by provider number. No duplication of services should occur by the various professional providers. For example, Manual Therapy (97140) should not be billed under a chiropractor’s provider number and, during the same encounter, under a physical therapist’s provider number.

Patients with Medicare or any other Federal Health Insurance Program should not be seen as MDP patients unless the physician-level staff meets the 75% Rule federal staffing requirement and are present in the facility at the time the services are rendered. If the 75% Rule staffing requirement is not met, patients of the practice may receive chiropractic care, performed by the chiropractor, based upon their consent and medical necessity.

A MDP should have an effective compliance program in place. This includes the designation of a compliance officer or committee, a baseline compliance audit and annual compliance audits. The fee schedule of the MDP should be reasonable and customary for the region in which the practice is located.

MDP service offerings

Expanding the services provided in your MDP can generate additional sources of new patients and diversify your revenue stream. Chiropractors without a medical provider on staff are required to refer these services to medical colleagues outside of their practice. In MDPs, many of the procedures can be performed by your medical team members with some additional education and training required.

Trigger point and facet joint injections may be an option in treating pain for some patients. When chiropractic, physical therapy, anti-inflammatory medications, and muscle relaxants have not provided the relief of pain, injection of the painful trigger points or facet joints with a local anesthetic and steroid medication may provide lasting relief.The field of regenerative medicine includes emerging therapies that have the potential to heal damaged and painful tissues in ways that were unheard of just a few years ago. These therapies have the potential to fully heal injuries and damaged tissues that might otherwise be beyond repair. Regenerative medicine provides patients with options that allow them to improve their function and quality of life and decrease their possibility of becoming dependent on harmful medications.Bioidentical hormones are an exact molecule-for-molecule match to the hormones that the body naturally produces. Bioidentical Hormone Replacement Therapy (BHRT) is a powerful solution to restore peak performance and reduce the aging process. Customized programs are individualized to specific goals — every patient is given a specific formula.Intravenous Nutrition Therapy (IVNT) is a safe and effective method of delivering vitamins, minerals and amino acids directly into the bloodstream. IVNT overcomes nutritional deficiencies by introducing them directly into the body, bypassing many of the obstacles within the digestive system that might prevent absorption. The 30-45-minute sessions enhance energy, improve mood, and help prevent future health conditions caused by stress, malnutrition and dehydration.

multidisciplinary approach

Your multidisciplinary medical practice professional support team should also take a multidisciplinary approach, with non-lawyer professionals working in conjunction with lawyers. When lawyers and other professionals from various disciplines such as accountants and management consultants work together, the results are superior.

Take this approach and you can help ensure the long-term legality and profitability of your practice.

MARK SANNA, DC, ACRB LEVEL II, FICC, is a member of the Chiropractic Summit and a board member of the Foundation for Chiropractic Progress. He is the CEO of Breakthrough Coaching and can be reached at mybreakthrough.com or 800-723-8423.

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Beware false claims, anti-kickbacks with the medically integrated practice

The medically integrated practice presents specific rewards as well as challenges

Over the past few years, many chiropractors have begun pursuing the idea of a medically integrated practice. There are many benefits to incorporating other aspects of health care (i.e., neurology, orthopedic, physical therapy, occupational therapy, nurse practitioners, etc.) to ensure that patients are getting the best possible care by offering one-stop shopping and streamlining communications between practitioners.

“This means that medical errors are minimized, unnecessary tests avoided, prescription painkillers reduced, and patients ultimately will receive complete care,” Jesse Cooper, DC, told the American Chiropractic Academy (ACOM Health, 2019). However, there are stringent guidelines and legal ramifications if an integrated practice is not set up correctly.

The medically integrated practice: assume auditing and prepare accordingly

According to Mark Sanna, DC, ACRB LEVEL II, FICC, also featured in this issue, “State corporate laws and scope of practice regulations control how multidisciplinary practices must be formed and operated. These requirements vary dramatically from state to state.”

He strongly recommends retaining a health care attorney familiar with group practice health care laws and regulations in your state. And compliance doesn’t end after the corporation is established. Before adding a service, research the relevant state regulations, including who can perform it, in what setting, and how it can be billed. Assume everything will be audited and prepare accordingly.

You should also review the medical policies and provider agreements of the insurance carriers in your state. Often you will see language that prohibits billing physical medicine services by more than one provider on the same day or limits on the number of units or services that can be provided the same day. For example, this means if you provide a 98940-98043 service, it may count as a unit or service, which could take away from the number of timed units provided by a physical therapist.

Review applicable new E&M codes

In practices with multiple providers, you should also be aware of the number of E&M codes that can be provided in a single day, particularly since the services may be billed out under the same tax ID number. If you should refer a patient who entered the office to see your nurse practitioner, but was subsequently referred to you, the E&M service you provided may not be covered.

Laws and regulations governing health care apply to any health care entity specific to certain programs such as Medicare. For example, the Health Insurance Portability and Accountability Act (HIPAA) established national standards for electronic health care transactions, which apply to nearly every health care practice (OCR, 2017). On the other hand, the federal Physician Self-Referral Law applies specifically to Medicare and Medicaid. However, some states have their versions of such laws, which may be broader than the federal version, such as applying to all health care payers, not just federal health plans. There are regulatory instances where a medically integrated practice could run afoul if they are not careful.

nti-Kickback Statutes

When operating a medically integrated practice, you must be aware of the federal and state Anti-Kickback Statutes (AKS) and fee-splitting prohibitions. AKS is a federal criminal law that forbids exchanging or offering to exchange anything of value to obtain getting referrals of any federal government health care business. They can be violated by paying or offering bonuses for referrals for other services. They can also be violated by providing free or reduced rates for office space with contracted providers.

Many providers are not aware that the AKS can be triggered by not charging for each and every service you provide. If a patient who saw the nurse practitioner first was referred to you for evaluation, if the service is not covered because it was provided on the same day and under the same tax ID number, you must charge your actual fee for the service. You should not offer it at no charge or at a reduced fee just because they saw your nurse practitioner first. Doing so would be considered an inducement violation.

Conviction on even one charge can result in five years in jail, $25,000 in fines, and exclusion from the right to participate in any federal health care program (not just Medicare or Medicaid).

False Claims Act

This law prohibits doctors from presenting false claims to the government for payment of medical bills. False claims include overbilling and billing for services that did not occur.

The chiropractor/medical clinic combination can create the risk of false claims since the health providers often bill at different rates and provide different services (Cohen Healthcare, n.d.). How would this occur? If a patient saw the MD or nurse practitioner first and was charged an E&M code, then they saw you, and you did not charge your actual fee or include the service as part of the prior evaluation, the fact that you didn’t charge for the billable service could be considered a false claim. Meaning, you didn’t report the service.

If you used a lower-level E&M code to lower the cost, that is considered down coding, which is a false claim. Many providers think that a False Claim Act (FCA) violation only occurs if you bill for a service that was not provided. The reality is, not billing for any service that was provided is also considered an FCA violation. The OIG levied an $80,000 fine to a chiropractor recently for not charging for muscle stim. The doctor may have thought that since Medicare does not pay for this service when provided by a chiropractor, that he would simply waive that charge. How did a $15-20 service lead to an $80K fine? Because these violations are a “per-occurrence” fine. They add up fast!

Physician, don’t refer thyself

Self-referral is the practice of referring patients to health care entities in which the referring provider has a financial interest. Because of the inherent conflict this creates between the provider’s financial considerations and his/her medical judgment regarding the patient, such referrals are prohibited by most states and under federal law (CMS, 2021).

A medically integrated practice, unless properly structured, could implicate federal and/or state self-referral laws. Assuming that the collaboration is structured as two entities, if the chiropractor or medical doctor owns an interest in both entities, there could be a self-referral problem.

The barriers to medically integrated practices — regulatory, administrative, financial and ideological—are considerable but can be profitable when set up correctly. If implemented correctly, it works well for patients, staff, providers and owners. Ultimately, you must consider the risk-reward ratio.

Even if you set everything up perfectly, you must understand and accept that the sheer creation of a medically integrated practice elevates scrutiny and your profile in the eyes of payers and regulators. To minimize your risks, you should consider hiring a compliance officer or outsourcing your compliance. You should also make sure that your financial policies are bulletproof. If you are offering any type of discounts to patients who may see multiple providers, make sure they are legal and compliant with all levels of regulations and your provider agreements. Finally, contact your malpractice carrier to see if they offer additional coverage for billing and regulatory investigations. Often for less than your malpractice coverage, some companies can add up to $1 million in additional coverage to your malpractice policy that will help cover fines and penalties that might be incurred.

Delivering the highest standard of care

To become an effective integrated practice, the most crucial step is to create a clear vision of the mission and purpose of the business. Determine why this comprehensive care approach is worthwhile, dig into the nuts and bolts of operating it, and then execute those ideas.

The primary goal must consistently be delivering the highest standard of care to patients (Higashi, 2016). Incorporating best-practice concepts, no matter what the structure, is an essential part of creating a successful integrated practice. This is clearly an instance where “lawyering up” on the front end is imperative and much less expensive than hiring a lawyer if a problem arises.

For those who choose to do it right, medical integration can be a rewarding and profitable investment and provide a higher level of service for your community and the patients you serve.

RAY FOXWORTH, DC, FICC, MCS-P, is a certified Medical Compliance Specialist and president of ChiroHealthUSA. A practicing chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, is a former staff chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic.

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Laser Therapy for Acute Shoulder Injury: A Case Story

Because of its mobility, the shoulder is one of the most at-risk joints in the body. It’s no wonder chiropractors often see shoulder injuries; shoulder pain is reported in 14.7 per 1,000 patients per year with a lifetime prevalence of up to 70%, and a recurrence rate as high as 25%.[1] These injuries can develop after a major incident, minor movements, or seemingly out of nowhere – and they become more prevalent with age.

Treatments for shoulder injuries are typically multi-faceted and can range from adjustments to NSAIDs to surgery in severe cases. Super pulsed laser therapy offers a non-invasive way for chiropractors to relieve pain and inflammation and accelerate the recovery process, allowing patients to get back to normal activities faster than traditional methods that may come with risks or side effects.

Keep reading to find out how one chiropractor used a comprehensive super pulsed laser therapy protocol combined with Activator Methods to prevent a case of frozen shoulder in a patient, reducing her recovery time from 18-24 months down to just 4 weeks.

Combination of Photobiomodulation and Chiropractic Care for the Management of an Acute Shoulder Injury

Author: Brian Fitzpatrick, DC, CLS


The patient presented with an acute supraspinatus injury and showed signs of early painful phase of adhesive capsulitis. The classic presentation of adhesive capsulitis includes localized shoulder pain and restricted active and passive range of motion and follows 3 phases: painful, stiffening, and thawing. Adhesive capsulitis is more prevalent in women between the ages of 40-70 and often occurs after surgery or an injury. Common treatments include NSAIDs and physical therapy, including stretches. The prognosis is often 18-24 months for complete recovery.


The patient’s demographic and occupational history suggested that adhesive capsulitis was a high probability, if left untreated. Both photobiomodulation and chiropractic care have been shown to be effective in treating acute musculoskeletal conditions.[2] For this case study, the two treatments were applied together, utilizing Activator Methods for chiropractic protocols and the Priority Principle for phototherapy protocols. The patient was assessed subjectively (VAS) and objectively (range of motion).

Patient Profile

A 59-year-old female patient came into the office with a new complaint that started one day prior when she woke up at 3:30 am with severe right shoulder pain after leaf blowing the day before. She remarked that her sleep was severely disturbed, and she was barely able to move her right shoulder. She visited her family doctor earlier that day and was told to continue taking Advil and seek out physical therapy. The patient presented with no co-morbidities and noted that her greatest concern was moving her right arm, given her custodial occupation requires her to reach above her to head to wipe and scrub walls.


Further questioning and examination revealed that the patient’s main complaint was localized to the right glenohumeral joint capsule and lateral supraspinatus insertion and elicited 9/10 pain with any movement beyond 10-20 degrees in any direction. Orthopedic tests of Apley’s, Dugas, and Impingement were positive with limited range of motions and localized pain to the right glenohumeral joint capsule. Inflammation was noted around the right glenohumeral joint capsule and supraspinatus insertion and hypertonicity in the right trapezius and cervical paraspinal musculature.

Figure 1: The following right shoulder ranges of motion were measured, each resulting in severe shoulder pain.


A treatment plan was constructed with a treatment frequency of 3 times a week for 2 weeks; then 2 times a week for 1 week; and then 1 time a week for 1 week (totaling 9 visits over 4 weeks). Each visit consisted of an Activator Method basic scan and additional testing to the right glenohumeral and rotator cuff regions. Chiropractic adjustments were performed as indicated. Phototherapy with combination of super pulsed laser and light-emitting diodes (Multi Radiance Medical) was also utilized each visit by applying the concepts of the Priority Principle.


On each visit, the patient’s right shoulder abduction and pain associated with that movement was measured. By the third visit, the inflammatory process had resolved, resulting in no more sharp pain with end range of motion and was replaced with a mild to moderate dull ache. Pain-free range of motion increased from 10 degrees to 160 degrees within the first week and then plateaued until the end of the treatment phase (Figure 2).

The patient reported being able to return to work without restrictions by the second week of care and reported no exacerbations during the 3rd and 4th weeks of care.


This case illustrates the importance of when treatment is delivered in shoulder injuries. By treating the patient within 48 hours of the initial injury, the Rescue Protocol (5-1000Hz for 3 minutes) from the Priority Principle was able to be used on the first visit, followed by utilizing the Inflammation Principle (50 Hz for 3 minutes) on the 2nd visit to resolve acute inflammation before the tissue had a chance to move into the subacute and chronic phases. Due to this, by the 3rd visit (5th day since the injury onset), the patient reported that pain has decreased from a 9 to a 3 out of 10 and right shoulder abduction has increased from 10 to 160 degrees and was able to return to full work duties the following week.

Secondary adhesive capsulitis is usually preceded by some sort of trauma or surgery that forced immobilization of the shoulder. By addressing the inflammation first, the inflammatory nociceptive pain subsided and shoulder range of motion was restored before the stiffening phase could begin.

While both chiropractic adjustments[3] and low-level laser therapy[4] have been shown to be effective at treating adhesive capsulitis after the stiffness phase, the patient’s lifestyle modifications and prognosis are better if treated earlier.

From the 3rd visit on, the patient presented with no signs of acute injury (swelling, inflammation, significant pain, or spasm) so the Tissue Repair Principle (5-250Hz for 3 minutes locally and 50Hz for 5 minutes at the subclavian artery) was used to address the functional movement deficits until full pain-free range of motion was restored and the patient was discharged.

By addressing the shoulder injury early and following through with care until there were no residual symptoms, the patient has had no right shoulder complaints for 3 years.

Learn more about laser therapy for chiropractic in the Laser Therapy Resource Center

bout the Author

Brian Fitzpatrick, DC, 2007 valedictorian from Palmer College of Chiropractic where he received the Virgil V. Strang Philosophy Award as well as the John Connolly Memorial Award for scholarship and involvement in Palmer and community organizations.

Dr. Fitzpatrick is an Associate Clinical Instructor for Activator Methods, a Certified Laser Specialist, and a member of the Medical Advisory Board for Multi Radiance Medical. He practices at Fitzpatrick Family Chiropractic in Solon, IA.


Cadogan, A., Laslett, M., Hing, W.A. et al. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord 12, 119 (2011). https://doi.org/10.1186/1471-2474-12-119Cotler, H. B., Chow, R. T., Hamblin, M. R., & Carroll, J. (2015). The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ orthopedics & rheumatology, 2(5), 00068. https://doi.org/10.15406/mojor.2015.02.00068Polkinghorn B.S. Chiropractic treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. J Manipulative Physiol Ther. 1995;18 (2):105–115.David Ip and Nga-Yue Fu. Two-year follow-up of low-level laser therapy for elderly with painful adhesive capsulitis of the shoulder. J Pain Res. 2015; 8: 247–252.

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The best CBD ratio for anxiety to lessen patient symptoms

One of the difficulties when it comes to CBD research — hemp was only legalized at the end of 2018, reducing scientist’s ability to find the best CBD ratio for anxiety

Roughly 40 million adult Americans have some type of anxiety disorder according to the Anxiety & Depression Association of America, making it one of the most common mental illnesses today. The good news is that anxiety is highly treatable, especially these days with the research findings with CBD and the ability for patients to find their own best CBD ratio for anxiety.

The bad news is that almost two-thirds of people who suffer anxiety — or approximately 63.1% — aren’t receiving treatment.

If a person’s anxiety is severe, seeking professional help is important to finding relief. A counselor, therapist, psychologist, or psychiatrist can help determine the root cause, decide whether medications or additional testing are necessary, and recommend the best course of treatment. For more mild cases of anxiety, research suggests that the hemp plant extract cannabidiol (CBD) may help.

CBD and anxiety

In 2019, the Permanente Journal published a large case series involving 72 patients. For 47 of these patients, the primary concern was anxiety. The remaining 25 were primarily concerned with poor sleep. Most of the patients received 25 mg capsules of CBD daily, with some receiving either 50 mg or 75 mg doses in an effort to determine the best CBD ratio for anxiety. If the patient was more concerned with anxiety, the capsules were taken in the morning. If they were more concerned with sleep quality, the capsules were given after dinner.

After one month of taking CBD, 79.2% of the participants reported that their anxiety had improved. At the two-month mark, 78.1% still had improved anxiety levels, with these numbers holding fairly steady three months into the treatment. Researchers also reported that, overall, the CBD was well tolerated with only a few of the patients experiencing side effects such as fatigue and dry eyes.

This study echoes similar results published in Neurotherapeutics in 2015. In this case, researchers reviewed 49 preclinical, clinical, and epidemiological studies. Their review found that preclinical evidence was strong for CBD helping to ease anxiety, citing that more research is needed with regard to chronic and therapeutic dosing.

How CBD eases feelings of anxiousness

The 2015 review explains that CBD is thought to help with anxiety by the way it interacts with the cannabinoid type 1 receptor (CB1R), serotonin 5-beta hydroxytryptamine receptor 1 (5-HT1A), and transient receptor potential vanilloid type 1 (TRPV1) receptor. These are the receptors that regulate anxiety-related behaviors and fear.

A piece of research published in Frontiers in Pharmacology in 2016 adds that there is also evidence to suggest that CBD might also interrupt memory processes, which may help reduce anxieties related to fear by changing the way certain memories are recalled. It might even enhance extinction, which is when associations with situations and bad outcomes are weakened, thus reducing their effects.

It should be noted that one of the difficulties when it comes to CBD research is that industrial hemp was only legalized at the end of 2018, reducing scientist’s ability to study its effects before that date. Plus, a majority of the studies previously conducted were on animals versus humans. While some crossover generalizations may be hypothesized, they are not definitive proof, meaning that more studies must be completed to have evidential results.

CBD types and the best CBD ratio for anxiety

A systematic review published in 2020 in the Journal of Clinical Medicine Research provided a compilation of 25 different human studies involving CBD, many of which looked at the best CBD ratio for anxiety. Almost all of these pieces of research involved oral CBD capsules and, based on their findings, were reportedly effective at reducing anxiety, especially at doses ranging from 300 mg to 600 mg.

Another 2020 analysis compared oral CBD capsules with an oral solution and oromucosal spray or drops. It found that oral capsules had the quickest absorption rate, resulting in a time of maximum concentration of 2.1 hours. This was less than half of the time for oromucosal spray which didn’t reach max concentration until 4.75 hours.

The one concern with oral capsules is first-pass metabolism potentially degrading some of the CBD and reducing its bioavailability. A 2019 study published in the journal Molecules found that when VESIsorb formulation technology is used, CBD bioavailability increases dramatically. It also allows for faster absorption with no safety concerns being found.

The bottom line

All of these studies seem to suggest that an oral CBD may be the most effective for patients who want to lessen their anxiety, with products using the VESIsorb formulation technology offering the best results in terms of bioavailability and absorption rate. Several of these pieces of research also involved participants taking the CBD on an empty stomach. Providing this guidance may help patients get the best results possible when attempting to determine the best CBD ratio for anxiety.


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Sciatica exercises to avoid

Exercise is one of the most effective strategies to alleviate the symptoms of sciatica. However, the manner in which you exercise is also vital. Keep in mind that not all exercise programs will benefit your illness. There are certain sciatica exercises to avoid so to not cause additional sciatic pain.

Pay attention to your body and avoid any actions that give you pain. Certain workouts, especially those that strain or put pressure on your back, core, or legs, might aggravate sciatica symptoms. While it’s critical to improve these areas’ strength and flexibility, you should do it gradually and safely.

High-impact activities might exacerbate symptoms and lead to injury. Take a break from action if you’re in a lot of pain. Inactivity or sitting for long periods of time, on the other hand, may aggravate your symptoms, so try to get some mild exercise or stretch in whenever you can.

If you have sciatica, avoid the following workouts, stretches, and activities. It’s also a good idea to remember these sciatica exercises to avoid if you have general back pain without sciatica pain.

If you have sciatica pain, stay away from these exercises.

Heavy hamstring stretching

This puts extra strain on the hamstring muscles, which can have an indirect effect on the sciatic nerve, making the sciatica worse.

Bent over row:

Herniated disc can be caused by poor posture and bent over row. You don’t want to wreak havoc on the spine or disrupt the overall structure. When you’re in this position, you’re putting a lot of pressure on your spine, which might make it worse. The root sciatic nerve may be exposed as a result of the pressure, resulting in inflammation and infection.

Sit-ups with straight legs:

These workouts can also cause irritation and numbness below the waist by disrupting the anatomy of the spinal cord. Injury that is permanent is possible.

Stretches for the abdominal muscles:

This stance can put strain on the back bone, causing the sciatic nerves to be compressed. This is an exercise you should avoid at all costs.

Squats with full body weight:

Squats with barbells can cause harm to the lower spine by compressing nerves and intervertebral discs. It may also cause pain in the buttocks and legs. Squats with weights put more pressure on your lower back, sciatic nerve, and intervertebral herniated disc. They can also cause pain and harm by putting strain on your legs. Instead of using weights, try them without them, keeping your core engaged and your back in a neutral position. If you experience any back pain or tightness, come to a halt.

Deadlifts with a lot of weight:

This exercise can lead to spinal damage, which is one of the leading causes of lower back pain and sciatic nerve pain.

Lifting weights:

Only do this if you have enough support for your lower back.

Leg Exercises:

Exercises like double leg lift, single leg lifts and leg curls should be avoided while lying down. This will put strain on your lower back and injure your spinal cord, making your sciatic nerve pain situation worse.

Standing and seated forward bends

This exercise can aggravate sciatica pain by causing tension and stress in the lower back, pelvis, and leg muscles. The sciatic nerve runs under the hamstrings, which is why it often feels like the hamstring itself that is causing the pain in sciatica. So when you stretch in this way, it probably won’t help to alleviate the pain.

Stretching Hurdler

The back, hips, and hamstrings are all strained in this sitting spinal stretch. As you fold forward, twisting your pelvis puts greater stress on your back and the sciatic nerve pain. Don’t overdo hamstring exercises, as repeated or intense stretching can irritate your sciatic nerve. Stick to five stretches on each side of your body. Knee to Opposite Shoulder The knee to opposite shoulder exercise is a simple stretch to relieve sciatic nerve pain. It helps by loosening gluteal and piriformis muscles, which are located deep in the buttocks. When these muscles become inflamed, they press against the sciatic nerve and cause pain and other symptoms.

Leg circles in the supine position

Leg circles are fairly simple . You just swing your leg around in a circular motion ; however , this could lead to irritation thus increasing sciatica symptoms. As you rotate your leg in a circular motion, this Pilates exercise stretches the hamstring. This can result in sciatic pain, irritation of the sciatic nerve, and hamstring injury.

Double leg lift

This double leg lift involves simultaneously elevating and lowering both legs, which works your abdominal muscles and leg muscles. It can increase sciatic pain, particularly if you perform it incorrectly.

Pose in a revolving triangle

This pose may cause your spine, hips, and hamstrings to overstretch, and will aggravate sciatic pain.

Burpees are a type of exercise to avoid

High-impact motions are used in this workout, which can aggravate back and hip pain. Bending forward and jumping repeatedly might increase the sciatica symptoms you are experiencing.


Cycling, especially on a hard bike seat, can put strain on your spine and sciatic nerve. Sciatica can be aggravated by riding in a slumped or forward-leaning position, especially if your seat and handlebars are positioned properly.

Sports with a high level of effort

Any high-impact activity or contact sport that requires you to make quick movements or puts stress on your body should be avoided. Basketball, soccer, tennis, volleyball, running, and HIIT workouts are all examples of this and can make pain worse.

If I have sciatic pain, what activities should I avoid?

Touching your toes and other classic lower-body exercises may, without a doubt, be beneficial in preventing back problems. After all, maintaining lower-back flexibility can help you stay limber so you can conduct core-strengthening exercises. As a result, strengthening your supporting muscles can reduce the likelihood of nerve compression.

However, many of these so-called sciatica gym exercises can actually do more harm than good as therapies for pre-existing conditions. Flexibility is like bending forward in the back to reach your toes. Bulging or herniated disks are frequently aggravated by this stretching motion. To avoid sciatica pain, consult your doctor or physical therapist about stretching exercises.

The following physical activities should be avoided:

Sports that are “twisty” should be avoided.

Jobs or sports that force you to rotate your torso are more likely to cause or aggravate sciatica. When it comes to workouts or hobbies that include twisting movements, be cautious.

Soccer and ice hockey, as well as tennis, basketball, and paddleboarding, are examples of repetitive twisting exercises to avoid sciatica discomfort. Swinging your body to strengthen the obliques may also need to be avoided.

You might find that the type of twisting required by your favorite pastime does not bother your sciatica. If this is the case, your doctor may give your workouts the green light. However, if you have twinges or numbness as a result of these exercises, you should cease doing them.

Sitting for extended periods of time should be avoided.

Long periods of sitting, according to the Cleveland Clinic, might aggravate sciatica. Perhaps it’s time to reconsider that long canoe or kayak expedition. Both demand a long amount of sitting, with the possibility of not being able to stretch your legs by pulling to the shore.

If you pedal, keep in mind that some people with sciatica find it difficult to sit for lengthy periods of time on a bicycle. Breaks should be taken frequently. Consider having your seat properly adjusted, as well as pedaling your back off the seat on occasion.

Lifting Weights Should Be Done With Caution

Because herniated disks are a common cause of sciatic discomfort, movements that aggravate the spine are definitely among the sciatic exercises to avoid. Although strong core muscles can assist prevent nerve compression and other causes of sciatica, deadlifts can actually make the disease worse.

Lifting big weights puts stress on your back since you have to bend your waist to raise them, according to the American Council for Exercise. Furthermore, several of the recommended gym workouts for sciatica actually increase body tiredness, which leads to incorrect lifting – worsening existing back problems.

Pay Attention to Your Body

Sciatica affects people in different ways. It can be felt as numbness rather than severe pain in some persons. It might affect your calf and thigh muscles, as well as your buttocks and lower back. Much of this diversity is due to the underlying reason of each patient’s sciatica.

According to a 2018 textbook chapter released by the US National Library of Medicine, technically different illnesses such as piriformis syndrome can either directly impact the sciatic nerve or mimic the symptoms.

Because it’s difficult to forecast where sciatica will strike, it’s also difficult to forecast which movements will produce flare-ups. The best course of action is to quit doing any exercise that causes numbness or pain. That doesn’t mean, for example, that you’ll never be able to play tennis again. However, it does suggest that training with a physical therapist to improve strength and stamina is a good place to start.


Sciatica affects some people more than others, as it does with many other bodily problems. If you fall into a few of these categories, you might be at a higher risk.

Age is a factor.

As we become older, we develop a slew of new aches and tingles all over our bodies. It’s just a natural component of the aging process. Herniated discs, a common cause of sciatica, are more likely as we age due to changes in the spine.

Diabetes is a disease that affects people

Diabetes is a disorder in which your body’s response to blood sugar levels causes nerve damage. Diabetes can increase your risk of sciatica because it is caused by problems with the sciatic nerve.

Obesity is a problem that affects many people.

Because of the sciatic nerve’s connection to the spine, the more pressure on the spine, the more likely you are to experience sciatica pain. Obese people put a lot more strain on their spine than those who are physically fit.

Sitting For Extended Time

If you work in an office or spend a lot of time sitting, you may be more susceptible to sciatica. This is due to the strain on the spine, as well as the likelihood of bad posture.


The nicest part about assisted stretching is that your stretch therapist does all of the work. They’ve got you covered on everything from what stretches you need to how many times you should do them. They even help you stretch, as the name implies, so there’s less risk of pinching a nerve or pushing your body beyond its limitations.

Furthermore, if you’re suffering from sciatica pain, it’s critical not to exasperate the situation. Many stretches can make you feel much better, but they can also have the reverse impact. Seeing a professional can make all the difference.


Numerous people are unaware of many facts about sciatica. Apart from the sciatica exercises to avoid, here are a few intriguing facts:

  • Stretching and exercising is preferable to merely resting.
  • Other disorders, such as a shattered hip or pelvic muscle spasm, might cause similar symptoms.
  • Sciatica affects men three times more than it does women.
  • Sciatica can be avoided by maintaining excellent posture.

Conclusion around sciatica exercises to avoid

If you suffer from sciatica, it’s important to be mindful of the types of sciatica exercises that will aggravate your symptoms. For example, a hard workout with intense stretching or weightlifting could make things worse for someone who is already suffering. This article has outlined specific workouts and poses that may not work well for those with sciatica. Have you tried any of these? What were your results? Share them in the comments below!

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Carlson Releases a New Strength of Solar D Gems; D3, Omega-3s

Carlson has released a new strength of their popular Solar D Gems product, with 6,000 IU (150 mcg) of vitamin D3, plus 115 mg of omega-3s to promote healthy immune function and bone health.*

Vitamin D is a vitamin we can get through food and also a hormone our body makes from the sun. Despite the multiple ways of getting vitamin D, many are still deficient due to changing seasons, sunscreen, skin tone, age, and clothing.

The omega-3s in Solar D Gems are wild caught and sustainably sourced using traditional fishing practices. The beneficial omega-3s EPA and DHA support heart, brain, vision, and joint health.*

Carlson Solar D Gems have delicious natural lemon flavor. For more information, visit carlsonlabs.com.

* This statement has not been approved by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.

Carlson began in Chicago in 1965 as one woman’s mission to improve the health of her family by creating nutritional supplements with high-quality ingredients. Susan Carlson’s father suffered from heart issues but found relief after taking vitamin E. Inspired by this discovery and her background as a pharmacist, Susan created one of the first full lines of vitamin E worldwide, and the product line continued growing to meet the health needs of local families. Carlson began popping up on store shelves around Chicago, and the wave continued across the nation. In the early 1980s, Carlson helped launch the omega-3 market in North America, importing our first wild caught, sustainably sourced fish oils from Norway. Today, the commitment to helping families live a healthier lifestyle continues, as the next generation of the Carlson family leads the company. Carlson now offers more than 200 vitamins, minerals, omega-3s, kids’ products, and other high-quality nutritional supplements. At Carlson, our family cares about the health of your family.

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Herb Tech Pharma named one of cannabis industry’s 18 leading global companies

Based in Beverly, Massachusetts, Herb Tech Pharmaceuticals is a specialty pharmaceutical company focused on the development of Hemp CBD and other botanical extracts. With its consumer- based focus deriving from its unique history, Herb Tech Pharmaceuticals is committed to delivering superior topical and oral products.

“The decision that a consumer makes to purchase a health and wellness product is an important one and one that we at Herb Tech Pharma do not take lightly,” said representative Laura Stephens. “Naturally, we believe that the consumer is relying on us to produce a product that can safely and effectively address their health and wellness needs. Here at Herb Tech Pharma, our philosophy focuses on the core belief that the gastro-intestinal system is not the target area for the absorption of CBD or botanical extracts. As naturally derived ingredients, the gastro- intestinal system treats CBD and botanicals like food and destroys them. The little that remains must then be absorbed through the stomach lining, pass through the liver, and only then reach general circulation where they travel throughout the body looking for receptors.

“Using our topical phase change technology or oral micro mist technology can reduce the stomach issues that some consumers could realise from oral products. Typically, our superiority to others is based on our four pillars which includes advanced formulation science, purity and concentration of CBD and extracts, full panel independent validation to ensure of compliance and transparency, and lastly packaging that both protects the product and aids the consumer with proper dosing.

At Herb Tech Pharma, we truly believe formulation science combined with our other product pillars helps ensure that the consumer has the best possible health and wellness experience from a brand that they can trust.”

When it comes to recruitment, the firm typically look for candidates who can demonstrate three key skills.

“With our team culture evolving around subject matter expertise, innovation, and passion, we want all of our individual team members to be experts in their fields, to be able to demonstrate innovative problem-solving skills and show a passion for creating unique products,” Stephens says. “By heavily investing in the development of our current science platforms as well as more advanced biochemical technologies for prescriptive drug applications, we believe this commitment has allowed us to forge our own path as we push the industry to focus more on product quality, innovation and consumer trust.”

The outbreak of COVID-19 has further highlighted the lack of understanding retailers and consumers have about white label products. In response to this, Herb Tech Pharma have launched a program to educate the consumer and retailer on how to read a label, Stephens says.

“Since COVID-19 has heightened the public’s focus on health and wellness, consumers and retailers are asking more questions about their products which provides companies like Herb Tech Pharma with an opportunity to educate the consumer and retailer on what distinguishes product quality. By completing our program, consumers are able to make better, educated product purchasing decisions.

“Here at Herb Tech Pharma, we continually invest in our formulation science platforms and intellectual property. In this regard, we have a number of unique and exciting programs under development that we believe will not only add to our product portfolio but also help further evolve the industry. Moving forward, with such fierce competition in our industry, maintaining our current position will be challenging, but with the efforts of our team and our commitment to innovation there are plenty of reasons to be optimistic about our future.”

Company: Herb Tech Pharmaceuticals Inc. Contact: Laura Stephens

Website: http://www.herbtechpharma.com

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Vitamin D and falls prevention for senior patients; dosage, calcium

Vitamin D and falls prevention research has shown that senior patients with lower vitamin D levels have poorer functional mobility and cognitive function

Vitamin D is known for providing certain health benefits, including promoting calcium absorption (which supports bone health and proper muscle function), reduced inflammation, and glucose metabolism according to the Office of Dietary Supplements (ODS). However, there is one additional benefit that is less talked about — vitamin D and falls prevention for elderly and senior patients.

Vitamin D and falls prevention

In 2011, the Journal of Clinical Endocrinology & Metabolism published a meta-analysis of 26 trials involving a total of 45,782 participants in regard to vitamin D and falls prevention. It found that subjects who took both vitamin D and calcium had a reduced fall risk. This effect was even more pronounced when these individuals started their respective studies with a vitamin D deficiency.

A 2014 study found similar results. It was conducted on 404 patients at a memory clinic and found that seniors with lower vitamin D levels had poorer functional mobility. This was assessed by looking at their walking speeds and by using the Timed Up and Go (TUG) test. They also had poorer cognitive function. The findings were published in the journal Gerontology.

A 2016 case-control study in the Journal of Nutrition, Health & Aging adds that not only is vitamin D deficiency correlated with increased fall risk, but those with this type of deficiency also have more recurrent falls. Further, this vitamin appears to increase fall risk somewhat indirectly, by influencing conditions that predispose older persons to a fall versus inducing the fall itself.

The vitamin D-calcium connection

It should be noted that several of the studies looking at vitamin D’s effects on fall risk also involved the study subjects taking calcium. One was the previously mentioned 2011 study published in the Journal of Clinical Endocrinology & Metabolism. Another was a study published in Osteoporosis International.

This second study found that seniors taking calcium and vitamin D had a “significant decrease” in falls when compared to those taking calcium alone. Specifically, their number of falls decreased by 27% after one year of calcium and vitamin D supplementation. At 20 months, first falls for this group were decreased by 39%, partially by improving muscle function.

Vitamin D dosage impact on fall risk

Other studies have tried to ascertain whether a certain dosage of vitamin D may provide a greater benefit for reducing one’s fall risk. Findings have been somewhat unclear.

For example, a 2014 study in the Archives of Public Health reports that evidence supports an optimal vitamin D dosage of 800 IU per day for fall prevention. Another mentions a dosage range of between 800 IU and 1,000 IU daily for optimal effects, which this amount reducing falls by 16%.

Additional studies suggest that dosage might not be as relevant at higher doses. One was a 2016 study involving 200 subjects aged 70 and older who had a prior fall. This research involved participants taking either 24,000 IU of vitamin D3 or 60,000 IU, and it found that the actual dosage amount made no difference.

Published in JAMA Internal Medicine, this study concluded that there was no apparent fall-related benefit when choosing one amount over the other. This was even though those taking higher dosages had achieved blood level concentrations of at least 30 nanograms per milliliter (ng/mL).

A 2020 randomized trial also found that taking 1,000 IU or higher had no greater effect for reducing falls than those taking 200 IU. It further questioned whether taking 1,000 IU or more of vitamin D was safe.

Helping patients find the right vitamin D dosage

The ODS recommends that most adults get 15 mcg of vitamin D daily, which equates to 600 IU. Individuals 70 years of age and older should have slightly more, with a recommended daily allowance of 20 mcg or 800 IU.

Vitamin D can be found in foods such as milk, breakfast cereals, and fatty fish. Patients can also increase their vitamin D levels by spending a few minutes daily in the sun. Supplements are an additional way to increase one’s intake of this key nutrient.

Older adults aren’t the only ones at risk of low vitamin D levels. The concern of a deficiency is also higher for people with dark skin, those who have a medical condition that limits their ability to absorb fat (such as Crohn’s disease or celiac disease), and individuals who are obese or who’ve had gastric bypass surgery.

A blood test can determine a person’s vitamin D levels and provide guidance as to whether supplementation may be advised to address vitamin D and falls prevention.

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