A U.S. study published in Chiropractic & Manual Therapies shows that chiropractors adjust their treatments based on how a patient is perceived age-wise – both physically and mentally. The researchers examined how experienced chiropractors alter force and movement patterns when performing spinal manipulative therapy (SMT) on patients of different ages.
The study involved 16 chiropractors, each of whom performed manipulations on an advanced human-like manikin based on 12 AI-generated patient vignettes that varied across three dimensions of age: chronological age (35, 65, and 85 years), pathological age (degenerative condition of the spine), and the so-called “felt age” – that is, how the patient perceives their own aging.
The results showed clear patterns: the older the patients appeared, the less force the chiropractors used during the manipulation. This was true for both chronological and pathological age. However, felt age had only a limited effect, although chiropractors responded more quickly to patients who seemed older in tone and attitude.
The study highlights the importance of understanding age not only as a number of years but also as a biological condition and self-perception, to tailor the strength of treatment and avoid overexertion. This can be especially critical for frail elderly individuals, where too much force could cause harm.
The research also raises the question of whether chiropractors should receive more systematic training to adjust force based on evidence-based parameters rather than relying solely on intuition.
In their conclusion, the researchers emphasize the need for further research: What levels of force and motion are the safest and most effective for older adults? The answers could help make chiropractic care both safer and more precise for the growing elderly population. This new knowledge can also inform future education for chiropractors.
Michele J. Maiers, Alexander R. Sundin, Ryan J. Oster, Steven Kreul, Quinn Malone, Steven R. Passmore. Contextual factors related to aging determine force-based manipulation dosage: a prospective cross-sectional study. Chiropractic & Manual Therapies 2025.