Military Medicine 2009 (Jun); 174 (6): vi–vii ~ FULL TEXT
Bart N. Green, DC, MSEd; Claire D. Johnson, DC, MSEd; Anthony J. Lisi, DC
Department of Physical and Occupational Therapy,
Naval Medical Center San Diego,
MCAS Miramar Branch Medical Clinic,
PO Box 452002, San Diego, CA 92145-2002
From the FULL TEXT :
CHIROPRACTIC IN HEALTHCARE
The use of various forms of complementary and alternative
medicine (CAM) continues to grow in the United States.  Eisenberg and colleagues  defined CAM as: “Interventions not
taught widely at U.S. medical schools or generally available at
U.S. hospitals.” Popular CAM practices include: herbal remedies,
yoga, acupuncture and, chiropractic.  Chiropractic care is reportedly used by 7.4%  to 11%  of the American adult population, representing approximately 190 million office visits
per year and about 30% of all CAM practitioner visits.  Smith and colleagues recently reported that as much as one third of Navy and Marine Corps personnel utilize some form of CAM, including chiropractic care.  This editorial offers a brief overview of chiropractic care in military and veteran facilities.
CHIROPRACTIC CARE IS AVAILABLE ON-STATION
Since a 3-year demonstration program launched in 1995
showed successful inclusion of chiropractic services in 10 different Department of Defense (DoD) sites, 6 the service has
grown to approximately 45 military treatment facilities across
the United States,  and is still expanding.  In 2004, chiropractic care was introduced into the Department of Veterans Affairs (VA)  and is currently available at 35 VA facilities.  At these locations, doctors of chiropractic work within each hospital or clinic and become an integral part of the healthcare team at each facility. When beneficiaries are consulted for chiropractic care, the chiropractor’s case management approach is transparent to all providers at the facility because of both routine interactions between providers and access to electronic medical records.
WHAT IS A CHIROPRACTOR?
Chiropractors are licensed healthcare professionals who, after
completing required prerequisite college courses, must complete
4 years of training, certification, and licensure.  They primarily focus on neuromuscoloskeletal conditions, such as headache, backache, neck pain, sprains, strains, and are trained to diagnose, comanage, and refer appropriately. Although the number of publications about chiropractic care specifically
included within the DoD/VA setting is limited [12-18] there are many articles regarding chiropractic care in general. Two of
the most common questions asked by medical personnel are
what types of conditions to send to a chiropractor and how
chiropractors fit into the system.
CONDITIONS TO REFER TO A CHIROPRACTOR
Typically, chiropractors within the DoD and VA are successful
in treating various spinal conditions such as mechanical
low back pain, neck pain, and radiculopathy. Chiropractors
additionally often manage a variety of other neuromusculoskeletal problems such as tension-type headaches, extremity conditions, tendinopathies, and noncardiac chest pain.
Because of the limited number of chiropractors working in
DoD and VA facilities, there may be a wait time for patients to
be seen for initial consults.  However, most on-station chiropractors make time to see acute cases at the request of a fellow provider. Service agreements help to delineate appropriate consultation processes, and collegial communication among providers allows all to work in the patients’ best interests.
CHIROPRACTORS IN THE SYSTEM
Chiropractors who have been selected to work within the DoD
or VA are credentialed and have experience working within
the medical healthcare environment. Some chiropractors are
certified in specialty areas, such as sports medicine or rehabilitation and may be able to offer expanded services because of this training. In today’s VA and DoD facilities, it is common to see chiropractors working alongside physical therapists, sports medicine physicians, primary care managers, and other specialists, depending upon the needs of the beneficiaries in the area. Chiropractors are functioning currently in departments of primary care, physical therapy, orthopedics, and sports medicine in many VA and DoD facilities and, in some locations, exist as stand-alone departments. Neurosurgeons and orthopedic surgeons sometimes request a course of physical therapy and/or chiropractic care to see if a case will respond to conservative management before planning on surgery. Those cases that go through a course of chiropractic care and do not improve are often excellent candidates for surgery. As well, some chiropractors may be available to assist with postsurgical care as the patient goes through rehabilitation.
Various subpopulations of active duty service members are
a good match for chiropractic care, as chiropractors provide
conservative care, do not prescribe medications, and are most
often able to treat a patient without the need for light duty
or med-down status. For example, chiropractic care can be a
valuable asset in the aviation community where pilots, who
often have neck and back problems,  can obtain relief from
their pain without jeopardizing their flight status. Many posts
have discovered that in addition to assisting in the management
of common musculoskeletal problems, chiropractors are also well versed in providing education pertaining to injury prevention, ergonomics, and other health and wellness topics to provider groups and beneficiaries.
There have been early reports of how some chiropractors
function in DoD and VA facilities; this demonstrates the need
for additional documentation by experienced investigators.
Although more research is needed to demonstrate the effectiveness of chiropractic care in the DoD and VA settings,
experience thus far has shown the service can be of benefit to
both beneficiaries and the healthcare team.
Tindle H , Davis R , Phillips R , Eisenberg D :
Trends in use of complementary and alternative medicine by US adults: 1997-2002 .
Altern Ther Health Med 2005 ; 11 (1) : 42 – 9 .
Eisenberg DM, Kessler RC, Foster C, Morlock FE, Calkins DR, Delbanco TL.
Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use
New England Journal of Medicine 1993 (Jan 28); 328 (4): 246–252
Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC.
Trends in Alternative Medicine Use in the United States, 1990 to 1997:
Results of a Follow-up National Survey
JAMA 1998 (Nov 11); 280 (18): 1569–1575
Meeker, W., & Haldeman, S. (2002).
Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine
Annals of Internal Medicine 2002 (Feb 5); 136 (3): 216–227
Smith TC, Ryan MA, Smith B, et al.
Complementary and Alternative Medicine Use Among US Navy and Marine Corps Personnel
BMC Complement Altern Med. 2007 (May 16); 7: 16
Chiropractic Health Care Demonstration Program . Final Report .
Falls Church, VA , Birch and Davis Associates I , 2000 .
Government Accountability Office.
DOD’s Chiropractic Health Care Program
Washington, DC: US Government Accountability Office; 2005.
National Defense Authorization Act for Fiscal Year 2004, Pub. L. No. 108-136, § 711, 117 Stat. 1392, 1530, 2003 .
Department of Veterans Affairs Health Care Programs Enhancement Act of 2001
Public Law 107–135
Johnson C , Baird R , Dougherty PE , et al :
Chiropractic and public health: current state and future vision .
J Manipulative Physiol Ther 2008 ; 31 (6) :397 – 410 .
Bronfort, G, Haas, M, Evans, R, Kawchuk, G, and Dagenais, S.
Evidence-informed Management of Chronic Low Back Pain
with Spinal Manipulation and Mobilization
Spine J. 2008 (Jan); 8 (1): 213–225
Dunn AS :
A chiropractic internship program in the Department of Veterans Affairs Health Care System .
J Chiropr Educ 2005 ; 19 (2) : 92 – 6 .
Dunn AS :
Department of Defense chiropractic internships: A survey of internship participants and nonparticipants .
J Chiropr Educ 2006 ; 20 (2) :
115 – 22 .
Dunn AS , Towle JJ , McBrearty P , Fleeson SM :
Chiropractic consultation requests in the Veterans Affairs Health Care System:
demographic characteristics of the initial 100 patients at the Western New York medical center .
J Manipulative Physiol Ther 2006 ; 29 (6) : 448 – 54 .
Green BN , Schultz G , Stanley M :
Persistent synchondrosis of a primary sacral ossification center in an adult with low back pain .
Spine J 2007 ; 8 (6) : 1037–41 .
Green BN, Sims J, Allen R.
Use of Conventional and Alternative Treatment Strategies
for a Case of Low Back Pain in a F/A-18 Aviator
Chiropractic & Osteopathy 2006 (Jul 4); 14: 11
Dunn AS , Passmore SR :
When demand exceeds supply: allocating chiropractic services at VA medical facilities .
J Chiropr Humanit 2007 ; 14 : 22 – 7 .
Dunn, AS and Passmore, SR.
Consultation Request Patterns, Patient Characteristics, and Utilization of
Services within a Veterans Affairs Medical Center Chiropractic Clinic
Military Medicine 2008 (Jun); 173 (6): 599–603
Drew WED :
Spinal symptoms in aviators and their relationship to G-exposure and aircraft seating .
Aviat Space Environ Med 2000 ; 71 : 22 – 30 .
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