January 2006

Study shows US soldiers in Iraq need chiropractic

According to a study published in the Oct. 2005 issue of Anesthesia & Analgesia, "the major cause of attrition in recent wars has not been battle‑inflicted injuries but more ordinary conditions such as accidents and musculoskeletal complaints."

To reach their conclusions, researchers conducted a study of 162 soldiers who were referred to two large pain treatment centers located outside the theaters of combat. More than half (53%) presented with either radicular or axial low back pain, with lumbar herniated disk being the most frequently diagnosed condition (24%).

Field officers agree that the problem is a major one.

"Though soldiers are in better shape than the average citizen, they also face high‑stress conditions. That, combined with sleeping on cots with little back support, standing on their feet for hours at a time, riding in convoys in crunched positions and wearing heavy body armor, contributes to back troubles," noted Capt. Brian Kargus, of the 101st Airborne Division in Mosul, Iraq, in an article for USA Today.

Because chiropractic care is normally not available officially to active duty soldiers in such areas, most of them are not offered non‑allopathic care and are limited to drugs or surgery. The research paper revealed that 72% of the soldiers in the study received at least one nerve block/injection, the most common of which was lumbar epidural steroid administration. Nonsteroidal anti‑inflammatory drugs were prescribed to 56% of patients, opioids to 49%.

Although more than one third (34%) were referred to physical therapy, only 17% were provided any form of alternative therapy. Of these, half were treated with massage therapy and only 4.9% were given "chiropractic manipulation."

Not surprisingly, the results of the medical treatment were unimpressive. Less than one‑quarter of the soldiers in the study experienced a significant (50% or more) pain reduction after treatment, and just two percent of them were able to return to combat duty in Iraq.

"Not withstanding the human costs of deployed soldiers being medically boarded out of the military or transferred to noncombat roles, the economic impact of our small return‑to‑duty rate is staggering. For example, the financial cost of medically boarding just one Special Operations or other highly trained soldier and retraining a replacement can exceed U.S. $1,000,000," the researchers noted.

"This report clearly points out the need for doctors of chiropractic to be commissioned as officers in the US Armed Forces, and made an integral part of the health care services offered to all military personnel," stated Terry A. Rondberg, DC, president of the World Chiropractic Alliance, who serves as a member of the Department of Defense Chiropractic Health Care Benefits Advisory Committee, which is charged with providing recommendations on the implementation of chiropractic benefits for active duty military personnel.

Defense Authorization Bill (HR 5006), which was signed into law on October 23, 1992, authorizes the Secretary of Defense to "appoint chiropractors as commissioned officers in the armed forces to provide chiropractic care within the military health system." However, the Secretary has never acted on that authorization and no DC has ever been commissioned.

The World Chiropractic Alliance has actively fought for the commissioned status and, in 2000, issued a position paper urging that "the military be directed to immediately commence commissioning chiropractors as officers in all branches of the military."

The paper also proposes the creation of a separate Chiropractic Corps providing chiropractic examinations and adjustments to correct vertebral subluxations.

"A separate Dental Corps exists, recognizing that dentistry is a service separate and distinct from medicine," the paper explains. "Chiropractic does not belong in the Medical Specialist Corps. Physical therapy and rehabilitation services are already available within the military system; chiropractic examination and adjustment to correct vertebral subluxations are not. This provides consistency with the other existing Federal program, is the more cost‑effective approach, and satisfies legislative intent."

The World Chiropractic Alliance also strongly supports direct access to chiropractic care.

"Only a chiropractor is qualified to determine the appropriateness of chiropractic care," the position paper stresses. "Direct access would also eliminate the costs associated with a screening process by other providers."

The WCA continues to work with the International Chiropractors Association and Federation of Straight Chiropractors and Organizations as partners in the Chiropractic Coalition to lobby on this matter. In placing the issue on its legislative agenda, the Coalition leaders noted that osteopaths were commissioned as officers 20 years after DoD received authorization to do so. "We don't want to wait that long," they stated.