June 2006

Watch out, the baby boomers are coming

by Robert H. Blanks, PhD, President, Research and Clinical Science

Largely because of the exercise behavior of the 78 million baby boomers  born between 1946‑64, sports injuries have become the second most common reason for visits to a medical doctor's office nationwide, topped only by the common cold, according to a report in the National Ambulatory Medical Care, 2005.

Clearly, boomers are exercising. That's good, but they have not learned to exercise without injuries. Chiropractors need to get involved in a bigger way to solve this growing problem. 

Encouraged by doctors to follow an exercise program of three to five times per week, the now middle‑aged baby boomers are experiencing injuries in record numbers. They are getting knee and hip replacements, surgery for cartilage and ligament damage, and treatment for tendonitis, stress fractures, bursitis and arthritis.

The Bureau of Labor Statistics reports that injuries associated with athletics among middle‑aged Americans account for 488 million days of restricted work in 2002. Another study was conducted by the Consumer Product Safety Commission on emergency room costs in 1998. It determined that sports‑related medical costs had risen by 33% since 1991, amounting to $18.7 billion annually.

Many conclude that boomers over‑exercising or failing to use adequate preventative strategies (e.g., warm‑up stretches, rotating muscle groups exercised, etc.) ‑‑ behaviors that have turned sports medicine into a fast‑growing and very lucrative field.

The middle‑aged boomers are currently at the peak of their earning capacity, and many have good medical coverage to afford treatment for their sports‑related injuries. The serious costs for these services are shared by the patient, employer and insurer.

However, many are concerned about what will happen when this group reaches 65 years old and becomes a burden to the Medicare system. More than any other factor, the pulse of boomers coming through the system, and their health access behaviors, has become a major health care cost concern for policy experts.

Worksite wellness programs

A recent article in Smart Business Atlanta ("The race to wellness," April 2006) provides two essential components for a cost‑effective corporate wellness program that might possibly alleviate some of the sports‑ and other lifestyle‑related injuries. These are

1) ability to measure the success of the program, and

2) to provide a program that will change the behavior of the target audience.

These components are easier to list, but difficult to do.

The public health system is tracking the health access patterns of the boomer cohort and others, thereby fulfilling the first criteria for a successful wellness program.

But relatively little has been done to impact the health behaviors of these populations. Many are not exercising, as evidenced by the alarming incidence of obesity, heart disease and type II diabetes in the US, and those who do exercise are often not applying the rules of prevention to avoid injuries.

In addition to recommending exercise three to five times per week, health professionals must be more conscientious about instructing their patients on conducting a balanced exercise program to work all muscle groups and the need to follow the advice of experts trained in sports therapy.

Changing someone's health behavior is difficult but employers have tried several models to encourage participation in corporate wellness programs.

According to the 2006 International Foundation report on wellness, a number of major employers surveyed (including Chevron, General Mills, General Motors, Johnson and Johnson, Pacific Bell, Procter and Gamble, Tenneco) determined that providing an onsite facility produces only a low‑to‑average participation rate, ranging from 10‑50%. Yet, even this low participation rate reaped sufficient savings in the cost of insurance premiums and increased worker productivity to justify the program financially.

Other companies have experimented with incentive‑based programs. About two‑thirds of the companies surveyed reported using an incentive program such as gift cards, reduced co‑pays, gym bags and water bottles, etc. to increase participation rates. Combined incentive‑ and punitive‑based programs (the carrot and stick approach) are being tried and early results indicate a direct correlation with the results of the wellness program and participation levels.

Greater utilization of chiropractic wellness services.

A better solution might be to increase the use of chiropractic wellness services into these programs.

Many efforts have been put forth by the chiropractic profession to promote healthy lifestyle behavior and to shift patient behavior towards a prevention strategy of long‑term care.

A recent national survey of chiropractors showed that the overwhelming majority of DCs support a healthy‑patient lifestyle: 97.8% recommend exercise, 93.6% recommend maintenance/wellness care, and 93.2% provide ergonomic recommendations (McDonald et al., 2003).

Members of the ACA Council on Sports Injuries and Physical Fitness work with athletes of all levels, from novice to elite, to enhance athletic performance, and promote physical fitness. Chiropractors are working in record numbers with other sports organizations such as the National Athletic Trainers Association and the American College of Sports Medicine to initiate injury prevention programs for optimal personal fitness programs or organized sports.

The problem for the profession is that chiropractic services are grossly underutilized. Whereas virtually all sports teams have a chiropractor, utilization of chiropractic services by the general public is extremely low. A large demographic of Complementary and Alternative Medicine study of 31,044 Americans indicated that chiropractic is utilized by only 7.5% of the general population (US Health and Human Services, Advanced Data from Vital and Health Statistics, 2004).

To be effective, chiropractors have to be involved with the wellness programs of all corporations and a part of every personal health program. They have to be allowed to pursue the tenets of chiropractic, which according to the widely supported definition developed by the Association of Chiropractic Colleges that: "Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation" and not simply limited to condition‑based musculoskeletal problems.

What we need to do to reverse the alarming trend of underutilization of chiropractic services is to rapidly build the evidence of chiropractic effectiveness for non‑musculoskeletal conditions. We need also to focus attention on the broad wellness benefits of the adjustment and the importance of long‑term periodic care.

We already have some data to support wellness benefits of chiropractic (as referenced in the CCP Guidelines) but new studies must be generated to cover all the new areas of opportunity including an expansion of the chiropractic sports injury prevention field.

One of my favorite quotes is from Oliver Wendell Holmes Jr. "Man's mind stretched to a new idea never goes back to its original dimension." 

As a basic scientist trained in the field of vestibular and balance disorders, I was introduced to chiropractic 10 years ago and had the privilege of working with the Network Spinal Analysis group to produce what is still the largest wellness chiropractic study in the field (Blanks et al., 1997, Schuster et al., 2004a, b).

The RCS (Research & Clinical Science) concept in an outgrowth of the original wellness objective, except that now we have designed a general assessment of chiropractic across all techniques. The mind has been expanded to embrace chiropractic as wellness and not merely a discipline with a condition‑based agenda.

The RCS organization looks forward to working with all doctors interested in building the chiropractic literature base. We have placed a special focus on applying rigorous research designs to develop scientific rationale behind practical applications, preventative programs and wellness strategies for areas such as the featured topic of sports injuries.

Sources

Blanks, R.H.I., Schuster, T. L., Dobson, M. A retrospective assessment of network care using a survey of self‑rated health, wellness and quality of life. J. Vertebral Subluxation Res. 1:15‑31, 1997.

Schuster, T.L., Dobson M, Jaregui, M. Blanks, R.H.I. Wellness Lifestyles 1: A Theoretical Framework Linking Wellness, Health Lifestyles, and Complementary and Alternative Medicine. J. Alternative and Complementary Med. 10(2):349‑356, 2004a.

Schuster, T.L.,  Dobson, M., Jaregui, M., Blanks, R.H.I. Wellness lifestyles II: Modeling Relationships Between Wellness, Health Lifestyle Practices, and Network Spinal Analysis. J. Alternative and Complementary Med. 10(2):357‑368, 2004b.

McDonald W, Durkin K, Iseman S, Pfefer M, Randall B, Smoke L, Wilson K. How Chiropractors Think and Practice: The Survey of North American Chiropractors, Institute for Social Res, Ohio Northern Univ, Ada, Ohio, 2003.

(RCS co‑founder and President Dr. Robert Blanks is Professor in the Department of Biomedical Sciences at Florida Atlantic University and a past Professor of Anatomy and Neurobiology at the University of California, Irvine. Prior to this he spent two years at the Max Planck Institute for Brain Research in Frankfurt, Germany and two years in the Department of Anatomy at Harvard Medical School. Dr. Blanks is on the Advisory Board of the International Spinal Health Institute, is a Board Member of the Council on Chiropractic Practice and is actively involved in chiropractic research. To learn more about health outcomes research and RCS, call 800‑909‑1354 or 480‑303‑1694.)