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Recent Study Reinforces Effectiveness of Spinal Manipulation, Says American Chiropractic Association

The American Chiropractic Association (ACA) is applauding a new study from the Medical Research Council (MRC) that shows that spinal manipulation – the primary form of care performed by doctors of chiropractic – combined with an exercise program offers effective treatment for those suffering from back pain. The study, published in the Nov. 19 issue of the British Medical Journal [see abstract below], found that a collective approach to back pain treatment provided “significant relief of symptoms and improvements in general health.” Specifically, the study found that the greatest reduction of pain and the greatest improvement in back function was experienced by patients who received a treatment approach consisting of spinal manipulation and exercise in addition to care from their general practitioner. The MRC is based in the United Kingdom where its research is funded by the country’s taxpayers. The council promotes medical and related science research with the aims of improving the health and quality of life of the general public. The MRC is independent in its choice of which research to support. “The costs of back pain and other musculoskeletal conditions on the country's economy and workforce productivity are staggering - conservatively estimated at about $50 billion per year,” commented ACA President Donald J. Krippendorf, DC. “The ACA is pleased that research such as this is being conducted and brought to the attention of the public through journals such as the British Medical Journal. With reports such as these, we can offer our patients the best care possible.” The MRC trial included more than 1,300 patients from across the United Kingdom, whose back pain had not improved after receiving care from a general practitioner. Treatment options were: • A physical exercise program • Spinal manipulation alone • A combined package of spinal manipulation followed by a exercise regimen The results showed that patients in all treatment groups reported improved back function and reduced pain over time, but to varying degrees. However, the greatest improvement was found in the patients assigned to combined manipulation and exercise. According to the ACA, the MRC study is one of a number of recent studies regarding chiropractic’s effectiveness for back pain over traditional medical care. A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients' first year of symptoms. And a study published in the July 15, 2003, edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than does a variety of medications. ACA Press Release. November 29, 2004. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care ABSTRACT Objective: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. Design: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. Setting: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. Participants: 1287 (96%) of 1334 trial participants. Main Outcome Measures: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. Results: Over one year, mean treatment costs relative to "best care" were £195 ($360; 279 euro; 95% credibility interval £85 to £308) for manipulation, £140 (£3 to £278) for exercise, and £125 (£21 to £228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost £3800; in economic terms it had an "incremental cost effectiveness ratio" of £3800. Manipulation alone had a ratio of £8700 relative to combined treatment. If the NHS was prepared to pay at least £10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of £8300 relative to best care. Conclusions: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise. UK BEAM Trial Team. British Medical Journal.

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Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain

A Randomized, Controlled Trial Background: Dysfunction of the cervicothoracic spine and the adjacent ribs (also called the shoulder girdle) is considered to predict occurrence and poor outcome of shoulder symptoms. It can be treated with manipulative therapy, but scientific evidence for the effectiveness of such therapy is lacking. Objective: To study the effectiveness of manipulative therapy for the shoulder girdle in addition to usual medical care for relief of shoulder pain and dysfunction. Design: Randomized, controlled trial. Setting: General practices in Groningen, the Netherlands. Patients: 150 patients with shoulder symptoms and dysfunction of the shoulder girdle. Interventions: All patients received usual medical care from their general practitioners. Only the intervention group received additional manipulative therapy, up to 6 treatment sessions in a 12-week period. Measurements: Patient-perceived recovery, severity of the main complaint, shoulder pain, shoulder disability, and general health. Data were collected during and at the end of the treatment period (at 6 and 12 weeks) and during the follow-up period (at 26 and 52 weeks). Results: During treatment (6 weeks), no significant differences were found between study groups. After completion of treatment (12 weeks), 43% of the intervention group and 21% of the control group reported full recovery. After 52 weeks, approximately the same difference in recovery rate (17 percentage points) was seen between groups. During the intervention and follow-up periods, a consistent between-group difference in severity of the main complaint, shoulder pain and disability, and general health favored additional manipulative therapy. Limitations: The sample size was small, and assessment of end points was subjective. Conclusion: Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms. SUMMARIES FOR PATIENTS September 2004 issue of Annals of Internal Medicine | Volume 141 Issue 6| Pages 432-439


Chiropractors gaining new respect across the U.S.

Q. My mother is super-active for a woman past 80. She insists on cutting her lawn and regularly runs errands for neighbors, who largely are shut-ins. Still, she complains of “achy legs” and plans now on seeing some local chiropractor. Is this wise? A. The day has long past when chiropractors were regarded solely as “bone crackers” and shunned as pariahs, to be held outside the bounds of scientific medicine. There are many hospitals today with chiropractors on staff. Moreover, Medicare reimburses for “spinal manipulation” therapy. In effect, this places the federal government’s approval seal on both manipulator and his or her treatment. Now, having said this, I quickly add that a conservative, even deliberate, approach to most matters of health and medicine strikes me as appropriate. For example, let’s together examine the matter of chronic pain in the back, which could in fact also cause someone to suffer “achy legs.” First, accept that more than 70 percent of American adults, at some point in their lives experience what medicine labels “significant lower-back pain.” (Aside: the first rule for treatment of back pain: the pain almost always goes away, with or without treatment.) Next, know that the rush to treatment for back pain is good business. Indeed, the current estimate for this medical care is more than $26 billion annually. Disabling back pain commonly occurs between the ages of 45 and 64, when many people are anxious to return to work to prove they’re still fit. The result: a rush to surgery, in particular the lower-lumbar spinal fusion. There were more than 150,000 such operations performed last year, and while critics of medicine acknowledge this surgery is excellent for patients with fractured spines or spinal cancers, no one is absolutely sure how effective it is for lower back pain. Yet, these fusions continue-and no one steps up to suggest we call a temporary halt, at least until we have persuasive proof. Plainly, faith in medicine runs very deep in today’s America. Now, before someone yells “Doctor hater” or insinuates a bias exists in favor of chiropractors, let me state: 1) no relatives, or close friends, practice chiropractic medicine; 2) however, a beloved son, Paul R. Lindeman, is a board-certified internist. Further, I once worked inside the House of Medicine, referring to the headquarters building of the American Medical Association (AMA) in Chicago. During these years, there was an aggressive committee whose full-time mission was to uncover failings, mishaps and errors committed by chiropractors. In my role as editor-in-chief of Today’s Health, the AMA’s consumer magazine, I understood the subject represented trouble, editorially speaking. Chiropractors were considered imposters, or “fakes.” (Aside: this was just 30 years ago.) Thus, the lessons for today: Back pain is common, it’s expensive and there oftentimes is a rush to treat it “now!” Meanwhile, medical science knows not nearly enough about the origin and/or cause of this trauma. “We know more about the surface of the moon than we do how to treat the bad back,” continues as popular wisdom. For too long, chiropractors have worked under a shadow, in a dark place where bias holds currency. At a time when all science is moving faster and faster, why not invite these professionals to the main banquet: challenge the supposed newcomers (the discovery of chiropractic dates to September, 1895) to “show us what you got!” And please publish all findings in the accepted medical literature. Consider, our compelling need to do better: the United States spends more than $4,500 per person per year on health care. Costa Rica, with half as many doctors per capita, spends just $300 per person every year. Yet life expectancy at birth is all but identical in both countries? Here then are a number of reason why we’re “sick:” an estimated 127 million Americans, of all ages, are obese or overweight, while 47 million still smoke, risking any number of cancers. Additionally, 14 million abuse alcohol, and 16 million use addictive drugs. Plainly, we need a serious, continuing national campaign promoting good health habits, so how about this for a first proposal: a cut in Medicare premiums and taxes for those older adults who demonstrate they’re avoiding the leading risks to a healthful lifestyle? In summary, they’re living right. Finally, this free advice to chiropractors: join the good health practices campaign. Tell your senior patients to exercise (nearly everyone can walk), eat smart, be sociable, volunteer, read and learn. Too few medical doctors, pressured for time, follow this common sense regimen. Bard Lindeman welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Bard at 5428 Oxbow Rd., Stone Mountain, GA 30087-1228; fax to 404-815-5787; or send e-mail to [email protected] Reprinted with permission of Bard Lindeman, article in the Gwinnett Daily Post. Bard Lindeman covers issues faced by seniors, including family, health, retirement, elder care and aging. He has received the American Society on Aging National Media Award.


Self-treatment of benign paroxysmal positional vertigo

Semont maneuver vs Epley procedure ABSTRACT The authors compared the efficacy of a self-applied modified Semont maneuver (MSM) with self-treatment with a modified Epley procedure (MEP) in 70 patients with posterior canal benign paroxysmal positional vertigo. The response rate after 1 week, defined as absence of positional vertigo and torsional/upbeating nystagmus on positional testing, was 95% in the MEP group (n = 37) vs 58% in the MSM group (n = 33; p < 0.001). Treatment failure was related to incorrect performance of the maneuver in the MSM group, whereas treatment-related side effects did not differ significantly between the groups. View the procedure on videos © 2004 American Academy of Neurology NEUROLOGY 2004;63:150-152 To read the FULL TEXT click on the link below:

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Chiropractic Care: Is It Substitution Care or Add-on Care in Corporate Medical Plans?

Metz, R Douglas DC; Nelson, Craig F. DC, MS; LaBrot, Thomas DC; Pelletier, Kenneth R. PhD, MD(hc) Abstract: An analysis of claims data from a managed care health plan was performed to evaluate whether patients use chiropractic care as a substitution for medical care or in addition to medical care. Rates of neuromusculoskeletal complaints in 9e diagnostic categories were compared between groups with and without chiropractic coverage. For the 4-year study period, there were 3,129,752 insured member years in the groups with chiropractic coverage and 5,197,686 insured member years in the groups without chiropractic coverage. Expressed in terms of unique patients with neuromusculoskeletal complaints, the cohort with chiropractic coverage experienced a rate of 162.0 complaints per 1000 member years compared with 171.3 complaints in the cohort without chiropractic coverage. These results indicate that patients use chiropractic care as a direct substitution for medical care. (C)2004The American College of Occupational and Environmental Medicine Journal of Occupational & Environmental Medicine. 46(8):847-855, August 2004.

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A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain

ABSTRACT Background: The adult lifetime incidence for low back pain is 75% to 85% in the United States. Investigating appropriate care has proven difficult, since, in general, acute pain subsides spontaneously and chronic pain is resistant to intervention. Subacute back pain has been rarely studied. Objective: To compare the relative efficacy of chiropractic adjustments with muscle relaxants and placebo/sham for subacute low back pain. Design: A randomized, double-blind clinical trial. Methods: Subjects (N = 192) experiencing low back pain of 2 to 6 weeks' duration were randomly allocated to 3 groups with interventions applied over 2 weeks. Interventions were either chiropractic adjustments with placebo medicine, muscle relaxants with sham adjustments, or placebo medicine with sham adjustments. Visual Analog Scale for Pain, Oswestry Disability Questionnaire, and Modified Zung Depression Scale were assessed at baseline, 2 weeks, and 4 weeks. Schober's flexibility test, acetaminophen usage, and Global Impression of Severity Scale (GIS), a physician's clinical impression used as a secondary outcome, were assessed at baseline and 2 weeks. Results: Baseline values, except GIS, were similar for all groups. When all subjects completing the protocol were combined (N = 146), the data revealed pain, disability, depression, and GIS decreased significantly (P < .0001); lumbar flexibility did not change. Statistical differences across groups were seen for pain, a primary outcome, (chiropractic group improved more than control group) and GIS (chiropractic group improved more than other groups). No significant differences were seen for disability, depression, flexibility, or acetaminophen usage across groups. Conclusion: Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS. Hoiriis KT, et al. Journal of Manipulative and Physiological Therapeutics. July/August 2004; Vol. 27, No. 6. Read the complete study by clicking on the JMPT Online link in the "Members' Only" section. Not a member? Than join NYSCA today to access this and other regularly updated information.

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Two Doctors of Chiropractic Join Elite Team of Olympic Health Care Providers

ARLINGTON, Va., Aug. 12 -- For the first time in the history of the Olympic Games two doctors of chiropractic will serve on the official U.S. Olympic Team medical staff, an elite group of health care providers selected by the U.S. Olympic Committee (USOC) to treat U.S. Olympiads. Drs. Marc Jaffe of Summit, N.J., and Ira Shapiro of Old Bridge, N.J., will join 44 other medical professionals serving the U.S. Olympic Team at the Summer Games in Athens, Greece. Since 1980, there has been only one doctor of chiropractic (DC) included on the medical staff of each U.S. Summer Olympic Team, and 2002 was the first year that a DC served on the U.S. Winter Olympic Team's medical staff. However, increasing athlete demand for chiropractic care has persuaded the USOC to boost the amount of available care at the 2004 Summer Games. "It is a true testament to the value of chiropractic care to be recognized by the U.S. Olympic Committee. It is with great pleasure that ACA's members have served athletes in past Olympics, and with two doctors of chiropractic on staff for this summer's games, we can be assured that our athletes have the best health care available," said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. During the games, medical staff will be available to the athletes at practice and during competition. Some of the staff will also work with athletes at the USOC's medical clinic in the Athlete's Village. "It's the athlete who realizes the benefit [of chiropractic care]. That's why we're in the Olympic movement," explained Dr. Shapiro. "We fit in perfectly with everything that goes on there." Athletes have long understood the value of chiropractic care as a means to maintain their health and improve their competitiveness. In the past, U.S. athletes sought out chiropractic care on the side because they strongly believed in its effectiveness to alleviate pain at the source and to condition their bodies for peak performance. Additionally, with increased scrutiny surrounding the use of performance-enhancing drugs, athletes are turning to safe, drug-free health care whenever possible. Athletes outside of the Olympics rely on chiropractic care, too. Both Drs. Jaffe and Shapiro have dedicated much of their professional lives to treating the nation's finest athletes. Dr. Jaffe has served as an attending chiropractor for events such as the U.S. Track and Field Championships, the U.S. Weightlifting Championships, the U.S. Triathlon Championships and the New York City Marathon. Furthermore, he is a consultant to the Rutgers University football team and is listed as a treating chiropractor in a manual distributed by the NFL to players for the New York Giants and New York Jets. Dr. Shapiro has an equally illustrious list of credentials that include service as an attending physician at the Gatorade Ironman Triathlon World Championship, the U.S. Figure Skating Championships and the World Championship of Freestyle Wrestling. However, previous experience does not ensure a berth on the U.S. Olympic medical staff. Both doctors were required to complete a rigorous evaluation of their clinical skills and of their abilities to work as a team with Olympic athletes and other medical staff. With the growing popularity of complementary and alternative medicine, chiropractic care has become increasingly integrated with other, more traditional medical treatments. The USOC medical team uses a similar approach by creating a group of providers who work cooperatively to maximize the athletes' health and well-being. "We have a tremendous collaborative working relationship with the other health care professionals," observed Dr. Shapiro -- who adds that there is a saying that the chiropractor is the busiest person around at USOC medical facilities. Chiropractic has been practiced in the United States for more than 100 years, and each year, millions of Americans trust their health to one of the nation's 60,000 doctors of chiropractic. To read research studies about the effectiveness of chiropractic care, visit ACA's website at:

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Arlington, VA – For the first time in history, a doctor of chiropractic graduated from a military hospital residency program -- when Joanna Hudec, DC, completed a fellowship in integrative medicine at the National Naval Medical Center (NNMC) in Bethesda, MD on June 18, 2004. Hudec’s history-making graduation is seen by many as one of the clearest signs to date that the chiropractic profession works well with the medical community. Known as “the President’s hospital” because it is the site at which sitting U.S. presidents and other dignitaries receive care, NNMC is considered the “flagship of naval medicine.” The hospital also is the National Capital Region Resource for homeland defense. Most importantly, NNMC keeps the uniformed services mission ready and provides care to their families. “For chiropractic care to be integrated into a program within the most hallowed halls of medicine is an unparalleled step for this profession,” said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. “The ACA sincerely thanks Dr. Hudec for the shining example she has set for chiropractic.” U.S. Surgeon General Dr. Richard Carmona not only attended the graduation ceremony -- which included about 355 medical interns, residents and fellows -- but also congratulated Dr. Hudec for her efforts and thanked NNMC attending physician William Morgan, DC for the time he spent as the program director of this residency. Additionally, the commanding officers of both NNMC and Walter Reed Army Medical Center thanked Dr. Hudec for her outstanding work. At a dinner following the ceremony, Texas Chiropractic College (TCC) President Richard Brassard, DC, presented Dr. Hudec with a diploma certifying her completion of TCC’s Postdoctoral Fellowship in Integrative Medicine. Dr. Hudec began her 12-month fellowship at NNMC in April of 2003. Recognizing the need for doctors of chiropractic to be trained to work in an integrative hospital environment, TCC Director of Research James Giordano, PhD, and Dr. Morgan envisioned and then implemented the fellowship program, which is expected to become an ongoing, annual program. Dr. Hudec, an ACA member, called the founding of the fellowship program “just the beginning of the advancement of chiropractic into the military.” “In establishing this fellowship program, Texas Chiropractic College has made a very real contribution to our profession’s ongoing efforts toward integration into both the military health care system and our nation’s hospital system,” said Dr. Krippendorf. During her fellowship program, Dr. Hudec established a chiropractic clinic for the medical students at the Uniformed Services University of the Health Sciences (USUHS), also located in Bethesda, MD. That clinic is believed to be the only chiropractic clinic ever established within a medical school. A major goal of the military hospital chiropractic fellowship program is to provide a qualified pool of doctors of chiropractic to serve the needs of civilian, Department of Veterans Affairs (DVA) and Department of Defense (DOD) hospital-based chiropractic clinics.

An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a 'gold standard'

Abstract Background: Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV) to assess the validity of motion palpation in detecting a true fixation. Methods: Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). The congenital block segments included two subjects with fusion at the C2– 3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2. Kappa coefficients (K) were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity and specificity of the diagnostic procedure were also calculated. Results: Kappa coefficients (K) showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65), with substantial (K = 0.76) and moderate (K = 0.46) agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 – 98%). Conclusion: This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine. BMC Musculoskeletal Disorders 2004, 5:19 - Published: 15 June 2004


Clinical and Cost Outcomes of an Integrative Medicine IPA

ABSTRACT Objective: We hypothesized that primary care physicians (PCPs) specializing in a nonpharmaceutical/nonsurgical approach as their primary modality and utilizing a variety of complementary/alternative medicine (CAM) techniques integrated with allopathic medicine would have superior clinical and cost outcomes compared with PCPs utilizing conventional medicine alone. Design: Incurred claims and stratified randomized patient surveys were analyzed for clinical outcomes, cost offsets, and member satisfaction compared with normative values. Comparative blinded data, using nonrandomized matched comparison groups, was analyzed for age/sex demographics and disease profiles to examine sample bias. Setting: An integrative medicine independent provider association (IPA) contracted with a National Committee for Quality Assurance (NCQA)-accredited health maintenance organization (HMO) in metropolitan Chicago. Subjects: All members enrolled with the integrative medicine IPA from January 1, 1999 through December 31, 2002. Results: Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame. Conclusion: In the limited population studied, PCPs utilizing an integrative medical approach emphasizing a variety of CAM therapies had substantially improved clinical outcomes and cost offsets compared with PCPs utilizing conventional medicine alone. While certainly promising, these initial results may not be consistent on a larger and more diverse population. Sarnat RL, Winterstein J. Journal of Manipulative and Physiological Therapeutics. June 2004; Vol. 27, No. 5.

VA to Begin Chiropractic Care

WASHINGTON -- Veterans can receive chiropractic care at 26 selected Department of Veterans Affairs (VA) facilities beginning this fall, Secretary of Veterans Affairs Anthony J. Principi announced today. VA will hire or contract with doctors of chiropractic to provide the care. In consultation with VA primary care providers, doctors of chiropractic will offer patient evaluations and chiropractic care for neuromusculoskeletal conditions. "Today, VA makes another significant improvement to the world-class health care we provide for eligible veterans," said Principi. "Veterans who will benefit from chiropractic services will now have the opportunity to receive chiropractic care to restore them to good health." Locations where chiropractic care will be provided include Togus, Maine; West Haven and Newington, Conn.; Buffalo and the Bronx, N.Y.; Butler, Pa.; Martinsburg, W.Va.; Columbia, S.C.; Augusta, Ga.; Tampa and Miami, Fla.; Mountain Home, Tenn.; Columbus, Ohio; Danville, Ill.; Iron Mountain, Mich.; Kansas City, Kan.; Jackson, Miss.; San Antonio, Temple, and Dallas, Texas; Albuquerque, N.M.; Fort Harrison, Mont.; Seattle, Wash.; Sacramento and Los Angeles, Calif.; and Sioux Falls, S.D. Eligible veterans in areas distant from these locations will also be able to receive chiropractic care through VA's outpatient fee-basis program after a referral by their primary care provider, and prior authorization by the department. VA was authorized to offer chiropractic care and services under the provisions of section 204 of Public Law 107-135, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001. Chiropractors seeking employment or to provide contract services to veterans should call the Human Resources office of any of the above facilities. Some VA positions may be advertised at:



ARLINGTON, VA -- The American Chiropractic Association (ACA) today applauded Congressman Bob Filner (D-CA) for introducing legislation to provide veterans with direct access to a doctor of chiropractic through the Department of Veterans Affairs (DVA) health care system. The ACA, the nation's largest chiropractic organization, worked closely with Congressman Filner on the direct access bill now before Congress and on other ongoing efforts to ensure unimpeded access to chiropractic care. In the past, segments of the federal bureaucracy have been reluctant to implement directives from Congress regarding chiropractic care. This new bill (HR 4051) seeks to send a message to opponents of chiropractic - inside and outside of the government - that America's veterans will not be denied the chiropractic care they need and deserve. "Congressman Filner is a powerful and effective leader on health care issues and a well-known fighter for America's veterans," said ACA President and U.S. Navy veteran Donald J. Krippendorf, DC. "He has shown time and again that he is committed to protecting the rights of doctors of chiropractic and chiropractic patients. Introduction in the U.S. House of Representatives of the "Better Access to Chiropractors to Keep our Veterans Healthy Act" by Congressman Filner is a strong statement of support for chiropractic care and its positive benefits for veterans and other patients." The Filner bill (HR 4051) seeks to amend Title 38 of the United States Code to permit eligible veterans to receive direct access to chiropractic care at Department of Veterans Affairs hospitals and clinics. Section 3 of HR 4051 states that "The Secretary [of Veterans Affairs] shall permit eligible veterans to receive needed [health care] services, rehabilitative services, and preventative health services from a licensed doctor of chiropractic on a direct access basis at the election of the eligible veteran, if such services are within the state scope of practice of such doctor of chiropractic." The measure goes on to directly prohibit discrimination among licensed health care providers by the DVA when determining which services a patient needs. Congressman Filner is a senior member of the Committee on Veterans Affairs. He represents California's 51st Congressional District, including Imperial County and a portion of San Diego County and the communities of Bonita, Brawley, Calexico, Calipatria, Chula Vista, El Centro, Heber, Holtville, Imperial, La Presa, National City, San Diego, Seeley and Westmoreland. In 2004, the ACA presented Congressman Filner with its Veterans Health Care Leadership Award.


Washington, DC - The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) commended Department of Veterans Affairs (DVA) Secretary Anthony Principi for issuing an historic and far-reaching blueprint for formalizing the full inclusion of chiropractic care into the massive veterans health care system in the United States. Secretary Principi’s decision today to implement more than three dozen recommendations made by a multi-disciplinary health care advisory panel will dramatically improve the quality of care available to millions of veterans in the U.S. and increase access to chiropractic care for every veteran who wants or needs to see a doctor of chiropractic. The Secretary’s bold action originated with legislative directives from Congress in 2002 and 2003 - passed at the urging of the ACA, the ACC and America’s veterans - to establish a permanent chiropractic benefit through the DVA system and authorize the DVA to hire and employ doctors of chiropractic as care providers. “This is a great victory for veterans and an historic new opportunity for doctors of chiropractic across America,” said ACA President and U.S. Navy veteran Donald Krippendorf, DC. “Secretary Principi always makes certain that veterans come first. He’s done so today by acting decisively to bring chiropractic care into veterans hospitals from coast-to-coast and to make doctors of chiropractic full partners in providing care to all those who answered our country’s call to serve.” Since the creation of the DVA health system, the nation’s doctors of chiropractic (DCs) have been kept outside the system and all but prevented from providing proven, cost-effective and much-needed care to veterans, including those among the most vulnerable and in need of the range of the health care services DCs are licensed to provide. In 2002, 4.5 million patients received care in DVA health facilities, including 75% of all disabled and low-income veterans. Although the DVA health care budget is roughly $26 billion, in 2002, less than $370,000 went toward chiropractic services for veterans. In issuing today’s order to his department to begin inclusion of chiropractic care, Secretary Principi specifically acknowledged that the goal is “to ensure that chiropractic care is ultimately available and accessible to veterans who need it throughout the DVA system.” Several key elements of Secretary Principi’s blueprint were strongly supported by the ACA and the ACC, including: · DVA’s endorsement of the integration of full-scope chiropractic care (under applicable state law) into all missions of the DVA health care system, including patient care, education, research and response to disasters and national emergencies, and DVA facilities across the country. · DVA’s endorsement of a successful and patient-friendly model - essentially based on the operations of Bethesda National Naval Medical Center - of full integration of doctors of chiropractic as partners in health care teams. · Inclusion of chiropractic care into the VA's funding of research into treatment of service-connected conditions. · Inclusion of chiropractic colleges and students in training programs at VA facilities. · Establishment of a goal to ensure continuity of chiropractic care for newly discharged veterans who have been receiving chiropractic care through the Defense Department health care system. Jean Moss, DC, President of the ACC, commended Principi’s decision to integrate chiropractic care into the DVA health system, saying, “The administration, faculty and students of chiropractic colleges across America are delighted that Secretary Principi has taken steps to ensure that DCs can now directly contribute to the health and well-being of veterans. I am pleased, too, that chiropractic college students will become eligible to participate in internship programs at DVA hospitals and that a fair share of federal research funding will be directed to further documenting the efficacy and cost-effectiveness of chiropractic care.” Dr. Krippendorf added, “The ACA is a membership organization that is comprised of thousands of hard-working health professionals who are pillars of their communities in all 50 states. Our advocacy for full inclusion of chiropractic care in the DVA system is part of our broader campaign to ensure that DCs and their patients are treated fairly in all of the Federal government’s health care programs and initiatives. We’ve made great progress across the board, but the fight for fairness continues and the ACA is ever vigilant.” In addition to legislation authorizing the DVA to employ chiropractors (Public Law 108-170), ACA-backed bills to test expanded access to chiropractic services under Medicare (Public Law 108-173) and to accelerate the implementation of chiropractic care in the military (Public Law 108-136) were also signed into law by President Bush in 2003. In 2004, the ACA will make it a priority to ensure that Secretary Principi’s recommendations are speedily implemented, and work with Congress on new legislation to ensure that chiropractic patients are never wrongly denied access to care. There are about 60,000 DCs in the U.S. and an estimated 25 million chiropractic patients. “Today’s historic action involved the hard work and determined efforts of several members of the DVA’s Chiropractic Advisory Committee, including Drs. Reed Phillips, Cynthia Vaughn and Rick McMichael,” said ACA Chairman and Army veteran George McClelland, DC. “These outstanding leaders have helped improve America’s veterans health care system, eliminated discriminatory practices against their fellow DCs and won meaningful protections for a most deserving group of chiropractic patients.”

Six Leading Presidential Candidates Endorse Chiropractic

ARLINGTON, Va -- With just one week remaining before the beginning of the Iowa caucuses, the American Chiropractic Association (ACA) has secured official statements on chiropractic care from each of the six leading Democratic presidential candidates. ACA secured these statements through close cooperative efforts with the Iowa Chiropractic Society and politically active doctors of chiropractic across the country. "Though they may often disagree on other issues, the leading presidential candidates for the Democratic presidential nomination appear to completely agree on the value and benefits of chiropractic care," said ACA President Donald Krippendorf, DC. "The ACA is encouraged by this enthusiastic support and more determined than ever to ensure that it is maintained by our elected leaders long after Election Day." Governor Howard Dean, Congressman Dick Gephardt, Senator John Kerry, Senator John Edwards, General Wesley Clark and Senator Joe Lieberman round out the list of candidates who have submitted statements. To view these statements, visit: The ACA, the largest national organization representing doctors of chiropractic, has taken an active role in the months leading up to the January 19, 2004 Iowa precinct caucuses in evaluating the health care policy positions of each of the announced presidential contenders. This effort has included meetings with major candidates and senior campaign officials, and the use of ACA's specially designed issues questionnaire. "The candidates are recognizing the political clout of Iowa's chiropractic constituency," said F. Dow Bates, DC, ACA Iowa Delegate. "The numbers speak for themselves. Iowa is home to thousands of doctors of chiropractic and chiropractic assistants, tens of thousands of chiropractic patients and the largest chiropractic college in the world. The road to victory in the Iowa caucuses goes straight through the offices of the state's doctors of chiropractic." Providing additional outreach were Keith Overland, DC, ACA Connecticut delegate, who serves as a health care policy adviser to the Lieberman campaign, and Dan Redwood, DC, of Virginia, who helped secure General Clark's statement. Source: American Chiropractic Association

Advisory panel nixes VA patient self-referral to chiropractors

Chiropractic care at the Dept. of Veterans Affairs could expand dramatically, if the final recommendations of the VA chiropractic advisory committee are followed. "Any provider of care in the VA would be able to refer a patient for chiropractic services," said Warren Jones, MD, a member of the advisory committee and immediate past president of the American Academy of Family Physicians. This would mean that nurse practitioners and rehabilitation therapists could be making referrals as well as orthopedic surgeons and primary care physicians.


Study debunking the long- held belief firm mattresses are beneficial for low-back pain

A new study debunking the long- held belief by many that firm mattresses are beneficial for low-back pain should prompt some consumers to re-think their choices in mattresses, according to the American Chiropractic Association (ACA). A study published in the November 15 issue of The Lancet found that people who slept on mattresses of medium firmness were twice as likely to report improvement in low-back pain symptoms than those who slept on firm mattresses. Doctors of chiropractic have long counseled patients that "comfortably supportive" mattresses are superior to very firm "table board" mattresses, said George McClelland, DC, chairman of the board of the American Chiropractic Association. "A medium-firm mattress will more readily adapt to the natural curvatures in a person's spine," he explained. Dr. McClelland and the ACA recommend the following tips for choosing mattresses: If you're not in the market for a new mattress, and your current mattress is too firm, you can soften it up by putting a 1- to 2-inch-thick padding on top of it -- usually available at mattress and bedding stores. A mattress should provide uniform support from head to toe. If there are gaps between your body and your mattress (such as at the waist), you're not getting the full support that you need. Every few months, turn your mattress clockwise, or upside down, so that body indentations are kept to a minimum. It's also good to rotate the mattress frame every so often to reduce wear and tear. If you're waking up uncomfortable, it might be time for a new mattress. There is no standard life span for a mattress; it all depends on the kind of usage it gets. Be aware that changes in your life can signal the need for a new mattress. For example, if you've lost or gained a lot of weight, if a medical condition has changed the way you sleep, or even if you have changed partners, it could mean that it's time to find a new mattress that will accommodate those changes and help you sleep more soundly. When you're purchasing a mattress, don't be embarrassed to actually lie down on it at the store to check its fit and comfort. Don't just sit on it to test it.

Chiropractic Can Help Reduce the Toll of Pain and Prescription Drugs on Nation's Health Care System, Says ACA

New studies showing the staggering costs of headaches, back pain and other musculoskeletal conditions on the country's economy and the skyrocketing effect prescription drugs have on insurance premiums should convince the nation's employers and insurers to more fully integrate chiropractic care into employee health plans, according to the American Chiropractic Association (ACA). A November 12 study in the Journal of the American Medical Association found that headaches and back pain are leading reasons for lost productivity and absenteeism in the workforce -- costing more than $61 billion each year. And the 2003 Annual Employer Health Benefits Survey, conducted by the Kaiser Family Foundation and Health Research and Educational Trust, found that higher prescription drug costs are a major factor contributing to increases in health insurance premiums. "Over the years, studies have shown that chiropractic care is effective at treating headaches and back pain and can get workers back on the job more quickly than traditional forms of care," said ACA President Donald J. Krippendorf, DC. "At the same time, chiropractic also helps workers avoid expensive prescription drugs -- making it a perfect fit for employers looking to control health care costs." Back pain and headaches, in particular, are two conditions that doctors of chiropractic have successfully treated for decades -- and several studies have demonstrated chiropractic's effectiveness. Most recently, a study published in the July 15, 2003 issue of the medical journal Spine found that manual manipulation -- the primary form of treatment performed by doctors of chiropractic -- provides better short-term relief of chronic back pain than medication. In 2001, researchers at Duke University found cervical -- or neck -- manipulation appropriate for both tension type headache and cervicogenic headache and noted that "cervical spinal manipulation has a very low risk of serious complications" which may be "one of its appeals over drug treatment." Just a sampling of other studies include: A 1997 study published in Spine found "strong evidence that manipulation is more effective than a placebo treatment for chronic low-back pain or than usual care by the general practitioner, bed rest, analgesics and massage." A 1996 study published in the journal Medical Care found that first contact chiropractic care for common low back conditions costs substantially less than traditional medical treatment and "deserves careful consideration" by managed care executives concerned with controlling health care spending. In 1994, the U.S. Agency for Health Care Policy and Research found that "spinal manipulation is effective in reducing pain and perhaps speeding recovery" within the first month of acute low-back pain symptoms. A 1993 study conducted in Canada and funded by the Ontario Ministry of Health found that "the overwhelming body of evidence" shows that chiropractic management of low-back pain is more cost-effective than medical management, and that "many medical therapies are of questionable validity or are clearly inadequate." For more information on chiropractic care and research on its effectiveness, visit ACA's Web site at The ACA, based in Arlington, VA, is the largest chiropractic organization in the country. The ACA promotes the highest standards of ethics and patient care, contributing to the health and well being of millions of chiropractic patients.

Legislation to Establish Chiropractic Care Parity for Military Retirees, Dependents and Survivors through TRICARE

Attached is a copy of a Congressional "Dear Colleague" letter from Rep. Ed Schrock (R-VA) and Rep. Lane Evans (D-IL) being circulated in today's afternoon mail on Capitol Hill. It asks Members of the U.S. House of Representatives to join as original co-sponsors of an ACA-backed legislative proposal to extend chiropractic health parity to U.S. military retirees, dependents and survivors through the TRICARE program. In recent years, Congress has passed, and the President has signed into law, legislation establishing a permanent chiropractic care benefit for both active duty military personnel and veterans. The Schrock-Evans Chiropractic Parity in TRICARE Bill represents the next step toward ensuring that all of America’s current and former military service personnel, and their families, have access to the chiropractic services they need and deserve. ACA and the Association of Chiropractic Colleges have been involved in discussions concerning this issue since earlier this year and have committed to working closely with Reps. Schrock and Evans to build strong support for the legislation among pro-chiropractic Members of Congress. Accordingly, ACA urges all concerned DCs, CAs, chiropractic students and patients and friends of the chiropractic profession to immediately contact their representatives in the U.S. House to request that they join as original co-sponsors of the soon-to-be-introduced Schrock-Evans Chiropractic Parity in TRICARE Bill. As a chiropractic supporter, it is essential that you take immediate action on this matter by calling your Congressman or Congresswoman at his/her local office or through the U.S. Capitol switchboard at (202) 225-3121. Please urge co-sponsorship of the Schrock-Evans Chiropractic Parity in TRICARE Bill.


At its annual meeting, the ACA House of Delegates passed the following resolution endorsing the Association of Chiropractic College's clarification of the ACC paradigm related to diagnosis as follows: "A diagnosis is an expert opinion identifying the nature and cause of a patient's concern or complaint, and/or abnormal finding(s). It is essential to the ongoing process of reasoning used by the doctor of chiropractic in cooperation with the patient to direct, manage, and optimize the patient's health and well-being. "The process of arriving at a diagnosis by a doctor of chiropractic includes: obtaining pertinent patient history; conducting physical, neurological, orthopedic, and other appropriate examination procedures; ordering and interpreting specialized diagnostic imaging and/or laboratory tests as indicated by symptoms and/or clinical findings; and performing postural and functional biomechanical analysis to determine the presence of articular dysfunction and/or subluxation. "The Association of Chiropractic Colleges continues to foster a unique, distinct chiropractic profession that generates, develops, and utilizes the highest level of evidence possible in the provision of effective, prudent, and cost-conscious patient evaluation and care." (Note: This does not replace the current definition of diagnosis as found in the ACA Master Plan and other policy statements of the ACA. Motion Carried.)

MCH Offering Chiropractic

At a luncheon in late July at Monroe Community Hospital, Paul Dougherty took a seat at the table with a group of doctors. The symbolism wasn’t lost on anyone. A chiropractor by trade, Dougherty would have been viewed as a quack by this crowd just 20 years ago, but now he’s helping to blaze a trail that is pushing chiropractic medicine into the mainstream. Dougherty heads a newly created chiropractic clinic at Monroe Community Hospital that is believed to be the first of its kind in the country, one that offers chiropractic therapy in the setting of a long-term care institution. Here at the county’s largest nursing home, Dougherty works side by side with doctors to relieve the back and neck pain of elderly residents with chronic illnesses. When pain medications don’t do the job, Dougherty goes to work stretching and cracking the spinal columns of residents like 52-year-old Pat Gribb, who suffers from multiple sclerosis and spends all day in a wheelchair. “ It’s not a comfortable position to be in,” said Gribb, whose back pain was relieved last month when Dougherty stretched her back to unlock several compressed vertebrae. “ I immediately felt the difference.” As late as 1983, the American Medical Association considered it unethical for doctors to refer patients to chiropractors. Today, though, those guidelines encourage chiropractic treatment when doctors think it is in the best interest of their patients. About 500 hospitals in the U.S. now have chiropractors on their staffs, according to the American Chiropractic Association in Arlington, Va. “ That sounds like a pretty good number, but when you consider that there are 6,000 hospitals in the country, we still have a long way to go,” said Jerome F. McAndrews, spokesman for the group. McAndrews said he is not aware of another experiment like the one at Monroe Community Hospital: a chiropractic clinic within the halls of a nursing home. The clinic, jointly operated by the New York Chiropractic College in Seneca Falls, also is a teaching site for students and offers outpatient services. “ We’re not trying to be physicians. That’s not what we do,” said Dougherty, an associate professor at the college. “ But we do think that we have a role to play in pain management.” The clinic began as a demonstration project last year, treating 48 elderly residents with back pain, headaches, neck pains and shoulder stiffness. Monroe Community Hospital officials liked the way that these patients responded to the chiropractic treatments, so they decided to open it to the rest of the resident population. The treatment is not considered appropriate, though, for extremely frail patients. “ The goal is to reduce pain, and however you do it, I don’t care as long as it’s safe and effective,” said Dr. Paul Katz, medical director at Monroe Community Hospital. “ I admit it that when I was in medical school in the ‘70s, chiropractic had a very negative connotation to it,” Katz said. “ But there’s a lot more science behind what they do now, and it’s really given me a greater appreciation for their role.” Chiropractic medicine involves manipulating joints and muscles to improve their function. It is not known why this causes pain to subside, but it may have to do with a relaxing effect on the central nervous system, Dougherty said. Dougherty is the first to argue that more scientific research is needed. In fact, he and Monroe Community Hospital officials have applied for a $750,000 grant from the U.S. Department of Health and Human Services to conduct a three-year study on how elderly patients react to chiropractic therapy. If approved — the government’s decision is due in late August — Monroe Community Hospital will have two study groups: those who get traditional medical treatments for back pain (steroid injections, pain medications), vs. those who get medical treatment plus chiropractic. Outcomes will be measured by using a standard of patient satisfaction and cost effectiveness. “ I think there’s a future in integrating chiropractic with traditional medicine, and it’s exciting to be on the front-end of it,” Dougherty said. Courtesy of The Democrat and Chronicle