Chiropractic Care for Veterans: Are There Benefits?

Regardless of where you come from, National Service is both a national honour, a patriotic act, and a unique vocation in that there are specific ailments that make healthcare for veterans distinct from many other groups. A 2018 report listed the most common medically diagnosed symptoms for current and transitioned (retired or remustered) defence force personnel as [1]:

• Chronic low back pain (18.5%)
• Hearing loss (15.7%)
• High cholesterol (12.8%)
• Other musculoskeletal conditions (12.2%)
• High blood pressure (12.0%)

However, the most common self-reported symptoms included things like sleep, fatigue, waking up feeling unrefreshed, having irritable outbursts, joint stiffness, ringing in the ears, headaches, muscle aches and pains and difficulty finding the right word. While these were true for current or recently transitioned personnel, male veterans who had served in older conflicts such as Korea, Vietnam or the Gulf War conflicts also showed a higher prevalence of selected cancers, mental health conditions including PTSD, and a higher prevalence of overall medical conditions. [1] Sadly, hypertension, ischemic heart disease, asthma and other autoimmune conditions were part of this cohort of diseases.

While it is difficult to apply broad brush strokes to this cohort of health conditions, or indeed to veteran health as a whole, some research has been undertaken pertaining to veterans under chiropractic care, and other data (including a plethora of case reports and smaller studies) has examined some of these conditions more specifically.

The Therapeutic Alliance

It may be worthwhile mentioning that the first is the therapeutic alliance between the chiropractor and the person under care. While chiropractors often use the term “patient” as it is well understood by people, we aren’t a treatment and cure modality. We are a care modality. We care for the nervous system, and the nervous system does the rest. But a big part of that is the therapeutic alliance whereby the veteran feels safe and listened to in the chiropractor’s practice. Two notable studies showed that when chiropractors work in alliance with people under their care, it increases patient confidence, allows context and goals of care for both patient and chiropractor to be part of the experience. [2, 3] Over time, as patients understand they are working with their chiropractor and not having treatment plans dictated to them, this creates a safe and reciprocal environment where one doesn’t have to be in “fight or flight” when receiving care.

Given the context veterans operated in, we don’t yet know just how important this aspect alone could be.

Chronic Pain

Research is very clear that chronic pain can negatively impact physical activity and performance as well as mental health. The annual cost of chronic pain in the United States is estimated at $635 billion, with chronic low back pain (CLBP) being one of the leading contributors to that cost. [4]

Painful musculoskeletal conditions are prevalent among veterans, who are a vulnerable population for both chronic pain and opioid use, with 66% reporting pain and 9% experiencing severe pain. [5] We already know that, regardless of age, veterans may experience physical limitations/issues, including back and neck pain, headaches and migraines, joint pain, or even post-traumatic stress disorder (PTSD) related symptoms.

Individuals with chronic low back pain (CLBP) may experience a fear of movement due to the potential for pain exacerbation. This fear can contribute to both self-reported and performance-based disability in older adults. [6,7,8]

Neck Pain

Neck pain is also a common complaint among veterans. Military personnel may experience neck pain due to a variety of factors that can range from the demands of office work to the trauma of combat. [6] A retrospective study examined the records of female veterans who attended a chiropractic clinic for neck pain between 2009 and 2015. Carried out by the VA Western New York Healthcare System (VAWNYHS), the objective of the study was to determine if U.S. female veterans had demonstrable improvements in neck pain after chiropractic management.

A total of 34 veterans qualified for the study and underwent an average of 8.8 chiropractic treatment sessions. The study found that these veterans experienced significant reductions in both pain levels (measured by NRS) and neck disability (measured by NBQ). The average improvement was 45% for pain and 38% for neck disability, exceeding the minimum clinically important difference.

This area of research is particularly important as chiropractic research has looked at even subclinical neck pain – that is below the level you seek treatment for – is important for mental rotation tasks, joint position sense and more. This shows us that neck pain may impact many aspects of physical and mental functioning.

Beyond Chronic Pain

Chiropractic care is already synonymous with low back pain treatment, but what many people don’t know is that there is a growing body of evidence for many of these other ailments, too. These include evidence showing that Chiropractic care is becoming a common complementary and integrative approach among veterans looking for alternatives to managing their health. In most instances, those who seek usually hope to reduce pain, improve mobility, and enhance overall well-being. Other evidence includes:

• Strong evidence for chiropractic care in the treatment of low-back pain and low-back-related leg complaints as well as other musculoskeletal complains[9]
• A significant body of research confirms that chiropractic care may reduce hypertension. While further research was suggested in order to understand the mechanisms, chiropractic’s role in modulating the Vagus nerve and the activity of the autonomic nervous system may be at play. [10]
• A number of case reports exist wherein chiropractic care has been helpful for cervicogenic hearing loss or tinnitus. [11-13] This may indicate larger possibilities for chiropractic care and hearing, but more research is required.
• Data is emerging through case reports showing individual cases of improved mental health or mental acuity while under chiropractic care. [14-20] More research is required, but it is an exciting line of investigation as chiropractors care for the nervous system, which encompasses the brain and spinal cord and reaches every nerve in the body.
• Chiropractic research has also been linked to healthier aging, including reduced falls risk in older adults. [21]. This may be significant for older veterans.

All of this is before we even get to the wide-ranging topic of quality of life. All this research is exciting for chiropractors, but how might it look for an individual? A recent case report looks at this and shows how it all might come together for the person who matters most in chiropractic – the person under care.

How might this work in practice?

One case study published by the Journal of Contemporary Chiropractic describes a 50-year-old male veteran who had experienced chronic back pain for ten years and was heavily reliant on daily opioids (hydrocodone and morphine). Due to his pain, he had ceased weightlifting, biking, and other physical activities. During periods of increased pain, he had been given a cane and crutches. He also reported “fatigue and lack of desire to do things”.

After receiving six chiropractic treatments over three months, which included manual manipulation, flexion-distraction therapy, stretching, and lumbar traction, he experienced significant reductions in pain, increased physical activity, and improved overall quality of life. These improvements allowed him to reduce his reliance on opioids and eventually discontinue their use altogether. His primary objective was to minimize his use of medication and take control of his pain management, which he felt he had achieved.

And another case…

A similar case study, also published by the Journal of Contemporary Chiropractic, demonstrates the effectiveness of chiropractic care and active rehabilitation in managing chronic post-surgical spinal pain. The 70-year-old veteran with chronic back pain and a history of spinal surgeries was successfully tapered off long-term pain medication through a combination of chiropractic treatments and at-home exercises.

He received just seven chiropractic sessions over three months, which included spinal manipulation, flexion-distraction, stretching, and prone press-ups. These interventions helped to manage his pain and allowed for a gradual reduction in medication. The patient maintained his pain management by continuing to receive chiropractic care every 4-6 weeks.

As doctors of the nervous system, chiropractors are focused on calming the nervous system and allowing it to return to a state in which healing can occur in the body. This is what subluxation-based care is all about. For veterans, a calm nervous system takes on even greater importance. While research continues to show us what is behind the effects of chiropractic care and the potential meaning for symptoms, one thing is clear: when veterans have cared for us in ways we can’t see, its our honour to care for them in the aftermath.

References

1. https://medcast.com.au/blog/what-health-issues-are-you-likely-to-encounter-in-your-veterans
2. Lambers NM, Bolton JE. Perceptions of the quality of the therapeutic alliance in chiropractic care in The Netherlands: a cross-sectional survey. Chiropr Man Therap. 2016 Jun 8;24:18. doi: 10.1186/s12998-016-0100-4. PMID: 27280015; PMCID: PMC4897913.
3. Ivanova, D., Newell, D., Field, J. et al.The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic. Chiropr Man Therap 32, 10 (2024). https://doi.org/10.1186/s12998-023-00527-8
4. Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015;90(1):139-147. doi:10.1016/j.mayocp.2014.09.010
5. Nahin RL. Severe pain in veterans: the effect of age and sex, and comparisons with the general population. J Pain. 2017;18(3):247-254. doi:10.1016/j.jpain.2016.10.021
6. Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816-836. doi:10.1016/j.spinee.2013.09.036
7. Camacho-Soto A, Sowa GA, Perera S, Weiner DK. Fear avoidance beliefs predict disability in older adults with chronic low back pain. Phys Med Rhabili. 2012;4(7):493-497. doi:10.1016/j.pmrj.2012.01.017

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