Military members perform a physically and psychologically demanding job—and you may assume conservative care, such as chiropractic, may not be enough to ease their pain. But a 2017 study showed that chiropractic delivered meaningful relief to female veterans with low back pain.
Back Pain Is a Big Problem for Female Veterans
The study, published in the October 2017 Journal of Manipulative and Physiological Therapeutics, noted that musculoskeletal conditions, such as low back pain, are the leading cause of morbidity for female veterans. Morbidity refers to diseases and conditions that people live with, such as chronic spine pain or diabetes.
“Diseases that people live with have the potential to impact quality of life, may result in short- or long-term disability, and can ultimately affect individuals financially due to time off work and financial resources being allocated to health care needs,” said Kelsey L. Corcoran, DC, a co-author of the study.
The study’s authors also said female veterans who used the Veterans Health Administration (VHA) system had a higher rate of service-connected disability greater than 50% compared to male veterans. This may be connected to age, as younger veterans have a higher percentage of service-connected disability, the authors said.
“The female veteran population is, on average, younger, and a higher percentage of the overall female veteran population served in recent wars (Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn) compared to the overall male veteran population,” Dr. Corcoran said.
Additionally, Dr. Corcoran noted that recent wars have featured repeated and prolonged deployments, which likely contributes to more injuries.
A Look at the Study—and What It Means for Women in the Military
Researchers reviewed the charts of 70 female veterans who sought chiropractic care for their low back pain at VA Western New York Healthcare System in Buffalo, New York. The average patient was about 45-years old, overweight, and white.
Female veteran patients were included in the study if they:
- Visited the chiropractic clinic during a 7-year period from January 2009 to December 2015
- Were 18- to 89-years of age during care
- Were treated at least 2 times
- Had both baseline (taken at the start of care) and outcome (taken at the end of care) measures collected for their course of care
Andrew S. Dunn, DC, a co-author of the study, also said that patients who had a low level of back pain were excluded from the study. This was because the percentage of improvement could be misleading for a person with a low severity of pain as baseline.
The female veterans in the study underwent a variety of chiropractic therapies, including:
- Spinal manipulative therapy (SMT): Involves a high-velocity thrust by manual application (that is, using the chiropractor’s hands) to regions of restricted movement within the low back
- Spinal mobilization: Similar to SMT, except the thrust is replaced by gentler repetitive passive motions applied to the spine
- Flexion-distraction therapy: A gentle form of intermittent traction in a variety of ranges, along with manual pressure applied to the lower back
- Myofascial release: A form of massage therapy to muscles that are undergoing passive lengthening
“Within the bounds of this study, these therapies were applied alone or in some combination, guided by response, and based upon the nature of the presenting complaint, pain severity, patient preference, and ability of the patient to tolerate the various forms of manual therapy with treatments applied initially from a least aggressive standpoint,” Dr. Dunn said.
To help measure chiropractic’s effectiveness at the end of treatment, the research team relied primarily on results of the Back Bournemouth Questionnaire (BBQ), a 7-question form that assesses current pain level as well as other psychosocial factors, such as depression.
“Pain is an incredibly complex biological phenomenon influenced by both physical and mental health factors,” Dr. Corcoran said. “The BBQ is one way we acknowledge the multi-dimensional nature of pain. We consider this especially important given the mental health conditions and factors that affect many of our veterans, such as post-traumatic stress disorder and military sexual trauma.”
Based on comparing the patients’ BBQ scores at the beginning of treatment and again at the end, the researchers found that patients’ low back pain improved under chiropractic care.
Do the Results Impact the Female Civilian Population?
Spinal manipulation has been more thoroughly researched in the civilian population than in the veteran population. In the civilian population, spinal manipulation has been shown to effectively treat low back pain. In fact, the American College of Physicians Clinical Practice Guidelines included spinal manipulation among the recommended non-drug treatments for low back pain.
But exactly how these results translate to civilian women remains to be seen.
“No studies yet compare the treatment response between female civilian and female veteran patients, so it is unknown if their responses would differ in any significant way,” Dr. Corcoran said.
Care After Service: Do Female Vets Seek VA or Non-VA Chiropractors?
Historically, female veterans have used VHA medical services at low rates, but that is changing. Since 2000, female VHA users have more than doubled—and today, 32% of female veterans enroll in VA health care after military separation.
Chiropractic was first introduced to the VA in 2004, and it is offered at 82 VA facilities nationwide—a number that has grown annually.
While chiropractic within the VA health system is expanding, many veterans receive chiropractic care outside of the VA. Not all veterans are eligible for or choose to receive VA health care.
“We expect many veterans receive chiropractic care outside of the VA, given the high rate of musculoskeletal ailments in the veteran population,” Dr. Corcoran said.
Dr. Corcoran said veterans who have questions about their eligibility for VA health care can find more information online or call 1-877-222-VETS (8387).