SOURCE: From the U.S. Bureau of Labor Statistics Occupational Outlook Handbook, 2010-11

Chiropractors, also known as doctors of chiropractic or chiropractic physicians, diagnose and treat patients with health problems of the musculoskeletal system and treat the effects of those problems on the nervous system and on general health. Many chiropractic treatments deal specifically with the spine and the manipulation of the spine. Chiropractic is based on the principle that spinal joint misalignments interfere with the nervous system and can result in lower resistance to disease and many different conditions of diminished health.

The chiropractic approach to healthcare focuses on the patient’s overall health. Chiropractors provide natural, drugless, nonsurgical health treatments, relying on the body’s inherent recuperative abilities. They also recognize that many factors affect health, including exercise, diet, rest, environment, and heredity. Chiropractors recommend changes in lifestyle that affect those factors. In some situations, chiropractors refer patients to or consult with other health practitioners.

Like other health practitioners, chiropractors follow a standard routine to get information needed to diagnose and treat patients. They take the patient’s health history; conduct physical, neurological, and orthopedic examinations; and may order laboratory tests. X rays and other diagnostic images are important tools because of the chiropractor’s emphasis on the spine and its proper function. Chiropractors also analyze the patient’s posture and spine using a specialized technique. For patients whose health problems can be traced to the musculoskeletal system, chiropractors manually adjust the spinal column.

Some chiropractors use additional procedures in their practices, including therapies using heat, water, light, massage, ultrasound, electric currents, and acupuncture . They may apply supports such as straps, tape, braces, or shoe inserts. Chiropractors often counsel patients about health concepts such as nutrition, exercise, changes in lifestyle, and stress management, but chiropractors do not prescribe drugs or perform surgery.

In addition to general chiropractic practice, some chiropractors specialize in sports injuries, neurology, orthopedics, pediatrics, nutrition, internal disorders, or diagnostic imaging.

Many chiropractors are solo or group practitioners who also have the administrative responsibilities of running a practice. In larger offices, chiropractors delegate these tasks to office managers and chiropractic assistants. Chiropractors in private practice are responsible for developing a patient base, hiring employees, and keeping records.

Education and training. In 2009, 16 chiropractic programs in the United States were accredited by the Council on Chiropractic Education. Applicants must have at least 90 semester hours of undergraduate study leading toward a bachelor’s degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor’s degree, which may eventually become the minimum entry requirement. Several chiropractic colleges offer prechiropractic study, as well as a bachelor’s degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the States.

Chiropractic programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience. During the first 2 years, most chiropractic programs emphasize classroom and laboratory work in sciences such as anatomy, physiology, public health, microbiology, pathology, and biochemistry. The last 2 years focus on courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. Chiropractic programs and institutions grant the degree of Doctor of Chiropractic (D.C.).

Chiropractic colleges also offer postdoctoral training in orthopedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practice, pediatrics, and applied chiropractic sciences. Once such training is complete, chiropractors may take specialty exams leading to “diplomate” status in a given specialty. Exams are administered by chiropractic specialty boards.

Our deepest appreciation to Carl S. Cleveland III, DC for conducting this in-depth Interview

How were you introduced to chiropractic and how has it helped you?

My dad introduced me to chiropractic on one of my visits home, one of my leaves. He could start to see that I was wearing physically. My dad had arthritis, so he often would go down to see the chiropractor in our town. Actually, our town doesn’t even have traffic lights, so it was the next town over, in Owego, New York. He said, “I think you ought to go down and see Dr. Perestam. I think he could make you feel better.” And so I did, and he was absolutely right. My very first visit to the chiropractor was awesome and so has every subsequent visit to the chiropractor. I always leave feeling better. I tell people it’s like I can breathe better. I feel taller. So I got a taste of how wonderful that care is. Unfortunately, though, I only went home once or twice a year. Every time I went home, people would give up their appointments. They’d go, “Do you need to go to the chiropractor? I’ll give you my appointment.” So I was always fit in.

But in the military, there were no chiropractors at the treatment facility, so it was not readily accessible and available to me. So although I knew that it would help, I did not have sustained chiropractic care until after I retired. And it’s helped me amazingly! I don’t even know how to describe what my situation was two years ago when I retired, compared to today. I just physically was at the end of my rope and that’s why I retired, with chronic fibromyalgia. I would push and push and push all day long. When I’d get home, I would just curl up in a ball. My skin hurt, my body ached, a thousand pins in my cheeks and my lips and my tongue. What the military did for me was to give me drugs, pain medicine and sleep medicine. I had every drug imaginable. And although that helped maybe curb it a little bit, it caused so many other horrible reactions, in my esophagus, my stomach, ulcers. It’s a spiral. What helps you also hurts you in that regard, I think.

And so at 49, I’m sitting there taking a dozen prescribed drugs – every three hours, every four hours, every six hours. And I just went, “This is crazy.” I plan on living to 100. In my family we do live to 100, so I’ve got to figure out another way. So I sought chiropractic as a routine care. Now, two years later, I take no prescribed drugs. Zero. I go to the chiropractor about every two to three weeks, depending on my travel schedule. And I can take a shower without the water hurting my skin. My skin’s not on fire now. I mean, I have fibromyalgia, but it’s not chronic. And I know so much more now about how to deal with that. And chiropractic is a huge part of the equation.

How long were you under chiropractic care before you began to see results?

Every time I go to the chiropractor, I always have immediate relief. But I would say that I had sustained chiropractic care for maybe three months, while slowly taking myself off all the prescribed drugs. Within a year, I was pretty much off all the prescribed drugs. An important part of chiropractic is that the doctor of chiropractic brings you into the relationship. That doctor-patient relationship is unlike what I had with any other doctor out there in the military, and I saw a fair share of doctors, from rheumatologists to neurologists.

I think that’s the reason you see results even more quickly, because DCs listen. They want you to be part of the solution and you are part of the solution. Nobody knows your body like you. I think that was extremely helpful. And my doctor of chiropractic, Carol Ann Malizia, introduced me to the importance of things like understanding nutrition. There are no left and right aiming stakes (as we call them in the military), no boundaries for the chiropractor in terms of how it all comes together, and I like that as well. Because in the military, if I started out with a rheumatologist on the 9th floor, they get to a certain point where they can’t do any more and they send you to a neurologist on the 8th floor, and they get to a certain point where they can’t do anything, so they send you to another doctor. Well, that’s a bit crazy. Whereas what I find with the doctor of chiropractic is that they have the talented minds and hands and hearts to understand the whole body and how it all works together. And take somebody like me, who’s an ordinary farm girl who spent her life in the military, and it helps me understand that better. To me, that’s amazing.

Today, as you know, there are doctors of chiropractic practicing some 60 military bases and at approximately 25 VA hospitals. We know that members of the military are very pleased with these services because we hear their comments about their response to chiropractic care. Having been a leader and a manager in the military, how do you see chiropractic – when positioned on military bases – influencing the quality of services that our personnel in the military provide?

I think it can have a direct, positive impact on readiness. Readiness is a key watchword for the military, especially the Army. The Army’s mission is to be “trained and ready to fight and win our nation’s wars.” Readiness is about the individual being ready physically, mentally, emotionally, and spiritually. Chiropractic plays into that, I believe, exponentially, because the chiropractor sees the whole person. If more of our leadership would understand, I am convinced that you would have a reduction in the use of prescribed drugs. Prescribed drugs right now are killing our military. Pick up any military newspaper and you will see that this is a war that we are really struggling with.

We are a nation at war, a military at war, and so a quick fix is prescribed drugs. Unfortunately, a doctor in Iraq will prescribe a drug, and then you’ll go back home on vacation and another doctor will prescribe another drug. They may be in direct conflict with each other and nobody’s paying attention. I don’t mean that derogatorily but it is true. I mean, I am a general and I suffered through that. Nobody is really talking to each other, so I’m getting all of these prescribed drugs. And unless I am reading all of the side effects and asking questions about whether it is safe to take this one with this one, I might not know. I think it is leading to a lot of our problems with suicide, drug overdose, and drug dependency. Physical pain leads to emotional burdens; emotional burdens lead to physical burdens. They’re tied together. So in a time of war, this has just escalated.

As a leader, my position now (knowing even more than when I was in the military), is that there is a role for the chiropractor in being a combat multiplier for our units. In my vision, I can see, 20 years from now, positioned next to the brigade surgeon in our brigade combat team, a chiropractor. If I had known when I was in Iraq that chiropractic care was among our benefits, that in 2000 Congress had passed a law that said chiropractic care is a benefit for all military, I would personally have gone out to all of my Reserve and National Guard units and done a survey to find out if any of them were chiropractors, with a uniform on but being something else, like a supply officer or whatever. If I had found any of them that were chiropractors, I’d have said, “Okay, we’re going to call back home, ship your table over and set up shop. We’ll find somebody else to be the supply officer, but you’re unique and I need you as a chiropractor helping our soldiers.” I’d have set up shop for them had I known, but I didn’t know.

What strategy should the leadership of the chiropractic profession take to help lead the decision makers in the military to choose chiropractic, to recognize the cost-effective benefits of how this can serve military personnel?

There has to be a strategy. For me, I think it involves finding personal friends that are still in the military that have used or are using a chiropractor. Testimonials are huge. I think this is where I’ve been value-added, in that there are a lot of senior officers and soldiers that know me and we have a relationship. They see how chiropractic has helped and that immediately strikes up an interest for them to find out more about chiropractic care. So that’s on a personal level. At the strategic level, it’s almost simple. Congress passed it as a law and told DOD to make it happen. DOD is not making it happen. So if I, as a General Officer, was told that I have a mission to do something and ten years later I’m only doing 25 percent of my mission, that would be considered a failure. I mean, nobody would put up with it.

So I think that somehow we’ve got to get in with the leadership of the military and say, “This is a benefit and it’s not happening. How can we take the leadership of chiropractic and the leadership of the military, come to the table, and help you to develop a strategy to resource this?” Right down to the method, the process, by which we get patients to the chiropractor. In the military, it’s by referral and I hate that it’s a referral. Because anybody that uses a chiropractor knows that they don’t need to go to another doctor to be referred. But that’s the way the military is organized. So we’re not even leveraging the chiropractors we have the way we should. There’s a waiting list for every chiropractor out there in the VA and DOD, 90 to 120 days to see the chiropractor. That’s just horrible. And the reason that the waiting list is so long is that Tricare doesn’t cover it. It’s absurd that Tricare doesn’t cover chiropractic care. If I can’t get it at my treatment facility and Tricare doesn’t give it to me, it’s a benefit on a piece of paper only. It’s not worthless but it’s not beneficial.

I think Congress took the first step. I understand resources. I understand managing budgets and managing people. And I understand that just because Congress passed a law doesn’t mean that it automatically happens. The military has to figure out how it’s going to happen. There are several axes to the strategy. One is, how do we demonstrate to the leadership that this will improve readiness? I think the only way to do that is to start gathering those testimonials. Start getting Sgt. Allen at the VA center in Connecticut, who says, “For two years I went to a PT and in one visit to a chiropractor, I feel so much better. There’s no doubt I could put my rucksack back on today and go out and do those patrols in Baghdad. And oh, by the way, if we had chiropractors out front, at the tip of the spear where we need them most, where kids are out there doing patrols, can you imagine how much better we could do our mission?”

Yes, I can imagine that. Not only can I imagine it but I believe we should resource chiropractors forward on the battlefield and then work our way back. How do we get the leadership to imagine that? One aspect is testimonials. Another is somehow to be able to estimate the cost-benefit. That fewer soldiers will be taking drugs. It doesn’t take a rocket scientist to figure out that that would automatically be a better deal. And we wouldn’t lose people from the military. Like myself. I mean, I had to retire. That’s 27 years of experience walking out the door. That’s almost criminal. So I see a couple of axes of advance here. And we’ve got to go even further out with our vision and show that if we put chiropractors in the right place, then we have the potential to improve our mission readiness.

You mentioned Tricare. Could you please explain that?

Tricare is our insurance in the military. For example, if I go to my local [military] treatment facility and the doctor looks in my eyes, sees something that’s not good, and says I need to see a neurologist, then he would send me off post because we can’t afford to have a neurologist at every treatment facility. That’s why we have Tricare. You get the referral to go to the neurologist out there in the civilian economy and Tricare covers it. Really, up until the point where I hit chiropractic I thought Tricare covered everything I couldn’t get in the military. It wasn’t until I got involved with the Foundation for Chiropractic Progress that I realized it doesn’t. That’s when I saw the House resolution bill that would force Tricare to cover chiropractic. And the House passed it this year. Unfortunately, there wasn’t a companion bill in the Senate so we are starting over again next year. We can’t give up, we need to do this.

It has been reported that musculoskeletal afflictions are the most common injury from the war with our veterans as they present at VA hospitals. Of course, you know chiropractic focuses on the musculoskeletal system.

Absolutely.

What are your thoughts on that? I know you have spoken about wearing a heavy backpack as soldiers do when they’re out in the field.

I am not surprised at all that musculoskeletal is the number one problem. We have no days off. When you’re in combat it’s seven days a week, 24 hours a day. So if you get an email from a friend that says to have a nice weekend – there’s no such thing as a weekend. You have to be in your gear constantly, because even on base it’s a dangerous place, with mortars and rockets. So you’re constantly wearing very heavy gear. It’s Kevlar. These are metal plates that are in your, to use an older term, flak-vest. Your helmet’s heavy. I wish I had weighed my helmet before leaving the Army. I still have my steel pot from the 1970s. That’s what they wore in Vietnam. I actually bought that one, so I have it. But you’re talking about 8 to 12 pounds of a helmet that’s weighing on your neck.

For someone like me, who is 110 pounds, my gear could weigh as much as 60 pounds. And that’s not with a full rucksack. If you take the infantry, the MPs, and all the other soldiers who are doing foot patrols, they are easily carrying 80 to 100, and in some cases even 120 pounds. That includes ammunition, weapons, batteries for their radios, etc. And they’re changing altitudes. In Afghanistan, you can change thousands of feet in altitude. You start out at Bagram in the valley between the mountains and you get on a helicopter and go up to the top of the mountain. You’re changing in altitude and changing in temperatures. It could change 50 degrees. So all that physical trauma and stress, the weight, the emotion (you can just imagine the emotion of being dropped off on top of a mountain in Afghanistan), the weight of all those things is a huge burden on our bodies.

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