article archive
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.)