Physical medicine and manual therapies for pain are thousands of years old, dating back to 400 BC in Europe when Hippocrates described spinal manipulative techniques using gravity for the treatment of scoliosis.1 Obviously, musculoskeletal care (MSK) has significantly evolved over the past 24 centuries, but with an estimated 127 million Americans (one in two adults) affected by a musculoskeletal (MSK) condition in 2021,2 it is clear the need remains for efficient MSK care solutions. Everyone in the healthcare space is competing to provide solutions because of the high cost and prevalence of MSK disorders. In fact, MSK conditions are the number one cost-driver for businesses,3 and that number is increasing. Direct costs of MSK disorders are approximately $20 billion a year, with indirect costs (lost productivity, absenteeism, errors, etc.) equaling approximately five times the direct cost or $100 billion per year.4
We need to look for the best options to address common societal and medical problems plaguing the healthcare system, such as the overuse of opioids, surgery, imaging, and failure to provide patients with effective education and advice.5 According to the Centers for Disease Control and Prevention, 8-12% of people using an opioid for chronic pain develop an opioid-use disorder. In 2019, nearly 50,000 people in the U.S. died from opioid-involved overdoses.6 As a country, we have the perfect landscape for chiropractic care to establish itself as a dependable alternative to pain management and the obvious entry point for conservative care.
By offering multidisciplinary solutions as a conservative care option for MSK conditions, chiropractors can help employers drive down health insurance costs, teach patients to fix and prevent injury and pain, and ultimately save lives. The chiropractic profession is expanding beyond its traditional forms of treatment by reaching deeper into both alternative medicine and primary care7 and, in turn, becoming a more mainstream avenue for pain relief.
Benefits of a Multidisciplinary Approach
Healthcare providers and patients looking for MSK solutions often view chiropractic as spine-only and tend to only look at chiropractic care for spinal manipulation.8 In reality, a lot more is involved in conservative care when it comes to what a chiropractor can provide in terms of the treatment of a broad range of MSK conditions.
Taking a multidisciplinary approach allows chiropractors to treat a broad range of complaints patients may have, which will help strengthen relationships and trust with other medical professionals, positioning chiropractors and their teams as the go-to experts for anything MSK-related. Outside of specific cases where there are contraindications, early introduction of conservative care tends to lead to lower costs and better outcomes for patients.
The demand for MSK solutions provides a golden opportunity for all conservative care providers to collaborate and work together with other medical professionals. For example, chiropractic services successfully expanded into the Veterans Health Administration (VA), the largest integrated healthcare delivery system in the U.S., proving chiropractic care is feasible within medical settings.9
Chiropractors working in practices with physical therapy groups and other primary and medical care providers have allowed for improved care coordination and broadened the patient population. Improving collaboration between medical doctors and doctors of chiropractic, or even embedding chiropractors in medical settings such as hospitals or community health centers, improves access to evidence-based care for MSK conditions.10 Chiropractic will naturally become the first point of entry as you expand your chiropractic tool kit through collaboration with physical therapists and providers from other disciplines.
As we continue to build trust in our conservative care through amazing outcomes and establishing partnerships, focus can then turn to educating the patient around the “why” behind MSK health outcomes and establishing their trust in conservative care, which will ultimately expedite the process of becoming the entry point for MSK care.
Implement Telehealth
Another approach to advancing the chiropractic profession into the multidisciplinary realm is to provide a telehealth option for patients. Whether it is an initial consultation, a prescribed MSK treatment plan, or simply providing patients with exercises they can do at home to maintain adjustments, telehealth is emerging as a trend to elevate conservative care. Telehealth provides chiropractors with a way to increase their practices’ overall scope and reach and allows them the opportunity to help as many people as possible. The ongoing COVID-19 pandemic has vaulted the population into a world where seeing a provider via video-conferencing software is common, even for previous hands-on MSK services, such as examinations, risk assessment, advice, and rehabilitative exercises.
...“The chiropractic industry can greatly benefit itself and its patients by becoming widely known as whole-body MSK conservative-care providers.”
While there may be some concern about taking manual therapy to the virtual space, in our experience, the ability to get results from a telehealth consultation is on track with in-patient appointments. Patients have been pleased to find telehealth appointments are helpful, their concerns are addressed, and they are happy to have a safe method to see their doctor.11 In fact, we have seen 88% injury resolution in the clinic,12 while we are at 87% via telehealth.13
Embrace the Future
The ideal future of chiropractic is having the profession viewed as the entry point for the treatment of all MSK conditions and conservative care. Dentists have done a great job of educating the public that if your tooth hurts, you should go directly to a dentist. However, if a patient’s shoulder hurts, where should they go? Do they make an appointment with a primary care physician, physical therapist, occupational therapist, or chiropractor? MSK pain is often confusing for patients because they just don’t know where to start. The chiropractic industry can greatly benefit itself and its patients by becoming widely known as whole-body MSK conservative-care providers.
Doctors of chiropractic excel at delivering wellness, and we have the opportunity to continue to impact MSK health by increasing the scope of what our practices provide. Chiropractic care is implementing more evidence-based approaches, including functional medicine and active rehab, to continually imbed chiropractic into conventional preventative care. Most people want to get well naturally and avoid drugs and surgery. Finding the balance is where chiropractors can get the most out of their practices, making the outcome a win-win for everyone. Ultimately, what improves the experience, cost, and outcome for the patient should be the focus for what you decide to implement in your practice.
Dr. Chris Cato is Chief Population Health Officer for Airrosti and a telehealth provider with Airrosti Remote Recovery. Before joining Airrosti in 2004, Dr. Cato earned his Doctor of Chiropractic from Parker College of Chiropractic in Dallas, Texas. He earned his undergraduate degree from Midwestern State University in Wichita Falls, Texas. Contact info: [email protected]
References
1. Pettman, E. (2007). A history of manipulative therapy. Retrieved May 28, 2021, from https://www.ncbi.nlm.nih.gov/p...
2. National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division: Board on Health Care Services; Committee on Identifying Disabling Medical Conditions Likely to Improve with Treatment. Selected Health Conditions and Likelihood of Improvement with Treatment. Washington (DC): National Academies Press (US): 2020 Apr 21. 5, Musculoskeletal Disorders. Available from: https://www. ncbi.nlm.nih.gov/books/NBK559512/
3. Glen Cheng, Nischal Chennuru and Liz Kwo (November 23rd 2020). Evaluating the Clinical and Cost Effectiveness of Musculoskeletal Digital Health Solutions [Online First], IntechOpen, DOT. 10.57727 intechopen.94841. Available from: https://www.intechopen.com/onl... e-fir st/evaluating-the-clinical-and-cost-effectiveness-of-musculoskeletal-digital-health-solutions
4. Nobel, J., MD, MPH, Sherman, C., Sasser, E., MPH, & Pickering, L., MPH. (2017). Preventing and Treating Musculoskeletal Disorders: New Strategies for Employers (pp. 1-20, Rep.). New York, NY: Northeast Business Group on Health, doi:https://nebgh.org/wp-content/u...
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6. (DCD), D. (2010). Opioid crisis statistics. Retrieved May 28, 2021, from https://www.hhs.gov/opioids/ab... %20estimated%20 10.1,and%20 745%2C000%20people%20used%20heroin.&:text=Appropriate%20prescribing%20of%20opioids%20is,and%20safety%20of%20Medicare%20beneficiaries
7. Cooper, R., & McKee, H. (2003). Chiropractic in the United States: Trends and Issues. Retrieved May 28, 2021, from https://www. ncbi.nlm.nih.gov/pmc/articles/PMC2690192/
8. Weeks WB, Goertz CM, Meeker WC, Marchiori DM. Public Perceptions of Doctors of Chiropractic: Results of a National Survey and Examination of Variation According to Respondents' Likelihood to Use Chiropractic, Experience with Chiropractic, and Chiropractic Supply in Local Health Care Markets. J Manipulative Physiol Ther 2015 Oct;38(8):533-44. doi:10.1016/j.jmpt.2015.08.001. Epub 2015 Sep 8. PMID: 26362263.
9. LisiAJ, Brandt CA. Trends in the Use and Characteristics of Chiropractic Services in the Department of Veterans Affairs. J Manipulative Physiol Ther 2016:39:381-6.doi: 10.1016/j.jmpt.2016.04.005pmid:http://www.ncbi.nlm.nih.gov/pubmed/27...
10. Bart N. Green, Ti V. Pence, Lawrence Kwan, Jesse Rokicki-Parashar, Rapid Deployment of Chiropractic Telehealth at Two Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field, Journal of Manipulative and Physiological Therapeutics, Volume 43, Issue 5, 2020, Pages 404.el-404.el0, ISSN0161-4754, https://doi. org/10.1016/j.jmpt. 2020.05.008.
11. Kash BA, Deshmukh AA. and Developing a Strategic Marketing Plan for Physical and Occupational Therapy Services: A Collaborative Project Between a Critical Access Hospital and a Graduate Program in Health Care Management. Health Mark Q. 2013: 30: 263280. https://doi.org/10.1080/07359683.2013.814507
12. Results & Value: Airrosti: We fix Pain Fast. (2021, May 10). Retrieved May 28, 2021, from https://www.airrosti.com/resul...
13. Airrosti remote recovery: Virtual Treatment: Online Provider Visits. (2021, May 27). Retrieved May 28, 2021, from https://www.airrosti.com/remoterecovery/
