Thank you, Dr. Brough.
What can we do today? We can do better at less cost. That's why we're pleased to have this time with you. We're proposing to build on what works for other militaries. We commend the recent efforts of the CF to look at new approaches, as they've done with mental health.
Let's reflect on our role as chiropractors and the care we can provide to soldiers. Our primary therapeutic approach is spinal manipulation, which evidence shows is an important clinical tool in treating musculoskeletal conditions. Spinal manipulation is recommended by numerous clinical practice guidelines, including the U.S. Veterans Administration, the Bone and Joint Decade task force, the American College of Physicians, the American Pain Society, and Britain's National Institute for Health and Care Excellence.
Manipulation is often complemented by other therapies, including rehabilitation, and is readily available on base to soldiers in the U.S. While other professions can do manipulation, 94% of spinal manipulation in Canada is performed by chiropractors. Our proficiency and competence in spinal manipulative therapy and musculoskeletal care makes sense for soldiers who must bear the burden of these injuries. This is why chiropractic services are already recognized by both the Department of National Defence and Veterans Affairs Canada as part of an extended health care benefit.
However, access to chiropractic services for the Canadian military is limited. Physicians, nurses, and physiotherapists can refer a soldier to chiropractors based in the community, typically after an extended period has passed and when nothing else is working. The patient is now considered chronic and we know that intervening earlier in a team-based setting can greatly improve outcomes and prompt return to duty. In fact, most other Canadians, even the families of our military members, have better access to chiropractic care than the soldiers themselves in dealing with these service-related injuries.
Our role is to complement primary care providers such as medical doctors while they coordinate care. This role is well supported by evidence. I can provide an example.
A 38-year-old active duty instructor pilot was suffering from neck pain for two years with little relief. He managed primarily with the use of anti-inflammatories until being referred to a chiropractor. He received treatment over a four-week period, which included manipulation complemented by home exercise. At follow-up he reported no pain or stiffness, and he had a full range of active movement in the neck. He returned to full duty without symptoms. This is only one example of the role chiropractors play in coordination with primary care. However, the delays experienced continue to be a reality. Given the tremendous impact, an MSK strategy is needed to help more members of our military get the timely care they need.
Better care doesn't have to cost more. The evidence is clear. A U.S. military study published this year in Spine, by Dr. Goertz, found that the chiropractic care provided as part of a health care team decreases pain and improves function, which decreases overall costs. Similarly, another U.S. study by Heymans concluded that the addition of chiropractors resulted in faster recovery for injured soldiers.
Also, the Veterans Health Administration in the U.S. is considered to be a model to emulate. Veterans have an array of services available, including chiropractic care. This allows for significant improvement in pain, function, and overall savings. The model is collaborative and similar to the Olympic care model for athletes. The soldier and veteran are at the centre of the care model.
Canada has an obligation to provide the best care available to members of the Canadian Forces for their unlimited dedication and sacrifice. However, this requires some rethinking of the health delivery system in order to provide better care at better value. CCA has been encouraged by recent CF efforts to address the management of lower back pain through an expert panel by developing a care pathway. CCA would suggest that DND and the Canadian Forces build on recent efforts to develop a mental health strategy and invest in a broader and more systemic musculoskeletal strategy. We've included details in our written submission.
Back to you, Dr. Brough.