Veterans

“Folks returning from combat have a constellation of health concerns, including physical issues, psychological issues and psycho-social issues concerning things like work and family,” said Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative.

About This Page

Veteran-specific discussions regarding wounded veterans are abundant on the Internet. Many of our active service men and women, retired and wounded veterans, are returning home with many types of injuries affecting every aspect of the human condition: physical, mental, emotional, and spiritual health. While the latter three aspects of health are out of the direct scope for the average massage therapist, each one may also indirectly benefit from therapeutic massage to some degree.

A veteran’s physical health, however, can greatly benefit from nearly all forms of massage therapy directly. This page is dedicated to showing the reader why and how from our viewpoint.

Concern for Veterans

Recovering from musculoskeletal injuries is important for everyone. Unfortunately, the current medical model of conventional care places limitations on insurance coverage for recovery. Patients are returned to basic function, not improved function.

Thus, it is up to the individual to advance themselves beyond basic function. Luckily, there are a number of professionals out there who aim to help people get not only well, but better. We look at the entire individual, not simply the injury. Manchester-Bedford Myoskeletal is one such clinic. After all, you aren’t an injury; you’re a person.

Massage therapy is not currently covered by Medicare or Medicaid despite efficacy being shown for many aspects of veteran’s health concerns (depression, anxiety, stress, range of motion improvement, joint mobility, breakup of adhesive scar tissue, carpal tunnel and thoracic outlet syndromes, neck pain, non-specific low back pain, and several other medical conditions and pathologies). However, the Veteran’s Administration has begun referring patients to community Licensed Massage Therapists in many areas of the US for these concerns as well as PTSD, military sexual trauma, and traumatic brain injury. And New Hampshire is one of those states and we are one of those clinics!

Why Myoskeletal Alignment for Veterans?

Application of Myoskeletal Alignment Techniques^® (MAT) can be exceptionally useful for vets recovering from musculoskeletal injury and other conditions. The human body is keen about finding ways to allow us to move and function as near to normal as possible. We call these creative changes “muscular compensation”, and they’re helpful in keeping us going. However, over time, common compensations can result in skeletal and other soft tissue problems directly and indirectly related to the original injury as well as cause us to develop or increase rise of new injury and inefficient movement function elsewhere.

The goal of MAT is to reduce or eliminate common compensatory strain patterns affecting the skeleton and posture before they become pain patterns by changing the brain’s mind about pain. In other words, prevention and maintenance is the ultimate goal. However, most people tend to wait until pain deteriorates their lifestyle before seeking help. MAT is extremely useful here, too, although unwinding chronic compensation patterns takes significantly longer to accomplish in most cases. We also work with patients with chronic pain symptoms, helping these folks manage irreparable injuries and diseases without invasive surgery or pharmaceuticals.

Nonetheless, we want you to get back to doing things you would normally do if it weren’t for the muscle and fascial pain and dysfunctional movement patterns, as long is it is humanly possible to do so. Unfortunately, many vets return home with more severe injuries including loss of limbs and other structural damage, such as fractured, broken or weakened bones, joint damage, organ damage, fascial scarring, and so on. In some cases, musculoskeletal compensations may not be able to be undone safely. The body has a way of balancing itself out, even if balance is found in poor posture, such as the case with scoliosis, vestibular imbalance, loss of vision, hearing, and nerve function, and so on.

In such cases as just described, MAT can often help prevent or slow down further deterioration by releasing the functional aspects of structural compensation. It depends on how a body is evaluated at the time of treatment. Regrettably, not every individual is a good candidate for MAT.

Why Remedial Massage for Veterans?

The vast majority of veterans with muscle pain or dysfunction will benefit in many different ways from remedial massage. Remedial massage here at Manchester-Bedford Myoskeletal is a clinical approach to reducing or eliminating muscle and fascial strain from injury not necessarily related to posture. Our protocols focus on dysfunctional muscle and movement patterns in “kinetic chains” as symptoms rather than causes of chronic pain.

For instance, you may feel pain at the outside of your knee. Most practitioners would work on the knee. But there are patterns in functional movement which may include muscle fibers firing far from the point where pain is felt. So, the actual cause of dysfunction may be occurring distant from the point of pain. In the case of the knee, there may be a dysfunction in the low back or a butt muscle causing pain to show up in the lateral knee. You could work on the outside of the knee all day long, but you’d never touch the root of the problem.

Or plantar fasciiosis (considered a newer, more appropriate term for plantar fasciitis). Pain is felt on the bottom of the foot when one weights a step, especially soon after getting out of bed in the morning. But the problem, again, may be far removed from there and actually be the buttocks, hamstrings, or calves. In fact, trouble may be traced all the way to the neck!

Manchester-Bedford Myoskeletal LLC and Veterans

We specialize in musculoskeletal dysfunction and veterans are reporting musculoskeletal injuries (MSIs) in record number. We believe in an integrative approach to healthcare, including the work we do here. Neither MAT nor remedial massage is an end-all to your problems, but our approach is not identified or covered in any other aspect of government healthcare. Soft tissue injuries such as those our vets are returning stateside with are begging for our type of soft tissue work.

We’re not pain chasers, and we are not a spa. We require patients to be self-motivated and actively involved in their recovery. While our work is left uncovered by most civilian health insurance, we aim to help you improve your condition as quickly as possible and get you back to living life and doing things you want to do.

We work with any physicians willing to refer veterans for clinical massage therapy, and will report our assessments and progress notes to them if you desire. We often confer with primary care physicians, specialists, chiropractors, and physical therapists, to assure ourselves that there are no contraindications for our work for your individual concerns, and to become a valuable asset in your doctor’s plan of patient centered care.

If your health insurance is through the VA, we’re honored to note that we are In-Network providers of massage therapy services through the Manchester, NH and White River Junction, VT VA Medical Center Community Care Networks.

We also work with self-referred individuals, whether working under a doctor’s care or not. We take care to assess and evaluate each person at every appointment and address how your body presents on that day at that time. A doctor’s note or prescription is not necessary to become a patient at Manchester-Bedford Myoskeletal. However, you must be referred to us through a VA physician if you have insurance through the VA.

For more information about what we do, please browse this website, particularly the “Learning Shelf” tab at the top of every page. Should you have any questions, feel free to send us a message from our contact form. When you are convinced that Manchester-Bedford Myoskeletal is where you are ready to be seen, click the “Schedule Your Appointment” link at the top of the right-side panel of every page and make your First Visit Assessment appointment. VA patients will require a referral from their primary care physician.

Injury Data

Categories of Veterans Issues

According to an August 2010 study published in the Journal of Pain, more than half of Gulf War veterans reported chronic muscle pain or, as the military calls them, Musculoskeletal Injuries (MSIs), even 20 years later. Areas affected were necks, shoulders, backs, and knees. While musculoskeletal injury and pain is one category of health problems vets are presenting with, six other categories also exist. They are:

1. Mental Health issues — One in ten Iraq veterans developed serious mental health problems. Post Traumatic Stress Disorder (PTSD), violent behavior, depression, and alcohol abuse.
2. Chemical Exposure — Environmental agents and toxic chemicals have been identified.
3. Infectious Diseases — Some vets have returned with symptoms of native parasitic diseases and bacterial infections which, according the Veterans Administration, may even be fatal.
4. Noise and Vibration Exposure — As you may guess, gunfire, explosion, concussion, heavy weapons, engine rooms, aircraft noise are common, affecting the low back musculature, parasthesia (numbness, tingling, and pain) in hands and fingers.
5. Traumatic Brain Injury — 20% of survivors from this type of injury say they may have had an event that resulted in mild concussion.
6. Urologic Injury — These are penetrating injuries to the groin area, bladder, ureters, kidneys, and genitalia.

Common Injuries

The most common medical injuries being reported recently are musculoskeletal in nature. While the name infers muscles and bone, all soft tissue is included since all types of soft tissue are affected in one way or another. These tissues include muscles, of course, tendons, ligaments, nerves, cartilage, bone, and (while not technically being reported) fascia or connective tissue. They may be acute in nature, meaning traumatic, or caused by overuse or repetitive use. While both types have the capacity to become chronic over time, overuse/repetitive use tend to do so more readily. Among these injuries are muscle strains and sprains, joint sprains and dislocations, tendinopathy, tendon and ligament tears and ruptures, and bursitis or other tissue inflammation.

How often are these types of injuries being reported? Believe it or not, two to three times more than the next category, which, as you may suspect, is mental health. In fact, nearly two million incidents of musculoskeletal injury were reported from all collective military services during the 2006 calendar year. In 2010, 30% of all military injuries were soft tissue related. During the same year, 15% were mental health related.

From 2004 to 2007, some 34,000 military personnel were medevaced from Iran and Afghanistan. Twenty-four percent of those evacuations were for non-combat related musculoskeletal injuries. That is to say, these were not all caused by the enemy, but were incurred in operational environments. Fourteen percent of the total were combat-incurred.

One study of non-operational environments found that 27% of men and 57% of women going through basic combat training reported musculoskeletal injuries. This high incidence of occurrence is undoubtedly due to personnel being unaccustomed to the new rigors of such training. However, it was also found that individuals of opposite sex, when compared by aerobic fitness markers, injury rates were similar. Thus, tendency factor of injury due to the sex of the individual failed to prove out, while aerobic fitness appeared the more likely suspect.

Military Women as a Group

The highest incidence of musculoskeletal injury among military women by far are injuries to the lower extremities, and even more so for Army women. In basic combat training and advanced individual training, the legs were involved in 79-88% of all musculoskeletal injuries. Most of these occurred in sports- or physical fitness related activities. And Army women were more susceptible to the tune of twice as many hospitalizations than Air Force women, and three times as many as Navy women during the same type of training.

Overuse injuries included:

• Stress reactions and fractures
• Shin pain
• Patellofemoral syndrome
• Patellar tendinitis/tendinosis
• Iliotibial band friction syndrome
• Achilles tendinitis/tendinosis, and
• Low back pain

Women also had higher incidence than men of pelvic musculoskeletal disorders, namely stress fractures and such others associated with pregnancy and sexual trauma. Moreover, MSIs increased over time in the first seven years of service for veterans, with a small reduction in the seventh year. Numerous factors appear to be considered partially or full causal when comparing females to males. But, again, aerobic fitness appears to indicate a more similar trend between the sexes.

Across the Military Services

Another interesting study was done involving 158 soldiers who had received orthopedic injuries in combat. The study reported that even though rehabilitation was conducted and completed, 99 individuals were unable to deploy or, in some cases, catch up later with their units.

Through all the services, about 80% of all injuries involved the back, spine, and/or [legs]. Fourteen percent involved shoulders, arms and hands. Of the 30.7% of injuries involving the spine, 70%, unsurprisingly, were in the lumbar region (low back). Interestingly, 31.5% of all injuries involved knees and ankles.

Looking Ahead

This evidence is now seriously being considered within the military upper echelons now. Recent announcements include targeted ways of reducing MSIs using evidence-based research. In fact, many surprising factors have surfaced. First, injuries sustained in basic combat training appear to increase likelihood of re injury later, particularly with (but in no way limited to) ankle and lower extremity injuries. That is, 30-50% more likely. Previous knee injuries have a 7-10 fold increase in likelihood of re injury.

Another concern found is that many of the common approaches to reducing injury were found to be without scientific basis or had limited evidence. Some of these included:

• Targeted muscle strengthening
• Running on softer surfaces
• Wearing shock-absorbing insoles
• Stopping smoking
• Stretching, and
• Replacing running shoes at regular intervals

On the other hand, these interventions were found to have strong evidence:

• Reduction in running frequency, duration and distance
• Training that includes neuromuscular, proprioception, and agility activities
• Wearing mouth guards
• Use of ankle braces for high risk activities, and
• Improved aerobic fitness

As a result, the military began to change the way they train personnel. In fact, they’re still changing. Sit-ups, for instance, have recently been dropped from their Physical Readiness Training (PRT). Instead, the military has started training for readiness rather than fitness. Since the new program has begun, they are reporting significantly fewer musculoskeletal injuries during basic and advanced combat training. And that’s a good thing.