Strain Counterstrain Pain Treatment: A Solution for Military Members to Succeed.

Military members are required to perform in austere environments in which standard medical care routinely provided in the civilian setting is not available. Medical problems requiring hospital-based treatment which is not available in the field, shipboard, or deployed setting can be a cause for military members to be permanently discharged from active duty for medical reasons. We present a case of chronic low back pain treated with epidural steroid injections not routinely available aboard ship. The member was found unfit for shipboard duties, potentially ending her career in the military. The patient's low back pain resolved with Strain Counterstrain (SCS) techniques. Additionally, SCS treatments also resolved undisclosed chronic pelvic pain, leading to improved overall quality of life. Strain Counterstrain is a non-interventional treatment which does not require special equipment, is available in austere environments and aboard ship, and allowed the member to remain on active duty. Strain Counterstrain is a manual muscle-retraining procedure easily learned, which can be performed in the field, on ship, in the deployed setting, in primary care, as well as in specialty pain medicine clinics.

Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project.

Introduction: Complementary and integrative medicine (CIM) use in the USA continues to expand, including within the Military Health System (MHS) and Veterans Health Administration (VHA). To mitigate the opioid crisis and provide additional non-pharmacological pain management options, a large cross-agency collaborative project sought to develop and implement a systems-wide curriculum, entitled Acupuncture Training Across Clinical Settings (ATACS). Materials and Methods: ATACS curriculum content and structure were created and refined over the course of the project in response to consultations with Subject Matter Experts and provider feedback. Course content was developed to be applicable to the MHS and VHA environments and training was open to many types of providers. Training included a 4-hr didactic and "hands on" clinical training program focused on a single auricular acupuncture protocol, Battlefield Acupuncture. Trainee learning and skills proficiency were evaluated by trainer-observation and written examination. Immediately following training, providers completed an evaluation survey on their ATACS experience. One month later, they were asked to complete another survey regarding their auricular acupuncture use and barriers to use. The present evaluation describes the ATACS curriculum, faculty and trainee characteristics, as well as trainee and program developer perspectives. Results: Over the course of a 19-mo period, 2,712 providers completed the in-person, 4-hr didactic and hands-on clinical training session. Due to the increasing requests for training, additional ATACS faculty were trained. Overall, 113 providers were approved to be training faculty. Responses from the trainee surveys indicated high satisfaction with the ATACS training program and illuminated several challenges to using auricular acupuncture with patients. The most common reported barrier to using auricular acupuncture was the lack of obtaining privileges to administer auricular acupuncture within clinical practice. Conclusion: The ATACS program provided a foundational template to increase CIM across the MHS and VHA. The lessons learned in the program's implementation will aid future CIM training programs and improve program evaluations. Future work is needed to determine the most efficient means of improving CIM credentialing and privileging procedures, standardizing and adopting uniform CIM EHR codes and documentation, and examining the effectiveness of CIM techniques in real-world settings.

Recurrent Shoulder Instability in a Young, Active, Military Population and Its Professional Implications.

BACKGROUND: Shoulder instability is a topic of significant interest within the sports medicine literature, particularly regarding recurrence rates and the ideal treatment indications and techniques. Little has been published specifically addressing the occupational implications of symptomatic recurrent shoulder instability. HYPOTHESIS: Previous arthroscopic repair will continue to be a significant predisposing factor for recurrent instability in a young, active population, and that recurrent instability may have a negative effect on college graduation and postgraduate occupational selection. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: We conducted a retrospective review of approved medical waivers for surgical treatment of anterior shoulder dislocation or instability prior to matriculation at the US Military Academy or the US Naval Academy for the graduating classes of 2010 to 2013. Statistical analysis was performed to determine the incidence and risk factors for recurrence and to determine the impact on graduation rate and occupation selection. RESULTS: Fifty-nine patients were evaluated; 34% developed recurrent anterior instability. Patients with previous arthroscopic repair had a significantly higher incidence of recurrence (38%, P = 0.044). Recurrent shoulder instability did not significantly affect graduation rates or self-selected occupation ( P ≥ 0.05). CONCLUSION: There is a significant rate of recurrent shoulder instability after primary surgical repair, particularly among young, active individuals. In addition, arthroscopic repair resulted in a significantly higher recurrence rate compared with open repair in our population. Surgical repair for shoulder instability should not necessarily preclude young individuals from pursuing (or being considered for) occupations that may place them at greater risk of recurrence. CLINICAL RELEVANCE: The risk of recurrent instability is greater than the rate typically described, which may suggest that some subpopulations are at greater risk than others. A unique data point regarding instability is the effect on occupation selection.

Training in ACSM black flag heat stress conditions: how U.S. marines do it.

Exertional heat injuries have gained public attention over the past several years, as have the means to prevent and treat them. One of the simplest preventive measures is to refrain from physical training and competition during times of increased environmental heat stress. Unfortunately, this often is not possible or desirable in certain populations. As a result of operational and training requirements, the U.S. Marine Corps and the U.S. Navy medical team have developed an effective exertional heat injury prevention strategy that relies upon education, leadership, and continuous hands-on observation. The fundamental aspects of this approach can be applied to other team sporting activities.