by Meridel I. Gatterman, MA, DC, MEd,
ACA Wellness Subcommittee on Education
Over the past four years, a number of initiatives have been undertaken by the chiropractic community to promote the health and wellness of patients and the general public. A number of these initiatives were under the auspices of the American Chiropractic Association’s (ACA) committee on health promotion and wellness. Chaired by Ron Rupert, dean of research at Parker Chiropractic College, and assisted by Cathy Burke, ACA education director, a number of subcommittees instituted initiatives that put health promotion and wellness at the forefront of academic endeavors.
The education subcommittee I chaired completed a number of academic initiatives. Two of these were assessments of the involvement of DCs in the promotion of health and wellness, and the development of health promotion and wellness competencies adopted by the Council on Chiropractic Education (CCE) in January 2007.
The degree to which chiropractors are practicing health promotion and wellness procedures was determined through specific questions designed by John Hyland and me, which were included in the 2005 National Board of Chiropractic Examiners Job Analysis.  This self-reported survey provides an indication of the practice of chiropractic in the United States.
First among these procedures was promotion of physical fitness and exercise, recommended by 98 percent of chiropractors for 64 percent of their patients. Nutritional and dietary recommendations were provided for 52 percent of patients by 98 percent of practicing chiropractors. Ergonomic and postural advice was provided for 62 percent of patients by 97 percent of chiropractors, and educating patients on how to change risky and unhealthy behaviors was provided for 55 percent of individuals by 97 percent of the practicing chiropractors. Self-care strategies were provided by 97 percent of chiropractors for 61 percent of patients. Relaxation and stress-reduction recommendations were made to 50 percent of patients. Screening advice for disease prevention was employed the least, with 91 percent of chiropractors offering it to only 40 percent of patients.
In 2004 and again in 2005, I submitted specific health promotion and wellness competencies for consideration by the CCE. Facilitated by Joe Brimhall, these competencies became standards in 2007. The goals of specific wellness competencies were designed to facilitate:
- patient understanding of factors that promote wellness;
- a proactive approach that encourages patients to take responsibility for their health;
- skills for counseling patients on healthy habits and lifestyle; and
- strategies for working with patients in a partnership for shared decision-making.
I worked with the committee, chaired by Cheryl Hawk, for the implementation of health promotion and wellness strategies, and to develop postgraduate training for doctors of chiropractic. Incorporating this work, Cleveland Chiropractic College is launching two health promotion and wellness programs in 2008. Directed by Will Evans, the health degree programs include a master’s degree in health promotion and a 100-hour continuing-education program for practicing doctors of chiropractic in academic health promotion. The master’s level program begins enrollment in the fall of 2008, pending approval of the North Central Association of Colleges and the Higher Learning Commission.
The new 36-hour Master of Science degree offered by Cleveland Chiropractic College will be a traditional academic degree program in health promotion aimed at improving patient and community health. A goal of this program is to have some courses made available through distance education or intensive four- to five-day sessions at the Kansas City campus and/or the Los Angeles campus. Clinicians, undergraduate-level health educators and public health workers, along with dieticians, school teachers and others, may benefit from this degree program, which will train participants in needs analysis, program design and implementation, along with program evaluation. Instruction on how to coach patients regarding their health also will be a focus of the master’s program. Successful graduates should be able to sit for the Certified Health Education Specialists examination through the National Commission on Health Education Credentialing (NCHEC) pending the program’s approval from North Central and NCHEC accrediting agencies. (For more information on health education credentialing, see www.nchec.org.)
The focus of the postgraduate program will be to educate doctors of chiropractic on how to serve as consultants to patients, communities and worksites in the area of health promotion. Focus areas for sessions are general health promotion, worksite wellness, sports health and athletics, wellness across the lifespan, nutrition and fitness aspects of health promotion. The faculty for the postgraduate program comes from a variety of disciplines. Most hold dual credentials in more than one field, including chiropractic and health promotion. Four faculty members hold doctorate degrees related to health promotion.
Another graduate-level program has been underway for several years at Northwestern Health Sciences University. This program offers a certificate program in integrative health and wellness.  Graduates of this program emphasize the importance of health promotion and wellness and have the ability to apply their knowledge in this area. They must demonstrate competence, compassion and care in the service of patients from all cultural and spiritual backgrounds. They must understand the importance of actively managing and maintaining one’s own health and wellness, including the integration of body, mind and spirit. Courses taken in the clinical track include: Principles of Integrative Health, Wellness and Practice; Healing, Health and Culture; Health and Wellness Counseling; and Exercise and Clinical Nutrition.
One of the most popular health promotion and wellness initiatives spearheaded by the chiropractic profession in recent years is the “Straighten Up” program.  This bold and innovative initiative was designed to empower people to an improved quality of life and a healthy lifestyle by spending two or three minutes every day to care for their spinal health, just as they care for their dental health.
In the summer of 2004, a five-person expert seed panel and a multidisciplinary Delphi review panel of approximately 100 health care professionals, led by Ron Kirk, began shaping and testing a spinal exercise module known as “Straighten Up America.” The program includes an ergonomic break, exercise warm-up or cooldown, a short set of healthy lifestyle recommendations congruent with the goals and objectives of national and international physical activity, and health promotion initiatives. In January 2005, Tommy Thompson, then-U.S. Secretary of Health and Human Services, commended the individuals who developed “Straighten Up” for their “leadership in the field of spinal health.” For his efforts, Ron Kirk was named Person of the Year for 2007 by Dynamic Chiropractic – a well-deserved honor.
Results from tests of the program are very promising. After five weeks of daily practice of “Straighten Up” exercises, 83 percent of study participants reported they had improved their posture. And 78 percent reported they had strengthened their core muscles, while 80 percent reported they could sit and stand more upright and their backs were more comfortable.
Multiple language translations of “Straighten Up” have been undertaken for global implementation and habituation. To date, the “Straighten Up” curriculum has been translated into eight languages.  Thus far, spinal health empowerment programs have been developed in Australia, Great Britain, Sweden, Cyprus, Hong Kong, South Africa, Korea, India and Canada.
Some of the venues that have enthusiastically received the “Straighten Up” program  include the: United States of America House of Representatives Wellness Center; United States Bone and Joint Decade Meeting at the National Institutes of Health; American Public Health Association Annual Meeting; World Federation of Chiropractic/Foundation for Chiropractic Education Research Conference in Sydney, Australia; Chiropractic Coalition Summit; Association of Chiropractic Colleges/Research Agenda Annual Conference and Congress of Chiropractic State Associations Annual Convention.
For more information regarding “Straighten Up,” visit www.life.edu, www.cocsa.org or www.chirotoolbox.straightenupamerica.org.
Mindset for a Health Promotion and Wellness Model
Doctors of chiropractic who practice health promotion and wellness care offer a model different from the prevailing disease-centered model. Rather than focusing on conditions and diseases of body parts, they view the individual as a whole person. Emphasis is placed on optimizing function through maintenance of a healthy lifestyle. Assessment of realistic personal health risks is tailored to the individual. DCs have an important role to play in coaching patients and the public to undertake appropriate and effective lifestyle changes that promote health and wellness. It is important to focus on a health promotion model that embraces a more patient-centered model that can make profound changes in health and well-being. As more health promotion and wellness initiatives are undertaken by the chiropractic profession, chiropractors will gain recognition for their broader efforts, not just as technicians who “crack” backs, as some would have us.
1. Christensen MG. Job Analysis of Chiropractic. A Project Report, Survey Analysis, and Summary of the Practice of Chiropractic Within the United States. Greeley, Colo.: National Board of Chiropractic Examiners, 2005.
2. Gatterman MI. Chiropractic, Health Promotion and Wellness. Boston: Jones and Bartlett, 2007.
3. Feather K. “Straighten Up Continues to Expand Globally.” Dynamic Chiropractic, Jan. 15, 2008;26(2):32.