Assessment of Chiropractic Treatment in Active Duty Military Personnel Studies (ACT)

Funding Source: Department of Defense
Grant Number: W81XWH-10-DHP-CCTA
Award Amount: $7,500,000 ($5,100,000 to Palmer)
Funding Period: 02/01/2011 – 02/14/2019

Principal Investigator: Ian D. Coulter, Ph.D., RAND Corporation
Co-Principal Investigators: Christine Goertz, D.C., Ph.D., Joan Walter, J.D., P.A., Samueli Institute
Co-Investigators: Cynthia Long, Ph.D. Robert Vining, D.C.
Lead Project Manager: Amy Minkalis, D.C., M.S., CCRP

There were 750 participants involved with this multisite pragmatic clinical trial, making it the largest chiropractic trial in history. The overarching goal of this clinical trial was to determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone

Shannon Z, Long C, Chrischilles, Goertz C, Wallace R, Casteel C, Carnahan R. Whole-health factors as mechanisms of chiropractic care for low back pain in US active-duty military. International Congress on Integrative Medicine and Health, April 9-13, 2024.

Shannon ZK, Long CR, Chrischilles EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Affecting whole-person health of US military members through effects of chiropractic care on low back pain A mediation analysis. International Congress on Integrative Medicine and Health, April 9-13, 2024.

Shannon ZK, Long CR, Chrischilies EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Change in low back pain (LBP) intensity and interference as mechanisms of the effect of chiropractic care on biopsychosocial factors for US active-duty military members. WFC Biennial Congress, October 11-14, 2023, Queensland, Australia.

Shannon ZK, Long CR, Chrischilies EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Biopsychosocial Factors as Mechanisms of the Effect of Chiropracticare on Low Back Pain (LBP) in US Active-duty Military Members. WFC Biennial Congress, October 11-14, 2023, Queensland, Australia.

Shannon Z, Long C, Vining R, Goertz C.  Secondary Analysis of Pain Occurrence Data Collected via SMS Text Message During a Pragmatic, Clinical Trial Comparing Usual Medical Care Plus Chiropractic Care to Usual Medical Care Alone for Low Back Pain.  ACC-RAC Conference, March 19-21, 2020, San Diego, CA.

Shannon Z, Long CR, Vining RD, Goertz CM.  Pain Occurrence Collected via Weekly Text Message over 1 Year Pragmatic Trial Evaluating Chiropractic Care for Low Back Pain in Military Members.  International Congress on Integrative Medicine and Health, April 28-May 1st, 2020, Cleveland, OH [Event was cancelled due to COVID-19]

Goertz C, Shannon Z, Long C, Vining R, Hays R, Spritzer K, Coulter I. PROMIS®-29 Outcomes of US Military Personnel with Low Back Pain Adaptively Allocated to Usual Medical Care Alone Versus Usual Medical Care Plus Chiropractic Care. ACC-RAC Conference, March 14-16, 2019, Baltimore, MD. 

Goertz C, Long C, Shannon Z, Vining R, Hays RD, Spritzer K, Coulter I.  PROMIS-29 Outcomes of Active-Duty Military Personnel with Low Back Pain in a Pragmatic Clinical Trial Comparing Usual Medical Care Plus Chiropractic Care to Usual Medical Care Alone.  WFC-ECU Congress, March 20-23, 2019, Berlin, Germany. 

Goertz C, Long C, Vining R, Pohlman K, Walter J, Coulter I.  Controlled Trial Evaluating the Addition of Chiropractic Care to Medical Care for Patients with Low Back Pain. International Congress on Integrative Medicine and Health, May 8-11, 2018, Baltimore MD. 

Goertz C, Long C, Vining R, Pohlman K, Walter J, Coulter I. Pragmatic Comparative Effectiveness Controlled Trial Assessing Chiropractic Treatment for Active Duty US Military Personnel with Low Back Pain (ACT I).  Military Health System Research Symposium, August 27-30, 2017, Kissimmee FL. 

Goertz C, Long C, Vining R, Pohlman K, Walter J, Coulter I.  Assessment of Chiropractic Treatment for Active Duty, US Military Personnel with Low Back Pain:  A Randomized Controlled Trial.  DC 2017, March 16-18, 2017, Washington, DC. 

Goertz C, Salsbury S, Hawk C, Vining R, Branson R, Burgo L, Smith V, Wallace R, Long C, Lisi A.  Integrative Clinical Pathway for Veterans with Spine Pain and Mental Health Co-Morbidities: Results of a Delphi Process Study.  DC 2017, March 16-18, 2017, Washington, DC. 

Hays RD, Shannon ZK, Long CR, Spritzer KL, Vining RD, Coulter ID, Pohlman KA, Walter JA, Goertz CM. Health-Related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care Plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial. Pain Med. 2022 Aug 31;23(9): 1440-1449.

Ziegler AML, Shannon ZK, Long CR, Vining RD, Walter JA, Coulter ID, Goertz CM. Chiropractic services and diagnosis for low back Pain in 3 US Department of Defense Military treatment facilities: a secondary analysis of a pragmatic clinical trial. J Manipulative Physiol Ther. 2022;44(9):690-698. 

Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: a comparative effectiveness clinical trial. JAMA Network. Open 2018;1(1):e180105

Goertz CM, Long CR, Vining RD, Pohlman KA, Kane B, Corber L, Walter J, Coulter I. Assessment of chiropractic treatment for active duty, US military personnel with low back pain: study protocol for a randomized controlled trial. Trials 2016;17(70).

Funding Source: NCCIH
Grant Number: L30AT013015
Award Amount:
Funding Period: 07/01/2024 – 06/30/2026

Principal Investigator: Zacariah Shannon, D.C., M.S., Ph.D.
Primary Mentor(s): Cynthia Long, Ph.D., PStat
Site: Palmer College of Chiropractic, Davenport

During the Assessment of Chiropractic Treatment trial (ACT 1) of 750 active miliary personnel, participants were still in deployment cycles and initial follow-up data was only collected for 12 weeks. As these deployment cycles diminished, 1-year of follow-up was added for the final 154 participants. This secondary analysis of ACT 1 data will assess the effectiveness of chiropractic care plus usual medical vs. usual medical alone for LBP-related outcomes that include disability, physical, mental, and social health measures for this subgroup of participants. 

Shannon ZK, Long CR, Vining RD, McCarey J, Goertz CM. Longer-term chiropractic care outcomes for US active-duty military personnel with low back pain: Secondary analysis of a pragmatic clinical trial. WFC 18th Biennial Congress, May 7-10, 2025, Copenhagen, Denmark.

Shannon Z, Long C, Vining R, McCarey J, Goertz C. Longer-term chiropractic care outcomes for US active-duty military personnel with low back pain: Secondary analysis of a pragmatic clinical trial. International Congress on Integrative Medicine and Health, March 6-7, 2025, Seattle, Washington.

Shannon ZK, Long CR, Chrischilles EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Whole-health factors as mechanisms of chiropractic care for low back pain in US active-duty military. International Congress on Integrative Medicine and Health, April 9-13, 2024, Cleveland, OH.

Shannon ZK, Long CR, Chrischilles EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Affecting whole-person health of US military members through effects of chiropractic care on low back pain: A mediation analysis. International Congress on Integrative Medicine and Health, April 9-13, 2024, Cleveland, OH.

Shannon ZK, Long CR, Chrischilles EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Effect of chiropractic care on low back pain for active-duty military members: Mediation through biopsychosocial factors. PloS One. 2024; 19(10): e0310642.

Shannon ZK, Long CR, Chrischilles EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Secondary causal mediation analysis of a pragmatic clinical trial to evaluate the effect of chiropractic care for US active-duty military on biopsychosocial outcomes occurring through effects on low back pain interference and intensity. BMJ Open. 2024 Nov 19;14(11):e283509.

Funding Source: Department of Defense
Grant Number: W81XWH-10-DHP-CCTA
Award Amount: $7,500,000 ($5,100,000 to Palmer)
Funding Period: 02/01/2011 – 02/14/2019

Principal Investigator: Ian D. Coulter, Ph.D., RAND Corporation
Co-Principal Investigators: Christine Goertz, D.C., Ph.D., Joan Walter, J.D., P.A., Samueli Institute
Co-Investigators: Cynthia Long, Ph.D. Robert Vining, D.C.
Lead Project Manager: Julie Hartman, D.C., M.S.

Site Locations: Blanchfield Army Community Hospital, Chiropractic Clinic, Fort Campbell, Kentucky

Chiropractic manipulative therapy (CMT) has been shown to improve reaction time in some clinical studies and slight improvements in reaction time can be critical for military personnel, such as Special Operation Forces (SOF). This trial enrolled 110 Special Forces members to test whether CMT could lead to improved reaction and response timing in combat-ready Special Operation Forces personnel.

DeVocht JW, Vining R, Smith DL, Long C, Jones T, Goertz C. Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. Trials 2019;205

DeVocht JW, Smith DL, Long CR, Corber L, Kane B, Jones TM, Goertz CM. The effect of chiropractic treatment on the reaction and response times of special operation forces military personnel: study protocol for a randomized controlled trial. Trials 2016;17(457).

Funding Source: Department of Defense
Grant Number: W81XWH-10-DHP-CCTA
Award Amount: $7,500,000 ($5,100,000 to Palmer)
Funding Period: 02/01/2011 – 02/14/2019

Principal Investigator: Ian D. Coulter, Ph.D., RAND Corporation
Co-Principal Investigators: Christine Goertz, D.C., Ph.D., Joan Walter, J.D., P.A., Samueli Institute
Co-Investigators: Cynthia Long, Ph.D. Robert Vining, D.C.
Lead Project Manager: Amy Minkalis, D.C., M.S., CCRP

Site Locations: Naval Medical Center San Diego (NMCSD), San Diego, California 

Low back pain (LBP)  can negatively influence trunk muscle strength, balance, and endurance, potentially compromising the military readiness of active-duty military personnel with LBP. Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with LBP. This trial investigated whether chiropractic care influenced strength, balance, and/or endurance in active-duty United States military personnel with LBP.

Vining R, Minkalis M, Gudavalli MR, Xia T, Cober L, Franklin C, Goertz C.  Changes in Strength, Balance, and Endurance in Active Duty US Military Personnel with Low Back Pain Following Chiropractic Care.  ACC-RAC Conference, March 19-21, 2020, San Diego, CA.  

Long CR, Vining R, Minkalis A, Corber L, Franklin C, Goertz C.  Improved Strength, Balance, and Endurance in US Military Personnel with Low Back Pain Receiving Chiropractic Care.  APHA Annual Meeting, November 2-6, 2019, Philadelphia, PA.  

Vining R, Long C, Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz C. Effects of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a randomized controlled trial. J Altern Complement Med 2020;26(7):592-601.

Vining R, Minkalis A, Long CR, Corber L, Franklin C, Gudavalli MR, Xia T, Goertz CM. Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for randomized controlled trial. Trials 2018;19671