How 'battlefield acupuncture' helps Air Force Ravens stay in the fight

Dressed in a gi with a purple belt, the flight crew chief with the 89th Maintenance Group then takes turns with the ABU-clad Ravens executing a fireman’s carry followed in rapid succession by throwing the opponent to the mat and a ground-grappling technique to wrench hands, wrists, elbows, shoulders, and forearms in a direction they were never designed to move.

Two men perform martial arts in gym

Tech Sgt. Jessie Sosa demonstrates a jiu-jitsu throw for Senior Airman Anthony Vallejos. (U.S. Air Force photo by J.M. Eddins Jr.)

They repeat the succession of moves, fine-tuning technique, until the desired effect on the opponent is achieved – pain and complete submission.

When Sosa, an instructor and competitor in Brazilian Jiu Jitsu, asks his students if they had any questions, a Raven poses a query not directly related to close-quarters hand-to-hand combat.

“What are those things in you ears?”

It gives Sosa a chance to explain another technique that allows him to absorb the strain and pain of competitive combat without the use of a pain medication that may change his operational status to “Duties Not Including Flying” (DNIF)– Battlefield acupuncture.

The five small gold needles in each of Sosa’s ears ensure his pain is under control prior to performing aircraft maintenance, pre-flight checks, and loading of C-40 and C-32 aircraft used to transport the Vice President, Secretaries of State, Treasury, and Defense, and the First Lady and other government agency heads, dignitaries, and diplomats from Joint Base Andrews to overseas destinations.

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“We plan to support the Air Force’s initiative to complement western medicine with acupuncture care for service men and women in accordance with the May 2010 Pain Management Task Force objective and recommendation 4.2.1. Through this objective/recommendation, the Pain Management Task Force sought to enhance care to our DoD and VA beneficiaries by fostering this specific goal: “Incorporate integrative and alternative therapeutic modalities into a patient centered plan of care,” said Dr. Stephen Burns, Air Force Acupuncture Program.

Performing his mission can often inflict as much pain as a jiu jitsu match.

“The wear and tear of being a crew chief on the C-40 comes from the long hours crossing over the pond, which is roughly around eight or nine hours sitting in the seat,” said Sosa. “You don’t have a lot of mobility in those seats, so a lot of strain in your lower back.”

“The cargo space is limited. When we carry high-profile passengers, such as the Vice President, they bring a lot of communications gear with them. You’re crouched over in a cargo compartment loading all these heavy Pelican cases. It’s like Tetris, maximizing that space you have a lot of (physical) strain and you tend to pull your back muscles or your quads from doing all that labor working in the cramped cargo compartment.”

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Tech Sgt. Jessie Sosa performs a preflight check on the C-40 used to transport government officials and dignitaries at Joint Base Andrews, Md., Oct. 10, 2017. (U.S. Air Force photo by J.M. Eddins Jr.)

Western medicine would often dictate the prescribing of drugs, such as muscle relaxers or opioids, to control such severe back pain. However, those medications, which can alter mental capacity and judgment, would immediately disqualify Sosa from operational flight status, especially considering the importance of his passengers and cargo.

When Sosa’s work aches were combined with the pain of participating in combat sports, like wrestling and jiu jitsu, over-the-counter remedies offer little relief.

“I did yoga, Epsom salt baths, tried Bengay, any type of lotion that would help loosen up the muscle aches that I had. There’s nothing that worked,” said Sosa. “I can’t be drugged up while I’m working on Air Force Two, or teaching, because it blurs my vision. Being a mechanic you don’t want to have blurry vision on a mission. So basically, I just stay away from medications.”

Then Sosa discovered Battlefield Acupuncture (BFA) through a co-worker who often used it for relief from strained joints and back pain while doing Cross-fit workouts.

Sosa sought out Dr. Thomas Piazza, a 22-year Air Force physician, who is now the director of the Air Force Acupuncture Program at the JBA Acupuncture and Integrative Medicine Center, for a consultation.

Close up of an ear with small metal pins in it

A patient’s ear after five needles were inserted by former Air Force Colonel, Dr. Stephen Burns, during a Battlefield Acupuncture training session. (U.S. Air Force photo by J.M. Eddins Jr.)

“The first time I met Piazza, he really analyzed my body and really understood how much stress my body went through,” said Sosa. “He recommended Battlefield Acupuncture and said that it would definitely help me maintain my body and I’d still be able to do what I love to do … The first time I did Battlefield Acupuncture, it worked immediately on my lower back. So instead of being DNIF, I was able to take a mission the next day and fly overseas for eight hours and accomplish my mission without pain.”

Battlefield Acupuncture, which was developed by Dr. Richard Niemtzow, is a specific subset of the traditional acupuncture found in Eastern medicine. Small, semi-permanent, gold needles are applied to five points in each ear to provide effective and rapid pain management.

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According to Piazza, Battlefield Acupuncture works because the majority of the sensory nerve connections from the body culminate in specific areas in the brain, which are in close proximity to the sensory fibers coming from the ears. The entire body, and its organs, has corresponding points mapped on our ears. Inserting a needle in a particular point on the ear will activate the nerves in its corresponding part of the body and alleviate pain.

The procedure has been greeted enthusiastically by the military not only because of its results, but also the ease of application, portability and training in its use.

“BFA, in its elegant simplicity, has been designed so that many people can use it,” said Piazza, who coordinates and performs BFA training across the military.

A doctor checks a man's ear

Tech. Sgt. Jessie Sosa receives a Battlefield Acupuncture treatment from Dr. Thomas Piazza. (U.S. Air Force photo by J.M. Eddins Jr.)

“The technique is standardized, and everybody’s learning the same thing. It’s made a huge difference in the spread of Battlefield Acupuncture across the services. It only takes about four hours to train an individual. Approximately half is slideshow instruction, and about half is hands-on practicing with artificial ears, and, when circumstances allow, we have live volunteer patients come in so they can get the hands-on skills,” he added.

According to Dr. Stephen Burns, a 27-year Air Force veteran also working at the Air Force Acupuncture and Integrative Medicine Center, the needles can be administered quickly and remain in for days while the patient returns to work with minimal discomfort.

“Generally speaking, we put a needle in and have the first-time patient walk around to make sure there are no side effects,” said Burns. “Even then, we can do a complete treatment in less than 10 minutes. If the personnel are really practiced, and the patient’s gotten many treatments, you are able to treat a person in two or three minutes. They (acupuncture treatments) have very profound effects for about 80, 85 percent of patients. They will usually reduce their pain by at least 50 percent. And it may last for a few days or sometimes weeks, sometimes longer.”

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In the approximately 10,000 BFA treatments the doctors of the Air Force Acupuncture and Integrative Medicine Center have performed, Piazza estimates that side effects occur in a very small percentage of patients.

“Euphoria is our most common side effect and it occurs around 5 percent of the time. Emotional response, ear irritation, and wooziness/dizziness occur a little less than 5 percent of the time and nausea, passing out (needle reaction), and worsening symptoms occur less than 2 percent of the time,” said Piazza. “Longer-term problems, such as infection, are extremely rare, much less than 1 percent.”

According to Burns, the effectiveness of BFA is not only the pain relief for patients, but also how it positively impacts manning and readiness.

“Say I have somebody that has migraine headaches and they have to pull guard duty, if I give this guy narcotics, he can’t work, he can’t use his weapon. But if I can put ear needles in him, and he feels like, “I feel great. I can go to work. I’m not drowsy,” then that’s a huge force multiplier,” said Burns.

Close up of fingertips holding a cylinder with a small metal barb on it

Dr. Thomas Piazza holds a single gold needle used in the application of Battlefield Acupuncture for the relief of pain. (U.S. Air Force photo by J.M. Eddins Jr.)

 The needles, which are about one millimeter long with a flat disc on the end, come in a strip of eight in preloaded plastic applicators. The small size enables trained personnel to not only administer BFA treatments in a clinical setting but also in the field, hence the name – Battlefield Acupuncture.

“You can carry enough treatments for five, 10, 15 people in your BDUs,” said Burns. This has sparked interest in BFA within the community of Battlefield Airmen and other special forces, who see the treatment as way to maintain combat effectiveness.

If a team member is injured in combat and drugs to control pain must be administered, it may not only take the casualty out of the fight, but also one or more team members who must monitor and help remove the casualty.

During a training session with special-forces personnel, Burns was asked about just such a scenario.

“Right before the break somebody said, ‘Hey, Doc. Sometimes somebody gets shot and we have to put a tourniquet on him. When you put the tourniquet on him, after about a minute or two, they hurt so badly that somebody has to give that guy narcotics and then you got to watch him and make sure he’s breathing. Would this work?’”

People apply acupunture pins to ears

Students practice the application of Battlefield Acupuncture on each other and their instructor. (U.S. Air Force photo by J.M. Eddins Jr.)

 “So I had them come back after the break with tourniquets,” said Burns. “I said, ‘Let’s try it and see.’

“We put the tourniquets on and after about 30 seconds he says, ‘Yeah. That’s starting to hurt pretty good.’ After about a minute he’s like, ‘I can barely move my hands. This is killing me. I don’t think I could even grab a weapon’.

“We put in a needle and then the next needle in. I said ‘How do you feel?’ He said, ‘I don’t … That’s different. Wow.’ He’s starting to move his hands. I said, ‘Okay. Next needle, next needle.’ About 10 seconds apart, ‘Holy cow.’ He starts laughing and says, ‘Give me a weapon I think I could fire it.’ They showed themselves that, yeah, this could work.”

Despite the treatment’s name, the Air Force Surgeon General considers Battlefield Acupuncture a force readiness asset across all career fields. As such, BFA is a key component in the implementation of an Integrated Medicine approach throughout the force.

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“The concept of integrative medicine is a philosophy based in traditional western medicine, but bringing in some techniques that we would consider alternative,” said Maj. Luanne Danes, a biomedical services corps fellow in the Air Force Surgeon General’s office. Her primary mission during her yearlong fellowship is to advance Integrative Medicine and Battlefield Acupuncture in the Air Force.

“The purpose of Battlefield Acupuncture is to provide another avenue for effective pain management. Something other than pills, like opioids. The benefit is that it’s non-addictive. There are no withdrawal symptoms. It’s very quick, painless, safe and effective. So, very much a better option instead of opioids. The surgeon general, congress, all of the DOD is trying to reduce our dependence and reliance on opioids,” said Danes.

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Maj. Luanne Danes is a biomedical services fellow at the U.S. Air Force Surgeon General’s office at Defense Health Headquarters in Falls Church, Va. (U.S. Air Force photo by J.M. Eddins Jr.)

“Reducing the dependence on narcotics, like Percocet, different opioids, those type of medicines, will absolutely benefit the aircrew fields, because that’s all downtime. If you are injured, and we need to put you on an opioid for pain management, that takes you out of rotation. You’re not going to fly until we get you fixed again, and we get you off of those opioids. With Battlefield Acupuncture, we can utilize the technique instead of the opioids and get you up flying again much more quickly.”

Sosa is living proof of the advantages of BFA to force readiness as he not only stays on the job aboard Air Force Two, but also continues to train the Ravens who provide security for his aircraft in jiu jitsu to complement their already formidable skill set.

“Ravens usually train for outside environments. Guarding the jet outside, but on Air Force Two, the Ravens are required to be inside and outside, so the jiu jitsu training is focused mostly on indoor, confined environments that will help them subdue a person that’s trying to damage the aircraft or hurt the personnel around them,” said Sosa.

While the close-combat training adds to the capabilities of the young Ravens, Sosa’s use of Battlefield Acupuncture is also teaching them that there is a way to manage pain while remaining mission ready.

“I’ve put my body through a lot; a lot of tournaments and a lot of flight hours sitting in one seat for eight hours,” said Sosa. “I am a huge believer in battlefield acupuncture because it definitely helps me stay in the fight.”

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