Achieve postural stability with your athletic patients

Chiropractors often work with athletes, both amateur and professional.

As a group, athletes can be a very rewarding patient population. They are usually goal-oriented, eager to improve their physical abilities, compliant to professional advice, and a good source of referrals through close contacts with other athletes in your community.

Your training with and knowledge of the dynamics of the human body qualify you to diagnose and successfully attend to a wide range of sports-related injuries for a diverse group of athletes.

Appropriate adjunctive care—such as custom-made, flexible foot orthotics and at-home, low-tech rehab systems—is not only beneficial to the recovery and performance process, it also provides your practice with additional income-generating opportunities.

Factors to consider

Treatment for athletic injuries depends, of course, upon many factors: the type and seriousness of the injury or condition; how it occurred (sudden trauma, chronic problem, etc.); how long the condition had existed before professional care was sought; what steps were previously taken to treat the problem, etc.

Consider runners: It has been estimated that approximately 60 percent of the thirty million runners in this country will eventually experience an injury that may limit their activities.¹

Running places a tremendous stress on the lower extremities: feet, knees, legs, hips, and low back. The body of a runner weighing 150 lbs. has to absorb stress shock equivalent to 375-450 lbs. every time his or her heel makes contact with the running surface.²

Over time, overuse injuries often result, and may be magnified if there are any underlying structural problems in the lower part of the body.³

Problems such as knee or leg pains in a runner may indicate a postural imbalance (and, therefore, a need for custom-made orthotics), an inappropriate training program, overuse injuries, or stress conditions to soft tissues or bone.

Sources of breakdown

Overuse syndromes develop when the body’s repair process cannot keep up with the stressor and is overcome, with the eventual result that the tissue fails, resulting in injury.⁴

The major sources of these structural breakdowns leading to overuse injuries are biomechanical errors, structural asymmetries, tissue weaknesses, and excessive external loads.

Biomechanical errors are created by work or sports habits which place undue or unbalanced stress on normal body parts. One example would be the tendency of many long-distance runners to consistently run on the same side of the road. The result is excessive stress to the legs and pelvis due to the angulation of the road and the creation of an ‘environmental’ short leg syndrome.⁵

With the hyperpronation of the right foot, the right knee will be exposed to higher medial torque stresses (and possibly develop chondromalacia or iliotibial band symptoms), and the right sacroiliac joint will tend to fixate and become symptomatic.⁶

Structural asymmetries or imbalances result in increased biomechanical forces which cannot be corrected by changing work or training procedures. Leg length inequality can lead to overuse strain symptoms in the back and legs.^7-9

A study done with Norwegian military recruits found that stress reactions and fractures were not uncommon, and that 73 percent of all stress fractures occurred in a longer leg, while 16 percent were found in the shorter leg, and only 11 percent in patients with legs of equal length.¹⁰

Some studies have even found that degenerative changes in the hip joint and lumbar spine occur much more frequently on the side of a longer leg.^11-12

Tissue weaknesses such as muscle imbalance, articular cartilage derangement and ligament laxity can also be a significant factor in the development of overuse injuries. A good example of this is the foot with lax support ligaments for the longitudinal arch.¹³

The result is excessive rolling inwards of the foot and ankle (hyperpronation) during walking and running. This excessive torque force (twisting) can cause a variety of overuse strain symptoms to develop in the knee, leg, hip, pelvis, and spine.¹⁴

Excessive external loads or forces such as a sudden increase in training schedule, mileage or weights can overwhelm the body’s capacity to maintain and repair the musculoskeletal system. Running on unyielding surfaces, or even standing and working for hours every day on hard surfaces may eventually result in microtrauma breakdown and overuse symptoms.

Management options

These conditions can often be effectively managed if the problem is identified early and appropriate treatment is followed. While every patient’s case is unique, you should probably perform a postural analysis as part of your initial examination.

Important information can often be obtained through a simple evaluation of the standing posture.¹⁵

X-rays may also be required. Your patient’s training regimen and schedule may be reviewed, to see if there are any problem areas to correct.

In addition to any chiropractic adjustments, you may also recommend custom-made, flexible orthotics and at-home rehab exercise therapy.

References

1. Jacobs SJ, Berson BL. Injuries to runners: a study of entrants to a 10,000 meter race. Am J Sports Med 1986; 14:151-155.
2. Cavanaugh PR, LaFortune MA. Ground reaction forces in distance running. Biomech 1980; 13:397-406.
3. Adelaar RS. The practical biomechanics of running. Am J Sports Med 1986; 14:497-500.
4. O’Connor FG, Sobel JR, Nirschl RP. Five-step treatment for overuse injuries. Physician and Sportsmedicine 1992; 20(10):128-142.
5. Bayliss JW, Rzonca EC. Functional and structural leg length discrepancy: evaluation and treatment. Clin Pod Med Surg 1988; 5:509.
6. Schuit D, McPoil TG, Mulesa P. Incidence of sacroiliac malalignment in limb length discrepancies. J Am Pod Med Assoc 1989; 79:380-383.
7. Subotnick, SI. Limb length discrepancies of the lower extremity (the short leg syndrome). JOSPT 1981; 3:11-16.
8. Giles LGF, Taylor JR. Low back pain associated with leg length inequality. Spine 1981; 6:510-521.
9. Friberg O. Clinical symptoms and biomechanics of the lumbar spine and hip joint in leg length inequality. Spine 1983; 8:643-651.
10. Friberg O. Leg length asymmetry in stress fractures: a clinical and radiographic study. J Sports Med Phys Fitness 1982; 22:485-488.
11. Radin EL et al. Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet 1973; i:519-522.
12. Giles LGF, Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine 1982; 7(2):159-162.
13. Huang C-K, et al. Biomechanical evaluation of longitudinal arch stability. Foot & Ankle 1993; 14:353-357.
14. Subotnick SI, ed. Sports Medicine of the Lower Extremity. New York: Churchill Livingstone, 1989:164.
15. Bullock-Saxton J. Postural alignment in standing: a repeatability study. Austr J Physiother 1993; 39:25-29.