First-hand perspective: Principles of a sports medicine practice

Dr. Jack Dolbin is a 1977 Graduate of the National College of Chiropractic. Dolbin spent five years in the NFL. Currently, he is the owner of Pottsville Sports and Rehabilitation Center, a multidiscipline practice, employing chiropractors, physical therapists, and exercise physiologists. He served on the staff of Villanova University sports medicine team from 1993-2003. Call 570-622-7291 for more information.

Background

In the fall of 1993, I was attending a Villanova versus Northeastern University football game. My son was a redshirt freshman wideout and me, a retired NFL veteran. We sat together as spectators, dissecting the game and the individual player performances. In events that would decide the game, the Villanova field goal kicker, Frank Venezia, missed two very makeable field goals. He pushed them off to the right and short. I told my son he missed them because he was locked up in his lumbar spine and could not rotate around the axis of rotation, the transverse plane. As a result, Villanova lost the game.

The following Monday, I was treating patients when my secretary paged me and asked if I could speak to Andy Talley. I recognized the name as the head football coach at Villanova. Seems my son went to the coach and relayed my thoughts on why Frank missed those field goals.

Coach Talley asked if I could come down the next day and evaluate Frank and see if I could possibly correct the problem. I agreed to take the afternoon off the next day and drive the 87 miles to the university to see Frank. I did a basic chiropractic biomechanical exam, including the kinetic chain, and made the appropriate corrections.

The next day, Coach Talley called again. Seems Frank, in practice after my treatments, was pounding home 50 yarders. Coach Talley asked if I could come down again Thursday. I treated Frank again and then adjusted him before the Delaware game on the trainer’s table that Saturday. In the game against their arch rival Delaware, Frank kicked two 53-yard field goals to set a new school record. Villanova won the game.

The following Monday, the Villanova trainer, Dan Unger, called and asked if I could, again, come down Tuesday. I agreed and rescheduled my afternoon patients. When I arrived at the training room there were 11 athletes, including two swimmers, with various conditions wishing to see me. There began a 10-year relationship with some of the finest athletes, coaches, team doctors, and trainers in sports.

The following year, Villanova University put me on retainer and a fee-for-service plan that was quite generous. The schedule was demanding, trying to run a practice and still be at every game and two days a week in the training room. But I hired an associate to help keep the ship afloat at home and, over the years, I was responsible for more than 500 student athletes in 23 varsity, division I sports, some of whom went on to the Olympics, NBA, and NFL — including my son.

Since that time, I have been involved with the University of Maryland, the Pan American weightlifting competition, local high schools, and various athletes, including Steffi Graff. These athletes have come to learn that they perform better, are less susceptible to injury, and heal faster from injury when their body is free from factors that inhibit motion, inhibit normal blood flow, and allow for normal proprioceptive input.

Principles

I want to focus on some foundational principles and how chiropractic addresses them from a performance enhancement, injury prevention, and therapeutic stand point.

Two of those principles simply stated are:

1. The body moves in circular planes.
2. Sports are linear.

This seemingly contradictory principle is one key to our understanding of sports performance and injury prevention. The process of taking circular motion to create linear velocity involves the progressive engagement of the entire kinetic chain and sequential firing of the muscles in a coordinated pattern.

Let us look at a few examples:

1. A baseball pitcher or a football quarterback in the performance of their respective activity must involve the progressive engagement of the kinetic chain in circular planes to affect the velocity of the ball in the linear plane. If there is a motion deficit at any level from the talus in the push off phase, the lumbar spine in the rotary flexion/extension phase, the glenohumeral and scapular interaction in the respective planes of motion, the velocity will be compromised and, as the athlete tries to compensate, injury will occur and performance will decline.

2. The golfer must create club head speed to cause the ball to go in a linear direction. This involves the various joints, especially the low back, to take circular motion to create linear velocity. If he is unable to rotate around the transverse axis in the pelvis, he cannot achieve the necessary elements of his sport to the maximum degree. He then compensates by swinging harder, causing form breaks, poor performance, and possibly injury. Studies show that low back and pelvic adjustments improve the range of motion in all planes. Does it make sense that a chiropractor could be a great asset in this sport? Tiger Woods thinks so, as does Johnny Damon, who convinced the world champion New York Yankees to put a chiropractor on staff.

3. Consider the swimmer. Statistics tell us that 77 percent of swimmers will develop shoulder pain, usually rotator cuff or entrapment syndromes. But it is unilateral. If it were simply an overuse injury, it would be bilaterally, since swimmers use both arms equally.

I found in my experience treating Villanova swimmers for shoulder injuries that most had a loss of motion in their low backs and segmental dysfunction in the lumbar spine, thus preventing the lumbar spine from laterally flexing and the latissiums dorsi from elongating. This, in turn, prevents the scapula from rotating in the frontal plane due to the attachment of the latissimus dorsi muscle on the inferior angle of the scapula and the subsequent overreaching at the glenohumeral joint, causing micro trauma in the rotator cuff tendons.

While this is elementary to a chiropractor, our medical counterparts choose only to look at the inflamed tendon and intervene at that level, whereas the chiropractor will clean up the motion deficits in the kinetic chain, recommend repetitive motion exercises to restore normal muscle and joint function, thus eliminating the cause of the injury and rehabilitating the injured tendon.⁵

Let’s now look at a third principle. All soft tissue injuries are caused by exceeding the tensile strength of the tissue.^1,2 Consider, however, the intrinsic factors, primarily joint dysfunction, that predisposes the athlete to exceeding the tensile strength of the tissue. When a joint does not move or moves improperly, the connective tissue traversing that joint shortens, weakens and becomes dysfunctional, both in the support of the joint and the dynamic function of the joint.⁴

Studies have shown that improper proprioceptive afferents into the central nervous system (CNS) further disrupts coordinated motion patterns in the extremities. Chiropractic adjustments have been shown to normalize joint motion, activate mechanoreceptors, which impact the CNS in coordinated movements and restore normal joint stability, including the soft tissue traversing the joint. This, coupled with rehabilitation exercises to restore tensile strength and joint neurology, proprioceptive afferents, goes a long way in the prevention of overload injuries when detected before excessive stress occurs and enhancing the therapy post injury.³

Remember, all therapy speeds up, slows down, or modifies the natural healing process. In the acute phase, we want to slow down the inflammatory process. In the healing phase, we want to speed up the process; and in rehabilitation, we want to modify the process. Apart from motion, joints and soft tissues heal improperly and normal function is lost.⁴

Statistically, an improperly rehabilitated ankle sprain has an 80 percent chance of causing an injury farther up in the kinetic chain, most commonly the groin.^6,7

Conclusion

To have a successful sports medicine practice at any level, from the child athlete, to the professional, to the weekend warrior, knowledge of the basic biomechanical factors of sports performance and pathophysiology are essential. Beyond that, especially at the high school or club sport level where you may be required to do sideline or on the field evaluations, an advanced knowledge of things like concussions, when to transport, and play-no-play decisions require the chiropractor to get training beyond our basic chiropractic education.

Dealing with the female athlete and the child athlete requires one to have unique insight into the different problems presented by these population groups. Finally, a thorough understanding of the role of exercise and resistance training, as it relates to performance and injury prevention, is a real asset to any chiropractor wanting to develop a sports medicine practice.

The chiropractic profession has come a long way since Drs. Leonard Schroeder, James Ransom, Bill Womer, and others started the Council on Sports Injuries. We owe a great debt to those pioneers. Now it is our great opportunity to move the profession into the forefront of the sports medicine world. Along with this opportunity, we must realize an even greater responsibility to represent our profession with the utmost integrity and professionalism.

References

¹ Leadbetter, MD. Clinics in Sports Med 1995; 14(2):353-410

² Kibler, MD. Clinics in Sports Med 1995; 14(2): 447-457

³ Seaman, DC, MS Top Clin Chiro 1997;4(1) March vi-viii

⁴ Nelson, DC. Top Clin Chiro 1994;1:20-29

⁵ Herring, MD. Med & Science in Sports and Exercise 1990; 22(4) 453-456

⁶ Weisel, MD. Backlete 1997; 12 (5): 57

This research was provided by Hill Laboratories Co.

877-445-5020 * www.hilllabs.com