With the popularity of sports in this country today, more chiropractors are staking their claim as sports injury experts.
Even if only for marketing purposes, these “specialists” are growing in numbers.
For those who actually participate with teams or are attempting to become part of a team’s medical staff, job description at some point becomes a key issue. The diversity between technique, philosophy, adjunctive therapies, and sports knowledge, although an issue within the profession, has less meaning when determining how to fit into an existing staff.
On many pro teams, a chiropractor will visit the locker room on a certain day each week and adjust those players who want to be adjusted. In other situations, a chiropractor will work only in his or her office, and players will call and make appointments to be treated there. In both cases, the option is up to the player and typically the reason for the appointment is to relieve some pain, stiffness, or other symptom the athlete is experiencing. This also leaves the entire decision-making process up to the athlete, which is usually based on some prior experiences with chiropractic.
In other instances, and usually in lower-level sports, like in high schools and smaller colleges, the chiropractor is encouraged or forced to take on a more expanded role, like taping and working the sidelines of games to handle many of the crisis-oriented injuries. This opportunity, unfortunately, furthers the confusion to everyone as to exactly what the role of a chiropractor could and should be.
This author, for one, believes we should leave the sideline duties, as well as taping and other locker room responsibilities, to others. The role the sports chiropractor should play is so time consuming and critically important, and currently not performed by any other specialist. To spend our time performing tasks that can be handled by others reduces our value and continues the ongoing ignorance in the sports community as to what chiropractic is all about. It also puts us in a continual competition with other professions, and supports their ongoing efforts to keep us out of the locker rooms. Chiropractors should never have to compete with the trainer, physical therapist, or team medical doctor. Our roles and value should make everyone, from players to medical staff to owners or administrators, beg for our involvement.
The chiropractor’s role
In the most sophisticated sports-conditioning programs today, the best that happens is that the strength coach evaluates players for body structure, strengths, and weaknesses. This information is then translated into a conditioning program. However, less sophisticated programs (the majority) put athletes on strength and conditioning programs based on their sport or position. Very few base the program on the athlete’s specific structural needs.
The reason for this is that no member of the team’s medical staff knows how to structurally evaluate an athlete. This type of evaluation, if ever done, is only done after an athlete is injured, and the goal is to heal injuries. Any structural information gotten on the exam, however, is never used to improve conditioning.
The new role of the chiropractor is to provide structural management to athletes and teams. This program begins with a complete structural evaluation. From this, the chiropractor learns quantifiable information that can be used to educate the athlete as to the specific imbalances, distortion patterns, and weaknesses that need to be addressed. These evaluations should be done pre-season. In most situations, medical exams are done pre-season, but, for the most part, do not include any structural testing. Since most sports injuries are mechanical, or structural in nature, it makes sense that someone would perform structural evaluations before the season begins.
Corrections should not be based only on symptomatic involvement. Since structural imbalances can accelerate degeneration and increase the likelihood of injury, they should be immediately addressed with treatment, supports, nutrition, and exercises as soon as they’re found.
The Structural Management Program
The Structural Management Program begins with the premise that each and every athlete has a totally unique structure. The only way we can ever know the specific needs of that structure is to perform an examination identifying weaknesses, imbalances, and distortion patterns. The Structural Fingerprint Exam is done for that purpose. Many college and pro athletes who utilize chiropractic use the adjustment for relief of some form of symptoms. Very few of them have been educated to use chiropractic for the correction of structural distortions in order to prevent injuries. With exam, quantifiable evidence can be shown to the athlete and can become the basis for setting up a corrective structural management, strength/conditioning program.
The Structural Fingerprint Exam
As structural specialists, we need to begin looking at the athlete as an architectural structure. If the athlete were a building, balance would be important. In the athlete, this translates into reduced likelihood of injury and increased endurance. Improved balance and joint mobility would improve performance, as the athlete’s structure would better tolerate increased stress loads from both competition and conditioning.
The Structural Fingerprint Exam begins with a visual exam of the athlete in the standing position. Postural information should be noted, such as high shoulders and hips, internal or external rotation of the knees and feet, increased or decreased lordotic and kyphotic curves, etc.
Next is a complete foot exam, which includes checking the medial arches of the feet and the Q angle of the knees. Full range of motion of all key joints, as well as muscle tests, leg length measurements and basic orthopedic testing – such as Lasegue’s, Bilateral Leg Lowering, Patrick-Fabere, and Gaenslen’s – will provide valuable information. Palpation of the entire para-spinal regions will show muscle tension imbalances and subluxations.
The most important testing in this exam is the standing x-ray. This provides the unique information that becomes a reference point for beginning structural correction. Most patients have never been evaluated from a biomechanical point of view, nor have they learned quantifiable information about their structures. Standing x-rays will give 75 percent of the information needed to determine an athlete’s structural fingerprint. This information also puts chiropractors head and shoulders above all physical therapists, massage therapists, strength coaches, medical personnel, trainers, etc. We are THE authority for structural management.
The basic X-ray series should include an A-P open mouth and lateral cervical as well as an A-P and lateral L-S X-ray. These should always be done in the standing position with shoes off. On the normal open mouth view , there are some basic findings that should be measured. The alignment of the odontoid process with the SP of C2 should be observed. Any non-alignment is suggestive of a rotation of C2. The atlanto-axial and atlanto-odontoid spaces should be equal in size. Finally, the occiput should sit evenly on the spine. On the normal lateral x-ray, the important biomechanical findings are the lordotic curve, the disc spaces, and the gravity line, which should go through all cervical vertebrae.
If the gravity line is ahead of or behind the cervical spine, then the abnormal weight bearing will produce an acceleration of degenerative changes as well as an increase in potential injuries in the cervical spine. If injured, the degree of injury can be greater and the time needed for recovery can be prolonged. With all abnormal findings, a corrective program becomes critical, and chiropractors are the most viable candidates for diagnosing and treating these imbalances.
X-rays of the L-S spine should be A-P and lateral. On the normal A-P , the iliac crests are level, the spine is straight and in alignment with the pubic symphisis. The obturator foramen are equal in size. And, obviously, no pathologies are present. On the normal lateral L-S (Fig. 5), the disc spaces should be well maintained, the sacral base angle should be 36°-42°, and Ferguson’s gravity line should bisect the anterior third of the sacral base. Again, any abnormalities should become the starting point and reason for a corrective program.
The Advanced Conditioning Program (ACP)
Under the assumption that all people, including athletes, have never been thoroughly structurally evaluated and biomechanically corrected, it is assumed that the individual is living in a “deferred maintenance” state. Correction is mandatory to reduce the likelihood of injury and allow the athlete to tolerate a greater capacity of structural stress. The ACP is most effective in the absence of symptoms. If symptoms are present, it is better to eliminate them first.
The goal of the ACP is to improve balance, joint mobility, and muscular flexibility. If these three objectives can be met, the amount of stress an athlete’s structure can tolerate before breaking down increases exponentially. In the world of sports, this service provided to a team can become the most important service that team has available to it.
ACP is a 6-month program. Prior to the first adjustment, custom-made, flexible orthotics are recommended if any of the following are positive on the exam; pronation of either foot, supination of either foot, a difference between the right and left arch, foot flare, an increased Q angle, an abnormal sacral base angle, or an abnormal Ferguson’s gravity line. Orthotics are a key component in helping the adjustments hold longer.
Chiropractic adjustments start at 3x’s/week for 6 weeks, then the frequency is reduced to 2x’s/week for another 6 weeks. Treatments then go to once/week for 14 weeks. Any complimentary physical therapy can be used. The purpose of the adjustments is to re-educate the joints and supportive structures of the normal motion that should be within each and every joint of the body. With normal joint mobility, again, there is an increase capacity of stress that will be tolerated much better before injury occurs.
In addition to the adjustments, a specific exercise program is set up to attempt to improve any abnormal structural findings, such as an abnormal Ferguson’s line or sacral base angle. Muscle imbalances are a key part of structural imbalances, and cannot be ignored when attempting to correct the structure.
Chiropractic has fought for years to be accepted, yet we currently treat only 10 to 12 percent of the population. We fight to get into locker rooms, and once in, we assume the role allowed as a small part of the existing medical model that currently doesn’t know how to diagnose or treat mechanical injuries. Or, we try to mimic our medical colleagues, as though that’s what a good sports doctor does.
With The Structural Management Program, every chiropractor has the opportunity to become the sports expert in their community. No other profession remotely approaches the chiropractor’s ability to perform any of the above listed duties that are so critically needed by every athlete alive. From a focus of looking at the athlete from an architectural point of view, this program allows for a more comprehensive and marketable approach for all chiropractors in their community. This can find common ground for all chiropractors to subscribe to in an effort to unify our profession, and to see an abundance of patients far greater than 10-12 percent of the population.
Tim Maggs, DC, and his practice specializes in sports medicine and industrial medicine. He is a graduate of the National College of Chiropractic. In addition to his practice, Maggs likes to spread the word on biomechanics by authoring numerous columns, producing a talk radio show on sports medicine, and speaking at numerous engagements. Maggs is a featured speaker in Foot Levelers’ “Fall 2003 Seminar Series.” He can be contacted at 518-393-6566.