The Chiropractic Report www.chiropracticreport.com Editor: David Chapman-Smith LL.B. (Hons.) July 2008 Vol. 22 No. 4
The Role of Sports Chiropractic “. . . the loss of any single component in the neuromusculoskeletal appa- ratus leads to compensatory changes in the remaining functional parts.” Inman and Ralston, Human Walking1
A. Introduction elite athletes and their coaches. Tiger Woods, who has had chiropractic care s the Beijing Olympics throughout his career, was one of the approach, the June newsletter of A celebrities standing on the four corners the International Federation of Sports of the Chiropractic Centennial Float Chiropractic (FICS) has stories on some in the Rosebowl Parade in Pasadena in of the sports chiropractors who will be 1995. Dr. Dale Richardson of Austra- with their national teams: lia, who spends 26 weeks a year with • Dr. Michael Reed, who works fulltime the Professional Golfers’ Association for the US Olympic Committee in Col- (PGA) Tour, is just one of the several orado Springs as Medical Director of sports chiropractors currently working the Performance Services Division, will continuously with many top golfers to be one of five doctors of chiropractic improve their biomechanics and perfor- with the US team. mance, and avoid or manage injuries. • In New Zealand Dr. Gregory Oke of In North America baseball, basketball, Palmerston North, who was also in football and hockey franchises in the Professional Notes Athens in 2004, is once again a New MLB, NBA, NFL and NHL all have Zealand team doctor. In Australia, Dr. Golf Injuries team chiropractors. Ten years ago Ohio Margie Barry will be with the cycling State University had no formal chiro- Stude et al. report a written survey com- team. practic services for the Buckeyes, its pleted by recreational golfers attending a • Dr. Per Rehm of Malmo, Sweden will much loved football team, and other popular annual golf show in Minneapolis, be with the Swedish Equestrian Team athletes – today it has a team of chi- and giving doctors of chiropractic an for the equestrian events being held in ropractors led by Dr. Robin Hunter of insight into common problems, likely Hong Kong. Dr. Daniele Bertamini of Columbus. causes of them, and the general willing- Genoa will be with the Italian team for Leading European football/soccer clubs, ness of golfers to participate in specific rowing. such as AC Milan in Italy and Chelsea golf fitness exercises and programs if • Dr. Martin Camara of the Philippines, in England, have team chiropractors. provided. who was last year appointed a member Australian cricket star Adam Gilchrist For the 402 of the 462 golfers who visited of his country’s National Olympic Com- credits Perth chiropractor Dr. Noel Pat- the Northwestern Health Sciences Uni- mittee, will be a team doctor for the terson with keeping him healthy and versity booth and completed the survey: Philippines. His interdisciplinary group the world’s foremost wicketkeeper/bats- • 4 of 5 (80%) were male and 90% were Intercare is presently running a 6 week man for many years until his retirement of working age. There were 19 younger pre-Olympic training camp for swim- this year. Chilean tennis star Fernando than 20, 26 older than 60. Approximately mers from various countries. Gonzales, ranked fifth in the world last half (47%) had had prior chiropractic • Canada has 7 sports chiropractors year, maintains his form and avoids care. with its team, led by team doctors Dr. injury with the assistance of his chiro- practor Dr. Steven Flint, who also works • Most transported their own clubs, and Wilbour Kelsick of Port Moody, British Davis Cup fixtures for Chile. Softball almost 90% played golf at least 3 times Columbia and Dr. Lawrence Schlede- in huge in Taiwan – in recent years Dr. weekly, mainly for social purposes and witz of Steinbach, Manitoba. Others are with individual sports. Edward Chen of Taipei has been the exercise rather than competition. chiropractic consultant for the national 2. Because of their unique education • 9 of 10 (89%) wore spiked shoes when team. and specialized clinical skills in areas playing. These give stability, but add 3. What is the role of sports chiroprac- stress to joints in the foot, leg and back. of fundamental importance to sports performance and injury chiropractors tic? When and why should an athlete • 1 in 8 (12%) reported past injury while are now seen as an integral part of the seek the services of a chiropractor? continued on page 4 core sports medicine team by most What is happening in sports chiroprac- Main Article continued from page 1 tic education and research? What are tions in the kinetic chain, as is typically The Chiropractic Report is an international review the organizations representing sports the case, which is the key one to which of professional and research issues published six chiropractors, and what are they doing treatment should first be directed? times annually. You are welcome to use extracts to give athletes access to chiropractic from this Report. Kindly acknowledge the source. For example, for the gymnast with Subscribers may photocopy the Report or order services at major games events? These joint movement restriction and pain in additional copies (.80 cents each, plus shipping and other questions are addressed in the cervical spine and nearby trigger – minimum of 20 copies) for personal, non- this review of sports chiropractic. commercial use in association with their practices. points in the upper trapezius muscle, However, neither the complete Report nor the but also reduced joint mobility in the majority or whole of the leading article may be B. Scope of Practice thoracic spine, is the mid back the key reproduced in any other form without written permission. 4. Where they work with amateur teams area requiring attention for therapeutic success? The opinions and statements in this publication in the community, often as volunteers are those of the individual authors alone, not the and without assistance from other For the runner or football player with Editorial Board, World Federation of Chiropractic or healthcare professionals, chiropractors recurring hamstring injuries or muscle any other organization. have a broad diagnostic and therapeu- strains in the upper or lower leg, is the Subscription: for rates and order form, see page 8. tic role consistent with their educa- primary problem the muscle weakness • Visit www.chiropracticreport.com • Call 416.484.9601 tion and general chiropractic practice. or imbalance or overuse that exists and • Email us at [email protected] This includes assessment of injury and is being managed unsuccessfully with function throughout the neuromuscu- an exercise program – or is it an undi- Editorial Board Alan Breen DC, PhD, England loskeletal system, manual treatments, agnosed joint restriction in the pelvis or Raul Cadagan DC, PT, Argentina prescription and supervision of exer- knee and/or ankle which, when found Ricardo Fujikawa DC, MD, Brazil cise programs, use of physical therapy and corrected, complements the exer- Scott Haldeman DC, MD, PhD, United States Donald Henderson DC, Canada modalities, taping and prescription of cise program and solves the problem? Nari Hong DC, South Korea orthotics and other supports, nutri- From a chiropractic perspective there Gary Jacob DC, MPH, LAc, United States tional advice and counseling/education. Dana Lawrence DC, United States are two diagnostic levels. The first, Charlotte Leboeuf-Yde DC, PhD, Denmark This encompasses the three areas of where there is injury, is diagnosis of Craig Morris DC, United States importance to all athletes: the lesion and local tissue response. Lindsay Rowe DC, MD, DACBR, Australia • Hossein Sabbagh DC, Iran Managing injury – the fastest possible The second, far more complicated, is Louis Sportelli DC, United States recovery and rehabilitation, getting to diagnosis of the various dysfunctions Aubrey Swartz MD, United States the source of the problem throughout the locomotor system and Yasunobu Takeyachi DC, MD, Japan • Prevention of injury – most athletic which is primary, which are compensa- Changes of mailing instructions should be sent to tory. In the words of Liebenson and The Chiropractic Report, 203–1246 Yonge Street, injuries result from repetitive stress, Toronto, Ontario, Canada M4T 1W5, an accumulation of minor trauma and Skaggs “most individuals have many telephone 416.484.9601, fax 416.484.9665. overload, which finally leads to break- dysfunctions, some of which are adap- Printed by Harmony Printing Limited, 416.232.1472. down and injury. Chiropractic assess- tive and others mal-adaptive or com- Copyright © 2008 Chiropractic Report Inc. ment of biomechanical and neuromus- pensatory. Distinguishing between ISBN 0836-144 cular problems can prevent many such these dysfunctions is the essence of the injuries. functional examination, and it remains a most difficult art to master.” The cause ations – such as throwing, swimming, • Improved performance. It is because of pain “may be at some distance from weight training. of their success in this key area that the irritated pain generator (e.g. trigger b) From Michaud’s chapter Biomechan- chiropractors are now in such demand point or inflamed nerve root).”2 ics of the Foot and Ankle in a leading from elite athletes and their coaches. Following assessment comes skilled sports chiropractic text edited by Hyde However, what unique education, 4 manipulative and manual care, the and Gengenbach we learn: knowledge, perspective and clinical primary focus of chiropractic clinical • There are 28 bones and 55 joints/artic- skills do sports chiropractors bring to a training during five years of study. ulations in the foot and ankle full sports medicine team that has med- ical doctors, athletic trainers, physical 6. These are not skills that can be • They have different functions in the therapists and others? There are two acquired by other health professionals three stages of the gait cycle that is mea- major areas of unique education and in short postgraduate courses. To illus- sured from one heel hitting the ground clinical expertise – understanding and trate the complexity: until the same heel hits the ground managing the biomechanics of the neu- a) Today there are whole texts focus- again – the contact or landing period, romusculoskeletal system and, related ing on individual joints, such as Souza’s the midstance, and the propulsive to that, influencing neuromuscular con- Sports Injuries of the Shoulder: Conser- period. trol and performance. vative Management.3 Dr. Thomas Sou- • In the contact period the foot and 5. Clinical Biomechanics. The inter- za, of Palmer College of Chiropractic ankle are a mobile structure, dissipat- related biomechanics and function of West, San Jose, California which has a ing force and adapting to the ground the various parts of the body’s neuro- strong reputation in sports chiropractic, surface. When walking within one sec- musculoskeletal system represents a looks not only at the functional anato- ond the foot must become a rigid lever core field of chiropractic education and my and biomechanics of the shoulder in transferring weight from heel to fore- practice. Which joints, muscles and general, but also provides chapters on foot, when running within a fraction of other soft tissues are not functioning shoulder biomechanics in specific situ- a second. properly? If there are several dysfunc- • Richaud then provides 30 pages of
Page description of normal and abnormal c) 59 adults (age 18-27) were recruited is of central importance to improved muscle and joint function throughout from two professional Australian Rules sports performance – whether for exe- the different phases of the gait cycle. teams and randomly allocated to: cution of skilled movement or increase • The average person takes between • The control group – which continued in strength. With respect to strength for 10,000 and 15,000 steps daily, with each to receive standard club medical, para- example: foot absorbing 640 metric tons. It is, medical and sports science manage- • Rutherford demonstrated a 200% as Michaud observes, “easy to see why ment including medication, surgery, increase in quadriceps weightlifting even subtle biomechanical abnormali- manipulative physiotherapy, massage, ability after 12 weeks of training with ties might produce chronic injuries.” and conditioning and rehabilitation as extension exercises – however increase • Potential injuries are not only to the directed by club staff. in quadriceps strength, or maximum 6 foot and ankle – but also include shin • The intervention group – which isometric force, was only 11%. Much splints and soft-tissue strain in the received the above care, but also chi- of the improvement came from neural lower leg. ropractic management with a primary adaptation – better activation and con- trol of muscles through improved neu- • There are many different adjustive and focus on manipulation and/or mobiliza- rological function. manipulative techniques for the various tion and/or soft-tissue therapies to the joints, and such treatment may often spine, pelvis and lower extremity/leg. • Cross training studies show that where need to be combined with prescription This was on a minimum treatment the right arm is trained for increased of orthotics as discussed. schedule of one treatment per week for muscle bulk and strength, EMG record- 6 weeks, then one every 2 weeks for 3 ings demonstrate increased strength As suggested, an understanding of foot months, then on treatment monthly for in both the right and left arms. The left and ankle and other human biome- the remaining 3 months of the football arm benefits through central neural chanics – and how to assess and treat season. adaptation – improved neurological abnormal function – requires special- function on the opposite side of the ized education and is not gained from d) Injury definition and surveillance body mediated by the central nervous short postgraduate courses. were based on the AFL’s injury surveil- lance system, with injury diagnoses system. 7. The linked nature of the whole neu- determined by club staff blinded to Any loss of neuromusculoskeletal con- romusculoskeletal system, the impact which treatments had been received. trol and co-ordination is of significance of altered biomechanics in one part of to elite athletes, including sub-clinical the system on another, and the benefits e) After the trial period and 24 matches impairment. The sports chiropractor possible from chiropractic assessment there was a significant difference in has two roles when she or he addresses and management, are all illustrated in favor of those in the sports chiroprac- dysfunction – correcting biomechani- a recent study from Australia. This is a tic intervention group with respect to cal fault (here the chiropractor may be randomized controlled trial by Hoskins, the incidence of injuries and time lost seen by analogy as the mechanic) and Pollard and Bonello from Macquarie to injuries – hamstring injury (4 lost correcting its neurological impact (the University in Sydney which tested the weeks in intervention group vs. 14 chiropractor as the telecommunications results of adding chiropractic to other weeks in control group); lower limb expert). sports medicine services for profession- muscle strain (4 vs. 21) and non-contact al football players.5 There were much knee injury (4 vs. 24). The intervention fewer hamstring injuries and lower limb group also experienced significantly less C. Education muscle strains, and significantly less low-back pain. No adverse outcomes or 9. Accredited chiropractic colleges time lost to these and non-contact knee results were reported. worldwide have consistent minimum injuries, for those receiving preventive f) Hoskins et al. conclude that the addi- standards monitored by the Councils chiropractic care. Details are: tion of a sports chiropractor to a medi- on Chiropractic Education Interna- a) As Hoskins et al. explain, hamstring cal team appears to be beneficial for the tional (CCEI). These are the standards injuries are the most prevalent and prevention of injuries and improved adopted by legislation as the basis for recurring injuries in running-based health status in elite Australian Rules registration or licensure in the many power sports, including Australian players. countries that now regulate the practice Rules football. Conventional injury 8. Neuromuscular Control. A central of chiropractic. All chiropractors gradu- prevention focuses on local hamstring contribution of chiropractic to health ating from these colleges are qualified factors. These include poor flexibility, care has been the appreciation that to practice in the field of sports chiro- fatigue, lack of warm-up and weakness. biomechanical disturbances in the practic, and many of the sports chiro- However there is very limited scientific joints, especially of the spine which practors that work with elite athletes evidence to support these as risk factors encircles the central spinal cord and is and have established reputations have for injury. intimately linked to the spinal nerve no postgraduate qualifications other than practical field experience. b) The goal of the trial was to investi- roots, can irritate the nervous system gate whether or not a manual therapy through mechanisms of torsion, stretch However postgraduate qualifications intervention from a sports chiropractic and compression. This may result in have been established within the profes- approach could reduce local and non- sustained abnormal reflex activity, and sion, and are increasingly required as local risk factors, prevent hamstring and other interference with the ability of the credentials for participation at major other lower limb injuries, decrease low- nervous system to adapt to and benefit games. Internationally FICS offers an back pain, and alter health outcomes for from training. International Chiropractic Sports Sci- elite footballers. Neuromuscular adaptation and training continued on page 6
Page The Chiropractic World
Golf Injuries In cardiology practice palpation is commonly used to classify continued from page 1 patients with chest pain, and previous research has reported a link between reproducing chest pain on palpation and a non- cardiac origin or cause of pain. What is new in the present study playing golf, about 1 in 3 (35%) reported pain that interfered is that patients with chest pain or tenderness on palpation were with their enjoyment of the game. Most common areas of dis- tested for ischemic heart disease by myocardial perfusion scin- comfort after playing were the back (26%), feet (11%), shoulder tigraphy (MPS) imaging and demonstrated to have less disease (9%), knee (8%) and neck (6%). and more normal perfusion than other patients. • Over half (56%) already exercised regularly to maintain their Palpation was performed on 14 points on the anterior chest wall physical condition, but approximately half (47%) said they as described, and in accordance with a protocol previously pub- would also be willing to attend a specific golf fitness program. lished by Henrik Christensen DC, MD, PhD et al. MPS imaging scans Stude et al. reference much interesting research relevant to golf were read by 2 experienced observers who were blinded as to injuries which suggests: the results of the chest palpation. • The repeated one-sided swinging action in golf – which gener- (Kumarathurai P, Farooq MK et al. (2008) Muscular Tenderness ates club head speeds of 100 mph/160 kmh in less than 0.2 of a in the Anterior Chest Wall in Patients with Stable Angina Pectoris second – frequently leads to biomechanical and musculoskel- is Associated with Normal Myocardial Perfusion J Manipulative etal problems. (The new survey supports that.) Physiol Ther 31: 344-347) • Amateur golfers most frequently complain of back pain/inju- ries, professional golfers most commonly of wrist pain/injuries. Foot and knee problems are also common. WHO Congress on Traditional Medicine • Lower extremity and back problems may be related to use of 7–9 November 2008, Beijing, China standard spiked golf shoes that restrict movement, stress joints, and are not adapted to the needs of the individual. In a previ- Co-sponsored and hosted by the ous study Stude and Brink provided golfers with custom-casted Ministry of Health of China and orthotics for 6 weeks. This was shown to improve balance and State Administration of Traditional Chinese Medicine proprioceptive symmetry, reduce fatigue associated with play- ing 9 holes of simulated golf, improve gait patterns by influenc- ing pelvic rotation and stride length, and improve performance Symposium on Manual Methods of Health Care in terms of club head velocity and driving distance. (See the Organized by the main article for another chiropractic study – a controlled trial from Brazil – showing improved driving swing range and dis- World Federation of Chiropractic and tance after chiropractic care.) Wangjing Hospital of TCM Beijing Co-sponsored by (Stude DE, Hulbert J, Schoepp D (2008) Practice Behaviors, , Attitudes, Musculoskeletal Complaints, and Previous Exposure to European Chiropractors Union, British Chiropractic , Chiropractic Care in a Group of Recreational Golfers J Manipulative Association, and Chiropractors Association of Australia Physiol Ther 31: 313-318) Featuring: Other Research Notes • Opening Ceremonies, People’s Great Hall, Tiananmen Square 1. Angina Pectoris or Musculoskeletal Dysfunction – Den- – 2,500 people, welcome from Dr. Margaret Chan, Director- mark. A continuing line of research by chiropractic and medical General, World Health Organization researchers at the University of Southern Denmark is looking at • Symposium on Manual Methods of Health Care, November ways of identifying the many patients with suspected angina 7-8 – featuring chiropractic, osteopathy, tuina, nuad Thai, judo pectoris, and referred to cardiologists for further assessment, therapy, Swedish massage, etc who in fact have a musculoskeletal problem mimicking heart • Symposium on Acupuncture and Symposium on Herbal disease. Medicines, November 7–8 A new study by Kumarathurai et al. involving 273 subjects with • International Forum on Integration of TM/CAM into known or suspected stable angina, and also self-reported chest National Health Systems, November 7–8 pain, finds that the presence of tenderness in response to a stan- • Visits to TCM hospitals – November 9 dard pattern of palpation of the anterior chest wall is associated with normal myocardial perfusion imaging. Significantly more • Tours of Beijing, Great Wall and Xian Terracotta Warriors patients with such tenderness appear to have a musculoskeletal – during and post Congress origin for their suspected heart problem – and this association cannot be explained by other factors such as age, sex or self- For all information visit: reported pain. www.wfc.org/WHOBeijingSymposium
Page News and Views
2. Rib Manipulation for Tachycardia – USA. Published in JMPT eastern Australian states, including her home state of Victoria, at the same time as the new Danish study is a case report from and for formation of the International College of Chiropractic. Dr. Mary Rose Julian, in private chiropractic practice in Reston, This, Australia’s first school of chiropractic and a necessary devel- Virginia, which suggests a relationship between supraventricular opment for legislative success, is now the RMIT School of Chiro- tachycardia (SVT) and misalignment of the fourth rib. Instru- practic in Melbourne, Victoria. ment-assisted manipulation of the fourth rib brought rapid As World Federation of Chiropractic President Dr. Stathis Papa- and reproducible return to normal heart rate, and reduced dopoulos of Cyprus said in his letter read at her funeral, “Mary occurrences of paroxysmal SVT, to a man in his 50s over a 6 year Ann . . . demonstrated a rare and inspiring level of service, com- period. mitment and passion for the chiropractic profession . . . we will The patient had his fourth and fifth ribs on the right separated 3 all miss her greatly.” Dr. Chance is survived by her husband Dr. cm during successful mitral valve repair surgery. However post- Peters and four sons by her former husband Dr. Frank McCleod, operatively he began experiencing episodes of SVT 5 or 6 times who was a student with her at Palmer weekly for up to 20 minutes. Symptoms included rapid pulse, Canada: Last month Jason Busse, DC PhD, became the latest vertigo and head tremor. At first he endeavored to manage this Canadian Chiropractic Research Chair at a leading public uni- with standard medical treatments, including medications and versity – as an epidemiologist at the Department of Health physical maneuvers. Research Methodology, McMaster University, Hamilton, Ontario. On chiropractic examination palpation revealed a superior Under a well-planned and successful Canadian Chiropractic misalignment of the right fourth rib that was painful to palpa- Association (CCA) project led by Dr. Allan Gotlib, there are now tion. Following specific instrument-assisted manipulations as similar Chiropractic Research Chairs at six major universities described, symptoms subsided within 2 minutes. Frequency of across the country, with each researcher having matching fund- episodes of SVT was reduced to 2 or 3 per month. Over 6 years ing from the CCA and the federal government, and producing there was consistent manipulation of the rib, and consistent publicly funded research directly and through DC PhD students rapid results following treatment. working with them. Julian discusses hypotheses for the results achieved, which The goal, not now far off, is to have a Chiropractic Research Chair include autonomic and mechanical mechanisms. One is that at a major university in every Canadian province. Two optional activation of muscle spindle cells from the manipulative impulse sessions at the World Federation of Chiropractic’s 10th Biennial may have caused a proprioceptive response – which has been Congress in Montreal next year, a Congress co-sponsored and shown to have the potential to increase vagal tone in animals. hosted by the CCA, will feature short presentations on their work Another is that the stimulation of intercostal muscles might by these leading chiropractic scientists who have won research affect autonomic output and alter cardiac function. Another is chairs. Get ready to be very impressed by the quality of what that associated mobilization of T4 may have affected the gangli- you will hear there. For all information on the Congress visit on at that level which supplies autonomic outflow to the heart. www.wfc.org/congress2009. There are apparently over 1 million people in the US with PSVT. China: Hong Kong’s two chiropractic associations, each with 40– Drug therapy has limited effectiveness, and unwelcome toxicity 50 members, are working with doctors of chiropractic in the rest and side effects. Up to 75% of patients, Julian reports, are unable of China in the formation of a new Chiropractors’ Association to control symptoms with physical maneuvers. Here is a safe of China (CAC). Dr. Henry Chan (Palmer), President, Hong Kong alternative without side effects for consideration with hemody- Chiropractors’ Association (HKCA) and Dr. Vincent Chan (CMCC), namically stable patients. Like all good case reports, this offers President, Chiropractic Doctors’ Association of Hong Kong an interesting new prospect but needs confirmation in larger, (CDAHK), were both at a WFC hosted meeting in Seoul, Korea on controlled studies. June 6 where the decision to form a CAC was made. The Orga- (Julian MR (2008) Treatment of Paroxysmal Supraventricular nizing Committee comprises Dr. Anli Dong (Sherman) of Beijing, Tachycardia Using Instrument-Assisted Manipulation of the Fourth Chair; Dr. Henry Chan (Palmer) of Hong Kong (HKCA); Dr. Albert Rib: A 6 Year Case Report J Manipulative Physiol Ther 31: 389-391) Leung (CMCC) of Hong Kong (CDAHK); Dr. David Leung (CMCC) of Macao; Dr. David Bellin (Life) of Zigong. World Notes The CAC and the WFC are now producing a Chinese translation of the WHO Guidelines on Basic Training and Safety in Chiro- Australia: Dr. Mary Ann Chance, one of the profession’s fore- practic with a view to these being available for registrants and most leaders in Australia, passed away on June 12. Dr. Chance government authorities at the time of the WHO Congress on was a 1959 Palmer graduate who had a distinguished career in TM/CAM in Beijing November 7-9, 2008. clinical practice, then in leadership of the Australian Chiroprac- tors’ Association in the 1970s and 1980s, and then since 1983 as If you are a DC in China, or are aware of DCs in China, not known co-editor of the Chiropractic Journal of Australia with her hus- to Dr. Anli Dong and the WFC, please send contact informa- band Dr. Rolf Peters. tion to Dr. Dong at [email protected] and Serena Smith at [email protected]. From the mid-1970s Dr. Chance was part of the team that fought successfully for chiropractic legislation in all the unregulated
Page Main Article continued from page 3 ences Diploma (ICSSD), with information on courses at www. b) South Africa – Chronic Ankle Instability. In a small fics-sport.org. In Canada only those who have completed a but well-designed trial with 30 subjects Price, Kohne et al.9 300 hour plus practicum fellowship can become fellows of the reported that chiropractic manipulation of the talocrural Canadian College of Chiropractic Sports Sciences. In the US, or ankle joint improved both proprioception and range of there is a 100 hour plus practicum Diploma of the American motion in dorsiflexion, thereby assisting in the prevention of Chiropractic Board of Sports Physicians (DACBSP). Murdoch repeat ankle strains in patients with chronic ankle instabil- University in Australia is now offering a Masters in Sports ity. Their findings, they note, “support previous studies that Chiropractic, and other masters degree programs are in devel- found manipulation to be efficacious in the treatment of ankle opment in the UK (Anglo-European College of Chiropractic) sprains and chronic ankle instability.” and the US (Life University and Logan College). c) Australia – Shoulder Pain. Pribicevic and Pollard10 tested Dr. Ted Forcum of Beaverton, two chiropractic management protocols for the conservative Oregon, himself a gifted middle- management of shoulder pain in the following controlled trial: distance runner, is one of the US • 42 subjects with shoulder pain (age 18-45) were randomized Team Doctors for the Beijing into three groups – a control group (n 12) that received 10 Olympics. Here is his description minutes of ultrasound at a zero setting, a manipulation group of the USOC requirements he has (15) that received Diversified manipulation to the thoracic completed over a 10 year period to and/or cervical spine and/or the glenohumeral joint, and a 7 gain this status : multimodal group (15) that received chiropractic manipula- • Prior to application, a sports tion as above plus soft-tissue therapy (ischaemic compression/ related postgraduate qualification, friction) and electrotherapy. Treatment for all subjects was 8 a minimum of 5 years experience visits over 4 weeks. as a team doctor, and national • Outcomes measured were patient perception of pain (VAS level experience at a world class scale), orthopedic range of motion (pleurimeter and goniom- sporting event. Dr. Ted Forum, US Team Doctor, Beijing Olympics eter) and orthopedic tests (Hawkins and Neers, painful arc • A 2 week internship at the USOC and Jobes). Assessments were made at baseline, 4 weeks and 4 training center in Colorado Springs – served by him in 2004. months by a blinded research assistant. • USOC assignment to a major games – for him the Pan • There was clinically and statistically significant improvement American Games in Rio de Janeiro, Brazil in July 2007. for subjects in both treatment groups on all outcome measures at 4 weeks and at 4 months, but not for those in the control D. Research group. Those in the multimodal group had superior results in pain reduction and on orthopedic tests. 10. The main focus of sports chiropractic research is, natu- rally enough, the clinical results of chiropractic management • Pain in the multimodal group was decreased from 6.7 out of – both for performance enhancement and prevention and 10 at baseline to 1.8 after 4 weeks and 1.4 after 4 months. This management of injury. This can be seen in four new trials compared with 4.9 to 2.3 then 2.6 in the manipulation group, reported at last year’s major original research meeting for and 4.4 to 3.8 to 4.2 in the control group. the chiropractic profession, the International Conference on • Pribicevic and Pollard conclude that both treatment Chiropractic Research held as part of the World Federation of approaches, and particularly the multimodal one, are ben- Chiropractic’s 9th Biennial Congress in Portugal in May 2007, eficial for managing pain from the synovial structures of the jointly administered by the WFC and the Foundation for Chi- shoulder and/or shoulder girdle. Note again the chiropractic ropractic Education and Research (FCER). approach of addressing related structures in the musculoskel- One was the Hoskins, Pollard et al. trial already discussed. The etal system, not just the source of pain. other three are: a) Brazil – Swing Performance in Golfers. Bracher, Costa et E. FICS al.8 evaluated the effect of chiropractic manipulation on per- 11. The Federation Internationale de Chiropratique du Sport formance enhancement/range of swing in competitive golfers. or International Federation of Sports Chiropractic (FICS) • 43 golfers from two Sao Paulo clubs, all of whom had a is the international organization representing the specialty handicap under 15 and practiced golf for a four hour period of sports chiropractic. Formed in 1986, its headquarters are at least once a week, were randomly assigned to either the at the House of Sport in Lausanne, Switzerland which is the experimental group (supervised stretching program plus chi- home of the Olympic Movement, its offices and museum. ropractic manipulation for joint dysfunctions) or a control The voting members of FICS are national sports chiroprac- group (stretching program only). tic associations or councils (NCSCs), national chiropractic • All subjects performed full swing assessment as recommend- associations, colleges and student sports councils. Non-vot- ed by the PGA (three full swing maneuvers with a driver, ing members are individuals and other organizations. More with full swing ball range considered as the average distance) details, and application forms may be found at www.fics-sport. before and after treatment on each of four treatment days. org. FICS’s goals include: • On each of the four days an improvement in average full • Establishing relationships with international sports federa- swing performance was observed in the experimental group tions representing individual sports (e.g. FIFA representing only, and by the fourth day the improvement was statistically football), organizations responsible for major games (e.g. Pan significant. American, World, Olympics) and organizations for athletes (e.g. World Olympians Association, representing present and
Page left FICS archery, karate, rhythmic gymnastics, roller hockey, sumo President Dr. wrestling. Under contract with the Organizing Commit- Roland Noirat tee FICS provided a team of sports chiropractors for the last of Lausanne, World Games, in Duisberg, Germany in 2005. Under a similar Switzerland contract FICS will provide a team of 25 chiropractors for next right FICS News year’s Games. Editor Dr. Tom Hyde of Miami, c) Masters Games – Sydney, Australia, October 2009. These Florida, USA are the Games for masters’ athletes who, depending upon the sport, may be as young as in their 30s – as in swimming. Again, FICS is selecting and credentialing a team. The Masters Games administration, like FICS, the IOC Medical Commis- past Olympians), to promote access to chiropractic services sion and many others influential in international sports, has for athletes. its office in the House of Sport in Lausanne. • Promoting postgraduate education and research in sports d) South East Asian Games – Vientiane, Laos – November chiropractic. It does this in part through its Education Com- 2009. Over 3,000 athletes will attend these regional games. Dr. mission, currently chaired by Dr. Tim Stark of Murdoch Martin Camara, Chair, FICS Communication Commission, University, Perth, Australia, and its Research Commission, has been invited to arrange sports chiropractic services for the currently chaired by Dr. Henry Pollard DC, PhD of Macquarie athletes. Dr. Camara, who serves as a member of the Philip- University, Sydney, Australia. FICS offers postgraduate educa- pines National Olympic Committee, was also a team doctor tion through its International Chiropractic Sports Sciences for the Philippines team to the Asian Games in Doha, Qatar Diploma (ICSSD) program. Several of its Education Commis- last year. sion members are faculty at chiropractic colleges currently developing masters degree programs in sports sciences (e.g. 13. FICS is currently experiencing rapid growth and invites Murdoch University, the Anglo-European College of Chiro- your participation and support. Until this year it has had no practic in the UK, and Life University and Parker College in fulltime staff support because of limited resources. However, the US). because of the importance of sports chiropractic to the profes- sion as a whole and the evident need to develop education, 12. Chiropractic Services at Major Games. Chiropractic ser- research and practice in this key field, the World Federation of vices at the Olympics have generally been arranged at the Chiropractic (WFC) has entered into a new partnership with national level. This has been the case for the Beijing Olympics FICS. in August, and the Vancouver Winter Olympics in 2010, for which the Canadian College of Chiropractic Sports Sciences Under this the WFC is supplying staff and administrative sup- has already arranged the availability of chiropractic services port from its offices in Toronto, Canada. During the past year for all athletes at the main treatment facilities as part of the there are new FICS Statutes providing for an expanded Coun- core medical team. However FICS is also working with the cil and new membership categories, and new committees or IOC and its Medical Commission to ensure that properly cre- commissions as shown in Table 1. The next FICS Assembly dentialed sports chiropractors and their services remain avail- Table 1: FICS Commissions able for athletes at all future Olympics. Commission of Communication (CoCOM) Commission of Games (CoGAM) Other games for which FICS is organizing a sports chiroprac- Martin Camara, Chair – Philippines Tim Ray, Chair, ExCo – USA tic team for 2009 include: Mustafa Agaoglu – Turkey Marcelo Botelho – Brazil a) Mediterranean Games – Pescana, Italy, June 2009. Follow- Gaery Barbery – Australia Tom Greenway – United Kingdom ing discussions at the annual meeting the General Assembly Philippe Fleuriau – France Charmaine Korporaal – South Africa Tom Hyde, Editor, FICS News – USA Gregory Oke – New Zealand of International Sports Federations (GAISF) held in Athens Annette Joergensen – Denmark George Oxinos – Cyprus in June, the Organizing Committee and its Medical Director Yolanda Camacho Kortman – Costa Rica Alex Steinbrenner – Germany have asked FICS to provide sports chiropractic services for Octavio Terrazas Rios – Mexico Robert Wassermann – Singapore these regional games. Philippe Roulet – France Sheila Wilson – USA b) World Games – Kaohsuing, Taiwan, July 2009. Theses Commission of Education (CoEDU) Commission of International Sports Games, held under the patronage of the IOC, feature 30 popu- Tim Stark, Chair – Australia Federations (CoIFs) lar sports seeking admission to the Olympic Games, such as Rikke Craven, Co-Chair, ExCo – Denmark Alex Steinbrenner, Chair – Germany John Downes – USA Roland Noirat, ExCo – Switzerland Gordon Lawson – Canada Angela Salcedo – USA FICS team at the Brian Nook, ExCo – Australia World Games, Commission of Research (CoRES) Ed Rothman – United Kingdom Henry Pollard, Chair – Australia Duisberg, Dik Skippings – United Kingdom Eduardo Bracher – Brazil Germany, 2005 Ken Thomas – USA Jay Greenstein – USA Commission of Ethics (CoETH) Charmaine Korporaal , ExCo – South Africa Carla How, Co-Chair – United Kingdom Craig Liebenson – USA Susan Bromley, Co-Chair – USA Craig Morris – USA Roland Noirat, ExCo – Switzerland Thomas Souza – USA Commission of Finance (CoFIN) Christopher Wegelin, Chair – Switzerland Sherri LaShomb, Chief of Finances, ExCo – USA Howie Fidler – USA Fabrizio Mancini – USA
Page of Members and Research Symposium will be held together a full understanding of the physical demands of the sport and with the WFC Congress in Montreal next April 29-May 2. common injuries. As a doctor of chiropractic he volunteered This is being organized by one of the strongest national sports his services at local then national competitions, and was chiropractic organizations, the Canadian Chiropractic College increasingly consulted by sailors as patients. Next came an of Sports Sciences, and generously sponsored by Life Univer- invitation to work with the Canadian Sailing Team – and now sity and Palmer College of Chiropractic. Confirmed speakers the Beijing Olympics. He and his partner Dr. David O’Connor include Jack Taunton MD and Robert Armitage DC, the chiefs will also work with the Canadian Gymnastics Team. In this of medical and chiropractic services for the Vancouver Olym- case neither has a personal background in the sport – simply pics. a pattern of volunteer service leading to an established repu- If you have a sports chiropractic side to your practice, or sim- tation for ability to work within a sports medicine team to ply understand the importance of this area of practice to the enhance performance and minimize injury. future of the profession and wish to support its growth to full 15. Inman and Ralston, sports scientists at the Biomechanics maturity: Laboratory at the University of California at Berkeley who are • Visit www.fics-sport.org to learn more about FICS, and read quoted at the beginning of this article, have published a text recent issues of the FICS News. titled Human Walking. This gathers and summarizes 35 years of data on normal and abnormal walking funded by the US • Download a membership form and join as an individual National Institutes of Health and other agencies. This demon- member at an annual cost of US$50-00. strates conclusively, they conclude, that the loss of function in • Make plans to be at the FICS Assembly and Symposium, and any part of the neuromusculoskeletal system “leads to com- the WFC Congress in Montreal, next April 29. Registration pensatory changes in the remaining functional parts.”1 Put- forms for both events are now at www.wfc.org/congress2009. nam and Kozey say the same when studying running, and that any biomechanical analysis that treats the joints and segment F. Conclusion motions “as if they were independent of each other” is “clearly 11 14. Most chiropractors become involved in sports chiropractic inappropriate.” the same way as Dr. Timothy Marshall of Toronto, who will This is the core contribution of the sports chiropractor to the be going to the Beijing Olympics with the Canadian Sailing sports medicine team and athletes – the ability to find the key Team. That means a combination of a background in sport, joint and/or soft-tissue dysfunction or dysfunctions from an a willingness to provide volunteer services without charge to overall assessment of the NMS system, and to treat that with amateur athletes, and an appreciation that chiropractic offers a skilled manual and other conservative care. TCR unique and valuable approach to the assessment and manage- ment of dysfunction and injury in the neuromusculoskeletal References system in athletes. 1 Inman VT, Ralston HJ (1981) Human Walking, Williams and For many years Dr. Marshall was a competitive sailor, gaining Wilkins, Baltimore. 2 Liebenson C, Skaggs C (2006) The Roles of Rehabilitation and Exer- cise in Chiropractic Practice, Chapter 46 in Principles and Practice of SUBSCRIPTION AND ORDER FORM Chiropractic, ed Haldeman SH, Lippincott Williams and Wilkins, (6 bi-monthly issues) Year commences January Baltimore. Check one 3 Souza TA (1998) Sports Injuries of the Shoulder: Conservative Man- US and Canada 1 year $110.00 agement, Churchill Livingston, New York. (your currency) 2 years $199.00 4 Michaud TC (1997) Biomechanics of the Foot and Ankle, Chapter Australia 1 year A$130.00 15 in Conservative Management of Sports Injuries, ed Hyde TE and 2 years A$245.00 Gengenbach MS, Williams and Wilkins, Baltimore. Europe/elsewhere 1 year US$115.00 5 Hoskins W, Pollard H, Bonello R (2008) The Effect of Sports Chiro- 2 years US$210.00 practic on the Prevention of Athletic Injuries in Elite Athletes: A Ran- domized Controlled Trial, J Manipulative Physiol Ther. Name 6 Rutherford OM (1988) Muscular Co-ordination and Strength Train- ing:Implications for Injury Rehabilitation, Sports Med 5: 196-202. Address 7 FICS News, June 2008. City Province/State 8 Bracher ESB, Costa SMV, Yumi ET et al. (2007) Effect of Spinal Country Postal Code/Zip Manipulative Therapy on Full Swing Performance in Golf Players: A Telephone ( ) Randomized Controlled Trial, Abstract, Proceedings of the 9th Bien- nial Congress, World Federation of Chiropractic, 240. PLEASE CHECK ONE 9 Price JE, Kohne E et al. (2007) A Prospective Randomized Con- Visa Card number trolled Clinical Trial of the Effects of Manipulation on Propriocep- MasterCard Expiration date tion and Ankle Dorsiflexion in Chronic Ankle Instability Syndrome, Cheque/Check enclosed Abstract, Proceedings of the 9th Biennial Congress, World Federa- tion of Chiropractic, 171-173. Payable to: The Chiropractic Report 203–1246 Yonge Street 10 Pribicevic M, Pollard H (2007) A Randomized Controlled Clinical Trial of Chiropractic Treatment for Shoulder Pain, Abstract, Proceed- Toronto, Ontario, Canada M4T 1W5 ings of the 9th Biennial Congress, World Federation of Chiropractic, Tel: 416.484.9601 Fax: 416.484.9665 169-170. E-mail: [email protected] 11 Putnam CA, Kozey JW (1989) Substantive Issues in Running, Website: www.chiropracticreport.com Chapter 1 in Biomechanics of Sport, ed Vaughan CL, CRC Press, Boca Raton, Florida.
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