by Dr. Tim Maggs and Coach Al Miller © 1999
(This is the first in a series of three articles by Dr. Maggs and Coach Miller for Chiropractic Products Magazine)
Chiropractic has gained significant visibility and popularity in all sports in the past 10 years. Coaches and athletes are now beginning to appreciate the importance of biomechanics, balance and full motion in all joints of an athlete. After all, keeping players well is the sole objective of a team's medical staff.
Most chiropractic benefits seen to date actually pale next to the true potential chiropractic has to offer all sports. Under the assumption that no other professional is as well equipped as the chiropractor to evaluate, diagnose and treat the biomechanics of an athlete, the time is now for chiropractors to envision their role as an authority in the locker room. A qualified chiropractic protocol needs to be established as well as the development of cooperative relationships with other members of the medical staff working for the team. That necessary protocol consists of a plan of treatment originating from a thorough pre-season evaluation, including history, examination and necessary standing x-rays. This is followed with a report clearly communicated to the athlete outlining what recommendations and treatment will be required to make objective biomechanical improvements during the course of the season and then the management of that athlete throughout the season. Although this requires tremendous confidence and managerial skills, this is the role now available to the chiropractor in the locker room. This is a far more comprehensive approach to treating the athlete than simple symptomatic treatment when an athlete feels the need to be adjusted. In order for chiropractic to gain the respect it deserves, it must prepare itself to become the biomechanics authority it claims to be.
Once a thorough history and exam is completed on the athlete, the chiropractor must then develop a program in conjunction with the strength and conditioning department so that all personnel involved in the conditioning and treatment of this athlete are working towards the same short term and long term goals for the athlete.
Newer Heights and Higher Visions
While chiropractic is by far the most qualified profession to locate biomechanical faults and correct them, many sports chiropractors have fallen victim to providing treatment based only on symptoms, thus competing with all allopathic counterparts. Although we tend to still see ourselves as treating the cause of the problem, in truth we are merely treating "the pains", but using chiropractic manipulation as the medicine.
Many pro teams have chiropractors on staff to provide manipulation to players. Players, however, often are the ones who decide when and how frequently treatment is needed. While this involvement in the locker room is truly a success for chiropractic to be included with the trainer, physical therapist, orthopedist, dentist, massage therapist and a host of other professionals, this limited role should never be accepted as the ultimate objective. Chiropractic is capable of offering so much more. And if the profession can fully grasp their potential as the biomechanical experts in the arena of the pro locker room, they can then take that protocol to the colleges, high schools, grade schools and mass market. Every athlete wants the very best care they can get, and chiropractic has an opportunity to be a primary contributor to that care.
To gain this recognition and respect, chiropractors first must elevate their protocol to help the athlete attain higher levels of success. The athlete should never be the one determining frequency of treatment. All treatment considerations should be based on history, examination and appropriate standing x-rays. Once x-rays are marked and all information is reviewed, a season plan needs to be structured for that player for the coming year. Many chiropractors are unable to manage an athlete through 3-6 months worth of acute care, rehab and conditioning care. These shortfalls will prevent the profession from gaining the level of respect desired. But, if the profession can adapt a protocol which promotes management of the athlete through objective changes in biomechanics as well as improved communications with the staff and athlete, chiropractic will succeed in a large way in the sports world.
In the pro locker room, as well as colleges and many high schools, the strength and conditioning department is in charge of assessing all players in pre-season with periodic evaluations throughout the season. The strength coach is then responsible for determining what pace an athlete can become conditioned and the specific conditioning program appropriate for each athlete. The ultimate key to success is based on the coaches ability to manage that player before and during the season. A successful Strength Coach provides those exercises which help educate an athlete's nervous system. A successful Chiropractor locates and removes interference to that athlete's nervous system. Working hand in hand is critical.
Chiropractic must couple their efforts with the strength and conditioning coach for the good of the athlete. Both parties have tremendous interest in the biomechanics, joint motion, balance and skills of the player, and some of the testing is identical. But, both parties also provide totally diverse biomechanical benefits to the athlete, and joining forces will help create an exponentialism of benefits for both athlete and team.
Chiropractic Athlete/Patient History
The chiropractic history must not only focus on the present list of symptoms or injuries, but should also consider prior injuries. Keeping in mind that chiropractic has been very limited to many athletes currently involved in sports, the likelihood is strong that prior injuries, especially those to the spine, are still evident through limitations in the normal range of motion and creates an increased vulnerability to re-injury. Secondly, much of the chiropractic care given may have been symptom based care, and the actual fixations and restrictions of certain joints may still exist.
Balance, range of motion and symmetry are key issues when performing an athletic exam. If current standing x-rays have not been taken or are not available, new x-rays should be taken of the cervical spine, the lumbo-sacral spine and pelvis. Hip joints should always be included. Detecting positive objective structural findings, both on the exam and x-rays, is critical in motivating and educating the athlete to participate in a complete corrective care program. Without objective findings, it becomes much harder to convince an athlete of the benefits of complete chiropractic care.
Assessment in the Strength and Conditioning Department
When a new player comes to the team, one of the first things done is to review his medical jacket, which is a log of all prior injuries and treatments. Most players have gone through the Indianapolis Combine, which provides significant physical information on the player. When prior injuries exist, an in-depth history will then be taken by both the trainer and strength coach. A former strength coach may be contacted by the new team to determine what a player can and can't do. The player is then asked what he can do, what he feels comfortable doing and exactly what his psyche is with any existing injury.
At this point, a visual physical exam takes place, checking out the shoulders, the hips, the alignment of the spine, the gait as they walk to and from, the foot placement as they run and move and the entire kinesthetic circle of movement. Very little, if any, weighted movement will be done in the first week.
Balance and strength are critical components of an athlete's conditioning. One legged squats are used to check for both, while also determining ankle and knee flexibility. Football, for example, is a one legged game, and without one legged strength, a player will never make it. These two areas are further tested with a teeter board squat, or a prisoner's squat, which is a series of squats with the athlete's hands behind their head and then in front of them. This immediately tells the flexibility or inflexibility of a players hips. In the game of football, if hips are tight and restricted, a players movement will be severely compromised, especially, a defensive back, wide receiver or running back. Tight hips also hinders the explosive ability of an offensive or defensive lineman. Finally, with the teeter squat, if a player teeters one way or the other, restrictions or pains in one or both ankles should be considered.
A player is then asked to perform a solid hold for one minute on the low back hyperextension machine. This will check for strength in the low back, hips and hamstrings. It's important to watch a player during this exercise as weaknesses produce deviations during the exercise. One minute is a reasonable time to quickly assess the strength of an athlete.
During any evaluation process, both physical and psychological are looked at very closely. If an athlete can't perform specific exercises, but has a tremendous amount of "want to", they are termed a medical reject. On the other hand, a player who can perform but is unwilling to is a much more serious problem. This is the infestation of "don't want to work attitude".Sports is a working business. You must have athletes who are willing to work at all times and improve.
Chiropractic Report of Findings
In a report of findings, athletes tend to want to know how to get rid of pain so they can quickly get back. Although pain is important and current injuries must be of primary concern, long term structural improvements should always be the ultimate goal for the athlete. The first objective is to "put out the fire". Immediate reduction of symptoms, through treatment, physical therapy, ice/heat, nutritional supplementation or medication, restriction of activity and whatever other recommendations are needed should be implemented first. This period can last anywhere from one to eight weeks. However, once reduced, structural improvements should then become the primary concern. This is where chiropractors can begin to separate themselves from the rest of the medical staff and improve their relationship with the strength and conditioning departments. Management and communication skills become paramount.
The second phase of care, "rehabilitation", should take all positive objective findings and develop a program that will help turn those positive findings into negative findings. A positive Lasegue's, for example, will most often be eliminated once the first phase of care is completed. A severely increased sacral-base angle, however, as seen on a lateral L-S x-ray, takes a committed effort on both the athlete's and doctor's parts, and can only improve with proper treatment and exercise over a long enough period of time. This phase can last anywhere from 3-6 additional months, and re-x-rays should become a key component to determining what changes have taken place. Depending upon the degree of structural defects and the number of prior x-rays an athlete has had, at least one and maybe two sets of re-x-rays will be appropriate during and after this phase of care.
The final phase of care consists of whatever treatment and conditioning is needed to maintain the level of wellness which has been reached. With the work and effort that was put into the first two phases of care, it's important for an athlete to protect that investment and do whatever is necessary to maintain it. Frequency of chiropractic treatment will vary case to case, but will typically be a varying frequency. The benefits from a full rehabilitative program consist of less chance of re-injury or any new injury, a quicker recovery from injury and a greater ability to perform on a functional level.
Strength and Conditioning Program
Every athlete is like their own fingerprint. Recognition of weaknesses and strengths will greatly help in setting up a quality strength and conditioning program. A very successful program, working on order of development, was put together by Coach Al Vermeil, Head Strength Coach of the Chicago Bulls. This system works from a pyramid (Fig. 1), and begins at the base with Work Capacity. A sub-heading under this group is Body Composition. Many athletes come into camp with too much adipose tissue. They immediately begin on "the complex". This is a series of six exercises that are performed in succession with nominal weights. They include;
- Slow Movement/High Pull
- Muscle Snatch
- Good Morning Exercise
- Push Press
- Bent Over Row
These are done for 6 repetitions, in succession. An athlete will do a series of these ballistic movements, such as a squat and a push press, and they'll then come back immediately and perform a Saigon Squat, which is nothing more than just a squatting down exercise. Some athletes may have to grab a supportive rack for balance, but this set of exercises helps to dramatically open the hips, to the point where the athlete can get down to the ground.
Also in this base phase of conditioning are the aerobic and anaerobic categories. Of the two, the anaerobic is far more important. There are four parts to this program. There will be different types of runs performed and integrated with a core of exercises that are ballistic in nature with static stretches of 10 second durations. Once these are performed, a 40 yard run, such as a step over drill, will be done, and on the way back, the athlete will perform a backward skip. Another series of exercises will be done, and then another 40 yard run, this time, a side slide, which is just a straight legged slide movement. As the athlete becomes more conditioned, the number of repetitions will be increased.
With these exercises, an athlete will create more flexibility as well as small fiber work that can't be gotten in the weight room. With this, stability is greatly improved, which is important for all athletes. The key is to work in short bouts with repetitive numbers. This significantly cuts down on the fat of an athlete while improving flexibility.
The Work Capacity phase of the pyramid system sometimes takes an athlete 12 weeks to complete before moving on to the Strength Phase. If an athlete cannot perform the necessary moves, stretches and exercises required at the initial phase, it would be counter productive to move them to the second level of strength training. Many of the athletes who hold out on contracts miss this critical phase of development and ultimately end up injured. With proper time, discipline and willingness, an athlete will quickly move up the ladder to the ultimate phase, which is Speed.
An athlete is like a balloon. The stronger, faster and sometimes bigger they can become, the more successful they are. Unfortunately, when you blow up a balloon, there is a point where the balloon breaks. The same applies to athletes. The key is to push the envelope without breaking the athlete. Do everything that can be done so that the athlete can tolerate the conditioning as well as the sport itself. And use successful techniques to do this.
Chiropractic is the leading profession capable of recognizing and correcting structural defects. Based on the protocol outlined in this article, any athlete is capable of making significant improvements with most structural defects.
When these benefits are coupled with a solid conditioning program, either by a strength coach or a knowledgeable chiropractor, all athletes will have the potential to reach new heights. For chiropractors to treat purely on a symptomatic level and establish no relationship with strength coaches nor provide conditioning information to an athlete is insufficient. This is truly the time for all sports minded chiropractors to become far more involved with all local teams and establish the protocol that will provide the benefits that will help all athletes. It's time to improve both communication and management with the athletic community.