Pro Locker Room Conditioning For Kids Chiropractic's Integral Role

by Dr. Tim Maggs and Coach Al Miller © 2000

(This is the third in a series of articles co-authored by Dr. Tim Maggs and Coach Al Miller, Head Strength and Conditioning Coach for the Atlanta Falcons.)

The most underserved segment of our athletic population in this country has to be kids, age 6-14. This group of young athletes are conditioned and coached primarily by well intentioned dads. If there happens to be any type of pre-season examination, it will typically be done by the family doctor, whose exam might rule out anything from allergies to childhood diabetes, but will most likely never look at the biomechanics of this young athlete.

For many reasons, this gross oversight needs to be addressed. A young athlete's psyche, conditioning, understanding of physical injuries and prevention of sport related injuries can only improve if our current system demands better biomechanical awareness for our youths. Dads make sure there are no deaths during a game, but it's time we provide more sophistication, education and information to all of those involved. Once these kids reach high school, there is still a gross deficit in biomechanical and conditioning awareness, but if kids in elementary and junior high school can be introduced at a young age to the A, B, C's of physical wellness, then the program should carry over into later years.

Although there are many similarities between assessment and conditioning for both youths and adults, likewise, there are many differences. These differences need to be highlighted to those professionals who have the opportunity to work with this age group and promote the importance of improved knowledge, awareness and conditioning of the neuromusculoskeletal and biomechanical system. In short, each child entering the sports arena needs to be fully evaluated, informed of the structural corrections that need to be made, and managed through those corrections. An awareness of psychological influences will help any professional working with kids. As critical psychological and physical improvements are made, a more intense introductory conditioning program can be implemented.

Athletic Jacket

Every pro athlete has their own jacket. This jacket is a detailed diary of all injuries, treatments and improvements made during their pro career. This jacket follows an athlete wherever they go. If drafted, they have it with them. If taken in free agency, they have it with them. Simply put, it is their life history as an athlete, and that information is valuable to many people for many reasons.

Knowing the importance of this jacket, all athletes, including our kids, should start immediately tracking all of this valuable information. Having the ability to track biomechanical and psychological information becomes invaluable in many situations. Knowing what conditioning was done prior to certain injuries provides any coach or consultant with tremendous information. This seems only logical, as record keeping for all pertinent information can only help. It would contain each year's exam findings, subjective findings, illnesses, injuries, surgeries, medications, food supplements, etc. It would also document, as detailed as anyone would like, work-out programs done throughout the year. This would basically be a blue print of each child's athletic life, based around each year's biomechanical evaluations.

Once these evaluations are done, the findings must be interpreted properly and corrective treatments, therapies and exercises need to be employed. These treatments and modalities can and should extend into the season, in an effort to both improve any distortions found on the initial exam, as well as prevent any mid-season blow-out that might be avoidable with proper recommendations. And we should never lose sight of the bigger picture here; we want to help these young athletes develop into sound adults without the ramifications of burn-out and long term athletic abuse that so many retired athletes experience today.

The Tripod Evaluation

The overall fitness of youths in this country has greatly declined over the past 40 years. It should become everyone's responsibility to help seek improvement. Sports is one of the viable avenues to begin to make changes, as exercise and conditioning is an automatic component of any sports program. All this can begin with a sportsmedicine system willing to evaluate kids for more than classic medical conditions. A tripod program, consisting of 1) an understanding of the psychological profile, 2) a full biomechanical evaluation and 3) a logical fitness/conditioning program based on the sport of interest or fitness level of the child.

It is important to establish a communication and rapport with all kids you work with. If working with a group, it's easy to hide behind a group presentation and never really have to look each and every child in the eye, but individual success goes way up if each and every child is looked at and communicated to independently. Remember, each child/athlete is moved by reasons totally unique and different from the child next to them, and these uniquities must be found and tapped into.

Psychological Profile

The psyche of each child is an often overlooked component of this complete evaluation. We tend to think either the parents fully control what a child does or the child is a mere clone of what all kids should be like and will respond robotically to whatever we ask for. Somewhere along the way, this whole idea has to make sense to the child or the spirit behind the program will never become lit. Without a true spirit on behalf of the child, no program will reach full potential. It's far more logical to determine the formula needed to light the fire in this child before going on to the next phase of the program. A built-in motivation, to some degree, is mandatory and should be sought for the success of a program.

Some kids become motivated immediately when you inform them that this is exactly what Jason Williams, Mark McGwire, Peyton Manning, or whoever they may be able to relate to, had to do when they were kids to become the stars they've become. Sacrifice and discipline led them to success.

Other kids aren't moved by that type of motivation, so it's important to attempt to find something that will fuel their fire. For example, a child may have a weight problem, and that can become the source of motivation. Or, the child may already have some back pain, knee pain, neck pain, etc., and that can become the source for motivation. But, something has to fuel each and every kid, as hard as it may be to find the exact motivator. And the motivation should never be only because the parent wants the child to do it. Someone needs to find out what will make the child motivated, as the parent/child source for motivation will hit a dead-end at some point. If a motivational source can't be found, the long term success of any fitness program goes down.

Biomechanical Exam

Once a dialogue has been reached, a biomechanical evaluation (see side bar) should be done. Scoliosis screenings are today's version of a biomechanical exam. These screenings, many of which are performed by unskilled people, in no way locate the many specific biomechanical imbalances, fixations, irritations and defects that all kids are forced to cope with. Each child's structure is like their fingerprint, totally unique, and locating their imbalances, anomalies, areas of increased stress and sites of potential injuries is paramount in removing the artificial ceiling of physical capacity when starting this program.

Treatment Recommendations

When thinking in terms kids and athletics, we tend to not think of any treatments unless there is some associated pain and/or disability. This thinking needs to be revised, as every child has some degree of structural imbalance, areas of vulnerability and decreased performance potential. A short leg, rotated pelvis, increased sacral base angle, hypolordosis of the lumbar spine or a myriad of other potential faults will hamper progress. The solution consists of corrective structural treatment, restoring motion, alignment and curvature to all areas of the spine, improved flexibility, understanding of proper physical habits, improved diet and specific exercise based on the interests of the child. In order to reach maximum potential for each child, we must accept that there is no shortcut to getting there. It's a tedious process, but the outcome is well worth the cost. We no longer can sit and wait for acute low back pain, a symptomatic Osgood-Schlatter's or frequent headaches before we begin treatment or changes, despite the fact that most health insurances suggest and encourage just that.

Fitness/Conditioning For Kids

When thinking in terms of fitness and conditioning for this age group, it's important to introduce first things first, as a "rush to glory", such as time trials in running or maximum weight lifting will typically produce injury. Also, without the full educational phase for conditioning, the body will never acquire the necessary "memory" needed for maximum potential. It's critical to remember when thinking in terms of conditioning for kids, their nervous system needs to go through a thorough education process. If this phase is cut short, the nervous system responsible for reflexes, quickness, coordination and speed will never fully develop. The nervous system, in kids under the age of 15, also learns at a rate possibly 5 times quicker than older kids and adults. We notice this phenomenon when teaching kids computers, skiing, tying shoes or other multi-faceted tasks. This window of time makes it even more important to invest whatever is needed to enhance this period for conditioning.

Secondly, due to the influence of end zone dances, high fives and MTV celebrations seen on TV, many kids have a hard time learning to walk before they run. If the preliminary parts of a conditioning program are eliminated or cut short, the ultimate potential will be compromised.

Regardless of what sport a child is preparing for, basic conditioning will be mostly the same for all kids. Running, jumping, skipping, jump roping and jumping jacks are some of the simple drills kids automatically perform. Skipping, for example, has a plyometric component to it, a rhythm and timing component as well as a benefit for overall coordination. For young basketball players, skipping simulates the difficult mechanics needed to take a lay-up. Kids can use their arms in a lay-up fashion as they do their skipping drills. With many of the more sophisticated exercises or sport-specific exercises, all kids should be able to perform these 5 basic movements and be in reasonable shape, both physically as well as cardio-vascularly, before beginning them.

Second-level exercises can consist of carioca, a foot-work drill performed over a certain distance, that helps to build coordination and foot speed. Also, step-ups, such as on a stool or even a step, will help to build muscles, strength and coordination. Step-overs involve an athlete either performing the drill head-on or sideways. One version is to step over something like a broomhandle, with a 1-2-3 pattern and then step back with the same 1-2-3 pattern. This can be done 25-50 times for quickness and coordination. Step drills, going up a flight of stairs, where the child has to lead with the right and follow with the left, and then lead with the left and follow with the right, will help to improve focus and coordination.

When working in a gym or on a field, you can set up point-to-point runs of approximately 10-20 meters. Kids can run to the designated point in a frontword run, side-slide back (without crossing feet), run backwards back to the same point, and skip back. These types of drills can be done using forward runs, backward runs, skipping, carioca, side-slides and a host of other varying exercises. But, the important aspect of this drill is that it forces a young athlete to have to concentrate on what is next. This focus helps greatly and the diversification keeps the enthusiasm there. This drill also provides the stopping and starting forces the body must learn to handle, as this is needed in almost all sports.

Jumping drills are another important set of exercises. The use of a jump rope, repetitive jumps at a spot on the wall, volleyball type games, hurdling exercises, short-run jumps, long-jump drills or many others help to develop sprinting techniques with low-grade bounding. The drills can also be split into one-footed hopping as well as two-footed hopping.

Actual running drills are important, and kids should be able to run from the acceleration phase to the top end phase. You must be careful as ossification of the bones has not occurred yet. Emphasis should be placed on general improvements of time over specific distances. Even if improvements in times aren't immediately noticed, ultimate improvements will be recognized.

Weighted exercises should only be done on a very cautious and limited basis. Light barbells and light medicine balls are usually the weights of choice when introducing a young athlete to a weighted exercise. If a child cannot perform the movement drills outlined above, they should never be allowed to add weight to their program. With the lighter weights, squatting exercices, step-up exercises, abdominal exercises and some motion exercises are a relatively safe way to begin. If any strains or limitations are noticed, it may become necessary to progress slower.

Conclusion

Most young athletes in this country today are chosen on their immediate qualities, not their long term potential qualities. Most of our conditioning and sport selection works on the hurry up approach. Overall, we're not doing a very good job of physical preparation. Farm life is gone, most kids live in air-conditioned homes, computers and play-station reduce physical activities and the work ethic has become much softer. It's hard to ask our kids to step up and perform when we, as adults, fail to do so. Secondly, the field of biomechanics has grown considerably in the past decade, and it's importance in sports is becoming more recognizable everyday.

The hard reality is that kids need to be introduced to this more disciplined, sophisticated, organized and sensible physical preparation program at an earlier age in an effort to have a program they can build on in years to come. This program should provide maximum benefits with minimum potential for injury. With commitment and perseverance by the teachers in today's sports, athletics in this country can grow in many diverse and beneficial ways.

Sidebar

Biomechanical Exam

Visual Exam (For symmetry, heights and balance)

-Posterior View--ears, scapulae, waist folds, hips, gluteal crease, popliteal space, medial malleoli, heels.

-Lateral View--posture, cervical lordosis, thoacic kyphosis, lumbar lordosis, pelvic angle.

-Anterior View--head (occiput) alignment with body, shoulders, hips, arm lengths, knees, feet.

Range of Motions

-cervical, thoracic, lumbo-sacral, hips, knees, ankles, toes, shoulders, elbows, wrists, fingers.

Muscle Tests

-abdominals, obliques, low back extensors, adductors, abductors, quads, sartorius, hamstrings, hip flexors, calves, plantar flexors, dorsi-flexors, biceps, triceps, deltoids, rhomboids, latissimus dorsi's, traps, wrist flexors, wrist extensors, brachioradialis, pec majors, SCM's, cervical flexors, cervical extensors, cervical lateral flexors.

Deep Tendon Reflexes

Sensory Tests

Measurements

-leg lengths, arm lengths, thighs, calves, bicep/tricep, forearms, neck, chest (full inhalation/exhalation), waist, hips, height and weight, foot sizes.

Varus/Valgus

Toe-In Check

Lateral Arches

-loss of arch, increased arch, same or different, right vs. left.

Orthopedic Tests

-Straight Leg Raise, Bilateral Leg Raise, Patrick-Fabere's, Gaenslen's, L-S Compression, Thoracic Compression, Cervical Compression and Distraction, Adson's, Allen's, Deerfield Test.

Trigger Points

-sub-occipital, cervical paraspinal, traps, rhomboids, deltoids, tricep tendon, biceps tendon, wrist extensors, SCM's, quadratus lumborum, gluteus medius, piriformis, L-S paraspinal, S-I muscles, hamstrings, ilio-tibial band, calves, adductors, abductors, quads, plantar fascia, lateral shin muscles, medial shin muscles.

X-Rays

-(2) view cervical, (2) view lumbo-sacral views.

Conditioning in the Pro Locker Room Chiropractic's Integral Role

by Dr. Tim Maggs and Coach Al Miller © 1999

(This is the second in a series of articles co-authored by Dr. Tim Maggs and Coach Al Miller,
Head Strength and Conditioning Coach for the Atlanta Falcons.)

For years, Chiropractic has been trying to create and take possession of a niche within the sports world. Although years of research and success stories overwhelmingly prove the benefits of Chiropractic treatment for athletes, individual Chiropractors haven't always faired as well when attempting to become part of organized sports teams. Organizational politics and professional biases will always contribute to preventing the "new kid on the block" from entering the sanctity of a pro or college locker room.

In order for Chiropractic to enter this arena and carve out the much desired turf amongst the other professionals working for a team, there must be a professionalism and consistency in the protocol brought to a program. There must be a bigger purpose other than to relieve pain. The massage therapist can relieve pain. The physical therapist can relieve pain. The medical doctor can relieve pain. Stealing their precious turf in the locker room is virtually impossible. But, to become the biomechanics specialist with an iron clad protocol that is easily understood by all will lead Chiropractors to a corner in the locker room which is uninhabited. That is, until players, coaches and medical personnel begin to understand and appreciate the value and benefits of detecting and correcting biomechanical faults.

Ally of Strength and Conditioning Department

Strength and Conditioning Departments are highly concerned with all physical, biomechanical and structural information on an athlete, however, are unable to perform, interpret and provide the same testing and treatment that Chiropractors are skilled at providing. This relationship thus becomes the most important relationship for all Chiropractors interested in working with teams. As discussed in last months article, the Strength Coach and the Chiropractor should work hand in hand in reviewing each others evaluation of an athlete and the rehabilitative program should be cooperatively understood for the long term benefits of the athlete.

Chiropractic Rehab Program

True Chiropractic rehabilitative care can only begin with the absence of symptoms. If symptoms brought the athlete in for care, then symptoms need to be resolved prior to any rehab program.

Objective findings can come from multiple sources. One of the more valued objective structural tests available to the Chiropractor is that of the standing x-ray. There are many marking systems which show if an athlete is structurally aligned and balanced. Structural defects, or imbalances, include pelvic rotations, subluxations (locked joints), increased or decreased curves and narrowing or swelling of the disc spaces.

Some of the more popular markings used to show structural status are the gravity line, as seen on the lateral L-S view, dropped from the center of the body of L3, straight down. This gravity line should bisect the anterior third of the sacral base. If the line is anterior or posterior to this point, weight is being handled by parts of the spine not designed to handle the weight, and eventual problems are predictable. A second marking is that of the sacral base angle, which is normally 36°-42°. An angle greater or lesser will suggest a pelvic angle inconsistent with normal positioning of the pelvis, thus producing a work load which will not be tolerated well. These findings become compounded with the introduction of any athletic activity and are key references when setting up a rehab program.

The length of care and treatment in setting up a rehab program will be influenced by many factors. Typically, the age and health of the athlete are the two most important criteria, but the degree of structural defect usually dictates the amount of time needed for maximum improvement. Frequency of treatments and specifics of treatment provided will vary from doctor to doctor, technique to technique and patient to patient. A successful time frame for most rehab programs dealing with spinal rehabilitation will take anywhere from 3-6 months. The ultimate goal is to have objective improvements on a final re-examination, which will include re-x-rays, as well as any other contributing tests which were initially performed.

During this 3-6 month period, proper treatments and therapies are provided. Improved habits are taught. The integration of rehabilitative exercise and conditioning will provide the maximum potential benefits to all patients. Working with a strength coach, or physical personal trainer, will enhance Chiropractic rehabiltative care. This program can also include nutrional support and positive psychological training. But, the critical component here is time, and if a Chiropractor cannot communicate to and manage the patient for a long enough period of time, the likelihood of success is reduced greatly.

Strength and Conditioning Program

Also discussed in last month's article was The Pyramid System (Fig. 1), which is a conditioning program designed by Coach Al Vermeil, Head Strength and Conditioning Coach of the Chicago Bulls. This system is the backbone of the conditioning program for the Chicago Bulls and Atlanta Falcons.

The Pyramid System

The Pyramid System is a calculated individualized approach which brings each athlete along at a rate they are capable of handling. The desired goal for everyone involved is to push an athlete through a conditioning program as hastily as possible, but never at a pace that will produce injuries.

Work Capacity-1st Phase

Keep in mind that the best players in almost all sports are your fastest and most explosive athletes. The lower the conditioning level of an athlete, the more time they need to spend in the work capacity phase.

In this phase, there are many different types of exercises done. Medicine balls are used for abs and total body work. These can also be used with tempo runs. For example, an athlete can do 100 yards of underhand/overhand throw with 6 kilos, 10 kilos and 15 kilos. Once they reach 100 yards, they'll run 200 yards of tempo work, come back, throw it 100 yards and walk to the ball. Other exercises used could also be teeter boards for the lower body and physio balls for the upper body. All of these exercises are very important in preparing the body for overhead lifting.

The Work Capacity phase of the Pyramid System, for the most part, is done without the use of added weights to an athlete's program. There are six sub-categories, and each one provides immeasurable benefits in the final quest to get and keep an athlete conditioned. No athlete should go to the second phase of conditioning (Strength) until they are fully capable of performing all six sub-categories of Work Capacity.

1. Anaerobic Capacity-In basketball, the furthest distance you can run is 90 feet. In football, the furthest you'd ever run at one time is 110 yards. Anaerobic capacity is the athlete's ability to explode for periods of 5-6 seconds at a time with rapid recovery. This type of conditioning requires serious training, as the body's oxygen utilization system must dramatically improve as well as the recovery ability of the athlete. The athlete will ultimately need to perform the same task 10-15 times with a rest of about 40 seconds, which is the same as the time clock in football.
2. Body Composition-Today, there are extremely sophisticated means of detecting body fat that can come within a half-point of accuracy, plus or minus. Depending on the sport and position the athlete plays, the ideal body composition is critical for success of that athlete. The program is designed to help the athlete reach close to ideal body weight and composition before moving on to the second phase of the Pyramid.
3.  Joint Mobility-as Chiropractors have known for years, full and unrestricted joint mobility is critical for maximum performance and ultimate prevention of injuries. Joint mobility is influenced by the tendons of a muscle, the tension of supportive muscles, surrounding ligaments and biomechanical defects of an athlete. This area is especially important for Strength Coach and Chiropractor to work together on. For example, an increased sacral base angle will alter an athlete's ability to either flex or extend at the hips and waist. Without the knowledge and correction of this structural defect, an athlete may be pushed beyond what he's capable of handling.
4. Strength Endurance-This category works hand in hand with Anaerobic Capacity. This is an athlete's ability to apply a given force time and again, play after play for 50-70 plays per game. The strength aspect is recognized by an athlete's ability to show absolute strength, or the ability to exert force without the equation of time being a factor.
5. Core Strength-This is one of the most important categories in the Pyramid. Core strength refers to abdominal strength. This ranges all the way up to the thoracic cavity and down to the pubic crest. Core strength is critical for full body stabilization. If a body can't stabilize, an athlete will have a difficult time exerting force into the ground while moving fast. This will translate into an inability to take on blockers or playing against other players. This also requires strong low back muscles, such as the gluteals, lumbar erector spinae group and other pelvic muscles. This area of development is critical as it is one of the strongest parts of the body and the strength here will permeate out to the rest of the body.  Much abdominal work is done either on the floor or on physio balls. There is also an ab bench that is used, both with and without weights. The lumbar area is initially worked by performing hyperextensions without weights, or with pauses. This must be mastered before an athlete can ever add weights on their backs or over their heads.
6. Aerobic Capacity-this categoy is usually acquired if the anaerobic capacity is done correctly. For athletes such as football players, too much distance work should never be done, as that will retard both strength and speed.

Strength-2nd Phase

Once an athlete shows they can actively demonstrate running tempo runs, have improved core strength, good joint mobility, improved body composition, aerobic and anaerobic skills and are going through the warm-up series efficiently, they are now ready and able to go onto the next phase, the strength phase. This phase also continues to help body composition. Joint mobility is critical now as the athlete has to be able to perform movements with added weight. As discussed earlier, if an athlete has restricted movement without additional weights, problems will occur once weight training is added to the program. There are 3 sub-categories in the strength phase.

1. Maximum/Relative-Maximum is just what it says, the maximum amount of weight an athlete can press or squat. Relative is the amount of weight an athlete can lift relative to body weight. The ratio governs the amount of weight best tolerated by the athlete's height and weight. This ratio, along with the position a player plays, will determine the amount of weight used in strength training. It's important to make sure a player can power clean or snatch a certain percentage of their body weight and it helps to set up maximums without having to test the athlete. A 185 pound receiver certainly shouldn't lift the same as a 300 pound lineman or a 250 pound linebacker.
2. Eccentric Strength-Occurs often, especially when an athlete has to decelerate and perform quickly. This is done when an athlete has to stop quickly, change directions and load new muscles. Many athletes can fluidly move, but when asked to stop and load new muscles, many of their unseen problems become magnified, such as joint problems (i.e. hips, knees, feet, ankles). Using certain rhythms in weight training is important. Ideally, an athlete should come down slowly with weights and go up with explosion.
3. Static Strength-Again, this can only occur after work capacity has been achieved. This is the strength needed to assume and maintain a position for some period of time. Examples would be a batter in a stance, a lineman holding a 3 point position, etc.

Strength Speed/Speed Strength-3rd Phase

This is the phase an athlete will enter after completing the first two phases of the pyramid. Strength speed is basically your Olympic lifts, while speed strength is your plyometric movements, your bounding, your uphill work and similar exercises. Appropriate exercises are recommended to athletes based on their need for increased speed or increased strength. The important issue here is that a proper progression must be utilized to give the central nervous system adequate time to become educated.

1. Starting Strength-this is the amount of force you can generate from a stopped position, overcoming the inertia of the bar.
2. Explosive Strength-this addresses the rate of force development. With specific exercises, the speed of an athlete's explosiveness improves, which is a reflection of the speed and time needed for a muscle to attain maximum strength during a specific movement.
3. Reactive or Elastic Strength-movement where there is a rapid decelerization followed by a small amortization period followed by a very strong concentric contraction. An example of this is the depth jump.

Speed-4th Phase

Simply put, speed is the moving of the body through a range of motions, both arms and legs, in the fastest times. As stated earlier, the best athletes in all sports are typically those with the best speed.

Speed without strength will prevent an athlete from ever reaching full potential. The Olympic lift is mandatory for an athlete to gain complete strength. Other important factors consist of joint mobility, body composition and core strength, just to name a few. Ultimate speed is the culmination of all the ingredients which make up the pyramid. There are 3 sub-categories in the speed phase.

1. Acceleration-This is the most important ingredient in sports. This covers 0-about 45 yards.
2. Absolute Speed-This is the speed that takes over after the 45 yard mark.
3. Specific Speed-This refers to each particular sports pattern which has to be accomplished within a particular position. Every position needs different requirements. There may be similar movements, but no two positions have identical movements. Offensive guards pull and take angles, where defensive linemen don't. Wide receivers run a lot longer distances than an offensive lineman. A defensive back always starts out running backwards. A quarterback is going to run while looking over a shoulder. Linebackers can run either forward, lateral or backward. Running backs are like catching ricochet rabbit. And the tight ends are a combination of all the above. There is no one way to increase speed for all players, but there are common factors to impove speed for all positions.

Conclusion

Regardless of which protocol you refer to, whether it be a thorough consultation, examination, report of findings and corrective biomechanical program by a Chiropractor, or a thorough assessment and management of an athlete through the pyramid and throughout the season by a Strength Coach, the end result is only as good as the detail of the work done.

The benefit to the athlete improves greatly if both Chiropractor and Strength Coach go the extra mile to employ thorough management of the athlete. This benefit further improves if full and continued communication takes place.

Those Chiropractors interested in sports and working in the locker rooms throughout the country have to become more involved with the details of the athletes biomechanics and the objective improvements which can be made. They need to develop close working relationships with other members of organized sports teams, especially the strength coaches throughout the country.

And with every opportunity, continued biomechanical education needs to be provided to the athletes of all sports. Only with hard work and a committed effort by all will Chiropractic one day become that biomechanics authority in the pro locker room.

Conditioning Pyramid

Raising Chiropractic's Value in Pro Sports Through Vision, Management and Communication

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.

Joining Forces

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.

Chiropractic Exam

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.

Psychological Evaluation

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
• Squat
• 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.

Conclusion

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.