Chiropractic in Sport
The role of Chiropractic care in athlete performance
As a vital component of sports medicine, chiropractic care can enhance athletic performance, health, and competitiveness by addressing biomechanical imbalances and optimising neuromuscular function [15]. By focusing on the neuromusculoskeletal system and its optimisation for athletic performance, sports chiropractic care has emerged as a critical component of the healthcare management of athletes [1].
It is a specialised approach that combines the principles of chiropractic care with an understanding of the unique demands placed on the bodies of athletes, thereby facilitating injury prevention, rehabilitation, and overall performance enhancement [2]. Chiropractic care includes a variety of manual therapies, such as spinal manipulation, mobilisation, and soft tissue techniques, that target the musculoskeletal system to promote optimal function and relieve pain [3]. Several studies have found chiropractic care to be effective in treating common conditions seen in athletes, such as lower back pain, muscle strains, and joint dysfunctions [4,5]. In addition, the incorporation of chiropractic care into an athlete's healthcare regimen has been associated with enhanced biomechanics, decreased injury rates, and accelerated recovery [6].
The role of chiropractic care in athlete performance derives from its fundamental principles and techniques, which focus on the assessment, diagnosis, and treatment of neuromusculoskeletal disorders and their effect on an individual's overall function [9,10]. Chiropractic care is founded on the premise that optimal nervous system function and musculoskeletal health depend on the proper alignment of the spine and other joint structures [11]. Chiropractors use various techniques and approaches, such as spinal manipulation, mobilisation, soft tissue therapies, and rehabilitative exercises, to address biomechanical imbalances and improve an athlete's performance [2,12]. In the context of sports, common conditions treated by chiropractors include, but are not limited to, lower back pain, muscle strains, joint sprains, tendinopathies, and neural entrapments [4]. By addressing these issues with targeted chiropractic interventions, athletes can experience functional enhancements, decreased pain, and ultimately improved performance with high satisfaction [13].
In addition to treating existing injuries, chiropractic care plays a crucial role in injury prevention, biomechanical optimisation, and long-term physical maintenance for athletes. It has been demonstrated that chiropractic interventions, such as spinal manipulation and soft tissue therapies, are effective in the prevention and treatment of sports-related injuries, such as muscle strains and joint sprains [2]. In addition, these techniques contribute to improved biomechanics by enhancing joint mobility, muscle flexibility, and neuromuscular coordination, which ultimately results in improved athletic performance [2,4]. The recovery and maintenance of an athlete's physical health are also significantly influenced by chiropractic care. By addressing musculoskeletal imbalances and promoting proper biomechanics, chiropractors help athletes recover from training sessions and competitions more efficiently, thereby reducing the risk of overuse injuries and facilitating long-term health and performance [14]. Hence, the incorporation of chiropractic care into an athlete's healthcare and training regimen is essential for optimal performance, injury prevention, and physical maintenance.
Research demonstrating the efficacy of chiropractic care for athletes in addressing sports-related injuries and enhancing performance has highlighted its effectiveness. Numerous studies have reported positive outcomes in chiropractic-treated athletes, including improved musculoskeletal function, reduced pain, and enhanced recovery [1,2]. One study involving judo athletes found that cervical spine manipulation led to a significant increase in grip strength, highlighting the potential of chiropractic care to improve athletic performance [6]. Another study examining the role of sports chiropractors in the National Football League (NFL) demonstrated the benefits of chiropractic care in injury management and overall player health [4].
Moreover, the preventive and rehabilitative nature of chiropractic interventions can contribute to decreased injury rates and improved long-term health among athletes, thereby promoting career longevity and a higher quality of life after retirement [11].
There are still gaps in research despite the growing body of evidence supporting the incorporation of chiropractic care into sports medicine. Hence, further research is required to examine the long-term effects of chiropractic interventions on athlete performance and the potential benefits of combining chiropractic care with other healthcare modalities for optimal outcomes. In addition, more research is necessary to determine the most effective treatment protocols for specific sports and injury types, which will ultimately contribute to the development of evidence-based guidelines for chiropractic care in sports medicine [15].
Stump in 2001, discussed the perceived role of chiropractors in sports health care, and stated that “chiropractic adjustment/manipulation of the spine and extremities comprise the greatest part of most sports chiropractic practices.” Referencing a survey study by the same author which investigated the use and role of sport chiropractors in the National Football League (NFL), Stump determined that other sport injury professionals, specifically certified athletic trainers in the NFL, perceive “a role for the sport chiropractor primarily as a spinal specialist treating low back and other musculoskeletal injuries”.
Chiropractors’ role in professional sport in the USA has been well established for many years, in 2002 Stump found that thirty-one percent of NFL teams have a chiropractor in an official capacity on their staff and amongst the other teams that do not, a substantial majority of NFL teams had developed cooperative relationships with chiropractors, with 77% having referred a player to a chiropractor.
Kelsick [17] offers the example of a pre-participation examination, and comments that “by correcting the deficiencies discovered in the examination, athletic performance can be improved and the frustration level (of an athlete) decreased when the aetiology of poor performance is unclear.” This view of detecting and correcting impediments to performance is also offered in comments from Nook and Nook [18], who state that in their opinion “the basis and definition of chiropractic emphasises the correction of pathomechanics of the spinal and extremity joints restoring normal neurology and biomechanics.”
It is the spinal specialist role that Chiropractors can fulfil in an already established Sports Science & Medical department. Treating musculoskeletal injuries is already expertly managed by the various rehabilitation physiotherapists and related staff. Examining asymptomatic athletes with the aim of clearing biomechanical restrictions to the spine and extremity joints prior to athletic performance whether training or competition is unique and specific to a Chiropractors skill set. This is also no different to a standard Chiropractic examination in general practice of their so called preventative healthcare / maintenance patient base. This group of patients consult them in order to maintain their spinal health and reduce the likelihood of them experiencing future episodes of biomechanical pain after initially consulting regarding an acute musculoskeletal injury, often back/neck pain, sciatica or headaches, as the most frequently presenting complaints.
Haldeman [19,20] also commented on the proposed theories of how Spinal Manipulative Therapy (SMT) was thought to benefit athlete performance. Considering that SMT is thought to correct restricted spinal motion, Haldeman [19,20] contemplated the theory of how restricted spinal motion could potentially cause abnormal spinal mechanics and reflex muscular incoordination, which in turn could result in a reduced ability to maximise effort and thus disrupt the graceful, coordinated movement necessary in most sporting activities. This concept was repeated in a review on the same topic by Prokop and Wieting [21]. These authors commented that the “global objective (of SMT) is to restore normal pain-free motion with the highest level of motor control and coordination in a state of postural balance to allow the athlete to perform at the highest level of his or her capacity.” Recently, information on muscle inhibition/activation, muscle strength, motor reaction time, and motor training has shed light on the mechanisms of how SMT could perhaps indirectly affect athlete sport performance. See references [22-30].
The most well known example of Chiropractic techniques being used in elite football was at the Milan Lab which was successful in reducing injury incidence and prolonging the careers of senior professionals at AC Milan football club.
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