SPORTS CHIROPRACTIC RESEARCH

The Research Commission is responsible for promoting and encouraging research in sports chiropractic. This page is dedicated to providing you with access to chiropractic research papers,  access to useful resources and opportunities to get involved.  Find out how FICS is fostering and developing research and how you can get involved.

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Scope of Practice: Sports Chiropractic

Scope of Practice: 

Sports & Exercise chiropractic is a recognised subset of chiropractic that focuses on the comprehensive and holistic healthcare of the physically active individual or athlete, to prevent injury, restore optimal function and contribute to the enhancement of sports performance. They achieve this using sports-specific knowledge, skills and attitudes to achieve the best clinical practice while ensuring a high standard of professional, safe and ethical practice.

Sports & Exercise chiropractic professionals demonstrate advanced competencies in the customised approach to active individuals of all ages and abilities, at individual and group levels by utilising evidence-based, multi-modal techniques to enhance the function of the neuro-musculoskeletal system.

Sports & Exercise chiropractors have clinical expertise in manual therapy, exercise prescription and rehabilitation, education, translating the latest research into clinical practice, communication, lifestyle advice and leadership. They participate comfortably in a multi-disciplinary team environment, working closely with parents, coaches, other health providers and the community to provide the best high-quality care for each athlete.

Sports Chiropractic Australia
https://www.aice.org.au/cpg/sports
Date accessed: 26/01/21

CALLING FOR Volunteer masters athletes aged 60+ to be part of a research project

Dear BMAF members, 

RE: Volunteer masters athletes  aged 60+ are needed to take part in LSBU Professional Doctoral Research Study in an Online Survey  

Claudio Merkier is conducting a mixed-method research study for his Professional Doctorate (PhD) in Health and Social Care at London South Bank University.  

You are invited to take part in an online survey as part of the introduction to the research topic. Answers will be collected until February 2022. It takes about 15-20 minutes to fill it, and your responses are completely anonymous and confidential.  

The survey is divided into 5 sections: demographics, training and competition, injuries, management of injuries and your willingness to participate in the next phases of the project. 

Phase II will include a practice-based performance and clinical section, and phase III will be an online follow-up interview with the athletes that participated in phase II. 

Project title 

Older Masters Track and Field Athletes Perceptions and Functional Impacts of Pre-Competition Chiropractic and Manual Therapies on Lower Limb’s Strength, Jumping and Sports Performance 

What is the purpose of the research project? 

Athletes want to optimise their performance and prevent injuries, and they typically explore many different strategies to give them a competitive advantage in sports events. Worldwide, manual therapies and chiropractic have been increasingly utilised in sports to help elite and masters athletes with pain management, return to sports and rehabilitation after an injury, injury prevention, enhancement of performance, and to recover faster after competitions. 

Pre-competition chiropractic and manual therapies may be a way to identify and prevent a potential injury and to contribute to enhancing sports performance in masters athletes. Although there is vast research addressing the role of the best and common practices of chiropractic in older adults, none of them, thus far, have included the ageing athletic population until now. Therefore, the aim of the study is to explore and increase the understanding of the perceptions of chiropractic and manual therapies at pre-competition times, how it is experienced by aged 60+ masters track and field athletes, and its potential short-term functional impacts on lower limb strength, vertical jumping height, and sports performance. The project should be completed by the end of 2023. 

If you are a masters athlete aged 59 or younger, sorry, this survey isn’t for you. But you can still help by sharing the link to the survey with everyone you know that is 60 + or older and is a track and field masters athlete in the UK. 

Thank you for taking the time to read this information and for considering taking part in this project and help us better understand your perceptions of chiropractic and manual therapies! Your thoughts will be extremely helpful. 

If you have any questions, please contact the main researcher Claudio Merkier to find out more. 

Claudio Merkier contacts details: 

Email: merkierc@lsbu.ac.uk 

Mobile: 07787944910 

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Creating an Evidence Base

The Research Commission aim over the coming 5 years is to establish short, medium and long term goals for establishing a robust evidence base for sports chiropractic internationally. The commission will outline a strategy to create and focus the research effort supporting sports chiropractic and FICS and communicate this with stakeholder groups.

Aims of the research effort:

  • Describe modern-day sports chiropractic practice
  • Describe the patients presenting to sports chiropractors (by region).
  • Define the satisfaction rating of patients presenting to chiropractors
  • Describe the background of sports chiropractors (regionally)
  • Describe the scope of care delivered in modern-day sports chiropractic practice
  • Describe the outcomes of different sports chiropractic management approaches. By anatomical region; by prevalence in the region (the most common conditions); by cost (the most expensive to manage to society); and by population (patient setting: private practice, local, state, national, international), competition, training, other.
  • To describe the adverse events associated with sports chiropractic including the different practice/technique groups.

If you would like to partner with FICS on a research project or find out more information, contact the Research Commission Chair Dr Henry Pollard. email:hpollard@optushome.com.au 

Research Collaboration with FICS

FICS Research Commission research priorities, outlined above, will be sent to all Universities/College which has a chiropractic program.   For too long we have had a scattergun approach to research (in sports chiropractic) that was completely random and mostly useless to the political agenda of the profession.

The initial approach taught in the mid 80’s was a very statically oriented approach to assessment and treatment whereas in the last 10-15 years management has become far more dynamic in nature with assessment and management being much more movement-based. Whilst management has always contained some form of exercise therapy, management in the third phase typically contains a quick progression to functional exercise to aid the recovery of patients.

FICS believes these (amongst other management strategies) to be critically important for the modern sports chiropractor. Also, it is equally important for the researcher to investigate modern chiropractic multimodal management approaches. The research commission will be looking to establish a Research-Based Practice Network to investigate the methods used by modern sports chiropractors to manage their patients. The research committee will soon establish key areas of research focus and distribute these to the schools internationally to support and focus the research effort of the sports chiropractic community.  As a profession, we need to communicate and document through research publication who we are, what are our educational standards, what we treat (scope of practice) and how we treat (methods) in order to assist in the recognition of sports chiropractic by government regulators, medical and allied health groups and the greater public that we serve.

If you would like further information, reach out to the Research Commission Chair Dr Henry Pollard. hpollard@optushome.com.au

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Reading List

Below is a list of suggested research articles for sports chiropractors. These are not extensive and do not represent an opinion from FICS.

Article of Interest: How to select a chiropractor for the management of athletic conditions

Recommended article – Reviewer Corner

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Research priorities of international sporting federations and the IOC research centres, AND Whose research agenda is it?

Reviewer: Alex Lee, BSc, DC, FRCCSS(C)

Reference:

  1. Finch CF, Talpey S, Bradshaw A, Soligard T, Engebretsen L. Research priorities of international sporting federations and the IOC research centres. BMJ Open Sport Exerc Med [Internet]. 2016;2:1–8. Available from: http://dx.doi.org/10.1136/bmjsem-2016-000168
  2. Finch CF. Whose research agenda is it? Reconciling the views of researchers and sports stakeholders. Vol. 15, Br J Sports Med. BMJ Publishing Group; 2017. p. 3–4.

Article: Research priorities of international sporting federations and the IOC research centres,

Background/aim: The prevention of injury in sport and promotion of athlete’s health needs to be both targeted and underpinned by scientific evidence.

Objective: To identify the research priorities of International Sporting Federation (ISFs) compared to the current research focus of the International Olympic Committee Research Centres (IOC-RCs).

Methods: Online survey of ISF Medical Chairpersons (n=22, 69% response) and IOC-RC Directors (n=7, 78% response). Open-ended responses relating to injury/illness priorities and specific athlete targets were thematically coded. Ratings were given of the need for different research types according to the Translating Research into Injury Prevention Practice (TRIPP) Framework stages.

Results: Both ISFs and IOC-RFs prioritised research into concussion (27%, 72%, respectively), competitive overuse (23%, 43%) and youth (41%, 43%). The ISFs also ranked catastrophic injuries (14%), environmental factors (18%), elite athletes (18%) and Paralympic athletes (14%) as important. The IOC-RCs gave higher priority to preventing respiratory illness (43%), longterm health consequences of injury (43%) and recreational athletes (43%). There was a trend towards ISFs valuing TRIPP stage 5/6 research more highly and for the IOC-RCs to value TRIPP stage 1/2 research.

Conclusions: There are opportunities to better link the priorities and actions of the ISFs and IOC-RCs, to ensure more effective practice-policy-research partnerships for the benefit of all athletes. Setting a mutually-agreed research agenda will require further active engagement between researchers and broader ISF representatives.

Keywords: injury prevention, research agenda, sports research

Commentary/Critique: With the 2022 Winter Olympics underway, we can reflect on our roles as sports chiropractors working with athletes. We should not only care for them at the polyclinics, but also aim to prevent injury and illness to improve their health. To do so, we need to understand the injury prevention research effort.

This cross-sectional online survey1 compared the research priorities of ISFs to the IOC-RC to identify similarities and differences. These authors found the research priorities aligned well for concussion, anterior cruciate ligament injuries and chronic overuse injuries, with particular emphasis on youth. The IOC-RCs were more engaged with research into long-term negative health outcomes and recreational participants, while the ISFs are more interested in conducting implementation research and studies that evaluate intervention effectiveness.

Why is this work important? Presently, efforts are underway to develop research agendas for the sports chiropractic field in various jurisdictions. While identifying the opinions on research priorities from sports chiropractors is necessary to establish a research agenda, the field should also engage with their stakeholders (athletes and sports federations) to understand their viewpoints on research priorities. In Finch’s follow up editorial to this present study – “Whose research agenda is it? Reconciling the views of researchers and sports stakeholders”2 she discuses the importance of engaging with sports stakeholders when developing an injury prevention research agenda and recommends researchers partner with sports stakeholders early in the process of establishing a research agenda. She writes that by engaging with stakeholders, researchers can incorporate the sports-specific context into their research, which can increase the likelihood of adoption by the sports community. This work by Finch et al,1,2 should resonate with sports chiropractors as we should aim to be partners in the sports arena, not just on the field and polyclinic, but also in research laboratories and interdisciplinary investigative teams.

 

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Ambulatory Pain Management Guidelines

This great public policy looks at adults with acute or chronic pain, including cancer patients, without progressive or terminal disease, treated in an outpatient setting, excluding hospice and end-of-life care.

Objectives. Provide a framework for comprehensive pain evaluation and individualized multimodal treatment. Improve quality of life and function in patients experiencing pain, while reducing the morbidity and mortality associated with pain treatments, particularly opioid analgesics.

https://michmed-public.policystat.com/policy/7109483/latest/

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What researchers look for in PhD student

This is a great blog discussing what highly cited researchers look for in a PhD student. I believe any doctor wishing to undertake a PhD should take the time to look at this article.

https://clarivate.com/blog/heres-what-highly-cited-researchers-look-for-in-phd-students/?

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13 steps to writing a case paper

In this half-hour presentation, Dr Henry Pollard, Chair of the FICS Research Commission takes us through the elements of writing a case paper report. 

DOWNLOAD: PDF PowerPoint Notes

DOWNLOAD: Electronic outcome measures

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Drop-Piece High-Velocity...

Reviewer Name: Claudio Merkier

Title: Effect of Drop-Piece High-Velocity, Low-Amplitude Manipulation to the Midfoot of Asymptomatic Adult Sprinters on Performance During a Unilateral Horizontal Drop-Jump Test: A Feasibility Investigation

Reference: Bell, S. and Howarth, S. J. (2021) Effect of drop-piece high-velocity, low-amplitude manipulation to the midfoot of asymptomatic adult sprinters on performance during a unilateral horizontal drop-jump test: A feasibility investigation, Journal of Manipulative and Physiological Therapeutics, 44 (7), pp. 527-534. https://doi.org/10.1016/j.jmpt.2021.12.006

Introduction: Sprinters and athletic coaches frequently describe anecdotal improvements to sprinting performance following instrument-assisted high-velocity low-amplitude (IA-HVLA) manipulation applied to the athlete’s feet; however, there is minimal published data investigating these claims. Based on recent neurophysiological research demonstrating acute improvements in force production and fatigue resistance following spinal manipulation, a positive impact on sprint performance is plausible, although this remains unexplored in trained sprinters.

 Objectives: The purpose of this study was to investigate the feasibility of measuring the immediate effects of drop piece high-velocity, low-amplitude manipulation (DP-HVLAM) to the midfoot region on jump distance in competitive adult sprinters during a standardized unilateral horizontal drop-jump (U-HDJ) test.

Methods: Seven asymptomatic competitive adult sprinters (4 women) were recruited for this study. Testing was conducted on the dominant leg. Participants completed a 10-minute self-selected warm-up, followed by a 6-jump familiarization period with the U-HDJ test. All participants completed 3 U-HDJ trials before and after receiving DP-HVLAM to the joints of the midfoot assessed as being hypomobile by a licensed sports chiropractor. The primary outcome of the U-HDJ test was horizontal displacement, measured using an optoelectronic motion-capture system. Mean, SD, and 95% confidence intervals were determined for the post-treatment change in jump distance. A single-sample t-test with a = 0.05 assessed the post-treatment change in jumping distance.

Results: Authors were able to measure immediate effects. The preliminary findings showed an increase in jump distance after DP-HVLAM to the midfoot region (mean = 0.06 m, SD = 0.05 m; P = .014; 95% confidence interval, 0.02-0.11; effect size = 1.30).

Conclusion: This study demonstrates that it was feasible to measure immediate improvement in performance after DP-HVLAM in a clinical assessment with correlation to sprinting performance in a population of elite sprinters. As this was a feasibility study, the small sample size, overlapping confidence intervals, and specific population limit the extrapolation of these findings.

Keywords: Sports Medicine; Chiropractic; Biomechanical Phenomena; Foot; Running; Athletic Performance 

Critique: This feasibility study has addressed a clearly focused research question in terms of a specific population (adult competing sprinter athletes), intervention (mid-foot DP- HVLAM as clinically assessed by a licensed sports chiropractor). However, this study consisted of a single arm without control group comparison. The study methodology was clearly detailed with the purpose to assess the effects of an intervention (DP-HVLAM) on specific outcome measure (U-HDJ distance).

 A limitation for this study is the small sample size n=7 elite sprinters. A strength of this study is the inclusion of elite competition athletes.

 The authors reported the study was performed very close to competition time with minimal risk to safety and minimal adverse risk to performance and no adverse reaction effects of treatment. However, they acknowledged performance bias as contributary factors for the effects of DP-HVLAM, as no blinding of participants was possible due to the nature of the intervention.

 In summary, a well-designed laboratory feasibility study that assessed how a single session of DP-HVLAM of hypomobile lateral midfoot-joints increased temporarily      U-HDJ distance in competing asymptomatic adult sprinter athletes.

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Low back pain adult rowers........

Reviewer Name: Lizandi Schoeman

2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers

Wilson F, Thornton JS, Wilkie K, et al – 2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers; British Journal of Sports Medicine 2021;55:893-899.

Introduction

Low back pain (LBP) is the most frequently reported musculoskeletal disorder in the community, and can result in long-term pain and disability.1 2 Rowing is a sport associated with large volumes of training and high cumulative loading of the lumbar spine. The most frequently reported site of pain for rowers, as a result of rowing, is also the low back.3 4 The most recently published prospective study reported that 21% of all reported illness and injuries over eight seasons in a national rowing team were to the lumbar spine.5 Recent research has focused on epidemiology and biomechanical analyses to understand mechanisms that contribute to LBP onset. There has been a limited focus on management or prevention strategies.

There are currently no guidelines for managing LBP in rowers (hereby defined as ‘rowing-related LBP’) or in athletes who participate in other sports. There are guidelines for managing LBP in the general population, however while some principles of management are transferable, there is a need to consider issues that are particular to rowers and athletes.

The overall aim of this project was to inform clinical decisions and standards of care in order to reduce the long-term effects of LBP on rowers, and to influence outcome by reducing personal burden and healthcare costs.

Specifically, we aim to (1) synthesise and present the current evidence on LBP in adult rowers and (2) develop practical recommendations for prevention and management to facilitate translating evidence into practice.

Objective To synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice.

Methods There were four synthesis steps that informed the consensus statement. In step one, seven expert clinicians and researchers established the scope of the consensus statement and conducted a survey of experienced and expert clinicians to explore current practice. In step two, working groups examined current evidence relating to key scope questions and summarised key issues. In step three, we synthesised evidence for each group and used a modified Delphi process to aid in the creation of the overall consensus statements. Finally, in step four, we combined information from step three with the findings of the clinician survey (and with athlete and coach input) to produce recommendations for clinical practice.

Results The scope of the consensus statement included epidemiology; biomechanics; management; the athlete’s voice and clinical expertise. Prevention and management of LBP in rowers should include education on risk factors, rowing biomechanics and training load. If treatment is needed, non-invasive management, including early unloading from aggravating activities, effective pain control and exercise therapy should be considered. Fitness should be maintained with load management and progression to full training and competition. The role of surgery is unclear. Management should be athlete focused and a culture of openness within the team encouraged.

Conclusion Recommendations are based on current evidence and consensus and aligned with international LBP guidelines in non-athletic populations, but with advice aimed specifically at rowers. We recommend that research in relation to all aspects of prevention and management of LBP in rowers be intensified.

Critique

This paper provides insightful information that shows how pro-active management and specific recommendations given to rowers are critical in ensuring a decrease in the incidence of lower back pain.

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Lower limb biomechanical factors...

Reviewer Name: Lizandi Schoeman

Lower limb biomechanical factors associated with Achilles tendinopathy in runners: a systematic review

Zainuddin, F.L., Abd Rahman, N.A., Razman, R. et al. Lower limb biomechanical factors associated with Achilles tendinopathy in runners: a systematic review. Sport Sci Health (2021). https://doi.org/10.1007/s11332-021-00862-4

Introduction

Variations in lower limb biomechanics can predispose to Achilles tendinopathy (AT). However, evidence on lower limb biomechanical factors associated with AT in runners is limited.

Objectives

This review aimed to examine the existing literature systematically to identify lower limb biomechanical factors associated with AT in runners.

Methods

SCOPUS, ScienceDirect, and PUBMED databases were searched in April  2021 to investigate various lower limb biomechanics such as kinetics, kinematics, muscle activity, plantar pressure, and temporospatial parameter variables during running among AT patients.

Results

Ten studies reported significant differences in knee flexion angle, ankle dorsiflexion, ankle eversion, touchdown angle, and plantarflexion moment between runners with and without AT. Plantar pressure and the ground reaction force variables were also found to be significant discriminators. Muscle activity of tibialis anterior, as well as medial and lateral gastrocnemius during various running phases showed significant differences associated with AT. Runners with AT displayed a longer duration of eversion and over-pronation compared to healthy controls. The mechanical effects of orthotic shoes in runners were able to reduce the incidence of AT.

Conclusions

The findings of the current review indicated the biomechanical factors that could contribute to AT among runners. These factors can be assessed in clinical settings to minimise the injury risk among runners. The protocol of the review was registered at PROSPERO (CRD42021237500) on 18th March 2021.

Keywords: 

  • AT: Achilles tendinopathy
  • GRF: Ground reaction force
  • EMG: Electromyography
  • VISA-A: Victorian Institute of Sport Assessment-Achilles questionnaire
  • SD: Standard deviation
  • BW: Force normalized to subject body weight
  • CASO: Customized arch support orthoses
  • HL: Orthotic heel lift
  • PFM: Plantar flexion moment
  • Nm: Moment
  • W: Watt
  • s: Seconds
  • kg: Kilogram
  • ROM: Range of motion

Critique 

The research article produced insightful information regarding certain biomechanical issues that need to be addressed in order to ensure that Achilles tendinopathy amongst runners can be decreased.

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Frozen Shoulder Systematic Review...

Reviewer Name: Freya Moran

Title: Comparison of Treatments for Frozen Shoulder A Systematic Review and Meta-analysis

Reference: Challoumas, M. Biddle, M. McLean, N. Millar. Comparison of Treatments for Frozen Shoulder A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Dec; 3(12):
e2029581. doi: 10.1001/jamanetworkopen.2020.29581 

Background: Frozen shoulder is a condition seen in primary and secondary outpatient clinic settings with little evidence-based literature to dictate the most effective modalities, frequency and duration of treatment. This stems from a poor fundamental understanding of the mechanisms of this particular pathology, and as a result, treatment and management strategies are varying and patient outcomes are often unpredictable. This systematic review and meta-analysis aimed to answer the question of whether certain treatments were associated with better outcomes.

 Objectives: To assess compare the effectiveness of the many treatment options to better inform and guide the health care professional in the clinical setting.

Methods:

Search criteria for studies included any type that compared several treatment modalities, placebo, or no treatment. Exclusion criteria included those that compared varying doses, durations, or types of the same intervention (e.g. corticosteroid dosages or studies comparing different exercise types without comparison to other interventions). Two independent reviewers used the PRISMA reporting guidelines with a random-effects model. Primary outcomes were pain (results represented by mean differences) and function, and secondary outcomes included external rotation of the gleno-humeral joint (results represented by standardized mean differences). Follow-up included short-term at less than 12 weeks, mid term as between 12 weeks to less than 1 year, and long-term being more than 1 year.

Results:

65 eligible studies with 4097 participants were included in the systematic review. From the 34 studies with 2402 participants included in the pairwise meta-analysis, the only statistically superior treatment modality for short-term pain was shown to be intra-articular corticosteroid injection (MD, −1.0 visual analog scale [VAS] point; 95% CI, −1.5 to −0.5 VAS points; P < .001; vs physiotherapy: MD, −1.1 VAS points; 95% CI, −1.7 to −0.5 VAS points; P < .001) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; P < .001; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7; P < .001). There were 39 studies with 2736 included in the network meta-analysis, which additionally demonstrated that an additional home exercise program including simple exercises and stretches as well as electrotherapy and/or mobilization by a physiotherapist may be beneficial for mid-term outcomes (MD, −1.4 VAS points; 95% CI, −1.8 to −1.1 VAS points; P < .001).

 

Conclusion:

Early intervention via intra-articular corticosteroid injection in patients presenting with frozen shoulder is associated with better outcomes, and should be accompanied by a home exercise program.

 

Key words: frozen shoulder; adhesive capsulitis; meta-analysis; systematic review;

 

Critique: although the article included important outcome measures specific to range of motion and pain, it did not include clinically meaningful outcome criteria such as return to work or activities of daily living. Studies that compared different exercise types were excluded from the study because they did not compare exercise to any other interventions, which is unhelpful for the manual therapist seeking optimal muscle retraining guidelines, though meaningful for the primary care clinician in a multidisciplinary setting. Patients with comorbid conditions were not taken into account in analysis, which can be an important factor in patient outcomes. Additionally, there were no formal diagnostic criteria used to define frozen shoulder, only the use of inappropriate or inadequate diagnostic criteria taken into account (which was not defined in the article). However, patients diagnosed simply with “shoulder pain” were excluded, even if they may have had frozen shoulder, indicating a need for more defined diagnostic criteria as a part of clinician education. Overall, the article suggests that frozen shoulder has the best outcomes when correctly identified and diagnosed, and treated in the multidisciplinary setting.

 

 

 

 

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Research priorities and resources..

Reviewer: Alex Lee, BSc, DC, FRCCSS(C)

Title: Research priorities of international sporting federations and the IOC research centres, AND Whose research agenda is it? 

Reference:

  1. Finch CF, Talpey S, Bradshaw A, Soligard T, Engebretsen L. Research priorities of international sporting federations and the IOC research centres. BMJ Open Sport Exerc Med [Internet]. 2016;2:1–8. Available from: http://dx.doi.org/10.1136/bmjsem-2016-000168
  2. Finch CF. Whose research agenda is it? Reconciling the views of researchers and sports stakeholders. Vol. 15, Br J Sports Med. BMJ Publishing Group; 2017. p. 3–4.

Article: Research priorities of international sporting federations and the IOC research centres,

Background/aim: The prevention of injury in sport and promotion of athlete’s health needs to be both targeted and underpinned by scientific evidence.

Objective: To identify the research priorities of International Sporting Federation (ISFs) compared to the current research focus of the International Olympic Committee Research Centres (IOC-RCs).

Methods: Online survey of ISF Medical Chairpersons (n=22, 69% response) and IOC-RC Directors (n=7, 78% response). Open-ended responses relating to injury/illness priorities and specific athlete targets were thematically coded. Ratings were given of the need for different research types according to the Translating Research into Injury Prevention Practice (TRIPP) Framework stages.

Results: Both ISFs and IOC-RFs prioritised research into concussion (27%, 72%, respectively), competitive overuse (23%, 43%) and youth (41%, 43%). The ISFs also ranked catastrophic injuries (14%), environmental factors (18%), elite athletes (18%) and Paralympic athletes (14%) as important. The IOC-RCs gave higher priority to preventing respiratory illness (43%), longterm health consequences of injury (43%) and recreational athletes (43%). There was a trend towards ISFs valuing TRIPP stage 5/6 research more highly and for the IOC-RCs to value TRIPP stage 1/2 research.

Conclusions: There are opportunities to better link the priorities and actions of the ISFs and IOC-RCs, to ensure more effective practice-policy-research partnerships for the benefit of all athletes. Setting a mutually-agreed research agenda will require further active engagement between researchers and broader ISF representatives.

Keywords: injury prevention, research agenda, sports research

Commentary/Critique: With the 2022 Winter Olympics underway, we can reflect on our roles as sports chiropractors working with athletes. We should not only care for them at the polyclinics, but also aim to prevent injury and illness to improve their health. To do so, we need to understand the injury prevention research effort.

This cross-sectional online survey1 compared the research priorities of ISFs to the IOC-RC to identify similarities and differences. These authors found the research priorities aligned well for concussion, anterior cruciate ligament injuries and chronic overuse injuries, with particular emphasis on youth. The IOC-RCs were more engaged with research into long-term negative health outcomes and recreational participants, while the ISFs are more interested in conducting implementation research and studies that evaluate intervention effectiveness.

Why is this work important? Presently, efforts are underway to develop research agendas for the sports chiropractic field in various jurisdictions. While identifying the opinions on research priorities from sports chiropractors is necessary to establish a research agenda, the field should also engage with their stakeholders (athletes and sports federations) to understand their viewpoints on research priorities. In Finch’s follow up editorial to this present study – “Whose research agenda is it? Reconciling the views of researchers and sports stakeholders”2 she discuses the importance of engaging with sports stakeholders when developing an injury prevention research agenda and recommends researchers partner with sports stakeholders early in the process of establishing a research agenda. She writes that by engaging with stakeholders, researchers can incorporate the sports-specific context into their research, which can increase the likelihood of adoption by the sports community. This work by Finch et al,1,2 should resonate with sports chiropractors as we should aim to be partners in the sports arena, not just on the field and polyclinic, but also in research laboratories and interdisciplinary investigative teams.

 

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Single session of spinal manipulation..

Reviewer: Claudio Merkier

Title: The effects of a single session of spinal manipulation on strength and cortical drive-in athletes

Reference:  Christiansen, T. L., Niazi, I. K., Holt, K., Nedergaard, R. W., Duehr, J., Allen, K., Marshall, P. P., Türker, K. S., Hartvigsen, J. and Haavik, H. (2018) The effects of a single session of spinal manipulation on strength and cortical drive-in athletes, European Journal of Applied Physiology, 118 (4), pp. 737. DOI: 10.1007/s00421-018-3799-x.

Introduction:

Athletic performance is affected by a complex range of physiological factors, such as neuromuscular coordination, muscle strength and endurance. Neuromuscular fatigue, diminished muscle strength and power are all detrimental to sports performance with the likelihood to increase the risk of injuries. These factors can be assessed by measuring maximum voluntary contraction (MVC) and spinal reflex responses. Improvement of these physiological factors may contribute to optimize motor and athletic performance.

Objectives:

The primary aim of this study was to examine whether a single session of spinal manipulative therapy (SMT) increases strength and cortical drive in the soleus musculature of elite taekwondo athletes.

Methods:

Soleus-evoked V-waves, H-reflex and MVC of the plantar flexors were documented from 11 elite taekwondo athletes using a randomised controlled crossover design. Interventions were either SMT or passive movement control. Outcomes were assessed at pre-intervention and at three post-intervention time periods (immediate post, post 30 min and post 60 min). A multifactorial repeated measures ANOVA was conducted to assess within and between group differences. Time and session were used as factors. An after-test analysis was conducted when relevant significant effect was present and was set at p ≤ 0.05.

Results:

SMT increased MVC force [F (3,30) = 5.95, p < 0.01], and V-waves [F (3,30) = 4.25, p = 0.01] over time compared to the passive movement control. Between group differences were significant for all time periods (p < 0.05),  but not for the post60 force measurements (p = 0.07).

Conclusion:

A single session of SMT increased muscle strength and corticospinal excitability to ankle plantar flexor muscles in elite Taekwondo athletes. The increased MVC force lasted for 30 min and the corticospinal excitability increase persisted for at least 60 min.

Keywords:

Spinal manipulation, Athletic performance, Taekwondo, V-wave, H-reflex, Maximum voluntary contraction force, MVC, Fatigue.

Critique:

This randomised cross-over study has addressed a clearly focused research question in terms of a specific population (elite taekwondo athletes), intervention (SMT as clinically assessed by a chiropractor), and control comparison (passive movement of the head and spine prior to reaching the end feel of a joint).  The study was clearly designed to assess the effects of an intervention (SMT) on specific outcome measures (MVC and spinal reflexes such Hoffman’s reflex).

The assignment of participants to interventions or control was randomised by computer-generated random number table. However, the chiropractors and athletes were not blinded to group allocation due to the nature of the intervention. Outcome-assessors and bioengineering data-analysts remained blinded to group allocation throughout the study period and file names were coded before sent them to an independent data analyst.

A limitation for this study is the small sample size as the authors aimed to enrol 15 participants, but only 12 athletes were able to be recruited, and one of them were excluded, because he did not finish both sessions due to lack of interest.

A strength of this study is that each athlete acts as their own control which reduced the carry-over effects. Also, the order of receiving SMT was randomised, therefore levelling any potential benefits from the earlier evaluation.

The authors acknowledged performance bias and placebo effects as contributary factors for the effects of SMT, as no blinding of participants was possible due to the nature of the intervention. Their main recommendations for future athletic performance research are to mimic real setting studies by testing exercise outcomes related to the given sports and taken in consideration gender and age.

In summary, a well-designed laboratory study that assessed how a single session of SMT of dysfunctional joints increased temporarily plantar flexor muscle strength and cortical drive in elite taekwondo athletes.

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Hip Osteoarthritis

Title: Does This Patient Have Hip Osteoarthritis? 

Link: Does This Patient Have Hip Osteoarthritis?: The Rational Clinical Examination Systematic Review.

Reviewer: Dr Henry Pollard BSc, Grad DC, Grad Dip AppSc, MSportSc, PhD, ICSC, FAICE (2019)

Reference: Metcalfe D, Perry DC, Claireaux HA, Simel DL, Zogg CK, Costa ML.JAMA. 2019 Dec 17;322(23):2323-2333. doi: 10.1001/jama.2019.19413.

Objective: To identify the clinical findings that are most strongly associated with hip OA.

Data Sources: Systematic search of MEDLINE, PubMed, EMBASE, and CINAHL from inception until November 2019.

Study Selection: Included studies (1) quantified the accuracy of clinical findings (history, physical examination, or simple tests) and (2) used plain radiographs as the reference standard for diagnosing hip OA.

Data Extraction and Synthesis: Studies were assigned levels of evidence using the Rational Clinical Examination scale and assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. Data were extracted using individual hips as the unit of analysis and only pooled when findings were reported in 3 or more studies.

Main outcomes and measures: Sensitivity, specificity, and likelihood ratios (LRs).

Results: Six studies were included, with data from 1110 patients and 1324 hips, of which 509 (38%) showed radiographic evidence of OA. Among patients presenting to primary care physicians with hip or groin pain, the affected hip showed radiographic evidence of OA in 34% of cases. A family history of OA, personal history of knee OA, or pain on climbing stairs or walking up slopes all had LRs of 2.1 (sensitivity range, 33%-68%; specificity range, 68%-84%; broadest LR range: 95% CI, 1.1-3.8). To identify patients most likely to have OA, the most useful findings were squat causing posterior pain (sensitivity, 24%; specificity, 96%; LR, 6.1 [95% CI, 1.3-29]), groin pain on passive abduction or adduction (sensitivity, 33%; specificity, 94%; LR, 5.7 [95% CI, 1.6-20]), abductor weakness (sensitivity, 44%; specificity, 90%; LR, 4.5 [95% CI, 2.4-8.4]), and decreased passive hip adduction (sensitivity, 80%; specificity, 81%; LR, 4.2 [95% CI, 3.0-6.0]) or internal rotation (sensitivity, 66%; specificity, 79%; LR, 3.2 [95% CI, 1.7-6.0]) as measured by a goniometer or compared with the contralateral leg. The presence of normal passive hip adduction was most useful for suggesting the absence of OA (negative LR, 0.25 [95% CI, 0.11-0.54]).

Conclusions and relevances: Simple tests of hip motion and observing for pain during that motion were helpful in distinguishing patients most likely to have OA on plain radiography from those who will not. A combination of findings efficiently detects those most likely to have severe hip OA.

Critique: Hip osteoarthritis (OA) is a common cause of pain and disability. It is often present in adults/masters athletes. Additionally, through a mechanism of regional interdependence be associated with lumbar and knee complaints. This review presents key examination and history taking factors to consider during a consultation and examination.

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RTS guidelines - ankle sprain injuries.

Reviewer: Lizandi Schoeman

Title: RTS guidelines – acute lateral ankle sprain injuries.

Reference: Smith MD, Vicenzino B, Bahr R, et al. Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus. British Journal of Sports Medicine Published Online First: 22 June 2021. doi: 10.1136/bjsports-2021-104087.

Abstract

Background: Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap.

Methods: We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses.

Results: Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement—PAASS: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session).

Conclusion: Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury.

Key words: PAASS framework

Critique: This paper provides important guideline criteria for return to play that can be used by medical professionals when treating athletes with lateral ankle sprains. These injuries occur frequently in different sport codes and thus it is important that all medical professionals cover these main aspects when treating their athletes to prevent recurrent ankle sprain injuries.

 

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Lifestyles / mindsets of athletes

Reviewer: Alex Lee, BSc, DC, FRCCSS(C)

Title: Lifestyles and mindsets of Olympic, Paralympic and world champions: is an integrated approach the key to elite performance?

Reference: Burns L, Weissensteiner JR, Cohen M. Lifestyles and mindsets of Olympic, Paralympic and world champions: is an integrated approach the key to elite performance? Br J Sports Med. 2019;53:818-824.

Abstract: https://bjsm.bmj.com/content/53/13/818

Background: Being a world-class athlete is more than the outcome of an event; it is a way of life that encompasses all aspects of the athlete’s lifestyle and becomes an integral part of their identity. International sporting bodies advocate a holistic approach to athlete development, yet key lifestyle, relational, training and performance practices are commonly overlooked. Unlocking the secrets to performance involves understanding the attributes, skills, strategies, support, environment and lifestyles of elite athletes.

Objective: To explore the contribution, interplay, and impact of lifestyle and psychological factors among a sample of world-class, champion athletes.

Methods:  Open-ended, semi-structured interviews were conducted with 10 World, Olympic and Paralympic Champion athletes that covered their sporting development and athletic profile including their mindset, training and competition practices, along with lifestyle and other key factors to which they attributed their success. A thematic approach guided by grounded theory principles was employed to source and analyze their perspectives and experiences and determine common themes.

Results: Four dominant and overlapping themes emerged (see Box 1): psychological attributes, interpersonal relationships, performance strategies and lifestyle practices. All athletes attributed their success to psychological rather than physical factors, and the vast majority relied on mental rehearsal skills and recovery practices. Championship performance requires a particular way of life that integrates mindset, performance, lifestyle and relationship factors.

Box 1: Emergent themes and subthemes

Psychological attributes

  • Superior self-regulation
  • Intrinsic motivation
  • Effective visualization and imagery strategies
  • Reliance on faith, routines or rituals
  • Strong work ethics
  • Self-confidence and dominance
  • Effective coping strategies and positive mindset

Performance strategies

  • Maximizing training and performance opportunities
  • Effective utilization of sports science
  • Physical therapies and recovery

Interpersonal relationships

  • Having the right support team
  • The athlete-coach partnership

Lifestyle practices

  • Nutrition and hydration
  • Utilization of complementary therapies
  • Importance of time out

Conclusion: The athletic profile and support required to reach and sustain podium-level performance is multidimensional, integrated and psychological factors are paramount. Championship performance is likely to occur at the intersection of a strong psychological profile, interpersonal support, effective performance strategies and lifestyle.

Keywords:athlete, sport, performance, qualitative

Critique: As sports healthcare providers we aim to provide the best care possible to support our athletes to optimize their performance. We must recognize that performance is multi-factorial, and while we may approach improving performance from a clinician’s perspective, it is important to understand the athlete’s perspective and the contextual factors of being an athlete. This qualitative study helps fill this gap by studying the lived experience of World, Olympic and Paralympic champion athletes to understand their perspective of the factors that contribute to becoming a champion. The authors identified four major themes with subthemes and present a conceptual model that represents the complementary and dynamic nature of the contributors to world-class performance: psychology, performance, relationships and lifestyle. While psychological attributes were emphasized by the athletes, their reliance on the use of physical therapies for recovery and complementary therapies (such as chiropractic) as a part of their lifestyle practices was also identified. As sports healthcare providers, we can help our athletes attain performance success by contributing to the identified factors in Box 1 (above). Healthcare providers can support their athlete’s psychological strategies, utilize sports science and their clinical skills to optimize performance/recovery, be a part of an athlete’s interpersonal support team, and facilitate beneficial lifestyle practices.

A strength of this study is that the investigators interviewed elite athletes who attained Olympic, Paralympic and/or world championship medals. This sample of athletes have proven success, and their experience provides valuable insight into the factors that contribute to performance success. A weakness of this study is the small sample size (N=10). The authors do not state why they only interviewed 10 athletes. In qualitative research, authors typically report the point at which further interviews do not substantially change the qualitative codes identified from the analysis, referred to as data saturation. We do not know if further interviews would have substantially changed the analysis in this paper.

Overall, this paper provides valuable insight into the athlete’s perspective of what contributes to achieving performance success. As sports healthcare providers, we must do our best to understand the athlete’s perspective, so we can best tailor our care to help our athletes achieve their performance goals.

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Musculoskeletal Consider...

Reviewer Name: Freya Moran

Title: Musculoskeletal Considerations for Exercise and Sport.

Reference: L. Borowski, E. Barchi, J. Han, D. Friedman, C. Carter. Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy. American Academy of Orthopaedic Surgeons. August 15, 2021, Vol. 29, No 16. DOI: 101.5435/JAAOS-D-21-00044. 

Background: Despite the 75 million women of childbearing age (living in the United States), there is very little scientific literature regarding the risks and benefits of athletic activity, and the musculoskeletal conditions surrounding pregnancy. This has resulted in a protectionist attitude toward these individuals because consequences of these activities are largely unknown. Because the chances of a musculoskeletal health practitioner encountering one of these women as a patient is high, and resources for these professionals is scarce, treatments are often based on opinion rather than scientific data.

Objectives: To describe the musculoskeletal health considerations surrounding pregnancy and athletic individuals.

Methods: this review article summarized the current understanding of musculoskeletal conditions from 49 published articles on topics including joint stability, disordered eating habits, transient osteoporosis, pelvic floor muscle dysfunction and training, pubic diastasis, and back pain.

Results:

Health considerations that the musculoskeletal provider should be aware of include:

  • Preconception and the presence of eating disorder, particularly in cross-country, gymnastics, and other endurance or aesthetic sport. Common risk factors for eating disorders that professionals should be aware of include early sport-specific training, overuse and overtraining syndromes, positive injury history, pressure to lose weight, and negative sport culture/coaching behaviors. Additionally, history should include menstrual status to screen for amenorrhea, and the presence or history of osteoporosis. The effects of eating disorders may not be reversible, and even relative energy deficit in sport carries the risk of impaired function and diminished peak performance, as well as a disruption of the neuroendocrine axis and interference with fertility. Other complications include bone stress injury, decreased immunity, infertility, or unexpected pregnancy.
  • Joint instability beginning in the 10th week of pregnancy that can last to between 4 and 12 weeks after delivery. Relaxin reaches peak levels between weeks 10-12 of gestation, decreasing the tensile strength of ligaments in preparation for birth. However, women who already have hypermobility syndromes such as Ehlers-Danlos do not seem to suffer from an increased risk of negative outcomes. It was also noted that there has been no study investigating pregnancy-related ligament laxity and risk of manifesting patellofemoral or shoulder subluxation/dislocation.
  • Back pain appeared most often in athletes performing gymnastics, diving, weightlifting, and racquet sports. During pregnancy it appears most frequently at 22 weeks of gestation, and is associated with reduced hip extensor strength, lower endurance in the back extensors and hip abductors, and decreased activity of the paraspinal musculature at L4/5. Degenerative spondylolisthesis at L4/5 has a higher incidence in women who have had children. It was observed that athletic women experience pelvic girdle pain at the same rates as nonathletic women.
    • Red Flags include saddle anesthesia, new incontinence or retention, and progressive sensorimotor deficit.
    • Imaging: for women who show “red flags” for back pain, the appropriate imaging modality includes MRI or ultrasonography.
    • Treatment of LBP in pregnant populations has traditionally included exercise, but there is actually little scientific evidence to support this. Of the literature that does exist, water training and stability training of the hip abductors, adductors, gluteus maximus, transverse and oblique abdominis, erector spinae, lumbar multifidus QL, and latissimus dorsi are the most likely to improve outcomes.
  • Pelvic Girdle Pain is considered self-limiting and typically appears at 18 weeks, peaks between weeks 24 and 36, and resolves within 3 months postpartum. Stability exercise programs have been shown most effective. No differences were observed for individuals who used a postural realignment device, and it was observed that athletic women experience pelvic girdle pain at the same rates as nonathletic women.
  • Transient Osteoporosis: typically presents in the last trimester or immediately postpartum and most often affects the spine and hips. Osteoporosis associated with pregnancy is often more severe than premenopausal or idiopathic osteoporosis and often results in multiple pathologic fractures, most often of the vertebra (one study found that the average patient suffered 5.4 vertebral fractures by the time they were diagnosed). No data exists comparing athletic to nonathletic populations, however it is generally thought that patients with a history of disordered eating and history of multiple stress fractures may be more vulnerable to this condition, and should be treated with a multidisciplinary approach including supplementation of calcium and Vitamin D, and weight-bearing activity.
  • Pubic Symphesis Diastasis is considered pathological when more than 10mm. Most often occurring post-partum, risk factors for this condition include multiparity, fetal macrosomia, precipitous or prolonged labor, shoulder dystocia, forceps delivery, maternal connective tissue disorder, and previous pelvic pathology/trauma. Patients presenting with urinary dysfunction and pelvic instability or pain with ambulation should be closely monitored. CT scan may be indicated to observe injury to the posterior pelvic ring, but in most cases the condition is non-operative when less than 40mm unless instability or other progressive symptoms occur.
  • Carpal Tunnel Syndrome remains the most common neuropathy with prevalence as high as 62%, with most women reporting symptoms after 32 weeks. EMG testing is safe during pregnancy, but often not necessary as the clinical diagnosis of CTS is sufficient and the same as in non-pregnant individuals. The condition usually resolves after birth in 5 of 6 women, but can last up to a year. Treatment includes wrist splinting at night, corticosteroid injections, and lastly, surgical decompression.
  • De Quervain Tenosynovitis is under-researched in the athletic population in terms of whether athletes who use their hands or play racquet sports are more at risk. Postpartum is a typical time for presentation of symptoms as it relates to increased fluid retention, and treatment includes bracing, NSAID’s or CSI (corticosteroid injection), and rehabilitative exercises, however first dorsal compartment surgical release reports a 91% cure rate.
  • Diastasis Rectus Abdominis is found in more than half of pregnant women, however it is not yet known if the rate of occurrence is lower in athletes as compared to non-athletes. Abdominal strengthening protocols are sufficient treatment and surgery is performed mainly only for cosmetic reasons.
  • Pelvic Floor Dysfunction including symptoms of urinary or fecal incontinence, organ prolapse, and myofascial pain. Stress-related urinary incontinence is reported in up to 80% of female athletes even before pregnancy, but age, weight, and number of pregnancies are all risk factors for this condition. However, reported rates in athletes are similar to the non-athletic demographic. It was noted that cesarean delivery does not eliminate the risk of developing these symptoms. Pelvic floor physical therapy (PFPT) is an effective treatment option and recommended with level 1, Grade A evidence.

Conclusion:

The field of pregnancy-related musculoskeletal conditions in the athletic populations remains under-investigated and an area ripe for research. What literature that does exist suggests that activity during pregnancy has a positive effect, and therefore, a musculoskeletal practitioner is very likely to encounter an athlete who is, or wants to become pregnant. It is therefore critical that the individual understands the common conditions and their pathologies before engaging in treatment or designing a treatment plan that is most effective and evidence-informed.

Key words: pregnancy, musculoskeletal conditions, exercise, sport, review;

Critique:

Overall, the attitude of the article suggested that women should be encouraged to engage in physical activity before, during, and after pregnancy due to its multiple health benefits and risks being relatively low, so long as the individual does not suffer from other comorbidities or risk factors. The article strives to remind practitioners that pain during and after pregnancy is a common occurrence in both athletic and non-athletic populations, but that surgical treatment is rarely indicated, which favors the use of conservative care as a means of pain control. This review article stressed how under-researched this area is, and despite the lacking evidence created a well-rounded summary of common conditions all practitioners should be aware of, including a basic overview their treatment in the multidisciplinary setting and imaging modalities.

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Systematic Review: Chiro Treatments...

Chiropractic Treatment in Sports: Systematic Review of Randomized Controlled Trials

Reviewer: Dr Claudio Merkier, Bed, BSc, DC, CCEP, ICCSP, FFTP, MSc ,FRCC (Sports)

  1. Reference: Thiele, R. (2019) Chiropractic Treatment in Sports: Systematic Review of Randomized Controlled Trials, International Journal of Clinical Medicine Research, 6 (2), pp. 6-12. Available from: Click here for full paper
  1. Introduction: Since 1980, chiropractic has been used at the Olympic Games to accompany the USA’s top athletes therapeutically. The rapidly developing professional sports sector offers great scope for new therapeutic support for athletes in the areas of prevention, performance improvement, injury treatment and medical rehabilitation. 
  1. Objectives: The aim of this systematic review was to analyse the latest scientific findings, which can be evaluated on the basis of existing clinical controlled studies. The present article deals with the question: How efficient is the use of chiropractic in sports in the above-mentioned areas? 
  1. Methods: The research is carried out in the PubMed database. The evidence level of the individual studies is determined using the PEDro scale. The studies with evidence class I are evaluated in tabular form according to the PICO model. Endpoints assessed are grip strength in judo athletes, ankle injuries, medical rehabilitation with recurrent ankle sprains, jet lag symptoms.
  1. Results: The literature review includes 232 researched articles 8 on the subject, including 3 systematic reviews and 5 randomized clinical trials, of which 4 include evaluable results. Overall, in 3 studies, outcomes in the intervention group for performance enhancement, injury treatment and medical rehabilitation are significantly improved using chiropractic care. The jet lag treatment shows no differences compared to the control group.
  1. Conclusion: In 3 out of 4 studies, there are significant improvements with the use of chiropractic in therapy. Thus, it can be concluded, that the use of chiropractic in sports can improve performance and reduce injury times in medical rehabilitation. Chiropractic in sports is therefore quite efficient.
  1. Keywords: Sports, Chiropractic, Manipulation, Review, Rehabilitation, Athletes.
  1. Critique: This paper concludes that it is necessary to publish further studies before a conclusion can be drawn that “chiropractic in sports is quite efficient”. The conclusion is based on 3 studies with a high PEDro score rating. However, the total number of participants in the intervention groups included in the results were 9 (Botelho and Andrade), 15 (Lubbe et al.), and 15 (Pellow and Brantingham). The first study is on cervical manipulation while the other two are on ankle manipulation. There is a considerable gap in the sports chiropractic literature to make conclude much at all. A conclusion highlighting the limited literature of the supporting evidence and an inability to draw a meaningful conclusion would be more appropriate.
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Sports chiropractors with an ICCSP...

Reviewer: Henry Pollard

Title: A descriptive study of sports chiropractors with an ICCSP qualification: a cross-sectional survey

Nelson L, Pollard H, Ames R, Jarosz B, Garbutt P, Da Costa C. A descriptive study of sports chiropractors with an International Chiropractic Sport Science Practitioner qualification: a cross-sectional survey. Chiropr Man Therap. 2021 Dec 13;29(1):51. doi: 10.1186/s12998-021-00405-1. PMID: 34903268; PMCID: PMC8667448.

Abstract

Background

This paper describes the education and case management profile of sports chiropractors with the Federation of International Sports Chiropractors (FICS) postgraduate qualification: International Chiropractic Sport Science Practitioner (ICSSP). The ICSSP is the predominant international sports chiropractic qualification.

Methods

A cross-sectional survey, carried out between 22/10/2014 and 22/12/2014,was utilized with a 39-item web-based survey examining practitioner, practice and clinical management characteristics, and was distributed via email to all sports chiropractors who held an ICSSP qualification (n = 240) in 2014.

Results

The survey response rate was 64% (n = 154). 36% of chiropractors were aged between 31 and 40 years, just over three quarters were male, and 27% had been in practice for 5–10 years. The majority of respondents were based in North America. All sports chiropractors surveyed reported treating neuromusculoskeletal conditions outside of the spine. 91% utilized a multimodal approach in most of their treatments, prescribing rehabilitative exercises in 76% of consultations. Almost 64% of respondents reported current treatment of professional athletes, and 78% reported current treatment of semi-professional athletes, whilst the vast majority of those surveyed endorsed past treatment of professional (91%) and semi-professional (95%) athletes. All respondents reported referring to a range of conventional and allied health providers.

Conclusions

This study of ICSSP-qualified sports chiropractors describes a small but well-educated workforce treating high-level athletes, managing a wide range of spine and non-spinal neuromusculoskeletal conditions, utilising multimodal approaches (including active and passive strategies), and referring to and co-managing with other health practitioners.

Impression

This paper presents a nice snapshot of the characteristics of FICS based practitioners circa 2014.

Paper Link:  https://chiromt.biomedcentral.com/articles/10.1186/s12998-021-00405-1

 

Dr Pollard currently holds an Adjunct professorial position at Durban University of Technology (DUT). He has published 138 peer-reviewed manuscripts in medical and chiropractic peer-reviewed journals. His research interests include clinical & sports chiropractic, epidemiology of injury, sports medicine, and psychosocial factors in chronic pain. He has had 9 PhD and 3 MSc research student completions, and current 3 MSc and 3 PhD student supervisions at three universities. Additionally, he has helped raise over $1 million dollars for chiropractic research.

H Index: 29                  ResearchGate Rating: 35.41

Read full bio – Click here

Email Us:

Research Chair: Dr Pollard: hpollard@optushome.com.au

Admin:  admin@ficsport.org