Sports Chiropractic Research

The Research Commission is responsible for the promotion and encouragement of research in sports chiropractic. 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

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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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Does This Patient Have Hip Osteoarthritis?

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.

Lifestyles and mindsets of Olympic, Paralympic and world champions:

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

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

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.

Systematic Review: Chiropractic Treatment in Sports

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.
RTS guidelines - acute lateral ankle sprain injuries.

Reviewer: Lizandi Schoeman

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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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/?

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

Dr. Henry Pollard is the FICS Research Commission Chair. He is a practising Sports & Exercise Chiropractor and clinical scientist based in Sydney, Australia. He is the owner and director of a chiropractic clinic located in the Southern Sydney beachside suburb of Cronulla and has a special interest in Sports Chiropractic. He is also Head, Australasian Institute of Chiropractic Education (AICE), a business unit of the Australian Chiropractors Association (ACA). Prof Pollard has been in private clinical practice for the last 34 years, has been an Independent Chiropractic Consultant (IME) for State Insurance Regulatory Authority (SIRA) (Formerly known as WorkCover Authority of NSW) for 18 years and has taught for 30+ years in the areas of orthopedics, sports medicine, clinical management and research at several universities. He currently holds an Adjunct professorial position at CQUniversity. He has lectured at numerous conferences nationally and internationally in the fields of Chiropractic, Sports Medicine, and Research and has published 130 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. He currently has 2 MSc and 2 PhD student supervisions. Additionally, he has helped raise over $1 million dollars for chiropractic research.  In a career that has spanned nearly 35 years and three distinct phases: clinical / working with teams (collision and non-collision sports); academic/research and clinical/regulatory.

E-Mail:        hpollard@optushome.com.au               H Index:     26                  Researchgate Rating:   35.28

Dr Henry Pollard

FICS Research Commission Chair, BSc, Grad Dip Chiro, Grad Dip App Sc, M Sport Sc, PhD, ICSC, FICC, FAICE (2019)