Chiropratic care and Athletics

Doctors of Chiropractic in Sports Care Manipulation in the Rehabilitation of a High School Sprinter Eat Right for a Rapid Recovery A's Notes: Neck woes continue to plague hitters

Doctors of Chiropractic in Sports Care

Doctors of Chiropractic have found that they can also be effective in the nutritional aspects of athletic performance. They have been able to help in pre-competition preparation, competition endurance, and all aspects of injury prevention and treatment (4).

Chiropractic is becoming more a treatment of choice by professional and amateur athletes. This has been evident in the treatment of collegiate, Olympic, and professional athletes and has enabled chiropractic treatment to gain recognition (5). Chiropractic care is not only limited to the more advanced athlete, but young athletes are able to benefit from chiropractic treatment as well.

Due to the lack of education in the areas of biomechanical and neuromusculoskeletal dysfunction, medical doctors are not as well prepared to deal with athletic injuries. Because of this, many athletes of varying abilities are learning of the benefits of chiropractic care. Many high-performance athletes and their coaches have found that sports chiropractic plays a major role in three important areas of prime concern to all athletes: maximum musculoskeletal performance, prevention of injury, and management of injury (1,2).

Weekend and amateur athletes can learn about the importance of chiropractic adjustments from many professional athletes. No matter which sport you enjoy on your day off, you can find someone you admire in your area of interest that is being treated by a chiropractor. The list of advocates is long. Boxing heavyweight champion Evander Holyfield; Joe Montana, Jerry Rice, and Roger Craig of the four time Super Bowl champion San Francisco 49ers; golfer Chi Chi Rodriguez; world champion kick-boxer Dennis Alexio; as well as champions in virtually every major sport are becoming regular chiropractic patients. Many of these athletes insist on being adjusted by their chiropractors just prior to competition (3). They feel they are not able to perform at their optimum ability without the reassurance that they have full range of motion without restriction in their joints (7).

The changing outlook towards health from an allopathic standpoint to a more holistic approach has brought the study of nutrition to a more respectable position. The athlete is always looking to enhance performance, speed, injury rehabilitation, and increase endurance. In their search they are being drawn to the benefits of nutrition. Inadequate nutrition and unhealthy nutritional behavior is clearly linked to the etiology of practically every major chronic disease (8). Doctors of Chiropractic are able to give pertinent advice on vitamin supplementation, dietary intakes, environmental toxicities, homeostasis, and biomechanical reactions of bodily systems (4).
References

1. Chapman-Smith, D. "Sports chiropractic." The Chiropractic Report 1990; 4:1-6.
2. Johnson, P. "Chiropractic and youth." Today's Chiropractic 1987; 16:39,112.
3. Tyler, R.H. "Chiropractic fight doctor." Dynamic Chiropractic 1991; 9:1,27.
4. Press, S.J. "The role of the chiropractic physicians in the sports medical team." Am Chiropractor 1987; August:31-36.
5. Corwin, J.M. "Coming of age in the 1980s: sports chiropractic's rapid rise." Today's Chiropractic 1987; 16:31-32,112.
6. Freerks, H. "Dr. Nick Athens, unofficial team chiropractor for '89 Super Bowl champs." ICA Review 1989; 45:17.
7. sportelli, L. "Chiropractic sports science: a new perspective." J Chiropractic 1988; 25:19-22.
8. Sawyer, C.E. "Nutrition specialists fill vital role." J Chiropractic 1989; 26:28-30.
9. Hagerman, G.R.; Atkins, J.W. "The U.S. Alpine ski team's conditioning and injury-prevention program." Am Chiropractor November, 1989; 16-25.
10. Green, D.M. "Optimum evaluation, treatment, fitness rehabilitation approach to musculoskeletal joint dysfunction." Chiropractic Sports Med 1987; 1:26-28.
11. Cianciulli, A. "Sports chiropractic." Chiropractic Sports Med 1987; 2:46.
12. Whitman, M. "The complete blood count and its clinical nutritional implications." Dig Chiropractic Econ 1987; 29:20-23.
13. Nansel, D.; Cremata, E. "Effect of unilateral spinal adjustments on goniometrically-assessed cervical lateral-flexion end-range asymmetries in otherwise asymptomatic subjects." J. Manipulative Physiol Ther 1989; 6:419-427.
14. Johnson, L.M. "Chiropractic and the '88 Olympics." ICA Review 1988; 44(2):44,47.
15. Leonardi, L. "Global expansion through sports." ICA Review 1986; 42(1):50-51.

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History

An 18-year-old track athlete entered our facility with chronic left hamstring pain and low back pain. She sustained a hamstring sprain while sprinting for her high school team. After two months of treatment with the school's athletic trainer, the athlete felt little improvement.

We immediately implemented an aggressive rehabilitative program, which included strength training, extreme flexibility training, modalities, and osseous manipulation.

Rehabilitation Protocol

Gait Analysis

The athlete performed a gait analysis on a treadmill at 2, 5, and 10 miles per hour on a flat surface. At 2 miles per hour the athlete revealed the following findings. External rotation of the bilateral foot with ankle pronation. Valgus stress placed on both knee and a loss of her proper nutation/counter-nutation of the pelvis region. No additional changes were noted at 5 miles per hour.

At 10 miles per hour an increase in all findings were noted with the addition of pain and discomfort within her hamstring and low back region on the left. Visual inspection of the paralumbar musculature revealed an increased prominence of the left paravertebral musculature directly over the site of pain.

Shoe inspection revealed increased wear on the medial posterior heel bilaterally.

Short Leg Syndrome

The leg imbalances examined are due to spastic contraction of the extensor muscles in the lower spine and pelvic girdle. There are many reasons for a short leg (bone deformity, pathology, trauma, joint involvement, or break-down of the arch), our focus will be spastic muscular contraction.

To understand the relevance of a short leg analysis, we will examine a more accurate and descriptive phrase, the contracted leg. This denotes the neuropathological relationship imbalance, which appears as an inneverational overload to the extensor muscles, causing unilateral spastic contraction and unequal extremities. This spasticity occurs when certain muscles are over stimulated. Visualize the function of the central facilitary and inhibitory mechanisms. Normally the facility mechanism increases the normal spinal stretch reflex, while the inhibitory mechanism decreases the reflex. These systems consistently react to proprioceptive input to the cerebral cortex, cerebellum, and brain stem to maintain postural balance.

The cortex stores normal values of body function, while the actual state of the body is monitored and compared to the cortical data by the cerebellum and hypothalamus.

Proprioception is the sensation of joint motion (kinesthesia) and joint position. It is mediated by specialized mechanorecptors which respond to mechanical deformation. These receptors are important in modulating muscle function.

Structural imbalances (fixations or articular joint function) are displayed in the cerebral cerebellar/cortical system as increased input from the ascending cerebellar afferent fibers. The inhibitory influences are prevented from modifying the facilitary influences which now, unopposed, result in innervational overload, exaggerated spinal stretch reflex and a contracted leg.

Evaluation of Low Back and Extremities

The athlete revealed a left short leg and a right convexity of the lumbar spine, motion palpation revealed multiple fixations within the thoracolumbar spine. Myospasm and point tenderness (pt) was noted throughout the paravertebral muscular as well as the involved hamstring. Evaluation of the involved leg and ankle revealed an anterior talus which created a shortening of the posterior compartment musculature of the lower leg, and an anterior tibia which created tension within the hamstring group at its insertion point.

Further evaluation revealed the patient to have a high right hip upon posture analysis. Asymmetrical musculature of the paralumbar region.

Active and passive range of motions of the lumbar spine and hamstring were decreased in all planes by approximately 15 percent with pain noted in flexion in both areas.

The athlete experienced pain within the lumbosacral region when performing a double straight leg raise, a left Lasegue's and bilateral Kemp's. All muscle testing were within normal limits (5/5). Pain was noted when the hamstring was tested in flexion.

Radiographs (Lumbar Spine)

There is a mild to moderate deviation of the spinal axis to the right with a convexity, which has created an element of muscle spasm; mild degenerative sclerosis of the apophyseal joints bilaterally; and a low left ischium, due to the sacral deviation and the component of muscle spasm. Loss of the curve with malpositioning is noted. Due to the rotational component, facet syndrome can be expected.

Treatment

Initially interferential with moist heat and deep tissue massage. After three treatments, she complained of an increase in soreness in the hamstring, so contrast therapy was implemented with interferential. Deep tissue work was discontinued and effleurage massage performed.

Phonoporesis in a stretch position with cortisone was utilized about one week into treatment . This treatment proved to be the most effective.

At the end of the session, the athlete was thoroughly stretched in all ranges of motion for the lower and upper body and seen for a chiropractic evaluation and manipulation.

Rehabilitation

Included with treatment was an aggressive rehabilitation program consisting of Cybex, sitting and laying leg curl, and slant board exercise. We utilized split routines alternating between cardio work and weight training.

The principle of specific adaptation to imposed demands was utilized with minimal rest periods. The lower muscle groups were our main focus.

Strengthening and Conditioning

A comprehensive strengthening and condition program was implemented which included: aggressive flexibility utilizing proprioceptive neuromuscular facilitation stretching (PNF); conditioning was implemented utilizing the Versa Climber; upper body ergonomics (UBE); running with bands, and plyometrics.

Due to the athlete's injury, which occurred during the season, it was imperative to keep her well conditioned for her sport. Utilization of the Versa Climber simulating full out sprints, placed little stress on the hamstring and proved to be effective. Weight training utilizing Cybex, performing open and closed chain kinetic exercises with moderate to high repetitions.

Conclusion/Prognosis

The athlete showed great improvement in strength and flexibility after two weeks of treatment and rehabilitation. Osseous manipulation to the lumbar, pelvis, and extremity helped the hamstring to have an improved biomechanical advantage leading to her recovery. The athlete met the long and short-term goals that were set for her and is now engaged in normal sprint workouts. The mechanical dysfunction is now monitored once every 1-2 months.

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The CHO group will replace the lost glycogen with greatest efficiency. This group consists of three subsections. The three subsections are divided according to the glycemic index. Foods that quickly release glucose, the main replacement food for muscles, are listed high on the glycemic index. Foods that are slow to release glucose are listed lower. Sugars, syrups, breads, and potatoes are high glycemic index foods. Milk, yogurt, and most beans are low index foods. Eating high on the glycemic index will replace lost glycogen most quickly.

The timing of glycogen replacement is also important. According to Edward Coyle, PhD, and Effie Coyle, MA, RD, LD, in their article in the Physician and Sports Medicine, Feb. 1993, the timing is just as important as the type. Muscles absorb glycogen fastest in the two-hour period immediately following exercise. This absorption is maximized by eating 50 grams of high glycemic index foods. Even at this rapid rate, the replacement will occur at only seven to eight percent per hour. However, after the two-hour window, the replacement occurs at only five percent per hour. For an athlete on a frequent workout schedule, this additional replacement in the initial two hours is important. At only five percent per hour, it would take 20 hours at optimum replacement rates to fully replace lost fuel.

The recommendations of the authors are to eat 50 grams of high to moderate glycemic index foods immediately after exercise, then to continue to eat 50 grams every two hours until a large meal is consumed. Four hours after exercise, any CHO foods, whether high or low on the glycemic index, will result in a five percent per hour replacement rate. Any fats consumed will lower the replacement rate. Proteins seem to have a variable influence.

A quick and easy rule is that the sweeter the food the higher on the index it is placed. The exceptions are the fruits. They generally score lower due to the high concentration of fruit sugar, fructose. Fructose has to be converted to glucose before it is useful. This lowers its overall rating.

The easy recommendation is: Immediately following exercise eat 50 grams of high glycemic index foods. Continue to consume 50 grams of high to moderate glycemic foods every two hours until a full meal is consumed. Make CHO 60-70% of your total calories for every meal.

Following these guidelines will replace the lost muscle glycogen most quickly. This allows for fastest recovery.

Reference
Coyle EF: Carbohydrates that speed recovery from training. Phys Sports Med. 21(2), 111-123.

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OAKLAND -- Help wanted: On-call, 24-hour chiropractor. Call now, offer may end Sunday.

You could never tell by looking at the healthy September box scores, but hitting for the A's has become a real pain in the neck. Left fielder Ben Grieve missed only his sixth game in 159 chances Friday night with a stiff neck as the A's opened their final regular-season series against the Texas Rangers at the Coliseum.

Grieve is the third A's hitter in five weeks to miss time because of a neck injury. Second baseman Randy Velarde missed six games in late August with a strained neck, and he is just now regaining his hitting stroke. Designated hitter/first baseman Mike Stanley had his first at-bat in two weeks Thursday. He's still recovering from muscle spasms in his neck.

The A's, like the rest of the major-league teams, have a network of chiropractors from which they can consult at home or on the road. But their constant need for neck care makes the A's candidates for in-house service.

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