Recently I spoke to a group of chiropractic students, and those of you who have attended a seminar or lecture know how widely varying their questions can be. One of the questions I was asked dealt with special certification programs. The student later redefined his question to, “Do you have to be a Certified Chiropractic Sports Physician to work with professional teams?” Naturally, the answer is no. I told him there were a lot of chiropractors working with professional teams that do not have any type of certification other than their license to practice chiropractic. I further answered the question for the students by explaining that additional certifications–whether they are related to sports, pediatrics or orthopedics–are a personal choice. Most who take these types of courses do it to gather additional knowledge about a specific type of practice or to place an emphasis on their clinic.
Quite often you will see an advertisement where the doctor specializes in sports injury, or is a sports chiropractor, or even may list a team that he or she works with and is considered to be a team chiropractor. However, the ad is just a promotion. The real results are the services you deliver and/or provide for your patients.
When visiting with young doctors who consider themselves “experts” in treating sports injuries, I often ask them what types of rehabilitation or conditioning programs they recommend. What types of supportive devices do they use? Do they use any type of supplementation? How do they analyze gait mechanics? Quite often, I see that the only real expertise they have is that they provide a chiropractic adjustment. True, the chiropractic adjustment is the most powerful form of health care, and it is unparalleled in providing relief from pain and disability for millions of patients. But, in today’s world, we must be able to provide more for our patients–especially our athletes.
I compare this to the chiropractor who considers himself or herself a “wellness” chiropractor. The term “wellness” is defined in numerous ways, depending on the dictionary or person you talk with; but most definitions are similar in that they speak of multiple approaches to achieving true “wellness.” The bottom line is this: We are changing lifestyles.
So, how do you affect your patients’ lifestyles? Do you provide some type of rehabilitation or exercise for your patients? Do you consult with them on changes in their activities of daily living to help improve posture and reduce the chance of further injury? For most Americans, a recommendation of improved diet and eating habits can be life changing. All activities we recommend should be geared toward improving our patients’ lifestyles and, especially, paired with chiropractic care. This gives your patients the best chance for a healthy, happy and prosperous life!
Typically our standard of care includes the following: Consultation–We use this to gather valuable information on not just patients’ present condition, but also what other previous injuries or other factors might be predisposed to the present complaint. Are family, social, economical or ergonomic issues involved?
Examination–Includes some form of postural examination looking for symmetry in posture and gait, evaluations of ranges of motion.
Evaluation of the muscular integrity–This is important because the patient may indicate a weakness or tightness of a specific muscle group. You may even choose some form of balance test on both a firm and pliable surface to complement your neurological examination. There is no substitute for a good thorough palpation examination to detect possible deformities, muscle splinting or spasms.
Biomechanical evaluation–this is one of the most important aspects of our examination, especially with the athlete. When clinically necessary, weightbearing radiographs are a good component of our exam. Based on clinical necessity, we may need to take stress or motion views and use a treadmill to evaluate biomechanics of the athlete’s gait cycle. Regardless of the sport, all sports involve movement.
A very valuable tool for evaluating biomechanical symmetry is through the use of a digital foot scanner. A weightbearing scan of the patient allows us to determine biomechanical problems that exist within the foot that can affect normal biomechanical patterns of movement. These problems can cause compensation or additional stresses on joints, starting at the foot, thus transferring those stresses up through the musculoskeletal chain to the skull. As chiropractors, we understand how the whole kinetic chain works together from the normal movement pattern of the bones and joints, but it’s important to understand how the different muscles–both antagonist and protagonist–work at specific angles to allow movement and assist postural stability.
Most runners use some form of store-bought or custom-made orthotics. Most orthotics are designed to stabilize a specific foot problem. Case in point is the hard plastic, high-arched orthotics that reduce pronation but, also, restrict the normal movement pattern of the foot. Due to our understanding of how structural problems at the foot can affect the whole neuro-musculoskeletal chain, chiropractors should look to the whole of the patient and use custom-made, flexible orthotics. No doubt, neurologically, it is from “above down inside out,” but biomechanically it starts at the foot and goes up. It is just simple anatomy and biomechanics. “When the foot hits the ground everything changes!”
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.