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The effect on a racewalker's sports performance with chiropractic treatment: a case report

The Effect on a Racewalker's Sports Performance with
Ghiropractic Treatment: A Case Report
ABSTRACT: Objective: To describe the enhanced sporting performance of an elite masters'.racewalkerfollorving
chiropractic care.Ctinical Feafures; A S0-year-old male elite racewalker.prepanng forthe World Masters Athletic
Charirpionships presented for chiropradtic,care./ntervention and Outcome: Treatment involved chiropractic
spinal manipdlatiVe therapy (SMT) and tibiofemoral adjustments. Four day.s_post treatment the patient recorded
a'two-and-half-minute iniprdvemi:nt on his previous personal bg9! (PB) 151<m racewalking time. His pr.evioqs
15km PB was the currenf state record (set one year earlier) and his 1Okm PB was the national record (set six
years earlier). He was seen twice in th'e month-prior the Wo_rld Masters event (one per where
ihe above treatment was administered. The patient returned from the championships with two medals and two
frrrther PB nerformances over the 5km and 1Okm distances. Conclusion: There has been minimal research
further PB performances over the 5km and'1Okm distances. Conclusion:
published iegarding the enhanced sporting performance of athletes receiving chiropractic care. From this
base report a-nO tne-evidence presented, it -ppears that chiropractic.intervention can play.a.role. in optimizing
athletic'performance. This should be further investigated in randomized controlled and clinical trials.
CHIRoPRACTIC; SPORTS; (Other): ATHLETIC PERFORIVIANCE. Chiropr J Aust 2010; 40: 117-19.
Sport within Australia continues to grow in popularity
and professionalism.l This growth, at both the amateur and
professional levels, has produced a corresponding interest
imong athletes in chiropractic treatment.2'3 As a result,
numeious chiropractic practitioners and academics have
begun evaluating, studying and publishing research in the
field of sports chiropractic.3-e
Although there is a growing body of evidenc1G21 reporting
the positive effects of chiropractic management on sports-
speclfic diagnoses and sports-related injuries, there has been
minimA information published regarding chiropractic's effect
on overall athletic performance.
Lauro and Mouch22 found that athletes who trained and
received a l2-week program of chiropractic care had a
significant increase in their reaction time when_ compared
with athletes who trained but did not receive chiropractic
care. Schwartzbater et aF showed significant improvement
in muscle strength, long jump distance and microcirculation
(capillary counti) in baaeball players afaer a specific duration
of ippeicervical chiropractic care. Shrier el aF fotnd that
elite athletes involved in sprint sports tended to perform
Brett S.Jarosz, BAppSc(CompMed), MClinChiro, CertPT
Private Practice of Chiropractic
Gisborne, Victoria
W. Bruce Ellis, BAppSc(Chiro), BBSc, MChiroSc, DipAppSc(HumBiol)'
CertChiroClinPaeds, FACC
hivate Practice of Chiropractic
Gisborne, Victoria
Conflict in Interest Notice: There were no funding sources for this study
and no conflict of interest has been identified.
17 May 2010, accepted 28 June 2010
Chiropractic Journal of Australia
Volume 40 Number 3 September 2010
better in both vertical jump height and flying 40 meter
sprint time after high-velocity, low-amplitude manipulation
(HVLA). Sandell et aP5 demonstrated that chiropractic
treatment can improve hip extension ability, but the possible
effect of chiropractic treatment to enhance running velocity,
by increasing hip extensibility and thereby increasing the
running step, remained unproven. Costa et cF concluded
that chiropractic spinal manipulative therapy (SMT) in
association with muscle stretching seems to be associated
with an improvement of golf players' full-swing performance
when compared with muscle stretching alone.
The purpose of this case report is to contribute to the body
of empirical evidence by describing the enhanced sporting
performance of an elite masters' racewalker following
chiropractic care.
The patient was a 50-year-old male elite racewalker
preparing for the World Masters Athletic Championships.
Foimany years, he utilized various health care professionals
(chiropractors, physiotherapists, sports medicine practitioners,
remedial therapists) in an attempt to optimize his athletic
performance and prevent and/or recover from injury. Previous
ireatment consisted of: (1) chiropractic HVLA SMT to the
cervical , thoracic and lumbopelvic regions, (2) mobilization of
the lower extremity articulations and (3) soft tissue therapies
to the gastrocnemius/soleus complex, psoas, gluteal, erector
spinae, quadriceps femoris and hamstring musculature. He
reported that this method of management provided him with
the "freedom" (mobility and function) he required to continue
training and performing at his elite level.
In the month prior to the World Masters Athletic
Championships , the Ftient presented to the clinic complaining
of generalized lower extremity pain and low back stiffness.
Effect on Sports Performance
He reported that his routine yearly training program had
concluded, and he was now "trying to maintain his fitness in
preparation for the competition."
On physical examination, the right pelvis was higher
compared to the left in standing posture. There was weakness
of the bilateral psoas and quadriceps muscles on resisted
muscle testing, graded 4/5. Prominent motion restriction
of both tibiofemoral articulations, the thoracolumbar spine
and right sacro-iliac joint (SIJ) were noted during dynamic
(motion) palpation. Other physical examination fi ndings and
testing procedures including neurological and orthopaedic
examinations were unremarkable.
Treatment involved FIVLA SMT to the right SIJ and
thoracolumbar spine, and the application of a wrist extension
technique2T to a posterior tibia subluxation bilaterally. Post
treatment, muscle strength of the psoas and quadriceps was
graded 5/5 bilaterally.
The patient completed a l5km racewalking time trial four
days after the treatment. He recorded a two-and-half-minute
improvement on his previous personal best (PB) time. He
detailed the significance of this improvement - his previous
15km PB was the current state record (set one year earlier) and
his 10km PB was the national record (set six years earlier).
He was seen twice in the month prior to the World Masters
event (one visit per fortnight) where the above treatment was
administered. The patient returned from the championships
with two medals and two further PB performances over the
5km and 10km distances.
There has been minimal documentation regarding the
effect of chiropractic treatment on enhanced sporting
performance, despite the significant increase in the demand
and support for chiropractic care by athletes.3'a2e A recent
review ofthe literature revealed five studies that investigated
the effect of chiropractic treatment on various components of
athletic performance.22'% The literature suggests that athletic
performance can be enhanced by chiropractic intervention.
However, only two of these studies demonstrated significant
This case report demonstrated the enhanced sporting
performance of an elite masters' racewalker following
chiropractic treatment. Research has demonstrated that
the endurance performance of masters' athletes decreases
with age.3o-3aAccording to the literature, peak physiological
function for men occurs just before age 30 and then regresses
between 0J5 per cent and I percent per year.3sAerobic power
ffO2max) has been shownto decrease by 22 percent between
the ages of 40 and 70.36 This is supported by Rittweger et aF
who demonstrated metabolic power decreases by 26 per cent
in masters' endurance athletes between the ages of 4O and
90. However, this case revealed a significant improvement in
PB endurance pedormances, where the prior PB times were
achieved up to six years earlier.
For many years the patient had been managed with the
same treatment modalities applied to the same body regions
(chiropractic HVLA SMT, generalized lumbopelvic-hip
and lower extremity soft tissue therapies, lower extremity
mobilisations). It is the opinion of the authors that the positiYe
response seen in this case was related to addressing the
biomechanics of the tibiofemoral articulations. Importantly,
it should be noted that the physical examination findings of
prominent tibiofemoral motion restriction and the treatment
thereof, were reported by the patient to be the first time
this alteration in biomechanics had been observed and/or
Biomechanical analysis of racewalking gait demonstrates
significantly increased maximal knee extension and external
peak knee hyperextension moment than did running or
walking.3T During racewalking, participants spend 44 to 51
percent of stance with the knee in hyperextension.3T Knee
extension requires anterior movement of the tibia on the femur
in the sagittal plane and external rocation of the tibia relative
to the femur in the transverse planels It could be suggested
that the correction of the posterior-to-anterior tibial motion
restriction in relation to the femur enhanced this patient's
racewalking biomechanics.
Furthermore, Hamill et aFe illustrated that decreased
sagittal range of moti on (i.e: loss of flexion) of the knee joint
does not attenuate shock as well, passing an unreduced force
to L5lSl, possibly contributing to or resulting in low back
pain. It can be theorized that the increased maximal knee
extension nature of the racewalking gait biomechanics may
have resulted in this patient's low back stiffness. Therefore,
by addressing the patient's tibiofemoral biomechanics it can
also be hypothesised we increased the sagittal range of motion
of the knee, improving the shock attenuating abilities of the
lower kinetic chain.
Additional mechanisms could be proposed to explain
the positive effect of chiropractic treatment seen in this
case. These mechanisms include, but are not limited to, the
effects that chiropractic adjustments have on proprioception,
somatosensory processing and feed-forward muscle
Stump and Redwood3 state, "because professional sports
are highly competitive and thus intensely pragmatic, they
provide an arena in which new techniques can potentially
move quickly toward widespread acceptance once their
efficacy is established." This case report contributes to the
literahre that suggests athletic performance can be enhanced
by chiropractic intervention.n-% It must be noted however,
that the treatment protocol used in this case cannot be
generalised to all athletic
letic populations. Athletes necessitate
protocol designed and implemented
a specific treatment protocol designed and implemented
with their particular biomechanical, athletic and sporting
performance requirements in mind. In this case the athlete
had prminem modon restrictions of both the tibiofemoral
articulaions.Therefore,the emphasis of the treatment was to
increase the motion of the tibia in relation to the femur.
Therc has been minimal research published regarding
the enhnoed sporting performance of athletes receiving
chiropnactic care. From this case report and the evidence
presentod, it appean that chiropractic intervention can play
a role in opimizing athletic performance. This should be
ftrther investigated in randomised controlled and clinical
trials- Future directions for chiropractic research should
inyesigate bdh specific aspects of athletic performance and
specific sptrts-
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... The study sample comprised of one hundred and twenty men (17)(18)(19)(20)(21)(22) yearsold) diagnosed with cervical and lumbar spine pain. The sample was selected from students who wanting to apply for sport and military faculties. ...
... These data are from study participant 16. extension while running, 66 possibly improve balance in older people, 67 alter jump height and 40-m sprint time, 11 and improve walking speed. 68 The findings of this experiment have led to multiple future directions of research. The following should be explored: (1) determine if manipulating other levels of the spine will demonstrate a clearer trend at modifying exercise performance than was shown in this study, and (2) determine the impact thoracolumbar CMT specifically has on maximal cardiovascular exercise output through a VO 2 max test. ...
The purpose of this study was to determine if thoracolumbar chiropractic manipulative therapy (CMT) had an immediate impact on exercise performance by measuring blood lactate concentration, exercise heart rate, and rating of perceived exertion during a treadmill-based graded exercise test (GXT). Ten healthy, asymptomatic male and 10 female college students (age = 27.5 ± 3.7 years, height = 1.68 ± 0.09 m, body mass = 71.3 ± 11.6 kg: mean ± SD) were equally randomized into an AB:BA crossover study design. Ten participants were in the AB group, and 10 were in the BA group. The study involved 1 week of rest in between each of the 2 conditions: A (prone Diversified T12-L1 CMT) vs B (no CMT). Participants engaged in a treadmill GXT 5 minutes after each week's condition (A or B). Outcome measures were blood lactate concentration, exercise heart rate, and rating of perceived exertion monitored at the conclusion of each 3-minute stage of the GXT. The exercise test continued until the participant achieved greater than 8 mmol/L blood lactate, which correlates with maximal to near-maximal exercise effort. A dependent-samples t test was used to make comparisons between A and B conditions related to exercise performance. No statistically significant difference was shown among any exercise response dependent variables in this study. The results of this research preliminarily suggest that CMT to T12-L1 does not immediately impact exercise performance during a treadmill-based GXT using healthy college students.
The Discipline of Chiropractic at RMIT University considers it is well placed to contribute to the Australian research agenda for chiropractic. A strategy that has facilitated this capacity is the Discipline's shift towards educational research that explores the changing practices for learning and teaching within the chiropractic program. This shift has resulted in the engagement of many more academics in critical scholarship resulting in productivity as published papers and active projects. The academic members of the Discipline are encouraged to find their own place on a continuum from classroom inquiry to rigorous educational research and targeted clinical research. This strategic direction is aligned with that of the University which is to "aspire to international excellence in research in its chosen fields and aligned to and working with our global network of partnerships, industries and cities." This paper provides a summary of scholarly activity and research reported within the Discipline in November 2010 and concludes with the author's current concepts on ways chiropractic researchers may better address the need to understand the impact of chiropractic's unique clinical approach. Two qualitative methodologies are briefly described; Phenomenological research which relates observed phenomena to each other, and Grounded Theory which attempts to tease out one or more theories from the collected data. Qualitative methods provide a side view of what may be happening in the clinical environment to allow a better understanding and the subsequent formation of better quantitative research questions, especially in regard to "whole- person" research.
Full-text available
Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football. Sixty male subjects were assessed for eligibility with 59 meeting entry requirements and randomly allocated to an intervention (n = 29) or control group (n = 30), being matched for age and hamstring injury history. Twenty-eight intervention and 29 control group participants completed the trial. Both groups received the current best practice medical and sports science management, which acted as the control. Additionally, the intervention group received a sports chiropractic intervention. Treatment for the intervention group was individually determined and could involve manipulation/mobilization and/or soft tissue therapies to the spine and extremity. Minimum scheduling was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months). The main outcome measure was an injury surveillance with a missed match injury definition. After 24 matches there was no statistical significant difference between the groups for the incidence of hamstring injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051) and primary non-contact knee injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051). The difference for primary lower-limb muscle strains was significant (OR:0.097, 95%CI:0.011-0.839, p = 0.025). There was no significant difference for weeks missed due to hamstring injury (4 v 14, chi2:1.12, p = 0.29) and lower-limb muscle strains (4 v 21, chi2:2.66, p = 0.10). A significant difference in weeks missed due to non-contact knee injury was noted (1 v 24, chi2:6.70, p = 0.01). This study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non-contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management.
Objective: To discuss the mechanism of injury for turf toe, its effect on athletic performance, and the conservative evaluation and treatment for such a condition. Clinical Features: A 13-yr-old female soccer player suffered from pain in the great toe of her left foot. This pain had existed for approximately 4 months. Exquisite tenderness was elicited upon passive extension of her great toe. There was hyperpronation of the foot with associated bunion formation on the medial aspect of the head of the first metatarsal. She had a notable right rotatory thoracic convexity with associated elevation of the rib angles on the right. Intervention and Outcome: She had not responded to approximately 2 months of traditional medical care, including anti-inflammatory therapy. Her conservative care consisted of chiropractic manipulation of the metatarsophalangeal (MP) joint and navicular bone, mobilization of metatarsals, transverse friction therapy, ice massage, and evaluation for and use of custom-made orthotics. All of these services were performed in a private chiropractic clinic. Care initially consisted of 10 visits over a period of 5 months, with resolution of symptoms by the seventh visit. Conclusions: Appropriate and timely conservative care of sport-related injuries is essential. The early response and resolution of an injury that plagued traditional medical care is of clinical significance. This paper presents a conservative protocol for an extremity injury, based upon a unique and concise recollection of a personal case.
Objective: To discuss conservative management of peroneal nerve entrapment in a skier. Clinical features: A 19-year old male elite skier on the junior national ski team presented with complaints of pain and muscle weakness in the lateral aspect of his left lower leg, ankle and foot that had occurred while ski racing. Tenderness on palpation was noted over the left anterior talo-fibular ligament and left peronei and gastrocnemius muscle bellies. Manual resisted muscle testing revealed weakness of the anterior tibialis, peroneus longus and brevis muscles. All other neurological testing and vascular testing was normal and the remainder of the examination was unremarkable. Intervention and outcome: Initially diagnosed as an ankle sprain and muscle strain, the patient was treated for three days using pelvic and lower extremity chiropractic manipulation, interferential current, and cryotherapy. After three days, the patient reported improvement of foot and ankle pain but reported foot drop present when wearing his ski boot. Peroneal nerve entrapment was diagnosed and the patient's treatment plan was modified to additionally include acupuncture and soft tissue mobilization. A modified Gilliat's test was used to monitor how much pressure was needed to induce muscle weakness at the ankle. After three days of care, the patient reported alleviation of the pain and weakness. Conclusion: This case describes the management of peroneal nerve entrapment by conservative care including chiropractic manipulation of the lumbar spine, pelvis and lower extremity, interferential current, cryotherapy, acupuncture and trigger point therapy.
Demographic statistics were collected at the international sporting event the 6th All African Games in Harare, Zimbabwe, September 12-23, 1992. The Federation International de Chiropractique Sportive (FICS) sent 30 volunteer chiropractors from 6 different nations to treat the athletes and support personnel present at these games. Treatment data was collected that demonstrated 1957 treatments in the 10 days of competition. Patients were seem from 47 of the 48 nations present at the games. The data show which countries and sports made use of the chiropractic physician. This information demonstrates the need for chiropractic physicians at such national and international events. We will discuss how this information can be used to promote the use of sports chiropractic at sporting events.
This article is a practical clinical progression of the information presented in Part 1. Relevant symptoms, signs, and predisposing factors that help in the development of a diagnosis for acute and chronic injuries of the soft tissues (cartilage, muscles, fascia, capsules, ligaments, nerves) and the hard tissues (bone, cartilage) are discussed. Appropriate treatment options and management plans for these injuries, as well as specific conditions, such as exertional headache, chiropractic subluxation complexes, patellofemoral syndrome, compartment syndromes, and lumbopelvic syndromes, are explored. The sports chiropractor is well placed to provide comprehensive health care for those athletes who train with weights.
Stiffness and pain in the big toe, known as hallux rigidus (HR), is a complication of acute or chronic sprain/strain of the first metatarsophalangeal joint (MTPJ). As a cause of pain and dysfunction in the big toe, HR is the most common athletic disorder and secondary only to hallux abductovalgus in incidence. HR is divided into three grades based on the amount of degenerative joint disease found at the first MTPJ. Grade 1 HR cases, those with little or no degenerative changes, and possibly some Grade 2 HR cases, with mild-to-moderate loss of joint space and degenerative changes, appear to improve with joint mobilization/manipulation, modalities and exercise.