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

Authors:
The Effect on a Racewalker's Sports Performance with
Ghiropractic Treatment: A Case Report
BRETT S. JAROSZand W. BRUCE ELLIS
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 vis.it per fortnig.ht) 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.
I NDEX TERMS: (MeSH): CHIROPRACTTC; !'lN!t!l!urQ!,
CHIRoPRACTIC; SPORTS; (Other): ATHLETIC PERFORIVIANCE. Chiropr J Aust 2010; 40: 117-19.
INTRODUCTION
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.
CASE REPORT
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.
117
Effect on Sports Performance
JAROSCZ. ELLIS
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.
DtscusstoN
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
improvements.2223
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
118
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
treated.
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
activation.aM2
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.
CONGLUSION
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-
Chiropractic Joumal of Australia
Volurne zl0 Nmber 3 September 2010
I
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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. ...
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