I recently attended and spoke at the annual meeting of the American Chiropractic Board of Sports Physicians (ACBSP). What surprised me the most was the connection and camaraderie I felt with these doctors. I suspect most of us tend to get isolated in our practices and have limited contact with other DCs - and most of that contact may be nothing more than seeing other doctors' failed cases or observing questionable management practices. Personally, I have some tendency to feel alienated from my own profession and to feel that even though I am proud to be a chiropractor, I don't always appreciate how chiropractic is practiced in the world.
The tone, attitude and dedication of this group of sports chiropractors really impressed me. The discussions were not about patient volume, insurance hassles or practice-building; they were about how to get athletes back in the game and improving outcomes using the latest evidence. It's hard to communicate the overall tone of the event, but it was very uplifting. I felt as if I had come home to a chiropractic environment in which everyone was into getting the patient well quickly and recognized the necessity of using the multiple tools to which we have access.
Everyone I spoke with uses and appreciates rehab and soft-tissue approaches along with manipulation. The doctors are dedicated to continuing education, and most either already hold the advanced certification as certified chiropractic sports physicians/practitioners (CCSP) or diplomates of the ACBSP (DACBSP), or are studying toward these credentials.
I am not a sports chiropractor; I do treat some athletes, of course, but it is not the center of my practice. However, there are certain principles of sports chiropractic that I believe apply to most of our patients. Sports chiropractors work to get their patients well as quickly as possible. They want to get their athletes back on the field. They want to give their patients the tools to help themselves.
Most of the doctors had a wellness outlook, involving the whole lifestyle: day-to-day activities, nutritional components and obviously, exercise. Exercise was defined differently here, with components for rehab and components for training both athletes and weekend warriors. All of the docs seemed to embrace rehab and soft tissue as necessary components of chiropractic care.
I felt right at home in the sports chiropractic culture. I have not been this proud to be a chiropractor in a long time. I don't know how to describe this feeling. It was great! I was particularly impressed with the younger chiropractors at this event. I'll turn the podium over to some of the other speakers from the symposium now to share their wisdom. I made contact with as many as I could and asked them this question: "What's different about sports chiropractors?" Here are three of the many responses I received:
Robert "Skip" George, DC: "First, I approach every patient from a functional point of view. Of course, I get a complete history and exam, but I also look for the source of their pain and get them moving with ... rehab work and combine that with parts of Gray Cook's 'Functional Movement Screen,' Mike Boyle's work, and others. So, I approach each person from the standpoint of stability, movement, posture and alignment. This all fits with the chiropractic model and the sports practitioner.
"Then, I can apply functional training. If it is an older patient, they are grateful for balance and the confidence that they can perform their ADLs without injury or falling. They can even travel with the confidence that they won't have pain or limitation when they want to walk down a cobblestone street, for example. [The] same principle applies to a performance athlete, weekend warrior, or someone that just wants to be fit, firm and strong. Evaluate and treat, stabilize, get them moving in functional patterns, then fitness train the heck out of them!
"What fun to progress a person from pain and perhaps disability to working out and moving their body as it is intended to be moved. Our bodies are meant to move and be strong, have endurance, be flexible. Who better to provide that than the sports DC? Throw in nutrition, soft-tissue work, lifestyle help in terms of rest and renewal, and we are then 'Health Counselors.'
"For many in the profession, as you know, when we get together as a group the talk is about numbers, money, and beating our chests [about] how many new patients we had or adjusted that week. This is a poor measurement for success and actually limits our profession. Is making a good living and having a well-oiled business important? Absolutely ... it is critical. But income and success need to be measured in terms of balance and come first from competence professionally, personally and in relationships. Do we define and value all three or just become one-trick ponies focusing on one external indicator (i.e., income)?
"The great thing about the ACBSP Symposium is the energy we all experienced by having something real to offer. The other part of the enthusiasm is (and this is my perspective, so check this out on your own) we are the most happy when we are building. Building mastery, caring about what we are learning, understanding what works in detail, contributing to others in our profession, patients and community, and being more and more creative in how we practice and live our lives is the source of happiness, as far as I am concerned. That, I think, is what this group is about."
Ted Forcum, DC, DACBSP, 2008 U.S. Olympic Team Chiropractor: "Sports chiropractors do tend to have a fraternal feeling. At times we get exposed to unusual circumstances and due to travel, are placed in a common arena where we can develop a unique and extreme bond. Unlike other types of practices, sports chiropractors will frequently travel, go to venues and sites outside of their office in groups to provide care. Even as a practitioner that works in a solo position, there is a common bond usually by those in similar positions that share similar experiences, such as those that work with teams that have on-field assessments and travel. The nuances of the athletes themselves [also] is a common link between providers.
"I certainly am biased, but I find sports chiropractors to be amongst the cream of the crop. Most of the providers have additional education beyond their doctor of chiropractic. This education can be a CCSP, DACBSP, ICSSD (International Chiropractic Sports Science Diploma), and other designations such as ATC, master's degrees, PhDs, certified strength and conditioning specialists, corrective exercise specialist, performance exercise specialist, and training in techniques such as soft-tissue techniques like ART and Graston.
"Sports chiropractors often will just manipulate, but most do carry a lot of tools in their toolbox. As such, they will frequently be trained [in] and utilize soft-tissue techniques, taping techniques, rehabilitative procedures and modalities to aid the athletes' recovery. Most practitioners take a 'do what's necessary' [attitude] to get the athlete back in the field and performing at top level.
"Also unique to the sports chiropractor that does work outside their office or with teams is the understanding of hierarchy within health care. Much like those practitioners working with the military, there has to be a strong communication basis between other practitioners associated with this athlete's care, the athlete, coaches, and depending on the level of the athlete, parents and/or athlete managers. [Also] unique to sports chiropractic [is] the hierarchy of media and who addresses media. This is different from most other practices."
Robert C. Nelson, DC, DACBSP, CSCS, FICC: "The certified sports chiropractor is always expanding his/her tool box so that he or she can offer the best care for their athletes. Working with other sports chiropractors and other health care providers, they are exposed to many different techniques and 'tools.' They see the efficacy of the treatment presented and learn to make it their own. The dynamic is evidence-based, best care, to return the athlete or our other patients back to their sport or activity."
One principle to remember for every chiropractor: Get the athlete/patient back in their "game." This doesn't always have to involve athletes in competitive sports; it may mean finding a way for a grandmother to pick up her grandchild. Replace any despairing notion of, "You are too old and broken down to pick up your grandchild" with "Here is what you and I need to do to get you to be able to once again pick up your grandchild (or get out in the garden, travel, walk a mile, etc.). It's about focusing on the positive, getting back in the game, and finding a better way, instead of supporting and accepting the disability.
Thanks again to the American Chiropractic Board of Sports Physicians and to everyone I corresponded with in the writing of this article. To all of the sports chiropractors out there: Keep up the good work!
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