Every big tournament has a medical tent. At some of them, The World Games included, one of the people working inside it is a Chiropractor.
A Chiropractor with extra training
A Sports Chiropractor is a registered Chiropractor first. The sports part comes afterwards, as postgraduate study.
The international body for it is FICS, the International Federation of Sports Chiropractic (the initials come from its French name). It was started by national Sports Chiropractic leaders at a meeting in London in 1987 and is now based in Lausanne, Switzerland1. FICS runs a qualification called the International Certificate in Sports Chiropractic, or ICSC. A Chiropractor has to hold it to be picked for a FICS team at an international event. It includes a module on head injuries and concussion that must be renewed every two years2.
Dr Steven Smilkstein holds the ICSC and is a member of the FICS Education Commission.
What it looks like at an event
The World Games are held every four years for sports that are not on the Olympic programme. FICS has worked with the organisers since 2003 and supplies volunteer Chiropractors for the athletes and officials3.
Two published studies show what those Chiropractors do all day. At the 2013 Games in Cali, Colombia, 537 of the 2,964 accredited athletes (18.1%) chose to see a Chiropractor. The mid back was treated most often, then the lower back, then the neck. Muscle and soft tissue work was used on 80.9% of those athletes, manipulation on 78.5%, taping on 38% and joint mobilisation on 24.6%4. The 2017 Games in Wroclaw, Poland, produced 1,902 treatment records with much the same pattern5. Steven was one of the Chiropractors on that team.
How did the athletes feel afterwards? In 2013, 86.9% said they improved straight away. In 2017, 89% reported less pain immediately after treatment.
Read those figures with some care. Both studies are counts taken from treatment records. Neither had a comparison group, and everyone in them had chosen to come. They show what athletes ask for and how they felt walking out of the tent. They cannot show that the treatment caused the improvement.
Does it make you faster?
This is the question athletes ask most, and two reviews have looked at it.
The first, from 2017, found seven trials in which athletes were given spinal manipulation and then tested on something related to their sport. Four of the seven showed an improvement. The authors still called the evidence weak and asked for better studies6.
The second, from 2019, was stricter. It kept only the better-designed studies, 20 of them, all in healthy adults with no symptoms. It found no significant improvement in performance after manipulation7.
So if you are healthy and hoping an adjustment will take seconds off your 10 km time, the research does not back that up. A Sports Chiropractor is for the sore, stiff or injured body that is stopping you from training or competing the way you want to.
One part of a plan
A 2020 review of clinical guidelines for muscle and joint pain found that the good ones recommend hands-on treatment as an addition to exercise and education, and never as the whole plan8. Sport is no different. Treatment on the table can get a joint moving and settle a painful muscle. Strength work and a sensible return to training are what keep it that way.
Deciding when to go back matters as much as the treatment. An international consensus statement from 2016 says the decision should be shared between the athlete, the clinicians looking after them and the coach, and built up in stages9.
Not only for professionals
Most people who play sport in Johannesburg fit it in before or after work. A weekend cyclist's stiff neck and a club hockey player's hamstring need the same careful thinking as a professional's.
This article is general information and not a diagnosis. If you are injured or in pain, come in for an assessment.
References
- International Federation of Sports Chiropractic. About FICS. fics.sport
- International Federation of Sports Chiropractic. ICSC program overview. fics.sport
- American Chiropractic Association. World Games 2022: a "spectacular" event for Chiropractic inclusivity. acatoday.org
- Nook DD, Nook EC, Nook BC. Utilization of Chiropractic care at the World Games 2013. J Manipulative Physiol Ther. 2016;39(9):693-704.
- Nook DD, Nook EC, Nook BC. Utilization of Chiropractic care at The World Games 2017: a retrospective descriptive study. J Manipulative Physiol Ther. 2023;46:271-279. doi.org
- Botelho MB, Alvarenga BAP, Molina N, et al. Spinal manipulative therapy and sports performance enhancement: a systematic review. J Manipulative Physiol Ther. 2017;40(7):535-543.
- Corso M, Mior SA, Batley S, et al. The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence. Chiropr Man Therap. 2019;27:25. pmc.ncbi.nlm.nih.gov
- Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. bjsm.bmj.com
- Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50(14):853-864. pubmed.ncbi.nlm.nih.gov