In some circles the role of chiropractic care for treatment of athletic injuries is unclear. If chiropractors do taping what does the athletic trainer do? And if the chiropractor acts as the team physician what does the medical doctor do? In fact most athletic trainers and medical doctors don't have a good idea what the chiropractor can do which presents a real problem, especially if that person acts as the gatekeeper to the athletic event.
Restoration and regeneration are two European concepts of health care that
athletic coaches have used for decades to speed recovery and enhance
performance. Most American coaches, familiar with European training methods, use
some form of restoration and regeneration in their long range training plan.
Anything that can speed recovery will allow the athlete to train harder, more often and more safely, all
combining to enhance performance over the course of time.
The fact that a coach may recognize the importance of restoration and regeneration is often lost in the administrative delegation of duties at an athletic event. Health care services are usually delegated to the medical doctor whose main concern is life support. In turn, care of acute, non-life-threatening injuries are delegated to the athletic trainer. For many the role of chiropractic or massage therapy is attention to the placebo effect. Restoration and regeneration is not in their dictionary of care, figuratively or literally.
Athletic Care Triage Model
There is a theory in communication science that states that the dominant social group creates the lexicon of the language. Feminists use this theory to argue that language is basically a male construct. The definition of medical care, its concepts and realities, is a medical construct. One need only whisper the world "subluxation" in professionally mixed company to prove the point. If it is not in Dorland's or Taber's Medical Dictionaries the concept does not exist.
Political correctness dictates a healthcare dictionary. To date there is no "health care" dictionary. The reality is that this would not serve the politics of the dominant group. So in the mean- time disciplines such as chiropractic, massage, acupuncture and others remain alternative and complimentary .
The Athletic Triage Model
In September 2001, I served as Medical Director (in reality health care
director) for the Syracuse Festival of Races (SFOR), an international road
race held annually at Syracuse University. My responsibilities included
supervision of the emergency medical service (EMS), acute, non- life threatening
care (the athletic trainer) and the restorative and regenerative services
(chiropractic and massage). All practitioners had a job to do.. More importantly
all practitioners had their own job to do.
The service utilization statistics for the event were most revealing. Fortunately the EMS personnel saw no one. The athletic trainer had 11
visits. The lone massage therapist saw 11 patients (which is misleading, in 2002 eight massage therapists had 62 visits) and the ten NY Chiropractic College interns saw 112 visits. The line formed at the chiropractor's tent.
Armed with these statistics, I was permitted by the chair (a medical doctor) of the Sport Sciences Committee of USA Track and Field to address the committee (predominantly MD's and athletic trainers) at the December 2001 National Convention. My report included statistical findings and the introduction of the new athletic triage model used with the restoration and regeneration branch. Restoration and regeneration as a health care concept for performance enhancement through accelerated recovery not only now had a name but a place in the total care picture of an athlete. (Figure 1)
What is Restoration and Regeneration?
At its most basic level restoration and regeneration is the normalization of the basal metabolic
rate (BMR), the sympathetic and parasympathetic nervous systems and all the
functions they entail (circulation, assimilation, rest and elimination). In
competitive endeavors, where performance is prized over participation, there are
competitive advantages to accelerating the recovery process. Many competitions
require multiple rounds of competitions or performances over a short period of
time. Virtually every Olympic sport requires this and it is also a reality
during play-offs of most professional sports.
Accelerated recovery is critically important because it is fatigue or cumulative fatigue that is one of the major performance limiting factors. Ideal performance and a greater opportunity for success hinge on the athlete competing with a "full tank."
This is not a new concept. Most USATF Level l coaches utilize restoration and regeneration when they follow a "hard-easy" workout sequence in the weekly training plan. One day of hard work followed by an easy day to recover. As the sophistication of training theory evolves, particularly as used by the Europeans, time and effort are spent on activities that accelerate recovery (massage, chiropractic, diet, electro-therapy, hydrotherapy, etc.). I have a friend who was the Olympic Biathlon coach. He feels that Americans will never succeed in endurance based events using the present healthcare model of symptomatic care. It is his opinion that recovery efforts must be pursued aggressively and pro-actively and must be as closely scripted as other training components such as interval training or weight work.
The role of restoration and regeneration can be explained using Yokalev's model. (Figure 2). Yokalev's model is arguably the most widely used training theory model in the world. Basic metabolic rate (BMR) is represented by the x- axis. Time follows +x. Performance and fatigue make up the continuum of the y-axis. A training session, the intersection of x and y. (weight training, running, cycling, etc.) produces fatigue over time (-y). When a training session ends, recovery, over time, begins. If the training load is appropriate for the athlete's level of fitness a period of super-compensation or adaptation follows. In theory this is the desired improved performance. This pattern is repeated daily, weekly and monthly and if done judiciously, avoiding illness and injury, one could expect performance to improve as one's career progresses. (Figure 3).
Chiropractic and massage fit into this model as both disciplines help shift the
recovery curve to the left, (the dotted line} decreasing the time necessary to
return the body to its BMR. This is accelerated recovery. This is significant
because this allows the athlete to, in theory, safely train harder and more
often, accelerating the date of their potential, ultimate performance.
Incidentally, this is the effect of the banned, performance-enhancing drug,
an anabolic steroid, has on the body.
In truth this is a vast oversimplification of training theory. The actual practice becomes more complicated because of the multiple variables that need be factored into a yearly or semi-annual training cycle including competition dates, peaking plans and the planned and unplanned stressors of one's personal life. Great athletes only make it look easy.
Of particular note is that chiropractic can, when used prior to a competition, also enhance performance (increasing the super-compensation curve upwards on the y-axis). It has been known for decades that an adjusted articular joint enjoys an ease of movement and an increased range of motion and subsequent neuromuscular response. Studies by New York Chiropractic College's Joseph Miller, DC suggest that thoracic spine adjustments improve maximal oxygen consumption ability (max V02), the implications of which are staggering for an endurance athlete.
Unfortunately, as a profession chiropractors have done a less than stellar job getting the word out on this. Anecdotally or intuitively an athlete "knows" chiropractic care aids performance but with regards to the "why's" necessary to explain chiropractic's role to another health care provider the profession has fallen short. With the adaptation of the new triage model chiropractic now has a defined role, With a complementary service that can be defended with scientific fact. And this is, in part, why the line forms at the chiropractor's tent.
Dr. Ebbets is the editor of Track Coach Magazine, the technical journal of USA Track and Field. He has been the team chiropractor for USATF at two lAAF World Championships. He is also author of the novel Supernova, on the famed running program at Villanova University. Copies are available for $10.95 plus $1.25