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The use and role of sport chiropractors in the National Football League: A short report*

https://doi.org/10.1067/mmt.2002.122326 Get rights and content

Abstract

Objective: To analyze chiropractic utilization on National Football League (NFL) medical teams and the role played by chiropractors. Design: Postal survey of head athletic trainers of the 36 teams. Survey questions were developed from responses to a questionnaire submitted to a pilot group of 30 sport chiropractors and a panel of 20 postdoctoral faculty of the sport chiropractic program of the American Chiropractic Board of Sport Physicians, as well as a representative from the University of South Alabama. Results: Twenty-two of 36 questionnaires were returned for a return rate of 66%. Of the trainers who did respond, 45% have personally been treated by a chiropractor, and 55% have not. Seventy-seven percent of the trainers have referred to a chiropractor for evaluation or treatment, and 23% have not. Thirty-one percent of NFL teams use a chiropractor in an official capacity on their staffs, and 69% do not. When asked to identify conditions appropriate for referral to a chiropractor, the respondents identified low back pain (61%), “stingers” and “burners” usually associated with neck injury (31%), headaches (8%), asthma or other visceral disorders (0%). All respondents (100%) agree that some players use chiropractic care without referral from team medical staff. Conclusion: There is significant chiropractic participation in US professional football. Certified athletic trainers see a role for the sport chiropractor in the NFL, primarily as a spinal specialist treating low back and other musculoskeletal injuries. A substantial majority of NFL trainers have developed cooperative relationships with chiropractors, with 77% having referred a player to a chiropractor. Thirty-one percent of NFL teams have a chiropractor officially on staff, and an additional 12% of teams refer players to chiropractors but do not directly retain these chiropractors. (J Manipulative Physiol Ther 2002;25:E2)

Introduction

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. At each of the Olympic Games since 1980, an official chiropractic physician has been assigned to the United States team. A chiropractic physician training program has been in place since 1986 at the United States Olympic Training Center in Colorado Springs, Colo. Chiropractors have also served in official capacities at the Asian Games and Pan American Games. The surge of interest in sports and fitness in recent years,1 at both the amateur and professional levels and among both men and women, has produced a corresponding interest among athletes in chiropractic treatment.2

Basic chiropractic training places central emphasis on treatment of musculoskeletal injuries, and sport chiropractors have additional training in this area.3 There has been a significant increase in the demand and support for chiropractic care by athletes and their coaches. Joe Montana, Martina Navratilova, and Charles Barkley are among the high-profile professional athletes treated by doctors of chiropractic during their careers.4

Sports account for 10% to 15% of all severe spinal injuries.5 The majority of catastrophic injuries in American football are head and neck injuries.6, 7 Although football has received much media attention in this regard, recreational water sports have been identified as the cause of most sports-related severe spinal injuries.5, 8

The incidence of back pain in professional athletes is reportedly as high as 75% per year.9 This is especially true in football, a sport in which considerable time in the off-season is devoted to weight training. Excessive axial loading of the spine has been suggested as one cause of the high incidence of back pain in this group.8 During one year, 50% of the down linemen at a Division-I university sought medical attention for low back pain.8 Other studies report that up to 27% of college football players develop lumbar spine problems during their careers.9 Pitts and Popovich studied injuries of NFL players between the 1960s and 1990s and found an increasing incidence of NFL career-terminating injuries, with 46% of retiring players reporting injuries as the reason for their retirement (unpublished manuscripts, Ball State University, 1990, 1994).

Morley10 examined the effectiveness of manipulation of the spine and/or lower extremities in the treatment of chronically injured athletes and found that restoration of joint mobility and reduction of trigger points resulted in a noticeable improvement in ability to perform particular athletic events and a significant reduction in pain. Both manipulation and trigger point therapy are central aspects of chiropractic treatment. There is substantial documentation for the efficacy of spinal manipulation in the treatment of low back pain11, 12, 13, 14, 15 and other musculoskeletal disorders.16, 17, 18, 19

Our objective was to analyze chiropractic use and the role played by chiropractors on NFL medical teams.

Section snippets

Methods

A survey questionnaire was developed that used 10 demographic questions relating to training experience and 30 questions addressing the frequency and nature of referral of players to sport chiropractors and the modalities of treatment used. The college reading level used to enhance clarity and understanding of the questions was advised by a professor of English, reading, and business management at the University of South Alabama. Questions were developed from survey questions submitted to a

Results

Highest degree of education completed and major area of emphasis All trainers (100%) have at least a bachelor's degree, 52% have a master's degree, and 79% majored in health and physical education.

Work as an athletic trainer before joining the NFL A majority of trainers (82%) worked as trainers with college teams before entering the NFL, but 18% did not.

Have trainers been personally treated by chiropractors? Forty-five percent of trainers have been treated by a chiropractor, and 55% have not.

Discussion

There is significant chiropractic participation in professional football in the United States. Certified athletic trainers see a role for the sport chiropractor in the NFL, primarily as a spinal specialist treating low back and other musculoskeletal injuries. A substantial majority of NFL trainers have developed cooperative relationships with chiropractors, with 77% having referred a player to a DC. In addition, all trainers report that some of their teams' players seek chiropractic services on

Conclusion

Trainers agree that chiropractors are adequately trained and specialize in the use of spinal manipulation. They feel that chiropractors should have postgraduate education in sports-injury care and management before working in the NFL and that DCs should work under the direction of the team physician and trainers when on the medical staff of an NFL team. Trainers display a generally positive attitude toward chiropractic inclusion on their teams' medical staffs, and 5 trainers praised at great

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