CONCUSSIONS HAVE BECOME THE LIGHTNING ROD when discussing care of high school athletes today. While the prevention, assessment, treatment and management of concussions is critically important, the bigger issue is that virtually no discussion takes place with regard to the effects of sports on the cervical spine and below. Adolescent athletes practice and compete in many sports, with some even labeled as contact and collision sports, yet the evaluation and care of their musculoskeletal systems often is minimal. We need to become the ambassadors of the evaluation and care of the musculoskeletal system for these young athletes.
When I worked with the New York Giants for four years in the mid-1990s, I had the opportunity to learn under the guidance of their seasoned strength coach Al Miller. I also had the pleasure of working with the head strength coach of the Chicago Bulls at the same time, coach Al Vermeil. These two coaches were friends, and together they created a conditioning pyramid (see Figure 1). At the base of this pyramid are six conditioning categories. Every athlete in the New York Giants and Chicago Bulls system had to pass all of these tests prior to gaining access to the weight room. Yet, go to your nearest middle or high school weight rooms, and our young athletes are lifting away without any pre-screening for weaknesses or biomechanical imbalances or faults. This doesn’t even take into consideration proper lifting techniques.
All middle and high school athletes in this country must undergo a pre-season physical exam to be eligible to participate in their sports. This is a state-mandated medical exam. In some states, chiropractors can administer this exam, but it is still primarily a medical exam, i.e., eyes, ears, nose and throat. Very little, if any, of the exam looks at the unique biomechanics of the athlete.
Health Care Guidelines
We now have young athletes eligible to enter the weight room and participate in their respective sports with no one examining the (mal)functioning of their musculoskeletal systems. Not by coincidence, many of these athletes become injured, and the obvious first question to a caring parent becomes, Should I take my child to the doctor? The next question is, Whom do I take him or her to?
A referral to the orthopod generally leads to a referral to the physical therapist, as most injuries don’t require surgery. The referral to the physical therapist is now about two weeks after the injury occurred, and the therapist will typically provide some level of localized care for the duration of the athlete’s insurance coverage.
Again, no one has looked at or addressed the biomechanical faults that have contributed to this injury. And again, most likely the injury will return upon return to activity. Seasoned parents of older children who have played high school sports are much more hesitant to begin the journey of calling the pediatrician’s office for this first appointment. They know the outcome is both expensive and might be of little or no long-term therapeutic value. They are looking for an alternative solution.
The Structural Management® Program
The Structural Management® Program is the gold standard model when looking to care for middle and high school athletes. This biomechanical model is based on Maggs’ law, which states, When the loading of a tissue exceeds the capacity of that tissue, compensatory physiological changes occur.
Every human being has a Structural Fingerprint® (see Figure 2), and the information found on the Structural Fingerprint® Exam will provide predictable information with regard to what type of injuries a young athlete will be susceptible to, as well as what degenerative changes might occur as the athlete ages. Information from this examination will also allow the examiner to create a custom corrective and rehabilitative program the athlete can proactively begin. This approach is nothing more than treating the musculoskeletal system with the same level of interest as orthodontists treat teeth. Alignment and balance improve function and health. However, the musculoskeletal system is three systems inter-related, working under the influence of gravity and functioning with movable joints. Teeth have none of these contributing stressors.
A Structural Fingerprint® Exam should be done on all athletes prior to the start of their season. This exam should begin with the feet, having the athlete stand on a digital foot scanner (see Figure 3) to determine the (im)balances in each foot. The exam should then look at the knees, hips, low back, neck and shoulders for alignment and motion. Range-of-motion tests, trigger-point evaluations and notation of pain or restriction on movements should be documented.
Chiropractic physicians can make life-changing rehabilitative recommendations. Not only should the athlete who follows these recommendations have a safer middle and high school experience, but he or she should also have the necessary knowledge to reduce the likelihood of disability, disc injuries and surgeries in the future. With proper education, the young athlete should have the tools to ensure quality motion and a better quality of life. This information is currently absent from youth sports today.
Vision for the Future
My vision is that the chiropractic community unites with one goal in mind, to provide biomechanical examinations to all young athletes in this country at the start of their respective sports seasons. We will all interpret the information the same way, just as orthodontists do. Once this information is collected, the doctor of chiropractic (DC) is the most qualified and equipped to manage the athlete to improvement. Due to our differences in techniques, philosophies, physical therapies, nutritional supplementation, rehabilitation, etc., our profession has not found a way to become unified. However, each chiropractic physician will be able to follow the protocols of this program, while using whatever techniques and modalities each one decides is best. We will become one, while changing the way younger athletes are treated.
Tomorrow’s generation will become very aware of biomechanics and the importance it plays in each person’s life. These youngsters will realize the care of their musculoskeletal system is not like caring for an infection, but an ongoing, unending responsibility that will save society millions, billions, and maybe even trillions of dollars. One bonus is an improved quality of life. This is an opportunity the chiropractic profession cannot overlook.
Tim Maggs, DC, has been in private practice for 35 years and is the developer of The Structural Management® Program and The Concerned Parents of Young Athletes™ Program. Dr. Maggs, an ACA corporate partner, can be reached via email at RunningDr@aol.com. For more information, visit www.CPOYA.com.