Spinal Manipulative Therapy and Sports Performance Enhancement: A Systematic Review

Utilization of Chiropractic Care at The World Games 2017: A Retrospective Descriptive Study

OBJECTIVE

The purpose of this study was to report utilization of chiropractic care during The World Games 2017 in Wroclaw, Poland.

METHODS

A retrospective analysis was performed on treatment records. Thirty-five chiropractors trained in sports injuries provided care for athletes and non-athletes (support personnel) who voluntarily sought chiropractic care. Data included demographics (age, sex, role, country, and sport), category of anatomical regions treated, treatment modality (manipulation, myotherapy, mobilization, taping, and other), and participants' self-reported pain ratings.

RESULTS

A total of 1902 completed treatment forms representing 1902 encounters were included for athletes (n = 1238, 65%) and non-athletes (n = 664, 35%). There were 9385 individuals (athlete or non-athlete). Five hundred ninety of 3666 (16%) athletes and 422 of 5719 (7%) non-athletes received chiropractic treatment. Athletes represented 28 of 31 (90%) sports and 79 of 108 (73%) countries present. The thoracic spine was the most frequently treated spinal region (n = 846, 44%), followed by lumbar spine (n = 831, 44%) and cervical spine (n = 725, 38%). Frequency of treatment modalities was manipulation (n = 1610, 82%), myotherapy (n = 1522, 80%), mobilization (n = 607, 32%), and taping (n = 380, 20%). Acute injuries were more prevalent for athletes (61%) than non-athletes (35%), and athletes sought follow-up care (54%) more than non-athletes (36%). Overall, 89% of participants reported pain reduction immediately after treatment.

CONCLUSION

This article describes chiropractic care utilization at a multisport event as part of a health care team. The range of treatments included manipulation myotherapy, mobilization, and taping. Although a minority of athletes and non-athletes received chiropractic treatment, many participants reported pain reduction immediately after treatment.

I expected to be pain free: a qualitative study exploring athletes' expectations and experiences of care received by sports chiropractors

Background

Knowledge about patient satisfaction and experience with care they receive can guide practitioners in establishing doctor-patient relationships and improve health outcomes. Although evidence suggests high patient satisfaction with chiropractic care in general, there is limited understanding of the expectations and experiences of athletes receiving sports chiropractic care.

Objective

To explore the athletes’ expectations and experiences with care received from sports chiropractors, and their perceptions of relevant areas of future research.

Methods

A qualitative study was conducted through an interpretivist lens exploring the perspectives of elite and competitive athletes receiving care from sports chiropractors in Canada. Participants were purposively recruited and interviewed until saturation was reached. Two research team members independently analyzed the interview transcripts using a conventional approach to content analysis. Content was inductively coded and discussed by the research team to generate categories.

Results

We interviewed 18 participants between December 2018 and March 2020, 14 were national level athletes participating in sports ranging from paddling to combat sports. Reported reasons for seeking care included acute care, injury prevention, enhancing performance and maintenance care. Generated categories were organized under topics of experience with care, expectations of care, and research agenda. Participants experienced a variety of interventions, reassurance, varying treatment times, and reported positive impact on their athletic performance. They expected musculoskeletal assessment and treatment including at and beyond the injury site, symptom improvement, good communication and expertise from the chiropractor. Some participants suggested interpersonal and interprofessional communication can be improved, in particular the level of collaboration with other members of their health care team. Overall, participants reported a high level of trust and satisfaction with care received from sports chiropractors. From our participants’ perspective, suggested areas of research should focus on injury mechanics and prevention, impact of care on performance, and interprofessional collaboration.

Conclusions

In general, participants were very satisfied with care. Overall, participants’ expectations and experiences aligned but changed over time. Addressing the findings of this study can be used to enhance the quality of care provided to athletes from sports chiropractors, as well as inform future research agendas. Further work assessing if athletes in other competitive levels have similar experiences and expectations is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-022-00426-4.

Throwing performance after high-velocity low-amplitude thrust manipulation at the cervicothoracic and thoracolumbar junction in elite female water polo players: a randomized blind cross-over study

BACKGROUND

The effect of high-velocity low-amplitude (HVLA) thrust manipulation at the cervicothoracic and thoracolumbar junction in healthy elite female water polo players on throwing performance is unknown.

METHODS

Ten healthy members of the Dutch National female water polo team participated in this randomized blind cross-over study. All received a HVLA manipulation and a sham manipulation at the cervicothoracic and thoracolumbar junction. Hereafter maximum throwing speed, range of motion and isometric strength were measured at 1 hour, 48 hours and 4 weeks follow-up.

RESULTS

No significant differences in maximum throwing speed was found between HVLA and sham manipulation. In the non-dominant shoulder external rotation increased significantly (5.3±6.7°) 48 hours after sham manipulation, this effect was not considered clinically significant and diminished after four weeks.

CONCLUSIONS

Our results suggest that HVLA and sham manipulation had no effect on shot velocity or shoulder mobility and the same effect on shoulder strength in healthy elite female water polo players. The common use of cervicothoracic and thoracolumbar HVLA manipulation for improving performance in this specific group of athletes is therefore questionable.

Spinal Manipulation and Select Manual Therapies: Current Perspectives

Touch is fundamental to the doctor-patient relationship. Touch can produce neuromodulatory effects that mitigate pain and put patients at ease. Touch begins with a confident handshake and continues throughout the physical examination. Touching patients where they hurt is a clear indication that a provider understands their complaint. Touch often continues as a function of treatment. This article updates evidence surrounding human touch and addresses mechanisms of action for manual therapy, the impact of manual therapy on pain management, health care conditions for which manual therapy may be beneficial, treatment plans with dose-response evidence, and the impact of manual therapy on the health care system.

Preliminary Feasibility Study to Measure the Immediate Changes of Bilateral Asymmetry After Lumbar Spinal Manipulative Therapy in Asymptomatic Athletes

Objective

The purpose of this preliminary study was to assess the feasibility of a study to measure the immediate changes in bilateral asymmetry on physical performance tests before and after lumbar spinal manipulative therapy (SMT).

Methods

Thirteen asymptomatic athletes participated in this study. Each participant underwent a clinical and physical evaluation for inclusion according to eligibility criteria. Assessments were performed in all participants and included a physical test symmetry sequence (static standing position, squat, and countermovement jump) before and after lumbar SMT intervention. The immediate changes were quantitatively measured from before to after intervention by statistical calculations.

Results

All recruited participants completed the study, and none of them reported complaints during participation. Statistically significant differences between before and after lumbar SMT were found only for static symmetry (respectively, mean = 14.4% and 3.7%), not for squatting or the countermovement jump.

Conclusion

According our sample characteristics, asymptomatic athlete participants, presented initially bilateral asymmetry values, such as described in the literature, and after lumbar SMT, these values decreased significantly in static posture. This preliminary study demonstrates the feasibility to measure the pre-to-post changes in symmetry after lumbar SMT intervention. The results showed a great decrease in bilateral symmetry on static symmetry percentage, but none in dynamic tests, which deserves further investigation. Nevertheless, this preliminary study demonstrated the feasibility of measuring the immediate changes in symmetry produced by lumbar SMT, and of a larger study to measure whether lumbar SMT changes symmetry.

The Immediate Effect of Spinal Manipulation on Ball Velocity and Neuromuscular Function During an Instep Kick in Former Varsity Soccer Players: A Feasibility Study

Corso, M, Liang, L, Tran, S, Howitt, S, Srbely, J, and Mior, SA. The immediate effect of spinal manipulation on ball velocity and neuromuscular function during an instep kick in former Varsity soccer players: a feasibility study. J Strength Cond Res XX(X): 000-000, 2020-Spinal manipulation (SM) has been shown to increase ball velocity (BV) in soccer players. Evidence suggests that SM modulates responses at spinal or cortical levels to enhance force production in asymptomatic populations. No studies have explored the underlying neuromuscular mechanisms contributing to changes in BV post-SM in soccer players. We assessed the feasibility of measuring change in BV and neuromuscular function after SM in former Varsity level soccer players with a pre-post study design. Three to 5 maximal instep kicks were performed before and after SM at the L3-5 level. Ball velocity was measured using high-speed camera. Activation of lower limb and trunk musculature was recorded with electromyography. Outcomes included ease of recruitment, scheduling and data capture, as well as expectation and perception of SM effect and adverse events (AE). Fifteen potential subjects were recruited over 1.5 months. Eleven were scheduled (24-31 years; 8 females, 3 males). Two subjects reported mild AE after maximal voluntary isometric contraction testing. A significant increase in BV (mean change: 1.75 m·s [95% confidence interval: 0.5-3.0]) and a trend to increased peak-activation of knee extensors (90.7%) were observed post-SM. Findings suggest that our recruitment strategy and methodology are feasible in a larger trial with some modifications. Our preliminary findings support previous research by suggesting that increased BV may be mediated through increased activation of knee extensors during the kick. Our findings may offer additional insight into the underlying neuromuscular mechanisms contributing to immediate change in BV post-SM.

Chiropractic services in the active duty military setting: a scoping review

Background

Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are accessed to manage such injuries within and outside military healthcare systems; however, there is no recent description of such access nor outcomes. This scoping review aimed to synthesize published literature exploring the nature, models, and outcomes of chiropractic services provided to active duty military globally.

Method

We employed scoping review methodology. Systematic searches of relevant databases, including military collections and hand searches were conducted from inception to October 22, 2018. We included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. Paired reviewers independently reviewed all citations and articles using a two-phase screening process. Data from relevant articles were extracted into evidence tables and sorted by study type. Results were descriptively analyzed.

Results

We screened 497 articles and 20 met inclusion criteria. Chiropractic services were commonly provided on-base only in the US. Services were accessed by physician referral and commonly after initiation or non-response to other care. Use of scope of practice was determined by the system/facility, varying from intervention specific to comprehensive services. Back pain with and without radiculopathy accounted for most complaints. Treatment outcomes were reported primarily by case reports. However, two recent randomized trials reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain. Specific reaction time measures in special operation forces military did not improve after chiropractic care compared to wait-list control.

Conclusions

Our scoping review found the majority of published articles described chiropractic services in the active duty military in the US setting. Recent RCTs suggest a benefit of including chiropractic care to usual medical care in managing back pain in active duty military. Yet despite reported benefits in Australia, Canada, and the US, there is a need for further qualitative, descriptive, and clinical trial data worldwide to inform the role of chiropractic services in active duty military.

The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence

Introduction

The effectiveness of spinal manipulative therapy (SMT) for improving athletic performance in healthy athletes is unclear. Assessing the effect of SMT on other performance outcomes in asymptomatic populations may provide insight into the management of athletes where direct evidence may not be available. Our objective was to systematically review the literature on the effect of SMT on performance-related outcomes in asymptomatic adults.

Methods

MEDLINE, CINAHL, SPORTDiscus, and Cochrane Central Register of Controlled Trials were systematically searched from 1990 to March 23, 2018. Inclusion criteria was any study examining a performance-related outcome of SMT in asymptomatic adults. Methodological quality was assessed using the SIGN criteria. Studies with a low risk of bias were considered scientifically admissible for a best evidence synthesis. We calculated the between group mean change and 95% confidence intervals.

Results

Of 1415 articles screened, 20 studies had low risk of bias, seven were randomized crossover trials, 10 were randomized controlled trials (RCT) and three were RCT pilot trials. Four studies showed SMT had no effect on physiological parameters at rest or during exercise. There was no effect of SMT on scapular kinematics or transversus abdominus thickness. Three studies identified changes in muscle activation of the upper or lower limb, compared to two that did not. Five studies showed changes in range of motion (ROM). One study showed an increase lumbar proprioception and two identified changes in baropodometric variables after SMT. Sport-specific studies show no effect of SMT except for a small increase in basketball free-throw accuracy.

Conclusion

The preponderance of evidence suggests that SMT in comparison to sham or other interventions does not enhance performance-based outcomes in asymptomatic adult population. All studies are exploratory with immediate effects. In the few studies suggesting a positive immediate effect, the importance of such change is uncertain. Further high-quality performance specific studies are required to confirm these preliminary findings.

Electronic supplementary material

The online version of this article (10.1186/s12998-019-0246-y) contains supplementary material, which is available to authorized users.

Spinal Manipulative Therapy Effects in Autonomic Regulation and Exercise Performance in Recreational Healthy Athletes: A Randomized Controlled Trial

STUDY DESIGN

A randomized, double blind, parallel groups, sham-controlled trial.

OBJECTIVE

The aim of this study was to analyze the acute effects of spinal manipulative therapy (SMT) on performance and autonomic modulation.

SUMMARY OF BACKGROUND DATA

The use of SMT is progressively spreading from the clinical to the sporting context owing to its purported ergogenic effects. However, its effects remain unclear.

METHODS

Thirty-seven male recreational athletes (aged 37 ± 9 years) who had never received SMT were assigned to a sham (n = 19) or actual SMT group (n = 18). Study endpoints included autonomic modulation (heart rate variability), handgrip strength, jumping ability, and cycling performance [8-minute time trial (TT)]. Differences in custom effects between interventions were determined using magnitude-based inferences.

RESULTS

A significant and very likely lower value of a marker of sympathetic modulation, the stress score, was observed in response to actual compared with sham SMT [P = 0.007; effect size (ES) = -0.97]. A trend toward a significant and likely lower sympathetic:parasympathetic ratio (P = 0.055; ES = -0.96) and a likely higher natural logarithm of the root-mean-square differences of successive heartbeat intervals [(LnRMSSD), P = 0.12; ES = 0.36] was also found with actual SMT. Moreover, a significantly lower mean power output was observed during the TT with actual compared with sham SMT (P = 0.035; ES = -0.28). Nonsignificant (P > 0.05) and unclear or likely trivial differences (ES < 0.2) were found for the rest of endpoints, including handgrip strength, heart rate during the TT, and jump loss thereafter.

CONCLUSION

A single pre-exercise SMT session induced an acute shift toward parasympathetic dominance and slightly impaired performance in recreational healthy athletes.

LEVEL OF EVIDENCE

2.

The effects of a single session of lumbar spinal manipulative therapy in terms of physical performance test symmetry in asymptomatic athletes: a single-blinded, randomised controlled study

Background and aim

Musculoskeletal disorders in athletes, including spinal biomechanical dysfunctions, are believed to negatively influence symmetry. Spinal manipulative therapy (SMT) is recognised as a safe and effective treatment for musculoskeletal disorders, but there is little evidence about whether it can be beneficial in symmetry. Therefore, this study aimed to measure the effects of lumbar SMT in symmetry.

Methods

Forty asymptomatic athletes participated in the study. The randomisation procedure was performed according to the following group allocation: group 1 (SMT) and group 2 (SHAM). Each participant completed a physical activity questionnaire, and also underwent clinical and physical evaluation for inclusion according to eligibility criteria. Statistical significance (P<0.05) between groups and types of therapy were calculated by physical performance tests symmetry (static position, squat and counter movement jump (CMJ), pre- and post-SMT and SHAM. There were 14 trials of three symmetry tests for each participant, for a total of 560 trials.

Results

Lumbar SMT produced immediate effects in symmetry in the static position; however, the same effects were not found in squat and CMJ on symmetry 1. Therefore, our results showed a significant difference in pre- (mean 16.3%) and post-lumbar SMT (mean 3.7%) in static symmetry. However, symmetry 2 showed no statistical significant differences for any of the tests and intervention groups. No statistically significant effects in symmetry pre- to post-SHAM were found in any of the tests.

Conclusions

Statistically significant differences were found in lumbar SMT, but only for static symmetry. These findings suggest that SMT was effective in producing immediate effects in symmetry in the static position, but none in dynamic tests. Future studies could address our study's limitations.

Clinical trials register number

NCT03361592.