Sports chiropractic at the Olympic Games
Like athletes who must compete for a place on the U.S. Olympic team, doctors of chiropractic also must demonstrate their excellence before earning a position on the U.S. Olympic medical team. In 1992, Dr. Philip T. Santiago achieved that honor, representing his country and his profession in Barcelona, Spain. He now serves with Dr. John Danchik on the U.S. Olympic Committee that screens applicants for the lengthy Olympic selection process.
His first advice to doctors interested in doing this kind of work is to begin their postdoctoral studies in sports medicine. “First and foremost, you have to get the sports degree-either a Certified Chiropractic Sports Physician (CCSP) or the Diplomate in Sports. Applicants with a Diplomate start off with one of the highest marks in the selection process, because that course work teaches the sports medicine model. You learn, for example, about sports psychology, which is very important. Why do people run the triathlon? What motivates them? What is an injury-prone personality? Why does someone choose a team sport rather than an individual sport? You need to understand that there are a lot of different factors that motivate people in sports.”
Applicants also are required to have been in practice a minimum of five years and to have worked with a sports team for at least three years. They then may submit an application with their resume and other background and academic information. After careful review, Drs. Santiago and Danchik recommend top candidates for the Olympic Training Center in Colorado Springs, Colorado, where candidates volunteer for 15 days of training and evaluation by the medical staff, coaches, and athletes.
“If they like you,” Dr. Santiago continues, “they invite you back for the next cut-the Olympic Festival, Goodwill Games, University Games, or some other event. They keep inviting you back over a four-year span, and they keep cutting. Eventually, you are either cut or you make the Pan-Am Games or the Olympic Games.” In addition to one doctor of chiropractic, the U.S. Olympic medical team is composed of four orthopedists, four internists, and one psychologist, each of whom has undergone the same exhaustive selection process.
Once selected for the Olympics, medical team members are asked to be available for 10 weeks, though six or eight is more the norm. Stateside physical exams, screening, and credentialing of all athletes begin four weeks before the Olympics, followed by two weeks of the actual games, and one week for paper work and wrap-up. For Dr. Santiago, the whole experience was personally and professionally rewarding.
“It was incredible. Not only are you representing your profession but your country, which is a pretty cool thing to get to do. There are a lot of emotional highs and lows, especially as the lone chiropractor treating more than 600 athletes. The chiropractor is normally the busiest person there, with plenty of potential for burn-out.”
Following Barcelona, Dr. Santiago strongly recommended that two chiropractors serve on the team, but each country is allowed only a set number of credentialed staff. Considering that one medical doctor position was already exchanged for the chiropractor in 1988 for the Olympics in Seoul, Korea, he feels it is unlikely that the medical doctors on the team would be willing to accept a second medical doctor reduction in order to gain another chiropractor.
Athletes who achieve Olympic status are considered the best, and doctors of chiropractic are no different. Within their communities, respect for an Olympic chiropractor grows among local teams and the general public, who know that he has earned this honor through merit, and not by political appointment.
“It gives you a lot of clout back home,” Dr. Santiago adds. “And you bring home a lot of new information. While with the team, you’re working with the best, learning the whole time from the other doctors and trainers. When you work on an athlete, it’s a team approach. Everyone works together to provide the best care for the patient.”
The Road to Certification
Independence is an important quality in doctors of chiropractic. It allows them to complete a lengthy education process, set up and maintain their practices, and expand the parameters of their profession. But according to Dr. William Moreau, head of the certifying board of the American Chiropractic Board of Sports Physicians (ACBSP), there is a time when it’s best to accept help from others.
“During my seven years on the certifying board, I’ve learned just how independent chiropractors are,” Dr. Moreau says. “When it comes to issues in which we lack expertise, however, we need to learn to depend on other people for guidance. This is especially true regarding certification issues.”
The American Chiropractic Board of Sports Physicians certifies doctors of chiropractic in two tiers: the entry-level Certified Chiropractic Sports Physician (CCSP) and the Diplomate of the American Chiropractic Board of Sports Physicians (DACBSP). Recently, it enlisted the National Organization of Competency Assurance (NOCA) to assist with its certification process. A trade association that certifies specialists ranging from architects to interior designers, crane operators to chiropractors, NOCA represents a broad base of knowledge on how to create fair examinations that can accurately measure certificants’ knowledge and ability to perform skills. Once their procedures comply, specialized groups can earn National Commission for Certifying Agencies (NCCA) certification, which lends respected, independent validation to their certification processes.
“Doctors spend thousands of dollars and hundreds of hours away from their family and practice to obtain these certifications,” Dr. Moreau says, “and we need to make sure that when they earn certification, it is worth having. We want to represent our certificants to the highest level with a credential that people outside the profession recognize, and that has value to them in their daily practices.”
While this process can be lengthy and involved, the end goal offers a high degree of enhanced credibility to the chiropractic health care professional. “This is a goal of my life,” Dr. Moreau continues. “I feel that if the ACBSP can obtain this certification, it will be a feather in the hat for the entire profession. We’re not in a race for the ACBSP to be the first chiropractic board to be certified by NOCA. To the contrary, as I explain to others in the profession what NOCA is capable of offering, many other chiropractic specialty boards have now joined. Hopefully, we can all move together in the direction necessary to straighten out our certification issues. In some cases, we share common ground -ethics, for example- but each board also should have independence in the areas that are unique to their speciality. I want our profession to be able to continue to mature and move ahead. I feel it is the duty and responsibility of the specialists to lead the way so that we are able to retain our rights to perform the skills we are trained to do.”
High School Preparticipation Physicals: Still a Struggle
Only 25 states currently allow doctors of chiropractic to perform preparticipation examinations for high school athletic programs. Dr. William Moreau, head of the Certifying Board of the American Chiropractic Board of Sports Physicians (ACBSP), wants to see that change. “There is nothing in a well-formatted preparticipation examination that a doctor of chiropractic has not been trained to do during undergraduate studies at the chiropractic colleges,” states Dr. Moreau. He himself has performed thousands of preparticipation examinations and now instructs a class in that subject at Northwestern College of Chiropractic. “Some medical professionals state that doctors of chiropractic cannot auscultate the chest or detect infection, and that’s ridiculous. Of course we are trained to do those things; they are elementary skills. I believe some doctors may need to hone their skills in the area of cardiology, but otherwise, chiropractors can give very good assessments for physical evaluation of the athletes.”
Like any discipline, preparticipation examinations are performed more effectively after regular practice and study. Doctors who have not performed these examinations recently may need to brush up on their skills, especially key components of the preparticipation examination involving the heart and lungs. Dr. Moreau advises those doctors who are not comfortable performing this component to consider taking part in a multi-disciplinary examination in which they perform the spinal and orthopedic examinations alongside an allied health care professional who performs the chest examination.
In the growing climate of interdisciplinary cooperation, Dr. Moreau chooses not to set doctors of chiropractic against medical doctors, but rather encourages increased cooperation. “I prefer to take a stance that we should work together. Without question, medical doctors are qualified to perform the spinal and orthopedic aspects of the examination. But I feel doctors of chiropractic have some unique skills in that we perform musculoskeletal examinations every day, which means we should be adept at detecting any type of spinal problem, such as scoliosis in an adolescent athlete. And for doctors of chiropractic who have had training on the extremities, there is absolutely no question about their being capable of evaluating the shoulder, knee, or an extremity of any person with a history of a problem in that region.”
As to why so many states still do not allow chiropractors to perform preparticipation examinations, Dr. Moreau cites old prejudices and a pervasive misconception of the profession by the people in decision-making positions. “They really do not understand how well educated doctors of chiropractic are today,” Dr. Moreau explains. “My father graduated from chiropractic college in 1956, and when I came out in 1981, 1 recall that he was amazed at how well I was trained in comparison to the training he received. Now, as I teach young doctors currently enrolled in chiropractic colleges, I see that their education is much better than what I received. They have the opportunity today to be as good as any professional in the assessment, management, and treatment of conditions that affect the athlete. I have high confidence in them and their skills.”
In addition to a generalized misunderstanding of their skills and competency, competition also keeps doctors of chiropractic from performing preparticipation examinations. Sports medicine has exploded over the past 10 years, and treating athletes is high-profile work. Many practitioners-medical doctors, doctors of chiropractic, orthopedic surgeons, athletic trainers, physical therapists, and massage therapists-now want to become involved in sports medicine because of its positive environment and attention-getting potential. “You can bring a lot of attention to yourself by treating athletes,” Dr. Moreau continues. “It’s like a turf war. They don’t want to give any of this up to doctors of chiropractic.
Unfortunately, sometimes the high school athletic associations are influenced strongly by the medical associations. If those associations would make their decisions based on what is best for the student athlete, I believe doctors of chiropractic would become much more involved in performing these examinations.”
In those states where chiropractic associations are trying to obtain the right to perform preparticipation examinations from high school athletic associations, Dr. Moreau recommends holding workshops for doctors of chiropractic in order to better inform them about what constitutes a preparticipation examination and how one should be performed.
The American Chiropractic Board of Sports Physicians, the certifytng board for CCSPs and Diplomates in Sports, has prepared a position paper on preparticipation examinations that outlines what a prepartrpatoin examination should include, and quotes references that doctors can use to pursue particular areas of interset. That paper is available by writing ACBSP, 1820 Central Avenue, Estherville, Iowa 51334-2409.
Sports Chiropractic and the Martial Arts
Knock-outs. Dislocations. Fractures. Sprains/strains. Contusions. Not a typical day’s work for the average chiropractor-unless, that is, you are serving as a medical volunteer at a martial arts event. Dr. Timothy S. Wakefield from Allied Health Chiropractic Centers in Wisconsin often brings his experience as a DC/DACBSP and a first-degree black belt in Tae Kwon Do to the mat, where he works with athletes competing at the local, state, national, and international levels-a practice he recommends with enthusiasm.
“Being involved as a medical volunteer can be one of the most stimulating experiences of a professional career,” Dr. Wakefield states. “In our offices, we may see sports injuries two to three days after they occur. At the events, we see them within minutes. I am always amazed at how well these conditions respond to fast and effective conservative management.”
In 1993, Dr. Wakefield, who has been involved with Tae Kwon Do for more than 20 years, served as medical director of the Tae Kwon Do Nationals, supervising four medical teams emergency, pre- and post-competition, first aid, and ambulance-consisting of 25 doctors of chiropractic, three medical doctors, and one nurse. These teams were responsible for examining and assessing the athletes’ ability to compete safely. Dr. Wakefield says that while their motto, “The athlete’s safety is always first,” is always in mind, they naturally also want to help athletes continue to compete-especially considering that many train five to 10 years to get to a national tournament.
Duties for the emergency team include quickly assessing the athlete’s condition, treating on-mat trauma, and observing the competition. Pre- and post-competition team members evaluate and manage athletes before, after, and between rounds of the competition, with emphasis on stretching, taping, and injury assessment and management. The first– aid team treats scrapes, mat burns, and cuts, and administers some protective taping for chronic injuries. Finally, the ambulance team handles injuries that require transport to an emergency room.
In 1993, the first year that the chiropractic/medical team was established at the Tae Kwon Do Nationals, the team achieved a drastic reduction in emergency room visits, thereby saving valuable time, money, and dreams. According to the medical director for the 1992 Tae Kwon Do Nationals, there were more than 500 emergency room visits that year. In 1993, the chiropractic/medical team decreased that number to only 10. In 1995, that number dropped to nine. “I believe these reductions were due to very well organized tournaments and the opportunity for competitors to have evaluations by skilled sports doctors,” Dr. Wakefield adds. “That, in turn, led to prompt and effective conservative management before, during, and after rounds of competition.”
Dr. Wakefield co-authored an abstract that compared the types of injuries in the 1995 Tae Kwon Do Nationals to hours of training for each area. Research revealed that doctors of chiropractic are highly qualified and trained to treat these injuries, which include head and neck, upper-extremity, torso, and lower-extremity injuries. At the other end of the spectrum, an article published in the Journal of,Bone and Joint Surgery in October 1998 from the University of Pennsylvania School of Medicine reported that 82 percent of 85 medical school graduates studied failed to demonstrate basic competency on the musculoskeletal examination.1
“Chiropractic is effective at treating many organic and neuromusculoskeletal conditions,” Dr. Wakefield says. “In sports chiropractic, our focus is primarily musculoskeletal, and I’ve seen many doctors of chiropractic doing great work. Our training to perform multiple types of conservative care, such as physical therapy, first aid, stretching, taping, etc., enhances the effectiveness of chiropractic manipulative treatment and, in turn, can enhance athletic performance? The care we administer prior to a competition can increase biomechanical function, speed, flexibility, endurance, and strength, which can allow the athlete to function at optimum performance level.”
While sports chiropractic is effective for all disciplines, Dr. Wakefield advises doctors to first understand any sport they are involved in, including the rules and injuries typical and unique to it. “Working with martial arts athletes is different from other sports,” he explains. “In football, for example, they use their whole body to punish their opponent. In Tae Kwon Do, more trauma is sustained to the extremities, especially the hands and feet, because they use their hands and feet as weapons. It is important to know these differences.”
Sports chiropractic helps doctors to make quick, accurate judgments in short periods of time, a skill that can enhance their clinical practice. Doctors also benefit from the collaboration with colleagues on treating acute, sub-acute, and chronic sports injuries. “Watching other doctors perform treatments in a manner similar to or the same as I would,” Dr. Wakefield says, “gives me added confidence in my assessment and judgment skills every day in my office. Seeing others perform gives me an opportunity to learn other hands-on skills that I might never learn sitting in a seminar or reading a book.”
Reference:
1. Freedman KB, Berstein J. The Adequacy of Medical School Education in Museculoskeletal Medicine. Bone and Joint Surgery, 1421-1427, October 1998.
2. Wakefield TS, Heigl CH. Tae Kwon Do and the Doctor of Chiropractic-Abstract presented Sports Science Symposium, 1997.
Copyright American Chiropractic Association Mar 1999
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