Chiropractic Care for Athletes & Weekend Warriors
Certified Chiropractic Sports Physician Dr. Scott Rosner discusses back pain care for the weekend warrior
After work and family time runs its course, many adults turn to sports as an outlet for friendship, recreation, and decompression. According to a Harvard poll, of the 73% of adults polled who played sports regularly in high school, only 1 in 4 continue to play. Commonly known as weekend warriors these adults aren’t in the same shape as they were in their playing days, which can lead to acute or chronic injuries. This proneness to injury could come from overdoing it in the shortened time span, pushing through “a little pain,” or from lacking experience in their chosen sport.
Dr. Scott Rosner, a certified sports chiropractic physician at Weymouth Chiropractic and Wellness Center in Weymouth, Massachusetts, talked about the role of chiropractic care in helping weekend warriors stay on the field, the court, the green, and the ice.
BackerNation: Dr. Rosner, let’s begin with the definition of chiropractic.
Dr. Scott Rosner: Chiropractic is a non-invasive health care practice focused on disorders of the spine and joints. We focus on restoring normal range of motion to joints.
BN: What specialized training goes into becoming a chiropractor? How is it different from other doctors?
SR: Chiropractic care requires four years of undergrad, and then chiropractic school. It's a doctorate level program. Most are four-and-a-half years involving clinical sciences, orthopedic testing, neurologic testing, and then you go onto clinicals. Then there are national boards and state boards. Each state has its own requirements for the board exams. And then, you can specialize afterwards. There are different board certifications, like Certified Chiropractic Sports Physician — which I got — Clinical Nutritionist, Rehab, Pediatrics, and different subsets of specialties you can train in. Of course, because of the licensure, you're required to take continuing education every year.
Chiropractors Versus Physical Therapists for Treating Back Pain in Athletes
BN: What makes chiropractic care different than physical therapy?
SR: The biggest difference in the way I describe it to patients is I don't really do post-surgical rehab work. I tend to refer out to the physical therapists I work with for all post-surgical work. A lot of what we focus on is restoring that motion. And there is a lot of overlap in the professions because we also do muscle work and rehabilitative exercises. But where I see our strengths and where I work really well with our physical therapist is in the order in which care is received. The biggest thing is this: if we restore normal range of motion to an area, and then we send them out to physical therapy for those rehabilitative exercises, the patient is going to get more out of that care and they're going to yield better gains because now things are moving through a normal range of motion. That abnormal range of motion that caused the injury in the first place has been resolved. And now we can work on strength and rehabilitation.
And most chiropractors do muscle work. They do add some exercises and stretches, but it's more of a setting thing. I don't have a lot of rehab equipment in my office, so I tend to refer patients out for physical therapy when we need additional rehabilitation.
BN: How does that relationship work between chiropractor and physical therapist in terms of getting the patient back to where they want to be?
SR: It depends completely on the chiropractor and the therapist. There used to be a big riff between physical therapists and chiropractors just because we thought of each other as threats to the other's profession. But we're really not. Most of the therapists I work with are great at post-surgical like I mentioned, which I really don't do. And, if we all work together on getting patients moving a little better, it's just the patient who benefits in the long run when everyone is on the same team and the same page.
How Chiropractors Treat Back and Spine Conditions in Active Adults
BN: What sort of services do you offer for patients who have chronic lower back pain or even mild lower back pain they deal with on a regular basis?
SR: The most frequent thing people come in for is chiropractic adjustment for mobilization. There are a few different ways that we perform an adjustment. Most chiropractors are trained to make what's called a manual manipulation. That adjustment is a light pressure that restores motion. So, you might hear the crack or the pop, like when you're cracking your knuckles, which is just gas releasing between that joint. And so, the goal of the chiropractic adjustment is to restore motion to [the affected] area in addition to decrease inflammation at the site of the joint and restoring proprioception to that area.
Think of balancing on one foot. If you've had an ankle issue, you might not have as good of balance. The spine works the same way. It's getting input from our nervous system. If there's restriction in that joint and it's not quite moving as well as it can be or there's inflammation, it's going to change the way the nerves that are going to that joint are receiving the signal. And so, really the adjustment is our bread and butter. That's what every chiropractor does.
Now, some chiropractors use instruments to achieve motion and we do as well. It all depends on the patient's back history. I might be more inclined to use an instrument to make the adjustment if a patient has osteoporosis, or pregnancy past a certain point in the second trimester, or something in their history that just might make it contraindicated to a manual adjustment. We also do a lot of muscle work at our office using a variety of massagers, or what's called instrument assisted soft tissue, to free up the muscle and connective tissue to get blood flow to the area and help things move.
So, those are the main two things that we do. We also do ultrasound to improve blood flow and healing, prescribe home care, and add a couple other modalities, like cupping, which is very common in acupuncture treatment, to increase blood flow to an area.
BN: Let's touch on a couple of those. You talked about manual adjustments. I know the one thing people always want to know is, does it hurt?
SR: If done by a skilled chiropractor, it does not. The biggest thing with the adjustment is there's this common misconception that it's going to be like a Rambo-style move where Rambo takes the head and turns it. It's really not that. When we're making the adjustment, we put the joint in through a normal range of motion to a point called the lockout point, which is at that edge of the range of motion where the joint is restricted. It's a light impulse or mobilization to restore that motion; a quick flick of the wrist is all it takes.
So, could there be a pain if there's a ton of inflammation? Yes. But if done by a skilled chiropractor, there's going to be no restrictions or pain associated with it.
BN: You talked about muscle work and mentioned massage therapy and cupping. How do those things work to resolve back pain issues?
SR: It kind of depends on the level of the pain. If we talk in terms of chronic inflammation or a longstanding issue, well, we have to look at not only in the muscle but also the connective tissue. If you've ever seen a piece of raw chicken and have pulled back the skin, there's that clear, filmy tissue there. That's called fascia, or connective tissue. When there's an injury to an area, we start to move in a certain way to take pressure off. The connective tissue and the muscles start to react to that movement and build adhesions in that connective tissue to limit range of motion.
A lot of the muscle work that we do, whether cupping or with an instrument assisted soft tissue tool, is to loosen up that fascia layer so the muscle can return to some of that normal range of motion. So, with chronic issues, we're trying to reset not just that inflammation level and free up range of motion, but how that muscle and the connective tissue move as a whole.
The easy way to understand it is scar tissue formation. Say you have an injury or a surgical scar. That scar usually has a little harder of a feel to it because it's not laying down normal tissue. Well, if you have an injured muscle, tendon, or ligament, usually we have a little bit of scar tissue formation because the body is going to fill in the gaps where normal tissue was to restore motion to that area. But now it's like a rubber band that can't stretch as well. So, we really try to loosen that up and get things moving through a better range of motion with the muscle work. That's the main goal there.
The Most Common Problems Chiropractors See
BN: What sorts of back conditions do you typically see on a regular basis?
SR: It really depends. The most common things we see in the office are postural related issues. That's a big talking point nowadays because a lot of people sit at a computer all day long and, after eight hours, realize they haven't moved all day. We see things like strains and sprains, herniated discs, and bulging discs. Those are where our wheelhouse is for the back.
BN: From a cervical spine standpoint, do you see more like things related to texting and device-related neck issues?
SR: Absolutely. Those are 21st century problems, as they call tech neck and upper cross syndrome. Upper cross syndrome is a combination of things. It's forward head carriage and rounded forward shoulders posturally. What's happening in the muscles underneath is a combination of tight muscles along the back of the neck and into the shoulders, and then weak muscles in the front of the neck since everyone is in that classic computer hunch — hunched over their computer for extended periods of time throughout the day. We're also seeing a lot of symptoms similar to carpal tunnel syndrome from using the keyboard and mouse that are actually originating from the shoulder because of that forward drawn posture.
Preventing or Treating Sports Injuries with Chiropractic Care
BN: Let's talk about the sports medicine side of chiropractic. How often should you seek chiropractic care if you're an active adult who's got some mild back pain?
SR: Considering half of all Americans will have back pain at some point this year, it's a pretty frequent question. For patients coming in non-acute, meaning there wasn't any type of injury that caused their pain, well this discomfort isn't normal. There's clearly something putting pressure on some structure in that area, so we've got to figure out what's going on.
Most patients are checking in every four to six weeks, making sure things are moving how they should be. It's kind of similar to changing your oil or going to the dentist. It's maintenance care to make sure things are moving how they should be. And you get your tires rotated and your car aligned every so often, so I always suggest that you also get your spine aligned to make sure that things are moving how they should be and kind of prevent wear and tear down the line.
BN: Which sports put the most strain on the back to where people have to come and be get chiropractic care based on the type of athletics they play?
SR: I see a good amount of hockey players because of that forward drawn posture and the use of the hip flexor muscles with skating. I see a lot of golfers as well. And most of my golfers are amateur golfers, but I do see a couple of pros and they certainly need maintenance care. Improper mechanics with golf puts a ton of stress on the spine. I also do work with a lot of rugby players as well, just because of that niche. So, I would say those three sports are the ones that I see the most.
BN: For the everyday active person who plays for the church softball league or flag football, what are some basic back care tips you can give?
SR: The weekend warrior type forgets that what they're doing is an athletic event. To really put it into perspective, you're not just going to the church softball league once a week and running out there cold turkey, you got to treat it like an athletic event. So, there's three main things that you have to do with any athletic event: stretch, drink lots of water to hydrate and to flush the system after the event has ended, and ice and do proactive care.
If something is bothering you after your event, it means there's some sort of inflammation there. Use a combination of ice to decrease the inflammation and then heat to loosen up the muscles, in conjunction with lots of water intake and lots of stretching. That’s usually a winning formula.
BN: If someone is out playing a sport and they tweak their back, how long should they wait before seeking medical attention?
SR: I usually say immediately. The sooner you can correct whatever is going on, the easier the recovery will be. A lot of patients come in that same day or the next day because we're still in that acute phase of care. We can get movement back to that area, and we don't have some of these chronicity issues that settle in, like scar tissue formation and adhesions in the muscle or the connective tissue. So, it's actually easier to restore a little motion and decrease some of that inflammation pretty soon after the injury rather than waiting to see if it'll go away.
Most likely, the issue that caused that event during the sport was probably developing for a while and it caused some breakdown in the mechanics that caused the injury. So, it's better to get in sooner to correct it, rather than wait to see if it's going to go away on its own.
BN: Let’s say I'm out playing basketball, get bumped in the back, and my back feels tight. Why should I not have my teammates crack my back?
SR: It's dangerous to have a friend crack or mobilize the spine because they aren't trained. They can end up doing more harm than good. It takes a high skill to palpate those joints, test range of motion, make sure that there's nothing else going on, no underlying condition that could be contraindicated.
Plus, in all honesty, they're probably not getting to the right segment. Most of the time when you can move and turn in your chair and you hear a crack or a pop — a cavitation, as we call it— in the lower back, usually those are hyper mobile joints meaning joints that can move more to accommodate for the ones that are restricted. So, you're essentially taking the joint that can move more and trying to move it even more through a range of motion, which is going to be worse in the long run.
BN: Now, we've talked about a lot of different things. Was there anything that you wanted to add that I missed?
SR: Sports chiropractic has come a long way. I'll say that as a sports doc, we are now on every NFL team, every team but one MLB team and, I believe, in the Olympics. We participate in high school, college, and professional athletics. So really, sports chiropractors are mobilization experts. That's really what we do. It’s such a natural fit for athletes and weekend warriors to get adjusted and make sure that you're moving how you should be. That's it.