Journey To Zero With Southend United F.C., Southend R.F.C. & Chiropractic
That's our goal when working with elite footballers and rugby players: zero practice sessions and matches missed due to non contact low back and neck pain. Recent research has demonstrated that the rates of low back and neck pain are much higher in elite athletes than in the general population. At any one time roughly 20% of the adult general population suffers with low back pain. If our players are not playing to their potential due to back or neck pain it means the team is not winning as many matches as we should be.
Why Do Professional Sports Teams Need Chiropractors?
Because Chiropractors are experts in the management of mechanical back and neck pain. Both Southend United FC & Southend Rugby Club already employ excellent full time musculoskeletal physiotherapists. We add a specialised technical role in an effort to drive down the rates of back and neck pain and to a lesser degree certain types of extremity problems. Last season we had excellent results, historically the clubs have sent players to our London Rd clinic, but only when they had active, often disabling low back or neck pain.
Two seasons ago the medical staff at Southend United asked us to help them design a program to reduce the high incidence of missed practices and matches due to non contact low back pain, neck pain and hamstring injuries. Together with the club doctor & head physiotherapist we worked out a better approach than waiting until something went very wrong. The new emphasis is on prevention, we designed a weekly on-site clinic at the club training ground at "Boots & Laces" and it has been an enormous success as we have seen a sharp reduction in the rates of missed practices and matches. Recently, Southend Rugby Club has asked us to set up a program for them based on the success we have achieved at Southend United F.C. Have a read through this section and find out what we did and how we can use this same approach to help you.
This approach is backed up by high quality research demonstrating the effectiveness of chiropractic interventions. Here are some notable studies:
1. Published in 2010 Australian researches divided players from four professional Australian rules football teams into two groups: those with physiotherapists and sports doctors, and the other group with the addition of chiropractic services. The results were impressive. At the end of the season the two teams with the addition of chiropractic services reported a significant reduction in non contact low back pain, hamstring and knee injuries with a staggering reduction in the number of missed matches compared to the control group without chiropractic services (1-week playing time lost vs 24-weeks playing time lost). For a full summary of this impressive randomised controlled trial go here.
2. The UK BEAM trial, this study formed the basis of the new NHS NICE guidelines for the management of persistent low back pain. The researchers noted that at the end of the long term follow-up, those receiving both spinal manipulation and exercises (both core skills of chiropractors) had much better outcomes that those receiving just manipulation or exercise alone. For a full copy of the study go here. The EU also has formal guidelines for low back pain, for a full copy go here.
3. A British orthopaedic surgeon published the findings of his work in a Canadian hospital with chiropractors (Chiropractors are part of the NHS in Saskatchewan, Canada) on 283 consecutive people suffering chronic disabling low back pain. The average person had pain for over 6-yrs, many of them were disabled (unable to work) with pain and several had previous unsuccessful spinal surgery. Of those with mechanical pain, 81% improved and the results were maintained at one year follow-up. For a full copy of the study go here. For a detailed overview of disc related low back pain go here.
4. Another report from Canada, this one from the Ministry of Health in Ontario recommending that their NHS services of low back pain be managed by chiropractors. For a full copy of the executive summary go here.
5. It's not just low back pain. Here are two interesting observational studies by a group of leading UK orthopaedic surgeons, after these trials they concluded that in their opinion "chiropractic is the only proven treatment for chronic whiplash pain". For these two studies go here and here. The largest scale neck pain study done to date took 10-years to complete and is know as the "Neck Pain Task Force". It concluded recently that the preferred approaches to manage mechanical neck pain involve exercise and manual treatments. For a detailed overview go here.
6. The UK Medical Research Council published in the BMJ noted in their large scale clinic trial of chiropractic treatment vs. hospital outpatient services, those treated by chiropractors had significantly more benefit for their chronic low back pain at 3-yrs follow-up. For the full text of this study go here.
How Does Southend United & Southend Rugby Club Decide Who Needs Chiropractic Services?
We work closely with the physiotherapists, conditioning trainers and coaching staff and have devised a triage system to prioritise players. This is a team approach and not a "one man show". Priority one players are those with active low back or neck pain that have been identified by the team, they are seen immediately and then weekly throughout the season once recovered to minimise recurrences, if they have any mechanical joint restriction they receive spinal manipulation to gap the spinal joints which improves mobility and reduces pain and specific exercise targets. Priority two players are those with a past history of low back or neck pain or recurrent hamstring problems, they are seen initially and then every 2-3 weeks throughout the season once the episode is recovered even if they have no pain. Priority three players are those with no reported problems or new players to the team, they are assessed initially and then every 3-4 weeks throughout the season. By taking this preventive approach we have seen a sharp reduction in the number of missed practices and matches on par the the above Australian rules football study.
How Do We Assess The Players?
We utilise the same assessment strategies that we employ in our London Road clinic. For all players we take a comprehensive case history to screen for "yellow flags" (for two excellent studies investigating yellow flags, go here and here) & "red flags", these are conditions that may at first appear as normal back or neck pain but require specialist investigations and are outside of our scope of practice, most commonly from GP's or consultant orthopaedic surgeons at Kings Rd consulting rooms in Westcliff. Next, we do standard orthopaedic and neurological examinations followed by functional testing assessing endurance of specific muscle groups and uniquely chiropractic examinations assessing functional mobility of spinal joints. We rarely take x-rays as they don't normally provide any useful information in healthy populations under 55; if need be we make use of MRI scans as these have largely replaced x-rays. We also employ outcome assessment tools, specifically the Bournemouth outcome assessment form at regular intervals, which has been utilised in several large scale research projects and combines quality of life, psychometric testing and pain scoring. This type of combined assessment is considered the "gold standard" in measuring outcomes.
Those players that are deemed appropriate for chiropractic treatment are then given a care plan, including specific exercise targets, spinal mobilisations and spinal manipulations from the chiropractor. Those players in need of more comprehensive football specific exercises are assessed and managed by the strength and conditioning team. Players are reassessed weekly with outcome assessment forms and various functional testing is recorded. The goal is to assess, set targets, motivate and constantly reassess, the same strategy we brought over from our London Road clinic. Again, we work closely with the physiotherapists, training and coaching staff to make maximum use of the appropriate skills for the given condition as many players will have also have lower extremity problems that are best managed by the teams expert physiotherapists and rehabilitated by the strength and conditioning staff.
How Does This Differ From Other Clubs?
Enormously. More and more FA clubs have formal associations with chiropractors, and this is constantly increasing thanks to high quality research demonstrating the efficacy of timely chiropractic intervention to reduce the costs and disability associated with low back and neck pain but few teams have such an organised system. Secondly, few clubs have this type of targeted comprehensive spinal pathway program with specific data collection and outcome measurements. We use these in an effort to drive down rates of low back and neck pain, thereby minimising matches and practises missed due to non contact low back and neck pain. We believe that if we are seeing high rates of low back and neck pain, then there is something very wrong with our spinal pathway program, physical training and treatment.
Where Do We Go From Here?
We think our program is a model of what should, but rarely happens in professional sport and health-care, our approach is constantly evolving thanks to the input of our team members (chiropractors, physiotherapists, strength and conditioning staff as well as the coaching staff); there is no "I" in team work.
Our motto is "if we don't know where we have been we don't know where we are going". We are constantly looking at new ways to collect, refine and analyse player's data which provides us with the best possible outcomes.
We have written to several of our colleagues at other clubs in the Southeast to try and collaborate on a large scale clinical trial. We would like to take three clubs doing what we do at Southend United, three clubs who "outsource" to a chiropractor as was done in our old system at the discretion of the club medical staff and three clubs who still use the outdated system of not having a chiropractor associated with their club and keep track of the number of practices and matches missed due to non contact low back and neck pain as well as hamstring problems.
I Would Like to Know More.
If you are suffering with low back or neck pain and would like an expert assessment simply contact our London Road clinic on 01702-342329. If you are a physiotherapist in professional sport or a GP/consultant in sport, the NHS or industry and would like us to demonstrate how you can use our expertise to drive down your low back and neck pain rates and reduce your costs, simply contact us on the clinic number and arrange a time to observe what we do and how we do it. If you would like further information on how to select a chiropractor go here.
It's what we do, it's what we are good at.