Im sitting here preparing my powerpoint for 5 CE's I'm teaching in Champaign, IL on January 14 and an idea for a quick post came to mind. One of my slides I will use for my powerpoint can cause some pretty incendiary conversation among Chiropractors, and as I was editing the slide this morning I thought this would be a good time to elaborate on it.
The slide is an abstract from a study I found titled: "Chiropractic Treatment and the Enhancement of Sports Performance" The literature review was published in the Journal of the Canadian Chiropractic Association in 2010 by Andrew Miners BPHE CSCS.
The paper was a fantastic review of the literature that reviewed studies related to different hypothetical mechanisms as to how Chiropractic could indirectly affect different aspects of functional performance. The author reviewed studies related to several different mechanisms including:
-reduction of muscle inhibition
-Altered muscular EMG activity
-Muscle strength modulation
-and Cognitive motor reaction time and motor control
Despite the author sharing some excellent foundational studies that may elucidate methods that need further study, his conclusion stated: "Although many studies, ideas and theoretical frameworks have been postulated and discussed, it seems that at this time there is insufficient evidence to convincingly support the notion that treatment provided by chiropractors can directly and significantly improve athlete sport performance."
Even though this may sound like a damning conclusion, the author noted that the studies he cited were outstanding foundational work, but that little has been done and published to show direct impact on sports performance.
A couple notes on that. 1) Of course we need more studies. Every profession does. Human performance research would go a long way in chiropractic, and would break up the monotony of much of the allopathic, pain related research that seems to be coming out. 2) Aside from defining "treatment methodologies" in Chiropractic studies, we need to be less reductionist when it comes to studying sports performance. Allow me to explain.......
Anyone who has trained seriously for any type of sport knows that performance is a result of a long period of train up. The average training period for a marathon (for an average level competitor) is 16 weeks. Nearly every weightlifting cycle I have ever used to train for competition was periodized over 8-12 weeks at minimum. Improving performance and reaching peak performance is NEVER the result of a single day or single event.
Let's use creatine as example. Creatine is one of the most time tested supplements on the market. It has been making headlines since the 1990's. Strength and endurance athletes have been utilizing creatine with much anecdotal success and it is also one of the most studied supplements out there. If I were to design a study to evaluate the effects of creatine on sports performance, here is what I would NOT DO. I would not have an athlete perform a "pre-test" feat of strength or performance (let's say 40 yard dash), then ingest 3 MG of creatine and re-test the forty. That is too short sighted of a study design. Creatine boosts recovery and supplies more phosphagen for ATP synthesis for increased work output during training sessions. Taking it once would not improve performance, however regular consumption over the course of an entire training mesocycle or macrocycle would be a more applicable means of understanding how it could improve recovery and training during train up periods, rather than a single use improving performance.
Performance comes from a well balanced training program that allows for sufficient rest and recovery to adapt to increasing training loads, frequency, and intensity. Sport science seems to have established the best ways to train. The contemporary view of performance surrounds recovery. Adequate recovery following a training session allows for increased training intensity during the following session.
One of the biggest taboo topics in sports right now is the use of performance enhancing drugs (PED). While we always here the term "performance enhancing," the reality is that most of the drugs on the anti-doping list of banned substances are recovery enhancers. Generally, an athlete that utilizes PED's does so during the training period and then does their best to rid them from their system prior to competition when they are most likely to be tested. Remember Lance Armstrong and Marion Jones? At one time they were the two most tested athletes in the world, and despite it being uncovered that they had been using PED's during training, neither of them had EVER had a positive drug test in competition.
I am not condoning the use of PED's, but let's face it, they are a reality in sports. Any time there is money, sponsorships, and olympic medals at stake athletes will utilize whatever means they have to gain an edge. That edge typically comes in the form of anything that will boost recovery. Items that increase performance on the day of competition are heavily tested for and often times banned (EPO, Caffeine, and other stimulants are examples). One final example of this would be human growth hormone (HGH). Taking HGH once, prior to competition likely won't improve performance, which is why athletes take it off season to improve their training.
Where should Chiropractic put their research efforts in sports performance (or at least one area we should emphasize)? The effects of Chiropractic need to be studied in a population of athletes during their training period when training intensity is of the utmost concern. Take a population of athletes training for competition and compare them to a control group that does not get adjusted, for a four week period at minimum. Why four weeks? Because four weeks is an average mesocycle within a quarterly macrocycle. This means that during those four weeks the intensity, volume, and frequency of training will spike followed by a de-load or taper period, followed by some sort of assessment of performance. We should direct our outcome measures towards autonomic markers such as heart rate variability, inflammatory markers, cytokines, and other measures of recovery that the exercise physiology research world is putting a great deal of effort into studying.
If you are a Chiropractor in private practice, this may seem like a great deal of work. The best thing that we can do is continue to document our patients progress incredibly well and utilize HRV (which is the most simple and non invasive tool we can use in practice). Let's start getting more case studies like that published and correlate it with subjective outcome measures such as the rest-q Questionnaire In the meantime, I believe that this is the type of research that we can begin to create a demand for in the profession (and since this is a blog and not a formal means of scientific communication, I can state my opinion!).