A New Client Base: Caring for Middle and High School Athletes
By Tim Maggs, DC
Sarah came into my office at the age of 15 with bilateral ankle, right knee and bilateral apophyseal pains that prohibited her from participating on the crew team for the past 18 months. She was under the care of her pediatrician, orthopedist and physical therapist.
Alana came into my office with a history of low back pain associated with two bulging discs, as seen on an MRI. Alana's pain began when she was 13. She was now 15, had gone through multiple series of physical therapy sessions, and after two years, was still unable to row. At the very end, her orthopodedist recommended she stop sports altogether.
Michael was a 17-year-old soccer player and a junior in high school. He had the potential to possibly earn a Division 1 scholarship, however, after six months of care managed by his orthopedist he was still unable to play and during that time, his right ankle remained severely sprained.
What do these three athletes have in common? They were all treated by physicians and therapists only trained using the medical model of care. This reactive model waits for an athlete to become injured, only looks at the site of injury and is designed to only provide relief of the symptoms. This inadequate care is compounded by the limited care available, as much of today's acute care is governed by declining insurance reimbursements. In the end, the three athletes mentioned above, as well as all other middle and high school athletes in this country, are being grossly neglected with regard to the prevention and treatment of injuries for their critically important musculoskeletal system. Unfortunately, the chiropractic profession is being coerced by the evidence-based approach, which claims to use the most advanced research available, but in truth, is all about minimalism to satisfy the insurance industry. These three athletes, as well as all other middle and high school athletes in this country, are victims if they subscribe to this evidence-based, medical model approach.
Yearly Sports Exam
In every school in this country, a pre-season examination is required. In some states, chiropractors are allowed to perform these tests. But, in virtually every state, the mandated test that is performed consists primarily of medical tests; "cough, breathe in, now out, follow my finger with your eyes, swallow", etc. These are all medical tests. There are virtually no biomechanical or musculoskeletal tests performed. No one ever looks at an athlete's feet. No one ever looks at leg length. No one ever looks at joint range of motion or Q angles of the knees. No one ever looks at forward head carriage, Ferguson's gravity line or sacral base angle.
This yearly sports exam fails to detect any musculoskeletal imbalances, weaknesses or distortion patterns, despite the fact that musculoskeletal disorders and diseases are the leading cause of disability in the United States and account for more than one-half of all chronic conditions in people over 50 years of age in developed countries.
This age group is at the beginning of their very active musculoskeletal life, some of them in contact sports, some in collision sports, most of them in the weight rooms before their bodies are fully developed, and all of them going through continual repetitive activity. Yet, none of them are being evaluated biomechanically at a time in their life when the greatest corrections could be made with the least amount of cost (time, money and energy). Think about the orthodontist model of care. It's certainly not reactive, and it has become societally acceptable for all kids to be evaluated for the alignment of the teeth. The muscular, skeletal and nervous system all interact in a very intricate way, are victims of weight bearing and have many movable joints, yet no one ever examines them for misalignment or imbalance. This is a gross negligence by our healthcare community which chiropractors are the most qualified to correct.
The Need for Reform
In March 2002, President George W. Bush declared the years 2002 through 2011 the National Bone and Joint Decade. The mission of the U.S. Bone and Joint Decade was to "promote and facilitate collaboration among organizations committed to improving bone and joint health through education and research."
The economic impact of these conditions is staggering. In 2004, the sum of the direct expenditures in health care costs and the indirect expenditures in lost wages for persons with musculoskeletal disease diagnosis has been estimated to be $849 billion, or 7.7% of the national gross domestic product.
Beyond these statistics, the human toll in terms of the diminished quality of life is immeasurable. This situation is unlikely to improve in the foreseeable future and will likely be intensified by current demographic trends, including the graying of the baby boomer population, the epidemic of morbid obesity and the higher recreational activity levels of our elderly population.
The chiropractic profession, despite our differences, is still the most qualified profession when it comes to biomechanics and musculoskeletal evaluation and care. Never before has there been such opportunity to gain market share. With the popularity of sports today, the excitement in working with this younger age group, and the clear admission by the authorities in the medical model world that the current situation is unlikely to improve in the foreseeable future, it's time we unite and begin addressing the massive musculoskeletal needs of this age group.
In order to accomplish this movement, we need to begin educating parents, coaches, administrators and young athletes on the care of the musculoskeletal system. We need to define appropriate acute injury protocols. We need to establish the tests that are performed on a biomechanical exam, how to interpret these findings and how to communicate this information to the parents and young athletes. We need to upgrade our management skills, our communication skills and our clinical skills. All of this is very attainable if we can unite in the mission statement, to increase the availability and awareness of sports biomechanics in the middle and high school population.
Sarah is now participating full time in crew while continuing chiropractic care. Alana has fully returned to her athletic life and Michael is well on his way to getting a full Division 1 scholarship, as he is playing and training at 100%.
Editor's Note: This is part one of a six part series by Dr. Maggs.
Dr. Tim Maggs has been in private practice for 35 years and is the developer of The Structural Management® Program and The Concerned Parents of Young Athlete's® Program. He travels the country teaching his program Biomechanics, Imaging and Care of the High School Athlete. Dr. Maggs can be reached via email at
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