Chiropractic Utilization Within NCAA Division IA, Division IAA, and NFL Football Medical Staffs

1
Chiropractic Utilization Within NCAA Division
I-A, Division I-AA, and NFL Football Medical
Staffs

• Toby Brooks, PhD, ATC, CSCS, PES

2
Overview

• Objectives
• Rationale and background
• Research methods
• Results
• Limitations
• Conclusions and implications

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Objectives

• Briefly discuss the history and theoretical
  underpinnings of chiropractic services.
• Briefly discuss the utilization of chiropractic
  services among sports medicine teams associated
  with NCAA Division I-A, Division I-AA, and NFL
  football programs.
• Briefly discuss the perceptions of head athletic
  trainers with respect to the implementation of
  chiropractic services within their area of
  practice.

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Rationale and Background

• Increased scrutiny from coaching staffs as well
  as sports medicine team members to ensure no
  stone unturned
• Recent changes in the composition of the sports
  medicine team nationwide
• Widespread disagreement, exaggerated claims,
  half-truths, and misinformation on both sides of
  the debate

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Rationale and Background

• History of chiropractic
• cheir (hand) praxis (action)
• Alternative medicine technique focused upon
  normalizing the relationship between structure
  and function within the body -NCCAM, 2006
• Origins traced back to Hippocrates in ancient
  Greece
• Modern chiropractic founded in 1895 by Daniel
  David Palmer in Davenport, IA

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Rationale and Background

• Utilization
• 1997, estimated 192 million visits by Americans
  to chiropractors
• 88 million to treat neck and back pain NCCAM,
  2006
• Controversy
• Empirical studies consistently fail to
  demonstrate significant differences in outcomes
  of chiropractic compared to more traditional
  conservative management techniques

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Rationale and Background

• Controversy (cont.)
• Founder was a self-proclaimed magnetic healer
  Palmer, 1910
• Restoring nerve disruption caused by luxations
  touted to heal/treat anything from back pain to
  deafness Palmer, 1910

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Rationale and Background

• Controversy (cont.)
• Widespread and well-known rift between proponents
  of chiropractic and traditional healthcare
  professionals
• Despite differences, utilization has continued to
  increase steadily, notably among elite athletes
  White, 1998 Baron, 2005

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Rationale and Background

• Perhaps due to pseudo-science perception of the
  field, many athletic trainers seem hesitant to
  either utilize chiropractic or to admit that it
  is utilized in their settings despite oft-cited
  pressures from athletes and coaches to offer such
  services for pain management

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Rationale and Background

• Guiding questions
• To what extent is chiropractic utilized in the
  most successful NCAA Division I-A, Division I-AA,
  and NFL football programs?
• What is the rationale guiding that decision?
• Related question
• Is there a relationship between the size and/or
  composition of the sports medicine staff and the
  utilization of chiropractic?

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Research Methods

• Identified NCAA I-A top 25, NCAA I-AA top 10, and
  NFL top 10 (best records) for 2003-2004 season
• Telephoned head athletic trainer from each team
• Participants considered unresponsive if failed to
  return two telephone messages within five days

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Research Methods

• Conducted semi-structured interviews to
  determine
• Utilization of chiropractic within the sports
  medicine team
• Fee/compensation agreement for chiropractic
  services
• Composition of sports medicine staff and total
  staff size

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Results

• Response rate
• Total (n30) (66.67)
• NCAA I-A (n19 76.0)
• NCAA I-AA (n6 60.0)
• NFL (n5 50)
• Descriptive statistics used to present data due
  to small sample and ordinal nature of data

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Results Mean Staff Size
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Results Level of Chiropractic Utilization
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Results

• Compensation

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Results Perceptions of Chiropractic

• Perceptions
• Grounded theory qualitative analysis
• Heavy utilization (n11)
• Do no harm
• Cant hurt.
• Athlete preference
• The guys seem to like it.
• Coach preference and/or perception
• I want to make sure he knows we are doing
  everything we can.
• Access
• It is available and free, so why not use it?

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Results Perceptions of Chiropractic

• Perceptions
• Grounded theory qualitative analysis
• Moderate utilization (n12)
• Philosophical differences
• I dont really believe in it, but
• Previous experiences history
• It was here when I got here
• We used it when I was at
• Exception rule
• ________ works well with our staff and
  understands his role
• Dual credentialed DCs

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Results Perceptions of Chiropractic

• Perceptions
• Grounded theory qualitative analysis
• No utilization (n7)
• Sports med team issues
• We would lose our orthopaedic group
• Conflicts with foundations of physical therapy
• Personal beliefs
• Not a big fan
• Not used anywhere on campus
• Access
• Cannot afford/no qualified personnel

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Limitations

• Sample size
• Particularly problematic for NCAA I-AA NFL data
• Response rate
• Procedures to enhance
• Sport specificity
• Results may differ significantly in non-revenue
  sports, particularly because majority of programs
  that utilize chiropractic are provided
  staffing/services free of charge in exchange for
  advertising, exposure, and exclusivity rights

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Conclusions and Implications

• In general, higher profile programs (NFL, major
  conference I-A teams) tended to utilize
  chiropractic more heavily than smaller profile
  programs
• A majority of programs obtained chiropractic
  services either entirely free or in exchange for
  advertising or comparable non-cash reimbursements
  (exclusivity rights, etc.)

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Conclusions and Implications

• Although utilization of chiropractic services
  within elite football programs varies
  considerably, the decision is ultimately that of
  the head athletic trainer and other prominent
  members of the sports medicine team and is
  influenced by many factors

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References

• National Center for Complimentary and Alternative
  Medicine (2006). About chiropractic and its use
  in treating low back pain. http//nccam.nih.gov/he
  alth/chiropractic
• Palmer DD. (1910). The Chiropractors Adjuster
  A Textbook of the Science, Art and Philosophy of
  Chiropractic for Students and Practitioners.
  Portland, OR Portland Printing House.
• White, J. (1998). Alternative sports medicine.
  The Physician and Sportsmedicine, 26 (6).
• Baron, SH. (2005). A look at the role of
  chiropractors in the NFL. Chiropractic Economics,
  14. http//www.chiroeco.com/article/2005/issue14/
  SP1.php