We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission fromACAPress.
Chapter 27: Leg, Ankle, and Foot Injuries The lower leg, ankle, and foot work as a functional unit. Total body weight above is transmitted to the leg, ankle hinge, and foot in the upright position, and this force is greatly multiplied in locomotion. Thus the ankle and foot are uniquely affected by trauma and static deformities infrequently seen in other areas of the body. Injuries of the Leg
The most common injuries in this area are bruises, muscle strains, tendon lesions, postural stress, anterior and posterior compression syndromes, and tibia and fibula fractures. Bruises of the lower leg are less frequent than those of the thigh or knee, but the incidence of intrinsic strain, sprain, and stress fractures are much greater.
A continual program of running and jogging is typical of most sports. The result is often strengthening of the antigravity muscles at the expense of the gravity muscles — producing a dynamic imbalance unless both gravity and antigravity muscles are developed simultaneously. An anatomic or physiologic short leg as little as an eighth of an inch can affect a stride and produce an overstrain in long-distance track events.
Bruises and Contusions
The most common bruise of the lower extremity is that of the shin where disability may be great as the poorly protected tibial periosteum is usually involved. Skin splits in this area can be most difficult to heal. Signs of suppuration indicate referral to guard against periostitis and osteomyelitis.
Management. Treat as any skin-bone bruise with cold packs and antibacterial procedures, and shield the area with padding during competitive activity. When long socks are worn, the incidence of shinbone injuries is reduced. An old but effective protective method in professional football that does not add weight is to place four or five sheets of slick magazine pages around the shin that are secured by a cotton sock which is covered by the conventional sock. A blow to the shin is reduced to about a third of its force as the paper slips laterally on impact.
GASTROCNEMIUS CONTUSION
This is a common and most debilitating injury in contact sports. It is characterized by severe calf tenderness, abnormal muscle firmness of the engorged muscle, and inability to raise the heel during weight bearing.
Management. Treat with cold packs, compression, and elevation for 24 hr. Follow with mild heat and contrast baths. Massage is contraindicated as it might disturb muscle repair. The danger of ossification is less in the calf than in the thigh, but management must incorporate precautions against adhesions.
TRAUMATIC PHLEBITIS
Contusion to the greater saphenous vein may lead to rupture resulting in extensive swelling, ecchymosis, redness and other signs of local phlebitis. Tenderness will be found along the course of the vascular channel. During treatment, referral should be made upon the first signs of thrombosis.
Management. Management is by rest, cold, compression, and elevation for at least 24 hr. Later, progressive ambulation, mild heat, and contrast baths should be utilized. Progressive exercises may begin in 4-6 days. When competitive activity is resumed, the area should be provided extra protection.
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission fromACAPress.
Chapter 22: Shoulder Girdle Injuries This chapter concerns injuries of and about the scapula, clavicle, and shoulder. In sports, the shoulder girdle is a common site of minor injury and a not infrequent site of serious disability. It is second only to the knee as a chronic site of prolonged disability. Upper limb injuries amount to about 20% of sport-related injuries. They can be highly debilitating, require considerable lost field time, and can easily ruin a promising sports career.Introduction
The versatile shoulder girdle consists of the sternoclavicular, acromioclavicular, and glenohumeral joints, and the scapulothoracic articulation. These allow, as a whole, universal mobility by way of a shallow glenoid fossa, the joint capsule, and the suspension muscles and ligaments. The shoulder, a ball-and-socket joint, is freely movable and lacks a close connection between its articular surfaces.
The regional anatomy offers little to resist violent shoulder depression, and the shoulder tip itself has little protection from trauma. The length of the arm presents a long lever with a large head within a relatively small joint. This allows a great range of motion with little stability. The stability of the shoulder is derived entirely from its surrounding soft tissues.
History and Initial Care
A careful history recording the mechanism of trauma and the position of the limb during injury, careful inspection and palpation of the entire region, muscle and range-of-motion tests, and other standard neurologic-orthopedic tests will often arrive at an accurate diagnosis without the necessity of x-ray exposure. Forceful manipulations should always be reserved for late in the examination to evaluate contraindications.
Contusions, strains, sprains, bursitis, and neurologic deficits must be alertly recognized and treated. Fractures and dislocations, obviously, take precedence over soft-tissue injuries with the exception of severe bleeding. Always check for bony crepitus, fracture line tenderness and swelling, angulation and deformity. Because the shoulder readily “freezes” after injury, treatment must strive to maintain motion as soon as possible without encouraging recurring problems. The key to avoiding prolonged disability is early recognition and early mobilization.
There are now62 different Chaptersfrom Dr. Schafer’s various best-selling textbooks for your review,available exclusively at Chiro.Org
These learned articles by Dr. Schafer can also be found again easily by selecting the EDUCATION Category, on the right-hand side of this page, just below Recent Comments. We hope you will find them of interest.
Our thanks to ACAPress for access to these materials!
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission fromACAPress.
Chapter 1: Introduction to Sports-related Health Care
If you were to ask the average coach about the responsibilities of an athlete, he would most likely reply that he or she was to conduct one’s self to the credit of the team, play fair, obey the officials, keep in training, be a credit to the sport, follow the rules, and enjoy the game: win or lose. This is the rhetoric commonly spooned to the naively inclined. If it were true, fewer sports injuries would be suffered.
With rare exception, even the Little Leaguer is commonly taught to WIN, drilled to disguise foul play from the eyes of the referees and umpires. Even in so-called noncontact sports, emphasis is often placed on getting the other team’s stars out of the game without causing injury to your own team. While conditioning is emphasized, the motivation is frequently on the preservation of a potential winning season rather than on prevention of a personal injury to a human being.
These words are harsh, but realistic. Yet, doctors handling athletic injuries must have a realistic appraisal of sports today if they are in good conscience to properly evaluate disability and offer professional counsel.
The Art of Evaluation
All people participating in vigorous sports should have a complete examination at the beginning of the season; and re-evaluation is often necessary at seasonal intervals. Re-evaluation is always necessary with cases where the candidate has suffered a severe injury, illness, or had surgery.
Evaluation begins with questioning. Because of drilled routine, any doctor is well schooled in the taking of a proper case history. But with an athletic injury, both obvious and subtle questions often appear. How extensive was the preseason conditioning? How much time for warm up is allowed before each game or event? What precautions are taken for heat exhaustion, heat stroke, concussion, and so forth? Does the coach make substitution immediately upon the first sign of disability for proper evaluation? How adequate is the protective gear? How many others on the team have suffered this particular injury this season?
Who, what, when, where, how, and WHY? These are the questions which must be answered before any positive course of health care can be extended. A detailed history of past illness and injury is vital. In organized sports, an outline of the regimen of training should be a part of the history, as well as a record of performance. Most sports will require a detailed locomotor evaluation of the player. Special care must be made in evaluating the preadolescent competitor because of the wide range of height, weight, conditioning, and stages of maturation. A defect may bar a candidate from one sport but not another, or it may be only a deterrent until it is corrected or compensated. Many famous athletes have become great in spite of a severe handicap.
The articulations of the scapula, clavicle, and the humerus function as a biomechanical unit. Only when certain multiple segments are completely fixed can these parts possibly function independently in mechanical roles. Forces generated from or on one of the three segments influence the other two segments. Thus, they will be described here as a functional unit. Please underscore this point in your mind as you read this paper.
BACKGROUND
Shoulder pain can arise from either local or systemic causes. Jaquet points out that about 95% of all shoulder disorders are due to four conditions:
adhesive capsulitis
simple tendinitis,
tendinous perforation and rupture, and
hyperalgesic calcareous tendinitis.
Note that three of these four conditions are tendinous in origin, but tendon inflammation is not as common in the shoulder as it is in the elbow and wrist. However, because all tendons are relatively avascular, all are subject to chronic trauma, microtears, slow repair, and aging degeneration.
As in so many musculoskeletal disorders, thorough investigation of the history of shoulder pain may reveal that trauma did not initiate the first attack or an injury was just a precipitating event that revealed an underlying degenerative disorder. Besides direct injury, shoulder pain may have an inflammatory, a neurologic, a psychologic, a vascular, a metabolic, a neoplastic, a degenerative, a congenital, an autoimmune, or a toxic origin.
Shoulder pain has a high incidence. Cailliet says that it ranks third to low-back and neck pain. Despite its prevalence, posttraumatic shoulder pain can be deceiving. Accurate diagnosis is not an easy task. For example, there may be unavoidable occupational stress in the clinical picture that is aggravating the condition and delaying healing. How should the patient react when a doctor says “avoid overhead work” and the patient makes his living as a painter or pipe fitter of ceiling sprinkler systems? Temporary rest can be provided but not permanent relief from such occupational stress. It may have taken the patient many years of effort to reach his present status. This is not easily put aside. Counsel the patient thoroughly — from his or her viewpoint.
Normal mobility is extensive. The glenohumeral joint alone expresses abduction, adduction, elevation, extension, external rotation, flexion, horizontal abduction, horizontal adduction, and internal rotation. Thus, a thorough knowledge of shoulder kinematics, neurology, angiology, myology, and kinesiology is required for proper treatment to be applied.
John’s recent posting about the Sid Crosby Press Conference with Dr. Ted Carrick has excited many of our readers, as well as going completely viral on the web, because it really struck a nerve. (excuse the pun)
I’m more of a football fan, so I thought you might also like to hear how Jerry Rice (the all-time NFL leader in touchdowns) maintained his long and productive football career by receiving regular chiropractic care.
Jerry Rice Shares His Personal Success With Chiropractic
Joe Montana is a 4-time winner of the Super Bowl, and he credits his career resiliency to chiropractic.
Physical activity is extremely important for everyone, but especially for children. A well-designed exercise program enhances the physical and intellectual development of a child. Competitive sports are often a child’s first introduction to programmed exercise.
In the past decade, there has been an increase in the number of children participating in team and solo sports. Younger children are allowed to participate in sports for enjoyment, health and personal development. However, this changes as competitive elements become more dominant and young athletes train harder and longer, and may practice a sport throughout the whole year. Consequently, sports-related injuries in children have significantly increased.
To understand pediatric injuries that can occur during sports performance, it’s important to be aware of the peculiarities of the growing musculoskeletal system. Children’s tendons and ligaments are relatively stronger than the epiphyseal plate; therefore, with severe trauma the epiphyseal plate will give way before the ligament. However, children’s bones and muscles are more elastic and heal faster. At the peak period of adolescent linear growth, the musculoskeletal system is most vulnerable because of imbalances in strength and flexibility and changes in the biomechanical properties of bone.
Physiological loading is beneficial for bones, but excessive strains may produce serious injuries to joints. Low-intensity training can stimulate bone growth, but high-intensity training can inhibit it. Growth plate disturbances resulting from sports injuries can result in limb-length discrepancy, angular deformity or altered joint mechanics, possibly causing permanent disabilities. Sports involving contact and jumping have the highest injury levels.
Pediatric Musculoskeletal Growth
Chiropractors have been uniquely trained to understand the musculoskeletal system, making them excellent resources for the management of sports-injuries. We need only to make certain we are aware of the peculiarities of the pediatric musculoskeletal system when pursuing appropriate evaluation and case management.
Tom LaFountain hails from a very athletic family, so it would be natural that his career is somehow connected to sports. LaFountain is a chiropractic orthopedist who practices in Utica, but he also has been a member of the PGA sports medicine team since 1997. He has worked with some famous golfers including Phil Mickelson, Tiger Woods, Jim Furyk, Vijay Singh, Davis Love, Jack Nicklaus and Arnold Palmer.
Question: You’ve been involved as a chiropractor on the PGA Tour since 1997. How did that come about?
Answer: I had worked for seven years for the U.S. Speedskating Team and had done the Winter Olympic Games in Albertville, France, in 1992 and Lillihammar, Norway, in 1994. I became friends with a physical therapist who worked on the U.S. Luge team. He left to work with the PGA Tour after the 1992 Olympics. In 1997, he called me and said that they needed someone to work on the PGA Tour that had a specialty in spinal problems, and that he thought that I would be a good fit. I did a trial tournament at the Riviera Country Club in Los Angeles, signed on and have been there since.
His chiropractic/diagnostic skills are about as good as his golf game these days.
The man who left us with a self-diagnosed “bulging disc” in his neck last Sunday, the man who has become his own pain in the neck, has exactly that.
Woods said on Wednesday that tests showed an inflamed neck joint that causes pain and makes it hard to turn his head. This latest Tiger trauma will require little more than medicine, massage, and rest.
There were no tests conducted on his inflamed scorecards from his past two tournament.
Woods withdrew from the Player’s Championship Sunday after seven holes.
Thanks to ChiroAccess for access to these materials!
Chiropractors have a longstanding history of treating musculoskeletal sports injuries. There have been few research studies that document the value of chiropractic treatment for sports injuries and nearly no research that has looked at providing evidence that chiropractic care can play a role in preventing those injuries. The void and need for research supporting the role of chiropractic in sports injury prevention makes a randomized clinical trial (RCT) published last week (8 April, 2010) an important contribution to the literature. [1]
A March 2010 systematic review conducted in Germany underscores the value of neuromuscular training in preventing sports injuries. [1] They concluded that “On the basis of the results of seven high-quality studies, this review showed evidence for the effectiveness of proprioceptive/ neuromuscular training in reducing the incidence of certain types of sports injuries among adolescent and young adult athletes during pivoting sports.”
The pivoting sports included basketball, hockey, handball, volleyball, soccer and floorball. Multiple high quality studies now support the use of training programs to improve proprioception and the research further supports that this proprioceptive improvement translates to reduced risk of sports associated injuries. [2–4] The benefit is even greater for those with a previous history of sports injury.
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission fromACAPress.
Chapter 13: PHYSIOLOGIC THERAPEUTICS IN SPORTS
Chiropractic physiologic therapeutics is defined by the ACA Council on Physiotherapy as the application of forces and substances that induce a physiologic response and use and/or allow the body’s natural processes to return to a more normal state of health.
This section is not intended to be instructional in specific modality application, but rather to bring to attention commonly utilized procedures and their rationale within the management of sports injuries. For this reason, emphasis will be on application-rationale within athletics, indications, and contraindications, rather than technique.
Physiologic Therapeutics
Physiologic therapeutics make use of the therapeutic effects of mechanotherapy, hydrotherapy, electrotherapy, light, heat, cold, air, soft-tissue manipulation, and massage. The rational application of these natural forces requires a knowledge of the actions and effects on pathophysiologic processes.
The use of physiotherapy to facilitate basic chiropractic care has been popular within the profession since the turn of the century. However, any therapeutic agent possesses a potential for effectiveness and a potential for danger. Each modality has its indications and contraindications, and certain precautions must be observed if the modality is to be applied safely and effectively in line with the biophysics and physiologic responses involved.
By 
Stories Feed
Recent Comments