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

Chiropractic Utilization Within NCAA Division I-A, Division I-AA, and NFL Football Medical Staffs. Toby Brooks, PhD, ATC, CSCS, PES. Overview. Objectives Rationale and background Research methods Results Limitations Conclusions and implications. Objectives.

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

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  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

  3. 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.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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?

  11. 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

  12. 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

  13. Results • Response rate • Total (n=30) (66.67%) • NCAA I-A (n=19; 76.0%) • NCAA I-AA (n=6; 60.0%) • NFL (n=5; 50%) • Descriptive statistics used to present data due to small sample and ordinal nature of data

  14. Results: Mean Staff Size

  15. Results: Level of Chiropractic Utilization

  16. Results • Compensation

  17. Results: Perceptions of Chiropractic • Perceptions • Grounded theory qualitative analysis • Heavy utilization (n=11) • Do no harm • “Can’t 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?”

  18. Results: Perceptions of Chiropractic • Perceptions • Grounded theory qualitative analysis • Moderate utilization (n=12) • Philosophical differences • “I don’t 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 DC’s

  19. Results: Perceptions of Chiropractic • Perceptions • Grounded theory qualitative analysis • No utilization (n=7) • 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

  20. 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

  21. 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.)

  22. 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

  23. References • National Center for Complimentary and Alternative Medicine (2006). About chiropractic and its use in treating low back pain. http://nccam.nih.gov/health/chiropractic • Palmer DD. (1910). The Chiropractor’s 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

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