A preponderance of athletes and athletically inclined patients walk into our chiropractic clinics seeking care. Even if someone is not a sports-focused chiropractor, active patients will invariably find their way to your door. Whether you expect it or not, you will treat athletic patients, so let’s discuss some observations and clues you can look for that will lead you down a treatment path to help them perform their best.
When we observe the wide range of patients engaged in various forms of physical activity, we notice they come from all walks of life. We see children getting started with youth sports. We see teenagers and young adults engaging in competitive high school and college sports. We see middle-aged and older adults vying to stay in shape, playing sports at various levels and intensities. Football, basketball, baseball, soccer, tennis, pickleball, volleyball, lacrosse, field hockey, golf, and yoga are just some of the examples of the many sports in which chiropractic patients are engaged. Those patients show up at your office in pain and need your help. At first glance, it seems like you need to be an “expert” in each sport to successfully treat them. Although it does help to know the nuances of specific activities, it’s not always necessary.
Aside from the many sports that patients play, each category of sports has its own complexities. Football, for instance, has coaches for offense, defense, and special teams. Baseball has hitting, pitching, and other player-position coaches. Those are broad examples, but they illustrate how complicated sports can be from the standpoint of chiropractors. It can be time consuming and frustrating to learn the ins and outs of every single sport. Instead of looking too closely at each activity, pull back and look at the big picture.
A common misconception is that costly or fancy equipment automatically enhances athletic performance. Expensive shoes, pricey sporting goods, longer training regiments, special foods, etc., will not compensate for poor body alignment. Restoring and maintaining healthy foot function is key to maintaining healthy alignment of the body and performing at the optimal level. Patients playing any type of sport that has them standing or running utilizes the transfer of body weight and forces up the axial kinetic chain of the body. This observation is the unifying theme for all weight-bearing sports.
Recall that the feet and arches are the foundation of our human house. They control the amount of ground force shock that enters the axial kinetic chain as well as the movements of all the joints above it. Custom-made, flexible, three-arch supportive orthotics are created for the feet but designed to stabilize the entire body. Wearing them during all weight-bearing activities helps athletes in the following ways:
1. Excessive foot pronation or supination is greatly reduced, creating a stable base of support under each foot.
2. Proper orthotics absorb ground shock forces coming into the heel bone with each heel strike during gait. There is an average of 5 g of shock with each strike of the calcaneus onto the ground. This shockwave shoots up the leg, pelvis, and spine and becomes 5 g at the TMJ within 5 m/s2. With running, the shock increases, so proper arch supports are necessary to protect the joints of the body.
3. Reduced ground forces to the joints of the body mean less wear and tear of the cartilage, ligaments, tendons, and other soft tissues of the body. It helps reduce the risk of injuries for athletes of all levels.
4. Patients will hold their chiropractic adjustments better when wearing their custom orthotics. With the feet, arches, and axial kinetic chain more supported, the forces causing our vertebrae and joints to subluxate are dampened.
The Role of Healthy Foot Function
The “foot-spine connection” is a phenomenon that most patients have no clue about because the focus is usually on the location of pain with the classic healthcare system in the U.S. As chiropractors, we have studied and witnessed the effects of overall body biomechanics and the related kinetic chains. In fact, much of our success has been analyzing the state of a patient’s body parts and biomechanics as ways of identifying aberrant movement patterns and subluxations/misalignments of specific joints that affect the whole. In other words, we do not just chase pain. We acknowledge the patient’s pain, but we look at the biomechanics of the body to locate the cause. Often the source of the pain is elsewhere.
So let me show you the foot-spine connection. Please stand up and get into a comfortable, anatomical position. Take your fingers and put them on both of the greater trochanters of your femurs. Now roll your feet all the way out into excessive supination (you will notice your inner arch gets higher). As you roll your feet out, you can feel the external rotational forces on the bones of the lower extremities. Hold that position for a second and feel the stress on the lateral ankle, knee, hip, pelvis, and lower spine.
While you are still standing, now roll your feet all the way in and really collapse those arches down. Feel the difference? The forces on the medial ankle, medial knee, hip, sacroiliac joint, and lower back are felt because you are forcefully overpronating the feet. Not every patient will have feet as severely pronated as you are simulating. In my experience, 99% of patients will have mild, moderate, or severe pronation, and 77% will have moderate to severe pronation.
That exercise demonstrates the connection between the bottom of the feet and the hips, pelvis, and spine. If your patients perform this exercise, it takes just a few minutes and helps them understand the role the feet play in supporting the rest of the body. It also allows you to explain how forces from the ground move upward in the body and can be a major contributing factor to the pain they likely feel.
The Impact of Overpronation
Do you recall the last time a patient presented with plantar fasciitis, heel spurs, Achilles tendonitis, shin splints, Osgood-Schlatter disease, knee meniscus or collateral ligament tears, ACL damage, patellofemoral disorders, or hip, sacroiliac, sciatic, arthritis, lower back, upper back, or neck pain? That list covers a lot of ailments chiropractors treat. Patients are focused on their pain. Since the feet overpronate, the medial rotational forces on the ankle, tibia, and femur become the predominant biomechanical pattern, and the body eventually wears down. Any of the ailments listed can be a sequela based on having collapsed arches.
Using the foot-spine connection, we can put into perspective patients who present with insidious onset pain and those who come in with single-incident trauma. Remember that people who overpronate are, in essence, experiencing repetitive biomechanical stress due to the pronation pattern from the feet up to the TMJ. It makes them susceptible to getting conditions like those previously listed.
In a world of health care where athletes are looking for treatments to keep performing, the foot-spine connection and the chiropractic treatment philosophy offer answers to “why” they feel the way they do and “how” they will be treated. It is easy to recommend the appropriate physiotherapy modalities, adjustments, rehab exercises, and the prescription of custom-molded, three-arch, flexible foot orthotics to support the feet, reduce internal rotation forces, and help stabilize the body. Ultimately, there is no compensating for the real performance enhancer, which is optimal alignment of the body through restoring healthy foot function.
Kevin M. Wong, DC, is a graduate of the University of California, Davis, and a 1996 graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, California. As a member of the Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming continuing-education seminars with Dr. Wong and other Foot Levelers Speakers at www.footlevelers.com/continuing-education-seminars.
