This is the first survey to describe the demographic and practice characteristics of FICS based sports chiropractors. Based on this survey, sports chiropractors are working with elite and professional athletes in many countries and sports and serve as an integral part of the sports medicine team. They are primarily male, between the ages of 31–40 years of age and have been in practice for 5–10 years.
The demographics in this study were predominantly male (78% n = 120) which is similar to other studies of the general chiropractic population (62.4–79.2% male).(10–13)
Sports chiropractic is not a modality. Chiropractors have been described as uni-modal,(14) utilising manipulation only, but the results of this survey suggests the contrary. 90.9% of respondents were multi-modal in the majority of their treatments. Spinal and extremity manipulation are commonly combined with soft tissue therapy (used by 97.4% of chiropractors), mobilisation (93.5%), kinesiotaping (90.9%), low force techniques (90.3%), instrument assisted soft tissue therapy (83.1%), rigid taping (66.9%), physical therapeutics (57.8%) and dry needling (37.7%). A 2009 survey of the general US chiropractic profession by Christensen et al revealed that more than three-quarters of general chiropractic practitioners use passive adjunctive care procedures including ice packs, trigger point therapy, braces, and electrical stimulation.(10) A recent survey by Adams et al describes that nearly half of the surveyed general chiropractors who treat athletes or sportspeople ‘often’ were more likely to use a multimodal approach to management more than their colleagues that did not treat athletes or sportspeople ‘often’.(9) This compares to the 97.4% of sports chiropractors in this study who utilise a multimodal approach to the management of their athletes. Based on the above, some of these views are likely based on inferences drawn from the philosophical boundaries of how general chiropractors may treat as a Primary Spine Care Providers (15, 16) in the past, and not how multimodal sports chiropractors (7–9, 17) currently manage patients.
Rehabilitative exercises are prescribed on 76% of visits, to a sports chiropractor, a figure that is greater than general chiropractors (31%).(16, 18) Despite a thorough search of the literature, there is no comparative figure that we could locate for physiotherapists or sports physiotherapists exercise on current prescription behaviours.
Chiropractors are often labelled “spine only” and there are many reasons ranging from self-promotion by chiropractors to misrepresentations by non-chiropractors.(19–23) A lengthy discussion of this issue has occurred in another commentary.(21) However, this survey reports sports chiropractors commonly treat both spinal and non-spinal neuromusculoskeletal conditions. 100% of sports chiropractors treat non-spinal neuromusculoskeletal conditions (99.4% spinal) and 37.2% of their patients have a primary complaint that is non-spinal musculoskeletal.
This survey also reports on the self-education of sports chiropractors who are sometimes labelled as not conforming to evidence-based practice.(2, 24) However, like medical practitioners, allied health care practitioners and other CAM practitioners, chiropractors perceive the need for evidence-informed practice.(25) Our study and others on sports chiropractors illustrate that need.(1) This study showed that sports chiropractors are well-read in research (on average 2.9 articles per week and 2.5 hours spent), although this survey did not examine the quality or retention of this reading or how they implement this research. This implementation of evidence into practice is not unique to chiropractic and sports chiropractic. It is noteworthy that similar issues have been described in orthodox medical and allied health groups. Some have suggested that a considerable amount of management in sports medicine is not supported by evidence.(26) It is noteworthy that health practitioners have a difficult time deciding between the research-based evidence, patient choice and their own clinical views (25, 27–33) so it should not be surprising that sports chiropractors are also afflicted by this challenge.
The current NFL season saw 41 team chiropractors working with all 32 teams and chiropractic services offered in the Summer Olympic games polyclinic in 2008, 2012 and 2016. As our study revealed, the vast majority of ICSSP chiropractors surveyed have at some stage in their careers treated professional (90.9%) and semi-professional (94.8%) athletes, with 20.1% currently working with a sports team full time. They also refer (63.6% often doing so) and co-manage (58.4% often) with other health professionals.
There are those that hold the views that chiropractors do not integrate well in a mainstream multi-disciplinary team, nor do they interact with other professionals on a regular basis.(24) Whilst this may have been true historically, chiropractors reported co-management of a greater proportion of health conditions with other professionals in 2014 than in 1998; this suggests an increasingly integrated approach to patient care.(10) These historical perceptions are not true of FICS based sports chiropractors based in our study and also others.(2, 34) The need to pursue best practice, evidence-based multimodal care is evident in the sports chiropractors described in this sample as they integrate their management offerings with others in the sports medicine team.(19)
This study attracted a good response rate of 64% likely to be representative of the FICS based sports chiropractors.(35, 36) However, whilst it may be the largest international group FICS is not representative of all sports chiropractic groups and that remains a limitation of the study.
Additionally, the survey was written in English and therefore limited to English speaking FICS chiropractors. However, despite the name FICS, the ICSSP/D qualification is only presented in English and therefore those who have completed it would be expected to be proficient in English.
This study was a preliminary study describing the activities of sports chiropractors. Future research could investigate different geographical, practice and practitioner characteristics, comparing sports chiropractors at different levels of involvement (local, state, national, international as well as describing in detail the treatment outcomes obtained by sports chiropractors.