How Chiropractors Are Improving Performance

From Pee Wee to varsity to professional sports, athletes at every level face similar challenges; namely, they want to perform at their best and avoid injuries on the field.

And when the inevitable damage does occur, whether from accidents or overtraining, they look to get back in the game as fast as possible. In this situation, the doctor of chiropractic is often the essential solution.

It’s not surprising, then, that you’ll find chiropractors working closely with sports teams in all settings. In fact, you might already be actively helping athletes in your community right now. And chiropractors are on staff with virtually all professional sports franchises and are highly visible at the Olympic Games.

DCs are such a natural fit for athletes’ needs for a number of relevant reasons. Whereas an MD will largely look to address trauma and treat with medication, a DC is attuned to movement, mechanics, and musculoskeletal concerns. Furthermore, the list of banned substances for athletes is a long one—highlighting the importance of a non-pharmacological approach to healthcare and wellness.1

A chiropractor also has a number of treatment modalities that are noninvasive, such as low-level laser therapy and kinesiology taping, which work in conjunction with the adjustment to achieve results that other healthcare professionals can’t deliver. You might want to expand your practice into this area, or even specialize in it, to gain access to these patients who have highly focused needs.

Competitive concerns

Before you can present yourself as a sports chiropractor, though, you should be comfortable treating the kinds of problems these patients tend to present.

Spencer Baron, DC, works extensively with athletes and was the team chiropractor for the Miami Dolphins for 19 years. He finds that being skilled at extremity work is vital to his practice. “You also want to be skilled in dealing with concussions, extra-spinal work, knees and shoulders, and you’ll see garden-variety injuries depending on the sport you’re interested in.”

As he points out, the types of injuries you’ll see depend in large part on the type of athlete you specialize in treating (if any). “Synchronized swimming produces lots of concussion injuries. You wouldn’t expect it, but there is frequent contact underwater.” Indeed, the New York Times reported on this danger and noted that the odds of a synchronized swimmer suffering a concussion may be as high as 100 percent over time.2 This underscores Baron’s finding that each type of sport has a signature injury associated with it.

Jeffrey Lewin, DC, has narrowed his focus on treating athletes and was on the first chiropractic delegation sent to the Maccabiah Games, the third-largest international sporting event after the Olympic and Asian games. He agrees that extremity adjusting is important: “In regular chiropractic, you see mostly neck and back pain, but in sports chiropractic the athlete is looking for a solution, with a minimum of downtime (or no downtime all). Shoulders, knees, feet, and ankles—we see these as often as spinal work and adjusting.”

Another specialist in sports chiropractic is Jay Greenstein, DC, who served as a recommended provider for the National Football League Players Association for the Washington Redskins, among many other appointments. He’s found that professional sports patients tend to present with acute and chronic stress injuries; acute as when a football player sprains a neck, and chronic as with knee injuries from repetitive use. “The difference

between regular patients and the athletic population, especially the high- level and professional athlete, is that there is typically more at stake—their livelihood. Our focus for all populations, however, is consistent in that we are not just eliminating pain and symptoms, we are unequivocally identifying the root functional causes, correcting those issues with a multitude of tools, and striving to maximize their performance based on their individual goals.”

High-level athletes, as well as weekend warriors, often have preexisting problems, Greenstein says, “And they are further exacerbated if they are only managed symptomatically. A key to being a sports chiropractor is educating the athlete on the benefits of not just resolving their injuries, but using chiropractic for prevention and maximizing performance.”

A difference in focus with sports chiropractic

In addition to the kinds of problems athletes present when seeking care, you’ll find they often have a particular goal in mind. That is, the general patient may be looking for pain relief and the restoration of normal function, but the athlete will be anxious to return to the field as quickly as possible and perform at an exceptional level.

According to Cindy Howard, DC, a board-certified nutritionist and chiropractic internist who works with athletes at all levels, the speed of recovery is of paramount importance to most. “Especially where money and jobs are dependent on it, and you’re looking to lower the incidence of recurrence or successive injuries,” she says. “It’s different as opposed to the layperson, who is willing to take more time to recover. But we have to be careful that we don’t put people back on the field too quick.”

Another difference Howard notes is that athletes are trained to work through discomfort and pain. “If we can increase their level of performance, if their energy goes up a fraction, if we can shave a second off their time so they can beat the next guy, they’re happy,” she says.

Douglas Lioon, as part of his career, launched a line of nutritional supple- ments targeted to meet athletes’ particular needs. “Athletes—especially professionals—are subjected to rigorous training and they’re constantly in that anabolic state, and the stress can compromise their immune system,” he says. As our other experts note, too, keeping a strong immune system is an ongoing concern for most athletes, because of the overwhelming demands they put on their bodies.

Specialized care

Lewin finds that the modalities used in sports chiropractic aren’t all that different from those used in general chiropractic. “We don’t use much ultrasound, but we use electrical, interferential, and low-volt muscle stim. We also do a lot of manual work, utilizing manual therapy, transverse friction massage, different types of IASTM,” he says.

Typically, when athletes have gotten into trouble with medication and performance-enhancing substances, it’s because of their competitive desire to outperform others and need to reduce pain. Yet these are two areas where chiropractic stands out.

“Any paraprofessional can offer physical therapy–style treatments like stim and manipulation, but only the DC offers spinal adjustment. And adjustments have been clinically demonstrated to offer performance improvement and pain reduction,” Baron says.

It is known that adjustments release endorphins in the brain, and research indicates that proprioception and voluntary muscle contractions are positively affected by chiropractic. Your ability to improve nervous system function can benefit your athlete patients who depend on fast reaction times. “You can be the strongest or the fastest at your sport, but if you can’t react faster than the other player, then you’re second place, not first,” Baron says.

Greenstein adds that there is ongoing research in New Zealand showing that adjustments can enhance central and peripheral nervous system performance. “We also use IASTM, kinesiology taping, low-level laser therapy, and cupping, which was big at the Olympics in Rio. It’s important to apply the right treatment in the right place at the right time.” He’s also found that corrective exercises can make all the difference for the athlete.

Internal affairs

Nutrition is playing a larger role in sports conditioning than ever before. The relationship between diet and muscular development is becoming increasingly understood and athletes are adopting sophisticated strategies. Problems in this area can show up as deficits on the field.

“I look at inflammation,” Howard says, “and adrenal fatigue—certain foods are more inflammatory than others, foods with additives that decrease the patient’s ability to heal faster.” She finds that the right approach to nutrition can exponentially increase the healing response. “As DCs, we look at the external body but the internal and chemical processes commonly get ignored,” she says.

Howard will recommend spices such as curcumin from an herbal standpoint, known for its anti- inflammatory properties. “Then there’s blueberries with their anthocyanins, and for omega 3s, omega 6s, and omega 9s I like salmon and olive oil, coconut oil, and raw nuts and their oil can be really great.”

She steers patients away from anything containing chemicals, food colorings and dyes, which can be cytotoxic (especially in the brain), aspartame, and monosodium glutamate. “Anything that doesn’t sound like a fruit, vegetable, nut, seed, bean, or protein,” Howard says.

Lewin points out that if you are going to work in the area of nutrition, you’ll want to be making educated recommendations: “It’s not unusual for our patients who need a nutritional workup to get an extensive questionnaire, bloodwork, urinalysis, stool sampling, and even salvia analysis. From this we can work with the patient to determine what they should and should not be eating. We can find out what foods are they are sensitive to.”

This is in line with Howard’s approach, too. “I do a ton of testing, and it ranges from food sensitivity testing—we look for foods that cause inflammation in white blood cells, stool sample testing for parasites or bacteria, and C-reactive protein for inflammation. When you look at most diseases, you find chronic inflammation and a poor immune system.”

She notes that if you can find the causes of inflammation and immune system dysfunction and remove them, you concomitantly reduce the level of disease and injury.

Supplementing safely

As mentioned earlier, supplements can be a fraught area for athletes at all levels, as well as their coaches and support staff. A statement from the National Federation of State High School Associations expresses concern that some supplement marketing tends to “reinforce a culture more concerned about short-term performance rather than overall long-term athletic development and good health.”3

The statement further notes that any supplement taken by an athlete should be for health reasons under the guidance of a healthcare professional and not for the purpose of enhancing performance. And even though a DC may have the best of intentions in recommending a product to an athlete patient, the possibility of a product being contaminated, adulterated, or not in accord with its labeling could result in a disqualification from sporting activity—a disaster for all concerned.

To address these issues, a consortium of industry regulators, manufacturers, and consumer groups developed the NSF Certified for Sport certification. Products bearing this designation are determined to be in full compliance with sporting rules and contain their indicated ingredients only.

Lioon has been through the NSF certification process many times: “It’s an extremely rigorous, highly monitored program that was designed so there are no surprises for anybody. And it has a high awareness level with trained athletes.”

From the consumer’s standpoint, a safety guarantee is essential, but from a manufacturer’s standpoint it’s a big deal, too. Lioon explains: “Some supplement ingredients are coming from Third World countries, where there are unethical players who spike a natural product with a controlled substance. If you’re a supplier and don’t know what to test for, the NSF program helps you ensure your supplier is playing by the rules.”

“There are still some great products of high quality out there,” Baron says, “but we were afraid to tell athletes about them until they were NSF certified. It’s expensive for companies to do the assays and random sample selection, and it’s expensive for a company to get that NSF approval, but it’s a useful tool for the practitioner.”

Hit the books

If you want to move your career in this direction, all of our experts agree that it starts with education. “The CCSP (Certified Chiropractic Sports Physician) course changed my practice forever,” Greenstein says. “Understanding all the additional tools I could use helps me to take better care of my patients, and I highly encourage other DCs to commit to lifelong learning. It helps provide solutions to clinical care you might not otherwise have.”

And Baron is a Diplomate of the American Chiropractic Board of Sports Physicians (DACBSP). “There’s only about 375 of us in the world, and it allows me to get results with athletes perhaps faster than a regular DC could because I’m trained in what to look for.” Like Greenstein, Baron finds his additional learning changes how he deals with regular patents. “And every patient should be treated like an elite athlete,” he says.

While her advanced education wasn’t technically a sports program, Howard found becoming a Diplomate of the American Board of Chiropractic Internists (DABCI) was valuable. “That education gave me over 300 hours of internal medicine, from a healthy preventive approach, and not just symptom-based care. We understand infectious processes, cardiovascular problems, and even pharmacology.”

Their recommendation is to start getting active in your community at the local level and start working with sports team and athletes, pro bono if necessary, to get experience and get your name out. Give talks, address clubs and teams, and with time and referrals success will follow.

And work on your social and communication skills.

Athletes will need you to “get” them, you’ll need to motivate them, and the effective sports DC will radiate energy and enthusiasm in addition to being an outstanding listener and clinician.

Daniel Sosnoski is the editor-in-chief of Chiropractic Economics. He can be reached at 904-567- 1539,, or through

Adam Freeman