WHAT’S THE CRAIC?

ARTICLE BY NICK METCALFE

Nick Metcalfe is Chair of the Royal College of Chiropractors Sports Faculty, has worked at Fulham FC for five seasons and owns two private multidisciplinary clinics in South-West London. He explains the role of chiropractors in sport and describes developments that are improving the quality of sports chiropractors in the UK.

“No bad backs round here mate” was a comment on my first day volunteering at my local football club. Back then, if you wanted to work in sport as a chiropractor, the advice was to start by volunteering at your local club and work your way up. It was me and my portable bench in the changing room and I was the sole person on the medical team. It took an ankle or knee injury before the players realised I could do more than help a bad back. And it took an amateur tape job and some massage before they realised that I didn’t just manipulate. But then they called me “physio”.

Many chiropractors have started here. After a couple of seasons volunteering at one club, a contact from the previous gig or an email leads the chiropractor to the league above or a side-step into a different sport. A few seasons later, through a combination of what seems like luck or knowing the right people, the sports chiropractor might get an opportunity in professional
sport. The route is tortuous and the ignored emails, the closed doors, the reliance on ‘who you know’ is hard to take. This process doesn’t identify the bright sparks in our profession, it risks extinguishing them. The attrition rate in sport is high and it’s much more comfortable to stick to private practice.

WELL-DEFINED COMPETENCIES
Fast forward to the present day and The Royal College of Chiropractors has a Sports Faculty and its members – sports chiropractors – now have a formal framework and well-defined competencies that they strive to achieve over time to progress their career in sport. It’s not only about qualifications; it’s also about reflective learning and logging cases. It’s interview-based learning where experienced sports chiropractors are involved in nurturing more junior chiropractors. Yes, the entry point is likely to still be volunteering at a local club but now there is a pathway and support along the way. The hope over the coming years is that the attrition rate is lower and the bright sparks are identified.

Most of my time involves assessing and treating non-injured players before training. My spinal assessment looks at elements of flexibility, strength and control and I’ll draw on the expertise of others in the medical team when a player requires it.

As a lone chiropractor in a physio dominated environment, I used to feel the need to prove that I was the same as them. I wanted to fit in. But as my journey in sport progressed and I gained experience and confidence, I realised that my real value came from being different. Sometimes not right away and not too different, but just the rightamount- different. It reasons that if everyone on the medical team brings a different lens then, as long as communication is effective, then less gets missed and the athlete benefits.

MY POINT OF DIFFERENCE
I was one of the “lucky” ones that made it through that old tortuous route into professional sport. Most recently, I’ve been at Fulham FC for five seasons, working twice per week. “Nick the click” they call me; a nod to the fact that manipulation is my point of difference, which I’m comfortable with. I will still combine the manipulation with other manual therapy techniques. If it’s a spine or pelvis it usually ends up on my treatment bench, but I’m comfortable giving exercises in the gym and when it’s all hands-on-deck I’ll “flush” the legs if the team requires it. I’ve given up on taping though.

Most of my time involves assessing and treating non-injured players before training. My spinal assessment looks at elements of flexibility, strength and control and I’ll draw on the expertise of others in the medical team when a player requires it. I understand that manipulation is a great tool when applied safely and appropriately but sometimes mobilisation, massage, or exercises might have a similar effect and be more appropriate. Plus, a player’s requirements might change depending on whether it’s before training, after training or before a game.

Apart from the non-injured players, over the five seasons at Fulham FC I’ve assessed players with irritable hamstrings with a possible neurogenic component, pelvic asymmetries that might be influencing recurrent soft tissue injuries in the leg, disc injuries, stiff ankles following inversion injuries, rib injuries, shoulder injuries and… bad backs.

Recently, Chiropractic was part of the Core Medical Services at The Commonwealth Games in Birmingham. 16 chiropractors were stationed across 3 venues over the 11 days and performed 248 athlete encounters. The sports that utilised chiropractic the most were athletics, rugby and weightlifting. In this multi-sport environment, Chiropractic sat alongside Osteopathy, Physiotherapy and Sports Massage and it has been the same recipe used by the hosts of the past three Olympic Games. Many of the athletes who used the chiropractor would be used to receiving chiropractic care at home, but their nation’s traveling medical team does not include a chiropractor. I’ve seen myself that a ‘Head of Medical’ might choose to bring in a quality-assured sports chiropractor part-time, rather than risk their players seeking an unknown chiropractor outside of the club.

Looking into the future, quality assured sports chiropractic is something The Royal College of Chiropractors Sports Faculty is striving to provide. A “Fellow” of the Sports Faculty is the top tier of membership and they will be an expert in their field. They will have achieved well-defined competencies, they are evidence-led, have great manual therapy skills, are sound communicators and can integrate within a multidisciplinary environment. Chiropractic is a small profession, and sports chiropractic is a niche within that, but the benefit is that change can happen quicker.

Expect to see many more highly competent sports chiropractors emerge over the next 5-10 years.

 

Nick Metcalfe
Contact@nickjmetcalfe.com

 

Article taken from Issue 61 of BASEM Today, a free publication for all BASEM members.