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RCT
ACE Report #181

Benefits of sports chiropractic manual therapy for football players


Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A

The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial.

BMC Musculoskelet Disord. 2010 Apr 8;11:64.

Contributing Authors: W Hoskins H Pollard

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Synopsis

60 young male semi-elite male Australian Rules football players were randomized to receive a chiropractic manual therapy intervention or to the current best practice medical and sports science management during the football season. At the end of season, it was observed that the sports chiropractic manual therapy, in addition to the current best practice management, was effective in prevention of primary lower limb muscle strain injuries,but not hamstrings injuries or primary non-contact knee injuries.

Publication Funding Details +
Funding:
Not Reported
Conflicts:
None disclosed

Risk of Bias

6/10

Reporting Criteria

18/20

Fragility Index

N/A

Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

3/4

Randomization

4/4

Outcome Measurements

4/4

Inclusion / Exclusion

4/4

Therapy Description

3/4

Statistics

Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

A total of 16% of players are injured per season in the Australian Football League, and hamstring injuries constitute the most frequent injury. A recent review of the literature recommended further investigation of newer approaches to prevent hamstring injuries. This study evaluates the role of chiropractic manual therapy interventions in the prevention of football injuries.

What was the principal research question?

In semi-elite male Australian football players, is a sports chiropractic manual therapy, in addition to the current best practice management, effective in preventing hamstring, knee, and lower limb injuries?

Study Characteristics -
Population:
60 male semi-elite male Australian Rules football players (mean age=20.2 yr)
Intervention:
Sports chiropractic manual therapy: In addition to current best practice regarding medication, manipulative physiotherapy, massage, strength and conditioning administered by the club staff, participants received sports chiropractic treatment. This treatment was pragmatic and individualized based on the discretion of the therapist, which could have involved high-velocity, low-amplitude manipulation, and mobilization (Mean age: 20.2; n=29).
Comparison:
Control group: Participants were treated with the what is regarded as the current best practice regarding medication, manipulative physiotherapy, massage, strength and conditioning, administered by the club staff (Mean age: 20.2; n=30).
Outcomes:
Primary Outcome Measure: Hamstring Injury, Non-contact knee injury Secondary Outcome Measure: primary lower limb muscle strains, weeks missed due to injury, low back pain and health status
Methods:
Prospective, Multi-Center(2), RCT
Time:
6 and 24 week follow up

What were the important findings?

  • At the completion of season, the intervention and the control group did not differ in the prevention of hamstring injuries (p=0.051)
  • The intervention and the control group did not differ in the prevention of primary non-contact knee injury (p=0.051)
  • There was a statistically significant difference between the two groups with respect to the prevention of primary lower-limb muscle strains (p=0.025)
  • The intervention group experienced a positive change in overall (p=0.006), as well as in current low back pain (p=0.026).
  • The intervention group experienced a positive change in functional limitation due to physical health (p=0.004), bodily pain (p=0.034), general health (p=0.027), and physical summary score (p=0.013).

What should I remember most?

A sports chiropractic manual therapy together with the current best practice management was effective in the prevention of primary lower limb muscle strain injuries, but not hamstrings injuries or primary non-contact knee injuries. Furthermore, the players who received this intervention had a reduction in low back pain, as well as enhancements in some aspects of the physical components of health status.

How will this affect the care of my patients?

In treating semi-elite male Australian football players, an addition of sports chiropractic manual therapy to the current practice management should be considered in an effort to prevent lower-limb muscle strains.

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