Still, the chiropractor's base of knowledge is predominately clinical. Care after the fact. Study and actual experience of other related sport topics is typically minimal for the average chiropractor, as is also true for the average medical doctor. Pre-participation sports physicals, exercise program design, sports nutrition, emergency procedures and rehabilitation are among the areas of knowledge in which the sports chiropractor should be well versed. Specialized training is critical.

Chiropractors considering participation in sports venues should look closely at the following:

Pre-participation Physicals: The requirements for most sports physicals are heavily weighted toward examination of visceral systems. Evaluation of the head and neck, heart, lungs, abdomen and genitourinary systems is emphasized over the neuromusculoskeletal systems. This requires the doctor to sharpen many exam skills.

NCAA requirements/standards for pre-participation physicals can be obtained online. Collegiate and public school websites often contain the physical forms required for their athletes. Downloading these forms to check for content and to have on hand is recommended.

Exercise Program Design: Exercise program design is a science in and of itself. Training frequently involves seeking knowledge normally geared toward personal trainers and strength coaches. The study of energy systems, weight training and aerobic conditioning are a must in understanding an athlete's initial training and the training program the athlete will return to post-injury.

Sports Nutrition: Nutrition needs for the average individual are quite different from those of a competitive athlete. Nutritional needs for an athlete are closely linked to the requirements of the primary energy systems the athlete requires for training and competition, which means that there must be seamless integration between the design of the athlete's nutritional program and his or her exercise program.

In some cases, athletic diets may include double the calories and nutrients required for the average person due to the increased energy expended during training and competition. Knowledge must also include consideration for altering an athlete's diet in the off-season.

Emergency Procedures: Athletes may suffer broken bones, ruptured organs, heat stroke, heart attacks, concussions and other conditions that require emergency assessment and care. The basics of assessment and care for these conditions are covered in chiropractic education. However, experience and refinement of these skills are required for the protection of the athlete and the chiropractor.

Chiropractors with a background as an athletic trainer, emergency medical technician, nurse or paramedic start with an advantage. Most chiropractic sports programs include training in emergency procedures that is more detailed than the training received during the chiropractor's course of study. Emergency medical technician, first aid and CPR training can often be obtained through local night classes for the practicing chiropractor seeking to enhance his or her skills.

Rehabilitation: Functional rehabilitation of both athletes and average chiropractic patients has become a critical area of patient care in recent years. Beginning rehabilitative procedures earlier in care is more effective than prolonged passive care, having a positive impact on the rate and quality of healing. The ability to assess the athlete functionally and develop an appropriate rehabilitation program is a vital part of the modern chiropractor's tool box.

It isn't "all or nothing": The best scenario for the chiropractor is to have knowledge in each of the above areas. However, a doctor can limit his or her participation to those areas that he or she feels most comfortable with and/or finds of greatest interest. This also allows the doctor to begin participation on a limited basis while obtaining additional training. Care for athletes post-injury can begin immediately in almost any chiropractic office.

K. Jeffrey Miller, DC, DABCO, is Chairman of the Clinical Sciences Department at Cleveland Chiropractic College-Kansas City.