 Hamstring injuries are among the most common and costly sports injuries. Conventional injury prevention has focused on local factors such as poor flexibility of the hamstring muscles, fatigue and lack of warm-up, rather than non-local factors typically addressed under chiropractic care—such as the biomechanics and postural control mechanisms of the lumbar spine and pelvis. However, evidence supporting both local and nonlocal factors has been lacking.
Therefore, the importance of a new randomized controlled trial (RCT) by Australian chiropractic researchers Wayne Hoskins, DC, PhD, and Henry Pollard, DC, PhD, published in BMC Musculoskeletal Disorders. For the 2005 season for 60 players from two Australian Rules football teams, normal best sports medicine care was compared with the same care plus chiropractic management.
Background and Goals
Hoskins and Pollard are from the Macquarie Injury Management Group, Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, Australia. Hoskins’ postgraduate studies and research have focused on the prevention and management of hamstring injuries. He had to temporarily relocate from Sydney to Melbourne for the trial, for which he was the treating clinician. Pollard, who is Director of Research at the Department of Chiropractic, Macquarie University, also serves as Chair of the Research Commission of the Federation Internationale du Sport de Chiropractique (FICS—www.fics-sport.org) the international organization representing the specialty of sports chiropractic.
They were aware that hamstring injuries are a major problem for the Australian Football League (AFL) and its players, that there were very few well-designed studies on injury prevention, and that there were none on chiropractic preventive care. As a result they designed an RCT with the following objective: “to investigate whether a sports chiropractic intervention consisting of pragmatically and individually determined high-velocity, low-amplitude (HVLA) manipulation, mobilization and/or supporting soft-tissue therapies to the spine, pelvis and extremity could reduce local and non-local hamstring injury risk factors to prevent the occurrence of hamstring and other non-contact lower limb injuries in semi-elite Australian Rules footballers.”
To set up the trial they applied to the AFL Research Board for funding. As a prerequisite they needed the support of one of the AFL’s 16 clubs. Notwithstanding that no club employed a chiropractor on its medical staff, 5 clubs agreed to support the project. They would help with recruitment of players/subjects from their feeder clubs.
In fact no funding was given by the AFL Research Board. Four clubs with semi-elite players based in Melbourne in the Victorian Football League (VFL) agreed to participate, with consent from management, coaching and medical staff. This would have given the planned 120 players/subjects for the trial to have the desired numbers and statistical power. Because of changed medical staff, 2 clubs pulled their support at a late stage. As a result the trial proceeded with 2 clubs and 60 subjects—30 for each of the treatment and control groups.
Inclusion/Exclusion Criteria
Players were eligible for the trial if they were listed players in their club’s VFL squad and did not have ‘red flag’ conditions (e.g., fractures or destructive spinal lesions) or ‘yellow flags’ (e.g., litigation, insurance claims) or “severe history of chronic hamstring problems.” |
