Hitting a Home Run With A Sports Chiropractic Practice

Whether you want to work on professional athletes or the occasional weekend warrior, certain methods and procedures will make you much more successful at treating and attracting athletic patients. Athletes tend to be an incredibly loyal patient base that will refer their entire team, and occasionally even their competitors, if they trust you and get results. While chiropractic adjustments are our single most effective method of treatment, you must be able to recognize and treat soft-tissue and extremity injuries to have a successful sports chiropractic practice.

It can be difficult to convince an athlete who has never had "back pain" that he needs a weekly adjustment for his infrapatellar tendinosis. In order to build a successful sports chiropractic practice, it is vital to have a group of medical specialists to refer your patients when chiropractic care is not effective. Remember no one "fixes" everyone, and if you are not helping your patient, they will find another doctor anyway. You should have specialists in all areas of medicine you can refer to who understand your abilities. In turn, they'll refer that patient back to you, and actually many more. Wouldn't you rather have your patients treated by doctors who will put in a good word for you, rather than a close-minded, old timer who dislikes all chiropractors?

Getting To First Base

To effectively treat sports injuries, you have to be able to first determine an accurate diagnosis and then have methods to treat those injuries. Having a degree in sports medicine and becoming an NATA-certified athletic trainer prior to becoming a chiropractor gave me a head start in sports-injury evaluation and treatment. That was later enhanced with my CCSP training and then full-body certification in Active Release Technique; and eventually becoming an ART instructor. I feel Active Release is a very effective method of treating nonsurgical, sports-related soft-tissue injuries. Graston has also been helpful in my practice in getting to areas too deep or too small for using hands only. It is also a bit easier on your hands than ART. The proper use of manual therapies, passive modalities and rehabilitation can greatly decrease recovery time. You should become competent in other forms of treatment for soft-tissue injuries and familiar with proper rehabilitation.

Explain to your patient that if treatment is going to work, it will work quickly. I usually tell my athletic patients they should see at least 50 percent improvement in symptoms in two to four visits. If they are not improving quickly, I consider referring them out to other sports medicine specialists. Take as many sports medicine seminars as possible and attend sporting events, even if only to observe. Then you must go to the place where they occur, on the field, in the gym, and on the road.

Rounding Second

The best way to become familiar with sports injuries is to see them when they occur. When injuries do occur and there is medical staff covering the event, try to speak to medical staff. Do not try to treat something or push your way in the picture. This can be difficult because we want to help everyone, but be selective in your claims and abilities. After the injury, explain you may be able to assist in the athletes' recovery.

Even if you know you can treat an injury and you have great success in your office, do not make those claims. You should take a more subtle approach and say, "I have seen that injury in my office and we usually have some good results". Even if you are 99 percent sure you can help someone (even when no one else has) don't be boisterous and over-confident. The first time you guarantee results, you are sure to fail, and then everything you say will be questioned.

Another key to building a sports chiropractic practice is knowing which specialist to use and when to use them. While I refer to just about every medical specialty, there are certain specialists that see about 75 percent of my patients. These same doctors are also responsible for a lot of new patients. The most frequently used, and most helpful to my patients, are primary care sports medicine specialists. These are MDs or DOs who are first primary care family doctors. They then go through a one-year fellowship program specializing in sports medicine. Here they learn how to treat all of the nonsurgical sports injuries from concussions and stress fractures to mononucleosis and sports hernias. Many work for orthopedic groups and triage new patients, so the surgeons can spend more time in the operating room. They usually order studies, inject injuries, aspirate joints and then refer to the orthopedic doctor when needed. I see approximately 35-50 new patients per month and half are referred by these doctors. The others are referred by patients' friends or team mates. The only advertising we do is through our Web site and an occasional advertisement in a local high school sports program.

[pb]Rounding Third

We all know that most people with lumbar pain see their family doctors first. From there, they usually get referred directly to an orthopedic group or physical therapy. Many MDs don't even know DCs in their area. I have heard patients say, "My doctor said it was OK to go to a chiropractor, but when I asked whom I should see, they didn't have a name." That is the perfect time to reach out and also send them some patients.

It is our job to connect with these doctors and the best way is by sending them the patients we cannot help. Then follow up by calling the doctor and asking about the patient you sent. Many patients are unhappy with their family doctor. That is the perfect time to send them to one of your doctors. I do the same with family doctors. I also mention if they change to a doctor I recommend, it is much easier to get what we need such as diagnostic studies, medications, etc. Given capitated plans and other limitations, this can be vital in providing proper care. Also, in the event of an emergency, I can usually get to their doctor even if they cannot.

Call orthopedic groups in your area and ask if they have any primary care sports medicine doctors. If they do, call that doctor and ask if you can refer patients to them. Tell them you frequently get patients who need their care and are beyond our scope of practice at this time. Athletes and even the average patient benefit greatly from the combination of care. Cortisone injections, prolotherapy, PRP and other medical treatments are very effective and can greatly assist in a faster return to activity.

If timing is important, then both methods of care should be used. Even if the patient is not a highly paid athlete, timing can be as, or more, important. Professional athletes normally do not have pressing financial needs. A self-employed general contractor trying to feed his family, who does not get paid if he does not work, is even more pressed for time.

I always offer a holistic approach first. However, if a cortisone injection or other commonly used medical treatment, along with my care, will get someone back a month faster, then the patient should be aware and the treatment should at least be offered. Most patients will choose to forego aggressive medical care. That is why they are in your office in the first place, but all patients appreciate a definitive treatment plan with options open to their preference.

Heading for Home

After you calm patients' symptoms, you must recommend rehabilitation and strengthening exercises. Strengthening is vital to proper recovery. I tell all my patients that if they do the exercises we show them and get stronger, they will not need us. When they are released, one of three scenarios usually occurs: They do their exercises for a while, slack off, flare up and come back; they feel great, overtrain, get injured again, and return to you for treatment of another injury; or they do their exercises, feel great and refer everyone and their brother to your practice.

If you send a number of patients to a certain medical doctor and do not get referrals back, stop referring and start sending to another doctor. I have even called doctors and said it is a two-way street, and I need to see work coming from them as well. Continue to do this until you start to see regular referrals.

Other medical doctors who have become very valuable to my practice are pain-control specialists. Typically, they are either physiatrists or anesthesiologists. They are usually the last resort prior to surgery, or at least many patients think that is the case. In reality, many of their patients have been treated with standard medicine and physical therapy. Or they have only received chiropractic care without proper rehabilitation. Many of these patients do very well with the combination of care. It is basically impossible to have someone do their rehab elsewhere, due to time and financial constraints, so in-office therapeutic exercise is very valuable. The benefit of a chiropractic office is we can change treatment protocols daily if necessary. If a patient is in a lot of pain we'll do more passive modalities, active release, and less therapeutic exercise. I use this same basic approach with just about any type of doctor and have been able to develop relationships with some of the best doctors in the country, from the Hospital for Special Surgery to the Mayo Clinic.