The role of Chiropractic Care in Prevention of MSK Injuries in Sports Assignment Sample

Chapter 1: Introduction

1.1. Introduction

This study has assessed the importance of chiropractic care, which is considered as alternative medicine in the treatment of musculoskeletal disorders and has achieved an immense reputation in sports medicine. Therefore, it is important in the sector of the medicine industry where it can reduce MSK disorders. Therefore, this study is also informative as it can explore the function of the prevention of injuries in the sport. This type of injury has been observed among the athletes including bodybuilders, boxers, and cage fighters. Therefore, this study has been helpful in exploring the role of prevention in the case of MSK injuries with the representation of proper aims and objectives required to be accomplished.

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This study is very relevant in the sports industry as injuries in sports are very common among athletes especially those who are engaged in contact and high-impact sports including bodybuilding, cage fighting, and boxers (Hawk et al. 2021). There were many traditional methods to prevent this type of injury like physiotherapy and conditioning exercises but those are not very much effective according to the different types of requirements among the athletes. So chiropractic care has involved the therapies of spinal manipulation with several manual healings. So this type of treatment can be considered as the alternative method to the traditional method which can successfully reduce injuries of Musculoskeletal.

It has been observed that sports injuries are very fatal in the careers of athletes and discomfort to their bodies. Thus, while physical therapy and strength conditioning are useful, more often they are not sufficient to prevent or entirely protect against injuries. Chiropractic care is one that focuses on the spine; it provides a viable option that can help prevent MSK injury significantly. However, more specifically to the application of chiropractic interventions in the care of sports injuries, limited research has been done (Saad et al. 2020). Consequently, there is a dearth of literature on how chiropractic care can be incorporated into the injury prevention processes This forms the narrative of this systematic review study with the view of identifying avenues of integrating chiropractic care into the techniques of injury prevention. This knowledge of comparative efficacy will empower athletes, trainers, and other participants in sports medicine to make the right decision as to the appropriate incorporation of chiropractic methodologies in injury prevention as well as treatment (Hawk et al. 2020). The findings from the present study may be used to advance the ways and measures to prevent injuries thereby addressing athlete’s overall welfare, productivity, and career span of the sporting disciplines they practice.

The relevance of this investigation therefore arises from its ability to inform existing strategies for preventing sports injuries. As a result, this study will present rather a powerful case of how it is possible to work out a rigid algorithm to check the efficiency of chiropractic interventions in the prevention of MSK injuries and, thus, reveal the prospects for the treatment and its advantages. In the field of sports, specifically boxing, cage fighting, and bodybuilding, getting back into shape after getting injured is a major concern, Injuries are very common in these sports and this makes injury prevention significant in prolonging careers (Lin et al. 2023). The findings of this study will be useful to athletes and other players in sports together with the sports medicine personnel to explain the likelihood of gains that can be obtained from incorporating chiropractic management into the intervention strategies. Further, contrasting chiropractic to current preventive strategies will help to identify the stakes and weaknesses of chiropractic and assist in the creation of complex approaches to multiple-modal injury prevention (Eindhoven et al. 2022). The findings of this study will provide further insight into the future practices of sports medicine and therefore can lessen the diseases in regards to athletes and reduce the cost of health care in relation to cases of sporting disasters.

1.2 Research Questions

1. How efficient is chiropractic care in decreasing the risk of MSK injuries among athletes and bodybuilders?
2. How does the efficiency of chiropractic care in comparison with the traditional method of treatment?
3. What are the different features can be adopted for the chiropractic care?
4. What is the relebance of evidence-based approach in treatment of chropractic aspects?

Chapter 2: Literature Review

2.1 Introduction

Injuries are a very common factor for sports athletes all around the world. Due to their high prevalence among sportspersons, these sports injuries have become a major concern for their career. It was identified that effective methods of prevention and treatment of sports injuries are very vital for ensuring the safety of an athlete’s career. This second chapter of this research dissertation includes the formation of a well-structured literature review of past journals and articles related to this research area. The empirical study section of this chapter comprised of review of the previously completed literature. On the other hand, this chapter also includes the description of highly relevant theoretical frameworks and models, which are highly related to chiropractic and sports injuries.

2.2 Empirical Studies

2.2.1 Sports Injuries Formation and Their Nature

According to the research paper of Fonseca et al. 2020, the development of sports-related injuries for any athletes can be formed through a vast variety of factors and their interactions. Also, the authors have mentioned that the formation of sports injuries might happen because of the sports profiles of an athlete. The primary aim of this research paper was the understanding of appropriate forecasting methods for sports injuries. The term “sports injury” can be described as the types of injuries, which are formed during the practice of any particular sport or during the matches. However, it was found that sports injuries are not limited to only the sportspersons. Workers who work in factories can also developed sports injuries such as tennis elbow, shoulder injuries, tendinitis etc. This study has divided sports injuries into two different classes. These injury classes include acute and chronic injuries.

It was identified that acute injuries are those injuries, which occur suddenly. On the other hand, chronic injuries are completely opposite to acute injuries as they develop gradually over time. This research paper has mentioned about most common sports injuries. Examples of these common injuries are shoulder injuries like Rotator cuff injury, Impingement, Instability, etc. While elbow injuries include Tennis elbow or lateral epicondylitis etc.

According to Tee et al. 2022, injuries, which are associated with sports and exercises, are very complex in nature. On the other hand, they have also mentioned that the prevention of these injuries also requires considerable effort. The main purpose of Tee et al. 2022’s paper was the identification of prevailing approaches to sports injury prevention. To active this goal, this research has used the method of a critical literature review. The findings of this study have shown that there are various variables are present which have the ability to increase the complexness of sports injuries. These factors include the formation of a sport’s athletes’ profile, the length of their career etc. On the other hand, the development of these elements is also very crucial for the prevention of sports injuries among players and athletes.

2.2.2 Musculoskeletal injuries and their Relevance

The research of Gimigliano et al. 2021, have mentioned that Musculoskeletal injury (MSK-I), is a general condition which refers to damage to muscles, bones, tendons, joints, ligaments, and other soft tissues of a human being. This MSK-I is identified as a very popular and common injuries which can be found in athletes all around the world. It was identified that the information about this type of injury can cause challenges for the athletes such as low performance, missing matches and financial issues. The primary purpose of this study was identified as the analysis of epidemiological data, which are related to musculoskeletal injury and their presence in sports athletes. For the development of this research, the authors used a systematic literature review. However, the authors also mentioned that finding epidemiological information for musculoskeletal injury in athletes is very rare. According to the findings of this study, their sports type can prevent the formation of MSK in an athlete. It was found that the chances of development of this injury are higher in athletes of karate, athletics, and football. On the other hand, the chances of the MSK injury are lower in summing, shooting, etc .

Figure 2: Distribution of musculoskeletal injuries in athletes

(Source: https://link.springer.com/content/pdf/10.1186/s12891-020-3141-8.pdf)

According to Goes et al. 2020, Musculoskeletal injuries (MSK-I) are a very crucial and serious problem because this disease can be found mostly in sportspersons. It was identified that the formation of these injuries can produce a high amount of costs for the patients. This particular research paper has shown that MSK injury occurs in many muscle and skeleton joints of a human being. The percentage of injury forming areas is identified as 5 to 60% for joint injuries, 20 to 60% for muscle injuries and 10 to 50% for tendinopathy. In addition, there are non-modifiable and modifiable elements present, which have the ability to influence the MSK. The authors of this particular paper have used the primary and quantitative data regarding MSK injuries and analyzed them with statistical methods. The findings have shown that relevance of joint injuries is higher in combat athletes as these sports have huge effects on their muscle. On the other hand, joint injuries forms less in the soccer players. The relevance of another type of MSK, muscle injuries is higher in the bodies of football and handball players. The additional studies that the researchers included also provided similar evidences. However, the data have shown that the formation of muscle injuries is majorly the same in all of the analyzed sports athletes’ data. It can be understood from these results, that the occurrence of muscle injuries is the most common type of MSKs. The last type of MSK (tendinitis), which was analyzed in this paper, has the highest amount of occurrence level in water polo athletes.

According to Bullock et al. (2022), the aim of this study was to evaluate the validity and accuracy of the musculoskeletal injury prediction models commonly utilized in sporting disciplines. The important aspect that highlights the quality of the study done is how it outlined the methodological quality assessment and the accuracy of the existing models that were used in an effort to predict the incidence of athletes’ injuries. As inferred from the present review, while more application of PA has been identified for prevention of injuries, the models also demonstrated high incoherency in their dependability and preciseness.

The review highlighted several key issues, that have also noted that managers are often confronted with methodological problems of many models that concern such things as or the lack of their validation and other preconditions of the implementations from the point of view of statistical methods. Thirdly, the selection of sports injuries may not always be profound and may not encompass sophistication at others, which might not change dyism in sports injuries, and might distort the models’ cross-contextual and cross-population generalizability. This work also uncovered absence of, high quality, or shared work for model development as well as of the different forms of data consolidating and the centrality of biological and psychological variables that may possibly predispose one to injury.

Whereas there are some benefits though, they are rather certain weak points within the methodological approach of such predictive models; therefore, the general legitimacy of such a kind of models remains questionable. In this respect, the authors plead for better approaches to research, which gives the understanding that data retrieved, should be a large and heterogeneous sample, the validation and a deep understanding of multiple factors linked to sports injuries. Maybe the improvement brought by these factors may lead to improved and accurate forecast of injuries that increase the efficiency of athletic related groups

According to the study of Alkassabi et al. 2022, Musculoskeletal (MSK) discomfort and injuries are identified as very popular injury types that can happen to an athlete. Also, these are some of the top 20 causes of years lived with disabilities in the entire world. Through the formation of MSK injuries, additional distress condition such as severe pain and disability increases significantly. However, the authors of this research paper have stated that persistent pain, which forms after the development of an MSK injury, can be seen in both general population and sportspersons. Some cases have shown that the outcomes of these injuries can create a lifetime burden, for example, loss of their profession. It was identified that this research used the process of systematic review and meta-analysis to examine the clinical information associated with these two diseases. The search procedure for literatures was created in association with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The searched databases of this research were MEDLINE, PubMed, ProQuest, and Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) etc. From the results of this meta-analysis process, valuable information related to the persistent pain following MSK injury were identified in this research. However, due to the lack of data specification for the analysis, the outcomes of this research are formed with the help of a narrative review method.

Figure 3: Identification of risk factors for the MSK injury development

(Source: https://www.mdpi.com/1660-4601/19/15/9318)

One of the primary risk factors regarding MSK injury development was identified as a person’s age. On the other hand, the initial discomfort level was observed as a risk factor for the development of chronic pain in this research paper. One of the literatures that have been examined by this research mentioned the formation of f traumatic MSK injuries for the causes of chronic pain development in patients.

According to Lin et al. 2023, this research work primarily aims to examine the chiropractic adjustment in the practices of sports medicine in China and Hong Kong with reference to the issue of performance and recovery. Chiropractic principles involve the biomechanics and neurophysiology of the human body in relation to its structure and content with techniques like the spinal adjustment and massage therapy. It has been observed that it is especially helpful in cases of typical athletic injuries such as lower back pain and muscle tears and helps in enhancing athletic achievement and cutting short the chances of athletic injuries. However, the level of chiropractic care consumption in these regions is still smaller compared to the regular share of chiropractic consumption markets. The sports chiropractic council of Hong Kong China established in 2005 has played a very crucial role in dissemination of chiropractic care with the sports medicine. Current developments for China and Hong Kong’s sports industries, due to financial support from the government and extensive infrastructures, are feasible areas for the development of chiropractic services. Higher recognition and permissive legislation are required for the improved implementation of chiropractic with athletes and utilization of its opportunities in the sphere of sports.

According to Saad et al. 2020, the purpose of this study was to establish the effects of sports chiropractic care on the prevention and management of LP in T&F athletes. This stresses that a bad posture, obesity, and maintaining workouts without supervision can cause lower-back pains resulting from muscle or ligament rupture or herniated discs. The study also found that through the a combination of spinal manipulative therapy, manual therapy and thoracic spinal manipulation for core strengthening, chronic pain, improved flexibility and prevention of further occurrences of the injury can be easily solved among the sporting individuals. The study concluded that there was efficacy of the sports chiropractic in cutting down pain and enhancing the lordotic spinal motion, endorsing the applicability of the specialty’s prevention of sports-related injuries. Overall, chiropractic care, grounded on spinal manipulation, is effective in the relief and management of chronic LBP and various other MSK disorders. Although the outcomes of chiropractic care are encouraging, this method is not implemented in some countries for example Egypt. The study seeks to support the incorporation of chiropractic care in the management of athletes and the populations’ health.

Figure 4: The rate of response in the survey assessed in study

(Source: Lee et al. 2022)

According to Lee et al. 2022, the authors find out the relevant concept among the chiropractors for proper work in the sports category. The purpose of this study was to determine areas for possible research focus to guide the formulation of an agenda of research for the chiropractors practicing in Canada in the field of sports. This comprised consulting with all the various stakeholders within the niche of sports chiropractic to make sure that the research agenda addresses the current goals of the respective niche. The research, therefore, used a sequential exploratory mixed method design with an exploratory phase as well as a main phase. Subsequently, clinicians, researchers and leaders in the field of sports chiropractic in Canada were asked to complete a survey that would help further develop a preliminary list of the priorities for research. This was done to pave way for the Delphi procedure which is a structured communication procedure used to come to a consensus on these priorities. Last of all, a prioritization survey was carried in order to rank the above mentioned research priorities. The study was able to achieve the objective of determining the three most significant areas of research for chiropractors in Canada specializing in the sporting field. The most important area was the impact of the chiropractic manipulations on the performance amongst athletes, regarding the importance of establishing the efficacy of the chiropractic interventions in the improvement of athletic performance and healing indices amongst athletes. The second priority was on systematic literature reviews that specifically covered aspects relating to the sport healthcare teams; the relevance of this priority was based on the desire to examine the nature and efficiency of the composed teams within the sports environments. The third identifiable priority was therefore CSM concerning spinal manipulative and mobilization therapy, which falls under two main frameworks, that is, the chiral protocol and manipulation that is a cornerstone of chiropractic (Lee et al. 2022). Particularly as to special requirements the study involved low back pain, neck pain, and concussion as the most studied conditions. These conditions are usually found in sports and impact the physical ability of players greatly. Collaborative working with physicians especially in the field of sports and with academic institutions including universities and colleges was also highlighted as a way of promoting the quality and practical research work in chiropractic sports. The findings of the current study present a concise list of research issues, as viewed by the Canadian sports chiropractic professionals.

2.3 Theories and Models

The combination of chiropractic care in the sporting sector can used to prevent musculoskeletal injuries which can be supported by the different types of models and theories. The different types of models like ‘biomechanical and neurophysiological’ can enlighten the significance of suitable arrangement and function of the nervous system in a correct way (Grabowska et al. 2022). Two types of theories are also elaborated in this which can offer the theoretical framework for explaining the procedure and how chiropractic care can able to prevent wounds.

Biomechanical Model

The biomechanical model of chiropractic care involves more of the physical well being and movement of the muscles and bones of the body. It focused on correct posture, proper alignment of the spinal column, overall relaxed joint and muscle tone as a significant component of excellent mechanical health. The current theory comes in handy when analyzing as well as trying to rectify biomechanical faults that may result to the clients’ injury, in the context of sports (Myburgh et al. 2021). Chiropractors use methods like spinal manipulation, joint mobilisation and soft tissue mobilisation possibly to correct a athletes biomechanics and these may help to prevent some of the injuries that an athlete develops such as strains, sprains and overuse injuries.

Neurophysiological Model

The neurophysiological model took cognisance of the nervous system and the musculoskeletal system as its main factors. This paper holds the belief that spinal adjustments have the potential to affect the nervous system due to the enhanced signals that are transacted between the brain and the rest of the body (Vining et al. 2020). In sports this version of the model is useful as it applies to proprioception, reflex and various forms of motor controlling.

Figure 5: Model of Neurophysiology for pain

(Source: https://link.springer.com/chapter/10.1007/978-2-8178-0414-9_3)

Chiropractic adjustments positively affect neuromuscular coordination and response which are vital in avoiding accidents. Accomplished neural changes improve balance, coordination, and muscle positioning; such aspects minimize the risk of injuries.

Gate Control Theory of Pain

According to the Gate Control Theory of Pain by Melzack and Wall the sensation of pain is not only produced by a direct damage of the tissue but also by the nervous system (Wong et al. 2023). This theory states that non-painful input such as that can be gained through chiropraic can shut the ‘GAS’ to painful input hence preventing pain messages from reaching the brain.

Figure 6: Theory of Gate Control Pain

(Source: https://science.howstuffworks.com/life/inside-the-mind/human-brain/pain4.htm)

Equally, in relation to the sports activity, chiropractic treatment helps in the alleviation of pain originating from musculoskeletal injuries through modulation of the nervous system. Daily adjustments can able to prevent the cycles of chronic pain that are observed in the injuries by keeping a suitable nervous system with the correct function of spinal alignment.

Kinetic Chain Theory

According to the Kinetic Chain Theory, the body's musculoskeletal system is set up as a chain and the movement in one segment impacts the others (Nieuwenhuis, 2023). This theory is core in sports medicine and rehabilitation and articulates that when one area in the body is compromised, either through disease or injury, the rest of the body will eventually compensate for the loss of the compromised part and therefore get injured.

Figure 7: Kinetic Chain Theory

(Source: https://bodyinbalancept.com/the-concept-of-the-kinetic-chain/)

The chiropractic care can set the objective to assure that all the portions of the kinetic chain are required to function properly so it can prevent the injuries of the athletes. It can be demonstrated by an example like, chiropractors can prevent the strain in the different body parts such as ankles, hips and knees by identifying the spinal misalignments (Mustafa et al. 2022). So this is particularly appropriate in sports which can involve in monotonous movements and high demands of physical activities.

2.4 Literature Gap

The studies’ synthesis sheds different facets of sports-related musculoskeletal injuries embracing their chiropractic prevention and treatment. Yet, the following gaps are seen in the literature. To start with it is necessary to state that there are no adequate and up-to-date data on epidemiological characteristics of sports-related MSK injuries for different types of sports. This gap thus impacts the best opportunities to estimate the occurrence and risk factors of these injuries in different fields of sports. Apart, one of the studies concerns the necessity of developing the prognosis of sports injuries, but there is also a lack of sufficient investigations in regards to the predictive accuracy and validity of the existing models, which can be seen in one of the chosen studies (Arslan, and Yılmaz, 2022). This gap makes it evident that there should be the development of better models that would serve to predict the likelihood of an individual getting an injury. Besides, two works have focused on the given issue and approaches to preventing the occurrence of injuries, as well as the effectiveness of chiropractic treatment; however, there is a lack of data about the long-term outcomes of chiropractic intervention and the comparison of the chiropractic treatment results with the essential preventative measures. This is especially the case given the potential of the results in the development of standards of care and best practices for treating patients. The differences in the level of adoption and integration of chiropractic the authors proposed a research direction on the implementation of chiropractic services in different countries and sports.

2.5 Conceptual Framework

Figure 8: The Conceptual Framework

(Source: Self created in Draw.io)

The representation of the conceptual framework shows that the context depends on the frequencies of injuries among the athletes and also shows the four types of independent variables. Types of the intervention, types of the sports which the sportsperson has played with the load of the training also included in the independent variables.

2.6 Conclusion

In conclusion, it can be concluded that the chapter of literature review on the context of the function of chiropractic care in the MSK injuries is crucial in representing the several information which are accumulated with the help of different journals. Different articles have shared the information related to this chiropractic care and make easy to undersatnd how this can be helpful among athletes. The theories and models are also represented which are appropriate with the context of the study. Two models with two theories are represented in this study which are suitable and can be helpful in the future perspectives. In addition, this literature review chapter also includes the decription of research gaps or limitaitions, present in the reviewed literatures.

Chapter 3: Systematic Methodology

3.1 Research Aim

The aim of this investigation is to evaluate the efficiency of chiropractic care in the deterioration of risk in the injuries of musculoskeletal among athletes, bodybuilders, boxers, and cage fighters. This has also compared the efficiency of the traditional method of treatment with chiropractic care.

3.2 Research Objectives

• To compare the efficiency of chiropractic care with the previous traditional care of treatment in the deterioration of sports injuries.
• To contribute evidence-based recommendations for sports medicine experts and athletes about the chiropractic treatment strategy.
• To find out the ways of prevention of musculoskeletal injuries and the ways of reduction.
• To conduct the systematical analysis among the existing relevant studies which has contributed knowledge to the efficiency of chiropractic treatment.

3.3 Study design

The design of this study related to chiropractic care has been accomplished with the help of a qualitative systematic literature review. So the methodology is based on the selection of the acquired data, critical evaluation of those collected data, and synthetization of the existing articles on the context of chiropractic care in the reduction of pain. So this study has followed the predetermined protocol for ensuring accuracy and reducing bias. This study will engage the literature review, choice, and appraisal of the quality of the extraction of data from those selected studies that are relevant to the context and published in the last five years (Singh, 2021). Guidelines approved according to Prisma and CASP checklists will be selected to maintain the quality of the outcomes.

3.4 Search strategy

The strategy for searching the data can integrate several keywords and terms related to the “Medical subject headings” for recognizing the suitable publications to analyze. So this search will accompanied by various electronic databases, The approach for the paper entails the use of keywords and Medical Subject Heading relevant to chiropractic and the prevention of musculoskeletal injury. Scientific papers from the last five years will be included in the study and sources that will be utilized include PubMed, Scopus, and Cochrane Library (Axén et al. 2020). The identified keywords will be ‘chiropractic care,’ ‘musculoskeletal injuries,’ ‘sports,’ and ‘prevention. ’ Boolean operators (AND, OR) will be used to adjust the search results; matching only the studies that focus on the role of chiropractic interventions in preventing MSK injuries for sports.

Figure 9: Research strategy

(Source: https://pubrica.com/)

3.5 Eligibility criteria (PICO)

Population: An injury acquired by athletes participating in sports activities resulting in musculoskeletal trauma: sports-related musculoskeletal injury (MSK-I).

Intervention: Research on the growth, and approaches to control as well as treat athletic injuries, including those that involve chiropractic treatment.

Comparison: Not stated, but may involve the comparison with other techniques of injury prevention or treatment.

Outcome: It concentrates on the process and character of an injury, risk reduction, and effectiveness of an intervention.

Figure 10: PICO framework

(https://h5p.org/)

Inclusion Criteria

Any research should cover the procedures of working and the kinds of sports afflictions regarding acute and chronic sports injuries. Analysis should describe future studies addressing musculoskeletal injuries (MSK-I) and effects on athletes’ performance, rehabilitation, and costs. Accordingly, included studies should, if possible, be of high methodological quality, including systematic reviews, meta-analyses or other critical literature reviews. Moreover, findings on the effectiveness of chiropractic intervention and other approaches for the prevention and treatment of sport injuries will be reviewed.

Exclusion Criteria

Literature outside of sports injuries or athletes’ musculoskeletal conditions will also be excluded from analysis. Studies which are not supported by any statistics or research data and or are just assumption-based are not admissible (Abou, 2020). Thus, the sources, which were published outside the specified time period or in the form of articles that did not participate in the peer review process, will be excluded from analysis, as well as non-scientific articles, such as opinions or editorials. Investigations that report non-sport and non-athlete related injuries, and research on injuries in non-athlete populations will also be excluded.

3.6 The process of data collection

The means of data collection used in this systematic review shall be to search for data in the specified databases using the formulated search technique. Two different individuals, who will decide against the background of the established inclusion and exclusion criteria whether a study should indeed be included in the analysis (Hawk et al., 2021), will check these titles and abstracts. Eventually, full texts of the studies that might be eligible for the analysis will be considered. All sorts of controversy shall be deliberated by way of discussion or consultation with the third reviewer. Selective data extraction will be done on a data extraction form where key aspects of the studies such as general characteristics of studies, participants, interventions, outcomes and results will be provided. The reviewers will double check the data that was extracted in order to prevent errors. We will keep a record of all and any decisions made as well as any extractions done in this process meeting PRISMA standard to improve the paper’s reliability and repeatability.

3.6.1 PRISMA Guidelines

In the course of this systematic review, much adherence was given to the PRISMA guidelines. After the first database search, we found n = 50 articles which might be related to our study. There were several studies that had been analyzed multiple times; therefore, after eliminating the duplicates, there were 45 titles and abstracts to screen. Of these, n = 20 were excluded according to the pre-stated criteria giving. After that n = 25 articles for full-text review. During the full-text assessment, this excluded n = 5 articles for various reasons: n = 2 were not to sports-related MSK injuries, n = 2 no chiropractic care, n = 1 postdate outside the last five years, n = 2 not peer-reviewed articles, n = 2 no English full text available. The studies were reviewed and filtered based on mentioned inclusion criteria and the remaining n = 9, which were included to final analysis and review.

Figure 11: PRISMA review

(Source: Self-created in draw.io)

3.7 Quality assessment of risk and bias

Risk of bias and quality assessment will be conducted depending on the study type of included studies individually as recommended for each type of study. For the assessment of the risks of bias in the selected RCTs, the Cochrane Risk of Bias tool will be used considering the main domains like randomization, allocation concealment, blinding, and reporting of the outcomes data. Assessment of observational studies will be done using Newcastle-Ottawa Scale, which looks at selection, comparability and outcome. For systematic reviews, assessing methodological quality, the AMSTAR-2 tool will be used. Two independent reviewers will do these assessments; in the case of disagreements, the two shall sit down and discuss or consult another reviewer (Eindhoven et al., 2022). The findings of these quality assessments will be provided in the form of table and will be taken into account while synthesizing the quality of evidence summarized in each study.

Figure 12: AMSTAR-2 tool

(Source: https://ars.els-cdn.com/)

3.8 Description of the Extracted Data

The information that has been taken from all the literatures will be organized systematically below in a data extraction process containing general information of all the literatures that will be involved. Information to be considered will be the author and year of publication of the study, type of publication, participant factors such as age, gender and the type of sports they engaged in, sample size and design of the study (Côté et al., 2021). These will include the summary of the treatment where details of the treatment which may involve chiropractic process, the frequency at which the treatment will be applied and the total time of the treatment will be put. Improvements such as the rate of injury, the performance and acceptance of the preventive measures and the rate at which people recover from the injuries that they have received will be documented under the outcome measures for the task of prevention of MSK injuries. In an overall way and in detailed way, projected results will be described with reference to the study goals Overall and detailed summaries will be chosen with reference to the research and Contrast or Comparison between Hypotheses when using Analytical Statistics.

Chapter 4: Findings and Analysis

4.1. Introduction

The chapter on the findings of the evidence has gathered information related to chiropractic care. This type of care is very effective in preventing MSK among athletes in the sports industry. This chapter finds the different evidences that support the objective of the study and accumulated from the different sources. This chapter presents evidence from various journals that have practices on chiropractic care to reduce MSK injuries in the sports industry. The analysis of those presented findings is also presented in this to get a better understanding of how the findings can be helpful in this study.

4.2. Findings

Figure 13: The Recommendations for Clinical Preventive Services

(Source: Hawk et al. 2021)

Patients and clinical practice guidelines The study used two phases, the first one was to obtain and rank the clinical practice guidelines and systematic reviews that contained information on health promotion, disease prevention, diet, physical activity, obesity, smoking cessation, the effectiveness of spinal manipulation, and influence of various aspects of lifestyle on the immunity. At the first stage of the search, the number of citations was 89 and after the exclusion of duplicates and studies not meeting inclusion criteria, we had 27 studies included in the final review. Concerning priorities, the guidelines elaborated included those concerning healthier eating, exercise, weight loss, and smoking cessation. To start with, guidelines published before the year 2018 have been included where no newer guidelines exist. These 27 CPGs were assessed for quality, and the quality of all the CPGs was either high or acceptable. The multiple quality ratings and the exact guidelines are presented in the framework of the study. In the second stage, the search was for systematic reviews on areas in which no relevant CPGs were found, especially on the degree of immune system modulation by spinal manipulation and the impact of certain dietary and exercise habits on the immune system. The authors’ preliminary search yielded 112 articles, although eight were found suitable after applying strict exclusion criteria. All the eight systematic reviews identified were considered of high quality and the studies’ findings were presented. Thus the quality of the evidence and the strength of the recommendations was higher in some topics than in others. High-quality evidence existed in relation to secondary and tertiary prevention and included screening and counseling on health behavior, infection control in ambulatory care, and chiropractic management of pain (Hawk et al. 2021). Whereas for the effects of physical activity and environmental risk factors on the immune system, the recommendations were strong even though the evidence is less robust because of the overall benefits and low risks of intervention. Nevertheless, the results of the systematic reviews of spinal manipulation and immune function were mostly low quality, and heavily derived from non-clinical subjects. Despite most of the reviews being of high quality, the provided evidence was not very strong enough to warrant the overturning of buttoned-up directives due to danger multiplier; this was especially true given the fact that a number of potentially helpful interventions for which there is otherwise limited evidential support may be avoided or delayed.

Figure 14: The differences between the experimental group and the control group

(Source: Saad et al. 2020)

The research questions endeavored to determine sports chiropractic and its utility in the primary prevention of LBP in T&F athletes. The research involved 17 athletes from the Sharkia club, divided into two groups: An Experimental group (twenty-three subjects) and a Control group (twenty-two subjects). Both groups trained four times a week for ten weeks, and all of the training modalities were completed during each session. Some of the measurements that were taken in the course of the study included height, weight, training experience, and whether or not the participant had low back pain. These were important exclusion criteria during the enrolment of the participants that eliminated those with bone fractures, osteoporosis, diabetes, cardiovascular diseases, or those who had undergone any surgery in the previous three months or used substances such as alcohol, cocaine, cigarettes, or anti-seizure drugs (Saad et al. 2020). In essence, the findings of the study were that the flexibility scores and levels of discomfort expressed by the athletes were considerably higher before the competition than the post-completion scores. In particular, those athletes treated with sports chiropractic care showed marked improvement in features of low back pain differentiating the group from the Control group. It is however important to note that the predominant effects cited above applied to the group of athletes in the Experimental group where aspects of flexibility were seen to improve hence supporting the argument that sports chiropractic may have a positive effect on athletes' performance by relieving them of pain. The results of this study indicate that the inclusion of sports chiropractic in the training program of track and field athletes will help minimize the chances of low back pain with consequent improvements in flexibility and resultant athletic performance. The study also establishes that chiropractic care may be useful prophylactically with people involved in high-contact or repetitive loading sports such as track and field athletes. Therefore, the objective of this study was to establish the outcome of the principles of sports chiropractic regarding primary prevention of LBP among T&F Players.

Figure 15: The Integration of the chiropractic care into the sports industry

(Source: Lin et al. 2023)

This paper examines the potential of chiropractic care for the sports industry most especially in the People’s Republic of China and Hong Kong. Chiropractic care as part of sports medicine can therefore assist in improving performance, well-being as well as competitiveness through the identification and correction of biomechanical flaws as well as the modulation of musculoskeletal fitness. The implications of the study are outlined in terms of the doors that chiropractic has opened for the sports industry In general, the authors claim that the occupation of the sector with the approach will attract international activities and investment, with the contribution to the development of the overall economic indicators of the growth of the sector. Chiropractic cures are more important to athletes because they not only cure contracted injuries but also help prevent future ones. The study focuses on the idea that therapies like spinal manipulation and soft tissue mobilization are practical in the treatment of sports-related injuries including muscular and ligamentous strains. These interventions lead to better biomechanics by increasing the range of motion of the joints, flexibility of muscles, and neuromuscular coordination resulting in increased performance (Lin et al. 2023). In addition, chiropractic care helps in the healing and wellness of athletes’ bodies and prevents over-training of their muscles and bones, thus leading to long-term health and fitness. Valid and reliable studies offered in the study provide an indication of the effectiveness of chiropractic application in handling of sports injuries and improvement of performance. The benefits described are several and include better musculoskeletal function, the level of pain, and recovery rate. For instance, cervical spine manipulation was shown in a study with judo athletes that it could improve athletic performance since it enhances grip strength. Another research done on sports chiropractors working under the National Football League demonstrated that chiropractic is useful in sports for the treatment of injuries as well as other health considerations. However, the study also identifies some limitations to the current literature, including the absence of data on the durability of changes in athletic performance after chiropractic treatment, and the lack of evidence that chiropractic they interacts synergistically with other systems of medicine[Refer to Appendix 6].

4.3. Analysis of Findings

Exploration of clinical practice guidelines with the help of chiropractic care

The first study systematically synthesized sources such as clinical practice guidelines and systematic reviews to determine their applicability and quality towards health and disease prevention. The first stage involved listing and categorizing the primary CPGs on health promotion, health and well-being, healthy eating, movement and exercise, obesity management, smoking control, and lifestyle and immunity. Of the total 89 citations identified, 27 articles were finally included in the current review and evaluated with respect to their quality. An important note to make, all the included CPGs were considered to be of high or acceptable standards indicating the strong recommendations given. Another important strong point of the study is that the quality of the guidelines was assessed rather thoroughly and all the sources that did not meet the stringent criteria were systematically excluded from the consideration (Vandertuin et al. 2024). Nevertheless, the use of the guidelines existing before 2018 if there were no more recent guidelines might have hampered the work of the study. This is especially the case where the subject of study is easily changing as is the case in health promotion and disease prevention where newer studies may offer more contemporary and accurate guidelines. The second phase of this study has focused on the reviews which are not relevant to the CPGs but they are based on the study which has found the effects on the spine. The recommendations regarding physical activities and the external risk factors were very strongly presented as there are low risks and advantages are also noticed.

Benefits of chiropractic care in the sports industry

The second study examined the effectiveness of sports chiropractic for the primary prevention of low back pain or LBP in athletes in track and field. This study was a two-group pre and post-experimental research where the subject consisted of seventeen athletes comprising the club. The objectives of the study were met showing increased flexibility of athletes when they received the sports chiropractic care and less discomfort, especially in the experimental group (Black et al. 2023). The availability of literature to back this credence averses to support the belief that sports chiropractic enhances athletic performance by reducing pain and enhancing flexibility. That both groups were trained four times a week for ten weeks forms a solid platform on which the study tests the impact of chiropractic on the experimental group against the effect on the control. the research study has a small cohort of participants, it has been noticed that 17 athletes to be precise, subsequently, this weakens the validity of the results across other populations. This study has excluded the contestants who have dealt with the condition of osteoporosis, fractures of bones, and cardiovascular diseases (Madigan et al. 2020). So this has limited the employment of the chiropractic care in the sports. This study has also recommended that the integration of sports with chiropractic care can help in the reduction of the LBP and enhance the flexibility in the body so this directly improves performance in sports.

The incorporation of chiropractic into the sports industry

Another study has also observed the perspective of chiropractic care for the sports industry. It has also focused on the employment of the different countries to get an understanding of its impact. This has also enlightened one that the function of chiropractic can improve sports performance and boost the competitive nature by recognizing the flaws (Sherriff et al. 2023). This type of care has abilities to improve the musculoskeletal fitness. The authors have elaborated on this care in the international activities so it has helped in the growth of the economy. This study has also focused on the advantages of chiropractic interventions, particularly for tissue mobilization and spinal operation.

4.4 Conclusion

In conclusion, it can be concluded that the findings and analysis of the employment of chiropractic care in the sports industry are very essential to describe prominently. This chapter has presented the impact of chiropractic care with the help of different authors. The findings of those journals are also analyzed in this chapter which has helped in the emphasization of the study. The different evidences of the various journals are presented which will help in the next chapters also. The findings related to the benefits of chiropractic care have been analyzed here which has affected the performance of the athletes.

Chapter 5: Discussion

5.1 Introduction

The study of the understanding of the function of chiropractic care in the prevention of MSK pain among athletes has been represented in this chapter efficiently. The representation of the discussion of various journals is also displayed in this chapter. With the help of the previous chapters this study can get the efficient information to describe those points effectively. The different studies are also established with the emphasisation of the benefits of the chiropractic care in the sports industry. This has elaborated the effects of chiropractic care in different areas and how these areas can get the benefits are also highlighted.

5.2 Discussion

The efficiency of the chiropractic care for managing low back pain

The present work was to assess the efficacy of SMT for the management of LBP in relation to conservative care. The studies therefore imply that chiropractic care especially SM Therapy evidently has specific advantages over conservative treatments in terms of alleviation of pain, lumbar range of motion, disability, and general health status (Wong et al. 2023). As a review, the current study indicates some advantages of expecting chiropractic treatment in future management of LBP but also calls for other concluding rigorous work on current deficiencies of evidence through using control trials. Chiropractic is based on the ‘principle of first doing no harm’ and relative evidence suggests that the SMT is safe, with a low risk of causes of ‘major harm’ and offers only ‘short-term and mild self-limiting adverse effects’. With parameters of manual therapy and physiotherapy that is complimented by exercises this conservative approach has had clinical efficacy and is safer compared to more aggressive methods such as medication or surgery. The study importantly underlines the need to sustain this conservative approach, if only this approach remains scientifically and financially sustainable. Most important, there is still no treatment modality regarded as universally optimal for addressing LBP. However, there has been a consistent tendency in SMT, especially for the thrust manipulation, to provide a significant decrease in the pain intensity and an enhancement of the general functionality. The mechanical-assisted manipulation tools are more frequently used in the present work as the alternatives to MTM, however, MTM seems to be more effective in short-term improvements in pain and disability. This work disputes the notion that MTM and MAM are in the same category of therapeutic method and should encourage the patients to understand the differences in the outcome of manipulative therapy.

Development of conservative management approaches for Osteoarthritis

Osteoarthritis still presents as a considerable health problem, as it is the most common joint disorder and a major source of disability, with a considerable economic burden on the health care system and society. As for the broader economic consequences of dating abuse, with special reference to reduced productivity of the affected women and the overall quality of life, researchers expect the cost to exceed $23 billion per year. These figures emphasize the necessity for enhancing the effectiveness of the techniques utilized to control OA as to minimize individual and social costs OA The conventional management techniques for OA have been criticized for their poor efficiency and possible side effects (Smith, 2022). The medications are applied for, for example paracetamol although widely used carry negligible therapeutic effects while exposing patients to a variety of dangers including allergies and destructive effects to internal organs including the liver and kidney. There are other problems associated with a higher demand for opioids: addiction, and side effects, such as nausea, increased sensitivity to pain which is known as hyperalgesia, and decreased respiratory rate. Similarly NSAIDs, though useful in pain relief, they involve important side effects mainly gastrointestinal and cardiovascular. These challenges raise the further question of why current treatment is handled in the ways it is and stress the significance of revising treatments in favor of safer and more efficacious ones.

Improvement of the interprofessional corporation in the practices of chiropractic

In view of the dyic changes in the dyics of health care, and to enhance the quality of health care outcomes, chiropractors need to actively participate in inter-professional practice with PCPs and various medical/surgical specialists. Closely related is the need to work with other professions to progress chiropractic professionalism as well as provide helpful inputs to team-based care. This study lays emphasis to the fact that there is a need to acknowledge the convergence and divergence of training among the several medical practitioners. Knowledge of these aspects can thus improve chiropractic experience and performance in interprofessional relationships. The study specifies the medical and surgical specialties that are most relevant to ordinary chiropractic activity in the USA; the author admits that, although there are a large number of intersections between the specialties in terms of the diseases managed and tools applied, each one is specialized on a certain set of diseases. It is based on such understanding that chiropractic practice is practiced especially when attending to diverse patients. This study has aimed to offer a summary related to the specialties of surgical and medical which are most available in the practices of chiropractic (Austin, et al. 2021). With the help of recognition of the specialties, chiropractors can enhance the integration into chiropractic care among the participants. This study has covered the analysis by presenting the descriptive analysis for establishing the preliminary content. This study has employed this analysis among the specialties of medicinal fields which has helped the authors in getting the clinical evidence. The results of this study have also suggested about emergency medicine, rehabilitation, and concerning of rheumatology, surgeries in orthopedic sectors, and neurological surgery (Csiernik et al. 2022). All of these are recommended as the specialists for the study related to chiropractors. So the understanding of this concept in this study has offered the implications for interprofessional training and integration which can improve the quality of care among the patients.

Influencing factors among chiropractors

Figure 16: Numbers of the new patent referred by practitioners of chiropractic care

(Source: Blanchette et al. 2021)

The present research is one of the first attempts to identify factors affecting the level of GP referrals to Danish chiropractors on the background of the ongoing recognition of chiropractic as a part of the official State healthcare system. It was established that a third (31%) of new patients access chiropractors through GP referral, which is almost triple the proportion accessing through the eight most commonly cited general practitioner conditions. In a similar study conducted in Canada, 5% of the respondents put (Blanchette et al. 2021). Although the amount of received referrals does not always reflect the nature and intensity of professional work relations, the present study offers insights into the nature of chiropractor-GP interactions in Denmark. The aim of the study was to investigate the number of weekly patient referrals from GPs to chiropractors and to examine factors that relate to chiropractors’ referral rates. A convenient, anonymous, cross-sectional web-based survey was completed by 600 ADC members of which 286 met the inclusion criteria for analysis. These outcomes showed the degrees to which the values were supported and the fact that, on average, chiropractors acquired the evidence. Five referrals from GPs per week, the rate of these referrals varying according to specific circumstances. Some of the established findings revealed that chiropractic clinics with more than one chiropractor, and clinics using diagnostic ultrasound, were likely to be the target of GP referrals. Specialists in geriatrics as well as those who provided care to a greater number of new patients in a week received more referrals from GPs. Interestingly, the study found a reciprocal relationship between referrals: those with more referrals to GPs returned more referrals to the chiropractors. These results are discussed in the context of the three domains from the framework for delivering collaborative musculoskeletal care involving chiropractors and medical doctors which includes communication, practice parameters, and service delivery (Engelbrecht, 2023). The results of the study underscore the need for the development of an effective working relationship between chiropractors and GPs as well as better facilities to improve the quality of integrated patient care within the context of the health care delivery system.

5.3 Conclusion

In conclusion, it can be concluded that the chapter on the discussion chapter has effectively presented the various studies to demonstrate the role of the chiropractic care. The discussion chapter has established the evidence of various studies which are relevant to the objectives of the study. The study found the role of the care among the athletes and it has also demonstrated the preventive measures to reduce musculoskeletal pain among the sportspersons. This type of care can be used as an efficient measurement to reduce the pain apart from the conventional method for treatment. The discussion chapters have depicted the illustrations of the evidence which are accumulated from the various articles presented by the authors.

Chapter 6: Conclusions

6. 1. Introduction

The chapter of the conclusion regarding the role of chiropractic care in reducing pain among the sportspersons in the sports industry. This chapter has presented the linking with the objectives which were taken prior to the study and requires to be accomplished through the study. The four objectives that have been taken in this study are to be established with the help of this study. The recommendations are also presented in this which are required to be fulfilled in the future implementation.

6.2 Linking With Objectives

To compare the efficiency of chiropractic care with the previous traditional care of treatment in the deterioration of sports injuries.

In a way, the study is successful in meeting all of its four aims as it provides a research-anchored and comprehensive analysis of the concern of the effectiveness of chiropractic care. This fairly categorizes chiropractic treatment with orthodoxy to establish the efficiency of these treatments in averting the exacerbation of sports injuries (McSwan et al. 2021). The paper proves useful in understanding the benefits chiropractic care can retain in relation to pain attenuation and optimization of movement and Ak’s general functionality in athletes. This comparison assists in explaining how chiropractic care is preferred to other conventional approaches thus achieving the first goal.

To contribute evidence-based recommendations for sports medicine experts and athletes about the chiropractic treatment strategy.

The study is invaluable for the field of Sports Medicine and finds its basis for recommendation in practice and in theory for the athlete. As highlighted in the study and by reviewing the strategies of chiropractic treatment, the paper provides clear and tangible steps that are supported by research that informs clinical practice. The above recommendations enable them to come up with the right decision regarding the use of chiropractic in the rehabilitation of athletes, thus addressing the second objective.

To find out the ways of prevention of musculoskeletal injuries and the ways of reduction.

This research focuses on the possible measures in the domain of chiropractic that can be used to prevent the development of musculoskeletal injuries in the first place and improve the effectiveness of treatment in case of their appearance (Wang et al. 2023). Compared to conventional modes of treatment, the main goal of chiropractic care is to identify and treat existing injuries as well as in preventing new injuries; therefore, the study is in line with its third aim. The focus on prevention supports the agenda of an elective approach towards the achievement of the well-being of sportspeople, especially in their training as well as in competitions, without increased susceptibility to injuries.

To conduct the systematical analysis among the existing relevant studies which has contributed knowledge to the efficiency of chiropractic treatment.

Last of all, the study performs a systematic review of the current literature on chiropractic therapy. This consolidation remains current knowledge and assesses the robustness of evidence gathered, as well as foraging areas that require future research. In this way, the study establishes a wide perspective on the effectiveness of Chiropractic care in meeting the fourth goal. The systematic approach means that the findings are valid, reliable, and sensitive to real life and other studies on clinical practice.

6. 3. Recommendations

Combination of chiropractic care with the athlete's group

Considering ideological findings showing the positive influence of chiropractic manipulation in injury control and prevention in sporting disciplines it is apparent that sporting injury management teams should embrace chiropractors as fundamental team players. The authors revealed how chiropractic care can be a unique alternative or adjunct to conventional medical and physiotherapy treatment mainly for musculoskeletal injuries. Engaging those means that patients are apt to have better all-round care that considers other aspects of the body such as biomechanical in matters concerning prevention and healing.

Adoption Strategies for EBP in Chiropractic Care

Chiropractors should practice what has been established scientifically so that the athletes receive the best care. This encompasses the need to read new research findings, use established methods, and make corrections from new information they find (Olson et al. 2020). This means that chiropractors can improve the outcomes of interventions; decrease the occurrence of reinjury and foster improved results in athletes who seek their services in the future.

The training and education strategies among the practitioners

Educational and training of sports medicine doctors, physiotherapists, and athletic trainers should include information on the use of and advantages of chiropractic care. Getting an insight into the care that chiropractic therapy plays in injury treatment as well as prevention can help in promoting interprofessional relations, and help in ensuring that athletes receive care that meets all their needs.

The strategies of chiropractic care

Chiropractic care should be presented as a method of prevention, thus athletes and coaches need to be informed of this. Corrective spinal adjustments and wellness check-ups enable a chiropractor to discover worrying signs and correct the problem before turning into a major accident. Habits like correct posture, correct spine positioning whilst exercising, and eradicating muscle imbalance will significantly reduce the risk of injuries and enhance the athletes’ ability.

Motivation for the collaborative research

There is still a necessity to introduce further research in the hope of enhancing the body of knowledge on chiropractic intervention in sports medicine. More cooperation between medical doctors, chiropractors, and universities to provide possibilities to develop new therapeutic approaches, improve the existing ones, and extend the knowledge of the positive effects of chiropractic manipulations (Naidoo, 2023). Such research should expand more significant research studies and randomized clinical trials for more comprehensive results.

6.4 Conclusion

In conclusion, it can be concluded that the function of chiropractic care in the reduction of musculoskeletal pain among sportspersons is represented with the help of the whole study. This chapter has represented that this has accomplished four of the objectives. The recommendations that are required to be fulfilled in future implementation are also demonstrated in this chapter. The study has represented all of the chapters efficiently to establish the aim and objectives of the study.

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Author Bio

Jamie Morghan   4 Years | D,Sc. in egineering

I have always liked doing research and writing a thesis for engineering subjects. In my graduation years also, I was able to score the highest marks in all my submissions. Am a very determined writer who can write efficiently even for short periods. I have a lot of experience in designing assignments according to student's requirements.