A tale of two remedies - surgery or chiropractic treatment for an injured runner

American Fitness, Nov-Dec, 1994 by Shelly Downing

Where should an injured runner go for treatment? A discussion with an orthopedic surgeon and a chiropractor helps clear up some confusion.

With 26 bones, 19 muscles and 107 ligaments in the foot alone, chances are high runners will eventually seek help for an injury. But confusion abounds as to where to go. An injured athlete must sort through the chiropractor vs. sportsmedicine physician debate to get the right treatment.

What exactly are the differences between a chiropractor and a sportsmedicine physician? Chiropractic training is equivalent to that of a medical physician, and the number of hours for licensing is actually longer, according to the Colorado Chiropractic Association. A doctor of chiropractic completes four years in a chiropractic school, with focused study of anatomy and physiology, and then moves to specialties like acupuncture, deep tissue massage or physical therapy. Physicians must complete four years of medical school, then three to four years of residency in a chosen specialty, such as pediatrics or orthopedics. Both must complete state and national board exams. In practice, chiropractors are licensed to provide all forms of health care, but not administer drugs or perform surgery.

Others don't see the two fields as equivalent. "The intellectual intensity of the hours studied by a chiropractor is not anywhere near what a medical physician studies," says John Renner, M.D., president of the Consumer Health Research Institute in Kansas City and a family practitioner. "Chiropractors have a place in the health care system, but they are not the primary place to start."

Physicians practice a sort of team approach to health care. As the first health care practitioner the patient sees, the physician acts as a coordinator. After an evaluation, the physician sends the patient to another health specialist, which may include a different physician, physical therapist, nutritionist or chiropractor. The chiropractor's treatment centers on the musculoskeletal system and the relationship between the spine and nervous system to achieve a homeostasis or balance of the spine.

Despite the apparent differences in the educational emphasis, philosophies and practice of the two health professions, they have striking similarities in the sports world. Both chiropractors and physicians travel to the Olympics and other international events to treat athletes, and both can call themselves sportsmedicine specialists. There is no formal training required of a sportsmedicine specialist other than an advanced degree in the sciences, according to the American College of Sports Medicine (ACSM).

How does a runner decide which health professional to use? American Fitness talked to a surgeon and chiropractor, and asked them how they would help the runner. Doug Jackson, M.D., is an orthopedic surgeon at Long Beach Memorial Medical Center in Long Beach, California, and director of the Southern California Center for Sportsmedicine. He has treated runners of every ability, from marathon winners to Olympic medalists. Steven Campbell, D.C., has been a chiropractor in Boulder, Colorado for 10 years and treats world-class runners.

American Fitness: Who would runners benefit from more - a chiropractor or a sportsmedicine physician?

Doug Jackson: I have a strong bias that a sportsmedicine physician is more beneficial. Whoever a person is seeing for running injuries needs the expertise and knowledge of the specific area.

Steven Campbell: When you have an injury, you should start with the treatment that's the least invasive. A chiropractor deals with musculoskeletal injuries, but knee problems are what I see the most. Since running is not a contact sport, the injuries are not trauma-type injuries. Knee problems are usually mechanical, caused, for example, by shoes. Even professional runners with shoe contracts wear worn-out shoes, or they walk around in the same pair of shoes in which they train.

AF. Why does a runner choose either a chiropractor or sportsmedicine physician?

DJ: People from different backgrounds already have a feeling for whether they should see a chiropractor or sportsmedicine physician. Sometimes, a patient gets frustrated with a physician's inability to treat them and then they will turn to alternative methods. Runners will decide for themselves which doctor to see because they're a more sophisticated bunch. Runners who have complaints with their spine will seek alternative treatment as opposed to someone with a problem like tendinitis.

SC: Out of 10 people who walk into my office with tennis elbow, seven will heal and three won't. They probably need a different treatment, which may include surgery or medication. Chiropractors and physicians are seeing each others' failure. If you sit in your little hole and don't see what's happening, chiropractors would think the M.D.s are failing.

AF. How do the philosophies of your professions differ?

DJ: One major difference is the approach to the underlying cause of the pain - chiropractors focus on alignment and readjustment of the spine. The background and training are also entirely different between the two. We approach problems differently. However, we both treat runners similarly.