“Less is more and there is no need to be aggressive”
Joint manipulation (or mobilization) is a great skill to use with athletes who are in pain and for those who need a little “tune-up” before a competition.
I’ve worked in professional sports and worked with pro athletes over the last decade and I’ve seen cases where joint manipulation was used improperly and led to poor outcomes in the worst case scenario.
Case study #1:
An elite-level throwing athlete was set to compete in an international tournament within the week. A healthcare professional who didn’t treat this athlete regularly was at the event to support local athletes. In these scenarios, it’s common for a healthcare professional to want notoriety to know they were a big part of the athlete’s performance. This is where things can go wrong. The healthcare professional in this situation performed a seated grade 5 anterior-posterior glenohumeral manipulation. The athlete had immediate pain and was unable to perform. Upon returning to the United States, the athlete discovered a torn labrum as a result of the manipulation and underwent surgery a few weeks later. The lesson learned is to avoid aggressive or unfamiliar techniques for an athlete that is about to compete.
Case study #2:
An elite-level sprinter was scheduled to compete in the 200m quarterfinal at a world championship event. The morning of the event, the athlete approached the medical tent at the arena and asked for medical support to alleviate their lower back tightness. A healthcare professional performed a side-lying lumbar grade 5 manipulation with significant force, causing the athlete to walk out with more discomfort. In hindsight, taping, modalities, and a lower force would have been less risky. This approach is best used on the day of an event.
Case study #3:
A heptathlete sought treatment for lumbar and SIJ tightness five days prior to a national qualifying event. The healthcare professional offered manual therapy, corrective exercises, and education. At the end of the session, in addition to lumbar and SIJ grade 5 mobilization in supine and side-lying, the healthcare professional performed a supine grade 5 hip distraction bilaterally. The next day, the athlete complained of hip pinching and was unable to complete full strides due to the discomfort. The athlete came in complaining of lumbar tightness and developed hip pain after treatment. In cases like this, grade 5 manipulations are warranted but if athletes are not used to this treatment, avoid them during their competition weeks.
There are a lot of lessons in these cases. Less is more and there is no need to be aggressive in such a critical time. Our job is to help athletes perform their best with the lowest risk of injury. In the event you are able to work with novice or local athletes at an event or on the week of the event, proceed with caution and perform “tune-ups” rather than a traditional hour-long PT session in the clinic. It’s a different setting which requires a different approach.
Below is the podcast I created for sports physical therapists on this topic:
If you have any questions, please email me at email@example.com.
Dr. Chris Garcia, PT, DPT, SCS, CSCS, USAW
P.S. If you’re more of a visual learner, check out my YouTube video on this topic below.
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