Should you see a chiropractor or an osteopath for sports injuries or to improve sports performance?

Many chiropractors and osteopaths advertise their treatments for the prevention and treatment of sports injuries. Some also claim to be able to improve sports performance. Do these claims stand up to scientific scrutiny? Should chiropractors and osteopaths be advertising these treatments?

Summary of conclusions:

1. The most common types of sports injuries have not been shown to benefit from chiropractic or osteopathy treatment.

2. There are some specific types of sports injury where treatment from a chiropractor or osteopath may provide some benefit. It would make sense to try and get an accurate diagnosis first before considering going to an osteopath or chiropractor to make sure that the injury you have may benefit from these treatments.

3. Treatment from a chiropractor or osteopath has not been shown to provide any benefit for injury prevention.

4. There is no good evidence that chiropractic or osteopathy treatments provide any benefit for sports performance.

Injury prevention

The first thing to clear up is the suitability of chiropractic and osteopathy treatments as a prevention of injuries. This can be stated very simply:

Chiropractic and osteopathy treatments have not been shown to provide any benefit for the prevention of injuries.

Whilst we are on the topic of prevention, it’s worth pointing out that chiropractic and osteopathy treatments have not been shown to provide any benefits for the prevention of any other health condition either. There is no good reason why anyone should visit a chiropractor or osteopath on a regular or long-term basis.

Treatment of sports injuries

In November 2017 the Advertising Standards Authority (ASA) published new guidance for chiropractors on the treatment of sciatica, sports injuries, whiplash as well the treatment of babies, children & pregnant women. Within this document it states “The ASA considers consumers will understand broad claims made by chiropractors for the treatment of “sports injuries” to mean that chiropractic is effective for the treatment of all, or most, problems which may arise from sports injury. Given the evidence for efficacy is limited to certain, usually minor conditions which could be caused by injuries sustained during sporting activities, the ASA considers that consumers are likely to be misled by such broad claims”. The ASA provides a list of specific sports injuries that chiropractors may claim to treat including some specific shoulder injuries, short term management of ankle sprains and plantar fasciitis. The ASA guidelines for osteopaths are less detailed in this area but do state that osteopaths may only claim to treat “minor sports injuries”. What’s very clear is that an osteopath or chiropractor who claims to treat a wide range of sports injuries is not going to be compliant with the ASA guidelines due to a lack of evidence to support these treatments.

The most common injuries are sprains and strains (definitions from NHS website):

• A sprain is a torn or twisted ligament (tissue that connects the joints)
• A strain is an overstretched or torn muscle (also known as a pulled muscle)

A useful source of clear guidance on suitability of treatments can be found in the relevant NICE guidelines. The NICE guidelines for sprains and strains don’t suggest chiropractic or osteopathy as a suitable treatment. In fact, the NHS website states that for these common injuries “Most can be treated at home without seeing a GP”.

Sports performance

Some chiropractors and osteopaths claim that by having treatments with them you will improve your sports performance. In some cases they claim that this is achieved by improving the “alignment” of your body through their treatments therefore enabling you to perform better. The concept of “alignment” as promoted by some chiropractors and osteopaths is nonsensical. The human body does not become “misaligned” and treatments from a chiropractor or osteopath will not “correct” these misalignments.

As to whether treatment from a chiropractor or osteopath improves sports performance, there is no good evidence to suggest that it does. Like any treatment, chiropractic and osteopathy carry risks. It therefore doesn’t make sense to undertake a treatment that hasn’t been shown to provide any benefit for sports performance when there is the potential for harm from the treatment.

What action can be taken to stop these misleading claims?

One example of a chiropractic practice that claims to be able to prevent and treat a wide range of injuries as well as help with sports performance is Putney Chiropractic Clinic. I complained to the ASA about the claims made by this clinic including their suggestion that chiropractic could result in “more energy”, “maximise performance” and prevent and treat a wide range of injuries. The response from the ASA was to refer this to their compliance team. The ASA do this when what you have complained about is a clear issue that they have already taken a stance on. The claims made by Putney Chiropractic Clinic breach the ASA guidelines as they are not substantiated by evidence. This is not an isolated incident and I will be making complaints about other chiropractors and osteopaths in future.

Conclusions

The term “sports injury” covers a wide range of different potential problems such as sprains, strains, back injury and concussion. Chiropractic and osteopathy have only been shown to provide benefit for a small number of these. Maybe you have already been given a diagnosis of the particular type of injury you have and it is one of those for which chiropractic or osteopathy have been shown to provide some benefit. In this situation then you may benefit from seeing a chiropractor or osteopath, although you should compare the suitability of this against other treatment options that are available. In all other situations these treatments are not recommended.

In terms of injury prevention, there is no good reason to see a chiropractor or osteopath. The same advice applies for sports performance.