Dave Richardson interviews Gerry Ramogida, Consultant Chiropractor for the Seattle Seahawks and Performance Therapist with UK Athletics
I have to admit that I didn?t know too much about chiropractic medicine before this interview. However, my (unfair) perception was one of an alternative, quirky or perhaps ?last chance saloon? approach to rehabilitation. Before talking to Gerry my research takes me to a wealth of chiropractic clinics across the globe. Such clinics claim to ?alleviate pain by identifying, treating and subsequently reducing the presence of any mechanical disorders related to the musculoskeletal system?. Chiropractors typically concentrate their efforts around the spine under the assumptions that such disorders affect general health via the nervous system. I?m keen to know why I don?t know more about the 3rd largest health profession in the world (after medicine and dentistry)! Moreover, what place does it have in sport?
Gerry Ramogida is the consultant chiropractor for the much celebrated Seattle Seahawks. He is also a performance therapist for UK Athletics. The Canadian born chiropractor has a wealth of practical experience within top level sport, including Olympic experiences in Athens and Beijing, World Track and Field Championships in Edmonton, Paris, Helsinki, and Japan, as well as the Commonwealth Games in England and Pan American Games in Brazil. So, in essence, he must be doing something right. My (unfair) assessment of the chiropractic profession has been tainted. I am not the first person to not fully understand what they do. It would appear that the American Medical Association (AMA) once referred to this now 116 year old profession as an ?irrational and unscientific approach to disease?. Gerry alludes to the case of Chester Wilk and four other chiropractors. It was only as recently as 1987, when Wilk successfully sued the AMA for unlawful restraint of trade. Such a protracted dismissal (scepticism, uncertainty, medical snobbery, self-preservation or protectionism) of a profession by the medical authorities would indeed infect anyone?s thoughts about the profession and its application.
Gerry graduated as a Doctor of Chiropractic, summa cum laude (with highest honour), from the Western States Chiropractic College, Portland, Oregon. His own athletic career includes US college (American) football and high school soccer. He claims that his interest in the chiropractic profession stems from his own injury prone sporting experiences and his father?s long term history of back pain. More significantly perhaps, was TV clip showing the legendary quarterback Joe Montana being treated by a chiropractor on the sideline during Super Bowl XXIII, ?to be able to work with athletes on the competition field, during or in between the game, whilst there out there, kind of inspired me.? Joe Montana went on to throw the winning touchdown pass with just 34 seconds left in the game!
You don?t just land a job at the Seattle Seahawks straight from college though. Gerry?s advice to those wishing to travel the high performance sports pathway is to ?just get involved, volunteer for everything?. Such an approach has provided Gerry with experiences of many sports, including ice hockey, soccer, rugby, karate and athletics, as well as encounters with an array of different athlete characters. Gerry is also quick to recognise the practitioners that have gone before him, paving the way for chiropractors to move into, and be accepted, in professional sport. However, Gerry?s first encounters with the Seattle Seahawks? team of physicians was still challenging. Initially Gerry was received with perhaps the same scepticism and medical snobbery that was previously the reserve of the AMA, ?They weren?t happy. They felt that they had physiotherapists within Seattle that would have easily done what I could do and they couldn?t understand? what possibly I could bring that was worth them paying for me to come down (from Vancouver) and work on their players? they weren?t unfriendly but I could definitely feel that they were sitting there thinking ok show us why, show us what it is you do that makes you special?. The historical turbulence of the chiropractic profession meant that scientific funding was difficult to secure. Subsequently, there was (and still is relatively speaking) a lack of science to substantiate and confirm certain claims. A core concept of traditional chiropractic techniques is subluxation, ?? if there was any misalignment in the spine at a particular vertebrae, then that would compress the nerve and the nerve wouldn?t function properly and then any innervation by that nerve would therefore not function at 100% and if that be your heart then you?d end up with heart disease or your kidney or whatever the case?. Debate still reigns, even amongst the chiropractic profession, around the use of traditional subluxation techniques and a move towards limiting the profession to more evidence based neuromusculoskeletal conditions. I can get why, the Seahawks team of physicians were a little uneasy. Gerry admits that they (the profession) need more funding and more research. However, he also wants you to trust in his ability. His knowledge of anatomy is unquestionable. It was this depth of knowledge that eventually saw players being referred to him by the physicians. Initially, he just offered a different way of looking at things, ?typically people look at injuries and they look at the source of pain. The way I was taught was that the source of the pain isn?t (necessarily) where the problem is, it?s just the point where it?s presenting itself as a problem. So I just brought an additional approach of working away from the site, trying to influence all those tissues that attach or have influence on the function of the injured area, working those, and often times you do get an overall improvement?. The hands on approach of the chiropractor demands that you ?really understand the anatomy under your hands, the levels, the layers, what?s underneath. Gerry explains further, ?for example in the lower back the multifidus (muscle) has a specific fibre orientation. The larger muscles over top also have a specific fibre orientation. If you?re not treating to address one or the other or the interaction between the two so that they can glide freely, then your treatment isn?t going to be effective.? In essence Gerry brought a ?new set of tools? to the Seahawks medical team. Still, Gerry recalls ?curing? a burly 250lb defensive player of pain on the outside of his knee following micro fracture surgery as a defining moment in his career. The physicians couldn?t isolate the cause of the pain, ?I took a look and, in essence, as a result of the chronic inflammation and swelling that had occurred there was a degree of scarring on the medial aspect of the knee where the hamstrings, sartorius and gracilis were inserting? those tendons couldn?t glide as he was flexing and extending the knee. So I did a few minutes of work and I said just get up and try that, just see how that is. He got up and he moved it and he just started getting louder and louder, he was like ?there?s no pain, there?s no pain? and he walked away and walked back and then he was swearing, ?there?s no f***ing pain!? ?How can this guy come in here for 5 minutes. I?ve had pain for 5 months and now there?s no pain there!? And so I didn?t know if they were actually going to be happy about that or if I was going to be in trouble?. Fortunately, for Gerry it worked out positively. He recounts other similar moments but ultimately the ?art? of his practice, alongside the science, whether substantive enough for the traditional medical profession or not, is plainly evident. Gerry?s been with the Seahawks since 2002 and has gained the respect and confidence of the training staff and the medical staff. The NFL boasts a full-time chiropractor, or (at least) a chiropractor consulting with the staff, at every NFL team. Gerry, readily admits that his role has changed over the years. The intense, violent, collision based nature of American Football dictates that Gerry?s role has moved from injury prevention and performance enhancement towards just enabling players to survive and keep them playing.
Gerry finds the relatively gentile environment of working as a performance therapist for UK Athletics as an opportunity to work more closely with athletes and coaches on performance enhancement and injury prevention. Rehabilitation is part of the remit, but again it appears that an active recovery that matches the athletic event itself. ?Specifically, if we have a hamstring injury, we may start back at walking speed and try to maintain some of the joint positions that you would use in (say) a sprint. So you?re trying to maintain dorsiflexion, landing on the heel, rolling through the foot, so you?re just trying to encourage movement through all the joints and to a range that?s comfortable?. New approaches or new philosophies of treatment present professional challenges to aligned practitioners who may do things ?differently?. Gerry?s position and role with UKA has allowed for a more strategic approach to practice. Gerry is highly complimentary about the UKA set-up and indeed its openness and willingness to listen and embrace new knowledge, ?we?ve been able to overlay our approach to rehab to the more traditional approaches based on strengthening strategies and progressions.? The plethora of sports scientists within the UKA system, especially the biomechanists, is also refreshing for Gerry, ?because I base what I do from the observation of movement and now I have individuals that I can work with that can give me feedback on ground contact time, stride length, symmetry of movement, acceleration, max velocity. For me it?s like being a kid in a candy store. I can get feedback as to whether we are actually making a difference or making improvement which, before, you were just trying to do with your eye and athlete feedback.?
The various chiropractor associations tend to advocate a multi-disciplinary approach to practice that includes physical therapy, psychological counselling, wellness and diet. Whilst Gerry is content that he has been highly schooled in nutrition and that, indeed, nutritional advice and guidance is a strength of chiropractic education. The hands-on approach to practice affords the chiropractor numerous intimate moments with the athlete. Indeed, Gerry?s ?consultancy? position at the Seahawks also positions him as a ?trusted? outsider as opposed to another member of the organisation just trying to get the player back on the field as quickly as possible. The introduction to psychological techniques and training as part of the chiropractic education programme means that Gerry is not uncomfortable but he does express a need to recognise when you are over-stepping your boundaries. In this sense, the chiropractor, as with other more athlete-intimate professions, can be vulnerable to privileged information. The morals, ethics, whys and wherefores can be left for my colleague Dr Nesti to unravel in another Leader article, but Gerry?s recognition of such professional respect is indeed refreshing. For me, Gerry and his profession offer a unique and comprehensive non-operative musculoskeletal perspective that appears to compliment performance enhancement, injury prevention and rehabilitation. Gerry?s journey is full of respect for others (including his predecessors, physicians, osteopaths, physiotherapists, fitness and conditioners, biomechanists, psychologists and coaches et cetera). Perhaps, if we were to afford the same respect and humility to the chiropractic profession, embrace its holistic position and trust those that operate within such a paradigm then we could begin to add ?the chiropractor? to the list of core support staff required by high performance athletes. I sense that those chiropractors that (hopefully) follow Gerry into high performance sport, will be able to thank him for his efforts.
Dave Richardson PhD is a specialist in youth development, organisational culture and community and is the assistant director of the School of Sport and Exercise Sciences at Liverpool John Moores University.
The views of our regular columnists are independent, and as such do not represent those of Leaders in Performance.
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