Reducing the stress and strain through chiropractic care

In warmer weather, many patients use the longer, sunnier days to spend more time outdoors playing sports and being more active. This can add up to increased strain on their bodies. As chiropractors, we can partner with our patients to help take the stress out of the summer activities they love. This supports adjustments that hold better and enhances the success of ongoing chiropractic care while helping boost athletic performance and lowering injury risk.

Better Ergonomics Helps Improve Performance

Most people are not attuned to proper ergonomics and body position when they play sports. Even when they have coaches or personal trainers, many athletes are uninformed about how poor body mechanics can contribute to pain. They could be standing, lifting, bending, or moving improperly and when those motions are repeated over and over, it increases the stress throughout the kinetic chain. As an expert on how all parts of the body are interconnected, you can use your knowledge of posture and biomechanics to help them understand.

You don’t need to be an expert in the particulars of every sport to advise patients on the proper mechanics of healthy movement. 

It can be as easy as having the patient demonstrate how they swing their tennis racquet or golf club, dribble a basketball or jump up to spike a volleyball. Observe them as they perform their activity and you can identify aspects of their movements that exhibit stress on their body parts. 

These can then be corrected so their mechanics are more ergonomic. Even small changes can make a big difference in their ability to continue playing their favorite sports and their health in general. 

Let’s address some of the most popular summer sports:

Tennis and Pickleball: 

Racket sports are notorious for contributing to shoulder, neck, and upper back pain. When you couple that with all of the twisting of the torso and lower back, you can get spinal pain and rib subluxations in the front, back, or side of the chest. In tennis, a lot of power is generated through the upper extremity which then transfers from the racket head to the ball. This puts repetitive stress on all of the upper extremities. Add in the short bursts of sprinting, lunging, and jumping, and there could be lower extremity strain as well. 

Pickleball is a faster-paced game on a smaller court. The plastic ball is lighter than a tennis ball and players usually play doubles. Depending on position, a player may not be required to move their feet as much as in tennis. Pickleballers suffer a lot of the same issues tennis players do and have an increased rate of injuries due to how much faster the game is and the increased frequency of the lunging and reaching for the pickleball. This is the sport that most often brings patients into my office for pain treatment. 

Case Study/Pickleball

Jane is a 65-year-old female who has been playing pickleball for 6 months. She plays 4-5 days per week for at 3-4 hours at a time. Sometimes she gets talked into playing on the weekends. Over the last few weeks, she has experienced more pain in her right outside elbow. Over the last week, the pain has moved into her right shoulder and into the neck and upper back. Her exam was fairly unremarkable with ROM limited in the shoulder and C/T spine by mild to moderate pain. Orthopedic testing indicated lateral epicondylitis. But evaluating her shoulder and C/T spine, I found her shoulder joints (GH, AC, SC) and ribs 2-6 were subluxated on the right side anterior and posterior. Furthermore, she was a severe pronator and the strain from her excessively flat feet were involving the upper kinetic chain contributing to her postural strain.

The repetitive stress of using her right arm to serve, volley, and “smash” the plastic pickleball caused the subluxations observed. Aside from adjusting all of her involved joints (including the wrist/hand bones for good measure), I used elastic therapeutic tape to stabilize her right shoulder. I also got her a pair of custom three-arch orthotics to balance and align her body’s foundation—the feet. It took 5 days for Jane to get accustomed to the new orthotics and she began playing pickleball again. It took 4 chiropractic sessions to stabilize her elbow, shoulder and C/T spine. She is back to playing pickleball with no pain and wearing custom orthotics regularly during her pickleball matches and everyday activities.  

Basketball and Volleyball

In basketball jogging and running are coupled with the usage of the upper extremities. These can cause issues all over the body from the feet/ankles upwards. Volleyball and basketball incorporate jumping motions and the shock of jumping and landing on the feet magnifies the ground shock that begins at the feet/ankles and moves up into the knees, hips, pelvis, spine, neck, shoulder, elbows and wrists/hands.

Case Study/Volleyball

Sarah is a 15-year-old female volleyball player who is playing competitively at the club level and for her high school team. She presented with chronic upper/mid back, bilateral shoulder, neck pain, and headaches with no serious trauma or injury as a factor. Her symptoms developed over four months and were getting progressively worse.  

Aside from the fact that her cervical, upper thoracic, and shoulder joints (GH, AC, SC) were out of alignment, she had moderately overpronating feet. I also noticed some issues with how she was setting and serving the ball. I had her work with her coach to smooth out the biomechanical stresses which helped.

We combined cold laser therapy, chiropractic adjustments, custom three-arch orthotics, and some focused stretching and strengthening exercises that helped improve her pain and stability. Within the first two days of using her custom orthotics, she felt a positive difference. Her symptoms improved over the next two weeks. Sarah now comes in for tune-up chiropractic visits every two weeks.

Golf, baseball, and softball:

Neck, shoulder, elbow, and wrist/hand injuries are common due to the repetitive nature of stress from swinging the club or bat in a unilateral fashion. These athletes tend to swing to the same side all of the time when hitting a golf ball, baseball, or softball. There is very little contralateral balance, or swinging to the other side, to keep the body even. The frequent twisting of the torso and pelvis can cause spinal and rib pain as well. We have to remember to add in the element of running with baseball/softball. That will create issues in the lower extremities as well.


The buoyancy of the water helps to cushion joints against the wear and tear of repetitive swim strokes. However, the intensity, frequency and type of swim stroke the patient performs can exacerbate pain in the shoulder, neck, upper back, hip, pelvis and lower back regions. Partnering with their coach can be very beneficial to aid you in identifying and addressing problem areas. 


On a traditional, upright bicycle, a biker is sitting in their seat and their sacrum and SI joints are under pressure. They also lean forward while riding to reach the handlebars and in some cases to streamline themselves on the bike. Occasional bumps, potholes, curbs and other road hazards can increase the stress on their bodies.

Have the patient bring in their bike and help them adjust the seats and handlebars for the optimal ergonomic position. You can analyze how much stress their spine and extremities are experiencing when you watch them ride or simulate their ride. You could also demonstrate proper riding positions to help them understand. Partnering with local biking groups to provide this service to their members is a great way to expand your chiropractic expertise to athletes within your community and help heal more patients.


With hiking in full swing, have your patient bring in their fully weighted daypack or backpack for you to examine. Keep these parameters in mind:

  • A loaded daypack should not weigh more than about 10 percent of the person’s body weight (if a patient weighs 150 pounds, their daypack should not exceed 15 pounds).
  • A loaded backpack should not weigh more than about 20 percent of a person’s body weight (if a patient weighs 150 pounds, their backpack should not exceed 30 pounds).

People typically do not wear their packs properly. Often the pack is resting too low on the body somewhere near the patient’s lower back or pelvis instead of around the upper/mid back. Have them put the pack on in front of you so you can adjust it for them. It’s crucial that they use a pack that is suitable for their body and frame shape.

Another key factor: the weight of the pack also puts extra pressure on the patient’s feet. This further exacerbates over-pronation or over-supination of the feet. Custom orthotics with proper 3-arch support are especially critical for these patients. Uneven trail terrain also calls for the enhanced stability orthotics provide; this can help boost endurance and reduce injuries.

Don’t Forget About the Feet

Recall that in any weight-bearing activity, the negative biomechanics of excessive foot pronation will affect the lower extremity, the axial spine, and the upper extremity. Under optimal circumstances, the 3 plantar foot arches function to absorb and disperse the 5 G of ground shock on an average heel strike. Healthy functioning arches dampen the shockwave to .5 G by the time it reaches the head and jaw. 

If the foot is excessively pronating, as it is for 90% of the patients that I treat, the arches are flatter, and the heel strike shockwave comes into the body with more and more force. Thus the biomechanical stress on the joints and soft tissues is also increased and the repetitive activities and sports can cause pain that they present to our clinics. Keeping the 26 foot bones adjusted and the 3 arches properly supported is key to the longer-term stability of the whole body no matter what sport they are engaged in.

Treatment Suggestions:

  1. Provide a plan for ongoing, proactive chiropractic care. Regular chiropractic adjustments to the spine and extremities will address postural instability for better performance while reducing joint and soft tissue impact, helping to break the cycle of chronic pain and injuries. Chiropractic care helps patients achieve optimal form and posture for better performance in all sports.
  1. Assess every patient’s feet—practically everyone has some degree of foot dysfunction and would benefit from custom flexible orthotics that support all three arches of the feet to help reduce pain, fight fatigue and lessen joint stress. This ensures the feet are supporting the axial kinetic chain. Support from the ground up will help reduce shock and stress and stabilize the spine and extremities. Patients should wear their orthotics not just during sports but in all their daily activities. This helps maintain healthy alignment for the best possible care.

In conclusion

Chiropractors can help patients enjoy their favorite sports and activities by reducing excessive strain on the body through ongoing care, ergonomic guidance, and custom three-arch orthotics. By implementing some of the tips in this blog into your care, you could become the go-to training partner for active people within your community during the summer season and all year round.

Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.

As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.