[embed]https://www.youtube.com/watch?v=1qdKlvKwwPM&t=11s[/embed]

In this video we discuss the necessary steps it takes to optimize athletic development and "build an athlete".

Key points discussed are:

• The importance of practicing your sport skills and practicing with intent
• Taking the necessary steps to stay healthy in a strength & conditioning program
• Understanding the process of long-term adaptations in athletics
• The application of the speed-strength continuum, it's importance in programming and identifying where athletes fall within the continuum

Please watch: https://www.youtube.com/embed/xBOWKP4CO4Y

Above is a short video addressing common reasons why ground and/or knee pain develops and two exercises to get to the root of the problem. Addressing muscular dysfunction through therapeutic exercise continues to prove to be the most effective and evidence-based intervention for common musculoskeletal conditions such as tendinitis, bursitis, sprain/strains, joint pain and muscle tightness.

These exercises involve minimal equipment and are easy to perform at home, in a hotel room, or at the gym. All you need is:

• Chair/bench or some form on a firm elevated surface
• Your own bodyweight

Exercises covered in this video:

1. The Adductor (Groin) Side Plank
2. The Rear-foot Elevated Split Squat (Bulgarian Split Squat)

Also covered in the video are common reasons why groin and/or knee pain may develop and why these exercises can be very effective once a patient is out of pain.

 
More related reading:

https://www.gallagherperformance.com/blog/why-therapists-should-understand-strength

https://www.gallagherperformance.com/blog/the-solution-to-long-term-improvement-of-back-pain

https://www.gallagherperformance.com/blog/advanced-training-for-elite-athletes

https://www.youtube.com/watch?v=ceIcoreYu8o&t=4s

This video illustrates how we integrate chiropractic, rehabilitation and dynamic neuromuscular stabilization (DNS) into patient treatment. For the purposes of this video, these techniques were used to speed up post-workout recovery, ensure structural balance and improve how the body functions. Similar to fine-tuning a race car, the human body can benefit tremendously from fine-tuning to keep body prepared for high performance.

Key take home points:

• Treatment is directed at patient-specific goals and outcomes. There are different levels of care that may need, ranging from symptomatic (i.e. painful conditions) to more performance-based therapy or fine-tuning.
• Chiropractic manipulative therapy (i.e. adjusting) was not filmed but utilized for the spine and hips.
• Soft-tissue work was done manually and instrument-assisted to mobilize muscle and connective tissue to improve recovery.
• Dynamic neuromuscular stabilization (DNS) was used to fine-tune motor patterns and muscular activation. Proper muscular activation and stabilization function of muscles helps to ensure proper muscular coordination while minimizing stress on the joints.
• This all adds up to optimizing performance while keeping the body as healthy as possible.

April 2017 marks four years since Gallagher Performance opened and with another anniversary passing, I thought it was time to start reflecting back on our fourth year in business.

All our services from chiropractic to massage to personal training to sports performance training continue to experience steady, consistent growth since we first opened. Growth that led us into our own facility in December 2016. The move has been a very positive and necessary one for our continual business development.

On January 2, 2017, Gallagher Performance opened in our new location. After long hours and lots of work we ended up looking like this:



The new facility has enabled us to widen our reach, both within the community and online. Being a community resource is tremendously important to us. We are now able to hold classes, lectures and have been asked to speak to area sports teams and organizations. We are also now able to provide more educational videos on our social media and YouTube channels.

Even with the transition to a new facility, we remain loyal to providing quality of service over quantity. Gallagher Performance is about individualized attention in all our services. This is why our chiropractic and rehab patients are with their doctor every minute of every office visit. This is why Gallagher Performance isn't a gym; it's a training facility. We don't offer an open gym membership, but rather different levels of training services to meet the needs of our clients and athletes. The reason why we set it up this way is because we want people to experience how supervised training by qualified professionals yields amazing results. And our clients are achieving remarkable results in private and semi-private settings that enable individual considerations to be made appropriately.

In regards to our services, it has been another great year. GP’s chiropractic and rehab therapy was recognized as one of the best in the Pittsburgh area for a third consecutive year. The results we achieve through our chiropractic, manual therapy and functional rehabilitation have helped people get out of pain and return to the activities they enjoy. There have been literally dozens of patients who have come to us after a doctor has told them they needed surgery, but we’ve helped them avoid these procedures. We've helped them understand the importance of not only getting out of pain, but why changing the function of their body is the key to a successful outcome and long-term recovery.

Our personal and performance training services continue to generate tremendous results for our clients and athletes. The results keep our clients loyal and the referrals coming in. We have truly cared about delivering quality in all services since we opened. It’s a great feeling to see how much our clients appreciate the attention, know-how, and confidence they receive while working with us. When you focus on quality of service and improving the consumer experience, only good things can happen.

During our four years, we have seen tremendous growth in our distance/online training services as we have gone international. Now while we are growing and our reach may not be that impressive by some industry standards, it is humbling to see how our distance services are being sought after by people beyond the state of Pennsylvania. We have seen the reach grow to 12 states (AZ, CT, GA, IA, IL, MT, NJ, NY, NC, OH, TX, WI), into Canada (Alberta, Ontario), and into Portugal, Italy, and Japan.



The reason for our growth isn't a big marketing budget. Rather, we work hard to set up everyone we work with for success in any way possible –  trusting that those efforts will lead to referrals and retention. At Gallagher Performance, we don’t try to just “factory line” our clients/athletes through the same program with a "cookie cutter" approach.  This is because we understand training and rehabilitation is a very individual experience and everyone we work with needs very individual considerations made for them. That's what it takes to produce lasting, meaningful results.

Our sports performance training services continue to be utilized by a variety of athletes from a growing list of amateur/club organizations, high schools, and colleges. In addition, GP continues to direct the Strength & Conditioning program for the Franklin Regional Hockey Club as we move into our fourth year.

During the past year, we've seen new names join of list of athletes who have reached the collegiate level. This is tremendous accomplishment on their behalf and we are privileged to work with such determined and hard working athletes. Here's the list we have worked with, from sports performance to chiropractic and rehabilitation, and where they are coming from:

 Collegiate Athletes

• Wes Ashley, University of Wisconsin - Stevens Point (NCAA DIII) - Hockey
• Andrew Brncic, Alderson Broaddus University (NCAA DII) - Football
• Colin Childs, California University of Pennsylvania (NCAA DII) - Football
• Ben Dipko, Slippery Rock University (NCAA DII) - Football
• Noah Dipko, Indiana University of Pennsylvania (NCAA DII) - Football
• Justin Gismondi, Robert Morris University (ACHA DI) - Hockey
• Ryan Grieco, Seton Hill University (NCAA DII) - Baseball
• Carter Henderson, Duquesne University (NCAA DI) - Football
• Evan James, Penn State University Greater Allegheny (NCAA III) - Baseball
• Colin Jonov, Bucknell University (NCAA DI) - Football
• Katie Kimmich, Seton Hill University (NCAA DII) - Soccer
• Dante Luther, Washington & Jefferson University (NCAA DII) - Football
• Jake Roberge, Northwestern University (NCAA DI) - Soccer
• Mike Roberge, Northwestern University (NCAA DI) - Soccer
• Charan Singh, University of Massachusetts (NCAA DI) – Football
• Todd Summers, Villinova University (NCAA DI) - Football
• Ryan Watson, Lake Erie College (NCAA DII) - Soccer
• Christian Wilson, Mount St. Mary’s (NCAA DI) - Track & Field

"After an injury tissues heal, but muscles learn. They readily develop habits of guarding that outlast the injury" - Janet Travell, MD

1. Therapeutic exercise is the most evidence-based treatment.
2. Passive treatments (tape, modalities,etc.) may offer temporary relief but are not helpful in medium and long term recovery.
3. Injections and surgery have been not shown any greater effectiveness in outcomes than exercise.
4. Seek advice and treatment from a licensed professional who specializes in functional movement. Ideally this would be a rehabilitation chiropractor or physical therapist with movement specializations are the gold standard here. These practitioners focus on the functional paradigm of manual/physical medicine. And no, your "functional trainer" at the gym doesn't count.
5. Self-management is key. Reduce activities that provoke pain, apply gradual exposure to activities to build confidence and tissue capacity through exercise. Exercise must be tailored to you to reduce pain and improve strength and function throughout your entire body.
6. Progress load and exposure gradually. The key is to be consistent with your exercise therapy. Forget about how much you were doing before the injury and what others are able to do. Everyone responds differently. Focus on your recovery and what works to get you back on track.
7. Getting back on track can take a long time. In some cases, upwards of 3 to 12 months depending on a number of factors including duration of symptoms, functional deficits and patient compliance during their exercise program. Keep in mind, other treatments can offer faster recovery but nothing has demonstrated better long-term results than progressive exercise.

Pain is incredibly complex, making the treatment and management of chronic or persistent pain a unique challenge. After reading this article, the hope is that you have a better understanding of the complexities of pain and how treatment must be directed if one is truly to overcome chronic pain.

Pain has a nasty habit of getting in the way of activities that we not only enjoy, but also the mundane tasks of everyday living. It becomes of paramount importance that treatment not only decreases pain, but also that the individual is able to resume activities that are important to them with improved function and mechanics.

To begin with, let's start with an understanding of pain and the reality behind why we perceive pain.

1) Pain is in the Brain
Pain is a message from our brain that is meant to protect us.  Even though pain is meant to protect us, pain is not a reliable source of indicating the extent of an injury or even where the injury is located. The classic example here is phantom limb pain. Amputees regularly will experience this phenomenon. One may experience left leg pain, yet they do not have a left leg. If pain is purely related to damage or injury, how would one experience pain in a limb that doesn’t exist?

The reality of pain perception can be a difficult education point as this is typically a new concept for the majority of patients and one they may need some time to understand. But it’s critical as their beliefs about pain can complicate the recovery process. It’s extremely beneficial for patients to learn about pain and address fear-avoidance behaviors and other factors that will interfere with reactivation into normal movement and activities of daily living.

2) Hurt Doesn't Equal Harm
Another key component of the education process is that “hurt doesn’t equal harm”. Just because a movement or activity may “hurt” this doesn’t mean that you are doing harm to the body or damaging tissues. In fact, there is a growing body of research supporting poor correlation between pain and structural changes seen on advanced medical imaging. Just because one has degenerative joint disease, a disc bulge, or rotator cuff tear doesn’t mean they will have pain as these imaging findings are routinely found in asymptomatic individuals.

It’s important patients understand this concept because when it comes to exposure to movement through exercise, you don’t want the fear of structural damage to interfere with the ability to become more active. While not all movement will be pain free, movement isn’t causing harm. And that’s extremely powerful for patients to understand.

3) Movement is Medicine
Movement has the ability to be healing by reducing the pain response in our brain. Thus this is why movement is like medicine and why movement eventually has to take center stage in the management of chronic pain. Similar to manual therapy, graded exposure to movement through exercise will essentially teach your nervous system to “wind down” and not be as sensitive to pain. In doing so, you become more confident and reassured that you can do more without pain or the fear of a relapse in your condition.

4) The Work is Just Beginning 
Unfortunately, the pain fix isn’t an overnight solution. For chronic pain patients, often times the rehabilitation process can take months of consistent work and repeated inputs to the nervous system to make a substantial change on pain and function. Repeated inputs come in the form of manual therapy and home exercise/self management strategies. Thus patient’s must understand the importance of compliance within their home exercise program as this makes a significant difference in their outcomes.

It’s important they understand the nervous system is easily tricked. It's easy to yield immediate change, but these changes should not be confused with lasting results. This concept is illustrated with any number of assessments commonly used in chiropractic and physical therapy offices – from leg length analysis to functional screens - as well as therapeutic interventions – from manual therapy to manipulation. By performing pre and post checks, it's possible to see immediate changes within one treatment. It can be easy to impact pain and create changes in range of motion or body function that have patients leaving your office feeling great.

But no single input can create lasting change. It requires multiple inputs over a period a time to create lasting change within the nervous system. This is why exercise and training is so important. If patients are not provided with the right exercises to compliment therapy, this is why they have pain relapses. Patients must exercise and must train to make a lasting change within their body. Otherwise they will get frustrated with chronic recurrences of leaving a provider's office feeling great only to experience a return of pain symptoms. And this becomes the pain cycle many become stuck in unless a change is made.

Break the Pain Cycle
If you are dealing with chronic or persistent pain or stuck in the pain cycle, the hope is that this article gets you thinking differently about how pain should be managed for successful outcomes. It’s why the management of painful conditions, especially chronic pain, must focus on pain education, the appropriate use of manual therapy (ex: joint mobilizations/manipulation, relaxation techniques such as PIR, soft-tissue and neurodynamic mobilizations) and graded movement exposure through exercise.

More related reading:

https://gallagherperformance.com/solving-pain-influence-czech-rehabilitation-techniques/

 

Running season is fast approaching. Spring and summer have a host of events from marathons, to half marathons, to triathlons, to various course races. Many have likely already started their training. And then of course we can’t forget those who will simply take up running in hopes of shedding unwanted body weight for the summer.

Whether you are taking up running to become healthier and lose weight, to qualify for Boston, or if you have your eyes set on crossing a race off your bucket list, your routine training will either build you toward your goal or you will be bogged down with nagging injury after nagging injury.

When you consider that 65-80% of runners will sustain an injury during the running season, clearly there is something that needs addressed to help runners cut down their chances of being sidelined or having recurrent issues during their training.

If there is one thing that most people know about me is that I’m not a distance runner. I’ll make that disclaimer up front. Never been a distance or endurance athlete and never will be. I live in the power-speed world of athletics. However, as a former hockey player and strength athlete, one of favorite past times and off-season training methods was (and still is) sprints.

Between my background as a chiropractic rehabilitation specialist as well as personal and professional experience in speed development, I’ve learned a thing or two about what it takes to build a body that is resilient to the demands of running/sprinting rather than breaking down. And at Gallagher Performance we have developed a reputation for not only building speed demons, but keeping their body healthy and ready in the process.

So what gives? Why is someone like me writing an article about running?

The name of the game in athletics is physical preparation and the same can be said of distance running. Unfortunately there seems to be a misunderstanding in that one only needs to run to be successful at running. While this may be true for some, there are numerous others who simply cannot solely rely on running in order to be prepared to run. Simply just running to be ready to run is an oversimplification of arguably the most complex human movement.

If that sounds ridiculous or confusing, let me explain my logic.

Most runners will eventually encounter their fair share of aches, pains, strains and overuse injuries. Plantar fasciitis, shin splints, tendonitis, stress fractures, runner’s knee, IT band syndrome and joint pain are common to the running community. Once training demands exceed what is one physically prepared for, this is where things start to go south.
These conditions may be present for a number of reasons, including any of the following:

• Sharp increases in training volume
• Foot wear
• Gait mechanics
• Strength deficits
• Joint dysfunction or fixations
• Improper motor control of lower extremities and/or torso
• Overtraining
• Inadequate physical preparation

The value of movement is undeniable. But the industry of movement has become a bit of a circus.

I have seen some doctors, therapists, and trainers using the label of “movement provider” lately and while I’m not quite sure what that means, I can speculate as to what they are trying to communicate. Yes there are many universal truths when it comes to human movement, health and performance, but the true pioneers of movement are few. Social media has created a tool for spreading quality information and education. I understand leveraging social media can become incredibly valuable to a business. However, when it comes to movement, exercise, and fitness, social media has become more entertainment than substance.

It’s become a sea one can easily become lost in, caught up in the wow factor of challenging movement drills and variations while others are less likely to engage with more of a simplistic focus. Movement providers from licensed healthcare professionals to run-of-the-mill trainers pop up all over the worldwide web and social media sending messages that may seem conflicting. There’s more information than ever yet many people searching for solutions are more confused than ever. The industry seems to thrive on confusion more than any other. Confusion creates dependence and the industry loves confusion because someone has to have the answers. They want to build an audience.

But are you building an audience based on your information being entertaining or effective?

Sadly it seems that he who yells the loudest, gets the most followers and gets the most attention must have the answers right? I mean they do have 62,000 followers, they must know their stuff? Not necessarily. Entertaining may score you points on social media, but effective scores you points with patients and clients. Yes there are extremely effective movement experts with massive followings, but I doubt they exist in the real world in the masses like they do on social media. If you’re chasing entertainment yet don’t know how to effectively get someone from point A to point B, it’s all smoke and mirrors.

While overhead lateral rotational lunges with hanging bands may score thousands of views on Instagram, does it have any significant relevance? From a clinical perspective, those who treat patients regularly know the majority of what entertains on social media has little transfer to patient care. The reality is that the majority of patients with musculoskeletal issues have lost the ability to perform basic human movement. There is a reason why the lumbar disc patient is a disc patient. Most of them are deconditioned and lack adequate strength, motor control, mechanics and proprioceptive awareness not only in their low back, but likely in their feet and hips as well. They need the basics. The fundamentals. Problem is the basics aren’t sexy and don’t get you likes or follows on social media. Advanced progressions of basic human movements make up 90% of what’s on social media, yet in the office 90% of our patients only need the basics. The same can be said for the population that works with a personal trainer or strength & conditioning professional. They often need the basics and just building off them.

The majority of patients and clients need to master the basics without the need of external resistance. For most, simply working against the resistance of their own bodyweight is sufficient. Problem is, if you take away the bands, the barbells, the kettlebells, the dumbells, the cables and sliders from some doctors, therapists, and trainers, they will struggle to think of exercise progressions/regressions to yield better movement by simply using one’s own body. The really good movement providers can achieve improvement without the need of equipment. This may be incredibly simplistic and not score big points on Instagram or Facebook, but you’d be surprised at how challenging the basics and their variations will be. So if you are using social media as your reference library on how to rehab your own injury, rehab a patient, or create a workout for your next training client, I would be incredibly cautious.

Sure the squat may be basic, but how many are actually capable of a proper bodyweight squat? The answer may surprise you. Yet how many are capable of a proper squat before heavier and heavier loads are introduced or they try an overhead, band-resisted, anti-rotational squat? I’m gonna bet not many. If you’re capable of performing an overhead, band-resisted, anti-rotational squat with ideal form, great. You’re part of less than 1% of the population that is capable. The other 99% need more of the basics and arguably may never need to do that advanced of an exercise. Most won’t even have the desire as they won’t see the relevance.

The basics may be boring, but they are incredibly effective. We all need them. The basics serve as the foundation. What kind of basics are we talking about? If I was to build a short list of basics to ask yourself, it would look something like this:

• Are you able to breathe without excessive chest or shoulder movement?
• Are you able to balance on one-leg for at least 60 seconds?
• Are you able to balance on one-leg (eyes closed) for at least 30 seconds?
• Are you able to hold a plank for at least 60 seconds?
• Are you able to hold a side plank for at least 30 seconds on each side?
• Are you able to perform a lunge with ideal form and control?
• Are you able to perform a squat with ideal form and control?
• Are you able to raise your arms overhead with ideal form and control?
• Are any of these movements painful?
• Are any of these movements difficult to perform due to tightness or restricted range of motion?

Our approach to working with shoulder pain or injuries is very unique in that we really don’t work around shoulder injuries when properly indicated. The majority of the time, we don’t force someone to rest for several days while inflammation quiets down. Yes, it can be necessary in rare circumstances. However, rest and traditional methods of ice and anti-inflammatory meds are often over utilized when properly prescribed movement (i.e. exercise) is probably the better bet for improved recovery. At Gallagher Performance, we have a nasty habit of getting our athletes, clients and patients to work through pain and injuries by strategically incorporating exercise with specialized approaches tailored to find “the hardest thing they do well”. We want to find what they can be successful with while not posing any undue risk. And the best part? The system works.

When it comes to the shoulder, pain and injury is most commonly associated with poor shoulder function and faulty mechanics. And when I say most commonly, it’s not a stretch to say over 50% of shoulder injuries are due to these underlying problems. If muscles are unable to fire properly to provide ideal amounts of support (stability) and motion (mobility), then injury will occur regardless of how strong or flexible one is.
I have written extensively on the subject of the “hidden cause of injury” since the root cause of the overwhelming major of musculoskeletal injury is dysfunctional movement. Most doctors and trainers do not have the training or eye to look for dysfunctional movement and no amount of rest, ice, and Advil will ever provide the solution. No amount of passive modalities, taping, cupping, mobility drills, or stretching will correct dysfunctional movement. When it comes to shoulders, the solution to reducing shoulder pain and preventing injury is all about restoring proper rhythm and mechanics of the shoulder joint. This includes all it’s associated articulations – the glenohumeral and scapulothoracic. Basically we have to improve how both the “ball and socket” joint or “shoulder joint” (as most of us know it) and “shoulder blade” function together.

When it comes to improving the function of the shoulder, we’ll take an athlete or patient and have them perform variations of rows, pulls, presses, and ground-based movements with adequate loads to reinforce ideal body mechanics and correct dysfunctional movement or stability patterns. This is done through a combination of exercises, tempos, external stimuli, and progressions to essentially re-educate the nervous system. This is why it’s called neuromuscular re-education. We must teach the nervous system to do things better and break bad habits. Yes bad habits can be very challenging to break. Most people would rather pop a pill or rest until their pain disappears rather than break bad habits because breaking bad habits sounds like hard work. Popping pills and rest are great because they are easy and effective. But those who deal with chronic recurrences may want to think about a different strategy once their patience wears thin.
For example, some lifters have such poor thoracic spine posture and scapular dyskinesis that they may need 6 months+ of rehab and corrective work. But they have no interest in that. They have no interest in stepping back a little and refocusing their training for long-term development. They prefer to band-aid symptoms while they push their training and perpetuate the pain cycle.

The funny thing is breaking bad habits isn't as hard as most people think. If you work with the right person you’d be surprised what proper coaching, cueing, and exercise can do in a relatively short period of time. The reality is most people are highly resistant to breaking bad habits because of either ego or the unwillingness to take a step backward. Typically after a number of training or therapy sessions, the individual is able to perform any and all movements without pain and with improved shoulder mechanics. For those dealing with shoulder pain, improving their mechanics through sensory-motor training enables their nervous system to be re-educated. This re-education process is the most effective form of therapy and healing available. It cannot be understated that a critical component of this process is proper coaching and cueing. This is the responsibility of the coach or therapist. As much as proper coaching and cueing can be beneficial, improper coaching and cueing can prove to be very damaging. It is my opinion that many injuries occur because the athlete or patient had previously received very poor coaching or instruction.

This is exactly why performing exercise with proper technique is proving to be the single most effective form of therapy as it promotes almost immediate healing. If someone is having pain during a movement, they are doing something wrong. Correct them into the proper movement and watch their pain disappear. The key is re-educating the nervous system so movement becomes both therapeutic and performance-enhancing to one’s body rather than promoting pain and destroying joints.  This is truth when it comes to the shoulder joint as well as any joint within the human body.

Tired of pain? Want to reach your full potential? Visit gallagherperf.wpengine.com
EXPERIENCE THE DIFFERENCE.

More related reading:

https://gallagherperformance.com/finding-a-solution-to-your-shoulder-pain/

The problem:
It’s not uncommon for people with recurrent episodes of back pain to become fearful and to start avoiding activities in life. They begin to associate pain with the activity and that the activity is doing harm. Thus, in their minds, pain equals harm and any activity that causes pain avoided. The problem becomes that as this the list of activities grow, deconditioning sets in and begins to feed into back pain. At this point, most figure they are just “getting old” or figure they will need to “learn to live with the pain”. The reality is there is a solution to help you fight against these feeling of fear and limitation and enable you to fight dysfunction in your body.

The solution:
Research tells us that exercise should be part of your back pain solution. This isn’t true of just backs, as exercise should be part of any joint pain solution. Time and time again, more than any other intervention, exercise has demonstrated the ability to provide positive outcomes in back pain relief and reduced relapses. However, too often people use different exercises to help reduce their pain only to find that exercise makes their back feel worse. The solution isn’t just simply exercise, the solution is understanding the right exercises to do while also understanding which exercises to avoid. You need to know what exercises for sciatica and disc herniation are best to do 1st to create a good foundation of movement before progressing to more difficult exercises. Where do you go for that information? Over the past several years we have put together a clinically successful exercise progression program for our patients and clients with back pain. These exercise progressions serve as the framework for rehabilitation and also serve as the foundation for improving athletic performance. Join us for our Core Training – From Rehab to Performance workshop and learn more about what you can begin doing immediately to help reduce your back pain, feel better, and improve your performance in sport or life.

 
 


More related reading:

https://gallagherperformance.com/the-best-exercise/

The insurance industry has become increasingly difficult to work with as many large carriers have limited or completely closed off providers from joining their network.

In such cases, we operate as a fee-for-service facility and offer affordable plans that truly increase the value of our patient’s experience. But rather than take my word for it, let's do the comparison between traditional chiropractic and the difference at Gallagher Performance.

TRADITIONAL CHIROPRACTIC
Most traditional chiropractors spend 5-15 minutes per patient and often attempt to have them come 2-3 times per week for an extended period of time. Most patients only experience passive modalities and adjustments with a predictable routine of stim-heat-adjust-out the door. And if there is rehab, often it is supervised by unlicensed aides who instruct patients in exercises. Most traditional chiropractors will see a patient 18-24 times in order to resolve their problem. Depending on co-pay or co-insurance, the out-of-pocket expense can add up quickly. For someone who has a $25 copay, that means they will have $450-$600 of out-of-pocket expense.
THE GALLAGHER PERFORMANCE DIFFERENCE
At Gallagher Performance, you spend 30-60 minutes with your chiropractor, enabling faster recovery in fewer visits. Most of our patients recover in less than 8 visits, spend 100% of their time 1-on-1 with a board-certified rehabilitation chiropractor, and are provided with essential knowledge and tools needed to ensure pain doesn’t come back. Our approach will actually save you money while providing you with a higher quality of treatment. That’s value you can’t compare!

 

Often I am asked, "What is the best exercise?" or "What is the best type of exercise?"

To answer that question, let's set the stage of what exercise really is - movement.

Teaching patients not only about chiropractic but how to move better all comes back to function and understanding how all the intricate parts of our body make up a highly complex movement system. But here are some key points to understand:

1) Function determines movement. Chiropractic and rehabilitation seek to restore proper movement function. Functional examinations determine WHY movement is painful or problematic. Utilizing the functional model of movement helps to determine who is at risk for injury, which movement patterns or body regions are dysfunctional, and what treatment or exercise strategy is needed to address those issues in combination with chiropractic/manual therapy methods.

2) Function is critical to movement and movement is critical to our health. Our bodies are designed to move. The growing list of chronic diseases and immense burden on the healthcare system associated with an overly sedentary society clearly demonstrates one conclusion – we need to move more.

3) Movement is exercise and exercise is medicine. The medicinal benefits of exercise are numerous. There is a reason why exercise and proper nutrition is being labeled as "lifestyle medicine".

For those who wish to start an exercise program, the public is told to “see your doctor” before starting an exercise program. Most patients are cleared to exercise after history and vitals are considered “normal”. Sure your organ system may be healthy enough for exercise, but nothing is mentioned about seeing a doctor to determine how well you move or how well your muscles and joints are functioning. Why wouldn’t this be considered? Why wouldn’t seeing a “movement specialist” before considering an exercise program be equally advocated?

So, in typical fashion, most of us embark on an exercise program believing we will be healthier for it. We are told to exercise and practice sound nutritional habits, but what do most of us do for exercise?  How about go to the gym, sit on a machine and pull or push weights while hunched over with lousy posture.  Or, after sitting for 40-60 hours per week, let’s go out and put staggering amounts of stress on our bodies through recreational activities like weekend skiing, Thursday night softball league, rec league hockey, golf, or basketball.

There's nothing wrong with those activity choices, yet what happens when pain or injury come into the picture? Most of blame the exercise or blame the activity when, in most cases, we should be blaming our own body.

When it comes to pain and injury, the reality is what our body is capable of performing cannot meet the demands we are placing upon it. The overall function of our body must be ready to handle a specific task or movement otherwise problems will eventually arise. Problems that may range from mild (muscular tightness/stiffness, joint aches) to more severe (pain and/or injury).

The beauty of the functional model is that those regions that have mechanical sensitivity (pain) and/or abnormal motor control can be identified and solutions are discovered. Exposing these compensations and correcting them plays a huge role in not only getting patients out of pain, but improving how their body functions.

Why is changing how our body functions so important?
While pain is why most people seek care, the reality is if we only change pain and fail to change how a patient’s body functions, we have our reason why so many patients relapse. But if we get them out of pain and improve how their body functions then we are doing what we need to do to keep the pain from returning.

Whether we need mobility (improved range of motion) or stability (motor control), that can be addressed with a proper functional examination through movement. After a functional examination, it just makes sense to reinforce functional movement patterns with specialized exercise to build a foundation of proper movement coordination, strength and skill.  Now we are beginning to get somewhere to build form, function and fitness. Now we are getting people to move better through better exercise!

Correct movement is the best exercise
Once people learn better movement, how to project their joints and what exercises they should be performing, their bodies are much healthier for it. There is less risk of injury and most will ultimately start feeling better instantly. Rather than beating their bodies up due to poor movement, movement becomes healing. Correct exercise is the answer. Correct movement is what we need to get out of pain, feel capable and feel healthy.

That’s the essence of the functional model. It’s about promoting health and healing through therapy, movement, and patient-centered education. That’s what we pride ourselves on at Gallagher Performance as our model is truly unique in the services we provide and the results we achieve.

More related reading:

https://gallagherperformance.com/prevent-re-injury-integrated-training-rehabilitation/

https://gallagherperformance.com/powerful-innovative-approach-improving-body-functions/

https://gallagherperformance.com/do-you-really-need-more-mobility/

https://gallagherperformance.com/the-truth-about-functional-exercise/

Obesity is a problem. It's a real problem.

Today, 34% of the US adult population is obese and roughly 18% of US youth aged 2-19 years are obese. It is well established that children who are obese are more likely to be obese as adults, putting them more at risk for health problems such as heart disease, hypertension, type 2 diabetes, stroke, cancer, asthma, and osteoarthritis. The burden of obesity on the healthcare system is tremendous as billions of dollars are spent annually on prescription drug, emergency room and outpatient visit healthcare costs.

The Framingham study has demonstrated data that obesity rates have gone up 2% per  year and they project that by the year 2050, 42% of the US population could be obese. And that’s the best-case scenario.

Possible Theories for Climbing Obesity Rates
There are several theories that attempt to explain obesity and it's rise to "epidemic" status. Theories can range from obesity being the result of food purposefully manufactured to be addictive, to nutrient imbalances, to environmental, psychological, and genetic factors to name a few.

There has even been research done to investigate whether obesity is “contagious” or something that we can “catch”, similar to the flu or other infectious diseases. This research was centered on studies that have demonstrated those who have social connections to obese individuals are more likely to be obese themselves.

The reality is the cause of obesity is multi-factorial and there are likely many reasons for obesity with very individual considerations. While there are many factors that will raise one’s risk for obesity, it’s important to recognize one key factor in the prevention of obesity - the body is programmed to regulate body weight.

So how can Americans - who continue to get fat even with the increased prevalence of dieting – regain control over body weight regulation?

Get Moving!
Low energy expenditure and sedentary lifestyles are the cause of body weight dysregulation. Meaning, lack of exercise or low energy expenditure is the MAJOR limiting factor in the ability to properly control body weight.
Yes, nutrition makes a difference but we see athletes who eat poorly all the time without becoming obese. Why?

Their high activity level keeps body weight regulation tighter. Nutrition is important for energy balance and is responsible for physical change. However, no amount of calorie control will help until the genetic switch is turned “on” by appropriate levels of physical activity.
But who has time for all that exercise, right?

The most recent National Human Activity Pattern Survey and American Time Use Survey have found people watch, on average, 30-35 hours of TV per week or almost 5 hours a day! This is a drastic increase from 2007, as these surveys reported American’s watched 19.5-21 hours of TV per week or almost 3 hours a day on average.

Most Americans move too little! Period.

Put a Plan into Action
Here are some steps and strategies you can use to better regulate your bodyweight, fight the battle of the bulge, and reduce your risk of obesity:

• Build muscle with properly designed strength training and conditioning program. Incorporate regular, proper progression to encourage new stimuli and promote muscular and metabolic adaptations to fuel post-workout energy expenditure.
• Increase “non-exercise” physical activity. Simply put, sit less and move more. Get out for a walk, do some yard work, or ride a bike. Pick something you enjoy that gets you up and moving.
• Stay consistent with your nutrition and eating habits. Developing unhealthy or unsustainable nutritional habits can have disastrous consequences on your body’s body weight regulation. Avoid the tendency to "hop around" with your eating habits and change them based on what some celebrity or your friend is doing. Avoid extreme diets as these come with the risk of long-term overcompensations that can be challenging to change.
• Nutritional habits must be sustainable or they will not be successful. Sustainable actions produce optimum results. Your eating habits should be developed around practical application and science, not cookie-cutter planning or gimmicks. This is where individual considerations must be made and working with a professional has tremendous value.
• Sleep 7-9 hours each night. Sleep is an incredibly powerful tool in promoting an optimal hormonal environment for proper bodyweight regulation.
• Develop strong social support networks. Surround yourself with people who are like-minded and will support your health, fitness, and wellness goals.
• Realize you are responsible for you. Despite having the best training program or the best nutritional program or the best support network possible, you are ultimately in the driver’s seat and results will not come unless you put those plans into action. Commitment to consistent, sustainable action is the key. This is not an 20-day or 12-week fix. These are habits that are meant to last a lifetime. Recognize your responsibility and commit to it.

About the Author: Kristin Gallagher has a Bachelor of Science in Nutrition from Indiana University of Pennsylvania and is currently a first-year student in the Physician Assistant program at Baldwin Wallace University. She has a special interest in dermatology, food allergies, GI disorders, and understanding the role gut health plays in health and disease. This paper has been reproduced with her permission.
Over 2,500 years ago Hippocrates had stated that “all disease begins in the gut.” It has been in the last several decades that this connection has been explored in great detail and proven that the gut serves a much bigger role than just nutrient extraction. In fact, this topic has gained popularity especially within in the past couple years. There have been several connections established between the gut and the brain and the ways in which they communicate with one another through the nervous, immune and endocrine systems (Patel).

So the question becomes: how exactly does our gut microbiome influence our brain health? By controlling our gut microbiome, how exactly can we affect our brain health and in what ways?

This topic is of great interest because of the correlations found between certain conditions and how the microbiome influences the development of them. If what Hippocrates hypothesized is true, it is of the greatest importance for one to understand how exactly they can influence their own gut microbiome because of the clear correlation seen between the gut and the development of different diseases. This is of clinical significance because of the influence it can have on recommendations and treatment options for certain diseases. If you were given the option to increase the wealth of your future, wouldn’t you want to explore how?

The Pathways Established
First it is important to understand the mechanisms behind how the gut and the brain are believed to interact and communicate with one another. The biggest influence in their communication involves the permeability of the gut. It should be noted that activity between the two systems via the vagus nerve has also been acknowledged as an influence (Stilling). Intestinal permeability has been established as the most important factor influencing microbial interactions with the rest of the body. It has also been established that having normal gut microbiota is essential to prevent harmful bacteria from colonizing. When normal gut microbiota is changed, by antibiotic therapy for example, it is noted that this allows pathogenic organisms to colonize the gut epithelium which leads to toxin production and thus focal inflammation, causing an increase in gut permeability. So what happens when gut permeability increases? The increase leads to more gut bacteria being translocated across the intestinal wall, resulting in the activation of inflammatory cytokines and the vagal system, both of which modulate the activity of the central and enteric nervous systems. These systems control the development of our cognitive, emotional and behavioral processes which would make sense for the various abnormalities seen with abnormal gut microbiota. Increased permeability also leads to the translocation of metabolic products such as lipopolysaccharide (LPS) or neuroactive peptides, also affecting the activity of the central and enteric nervous systems (Yarandi).



So, how do we control gut permeability?

Research has revealed that a large influencer of gut permeability is stress, be it acute or chronic in nature (De Palma). It has been observed that stress reduces water secretion and increases ion secretion in the intestine, which affects the physical barrier of the gut. Stress not only directly affects the permeability of the gut but it also directly changes the content of the gut microbiota itself. Controlling stress, as well as other factors that have been seen to change gut permeability as well as the gut microbiota itself, may in fact directly control the extent of gut permeability (Stilling).

Additionally, it is important to understand how these changes are relayed to the brain. What serves as the communication between the gut and the brain? As stated earlier, it is under the influence of the vagus nerve but notably, the hypothalamic-pituitary-adrenal (HPA) axis is also a crucial pathway between the two. The HPA axis is a key stress regulatory system in the CNS and it is noted that gut microbes modulate the stress response and this pathway directly. Most of the studies regarding this pathway that have been completed up until this point have focused on using germ-free (GF) mice. What they have seen is that GF mice have an exaggerated HPA response to stress, but by injecting these mice with B. infantis, it corrects the abnormal response seen (Yarandi). From this information, the general understanding is that the content of our microbiota directly influences the integrity of our intestinal permeability and when this is affected, it allows for more influence of bacteria over the CNS and ENS thus establishing the relationship seen between our gut and our brain. Many other specific organisms, out of the 3.3 million non-human genes found in the human gut, have also been explored as well (Stilling).

The Importance of Infancy
Much of the literature on this topic looks at how the gut is influenced from birth. There are several environmental factors that have been associated with influencing the gut microbiome contents, these factors including: mode of delivery (vaginal or caesarean section), breast-feeding, diet, disease, status of the immune system, age, pharmacological treatments (especially antibiotics) and physical activity. There has been a noted correlation in that babies delivered by caesarean section, a number that has dramatically increased over the past several years, with an increase in autoimmune diseases and allergies being seen as well (Stilling). It has also been observed that babies not delivered vaginally also are seen to have a greater chance of developing allergies, asthma and diabetes later in life. Other findings noted include that breastfed babies show a decrease in harmful gut bacteria, such as Bifidobacterium, as compared to formula-fed babies. Studies reveal that formula-fed babies have an increase in harmful bacteria such as coliforms, Bacteroides and Clostridium difficile (Clarke). It is important to realize that the human intestinal tract is basically sterile at birth. It is then immediately colonized and exactly the way in which it is colonized is essential for the development of the baby. Maternal separation is also noted to play a role in inducing long-lasting hyperactivity of the HPA axis, increasing anxiety-like behavior, visceral hypersensitivity, intestinal permeability and altering the cholinergic activity in the gut (De Palma). Visceral hypersensitivity has been found to be correlated with irritable bowel syndrome and the administration of probiotic therapies has been shown to reverse this in animal and human trials (Stilling). The general idea is that when we are born, there is a window of opportunity for influencing the gut microbiota and that the presence or absence of any specific microbe during this window can have a notable, lasting effect (Yarandi).

The Diseases Correlated
With all this talk about the importance of the gut microbiota for normal pathway functioning and signaling, as well as how important it is in the first few years of life for our future leads us to the question: why should we care? There are a number of diseases that have been correlated with altered gut permeability and gut microbiota. With the increasing number of individuals being diagnosed with autism spectrum disorders (ASD), it is interesting to note the differences in the gut in these individuals as well. It is seen that they have abnormal gut microbiota (De Palma) as well as increases in bacteria from the Clostridium species and decreases in the Bacteroides species. It is postulated that this is why these patients often benefit from gluten free and casein free diets. It was also seen that ASD patients administered oral vancomycin, to help with their gastrointestinal (GI) issues, not only experienced a decrease in their GI symptoms but had an improvement in their autistic behavior as well (Yarandi). Other diseases that have been associated with abnormal gut microbiota include inflammatory bowel disease, irritable bowel syndrome, celiac disease, schizophrenia, depression, obesity, metabolic syndrome, anxiety, multiple sclerosis, Alzheimer’s disease and Parkinson’s disease (Foster). There are many specific bacterial associations seen in these different diseases but the foundation of each is dysbiosis, the disadvantageous alteration in microbial composition (Stilling). It is believed that dysbiotic changes in gut microbiota is what leads to disease states, behavioral changes, and changes in brain function (Foster). All of this poses a larger question as to the root of the problem; is it the changes in gut composition that cause diseases or the diseases that cause changes in the composition (Stilling)? The research still seeks to find an answer.

Conclusion
Of all the themes seen throughout the literature, these three were clearly the ones discussed the most. There are many more correlations seen and the evidence for them is still being built upon. The evidence stands clear that a diverse gut microbiome is beneficial to health and that changes in the microbiome directly affect behavior; the microbiome regulates nervous system development, our stress response, anxiety and appetite levels as well as our circadian rhythms. Clearly established in the literature is the obvious connection between the gut and the brain, making clear that a healthy microbiota is necessary to maintain a healthy nervous system (Mu).

Looking back to my question of inquiry, the literature proves that our gut microbiome does in fact influence our brain health as well as disease states and behavior. The research that has been done so far on this topic has just barely scratched the surface and further research on it is a necessity, especially honing in on studies in humans because most research up until now has been done utilizing mice and rats. There is much more to be said on this topic and I could only expose just the beginning of some of the findings to this date. This is just the beginning of a topic that holds a bright future for potentially changing medicine in a drastic way. Someday soon, we may be able to prove Hippocrates hypothesis to be true indeed – that all disease does in fact start in the gut.

Works Cited
Clarke, G., O'Mahony, S. M., Dinan, T. G., & Cryan, J. F. (2014). Priming for health: gut microbiota acquired in early life regulates physiology, brain and behaviour. Acta Paediatrica (Oslo, Norway: 1992), 103(8), 812-819. doi:10.1111/apa.12674
De Palma, G., Collins, S. M., Bercik, P., & Verdu, E. F. (2014). The microbiota-gut-brain axis in gastrointestinal disorders: stressed bugs, stressed brain or both?. The Journal Of Physiology, 592(14), 2989-2997. doi:10.1113/jphysiol.2014.273995
Foster, J. A., Lyte, M., Meyer, E., & Cryan, J. F. (2016). Gut Microbiota and Brain Function: An Evolving Field in Neuroscience. International Journal of Neuropsychopharmacology, 19(5), pyv114. http://doi.org/10.1093/ijnp/pyv114
Mu, C., Yang, Y., & Zhu, W. (2016). Gut Microbiota: The Brain Peacekeeper. Frontiers in Microbiology, 7, 345. http://doi.org/10.3389/fmicb.2016.00345
Patel, K. (2016). What have we learned about nutrition in the past 5 years? Retrieved November 13, 2016, from https://examine.com/nutrition/an-interesting-5-years/
Stilling, R. M., Dinan, T. G., & Cryan, J. F. (2014). Microbial genes, brain & behaviour - epigenetic regulation of the gut-brain axis. Genes, Brain, And Behavior, 13(1), 69-86. doi:10.1111/gbb.12109
Yarandi, S. S., Peterson, D. A., Treisman, G. J., Moran, T. H., & Pasricha, P. J. (2016). Modulatory Effects of Gut Microbiota on the Central Nervous System: How Gut Could Play a Role in Neuropsychiatric Health and Diseases. Journal of Neurogastroenterology and Motility, 22(2), 201–212. http://doi.org/10.5056/jnm15146
More related reading:

https://gallagherperformance.com/why-poor-recovery-will-make-you-sick-sad-and-weak/

“It’s cold season."

How many times have we heard that saying? Yes, we are approaching the time of year when most of us are more susceptible to coming down with a cold or the flu. But, I’ll let you in on a little secret – there is no “cold season”.

Rather than figuring out a strategy to keep our immune system working at it's peak potential, it's as if some of us just throw in the towel and accept that we will be sick, as if there is nothing we can do to prevent it.

Reality is we are constantly under attack by pathogens, viruses or bacteria that want to infect us. We are constantly exposed to pathogens and we are either winning or losing the battle. What is likely to blame for the “cold season” has more to do with what our body’s internal environment lacks than what is attacking us.

There's the saying, "An ounce of prevention is worth a pound of cure." I'm not saying cold season is completely preventable, but what I am trying to communicate is that we all can take steps to reduce our likelihood of getting sick and possibly prevent it.

Aside from proper exercise, nutrition, and lifestyle choices, what are some simple prevention steps you can take (any time of the year) to keep your immune system firing on all cylinders and help it win the battle against the "cold season"?

1) Sleep. The most powerful tool that you have to keep your immune system running high is sleep. Research demonstrates that lack of sleep compromises the immune system, thus predisposing you to sickness. There’s a reason why you sleep a lot when you are sick. Don't underestimate what proper sleep habits can do for your health. Are you getting enough sleep? Ask yourself the following questions:

• Do my eyelids feel heavy in the afternoon?
• Do I use caffeine as a “pick me up”?
• Do I sleep extra hours on the weekend?
• Do I fall asleep the minute my head hits the pillow?

November 11, 2016.

Veteran’s Day.

Today we recognize the selfless service and sacrifice of the men and women of our Armed Forces. It’s a day that should resonate with everyone in this country. Our veterans fought for the rights, privileges, and freedoms we take for granted everyday. For some, this day hits closer to home than others as we know loved ones who have served or are currently serving.

To all of you, we thank you for the service you have given to our country.

Veteran’s Day carries individual meaning as well. As for our family, this means reflecting on the service of our brother Joseph Anthony Bailey, currently serving the US Air Force in Aviano, Italy, our uncle Harry Eugene Fletcher, who served in the US Air Force during World War II, and grandfather, Harry William Getz, Jr., who served in the US Army during the Korean War. We are so proud of them and grateful to have such selfless individuals as part of our family as they felt the call to be of service to our country.

Today, I want to acknowledge our pap’s service as he passed away on August 18 and is no longer around for us to thank him. I’ve decided to write as a thank you to him. To honor and acknowledge not just his service, but also the man that he was and the impact he had on our family and those that knew him.

Pap was a very humble man, quiet and simple. He listened first before he spoke. He was patient as the day is long, but could be as stubborn as a Germans can be. Pap never finished high school. He wouldn’t be considered intelligent by the world’s standards, but he was smart. The kind of smart only life can teach you. Pap was a problem solver, possessing a mechanical mind that enabled him to fix just about anything.

I think this came from his work history. After his time in the military, pap owned his own service station, worked for the railroad and a tow service, and then eventually drove school bus for a local district before he retired. That just gives a glimpse of some of the trades he worked in during his time.

[caption id="attachment_2166" align="aligncenter" width="285"] Pap at his service station in East Liberty


He had simple tastes and interests. Some of the favorites he enjoyed were: old western movies, Clint Eastwood, country music, cereal, breakfast for dinner, root beer ice cubes, lemonade, listening to the rain, naps, any crunchy food, Pittsburgh sports, taking pride in his work, his faith and his family.

Pap loved cars. Whatever make or model he owned, he took care of it. Didn’t matter how beat up it was; he would fix it up with pride. He taught all his grandkids how to drive. But before we could drive, we had to learn about the car. We had to learn how to check fluid and oil levels, how to charge a dead battery, check and change an air filter, change a tire, check tire pressure, etc. These were prerequisites to driving. To him, driving was the easy part. Knowing the vehicle and proper maintenance of it was the key.

Pap loved sports. Loved the Pirates and the Steelers. But his first love grew to become hockey and it started with the Penguins. He started watching them in the mid 1980s, when they were awful and drafted some kid out of Montreal name Mario Lemieux. As a family, we are convinced he is the reason why all my brothers and sisters eventually played hockey. Pap started it. He bought my brother Matt and I our first pair of skates. Something I’ll always remember.

Hockey was just a small piece of the puzzle. Pap and gram came to as many of their grandkids events as they could. They rarely missed. No matter if it was on the stage, field, court, or ice. No matter if it was birthdays, holidays, or graduations. It didn’t matter; pap and gram were always there. They were always present and that was their greatest present to us.

Being present was easy for them because they both were givers by nature. Pap was always giving. Giving of his time and his resources. He did that for everyone. He never considered himself better than anyone. Pap had a unique ability to talk to a complete stranger as if he’d known them for years. You always felt welcomed around him and I think that had a lot to do with his childhood.

According to my mom, pap had a rough childhood growing up in Bay Head, New Jersey. The oldest of three boys, his mom died when he was 8 years old and it was a pain, as our mom would tell us, that never left him. His father was a good, but firm man who worked hard and instilled discipline and respect. All that said, pap grew up feeling he was never good enough. Never felt he had much to offer or was worthy of anything. He never felt deserving. People in his life didn’t think he would amount to anything, doubting he would accomplish much.

After his passing, it seemed to become clear to my family that pap’s self-image was probably a big reason why he was always so willing to help others. He truly didn’t think he was better than anyone. He felt people deserved his time and resources. He was always willing to serve, never expected anything in return, and preferred to stay in the background to avoid attention.

While people measure success or wealth by material standards,  Pap became more than rich in the thing that mattered most to him: his family. And he treated everyone he cared about as if they were family.

As for pap’s family, his father's work eventually brought him to the Homestead area of Pittsburgh. Not long after, he met his future wife Barbara. My gram says he chased her and chased her until she finally gave him a chance. That’s the only chance he would need. They eventually married February 14, 1953. Just three days later, he was shipped off to war and would be in Korea for 18 months.

I recall hearing that story for the first time when I was in high school, yet it took me several years to even get a ounce of a clue what they must have gone through as a newly married couple. I really had to step back in time and put myself in their shoes to fully appreciate what they went through to talk to each other.

Think about it. Think about the challenges of communicating. No international phone calls. No cell phones. No texting. No Internet. No Skype. No FaceTime. We are spoiled beyond belief with the ability to communicate with people around the world. They had none of it.

All they had was hand-written letters. That’s it!

What an awesome test. If the only way you had to communicate with someone was hand-written letters, for 18 months, would you do it? Would you send one everyday? Or would you throw in the towel and move on?

My pap wrote her a letter every single day he was in Korea. And gram wrote back, sealing every letter with a red lipstick kiss. He even included photographs of his time and gram ended up putting them all together in a scrapbook.

[caption id="attachment_2169" align="aligncenter" width="960"] The scrapbook of Pap's days in the Army


It’s no surprise their marriage lasted 63+ years. Their love and example has really showed our family something special through the years.

Learning about those letters was evidence enough to me that my pap was determined beyond belief to survive Korea and get back home. Realize he lived in a time that he didn’t have a choice. His generation had to go to war.

Through the years, he never spoke much about Korea and his experience. If asked, he would never go into details. However, during the final years of his life, he finally opened up about Korea.

War is brutal. My pap saw it first hand. When I say he saw it first hand, I mean he was in the hot zone. He was in combat, on the front lines. He saw his buddies die. He witnessed how shrapnel rips through human flesh. His stories of war so vivid, being able to describe all the sights, sounds, and smells. Like many veterans, these things stayed with him for life.

[caption id="attachment_2170" align="aligncenter" width="960"] Piece of shrapnel from Korea


Yet if you knew my pap you would never have known he was a veteran who had seen such horrors. That he lived in fear and doubt, everyday, for 18 months. He never let on to the deep wounds he carried after the war. At least to the grandkids. We never fully understood what he went through until the end of his life.

Pap never liked attention and would never bring attention to himself. When they would honor the veterans at church, he would never stand. That was just him. It wasn’t that he was making a statement. He simply viewed his service as his duty and that duty deserved no recognition. He viewed others as giving far more than he did, especially those that died. The fact that I’m writing this probably has him up in Heaven shaking his head.

While there are some that may argue what I’m writing would be more appropriate for Memorial Day, the truth is I’m writing this because, like every veteran, pap has a story that deserves to be told. Many of our veterans won’t tell their own story. They are too humble to bring attention to themselves. It’s not in their character. Our pap never brought attention to himself, but on this Veteran’s Day we are thanking him by bringing attention to his service, his life, and his legacy.

To Joe, Uncle Gene, Pap, and the veterans of the US Armed Forces, thank you for your service. It’s because of you that we truly live in the greatest country on Earth.



God Bless America.

Recently, Shannon Perrine of WTAE Channel 4 News in Pittsburgh featured a story on a patient of ours, Karla White. The focus of the story being Karla's same-day hip replacement surgery. It was a short, yet informative piece on the work of her surgeon and the rehabilitative process with special attention to the factors that played a role in a very successful outcome. If you have not seen the story, head to our Facebook page and check it out. All of our social media links are here on the website. You'll find them at the top of the page.

After the story aired yesterday, I had a number of thoughts that came to mind. Primarily these thoughts centered around how many medical professionals and the general public have a misunderstanding of the training and qualifications of chiropractors and strength & conditioning specialists. Especially as they relate to rehab, be it from injury or surgery. Many may find it unconventional and, at times, silly that one seeks out the professional help of a chiropractor or strength coach for the oversight of their rehabilitation.

Traditionally, once a patient is ready to begin post-surgical rehab, this process is guided by a physical therapist. It’s conventional thought and accepted practice.  You have surgery, then you go to physical therapy.

That said, there are post-surgical patients who will seek out a chiropractic rehabilitation specialist to manage their rehabilitation. And, depending upon the setting and patient, strength & conditioning specialists may be involved as well.

Now there may be a few thoughts running through your mind right now. Maybe thoughts such as:

“Wait….chiropractors aren’t qualified to do post-surgical rehab!”
“Why would you use a strength & conditioning specialist for a rehab patient? Those are only for athletes!”
This news story has opened up the opportunity to help educate, so let’s address these questions or concerns.

Are chiropractors qualified for post-surgical rehab?
The reality is, when patients seek a provider for their post-surgical rehab, they may choose to seek a professional who is not a physical therapist. Some may not have the flexibility to make their own decision, but for those patients are looking for the best person for the job and they will exercise their right to make that decision. Regardless of title (PT or DC), patients must be in the hands of a provider who has the professional training and expertise to handle their rehabilitation appropriately. Providers must be competent and efficient for the sake of minimizing post-surgical complications and improving outcomes.

I’ve highlighted this before in previous writings, but my residency truly provided professional training very few chiropractors ever receive. During my 3+ year residency, I managed or co-managed numerous spinal, shoulder, hand/wrist, hip, knee, and foot/ankle post-surgical rehabilitation programs. Our department at Palmer College of Chiropractic worked with local orthopedic and neuro surgeons to co-manage routine as well as highly complicated surgical cases within the Quad City area. Meaning, we saw everything from athletic injuries to total joint replacements.

I don’t stress this to simply pump my own tires, but to convey to our audience that I’m not new to post-surgical rehabilitation and there are chiropractors out there that have similar training and expertise as well. We don’t exist on the level of physical therapists nor are we claiming to be physical therapists. Physical therapists have their own unique training and skill set. The ones I know do outstanding work for their patients.

The point I’m trying to make is that it is possible for chiropractors to have a background in functional and post-surgical rehabilitation. These chiropractic rehabilitation specialists are qualified and are capable of successful post-surgical rehab outcomes.

What is the value of Strength & Conditioning during post-surgical rehab?
For all those that want to be evidence-based, exercise and strength training literally helps more musculoskeletal conditions that all other treatments. The same can be said of post-surgical rehab as it is all about regaining range of motion, strength, and functional capacity. If you have the privilege of having a knowledgeable and qualified strength & conditioning specialist in your corner, they will provide enormous value to the post-surgical recovery process.

Yes, the involvement of strength coaches may be more commonly used in the athletic world, within the collegiate, professional and international ranks. But, when available in the private sector, they add an immense advantage as the rehabilitative process is very time sensitive and it’s critically important no time is wasted. The more quickly a post-surgical patient can regain adequate strength and movement quality through gradual exposure to the functional demands of strength training, the more quickly they are able to return to their activities of daily living, job, or sport with confidence and minimal complication.

Strength coaches are experts in what almost all musculoskeletal conditions will benefit from: exercise and strength training. Keep in mind, they must have the appropriate qualifications. Not all strength coaches are created equal and those that are capable of being involved with a post-surgical patient are rare. I can't stress that enough. These professionals understand their role and the best results are seen when they work together with the rehabilitation specialist to ensure ideal outcomes for the patient.

Post-Surgical Rehab Success is All About Team
The success of the post-surgical rehab program is not solely dependent upon any one specific individual involved in the process. Successful post-surgical outcomes take on a team dynamic. In this case, the surgeon, rehabilitation specialist, strength & conditioning specialist, and patient all had critical roles.

The Surgeon
For Karla, she had a tremendous orthopedic surgeon in Dr. Julius Huebner. Due to a congenital condition and progressively worsening degenerative joint changes to the left hip, Karla underwent direct anterior approach total hip replacement in late May 2016. This surgical approach is essentially a “surgical strike” as described by Dr. Huebner in the video. His surgical procedure resulted in no damage to adjacent tissues and structures. The procedure was a precise as you can get, enabling same-day hip replacement surgery and a faster recovery.

The Rehabilitation and Strength & Conditioning Specialists
In preparation for her surgery, she worked with the team at Gallagher Performance during the months prior to her surgery to improve her post-surgical rehab outcomes. Her pre-surgery rehab program enabled Karla to remain as functional as possible during that time. Pre-surgical rehab programs are never easy and quite challenging. However, Karla is a tremendous patient who demonstrated nothing but commitment and patience, knowing that the work she did prior to surgery meant having that much less to do post-surgery.

Likewise, during the course of her post-surgical rehab program, Karla worked one-on-one with either myself or Ryan. I managed the early phases of her rehabilitation recovery, implementing manual therapy and exercise. This continued as she progressed to more strength training focus in her rehab. That's when Head Performance Coach, Ryan Gallagher, designed and implemented her strength & conditioning program.  The collaborative focus was on developing ideal movement patterns to spare her joints, thus improving the health and relative function of her legs, hips and spine. Exercise selection and progressions were based on post-surgical guidelines, tolerances, and functional capacity all while ensuring adequate strength and movement control were demonstrated.

The Patient
As for Karla, she was the ideal patient.  She was compliant and motivated throughout the entire process. Karla loves to be active and workout, which only added to her motivation. A motivated patient is so refreshing to work with for countless reasons. The rehabilitative process can be frustrating at times, with obstacles and ups-and-down marking the road. As challenging as rehab can be physically, rehab can be even more challenging mentally. To her credit, Karla was always willing to work, even when she was frustrated or progress was slow. She always worked hard and focused on the little details. It’s because of her attitude that she demonstrated and her drive to regain the quality of life she desired that she is where she is today.

Summing Up
The combined team effort was the key to the success of this post-surgical rehab story. This theme must be present to ensure a patient has the outcomes they desire. It’s a privilege to be involved, providing our services to complement the team effort required during the post-surgical process as we recognize our role in the rehabilitative process. We thank Dr. Huebner for his medical expertise, Karla for being outstanding to work with, and WTAE’s Shannon Perrine for her excellent coverage of the story.

At Gallagher Performance, our focus is on developing the resilience of our clients and patients. We are committed to utilizing cutting-edge, patient-focused progressions to help every individual we work with not only achieve but also exceed their goals. With our extensive training and knowledge in chiropractic, manual therapy, sports injuries, rehabilitation, and performance-based training, we work with all individuals who are interested in living healthy, active, and pain-free lives.

More related reading:

https://gallagherperformance.com/3-simple-steps-to-reduce-your-risk-of-sports-injuries/

Pittsburgh Award Program Honors the Achievement
Gallagher Performance has been selected for the 2016 Best of Pittsburgh Award in the Chiropractors category by the Pittsburgh Award Program and is among a very small group of businesses that have won the Best of Pittsburgh Award for three consecutive years.

Each year, the Pittsburgh Award Program identifies companies that we believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and our community. These exceptional companies help make the Pittsburgh area a great place to live, work and play.

Various sources of information were gathered and analyzed to choose the winners in each category. The 2016 Pittsburgh Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the Pittsburgh Award Program and data provided by third parties.

About Pittsburgh Award Program
The Pittsburgh Award Program is an annual awards program honoring the achievements and accomplishments of local businesses throughout the Pittsburgh area. Recognition is given to those companies that have shown the ability to use their best practices and implemented programs to generate competitive advantages and long-term value.

The Pittsburgh Award Program was established to recognize the best of local businesses in our community. Our organization works exclusively with local business owners, trade groups, professional associations and other business advertising and marketing groups. Our mission is to recognize the small business community's contributions to the U.S. economy.

SOURCE: Pittsburgh Award Program

As physical medicine becomes increasingly specialized, chiropractors and therapists must remain educated and capable of offering the highest quality in their professional services, knowledge, and examination abilities. Regardless of whether you are entrusted with the care of an athlete, chronic pain syndrome patient, or post-surgical rehabilitation, we have the job of reaching successful outcomes for each individual we encounter.

We must find their real source of pain, their true sources of dysfunction. Even if it means identifying sources others do not know exist.

We should be able to perform orthopedic, neurological, and also functional assessment to not only diagnosis problems, but also determine how to prevent any future problems.

One such country that has encouraged this level of thinking among it’s doctors and therapists is the Czech Republic.

The emergence of Czech ideas within the United States has grown over the last 15-20 years. My mentor and residency director, Dave Juehring, DC, DACRB, CSCS and director of the Sports Injury & Rehabilitation Department at Palmer College of Chiropractic in Davenport, IA has one of the most extensive backgrounds in Czech approaches to manual medicine and rehabilitation within the United States. In my opinion, there is no brighter mind in the chiropractic rehabilitation world. He may not be well known by industry standards, but those that know him know his knowledge and skill set is second to none.

The knowledge and expertise he is able to share with his residents, rehabilitation interns, and students has a profound impact on our professional development.

Among many lessons, he really has helped us understand the approach taken within the Czech School of Manual Medicine as well as the Prague Rehabilitation School. The intent of this article is to share some of this knowledge and highlight how these Czech methods can improve rehabilitation outcomes and athletic performance.

Alternative Thinking
The Czech School of Manual Medicine truly has revolutionized the management of musculoskeletal pain. Early in the 1950s, neurologists by the names Vladimir Janda, Karel Lewit, and Vaclav Vojta took a special interest in the rehabilitation of the motor (aka movement) system. As western medicine became progressively more technologically driven, Janda and Lewit focused on the value of manual approaches such as chiropractic, joint mobilizations, and neuromuscular rehab techniques, such as PIR (post isometric relaxation) as critical pieces of the rehabilitation plan. Janda was instrumental in the assessment of muscle imbalances, Lewit’s in joint dysfunctional. Vojta was instrumental in the discovery of global reflex locomotion patterns.

Collectively, their research focused on joint dysfunction, muscle imbalance, and the assessment of faulty movement patterns.

These concepts became components of identifying “Functional Pathology of the Motor System”. In other words, identifying why someone has developed pain or a movement related problem. In contrast to traditional medicine, which had a growing emphasis on medical imaging (X-rays, CT scans, MRIs) to identify structural pathology as the cause of pain.

Developing Ideas and Techniques
The work of Janda, Lewit, and Vojta influenced the work of Pavel Kolar and his work now represents a very innovative and powerful approach to how the central nervous system not only controls but expresses movement. This approach is known as Dynamic Neuromuscular Stabilization (DNS). The application of DNS has value from the neurologically impaired child to adults dealing with musculoskeletal pain to elite athletes. Kolar’s knowledge and skill set has landed him jobs with the Czech national teams in soccer, hockey, and tennis.

DNS has become highly effective in speeding recovery from injury, rehabilitate the body’s function as a unit, and enhance performance. Even the Czech President relies on his unique skill set. Kolar has worked with some of the world's best athletes, such as Jaromir Jagr, Roger Federer, and Novak Djokovic to name a few.

Thanks to the influence of these Czech clinicians, we are now able to look for predictable patterns of dysfunction within the human body and correlate them with pain or injury. It is in the Czech model we are able to piece together the clinical relevance of local, segmental joint treatments (mobilizations, manipulation), muscular imbalances, and central nervous system coordination of movement to optimize how the body functions and performs.

Read more on DNS here:

Dynamic Neuromuscular Stabilization: Advancing Therapy & Performance
The Hidden Causes of Sports Injury
https://gallagherperformance.com/chiropractic-rehab-dns-treatment/

https://gallagherperformance.com/sports-chiropractic-rehabilitation-massage-therapy/

In light of recent news from the Pittsburgh Penguins regarding Sidney Crosby sustaining another concussion during practice last Friday, the hockey community is a buzz. Crosby’s concussion history is well documented of recent, having sustained three in less than six years. Discussions and speculations of what this means for Crosby's season, and even career, are populating the Internet and sports talk shows.

Despite the advances in sports medicine as it relates to concussion diagnosis, management, and return to play guidelines, concussions remain a challenging condition for all involved.

The reality is concussions are truly challenging. Despite measures to "prevent concussions", concussions are not preventable. There is no such thing as concussion prevention. There is no single piece of equipment, be it a helmet or mouth guard, that is capable of preventing a concussion. Rather than prevention, the focus is on minimizing concussion rates through proper identification, management, and education.

Consider that within the United States, there are over 300,000 sport-related concussions per year and research suggests concussion rates are on the rise. If your child is in contact sports, there’s a risk of concussion. Thus making this is an extremely relevant conversation and one that shouldn't be taken lightly. That said, the goal of this article is to offer insights into what a concussion is, how they should be managed, and the chiropractors potential role in the process.

What is a concussion?
A concussion is a traumatic brain injury defined as a short-lived loss of brain function due to trauma that resolves spontaneously. With a concussion, there is no structural damage to the brain. Simply put, only brain function is altered.

Encased within the the skull, the brain floats in a pool of fluid, known as cerebrospinal fluid.  These protections allow the brain to withstand many of the minor injuries that occur in day-to-day life. However, if there is sufficient force to cause the brain to bounce against the bones of the skull, then there is potential for injury. It is the impact of the brain against the inside of the skull that cause the brain to be injured and interrupt its function. This impact is often due to rapid acceleration and deceleration movements of the head and neck. Rapid acceleration and deceleration of the head and neck can be created from a direct blow to the head or from impact that results in whiplash injury common in motor vehicle accidents and falls.

How are concussions diagnosed and treated?
First and foremost, anyone suspected of having a brain injury should seek evaluation by a neurologist trained in concussion evaluation.

The signs and symptoms of concussion may be obvious or very subtle. Most concussions are sustained without the individual losing consciousness or "blacking out". In several cases, the individual may not be aware they have sustained a concussion or may not connect their symptoms with a head injury. Complicating the picture is the fact that some individuals may have delayed onset of their symptoms, not presenting with concussion symptoms for several hours or days after the initial injury.

Typical symptoms of concussion include:

• Headache
• Difficulty concentrating or feeling “foggy”
• Poor recall or memory of recent events
• Changes in mood or personality
• Slower reaction times
• Dizziness, lightheadedness
• Nausea or vomiting
• Low tolerance of bright lights or loud sounds
• Irritability
• Changes in sleep patterns, such as being unable to sleep or sleeping more