Gallagher Performance Blog

FUNCTION IS AS REAL AS ANATOMY   The way our body functions is as real as our anatomy. There are some that like to act or state that " function" or "functional training" are fitness industry buzz words. They make light of the concept. And rightly so, as most of what is labeled  as "functional training" has very little to do...

According to research conducted by Dr. Stuart McGill, "People with back pain actually have stronger backs than people without back pain, so weakness is not the culprit." In our experience in both treating and training individuals suffering from low back pain, there are three common factors that seems to play a central role:

1) Breathing Pattern - of all the factors that play a role in back pain, breathing is the one that gets dismissed the easiest or patient's are quick to write-off as irrelevant. Truth of the matter is breathing plays a HUGE role. The diaphragm is our primary muscle for respiration AND serves as a deep stabilizer to the lumbar spine. If breathing is not normalized, no other movement in the human body can be. Breathing is that critical. Learning to properly breathing and integrate proper breathing into movement must be learned or else the rest of the stabilizing system of the spine will remain dysfunctional, continuing to contribute to pain.

2) Core Stability & Endurance - in order to build a resilient spine, the core must be stable and conditioned well enough to handle the demands of either daily living, exercise, or sport. The core does require higher levels of muscular endurance which must first be established before more specific qualities of strength or power can be trained. While training for endurance or strength, it's critical that one is aware of their core as it relates to static and dynamic postures in order to maintain stability that spares the joints and discs of the low back.

3) Hip Mobility - stiffness or tightness in the hips will ultimately result in more motion and stress being placed on the low back. The hips are designed for movement and when they get tight this will cause one to bend or twist too often in the low back region. Repetitive motions such as bending and twisting are commonly associated with low back pain. Simply put, the lower back is not designed for repetitive, excessive motion. Improving hip mobility will begin with proper breathing and the learned skill of proper core stability in posture and movement (do you see the theme here?) Then from there, specialized attention must be given to the musculature of the hips and core to correct imbalances and improve overall function.

To sum up - learn to breathe properly, stabilize the core, develop mobile/athletic hips.

 
More related reading:

https://www.gallagherperformance.com/blog/how-dns-solves-pain-and-improves-performance

https://www.gallagherperformance.com/blog/when-should-i-see-a-chiropractor
 
https://www.gallagherperformance.com/blog/3-ways-breathing-impacts-health-and-movement

https://www.gallagherperformance.com/blog/3-exercises-for-athletic-mobile-hips  

Just because you are in pain or injured does not mean you are fragile. Patient advice, education, and treatment that carries an over reliance on rest, ice, immobilization, and drugs only promotes fear-avoidance behaviors in patients - leaving them feeling fragile. What they need instead is graded exposure and reactivation to physical activity through movement re-education, strength training, and re-conditioning.

Research and clinical guidelines are consistently supporting exercise as THE number one intervention for back and joint pain.

Exercise provides the best long term outcomes. Sadly most people are never introduced to proper exercise for their back/joint pain OR would rather simply mask their pain symptoms with a drug, brace, tape, or some sort of passive modality yet they wonder why their pain continues to return.

These interventions have their merit, I'm not dismissing them as useless. However, when there is an over reliance upon these interventions without a shift in focus to graded exposure to physical activity through movement and exercise - it is easy to conclude why some people fail to get out of pain.

It's one thing to change pain, it's another to change how the body functions and impact the reasons WHY you developed pain in the first place. If you don't change function, this is the reason why patients relapse often.

Exercise become our gateway to change in the body. Exercise is treated like a drug in terms of dose and response. We need to dose (i.e. how much, what kinds, how often) exercise appropriately in order to get the ideal response (i.e. reduced pain, improved function).

Proper movement and smart exercise is the best medicine so let's dish it out!

You can accomplish more than you can imagine in just 15 minutes of daily, targeted exercise that is intelligently implement to address your weaknesses and eliminate your pain generators. Or the other option is to spend the majority of your day in pain, implementing questionable interventions that will do little to solve your problem in the long term.

Exercise should be viewed as a means to improve your quality of life. A means to make every day activities easier on your body. Or a means to improve function and therefore improving endurance, strength, power, and athleticism.

If you are ready to eliminate pain, erase weaknesses, improve how your body functions, or simply get in the best shape of your life - Gallagher Performance will get you on the right track to achieve those goals.

 
More related reading:

https://www.gallagherperformance.com/blog/a-powerful-innovative-approach-to-improving-how-the-body-functions

https://www.gallagherperformance.com/blog/tendinopathy-changing-treatment-and-improving-recovery

https://www.gallagherperformance.com/blog/how-movement-improves-brain-function

https://www.gallagherperformance.com/blog/how-dns-solves-pain-and-improves-performance


“I thought chiropractors only treated backs."  

This is one of the most common statements we hear in our office. Considering chiropractic is rooted in the treatment of the spine and that the majority of chiropractors treat spine-related conditions, this line of thinking is naturally expected.

However, at Gallagher Performance we do things differently. Gallagher Performance offers the latest in evidence-based treatment and hand-on care in the Murrysville, Monroeville, Plum, and surrounding Pittsburgh area. We treat more than just backs and necks. We treat a number of musculoskeletal conditions, such as:
  • Headaches
  • Migraines
  • TMJ
  • Shoulder pain
  • Rotator cuff injuries
  • Elbow pain (Golfer's Elbow and Tennis Elbow)
  • Tendinitis
  • Carpal Tunnel Syndrome
  • Hand and wrist pain
  • Hip pain
  • Piriformis Syndrome
  • IT Band Syndrome
  • Knee pain (Runner's Knee and Jumper's Knee)
  • Shin Splints
  • Plantar fasciitis
  • Ankle sprains
  • Nerve entrapments and compressions
  • Disc herniations
  • Sports Injuries
  • Post-Surgical rehabilitation
  • Prenatal and Postpartum care
  • and more

The Gallagher Performance Difference

Too often treatment precedes diagnosis. For far too many patients who are seeking care from a provider, treatment is often directed at delivering symptomatic relief without gaining a full clinical picture of why they are symptomatic in the first place. It's almost as if these providers deliver treatment goal of simply reducing or eliminating symptoms and that once absence of symptoms is achieved, the patient is free to return to activities as they were pre-injury status.

However, this model of treatment is why many patients are recurrently dealing with pain once they do return to activities.

For example, someone that works overhead or uses their arms all day (painter, drywall hanger, hair stylist, etc.) will more than likely run into shoulder impingement at some point in their professional careers.  An anti-inflammatory will help reduce pain. Getting a quick adjustment to the mid-back and cupping may provide a sense of relief in reduced muscular tension and improved range of motion, but what will really make a difference is making sure the muscles around the shoulder are doing their job to keep the joints stable and moving the way they’re supposed to. You see if proper function is not restored, pain will be quick to return because unnecessary stress is being placed on the shoulder joint. This unnecessary stress will eventually lead to injury.

Focus on The Root Cause, Not Symptoms

 
 

When it comes to many of the above musculoskeletal conditions, a trip to your primary care physician should probably not be your first stop. That's just being honest. Medical doctors have little training in the diagnosis of musculoskeletal conditions. This is generally why they simply prescribe anti-inflammatory medications, muscle relaxers, and tell you to go easy for few days.  Although this may enable your pain levels to reduce, it does not mean you are going to be problem free once you return to your activities. This is why making functional changes in the body is so important.

Again, this is why diagnosis is so important. Not only is it important to understand your sensitivities and what specific movements or activities you have pain with, but it's important to identify what is driving your pain. The driver of your pain is known as the root cause and, sometimes, the root cause of your pain is not in the same location as where you feel pain.

Once we identify what is driving your pain, then treatment is design to not only get you out of pain, but to also create the functional changes in your body to become more resilient so that pain does not return.

This is why we blend specific manual therapy, joint manipulation, and neuromuscular stabilization exercise progressions to improve control of movement and posture. If it’s a muscle or joint issue, we treat it. If it’s something we can’t treat, we’ll make sure you receive recommendations on the right specialist for your condition.
 
We want you to achieve your goals whether it’s getting back to work, sport, or just simply the activities you enjoy. Regardless of your goal, we pride ourselves on helping you achieve them as efficiently as possible.

Don’t let a joint or muscle injury stop you from reaching those goals. Let us help. After all, we take care of more than just backs.
 
[embed]https://www.youtube.com/watch?v=btwqe2CPW-M[/embed]

Contrary to what has been preached for years, it is now known that interventions such as rest, ice, anti-inflammatory medications and electrical stimulation will not solve the problem of tendinopathy. The application of these interventions was based upon the assumption that inflammation within connective tissue or joints was created by repetitive motions and sustained postures associated with labor, sport, or other forms of activity. However, this assumption has been proven to be wrong. New understanding of overuse injury is providing the foundation for treatment that truly addresses the root cause of your symptoms, not merely alleviating them.

New Understanding
We all know someone who has been told they have tendinitis, or inflammation of a tendon. Tendinitis is commonly referred to as an “overuse” injury.

Tendons are the structures that connect muscle to bone. They are critical in transmitting the force produced by muscles during movement. It was believed that tendons, when injured or over-stressed, became inflamed and painful. Inflammation is the body's natural response to injury. Inflammation begins the healing process. Applications such as rest, ice, and anti-inflammatory medication are prescribed to minimize the effects of inflammation.

Interesting thing is, research has demonstrated that inflammation is rarely present within tendons, thus providing a new understanding of how overuse injuries develop.

Back in 1979, a couple surgeons by the name of Robert P. Nirschl and Frank A. Pettrone examined sections of injured elbow tendons under a microscope. What they found was no presence of inflammation. None. What they did notice was how the tendons had degenerated. Their color and texture had changed. The tendons were grayish and swollen rather than white and soft.

No inflammation? No tendinitis. Tendinosis is the correct name for this condition. Tendinosis is the result of repeated or sustained muscular contraction associated with poor movement or posture, which decreases blood supply. The body begins to react in similar ways as if you had injured muscular tissue and scar tissue development is triggered. This would be a normal response if there were actual damage, but the body has been tricked. There is no injury, but scar tissue accumulates in healthy tissue due to compromised circulation. Accumulated scar tissue increases mechanical stress on tendons, limiting normal function of muscle contraction. Limited function means reduced strength, range of motion, and can lead to pain during activity.

Now that we understand the mechanism behind scar tissue production, the deeper question is, "What is the underlying reason for poor movement or poor posture that is responsible for the overload?" Because if the reason was simply just sustained postures or repetitive movements, wouldn’t we see more of the population coming down with overuse injuries?

Mobility vs Stability: Stabilizing the Confusion
Mobility seems to be the buzzword of the fitness industry and it’s certainly popular among certain camps within the physical medicine profession. There are plenty of products, assessments, and even entire workouts that are devoted to mobility. Some define mobility as the ability to achieve a certain posture or position, while others define it as the ability to achieve a certain range of motion specific to a movement (i.e. squat, push-up).

Advocates of mobility claim that mobility should be achieved first. We need mobility and lack of mobility is implicated as a predisposing factor for overuse injury. But is mobility the secret to preventing overuse injuries and unlocking athletic performance?

While mobility is important, if we consider the developmental model, stability should be the primary focus.

Enter the Developmental Model
Developmental kinesiology, or essentially understanding how we develop motor function through early childhood, emphasizes the existence of central movement patterns that are “hard-wired” from birth. For example, an infant does not need to be taught when and how to lift its head, roll over, reach, crawl, or walk. Each and every one of these movement patterns occurs automatically as the CNS matures. During this process of CNS maturation, the brain influences the development of stability before purposeful movement can occur.

The process begins with the coordination of spinal stabilization and breathing through what is known as the integrated spinal stabilizing system (ISSS). This constitutes the “deep core” and it is activated subconsciously before any purposeful movement. The musculature of the ISSS  contracts automatically under the control of the nervous system. The role of the ISSS is critical because it provides a fixed, stable base from which muscles can generate movement. The ISSS is essential to maintaining joints in a neutral position, thus maximizing muscular forces with minimal stress to structures such as ligaments, capsules, and cartilage.

Bottom line: Inadequate activation and stabilizing function of muscles may place greater stress within the body, compromising posture and movement. Mobility is DEPENDENT upon stability. You need stability first before you can achieve purposeful, efficient motion. A deficient stabilizing system is likely to lead to strain or overuse injury due to compensatory movements.

Managing Overuse Injury
Now that we have a better understanding of why scar tissue develops in the body and factors that contribute to poor movement and posture, its time to discuss what can be done in the treatment and prevention of overuse injuries.

#1 - Myofascial Release Techniques. Understanding that overuse injuries are most often degenerative scar tissue problems rather than inflammatory conditions, treatment strategies should change accordingly. Rest, ice, anti-inflammatory medication, and electrical stimulation are no longer ideal treatments. Treatment that involves myofascial release or soft-tissue manipulation becomes the focus in order to breakdown scar tissue and allow for normalized muscle/tendon function. Clinicians or therapists are able to locate scar tissue by touch. The hand is a powerful tool.  Characteristics they evaluate for may include abnormal texture, movement restriction, or increased tension. Treatment is often delivered by the hand or with the use of an instrument and is non-invasive in nature.

#2 - Improve the stabilization function of muscle. To ensure quality movement during functional activities or sport skill execution, it is critical that all stabilizers of the body are adequately activated. Insufficiency within certain muscles in the kinetic chain will result in muscular imbalances that can contribute to chronic pain or poor performance. Corrective stabilization strategies thus should always be the foundational concept of any training or rehabilitation program. Clinicians are beginning to recognize the importance of “training the brain” since the majority of motor dysfunctions may be more related to altered CNS function than local joint or muscle issues. The CNS is the “driver” and attention must be given to how it coordinates muscular patterns during movement in order to provide stability.

For example, if someone has difficulty performing a squat, rather than focusing on local “tight” or “weak” muscles or restricted movement in a specific joint, one may need to realize that the insufficiency is due to a dysfunctional ISSS pattern at the brain level.

Rather than focusing on mobilizing a tight glenohumeral capsule/joint and strengthening the rotator cuff musculature in the treatment of shoulder impingement in a baseball pitcher, should you focus on an inadequate ISSS and the "weak" link in the kinetic chain, such as poor dynamic scapular stability, proprioceptive deficits, or impaired lower extremity mobility.

The body functions as a single unit during complex movement, not in segments. The key is to maintain control, joint stability, and quality of movement. Every joint position depends on the coordination of stabilizing muscle function throughout the entire body. Through repetition, ideal stabilization patterns are achieved and then integrated in with sport-specific movements.

Patient Case (seen in video):
Presenting complaint of R Achilles pain during running and stiffness through the ankle upon waking or after prolonged sitting.

Finding of functional hallicus limitus on R (reduced big toe extension), R ankle dorsiflexion restriction, and lack of stability through the anterior oblique slings and R hip.

Treatment also included joint mobilization and manual soft tissue release not shown in video.

Address the cause, don't just address the site of symptoms.

 
More related reading:

https://gallagherperformance.com/tendinitis-changing-treatment-and-improving-recovery/

https://gallagherperformance.com/fascia_muscular-adhesions_how_they_relate-_to_pain_and_overuse_injuries/

https://gallagherperformance.com/makes-sports-rehabilitation-chiropractor/

https://gallagherperformance.com/dynamic-duo-chiropractic-dns/

https://gallagherperformance.com/structural-adaptations-how-they-impact-training-and-therapy/
Personal trainers or strength coaches don't have a license to diagnose, treat, or manage musculoskeletal conditions. Yet some are convinced they can play 'therapist' or 'doctor' on the regular.

While I do agree that it's important for coaches/trainers to understand pain and how to make appropriate modifications to an exercise plan based on a client/athlete's current limitations, it's completely inappropriate to give any level of medical advice. Just because you took a course or use correctives in your exercise plan, it does not put you on the level of a PT, DC, or MD regardless of your opinions of those professions.

For example, saw a patient who, for months, had been dealing with chronic knee pain. Yet her personal trainer convinced her it was no big deal and she needed to "pump blood into her knee" by exercising and that would heal her knee - only to be informed she has a torn meniscus. This kind of situation occurs more than you would believe and it's wrong.

Social media is littered with people such as this who present solutions to pain or specific physical ailments. They generically provide exercises or stretches for some common condition (low back pain, shoulder pain, knee pain). It's often just regurgitated information cause it's easy to copy.

Yet they know NOTHING about YOU, but assume to know you. This is wrong. People listen cause it's free advice and there is perceived authority. Sadly, a large social media following equals perceived authority in today's world.

They are providing 'treatment' in the form of exercises or stretches to relieve the pain they are 'diagnosing' you with. Some even goes as far as to discredit certain medical or rehab professionals. They say, "Don't listen to them." What they are really saying is, "Listen to me." Again, wrong.

No license? Don't listen to them. They aren't qualified.

Coaches and trainers - You want to wear a medical hat, then play by our rules. Go ahead and get yourself a professional degree and pass national or state licensure requirements. Until then, stay in your lane.

 
For more related reading:

https://gallagherperformance.com/pain-indicates-a-health-problem-not-a-fitness-problem/

https://gallagherperformance.com/5-reasons-not-skeptical-chiropractors/

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

https://gallagherperformance.com/beginners-guide-injury-recovery/

https://gallagherperformance.com/3-common-reasons-low-back-pain/

 
 
[embed]https://www.youtube.com/watch?v=v4DNb8Kl04Q[/embed]

Disc herniations and bulges can heal without surgery. Expert neurosurgeons will tell you the same thing. Yet why most elect for surgery is they never find conservative treatment that solves the problem.

We must identify the underlying reasons WHY the disc herniated or became sensitive. Often these reasons deal with improper movement and postures that overload the disc routinely. We get too focused on the event - the moment the back locked up and pain hit like a ton of bricks - and not enough focus is brought to the process that led to the injury.

With this patient, we had to focus on teaching sparing the spine while winding down sciatica symptoms in the right leg. Focus was also placed on flexion intolerance, reduced lumbar spine extension, and poor transverse plane stability of the lumbar spine and pelvis.

The combination of these interventions and pain education resulted in significant reduction of low back pain and near complete elimination of sciatica in TWO treatments.

The important thing to remember here is that while the total number of in office treatments was low, this patient was provided with the proper home instruction that enable him to make a dramatic impact on his pain and symptoms. Patients need to understand what is driving their pain. They need to understand how their postures, movements, and habits are either helping them or sabotaging their healing process. From here they can make the appropriate modifications and learn to problem solve their pain.

Sometimes you don't have to wait weeks or months for pain relief. Making lasting changes in the body is a different story. This can take a longer period of time with the correct inputs through repetition. And this is exactly why education and home care instruction is vital to patient success. Help them understand their pain and the recovery process.

 
For more related reading:

https://gallagherperformance.com/5-reasons-not-skeptical-chiropractors/

https://gallagherperformance.com/resetting-bodys-function-post-injury/

https://gallagherperformance.com/movement-that-enhances-performance-reduces-injury/

https://gallagherperformance.com/3-common-reasons-low-back-pain/

 
Our brain controls our posture and our muscles. Therefore posture and muscle tone (i.e. how tight or relaxed a muscle is) is an expression of the brain. We must pay attention to this expression and how it relates to movement.

A frequent cause of disturbance in our movement quality, why muscles get tight, why we display poor posture, and why we may have trigger points or pain is due to insufficient muscular stabilization of our spine.

Insufficiency is our stabilization system is exactly the reason why patients and athletes who have poor body awareness demonstrate poor ability to simply relaxation. Believe it or not, relaxation is easier said than done. If the brain doesn't know how to relax fully certain muscles, the low-grade state of contraction will keep muscles and surrounding joints under constant stress. This constant stress will ultimately lead to trigger points in muscles, dysfunctional movement patterns, and altered posture.

This is why specific exercise progressions that respect the developmental aspects of posture and movement are so critical. Exercise should not only address muscle function, but it must also address brain control to change how our body functions.

"Brain Education" focuses on the efficiency of our postural and movement control to avoid overloading of specific tissues and joints while promoting muscular balance.

Movement and relaxation is a skill. It must be practice daily through purposeful exercise with complete awareness to the feeling of the movement. This is the gateway to change in the body. These changes are valuable to anyone who is simply looking to get out of pain or improve their athletic ability.

However, there are still those that challenge the notion that there is an “ideal” or “good” posture. They will have you believe that there is no such thing as “good” or “bad” posture. The reality is, when it comes down to determining what is “good” or “bad” posture can be simply summed up by saying….”It depends.”

What will dictate “good” or “bad” when it comes to form or posture will depend upon a number of variables specific to the individual. We can find efficient form and ideal posture that someone should respect and when they don’t, the result is excessive wear and tear on their joints and tissues, leading to pain and progression of degenerative changes.

Yes we need to be efficient in movement and have a vast movement capacity. Yes there is no single posture that we should maintain for an extended period of time, no matter how “good” it is.

But those notions go out the window when our body meets increasing external resistance to our movement or we are performing movement at increasing speeds.

What does that mean?

Yes, we should be able to flex our spines and perform a body weight squat with posterior pelvic tilt (aka the dreaded “butt wink”) and resultant lumbar spine flexion. Yes this would be considered normal healthy human motion. But that doesn’t mean that one should perform a loaded barbell squat with the same intent or form. This could be an injury waiting to happen. When increased load or speed of movement comes into the picture (ex. barbell squat), very specific considerations must be made to that individual on the form and posture they express during the squat pattern to maximize their muscular efficiency and minimize stress placed on the joints.

These are the same considerations that must be respected when it comes to rehab and the subsequent development of fitness/physical ability. According to McGill, this breaks down into two stages:
  • Stabilization of the injury and reduction of pain by approaches that follow desensitization and healing.
  • Development of strength and physical ability only begins when the first stage has been achieved.
In order to desensitize the patient, we must promote postures and movement that minimize stress on the joints and injured tissues. Otherwise, as stated by Mosley, most people will “wind up” their nervous system as a way to over-protect because they are aren’t prepared for what they are asking their body to do. Desensitization and reducing perceived threat is critical in the first stage of healing.

Once pain is reduced, the development of specific fitness qualities can take center stage. This is when we address the complexity of the movement system. Panjabi established the importance of the passive, active, and neural systems for trunk/core stability and movement. Jull and Richardson found in voluntary movement, activity of the deep spinal muscles precedes activations of the superficial muscles (aka feed forward mechanism).

The integrated spinal stabilization system (ISSS) serves as the “feed forward stabilization mechanism”. The ISSS consists of the diaphragm, pelvic floor, all parts of the abdominal wall, short intersegmental spinal muscles, deep neck flexors, and serratus anterior.  We know that these muscles essentially form the “deep core” that is so important to train for efficiency of posture and movement.

The ISSS required “Brain Education” to work optimally. There is no way around it. We must focus our attention and efforts to ensuring that no matter the task, we must rely of the ISSS if we are going to realize our movement potential, maintain healthy posture, and minimize joint pain.

Don’t fall into the trap of believing someone who says “good” or “bad” posture doesn’t exist. Again the answer is it all depends. Posture and the considerations we make regarding it are always specific to the individual and task at hand. Posture shouldn’t handled in a general approach. Most rehab, training programs and online instruction is handled in an over-generalized fashion. When people need specific, when they need individualized considerations. And that’s the best approach when it comes to helping one learn how to educate their body in regards to what’s best for their posture and movement.

 
For more related reading:

https://gallagherperformance.com/movement-that-enhances-performance-reduces-injury/

https://gallagherperformance.com/a-movement-screen-will-never-show-movement-habits/

https://gallagherperformance.com/low_back_pain_causes_and_treatment_recommendations/

https://gallagherperformance.com/chiropractic-rehab-dns-treatment/

https://gallagherperformance.com/a-solution-to-headaches/

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

 
 
 
 
 
 
 
 
Movement gets a lot of hype these days and receives plenty of attention in the fitness industry, strength & conditioning industry, and rehabilitative fields. From movement screens to movement coaches, movement is a buzz word it seems some are simply trying to capitalize on.

Movement screens don't prevent injuries, they just give you information. What you do with that information is what matters. And do we really need all these screens to 'diagnose' what's wrong? Does someone suck at an overhead squat because they have tight ankles, weak glute medius, tight TFL, hip flexors, and lats? Or maybe because they are just simply uncoordinated? Because they don't understand the movement? You'd be surprised at how quickly movement expression can change with proper coaching of postures and technique. Watch what happens. Our brain has the ability to figure things out.


Coaches or therapists may provide an elaborate 'corrective exercise' program or 'activation' warmup, but what's the use when it's executed with poor quality of movement? Now you're just doing stuff that doesn't help. You could do a lot more with basic exercises that have a high quality of execution and movement competency. If all the focus is on "doing exercise" without the focus on the "feel of the movement", you're missing the boat.

Movement competency, injury prevention, and performance-based training are all linked. You can't separate them out. The best injury prevention methods are found in performance based applications. The best physical and athletic development models reduce injury. And both performance and prevention have a focus on movement efficiency or movement competency.

Performance and injury prevention boil down to how well do you express fundamental movement qualities. The best programs coach someone through movement so they feel and understand how to express higher levels of function/performance in exercise and sport.

Training and rehabilitation occur through movement, not simplistic exercises. Sadly that's what most people get. And that's why they don't progress, why they have pain, or why they relapse.

 
For more related reading:

https://gallagherperformance.com/movement-that-enhances-performance-reduces-injury/

https://gallagherperformance.com/the-hidden-causes-of-sports-injury/

https://gallagherperformance.com/technique_and_performance/

https://gallagherperformance.com/athleticism-requires-more-than-just-strength-speed/

https://gallagherperformance.com/a-few-words-on-athletic-development/

https://gallagherperformance.com/learn-how-to-spot-the-fitness-frauds/

https://gallagherperformance.com/a-movement-screen-will-never-show-movement-habits/

 
There is no question that knee injuries are a common occurrence among athletes. The incident of devasting knee injury, such as ACL tears, has been on the rise for years. Once considered an adult injury, ACL tears are occurring more often in children as reported by orthopedic specialists, estimating that thousands of children and teens suffer an ACL injury each year. According to statistics presented at the American Academy of Pediatrics 2011 annual meeting, over the past decade youth ACL injuries have increased 400% and girls are at eight times the risk of an ACL tear as compared to boys. Clearly, there is a problem with knee injuries among youth athletes. But where is the solution?

Mechanism of Injury and Risk Factors
To identify a solution, we must first identify the problem. In this case, the problem is the mechanism(s) of injury most commonly associated with ACL injury. Keep in mind that about 2/3 of all ACL injuries are non-contacted related. Meaning, the athlete didn’t have someone tackle them or have a player roll-up on their leg, resulting in injury. Non-contact injury opens the door to the possibility that a large percentage of ACL injuries can be reduced or prevented. Here are the most common mechanisms of injury associated with ACL injury:
  • Jumping/landing improperly
  • Planting followed by cutting or pivoting
  • Straight-knee landing
  • Stopping or landing with the knee hyperextended (too straight)
  • Sudden deceleration of movement
As far as risk factors are concerned, there have been several identified as having an association with ACL injuries, such as:
  • Weak hamstring and gluteal (hip) muscles
  • Poor neuromuscular control and balance
  • Poor dynamic biomechanics (Jumping, landing, cutting, etc.)
  • Fatigue
  • Female Gender
It is important that all risk factors be evaluated for how they play into an athlete’s risk of knee injury. Currently, there are movement screens available to help in identifying what potential risk factors may predispose an athlete to increased risk of ACL injury. Although these can prove to be valuable, one cannot underestimate the importance of simply watching an athlete move outside of a controlled environment. This means keeping an observant eye on them during training or practice and stressing them to see how their movement changes. You may be surprised by how much you learn about the physical abilities of that athlete from just simple observation.

Understanding the Female Athlete
Now that we have identified some mechanisms of injury and risk factors, we will turn our attention temporarily to the female athlete since they have their own special considerations in preventing ACL injuries. While researchers are continuing to study and gain understanding of the possible causes that may place young females at an increase risk of injury, a number of factors specific to female anatomy and development have been the focus of attention.

Female Hip and Knee Anatomy
Despite many young female athletes experiencing pain in their knees, the root of some of the problem may actually originate in the pelvis/hip structure. There is a growing trend among sports medicine specialists who focus on the pelvis/hip to reduce the incidence of knee pain and injury.

According to the Women’s Health and Fitness Guide (2006), the female pelvis has a number of differences as compared to the male pelvis for the purpose of accommodating childbirth. Among those differences, the female pelvis has a greater forward tilt and more forward facing hip joints.  These features of the female pelvis/hip result in the femur (thigh bone) being positioned with more of an inward angle and internal rotation at the knee as compared to the average male. It is this increased angle of the femur when compared to the vertical position of the tibia (shin bone). This anatomical difference is known as the "Q-angle" and is illustrated below.



What does all this mean? SImply put, it means the female knee is predisposed to having unfavorable forces placed on it and that the core, hip, and thigh musculature must be strong enough to compensate for the increased angle of the femur to the tibia, or else the female athlete may be at a higher risk for experiencing knee pain or injury.

What can be done?
Unfortunately, regardless of gender, there is no such thing as complete injury prevention. However, there are reasonable and appropriate steps that have been implement in programs that are successful in reducing the occurrence of knee pain and ACL injuries:
  1. Improve hamstring strength. The hamstring muscles have a critical role in maintaining healthy knees. Proper hamstring training and strengthening must take into consideration how the hamstrings function during the primary sporting movement(s). For example, land-based sports with an emphasis on jumping and sprinting ability will place a high demand on the hip extension action of the hamstring. The hamstrings must be trained accordingly to be able to meet and accommodate the forces generated during sport.
  2. Improve hip and core strength. The musculature of the core and hips have a tremendous amount of control on the pelvis and femur, and thus the knee. Poor hip control puts the knee in compromising positions, increasing the risk of injury. When the core and hips are weak, they needs to be a focus of treatment/exercises. This will serve to improve the stability of the knee.
  3. Improve Proprioception (Balance) and Neuromuscular Control. Sufficient proprioception and neuromuscular control is the difference between being able to ride a bike and falling on your butt every time you get on a bike. Understand that altered proprioception and neuromuscular control contribute to abnormal motion during dynamic sporting activities, such as cutting and jumping/landing. One study revealed, “Improved joint mechanics during landing were achieved regardless of the individual’s muscle strength, suggesting that strength may not always be a prerequisite for movement re-education.”  This should demonstrate the importance that mental focus and repetitive use of proper movement has on correcting mechanics.
  4. Decrease fatigue. There are 2 types of fatigue, peripheral (muscles) and central (brain).  Peripheral refers to exercise induced processes leading to decreased force production (typical muscle fatigue).  Central fatigue relates to a gradual exercise-induced reduction in voluntary muscle activation. Essentially meaning the brain gets fatigued. It is plausible to say injury comes from both, however from an injury prevention stand point; peripheral fatigue is difficult to manage because your muscles will get fatigued.  But targeted training of central fatigue might be the way to go in preventing injury. How does one train central control. As one study put it, “Exposure to more complex or cognitively demanding movement tasks may facilitate improved perception and decision making within the random sports environment.” This is were mental focus and developing an athlete's awareness of their body during drills becomes important. Mental imagery may prove beneficial in developing central control by utilizing “mental reps” to help engrain proper movement and ideal mechanics.
References:
  1. Powers  CM, Souza RB. Differences in Hip Kinematics, Muscle Strength, and Muscle Activation Between Subjects With and Without Patellofemoral Pain. J Ortho Sports Physical Thearpy. 2009;39(1):12-19.
  2. Powers CM. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. J Orthop Sports Phys Ther. 2010;40(2):42-51. http://www.jospt.org/issues/articleID.2396,type.2/article_detail.asp.
  3. Heiderscheit B. Lower Extremity Injuries: Is It Just About Hip Strength? J Ortho Sports Phys Ther. 2010;40(2):39-41. http://www.jospt.org/issues/articleID.2404,type.2/article_detail.asp.
  4. Mizner R, Kawaguchi J, Chmielewski T. Muscle Strength in the Lower Extremity Does Not Predict Postinstruction Improvements in the Landing Patterns of Female Athletes. J Orthop Sports Phys Ther. 2008;38(6):353-361. http://www.jospt.org/issues/articleID.1408,type.2/article_detail.asp.
  5. McLean SG, et al. Impact of Fatigue on Gender-Based High-Risk Landing Strategies. Medicine & Science in Sports & Exercise. October 2006.
  6. McLean SG. Fatigue-Induced ACL Injury Risk Stems from a Degradation in Central Control. Medicine & Science in Sports & Exercise. January 2009.
  7. Hilgefort M, Winchester B. Preventing ACL Injuries in Female Athletes.
 
 
Let’s start off with illustrating a scenario that may sound familiar to many of you:

As an athlete or someone who simply enjoys being active, you put in plenty of hours working out, training, practicing and competing.  Whether it’s running, jumping, throwing, swimming, skating, shooting, or swinging, you slowly begin to notice some minor irritation in a joint or muscle. It could be a knee, a shoulder, back, quad muscle, groin, foot, wrist, or your rotator cuff. You sense things don’t feel right, but you convince yourself it’s nothing serious. After all, it may be a little painful during activity and goes away quickly when you are done. Plus, you got an important game, match, or race coming up and you can’t afford to take any down time.

You decide to put conventional wisdom into practice and take it easy, resting as much as possible. You ice the area. After all, it’s what we have been told to do for years. You may even take it a step further and do some stretches to bring some relief to the area. If the pain is bad enough, you may reach for medication to help take the edge off.

However, over the course of weeks or months, you begin to notice this pattern occurring more frequency as your pain persists. It’s got you puzzled. Now your pain is not just present during training or sport, but you notice it with everyday tasks such as walking or opening doors. You could shrug off the pain before, but now pain during simple tasks has your attention. You may now be getting concerned since it’s not only taking less to cause pain, but your pain may be getting more intense. You may even start to avoid certain activities.

What you are learning and beginning to realize is that despite the efforts to ease your pain, your symptoms persist and are getting worse. Despite rest, ice, and medication, your symptoms are not improving.

Change the Approach
Contrary to what has been preached for years, it is now known that interventions such as rest, ice, anti-inflammatory medications and electrical stimulation will not solve your problem. The application of these interventions was based upon the assumption that inflammation within connective tissue or joints was created by repetitive motions and sustained postures associated with labor, sport, or other forms of activity. However, this assumption has been proven to be wrong. New understanding of overuse injury is providing the foundation for treatment that truly addresses the root cause of your symptoms, not merely alleviating them.

New Understanding
We all know someone who has been told they have tendinitis, or inflammation of a tendon. Tendinitis is commonly referred to as an “overuse” injury.

Tendons are the structures that connect muscle to bone. They are critical in transmitting the force produced by muscles during movement. It was believed that tendons, when injured or over-stressed, became inflamed and painful. Inflammation is the body's natural response to injury. Inflammation begins the healing process. Applications such as rest, ice, and anti-inflammatory medication are prescribed to minimize the effects of inflammation.

Interesting thing is, research has demonstrated that inflammation is rarely present within tendons, thus providing a new understanding of how overuse injuries develop.

Back in 1979, a couple surgeons by the name of Robert P. Nirschl and Frank A. Pettrone examined sections of injured elbow tendons under a microscope. What they found was no presence of inflammation. None. What they did notice was how the tendons had degenerated. Their color and texture had changed. The tendons were grayish and swollen rather than white and soft.

No inflammation? No tendinitis. Tendinosis is the correct name for this condition. Tendinosis is the result of repeated or sustained muscular contraction associated with poor movement or posture, which decreases blood supply. The body begins to react in similar ways as if you had injured muscular tissue and scar tissue development is triggered. This would be a normal response if there were actual damage, but the body has been tricked. There is no injury, but scar tissue accumulates in healthy tissue due to compromised circulation. Accumulated scar tissue increases mechanical stress on tendons, limiting normal function of muscle contraction. Limited function means reduced strength, range of motion, and can lead to pain during activity.

Now that we understand the mechanism behind scar tissue production, the deeper question is, "What is the underlying reason for poor movement or poor posture that is responsible for the overload?" Because if the reason was simply just sustained postures or repetitive movements, wouldn’t we see more of the population coming down with overuse injuries?

Mobility vs Stability: Stabilizing the Confusion
Mobility seems to be the buzzword of the fitness industry and it’s certainly popular among certain camps within the physical medicine profession. There are plenty of products, assessments, and even entire workouts that are devoted to mobility. Some define mobility as the ability to achieve a certain posture or position, while others define it as the ability to achieve a certain range of motion specific to a movement (i.e. squat, push-up).

Advocates of mobility claim that mobility should be achieved first. We need mobility and lack of mobility is implicated as a predisposing factor for overuse injury. But is mobility the secret to preventing overuse injuries and unlocking athletic performance?

While mobility is important, if we consider the developmental model, stability should be the primary focus.

Enter the Developmental Model
Developmental kinesiology, or essentially understanding how we develop motor function through early childhood, emphasizes the existence of central movement patterns that are “hard-wired” from birth. For example, an infant does not need to be taught when and how to lift its head, roll over, reach, crawl, or walk. Each and every one of these movement patterns occurs automatically as the CNS matures. During this process of CNS maturation, the brain influences the development of stability before purposeful movement can occur.

The process begins with the coordination of spinal stabilization and breathing through what is known as the integrated spinal stabilizing system (ISSS). This constitutes the “deep core” and it is activated subconsciously before any purposeful movement. The musculature of the ISSS  contracts automatically under the control of the nervous system. The role of the ISSS is critical because it provides a fixed, stable base from which muscles can generate movement. The ISSS is essential to maintaining joints in a neutral position, thus maximizing muscular forces with minimal stress to structures such as ligaments, capsules, and cartilage.

Bottom line: Inadequate activation and stabilizing function of muscles may place greater stress within the body, compromising posture and movement. Mobility is DEPENDENT upon stability. You need stability first before you can achieve purposeful, efficient motion. A deficient stabilizing system is likely to lead to strain or overuse injury due to compensatory movements.

Managing Overuse Injury
Now that we have a better understanding of why scar tissue develops in the body and factors that contribute to poor movement and posture, its time to discuss what can be done in the treatment and prevention of overuse injuries.

#1 - Myofascial Release Techniques. Understanding that overuse injuries are most often degenerative scar tissue problems rather than inflammatory conditions, treatment strategies should change accordingly. Rest, ice, anti-inflammatory medication, and electrical stimulation are no longer ideal treatments. Treatment that involves myofascial release or soft-tissue manipulation becomes the focus in order to breakdown scar tissue and allow for normalized muscle/tendon function. Clinicians or therapists are able to locate scar tissue by touch. The hand is a powerful tool.  Characteristics they evaluate for may include abnormal texture, movement restriction, or increased tension. Treatment is often delivered by the hand or with the use of an instrument and is non-invasive in nature.

#2 - Improve the stabilization function of muscle. To ensure quality movement during functional activities or sport skill execution, it is critical that all stabilizers of the body are adequately activated. Insufficiency within certain muscles in the kinetic chain will result in muscular imbalances that can contribute to chronic pain or poor performance. Corrective stabilization strategies thus should always be the foundational concept of any training or rehabilitation program. Clinicians are beginning to recognize the importance of “training the brain” since the majority of motor dysfunctions may be more related to altered CNS function than local joint or muscle issues. The CNS is the “driver” and attention must be given to how it coordinates muscular patterns during movement in order to provide stability.

For example, if someone has difficulty performing a squat, rather than focusing on local “tight” or “weak” muscles or restricted movement in a specific joint, one may need to realize that the insufficiency is due to a dysfunctional ISSS pattern at the brain level.

Rather than focusing on mobilizing a tight glenohumeral capsule/joint and strengthening the rotator cuff musculature in the treatment of shoulder impingement in a baseball pitcher, should you focus on an inadequate ISSS and the "weak" link in the kinetic chain, such as poor dynamic scapular stability, proprioceptive deficits, or impaired lower extremity mobility.

The body functions as a single unit during complex movement, not in segments. The key is to maintain control, joint stability, and quality of movement. Every joint position depends on the coordination of stabilizing muscle function throughout the entire body. Through repetition, ideal stabilization patterns are achieved and then integrated in with sport-specific movements.

Conclusion

New information has provided a deeper understanding of how overuse injuries develop and led to improved treatment. These concepts are foundational to the patient-care and sports performance training clients receive at Gallagher Performance. Myofascial release techniques can help offset the build-up of scar tissue within tendons or muscles, promoting normal function of those tissues. Ultimately, the ability to coordinate and control precise movement will minimize stress on the body and the trigger for scar tissue development. Developmental kinesiology provides a method for both assessment and the training or rehabilitation of muscular stabilization as it relates to efficient movement. The combination of these approaches not only reduces the risk of injury and pain syndromes resulting from overuse, but impacts sport performance.

Sources:
Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J. Biomech. 1999a;32(1):13-17.
Hagins M, Lamberg EM. Individuals with low back pain breathe differently than healthy individuals during a lifting task. J Orthop Sports Phys Ther. 2011;41:141-146.
Janda V. Muscles; central nervous regulation and back problems. In Korr IM (ed). Neurobiological mechanisms in manipulative therapy. Plunum Press, New York, 1978, pp 27-41.
Janda V. Muscles and motor control in cervicogenic disorders. In: Grant R (ed). Physical therapy of the cervical and thoracic spine. 1st edition. Churchill Livingstone, Edinburgh. 1994, pp 195-215.
Kibler WB. The role of the scapula in athletic shoulder function. AM J Sports Med. 1998;26(2):325-336.
Kolar P, Sulc J, Kyncl M, Sanda J, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):352-62.
Kolar P. Facilitation of Agonist-Antagonist Co-activation by Reflex Stimulation Methods. In: Craig Liebenson: Rehabiliation of the Spine – A Practioner’s Manual. Lippincott Williams & Wilkins, 2nd edition 2006, 531-565.
McGill SM, Grenier S, Kavcic N, et al. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003;13(4):353-359.
Page P, Frank C, Lardner R: Assessment & Treatment of Muscle Imbalances. The Janda Approach. Human Kinetics. 2010.
Panjabi MM. The stabilizing function of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-9.
Panjabi MM. The stabilizing function of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5(4):390-6.
Schlottz-Christensen B, Mooney V, Azad S, et al. The Role of Active Release Manual Therapy for Upper Extremity Overuse Syndromes: A Preliminary Report. J of Occup Rehab. 1999;9(3).
 
 
GP recently interviewed Mike O'Donnell DC, CCSP, CSCS. Dr. Mike and his wife, Jessica, run Back in Action Chiropractic located in Fort Wayne, IN. Not only do they provide expert understanding of chiropractic and rehabilitative care, they also bring to the table the unique insight as highly accomplished strength athletes. Simply put, their accomplishments would take up an entire blog post. It's rare to find a clinician and staff not only capable of identifying with athletes and addressing their needs appropriately, but also able to apply these same concepts to improve outcomes for patients. I had the privilege of being classmates with Mike during our chiropractic education at Palmer College in Davenport, IA. Once I got the understanding of Mike's background as both a strength athlete and coach, I knew he would be an invaluable resource not only in my training as an aspiring strength athlete, but in my clinical development as well. My brother and I are truly fortunate to have him and Jess as friends and mentors.

Now on with the interview.

GP: Provide our readers with some information about your background as an athlete, competitive powerlifter and strength coach.
MO: The day after 7th grade football ended I began lifting in my basement. I competed in my first powerlifting meet when I was 15 and won the ADFPA teen nationals that same year. Through high school I played football and was team captain. To train for football I simply did more speed and plyometric work. As a high school and junior lifter, I won six national titles and went to the IPF Junior Worlds, taking the bronze in my last year, 1999. I competed against many lifters who are regarded as the best in the sport today. I have lifted in the USAPL Open Nationals several times. As an undergrad at Western Michigan I studied Exercise Science. This did not include enough sport science to make me happy, so I did tons of research on my own. After my bachelor degree I worked under Buddy Morris at Pitt for a short time. That was a great learning experience. Eventually I decided to go get my DC degree and learn much more about chiropractic and rehabilitation.

GP: You are well educated on the training methodologies utilized in the former Soviet Union and Eastern Bloc countries. Could you explain briefly how those methodologies differ from North American approaches and the impact it has on athletic development here in the United States?
MO: In North America, athletes start playing a sport as unprepared youth with no background in general conditioning. This isn't always true, but we have no system to condition young athletes besides just playing the sport. In an Eastern model, camps are held without a sport focus to condition young athletes, and the specialization comes later. In general, early specialization is a mistake. This has been proven to limit progress, lead to early burnout, and increase injury rate.

GP: You have worked with athletes of all ages and abilities. In your opinion, where are we still falling short in the development of athletes in America?
MO: We fall short in several ways. Early level coaches (high school and below) often have poor qualifications. Also athletes are eager to maximize their results as early as possible. This leads to poor skill development. It is extremely difficult for athletes to unlearn poor habits or a poor work ethic. All too often young athletes look to non-training means (i.e. drugs) for improvement as well.

GP: What would you identify as the fundamental components of effective and efficient programming for athletes?
MO: Once good general preparation is established, the programming should be as specific as possible. Factors like frequency, work load and intensity vary from athlete to athlete and at different phases of training. Weaknesses should be assessed constantly and addressed, but focus should never be taken off the sport form. Overall, one should train as often as possibly but remain as fresh as possible. The programming should never compromise technique.

GP: One common theme you’ll see among trainers/coaches is very little thought that is given to the order of exercise selection/variation during a training plan. It’s almost as if many trainers just ‘make-up’ workouts. Give us your thoughts on the importance of organization of training for athletes?
MO: Organization of training and exercise selection expertise are prerequisites to training anyone. Entire teams should not all be performing the same training. This would assume the entire team has the same deficiencies. There are way too many under qualified "strength coaches" and trainers out there. Even some of the highly regarded strength coaches or online trainers are a joke. This is why I personally have no tolerance for movements and training styles that are fad- based. Put some thought into what you, or your athletes, really need and address it in your training. Further, organizing training should be an ongoing process. There are no perfect programs. Just phases or training blocks. On the other hand, there are some coaches that over coach their lifters/athletes. They are so worried about their own role in the athlete's development that the athlete cannot focus on their performance, or maybe the training isn't being attacked with the mentality that it should be.

GP: What do you see as the most common mistakes coaches and trainers are making in the preparation of athletes?
MO: The most common mistakes - the coach who tries to be the athlete's friend (not hard on them); poor analysis of training needs and the current state of the athlete; and the most important aspect in my opinion (this goes for anyone seeking a great PT, DC, manual therapist or strength coach) is that the coach cannot identify with the athlete because they weren't an athlete themselves. I know several above average coaches that are held back my the mere fact that their athletes cannot identify with them. Either they weren't athletes at all, or they are an unimpressive presence altogether!

GP: What are the qualities and attributes that athletes and parents should look for in a trainer/strength coach before investing in their services?
MO: Sporting background and accomplishments, educational background and accomplishments, and clinical competence, methods, and track record. Period. Anything less, and I am skeptical about what I am getting. I don't care who has the best DVD!

GP: How has the background as a competitive strength athlete and strength coach benefited you as a chiropractor and your ability to manage patients from acute stage to reactivation through active care?
MO: This is a great question, because I tell people that ask that I use my training, coaching, and professional background everyday when treating patients. My philosophy in the clinic is the more accurate the assessment, the more accurately I can apply your treatment, whether its passive or active care. As the phases of care progress, it's important to know what type of care or movements to change to. This assessment or "eye for the deficiency" can take years to develop. Today there are systems and seminars to attend and learn these analytical methods, but learning this way can lead to a lot of limitation and misunderstanding. I would advise students, whether they are professional level yet or not, to use the gym as your lab. Lift and learn!!!

That's a Wrap
Mike, thank you for taking the time to answer our questions. Your knowledge and insight is truly appreciated. We always learn something from you and hope our readers learned something as well. For anyone in the Fort Wayne area, be sure to check out Back in Action Chiropractic for the best results when it comes to your health or sport-related goals.
Similar to a growing number of athletic facilities across the US, Gallagher Performance places a significant amount of emphasis on assessing our athletes in order to address structural adaptations and movement dysfunctions appropriately during the course of the athlete’s training program. This trend is seen throughout collegiate and professional athletics as organizations are recognizing the importance of keeping their athletes healthy by promoting optimal training environments.

However, this service is rarely available to young athletes prior to sport participation or a training program. This is truly unfortunate since proper screening of athletes is not available when it arguably matters most, during the early stages of athletic development. Dr. Mike O’Donnell DC, CCSP, CSCS touched on this concept in a recent interview. He states,
“In North America, athletes start playing a sport as unprepared youth with no background in general conditioning. This isn’t always true, but we have no system to condition young athletes besides just playing the sport. In an Eastern model, camps are held without a sport focus to condition young athletes, and the specialization comes later. In general, early specialization is a mistake. This has been proven to limit progress, lead to early burnout, and increase injury rate.”
Certainly in an ideal situation, young athletes would be introduced to general conditioning prior to sport participation. Likewise, prior to the initiation of a general conditioning program and/or sport participation, young athletes should be screened to provide an understanding of any structural adaptations that will require individualized considerations to ensure continual progress in the pursuit of achieving athletic mastery and minimize the risk of serious injury.

Structural Adaptations: How Common Are They?
There are numerous studies suggesting that the majority of people in the general population, especially athletes, have developed various forms of structural adaptations. What are structural adaptations? Essentially they are alterations in the anatomical structure of the body due to repeated physical stresses placed upon joints and connective tissue. These adaptations often occur during the developmental years. Keep in mind, structural adaptations are not pathological in nature, but certainly require their own unique management strategies since they will impact movement mechanics and potentially be a reason for movement dysfunction. It is also important to understand that not all individuals with structural adaptations will present with symptoms, such as pain. In fact, the majority of them will not present with pain.

Below are just some of the findings from a growing collection of evidence that suggests how frequently structural adaptations may occur:
  • 79% of asymptomatic professional baseball pitchers have evidence of shoulder labrum abnormalities on MRI.
  • 40% of dominant shoulders in asymptomatic tennis and baseball players had evidence of partial or full-thickness rotator cuff tears on MRI.
  • 34% of asymptomatic individuals in the general population had evidence of rotator cuff tears. 54% of those 60 years of age and older had evidence of rotator cuff tears - so if you’re dealing with older adults, you could safely assume they are present in almost half of this population.
  • Recent research has demonstrated that high school baseball pitchers from southern, warm weather climates have decreased shoulder internal rotation range of motion and external rotation strength compared to northern, cold weather climate players. This is likely attributed to adaptation from the number of months spent participating in pitching activities during the calendar year.
  • 64% of asymptomatic people that underwent an MRI of their lumbar region had abnormal findings. Keep in mind these are individuals with evidence of lumbar disc pathology (i.e. bulge or herniation) who have NO symptoms and NO pain.
  • 93% of youth hockey players age 16-19 have evidence of femoroacetabular impingement (FAI) and hip labral tears. FAI is the result of bony overgrowth found at the femoral head and/or acetabulum of the pelvis. FAI has been linked to increased risk of injury for osteitis pubis and sports hernias.
  • 77% NCAA D1 and professional hockey players evaluated in one study had abnormal hip/groin MRI despite being asymptomatic. Hockey players are also more likely to have a structural change known in the hip known as hip retroversion, which allows for greater hip external rotation and reduces the degree of hip internal rotation.
  • 87% of 125 NFL prospects had findings consistent with FAI on MRI. The only independent predictor of groin pain was the degree of bony overgrowth.
  • Evidence suggests that roughly 25% of men in the general population have some degree of FAI despite being asymptomatic.
Conclusion
Structural adaptations are clearly a common occurrence both in athletes as well as the general population. The impact these adaptations have on movement cannot and should not be ignored. For example, individuals with FAI will experience varying degrees of limited hip flexion range of motion. This limitation in hip flexion will impact exercises such as squats, lunges, and other considerations in lower body training methods. If this limitation is ignored or missed, it can have potentially serious implications such as the development of labral tears or lumbar disc injury due to compensations in movement through the hips, pelvis and lumbar spine.

The key point to recognize is the presence of such adaptations have their own unique impacts on posture and movement that influence the design and outcomes of both training and treatment plans. Training programs need to take these issues into account, making considerations for differences in gender, age, level of physical preparation, primary sport(s) participation, and injury history. While some structural adaptations can be impacted by corrective strategies, others simply need to be accounted for in exercise selection and movement education in order to avoid causing them to reach symptom threshold.

References
  1. Miniaci et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):66-73.
  2. Connor et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7. 
  3. Sher et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-15.
  4. Jensen et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73.
  5. Kaplan et al. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med. 2011 Feb;39(2):320-328. 
  6. Birmingham et al. The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012, 40(5), 1113-1118.
  7. Philippon et al. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013, 41(6), 1357-1362.
  8. Silvis et al. High Prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011, 39(4), 715-721.
  9. Larson et al. Increasing alpha angle is predictive of athletic-related “hip” and “groin” pain in collegiate national football league prospects. Arthroscopy. 2013, 29(3), 405-410. 
  10. Hack et al. Prevalence of cam-type femoracetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010, 92(14), 2436-2444.
 
 
 
Athletic performance is a developmental process, one that ideally involves the integrated efforts of coaches/trainers and therapists in order to maximize results. This is often a complete paradigm shift for many of our athletes and their parents. Unfortunately being focused on short-term results over long-term development is hurting athletes more than it will ever benefit them.

After some recent conversations with our athletes and their parents about the importance of understanding the integrated approach taken to athletic development at GP, we thought we'd provide our readers with a few recommendations. Our hope is that these recommendations help guide the decision making process for young aspiring athletes when it comes to selecting who oversees their training and why an integrated approach may just be what they need.
  1. The ‘watchful’ eye of a coach/trainer and therapist is an invaluable asset to athletic development. This is a skill set that many athletes are unfortunately never exposed to. The ability to identify mechanical faults and implement collaborative strategies between coach and therapist to correct these faults sets the stage for reaching athletic mastery while minimizing injury risk. The ‘eye’ for mechanical faults is one thing, knowing how to manage and correct them is an entirely different story. Athletes require an individual(s) competent in both.
  2. Physical limitations due to anatomical/structural changes and motor control/technical deficiencies require different management strategies in an athlete’s programming. It is the job of the coach/trainer and therapist to recognize this difference. This should be a prerequisite when considering the services you are about to invest in. If they don't understand these concepts, that should be a red flag. Developing movement efficiency is arguably the best way to simultaneously enhance sport performance and reduce injury risk. Understanding how to manage physical limitations will directly impact movement efficiency and athleticism.
  3. When injury occurs, integrated models for “rehab” are better than medically driven models. This of course is dependent on the level and experience of both the coach/trainer and therapist involved. Ideally the athlete’s recovery process utilizes exercises and drills within a modified training program. This serves to minimize time away from the field or weight room and maximize technical improvement of sport-related skills. Dysfunctions of the musculoskeletal system can also be addressed through performance therapy. For more reading on performance therapy, check out this article.
These recommendations are by no means a comprehensive list. When considering the appropriate path for an athlete's development, there can be several factors to keep in mind at any one time. However, these tips cover several of the basic essentials when it comes to improving an athlete's performance while keeping them healthy.

The model used at Gallagher Performance isn't used solely for our athletes. A number of our patients and training clientele have benefited tremendously from experiencing how we integrate training and therapy. We use this model to optimize health and performance while getting to the root of many chronic pain problems. It's why we have adopted the tag line "Experience the Difference".

If you think the model of training and therapy at Gallagher Performance is for you, give our office a call at (724) 875-2657 and Experience the Difference.

 
 
In our previous article, Structural Adaptations – Not Just An Athlete’s Problem, we discussed structural adaptations and why they must be accounted for in both training and treatment plans. Clearly, structural adaptations have impacts from a sports performance and clinical perspective.  With that in mind, prior to treatment, our goal is to not simply assess from a structural standpoint, but to also assess functional capacity to determine if there is a functional capacity deficit (i.e. endurance, strength, balance, reactivity, dynamic posture control). It is my job as a clinician to choose the most appropriate evaluations to identify functional deficits. I choose not to limit my evaluations to x-rays or imaging and finding structural abnormalities. It should be evident that treatment based on the findings of imaging alone is flawed when you consider the enormous amount of false positive rates in asymptomatic people. This is why I couple structural evaluation with a functional evaluation that looks at motor patterns or movement, not just isolated joint range of motion or strength.

As a chiropractor, I tend to go against traditional approaches in how much attention I give to static body alignment compared to most of my peers. Reason being is that often times a patient can look a certain way (i.e. “dysfunctional”) in a static stance, but when asked to perform a skill, they nail it. This can be especially true of athletes. What I was able to learn over and over again during the course of my residency is that if someone can’t perform a certain movement (i.e. squat), it may be more practical to coach or educate them on better movement (i.e. motor learning) prior to isolating and treating joint or mobility “dysfunctions”. The reality is, if a patient or athlete is performing a new or unfamiliar movement, sometimes they simply lack the skill to execute it in an ideal fashion. This is the prime reason why I find functional evaluations invaluable in determining the best course of treatment.

When it comes to functional capacity, the assessment is intended to identify the relevant functional deficit of that patient. What is relevant to that patient will depend on their history. What areas are bothering them? What does their injury history tell you? What activities have they been involved in that have provided accumulated stress or strain to their body? This can provide insight into the adaptations or compensations patients may exhibit. As for athletes, it is important to remember: the higher level the athlete, the better they are at compensating. Despite being asymptomatic, those compensations will eventually catch up to them and become symptomatic. This will not only impact performance, but injury risk and longevity as well.

Once a functional capacity deficit is identified, the process of treatment can begin. For example, poor stabilization patterns during movement are a common functional deficit. Whether it is lack of stability during everyday tasks such as walking, carrying, lifting, etc., or sport-related skills such as kicking, throwing, sprinting or jumping, it’s important to understand that the functional capacity of each of these activities has different demands as it relates to stability. Our approach must be tailored to match the stabilization demands in order to normalize movement patterns and improve the load-bearing capacity of tissues involved. This is the goal of treatment. Perfection of movement is not the goal. Arguably, perfect movement does not exist. Consider elite athletes who practice their skills all day, consistently, year after year. Are they perfect with their movement 100% of the time? No. Movement has far too many variables to achieve perfection. The goal is better movement coupled with increased tissue capacity to better withstand overloads when movement goes awry.

As a chiropractor, I possess a license to manipulate and improve the function of the neuromusculoskeletal (NMS) system. I prescribe what I feel is necessary for treatment, whether it is joint manipulation, soft tissue/massage therapy, or exercise prescription. When it comes to the management of the clients and athletes here at GP, we perform functional evaluations prior to all training programs and chiropractic treatment. But the evaluation process does not end on day one. Evaluation is a continual process, from session to session. This is vital to monitor for improvement and knowing when to adapt the current training or treatment plan. Continual functional evaluation enables us to handle physical ailments appropriately when they occur. This is just part of the process of our Integrated Approach. It’s important to understand the rationale for a prescribed course of action. Thus giving both chiropractic and training services a better understanding of what to do for each individual to maximize results. So from a treatment perspective, it really isn’t just about knowing how to manipulate or perform ‘active release’ on muscles. Far too often people may know what they do; they may know why they do what they do; but do they actually understand the effects of what they just did? As a clinician, it’s important to understand the effects of the treatment you just provided and the reasons why they were provided.

Summing it All Up
Functional assessments provided at GP help to identify the most necessary intervention or treatment. It helps to identify the root cause of your symptoms and enables you to function better. Structural evaluations can be valuable, but functional evaluations should not be overlooked. There is important information to be gained from both. If you are experiencing unresolved issues such as joint pain, muscle tightness, or limitation in performing specific sport-related or daily activities, consider seeking out a clinician in your area who is credible and offers functional evaluations as part of their services.

 
[embed]https://www.youtube.com/watch?v=HKaJauyaDoc[/embed]

Introducting the Best Hip Exercise You’re Not Doing - Half Kneeling to Heel Sitting

For all you glute and booty fanatics, nothing beats properly performed squats, deadlifts, lunges, and RDLs for glutes that not only look great but work even better.

Problem is most people don’t perform the big exercises well and therefore resort to ways to “activate” or better “isolate” glute function. This is why hip thrusts, clam shells, and so on exist. They can all have their place when used with a plan and purpose.

From DNS we bring you a great drill to learn how to properly load the glutes, improve hip rotational mobility, and restore ideal function between the hips and torso. Introducing half kneeling to tall sitting.

Don’t underestimate this drill. It’s much more challenging than it looks. If you can perform this with control and precision of movement and posture, congrats you have beautifully functioning hips. For those that have challenges with it, be patient and focus on feeling the movement performed correctly. You want to feel the glute and vastus medialis of the quad working together through the movement.

Is this a real struggle for you? Plug this drill into your regular training routine. Follow the advice in the video. Perform it on the regular and watch how it not only helps your strength and movement improve but also gets rid of unwanted muscle tightness or pain in the low back, hips, and knees.

 
For more related reading:

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

https://gallagherperformance.com/3-exercises-athletic-mobile-hips/

https://gallagherperformance.com/resetting-bodys-function-post-injury/

https://gallagherperformance.com/movement-that-enhances-performance-reduces-injury/

https://gallagherperformance.com/exercise-hacks-ep-15-fix-tight-hips-and-improve-athleticism-with-lateral-movement/
[embed]https://youtu.be/zG7_oNLY8jg[/embed]

Sensory Motor Training

SMT is a targeted approach to training the proprioceptive system and it’s pathways involved with the control of equilibrium and posture.

SMT is used to train the upright posture of the body with the emphasis placed on ideal posture during dynamic stability.

Benefits of SMT:

1️⃣ Increases speed of activation of muscle

2️⃣ Improves muscle coordination

3️⃣ Improves pelvic stability through the increased activation of the trunk and gluteal muscles

4️⃣ Improves foot function when ideal foot loading and posture is maintained

 
Indications for SMT (sub acute patients and performance training considerations):

✅ Post-injury or post-operative

✅ Chronic back or neck pain

✅ Faulty posture with respiratory dysfunction

✅ General hypermobility or instability

✅ Postpartum muscle imbalance

✅ Prevention of falls in senior populations

✅ General physical preparation or fitness

SMT has a wide range of applications and is traditionally trained through 1-leg balance drills, wobble boards, rocker boards, balance sandals, and mini trampolines. All tools we use regularly at GP.

Here we demonstrate a couple advanced variations which incorporate anti-rotational stressors via bands or kettlebells which only take muscular coordination and dynamic stability challenge to another level.

Source: Rehabilitation of the Spine by Liebenson

 
For more related reading:

https://gallagherperformance.com/pain-indicates-a-health-problem-not-a-fitness-problem/

https://gallagherperformance.com/a-solution-to-headaches/

https://gallagherperformance.com/exercise-choose-consistency-over-intensity/

https://gallagherperformance.com/maintaining-health-athleticism-over-the-long-run/

https://gallagherperformance.com/chiropractic-rehab-dns-treatment/
One of my favorite quotes I’ve heard. Period.

Identification and treatment of muscular trigger points is often a common therapeutic intervention of physical therapists, massage therapists, chiropractors, and other physical medicine providers. There’s an entire industry of products devoted to enabling people to work on their triggers points at home or at the gym. Clearly trigger points and muscular pain is a problem that many struggle with and yet never seem to resolve despite their own best efforts.

The bigger question many people ask is why. “Why do I have that trigger point?” Yes treatment of triggers points is valuable, but often the trigger point is a result of a poor functioning muscular and joint system. This is the why. Left unaddressed, poor function will continue to drive the presence of trigger points.

Trigger points arguably present to help stabilize our body and prevent unnecessary load or stress to tissues or joints that could potentially result in injury.

This is why we must evaluate for and restore proper joint function and proper movement function. Otherwise we have our answer to the recurrent presence of trigger points.

What this means is that resolution of trigger points is best treated with a combination of manual massage therapy/release techniques, chiropractic manipulative therapy when indicated, and restoring proper movement/posture habits to our body. Simply rolling on a foam ball is not enough. Sure you may get relief, but given enough time, that trigger point will return if not treated more comprehensively.

If you’re spinning your wheels why you can’t get out of pain or get rid of tight muscles, you need to identify the gaps in your approach because something is being missed that is driving those symptoms.

Looking for answers and a more comprehensive approach to helping you get out of pain? Give our office a call at (724) 519-2833.

 
For more related reading:

https://gallagherperformance.com/exercise-hacks-ep-11-train-abdominal-slings-functional-core/

https://gallagherperformance.com/a-movement-screen-will-never-show-movement-habits/

https://gallagherperformance.com/posture-movement-require-brain-education/

https://gallagherperformance.com/low_back_pain_causes_and_treatment_recommendations/

https://gallagherperformance.com/movement-that-enhances-performance-reduces-injury/
Yes it sounds extreme, but it could be our reality. If healthcare spending continues to increase at its current rate, It is estimated that by the year 2040 that 100% of the federal budget will go towards Medicare and Medicaid. That's 100% - meaning no money for anything else.

According to the latest CDC report, 1 in 2 American adults have a chronic disease and 1 in 4 have multiple chronic diseases. Roughly 40% of adults and 20% of adolescents are obese. 30% of children have a chronic disease, up from 13% in 1994. These numbers represent a massive burden to not only to our healthcare system, but our country.

We know that 100 million Americans are prediabetic or have Type 2 diabetes. That's 1/3 of the population. And 88% of people who are prediabetic don't know they are. Now consider the average cost of treating an individual with Type 2 diabetes is $14,000. When you do the math the numbers are staggering beyond belief - and it's only for diabetes!

There is no sustainable way to pay for the rising costs associated with the treatment of chronic disease. It's a major issue that needs to come to forefront of serious conversation with the realization of the personal responsibility we all need to assume in the prevention of these diseases.

Yes they are preventable and no the reason is not just your genetics. 85% of disease risk comes from behavioral and environmental factors while only 15% is related to genetic factors. Meaning the vast majority of chronic disease risk factors are under our control and there needs to be an emphasis on this point.

The solution must have a primary focus on prevention and reversal of disease rather than merely suppressing symptoms. We need to take control of our behaviors as they relate to our lifestyle choices. Choices such as getting adequate physical activity/exercise, nutrition, sleep, and stress management become the real medicine because they have THE biggest impact on our health. And there needs to be more personal responsibility assumed in these areas.

If you won't do it for yourself, do it for America.

 
For more related reading:

https://gallagherperformance.com/receiving-value-treatment-training/

https://gallagherperformance.com/stop-chasing-shortcuts/
There's a major flaw in the fitness industry - the ignorance of movement quality at the expense of fitness goals.

How far can you run? How fast can you complete this workout? How much can you lift? How many reps can you do? How hard are you willing to push yourself?

What fitness has driven us to believe is that these are the true measures of progress and physical fitness. Yet there is little attention paid to how well we move and how important that is to our health and fitness.

Yes we must progressively challenge the body in order for it to change and adapt. Yes higher intensity exercise is associated with greater improvements in health and fitness markers. Yes if you want to push your body to higher levels of performance you are going to feel it. But at what expense?

Are we willing to prioritize fitness goals over the health of our spine and joints?

There is an old Chinese proverb that says "You are as old as your spine." There is a lot of truth in this statement. There are plenty of people in their 20s and 30s who have stiff and painful backs that make them feel much older than they really are. Likewise, there are those in their senior years who feel great and have less physical limitation than people half their age.

When we focus on movement and the posture associated with movement, our bodies follow suit. Our muscles work more efficiently and our joints are spared. Movement becomes healing and therapeutic rather than damaging.

When we prioritize movement, we can progressively train harder by being smarter. We promote fitness as well as longevity of our spine and joints. When we chase goals and numbers at the expense of movement quality, we find ourselves nursing injuries that interrupt progress. We end up with joints that are beat up, stiff, and painful.

If you don't focus on the details of your movement now, you'll likely be forced to focus on them later. This is the difference between training for performance and rehab. Movement that enhances performance also reduces injury. Don't ignore the importance of movement quality. It may just make or break your fitness goals.

 
For more related reading:

https://gallagherperformance.com/dynamic-duo-chiropractic-dns/

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

https://gallagherperformance.com/understanding-methods-application-training-rehab/

https://gallagherperformance.com/ultimate-runners-guide-to-injury-prevention/

 
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Contact

  • 4484 William Penn Highway

  • Murrysville, PA 15668

Hours of Operation

  • CHIROPRACTIC
    Monday-Thursday: 9am-1pm, 3pm-6pm
    Friday: 9am-1pm, 3pm-5pm
    Saturday: by appointment only
  • MASSAGE & TRAINING
    Hours are by appointment only