Gallagher Performance Blog

"After an injury tissues heal, but muscles learn. They readily develop habits of guarding that outlast the injury" - Janet Travell, MD
Guarding after an injury is normal and it is to be expected. However, when left unidentified and untreated, guarding or protective patterns can become common reasons for chronicity and why someone "hasn't got better". This is why we must go beyond structural injury and think function in treatment rehabilitation.

From the functional viewpoint, we must evaluate for these guarding patterns that patients readily default to due to injury/pain.  Identifying and treating these guarding patterns appropriately will often times enable patients to feel better almost immediately.

While yes it is important to evaluate for structural injury (fracture, dislocation, ligament sprains, tendinopathies, disc herniations, etc.) and manage them accordingly, the reality is these tissues will heal in time. However, after these injuries heal, there can be presentations within the body that create complications in achieving full recovery or become reasons for relapse.

Often times patients will complain about tight calves and hamstrings after spraining an ankle or tightness in their low back and hips after a disc rupture. Or they may have developed pain and/or sensitivities in other areas of their body seemingly unrelated to their initial site of injury.

The ankle ligaments will heal. The disc will heal. But the body will guard and protect and this becomes programmed within the nervous system. This is exactly what we need to treat for patients to get better and this new reality becomes very liberating for patients.

When patients come to understand that their injury has healed, but it's their brain and muscles that must re-learn how to work as they did before the injury, they become less fearful and more confident in a positive outcome. Essentially, they come to understand that we must reset their body so their neuromuscular function returns to pre-injury status.

To reset the right things in the body, we must assess and analyze the problem then utilize corrective measures in treatment and/or training. This system helps us develop efficiency in treatment and enables us to expect results.

What type of corrective measures? The gold standard becomes manual therapy and therapeutic exercise. When combined, these serve to get patients out of pain and improve the function in their body.

Yes these results can often times be rather immediate, however in some cases recovery can test a patient's patience as the process may be slower than they aniticipated.

When progress is slow, it is important to remember the following:
  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.
When patients understand that guarding is normal, that we must reset and improve their body's function and they understand the process, they in turn are very likely to experience a positive outcome.

More related reading:

https://gallagherperformance.com/the-importance-of-functional-evaluation/
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.
More related reading:

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

https://gallagherperformance.com/dynamic-neuromuscular-stabilization-advancing-therapy-performance/

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

https://gallagherperformance.com/solving-pain-influence-czech-rehabilitation-techniques/
[embed]https://www.youtube.com/watch?v=5m32gpo5AG4[/embed]

In this short video we discuss a commonly performed exercise in some group exercise or fitness classes as well as sport performance training programs - the pistol squat.

The pistol squat is a challenging exercise. For some it is a competitive exercise and one that they must train and improve.

However, what if you aren't training to compete in an event that includes pistol squats? What if you are training for general fitness or sport performance and want a better alternative? An alternative that will build great single-leg strength and control, and have better transfer to improving athleticism, speed, all while keeping the joints healthier?

Enter the skater squat.

You see for many people, the pistol squat can contribute to unnecessary compressive forces on the spine and hips that can lead to pain and movement intolerances. This is an unwanted result of training or exercise. Who wants to spend weeks working out only to takes weeks off due to pain or injury?

And these reasons are exactly why the skater squat becomes a better alternative to the pistol squat. You get a uniquely challenging single-leg exercise that builds strength, is more friendly to the spine and hips, and more closely mimics the dynamics of running, sprinting and skating.

As always, Gallagher Performance is here to answer your questions when it comes to exercise, rehabilitation, chiropractic, and sport performance. Watch the video to learn more.

More related reading:

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

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

https://gallagherperformance.com/solution-long-term-improvement-back-pain/

https://gallagherperformance.com/advanced-training-for-elite-athletes/
In the spirit of fall, school back in session, and the start of the competitive season for many sports, we thought we'd run a little referral contest.

I mean who doesn't love a little competition?

The next time a friend, family member or co-worker is looking for quality in chiropractic, rehabilitation, massage therapy, or personal/sports performance training, please tell them about Gallagher Performance.

We're committed to providing the highest quality in our services so all our patients and clients have an experience they are proud to share.

So thank you for your referrals as they are the greatest compliment our business can receive. It just so happens that by the end of September 2017, your referral efforts may just earn you a $150 Sheetz gift card!

Referral Contest Rules:
  • Contest runs from September 1, 2017 to September 30, 2017.
  • There is no limit to the number of times a name can be entered.
  • Referrals and reviews must occur during the time of the contest as stated above.
  • Individual with the most entries (combination of referrals and reviews) will receive a $150 Sheetz gift card.
  • Winner will be announced October 1, 2017.


 
 
Scoliosis.

The diagnosis can make anyone uneasy and it can become even more unnerving for parents when they hear that diagnosis for a child. Scoliosis in children between the ages of 10-18 years of age is termed adolescent scoliosis and can be due to many causes. But the most common type of scoliosis in the adolescent period is one in which the cause is unknown and is called adolescent idiopathic scoliosis (AIS). The reason why it is called idiopathic scoliosis is because there are currently no identifiable reasons as to why scoliosis develops in these children.

When we consider the current limited understanding of scoliosis in a traditional medical sense and the limitations in medically accepted treatment of AIS, it makes one wonder if there is a model of evaluation, treatment and management of scoliosis that may provide the potential for deeper understanding of the condition and reasons why it develops. Possibly bringing to light conservative treatment measures that have the ability to stop it's progression - or even reverse it.

Before we get to more detail on these discussion points, lets review what is currently known about AIS, from symptoms to treatment.

Symptoms
AIS generally does not result in pain or neurologic symptoms in children and teenagers. I can't stress this enough as often times this is the reason why the diagnosis of scoliosis can blindside many. Again, your child or teenager often times has no pain and no complaints. They seem to be perfectly healthy, active kids. This is a big reason why often times, scoliosis is either identified by primary care physicians during routine annual exams or during school exams.

While there may be no pain present and the child seems to be otherwise healthy despite curvature changes in the spine, how serious can the condition really be if it isn't that limiting?

While pain and neurologic symptoms may not be present, there can be disturbances within the nervous system on the cerebellar and sensory-motor integration level (1). Often there can be altered reflexes as identified by Janda, hypermobility, and muscular imbalances which create functional changes within the body (1). These functional changes have a direct effect on movement, thus having a direct effect on structure. In this case, the curvature of our spine (structure) is directly related to the function of our musculature and movement system.

Disturbances within our muscular/movement system can be identified by functional evaluation, however these evaluations are not typically part of the traditional medical evaluation process.

Does this lack of functional evaluation potentially leave pieces of the scoliosis puzzle unsolved? Pieces that would aid in determining the most appropriate course of treatment and management - and potentially a patient-specific reason for the development of the condition?

Evaluation & Physical Exam Findings
Classically, the physical evaluation and physical exam of a child diagnosed with AIS has a few key findings:
  • Visible signs of lateral spine curvature along with asymmetries seen in the shoulders or hips, in which one side appears higher than the other.
  • Adam's Forward Bending Test revealing either structural or nonstructural (aka functional) scoliosis. Adam's Test is consider the most sensitive test for scoliosis and the most common test used in the diagnosis of scoliosis.
  • Radiographs or x-ray indicating positive findings for scoliosis. The curves are often measured for angles of the curves to determine severity.
While the physical findings from these objective exams are valuable and necessary to consider, there remains a lack of evaluation into how one's body is functioning. Functional evaluations are extremely valuable in determining possible underlying reasons for the structural changes seen in AIS.

Some functional evaluation considerations that are made from the world of Dynamic Neuromuscular Stabilization (DNS) include:
  • Functional tests to assess movement control and coordination of the musculature surrounding the shoulders, spine, and hips.
  • The central role proper neuromuscular function plays in spinal stabilization and optimal spinal posture.
  • Sensory-motor integration and cerebellar function in the patient's ability to sense their body awareness, posture, and joint position in space.
  • Hypermobility and other present musculoskeletal compensations in response to poor function of the integrated stability stabilization system (ISSS).
The more accurate the evaluation, the more accurately treatment can be applied. Functional evaluation only compliments orthopedic and neurological evaluation. Ideally, functional evaluation such as that provided by DNS would be consider as a necessary component for it's ability to bring to light issues that more traditional orthopedic and neurologic testing are unable to identify.

Treatment
Traditional medical treatment of AIS falls into three main categories:
  1. Observation
  2. Bracing
  3. Surgery
These traditional treatment and management strategies are used in accordance with guidelines based on severity and/or progression of AIS.

But are there other treatment options? Ones that may be considered more "alternative" yet may possess the potential to yield positive results in the treatment and management of children and teens with AIS?

Often interventions such as chiropractic, physical therapy, rehabilitation, and exercise therapy can be  considered by some as alternative treatments to prevent progression of AIS. However, when applied appropriately in the treatment of AIS, these "alternative" treatments can offer something that observation, bracing, or surgery cannot - truly addressing the underlying functional causes in the development of structural asymmetries.

Improving the way one moves and functions - through targeted therapeutic exercise, joint mobilizations, and/or spinal manipulation - can have huge impact on preventing the progression of AIS. Coming from the Prague School of Rehabilitation, the pioneers of DNS therapy, they not only have success in treating AIS, they even have cases of reversal. Clearly there is something we can learn from the model utilized by DNS practicioners in improving our model of scoliosis evaluation, treatment, and management.

The hope is that this article has brought to light some reasons why we should reconsider how scoliosis is evaluated and treated as well as treatment options that exist, but can be rather difficult to find.

References:
  1. Cerebellar function and hypermobility in patients with idiopathic scoliosis, Kobesova A, Drdakova L, Andel R, Kolar P. International Musculoskeletal Medicine. , 2013, 35(3): 99-105.
 
For further reading on DNS and the importance of functional evaluation, please check out the links below:

 
https://gallagherperformance.com/dynamic-neuromuscular-stabilization-advancing-therapy-performance/

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

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

https://gallagherperformance.com/the-importance-of-functional-evaluation/

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

[embed]https://www.youtube.com/watch?v=yzgQdT5KcI0[/embed]

Based on updated modern knowledge of tendinopathy, tendinitis, or tendon pain, let's shed some light on the best ways to rehabilitate for complete recovery. Part of this discussion will bust several "myths" or "misconceptions" that have existed about the treatment and management of tendon pain.
  1. MOVE! It is best to avoid complete rest as movement and blood flow is the driving force to the recovery and healing mechanisms of the body. Complete rest is ineffective as it decreases the ability of a tendon to handle load. Rather, you should reduce loads to a level that the tendon can tolerate and gradually rehabilitate the tendon back to proper function. It's important to understand what your movement sensitivities and limitations are and adapt accordingly. Being told to completely rest is poor advice as medical understanding of healing tendinopathies has greatly improved.
  2. PRIORITIZE ACTIVE REHAB OVER PASSIVE TREATMENT. Again this builds off our first point. Active rehabilitation that requires the movement of your body through proper joint range of motion under appropriate pain-free loads is proving to be the golden standard in recovery from tendon and joint pain. Passive treatments such as electric stimulation, laser, ultrasound, taping and cupping have very little evidence to support their long-term efficacy in treatment outcomes. But people love them cause they are easy. They are done to you, not by you. Sure they may provide short-term symptom relief, but they do little in regards to long-term progress. Why? Because these treatments do nothing in regards of improving the ability of the tendon to absorb and handle load. Therapeutic exercises aimed at restoring proper movement patterns with progressive loading is the key to retraining the ability of the tendon to handle load appropriately. Thus resulting in successful long-term outcomes from tendon pain. The reality is, the most effective stuff is usually the hard stuff. This is true in training, nutrition, and recovery. The hard stuff is always more effective than the easy stuff. Sure you may need some passive treatment to help control pain, but you will never fully heal a tendon without long-term focus on exercise-based rehabilitation.
  3. STOP IGNORING YOUR PAIN. Pain is the your body's way of telling you that the load you are placing on your tendon is too much. You must stop ignoring this and reduce your training load, volume or frequency. Again tendon pain is caused by routinely overloading the tendon. If you continue to overload your tendon, why do you ignore the pain or expect it to magically heal? Don't ignore the pain and realize your body is sending your a message that's worth your attention.
  4. DON'T STRETCH YOUR TENDONS. Stretching your tendons will only serve to further irritate and exacerbate your tendon pain. Stretching tendons can be detrimental to their structure and health. Our tendons work like a spring, absorbing and releasing forces as we move. Tendon stress is at it's highest when we do activities such as sprinting, jumping and throwing. This is when the spring function of a tendon is most critical. This is important to understand, as for many people they may only experience tendon pain during sports or exercise. If you stretch a spring, you will compromise it's function. Springs don't need to be flexible so please don't stretch your tendons.
  5. AVOID SHORTCUTS WITH REHABILITATION. When it comes to tendon pathologies or tendon pain, there are no shortcuts in rehab. There is no magical potion or pill or modality. Treatments or interventions that promise cures often provide short-term pain relief only for the pain to come back again. Even injection therapy has shown to be effective only when exercise-based rehabilitation is not. You must realize that our tendons need time to rebuild strength and proper function. Often they need a significant amount of time and rehabilitation can take months. If exercise-based rehabilitation is not a priority, then we have our answer as to why many deal with chronic or recurrent tendon pain as they aren't addressing the reason why their tendon pain developed in the first place.
More related reading:

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

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

https://gallagherperformance.com/improved-approach-chronic-pain-management/

https://gallagherperformance.com/chiropractic-rehab-dns-treatment/
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/
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
This article is not intended to address training theory or programming as it relates to preparation for an endurance event, foot wear or gait mechanics. What I want to address is the reality that one must be physically prepared for a specific event and this requires that a runner must possess the necessary prerequisites in movement as it relates to running.
And no, being physically prepared doesn’t mean being fit or having a certain level of fitness. Being physically prepared for a distance running event goes far beyond one’s aerobic fitness.

To get my point across, allow me to use the analogy of intelligence. One can be intelligent yet being prepared for an exam in Civil War History is another issue. Now one may take that exam and it could go very well or horribly bad, but it doesn’t change the fact that the individual is still intelligent. What it means is they were either prepared or unprepared for that specific exam.

So while one may be “fit”, it does not mean they are physically prepared for a specific physical event. Even if one lifts weights, bikes, and jogs on a regular basis it doesn’t mean they are ready for a marathon. And most understand this, as they will specifically prepare for a marathon by training for it over a number of weeks.

But what is one to do to make sure their body is ready for the demands of running other than simply running? I mean that’s all one needs to do right? Just get out there and put in the miles right?

Yes, you will have to put your time in on the road or track. That’s a given. But there are also other considerations to make beyond the traditional means of endurance training (see this article here - 2 Common Misconceptions in Endurance Training).

The reality is running is tremendously demanding on the body and it’s even more so from a distance standpoint because of the need for far greater precision in running form, mechanics and motor control of the feet, ankles, hips and torso.

The need for strength and precision in movement control for the distance runner should make training strength and precision in movement control a high priority. This skill of awareness or proprioceptive ability can be trained through exercise. And this brings us to the heart of the article – ensuring you are physically prepared for running. Ensuring that your feet/ankles, hips and torso are more resilient against the cumulative physical demands of running.

Understand that I realize, like any competitive athlete, the cumulative trauma of the competitive season adds up and it is a challenge to stay 100% healthy. There are a number of variables that go into keeping one healthy. The hope is that through this article you gain an understanding of how training and maintaining certain physical abilities through specific exercises will not only help to offset what your body endures on the road, but make it more resilient as well.

The following exercises will serve to build the physical foundation that will help one stay healthier during training and the competitive running season, thus making sure your physical preparation meets or exceeds training demands.

1. Respiration with Trunk Stabilization
[embed]https://www.youtube.com/watch?v=UxONX_8ZGkI[/embed]

2. McGill Side Bridge
[embed]https://www.youtube.com/watch?v=NJhqDATf5_k[/embed]

3. Low Oblique Bridge with Hip Differentiation
[embed]https://www.youtube.com/watch?v=IXc7wr3oBkY[/embed]

4. Single Leg Balance & Swaps
[embed]https://www.youtube.com/watch?v=Exz8f-ngKPM[/embed]

5. Pallof Press
[embed]https://www.youtube.com/watch?v=i-0HIVP5ZQA[/embed]

6. Plank Progressions
[embed]https://www.youtube.com/watch?v=aKWc4XJ9xKI[/embed]

7. Box Squat
[embed]https://www.youtube.com/watch?v=WJh3xyMWj7g[/embed]

8. Romanian Deadlift
[embed]https://www.youtube.com/watch?v=l4Mk6OEE2RQ[/embed]

9. Lunge Matrix
[embed]https://www.youtube.com/watch?v=UGdmImUcQFw[/embed]

10. Power-Speed Drills
[embed]https://www.youtube.com/watch?v=Ti5-hTsOC-8[/embed]

That's a Wrap
While this list is far from comprehensive, it will serve as a general template to help runners to address basic physical prerequisites needed to stay healthy and train with minimal risk of setbacks. This is general template for physical preparation of a runner. Remember, like any athlete, physical preparation serves as your foundation as a runner. Take time to develop your physical preparation. Take time to develop your strength and movement control as it will allow you to get more out of training and keep your body healthy in the process.
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
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/
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/
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 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?
If you have answered, “Yes”, to one or more of these questions, you are lacking the basics. Lacking of these basics has been correlated with increased incidence of back pain, neck pain, hip pain, knee pain, foot/ankle pain as well as reduced athletic ability. And believe it or not, no equipment is needed to help someone achieve these basic standards. All you need is your body and the ground. This is what the really good movement providers understand and it’s all they need to work with.

Why are the basics so important?

People want to exercise to get in shape and improve their health yet most of us aren’t in shape to exercise. When we loose the basics – the fundamentals to human movement – more complex or more demanding activities will take a toll on our body. If the basics are challenging yet you wonder why you have knee pain after running or why your back kills after leg day, you now have some possible answers. Our body will eventually pay a price when higher and higher demands are placed on an inadequate foundation. Make a point to master the basics and never loose them. Your movement provider should be capable of helping you achieve the basics. In doing so you’ll realize a quality of health and physical ability that may have previously seemed impossible to achieve.

More related reading:

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

 
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
 
In some cases, chiropractors can be the first point of access for individuals who recently sustained a head or neck injury, such as those occurring in sports, car accident or fall. Chiropractors, especially ones who are certified by the American Chiropractic Rehabilitation Board, regularly manage athletes who suffer sports injuries, such as concussions, and are trained in proper diagnosis and understand the importance of referral for additional medical evaluation. Gallagher Performance offers such quality in their chiropractic services and has been part of the co-managment team in a number of concussion cases.

An effective tool chiropractors may use to assess the severity of a concussion is called the Sport Concussion Assessment Tool 2 (SCAT2). The SCAT2 is used to evaluate, assess, and manage concussions in athletes 10 years and older with the end goal of safely returning the athlete back to the sport.

How are concussions treated and what is the Chiropractors role?
After evaluation, rest is the best treatment. Depending on severity, most symptoms resolve relatively quickly while treatment is directed at symptom control for headaches, nausea, dizziness, and sleep problems. Rest does not simply mean physical rest. Brain rest is equally important as physical rest. Exposure to television, computers, and smartphones and other devices can stimulate the brain and aggravate symptoms. Limiting use of those devices may be helpful in allowing the brain to recover more quickly. Brain rest may also involve student-athletes being held out of the classroom and encouraged not to read, study, or taking exams as this mental effort can aggravate symptoms and possibly delay healing.

When it comes to management and, for athletes, return to play guidelines, often a team of medical professionals are involved. Chiropractors may find themselves as part of this co-management team.

Chiropractors may not be the first medical professional you imagine when it comes to concussion management and treatment, but sport and rehabilitation chiropractors are trained to support the patient during the recovery process. Largely this is due to their focus on treating spinal joint dysfunction present in the head or neck, myofascial techniques to restore muscular and connective tissue function, and sensory-motor based exercise protocols to restore ideal neuromuscular function. For further consideration, two recent literature reviews outlined how chiropractors can effectively manage athletes with concussions (1,2).

Ultimately, the brain will recover at it’s own pace. For athletes, return to play guidelines are established to ensure they are safe to return to sport competition. This involves the close observation of the athlete to ensure no symptoms are present during gradual exposure to increased cardiovascular demands all the way to more intensive and sport-specific measures.

Dear Patient, Be Patient
While 80 - 90% of individuals who suffer a concussion will recover within 7 - 10 days, some will experience symptoms for weeks or months. The length of recovery is not necessarily related to the extent of the initial injury.

Employers or school officials should be informed of the concussion diagnosis and aware of potential issues of poor performance due to difficulty with concentration and comprehension. Return to sport is fully dependent upon complete resolution of concussion symptoms and this decision should come from the neurologist overseeing care. Remember to be patient. The brain is a delicate structure and will heal with time. Don’t rush your recovery process. Returning too quickly can put you at increased risk for worsening your previous condition. Let the brain recover and reboot.

Gallagher Performance has extensive training and experience in evaluation and co-management of patients and athletes who have sustained a concussion. Our experience allows us to assist in providing gold standard care when it comes to concussions.

This blog post was written by Sean Gallagher, DC, DACRB, PES
To schedule your appointment, call (724) 875-2657.

References
Johnson, C.D., et al. Chiropractic and concussion in sport: a narrative review of the literature. Journal of Chiropractic Medicine 2013 (12):216-229.
Shane, E.R., et al. Sports Chiropractic management of concussions using the Sports Concussion Assessment Tool 2 symptom scoring, serial examinations, and graded return to play protocol: a retrospective case series. Journal of  Chiropractic Medicine 2013 (12): 252-9.
 
 
There is a reason why countless professional and Olympic athletes receive regular chiropractic care. The physiologic and neurologic benefit of spinal manipulation is super charged when used in a comprehensive care plan to address pain and dysfunction.

This infographic puts it into words nicely!

Movement is essential to the function of our heart, lungs, and lymphatic system. Movement is critical to keeping our muscles, joints, cartilage, and connective tissue healthy. Movement aids in the delivery of oxygen and nutrients throughout our body and assists in removal of metabolic waste products.

These are points that the majority of us have either heard about or have come to understand about the importance of movement as it relates to our overall health.

Yet one major benefit of movement is often overlooked - the stimulation of pathways required for proper brain and body function.

Yep, that’s correct. Movement - especially of the spine - is required for proper brain function and coordination of activities such as concentration and learning, motor control, emotions, and optimizes organ and immune function.
There is a reason why you experience an increase in mental alertness after exercise or even a visit to the chiropractor. According to Roger Sperry, Nobel Prize recipient in Brain Research, movement of the spine generates 90% of the nerve stimulation used to run the brain.
The brain does not simply control the body, the brain requires constant stimulation and that stimulation comes from movement.

Movement charges your brain’s battery and enables you to think, function, and feel better.
Sound a bit too good to be true?

The work of some of the most prominent neurologists and physiologists in the world continually support the role of movement in brain and nervous system health.

The stimulation your brain receives from movement – once again, especially of your spine – is now being considered essential to optimal brain function and development. In fact, research is now showing that people who do not adequately stimulate their brain through movement have learning, memory, emotional, and behavioral deficits.
This is especially true for children because spinal joint receptor stimulation plays an integral role in the development of the child’s brain and nervous system. The effects of decreased stimulation of the brain in childhood have been linked to central motor impairment, developmental impairments, learning disabilities, and concentration problems like ADHD.

Regardless of your age, the message should be clear at this point: Movement does a body – and brain – good.
Get out and get moving.

More related reading:

https://gallagherperformance.com/tips-on-recovery-and-restoration/

https://gallagherperformance.com/does-practice-make-permanent-how-practice-rewires-your-nervous-system/
The majority of us will not get through life without sustaining some degree of injury. The joints of the back, shoulder, hips, knees and ankles are all very common injury sites for not just athletes, but the general fitness population as well.

Most injuries that develop over time tend to have one thing in common, a breakdown in the human movement system. Meaning it could be that you are performing specific movements with sub-optimal technique or perhaps muscle imbalances are responsible for your symptom presentation. Regardless of the reason for injury, the goal is the same; to make movement more efficient to ensure that once training or competition resumes, the chance of re-injury is minimal.

Efficiency of movement is rarely a goal achieved in therapy. Incomplete rehabilitation in athletes and the general fitness population has lead to a re-injury epidemic. The problem is rooted in either the push to return athletes to the field as quickly as possible or rushing patients through the rehabilitative process.

With the ever changing landscaped of health insurance, the overwhelming majority of athletes and patients deal with increasing out-of-pocket expenses and limited number of therapy visits. Ultimately, many patients never complete their rehabilitation process.

This may be for a number of reasons, but in most cases athletes or patients are discharged once specific objective and ADL (activities of daily living) measures are satisfied. Sure you may have minimal to no pain, full range of motion and seemingly adequate strength resorted, and basic activities are easy to perform, but this does not ensure you are ready to resume training and competition.

And this is exactly where most get stuck.

They are lead to believe they are ready to resume sport training or their exercise program, but soon after resuming they realize they aren't as ready as they thought they were.

The transitional period between rehabilitation and performance-based training is the most critical period to ensure complete rehabilitation and that the transition back into training and competition carries minimal risk of re-injury.
Sadly, due to points made previously about the state of healthcare, many personal trainers and strength coaches are finishing off the rehab process.

Why do I say sadly?

Frankly, the majority of personal trainers aren’t educated enough to be overseeing such a delicate process, yet many position themselves as psedo-therapists. I’ve lost count of how many personal trainers I’ve seen giving “massage” or performing “joint mobilization” during their training sessions. They have no training or qualifications to perform such work and ultimately the person at most risk is the individual they are working on. Word to the wise: if your personal trainer is performing such work on you and has no license to perform such work, run the other way and seek out a qualified professional.
Within the fitness industry, there has been a large growth in facilities that blend rehabilitation with prevention strategies within strength and performance based training programs. Done well and overseen by qualified professionals, this is a great way to manage what is seen both in a rehab and training setting. This process should not be handled improperly. Implementing “corrective” or therapeutic exercises strategies into a performance-based training program should be lead by qualified professional(s). There used to be a gap between the professionals in the therapy and strength & performance world. Progressively though, that gap is slowly closing as more therapists crossover into the world of strength & conditioning.

Returning from injury isn’t and shouldn’t be a quick process. It’s far better to train smarter through the process. Improving on the function of the body while adding qualities such as endurance, strength, reactivity, power, etc. will help ensure successful outcomes. It’s less about isolation and more about training systematically to re-groove movement patterns. For anyone who has suffered an injury, they all want to get back to their previous level of function while also building the confidence they will not re-injure themselves. It can and will be a detailed process that involves rest, manual therapy directed at specific joints and soft tissues, as well proper exercise progressions. And yes, this means regressing, substituting, and even just slowing down exercises until they are owned.

Once movement and exercises are owned, it opens the door to further progressions in a performance-based setting to help ensure a more complete rehabilitation resulting in reduced risk of re-injury. This has become a huge part of what we do at Gallagher Performance as we successfully help our athletes and patients resume an active, pain-free lifestyle.

More related reading:

https://gallagherperformance.com/technique_and_performance/
The Gallagher Performance approach will improve the way your body moves and functions. 
Simple yet effective changes to improperly functioning muscles and joints will allow the body to make immediate shifts toward working as a functional unit. Thus reducing pain and enabling higher levels of strength, speed, and power with greater resilience.

The results are incredible. Time and time again, our patients and athletes quickly change from a state of pain and tension, to a state of relaxation primed for performance. This all comes back to assessment and knowledge. When we do the right thing, the body responds immediately.

The methods used at Gallagher Performance are utilized internationally by elite athletes, sports teams, and health practitioners. Not only are we able to efficiently and effectively treat injuries and enhance sports performance, our methods are also powerful tools for stress management, quickly breaking common patterns of movement dysfunction related to chronic pain. The methods have international recognition and no provider, therapist, or trainer in the Pittsburgh area has  the training and background in these methods that Gallagher Performance offers, making us truly unique. 
HOW DOES THE GP SYSTEM WORK?
Our body is designed to breathe and move. In order to breathe and move, our body finds ways to accomplish these tasks, and it’s willing to do so in efficient or inefficient ways. Our breathing and movement can develop compensation patterns or “key dysfunctions” that become the target of successful musculoskeletal treatment.

These compensation patterns cannot be ignored, as they put us at risk of poor sport performance, tension, or pain.  Our body’s ability to overcome the stress of life can result in reduced movement quality and energy levels. Measurable reductions in stability, strength, power, mobility, and stamina are often the result. Our body becomes less resilient, increasing the chance for fatigue and breakdown.

If you experience a traumatic event or injury, you know exactly what I’m talking about. Post injury, you’ll notice the slow and gradual decline in energy, function, and performance. Compensations begin to manifest in order for us to avoid pain and accomplish daily tasks. The result may range from noticeable decline in energy, to impaired function of muscles and joints, to chronic pain which long outlasts the initial injury.
It is almost inevitable nowadays for the majority of us to experience the effects that stress, injury, and/or compensation has on the human body.  And it can be simple to reverse those effects when you focus on what your body needs to regain ideal function.
The system at Gallagher Performance starts by testing how your body is currently functioning, so that changes can be clearly measured. This is accomplished through evaluating joint restriction, muscle activation and strength, and functional patterns of movement.

Once compensations are identified, we target “zones” to help activate the body to perform better. These “zones” can be a specific muscle, group of muscles, joints, or a combination.

Once we activate, we have to integrate. In order to do this, we run through the body’s movement patterns, testing and activating along the way to enable muscles and joints to regain their ideal function. Then through cueing and exercise, the brain can integrate improved patterns of movement, allowing you to move effectively and efficiently.

A body that moves better has less stress and less pain, allowing you to work at greater capacity and with greater energy.
That doesn’t mean you’ll suddenly be indestructible for the rest of your days. That would be too good to be true. After all, it you enjoy being active and testing your body’s limits, you are going to feel it. Our movement patterns need reminding and that’s why we use targeted home exercises to help the body reinforce ideal function and keep compensations from returning.

The methods and techniques used at Gallagher Performance are proven to be effective in getting people out of pain and elevating performance. We truly offer unique, powerful tools for control over your own health and performance.
More related reading:

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

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

https://gallagherperformance.com/improved-approach-chronic-pain-management/
Lately it’s hard to find time to keep up with our blog. Life and business have a way of keeping you busy. Ignoring our social platforms may happen for a period of time, but we always revisit them. If there is one thing I’ve always hoped is that our blog would be informative, educational, and entertaining (at times).

The summer months bring on increased work load. Once May rolls around, we take it up a notch or two at Gallagher Performance. Summer is a grind, but it’s also a blast. We love the grind, love the process. With the volume of high school and collegiate athletes training for strength and performance, along with the patients we see ranging from acute care to rehabilitation to return to play, summer provides tremendous learning opportunities.

Reflecting back on the past several weeks, there are some friendly reminders and lessons learned or re-learn that I wanted to share:
  • Power-speed athletes thrive on power-speed drills and exercises. Just because one can squat or deadlift 500+ doesn’t mean they are explosive and fast. Yes athletes need strength and for many they will need a primary focus on strength training. However, those newly acquired strength levels must also be displayed in more power-speed dominant means such as sprints, jumps, throws as they have greater specificity to athletics than anything barbell related.
  • Athletes need to rapidly absorb force and rapidly generate force and do it on a level of unconscious activation. That brings me to another point of muscle activation. Muscle activation is a craze nowadays and rightly so. The overwhelming majority of the population will benefit tremendously from learning how to activate and integrate muscles such as their tibialis anterior, glutes, and scapular stabilizers to name a few. A lost art in muscle activation seems to be the use of isometrics. There is always an isometric contraction during the amortization phase of movement. Even during the most explosive movements, there is an isometric contraction. Isometrics are also awesome for reprogramming and generating a powerful mind-muscle connection, making isometrics a great tool for performance as well as rehabilitation. We have been utilizing a select few isometric drills for uprighting, motor control, and priming for improved  force/strength generation. In a relatively short period of time, they have more than demonstrated significant value.
  • There is a right way to go about training and a wrong way. The right way will always be dependent on the needs of individual and their specific goals. Don't get caught up in hype, trends, and empty promises. Trust the tradition. There is magic in the basics of the barbell, free weights, sprints, jumps, and bodyweight drills. They have stood the test of time. Fads and trends come and go, the basics remain. Using these exercises is one thing, understanding how to structure them in a training plan is another animal in itself. Find a trainer/coach that understands training specificity or else you are simply wasting your time and money.
  • We are problem solvers. Either as a clinician or trainer/coach, the heart of what we do is problem solving. Maybe it’s a matter of ability or effort, but clinicians or trainers either have the ability or they don’t. The ability to problem solve comes from knowledge and experience and even instinct. When it comes to effort, frankly some are just lazy and don’t care to think hard as it complicates their job. Whether it is listening to what a patient/athlete is telling you or just simply watching, you’ve got to process the source of the problem and how you’re going to solve it. When it comes to performance or rehabilitation, everything makes sense. If it is happening there is good reason for it. If we don’t understand it, it doesn’t make sense to us, but it always makes sense. Never dismiss a client or patient as not making sense. Make the effort to make a change. Change your perspective. Learn more.
  • We all need a coach. No one gets through life all on their own. We all have needed mentors and coaches at some point in our life. These may have been parents, family members, close friends, teacher, professors, bosses, etc. If we pursue something of significance, chances are someone helped us along the way. We need the help of others than have more knowledge, more experience, more accomplishments. I have had a number of mentors and coaches. For everything they did for me, I hope I can pass that on to those that I work with in the role as a coach.
  • Take time to get to know your clients and athletes. Show you care about them. We do more than just simply get kids bigger, stronger, or faster. We have an opportunity everyday to connect with our clients and athletes and hopefully make a positive impact. The reward goes far beyond cash flow. It’s about making a difference for the better.
That’s all for now. Thanks for reading and enjoy the grind!

More related reading:

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

https://gallagherperformance.com/faqs-frequency-avoided-questions-of-strength-conditioning/
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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