Gallagher Performance Blog

Spinal manipulation, also known as Chiropractic Manipulative Therapy, is an effective and efficient way to improve joint mechanics, reduce pain, improve mobility, and facilitate the acquisition of improved movements patterns when implemented strategically into treatment plans.

Yet the benefits of spinal manipulation, or chiropractic care in general, is still met with skepticism.

We are so far past establishing that there is evidence supporting spinal manipulation. Rather, we are moving in the direction of how to best establish the use of spinal manipulation in the management of specific musculoskeletal conditions and pain syndromes. The fact is that there are so many studies, systematic reviews, and meta-analyses done on spinal manipulation that a Medline search would be overwhelming to discuss.

The evidence is well summed up by a review of international low back pain guidelines. Over the last 10 years, 12 countries have done critical reviews of the scientific literature concerning low back pain. The international consensus is that the evidence supports chiropractic spinal manipulation as an effective tool in managing low back pain, and therefore is included in the recommendations.

However, the benefits of spinal manipulation do not begin and end with back pain. There are numerous benefits to spinal manipulation that make chiropractic care an invaluable addition to one’s health related or athletic pursuits. Below is just a short list.
  1. Joint pain relief - The most obvious benefit is relief of pain. Chiropractic manipulative therapy (CMT) can almost instantly relieve pain experienced in the low back, mid-back, neck, and extremities and has demonstrated this in research.
  2. Disc Bulge/Sciatica - The European Spine Journal published the findings from a clinical trial with chiropractic manipulative therapy showing 72% success rate in treating sciatica and associated symptoms. Disc bulges respond favorably to spinal manipulation techniques which focus on resorting joint mechanics and unloading the intervertebral discs.
  3. Headaches (tension and migraine) – There are hundreds of peer reviewed research articles demonstrating the ability spinal manipulation to prevent and ease the burden of headaches and migraines.
  4. Blood Pressure - In 2007, a team of researchers published a study in the Human Journal of Hypertension demonstrating that one upper cervical chiropractic adjustment had the same effect as two blood pressure-lowering drugs. Those effects were not simply short-term, they lasted more than six months.
  5. Surgery Prevention - The Journal of the American Medical Association recently published its low back pain guidelines and suggested that people suffering from back pain first try chiropractic before resorting to surgery. When appropriate, a growing number of physicians and specialists are recommending patients pursue conservative management of musculoskeletal conditions and pain syndromes before surgical intervention. The majority of these patients avoid surgery as they respond extremely well to conservative management via chiropractic care, physical therapy, or a combination.
  6. Athletic Performance - 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. Simply stated, muscles just work better when proper joint motion is restored via manipulative therapy. Athletes thrive on proprioception and motor responses from sensory input. Proprioception and motor response all improve from spinal manipulation. Coupled with exercises to facilitate motor skill acquisition, the short-term responses from spinal manipulation eventually become long-term improvements in movement quality and efficiency.
Based on my knowledge and experience as a sports performance and rehabilitation chiropractor, I’ve seen some surprising improvements with pain, joint proprioception and overall movement quality due to chiropractic spinal manipulation. When appropriately indicated, I regularly use spinal manipulation for reducing joint pain, improving joint mechanics, reducing muscle tension, and improving movement.

As stated above, spinal manipulation is a power tool that can be used within a comprehensive treatment plan. These treatment plans often utilize a variety of approaches that emphasize soft tissue work, guided exercises to improve stabilization and movement patterns, and patient education. These combined approaches serve as a “gold standard” for successful management and treatment of a number of musculoskeletal conditions.

To learn more about chiropractic and how it can be a benefit to your health or athletic goals, please contact our office at (724) 519-2833.

More related reading:

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

https://gallagherperformance.com/the-solution-for-chronic-back-pain/

https://gallagherperformance.com/low_back_pain_causes_and_treatment_recommendations/
Headaches are among the most frustrating and debilitating conditions seen by healthcare practitioners, from primary care physicians to chiropractors. When severe enough, headaches may interfere or prevent even the most basic daily activities that we take for granted, such as thinking, talking, and reading.

While a logical assumption would be that the origin of headaches is in the head itself, science suggests many of the most common headaches are generated from the joints, muscles, and nerves of the neck.

The head and neck is an inherently unstable system that requires a complex neuromuscular system to surround the spinal column for control of movement and protection from injury. 

Many daily activities, such as prolonged sitting and poor posture, can affect the function and health of the joints, muscles, and nerves of the neck. Poor posture or prolonged postures common to students and the majority of the working class can lead to muscular imbalances, restricted joint motion, and unnecessary strain on the neck and upper back often responsible for headaches.

Referred pain and micro-trauma explain how this strain often results in headaches. Referred pain is a neurological phenomenon which is responsible for the perception of pain at a location other than where the problem exists. Using the headache as our example, the problem exists in your neck or upper back, yet your symptoms and perception of pain exists in your head. Micro-trauma is cumulative, small scale damage that occurs in and between soft tissues (muscles, tendons, joint capsules, ligaments and nerves) in response to strain. The bodies response to this strain is to lay down small amounts of repair tissue. Over time, a build up of repair tissue can form adhesions or scar within the soft tissue altering function. Left untreated, these adhesions often lead to pain, tightness, stiffness, restricted motion, and diminished blood flow. The result is a negative feedback cycle, the cumulative injury cycle.



So how do we stop the cycle?

Massage therapy, myofascial release, and IASTM (instrument assisted soft tissue mobilization) techniques are just some of the tools utilized at Gallagher Performance to address scar tissue adhesions and neurological dysfunction in soft tissue. Along with these tools, we often utilize chiropractic manipulative therapy (adjustments), sensory motor stimulation, and Dynamic Neuromuscular Stabilization (DNS) to improve posture, positional awareness, and help restore muscular balance. The combination of these therapies have helped numerous patients find a solution to chronic headaches or migraines.

The next time your dealing with a headache, consider Gallagher Performance. There is a solution to headaches that doesn't involve taking medication. Call our office at (724) 519-2833 to schedule your appointment.

More related reading:

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

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

https://gallagherperformance.com/why-stretching-wont-solve-your-tight-muscles/
It seems, inevitably, we get weekly questions wanting our insights or thoughts on some training or rehabilitation method.

Regardless of the whether its the fitness industry or physical medicine profession, methods come and go all the time. Some interventions have staying power as they provide lasting results. Some trends are just a flash in the pan. The more recent or more intriguing the trend, the more it seems to generate questions.

When it comes to rehabilitation, this can be seen in a wide range of modalities and procedures from electromuscular stimulation (EMS) to low level laser therapy, machine-based exercises to the functional approach, stretching to myofascial release techniques, and kinesiotaping to cupping.

In the fitness and training industry, there is an equal (likely greater) amount of options and trends to get hung up on. From kettlebells to TRX, Curves to Crossfit, bodybuilding methods to Olympic weightlifting, and unstable surface training to over-speed training just to name a few.

While the question, "What do you think of....," may be seem to be a simple question in nature, it's a difficult question to answer without understanding the context of it's application.

Unless the application is understood, the results one gets from a specific method is left in question.

If you severely sprain an ankle during a basketball game, sure taping and bracing will help in the early stages of healing. As healing and rehabilitation progress, manual therapy and exercise begin to take more focus. Single-leg balance and sensory-motor stimulation have demonstrated successful application in the rehabilitation of certain injuries, such as ankle sprains. But if you get on a BOSU ball or unstable surface too soon - and you re-injure your ankle - is the problem the unstable surface or just poor application?

Similarly, there are many people who take on a fitness or sports training program but end up worn down and banged up because their application of certain principles is just wrong. This may be due to joining a group exercise class or working with a trainer that provides poor advice and application of training principles. Or it could be due to an individual attempting to structure their own exercise program without proper knowledge of training method applications.

We all could benefit from someone who we can trust for sound advice who it comes to applying the principles of rehabilitation or exercise. They will be able to inform you on what methods may be best for your specific goals and your unique individual considerations. You need someone who can help guide and educate you, who is able to critically think and problem solve. This is what the best trainers, coaches, and therapists are able to do for their clients and athletes.

What we do at Gallagher Performance is exactly that. We critically think and problem solve for our clients and patients. We aim to educate them and implement the most appropriate applications for their desired goals and outcomes.

Despite this, the reality is our philosophy, our approach, or our applications may not be for everyone. We won't sacrifice long-term sustainability for temporary results. We take pride in quality over quantity. We won't focus on the latest trends or what other people are doing. We aren’t concerned with this.

Our primary concern is offering the best training and therapy to the people we work with while educating them on understanding sound application so they are able to make informed decisions. And we will always educate, even if that means people have to hear the hard truth. But hopefully in hearing the hard truth, they learn lessons that provide better guidance in the pursuit of their goals.

More related reading:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more on DNS here:

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

https://gallagherperformance.com/sports-chiropractic-rehabilitation-massage-therapy/
What is Fascia?
The soft connective tissue, located just under the skin, is a white membrane that wraps and connects muscles, bones, nerves, organs, blood vessels of the body.

This soft tissue is known as fascia. Think of fascia like the white fuzz inside an orange peel connecting and wrapping around the orange and the individual sections or slices.

At times, muscles and fascia are can become stuck or tear, resulting in soft tissue injuries or adhesions. Adhesions restrict movement and the quality of muscular contractions resulting in either soreness, pain, and/or reduced flexibility.

For a quirky take on fascia or "the fuzz", watch this video by Gil Hedley, PhD. The video provides great visuals as to what fascia looks like, how our muscles have to slide while we move, and what muscular adhesions look like and how they limit movement.

[embed]https://www.youtube.com/watch?v=_FtSP-tkSug[/embed]

How do you treat Fascial/Muscular Adhesions?
Treatment of fascial/muscular adhesions through manual or instrument assisted techniques have clinically proven to achieve successful outcomes in many acute and chronic conditions. Gallagher Performance offers a number of soft tissue approaches to treat painful or tight muscles, tendons, and ligaments. We have extensive training in identifying and treating muscular adhesions that compromise quality of motion and contribute to pain symptoms or reduced sports performance. Many overuse or repetitive use conditions respond well to treatment of soft-tissue structures through myofascial release, including back pain, shoulder pain, shin splints, runner’s knee (IT band syndrome), and plantar fasciitis.

Myofascial release is a manual or instrument assisted therapy targeting soft-tissue structures to reduce the presence of adhesive/scar tissue. Adhesive muscular tissue is arguably the most common yet most underdiagnosed condition in the entire human body. Muscular adhesions act like glue among muscles, fascia, tendons, ligaments, and even nerves. As a result, this reduces flexibility, strength, and stability to the body by altering movement control patterns. Adhesive tissue along nerves can cause numbness, aching, tension, tingling, and in some cases weakness. This is condition is called nerve entrapment and can happen in an estimated 150+ locations throughout the body.

How does adhesive tissue develop within the body?
Often adhesive tissue develops in result to acute injury or from overuse/repetitive trauma injury. Overuse injuries are caused by repetitive stress on the muscle and skeletal system without enough rest to allow the body to adapt. Studies show these overuse injuries account for more than half of pediatric sports injuries and often happen due to intensive focus on a single sport with an intensive practice and competition schedule. Unrecognized and untreated, they can sideline athletes from play and lead to more serious injuries.

Who is qualified to diagnose and treat fascial/muscular adhesions?
Sports medicine experts are advocating a greater role for therapists who can help athletes or active individuals recover without incurring lasting damage or hampering their activities. Specialists such as chiropractors, physical therapists, and massage therapists who specialize in sports-related injury and rehabilitation are often the first line of defense in managing and treating overuse injuries. These licensed professional are best for identifying muscular or fascial adhesions as they related to overuse injuries and movement disorders. With specialized training, these professionals are able to detect and treat muscular adhesions, expediting the healing process and minimizing downtime due to overuse injuries.

This is exactly why at Gallagher Performance we have a team which includes a massage therapist and a board certified chiropractic rehabilitation specialist. We strive to offer our athletes and patients the latest treatments and evidence-based soft tissue and rehabilitation techniques. Helping our athletes and patients achieve and sustain their best level of health and performance is our goal.

More related reading:

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

https://gallagherperformance.com/why-stretching-wont-solve-your-tight-muscles/

https://gallagherperformance.com/3-benefits-of-integrated-training-and-therapy/
Low back pain is not an uncommon condition among the American population. Several studies have supported data that demonstrates up to 85% of the population will experience at least one episode of low back pain during their lifetime. Low back pain is responsible for millions of dollars in healthcare costs every year.

In most cases, low back pain is relatively self-limiting condition, meaning it reduces naturally over a period of a few days. That said, it is not uncommon for many to experience severe pain. For this reason, it is important to begin treating low back pain conservatively with interventions such as chiropractic, manual therapy, therapeutic massage, and/or proper exercise prescription. All these conservative interventions have demonstrated their ability to successfully treat low back pain and its causes.

Some common back pain causes that respond well to a combination of chiropractic, manual therapy, massage, and/or exercise include:

Sprain/Strains: Injury to muscle and/or connective tissue, such as tendons or ligaments, suffered during activity, accidents, or lifting with poor form. Sprain/strains are extremely common and most range from mild to moderate (little to no tearing of tissue) and respond well to conservative treatment such as chiropractic, manual therapy, and progressive rehabilitation. Severe sprain/strains are characterized complete tears of ligaments or tendon ruptures. These may require surgical intervention.

Sacroiliac Joint Dysfunction: These pelvic joints usually produce pain as a result of alter joint mechanics from lifting or straightening up from a stooped position. The pain is usually relieved with sitting or lying down. Muscular tightness in the low back and hips is common.

Facet Syndrome: Pain in the low back that is localized, sharp and provoked with either extension (arching of the low back) or a combination of extension and rotation of the spine.

Sciatica: Radiating pain into the lower extremity on the posterior thigh/calf/foot. Sciatica can be caused by central issues (disc herniations) or peripheral issues (piriformis syndrome, nerve entrapment).

Disc Herniations: Low back pain which may also radiate pain into the hips or legs. Typically worse in the morning; worse with bending forward; usually better standing than sitting. Because of the disc injury, muscle spasms are not uncommon. These muscle spasms serve to limit movement in order to protect the disc from further injury.

Piriformis Syndrome/Nerve entrapment: Radiating pain on the posterior thigh and leg caused by tightness in the piriformis muscle. This muscle is deep within the hip lays underneath the glutes. Tightness in the piriformis can create irritation by entrapping the sciatic nerve, thus creating the radiation of pain.  The sciatic nerve can be entrapped within the hamstring and calf musculature as well. Low back pain may also accompany hip pain.

Myofascial Pain Syndrome: This is a chronic form of muscle pain caused by trigger points. These trigger points are often present within muscles of the low back and hips due to any combination of joint dysfunction, postural imbalances, and/or poor stabilization/support function of the core musculature.

Spondylolishthesis: A fracture of the vertebrae resulting in pain with extension. Similar to sprain/strains, spondylolishthesis is graded in severity. Mild forms for spondylos can respond well to chiropractic manipulative therapy (CMT) and rehabilitation programs. This condition is frequent in athletic populations who perform repeated extension movements, such as gymnasts, football players, wrestlers, and weightlifters.

In many cases, several studies support that low back pain responds exceptionally well to the combination of chiropractic care, manual therapy, massage, and proper exercise instruction.  If you are suffering from low back pain, whatever the cause, consider Gallagher Performance for your evaluation and treatment. Our goal is to relieve your pain while teaching you what you can do to keep the pain from returning. Please contact us as we have every expectation that our chiropractic and rehabilitation programs will help you Experience the Difference.
 
This blog post was written by Dr. Sean Gallagher.

Gallagher Performance offers customized treatment plans. Visit our website for complete contact information. 
To schedule your appointment, call (724) 519-2833.
 
More related reading:

https://gallagherperformance.com/why-stretching-wont-solve-your-tight-muscles/
[embed]https://www.youtube.com/watch?v=dzaixhJKgnQ[/embed]

Hi. I’m Dr. Sean Gallagher. Welcome to Gallagher Performance. I’d like to tell you about what we have to offer and why it might be a right fit for you to come check us out.

We offer chiropractic, functional rehabilitation, massage therapy, nutritional programs, as well as sports performance and personal training programs.

To begin with, my approach to chiropractic is different from what most have come to expect or have experienced in the past. As a chiropractor, my focus is on returning you to proper function and teaching you what you can do to keep pain from returning. Rather than spending 5 minutes with my patients, I usually spend 30 -60 minutes.

New patient evaluations are an hour long, as this allows me the opportunity to listen and understand their history as well as their desired goals and outcomes from treatment. All new patients receive a neurological and functional-based evaluation as this serves to create a working diagnosis and treatment plan recommendations.

Our functional-based evaluation and treatment plans are focused on looking at how you move so I can figure out strategies to help you move better and ultimately help you understand what could be causing your pain and what you can do to keep it from returning. The process is truly focused on you as the patient and your desired outcomes.

In addition to chiropractic adjustments or manipulations, I perform soft tissue treatments to improve the integrity and function of the muscular system. Massage therapy is offered here as well as it is extremely effective in treating painful or tight muscles and assisting in the healing process. Additional rehabilitation work focuses on improving movement qualities such as endurance, strength, stability, balance, agility, coordination, and body awareness.

When it comes to training, Gallagher Performance is all about individualizing the training process. That’s because we understand each person responds differently to training due to a multitude of factors that must be accounted for. We take time to understand your injury history, training experience, primary sport(s) played, and several other factors. Regardless of whether training occurs in a private or semi-private setting, clients are all closely coached through the entirety of their program to maximize results. This is what separates us and makes us unique from area competitors.

So if you’re looking to improve your performance, whether in sports, the achievement of your health and fitness pursuits, or you just need a tune-up to get your body feeling better, whatever the reason, come see us at Gallagher Performance. We are committed to you achieving your health and fitness goals and would love to be of service to you. Thank you.
Imagine a world where patients get the advise, education, and treatment they need. Imagine doctors who:
  • Make sense of what a patients says
  • Know exactly what a patient needs
  • Confidently provide gold standard advice and treatment interventions
This world is obtainable, but it must first begin with better quality, order and structure to our thinking patterns. One of the fundamental challenges with healthcare is that the human body is amazingly complex and adaptive. In response to the complex nature of dealing with the human body, doctors and therapists may have the tendency to routinely provide services that serve their own skill set better than appropriately addressing the patient's needs. Often times this leaves both the patient frustrated with lack of response to care.

Improving the Quality of Physical Medicine Care
The last 15 years have been great for musculoskeletal healthcare. There are several new treatment procedures and we have developed a deeper understanding of how the body works and how it breaks down. This has had tremendous impact on the world of physical medicine care, and chiropractic profession is no exception. The advancement of musculoskeletal care education has fueled a growing speciality within the chiropractic profession, sports injury & rehabilitation.

While physical therapy is often the first choice for medical doctor referrals in rehabbing an exercise or sports-related injury, there is a growing trend among athletes and individuals who enjoy an active lifestyle to turn to sports injury & rehabilitation chiropractors.

You may be thinking, “I thought chiropractors were only good for treating low back and neck pain and headaches.”
Just like the medical profession, there are many areas of specialty in chiropractic. Those who specialize as a sports injury & rehabilitation chiropractor have undergone the traditional education on joint manipulation or adjustments. However, in addition to their core curriculum, sports injury & rehabilitation complete hundreds of hours in continuing education learning about exercise and sport-related injuries, manual therapy, and functional rehabilitation methods.

What's so special about a sports injury & rehabilitation chiropractor?
Chiropractors who utilize a sports injury & rehabilitation approach incorporate joint mobilization/manipulation, soft-tissue treatments, various manual therapies, and functional rehabilitation techniques to provide a gold standard of care in treatment for individuals with exercise and sport-related injuries.

If you choose to visit a sports injury & rehabilitation chiropractor, you can expect a comprehensive examination before treatment begins. These examinations generally include:
  • A detailed history, orthopedic and neurologic examination, and functional based examination to create a working diagnosis.
  • Functional based examination to focus on the spine, shoulders, hips and feet, as these joints and their respective functions serve as the "key joints" of the human body.
  • Joint and muscle palpation to assess the quality of your joint movement, trigger points, and muscular imbalances.
Once the examination is completed, we want to discuss your specific goals in order to create a customized treatment plan for your road to recovery. The more accurately we assess, the more accurately we can apply treatment. Four types of treatment used at Gallagher Performance for exercise and sports-related injuries are:
  1. CHIROPRACTIC MANIPULATIVE THERAPYGallagher Performance provides the latest techniques, including joint manipulation (adjusting), designed to treat musculoskeletal complaints. The purpose of joint manipulation is to release restricted joints of the body, primarily in the spine and extremities. Joint commonly become restricted as a response to poor posture, imbalanced muscle activity, and/or trauma. By releasing a restricted joint through manipulation, improvements in the quality of motion of the joint are gained that may not be possible with exercise or other interventions. Manipulation also serves to reduce pain and relax tight muscles.
  2. FUNCTIONAL REHABILITATIONIn addition to providing relief through manipulative therapy and treating muscular adhesions, it can prove to be incredibly valuable to identify the source of a patient’s symptoms. The functional approach to rehabilitation includes identifying joint dysfunction, muscular imbalances, trigger points, and faulty movement patterns. These are often the hidden causes of injury. Observing how a patient moves and functions allows us to identify improper movement patterns that become contributors to pain and poor sport performance. By placing an emphasis on strategies to improve movement and function, functional rehabilitation is effective in improving qualities of endurance, strength, stability, balance, agility, coordination, and body awareness.
  3. DYNAMIC NEUROMUSCULAR STABILIZATION (DNS)By applying principles and techniques rooted in the study of child development, DNS aims to improve activation and neural control of muscles and ideal movement patterns. DNS promotes the ideal postures, movements, and degree of body awareness that is essential not only to athleticism, but to also treating the underlying causes of several pain syndromes.
  4. MYOFASCIAL RELEASEGallagher Performance offers a number of soft tissue approaches to treat painful or tight muscles, tendons, and ligaments. We have extensive training in identifying and treating muscular adhesions that compromise quality of motion and contribute to pain symptoms or reduced sports performance. Many overuse or repetitive use conditions respond well to treatment of soft-tissue structures, including back pain, shoulder pain, shin splints, runner’s knee (IT band syndrome), and plantar fasciitis.
If you have any questions or have been struggling with pain related to your activities, exercise or sport, Gallagher Performance offers customized treatment plans to get you our of pain and performing better.

To schedule your appointment, call (724) 519.2833

More related reading:

https://gallagherperformance.com/options-dont-take-insurance/

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

https://gallagherperformance.com/resetting-bodys-function-post-injury/
Back pain was believed to be a self limiting condition for the majority of individuals, meaning that the nature of back pain is that it would "run its course" and eventually pain would go away on its own.  Current research has demonstrated that this understanding of back pain is flawed; yet many clinicians still hold this belief.

In fact, 85% of people with a single episode of low back pain will likely experience future recurrences and 2-8% of those individuals will develop chronic back pain.

Chronic pain accounts for 75% of all healthcare costs related to low back pain, is second only to the common cold in missed days from work, and is the number one reason for workmen compensation claims.

Considering the burden chronic back pain places on healthcare resources, patient management appears to be an issue in need of addressing appropriately as many patients find it difficult to find effective treatment.

Low Back Treatments That Don't Help
Now many experts are questioning the model in which back pain is treated as a growing body of research suggests many common back pain ‘cures’ just don’t work. These include:
  • Ultrasound
  • TENS machines
  • Strong opium-type painkillers, such as diamorphine
  • Spinal injections
  • Spinal fusion
  • Disc replacement
Prescribing drugs or cutting people open when you don't know what's causing the pain is very unlikely to be successful in the long term. Surgery should only be used as a very last resort. There is a significant lack of efficacy for many treatments, but the deeper issue here seems to be that many healthcare providers have difficulty in accurately identifying the cause of ‘non-specific low back pain’.

Top spine expert, Professor Stuart McGill is the world’s leading spinal biomechanics researcher and has identified common reasons for back pain and the importance of exercise as an intervention for effective treatment.

In Dr. McGill's opinion, based on over 30 years of research, every case of back pain has a cause and the reason many treatments are ineffective is because they are used on a one-size fits-all approach, rarely targeting the underlying problem.
There are many possible causes for back pain, but you must first find the positions and stresses that trigger pain. As Dr. McGill says, finding these positions and stressors allows the provider to formulate a precise diagnosis and a roadmap to recovery. This roadmap is guided exercises that can correct the harmful patterns and build a stable, firm spine.

Addressing Misconceptions
The importance of a firm spine can come as a surprise to many, as the common perception is that your back must be flexible in order to be healthy and pain-free.

The spine must be firm and have strong muscles surrounding it to help transmit forces from the legs and the shoulders while minimizing the stress on the spine. When the muscles of the spine aren’t strong enough, micro-movements can occur that eventually can sensitize the spine and lead to a painful back.

If you have some movements, which are comfortable to build on, this opens the door to conservative management and recovery through guided exercise

However, recommendation of exercise without a clear understanding of movement intolerances and muscles that must be strengthened can also be harmful

Guided Exercise: The #1 Intervention for Low Back Pain
Exercise is essential both to protect and repair your back, but simply hitting the gym or doing Pilates or yoga without knowing the movement patterns that are generating your pain or the ones that will protect and build a pain-free back, has little chance of being effective.

Thanks to exercises specifically targeted at a patient’s problems, we are able to help educate them on proper posture and movement so they do not put damaging load on their spine. The guided exercise model is truly about identifying a patient's underlying back pain generators and educating them on not only how they can get out pain, but also what they can do to keep it from returning.

When you consider that 85% of individuals who have low back pain will experience future recurrences, there must be a priority placed on educating patient's about proper posture, movement, and exercises that build a firm, strong spine. Guided exercises are showing clear efficacy for use in patients with low back pain and should be a staple in their treatment plan.

If you are suffering from low back pain, whatever the cause, consider Gallagher Performance for your evaluation and treatment. Our goal is to relieve your pain while teaching you what you can do to keep the pain from returning.

More related reading:

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

 
Here at Gallagher Performance we not only strive to provide the best in chiropractic, rehabilitation and manual medicine treatments for our patients, but we also utilize comprehensive diagnostic methods and tools to help determine which treatment is best for you. This allows us to apply to most ideal therapeutic interventions. At GP, this could include any combination of the following: chiropractic manipulative therapy, manual therapy according to Lewit and Janda, Vojta Therapy, myofascial release, trigger point therapy, neuromobilizations, and dynamic neuromuscular stabilization (DNS).

Despite many of our patients having previous experience with chiropractic or physical therapy, they are unfamiliar with DNS. Gallagher Performance specializes in DNS therapy. Dr. Gallagher has been studying and utilizing DNS since 2007. His extensive training and background allows him to provide a level of care that is unique to the Pittsburgh area.

Since DNS has implications in both physical rehabilitation and training, we spend a great deal of time educating our patients and clients on DNS and answering some frequency asked questions. With that in mind, the goal of this article is to help educate our readers about DNS and the significance this intervention has as it relates to pain or sports performance.

What is DNS therapy?
DNS is a revolutionary European approach in the treatment of back pain and several neuromuscular conditions. DNS therapy is based on the neuroplasticity of the Central Nervous System and targets the cause of pain/dysfunction rather than its manifestations. DNS therapy evokes ideal movement patterns by manual stimulation of developmental reflex zones and utilizes specific exercises to improve neuromuscular control. The therapeutic benefits become significantly expanded from previous standards of rehabilitation. Any one from infants to adolescents, chronic pain patients to athletes can all benefit from DNS therapy.

How does DNS compliment chiropractic adjustments? 
DNS therapy favorably compliments traditional chiropractic adjustments in several ways. When patients may be apprehensive about receiving an aggressive or forceful chiropractic adjustment, DNS offers gentle, non-forceful, low velocity manipulation that is well tolerated and safe. For those that receive traditional chiropractic adjustments, DNS works in concert to normalize joint function and restore muscular balance, leading to more sustainable improvements in reduced pain and improved function.

Often times, symptom relief experienced from a chiropractic adjustment can be short-lived with symptoms returning rather quickly. In contrast, when DNS is applied in a chiropractic setting, the approach allows for longer-lasting symptom relief due to therapy’s ability to improve Central Nervous System (CNS) coordination and joint stability which is then maintained by performing prescribed home exercises.

DNS therapy simply enables a chiropractor to effectively treat and manage a broad range of musculoskeletal and neurological disorders. While traditional chiropractic may be limited in what can be done through chiropractic adjustments and passive modalities, DNS represents a powerful alternative to chiropractic care when dealing with pain syndromes and more complex structural pathologies where the effectiveness of traditional chiropractic is highly limited.

How is DNS therapy able to get me out of pain and moving better when other conservative therapies have failed?
The results achieved by DNS therapy are often difficult to achieve with traditional methods used by chiropractors and physical therapists due to the physiological phenomenon that occurs during treatment to minimize muscular imbalances, relieving painful protective muscle spasms, resulting in a more stable musculoskeletal system with improved spinal stability and postural awareness.

During DNS therapy, induced movements are controlled not locally, but by the higher levels of the Central Nervous System. This then results in faster and longer-lasting improvement in function and pain relief.  When combined with exercise, the promotion of joint stability and ideal movement becomes habitual and independent of conscious effort.

How are DNS exercises different from traditional physical therapy or physical training exercises?
In the majority of physical therapy and chiropractic clinics, as well as in personal training settings, exercises are performed that simply train muscles in isolation. The patient who has shoulder pain and is only prescribed shoulder exercises illustrates this concept. The fault in strengthening weakened muscles through isolation training is that isolation training will fail to unify the painful or problematic joint with the entire locomotor system. Sure you can perform all the isolation exercises you wish, but this does not guarantee that the strength or coordination gained will automatically transform into adequate performance.

DNS exercises are applied in accordance with development kinesiology or essentially how we develop motor function during childhood. As we develop, reflexive movements (primitive, postural, locomotor) become more refined and coordinated, ultimately leading to specific movements we produce later in life such as walking, running, jumping, reaching, throwing, etc.

However, developing these skills does not happen magically.  Learning to control the body and developing fundamental skills make up our motor milestones.  These milestones mark critical points in our development and there is a progression that these milestones follow.  This is known as developmental kinesiology. In simplistic terms, we need to be able to lift our head and support it, roll over, crawl, support ourselves upright, walk with assistance, and then walk without support.

The understanding of developmental kinesiology and critical motor milestones allows the provider to make exercise progressions and regressions during the course of therapy in order to appropriately address the underlying locomotor system dysfunction(s).

These exercises are applicable for patients with variety of acute and chronic conditions as well as for athletes who are trying to improve their performance and also prevent or rehabilitate injuries.

Often DNS exercises are conducted with active support from the clinician to insure that the patient maintains proper support and executes ideal movement. DNS exercises could include the use of stability balls or bands to further facilitate the desired response of the exercise.  These exercises are not only used to improve the stability of the spine, muscle coordination, balance and strength, but also to increase the body’s awareness and sensory integration.

Conclusion
All of a sudden, conservative management and treatment of patients and training of athletes looks a lot different than what is traditional accepted.

DNS is not only a magnificent approach for preventing and rehabilitating pain syndromes in the movement system it is also becoming extremely popular in sports performance circles. The same ideal patterns that keep an individual out of pain also maximize the efficiency of the movements, which not only reduces risk of injury but improves performance.

When you consider the principles of DNS, it truly is not about what exercises we prescribe or what exercises we perform, but rather what we are actually getting from those exercises when we perform them that is important. DNS provides a system of evaluation and treatment which follows motor development, thus providing an effective way to help our patients get the most out of therapy and our clients get the most out of training.

Sources:
Dynamic Neuromuscular Stabilization & Sports Rehabilitation, Frank C, Kobesova A, Kolar P. Int J Sports Phys Ther. , 2013 Feb;8(1):62-73.
A case study utilizing Vojta/Dynamic Neuromuscular Stabilization therapy to control symptoms of a chronic migraine sufferer, Juehring DD, Barber MR. J Bodyw Mov Ther, 2011 Oct;15(4):538-41.
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.
Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength., Kobesova A, Dzvonik J, Kolar P, Sardina A, Andel R. Isokinetics and exercise Science. , 2015;23:21-32, 
Developmental Kinesiology: Three Levels of Motor Control i the Assessment and Treatment of the Motor System. Kobesova A, Kolar P. Journal of Bodywork and Movement Therapies., 2014;18(1):23-33.
The Prague School of Rehabilitation, Kobesova A, Osborne N. International Musculoskeletal Medicine, 2012;34(2):39-41.
Postural - Locomotion Function in the Diagnosis and Treatment of Movement Disorders, Kolar P, Kobesova A. Clinical Chiropractic, 2010;13(1):58-68.
Analysis of Diaphragm Movement during Tidal Breathing and during its Activation while Breath Holding Using MRI Synchronized with Spirometry. Kolar P, Neuwirth J, Sanda J, Suchanek V, Svata Z, Volejnik J, Pivec M. Physiol Res, 2009;58(3):383-92.
Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. J Orthop Sports Phys Ther, 2012;42:352-362.
Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment, Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A. J Appl Physiol. , 2012;42(4):352-62.
Importance of Developmental Kinesiology for Manual Medicine, Kolar P. translated from Czech Journal of Rehabilitation and Physical Therapy, 1996;4:139-143.
Surgical treatment and motor development in patients suffering from cerebral palsy, Kolar P. Translated from Czech Journal of Rehabilitation and Physical Therapy, 2001;8(4):165-168.
Long-Term Efficacy of Dynamic Neuromuscular Stabilization in Treatment of Chronic Musculoskeletal Pain, Bokarius AV, Bokarius V. 12th World Congress on Pain. Glasgow, Scotland. Aug 17-22, 2008. Presentation # PF225.
A case study utilizing spinal manipulation and dynamic neuromuscular stabilization care to enhance function of a post cerebrovascular accident patient, Oppelt M,Juehring D,Sorgenfrey G, Harvey PJ, Larkin-Thier SM. Journal of Bodywork and Movement Therapies., 2014;18:17-22.
More related reading:

https://gallagherperformance.com/solving-pain-influence-czech-rehabilitation-techniques/
For many of our readers, you may not be aware of the specialized background that Gallagher Performance has in personal training, athletic development, chiropractic rehabilitation, manual therapies, and sports-injury care.

Whether you are pursuing professional services for personal/performance-based training or you’re thinking of seeing a health professional about a sports injury, Gallagher Performance has two board-certified specialists who are capable of addressing your goals and needs.

Meet the Staff

Ryan Gallagher LMT, NASM-CES: Head Performance Coach
Ryan Gallagher is the Head Performance Coach and a Licensed Massage Therapist at Gallagher Performance. Ryan has quickly established himself as a highly sought after coach for athletic development, helping athletes achieve new performance bests while implementing specialized strategies along with manual therapy to keep his athlete’s healthy during their competitive and off-seasons.

Ryan has been involved in the fitness and sports performance industry since 2007. During that time, he has worked extensively with youth, high school, collegiate, and professional athletes. He has also worked with competitive strength athletes in powerlifting and Strongman, as well as physique athletes (bodybuilding, figure, and bikini).

Ryan is certified as a Corrective Exercise Specialist (CES) through the National Academy of Sports Medicine (NASM) and is also a Nationally Certified Licensed Massage Therapist (LMT) through the National Certification Board for Therapeutic Massage and Bodywork. Ryan holds a bachelor’s degree in Sports Management with a concentration in Wellness and Fitness from California University of Pennsylvania.

To compliment his educational background, Ryan is an accomplished athlete in the sports of ice hockey, bodybuilding, powerlifting, and Strongman. HIs diverse athletic and educational background provide Ryan with an highly extensive and unique skill set that allows him to efficiently and effectively help his clients achieve their goals while staying healthy in the process.

Sean Gallagher DC, DACRB, NASM-PES: Director of Sports Therapy, Performance Coach
Dr. Sean Gallagher is the Director of Sports Therapy and also serves as a Performance Coach at Gallagher Performance. In 2009, Sean earned his Doctor of Chiropractic degree from Palmer College of Chiropractic in Davenport, IA. Prior to attending Palmer, he earned a bachelor’s degree in Exercise & Sports Science from Ohio University.

After graduating from Palmer, Sean entered a residency program in Palmer College of Chiropractic’s Sports Injury & Rehabilitation Department. The residency is the only one of its kind within a chiropractic college in the United States. Under the direction of former Olympian, Dave Juehring DC, DACRB, CSCS and Ranier Pavlicek DC, ATC, DACRB, CSCS, the residency provided Sean the opportunity to further the development of clinical skills in the realm of diagnosis, treatment and management of sport-related injuries. During this time, he received extensive training in manual therapies and developmental stabilization methods influenced by the German and Czech rehabilitation schools.

Sean graduated from his residency and completed his board certification in 2012, making him one of a select few chiropractors in the country that have successfully completed a rehabilitation and sports-injury residency. He is a board certified rehabilitation specialist through the American Chiropractic Rehabilitation Board (ACRB) that abides by the standards set out by the National Commission for Certifying Agencies.

To compliment his clinical training and experience, Sean also serves as a Performance Coach with years of experience working with athletes of all abilities and is a certified Performance Enhancement Specialist (PES) through NASM. He is an accomplished athlete in the sports of ice hockey and Strongman. During his time at Ohio University, he was part of the 2004 ACHA D1 National Championship team. In 2001, he was named to the NHL’s Central Scouting Service “Top 10” High School players in the US and was ranked among the top players in North America (US and Canada). As a competitive amateur Strongman, he has won or placed in several NAS sanctioned competitions since 2010 and was a National qualifier in 2010, 2011 and 2012.

Our staff welcomes the opportunity to get you back to 100% and help you reach your fitness or performance-related goals. When you think of sports performance training and chiropractic rehabilitative care in the Pittsburgh area, remember the team of experts at Gallagher Performance.

 
As a chiropractor that specializes in manual therapy and rehab protocols, I see patients dealing with a variety of problems. Now while the conditions can vary greatly, the common denominator that all my patients share is that they are either in pain or unable to perform a specific activity at a level they desire. Being able to provide a service to help people was exactly why I got into chiropractic and it is why I work to continually develop my craft and treatment philosophy. My treatment philosophy has helped to develop my system for how I go about evaluating and treating each patient that comes to me for help. As valuable as my education and residency has been to developing my treatment philosophy, the insight and knowledge I have gained on strength and conditioning as an athlete and coach has been equally valuable.

A great mentor of mine told me that with his background as a strength coach, he uses that background and mindset everyday with his patients. Some years later, I continually have a renewed appreciation for what he communicated in that statement because looking at my patients through the "lens of strength" can provide me with a refreshing perspective.

Why?

Simply put, strength matters. Strength has the ability to cover up dysfunction. Strength will directly impact movement quality. Strength will improve mobility or flexibility issues. Strength has tremendous ability to minimize or reduce overuse injuries. Strength becomes a focus in my treatment plans and the advice I provide my patients.

In my opinion, a major player in the outcomes of patient care is the quality of advice they receive. Much of the advice I provide is directed at my patient's current exercise routine. And, at times, the advice is very blunt. The type of advice that is often tough to swallow on their part because it means big changes

What does that advice look like?

Say you are dealing with low back pain that is worsened from repetitive flexion. You can’t tolerate bending forward to tie your shoes or get nervous just thinking about picking up something from the floor, yet you love your group exercise class that has you running through dozens of crunches, sit-ups, air squats, and wall-balls. Your back is not going to respond to any form of therapy until you remove the irritating factor (your group exercise class) and follow the advice of substituting in more appropriate exercises that promote a healthy back.

Say you can’t properly lift your arms overhead with ideal form and posture through the shoulders, spine, and hips. Now you want to participate in an exercise routine that includes Olympic lifts such as the snatch and overhead pressing. What you must understand is that you lack the prerequisites to perform loaded overhead exercises. This is why your shoulders or low back hurt after overhead pressing or performing a full snatch and you need to be advised accordingly.

Advice should be constructive, providing a solution. However, there is some advice that is simply unacceptable. The classic example of this is the runner who develops knee pain, decides to see a doctor and is told, "Stop running."

Unacceptable.

The solution is rarely that simple. Maybe that runner lacks movement control in joints in such as the ankles, hips, pelvis, and spine because they lack adequate strength in surrounding musculature. Maybe that should be addressed while their current running program is restructured according to their tolerances.

There are solutions and often those solutions involve strength development.

As a therapist, odds are in your favor that you are going to find a strength deficit that is playing into that runner's knee pain. Odds are in your favor that you are going to find that lack of strength is correlated with any number of common conditions.

Lack of strength is never solved by inactivity and prescribing rest. Strength requires the opposite. Strength requires focus, guided effort. Strength is a difficult pursuit and it requires that one knows what they are doing if you are going to coach the process.

On my end as a therapist, what becomes even more difficult to navigate is managing a patient who has his or her own personal trainer or strength coach. I always ask them what they are doing for "training," and most times my response is inwardly shaking my head. I don’t say anything, unless I’m asked. If I’m asked, then it is time to be brutally honest.

It is important to note that you shouldn’t just take exercises away, but substitute better ones. My job is to find the best exercise for the job. This is why developing a large exercise pool to draw from is invaluable as a strength coach and as a rehab specialist. Having a huge exercise pool will allow you to make progressions, regressions, and substitutions based on movement patterns, training goals, mechanical sensitivities, or movement limitations.

At GP, we have taken time to develop our exercise pools for lower body pushes/pulls, upper body pushes/pulls, hybrids, developmental stabilization, etc. This allows seamless transition between phases of rehabilitative care for my patients and continual development from a strength and performance perspective for my athletes because we have developed our plan for progressive development. This understanding of strength also allows me to provide the most appropriate advice when it comes to exercise selection.

As William Penn said, “Right is right even if everyone is against it, and wrong is wrong even if everyone is for it.” People are there for your expertise and knowledge as much as your skills. Remember to provide the care and treatment you would want to receive and provide them with the advice and direction you would want to understand.

More related reading:

https://gallagherperformance.com/interview-with-mike-odonnell-dc-ccsp-cscs/

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

https://gallagherperformance.com/before-you-go-to-a-chiropractor-read-this-first/
What you need to know:
  • Many healthcare providers and trainers poorly understand how movement of the nervous system relates to several common pain syndromes and musculoskeletal conditions.
  • Dealing with neural tension is not as simple as just stretching. While stretching may feel good, it very easily may aggravate symptoms.
  • Once appropriate treatment of neural tension begins, patients often normalize their movement very quickly and experience pain relief. Often this pain relief is instantaneous.
What is Neural Tension?
Neural tension is rather unheard of yet it often plays a significant role in many pain syndromes and musculoskeletal conditions. We all understand for movement to occur in the body, joints must move and your muscles must contract. But did you know that your nervous system tissue must also move freely and unimpeded during movement?

Neural tension is commonly mistaken for muscle tension. Your nerves were not designed to stretch, but rather to glide and give during movement.
If some form of obstruction (soft tissue or bony) impedes your neural tissue then pain or restriction of normal nerve movement is a common result. This normal nerve movement may only be a matter of millimeters, but nerve tissue is highly sensitive and does not like to stretch. Thus if too much stretch is placed on a nerve, the result is adverse neural tension and that can create pain, limited range of motion, as well as other classical symptoms associated with nerve tissue (numbness, burning, shooting pain, etc.)

Neural Tension Treatment
The movement of your nerves, or neurodynamics, can be assessed by a licensed chiropractor or therapist trained in the process of detecting and treating neural tension. Screens or tests commonly used to identify neural tension help identify not only which nerve(s) have adverse neural tension but also where the nerve is being obstructed during its movement.  Identify where the nerve is being obstructed is critically important because treatment is tailored to the site of obstruction.

Again, this highlights the importance of an accurate assessment as treatment can be more accurately applied to the structure(s) creating adverse neural tension. Once treatment begins, patients often normalize their movement very quickly and experience pain relief. Often this nerve pain relief is instantaneous.

What Conditions Commonly Involve Adverse Neural Tension?
Some common conditions that adverse neural tension often plays a role in or is a complicating factor that must be treated include:
  • Neck Pain
  • Shoulder Pain
  • Tennis Elbow
  • Carpal Tunnel Syndrome
  • Low Back Pain
  • Hip Pain
  • Sciatica
  • Plantar Fasciitis
Stretching vs Nerve Mobilizations
A common misconception in the treatment of back pain and associated muscle tightness is the idea that one must stretch to get relief. Stretching may bring temporary relief, only for one to experience the tightness come back once again or, worse yet, an increase in their pain.

Interestingly, when neural tension is identified as the underlying reason for muscle tightness, the treatment of neural tension doesn't actually involve stretching. Excessive stretching can actually irritate your nerves and increase pain. Excessive stretching may potentially damage your nerves as well.

This should make the message pretty clear - stretching may not be the best thing for your back when it's giving you all the signs that it isn't responding favorably.

Rather than stretching, restricted nerves and the surrounding muscles require a different approach known as nerve mobilizations or nerve sliders. Qualified chiropractors and physical therapists will utilize nerve mobilizations to help entraped nerves slide better during movement. They will also treat the surrounding muscles or tissues that is obstructing your normal nerve movement. After treatment, they will retest your neurodynamics and repeat the process until your full neural movement is restored. This process may take a few treatments to clear up, or take several, depending on severity.

Research Supports Neurodynamics
The concept of neurodynamics or neuromobilization is originally based on the research of Michael Shacklock and David Butler. Over the past several years, further research has added to the scientific support of the concept that your nerve tissue requires full freedom of movement to remain pain-free.

The following excerpts are from Michael Shacklock’s book Clinical Neurodynamics: a new system of musculoskeletal treatment:
"Neurodynamics is an innovative management tool involving conservative decompression of nerves, various neural mobilising techniques and patient education techniques. Neurodynamics offers a fresh understanding and management strategies for common syndromes such as plantar fasciitis, tennis elbow, nerve root disorders, carpal tunnel syndromes and spinal pain."

"Essentially the entire nervous system is a continuous structure and it moves and slides in the body as we move and the movement is related to critical physiological processes such as blood flow to neurones. This movement is quite dramatic and it is not hard to imagine that fluid such as blood in the nerve bed, a constricting scar, inflammation around the nerve or a nerve having to contend with arthritic changes or proximity to an unstable joint could have damaging effects, some of which could lead to pain."
Final Words
Neural tension can be present with many common musculoskeletal conditions, such as back pain. Very often neural tension is easily mistaken for muscle tension, leading many to want to stretch in order to find relief. Stretching can be counterproductive and may aggravate pain symptoms. In order to treat neural tension, it must be examined accordingly. At GP, we are trained in detecting and treating adverse neural tension and why it is present.

If your pain is not resolving with other interventions, consider your pain may be associated with neural tension and you may benefit from the most appropriate course of treatment and client education.

More related reading:

https://gallagherperformance.com/why-stretching-wont-solve-your-tight-muscles/

 
Pittsburgh Award Program Honors the Achievement
Gallagher Performance has been selected for the 2015 Best of Pittsburgh Award in the Chiropractors category by the Pittsburgh Award Program.

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 2015 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
I first started working with Sean, at Gallagher Performance, due to an injury to my back/SI Joint in 2014. The injury occurred December of 2013 and I went through almost a year of physical therapy and other doctor appointments before coming to Sean to fix the problem. Sean realized what the problem was and started giving me a combination of chiropractic adjustments and specific exercises to strengthen the area and eliminate the problem.

Over the time when I was injured, I was unable to do anything overly physical. The worst thing that can ever happen to a former athlete is to realize that they can no longer be athletic. I needed to do something more, so I came back to Sean immediately and had him write me up a plan and provide one on one guidance to help me achieve my fitness goals. Sean prescribed a rigorous training program that challenged me day in and day out. I noticed results very quickly and within 12 weeks, I felt better than I had felt in the past 10 years!

I am still going strong with Sean's plans and I look forward to seeing what the future brings using the PROVEN Gallagher Performance methods. Sean single handedly took me from a stale couch potato and he has given me back my manhood! Thanks to Sean I feel like an athlete again. I would recommend Gallagher Performance to ANYBODY looking to get in better shape! They are the best around, hands down!
-Shaun Davis
April 2015 marks two years since Gallagher Performance opened and with the anniversary on the horizon, I thought it was time to start reflecting back on our second year in business.

All our services from chiropractic to massage to personal training to sports performance training continue to experience steady, consistent success. Sure we do not operate at the volume of more established businesses, but our business model places a greater focus on individualized instruction over pure numbers. To us, business success is not simply measured in terms of client volume or monetary gain. For us, success is also measured by identifying how others have been positively impacted by their experience at GP. This could be in the form of clients experiencing improved self-image and confidence that extends beyond the weight room, improved markers of health, improved ability to perform activities without pain or limitation, avoided surgeries, or learning how you inspired a young athlete to pursue a career in chiropractic or fitness. This is exciting to us and it is humbling to learn how you are making a difference.

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

Of all our services, this is most easily observed with our sports performance training. In only two years, we have seen our sports performance training services utilized by a variety of athletes from a growing list of amateur/club organizations, high schools, and colleges. In addition, GP continues to direct the Strength & Conditioning program for the Franklin Regional Hockey Organization.

Here is a glimpse into what types of athletes we have worked with and where they are coming from:

Sports/Events
  • Baseball
  • Basketball
  • Cross Country
  • Football
  • Golf
  • Hockey
  • Lacrosse
  • Physique (Bodybuilding, Bikini, Figure)
  • Powerlifting
  • Soccer
  • Strongman
  • Track and Field (sprint event focus)
High Schools
  • Franklin Regional
  • Greensburg Central Catholic
  • Hempfield
  • Penn Hills
  • Plum
  • Seneca Valley
 College Athletes
  • Andrew Brncic, Alderson Broaddus University (NCAA DII) - Football
  • Colin Jonov, Bucknell University (NCAA DI) - Football
  • Colin Childs, California University of Pennsylvania (NCAA DII) - Football
  • Jake Roberge, Northwestern University (NCAA DI) - Soccer
  • Ben Dipko, Slippery Rock University (NCAA DII) - Football
  • Christian Wilson, Mount St. Mary’s (ACHA DIII) - Hockey
  • Ryan Grieco, Lake Erie College (NCAA DII) - Baseball
  • Evan James, Penn State University Greater Allegheny (NCAA III) - Baseball
  • Dante Luther, Washington & Jefferson University (NCAA DII) - Football
  • Charan Singh, University of Massachusetts (NCAA DI) – Football
We could continue on about each of these athletes, but suffice it to say that we are very proud of each of them, their work ethic, their character, and what they’ve accomplished.

Another Year in the Books
In wrapping up, we acknowledge that GP would not be what it is without the consistent support we receive. A sincere thank you goes out to all you – clients/athletes, parents, family, friends, social media followers, and professional colleagues – for your continual support over the past two years. Special thanks to our marketing firm, 4C Technologies, for their continual support and expertise. We also want to extend a huge thank you to Diamond Athletic Club for being second to none and providing us the venue to operate as a business. Without you all, GP would not be what is today, and we look forward to many more years to come.

More related reading:

https://gallagherperformance.com/four-years-gallagher-performance/
As a chiropractor, I often treat people who have already exhausted all of their insurance money from seeing other chiropractors and/or physical therapists. They come to me out-of-pocket and immediately expect me to do significantly more in one or two visits than the previous professional(s) did after the 12-20 visits that drained their insurance benefits.

I’ve routinely accepted the challenge and many times I’ve closed their case in 2-4 visits by having them listen to advice, advice that addresses underlying issues previously missed or ignored by other providers. Yes, I am a chiropractor and I will adjust and perform manual therapy as needed. But the difference maker time and time again has been the time focused on education directed at independence. Promoting independence on the patient’s behalf is a game changer. This is why I feel so strongly that empowering a patient should be the focus behind therapy and prescribed home programs. As patients discover how they are able to better themselves, their compliance becomes a non-issue and outcomes drastically improve.

The opportunity to educate others is a responsibility that should never be taken lightly. As a provider, the methods utilized to accurately assess a patient’s condition and direct treatment must also serve to improve provider-patient education and accountability.

Gray Cook places this perspective into words very well:
“Our current medical and physical cultures are wasting a lot of time and not creating independence in our clients or our patients. Do we want them to be well and go tell others about their experience or do we want them to keep returning as continual consumers? At what point does wasting time conflict with an oath to do no harm?”
Are you wasting your patient’s time?
One of the fundamental challenges within healthcare is that the human body is a complex adaptive system composed of several interacting parts that are continually changing in response to the stimulus from the environment. This complexity makes understanding the human body a difficult task. Unfortunately, some healthcare providers find reality too complex and would rather repeat the same routine evaluations and treatment over and over again to fit their own skill set rather than truly diagnosing a patient’s condition before administering treatment. This is where providers should question their principles. Are you doing the same thing over and over? Are you so ritualized that your care lacks individualized attention? Are you wasting your patient’s time because you keep missing their problem?

The very essence of what we do is problem solving. Before you can solve a problem, you first must identify what is relevant. On most patients, you can find any number of problems, but it is the relevant problems that are the key. To find relevant problems, you must have a reliable method. The foundation for any method is knowledge and experience. Knowledge and experience that is rooted in understanding how basic science (anatomy, physiology, biochemistry, etc.), pathology, assessment (orthopedics, technique, imaging, etc.), and treatment all integrate.

I’m continually shocked and disappointed when speaking with a new patient who has been told by previous providers that their symptoms “Don’t make sense.” When it comes to musculoskeletal (MS) care, everything makes sense. It may be extremely complex, but it makes sense. If something doesn’t make sense to you, then you don’t understand it well enough. Make changes. Take a more detailed history. Change your perspective. Perform a more detailed assessment. Expand your knowledge base. Do something different.

Never dismiss a patient as not making sense.

As a physical medicine provider, it is your job to have a knowledge base that is large enough to encompass the overwhelming majority of MS problems and conservative interventions. If you don’t, chances are you will suffer along with your patients because your knowledge base is not sufficient enough to diagnose their problems.

Diagnosis must have accuracy and completeness. It must include a pain generator and the relevant problems or dysfunctions. These must be put into context for the patient so they can understand how they came to be the way they are. This is critical as it provides the framework for the education and advice you provide your patient.

Ultimately, that very same framework serves to empower your patients to become more independent. The process is about transitioning them from dependence on you as the provider to an independent patient who truly understands their problem, how to go about fixing it, and the steps needed to prevent recurrent issues in the future.

Final Words
I’m not trying to do anything in my work at Gallagher Performance that is unheard of, but it is still rather uncommon. For my conscience, I would rather create independence than be routine. I also feel that this conscience is growing among healthcare providers and that it is a mindset patients desire to see from their provider.

Promote independence. Your patients will thank you.

More related reading:

https://gallagherperformance.com/stress-overload-and-injury/

https://gallagherperformance.com/relief-care-vs-regular-chiropractic-care/

https://gallagherperformance.com/before-you-go-to-a-chiropractor-read-this-first/
GP recently interviewed Ben Gallagher DPT, FMSC. If you happened to figure out that Dr. Ben is related to us, you are correct. Ben is a physical therapist at Somerset (PA) Hospital Rehabilitation and Wellness Center. As brothers, we share some very similar concepts in the treatment of patients. But, we also share contrasting viewpoints, which makes it fun to learn from each other and gain a better understanding of the professional roles we serve in providing improved quality of patient care.

Now, let's get to the questions.

GP: Please introduce yourself and give our readers some information on your professional, educational, and athletic background (as well as what you have had to overcome since birth in order to participate in athletics).
BG: My name is Ben Gallagher, brother to Sean and Ryan. I live in Somerset, PA with my wife and daughter. I am a physical therapist and have been working at Somerset Hospital Rehabilitation and Wellness Center for over two years. I graduated from Indiana University of Pennsylvania (IUP) with a degree in Exercise Science in 2008. Then went on to Saint Francis (PA) University to get my Doctorate in Physical Therapy, graduating in 2012. Since graduating I have become FMS (Functional Movement Screen) certified, focusing my continuing education on movement analysis and manual therapies thus far.

Athletically, I grew up playing most sports, mainly focusing on basketball until the 8th grade when I got into ice-hockey as a goaltender, then that became my passion. I played through high school and into college at IUP. As for what I had to "overcome," that would be referencing my heart condition. I was born with Tetrology of Fallot, a congenital disorder that required surgery as a young child and again in 2008, and another in about 15-20 years. The condition restricted me from some sports and it is not advised I lift max weights, placing a limitation of how I could physically train for sport. However, prior to my 2008 surgery, in which my heart was over 3x normal size, I had no issues or symptoms. The doctors attributed my training to why I could function so well with such a crappy heart. Training was a mainstay, and still is.

GP: The thought process in your evaluation and management of patients is not widely instructed in physical therapy programs. What were the biggest influences in your professional development in not only the care that you provide, but also why you sought out additional resources beyond what you learned in school?
BG: The purpose of physical therapy school is to: 1) make sure you pass the licensure exam, and 2) make sure you don't seriously hurt anyone. As for producing quality clinicians? No. School just teaches you the basics, and most practicing therapists provide you just that, the basics, which is what you could find on a Google search. So, as for what helped my professional development, honestly the biggest thing was I just thought differently. I saw things differently and I attribute that to my athletic background and training history. For example, as a PT student I would tell my class-mates, "I'm gonna have my grandmas deadlifting." My classmates would gasp, as if that was the most absurd thing they ever heard. But my thinking was, "If someone needs to build strength, why am I gonna have them lie down and lift their leg? When I want to build strength, I train the squat and deadlift, so how couldn't the same application benefit my patients?" Now let me clarify, not all movements are appropriate for all people, at all times. That's why programs need to be individualized, not cookie-cutter.

So for me, I thought, why do I want to further inundate myself with PT knowledge that is elementary and narrow-minded. I sought out other means to fill that thirst for a fuller, better understanding of how the body functions. FMS, which is for any health or fitness professional, is just one of many means to that end that I am pursuing.

Plus, I have to add this: In reference to the grandmas deadlifting story, there was a research article published shortly after in regards to the most effective exercises to strengthen the hips. The study basically ridiculed all traditional PT exercises and found the most effective was a single-leg deadlift. How 'bout them apples?

GP: You are extremely involved with your patient’s care, preferring to perform a lot of manual therapy and oversee the exercise process. This is not common of the majority of physical therapists. Can you speak to why you find this so valuable in the outcomes your patients are able to achieve?
BG: I don't even know where to begin with this issue. I get fired up about the lack of quality care there is in this field.  Most therapists treat with a shot-gun approach, meaning they're not sure what is really going on or how to treat so they will throw a ton of stuff at you hoping something sticks and works. But the best in rehab are like snipers. They isolate what the exact issue is and address it appropriately. And how can you do that if you are not present and in the mix with your patient's rehab process?

GP: As a physical therapist, you see tremendous value in what chiropractic care has to offer. Could you please give your thoughts on what makes chiropractic and physical therapy so complementary?
BG: Following off the above question, when you are involved with your patient's care, you may find that some issue(s) may be out of your scope and there may be better, more skilled hands that are able to provide effective care. How can one means of healthcare be the most effective? What is most effective is what the patient needs. How can chiropractic care be so bad, which is the view of many therapists, when chiropractors help so many? And how can therapists think we are the kings of rehab and exercise when many therapists stick you on a machine and walk away? I have referred patients to chiropractors and massage therapists. But, I do so instructing them on what they need to share with those professionals, because just going blindly to another professional does not always mean you will get quality care. Chiropractor, massage therapist, physical therapist, strength coach….I don't care what your title is; if you're good, you're good.

GP: Posture, stability, and mobility are intensely debated topics at conferences and continuing education seminars. Could you expand on your philosophy when it comes to the dynamic role between posture, stability, and mobility, what athletes and coaches should understand about these topics, and what should be left to physical medicine providers such as physical therapists and chiropractors?
BG: The first thing that athletes and coaches should understand about posture, stability and mobility is that you likely don't fully understand these concepts. Most lay people honestly don't understand how posture impacts how their body feels and the role it has in movement. Someone with good posture likely can't explain why they have good posture or how they achieved it. But, that is why we, as professionals, are here.

The stability-mobility debate is like a left-wing versus right-wing debate. My philosophy is it's a spectrum. No one physical issue is 100% in either direction, but I do believe stability is the issue the majority of the time. And if mobility is an issue, and is addressed, such as stretching or mobilizing, it should complimented by stabilization training to ensure you have control of the new motion you have just obtained.

GP: You have developed a reputation in your area as a “go-to-therapist” for athletes being referred from orthopedic surgeons because of your eye for assessing movement and your ability to successfully return athletes to competition. Besides the FMS, what other assessments do you find valuable in dealing with athletes and their competition needs?
BG: For those who don't know, the FMS is a tool used to assess a person's quality of movement using seven standardized movements. If you move poorly, you are then going to compensate, compensation leads to altered or poor biomechanics, which leads to injury. So the whole purpose of the FMS is to make sure you move well. The job of the clinician is to not only identify poor movement, but to also figure out why you are not moving well. Therefore, what other assessments do I find valuable for athletes? I want to see them go through their athletic movements: swing a golf club or hockey stick, throw a ball, jump, land, cut, sprint, run, etc.

To be able to do this effectively you must first be able to analyze the movement correctly. Is the movement efficient? If it is not, then you must be able to figure out why it is not and be able to address the problem effectively. All this said, what is really needed is knowledge of athletic movement, a good clinical eye, and the knowledge of how to fix whatever issues are present.

That’s a Wrap
Ben, thank you for taking the time to answer our questions. Your knowledge and insight is truly appreciated. We hope this was informative for our readers as well. For those in the Somerset, PA area, be sure to check out Ben at the Somerset Hospital Rehabilitation and Wellness Center for tremendous results when it comes to returning from injury or understanding how to move better for your exercise or sport-related goals.

More related reading:

https://gallagherperformance.com/posture-and-movement-linking-training-and-therapy/

https://gallagherperformance.com/prevent-re-injury-integrated-training-rehabilitation/
The purpose of this article is to provide some basic information about the importance of understanding the role posture and function have in pain, injury, and movement dysfunction. The hope is that you will gain an understanding of why your chiropractor or therapist must evaluate and bring into consideration issues that may not seem related to your pain.
Patients come to us with symptoms and we want to get to the source of their symptoms. In addition to providing relief through manipulative therapy and treating muscular adhesions, it can prove to be incredibly valuable to identify the source of their symptoms. In my experience, the source of a client or patient’s symptoms is often found in painless dysfunction of the motor system.

All too common, providers become reductionist in their evaluation and treatment of the motor (aka musculoskeletal) system. In order to provide long-term solutions and minimize reoccurrences, a holistic or global approach to evaluating functional capacity is needed to identify what is driving pathology in the motor system. This concept is of critical importance when you understand that the majority of motor system pathologies exist because the demands of activity exceed the individual’s capacity. If the demands upon the motor system are at a high level, then capacity must be even higher. Even if demands are relatively low, capacity still must exceed the level of the demand. If there is a capacity “shortage”, the result is a higher injury risk. In musculoskeletal care, one of the greatest challenges is identifying functional capacity “shortages” and how to address them during the course of conservative treatment to provide both immediate and sustainable results.

Professor Vladimir Janda and Dr. Karel Lewit pioneered the process of identifying functional pathology within the motor system. The model is in contrast to the traditional North American orthopedic model, which focuses on structural pathology (ex: disc herniations, rotator cuff injury, labral tears, etc.) as the reason for pain and impairment. But simply focusing on structural pathology can take your eyes away from identifying key reasons as to why they developed in the first place.

Outside of structural pathologies, the functional approach to managing motor system pathologies includes identifying joint dysfunction, muscular imbalances, trigger points, and faulty movement patterns. Faulty movement patterns are protective movements that form in response to pain or the anticipation of pain. These are often the hidden causes of injury, the reasons why many structural pathologies occur. Czech physician Vladimir Janda likened musculoskeletal pain and dysfunction as a chain reaction, thus stressing the importance of looking beyond the site of pain for the source of pain. Janda observed that due to the interactions of the skeletal system, muscular system, and central nervous system (CNS), dysfunction at any one joint or muscle is reflected in the quality and function of joints/muscles throughout the entire body. This opens the door to the possibility that the source of pain may be distant from the site of pain.

Janda also recognized that muscle and connective tissue are common to several joint segments; therefore, movement and pain are never isolated to a single joint. He often spoke of “muscular slings” or groups of functionally interrelated muscles. Muscles must disperse load among joints and provide stabilization for movement, making no movement truly isolated. This ultimately is the reason why many providers within physical medicine are catching onto the saying, “Stop chasing pain.” Chasing pain and other symptoms (ex: tightness, stiffness, restricted movement) may provide short-term relief, but are you providing long-term results?

A common intervention in the rehabilitation of motor system pathology is therapeutic exercise and resistance training. These exercises are used to help restore any number of neuromuscular qualities, such as endurance, strength, and motor control. But often, even in a rehab setting, exercises fail to progress a patient in the recovery process. Sometimes, the application of exercise can make a patient's condition worse. Similarly, many people with the intention of being healthy and wanting to help their body “feel better” will use resistance training in their exercise regimen. Working out, exercising, strength training should improve our state of muscle balance, right? Sure they get the cardiovascular, endocrine, and psychological benefits of exercise, but they start to wonder why all their exercising is only making certain areas of their body feel worse. This is why it’s important to learn that unless exercising occurs in a thoughtful manner, based on a functional evaluation of movement and capacity, the benefits of reducing injury risk, improving posture, enhancing motor control, and restoring muscular balance will be difficult to achieve.

For example, what Janda discovered is the tendency for certain muscles within the body to become tight and overactive, while others have the tendency to become weak and underactive. So if someone is performing general exercises, the brain will select the muscles that are already tight to perform the majority of the work. This is a phenomenon knows as “compensation” or “substitution”. Muscles that are already chronically overused will continue to be overused, leading to greater risk of an overload injury. The muscles that are “weak” have developed a sensory-motor amnesia that will not correct itself unless the exercise is carefully selected and tailored to activate these dormant muscles. Such exercises emphasis the quality of the movement pattern over any prescribed number of sets or reps. The eye of the provider can’t be focused on isolated impairments, but on finding the motor control error. Finding the hidden causes of injury or motor system dysfunction.

Remember, what enhances performance also reduces injury. Finding the solutions to enhancing performance will often address hidden motor system dysfunctions. If you are training for athletic performance, you must build functionally specific or sport-specific capacity. If you are recovering from injury, you must build function rather than solely focusing on palliative measures and treating the site of symptoms. In either scenario, you are building a better athlete and fast tracking the rehabilitation process by taking a functional approach to motor system dysfunction.

More related reading:

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

https://gallagherperformance.com/the-importance-of-functional-evaluation/
Mobility is sexy and it sells.

Get your foam rollers. Get your PVC pipe. Get your stretch bands. Let’s get mobile!

Between mobility screens, mobility workouts, mobility tools, and mobility DVDs, there are plenty of opinions and products available for purchase.  The experts are convincing you of how crucial mobility is for health and performance, while doing their best to convince you to purchase their product.

Enough with it.

While some elements of mobility have merit, many of the approaches to mobility (warm-ups, DVDs, seminars, evaluation systems) are very general and cookie-cutter. A lot of it is unoriginal thought simply repackage and over-priced. Many of these products are not impressive. They are systematic programs that are easy to apply. It’s the classic, “If you see X, then perform Y” approach, providing correctives for movement errors and superficially removing a degree of critical thinking. No wonder the products are so appealing. Someone else has done the thinking for you, so just follow the instructions in the manual and you too can be an expert.

Mobility and movement so easy that seemingly anyone can be an expert?
What troubles me is the trend towards ‘simplifying’ movement, when movement is quite the opposite. Movement is complex. It should be recognized that once you add variables such as load or speed or vector/direction, movement changes. Most screens do not account for these variables and I wish more ‘experts’ understood this clearly.

One individual who has a unique, and truly expert, understanding of the complexity of movement is Stuart McGill. McGill is a spine biomechanics professor from the University of Waterloo. He has authored over 300 scientific publications that address the issues of lumbar spine function, low back injury mechanisms, investigation of the mechanisms involved in rehabilitation programs, injury avoidance strategies, and high-performance training of the back. He serves as a consultant to many medical management groups, elite sports teams and athletes, governments, corporations and legal firms. On top of all those responsibilities, he is often referred the most challenging back pain cases from around the world.

Professor McGill sees two patients per week, spending 3 hours with each patient. His evaluation is of paramount importance in relation to the success he has in treating his clients and athletes. The time he spends on evaluation is often significantly more than many providers spend with a patient on their first visit. As a chiropractor, I know doctors that see 15-40 patients a day and don’t have the time to spend on lengthy assessments. Quick and easy ‘systems’ or ‘assessments’ are exactly what many professionals in the fields of rehabilitation and fitness need.

But does ‘quick and easy’ ensure a thorough exam? Does it ensure all variables have been accounted for? Unfortunately, this is what many have to deal with, so 'quick and easy' is certainly better than no assessment at all. But keep it mind there is a huge limitation to operating in that fashion. This is exactly why my brother and I tailored the operation of GP to allow for the necessary amount of time for our assessments.

At GP, we do not perform general assessments. Every single assessment is personalized to the individual, modified to meet their objectives. What we perform during an assessment “depends” on the presentation in front of us. We understand that movement and the action of musculature is not always obvious. Muscle action will change depending on the movement task, having an effect throughout the entire body. Regarding the ability to recognize the muscular demands of movement, Professor McGill has said, “This is the transition point between a trainer and master trainer.” I’m sure he would say that this also separates a therapist and master therapist.

You will not find our approach in convenient DVD and PDF format, leading you step-by-step through our evaluation and corrective process. Why? The approach we take at GP is very difficult to teach and has taken years to develop through mentorship, experience and self-learning. Whereas, most movement screening systems have the advantage of being easy to teach.

Being ‘easy to teach’ is good for business. But is it the best service for our clients and athletes? Certification courses are designed to churn out new coaches or new trainers at a mind-numbing pace. You would be foolish to assume everyone walking away with a certification functions with ‘expert’ understanding. But that’s what they want you to believe since most attempt to position themselves as experts.

Moving beyond the initial assessment, continual re-assessment is a staple of the process at GP. Our approach focuses on continually assessing and fine-tuning the program as necessary. This is why mobility, like any ‘movement fix’, must be applied appropriately with a solid understanding as to why it's being applied.

Just because someone has a tight hip, doesn’t mean you should blindly advocate foam rolling and performing goblet squats.

Can’t maintain your arms overhead during an overhead squat?

Oh, that is totally caused by tight lats. You need some foam rolling on the lats and then band stretch the daylight out of those bad boys.

Heels come off the ground during the squat? Tight calves and limited dorsiflexion, right?

Let’s foam roll those calves and mobilize those ankles.

This thinking is widespread and too simplistic. In my opinion, it’s no different in application than simply telling someone to stretch because they are tight. Do you think it's superior or different because you applied a foam roller? Sure it may get results a percentage of the time, but often there are deeper underlying issues being missed. Let’s consider the following quotes:
“Soft tissue injuries result from excessive tension, so excessive tension in the rehabilitation setting is counterproductive…stretching of…chronically tight tissue is counterproductive. It may give an initial sensation of relief because the muscle spindles have been deadened, but this practice…weakens the tissue further because of the weakened proprioceptive response.” – Boo Schexnayder
“Stop trying to stretch and mobilize, let tissues settle and regain their proprioceptive abilities so they tell the truth.” – Stuart McGill
Movement Presupposes Stability
Rather than jumping to mobility, we frequently start the therapeutic or rehabilitative process with the emphasis on grooving motor patterns while building whole body and joint stability. Specifically, addressing proximal (core) stability. The musculature of the core is not simply your abs, but all the musculature that interconnects your spine, shoulders, and hips. There is tremendous linkage and interdependence between these key joints of the body. The inability to properly stabilize these regions of the body during movement will ultimately impact distal mobility. Distal refers to the extremities, aka the arms and legs and their respective joints (elbow, wrist, knee ankle, etc.).

As the saying goes, “Proximal stability for distal mobility.”
Through their studies, the Prague school of Rehabilitation has discovered/demonstrated that stabilization and movement are global (systemic) events involving the entire body.

One cannot move without first stabilizing, thus making the support function of the feet, hips, and core of primary importance before movement or mobility is considered.

To improve one's ability to stabilize during movement (AKA ‘dynamic stability’) one must not only train the muscles of the trunk, but also the support function of these muscles.

Dynamic Stability
Training dynamic stability is less about maximizing the loads that the athlete can tolerate and more about training (restoring) the ideal stabilization/movement patterns. Ideal movement patterns are more efficient, leading to increased performance and decreased risk of injury. This is the benefit of quality and efficient movement due to ideal support function.

So what are the consequences of inefficiency?

If you cannot stabilize with proper patterns, compensatory movement patterns dominate leading to hyperactivity of larger muscles groups. Hyperactivity of muscles will make them feel tight. You are going to feel tight. You are going to have restricted joints that are taking an unnecessary beating from the increased forces they are trying to handle. You are going to want to reach for that foam roller and mobilize all day long, but odds are you are going to do so without much success.

In other words, the majority of tightness and mobility issues are a secondary reaction to faulty stabilization patterns and poor support function of the musculature in the feet, hips, trunk, and/or shoulders.

Concluding Thoughts
While others say, "Smash those tissues" or "Mobilize that joint", we say learn to support and stabilize first. Truth is, if you are in constant need of using foam-rollers, tennis balls, and mobility drills, chances are your training is 99% to blame. You need to bring more balance (aka stability) to your body and get strong. It's amazing what can be accomplished when neuromuscular strength qualities, stabilization patterns, and synchronization of movement takes precedent over mobility drills.

This article was intended to challenge the current trend of thinking "mobility first" when it comes to movement-related problems. As mentioned previously, movement is very complex and to approach movement from a simplistic mindset arguably is not an ideal starting point. A thorough assessment, tailored to the individual, will ultimately provide the information needed to implement the most appropriate course of treatment and exercise.

For more reading on this subject, check out these related articles:

Why Stretching Won't Solve Your Tight Muscles
Dynamic Neuromuscular Stabilization: Advancing Therapy & Performance
Rethinking Tendinitis
3 Reasons You Should Train for Maximal Strength
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