Gallagher Performance Blog

Exercise or training should not be fatigue seeking. The problem with a lot of training programs or exercise in general is that they are fatigue seeking.

The primary mentality is to work hard, wear you down and make you sore rather than build competency or skill. This is a mistake and, all do respect, it's wrong.

This is especially true for athletes. If your workout or training is taxing you so much and making you so sore that you can't perform or learn new sport skills, it is counterproductive. You physically cannot drain yourself in a workout, day in and day out, and expect to see improvements in sport mastery. Your body doesn't have enough reserves and you'll never reach mastery.

You cannot go "all out" every work. You cannot go maximal effort every day. But most people think this is they way to do it because that's what they've been told or what most of us see in videos of athletes training. This could be any sport athlete, fighter, or strength athlete. No one wants to put out a video of an athlete who is tapering or who is focusing on building training volume rather than going hard. We just see videos and visions of these athletes peaking or when intensity is at its highest. We made the mistake of assuming this is how they train all the time.

If you would watch most athletes train and practice year round, you'd see a totally different story. Your reaction may be more along the line of, "That wasn't so intense. That wasn't that tiring." Great athletes train for the long run, not to burn themselves out.

Why? You want to set yourself up to train the next day rather than feeling like you are so sore and tired that you can't train or have a lousy training session. This mentality and approach correlates with mastery.

You can't red line the body regularly with intensity. Most athletes that practice this mentality are too beat up by the time they get good at their sport.

Yes great athletes train with intensity but they do it periodically and strategically.  This is "Consistency over Intensity". You don't have to be an athlete to learn from these concepts. Apply them get far more out of your workouts and your training in achieving your strength or fitness goals.

 
For more related reading:

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

 
https://gallagherperformance.com/training-tip-improve-your-conditioning/

 
https://gallagherperformance.com/quotes-and-insights-from-buddy-morris-strength-coach-of-the-arizona-cardinals/

 
https://gallagherperformance.com/how-do-you-build-an-athlete/
There are many examples of things we just assume to be true for long periods of time that aren't true at all. The perpetuation of this group think is a real problem.

This is especially true when it comes to the industries of nutrition, health care, and fitness. Here's some examples:

Dietary cholesterol has no impact on blood cholesterol levels. There is no reason to limit cholesterol in the diet. It has no impact on risk of heart disease and there is no evidence to support any link to heart disease. Except in the cases of genetic variations, the same can be said for saturated fat. Most people end up avoiding these nutrients at the expense of their own health and performance.


Sodium has been demonized for decades when its arguably one of the most critically essential nutrients in our diet. Sodium has no impact on blood pressure when you control for variables such as potassium, calcium, Vitamin K, Vitamin D, and thyroid hormone levels. The recommendations for adequate sodium intake can vary greatly based on individualized considerations, but many people are falling short of a healthy range of sodium simply because they believe too much sodium is bad for them.

More and more research is proving the efficacy of chiropractic and massage therapy. Sure there are some bad eggs out there, but the overwhelming majority provide excellent results through treatment that is both evidence-based and safe.

Resistance training has long been considered too harmful or damaging for adolescents. However the reality is, when proper instruction, supervision and programming is accounted for, resistance training is safer than most youth sports.

A huge reason why these misconceptions perpetuate lies in over generalized recommendations. As with most cases, the best answer to finding a solution is, "It depends." We need to move toward more personalized recommendations that take into account an individual's current health status, goals, lifestyle habits, and genetics while taking it consideration the most current guidelines.

You are either part of the problem and perpetuating group think or part of the solution and exposing false claims.

Don't be part of the problem, be part of the solution. What misconceptions do you encounter regularly that people need to hear the true story on?

 
More related reading:

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

https://gallagherperformance.com/commonmistakesindevelopingyoungathletes/

https://gallagherperformance.com/is-weight-training-inappropriate-for-young-athletes/

https://gallagherperformance.com/4-things-you-need-to-know-about-sports-performance/

https://gallagherperformance.com/attitude-is-everything/
When it comes to athleticism, there is a sad misconception among far too many individuals that athletes are "born not made". People that believe this will often say, “You can’t teach speed” or “That’s just a gifted athlete”. While genetics can play a role in athleticism, arguably the greatest impact on an athlete’s development (or lack thereof) is the training system that is implemented. This would include all elements from its organization to exercise selection and other variables.

While all sports have their own unique considerations, ice hockey demands high levels of athleticism. The transfer of training from off-ice preparation to on-ice performance presents a host of challenges. With the nature of today’s game, proper off-ice training can provide youth and elite level hockey players with the advantage they need to elevate their game.

Here are some tips: 
1. WARM-UP PROPERLY 
In preparation for exercise, the body should be moved through large ranges in all three planes of motion (sagittal, frontal and transverse). Movement prepares the brain and body for exercise by activating the nervous system, warming tissues such as muscles and tendons, and lubricates joints. Movements performed in all planes of motion on a consistent basis will improve stabilization patterns, mobility, coordination, balance, and movement efficiency. Making the time to properly warm-up with allow you to get more out of your training. Simply put, it makes training more productive and will reduce the risk of injury.

2. TRAIN MOVEMENTS, NOT MUSCLES 
The human body operates as an integrated system. Joints and muscles are all coordinated by the central nervous system to produce movement. Muscles never work in isolation, meaning that there is always a pattern of muscle recruitment that occurs with every movement we make. Depending on how we recruit muscles, movement will occur in efficient or inefficient ways. Athletes require mastery of movement. Unlike those who train to for basic fitness or simply to ‘look better’, athletic development and performance-based training programs aim to improve how an athlete moves. Goals focus on strength, stability, mobility, speed, and skill execution with a high degree of movement efficiency.  Sure many athletes look good, but this is often a by-product of their training, not the primary goal.

There can be a mistake in young athletes simply go to the gym and “working out”, either by themselves or with their friends. Especially when they have no plan. If most young athletes are honest, they don’t know what to do during the off-season. Even some trainers have no idea what they are doing with athletes and just “make-up” a training session as they go or select a random workout off the Internet. As the saying goes, “One program on a dry erase board for your group of clients/athletes isn’t training, it’s babysitting.” Higher quality strength and athletic development programs are becoming more available to young athletes; those athletes not involved in those programs will be left behind.

This concept was detailed in our article on Training for Elite Athletes.

3. GET IN TOUCH WITH THE GROUND
This point builds off the previous one. The majority of sport movements and skill execution are initiated by applying force to the ground with the feet/legs. As with land-based sports, the more force a hockey player applies to the ice, the greater acceleration and speed they generate. Strength and power development exercises should be selected based on their ability to enhance ground-force reaction. The same can be said for both speed and conditioning drills.

Utilizing squat and deadlift variations, Olympic lifts, medicine ball throws, jumps, plyometrics, sprints, and hockey-specific agility/change of direction drills would be the most beneficial in developing ground-force reaction. Unilateral movements such as single-leg squats and jumps, lateral bounds, split squats, and lunge variations will also help to develop the movement proficiency need for a powerful skating stride.

4. TRAIN THE CORE FOR FUNCTION, NOT LOOKS
The core is the body’s center of force transfer and movement control. The core is not simply your abs. It includes almost 30 muscles that attach to the spine, shoulders and hips, which function to stabilize the areas during movement. When the function of the core is compromised, inefficient movement results and risk of injury is increased. Hockey and its movement skills require high levels of core stabilization, endurance, strength and power transfer. The demands of athletics on the core will never be met by performing thousands of crunches. Your core training needs a more specific, specialized focus.

Stabilization exercises should focus on things such as maintaining proper lumbo-pelvic posture and the ability to resist or control movement in all planes of motion. Once proper stabilization is achieved, greater attention can be given to rotational power and force generation exercises for increased transfer of training into sport.

5. BE SMART ABOUT YOUR CONDITIONING
The sport of ice hockey places demands on both the anaerobic (alactic and lactic) and aerobic energy systems of the body. For the most part, hockey is an anaerobic game, characterized by intense bursts followed by periods of rest. The anaerobic system is challenged during these intense bursts while the aerobic system is utilized during the recovery period between shifts. This illustrates the need for both systems to be well developed for optimal performance.

Thus conditioning for hockey should focus on an interval-based approach to meet the energy system demand of the sport. Place a priority on developing the capacity and power of the anaerobic-alactic system along with the use of tempo runs/bike sessions to develop the aerobic system. Anaerobic-lactic training is extremely taxing on the body and difficult to recover from. This form of exhaustive conditioning should be used less frequently in the training program.

Remember, conditioning does not mean the same thing as speed training. For more information of developing hockey speed, read this article.

6. RECOVER, RECOVER, RECOVER
Recovery from exercise can be accelerated with proper attention to flexibility, mobility, massage, chiropractic treatment, nutrition and sleep. These approaches facilitate the body’s ability to recover from exercise. Nutritionally, ingesting the proper amounts of whole foods and supplements at the appropriate times during the day can prove to be a huge part of the recovery process. Replenishing energy stores (i.e. muscle glycogen) and providing the building blocks (i.e. protein, fats, vitamins, minerals) for tissue repair and regeneration are just some of the primary goals of proper nutrition. Self-management strategies such as foam rolling and stretching/flexibility work are valuable components in the recovery process. Maintaining proper muscle function and joint range of motion is critically important to minimize injury risk and ensure that you get the most out of your training.

Conclusion
Keep in mind the above tips serve as guidelines. Individual considerations cannot be met in an article of this nature. However, if applied correctly, these guidelines can serve to provide aspiring hockey players with a better understanding of how to go about their off-ice training. For those interested, GP specializes in the training and preparation of hockey players. Contact us for more information.
Similar to a growing number of athletic facilities across the US, Gallagher Performance places a significant amount of emphasis on assessing our athletes in order to address structural adaptations and movement dysfunctions appropriately during the course of the athlete’s training program. This trend is seen throughout collegiate and professional athletics as organizations are recognizing the importance of keeping their athletes healthy by promoting optimal training environments.

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

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

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

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

References
  1. Miniaci et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):66-73.
  2. Connor et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7. 
  3. Sher et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-15.
  4. Jensen et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73.
  5. Kaplan et al. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med. 2011 Feb;39(2):320-328. 
  6. Birmingham et al. The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012, 40(5), 1113-1118.
  7. Philippon et al. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013, 41(6), 1357-1362.
  8. Silvis et al. High Prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011, 39(4), 715-721.
  9. Larson et al. Increasing alpha angle is predictive of athletic-related “hip” and “groin” pain in collegiate national football league prospects. Arthroscopy. 2013, 29(3), 405-410. 
  10. Hack et al. Prevalence of cam-type femoracetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010, 92(14), 2436-2444.
 
 
 
An interesting dynamic has been developing in youth sports. The dynamic has been generated by the current nature of greater focus placed upon competition rather than athlete development. This is evident by the increasing number of games played at the youth level, commonly seen within travel or club organizations. Now, while this trend is not a favorable one and can actually be detrimental to youth athletic development, it has seemed to be the driving force for another trend.

The trend being the greater awareness and proactive nature some parents and young athletes are taking to become more educated on proper nutrition and training. The reality is, at the youth, club, and high school levels of sport, there is a competitive advantage to athletes who not only improve their athletic qualities (strength, speed, power, stamina, etc.), but also become healthier by making better food choices or finding ways to improve recovery.

When it comes to athletic development and preparation, there is no such thing as a “one size fits all” approach. There are far too many individual differences to account for. However, there are some basic principles or guidelines that most any aspiring athlete can implement and see results.

That said, here are five tips that can put you on track to experience better health and more consistent sport performance:

1. STRATEGIC FOOD SHOPPING
 When shopping for food, stay on the perimeter of the store. This is where you’ll find the best in whole food selection such as beef, chicken, fresh produce, and other food that should be the foundation of quality nutrition. The middle aisles mostly consist of processed foods. Sure they may taste awesome, but they do little to support the nutritional demands of young athletes.

2. READ FOOD LABELS
 The importance of reading food or ingredient lists cannot be stated enough. It's important that you know what you are consuming. Food labels can be misleading. For example, items can read “Low Fat” or “Non Fat” in an attempt to appear as a ‘healthier’ choice. However, if you read the label closely, you will find that these foods often have added sugar and/or artificial flavors. As we discussed in this article, fats, such as saturated fat are not the bad guy. Sure, you should avoid foods with trans fat, but the over-consumption of sugar and other processed foods will do more harm to your body than quality, healthy fat ever will.

Focus on selecting foods with a short ingredient list. Food manufactures appear to be taking notice, as they are producing a greater selection of foods with few and familiar ingredients to appeal to the consumer demand for healthier, natural foods.

3. EAT RIGHT, ALL DAY LONG
 When it comes to meals, you can find plenty of people who will advocate breakfast as the most important meal of the day. Others will say dinner. Some may even say lunch. Regardless of opinion, it’s more important to be consistent with your nutritional intake during the ENTIRE day. As a growing and developing athlete, simply focusing on nailing one meal won’t cut it.

It’s important to consume food at adequate levels throughout the day to replenish energy stores and promote an environment within your body that is essential for growth and repair.

4. IN-SEASON MAINTENANCE
 Strength and weight gains occur during the offseason. During the season, athletes need to focus on maintaining what they have built during their offseason.

Why?

With the abundance of practices and games during the season, athletes do not have the energy reserves and time to make strength or weight gains and recover in time for competition. Plus, many athletes can be banged up during the year, thus limiting what you can do with their training. This makes having a trainer or coach who understands how to work around minor injuries of tremendous value.

Establishing an in-season maintenance program can keep athletes healthier and performing at more consistent levels during the season. It also allows them to step into offseason training with greater ease and ahead of the game.

5. TRAIN SMARTER, NOT HARDER
 This is contrary to what almost every athlete hears at some point in their career. Athletes are told to train hard, work hard, etc. While hard work is necessary and valuable, there comes a point when being smart about your training is even more valuable.

Training should produce results. You should be getting something out of it rather than just being exhausted. It’s not difficult to make someone tired. Anyone can make you tired. Those trainers and coaches are a dime-a-dozen. What athletes need is someone that will produce results. There should be measurable gains in strength, speed, and power. If you are not seeing gains and simply becoming more and more tired, you need to start training smarter.

For additional reading on the difference between training smart vs. training hard, check out this article.


There seems to be a growing number of programs and trainers touting how they offer ‘pain-free training’ and that anything less than what they offer is simply inferior by design.

Any intelligent trainer, coach, or therapist will acknowledge the value of proper training to ensure no serious orthopedic issues develop. No one wants their clients becoming pain patients. Proper training is multi-faceted from proper form to proper exercise selection to proper volume and loading parameters. These are a given. These are essential to ensuring we minimize injury risk and improve tissue resilience.

However the reality is if you are going to push your body to new levels of performance, you are going to feel it. It’s going to be uncomfortable. It’s going to hurt at times. If you aren’t looking to better yourself, why are you even training in the first place? Essentially at the heart of training is pushing your body to a place it’s never been before. There aren’t many people out there who have pushed their bodies in training who haven’t ended up ‘feeling it’ in the form of soreness, physical discomfort, and yes - at times - pain.

By all means, yes, we shouldn’t train recklessly. We should be practical and intelligent in our execution of a training plan. But we also shouldn’t be alarmed and fear we are doing something terribly wrong when we deal with discomfort, aches and pains. It comes with the territory of pushing our bodies to new levels of fitness or performance. This is why recovery methods and seeking out qualified professional care from sports/rehab chiropractors, massage therapists, and physical therapists can do wonders for helping our bodies better manage the stress of training. ——

No one wants to be in pain, but push yourself hard enough for long enough, you’ll feel it. We need to understand better pain education, how to be more realistic with training expectations, and how to manage the stress of our bodies to avoid serious pain or orthopedic problems.

 
For more related reading:

https://gallagherperformance.com/the-site-of-pain-is-rarely-the-source-of-pain/

https://gallagherperformance.com/15-minutes-of-exercise-or-8-hours-of-pain/

https://gallagherperformance.com/groin-pain-rehabilitation/

https://gallagherperformance.com/pain-indicates-a-health-problem-not-a-fitness-problem/
Yes it sounds extreme, but it could be our reality. If healthcare spending continues to increase at its current rate, It is estimated that by the year 2040 that 100% of the federal budget will go towards Medicare and Medicaid. That's 100% - meaning no money for anything else.

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

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

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

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

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

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

 
For more related reading:

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

https://gallagherperformance.com/stop-chasing-shortcuts/
[embed]https://www.youtube.com/watch?v=VHRCCRmeznQ[/embed]

Ideal movement and optimal strength development first begins with using the diaphragm as the primary muscle for respiration and for Intra-abdominal Pressure (IAP) or what is also known as the abdominal brace.

A frequent piece of feedback we receive at GP is that much of what we coach is the opposite of what most people have always heard. In regards to breathing and bracing, too many people have either heard or been coached to 'draw' or 'suck' in their abdominal wall. These tips only serve to rob people of stability and strength and play a role in low back pain.


In this video series we discuss how to test IAP for yourself. This is much more challenging that it seems. Insufficient IAP is many times due to poor diaphragm activity and its functional relationship with the abdominal muscles. Poor IAP indicates an underperforming core.

If you're dealing with acute/chronic pain, frustration with progress in the gym, or plateaus in athletic performance and haven't had your breathing and IAP assessed - you're missing out! Learning to properly breathe with the diaphragm can be the stepping stone to the realizing the potential you have when it comes to physical ability. Since breathing is foundational to correct IAP, the core cannot function as it is intended until breathing is normalized. The core is our body's powerhouse and it starts with breathing. It sounds too simple to be true, but improving your breathing can have profound impacts on pain and performance.

Re-training the breathing pattern and creating sufficient IAP cannot be fully covered in a series of 60 second videos. Want to learn more? Set up a consult with us. Assessing, coaching, and learning is very individual. When it comes to getting rid of pain and improving how your body works, GP's level of care, attention, and progressive instruction with our personalized training, chiropractic, and rehab will get you to your goals.

 
More related reading:

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

https://gallagherperformance.com/3-ways-breathing-impacts-health-performance/

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

https://gallagherperformance.com/dns-solves-pain-improves-performance/

 
The combination of chiropractic/manual therapy and massage therapy paired with smart training can make a profound impact on any musculoskeletal condition you may be dealing with. There's tremendous value in care and training that focuses on the goals and outcomes you care about. You place a value on your health or performance and you should receive services that deliver value.

The challenge is finding a chiropractor, therapist, or trainer who aligns with your values and the value that you place on your body and health. There's a spectrum on which these providers exist and it becomes your responsibility to do your homework. To make sure you find someone that can deliver the care, quality, results, and value that you're looking for.


You can go to 10 chiropractors and have 10 totally different experiences. You could see 10 personal trainers and have 10 totally different experiences. Yet all those experiences fall under the broad categories of 'chiropractic' or 'personal training'.

You don't know what you're getting into until you do some research and understand how someone practices or how they are going to approach your specific exercise program.

Some may argue one way may not be better than another way, but there are certainly more affective means of treatment and training that get better results.

There is a responsibility on the individual to find someone who will deliver that value. People often go through detailed vetting processes when it comes to a mechanic, electrician, plumber, doctor, etc. When it comes to your health, are you vetting the people you work with?

A big reason why we get a lot of athletes and individuals that prioritize their health is they do their homework. They want to understand how the body works and they are driven to optimize it. They search out the right person for the job. They want someone to deliver value in the care and the training that they are receiving because they realize they only have one body and they want to take care of it to the best of their ability.

Are you placing value on your health, fitness, or sport goals? Or are you just looking for the best price?

 
More related reading:

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

https://gallagherperformance.com/essentials-of-keeping-athletes-healthy/

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

https://gallagherperformance.com/the-benefits-of-performance-therapy/

https://gallagherperformance.com/powerful-innovative-approach-improving-body-functions/
[embed]https://www.youtube.com/watch?v=YybcsllEkhk[/embed]

Two common sites for pain and movement problems are the low back and sacroiliac (SI) joints. The SI joints are a common site for sensitivity due to biomechanical overload.

Once we have screened for sensitivities, pain generators and movement dysfunction, the presence of SI joint dysfunction is often found along with poor abdominal sling function. Chiropractic adjustments are great for addressing joint dysfunction, but we must train movement through specific exercise.


Addressing abdominal sling function is critical as the SI joints receive stability from the force closure our musculature provides. Poor function of these abdominal slings results in poor stability (and often pain) in the SI joints during walking, running, squatting, lunging, bending, pushing or pulling.

Our abdominal slings are present on the front (anterior) and back (posterior) of our core. The anterior sling being made of the pec major, external oblique, internal oblique, and transverse abdominus. The posterior sling being made of the latissiums dorsi and opposite glute complex.

These exercises demonstrate how to strengthen the abdominal slings as a functional unit. You want to think transverse plane.

Cable chop variations are great for the anterior sling. Cable chops are excellent for building a functional anterior sling for stability and efficient force transfer, especially for front side mechanics as it relates to running, sprinting, jumping, and throwing.

The posterior sling can be targeted with Single-leg Romanian deadlift (RDL) variations as shown. Drawing tension through the lats and glutes provides the stability in the posterior sling to improve motor control of the lumbopelvic region for efficient hip extension. Clean, efficient and - at times - powerful hip extension is critical to a number of athletic movements as well as daily living.

Our hips should be the "King of Motion" in the body, yet many of us deal with tight hips and painful backs or SI joints as a consequence. Our hip movement must be trained and optimized, but the hips will only be as efficient as the abdominal slings allow.

For improved function and less pain, think outside the box when it comes to your abdominal training. Function serves a far greater purpose than aesthetics.

Give these exercises a shot. Let us know your thoughts or questions!

 
For more related reading:

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

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

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

 
https://gallagherperformance.com/exercise-hacks-ep-8-breathing-bracing/

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

 


 
Movement screens or testing can offer valuable insight into why you have pain or limited function.

However what tends to be more valuable is when someone help you understand your movement habits.

By observing how someone moves and the postures they assume during daily activities - walking, bending, twisting, reaching, pushing, or pulling - we can tell you more about the chronic stresses that may be the major contributors to your current problem.


Without understanding your movement habits, we are missing a big part of the healing process or why you experience plateaus in your training/exercise program.

Once you understand movement habits the focus becomes finding what provokes your pain and discovering your weaknesses. By identifying pain triggers, we can build a plan that enables you to control your pain and improve function while your body heals.

Systems and screens for movement are a useful tool, but they tend to be general in nature. They aren't highly specific to the individual all the time. They might work, but often times you must dig deeper and be more accurate in observation, evaluation, treatment, and self-management to help someone achieve their goals.

 
For more related reading:

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

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

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

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

https://gallagherperformance.com/tendinitis-changing-treatment-and-improving-recovery/
 
There's no single blueprint coaches follow when building an athlete. There are no shortcuts. Those cool looking, cookie-cutter programs found online, they often result in failure. In the training world, athletes aren’t built by copying the same program and applying it across the board. At GP, we are in the business of individualized architecture – intelligently designing personalized programs for each athlete. Whether in the weight room or on the field, it should be individual-specific.

We dial in to specificity instead of just saying let’s just go train hard and get bigger, stronger, or faster in the generic sense. Coaches and athletes can be obsessed with bigger, stronger, faster. Yes these are important elements of training but not at the expense of movement skill.

Sometimes athletes need more specific work when it comes to the quality of their movement in regards to stabilization, sequencing, rhythm, relaxation, timing, etc. Developing movement skill is often ignored or disregarded. The problem is there can be a huge disconnect between what an athlete thinks they are doing during a specific movement and what they are actually doing. We must improve their perception and awareness of movement. When combined with proper strength and conditioning, Improving an athlete's body awareness and movement skill will yield far greater results than just focusing solely on strength and speed numbers.

Movement skill acquisition should increase with as strength and speed development increases. This will only enable the athlete to move more efficiently and with less risk of injury.

There are different methodologies, philosophies, systems and styles used in the strength and conditioning industry. Reality is there is no gold standard by which everyone should follow. It’s about finding the right fit for both athlete and coach. Every athlete is slightly different and there won’t be one method that will work for every athlete. That's exactly why individualized decisions should be made for the athlete.

 
For more related reading:

https://gallagherperformance.com/thinking-of-taking-your-child-to-a-trainer-read-this-first/

 
https://gallagherperformance.com/understanding-the-benefits-and-concerns-of-youth-strength-training-programs/

https://gallagherperformance.com/the-essentials-of-speed-training/

https://gallagherperformance.com/how-do-you-build-an-athlete/

https://gallagherperformance.com/guidelines-for-selecting-a-strength-coach-or-personal-trainer/

 
 
The chiropractic profession is an interesting one to be a part of. For some, they more than accept the role chiropractic can play in not only getting them out of pain, but also elevating their overall sense of health and well-being. For others, they remain skeptical and dismissive for reasons that simply come down to myths and misconceptions that have been perpetuated for years. We can thank growing amounts of scientific evidence that has proven many common myths and misconceptions about chiropractic to be false.

In this article, we want to address some common myths and misconceptions regarding chiropractic,  addressing them from an educational viewpoint. But before we get into those, it would benefical to define what chiropractic is for those of our readers who may not be familiar with the scope of the profession.

What is Chiropractic?

Chiropractic is the most commonly utilized form of complementary and alternative medicine (CAM) in the United States, focusing on the musculoskeletal and nervous systems. Doctors of Chiropractic perform examinations, diagnose conditions, and determine appropriate and safe treatment plans utilizing an effective, hands-on approach without the use of drugs or surgery. Other than traditional chiropractic adjustments or manipulative therapy, chiropractors can receive additional training in rehabilitation, sports injuries, myofasical release techniques, taping, bracing, passive modalities (i.e. electrical stimulation, ultrasound, laser therapy), as well as nutrition and implement these into patient treatment plans.

Now that we've had a brief overview of what chiropractic is, let's discuss some common myths and misconceptions.

#1 - There is no scientific evidence to support chiropractic

This is probably the number one myth or misconception that I encounter on a regular basis. The reality is, there is a massive amount of scientific research that supports the effectiveness of chiropractic and chiropractic manipulative therapy (CMT) for a number of musculoskeletal conditions.

CMT has demonstrated effectiveness in the treatment of:
  • Low back pain (1)
  • Sciatica (2)
  • Neck pain (3)
  • Headaches (Tension and Migraine) (4)
  • Shoulder pain (5)
  • Hypertension (aka high blood pressure) (6)
  • Certain neurological conditions (7)

#2 - Chiropractors only treat necks and backs

On the heels of our first myth/misconception, the effectiveness of chiropractic goes far beyond simply treating neck and back pain. Yes, randomized controlled trials support the efficacy of chiropractic treatment for common acute and chronic conditions such as headaches, neck pain and low back pain. However, with specialized training, chiropractors are also capable of treating disc injuries, sciatic pain, strain and sprain injuries, nerve pain, vertigo, TMJ, ear infections, plantar fasciitis, asthma, ADHD, whiplash, scoliosis, IT band syndrome, injuries from auto accidents, and symptoms associated with pregnancy.   Common overuse conditions such rotator cuff injuries, tennis elbow, carpal tunnel syndrome, and other forms of tendonitis also respond well to chiropractic treatment.

Not all chiropractors are the same in their competency and abilities. It's important that you perform your due diligence to find a chiropractor that will be able to treat your condition effectively.

#3 - Once you start going to a chiropractor, you have to go for life

Many of heard that once you go to a chiropractor, you have to go for life.  The same thing can be said of a many healthcare providers, such as regular check-ups with your MD or your dentist. Many people choose to continue getting periodic adjustments and chiropractic therapy to help them feel better.  Others may decide to see us from time to time for episodes of pain or relapses in their condition.

It’s your choice.

Now while some chiropractors and their approach to patient management have given all chiropractors a bad name, the majority of chiropractors aren't looking to make you come back regularly for the rest of your life. But what they hope for is that they have a patient for life and that when someone needs to be seen, they know were they can go for trusted treatment and advice.

#4 - All you do is "crack backs", that's easy

This one is probably the most humorous to me as many will imply that what a chiropractor does is "easy". That all we do is simply "crack backs" and that is easy to do. I've had people tell me, "I can do what you do." The reality is that while yes, making a joint "crack" or "pop" is relatively easy to learn to do, the complication is finding where and how to adjust/manipulate. Palpation is the true art and skill - and it takes years to develop and fine-tune.

The chiropractic adjustment or manipulative therapy is what chiropractors are best known for, but thanks to advancements in the management of musculoskeletal conditions, chiropractors also incorporate many facets into their evaluation and treatment of patients.

Not all chiropractors will just place you in a room with heat and stim, adjust you in less than 5 minutes and send you on your way.

I can't speak for all chiropractors and why they practice the way they do. For me, I choose to incorporate a number of treatment options for the betterment of my patients and their goal-specific outcomes.

In addition to chiropractic manipulative therapy, Gallagher Performance offers:
  1. MYOFASCIAL RELEASE. Myofascial release targets adhesions that develop either within a single muscle or between adjacent muscles and other forms of connective tissue such as fascia, tendons and ligaments. Many athletes and patients experience accumulative or overuse trauma (ex: plantar fasciitis due to running or carpal tunnel syndrome due to prolonged computer/desk work). The goal becomes to work a muscle to remove adhesions and restore neuromuscular function to decrease pain while increasing range of motion, strength, and coordination of movement.
  2. FUNCTIONAL REHABILITATION. In addition to providing relief through chiropractic 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) & VOJTA THERAPY. DNS and Vojta Therapy are advanced approaches used to not only treat a variety of neuromuscular conditions but  also used by athletes worldwide to elevate performance. By applying principles and techniques rooted in the study of child development, DNS and Vojta Therapy aim to improve and restore the activation ideal movement patterns. These techniques are used to promote 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 that are commonly treated by chiropractors and rehabilitation specialists. There are dozens of studies to support the effectiveness of DNS.
  4. NERVE FLOSSING (NEURODYNAMIC MOBILIZATIONS). Nerve flossing is a specialized diagnostic and treatment technique commonly used to diagnose and treat neural tension, which usually expresses symptoms such as muscular tightness, pain, weakness, numbness and/or tingling. Nerve flossing is proposed to help nerves and its branches slide against adjacent structures (muscles, bone, etc.), increase blood flow, oxygen and nutrient delivery, and improve the immune response. (8)
  5. THERAPEUTIC & CORRECTIVE EXERCISE. Exercise progressions and protocols are used to develop strength, range of motion, re-educate the neuromuscular system in order to address the underlying causes of dysfunction and pain.

Final Thoughts

Chiropractic care can prove to be more beneficial than many may realize or want to acknowledge. When combined with manual therapy, functional approaches to rehabilitation, and sound scientific principles of exercise prescription, chiropractors have an ability to conservatively effective treat a wide array of conditions. The evidence shared in this article only scratches the surface. There is more research than I can fit into this blog post. I encourage you to research and read if you are inclined. Become educated and informed so you can make the best decisions for you and your health.

 
More related reading:

https://gallagherperformance.com/before-you-go-to-a-chiropractor-read-this-first/

https://gallagherperformance.com/the-benefits-of-performance-therapy/

https://gallagherperformance.com/best-way-recover-tendon-pain/

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

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

When it comes to Dynamic Neuromuscular Stabilization (DNS), those that are familiar with the method will often ask me, "How do I find the time to treat my patients with chiropractic, rehab methods, and DNS?"
The reasons for the question is simple - DNS is seen as very time consuming. The challenge with DNS is incorporating the method into a busy practice while remaining efficient and delivering a high level of quality care to your patients.

It's a difficult scenario for me to connect with since I have always maintained a schedule which enables me to spend 30-60 minutes with each patient. However, I realize this is not the norm for the overwhelming majority of chiropractors and they are under more of a time crunch to deliver the most they can in a shorter period of time. Even most physical therapists I know do not have that time to spend with a patient 1-on-1 as they normally have a number of patients blocked together for appointments and rely upon help from their assistants.

That said, the reality is until one has been properly trained in DNS, they will continue to assume that the amount of assessments, patient education, instruction, and exercise-based interventions will all add up to extra time with patients they simple don't have.

In my opinion, the time I have taken to study, learn, and implement DNS concepts into my patient care has only been a compliment to what I do as a chiropractor. Chiropractic, in a very traditional sense, is the healing art based on the science of the nervous system and it's relationship to altered spinal joint mechanics. At its very root, chiropractic aims to improve the functional of the nervous system through manual methods or manipulative therapy of the spinal joints. There is a tremendous focus on the musculoskeletal system and its relationship to the health of the nervous system. Chiropractors evaluate for postural, structural, functional, and movement-based imbalances that play a role in either pain, dysfunction, or reduced expression of overall health.

As a chiropractor, we routinely treat patients to get them out of pain, but we also work with them to restore health and a quality of life they want to maintain. And that's what makes chiropractic and DNS such an awesome combination. They both produce results that enable patients to get out of pain, improve function, restore health and get back to enjoying their life. 
As a chiropractor, I use DNS assessments to identify movement patterns that are non-ideal in regard to stability and mobility. DNS is not merely a technique, but rather an overall strategy to better understand the principles of movement. It includes both a knowledge and theoretical base that forms the foundation for assessment, treatment, exercise and functional strategies.

We aren't simply just looking for joints that don't move well or muscles that are too tight or weak. The focus of DNS is correcting faulty movement patterns that ultimately cause tight or weak muscles and joint fixations. By performing basic assessments it is possible to identify what the problems are and what exercise interventions would successfully achieve the desired correction - and this can all be done quickly. This biggest misconception is that providers need to instruct their patients in a large number of exercises in order to correct dysfunction in movement stability or mobility. This couldn't be further from the truth. My patients only perform the most challenging exercises with the proper stabilization and movement control. This means that most patients are leaving with 2-3 home exercises and there are those that will leave with only one exercise.
These exercises are intend to improve the sensory messages our brain receives from movement. We can thank the modern sedentary lifestyle and simply not moving with enough variety for the decline we see in maintaining a healthy brain and nervous system. This decline presents itself in postural abnormalities and altered movement patterns And both can be addressed through exercises and improved proprioceptive control of our joints and movement.

The exercises are intended to be functionally-based and proprioceptively-rich. This enables the patient to create a lot change from just from a few exercises - training economy at it's finest. When it comes to DNS exercises, patients get a great deal of results without having to invest a lot of time.
Furthermore, chiropractic adjustments improve sensory inputs from the spine to the brain and this proprioceptive stimulus opens a window by which we can use DNS to improve our body's control of posture and movement. DNS exercises enable us to provide a regular proprioceptive stimulus that will create change in the body.
And isn't that why patients seek out chiropractors in the first place? They are coming to us hoping we will make a change in their body that not only provides relief, but also results in lasting changes they can maintain.

 
For more reading:

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

https://gallagherperformance.com/dns-solves-pain-improves-performance/

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

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

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

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

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

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

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

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

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

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

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

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

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

More related reading:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More related reading:

https://gallagherperformance.com/3-simple-steps-to-reduce-your-risk-of-sports-injuries/
About the Author: Kristin Gallagher has a Bachelor of Science in Nutrition from Indiana University of Pennsylvania and is currently a first-year student in the Physician Assistant program at Baldwin Wallace University. She has a special interest in dermatology, food allergies, GI disorders, and understanding the role gut health plays in health and disease. This paper has been reproduced with her permission.
Over 2,500 years ago Hippocrates had stated that “all disease begins in the gut.” It has been in the last several decades that this connection has been explored in great detail and proven that the gut serves a much bigger role than just nutrient extraction. In fact, this topic has gained popularity especially within in the past couple years. There have been several connections established between the gut and the brain and the ways in which they communicate with one another through the nervous, immune and endocrine systems (Patel).

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

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

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



So, how do we control gut permeability?

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

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

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

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

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

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

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

https://gallagherperformance.com/why-poor-recovery-will-make-you-sick-sad-and-weak/
Running season is fast approaching. Spring and summer have a host of events from marathons, to half marathons, to triathlons, to various course races. Many have likely already started their training. And then of course we can’t forget those who will simply take up running in hopes of shedding unwanted body weight for the summer.

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

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

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

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

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

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

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

Most runners will eventually encounter their fair share of aches, pains, strains and overuse injuries. Plantar fasciitis, shin splints, tendonitis, stress fractures, runner’s knee, IT band syndrome and joint pain are common to the running community. Once training demands exceed what is one physically prepared for, this is where things start to go south.
These conditions may be present for a number of reasons, including any of the following:
  • Sharp increases in training volume
  • Foot wear
  • Gait mechanics
  • Strength deficits
  • Joint dysfunction or fixations
  • Improper motor control of lower extremities and/or torso
  • Overtraining
  • Inadequate physical preparation
This article is not intended to address training theory or programming as it relates to preparation for an endurance event, foot wear or gait mechanics. What I want to address is the reality that one must be physically prepared for a specific event and this requires that a runner must possess the necessary prerequisites in movement as it relates to running.
And no, being physically prepared doesn’t mean being fit or having a certain level of fitness. Being physically prepared for a distance running event goes far beyond one’s aerobic fitness.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That's a Wrap
While this list is far from comprehensive, it will serve as a general template to help runners to address basic physical prerequisites needed to stay healthy and train with minimal risk of setbacks. This is general template for physical preparation of a runner. Remember, like any athlete, physical preparation serves as your foundation as a runner. Take time to develop your physical preparation. Take time to develop your strength and movement control as it will allow you to get more out of training and keep your body healthy in the process.
Pittsburgh Award Program Honors the Achievement
Gallagher Performance has been selected for the 2016 Best of Pittsburgh Award in the Chiropractors category by the Pittsburgh Award Program and is among a very small group of businesses that have won the Best of Pittsburgh Award for three consecutive years.

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

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

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

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

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

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

 
 


More related reading:

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