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

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

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

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

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

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

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

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

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

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

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

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

More related reading:

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

 

The majority of us will not get through life without sustaining some degree of injury. The joints of the back, shoulder, hips, knees and ankles are all very common injury sites for not just athletes, but the general fitness population as well.

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

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

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

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

And this is exactly where most get stuck.

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

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

Why do I say sadly?

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

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

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

More related reading:

https://gallagherperformance.com/technique_and_performance/

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reflecting back on the past several weeks, there are some friendly reminders and lessons learned or re-learn that I wanted to share:

• Power-speed athletes thrive on power-speed drills and exercises. Just because one can squat or deadlift 500+ doesn’t mean they are explosive and fast. Yes athletes need strength and for many they will need a primary focus on strength training. However, those newly acquired strength levels must also be displayed in more power-speed dominant means such as sprints, jumps, throws as they have greater specificity to athletics than anything barbell related.

• Athletes need to rapidly absorb force and rapidly generate force and do it on a level of unconscious activation. That brings me to another point of muscle activation. Muscle activation is a craze nowadays and rightly so. The overwhelming majority of the population will benefit tremendously from learning how to activate and integrate muscles such as their tibialis anterior, glutes, and scapular stabilizers to name a few. A lost art in muscle activation seems to be the use of isometrics. There is always an isometric contraction during the amortization phase of movement. Even during the most explosive movements, there is an isometric contraction. Isometrics are also awesome for reprogramming and generating a powerful mind-muscle connection, making isometrics a great tool for performance as well as rehabilitation. We have been utilizing a select few isometric drills for uprighting, motor control, and priming for improved  force/strength generation. In a relatively short period of time, they have more than demonstrated significant value.

• There is a right way to go about training and a wrong way. The right way will always be dependent on the needs of individual and their specific goals. Don't get caught up in hype, trends, and empty promises. Trust the tradition. There is magic in the basics of the barbell, free weights, sprints, jumps, and bodyweight drills. They have stood the test of time. Fads and trends come and go, the basics remain. Using these exercises is one thing, understanding how to structure them in a training plan is another animal in itself. Find a trainer/coach that understands training specificity or else you are simply wasting your time and money.

• We are problem solvers. Either as a clinician or trainer/coach, the heart of what we do is problem solving. Maybe it’s a matter of ability or effort, but clinicians or trainers either have the ability or they don’t. The ability to problem solve comes from knowledge and experience and even instinct. When it comes to effort, frankly some are just lazy and don’t care to think hard as it complicates their job. Whether it is listening to what a patient/athlete is telling you or just simply watching, you’ve got to process the source of the problem and how you’re going to solve it. When it comes to performance or rehabilitation, everything makes sense. If it is happening there is good reason for it. If we don’t understand it, it doesn’t make sense to us, but it always makes sense. Never dismiss a client or patient as not making sense. Make the effort to make a change. Change your perspective. Learn more.

• We all need a coach. No one gets through life all on their own. We all have needed mentors and coaches at some point in our life. These may have been parents, family members, close friends, teacher, professors, bosses, etc. If we pursue something of significance, chances are someone helped us along the way. We need the help of others than have more knowledge, more experience, more accomplishments. I have had a number of mentors and coaches. For everything they did for me, I hope I can pass that on to those that I work with in the role as a coach.

• Take time to get to know your clients and athletes. Show you care about them. We do more than just simply get kids bigger, stronger, or faster. We have an opportunity everyday to connect with our clients and athletes and hopefully make a positive impact. The reward goes far beyond cash flow. It’s about making a difference for the better.

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

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

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

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

However, the benefits of spinal manipulation do not begin and end with back pain. There are numerous benefits to spinal manipulation that make chiropractic care an invaluable addition to one’s health related or athletic pursuits. Below is just a short list.

1. Joint pain relief - The most obvious benefit is relief of pain. Chiropractic manipulative therapy (CMT) can almost instantly relieve pain experienced in the low back, mid-back, neck, and extremities and has demonstrated this in research.
2. Disc Bulge/Sciatica - The European Spine Journal published the findings from a clinical trial with chiropractic manipulative therapy showing 72% success rate in treating sciatica and associated symptoms. Disc bulges respond favorably to spinal manipulation techniques which focus on resorting joint mechanics and unloading the intervertebral discs.
3. Headaches (tension and migraine) – There are hundreds of peer reviewed research articles demonstrating the ability spinal manipulation to prevent and ease the burden of headaches and migraines.
4. Blood Pressure - In 2007, a team of researchers published a study in the Human Journal of Hypertension demonstrating that one upper cervical chiropractic adjustment had the same effect as two blood pressure-lowering drugs. Those effects were not simply short-term, they lasted more than six months.
5. Surgery Prevention - The Journal of the American Medical Association recently published its low back pain guidelines and suggested that people suffering from back pain first try chiropractic before resorting to surgery. When appropriate, a growing number of physicians and specialists are recommending patients pursue conservative management of musculoskeletal conditions and pain syndromes before surgical intervention. The majority of these patients avoid surgery as they respond extremely well to conservative management via chiropractic care, physical therapy, or a combination.
6. Athletic Performance - There is a reason why countless professional and Olympic athletes receive regular chiropractic care. The physiologic and neurologic benefit of spinal manipulation is super charged when used in a comprehensive care plan to address pain and dysfunction. Simply stated, muscles just work better when proper joint motion is restored via manipulative therapy. Athletes thrive on proprioception and motor responses from sensory input. Proprioception and motor response all improve from spinal manipulation. Coupled with exercises to facilitate motor skill acquisition, the short-term responses from spinal manipulation eventually become long-term improvements in movement quality and efficiency.

There is a reason why countless professional and Olympic athletes receive regular chiropractic care. The physiologic and neurologic benefit of spinal manipulation is super charged when used in a comprehensive care plan to address pain and dysfunction.

This infographic puts it into words nicely!

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

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

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

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

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



So how do we stop the cycle?

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

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

More related reading:

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

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

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

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

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

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

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

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

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

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

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

More related reading:

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

https://gallagherperformance.com/does-practice-make-permanent-how-practice-rewires-your-nervous-system/

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

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

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

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

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

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

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

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

Typical symptoms of concussion include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more on DNS here:

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

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

What is Fascia?
The soft connective tissue, located just under the skin, is a white membrane that wraps and connects muscles, bones, nerves, organs, blood vessels of the body.

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

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

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

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

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

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

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

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

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

More related reading:

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

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

https://gallagherperformance.com/3-benefits-of-integrated-training-and-therapy/

Attitude.

We've all heard about it since we were young. We've heard it from parents, family, friends, teachers, and/or coaches who preached the importance of attitude.

Sometimes it takes a certain individual to have an impact in ways others cannot. Likely you have had someone in your life tell you the same thing you've heard countless times before, but for some reason it sticks. It sinks in. These people capture our respect. We feel they are deserving of our attention and we finally listen.

When it came to the importance of attitude, my Uncle Gene was just one person who made a big impact on my views. My uncle served in WWII and when he talked attitude, I listened.

Why?

It had everything to do with that fact that he embodied the message of "Attitude".

During his time serving in WWII, he was on a test flight near Foggia, Italy when a parachute flare bomb failed to release from his B-25. The bomb was hung near the rear hook on the shackle. With the safety wire pulled, the vane was able to spin freely. Realizing the danger of the situation, he climbed down into the bomb bay and, supporting himself with his elbows, he freed the bomb with his feet. For his actions he was awarded the Soldier's Medal for heroism. I have this medal in my bedroom to this day.

Now while his actions were awarded, it was his attitude in that moment that was the clear defining factor.

He was no more physically capable than any others aboard that plane. As a member of the Air Force, these men all had to be in top physical condition to serve our country. It wasn't that he was any bigger or stronger than the next guy. Simply put, in that moment he displayed resourcefulness and selfless courage to step into that situation. His attitude dictated his actions. Because of his attitude and actions, he received recognition for what he accomplished.

In a world where accomplishments matter, attitude matters most.

So what are some key characteristics of the attitudes or mindsets which promote success, be it in sport or in life?

JoAnn Dahlkoetter, Ph.D., author of Your Performing Edge and an internationally recognized sports psychologist, has identified characteristics that make a champion athlete that are able to be developed by anyone who wants to excel in sport:

• Enthusiasm and Desire – Top athletes have a hunger, a fire inside which fuels their passion to achieve an important goal, regardless of their level of talent or ability.
• Courage to Succeed - It takes courage to sacrifice, to work out when you’re tired, to seek out tough competition, to stick to your program, to test your limits, and to overcome obstacles.
• Internal motivation and self-direction – Direction and drive need to come from within. The goals must be ones that you have chosen because that’s exactly what you want to be doing.
• Commitment to Excellence – Elite athletes know that to excel at their sport, they must decide to make it a priority in their life. They make an honest effort each day to be the best at what they do. At some point you must say, I want to be really good at this; I want this to work.
• Discipline, Consistency, Organization – Elite athletes love what they do and it is easier for them to maintain consistency in training and in competing. Regardless of personal problems, fatigue, or difficult circumstances, they can generate the optimal amount of excitement and energy to do their best.
• Being focused and yet relaxed – Champions have the ability to maintain concentration for long periods of time. They can easily let go of distractions and take control of their attention. They don’t let emotions get the best of them and cause poor performance.
• Ability to handle adversity – Top athletes know how to deal with difficult situations. Adversity builds character, but adversity also reveals character. When elite athletes know the odds are against them they embrace the chance to explore the outer limits of their potential. Rather than avoiding pressure, they feel challenged by it. They are calm and relaxed under fire. Setbacks become an opportunity for learning.

The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do. It is more important than appearance, giftedness, or skill. It will make or break a company, a church, a home. The remarkable thing is we have a choice every day regarding the attitudes we will embrace for that day. We cannot change our past...we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude. I am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you...we are in charge of our Attitudes.

Low back pain is not an uncommon condition among the American population. Several studies have supported data that demonstrates up to 85% of the population will experience at least one episode of low back pain during their lifetime. Low back pain is responsible for millions of dollars in healthcare costs every year.

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

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

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

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

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

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

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

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

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

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

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

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

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

Imagine a world where patients get the advise, education, and treatment they need. Imagine doctors who:

• Make sense of what a patients says
• Know exactly what a patient needs
• Confidently provide gold standard advice and treatment interventions

• A detailed history, orthopedic and neurologic examination, and functional based examination to create a working diagnosis.
• Functional based examination to focus on the spine, shoulders, hips and feet, as these joints and their respective functions serve as the "key joints" of the human body.
• Joint and muscle palpation to assess the quality of your joint movement, trigger points, and muscular imbalances.

1. CHIROPRACTIC MANIPULATIVE THERAPYGallagher Performance provides the latest techniques, including joint manipulation (adjusting), designed to treat musculoskeletal complaints. The purpose of joint manipulation is to release restricted joints of the body, primarily in the spine and extremities. Joint commonly become restricted as a response to poor posture, imbalanced muscle activity, and/or trauma. By releasing a restricted joint through manipulation, improvements in the quality of motion of the joint are gained that may not be possible with exercise or other interventions. Manipulation also serves to reduce pain and relax tight muscles.
2. FUNCTIONAL REHABILITATIONIn addition to providing relief through manipulative therapy and treating muscular adhesions, it can prove to be incredibly valuable to identify the source of a patient’s symptoms. The functional approach to rehabilitation includes identifying joint dysfunction, muscular imbalances, trigger points, and faulty movement patterns. These are often the hidden causes of injury. Observing how a patient moves and functions allows us to identify improper movement patterns that become contributors to pain and poor sport performance. By placing an emphasis on strategies to improve movement and function, functional rehabilitation is effective in improving qualities of endurance, strength, stability, balance, agility, coordination, and body awareness.
3. DYNAMIC NEUROMUSCULAR STABILIZATION (DNS)By applying principles and techniques rooted in the study of child development, DNS aims to improve activation and neural control of muscles and ideal movement patterns. DNS promotes the ideal postures, movements, and degree of body awareness that is essential not only to athleticism, but to also treating the underlying causes of several pain syndromes.
4. MYOFASCIAL RELEASEGallagher Performance offers a number of soft tissue approaches to treat painful or tight muscles, tendons, and ligaments. We have extensive training in identifying and treating muscular adhesions that compromise quality of motion and contribute to pain symptoms or reduced sports performance. Many overuse or repetitive use conditions respond well to treatment of soft-tissue structures, including back pain, shoulder pain, shin splints, runner’s knee (IT band syndrome), and plantar fasciitis.

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

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

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

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

Low Back Treatments That Don't Help
Now many experts are questioning the model in which back pain is treated as a growing body of research suggests many common back pain ‘cures’ just don’t work. These include:

• Ultrasound
• TENS machines
• Strong opium-type painkillers, such as diamorphine
• Spinal injections
• Spinal fusion
• Disc replacement

For many of our readers, you may not be aware of the specialized background that Gallagher Performance has in personal training, athletic development, chiropractic rehabilitation, manual therapies, and sports-injury care.

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

Meet the Staff

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

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

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

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

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

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

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

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

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

 

Injuries are a part of sport and life. It is an unfortunate reality and a lesson some encounter with greater frequency than others. I have had my fair share of injuries as well. The reason why I am writing this post is because of my most recent injury.

Over the past 14 weeks, I have been prepping for a strongman competition in Iowa on May 16. The training cycle had been going smoothly and I was feeling good heading into the final days before my taper. Four days ago, I pulled my left bicep during tire flips. The tire flip is one event that is notorious for causing bicep injuries due to the large amount of mechanical stress it places on the biceps. Fortunately, I did not suffer a complete tear, no surgery needed. However, competing is out of the question. When you are self-employed and your job requires the uses of your hands, there is no need for any further set backs.

For some, injuries mean down time from training. They see injuries as an obstacle. Not in my mind. An obstacle is what you see when you take your eyes off the goal. There are still ways to train around injuries. Sure, I will not be able to do anything stressful with my left arm for 3-6 weeks, but I can still get a powerful training stimulus from a incorporating squat and single-leg variations for lower body strength, jumps/bounds/hops for more intensive CNS stimulus, and training my non-injured arm to help maintain strength and speed recovery of my injured arm.

Wait….what? Training your non-injured arm helps to keep your injured arm strong and heal faster?

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

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

Why?

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

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

What does that advice look like?

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

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

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

Unacceptable.

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

There are solutions and often those solutions involve strength development.

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

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

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

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

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

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

More related reading:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sources:
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Cerebellar function and hypermobility in patients with idiopathic scoliosis, Kobesova A, Drdakova L, Andel R, Kolar P. International Musculoskeletal Medicine. , 2013, 35(3): 99-105.
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Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. J Orthop Sports Phys Ther, 2012;42:352-362.
Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment, Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A. J Appl Physiol. , 2012;42(4):352-62.
Importance of Developmental Kinesiology for Manual Medicine, Kolar P. translated from Czech Journal of Rehabilitation and Physical Therapy, 1996;4:139-143.
Surgical treatment and motor development in patients suffering from cerebral palsy, Kolar P. Translated from Czech Journal of Rehabilitation and Physical Therapy, 2001;8(4):165-168.
Long-Term Efficacy of Dynamic Neuromuscular Stabilization in Treatment of Chronic Musculoskeletal Pain, Bokarius AV, Bokarius V. 12th World Congress on Pain. Glasgow, Scotland. Aug 17-22, 2008. Presentation # PF225.
A case study utilizing spinal manipulation and dynamic neuromuscular stabilization care to enhance function of a post cerebrovascular accident patient, Oppelt M,Juehring D,Sorgenfrey G, Harvey PJ, Larkin-Thier SM. Journal of Bodywork and Movement Therapies., 2014;18:17-22.
More related reading:

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

What is the purpose of the warm-up? How important is the role stretching and mobility during the warm-up process? Plenty of clinicians and trainers preach mobility, mobility, mobility. Is mobility truly the answer? We answer those questions in this short video.

https://www.youtube.com/watch?v=k-mlmqBmNyg