Gallagher Performance Blog

What you need to know: Many healthcare providers and trainers poorly understand why someone 'feels tight'. Dealing with muscle tightness is not as simple as just stretching.

Why Muscles Become Tight 

The human body is designed to move and movement requires varying amounts of stability and motion. When movement occurs, patterns of stability and motion can occur in efficient or inefficient ways. As structures accommodate movement, the load placed on everything from joints to muscles and tendons to nerves changes and these changes can produce symptoms. In the process of wanting to avoid symptoms, the body will often develop compensation patterns. A common result of this compensation process is the feeling of being 'tight' or 'tension'. This tension serves a protective role, thus it is referred to as protective tension.

The development of protective tension and the reason behind its presentation is one of the least understood mechanisms in musculoskeletal care. The body is smart enough to constantly monitor loads and prevent excessive load of any given structure to ultimately help prevent injury. If you are feeling 'tight', there is a reason and your body is sending you a signal. However, many people will ignore this signal until more pressing issues develop, such as pain. So how does one handle a muscle that 'feels tight'? Unfortunately, the solution is not as simple as just stretching. Stretching often provides temporary relief because of underlying joint dysfunction, stability and/or mobility deficits, or muscular weaknesses that need addressed.

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

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

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

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

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

 
More related reading:

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

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

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

[embed]https://www.youtube.com/watch?v=btwqe2CPW-M[/embed]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
More related reading:

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

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

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

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

https://gallagherperformance.com/structural-adaptations-how-they-impact-training-and-therapy/
[embed]https://www.youtube.com/watch?v=v4DNb8Kl04Q[/embed]

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

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

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

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

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

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

 
For more related reading:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What does that mean?

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

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

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

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

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

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

 
For more related reading:

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

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

https://gallagherperformance.com/low_back_pain_causes_and_treatment_recommendations/

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

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

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

 
 
 
 
 
 
 
 
For those of you familiar with GP, you know we take the balance between training and recovery very seriously. It's a subject we feel we cannot educate our clients on enough. Recovery is too often a poorly understood or ignore aspect of training and the organization of sport (i.e. practice, competition). Many coaches and trainers push their athletes to the brink, attempting to build physical stamina and mental resilience. This is a part of sport and a necessary component to improving physical attributes such as strength, speed, and power. However, if you miss the boat on recovery, you could be sabotaging your efforts.

Why is recovery so important?
How much time do you spend training on a weekly basis, working towards physical or athletic goals? Probably not much, at least when compared to the amount of time spent between those sessions.

Training, regardless if you run, lift, swim, or skate, is a stimulus to the body. It's a stimulus for change and that stimulus will only generate results if you recover adequately between training sessions.

When recovery is poor, health and performance begin to suffer. This is the point at which many people describe themselves as "feeling flat" or “hitting a wall.” What they are communicating is low energy levels and an overall sensation of not feeling right. Fatigue has built-up because recovery has not been adequate. This state of fatigue can be referred to as “over-reaching" and in more serious cases it is known as "over-training."

Over-training can involve signs/symptoms such as:
  • significant decreases in power or capacity of physical attributes such as strength, speed, or power
  • significant and chronic joint and muscle pain
  • significant changes in mood, such as depression
  • significant sleep disruption
  • major immune problems — frequent illness (i.e. bacterial/viral infections)
  • hormonal suppression (i.e. low thyroid, low sex hormones, amenorrhea or irregular periods in women)
Over-reaching is a much milder version of overtraining, but is a far more common and can involve:
  • low energy
  • lack of motivation to train
  • feeling "run-down"
  • persistent sore and achey joints or muscles
  • mild mood changes such as feeling more irritable, moody, or anxious
Understanding Recovery
Lack of recovery is a complex phenomenon with wide-ranging effects, with the heart of the issue being fatigue. The underlying causes of fatigue fall into two main categories:
  1. Central (CNS) - The central nervous system (CNS) serves the purpose of monitoring the body, similar to the function of a car engine regulator. If you "redline" the engine of your car too long, the engine shuts down. Your brain attempts to protect your body in the same fashion by reducing the ability of your body to "fire muscles" through nerve impulses.
  2. Peripheral (muscular) - The other form of fatigue, peripheral, is related to energy system depletion and/or metabolic byproduct accumulation. Sticking with the car analogy, this is similar to running out of gas.
There are plenty of activities and responsibilities that will consume our days and the time between workouts, or in other words, our recovery time. The activities that we choose to be involved in will have a profound impact on our ability to recoup and recover. To understand the influence our activities can have on our recovery, we must first place them into two distinct categories:
  • Sympathetic activities – often referred to as “fight or flight”
  • Parasympathetic activities – often referred to as “rest and digest”
Sympathetic activities dominate our lives. Whether it's the pursuit of educational, athletic, or career goals, trying to establish financial stability, or building relationships, these activities bring on varying degrees of stress. Your body reacts to stress by elevating levels of cortisol and adrenaline.

Stress, or over-stimulation of the sympathetic nervous system, can become chronic. If that happens, production of stress hormones begins to slow and the development of ongoing, chronic fatigue may occur. This is central fatigue. The body has been "redlining" for too long and is beginning to shut down. See the problem?

Now, I'd think we'd all be fans of simply removing all stressors from life. Doesn't that sound appealing? However, that is not a realistic option. Instead of eliminating stress, the key is to establish a balance with relaxing and invigorating activities.

Relaxing and invigorating activities stimulate the parasympathetic nervous system, which is vital to restoring balance to the body and improving recovery. Such activities include:
  • Low-intensity, aerobic-based exercise (cycling, walking, hiking)
  • Massage
  • Yoga
  • Meditation
  • Hot tub or sauna
  • Relaxing hobbies such as reading or listening to music
  • Meaningful relationships
  • Drinking tea
Depending on your tastes and what you find to be relaxing, any of the above activities can have the ability to lower stress, improve oxygenation of tissues, facilitate lymph circulation, and promote a hormonal environment that is vital to recovery.

Keep in mind, one activity is not necessarily better than another. All that matters is that you pick a specific activity that you find enjoyable. The many systems of the body are working overtime between training sessions to bring the body back to balance, the least you could do is give your body a boost.

Immunity and Recovery
Training is a stressor to the human body. The stress which training places upon the body is truly under-appreciated. Training stresses the entire body and all it's systems, such as the cardiopulmonary system, detoxification system, hormonal system, metabolic system, central nervous system, neuromuscular system, and the immune system. They are all affected by training and all these systems do not recover at the same time.

When it comes to immunity, the relationship between exercise and immunity is what researchers call a “J-shaped curve”.
  • Sedentary individuals are at moderate risk for infection. Their immune system isn’t running as well as it could be.
  • Individuals who are regularly active, using moderate intensity and variety in their training, demonstrate the most resistant immune systems.
  • Individuals who are active, but consistently pushing the limits in workout frequency, duration, intensity, or loading without proper recovery put themselves at increased risk for becoming sick.
Take home: High levels of exercise intensity with inadequate recovery can result in immunosuppression. Don't allow your lack of recovery to leave you at an increased risk of coming down with a cold, virus, or infection.

Nutrition and Recovery
When it comes to nutrition and recovery, eating real food in its unprocessed form will give your body the nutrients it needs. Make consuming whole foods, along with herbs and spices, such as turmeric and garlic, a priority in keeping inflammation to moderate levels and assisting in recovery. It's also important to consume adequate amounts of water and fluids to assist with lymphatic function.

Supplements used before, during, or after training, known as peri-workout nutrition, can enhance the recovery process. These include the use of carbohydrates, protein and BCAAs. Glutamine and creatine have also been shown to be effective in promoting recovery. It's important to understand that if recovery supplements or a nutrient dense meal aren’t consumed in a timely fashion after workouts, the regeneration process can be delayed.

Recovery Recommendations
To sum up, here is a general list of recommendations to help you improve your recovery:
  • Make a point of including 20-30 minutes of parasympathetic activity each day (i.e. meditation, massage, warm bath, good conversation, laughing, etc.)
  • Consume nutrient dense foods at regular intervals, use herbs and spices, and drink adequate amounts of water and tea
  • Consider using a carbohydrate, protein, BCAA, and/or creatine supplement as part of your peri-workout nutrition
  • Incorporate variety into your training program
  • Utilize low-intensity exercise on days between high-intensity training sessions to promote recovery (i.e. walking, cycling, swimming, flexibility work)
  • Avoid the regular use of anti-inflammatory medications
  • Make rest a priority and aim for 7-9 hours of sleep per night
Sources:
Beauchamp GK, et al. Ibuprofen-like activity in extra-virgin olive oil. Nature 2005;437:45-46.
Davis JM, et al. Curcumin effects on inflammation and performance recovery following eccentric exercise-induced muscle damage. Am J Physiol Regul Integr Comp Physiol 2007;292:R2168-R2173.
Ali M, Thomson M, Afzal M. Garlic and onions: their effect on eicosanoid metabolism and its clinical relevance. Prostaglandins Leukot Essent Fatty Acids 2000;62:55-73.
Laine L. The gastrointestinal effects of nonselective NSAIDs and COX-2-selective inhibitors. Semin Arthritis Rheum 2002; 32(Suppl 1):25–32.
Feingold D, Hame SL. Female athlete triad and stress fractures. Orthop Clin North Am 2006;37:575-83.
Long CL, et al. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN J Parenter Enteral Nutr 1979;3:452-456.
Emery PW. Metabolic changes in malnutrition. Eye 2005;19:1029-1034. Review.
Hughes MS, et al. Enhanced fracture and soft-tissue healing by means of anabolic dietary supplementation. J Bone Joint Surg Am 2006;88:2386-2394.
Trappe TA, et al. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab 2002;282:E551-E556.
Newsholme EA, Crabtree B, Ardawi MS. The role of high rates of glycolysis and glutamine utilization in rapidly dividing cells. Biosci Rep 1985; 5: 393–400.
Bulus N, et al. Physiologic importance of glutamine. Metabolism 1989; 38: 1–5.
Cersosimo E, et al. Role of glutamine in adaptations in nitrogen metabolism during fasting. Am J Physiol 1986; 250: E622–E628.
Schilling BK, et al. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc 2001;33:183-188.
Greenwood M, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem 2003;244:83-88.
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.
 
 
 
Athletic performance is a developmental process, one that ideally involves the integrated efforts of coaches/trainers and therapists in order to maximize results. This is often a complete paradigm shift for many of our athletes and their parents. Unfortunately being focused on short-term results over long-term development is hurting athletes more than it will ever benefit them.

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

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

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

 
 
[embed]https://youtu.be/ZjlZ0mx0Rqg[/embed]

Use active stretches to improve muscular flexibility, joint range of motion, and posture. These stretches and exercises can be incorporated into your warm-up routine, as an active recovery method, or used on a regular basis to improve the way you move and feel.

When compared to traditional static stretching, active stretches carry a number of benefits:

1. Enhanced proprioceptive input which facilitates changes in posture and the release of overactive/tight muscles.

2. Increased neuromuscular demand which drives activation of muscles in an end range position leading to improved motor control or dynamic joint stability.

3. When guided by postural principles, the increased global muscular activation leads to the coordination needed to enhance posture.

4. Helps create the 'feel' necessary for improving movement and posture. It's one thing to think through movement/posture, it's another thing to feel it. We want to feel movement/posture

5. Increased preparedness for training, practice, or competition.

 
For more related reading:

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

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

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

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

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

 
https://gallagherperformance.com/exercise-is-what-you-do-movement-is-what-you-feel/
There's a major flaw in the fitness industry - the ignorance of movement quality at the expense of fitness goals.

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

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

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

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

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

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

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

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

 
For more related reading:

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

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

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

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

 
[embed]https://www.youtube.com/watch?v=0gnAmWIjLCc[/embed]

Groin pain is a common complaint in athletes and active populations as well as a common source of frustration. What makes it so frustrating is the poor understanding of proper management because of the number complexities related to the true cause of groin pain.

15% of all injuries responsible for competition time lost in hockey players is due to groin pain from common conditions such as groin strain, femoral acetabular impingement (FAI), labral tears, and sports hernia.

Sports hernia is one of the most difficult causes of chronic groin pain to identify and manage. Sports hernia is a weakness and/or injury to the abdominal wall and supporting musculature which can result in groin pain. The difficulty in diagnosis lies the fact that most sports hernias do not produce a palpable hernia and are not seen on advanced medical imaging such as radiograph, ultrasound, MRI, or CT. Surgical exploration is generally the most excepted method in producing a definitive diagnosis of sports hernia after other potential sources of groin pain have been eliminated.

Diagnostic methods in determining the presence of sports hernia may include the identification of five classic signs and symptoms:
  1. Complaint of deep groin/lower abdominal pain,
  2. Exacerbation of pain with participation of sport activities that is relieved by rest,
  3. Tenderness with palpation of the pubic ramus,
  4. Pain with resisted hip adduction,
  5. Pain with resisted sit-up test
Disclaimer: Do not attempt to diagnosis your own condition. Proper evaluation and diagnosis of your pain or problem should be left to licensed medical professionals only.
Surgical intervention has been shown to be an effective method, both in the short-term and long-term, for the management of sports hernia while little is understood about the long-term effects of conservative, non-surgical treatment of this condition.

Here we show a glimpse inside the rehabilitation of post-surgical sports hernia for one of our hockey athletes. Early rehabilitation focus on core control and stability with progressive demands of the extremities.

This model will be vital for proper progression through treatment and functional training prior to return to sport. Rehabilitation must address underlying functional deficits of the core and hips while building a foundation of movement control and awareness necessary for the future development of strength, speed, and power.
For more related reading:

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

https://gallagherperformance.com/training-maximize-athletic-potential/

https://gallagherperformance.com/low_back_pain_treatments_that_just_wont_help/

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

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

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

You've thought about seeing a chiropractor before, but have hesitated because you:

  • Heard it was "BS" or "quackery"
  • Thought that once you start going, you'll have to go for life
  • Were afraid of being adjusted
  • Thought they just won't be able to help
Let's first address the reality that all chiropractors are not the same. While "chiropractic" refers to the profession as a whole, what many people experience - from one chiropractor to the next - can be quite different. There are numerous techniques and specialization within chiropractic that enable chiropractors to do more than "just crack necks and backs".

In fact, chiropractors have the ability to successfully treat a number of common musculoskeletal problems. Below you will find five reasons why you shouldn't be so skeptical of chiropractors and why finding a great chiropractor can prove to be a priceless investment to your health and well being.

1. Solve joint and muscle pain without unnecessary medication or surgery

Let's illustrate the significance of this point with an all-too-common experience for many of us. You begin to experience joint (neck, back, shoulder, knee, etc.) pain seemingly for no reason at all. Your pain has just appeared and you are puzzled as to why.

What do must people do first?

Most commonly, they start in the medicine cabinet with common over-the-counter (OTC) medications like Tylenol, Motrin, Advil, or Aleve. They may ice the area or apply pain-relieving gels. Others may just give it time and play the waiting game to see if the pain goes away on its own. If OTCs, ice, pain-relieving gels or time don’t do the trick, then they pay a visit their primary care physician only to receive a script for either anti-inflamatories or muscle relaxers and a referral for an orthopedic consult. The orthopedist will likely perform a physical examination along with possibly ordering imaging studies such X-ray, CT scan, or MRI. Based on your  examination and imaging results, one of two recommendations is often made - physical therapy or surgery.

Too often surgery can be recommended before more conservative approaches are given a chance. Disregarding the risks associated with surgery, what happens when the procedure fails? Surgery is not a great choice when pain is associated with a positive — often incidental — finding on an MRI. These incidental findings are well document and often times structural adaptations to functional problems.

When assessed properly by a trusted conservative musculoskeletal care specialist, whether a chiropractor or physical therapist, many muscle and joint problems can be resolved without the need for surgery.

Seek conservative care first. If you don't respond to care within 6 weeks, then it wish to consider more invasive procedures if they are indicated.

2. Manage complicated disorders

Remember when I said all chiropractors are different? It's true.

Just like the medical profession, there are many areas of specialty in chiropractic. Those who specialize as a sports injury & rehabilitation chiropractor (such as Dr. Gallagher) have undergone the traditional education on joint manipulation or adjustments. However, in addition to their core curriculum, sports injury & rehabilitation complete hundreds of hours in continuing education learning about exercise and sport-related injuries, manual therapy, and functional rehabilitation methods.

Chiropractors who utilize a sports injury & rehabilitation approach incorporate joint mobilization/manipulation, soft-tissue treatments, various manual therapies, and functional rehabilitation techniques to provide a gold standard of care in treatment for individuals with exercise and sport-related injuries. This combination of complementary approaches uniquely positions sports injury & rehabilitation chiropractors to manage complicated disorders that other specialists may have difficulty in treating.

3. Prevent future episodes of pain by changing function

Imagine a world where patients get the advise, education, and treatment they need. Imagine doctors who:
  • Make sense of what a patients says
  • Know exactly what a patient needs
  • Confidently provide gold standard advice and treatment interventions
This world is obtainable, but it must first begin with better quality, order and structure to our thinking patterns. One of the fundamental challenges with healthcare is that the human body is amazingly complex and adaptive. In response to the complex nature of dealing with the human body, doctors and therapists may have the tendency to routinely provide services that serve their own skill set better than appropriately addressing the patient’s needs. Often times this leaves both the patient frustrated with lack of response to care.

As ac chiropractor it's my job to educate my patients and help them problem solve. I have to help them understand not just what their problem is, but more importantly why it started.

In understanding why their problem started, we aim to change the function of their body. If patients don't commit to changing their behaviors and habits that got them into pain in the first place, then how can they expect to find a solution to their problem?

4. Enjoy a healthier lifestyle

As stated in the point above, chiropractors should be educators. As educators, we teach individuals how to live their best life and do so in a model that promotes our patients's have a sense of independence, capable of making informed, intelligent lifestyle choices.

Regardless of specialization, a universal truth to chiropractors is that they generally practice a “holistic” approach to patient treatment. Meaning chiropractors view the individual as a whole, identifying and focusing on more than just physical symptoms such as pain. By employing a combination of manual treatments, ergonomics, postural education, exercise prescription, nutritional interventions, lifestyle advice, and other strategies (practitioner dependent), chiropractic is more than just cracking backs to reduce pain. Chiropractors want their patients to enjoy a healthier lifestyle.

5. Enhanced performance

We put our bodies through the ringer daily (some more intensely then others). Periodic treatment from a qualified chiropractor will help keep your body running like a fine-tuned machine, improving your ability to perform and progress in your training programs by optimizing the body’s ability to function at it’s best.

How?

By combining chiropractic with functional rehabilitation and strength and conditioning principles.

It's exactly why we do what we do at Gallagher Performance.

Almost every case involving muscle or joint pain requires some level of strengthening exercise progression and education.  We will make sure you are doing the most appropriate exercises for your situation and your level of ability. By clearly educating each patient on why they are performing their prescribed exercises or stretches, the focus becomes about patient empowerment and providing them with a sense of what they can do for themselves to keep pain from returning.

Regardless of the number of treatments you receive, the goal remains the same – to make a lasting change in your body through posture and movement re-education.

Wrapping Up

There are many great reasons to visit a chiropractor. Every chiropractor is different, so just because one didn’t work for you it doesn't mean that all chiropractors are useless. You just haven't found the right one for the job and that can prove to be a difficult task. Yes there are some bad ones out there (like any profession), but there are plenty of good ones that can be trusted.

No matter who you see, keep in mind that it is critically important that you understand your problem,   your treatment plan, your expectations for recovery, and how to manage your problem during as well as after treatment.

At Gallagher Performance it is our intent to get you back to what you love doing and as quickly as possible. We create clarity by helping you understand your problem, why it behaves they way it does, and apply the right tool to make a lasting change in the way your body functions.

 
More related reading:

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

https://gallagherperformance.com/busting-chiropractic-myths-misconceptions/

https://gallagherperformance.com/are-you-promoting-independence/

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

https://gallagherperformance.com/when-should-i-see-chiropractor/
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/

[embed]https://www.youtube.com/watch?v=LNH6aIezqd0[/embed]

Outside of low back pain, shoulder pain is one of the most prevalent musculoskeletal complaints. For avid exercisers and athletes, shoulder pain is something most are familiar with, especially when it comes to horizontal pressing movements.

The most popular of the horizontal pressing movements being the barbell bench press. Bench press often enough, long enough, and heavy enough, you will likely experience some degree of limitation due to shoulder pain or injury.

This can be for a number of reasons that all should be considered. But there is one reason why the barbell bench press becomes unfriendly to the shoulders - the fixed position the scapula (shoulder blades) are placed into.

Creating a tight upper back and stapling the scapula to the bench is critical for a big press as this forms the foundation for pressing.

But let's consider healthy shoulder motion is dependent upon a freely moving scapula. Otherwise too much stress is placed at the glenohumeral joint (shoulder joint). Yes, accessory exercises should be programmed to maintain healthy shoulders but there is only so much that can be done to offset thousands of pounds of bench pressing volume. We absolutely should be proactive in our approach to avoiding shoulder pain and/or injury.

That's why it is important to incorporate horizontal pressing movements that allow the scapula to move more freely. Whether they are used as a primary movement, accessory movement or alternative while the shoulder is on the mend, the exercises seem in this video can offer increased shoulder stability and motor control while giving your joints and connective tissue a break from intense training. See in this video are:

1) Standing Horizontal Cable Press

2) Stability Ball Dumbbell Press

3) Stability Ball Alternating DB Press

4) Stability Ball Single-Arm DB Press

A great benefit to these exercises is the amount of core and hip engagement required which is awesome for teaching force transfer through the body and how to steer strength.

Note: if performing heavy presses on a stability ball be sure to use a properly rated ball.

 
 
 
For more related reading:

https://gallagherperformance.com/advanced-training-for-elite-athletes/

https://gallagherperformance.com/effective-treatment-shoulder-pain/
[embed]https://www.youtube.com/watch?v=oZUKOz1iuhk[/embed]

This video highlights the hamstring rehab with Carter Henderson. Carter was a standout linebacker at Duquesne University, leading the team in tackles the last two seasons. Now he is in preparation for an NFL Pro Day.

Carter came to GP for rehab of a hamstring pull 12 days out from his Pro Day. His initial 5 days focused on manual therapy, eleetromuscular stimulation (EMS), with a primary emphasis on exercise progressions based on his tolerances and weaknesses. Focus was placed on exercise specificity to the stresses the hamstrings encounter during sprinting. We aimed to match joint angles, mechanics, and dynamics as they relate to his sprint form and lateral movement.

Days 6-8 on his rehab focused on tempo runs and flying 40s, keeping intensity below 75% effort. Gradually worked into higher intensities with specificity to pro day drills. Focus still on manual therapy, joint mobilizations and manipulation when indicated.

Effective treatment for a hamstring strain, and for any injury, must address not only the site of pain but ALL possible predisposing factors. There are essentially three ‘reasons’ as to why hamstring injuries occur. Sprinting is not the problem. Focusing on each predisposing factor through progressive treatment and training will best prepare the athlete for return to sport activities.

The act of ‘pulling’ a hamstring usually occurs at high speed running during the terminal swing phase of the gait cycle. As the hip is decelerating the forceful momentum as the leg swings forward, the hamstrings are loaded and lengthening as you are finishing the swing phase before foot strike. There are predisposing factors that ultimately cause the hamstring to be compromised such as:
  1. Poor neuromuscular control of the lumbopelvic region,
  2. Asymmetries in muscle length and/or hip range of motion, and
  3. Sacroiliac joint dysfunction
All of these factors need to be and should be considered when devising a treatment and rehab protocol to ultimately reduce the risk of re-injury and improve rehabilitation outcomes.

The utilization of manipulation, massage, soft tissue techniques, and nutritional considerations to support tissue healing become the foundation of early care and recovery from hamstring injury. Everything used to facilitate healing is based on examination and identification of the presence of any predisposing factor(s).

The transition from rehabilitation to return to sport then becomes dependent upon a process that addresses proper tissue healing and exercise progressions to improve structural balance, lumbopelvic control, strength, and coordination of movement required by sport specific demands in output and movement patterns.

This essentially sums up the process behind Carter's rehabilitation program.

Carter has turned around nicely and tons of credit to him. He wasn't able to walk without pain when we first started his rehab and was able to run a 4.75 sec 40 yard sprint on his pro day at Duquesne University. He did everything right in his rehab. Carter is extremely coachable and great to work with and we wish him all the best.

 
For more related reading:

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

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

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

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

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



As Gray Cook says, pain indicates a health problem not a fitness problem. In rehab, we deal with pain and dysfunction. In exercise and training, we deal with dysfunction. Pain and health problems should be managed by a licensed professional with appropriate training.

Exercising in pain is not the solution and you should seek proper guidance on how to get out of pain and correct dysfunctions before resuming your regular exercise or training program. Otherwise you may just get stuck in the perpetual pain cycle. The plan is to reduce pain, improve the tolerance to exercise through graded exposure, dose exercise and train to correct dysfunctions.
The management of pain should not be left to unqualified individuals in the exercise/fitness industry. With the rise of continuing education programs and certifications intended to help fitness professionals identify, through screening, an individual's level of training readiness.

Movement screens are generally performed to assess for mechanical sensitivity (aka pain with movement) and/or abnormal motor control (aka movement dysfunction). The screens are usually graded on a scale to reflect a score indicative of that individual's current performance.

A sample scoring system would look something like this:

0 = pain

1 = can't perform movement or has loss of greater than 50% range of motion

2 = performs movement with compensation

3 = performs movement without compensation

Screening provides valuable information and obviously it is ideal to work one towards a higher movement score.

The issue I have taken up with screening is the tendency for some fitness professionals to act as a pseudo-therapist when a client is experiencing pain. In my opinion, unless you have a professional license to work with the human body (i.e. chiropractor, physical therapist, massage therapist, medical doctor, etc.) you have no business providing 'rehab' or 'advice' to a client. The best advice you can provide is to have them seek a professional medical opinion from a trusted source.

Again pain is a health problem, not a fitness problem. Most people within the fitness industry simply have a personal training certification. Managing a client's pain is not within your scope. Pain is a referral to a medical professional. Once pain is managed properly, then exercise is reintroduced.


Got pain?

Give our office a call and let us help you get out of pain by providing you the tools to understand your pain, how to prevent it, and how to improve the way your body functions. The model at Gallagher Performance was developed to bring excellence in both pain management and exercise/fitness education.

 
For more related reading:

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

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

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



Although we’ve worked with a broad spectrum of athletes - high school, collegiate, professional, former World’s Strongest Man, and elite triathletes - we work with just as many weekend warriors and those who simply love to be active. Whether it’s improving your running distance, increasing strength in the gym, or swinging a golf club without pain, we want to help you achieve your goals.

We also successfully treat those with overuse injuries, enabling them to return to the highly active lifestyle they enjoy.

Being active is an essential part to a healthy lifestyle. The many benefits of movement and exercise are well documented. Unfortunately, injury can become a reality for those that live an active lifestyle. When injury occurs, the effects are not only physical, but psychological as well. It is easy to become frustrated when your active lifestyle has been interrupted and concerned when you aren’t healing or turning around as quickly as you had hoped. Recovery from injury is a process that must be understood, appreciated and respected.

To help you better understand how to manage your own recovery from injury, here is a short list of items to be aware of so that you can respect the healing process and set yourself up for a timely and safe return to sport or activity.

Avoid Complete Rest

When injury occurs, it is often advocated to rest. Rest is a critical part of healing and the amount of rest one needs will be determined by the severity of the injury. Injury is a balance of load and capacity of tissues within the body. Once we exceed the capacity of a tissue (bone, ligament, muscle, tendon, disc, etc.) with a certain load, injury occurs. Rest helps restore the capacity of tissues by minimizing or removing load and thus allowing healing to occur.

As critical as rest is to the healing process, movement is equally, if not more, critical. In the absence of severe injury and conditions where movement would be contraindicated (i.e. fracture, dislocation), movement serves to facilitate healing. The majority of musculoskeletal injuries heal best when we don’t avoid activity, but rather when we modify activity. The important factor here being that one finds activities they can perform without pain and that will facilitate healing through movement. This may be as simple as walking or gentle range of motion exercises. However knowing exactly what you should do for your specific injury can be a complicated answer. This brings me to my next point.

Don’t Rely on Social Media Gurus to Solve Your Injury

When injury occurs, people want a definitive answer when it comes to what they injured and how to manage it. And there are growing numbers that are seeking this information out online without ever consulting a licensed healthcare specialist. This could be due to frustrations with the medical model, a growing consciousness to seek out “non-traditional” or “alternative” therapies, or simply wanting to avoid paying out of pocket when there is free information available online. There can be the mentality of, “Why pay someone to fix me when I can learn to fix myself?” Not that this is wrong, but please understand that there are limitations when it comes to purely trying to self-manage your injury.

Let me illustrate this point with an example of someone who may go onto an internet forum or social media page and state, “If have an L4-L5 disc bulge with sciatica, what exercises should I do to help me get out of pain?”

If you are seeking an answer out online, keep in mind the most appropriate answer you should receive is, “It depends”.

Any advice you receive from someone who hasn’t evaluated you is truly just throwing darts in the dark and hoping something sticks. Most people on the internet and social media who are offering up advice when it comes to injury rehabilitation are not licensed to do so, thus you should be skeptical. Many of these same people try to position themselves as an expert for one reason or another, but reality remains they are not a licensed professional and thus you should be skeptical. Skeptical because how can someone tell you what to do when they haven’t evaluated you – in person.

When it comes to injury rehabilitation, the evaluation process is the most critical step to ensure no time is wasted in the early phases of rehab and to minimize complications. Evaluations should consist of orthopedic and neurological testing as well as biomechanical/functional testing to evaluate for structural pathology, movement sensitivities and functional deficits.

The sharing of symptoms through some online medium is extremely limited in its value and it inherently creates bias. It will bias the feedback and direction you receive from who you are seeking advice from since all they have to operate off of is what you tell them. But when you are evaluated live, in person, by a licensed professional, bias can fall by the wayside when things are discovered that you may not feel are all that important or relevant to your present injury. Yes, history and understanding your problem is important, but it’s only a part of the puzzle.

This is because as professionals, we are trained to evaluate with our eyes and hands to assist in the diagnosis of your condition.

Seek Out Professional Evaluation and Treatment

There are numerous products and programs currently online that essentially attempt to remove the need for someone to see a licensed professional for an injury or ailment. These products or programs will draw people in as they hope to learn what they can do to fix themselves. There is nothing wrong with that, as self-management strategies are important for anyone to learn. People who are dealing with pain or injury must learn why their pain or injury developed in the first place and what they can do to help prevent it from returning.

However the limitation to these products or programs is that they are mass marketed, attempting to appeal to a large audience and, therefore, are very general in nature. They are incapable of being highly specific to the individual. These programs or products may work for some, but when someone needs more individualized solutions they need to turn to a licensed professional such as a chiropractic rehabilitation specialist or physical therapist who approaches injuries and ailments from a functional perspective, not solely based on structural pathology.

Specialists exist for a reason. When your in-home or self-management strategies fail or if you are having persistent or worsening symptoms, you should seek out professional consultation. Specialist such as sports medicine physicians, rehabilitation chiropractors and physical therapists are capable of providing solutions to pain and injury through either diagnosing your condition, devising a rehab plan, and providing treatment. Massage therapists are another specialist to consider as many ailments and injuries have soft-tissue components that respond favorably to massage therapy by reducing pain and restoring muscle function.

Recognize the Gift of Injury

The recovery from injury is as much mental as it is physical. Believe it or not, there is a gift of injury – forced discipline.

What do I mean by forced discipline?

Injury often times forces us to confront the very reasons why we got injured in the first place. The reason could be faulty mechanics, sharp increases in workout or training volume, or ignoring warning signs our brain was sending us.

Professional specialists mentioned above should assist in the process of helping you recognize the reason(s) for your injury and given you the direction needed in your recovery. But it's upon you to be disciplined and mindful during your recovery process and beyond. This new sense of discipline can apply to making better decisions when it comes to your rehab program, your posture, your movement, and the amount of stress or work you place upon your body.

Failure to do so can often lead to someone rushing his or her own recovery, returning too soon to sport or activity or frequent relapses. Be disciplined and regain control of your body.

Understand the Science of Pain

Failure to apply discipline in your recovery can also result in the feeling that your injury will never heal. The reality is all injuries heal. But long after the site of injury has healed, pain can still persist. Pain becomes a reminder to some that they aren’t healed. They will believe they are still injured.

“So if my injury is healed, then why am I still in pain?”

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, activities of daily living and sport.

Gradual exposure to correct movement which takes stress of tissues can help to desensitize the brain to pain signals. Movement re-education serves to reduce pain signaling in the brain. As one learns to move better, pain goes down. You need to break your pain cycle with a better movement solution. It’s that simple.

Wrapping Up

Thanks for reading. We hope this post was helpful. Please leave any comments or questions you may have. Share this post with those who you feel can benefit from understanding how to better approach recovering from injury or pain.

 
More related reading:

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

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

https://gallagherperformance.com/technique_and_performance/

https://gallagherperformance.com/nutrition-for-faster-recovery-from-injury/

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

https://gallagherperformance.com/effective-treatment-shoulder-pain/

 
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/

https://www.youtube.com/watch?v=ceIcoreYu8o&t=4s

This video illustrates how we integrate chiropractic, rehabilitation and dynamic neuromuscular stabilization (DNS) into patient treatment. For the purposes of this video, these techniques were used to speed up post-workout recovery, ensure structural balance and improve how the body functions. Similar to fine-tuning a race car, the human body can benefit tremendously from fine-tuning to keep body prepared for high performance.

Key take home points:
  • Treatment is directed at patient-specific goals and outcomes. There are different levels of care that may need, ranging from symptomatic (i.e. painful conditions) to more performance-based therapy or fine-tuning.
  • Chiropractic manipulative therapy (i.e. adjusting) was not filmed but utilized for the spine and hips.
  • Soft-tissue work was done manually and instrument-assisted to mobilize muscle and connective tissue to improve recovery.
  • Dynamic neuromuscular stabilization (DNS) was used to fine-tune motor patterns and muscular activation. Proper muscular activation and stabilization function of muscles helps to ensure proper muscular coordination while minimizing stress on the joints.
  • This all adds up to optimizing performance while keeping the body as healthy as possible.
More related reading:

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

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

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

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

  • 4484 William Penn Highway

  • Murrysville, PA 15668

Hours of Operation

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