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Resetting the Body's Function Post-Injury

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

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

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

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

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

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

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

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

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

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

More related reading:

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

Chiropractic, Rehab & DNS Treatment

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/

The BEST Way to Recover from Tendon Pain

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

Based on updated modern knowledge of tendinopathy, tendinitis, or tendon pain, let's shed some light on the best ways to rehabilitate for complete recovery. Part of this discussion will bust several "myths" or "misconceptions" that have existed about the treatment and management of tendon pain.

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

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

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

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

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

Post-Surgical Rehab Success is All About Team

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More related reading:

https://gallagherperformance.com/3-simple-steps-to-reduce-your-risk-of-sports-injuries/

Cold Season: Are You Winning the Battle for Your Immune System?

“It’s cold season."

How many times have we heard that saying? Yes, we are approaching the time of year when most of us are more susceptible to coming down with a cold or the flu. But, I’ll let you in on a little secret – there is no “cold season”.

Rather than figuring out a strategy to keep our immune system working at it's peak potential, it's as if some of us just throw in the towel and accept that we will be sick, as if there is nothing we can do to prevent it.

Reality is we are constantly under attack by pathogens, viruses or bacteria that want to infect us. We are constantly exposed to pathogens and we are either winning or losing the battle. What is likely to blame for the “cold season” has more to do with what our body’s internal environment lacks than what is attacking us.

There's the saying, "An ounce of prevention is worth a pound of cure." I'm not saying cold season is completely preventable, but what I am trying to communicate is that we all can take steps to reduce our likelihood of getting sick and possibly prevent it.

Aside from proper exercise, nutrition, and lifestyle choices, what are some simple prevention steps you can take (any time of the year) to keep your immune system firing on all cylinders and help it win the battle against the "cold season"?

1) Sleep. The most powerful tool that you have to keep your immune system running high is sleep. Research demonstrates that lack of sleep compromises the immune system, thus predisposing you to sickness. There’s a reason why you sleep a lot when you are sick. Don't underestimate what proper sleep habits can do for your health. Are you getting enough sleep? Ask yourself the following questions:

  • Do my eyelids feel heavy in the afternoon?
  • Do I use caffeine as a “pick me up”?
  • Do I sleep extra hours on the weekend?
  • Do I fall asleep the minute my head hits the pillow?
To promote deep, restful sleep try to keep your room as dark and cool as possible. Ideal room temperature appears to be 65-68 degrees. Calming agents like magnesium, valerian root, chamomile tea, or a warm bath used before bed can also promote more restful sleep. Avoid alcohol, caffeine, nicotine, and exercise before bed as these can interfere with our normal sleep rhythms or make it more difficult to settle.

Shoot for 7-8 hours of sleep per night. Athletes may need as much as 9-10 hours per night.

2) Vitamin D. Vitamin D deficiency is a global issue, which is disturbing as poor vitamin D status is linked to cardiovascular disease, diabetes, hypertension, certain cancers, and many other chronic conditions. Not only does Vitamin D have a critical role in immune system support, it also has also been shown to have anti-inflammatory, anti-microbial, and anti-viral effects.

According to James Cannell, MD, of the vitamin D council, most of us will need to take in 5000 IU per day to obtain healthy vitamin D blood levels and avid exercisers should shoot for as high as 10,000 IU per day. In comparison, the current RDA is set at 600 IU for individuals 1-70 years of age and 800 IU for those 71 years of age and older. Clearly there is a large gap between what is considered adequate and what is considered necessary for optimal health.

In determining appropriate vitamin D intake, it's important to know your vitamin D levels first. A simple test can be run by your doctor with blood work. Be sure to consult your healthcare provider.

3) Vitamin C. Vitamin C's role in immune system support is well established and less of a discussion is needed here. To maximize vitamin C's immune system boosting effects, It's best to consume a vitamin C supplement or vitamin C rich foods every 2-3 hours when sick as blood levels take 2-3 hours to peak, thus you will ensure blood levels remain high.

4) Zinc. For as much evidence as there is to back vitamin C’s ability to support the immune system, there is stronger evidence for zinc. However, zinc's role in immune system support is not as widely known. Zinc plays a central role in the immune response and zinc-deficient individuals are more susceptible to a variety of pathogens. While consuming whole foods rich in zinc should be standard dietary practice, directed use of products like Zicam, zinc lozenges, or highly bio-available zinc supplements at the early signs or symptoms of a cold has proven to be beneficial.

5) Glutamine. Glutamine is the most abundant amino acid in skeletal muscle, making it critical to the health and function of our muscular system. However, glutamine is also integral to the function of our digestive and immune systems. The health of our digestive system is critical to the health of our immune system as the GI tract uses a tremendous amount of glutamine to feed the mucosal cells. When needed, glutamine supplementation is a great way to support the immune system. Aim for 5-15g grams, three times a day. Make sure a dose is taken upon rising, mid day, and before bed. The dose before bed is important as the immune system is highly active during sleep.

6) Probiotics. Probiotics are healthy bacteria for our gut and they also have the ability to support the immune system. Simply stated, a healthy digestive system feeds a healthy immune system. Research has supported the ability of probiotics to reduce the occurrence of colds and gastrointestinal infections. Be sure to consume more probiotic foods or take a quality probiotic supplement. Foods such as yogurt, raw cheese, raw apple cider vinegar, and kombucha tea are just a few examples of foods rich in probiotics.

Wrap Up
Prevention is the key when it comes to staying healthy. We either make time for prevention or we make time for illness. Take the steps to support your immune system and win the fight during cold season.

More related reading:

 
https://gallagherperformance.com/why-poor-recovery-will-make-you-sick-sad-and-weak/

Improved Approach to Chronic Pain Management

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

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

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

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

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

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

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

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

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

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

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

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

More related reading:

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

 

Understanding Concussions and How Chiropractors Can Help

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

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

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

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

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

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

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

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

Typical symptoms of concussion include:

  • Headache
  • Difficulty concentrating or feeling “foggy”
  • Poor recall or memory of recent events
  • Changes in mood or personality
  • Slower reaction times
  • Dizziness, lightheadedness
  • Nausea or vomiting
  • Low tolerance of bright lights or loud sounds
  • Irritability
  • Changes in sleep patterns, such as being unable to sleep or sleeping more
 
In some cases, chiropractors can be the first point of access for individuals who recently sustained a head or neck injury, such as those occurring in sports, car accident or fall. Chiropractors, especially ones who are certified by the American Chiropractic Rehabilitation Board, regularly manage athletes who suffer sports injuries, such as concussions, and are trained in proper diagnosis and understand the importance of referral for additional medical evaluation. Gallagher Performance offers such quality in their chiropractic services and has been part of the co-managment team in a number of concussion cases.

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

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

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

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

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

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

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

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

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

References
Johnson, C.D., et al. Chiropractic and concussion in sport: a narrative review of the literature. Journal of Chiropractic Medicine 2013 (12):216-229.
Shane, E.R., et al. Sports Chiropractic management of concussions using the Sports Concussion Assessment Tool 2 symptom scoring, serial examinations, and graded return to play protocol: a retrospective case series. Journal of  Chiropractic Medicine 2013 (12): 252-9.
 
 

Solving Pain: The Influence of Czech Rehabilitation Techniques

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more on DNS here:

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

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

Fascia & Muscular Adhesions: How they relate to pain and overuse injuries

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

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

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

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

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

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

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

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

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

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

More related reading:

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

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

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

Stay Strong and Heal Faster While Injured

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

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

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

Wait….what? Training your non-injured arm helps to keep your injured arm strong and heal faster?
There is truth to that statement. The phenomenon I am referring to is known as “cross-education”. It is well established that to minimize the effects of detraining, performing single-side training with the non-injured limb (upper or lower body) will allow you to maintain strength and accelerate healing in the injured limb.

Cross-education occurs when you strength train a limb on one side of the body. The result is an increase in strength in the opposite limb on the other side of the body due to neural adaptations. Cross-education appears to be effective for all muscles and joints of the body, from shoulders and hips to ankles and wrists.

A study published in the Journal of Exercise Science and Fitness demonstrated that strength gains in the untrained limb are typically in the range of 5 – 25% depending on if that limb dominance. Strength gains average around 35 – 60% increase in the trained limb. Additionally, it appears that less range of motion will be lost in the injured limb due to the cross-education effect – another major benefit.

There are other studies on the subject of cross-education, but still cross-education is not completely understood. Strength gains in the injured limb are most likely due to neuromuscular adaptations and increased neural drive to the untrained muscle. A similar hypothesis is improved motor control because training the healthy limb results in recruitment of high-threshold motor units in both limbs. Keep in mind, there is no evidence of hypertrophy (muscle growth) or changes in muscle fiber types in the injured limb following single-side training.

Cross-education highlights the importance of single-limb exercises during training and rehabilitation from injury. Helping clients or athletes understand cross-education may encourage them to continue an exercise routine during time of injury, as it can help maintain strength and speed recovery. Cross-education is a perfect illustration of how one can turn a weakness into a strength through focused training efforts.

 
Sources:
Lee, M., Carroll, T. Cross-Education: Possible Mechanisms for the Contralateral Effects of Unilateral Resistance Training. Sports Medicine. 2007. 37(1), 1-14.
Zhou, Shi. Cross-Education and Neuromuscular Adaptations During Early Stage of Strength Training. Journal of Exercise Science and Fitness. 2003. 1(1), 54-60.
 
More related reading:

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

Painful Back? You May Be Hurting It By Stretching

What you need to know:

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

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

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

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

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

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

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

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

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

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

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

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

More related reading:

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

 

Why We Aren't Popular

Ryan and I have been fortunate to be influenced and mentored by some great coaches and athletes when it comes to the understanding of athletic development. There is no doubt that they have had a substantial impact on our abilities and coaching methodologies. Even with all the great mentors and book smarts, the lessons learned from being competitive athletes ourselves has had a significant impact on our coaching methodologies as well. From the point of view of an athlete, all that matters is wins and losses. At the end of the day, being an athlete is about developing your body’s potential for higher levels of performance. There are many coaches and many systems that currently exist which will have you believe their system is the only system. And they can be very good at it. With the amount of information that exists today in regards to developing strength, speed, power, etc., it’s not surprising why many trainers and coaches are doing their best to make the most “noise”. Noise may get you attention, but ensuring meaningful results is another story.

I find complete arrogance to exist when trainers or coaches speak in terms of absolute laws when it comes to specific systems or movements and their necessity for enhancing sport performance. For example, when one takes on the stance of broadly advocating movements such as Olympic lifts or powerlifting-based programs with a primary emphasis on the squat, bench press, and deadlift to develop strength-speed attributes of athletes, it must be examined very closely. There are many popular programs that exist today that can promise increased performance on a number of levels. It's all about selling a product. However, what escapes most is the fact that no element of an athletic development program should be carelessly added into the mix. You can't just randomly select a program based on it's popularity or how your buddy responded to it. You should not just add in something because someone told you to do so or you read it online.

What a lot of trainers, coaches, and athletes do not understand well enough is the impact movement has on the CNS. Movements such as the Olympic lifts, squat, bench press, and deadlift can all impose a significant amount of stress upon the central nervous system (CNS). The high CNS demand is generated from the necessity to execute these movements against maximal weights or submaximal weights at maximal velocity. The intent is to develop varying degrees of strength-speed qualities. It should be emphasized at this point that the typical athlete can adapt to only 2-3 CNS stressors at one time. Keep in mind, CNS stressors are not limited to physical training such as weightlifting, sprinting, jumping, etc. CNS stressors will also include practice, games, competitive events, and time devoted to sport-skill acquisition. These all come with a cost to the athlete’s CNS reserves. Understand that the athletes will take a significant beating from practice and competition. So any strength and conditioning work that is integrated into sport work will also draw heavily on the CNS. Trainers and coaches must accept the fact that they end up losing something in the weight room. But whether it is due to ego or fear of losing specific performance markers, there are many cases in which trainers or coaches may overly stress their athletes in the weight room, eventually leading to negative performance outcomes.

The importance is this: introducing movements, such as the Olympic lifts or variations of the powerlifts, while an athlete is focusing on more important tasks, such as developing sport skill, can come with negative consequences.

Now don't get me wrong. The utilization of the Olympic lifts, squat, bench, and deadlift have been used by elite athletes around the world. They more than serve their purpose in developing qualities that power-speed athletes desire. However, they should not be applied without first understanding the context. Sure an athlete may become stronger in the squat, bench, or clean, but are they performing at new levels on the field? Is their new strength level transferring into improved acceleration, speed, or power outputs in competition? Has the process of achieving increased strength interfered with their sport performance all because it was poorly planned?

This is exactly why educating athletes on what they need to focus on at the appropriate times during the competitive calendar is such a huge part of the process at Gallagher Performance. Young athletes want to work hard, but they need direction. The same can be said for any of our training clients, regardless of their training goals. They are all willing to put in the work provided it pushes them towards their goals. We have no “system” to sell our athletes and clients on. We address their needs while providing them the understanding of the sensitivity of the process. This, in turn, creates a more educated, more independent individual who understands how to achieve their goals despite all the noise and nonsense that exists in the fitness industry.

Sure many of our posts and articles may not be the most "popular" or most "liked". We don't give away a lot of information like other popular sites. We don't have a popular ebook. We don't give out sample training programs that are easy to follow or apply because the context will vary for everyone. One person may apply it and see tremendous results, while another may see no significant improvements. Rather, we write with the goal to educate. When it comes to fitness-related writing, it is definitely more popular to give people "fish" rather than "teaching them how to fish". This could be considered a bad business model when you look at what is deemed as successful in the fitness industry. So if teaching people how to be more sustainable on their own is not popular, we can live with that.

More related reading:

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

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

Periodization: Keep Athletes on Track for Success

Your nervous system has a nasty of habit of adapting.

Adaptation is the ultimate goal of training. Physical training is intended to create the stimulus needed for adaptation. Adaptation takes on a number looks, be it increased muscle mass, increased strength, improved speed and power outputs, or increased cardiovascular efficiency. The desired adaptations will always depend upon the needs of the athlete and how periodization influences each training phase or block.

Training phase? Training block? Periodization?

If these terms are unfamiliar to you, let us emphasize why they need to be important to you: Your nervous system gets bored of everything.
Our bodies are wired in such a way that unless we change some variable (volume, intensity, frequency, etc.) of the training stimulus, we will ultimately fail to continually adapt.

Periodization and the pursuit of adaptation is the foundation of scientific progression in physical training and athletic development. Great coaches will put you on a program long enough for you to adapting to it, then they introduce change.

Periodization is simply organization of training. One must have an expertise of how organization of training and exercise selection expertise impacts development. This is a prerequisite to training anyone, but unfortunately there are many under-qualified trainers and coaches out there that do not understand these concepts. Entire teams or groups of individuals should not all be performing the same training. This would assume the entire team or everyone in your group training class has the same deficiencies. Approaching training in this fashion is just ridiculous and deserves to be criticized. Periodization and training is an individualized process. The fitness industry and fad-based training has convinced the public that periodization and planning is not needed. Well, at least until training fails to produce meaningful results.

Understand there is no perfect program or system, just phases of training. Training is an ongoing process. Periodization and the planning of training is an ongoing process. This is why your trainer or coach must be putting some thought into your training, otherwise your success is always in jeopardy.

More related reading:

https://gallagherperformance.com/commonmistakesindevelopingyoungathletes/

The Value of In-Season Training for Athletes

 



The need for focused off-season training is well accepted. However, outside of the professional and collegiate ranks, the same cannot be said for in-season training. This is truly one of the greatest sources of misinformation that exists when it comes to progressive athletic development and minimizing the number of non-contact related sport injuries. Routine in-season training can benefit young athletes in a number of ways.

With the majority of our athletes wrapping up their off-season preparation and starting camps in the next couple weeks, we get several questions from these athletes and their parents about what 'should' or 'should not' be done during the season to continue progressing in an athletic development model.

For starters, we establish how critical in-season training is for any athlete. This is not a sales pitch, it's the truth. In-season training may not have the same public acceptance as off-season training, but that does not mean it is not valuable.

In-season training has been shown to not only maintain or improve physical qualities (strength, speed, power, etc.) developed during the off-season preparatory period, but it can improve the rate of recovery between competition and maintain healthy muscle/connective tissue qualities as well.

What does that all mean?

Continue reading

The Hidden Causes of Sports Injury

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

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

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

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

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

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

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

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

More related reading:

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

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

Tips on Recovery and Restoration

Training Hard vs Training SmartThere are many components to consider when looking to promote proper recovery and restoration from training, be it from sport training or simply the goal of personal fitness. Similar to the considerations made in program design, one must be smart about the tools or tricks they use when it comes to nutrition, rest, and restoration techniques. In my personal experience, the overwhelming majority of individuals who train and compete on a regular basis commonly lack an understanding of recovery methods that are only going to help them optimize their training outcomes. They focus so much attention on their actual training, but fail to bring the same level of focus and attention to detail when it comes to nutrition or even proper sleep habits. When this occurs, training results are typically limited. There becomes a greater resistance to progress, leaving many in this situation feeling frustrated and confused. This is exactly why the understanding of rest and restoration must be passed on to the client or athlete. Yes, there is a difference between rest and restoration.

Basically, rest implies sleep or doing something restful, such as a nap or relaxing while watching the game. However, rest does not guarantee restoration, or the recovery and renewal of the body’s systems (i.e. cardiorespiratory, neuromuscular, endocrine, immune, etc.) from training demands. Not all systems recover in the same time frame and their restoration needs will be dictated by training volume and/or intensity. For the purposes of this article, we are going to discuss the application of recovery and restoration methods as they apply to recovery of the nervous system, specifically the autonomic nervous system.

Keep in mind, it is the current state of the autonomic nervous system that should dictate both training load and restoration methods. Meaning, it should be determined whether an individual is in a state of sympathetic or parasympathetic dominance. The ability to recognize this is crucial in decision making and avoiding inappropriate training loads or restoration methods, as these can push you down the wrong path. Ideally, restoration methods should be as individualized as the training process if your goal is optimal results. But, in general, here are some guidelines that will help you identify where you may fall on the sympathetic-parasympathetic spectrum and how to apply restoration methods to bring you back into an optimal state of recovery.

A) Parasympathetic Dominance (most typically experienced by endurance athletes)

  • Signs and Symptoms: chronic tiredness or heavy fatigue, low motivation to train, low resting heart rate, low blood pressure, low libido.
Restoration Methods: use SYMPATHETIC based recovery protocols
  1. Active Recovery Training: The goal is to increase blood flow to the peripheral musculature, speeding up processes of aerobic metabolism inherent in recovery. These activities should ideally be of low muscular and metabolic load, such as an easy bike, swim, or circuits of body-weight exercises.  Avoid high CNS demands, keeping active recovery sessions within 20-30 minutes.
  2. Intensive Deep Tissue Massage: Deep tissue massage will up-regulate the sympathetic nervous system through increased proprioceptive input to CNS, which will influence changes in the state of the autonomic nervous system as well as the myofascial system.
  3. Cold Water Immersion: May reduce perception of fatigue and soreness after training sessions by up regulating the sympathetic nervous system.  Repeat 2-5 minutes in cold water for 3-5 rounds.
  4. Sauna: Increased core temperature results in increased sympathetic response and speed of metabolic processes. It should be noted that the parasympathetic response increases following sauna use. In general, when looking at recommendations for the use of the sauna to promote recovery, the sauna should be between 180-200 degrees for an optimal response. There are a number of various sauna protocols to aid in recovery. In general, repeat 2-4 rounds of 5-10 minutes in the sauna, followed by a cool shower rinse.
B) Sympathetic Dominance (
most typically experience by power-speed athletes)
  • Signs and Symptoms: elevated resting heart rate, elevated blood pressure, poor sleep, mood changes such as being more irritable, suppressed appetite, restlessness, poor or declining performance, low libido.
Restoration Methods: use PARASYMPATHETIC based recovery protocols
  1. Active Recovery Training: Yes, this has similar application and can be used in either parasympathetic or sympathetic dominance. Follow the guidelines as previously mentioned.
  2. Relaxation-based Massage: Soft, gentle touch can generate a powerful parasympathetic response. Massage with the targeted goal of promoting relaxation will down-regulated the sympathetic nervous system. Again, this is achieved through proprioceptive input to CNS.
  3. Hot Tub: Hot water immersion promotes relaxation and increased parasympathetic response. Greatest benefit is achieved when water temperature is around 102 for 10-20 minutes.
  4. Deep Water Floating and/or Swimming: Not as commonly known or utilized as other restoration methods, this method is exactly what it sounds like, floating in deep water. Deep Water Floating’s benefits come from the proprioceptive changes due to the body being unloaded from gravity. A common recommendation is to alternate between 5-10 minutes of swimming and 5-10 minutes of floating while using a floatation device to ensure complete relaxation.
Concluding Thoughts
This is by no means a comprehensive discussion on recovery and restoration methods. Other methods such as naps, meditation, relaxation techniques, EMS (electro-muscular stimulation), and reduction of training volume and/or intensity can be implemented with great success as well. Remember to be strategic in the selection of your recovery methods, keeping in mind how they impact the various systems of the body. These techniques will not overcome poor training, nutritional, and sleep habits. They are intended to be an adjunct to already properly structured training and rest schedule, allowing you to optimize your readiness to train and compete.

More related reading:

https://gallagherperformance.com/why-poor-recovery-will-make-you-sick-sad-and-weak/

https://gallagherperformance.com/the-2-most-common-reasons-why-results-suffer/

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

Q&A with Head Performance Coach Ryan Gallagher LMT, CES

GP: Please introduce yourself and give our readers some information on your professional, educational, and athletic background and achievements.
To all the readers out there, my name is Ryan Gallagher and I’m the Head Performance Coach at Gallagher Performance. Along with that I’m a licensed massage therapist, corrective exercise specialist, and nutritional consultant. My undergrad education was in Sports Management with a concentration in Wellness and Fitness and was completed at California University of Pennsylvania. I attended Hocking College in Ohio for massage.

Most of my childhood was spent participating in almost every sport imaginable. Around my mid-teen years, I decided to fully commit to ice-hockey. I was fortunate enough to play at the junior level, but through high school and after, I had a number of different injuries that derailed my playing career. Once I was done with hockey, I committed myself to strength athletics and I have since been competitive in powerlifting, strongman and bodybuilding. While I have competed with success, my eyes are on bigger goals that I have set for myself. My plans are to continue to compete for as long as I can. As far as competing goes, I have some plans but will keep that quiet for now.

GP: When and how did you become interested in sports performance, fitness, and nutrition? What have you found to be the most rewarding?
It all started with the influence of my parents and older brothers. Growing up, hockey was an expensive sport to play. My parents were willing to sacrifice a lot of their time and money in order to let me play a sport I deeply loved (and still do). I can clearly recall hearing both of them say, “If you want to play normal, club hockey you can. You can just have fun and take it easy. But, if you want to play juniors, if you want to travel and get exposure, then you need to meet us half way. You will need to work for it.” Essentially what I was committing myself to was a part-time job of training for hockey. Three-a-day training sessions in the summer were the norm and hitting the gym throughout the season was standard. My parents were willing to support me, so I wanted to push myself to say thank you. Once the training and sports performance aspect began, training became more than just a “thank you”. For me, it became an immediate love. Having brothers that came before me and were highly successful didn’t hurt at all either. They provided a great influence and had years of know-how under their belts to help direct me from the get-go.

The most rewarding part of it all is the process. Everyone wants the outcomes, and they want them immediately. But, the process of working towards your specific goal will tell you more about yourself than anything. Those who can grind and stick with something for an extended period of time will often realize far more significant results than others. Notice I said significant, not necessarily successful. There is a major difference.

GP: As a trainer and performance coach, you have had the opportunity to work with a wide range of clients. You have worked extensively with youth athletes, as well as high school, collegiate, and professional athletes. You have worked with competitive strength athletes in powerlifting and Strongman, and physique athletes (bodybuilding, figure, and bikini). And you have done so with tremendous success. It’s uncommon to meet a trainer who is competent in handling such a diverse client base while providing them with the guidance needed for successful outcomes. What allows you to handle such a diverse client base with success?
This answer could be long winded and boring, so I will try to keep it short and sweet (kind of like me!). The obvious component is the understanding and education on how to properly address each individual and their specific needs. Despite all the accolades, degrees, or certifications one may have, it is my opinion that an incredibly invaluable skill set is the ability to read your client. To know when to push them, when to back off and how various external and internal stressors may be at play. These are lessons that no textbook can teach you. You either have that x-factor or you don’t.

GP: With the extensive amount of information available today, nutrition and nutritional advice can become extremely frustrating and confusing. What is your philosophy when it comes to nutrition? 
Perhaps it’s because I’m only familiar with the fitness industry, but there is a strong correlation with confusion and the fitness industry. I don’t think there’s an industry out there that is more confusing and frustrating. People love to create confusion because confusion creates dependency. So he or she that yells the loudest will more than likely make the most money. Especially if it goes against the grain of what is traditionally applied.

When it comes to nutrition and my “philosophy”, I guess you could say I don’t really have one. My end goal with clients is to establish a plan that is sustainable for them. If any one client can’t stick with a plan that is set forth, the success rate of that plan is drastically reduced. The approach is similar to the quote, “The person who goes 90% for years will go much further than the person who goes 110%, burns out, and quits.” That essentially sums up the approach I take with my clients.

Most clients just need direction. Whether that is a set plan to give them absolute direction or whether it is step-by-step process of educating them on healthy habits for long-term success. At the end of the day it comes back to knowing your client and how you need to tailor their program(s) to their needs at any given moment.

GP: As a massage therapist and corrective exercise specialist, you have integrated recovery and corrective strategies for your clients and athletes. What are your thoughts on the importance of movement quality and recovery strategies in client progress?
Pushing the limits of the human body and sport performance doesn’t necessarily come without paying a price. Our goal is to keep our athletes and general clients healthy through the process, but aches and pains inevitably settle in. Some people may be baffled by that, but take your squat from 500 lbs to 600 lbs or your 40-yard dash time from 4.50 down to 4.40 and, trust me, your body is going to be feeling it. Wanting to minimize the effects of hard training, most of our athletes partake in an in-season care plan that is set forth to include weekly treatments to injured areas or general recovery work to help them stay fresh. These guys and girls are getting the snot kicked out of them sometimes during their athletic events. Once they feel the difference in how taking care of their body helps their performance and overall well-being, they’re hooked. Some of them come in anticipating an hour massage on their low back because their low back is sore, but we may do an hour of extensive hip and abdominal exercises instead. That is a judgement call. That client will end up leaving with no low back pain and in a much better place both physically and mentally. Some will need more focused soft tissue work, others there may be other factors at play. Again, it comes back to knowing what your client needs and what will truly benefit them.

Establishing proper movement is critical and the foundational element in determining long-term development of the client you’re working with. If they don’t move well for them, then really, it’s all for not. I emphasize moving well for them because it’s different for everyone based on individual physical traits and characteristics. There is not a textbook way of performing any movement. Yes, there are obvious technicalities to each movement, but how it’s applied to everyone is different, and often not textbook.

I could go on about how the whole fitness industry can be it’s own worst enemy, but that would be more of a rant than anything. People need to get off their high horses and realize that because a movement isn’t done to their personal specifics, it is not necessarily wrong for that individual and the goals that they have.

So proper movement for the individual has to be established first. Once that is established you would be surprised at how many issues are removed. Especially once that client becomes stronger. Strength never hurt anybody.

GP: You have become sought after by both athletes and coaches for your ability to develop speed. If anyone would doubt it, your results speak for themselves. You have had the ability to further develop athletes who have either plateaued or failed to achieve results in other training programs. What do you attribute this ability to?
You won’t get anywhere without a substantial amount of knowledge and experience backing up your intentions. I was fortunate enough to start training and working with athletes at a very young age. So even at my age, I’ve been able to put in close to 10 years of professional experience working with clients from various demographics with an array of end-goals. The good trainers eventually make it to the top while, unfortunately, some really poor trainers are there too. The education, and arguably experience, only take you so far. It goes back to my earlier answers. Understanding your client, knowing them almost better than they know themselves, and being aware of how to direct them will set the framework for continual development.

More related reading:

https://gallagherperformance.com/3-simple-steps-to-reduce-your-risk-of-sports-injuries/

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

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

Do You Really Need More Mobility?

Mobility is sexy and it sells.

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

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

Enough with it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This thinking is widespread and too simplistic. In my opinion, it’s no different in application than simply telling someone to stretch because they are tight. Do you think it's superior or different because you applied a foam roller? Sure it may get results a percentage of the time, but often there are deeper underlying issues being missed. Let’s consider the following quotes:

“Soft tissue injuries result from excessive tension, so excessive tension in the rehabilitation setting is counterproductive…stretching of…chronically tight tissue is counterproductive. It may give an initial sensation of relief because the muscle spindles have been deadened, but this practice…weakens the tissue further because of the weakened proprioceptive response.” – Boo Schexnayder
“Stop trying to stretch and mobilize, let tissues settle and regain their proprioceptive abilities so they tell the truth.” – Stuart McGill
Movement Presupposes Stability
Rather than jumping to mobility, we frequently start the therapeutic or rehabilitative process with the emphasis on grooving motor patterns while building whole body and joint stability. Specifically, addressing proximal (core) stability. The musculature of the core is not simply your abs, but all the musculature that interconnects your spine, shoulders, and hips. There is tremendous linkage and interdependence between these key joints of the body. The inability to properly stabilize these regions of the body during movement will ultimately impact distal mobility. Distal refers to the extremities, aka the arms and legs and their respective joints (elbow, wrist, knee ankle, etc.).

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

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

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

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

So what are the consequences of inefficiency?

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

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

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

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

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

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

What's the Deal with the Tape?

Similar to the current trend of marketing driving training (discussed in this article), marketing appears to have a similar and undeniable impact on services provided in the world of physical medicine. From the latest and greatest in modalities such as laser therapy and electrical muscle stimulation to musculoskeletal injury interventions such as kinesio tape (KT), the colorful tape that gained popularity from the Olympics.

Earlier this week, a GP client was speaking of someone they know who recently got “taped” because they were having knee pain while running. This client went on to explain that a few days after getting taped, the very same person went out for a run and felt a “tearing and pop” in the same knee that had been taped and is now in worse pain than before.

Our client wanted to know, “What's the deal with the tape? Is it effective or is it a cheap trick?”

Kinesio Tape: Legit or Hype?
What seems to be at the center of any benefit from the application of KT is something known as novel sensory input. Basically, this means when you tape someone, they feel it. Sensory input changes “output” – in this case – motor control and perception of pain.

In the case of the painful knee (or any joint/muscle), stick some tape on it and odds are in your favor that the patient will feel slightly better for a brief period of time.
But is this really “therapy”, getting at the root of the problem, or simply masking pain symptoms?

First, we must start with an understanding of pain. Pain is your body’s way a telling you something is wrong. Pain with movement indicates a movement problem and no amount of tape will ever solve a movement/biomechanical problem. However, taping is very effective at altering proprioceptive/sensory feedback. Sensory input will dampen pain perception, thus making it easier for your brain to ignore pain signals and you are now feeling “less pain”. This is known as “sensory gating”.

You feel less pain and you are happy, so what’s the problem?

You have disrupted the injured tissue’s ability to tell the truth, now you are more likely to continually overload a compromised structure and worsen the condition. To illustrate this phenomenon, one only needs to recall Manteo Mitchell, the sprinter who sustained a fracture of his fibula – wearing KT – while running the 400m in 2012 Olympics. The applied KT allowed the athlete to distribute more load on a painful and compromised ankle. The tape did its job. It blocked pain and allowed the athlete to feel capable of competing, but unfortunately the result was a worse condition than before the tape was applied. Keep in mind, this isn’t always the outcome of taping but it certainly is a risk one must understand.

Not only are companies claiming the pain relieving benefits of KT, now some are stating how their tape prevents injury or enhances performance. Just go to their websites and read for yourself. Spider Tech’s website has the tag line: “Recovery, Performance, Prevention” and Rock Tape (on their About Us page) has this to say:

“I discovered that the tape can be used to ENHANCE PERFORMANCE. I found that taping in advance of exercise promotes increased blood flow to the muscles, thereby reducing fatigue.”
Marketing with fancy words and convenient KT placement on some elite athletes does wonders for a product’s popularity. But are the claims substantiated?

There are few high-quality studies on taping, but a recent systematic review of the research literature revealed that KT had insufficient evidence to support its use for musculoskeletal injury. Studies have shown that benefits from KT are generally minor, brief and inconsistent in nature. The value of taping is unclear, with several experts dismissing the effectiveness of taping as placebo only. The systematic review conclude that KT did provide short-term pain relief and even range of motion (ROM) improvement, but failed to offer any long-term results to patients.

In Closing
For the most part, taping is a lot of marketing hype. At best, taping is mostly a minor and imprecise method of pain control. The amount of tape being used by athletes lately is silly and, in my opinion, its popularity has more to do with marketing than results. Sure taping may make someone feel better and in a “results now” society this can go a long way to keep patients satisfied. However, there is no long-term solution to be found with any amount of tape.

Where does one turn for a long-term solution?

At GP, we consider ourselves part of a growing body of providers who strive to identify the repetitive movements and postural abnormalities that cause pain and discomfort by performing thorough and detailed examinations. Assessments and individualized treatment plans aim to identify the underlying cause of your condition rather than merely alleviating symptoms.

The more accurate the assessment, the more accurately treatment will target a patient's pain generators. At GP, we stress a collective and active approach on the part of each of our patients through education. By clearly educating each patient on their condition and why they are performing prescribed exercises, the focus becomes about patient empowerment and providing them with a sense of what they can do for themselves. This typically results in great patient compliance and shorter treatment plans, with the average patient realizing fully recovery in 4-8 treatments. Many patients quickly improve in as little as 2-3 treatments.

Reference:
Mostafavifar M, Wertz J, Borchers J. A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. Phys Sportsmed. 2012 Nov;40(4):33-40. 

 
More related reading:

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

https://gallagherperformance.com/technique_and_performance/

https://gallagherperformance.com/why-therapists-should-understand-strength/