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The Essentials of Keeping Athletes Healthy

The number one priority of any coach or trainer should be the health of your athletes. At GP, we look at any and all entities that should be addressed to increase the wellness of each of our athletes. This takes into account biomechanical/movement quality considerations, exposure to inappropriate training, the compatibility of current training loads and parameters, nutritional considerations, and the coordination of therapy and restoration techniques.

The process of developing athletes and ensuring they remain healthy in the process can present a major problem and one that could be remedied with both higher coaching education standards and the utilization of performance-based therapy.

1. Raising Coaching Education and Qualification Standards
To ensure the health of our athletes while realizing their athletic potential, we spend countless hours on improving movement efficiency as well as balancing workload compatibility during each training session and block. Statistics consistently demonstrate the more mechanically efficient you are, the less injuries you have. Movement efficiency also translates into athletes having higher levels of performance while expending less energy in the process. Expending less energy means less fatigue. This is important since athletes are more likely to get injured in a fatigued state.

Workload compatibility refers to the importance of understanding compatible training methods when addressing a dominant physical ability during a phase of training. For example, this demands that the coach/trainer understand if they are trying to develop alactic sprint abilities why glycolytic or anaerobic-lactic training must be restricted or avoided.

In the attempt to improve any number of physical abilities, most coaches/trainers often fall into the trap of pushing their athletes too hard in training. They understand that in order for athletes to perform any number of biomotor abilities (speed, strength, work capacity) at higher levels, they must push them during training to create a specific adaptation. In the process of achieving adaptation, often times they manipulate variables (intensity, frequency, duration, workload, etc.) without any understanding as to why they are making the change. As a result they compromise the athlete’s ability to adapt appropriately and set the stage for injury.

Simply put, more educated coaches understand workload compatibility and the development of specific biomotor abilities as they relate to an athlete’s sport. They have a system of checks and balances that dictate training variables and they are constantly monitoring their athletes to avoid declines in performance standards and injury.

Movement efficiency and the proper management of training loads/parameters is a relatively poorly understood concept by the majority of trainers/coaches when most of them have simply taken weekend certification courses and are under qualified, with no background in sport and exercise science. This is far too common in the US, as trainers with minimal experience and knowledge of these concepts as they relate to sport often find themselves responsible for the coaching and development of athletes.

This approach is in stark contrast to the coaching qualification process in the former Soviet Union, where the development of coaches/trainers was a scientific and well-planned undertaking. Those who wished to become coaches had to be high-level competitive athletes themselves and were required to take entrance exams in subjects such as biochemistry, physics, biology, and physiology. The applicants who made the cut were entered into one of the country’s Physical Culture Institutes to undergo four to five years of a rigorous, scientifically oriented coaching curriculum. Coaching in the former Soviet Union was not something one decided to do a “whim”. Coaching and the development of athletes was viewed as a career that required specialized education, mentorship, and training.

It doesn’t take long to realize why the Soviet Union dominated international athletic competition for as long as they did once you understand the qualification criteria for their coaches was a serious and intellectual process.

Athletes should seek out coaches and therapists who have the competitive sporting background and accomplishments, educational background and accomplishments, as well as clinical competence, methods, and track record to keep athletes healthy and performing at their best. Period. Anything less, and you should be skeptical about what you are getting.

2. Integration of Performance-Based Therapy
In addition to raising coaching education and qualification standards, excellence in therapy is another component that is often missing when it comes to keeping athletes healthy. Unless you have integrated sports medicine and therapy (sports chiropractic, massage, manual therapies, recovery methods), eventually an athlete will need to reduce the overall volume/intensity/frequency of training. What you are able to learn about an athlete in a therapy session is invaluable and can serve to help guide what you do in training.

As Dan Pfaff said best,

“A top athlete is like a formula one car and have you seen how much fine tuning they do with those things? The ability to run your hands over an athlete and know what is restricted gives you immense inside information into their functioning. You cannot expect the athlete to tell you either because they are terrible barometers when it comes to knowing what they are ready for. Just asking “are you ok for today’s workout?” is not enough because their motivation is so high athletes do not necessarily listen to what their own body is telling them.”
Therapy serves to normalize joint and soft tissue (muscle, tendon, ligament) function and promote movement efficiency by removing dysfunctional movement patterns. Similar to training, therapy cannot be randomly applied. Random application always equals random results. Therapy must be strategically implemented during the training plan. It should not be ignored that therapy provides a stimulus/stress to both tissues and the nervous system and, depending upon the athlete’s needs, must be utilized appropriately.

For instance, some forms of therapy can serve to promote recovery and restoration by pushing an athlete into a parasympathetic dominant state. Conversely, other forms of therapy can up-regulate the sympathetic nervous system and will either heighten performance levels or prolong the recovery/regeneration period depending upon when therapy is applied. Another factor that must be consider is how each individual athlete responds to therapy. Some athletes may respond to intensive therapy sessions just as they do to intensive training and therefore proper rest/recovery must be accounted for accordingly during the training week.

Closing Words
Both higher coaching education/qualification standards and performance-based therapy are necessary components in the health and performance of athletes. The more coaches know, the better they are able to serve their athletes and address their needs appropriately. Failure to integrate performance therapy in a complementary manner can be a mistake, as there tends to be an increase in reliance on other forms of therapy that stress rehabilitation and recovery rather than optimizing performance.

Related Articles:

What is Performance Therapy?
Have You Mastered Your Movement?

Stress Overload and Injury

In the world of athletics and pursuit of elite level performance, injuries are a given. However, the prevention of sports injuries is never as simple as identifying movements or exercises that should be avoided. It would be nice if it was that simple and if we could solve all the injury problems for athletes across the globe by eliminating one particular movement. Unfortunately, the human body is too complex to be solved by one solution that can be applied to everyone.

Rather than debate the role of specific exercises in a training or rehabilitation program, loading parameters and progressions, or whether certain exercises pose greater risk than reward, the purpose of this article is to discuss a much deeper concept that is at the heart of injury prevention and management, the balance between stress and adaptation.

Hello, My Name is Stress
Stress is something each and every one of us is all too familiar with. Whether it’s related to financial struggles, work-related problems, academic pressures, athletic expectations, family or relationship issues, stress is a common theme of the human existence. Now while these forms of mental stress are responsible for many reactions within the human body, for the purposes of this article this is not the kind of stress I am talking about. Rather, we will be discussing what is known as biological stress and how it relates to injury.

What is Biological Stress?

Biological stress accounts for all the physical demands (stress) placed on our bodies, both mechanical stress and metabolic stress.

Mechanical stress is a measure of the force produced and absorbed by the entire neuromusculoskeletal (NMS) system, including components such as nerves, muscle fibers, tendons, ligaments, fascia, and bone.

Metabolic stress is a measure of the demand placed on all the systems responsible for energy production/recovery and involves every major organ system in the body, such as the cardiovascular, nervous, muscular, endocrine, and immune systems.

As you can tell, both mechanical and metabolic stress are highly interrelated. The greater the degree of mechanical stress, the greater the degree of metabolic stress.

Balancing Stress & Adaptation
Training is best defined as, the targeted application of stress designed to disrupt homeostasis and put the body’s defense mechanisms at work; remodeling, strengthening and improving the efficiency of many different systems throughout the body.”
Factors that Influence Biological Stress:

  • Training Volume
  • Training Intensity
  • Training Frequency
  • Exercise Selection
These simple variables are what define individual training sessions and the training block/phase. They will dictate the amount of biological (mechanical and metabolic) stress, its application to the human body, and how much stress is applied. The training goal becomes to apply the correct type of stress in the appropriate dose/amount while targeted to the appropriate areas necessary to improve performance.

Training and biological stress is one side of the coin. The other side takes into consideration factors that influence adaptation. What makes the training process enormously more complex than it appears is what happens in between sessions as our body responds to the stress of the training session or adapts. The complexity stems from how many variables are involved in how we adapt to the stress imposed by training.

Factors that Influence Adaptation:
  • Genetics
  • Training History
  • Nutritional Habits
  • Sleep Quality
  • Mental Stress
Our genetics, nutritional habits, level of mental stress, training history, and sleep play a critical role in how quickly our body’s systems and tissues are able to rebuild and adapt from the stress of the training process. Get enough sleep, eat well, have better genetics and a long history of training, you will adapt much faster and respond quicker to the same level of training/stress than someone who is experiencing higher levels of mental stress, has poor sleeping habits, a poor diet, and lesser genetics. Even minor differences in any one of these factors can have a major impact on the ability to adapt to your current training.

Out of Balance, Out with Injury
By now, it should be clear that looking at sports injuries solely from the standpoint of the use or misuse of particular exercises or protocols doesn’t paint a very complete picture of why they happen. Even when discussions of injuries extend into the realm of assessing various movement patterns and joint function while trying to predict or minimize risk of injuries purely through improving quality of movement, often times these discussions fail to consider the fundamental concepts of the stress-adaptation balance.

The truth that is rarely discussed is that every athlete and individual is truly different and no two people will ever respond to a given training program or level of stress in the same manner. Recently, the days of individualized training have been replaced with current fitness trends of bootcamps, CrossFit, P90x and other such programs that irrationally encourage anyone and everyone to do the same thing.

Not only do such approaches always fail to consider a person’s individual ability to adapt to stress, they often preach that results are a direct result of nothing more than lots of effort with lots of intensity. The classic American attitude of “more is always better” approach has spilled over into training, training with high intensities at increasingly higher volumes. Now combine that with no individualized considerations and what you have is a recipe for injury. Current fitness trends seem to place a greater importance on the business model rather than having an appreciation and understanding of the complex function of the human body as it relates to developing a quality training program for the individual.

When you consider the stress-adaptation balance, it's not surprising why the injury rates are continually rising in youth sports. Young athletes today are under incredible pressures to specialize in one sport, be it from coaches or parents, and this is why it’s become sadly common to see athletes as young as 12-14 suffering from chronic stress injuries like tendinitis, or the more correct diagnosis of tendinosis. The ‘multi-sport’ athlete has been replaced with the ‘single-sport, all year long’ athlete. A year round competitive schedule, lack of properly constructed sport practice, and lack of time dedicated to physical preparation and athletic development is largely to blame for the huge increase in youth sports injuries in recent years.

I just happened to catch a recent interview with Tommy John on Dan Patrick’s radio show. For those of you who may be familiar with his name, Tommy John is a former MLB pitcher and the “Tommy John” surgery is named after him since he was the first individual to have the medical procedure of ulnar collateral ligament reconstruction. When asked about his thoughts as to why the surgery is so common now, Tommy John has this to say,
“I really believe….that sports, high school sports, little league sports, have become year round. And they force these kids at a very young age to pick a sport and that’s the only sport that they play, they train at. And you have these….pitching academies and your kid comes in and pays $2000-$3000 and you go in every Saturday and work on pitching. And I tell parents this, “If the best pitchers in the world don’t pitch year round, then why should your kid pitch year round?”….You have to get all these great surgeons that do Tommy John surgery, or did Tommy John surgery, they cringe when you say ‘year round pitching’ because you must let the arm rest.”
Without knowing exactly why, Tommy John nailed the central issue when it comes to several sports injuries, the lack of appropriate rest to allow the body the chance to recover and adapt to the stress placed upon it. Despite his example of baseball and pitching, the truth is each sport has it own unique injury rates. It truly all comes back to stress and the inability of most coaches and trainers to respect the stress and adaptation process. While some athletes are capable of adapting to stress far more efficiently than others, no one is immune from the effects of a poorly designed training or sport preparation program. Such programs are run by coaches or trainers that chronically stress athletes with little understanding of how to facilitate recovery and adaption, ultimately leading to injury.

Final Words
Regardless of whether you are a doctor, therapist, coach, athlete or simply just train to be healthy and stay in shape, this article was to present you with a more complete view of the role stress and adaptation play in the injury process. There is certainly value in assessing the degree of stress specific exercises may place on particular joints/tissues and whether or not they are appropriate for an individual given their needs or limitations. Failure to consider the role of stress tends to lead to an approach to injury prevention based purely on exercise selection/avoidance rather than one than also places consideration on biological stress and adaptation management.

More related reading:

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

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

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

https://gallagherperformance.com/magnesium-for-better-health-athletic-performance/

Posture and Movement: Linking Training and Therapy

We have noticed a problem here at GP and it’s likely a problem many others in the sports performance industry have also observed. The problem I am speaking of is rooted in the disunity that exists among specialists involved in the preparation, rehabilitation, and regeneration of athletes. From experience, I’m specifically speaking to the working relationship amongst coaches and physical medicine professionals, such as chiropractors and physiotherapists.

There are coaches who specialize in the physical preparation of athletes while others specialize in technical sport skill development. In the physical medicine world, there are professionals specializing across a broad range of rehabilitative, orthopedic, neuromuscular, manual therapy, and manipulative therapy services. The disunity seems to stem from a lack of communication and understanding as to why specific approaches or services are being provided by specialists involved with an athlete. We have heard similar stories from a number of our new athletes when they speak of previous experiences.

Commonly, the story sounds a little something like this:

Athlete X is being trained by Coach A for physical preparation purposes while also receiving private, sport skill development lessons from Coach B. Keep in mind that Athlete X underwent surgery at the end of their competitive season to repair an injury and has been seeing Therapist C for rehabilitative care. In addition to post-surgical rehabilitation, they also visit Therapist D for chiropractic and manual therapy services such as Active Release, Graston, or massage services.

Now while this may appear to be all well and good, the problem exists in that each individual specialist often has little to no understanding in regards to either the specific work loads or therapeutic interventions being made by the others, resulting in a collective degree of stress placed on the athlete far greater than any specialist is aware of because nobody is on the same page. All the while, Athlete X is either failing to progress in their rehabilitation, consistently dealing with the same nagging aches and pains, or is having inconsistent training sessions.

More In Common Than We Realize
Physical preparation of athletes, sport skill development, and rehabilitative/manual therapy share a common bond and that is the restoration or optimization of movement.

In athletics, the improvement of both sport skills and physical abilities is without question directly related to the systematic planning and organization of developmental protocols. Often these developmental protocols aim to improve qualities such as strength, speed, skill, stamina, suppleness (flexibility), and postural control as they relate to an athlete’s sport(s) of participation.

In the world of physical medicine (manual therapy, chiropractic, rehabilitation), protocols are utilized to promote the restoration, regeneration and recovery of the body’s nervous system and tissues, improve postural balance and control, and aid in the reduction of repetitive injury patterns.

Clearly, efficient movement and postural control should be of importance to coaches, therapists, and athletes alike. Efficient movement mechanics and their respective postures are dependent upon the balance and control of the body’s movement system. The movement system consists of over 200 bones, around 600 muscles, and a seemingly endless network of fascia and connective tissue. This system is monitored and controlled by a sophisticated network of proprioceptors or sensors, which serve as our brain’s guide for learning, establishing, and maintaining correct posture and movement.

Postural Training Considerations
Correct posture, as it relates to dynamic sport skill execution, is essential to athletic success. Posture is not just a static concept, associated only with sitting or standing. Posture is dynamic and must be thought of accordingly. Poor dynamic postural control will influence the development of biomotor abilities such as flexibility, coordination, strength, speed, and any combination of the previously mentioned.

Considering poor dynamic postural control is a recurring theme among many of our clients and athletes, the training and teaching philosophy at GP allows us to focus on postural improvements. This is accomplished through activities and drills that enhance the ability to hold correct postures and positions, promoting the directional strength needed for ideal force application by reducing muscular imbalances and biomechanical weaknesses. We introduce developmental posture drills in our training programs, since athletes who learn ideal postures during simple motor tasks will lay the foundation for more rapid mastery of increasingly complex motor skills while providing the long-term benefit of reduced risk of repetitive injury.

These developmental posture drills are limited only by knowledge of kinesiological principles as they relate to sport dynamics and one’s imagination. As dynamic postural control improves, the result is more advanced movement skills. Similar to any other biomotor ability, when planning for postural control drills in the training schedule, the volume, intensity, frequency, and work to rest ratios will be influenced by factors such as training age, time of the season, medical/injury history considerations, and skill/ability parameters.

Conclusion
Coaches and therapists would mutually benefit to be on the same page since  the goal of any physical preparatory program, including  the integration of rehabilitative or regenerative protocols when required, is nothing more than movement preparation based upon the evaluation of sport requirements. GP’s approach to physical preparation accounts for an inclusive approach when addressing proper movement. Our inclusive approach accounts for what is seen by the “eye” of the coach or therapist and allows us to adapt developmental protocols as needed. We do our best to account for all stressors each athlete is exposed to during a training week as well as over the course of a training cycle. We want to know when and how often they are working with other sport skill instructors and physical medicine professionals. We make our specific considerations for each athlete’s training not just based on their needs, but also on other factors such as outside workloads from practice, competition, skill development, and additional forms of therapy. If needed, we will consult with the other professionals involved in order to keep the athlete’s best interest in mind.

At GP, as physical medicine professionals and performance coaches, we are able to stay on the same page and promote a more seamless transition for our athletes as they progress through specific phases of training and/or therapy. Similar to other high-performance training centers, GP’s approach places a primary importance on feedback and communication between coach, therapist, and athlete to ensure quality and consistency in our services.

More related reading:

https://gallagherperformance.com/technique_and_performance/

https://gallagherperformance.com/have-you-mastered-your-movement/

The Benefits of Performance Therapy


For those of you that are familiar with Gallagher Performance, you understand the importance we place on the integration of our sports training, chiropractic, massage, and manual therapy services. We feel this model allows for optimizing sport-based outcomes while keeping our athletes healthy and ready-to-train. The model is not completely unique, as chiropractors, therapists, physical medicine providers, and strength/physical preparation coaches are collaborating in similar models to better serve their clients and athletes.

With that in mind, one frequently asked question we receive is,
"How are these services different from sports medicine care I can receive from a physical therapist or other specialist?"
The concept of what is commonly referred to as ‘Performance Therapy’ can be seen as a unique and completely separate approach from traditional sports medicine or physical therapy. To illustrate this, here's a quick look at a comparison of the mindset behind sports medicine and performance therapy.

Traditional Sports Medicine
  • Reactive approach to sports injuries
  • Therapy and rehabilitation focused
  • Emphasis placed on passive modalities, manual therapies, manipulation, therapeutic exercise
  • Tissue-specific
  • Patient-centered
  • Occasional focus placed on "injury prevention" strategies
  • Primary goal is the return to training or sport abilities prior to injury
Performance Therapy
  • Proactive approach between coach, athlete, and doctor/therapist
  • Focus is on mechanical efficiency for skill acquisition and motor learning
  • Continual "tweaking" to optimize performance
  • Manipulation and manual therapies used for facilitation, to enhance the process of building mechanical efficiency
  • Skill-specific
  • Athlete-centered
  • “Injury prevention” is a by-product of the process
  • Primary goal is to enhance sport performance
We are very fortunate to have a skilled and knowledgable team of therapists and coaches working at GP. The dynamic created between therapist and coach allows us to not only screen each client and athlete prior to all training programs, but to also carefully watch their movement during each training session. The goal is identify specific movement qualities that could potentially have a negative impact on sport-specific movements, the acquisition of new skills, or injury prevention methods. This approach continues throughout the duration of the training program and allows movement dysfunctions to be addressed before they lead to greater issues.

Performance therapy becomes not just about normalizing function or "returning to sport", but optimizing the function of the athlete and "enhancing performance". Therapeutic intervention (or "treatment") occurs as needed during training sessions. This can include the use of a variety of exercises to improve stability/mobility or techniques that activate the nervous system to improve movement coordination. Regardless of the intervention, the goal is for athlete to adapt and improve more quickly than if training and treatment were approached separately.

The transition between training and treatment must be seamless. When it comes to performance therapy, we have noticed the following goals are achieved:
  1. Greater Body Awareness. By integrating the appropriate intervention into the training plan, there is an effect on motor control that generates greater permanence on a neurological level. Basically meaning the athlete masters new movement skills faster. The instant feedback from treatment allows the athlete to provide the coach or therapist with an understanding as to how they feel/move during training. Coaching the athlete thus becomes more specific, allowing them to learn and improve quickly.
  2. Optimization of the Training Session.  Performance therapy integrated with training typically involves a lot of “tweaking” in order to meet the demands of the athlete. It provides the framework to keep athletes performing at their best more consistently. Several athletes receive some type of treatment or practice regeneration/recovery methods prior to competition. So why would they not receive similar interventions during an important training phase?  Both serve the same purpose to optimize performance.
  3. Improved Monitoring of the Athlete. Performance therapy provides additional information on the readiness of the athlete to train. Both the therapist and the coach use this information to make educated decisions regarding the details of each training session, allowing for true customization of your training plan. It’s important that athletes are monitored for how well they have recovered between training sessions so you know how hard to push them. Also, athletes tend to have the ability to 'hide' things very well. Being able to identify slight differences in muscle tightness or movement abnormalities not only will allow us to make better decisions about the training session, but also help prevent more serious matters such as injury or overtraining.
Keep in mind that performance therapy is not intended to create athletes who are dependent on this model, but rather athletes who are held more accountable in the pursuit of their own goals. The coach or therapist is provided with the information needed to recommend the most appropriate "homework" for the athlete, such as foam rolling specific muscles, mobility or stability drills, and the use of recovery methods. Furthermore, performance therapy is not intended to serve as a replacement for other forms of therapy. It is not simply moving the treatment room to the training room. Even though the goal of performance therapy is to reduce the amount of time spent on treatment and return to sport measures, there is a time and place for other medical and/or alternative interventions that should be understood and respected.

Closing Words
Both sports medicine and performance therapy are necessary components in the health and performance of athletes. Failure to integrate therapy in a complementary manner can be a mistake. Without performance therapy there tends to be an increase in reliance on other forms of therapy that stress rehabilitation and recovery.

In sports, the term "game changer" is often used to describe an athlete or action that results in a successful outcome that changes the course of a game. The same can be said about performance therapy because of its ability to play an invaluable role in an athlete's development. If you've been experiencing lack of results or just can't seem to stay healthy, performance therapy may just be the "game changer" you have been looking for to improve your abilities as an athlete and GP is where you can find it.

Finding a Solution to Your Shoulder Pain


 
"He who treats the site of pain is often lost."
- Karel Lewit

The purpose of this article is to provide some basic information about the importance of understanding the role posture and function have in pain 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.
When it comes to dealing with chronic musculoskeletal pain, the site of the pain is rarely the actual source of the pain. This concept is often missing or ignored in traditional North American treatment. Let's look at shoulder pain as an example. All too frequently the shoulder pain patient is provided an evaluation and treatment that is solely focused on the shoulder. Depending on the professional you see, the shoulder is typically treated with any combination of adjustments, passive modalities (ultrasound, electrical stimulation, laser), manual therapy, or shoulder exercises. If those fail, you may be referred for shoulder injections or you may become a potential candidate for shoulder surgery.

Notice the pattern? Everything is focused around the shoulder. That's where the pain is, so that's where my problem has to be, right? The same pattern can be seen with low back pain, neck pain, knee pain, etc. This seems like rational thought, but what if you, as the patient, do not respond? Does this mean that conservative treatment failed? Does it mean you need surgery? What if only focusing on the site of pain caused something very critical to a positive outcome to be missed?

Looking Beyond the Shoulder
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. Meaning shoulder movement does not occur only at the shoulder, but is dependent upon the function of the spine, rib cage, pelvis, and even the ankles. For example, trunk muscle stabilizers are activated before movement of the upper extremities begin; therefore, shoulder pain can be caused by poor core stabilization.

Hopefully you are coming to realize that while you may have pain in a specific area, it's not always the cause of the pain. Going back to the shoulder, a 2006 study that reported 49% of athletes with arthroscopically diagnosed posterior superior labral tears (SLAP lesions) also have a hip range of motion deficit or abduction weakness. This illustrates a key point. How often do you see shoulder pain/dysfunction treated by correcting hip mobility and stabilization patterns?

Outside of glenohumeral joint range of motion and rotator cuff endurance/strength, has your shoulder evaluation included any of the following items:

#1 - Breathing Pattern
The average person will take close to 20,000 breaths per day but until recently the impact breathing has on movement and dysfunction has been largely ignored. Proper breathing certainly provides great benefit to athletes and individuals who display a variety of movement dysfunction.  Neurologist Karel Lewit said, “If breathing is not normalized, no other movement pattern can be.” Understanding the impact proper breathing has on the body and how to restore ideal breathing patterns is critical in both athletic development and rehabilitation.

#2 - Thoracic and Cervical Spine Function
Spinal posture lays the foundation for shoulder function. Improper function of the thoracic (mid-back) and cervical (neck) areas of the spine will compromise the function of your shoulders. Imagine the spine as a series of cog wheels, movement in one area will impact all areas. This is visualized in the picture below:



Regardless of whether they are sitting or standing, the majority of people tend to fall into a posture very similar to what is seen on the left. Increased kyphosis of the thoracic spine (rounded mid-back) is a major reason for forward head posture and rounded shoulders. There are seventeen muscles that attach to the shoulder, many of them influencing the position and movement of not just the shoulders, but spine as well. Shoulder function is dependent on proper spinal posture and without correction of spinal posture, the shoulders don't have a fighting chance to stay healthy.

#3 - Mobility of the Opposite Hip and Ankle
The importance of looking at hip mobility was emphasized previously, but let's also consider the ankle. This ankle becomes of particular importance when dealing with overhead throwing athletes. Dysfunction at the ankle will alter mechanics up the kinetic chain and place undue stress on the shoulder and elbow. Correcting any muscular tightness or poor joint movement of the ankle sets the stage for ideal throwing mechanics and the prevention of shoulder injuries.

Closing Thoughts
Despite focusing on shoulder pain, many of these concepts hold true for any type of chronic musculoskeletal pain. Before abandoning all hope or 'learning to live with the pain', consider that being evaluated by a professional who will look beyond your site of pain could be the solution you have been looking for. That's why these concepts form the foundation of the examination and treatment process at Gallagher Performance.

Stay Hydrated: How Much Water Do You Need?

What you need to know:

  • Adequate water intake or hydration is determined by many factors.
  • Common advice such as "Drink 8 cups of water a day" or "Drink half your body weight in ounces" are far too simplistic and may not provide you with the water you need.
Why Water is Essential to Health and Performance
"Dehydration of as little as 2% loss of body weight results in impaired physiological and performance responses."
As your body's principal chemical component, water makes up roughly 60 percent of your total body weight. Every system and cell in your body depends on water. Water is essential to normal human function.

Lack of water leads to dehydration, a state that occurs when you don't have enough water to allow your body to perform normal functions. A review published in the Journal of the American Dietetics Association states that "Dehydration of as little as 2% loss of body weight results in impaired physiological and performance responses."

To put that into perspective, this would equate to losing almost 3lbs of water for an individual who weighs 150lbs. That may seem like a lot of water to lose, assuming that one must exercise a lot or resort to extreme measures to lose that much water. But let's take a closer look and see just how easy it is to lose water without exercising.

According to the Guyton Textbook of Medical Physiology, the same 150lb individual will lose about 2.3L of water daily from urine, feces, sweat, and insensible water loss through the skin and breathing. 2.3L equals almost 5lbs of water loss per day from normal body function. This estimation does not factor in a warmer climate. Naturally, sweat rates increase in warmer weather, so this same individual could lose up to 3.3L of water a day.

It should be clear that becoming dehydrated is not a difficult task. There is a common misconception that dehydration only occurs in people that sweat a lot due to exercise or warmer weather. This couldn't be further from the truth. Normal bodily functions can lead to dehydration if water intake is not addressed appropriately.

The importance of adequate water intake has important health considerations as well. There are studies that have demonstrated individuals who stay well hydrated are less likely to experience:
  • Cancers of the breast, colon, and urinary tract
  • Urinary stone disease
  • Mitral valve prolapse
  • Childhood and adolescent obesity
Meeting Your Basic Daily Needs
In sedentary individuals, it appears that men require about 12 cups of water per day and women require about 9 cups of water per day. Whole foods are estimated to provide 4 cups of that daily water total. Another 1 cup of that daily water recommendation comes from 'metabolic water' or water that your body makes from metabolic processes, thus making this water you don't have to worry about consuming.

So for the sedentary individual, they will require about 7 cups of water/fluid per day since the remaining 5 cups of water will come from food and normal metabolic function. This is assuming that one is eating enough to meet their calorie needs.

It's important that any fluid you count toward your daily total is non-caffeinated or non-alcoholic. Caffeine and alcohol raise water needs in the body. If you consume either of these, you will need more water.

Water Needs in Response to Physical Activity
As for athletes, there is strong evidence in the research showing that dehydration will have major impacts on endurance, strength, intensity, and mood. When it comes to athletes, little research has been done to determine exactly how much water intake is needed to prevent dehydration. This likely explains the wide variety of answers one can potentially be given when attempting to figure out how much water they need to rehydrate. The honest answer is, "It depends." The reality is, there are a number of factors that play into understanding how much fluid intake an athletes needs to appropriately rehydrate.

Athletes or active individuals will generally require greater amounts of water due to increased muscle mass, metabolic activity, and sweat rates. So how much water will an athlete require? For starters, we can make a safe assumption that athletes eat more food during the day than the average person and that they have a higher metabolic rate. With this in mind, they will be getting more water from food sources and metabolic function. Depending on the climate an athlete exercises in, daily water intake may need to increase to an additional 2-4L (8-16 cups) on training days. Water intake must be based on factors such as activity level, body mass, sweat rates, and climate.

Bottom Line
A safe, general guideline for athletes and water intake would be to consume 1/2 gallon of additional water on non-training days. When it comes to training days, an athlete may require a gallon or more of water per day to maintain adequate hydration levels.

Source:

Kleiner, S., Water: An essential but overlooked nutrient. Journal of the American Dietetics Association. Volume 99, Number 2, 200-206, 1999.
 
 

3 Simple Steps to Reduce Your Risk of Sports Injuries

The Problem
Youth, high school, college, and professional sports continue to rack up thousands of injuries each year. Despite advances in areas of sport such as equipment, coaching, and player safety guidelines, injury rates are not decreasing. In fact, many sport-related injuries have increased dramatically over the last decade, with a sharp rise in youth sport injuries as evident by some alarming statistics:

  • High school athletes account for an estimated 2 million injuries and 500,000 doctor visits and 30,000 hospitalizations each year.
  • Overuse injuries are responsible for nearly half of all sports injuries to middle and high school students.
  • Since 2000, there has been a fivefold increase in the number of serious shoulder and elbow injuries among youth baseball and softball players.
  • According to the CDC (Centers for Disease Control and Prevention), more than half of all sports injuries in children are preventable.
With those numbers in mind, let's look at football injuries since they alone account for over 500,000 injuries per year, twice as much as any other sport. More than half of all football injuries are to the lower extremity and roughly 67% of all football injuries are sprains/strains. Several injuries occur at the joints, especially the shoulders and knees. Many of these often require surgery and potentially have career-ending and/or lifelong implications.

The Solution
While injury is an inherited risk of participation in sport, there are steps that can be taken to reduce the risk of serious injury and to give athletes the best chance of a rapid and complete recovery when injuries do occur. Again, consider that more than half of sport-related injuries are deemed preventable. As with any health issue, prevention should be of primary importance. With that in mind, let's look at a few simple steps to reduced your risk of injury.

#1 - Movement Screening/Assessment
Many injuries are preventable with movement pre-screening that is designed to identify musculoskeletal asymmetries and weaknesses that are known to increase the risk of injury. Ideally, movement screening is performed before the season begins. These movement assessments are utilized by several professional and collegiate sports teams and are proving to be an asset in their ability to keep athletes healthy.

How?

They provide a starting point for implementing specific exercises and routines to bring structural balance back to the body. Don't make the assumption you or your young athlete is 'ready' for the season without any objective evidence that there is work they need to do. This is exactly why you will hear the advocates of movement screening say, "Assess, don't assume."

#2 - Intelligent Strength and Conditioning Program
Once your weaknesses and imbalances have been identified, it’s important that you find someone in your area who is capable of addressing them through intelligent programming.  If you’re injured, it’s more than likely that you have developed compensation in your movement that contributed to your injury. These compensation patterns are typically best handled with an appropriate combination of strength training and corrective exercise. The combination is key. Corrective exercise is not the only means of approaching imbalances in the body. Many people fail to appreciate that appropriately applied strength training has the ability to be corrective on its own.

Furthermore, if you are injured, finding someone who has a firm understanding of functional anatomy, how it relates to your injury, and how to train around your injury while still addressing your weaknesses can prove to be the difference in making a speedy recovery. After all, you don't just want to return to your sport, you should want to return better than you were before.

#3 - Appropriate In-Season Program
This point can't be stressed enough, as too many athletes tend to slack off during the season and don't place a priority on maintaining adequate strength, mobility, and neuromuscular control of their body. Basically, they don't pay as close attention to the little things as they did during the off-season. There can be any number of reasons for this, but if staying healthy is important, you must find the time. This becomes evident when you consider that 85% of non-contact ACL injuries occur mid-late season. Other sport-related injuries also have greater frequency of injury as the season progresses.

Appropriate in-season training is intended to provide lower volume and frequency of strength training while continuing to address injury prevention and recovery methods. To complement in-season training, services such as chiropractic and massage therapy can be implemented to restore structural balance and function to the body. This provides a solid template for keeping sport performance as high as possible throughout the season. Plus, athletes are able to enter the next off-season close to peak performance, rather than spending weeks or months returning to their previous form.

That's All Folks
Injuries are part of the nature of sport and, unfortunately, completely preventing injury is an unrealistic expectation. Despite that, the risk of injury should not be taken lightly by parents or athletes when the risk of serious injury can be greatly reduced by taking appropriate steps as outlined above.

For those of you in the Greater Pittsburgh area, this approach to keeping athletes healthy and performing at their best is available at Gallagher Performance. These services are not exclusive to athletes, but are available to all individuals who enjoy being active and wish to take a proactive approach to staying healthy.