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/

After completing my Sports Injury and Rehabilitation residency in September 2012, making the decision to start up this business with my brother, Ryan, was one of the most daunting tasks I have ever encountered, including all the efforts to get it started and keep it growing. Considering I had offers for some well paying jobs all over the country, why would I possibly want to take the risk of launching a business? As a sports chiropractor with a specialization in rehabilitation, I had job offers to perform patient rehab in established offices, working as little as 20 hours per week. I could do that along with writing, consulting, and putting on seminars – all while enjoying plenty of free time. However, I saw a huge problem. That wasn’t me. As much as I enjoy what I do as a sports chiropractor, I equally enjoy assessing and evaluating athletes, designing training programs, coaching, being in the gym, training, and helping athletes achieve their goals. There was no way I could find personal fulfillment in my job unless I could be directly involved with both the training and therapy of athletes. More money or less hours didn’t matter to me.

About the time I was wrapping up my residency at Palmer College, Ryan was finishing his massage therapy schooling and working full time as a trainer while residing in Ohio with his wife, TIffany. For years, we had dreamed and talked about starting our own business that integrated not only our services, but our educational and professional backgrounds. We knew we had a unique approach and the desire to provide quality in our sports performance training, chiropractic, massage, and nutritional services. We believed that if we did things for reasons that were in line with our values, the business would grow to provide fulfillment beyond just money. We wanted to measure our success by delivering great results to our clients and athletes.

GP opened in April 2013 and has experienced steady growth every month since our opening. Our sports performance training services have become increasingly popular. With the summer upon us, athletes are coming in looking to capitalize on their off-season by improving their abilities (speed, strength, power, agility, etc). Each athlete we have worked with has seen tremendous results, which speaks to our business model, the individualized approach we use with each athlete, and the character of our athletes. We are receiving large amounts of referrals, which, to us, is the greatest compliment our business can receive. Slowly, GP is gaining the reputation for having an approach that is unlike any athletic development program in the area.

We have seen our sports performance training services utilized by athletes who participate in soccer, cross country, basketball, baseball, lacrosse, hockey, and football. We even have a client who is preparing for military special operations in hopes of becoming a Navy SEAL. With that said, our training services have especially become popular among football and hockey players (high school, college, amateur, and junior level).

Reflecting back on the past year, there have been lessons learned and constant reminders of why we do what we do at GP. To begin with, we are consistently reminded that regardless of sport or competitive endeavor, the primary goal of any physical preparation program is to prepare the athlete for the demands of the competitive season and/or higher levels of competition. This sounds simple in nature, but is incredibly complex at times as an overwhelming majority of our young athletes need to master the fundamentals of general calisthenics and body weight exercises before introducing the execution of movements with either increasing resistance using external loads or at increasing velocities.  Some of our programs may not seem “advanced” and it’s for a good reason. Too many young athletes, and sometimes their parents, have bought into the idea that they should be training “like the pros”. Kids need the basics, and a lot of them, before more advanced training can be introduced.

Another lesson we continually learn at GP is the importance of promoting structural balance and recovery for our athletes. At any age or level of competition, it’s imperative to recognize the stress an athlete’s body experiences during their competitive season(s). Often a number of precautions and considerations must be made from the onset of training and throughout the duration of the off-season to restore balance to an athlete’s body and facilitate recovery. This becomes increasingly important as an athlete ages and progresses through higher levels of competition, as they accumulate greater amounts of wear and tear. The recovery and regeneration protocols used at GP have been a welcomed addition to our athletes’ programs, since many of them have never been introduced to approaches that keep them healthy and their performance levels more consistent. We do whatever it takes to keep our athletes healthy and injury-free as they seek to improve specific performance markers.

Something else we have come to appreciate more and more is how valuable the education our athletes receive is to them. In talking with our athletes, we have consistently discovered that they do not understand how or why an athlete must train according to the demands of their sport. This is a foreign concept to many of them. The educational process provides our athletes with the knowledge they need to understand how an athletic development model is applied to their sport. This has proven to be invaluable because our athletes truly appreciate understanding the mistakes they have made and understanding they are receiving guidance that has their best interest in mind, based solely on their needs.

The educational process and witnessing the development/results each of our clients and athletes achieve, to me, has been the most fulfilling part about what we do at GP. The smile a young kid gets when they step on the scale and see that they are 10 pounds heavier or the high-five and genuine enthusiasm shared when they set a new personal best in strength, jumping, or speed makes it all worth it. And as for our clients who are training to lose fat and/or improve general fitness levels, we love to get feedback that their body feels great, they are training pain-free, and are able to enjoy the training process while maximizing the benefits of their efforts.

The vision for GP was an easy one to establish. Ryan and I made the choice to build a business that was fulfilling both personally and professionally. The process has not been an easy one, but it has been rewarding and we are enjoying it.

We also acknowledge that GP would not be what it is without the consistent support we receive. A sincere thank you goes out to all you – clients/athletes, parents, family, friends, social media followers, and professional colleagues – for your continual support over the past year. Without you, GP would not be what is today, and we look forward to many more years to come.

More related reading:

https://gallagherperformance.com/why-we-arent-popular/

https://gallagherperformance.com/two-years-at-gallagher-performance/

 
 

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

• Genetics
• Training History
• Nutritional Habits
• Sleep Quality
• Mental Stress

“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.”

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.”

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.”

At GP, we get plenty of questions from our young athletes about training simply because they are exposed to more training information and conflicting ideas than ever before. Recently, we had one of our athletes ask us, “A lot of my teammates are training at _______ and the trainers there have them stand on BOSU balls and do different movements, telling them it’s what they need as athletes. I’ve watched them and it seems ridiculous to me. They can’t even do simple movements correctly. Why are they doing that?”

We love educating our clients and athletes, especially when it comes to any number of gimmicks that exist in the sports performance industry.

Whether you wish to refer to it as balance training or unstable surface training, plenty of images can come to mind of people standing on wobble boards, BOSU balls, and even stability balls. These items are often marketed as “functional training”, being capable of not only improving your balance, but also increasing core muscle activation and strength. Athletes are often told that balance training is essential to improving as an athlete and reducing their risk of injury.

This school of thought grew out of the physical therapy and rehabilitation setting. In the rehabilitation setting, there is some efficacy regarding the use of balance training in chronic low back pain and reducing the risk of recurrent injury, particularly when it comes to ankle sprains. Unfortunately, there seems to be a sect of the personal training and sports performance industry that has concluded that information gathered on injured patients is somehow applicable to the non-injured individual and high-performance athlete.

The reality is all exercise is functional, if applied correctly to address the needs of the individual. This takes into account their goals, primary sport form, strengthens/weakness, and imbalances that need attention. If your exercise has no direct transfer into any of these areas, the exercise is not “functional”. Functional exercise should never be determined by how it looks, but rather what it produces.

When it comes to balance/unstable surface training, the above paragraph is incredibly relevant.

Why?

Take a moment and ask yourself this question, “When am I ever on an unstable surface during my daily life? When do I compete on an unstable surface?”

If you answered honestly, chances are very little, if ever. So why are we training people on an unstable surface when they are almost never on unstable surfaces?

The fact of the matter is, the floor works just fine.  Unstable surface training probably does more for decreasing athleticism, strength, balance, and movement quality than it helps.

Here is a quote from an article written by the man known as Kiefer:

“You instantly tense up, you almost literally can’t perform certain movements because the nervous system senses the instability of the environment and fires in resistant ways to keep you balanced. In this process, it also shuts down the ability to produce maximum force….Think about it, if you start to slip in one direction and your reflexes caused your muscles to fire with maximum force against that motion—a motion that may be inevitable at that point, like falling—then you risk tearing muscle or connective tissue. The body is trying to protect you by making you weaker.”

1. Several researchers have demonstrated that there is significant increases in stabilizer activity during movements that require increased force (either greater resistance or higher speed) compared to activity seen in unstable environments [1-4].
2. Performing squats on unstable surfaces will increase core activation, but not necessarily core strength [5] and definitely decreases muscle force production [6].
3. Doing pushups on a physioball does less to activate stabilizing muscles than placing your feet on an elevated, stable bench[7].
4. Unstable surface training contributes nothing that cannot be achieved when performing stable surface exercises [8,9].
5. Stable surfaces are superior for some scenarios involving scapular rehabilitation [10].

1. Freeman S, Karpowicz A, Gray J, McGill S. Quantifying muscle patterns and spine load during various forms of the push-up. Med Sci Sports Exerc. 2006 Mar;38(3):570-7.
2. Hamlyn N, Behm DG, Young WB. Trunk muscle activation during dynamic weight-training exercises and isometric instability activities. J Strength Cond Res. 2007 Nov;21(4):1108-12.
3. Nuzzo JL, McCaulley GO, Cormie P, Cavill MJ, McBride JM. Trunk muscle activity during stability ball and free weight exercises. J Strength Cond Res. 2008 Jan;22(1):95-102.
4. Willardson JM, Fontana FE, Bressel E. Effect of surface stability on core muscle activity for dynamic resistance exercises. Int J Sports Physiol Perform. 2009 Mar;4(1):97-109.
5. Anderson K, Behm DG. Trunk muscle activity increases with unstable squat movements. Can J Appl Physiol. 2005 Feb;30(1):33-45.
6. Saeterbakken AH, Fimland MS. Muscle force output and electromyographic activity in squats with various unstable surfaces. J Strength Cond Res. 2012 Mar 24. Epub ahead of print.
7. Lehman GJ, Gilas D, Patel U. An unstable support surface does not increase scapulothoracic stabilizing muscle activity during push up and push up plus exercises. Man Ther. 2008 Dec;13(6):500-6.
8. Lehman GJ, MacMillan B, MacIntyre I, Chivers M, Fluter M. Shoulder muscle EMG activity during push up variations on and off a Swiss ball. Dyn Med. 2006 Jun 9;5:7.
9. de Oliveira AS, de Morais Carvalho M, de Brum DP. Activation of the shoulder and arm muscles during axial load exercises on a stable base of support and on a medicine ball. J Electromyogr Kinesiol. 2008 Jun;18(3):472-9.
10. Martins J, Tucci HT, Andrade R, Araújo RC, Bevilaqua-Grossi D, Oliveira AS. Electromyographic amplitude ratio of serratus anterior and upper trapezius muscles during modified push-ups and bench press exercises. J Strength Cond Res. 2008 Mar;22(2):477-84. 

In order to meet the demands of working with athletes of all levels of preparation, the services at GP are constantly evolving and adapting on many levels. When it comes to the physical preparation of our athletes, there is no single program or method we use with every athlete. We are constantly assessing each athlete from day to day, learning what he or she is capable of performing during any given training session. Constantly assessing our athletes during their dynamic movements also allows us to identify weakness and address them accordingly from both an injury prevention and performance enhancement perspective.

Our approach can often times be a source of both intrigue and confusion for parents and their young athletes, since the majority of them are all too familiar with a ‘one-size fits all’ approach. Many of these athletes even come with ‘cookie-cutter’ strength and conditioning programs given to them by their coach or previous trainer. It becomes our job to explain our approach to training and athletic development and why these ‘cookie-cutter’ programs fail to address individual needs of each athlete. After explaining why each individual athlete requires their own individualized approach and why no two athletes will respond similarly to the same program, it makes sense to them. They often find this very refreshing. What doesn’t make sense to them is how so many coaches and trainers are ignorant of this fact.

In an interview with Buddy Morris, Joel Jamison addressed the heart of the matter by saying,

“Coaches and trainers maybe don’t do the best job of understanding the needs of the sport and they tend to let their athletes over train because of the….push of this country is more intensity, the quick buck, the fast results. The other thing I think that’s influenced our industry probably negatively more than anything else is the marketing aspect. That there’s products, and there’s training methods, and there’s everything being pushed to athletes and coaches from a marketing perspective. We’ve all seen the cross fits, the P90 Xs, all the functional training stuff. It’s the marketing driving the training rather than the training driving the results or the results being based on something scientific.”

”We're trying to create circus acts in this country so, like you said, people can generate revenue. So if you actually read and you understand training methodics and you understand the athlete and training the athlete, you won’t buy into all this stuff out there.”

The emphasis of many athletic development programs is typically rooted in developing the physical qualities needed in the sport of competition. Physical qualities usually emphasized are endurance/work capacity, strength, body awareness, agility, quickness, speed, and explosive power. Improvements made in any of the previously mentioned physical qualities can certainly improve an athlete’s fitness and physical preparedness for competition. But great athletes are rarely defined by their level of fitness and how ‘in-shape’ they are. They are defined by their ability to play the game and perform the skills of the sport. Great coaches and trainers understand this, being able to take an athlete’s newly developed physical qualities and transfer them to into improved skill execution or technical mastery of sport related movements.

This is accomplished by specificity of training.

In order to ensure specificity of training, it is first necessary to determine the exact physical qualities an athlete is in greatest need of. Many coaches and trainers refer to this as ‘identifying the deficiency’. Once the deficiency is identified and an understanding is developed as to how the deficiency is limiting on-field performance, the deficiency can be trained appropriately.

To identify deficiencies, the majority of coaches and trainers utilize tests to determine an athlete’s level of strength, endurance, explosiveness, and even flexibility. While these tests are often necessary and provide quantitative information that will help assess how an athlete stacks up in comparison to others, what these tests fail to indicate is how efficiently an athlete can perform sport-specific skills or maneuvers.

Physical performance tests fail to indicate an athlete’s needs in relation to game performance. To ensure transfer of training into improved sport performance, identifying an athlete’s developmental needs must take into account an analysis of all components involved in successful competition. Often, this involves a complete biomechanical analysis of movements related to sport-skill execution.

For example, the deep squat is often a staple of many strength and conditioning programs. It can be a tremendous exercise for building hip strength and power and for a variety of other reasons. But when you examine the sport-related movements of many athletes, one can come to the determination that the need to deep squat is not a priority for many athletes. Consider hockey and basketball players. These sports require hip external rotation strength and power to execute sport-specific movements (skating, lateral cuts, change of direction, etc.). Rather than placing greater and greater emphasis on improving strength in the deep squat, these athletes will be better served in developing hip external rotation through other exercises which more closely mimic the external rotation demands of the hips in competition.

Again, great athletes are rarely the strongest or the fittest. There are studies that demonstrate Olympic-level athletes and World Record holders are not the strongest athletes (with the exception being in strength sports such as powerlifting and Olympic weightlifting). Athletes on the highest levels of performance do not lift the greatest amount of weight in commonly used exercises, such as the clean, squat, bench, or deadlift.

More commonly, athletes will fall in the midrange of strength numbers. What this is demonstrating is a ‘point of diminishing returns’. Many athletes reach a point at which increases in strength or other physical qualities do not always equate to improved sport performance.

Successful athletes must be able to execute sport skills with technical mastery and precision. Regardless if you are a hockey, football, soccer, lacrosse, baseball, tennis or track athlete, you need great acceleration, speed, agility (ability to change direction quickly), and the ability to jump high (which also requires explosive power). But arguably most important is the ability to perform all sport skills with mastery and precision of movement.

An athlete will never be successful if they do not have the ability to execute sport skills successfully. This is why technique must be closely analyzed and why the training of physical qualities must directly enhance the performance of sport-specific skill execution.

Analyzing an athlete’s sport skill technique and the demands of game play becomes a necessary first step to determine exactly what their training program should consist of. Often to correct and/or enhance technique, special strength exercises are implemented to develop the specific strength an athlete needs to execute movements more efficiently.

We addressed special strength exercises in this article. Special strength exercises are intended to replicate the exact neuromuscular pathways utilized in the execution of specific sport skills.

With proper analysis and identifying the ‘deficiency’ of the athlete, it enables the training program to have greater transfer into sport performance. The training program is continually adjusted as improvements in strength, speed, agility, and explosive power are integrated into technical mastery of skill execution.

Related Articles:

Training for Elite Athletes
Common Mistakes in Developing Young Athletes

In the attempt to improve athletic performance or prevent sports-related injuries, it is common to read that muscles in the body should be balanced. At times, what “balanced” means is never fully explained and is often assumed to mean that muscles on both sides of a joint should be equal in qualities such as endurance or strength. As a result, trainers and coaches may advise athletes to perform equal training for musculature on all sides of a joint to ensure balance.

The intent is to achieve symmetry. Not just at one particular joint, but often throughout the body. The goal is to see symmetrical movement on both sides of the body. Consider how therapists and coaches will use movement-screening systems to evaluate movement and then apply correctives with the goal to ‘balance’ the body or to reduce the risk of injury.

However, one must question if this the most intelligent thing to do in relation to high-level athletic performance. 
From the few studies done on this topic and from observation, symmetry may not be an effective means of improving performance. Rather, It appears that the majority of high-level athletes are asymmetrical.

This should not be surprising if you have been looking closely at high-level athletes. I recently attended the ACA Rehabilitation Symposium in Las Vegas over this past weekend. Professor Stuart McGill was one of the featured speakers and he has extensively researched the factors which make great athletes great. Professor McGill provided numerous examples from cases he has seen over of the years of athletes being ruined by someone attempting to 'balance' their body. The intent was on improving their performance or ‘correcting’ movement, yet the end result was making that athlete a patient. Essentially, he cautioned us all as chiropractors, therapists, and trainers to be very wise in what we do with our athletes.

One example he provided was Olympic sprinters and how many of them have very stiff, tight ankles. He stated how this is necessary for their performance and ultimately their success as elite level sprinters. Their ankles must be stiff to serve as ‘springs’ for explosive running. Yet, as he stated, many therapists would want to ‘mobilize’ their ankles and ‘release’ or ‘stretch’ the musculature surrounding the ankle to improve range of motion. However, now you have robbed them of the very thing that makes them a great athlete in their sport.

His example brought to mind a high school football player who trains at GP. He is our fastest athlete and his ankles are incredibly stiff. This stood out immediately upon his initial assessment. Did we do anything to mobilize his ankles? No. We didn’t touch his ankles, understanding that his ankle stiffness is what made him fast. Made him incredibly agile and quick.

If you try to balance muscular development or joint function, it can potentially interfere greatly with an athlete’s performance. It’s important to remember that what makes athletes asymmetrical also makes them great. It is not only a consequence of their training, but often what their sport demands. To take time out of their training to balance their body arguably interferes with more productive training.

This does not mean that they do not do exercises to keep their body healthy and prevent injury. We have our athletes perform many exercises for this purpose, but they are typically done during the general preparatory period, not in the competitive or precompetitive periods.

Former Soviet Union sport scientists studied this concept. The Soviets understood that asymmetry appears to be a key to athletic success. Asymmetry that is produced appears to allow athletes to go above and beyond what other ”well-balanced” athletes are capable of doing. It seems that the asymmetry allows the athlete to perform on a higher level.

There appears to be enough evidence to indicate that perhaps we should not be anxious to 'balance' every athlete’s physical development. Keep in mind that this does not mean that you ignore development of antagonistic muscles. But you do not emphasize them to the same extent as you do with the main muscles and joints involved in the execution of the athlete's competitive sports skill.

More related reading:

https://gallagherperformance.com/athletic-development-will-your-child-be-a-success-or-burn-out/

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

https://gallagherperformance.com/commonmistakesindevelopingyoungathletes/

It seems almost routine now that we come across parents who are curious about what type of ‘training’ their child should be doing to become a better athlete. Ultimately, the majority of parents are concerned about their child lifting weights. Typically their child is 12-15 years of age and the parents feel that weight training at that age is inappropriate and could be potentially dangerous (e.g., stunt their child’s growth). Since this idea is so widespread, we felt it would be valuable to address the topic and the determining factors of whether weight training is suitable for a young athlete.

To start, let’s set the stage for our discussion by simply stating that weight training is one form of ‘resistance’ training. There are plenty of ways to apply ‘resistance’ to the body. From bands to weighted vests to body weight exercises, they are all considered resistance training. If you asked most parents if they had a problem with their child doing push-ups or walking lunges, the majority of them would likely reply, “No”. Lifting weights, at times, can provide less resistance than common body weight exercises yet lifting weights is somehow deemed more dangerous.

Why?

The majority of parents are primarily concerned about the risk of growth plate fracture and the possible result of stunted growth.

To address these concerns, the National Strength and Conditioning Association (NSCA) published a position statement. They determined that resistance training is safe, even for children as young as 6, and that the risk of growth plate fracture and stunted growth is completely unsupported. Simply put, it does not happen and weight training is safe with appropriate coaching and progression. Additionally, research has demonstrated significantly higher injury rates in youth sports (football, basketball, soccer, baseball, hockey, etc.) when compared to weightlifting.
When it comes to coaching and progression, this is where considerations from Long-Term Athletic Development (LTAD) models become invaluable in helping to understand sensitive “windows” during an athlete’s development. These windows identify when to capitalize on certain physical qualities. Looking at LTAD models, children around 12 years old are in a critical window for their speed development. This means that while they can improve in all athletic attributes (balance, coordination, rhythm/timing, relaxation, strength), speed development will experience faster rates of improvement. Speed simply comes down to putting a lot of force into the ground quickly. Explosive movement requires high power output and this relies on your “fast twitch” muscle fibers. Resistance training is one method to efficiently train “fast twitch” muscle. In this context, certain exercises aren’t always what they appear to be. For example, a young athlete performing squats may not be simply performing squats, but rather “speed training” because it’s a tool to teach them to produce force quickly and utilize their muscles in an explosive manner. Improve an athlete’s ability to produce force and they will get faster. Force production is directly controlled by the nervous system. Neural development is very sensitive for children 12-13 years of age. This means that the nervous system, which coordinates all movement, is primed for learning and improving efficiency of complex movements. This is one reason why resistance training is appropriate for athletes during this time period; it can capitalize on a sensitive period of neural development to help kids move with improved body awareness AND coordination, thus resulting in increases in qualities such as strength, power, and speed.
Concluding Thoughts
There are many factors to consider when it comes to “appropriate training” for young athletes. While there are safety concerns, age-appropriate and developmentally specific training methods can be extremely effective. For young athletes, weight training is a safe and effective means to develop body control/awareness and improve athletic qualities, such as speed. Weight training, as part of an athletic development program, should follow a structured approach under the supervision of a knowledgeable and qualified coach.

To ensure the highest quality outcomes and safety, GP understands and utilizes LTAD models in the training of their young athletes.

Related Articles:

Success or Failure: What Are You Setting Your Young Athlete Up For?
Don't Fall for the Speed Trap
Identifying Strength Needs for Athletes

Technique is fundamental and should be the primary focus of instruction when it comes to any new exercise or sport skill. It's essential to the continual refinement of movement skills. Technique also has implications in the rehabilitation process as well.

However, there appears to be a huge gap in terms of what most people acknowledge as proper technique and the technique they actually demonstrate or coach.

1. Sure many coaches and trainers can "tell" you what proper technique is, but are they capable of identifying technique errors?
2. Are they skilled and knowledgeable enough to understand why they are seeing technique errors and how to systematically go about improving technique?
3. Do they understand the joint and muscular actions involved in the complex execution of specific movements?
4. Do they understand that technique can be dictated by your anatomical structure and that there is no such thing as a "one size fits all" approach when it comes to coaching proper technique?
Despite hearing time and time again from coaches, trainers, and clinicians preaching, "Technique, technique, technique", the reality is many in the fields of health and fitness do not understand technique as well as they should. Sure, they may claim to practice or teach 'perfect technique' to their clients or patients. They may agree that technique is important and that it should be accounted for.

But are they actually making sure your technique is what works best for you?

Take for example a high school athlete that was recently seen at GP. His primary complaint was low back tightness and pain following squatting and lower body training days. He had been seeing a local chiropractor for his back pain and training with a teammate at another local gym. He had been receiving care for almost 6 weeks with no change. Despite 2x/week adjustments and performing a routine of abdominal strengthening exercises and hamstring stretches, he continued to have 'severe' tightness and occasional pain in his low back for 3-5 days after squatting.

As I dug deeper into the nature of his low back tightness, the pattern of his symptoms made me increasingly suspicious that something was clearly wrong with his squat technique.

So I asked him, "How's your squat technique?" I wanted to get inside his head and hear his thoughts on his technique. His reply was, "I think it's pretty good. I learned from my training partner who has lifted more than I have and our football team's strength coach gave us tips."

I want to emphasize this point. He believed his technique was not an issue. He believed he had received good coaching when it came to his squat technique. Rather he kept expressing how he had been told he had weak abs and needed to stretch his hamstrings, and that this was the root of his problem. His mind wasn't focused on technique.
At GP, we have the luxury of using the gym to provide real time feedback during our evaluations. This kid looked pretty good doing a body weight squat, but I knew things would change once we got him loaded up. So we took our session to the gym floor. Needless to say, there were a number of technique issues with his squat that were ultimately at the heart of why he was routinely over-stressing his low back. Rather than addressing mobility or strength issues, we simply figured out the technique he must utilize based on his anatomical structure.

This young athlete had structural adaptations that had to be taken into consideration when figuring out the most appropriate squat technique that worked for him. These very same structural adaptations had been previously overlooked, yet they played a huge role in why he was symptomatic.

After cleaning up his technique issues, it was no surprise to me that his back was not a complaint. But it was a huge surprise to him. He had just spent weeks getting adjusted, strengthening his abs and stretching with no results. How could something so simple as technique modification resolve his issue?

Closing Thoughts
When someone is experiencing a weakness in their performance or is recovering from a musculoskeletal injury, determine if the main culprit is improper technique.

Far too often, most will think to only improve physical abilities (endurance, strength, balance, coordination, flexibility, etc.) when dealing with poor performance or injury rehabilitation. While addressing physical abilities is important, physical abilities have limited value without proper technique.

In the ideal situation, technique changes or modifications should be made simultaneously as strength or other physical abilities develop. For athletes, strength should be coupled with skill through what is known as special strength exercises. In other words, strength is developed in the same neuromuscular pathway as used in execution of their competitive skill(s).

Rehabilitation programs that primarily focus on isolated physical abilities without integrating those newly developed abilities into specific movement tasks or sport skill will fail to ensure that athletes are equipped to handle the demands of competition. When it comes to injury rehabilitation and injury prevention, failure to couple strength as it relates to technique will increase the chance of recurring injury.

Consider the relationship between hamstring injuries and sprinting. Several athletes frequently experience hamstring injuries, which can take weeks or months to rehabilitate. However, when efficient sprinting mechanics are coupled with development of the physical abilities specific to the actions involved in sprinting, the chances of hamstring injuries are essentially nonexistent.

This is why experts are convinced several common athletic injuries, not just hamstring injuries, are preventable. This also explains why having a coach and/or therapist who understands technique is invaluable to athletes.

 

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

In our previous article, Structural Adaptations – Not Just An Athlete’s Problem, we discussed structural adaptations and why they must be accounted for in both training and treatment plans. Clearly, structural adaptations have impacts from a sports performance and clinical perspective.  With that in mind, prior to treatment, our goal is to not simply assess from a structural standpoint, but to also assess functional capacity to determine if there is a functional capacity deficit (i.e. endurance, strength, balance, reactivity, dynamic posture control). It is my job as a clinician to choose the most appropriate evaluations to identify functional deficits. I choose not to limit my evaluations to x-rays or imaging and finding structural abnormalities. It should be evident that treatment based on the findings of imaging alone is flawed when you consider the enormous amount of false positive rates in asymptomatic people. This is why I couple structural evaluation with a functional evaluation that looks at motor patterns or movement, not just isolated joint range of motion or strength.

As a chiropractor, I tend to go against traditional approaches in how much attention I give to static body alignment compared to most of my peers. Reason being is that often times a patient can look a certain way (i.e. “dysfunctional”) in a static stance, but when asked to perform a skill, they nail it. This can be especially true of athletes. What I was able to learn over and over again during the course of my residency is that if someone can’t perform a certain movement (i.e. squat), it may be more practical to coach or educate them on better movement (i.e. motor learning) prior to isolating and treating joint or mobility “dysfunctions”. The reality is, if a patient or athlete is performing a new or unfamiliar movement, sometimes they simply lack the skill to execute it in an ideal fashion. This is the prime reason why I find functional evaluations invaluable in determining the best course of treatment.

When it comes to functional capacity, the assessment is intended to identify the relevant functional deficit of that patient. What is relevant to that patient will depend on their history. What areas are bothering them? What does their injury history tell you? What activities have they been involved in that have provided accumulated stress or strain to their body? This can provide insight into the adaptations or compensations patients may exhibit. As for athletes, it is important to remember: the higher level the athlete, the better they are at compensating. Despite being asymptomatic, those compensations will eventually catch up to them and become symptomatic. This will not only impact performance, but injury risk and longevity as well.

Once a functional capacity deficit is identified, the process of treatment can begin. For example, poor stabilization patterns during movement are a common functional deficit. Whether it is lack of stability during everyday tasks such as walking, carrying, lifting, etc., or sport-related skills such as kicking, throwing, sprinting or jumping, it’s important to understand that the functional capacity of each of these activities has different demands as it relates to stability. Our approach must be tailored to match the stabilization demands in order to normalize movement patterns and improve the load-bearing capacity of tissues involved. This is the goal of treatment. Perfection of movement is not the goal. Arguably, perfect movement does not exist. Consider elite athletes who practice their skills all day, consistently, year after year. Are they perfect with their movement 100% of the time? No. Movement has far too many variables to achieve perfection. The goal is better movement coupled with increased tissue capacity to better withstand overloads when movement goes awry.

As a chiropractor, I possess a license to manipulate and improve the function of the neuromusculoskeletal (NMS) system. I prescribe what I feel is necessary for treatment, whether it is joint manipulation, soft tissue/massage therapy, or exercise prescription. When it comes to the management of the clients and athletes here at GP, we perform functional evaluations prior to all training programs and chiropractic treatment. But the evaluation process does not end on day one. Evaluation is a continual process, from session to session. This is vital to monitor for improvement and knowing when to adapt the current training or treatment plan. Continual functional evaluation enables us to handle physical ailments appropriately when they occur. This is just part of the process of our Integrated Approach. It’s important to understand the rationale for a prescribed course of action. Thus giving both chiropractic and training services a better understanding of what to do for each individual to maximize results. So from a treatment perspective, it really isn’t just about knowing how to manipulate or perform ‘active release’ on muscles. Far too often people may know what they do; they may know why they do what they do; but do they actually understand the effects of what they just did? As a clinician, it’s important to understand the effects of the treatment you just provided and the reasons why they were provided.

Summing it All Up
Functional assessments provided at GP help to identify the most necessary intervention or treatment. It helps to identify the root cause of your symptoms and enables you to function better. Structural evaluations can be valuable, but functional evaluations should not be overlooked. There is important information to be gained from both. If you are experiencing unresolved issues such as joint pain, muscle tightness, or limitation in performing specific sport-related or daily activities, consider seeking out a clinician in your area who is credible and offers functional evaluations as part of their services.

 

Similar to a growing number of athletic facilities across the US, Gallagher Performance places a significant amount of emphasis on assessing our athletes in order to address structural adaptations and movement dysfunctions appropriately during the course of the athlete’s training program. This trend is seen throughout collegiate and professional athletics as organizations are recognizing the importance of keeping their athletes healthy by promoting optimal training environments.

However, this service is rarely available to young athletes prior to sport participation or a training program. This is truly unfortunate since proper screening of athletes is not available when it arguably matters most, during the early stages of athletic development. Dr. Mike O’Donnell DC, CCSP, CSCS touched on this concept in a recent interview. He states,

“In North America, athletes start playing a sport as unprepared youth with no background in general conditioning. This isn’t always true, but we have no system to condition young athletes besides just playing the sport. In an Eastern model, camps are held without a sport focus to condition young athletes, and the specialization comes later. In general, early specialization is a mistake. This has been proven to limit progress, lead to early burnout, and increase injury rate.”

• 79% of asymptomatic professional baseball pitchers have evidence of shoulder labrum abnormalities on MRI.
• 40% of dominant shoulders in asymptomatic tennis and baseball players had evidence of partial or full-thickness rotator cuff tears on MRI.
• 34% of asymptomatic individuals in the general population had evidence of rotator cuff tears. 54% of those 60 years of age and older had evidence of rotator cuff tears - so if you’re dealing with older adults, you could safely assume they are present in almost half of this population.
• Recent research has demonstrated that high school baseball pitchers from southern, warm weather climates have decreased shoulder internal rotation range of motion and external rotation strength compared to northern, cold weather climate players. This is likely attributed to adaptation from the number of months spent participating in pitching activities during the calendar year.
• 64% of asymptomatic people that underwent an MRI of their lumbar region had abnormal findings. Keep in mind these are individuals with evidence of lumbar disc pathology (i.e. bulge or herniation) who have NO symptoms and NO pain.
• 93% of youth hockey players age 16-19 have evidence of femoroacetabular impingement (FAI) and hip labral tears. FAI is the result of bony overgrowth found at the femoral head and/or acetabulum of the pelvis. FAI has been linked to increased risk of injury for osteitis pubis and sports hernias.
• 77% NCAA D1 and professional hockey players evaluated in one study had abnormal hip/groin MRI despite being asymptomatic. Hockey players are also more likely to have a structural change known in the hip known as hip retroversion, which allows for greater hip external rotation and reduces the degree of hip internal rotation.
• 87% of 125 NFL prospects had findings consistent with FAI on MRI. The only independent predictor of groin pain was the degree of bony overgrowth.
• Evidence suggests that roughly 25% of men in the general population have some degree of FAI despite being asymptomatic.

1. Miniaci et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):66-73.
2. Connor et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7. 
3. Sher et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-15.
4. Jensen et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73.
5. Kaplan et al. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med. 2011 Feb;39(2):320-328. 
6. Birmingham et al. The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012, 40(5), 1113-1118.
7. Philippon et al. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013, 41(6), 1357-1362.
8. Silvis et al. High Prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011, 39(4), 715-721.
9. Larson et al. Increasing alpha angle is predictive of athletic-related “hip” and “groin” pain in collegiate national football league prospects. Arthroscopy. 2013, 29(3), 405-410. 
10. Hack et al. Prevalence of cam-type femoracetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010, 92(14), 2436-2444.

Athletic performance is a developmental process, one that ideally involves the integrated efforts of coaches/trainers and therapists in order to maximize results. This is often a complete paradigm shift for many of our athletes and their parents. Unfortunately being focused on short-term results over long-term development is hurting athletes more than it will ever benefit them.

After some recent conversations with our athletes and their parents about the importance of understanding the integrated approach taken to athletic development at GP, we thought we'd provide our readers with a few recommendations. Our hope is that these recommendations help guide the decision making process for young aspiring athletes when it comes to selecting who oversees their training and why an integrated approach may just be what they need.

1. The ‘watchful’ eye of a coach/trainer and therapist is an invaluable asset to athletic development. This is a skill set that many athletes are unfortunately never exposed to. The ability to identify mechanical faults and implement collaborative strategies between coach and therapist to correct these faults sets the stage for reaching athletic mastery while minimizing injury risk. The ‘eye’ for mechanical faults is one thing, knowing how to manage and correct them is an entirely different story. Athletes require an individual(s) competent in both.
2. Physical limitations due to anatomical/structural changes and motor control/technical deficiencies require different management strategies in an athlete’s programming. It is the job of the coach/trainer and therapist to recognize this difference. This should be a prerequisite when considering the services you are about to invest in. If they don't understand these concepts, that should be a red flag. Developing movement efficiency is arguably the best way to simultaneously enhance sport performance and reduce injury risk. Understanding how to manage physical limitations will directly impact movement efficiency and athleticism.
3. When injury occurs, integrated models for “rehab” are better than medically driven models. This of course is dependent on the level and experience of both the coach/trainer and therapist involved. Ideally the athlete’s recovery process utilizes exercises and drills within a modified training program. This serves to minimize time away from the field or weight room and maximize technical improvement of sport-related skills. Dysfunctions of the musculoskeletal system can also be addressed through performance therapy. For more reading on performance therapy, check out this article.

GP recently interviewed Mike O'Donnell DC, CCSP, CSCS. Dr. Mike and his wife, Jessica, run Back in Action Chiropractic located in Fort Wayne, IN. Not only do they provide expert understanding of chiropractic and rehabilitative care, they also bring to the table the unique insight as highly accomplished strength athletes. Simply put, their accomplishments would take up an entire blog post. It's rare to find a clinician and staff not only capable of identifying with athletes and addressing their needs appropriately, but also able to apply these same concepts to improve outcomes for patients. I had the privilege of being classmates with Mike during our chiropractic education at Palmer College in Davenport, IA. Once I got the understanding of Mike's background as both a strength athlete and coach, I knew he would be an invaluable resource not only in my training as an aspiring strength athlete, but in my clinical development as well. My brother and I are truly fortunate to have him and Jess as friends and mentors.

Now on with the interview.

GP: Provide our readers with some information about your background as an athlete, competitive powerlifter and strength coach.
MO: The day after 7th grade football ended I began lifting in my basement. I competed in my first powerlifting meet when I was 15 and won the ADFPA teen nationals that same year. Through high school I played football and was team captain. To train for football I simply did more speed and plyometric work. As a high school and junior lifter, I won six national titles and went to the IPF Junior Worlds, taking the bronze in my last year, 1999. I competed against many lifters who are regarded as the best in the sport today. I have lifted in the USAPL Open Nationals several times. As an undergrad at Western Michigan I studied Exercise Science. This did not include enough sport science to make me happy, so I did tons of research on my own. After my bachelor degree I worked under Buddy Morris at Pitt for a short time. That was a great learning experience. Eventually I decided to go get my DC degree and learn much more about chiropractic and rehabilitation.

GP: You are well educated on the training methodologies utilized in the former Soviet Union and Eastern Bloc countries. Could you explain briefly how those methodologies differ from North American approaches and the impact it has on athletic development here in the United States?
MO: In North America, athletes start playing a sport as unprepared youth with no background in general conditioning. This isn't always true, but we have no system to condition young athletes besides just playing the sport. In an Eastern model, camps are held without a sport focus to condition young athletes, and the specialization comes later. In general, early specialization is a mistake. This has been proven to limit progress, lead to early burnout, and increase injury rate.

GP: You have worked with athletes of all ages and abilities. In your opinion, where are we still falling short in the development of athletes in America?
MO: We fall short in several ways. Early level coaches (high school and below) often have poor qualifications. Also athletes are eager to maximize their results as early as possible. This leads to poor skill development. It is extremely difficult for athletes to unlearn poor habits or a poor work ethic. All too often young athletes look to non-training means (i.e. drugs) for improvement as well.

GP: What would you identify as the fundamental components of effective and efficient programming for athletes?
MO: Once good general preparation is established, the programming should be as specific as possible. Factors like frequency, work load and intensity vary from athlete to athlete and at different phases of training. Weaknesses should be assessed constantly and addressed, but focus should never be taken off the sport form. Overall, one should train as often as possibly but remain as fresh as possible. The programming should never compromise technique.

GP: One common theme you’ll see among trainers/coaches is very little thought that is given to the order of exercise selection/variation during a training plan. It’s almost as if many trainers just ‘make-up’ workouts. Give us your thoughts on the importance of organization of training for athletes?
MO: Organization of training and exercise selection expertise are prerequisites to training anyone. Entire teams should not all be performing the same training. This would assume the entire team has the same deficiencies. There are way too many under qualified "strength coaches" and trainers out there. Even some of the highly regarded strength coaches or online trainers are a joke. This is why I personally have no tolerance for movements and training styles that are fad- based. Put some thought into what you, or your athletes, really need and address it in your training. Further, organizing training should be an ongoing process. There are no perfect programs. Just phases or training blocks. On the other hand, there are some coaches that over coach their lifters/athletes. They are so worried about their own role in the athlete's development that the athlete cannot focus on their performance, or maybe the training isn't being attacked with the mentality that it should be.

GP: What do you see as the most common mistakes coaches and trainers are making in the preparation of athletes?
MO: The most common mistakes - the coach who tries to be the athlete's friend (not hard on them); poor analysis of training needs and the current state of the athlete; and the most important aspect in my opinion (this goes for anyone seeking a great PT, DC, manual therapist or strength coach) is that the coach cannot identify with the athlete because they weren't an athlete themselves. I know several above average coaches that are held back my the mere fact that their athletes cannot identify with them. Either they weren't athletes at all, or they are an unimpressive presence altogether!

GP: What are the qualities and attributes that athletes and parents should look for in a trainer/strength coach before investing in their services?
MO: Sporting background and accomplishments, educational background and accomplishments, and clinical competence, methods, and track record. Period. Anything less, and I am skeptical about what I am getting. I don't care who has the best DVD!

GP: How has the background as a competitive strength athlete and strength coach benefited you as a chiropractor and your ability to manage patients from acute stage to reactivation through active care?
MO: This is a great question, because I tell people that ask that I use my training, coaching, and professional background everyday when treating patients. My philosophy in the clinic is the more accurate the assessment, the more accurately I can apply your treatment, whether its passive or active care. As the phases of care progress, it's important to know what type of care or movements to change to. This assessment or "eye for the deficiency" can take years to develop. Today there are systems and seminars to attend and learn these analytical methods, but learning this way can lead to a lot of limitation and misunderstanding. I would advise students, whether they are professional level yet or not, to use the gym as your lab. Lift and learn!!!

That's a Wrap
Mike, thank you for taking the time to answer our questions. Your knowledge and insight is truly appreciated. We always learn something from you and hope our readers learned something as well. For anyone in the Fort Wayne area, be sure to check out Back in Action Chiropractic for the best results when it comes to your health or sport-related goals.

When my brother and I envisioned Gallagher Performance, one of our primary objectives was to provide a system that truly identified the structural and functional limitations of athletes, thus addressing these issues properly before they became implicated in serious injury or potential surgery. We knew the perspectives and coordinated efforts of a strength coach, massage therapist, nutritionist, and chiropractor with advanced training in manual and rehabilitative techniques could provide athletes with the avenues needed for improving sport performance and health. After all, achieving high-end sport performance is a multi-faceted and complex process.

Among the approaches and individualized considerations that are made for each of our athletes and clients, a fundamental concept within our programming is the emphasis on proper breathing patterns through focused exercises to optimize breathing and its impact on sport-specific movements.

Breathing Correctly
When we breathe, proper function of the diaphragm is the key and it should drive respiration. The question is, are you using it correctly when you breathe? To find out, simply place the web space in between your thumb and index finger firmly on each side of your abdomen in the area between your lowest ribs and your hip bones (or iliac crests). Now take a few normal breaths.  What is happening? If you're using your diaphragm correctly, you should feel a "bulge" outward into your hands. Why? As you breathe in, the diaphragm pulls the lungs down and creates compression within your abdominal cavity. It is this compression that creates the bulge outward into your hands. You can also think out it as breathing into your waistband or belt. You should feel your abdomen expand in all directions with proper breathing and this should occur normally, not only with deep breathing.

Another area of focus is how much your shoulders elevate during inhalation. Commonly, when someone wants to take a deep breathe, they have the tendency to lift their shoulders up to get more air in. But this is the exact opposite of what we want. Lifting the shoulders during breathing pulls the lungs up, which prevents the diaphragm from pulling the lungs down and will reduce the amount of air we can breathe in. It's important to note that shoulder elevation is normal with intense physical exercise; however, during normal breathing and even moderate exercise, there should be no shoulder elevation.

Don't sweat it if you didn't pass the test? Breathing has more to do with poor habits than anything else, which opens to door to retraining. The retraining of proper breathing patterns is something we spend a lot of time focusing on at GP with our clients and athletes.

Breathing and Its Influence on Athletic Performance
Previously, the role breathing has in the promotion of a healthy spine, prevention of neck and back pain, and enhancement of muscular coordination was underappreciated by many in the world of sport performance and physical medicine. Nowadays, breathing patterns have gradually gained more and more attention for the critical role they play in spinal stabilization, movement efficiency and athletic performance. Now it’s time for us to get in on sharing the knowledge. Below are three simple ways that breathing can affect your performance as an athlete.

1. Improve Joint Mechanics There is no question that movement and range of motion needed from specific joints throughout the body is always activity dependent. For example, hip internal rotation (IR) deficits have gained a lot of attention in regards to faulty lower extremity mechanics during movement, such as the squat. To address the deficit, the idea of performing internal rotation stretches has been popular to help improve the restriction. But it is interesting to observe that simply teaching an athlete proper breathing, abdominal and hip extension/external rotation activation through exercise can improve hip IR tremendously without the application of any static stretching. This raises the question of stretching and we addressed that in the article, Why Stretching Won't Solve Your Tight Muscles. Essentially, if range of motion was improved through breathing and stabilization techniques, the limitation was due to position of the spine, pelvis, and surrounding musculature, NOT because of a limitation in the hip. The same can be said of any joint in the body. Using specific breathing exercises can restore balance to the key joints of the body (i.e. spine, shoulders, and hips) by promoting normal expression of movement and range of motion.
2. Optimize Movement Patterns If an athlete attempts to execute a sport or skill-specific movement from a non-neutral position, they are already set-up to be inefficient and will limit their performance to some degree. The result is compensatory movement patterns and athletes may or may not be aware of how they are compensating for poor movement quality. If you consider rotational sports such as baseball, hockey, golf, and throwing sports (i.e. shot put, hammer throw), it’s easy to see that spinal rotation is a key component to the execution of movements specific to each sport. If an athlete cannot rotate adequately through their spine, the first compensation becomes lateral bend. This will limit power and efficiency and predispose the athlete to overuse syndromes. Using breathing exercises to help restore a neutral spine will potentially help restore rotation to the spine. As spinal rotation improves, this new range of motion is then re-integrated into sport-specific movements with emphasis on quality and control. The outcome of focused breathing exercises becomes improved joint mechanics, more efficient technique, more power, and less risk of overuse injury. This is just one of the reasons we want coaches to understand that our job is to make their life easier.
3. Decrease Injury Risk, Improve Recovery Injury prevention is a challenging task. There are several factors that play into specific athletic injuries, each carrying their own unique considerations and strategies to decreased risk. There are many factors that predispose athletes to injury and with targeted approaches, appropriate steps can be taken to reduce the risk of injury by focusing on improving joint/muscle function, reducing the impact of fatigue, and ensuring adequate recovery. We already discussed how breathing can improve joint and muscle function. Utilizing optimal breathing patterns can delay fatigue by assisting in maximum air/oxygen exchange, therefore delaying the point at which aerobic metabolism ceases and anaerobic processes kick in. This is especially important during high-intensity activity, when the demand for oxygen is critical to prevent accumulation of metabolic byproducts responsible for lowering pH levels and inducing fatigue. Ideal breathing will also accelerate the recovery process between intense bouts of exercise, therefore promoting recovery of the body’s energy systems. Following training and competition, the use of proper breathing patterns will help the body shift into more of a parasympathetic state. Returning to parasympathetic dominance is the essence of recovery and breathing is one tool that can be used to enhance recovery. More detail on the importance of recovery can be read in our article, Understanding The Role of Recovery in Health and Performance.

Let’s start off with illustrating a scenario that may sound familiar to many of you:

As an athlete or someone who simply enjoys being active, you put in plenty of hours working out, training, practicing and competing.  Whether it’s running, jumping, throwing, swimming, skating, shooting, or swinging, you slowly begin to notice some minor irritation in a joint or muscle. It could be a knee, a shoulder, back, quad muscle, groin, foot, wrist, or your rotator cuff. You sense things don’t feel right, but you convince yourself it’s nothing serious. After all, it may be a little painful during activity and goes away quickly when you are done. Plus, you got an important game, match, or race coming up and you can’t afford to take any down time.

You decide to put conventional wisdom into practice and take it easy, resting as much as possible. You ice the area. After all, it’s what we have been told to do for years. You may even take it a step further and do some stretches to bring some relief to the area. If the pain is bad enough, you may reach for medication to help take the edge off.

However, over the course of weeks or months, you begin to notice this pattern occurring more frequency as your pain persists. It’s got you puzzled. Now your pain is not just present during training or sport, but you notice it with everyday tasks such as walking or opening doors. You could shrug off the pain before, but now pain during simple tasks has your attention. You may now be getting concerned since it’s not only taking less to cause pain, but your pain may be getting more intense. You may even start to avoid certain activities.

What you are learning and beginning to realize is that despite the efforts to ease your pain, your symptoms persist and are getting worse. Despite rest, ice, and medication, your symptoms are not improving.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

New information has provided a deeper understanding of how overuse injuries develop and led to improved treatment. These concepts are foundational to the patient-care and sports performance training clients receive at Gallagher Performance. Myofascial release techniques can help offset the build-up of scar tissue within tendons or muscles, promoting normal function of those tissues. Ultimately, the ability to coordinate and control precise movement will minimize stress on the body and the trigger for scar tissue development. Developmental kinesiology provides a method for both assessment and the training or rehabilitation of muscular stabilization as it relates to efficient movement. The combination of these approaches not only reduces the risk of injury and pain syndromes resulting from overuse, but impacts sport performance.

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Kibler WB. The role of the scapula in athletic shoulder function. AM J Sports Med. 1998;26(2):325-336.
Kolar P, Sulc J, Kyncl M, Sanda J, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):352-62.
Kolar P. Facilitation of Agonist-Antagonist Co-activation by Reflex Stimulation Methods. In: Craig Liebenson: Rehabiliation of the Spine – A Practioner’s Manual. Lippincott Williams & Wilkins, 2^nd edition 2006, 531-565.
McGill SM, Grenier S, Kavcic N, et al. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003;13(4):353-359.
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Schlottz-Christensen B, Mooney V, Azad S, et al. The Role of Active Release Manual Therapy for Upper Extremity Overuse Syndromes: A Preliminary Report. J of Occup Rehab. 1999;9(3).
 
 

There is no question that knee injuries are a common occurrence among athletes. The incident of devasting knee injury, such as ACL tears, has been on the rise for years. Once considered an adult injury, ACL tears are occurring more often in children as reported by orthopedic specialists, estimating that thousands of children and teens suffer an ACL injury each year. According to statistics presented at the American Academy of Pediatrics 2011 annual meeting, over the past decade youth ACL injuries have increased 400% and girls are at eight times the risk of an ACL tear as compared to boys. Clearly, there is a problem with knee injuries among youth athletes. But where is the solution?

Mechanism of Injury and Risk Factors
To identify a solution, we must first identify the problem. In this case, the problem is the mechanism(s) of injury most commonly associated with ACL injury. Keep in mind that about 2/3 of all ACL injuries are non-contacted related. Meaning, the athlete didn’t have someone tackle them or have a player roll-up on their leg, resulting in injury. Non-contact injury opens the door to the possibility that a large percentage of ACL injuries can be reduced or prevented. Here are the most common mechanisms of injury associated with ACL injury:

• Jumping/landing improperly
• Planting followed by cutting or pivoting
• Straight-knee landing
• Stopping or landing with the knee hyperextended (too straight)
• Sudden deceleration of movement

• Weak hamstring and gluteal (hip) muscles
• Poor neuromuscular control and balance
• Poor dynamic biomechanics (Jumping, landing, cutting, etc.)
• Fatigue
• Female Gender

1. Improve hamstring strength. The hamstring muscles have a critical role in maintaining healthy knees. Proper hamstring training and strengthening must take into consideration how the hamstrings function during the primary sporting movement(s). For example, land-based sports with an emphasis on jumping and sprinting ability will place a high demand on the hip extension action of the hamstring. The hamstrings must be trained accordingly to be able to meet and accommodate the forces generated during sport.
2. Improve hip and core strength. The musculature of the core and hips have a tremendous amount of control on the pelvis and femur, and thus the knee. Poor hip control puts the knee in compromising positions, increasing the risk of injury. When the core and hips are weak, they needs to be a focus of treatment/exercises. This will serve to improve the stability of the knee.
3. Improve Proprioception (Balance) and Neuromuscular Control. Sufficient proprioception and neuromuscular control is the difference between being able to ride a bike and falling on your butt every time you get on a bike. Understand that altered proprioception and neuromuscular control contribute to abnormal motion during dynamic sporting activities, such as cutting and jumping/landing. One study revealed, “Improved joint mechanics during landing were achieved regardless of the individual’s muscle strength, suggesting that strength may not always be a prerequisite for movement re-education.”  This should demonstrate the importance that mental focus and repetitive use of proper movement has on correcting mechanics.
4. Decrease fatigue. There are 2 types of fatigue, peripheral (muscles) and central (brain).  Peripheral refers to exercise induced processes leading to decreased force production (typical muscle fatigue).  Central fatigue relates to a gradual exercise-induced reduction in voluntary muscle activation. Essentially meaning the brain gets fatigued. It is plausible to say injury comes from both, however from an injury prevention stand point; peripheral fatigue is difficult to manage because your muscles will get fatigued.  But targeted training of central fatigue might be the way to go in preventing injury. How does one train central control. As one study put it, “Exposure to more complex or cognitively demanding movement tasks may facilitate improved perception and decision making within the random sports environment.” This is were mental focus and developing an athlete's awareness of their body during drills becomes important. Mental imagery may prove beneficial in developing central control by utilizing “mental reps” to help engrain proper movement and ideal mechanics.

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2. Powers CM. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. J Orthop Sports Phys Ther. 2010;40(2):42-51. http://www.jospt.org/issues/articleID.2396,type.2/article_detail.asp.
3. Heiderscheit B. Lower Extremity Injuries: Is It Just About Hip Strength? J Ortho Sports Phys Ther. 2010;40(2):39-41. http://www.jospt.org/issues/articleID.2404,type.2/article_detail.asp.
4. Mizner R, Kawaguchi J, Chmielewski T. Muscle Strength in the Lower Extremity Does Not Predict Postinstruction Improvements in the Landing Patterns of Female Athletes. J Orthop Sports Phys Ther. 2008;38(6):353-361. http://www.jospt.org/issues/articleID.1408,type.2/article_detail.asp.
5. McLean SG, et al. Impact of Fatigue on Gender-Based High-Risk Landing Strategies. Medicine & Science in Sports & Exercise. October 2006.
6. McLean SG. Fatigue-Induced ACL Injury Risk Stems from a Degradation in Central Control. Medicine & Science in Sports & Exercise. January 2009.
7. Hilgefort M, Winchester B. Preventing ACL Injuries in Female Athletes.

Lack of progress or results in any training or fitness program is a common frustration for many athletes and individuals. Let's take a look at two of the more common reasons why people fail to see results from their training efforts.

#1 – You Aren’t Training Correctly

“I don’t get it. I workout hard. I eat right. I follow advice. I feel like I’m doing everything right, but I just can’t seem to (plug your goal in here)”

• Was an assessment performed to understand if my body is prepared for the training ahead?
• Is my injury history accounted for and understood?
• Is this training program tailored to reach my goals?
• Am I going to learn proper lifting technique to minimize my injury risk?