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

• High school athletes account for an estimated 2 million injuries and 500,000 doctor visits and 30,000 hospitalizations each year.
• Overuse injuries are responsible for nearly half of all sports injuries to middle and high school students.
• Since 2000, there has been a fivefold increase in the number of serious shoulder and elbow injuries among youth baseball and softball players.
• According to the CDC (Centers for Disease Control and Prevention), more than half of all sports injuries in children are preventable.

With those numbers in mind, let's look at football injuries since they alone account for over 500,000 injuries per year, twice as much as any other sport. More than half of all football injuries are to the lower extremity and roughly 67% of all football injuries are sprains/strains. Several injuries occur at the joints, especially the shoulders and knees. Many of these often require surgery and potentially have career-ending and/or lifelong implications.

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

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

How?

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

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

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

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

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

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

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

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

- Karel Lewit

The purpose of this article is to provide some basic information about the importance of understanding the role posture and function have in pain and movement dysfunction. The hope is that you will gain an understanding of why your chiropractor or therapist must evaluate and bring into consideration issues that may not seem related to your pain.
When it comes to dealing with chronic musculoskeletal pain, the site of the pain is rarely the actual source of the pain. This concept is often missing or ignored in traditional North American treatment. Let's look at shoulder pain as an example. All too frequently the shoulder pain patient is provided an evaluation and treatment that is solely focused on the shoulder. Depending on the professional you see, the shoulder is typically treated with any combination of adjustments, passive modalities (ultrasound, electrical stimulation, laser), manual therapy, or shoulder exercises. If those fail, you may be referred for shoulder injections or you may become a potential candidate for shoulder surgery.

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

Looking Beyond the Shoulder
Czech physician Vladimir Janda likened musculoskeletal pain and dysfunction as a chain reaction, thus stressing the importance of looking beyond the site of pain for the source of pain. Janda observed that due to the interactions of the skeletal system, muscular system, and Central Nervous System (CNS), dysfunction at any one joint or muscle is reflected in the quality and function of joints/muscles throughout the entire body. This opens the door to the possibility that the source of pain may be distant from the site of pain.

Janda also recognized that muscle and connective tissue are common to several joint segments; therefore, movement and pain are never isolated to a single joint. He often spoke of "muscular slings" or groups of functionally interrelated muscles. Muscles must disperse load among joints and provide stabilization for movement, making no movement truly isolated. Meaning shoulder movement does not occur only at the shoulder, but is dependent upon the function of the spine, rib cage, pelvis, and even the ankles. For example, trunk muscle stabilizers are activated before movement of the upper extremities begin; therefore, shoulder pain can be caused by poor core stabilization.

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

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

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

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



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

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

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

It does not take a professional eye to take notice of the frequency of hamstring injuries in sport. Evaluating the injury list for collegiate and professional teams, you will find that hamstring injuries are at the top of non-contact related sport injuries. Even more staggering is that roughly 1/3 of all hamstring injuries will recur, with the majority recurring within the first 2 weeks. Now these statistics mainly reflect sports which involve sprinting, however hamstring issues can create problems for athletes regardless of sport. It is important to understand that hamstring health becomes more critical as increasing loads and demands are placed on them. Given these statistics, one can logically bring into questions if traditional return to play guidelines and rehabilitation programs are truly ideal.

BRIEF ANATOMY
A quick look at the picture above and it becomes clear the hamstring is actually the collection of four muscles. The semimembranosus (SM), semitendinosus (ST), bicep femoris long head (BFLH), and bicep femoris short head (BFSH). Understand that three of the hamstrings are biarticular (SM, ST, and BFLH). This means they are 'two-jointed' and cross the knee and hip, thus influencing both knee and hip movements.  The two primary actions the hamstring produces are hip extension (except for BFSH) and knee flexion (all 4). This brief overview of the hamstrings has implications as to the how and the why behind hamstring treatment, rehab, and training.



INJURY MECHANICS
The act of 'pulling' a hamstring usually occurs at high speed running during the terminal swing phase of the gait cycle. In the picture above, this phase is seen in the athlete's right leg. As the hip is decelerating the forceful momentum as the leg swings forward, the hamstrings are loaded and lengthening as you are finishing the swing phase before foot strike. There are predisposing factors that ultimately cause the hamstring to be compromised such as: poor neuromuscular control or the lumbopelvic region, asymmetries in muscle length and/or hip range of motion, and sacroiliac joint dysfunction. All of these factors need to be and should be considered when devising a treatment and rehab protocol to ultimately reduce the risk of re-injury.

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

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

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

 

"People are incredibly innovative in their efforts to screw up training."

- Charlie Francis, Canadian Speed Coach

When it comes to sport training and many training systems, there are aspects that are poorly managed or misused in their application. One that is very common is the lack of understanding of physiology as it relates to bioenergetic training parameters and workload compatibility in sport.

Programs and coaches may frequently implement high lactate training loads into their program for a variety of reasons. Exhaustive shuttle runs, suicides, gassers, extended sets, and 'circuit' style workouts are all examples of lactic training. The problem is even though they may be performed with perceived 'maximal effort', in order to accomplish the prescribed work, individuals are training at a medium intensity. This level of intensity is too slow to develop speed. They teach muscles to behave slowly. Furthermore, the recovery requirements are high and thus cut into the ability to perform more intensive work that would directly improve speed and explosive strength.

There is not much justification for the frequent use of lactic training loads when the nature of most field/court based sports is alactic/aerobic with varying degrees of lactate influence. This is illustrated by the influence of bioenergetics on mitochondrial concentration in skeletal muscle. Mitochondria are responsible for energy production and oxidative potential. More mitochondria means greater energy supply and faster recovery. Mitochondrial concentration is elevated in skeletal muscle by anaerobic-alactic and aerobic training, while anaerobic-lactic training results in their destruction. Lactate threshold training must be appropriately prescribed and closely monitored.

This is just one example of why training loads and parameters must have compatibility to ensure the greatest transfer into sport performance improvement. The sports training world has fallen victim to a number of gimmicks in the name of profitability. Gimmicks such as high speed or anti-gravity treadmills, ladder drills, and exhaustive circuit-based training are examples of training that has very little to no carry over into athletic performance. Read more about this here.

For athletes and individuals who take their training and health seriously, your results are too important for someone to 'screw it up'.