A testimonial worth sharing:

When I first visited Gallagher Performance 6 months ago, I went for a nagging discomfort around my shoulder on the right side of my back that had stuck with me for the past 7 years. Not only was this uncomfortable, but it was also a major limiting factor in my physical performance. For years on my own, I tried various types of stretches, mobility exercises, and strengthening exercises, all to no avail. Due to its chronic nature, I continued to research the potential issue, and was convinced it was fascial adhesions in that area causing the discomfort and limited mobility. From there, I went to a number of deep tissue massages from various professionals, but those only resulted in short-term relief, not the long-term fix I was looking for. I continued my journey by going to various physical therapists in the area. I would tell them I thought facial adhesions were causing this issue. They would listen, target that area with facial release methods, give me various stretches and mobility exercises, but still no results.

Finally, I found Gallagher Performance one day as I searched for a fix for my shoulder and decided to give them a shot. Since I was still convinced that fascial adhesions were my issue, I went for a deep tissue massage for my first session with Ryan. Ryan listened attentively as I told him about my symptoms and the fascial adhesions that I believed were causing my discomfort and limited mobility in that area. Once the session started, he went to work on those fascial adhesions that I so strongly believed were the culprit. But this is where Gallagher Performance separated themselves from all of the other practitioners that I visited. Even though Ryan started on the facial adhesions, through his extensive knowledge and expertise, he quickly identified that fascial adhesions were not the issue. In fact, I unknowingly had issues in other areas in my body that were the root causes of my discomfort in that area. From there, through Ryan’s genuine desire to help his clients, he introduced me to Sean in order to work through the multitude of issues that caused this chronic discomfort and limited mobility for the past 7 years. Since that first visit, I’ve continuously worked with Sean and have practically eliminated the issue that had limited me for so many years.

Ryan and Sean were the first professionals to take an honest and objective approach to my issue. Instead of allowing my unprofessional diagnosis of my issue dictate their actions and approach, they independently applied their experience and knowledge to diagnose my issue and set me on the correct path for a long-term fix. Sean’s expertise in his field, specifically his knowledge of DNS (Dynamic Neuromuscular Stabilization), gave me the tools I needed to fix the root causes of my issue. His unique knowledge of DNS was imperative to my early success, but as we continued to work together on my path to maximizing functionality and physical performance, his experience and expertise in every area physical therapy allowed him to effectively diagnosis and treat any issue that would arise. Even though my discomfort has subsided greatly, I continue to work with Sean on correcting other problem areas that are limiting the full functionality of my body that I require to perform at a high level as an ice hockey goaltender. Only when I began my work with Sean was I not only able correct a lingering issue, but was also able to (and continue to) maximize my physical performance and functionality in ways I’ve never experienced before.

In addition to my periodic visits with Sean, I have been working with Ryan on the nutrition and training side for three months now, and as with my work with Sean, experiencing results that I have never experienced in those areas. For years, I have tried various exercise and nutrition programs, but the results that I experienced (if any) were short-term. I was never able to stick to a nutrition plan for very long or have a training program that was designed specifically to my needs. Ryan met those needs by developing a nutrition and training program built on a very simple yet powerful concept – sustainability. No longer was I burning out of my nutrition program because it was to strict and unsustainable, nor was I giving up on my training program because I wasn’t seeing any progress. Through the scope of sustainability, Ryan develops programs that not only brings incredible results, but also have the ability to be adhered to for the long-term. In addition, since Ryan and Sean work closely together, Ryan is able to take the feedback from my work with Sean and adjust my nutrition and training plans accordingly. I never had success in the past using various cookie-cutter nutrition and training programs. But once I started working with Ryan, I began to see great results on a consistent basic through the plans that he developed specifically for me.

My experience with Ryan and Sean has been, and continues to be, exceptional. Not only is their knowledge and expertise high-level, but they are truly tremendous people. They genuinely want their clients to succeed and will do whatever it takes to make that happen. The level of support and professional expertise that I have received from both Sean and Ryan is unparalleled, and I can’t thank them enough for success they helped bring into my life.

I would not hesitate to recommend anyone to see Sean and Ryan. Whether you are an athlete or non-athlete, young or old, I have no doubt in my mind that Ryan and Sean will be able to provide the level of support you are looking for. Gallagher Performance is much more than just a chiropractor, a personal trainer, or a massage therapist – they offer a multitude of services that restore health, functionality, and maximize physical performance. If you are looking for a high level of expertise and support in any of these areas, I urge you to give Gallagher Performance a try. They are hand-down some of the best in the business.

-Zaid Alzaid

 
For more related reading:

https://gallagherperformance.com/dns-solves-pain-improves-performance/

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

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

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

Ideal movement and optimal strength development first begins with using the diaphragm as the primary muscle for respiration and for Intra-abdominal Pressure (IAP) or what is also known as the abdominal brace.

A frequent piece of feedback we receive at GP is that much of what we coach is the opposite of what most people have always heard. In regards to breathing and bracing, too many people have either heard or been coached to 'draw' or 'suck' in their abdominal wall. These tips only serve to rob people of stability and strength and play a role in low back pain.

When it comes to Dynamic Neuromuscular Stabilization (DNS), those that are familiar with the method will often ask me, "How do I find the time to treat my patients with chiropractic, rehab methods, and DNS?"
The reasons for the question is simple - DNS is seen as very time consuming. The challenge with DNS is incorporating the method into a busy practice while remaining efficient and delivering a high level of quality care to your patients.

It's a difficult scenario for me to connect with since I have always maintained a schedule which enables me to spend 30-60 minutes with each patient. However, I realize this is not the norm for the overwhelming majority of chiropractors and they are under more of a time crunch to deliver the most they can in a shorter period of time. Even most physical therapists I know do not have that time to spend with a patient 1-on-1 as they normally have a number of patients blocked together for appointments and rely upon help from their assistants.

That said, the reality is until one has been properly trained in DNS, they will continue to assume that the amount of assessments, patient education, instruction, and exercise-based interventions will all add up to extra time with patients they simple don't have.

In my opinion, the time I have taken to study, learn, and implement DNS concepts into my patient care has only been a compliment to what I do as a chiropractor. Chiropractic, in a very traditional sense, is the healing art based on the science of the nervous system and it's relationship to altered spinal joint mechanics. At its very root, chiropractic aims to improve the functional of the nervous system through manual methods or manipulative therapy of the spinal joints. There is a tremendous focus on the musculoskeletal system and its relationship to the health of the nervous system. Chiropractors evaluate for postural, structural, functional, and movement-based imbalances that play a role in either pain, dysfunction, or reduced expression of overall health.

As a chiropractor, we routinely treat patients to get them out of pain, but we also work with them to restore health and a quality of life they want to maintain. And that's what makes chiropractic and DNS such an awesome combination. They both produce results that enable patients to get out of pain, improve function, restore health and get back to enjoying their life. 
As a chiropractor, I use DNS assessments to identify movement patterns that are non-ideal in regard to stability and mobility. DNS is not merely a technique, but rather an overall strategy to better understand the principles of movement. It includes both a knowledge and theoretical base that forms the foundation for assessment, treatment, exercise and functional strategies.

We aren't simply just looking for joints that don't move well or muscles that are too tight or weak. The focus of DNS is correcting faulty movement patterns that ultimately cause tight or weak muscles and joint fixations. By performing basic assessments it is possible to identify what the problems are and what exercise interventions would successfully achieve the desired correction - and this can all be done quickly. This biggest misconception is that providers need to instruct their patients in a large number of exercises in order to correct dysfunction in movement stability or mobility. This couldn't be further from the truth. My patients only perform the most challenging exercises with the proper stabilization and movement control. This means that most patients are leaving with 2-3 home exercises and there are those that will leave with only one exercise.
These exercises are intend to improve the sensory messages our brain receives from movement. We can thank the modern sedentary lifestyle and simply not moving with enough variety for the decline we see in maintaining a healthy brain and nervous system. This decline presents itself in postural abnormalities and altered movement patterns And both can be addressed through exercises and improved proprioceptive control of our joints and movement.

The exercises are intended to be functionally-based and proprioceptively-rich. This enables the patient to create a lot change from just from a few exercises - training economy at it's finest. When it comes to DNS exercises, patients get a great deal of results without having to invest a lot of time.
Furthermore, chiropractic adjustments improve sensory inputs from the spine to the brain and this proprioceptive stimulus opens a window by which we can use DNS to improve our body's control of posture and movement. DNS exercises enable us to provide a regular proprioceptive stimulus that will create change in the body.
And isn't that why patients seek out chiropractors in the first place? They are coming to us hoping we will make a change in their body that not only provides relief, but also results in lasting changes they can maintain.

 
For more reading:

https://gallagherperformance.com/do-you-really-need-more-mobility/

https://gallagherperformance.com/dns-solves-pain-improves-performance/

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

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

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

The chiropractic profession is an interesting one to be a part of. For some, they more than accept the role chiropractic can play in not only getting them out of pain, but also elevating their overall sense of health and well-being. For others, they remain skeptical and dismissive for reasons that simply come down to myths and misconceptions that have been perpetuated for years. We can thank growing amounts of scientific evidence that has proven many common myths and misconceptions about chiropractic to be false.

In this article, we want to address some common myths and misconceptions regarding chiropractic,  addressing them from an educational viewpoint. But before we get into those, it would benefical to define what chiropractic is for those of our readers who may not be familiar with the scope of the profession.

What is Chiropractic?

#1 - There is no scientific evidence to support chiropractic

• Low back pain (1)
• Sciatica (2)
• Neck pain (3)
• Headaches (Tension and Migraine) (4)
• Shoulder pain (5)
• Hypertension (aka high blood pressure) (6)
• Certain neurological conditions (7)

#2 - Chiropractors only treat necks and backs

#3 - Once you start going to a chiropractor, you have to go for life

#4 - All you do is "crack backs", that's easy

1. MYOFASCIAL RELEASE. Myofascial release targets adhesions that develop either within a single muscle or between adjacent muscles and other forms of connective tissue such as fascia, tendons and ligaments. Many athletes and patients experience accumulative or overuse trauma (ex: plantar fasciitis due to running or carpal tunnel syndrome due to prolonged computer/desk work). The goal becomes to work a muscle to remove adhesions and restore neuromuscular function to decrease pain while increasing range of motion, strength, and coordination of movement.
2. FUNCTIONAL REHABILITATION. In addition to providing relief through chiropractic manipulative therapy and treating muscular adhesions, it can prove to be incredibly valuable to identify the source of a patient’s symptoms. The functional approach to rehabilitation includes identifying joint dysfunction, muscular imbalances, trigger points, and faulty movement patterns. These are often the hidden causes of injury. Observing how a patient moves and functions allows us to identify improper movement patterns that become contributors to pain and poor sport performance. By placing an emphasis on strategies to improve movement and function, functional rehabilitation is effective in improving qualities of endurance, strength, stability, balance, agility, coordination, and body awareness.
3. DYNAMIC NEUROMUSCULAR STABILIZATION (DNS) & VOJTA THERAPY. DNS and Vojta Therapy are advanced approaches used to not only treat a variety of neuromuscular conditions but  also used by athletes worldwide to elevate performance. By applying principles and techniques rooted in the study of child development, DNS and Vojta Therapy aim to improve and restore the activation ideal movement patterns. These techniques are used to promote the ideal postures, movements, and degree of body awareness that is essential not only to athleticism, but to also treating the underlying causes of several pain syndromes that are commonly treated by chiropractors and rehabilitation specialists. There are dozens of studies to support the effectiveness of DNS.
4. NERVE FLOSSING (NEURODYNAMIC MOBILIZATIONS). Nerve flossing is a specialized diagnostic and treatment technique commonly used to diagnose and treat neural tension, which usually expresses symptoms such as muscular tightness, pain, weakness, numbness and/or tingling. Nerve flossing is proposed to help nerves and its branches slide against adjacent structures (muscles, bone, etc.), increase blood flow, oxygen and nutrient delivery, and improve the immune response. (8)
5. THERAPEUTIC & CORRECTIVE EXERCISE. Exercise progressions and protocols are used to develop strength, range of motion, re-educate the neuromuscular system in order to address the underlying causes of dysfunction and pain.

Final Thoughts

[embed]https://www.youtube.com/watch?v=3oAEjdiQK1A&feature=youtu.be[/embed]

Clinically Pressed Podcast Episode 38

Had the opportunity to sit down with Joel and Kyle of Clinically Pressed and answer their questions.

Clinically Pressed is committed to sharing as much useful and applicable information as possible to their audience. Comprised of a PhD, DC and ATC, the CP podcast that seeks to make the complicated simple. CP wants to connect you with experts in their fields - all at no cost to you. They want their audience to be able to access information as easy as possible. Be sure to check them out on the web, on their social media, and support them on Patreon. Also be sure to check out their free weekly newsletter - Total Athletic Therapy.

Website: clinicallypressed.com
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From the Clinically Pressed website, here the notes from the show:

0:00- Episode introduction and check out Paragon Nutrition for some of the most effective and well done supplements on the market.  Use code “CP15” for 15% off at check out.

1:26-CP Intro Video: Courtesy of Justin Joy of “Elder Pine Media”  Contact: This email address is being protected from spambots. You need JavaScript enabled to view it.

2:04-Welcome Sean Gallagher DC of Gallagher Performance and the connection to Palmer College.

3:38-The sports injury department at Palmer and it being one of the only in the country.

6:00-Dr. Juehring of Palmer and his clinical experience along with his athletic background make him one of the hidden gems in the industry.

Chiropractors have traditionally been known for treating patients suffering from acute or chronic pain related to the neck and back. Chiropractic treatment that involves spinal manipulation is regarded as a standard for treatment of cervical spine (neck) pain and acute lower back pain. Not only is it safe, but it has also shown tremendous health benefits for improving range of motion and reducing pain in patients during the rehabilitation process.

However, chiropractors are also capable of helping patients rehab and recover from injuries suffered in an accident or sports. The role chiropractors play in rehabilitation and sports medicine has grown substantially in the last 10 years. Almost all professional sports teams in North America utilize chiropractic services because of the recognition chiropractors has received in their ability to help athletes perform at their highest possible level. Apart from this, many rehabilitation clinics include chiropractic care as part of the services offered to patients.

Consider for a moment that the Managing Director for Sports Medicine for the United States Olympic Committee is Dr. Bill Moreau....a chiropractor!

Holding a position as a sports rehabilitation chiropractor is growing in popularity and, just like an athlete, a sports rehabilitation chiropractor must possess many tools or skills to be both effective and efficient in treating patients who are active and athletic.

Below is a list out 5 critical elements you should find when looking for a chiropractor who will be capable of treating you from a rehabilitation or sports injury perspective. Consider that these are not simply just my opinion, but rather this list has been compiled based on the insight of several of my colleagues and mentors, their clinical experience, as well as my own clinical experience.

1. Palpation & Adjusting Skills. The heart of chiropractic is the ability to assess, diagnose and treat (heal) with our hands. Our hands truly are the greatest diagnostic tool available to us. I've had people say to me that what I do as a chiropractor is "easy" and that "anyone can adjust". There is some truth to that. Adjusting is easy. You can make a joint "pop" real easy. The challenging part is palpation and finding exactly what joint needs corrected, what motions are limited, and determine exactly how you will adjust the dysfunctional joint(s). Palpation is a skill and takes years to refine. You would be wise to find a sports rehabilitation chiropractor who is very skilled with their hands and capable of determining appropriate application of chiropractic adjustments.
2. Functional Approach to Evaluation and Treatment.  The use of functional evaluations is another critical skill of the sports rehabilitation chiropractor. The ability to assess movement and identify hidden causes to injury and pain become invaluable to helping patients find relief and optimize performance. If your chiropractor isn't taking time to assess your movement and helping identify how it may be playing a role in your pain or injury, you may be miss reasons why your pain is recurrent or why you just can't seem to get better.
3. Functional Rehabilitation. A sports rehabilitation chiropractor should incorporate rehabilitation and active care into your treatment plan. Almost every case involving muscle or joint pain requires some level of strengthening exercise progression and education. The functional approach to rehabilitation includes identifying joint dysfunction, muscular imbalances, trigger points, and faulty movement patterns. These are often the hidden causes of injury. Observing how a patient moves and functions allows us to identify improper movement patterns that become contributors to pain and poor sport performance. By placing an emphasis on strategies to improve movement and function, functional rehabilitation is effective in improving qualities of endurance, strength, stability, balance, agility, coordination, and body awareness.
4. Dynamic Neuromuscular Stabilization (DNS) and Vojta Therapy. DNS and Vojta Therapy are advanced approaches used to not only treat a variety of neuromuscular conditions but  also used by athletes worldwide to elevate performance. By applying principles and techniques rooted in the study of child development, DNS and Vojta Therapy aim to improve and restore the activation ideal movement patterns. These techniques are used to promote the ideal postures, movements, and degree of body awareness that is essential not only to athleticism, but to also treating the underlying causes of several pain syndromes that are commonly treated by sports rehabilitation chiropractors.
5. Myofascial Release & Manual Therapy Techniques. Myofascial release targets adhesions that develop either within a single muscle or between adjacent muscles and other forms of connective tissue such as fascia, tendons and ligaments. Sports rehabilitation chiropractors commonly use myofascial release & manual therapy techniques such as cross friction massage, active release, instrument assisted soft tissue mobilization, muscle activation, PIR, and PNF. Many athletes and patients experience accumulative or overuse trauma (ex: plantar fasciitis due to running or carpal tunnel syndrome due to prolonged computer/desk work). The goal becomes to work a muscle to remove adhesions and restore neuromuscular function to decrease pain while increasing range of motion, strength, and coordination of movement.

Scoliosis.

The diagnosis can make anyone uneasy and it can become even more unnerving for parents when they hear that diagnosis for a child. Scoliosis in children between the ages of 10-18 years of age is termed adolescent scoliosis and can be due to many causes. But the most common type of scoliosis in the adolescent period is one in which the cause is unknown and is called adolescent idiopathic scoliosis (AIS). The reason why it is called idiopathic scoliosis is because there are currently no identifiable reasons as to why scoliosis develops in these children.

When we consider the current limited understanding of scoliosis in a traditional medical sense and the limitations in medically accepted treatment of AIS, it makes one wonder if there is a model of evaluation, treatment and management of scoliosis that may provide the potential for deeper understanding of the condition and reasons why it develops. Possibly bringing to light conservative treatment measures that have the ability to stop it's progression - or even reverse it.

Before we get to more detail on these discussion points, lets review what is currently known about AIS, from symptoms to treatment.

Symptoms
AIS generally does not result in pain or neurologic symptoms in children and teenagers. I can't stress this enough as often times this is the reason why the diagnosis of scoliosis can blindside many. Again, your child or teenager often times has no pain and no complaints. They seem to be perfectly healthy, active kids. This is a big reason why often times, scoliosis is either identified by primary care physicians during routine annual exams or during school exams.

While there may be no pain present and the child seems to be otherwise healthy despite curvature changes in the spine, how serious can the condition really be if it isn't that limiting?

While pain and neurologic symptoms may not be present, there can be disturbances within the nervous system on the cerebellar and sensory-motor integration level (1). Often there can be altered reflexes as identified by Janda, hypermobility, and muscular imbalances which create functional changes within the body (1). These functional changes have a direct effect on movement, thus having a direct effect on structure. In this case, the curvature of our spine (structure) is directly related to the function of our musculature and movement system.

Disturbances within our muscular/movement system can be identified by functional evaluation, however these evaluations are not typically part of the traditional medical evaluation process.

Does this lack of functional evaluation potentially leave pieces of the scoliosis puzzle unsolved? Pieces that would aid in determining the most appropriate course of treatment and management - and potentially a patient-specific reason for the development of the condition?

Evaluation & Physical Exam Findings
Classically, the physical evaluation and physical exam of a child diagnosed with AIS has a few key findings:

• Visible signs of lateral spine curvature along with asymmetries seen in the shoulders or hips, in which one side appears higher than the other.
• Adam's Forward Bending Test revealing either structural or nonstructural (aka functional) scoliosis. Adam's Test is consider the most sensitive test for scoliosis and the most common test used in the diagnosis of scoliosis.
• Radiographs or x-ray indicating positive findings for scoliosis. The curves are often measured for angles of the curves to determine severity.

• Functional tests to assess movement control and coordination of the musculature surrounding the shoulders, spine, and hips.
• The central role proper neuromuscular function plays in spinal stabilization and optimal spinal posture.
• Sensory-motor integration and cerebellar function in the patient's ability to sense their body awareness, posture, and joint position in space.
• Hypermobility and other present musculoskeletal compensations in response to poor function of the integrated stability stabilization system (ISSS).

1. Observation
2. Bracing
3. Surgery

1. Cerebellar function and hypermobility in patients with idiopathic scoliosis, Kobesova A, Drdakova L, Andel R, Kolar P. International Musculoskeletal Medicine. , 2013, 35(3): 99-105.

[embed]https://www.youtube.com/watch?v=1aaE3CIouTU[/embed]

In this video we discuss some important points to consider when to see chiropractor or why to see a chiropractor, especially one that has a sports injury and rehab specialization and practices in a functional movement model.

Some points to consider:

• How important is your health to you? Health is an investment and requires a proactive approach rather than be reactive.
• Do you want to get out in front of rather muscle tightness and joint range of motion/mobility restrictions before they get more serious or painful?
• Most people are unsure of who to see for back pain and joint pain, even muscle tightness. They may see their PCP, but not receive the answers or solutions they were hoping for. They are looking for a provider they can trust.
• Those that have a positive experience with a chiropractor or have one they trust, turn to them when they start to "feel off" or they feel their body is moving as it normally does or they start to feel pain.
• Ideally, chiropractors who have a specialization in functional rehab, sports injury, and movement are the experts you should see for the most musculoskeletal conditions that we commonly deal with.
• When, or if, you see a chiropractor is ultimately your choice and one that can prove to be beneficial and a worth while investment.

[embed]https://www.youtube.com/watch?v=E-6qQsMxUkQ[/embed]

Short video on the principles of dynamic neuromuscular stabilization (DNS) and the role it plays in our office with chiropractic patients, rehabilitation and in our personal and sports performance training program design.

In this video you will learn:

1. What DNS is and why it's importance for getting someone out of pain and improving performance
   • How we develop our ability to move after birth and important stages of development (i.e. support, rolling, crawling, uprighting, walking)
   • Why these stages of development are relevant in a number of populations who are dealing with chronic pain
2. How our ability to move properly is lost
   • The importance of proper breathing patterns
   • The power DNS has to "reset" our body's ability to function properly
   • How DNS is used to coach and/or cue our patients or clients to enable them to have improved body awareness and why improved body awareness is associated with less pain and improved athleticism
3. The role DNS plays in finding the source of pain
   • The site of pain and the source of pain is often times a different story
   • Why rehab or treatment shouldn't always be directed at the areas where you feel pain
   • Why other areas of your body - that seem unrelated to your pain - should be evaluated
4. How DNS relates to Pain or Performance
   • DNS and it's ability to answer the question "why" your pain developed
   • DNS and it's ability to provide solutions to eliminate pain and improving function in the body to prevent recurrences

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

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

Key take home points:

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

April 2017 marks four years since Gallagher Performance opened and with another anniversary passing, I thought it was time to start reflecting back on our fourth year in business.

All our services from chiropractic to massage to personal training to sports performance training continue to experience steady, consistent growth since we first opened. Growth that led us into our own facility in December 2016. The move has been a very positive and necessary one for our continual business development.

On January 2, 2017, Gallagher Performance opened in our new location. After long hours and lots of work we ended up looking like this:



The new facility has enabled us to widen our reach, both within the community and online. Being a community resource is tremendously important to us. We are now able to hold classes, lectures and have been asked to speak to area sports teams and organizations. We are also now able to provide more educational videos on our social media and YouTube channels.

Even with the transition to a new facility, we remain loyal to providing quality of service over quantity. Gallagher Performance is about individualized attention in all our services. This is why our chiropractic and rehab patients are with their doctor every minute of every office visit. This is why Gallagher Performance isn't a gym; it's a training facility. We don't offer an open gym membership, but rather different levels of training services to meet the needs of our clients and athletes. The reason why we set it up this way is because we want people to experience how supervised training by qualified professionals yields amazing results. And our clients are achieving remarkable results in private and semi-private settings that enable individual considerations to be made appropriately.

In regards to our services, it has been another great year. GP’s chiropractic and rehab therapy was recognized as one of the best in the Pittsburgh area for a third consecutive year. The results we achieve through our chiropractic, manual therapy and functional rehabilitation have helped people get out of pain and return to the activities they enjoy. There have been literally dozens of patients who have come to us after a doctor has told them they needed surgery, but we’ve helped them avoid these procedures. We've helped them understand the importance of not only getting out of pain, but why changing the function of their body is the key to a successful outcome and long-term recovery.

Our personal and performance training services continue to generate tremendous results for our clients and athletes. The results keep our clients loyal and the referrals coming in. We have truly cared about delivering quality in all services since we opened. It’s a great feeling to see how much our clients appreciate the attention, know-how, and confidence they receive while working with us. When you focus on quality of service and improving the consumer experience, only good things can happen.

During our four years, we have seen tremendous growth in our distance/online training services as we have gone international. Now while we are growing and our reach may not be that impressive by some industry standards, it is humbling to see how our distance services are being sought after by people beyond the state of Pennsylvania. We have seen the reach grow to 12 states (AZ, CT, GA, IA, IL, MT, NJ, NY, NC, OH, TX, WI), into Canada (Alberta, Ontario), and into Portugal, Italy, and Japan.



The reason for our growth isn't a big marketing budget. Rather, we work hard to set up everyone we work with for success in any way possible –  trusting that those efforts will lead to referrals and retention. At Gallagher Performance, we don’t try to just “factory line” our clients/athletes through the same program with a "cookie cutter" approach.  This is because we understand training and rehabilitation is a very individual experience and everyone we work with needs very individual considerations made for them. That's what it takes to produce lasting, meaningful results.

Our sports performance training services continue to be utilized by a variety of athletes from a growing list of amateur/club organizations, high schools, and colleges. In addition, GP continues to direct the Strength & Conditioning program for the Franklin Regional Hockey Club as we move into our fourth year.

During the past year, we've seen new names join of list of athletes who have reached the collegiate level. This is tremendous accomplishment on their behalf and we are privileged to work with such determined and hard working athletes. Here's the list we have worked with, from sports performance to chiropractic and rehabilitation, and where they are coming from:

 Collegiate Athletes

• Wes Ashley, University of Wisconsin - Stevens Point (NCAA DIII) - Hockey
• Andrew Brncic, Alderson Broaddus University (NCAA DII) - Football
• Colin Childs, California University of Pennsylvania (NCAA DII) - Football
• Ben Dipko, Slippery Rock University (NCAA DII) - Football
• Noah Dipko, Indiana University of Pennsylvania (NCAA DII) - Football
• Justin Gismondi, Robert Morris University (ACHA DI) - Hockey
• Ryan Grieco, Seton Hill University (NCAA DII) - Baseball
• Carter Henderson, Duquesne University (NCAA DI) - Football
• Evan James, Penn State University Greater Allegheny (NCAA III) - Baseball
• Colin Jonov, Bucknell University (NCAA DI) - Football
• Katie Kimmich, Seton Hill University (NCAA DII) - Soccer
• Dante Luther, Washington & Jefferson University (NCAA DII) - Football
• Jake Roberge, Northwestern University (NCAA DI) - Soccer
• Mike Roberge, Northwestern University (NCAA DI) - Soccer
• Charan Singh, University of Massachusetts (NCAA DI) – Football
• Todd Summers, Villinova University (NCAA DI) - Football
• Ryan Watson, Lake Erie College (NCAA DII) - Soccer
• Christian Wilson, Mount St. Mary’s (NCAA DI) - Track & Field

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more on DNS here:

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

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

Here at Gallagher Performance we not only strive to provide the best in chiropractic, rehabilitation and manual medicine treatments for our patients, but we also utilize comprehensive diagnostic methods and tools to help determine which treatment is best for you. This allows us to apply to most ideal therapeutic interventions. At GP, this could include any combination of the following: chiropractic manipulative therapy, manual therapy according to Lewit and Janda, Vojta Therapy, myofascial release, trigger point therapy, neuromobilizations, and dynamic neuromuscular stabilization (DNS).

Despite many of our patients having previous experience with chiropractic or physical therapy, they are unfamiliar with DNS. Gallagher Performance specializes in DNS therapy. Dr. Gallagher has been studying and utilizing DNS since 2007. His extensive training and background allows him to provide a level of care that is unique to the Pittsburgh area.

Since DNS has implications in both physical rehabilitation and training, we spend a great deal of time educating our patients and clients on DNS and answering some frequency asked questions. With that in mind, the goal of this article is to help educate our readers about DNS and the significance this intervention has as it relates to pain or sports performance.

What is DNS therapy?
DNS is a revolutionary European approach in the treatment of back pain and several neuromuscular conditions. DNS therapy is based on the neuroplasticity of the Central Nervous System and targets the cause of pain/dysfunction rather than its manifestations. DNS therapy evokes ideal movement patterns by manual stimulation of developmental reflex zones and utilizes specific exercises to improve neuromuscular control. The therapeutic benefits become significantly expanded from previous standards of rehabilitation. Any one from infants to adolescents, chronic pain patients to athletes can all benefit from DNS therapy.

How does DNS compliment chiropractic adjustments? 
DNS therapy favorably compliments traditional chiropractic adjustments in several ways. When patients may be apprehensive about receiving an aggressive or forceful chiropractic adjustment, DNS offers gentle, non-forceful, low velocity manipulation that is well tolerated and safe. For those that receive traditional chiropractic adjustments, DNS works in concert to normalize joint function and restore muscular balance, leading to more sustainable improvements in reduced pain and improved function.

Often times, symptom relief experienced from a chiropractic adjustment can be short-lived with symptoms returning rather quickly. In contrast, when DNS is applied in a chiropractic setting, the approach allows for longer-lasting symptom relief due to therapy’s ability to improve Central Nervous System (CNS) coordination and joint stability which is then maintained by performing prescribed home exercises.

DNS therapy simply enables a chiropractor to effectively treat and manage a broad range of musculoskeletal and neurological disorders. While traditional chiropractic may be limited in what can be done through chiropractic adjustments and passive modalities, DNS represents a powerful alternative to chiropractic care when dealing with pain syndromes and more complex structural pathologies where the effectiveness of traditional chiropractic is highly limited.

How is DNS therapy able to get me out of pain and moving better when other conservative therapies have failed?
The results achieved by DNS therapy are often difficult to achieve with traditional methods used by chiropractors and physical therapists due to the physiological phenomenon that occurs during treatment to minimize muscular imbalances, relieving painful protective muscle spasms, resulting in a more stable musculoskeletal system with improved spinal stability and postural awareness.

During DNS therapy, induced movements are controlled not locally, but by the higher levels of the Central Nervous System. This then results in faster and longer-lasting improvement in function and pain relief.  When combined with exercise, the promotion of joint stability and ideal movement becomes habitual and independent of conscious effort.

How are DNS exercises different from traditional physical therapy or physical training exercises?
In the majority of physical therapy and chiropractic clinics, as well as in personal training settings, exercises are performed that simply train muscles in isolation. The patient who has shoulder pain and is only prescribed shoulder exercises illustrates this concept. The fault in strengthening weakened muscles through isolation training is that isolation training will fail to unify the painful or problematic joint with the entire locomotor system. Sure you can perform all the isolation exercises you wish, but this does not guarantee that the strength or coordination gained will automatically transform into adequate performance.

DNS exercises are applied in accordance with development kinesiology or essentially how we develop motor function during childhood. As we develop, reflexive movements (primitive, postural, locomotor) become more refined and coordinated, ultimately leading to specific movements we produce later in life such as walking, running, jumping, reaching, throwing, etc.

However, developing these skills does not happen magically.  Learning to control the body and developing fundamental skills make up our motor milestones.  These milestones mark critical points in our development and there is a progression that these milestones follow.  This is known as developmental kinesiology. In simplistic terms, we need to be able to lift our head and support it, roll over, crawl, support ourselves upright, walk with assistance, and then walk without support.

The understanding of developmental kinesiology and critical motor milestones allows the provider to make exercise progressions and regressions during the course of therapy in order to appropriately address the underlying locomotor system dysfunction(s).

These exercises are applicable for patients with variety of acute and chronic conditions as well as for athletes who are trying to improve their performance and also prevent or rehabilitate injuries.

Often DNS exercises are conducted with active support from the clinician to insure that the patient maintains proper support and executes ideal movement. DNS exercises could include the use of stability balls or bands to further facilitate the desired response of the exercise.  These exercises are not only used to improve the stability of the spine, muscle coordination, balance and strength, but also to increase the body’s awareness and sensory integration.

Conclusion
All of a sudden, conservative management and treatment of patients and training of athletes looks a lot different than what is traditional accepted.

DNS is not only a magnificent approach for preventing and rehabilitating pain syndromes in the movement system it is also becoming extremely popular in sports performance circles. The same ideal patterns that keep an individual out of pain also maximize the efficiency of the movements, which not only reduces risk of injury but improves performance.

When you consider the principles of DNS, it truly is not about what exercises we prescribe or what exercises we perform, but rather what we are actually getting from those exercises when we perform them that is important. DNS provides a system of evaluation and treatment which follows motor development, thus providing an effective way to help our patients get the most out of therapy and our clients get the most out of training.

Sources:
Dynamic Neuromuscular Stabilization & Sports Rehabilitation, Frank C, Kobesova A, Kolar P. Int J Sports Phys Ther. , 2013 Feb;8(1):62-73.
A case study utilizing Vojta/Dynamic Neuromuscular Stabilization therapy to control symptoms of a chronic migraine sufferer, Juehring DD, Barber MR. J Bodyw Mov Ther, 2011 Oct;15(4):538-41.
Cerebellar function and hypermobility in patients with idiopathic scoliosis, Kobesova A, Drdakova L, Andel R, Kolar P. International Musculoskeletal Medicine. , 2013, 35(3): 99-105.
Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength., Kobesova A, Dzvonik J, Kolar P, Sardina A, Andel R. Isokinetics and exercise Science. , 2015;23:21-32, 
Developmental Kinesiology: Three Levels of Motor Control i the Assessment and Treatment of the Motor System. Kobesova A, Kolar P. Journal of Bodywork and Movement Therapies., 2014;18(1):23-33.
The Prague School of Rehabilitation, Kobesova A, Osborne N. International Musculoskeletal Medicine, 2012;34(2):39-41.
Postural - Locomotion Function in the Diagnosis and Treatment of Movement Disorders, Kolar P, Kobesova A. Clinical Chiropractic, 2010;13(1):58-68.
Analysis of Diaphragm Movement during Tidal Breathing and during its Activation while Breath Holding Using MRI Synchronized with Spirometry. Kolar P, Neuwirth J, Sanda J, Suchanek V, Svata Z, Volejnik J, Pivec M. Physiol Res, 2009;58(3):383-92.
Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. J Orthop Sports Phys Ther, 2012;42:352-362.
Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment, Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A. J Appl Physiol. , 2012;42(4):352-62.
Importance of Developmental Kinesiology for Manual Medicine, Kolar P. translated from Czech Journal of Rehabilitation and Physical Therapy, 1996;4:139-143.
Surgical treatment and motor development in patients suffering from cerebral palsy, Kolar P. Translated from Czech Journal of Rehabilitation and Physical Therapy, 2001;8(4):165-168.
Long-Term Efficacy of Dynamic Neuromuscular Stabilization in Treatment of Chronic Musculoskeletal Pain, Bokarius AV, Bokarius V. 12th World Congress on Pain. Glasgow, Scotland. Aug 17-22, 2008. Presentation # PF225.
A case study utilizing spinal manipulation and dynamic neuromuscular stabilization care to enhance function of a post cerebrovascular accident patient, Oppelt M,Juehring D,Sorgenfrey G, Harvey PJ, Larkin-Thier SM. Journal of Bodywork and Movement Therapies., 2014;18:17-22.
More related reading:

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

Pittsburgh Award Program Honors the Achievement
Gallagher Performance has been selected for the 2015 Best of Pittsburgh Award in the Chiropractors category by the Pittsburgh Award Program.

Each year, the Pittsburgh Award Program identifies companies that we believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and our community. These exceptional companies help make the Pittsburgh area a great place to live, work and play.

Various sources of information were gathered and analyzed to choose the winners in each category. The 2015 Pittsburgh Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the Pittsburgh Award Program and data provided by third parties.

About Pittsburgh Award Program
The Pittsburgh Award Program is an annual awards program honoring the achievements and accomplishments of local businesses throughout the Pittsburgh area. Recognition is given to those companies that have shown the ability to use their best practices and implemented programs to generate competitive advantages and long-term value.

The Pittsburgh Award Program was established to recognize the best of local businesses in our community. Our organization works exclusively with local business owners, trade groups, professional associations and other business advertising and marketing groups. Our mission is to recognize the small business community's contributions to the U.S. economy.

SOURCE: Pittsburgh Award Program

If we had to sum up the training philosophy at Gallagher Performance, it would be,

“Our training revolves around the utilization of ground-based, multi-joint, proprioceptively rich movement patterns that are developmentally specific to each athlete during the weight training portion of the program, while concurrently addressing the specific metabolic demands of each athlete with our energy system training. All aspects of our programs adhere strictly to scientifically supported methodologies.”

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.

Sources:
Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J. Biomech. 1999a;32(1):13-17.
Hagins M, Lamberg EM. Individuals with low back pain breathe differently than healthy individuals during a lifting task. J Orthop Sports Phys Ther. 2011;41:141-146.
Janda V. Muscles; central nervous regulation and back problems. In Korr IM (ed). Neurobiological mechanisms in manipulative therapy. Plunum Press, New York, 1978, pp 27-41.
Janda V. Muscles and motor control in cervicogenic disorders. In: Grant R (ed). Physical therapy of the cervical and thoracic spine. 1^st edition. Churchill Livingstone, Edinburgh. 1994, pp 195-215.
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.
Page P, Frank C, Lardner R: Assessment & Treatment of Muscle Imbalances. The Janda Approach. Human Kinetics. 2010.
Panjabi MM. The stabilizing function of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-9.
Panjabi MM. The stabilizing function of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5(4):390-6.
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).
 
 

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

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.

The GP Clinic specializes in DNS (Dynamic Neuromuscular Stabilization). Dr. Gallagher's extensive training and background in DNS therapy allows him to provide a level of care that is unique to the Pittsburgh area.