There seems to be a growing number of programs and trainers touting how they offer ‘pain-free training’ and that anything less than what they offer is simply inferior by design.
Any intelligent trainer, coach, or therapist will acknowledge the value of proper training to ensure no serious orthopedic issues develop. No one wants their clients becoming pain patients. Proper training is multi-faceted from proper form to proper exercise selection to proper volume and loading parameters. These are a given. These are essential to ensuring we minimize injury risk and improve tissue resilience.
However the reality is if you are going to push your body to new levels of performance, you are going to feel it. It’s going to be uncomfortable. It’s going to hurt at times. If you aren’t looking to better yourself, why are you even training in the first place? Essentially at the heart of training is pushing your body to a place it’s never been before. There aren’t many people out there who have pushed their bodies in training who haven’t ended up ‘feeling it’ in the form of soreness, physical discomfort, and yes - at times - pain.
By all means, yes, we shouldn’t train recklessly. We should be practical and intelligent in our execution of a training plan. But we also shouldn’t be alarmed and fear we are doing something terribly wrong when we deal with discomfort, aches and pains. It comes with the territory of pushing our bodies to new levels of fitness or performance. This is why recovery methods and seeking out qualified professional care from sports/rehab chiropractors, massage therapists, and physical therapists can do wonders for helping our bodies better manage the stress of training. ——
No one wants to be in pain, but push yourself hard enough for long enough, you’ll feel it. We need to understand better pain education, how to be more realistic with training expectations, and how to manage the stress of our bodies to avoid serious pain or orthopedic problems.
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The most popular of the horizontal pressing movements being the barbell bench press. Bench press often enough, long enough, and heavy enough, you will likely experience some degree of limitation due to shoulder pain or injury.
This can be for a number of reasons that all should be considered. But there is one reason why the barbell bench press becomes unfriendly to the shoulders - the fixed position the scapula (shoulder blades) are placed into.
Creating a tight upper back and stapling the scapula to the bench is critical for a big press as this forms the foundation for pressing.
But let's consider healthy shoulder motion is dependent upon a freely moving scapula. Otherwise too much stress is placed at the glenohumeral joint (shoulder joint). Yes, accessory exercises should be programmed to maintain healthy shoulders but there is only so much that can be done to offset thousands of pounds of bench pressing volume. We absolutely should be proactive in our approach to avoiding shoulder pain and/or injury.
That's why it is important to incorporate horizontal pressing movements that allow the scapula to move more freely. Whether they are used as a primary movement, accessory movement or alternative while the shoulder is on the mend, the exercises seem in this video can offer increased shoulder stability and motor control while giving your joints and connective tissue a break from intense training. See in this video are:
1) Standing Horizontal Cable Press
2) Stability Ball Dumbbell Press
3) Stability Ball Alternating DB Press
4) Stability Ball Single-Arm DB Press
A great benefit to these exercises is the amount of core and hip engagement required which is awesome for teaching force transfer through the body and how to steer strength.
Note: if performing heavy presses on a stability ball be sure to use a properly rated ball.
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This training client sought out our services for three primary reasons:
1) Rehabilitate a chronic recurrent low back condition that has prevented him from training with any type of intensity or frequency for over two years AND get back to training while staying healthy in the process
2) Get stronger while packing on some quality size, and
3) Regain the feeling of athleticism from when he played college football.
We recently concluded 12 weeks and during that time he had three BOD POD evaluations. Debate on the accuracy of the BOD POD aside, impressive changes were made in only 8 weeks. These evaluations occurred on 11/21/17, 12/19/17, and 01/16/18.
Some of the BOD POD highlights include:
- Fat Weight lose of 3.786lbs
- Body Fat % decrease from 12.6 to 10.3
- Fate Free Weight gain of 6.745lbs
- Body Weight increase from 182.9 to 185.9
Images 1-3. BOD POD results from 1/16/18. This was the third, and most recent, analysis during an 8-week period.
Included below are photos of a few of his training weeks to give you a glimpse of how his training was structured. Along with the changes seen in his body composition, his strength continues to progress and he is training with weights and a frequency that he has not seen in over two years while maintaining a healthy feeling body.
Although we’ve worked with a broad spectrum of athletes - high school, collegiate, professional, former World’s Strongest Man, and elite triathletes - we work with just as many weekend warriors and those who simply love to be active. Whether it’s improving your running distance, increasing strength in the gym, or swinging a golf club without pain, we want to help you achieve your goals.
We also successfully treat those with overuse injuries, enabling them to return to the highly active lifestyle they enjoy.
Being active is an essential part to a healthy lifestyle. The many benefits of movement and exercise are well documented. Unfortunately, injury can become a reality for those that live an active lifestyle. When injury occurs, the effects are not only physical, but psychological as well. It is easy to become frustrated when your active lifestyle has been interrupted and concerned when you aren’t healing or turning around as quickly as you had hoped. Recovery from injury is a process that must be understood, appreciated and respected.
To help you better understand how to manage your own recovery from injury, here is a short list of items to be aware of so that you can respect the healing process and set yourself up for a timely and safe return to sport or activity.
Avoid Complete RestWhen injury occurs, it is often advocated to rest. Rest is a critical part of healing and the amount of rest one needs will be determined by the severity of the injury. Injury is a balance of load and capacity of tissues within the body. Once we exceed the capacity of a tissue (bone, ligament, muscle, tendon, disc, etc.) with a certain load, injury occurs. Rest helps restore the capacity of tissues by minimizing or removing load and thus allowing healing to occur.
As critical as rest is to the healing process, movement is equally, if not more, critical. In the absence of severe injury and conditions where movement would be contraindicated (i.e. fracture, dislocation), movement serves to facilitate healing. The majority of musculoskeletal injuries heal best when we don’t avoid activity, but rather when we modify activity. The important factor here being that one finds activities they can perform without pain and that will facilitate healing through movement. This may be as simple as walking or gentle range of motion exercises. However knowing exactly what you should do for your specific injury can be a complicated answer. This brings me to my next point.
Don’t Rely on Social Media Gurus to Solve Your InjuryWhen injury occurs, people want a definitive answer when it comes to what they injured and how to manage it. And there are growing numbers that are seeking this information out online without ever consulting a licensed healthcare specialist. This could be due to frustrations with the medical model, a growing consciousness to seek out “non-traditional” or “alternative” therapies, or simply wanting to avoid paying out of pocket when there is free information available online. There can be the mentality of, “Why pay someone to fix me when I can learn to fix myself?” Not that this is wrong, but please understand that there are limitations when it comes to purely trying to self-manage your injury.
Let me illustrate this point with an example of someone who may go onto an internet forum or social media page and state, “If have an L4-L5 disc bulge with sciatica, what exercises should I do to help me get out of pain?”
If you are seeking an answer out online, keep in mind the most appropriate answer you should receive is, “It depends”.
Any advice you receive from someone who hasn’t evaluated you is truly just throwing darts in the dark and hoping something sticks. Most people on the internet and social media who are offering up advice when it comes to injury rehabilitation are not licensed to do so, thus you should be skeptical. Many of these same people try to position themselves as an expert for one reason or another, but reality remains they are not a licensed professional and thus you should be skeptical. Skeptical because how can someone tell you what to do when they haven’t evaluated you – in person.
When it comes to injury rehabilitation, the evaluation process is the most critical step to ensure no time is wasted in the early phases of rehab and to minimize complications. Evaluations should consist of orthopedic and neurological testing as well as biomechanical/functional testing to evaluate for structural pathology, movement sensitivities and functional deficits.
The sharing of symptoms through some online medium is extremely limited in its value and it inherently creates bias. It will bias the feedback and direction you receive from who you are seeking advice from since all they have to operate off of is what you tell them. But when you are evaluated live, in person, by a licensed professional, bias can fall by the wayside when things are discovered that you may not feel are all that important or relevant to your present injury. Yes, history and understanding your problem is important, but it’s only a part of the puzzle.
This is because as professionals, we are trained to evaluate with our eyes and hands to assist in the diagnosis of your condition.
Seek Out Professional Evaluation and TreatmentThere are numerous products and programs currently online that essentially attempt to remove the need for someone to see a licensed professional for an injury or ailment. These products or programs will draw people in as they hope to learn what they can do to fix themselves. There is nothing wrong with that, as self-management strategies are important for anyone to learn. People who are dealing with pain or injury must learn why their pain or injury developed in the first place and what they can do to help prevent it from returning.
However the limitation to these products or programs is that they are mass marketed, attempting to appeal to a large audience and, therefore, are very general in nature. They are incapable of being highly specific to the individual. These programs or products may work for some, but when someone needs more individualized solutions they need to turn to a licensed professional such as a chiropractic rehabilitation specialist or physical therapist who approaches injuries and ailments from a functional perspective, not solely based on structural pathology.
Specialists exist for a reason. When your in-home or self-management strategies fail or if you are having persistent or worsening symptoms, you should seek out professional consultation. Specialist such as sports medicine physicians, rehabilitation chiropractors and physical therapists are capable of providing solutions to pain and injury through either diagnosing your condition, devising a rehab plan, and providing treatment. Massage therapists are another specialist to consider as many ailments and injuries have soft-tissue components that respond favorably to massage therapy by reducing pain and restoring muscle function.
Recognize the Gift of InjuryThe recovery from injury is as much mental as it is physical. Believe it or not, there is a gift of injury – forced discipline.
What do I mean by forced discipline?
Injury often times forces us to confront the very reasons why we got injured in the first place. The reason could be faulty mechanics, sharp increases in workout or training volume, or ignoring warning signs our brain was sending us.
Professional specialists mentioned above should assist in the process of helping you recognize the reason(s) for your injury and given you the direction needed in your recovery. But it's upon you to be disciplined and mindful during your recovery process and beyond. This new sense of discipline can apply to making better decisions when it comes to your rehab program, your posture, your movement, and the amount of stress or work you place upon your body.
Failure to do so can often lead to someone rushing his or her own recovery, returning too soon to sport or activity or frequent relapses. Be disciplined and regain control of your body.
Understand the Science of PainFailure to apply discipline in your recovery can also result in the feeling that your injury will never heal. The reality is all injuries heal. But long after the site of injury has healed, pain can still persist. Pain becomes a reminder to some that they aren’t healed. They will believe they are still injured.
“So if my injury is healed, then why am I still in pain?”
Pain is a message from our brain that is meant to protect us. Even though pain is meant to protect us, pain is not a reliable source of indicating the extent of an injury or even where the injury is located. The classic example here is phantom limb pain. Amputees regularly will experience this phenomenon. One may experience left leg pain, yet they do not have a left leg. If pain is purely related to damage or injury, how would one experience pain in a limb that doesn’t exist?
The reality of pain perception can be a difficult education point as this is typically a new concept for the majority of patients and one they may need some time to understand. But it’s critical as their beliefs about pain can complicate the recovery process. It’s extremely beneficial for patients to learn about pain and address fear-avoidance behaviors and other factors that will interfere with reactivation into normal movement, activities of daily living and sport.
Gradual exposure to correct movement which takes stress of tissues can help to desensitize the brain to pain signals. Movement re-education serves to reduce pain signaling in the brain. As one learns to move better, pain goes down. You need to break your pain cycle with a better movement solution. It’s that simple.
Wrapping UpThanks for reading. We hope this post was helpful. Please leave any comments or questions you may have. Share this post with those who you feel can benefit from understanding how to better approach recovering from injury or pain.
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Please watch: https://www.youtube.com/watch?v=RRZL6Y6gtZI
In this video, we discuss exercises aimed at training proper hip dissociation - an often overlooked and undertrained function of the hips. Poor hip dissociation is commonly a reason for pain and poor performance.
Some key points discussed in this video:
- What hip dissociation means. Hip dissociation is the ability to independently move the hips without compensations from the rest of the body.
- Why poor hip dissociation and compensations are often a reason for low back pain, hip pain, and even pain within the knees and feet/ankles.
- How poor hip dissociation is related to increased risk of injury.
- Why the inability to move properly though the hips limits athletic potential and will negatively impact your performance.
- And most importantly - what to do to improve your ability to move your hips independently with simple exercises that you can perform at home, at the gym, or basically anywhere with just a few simple tools.
Thanks for watching and as always, let us know your questions or comments.
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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.
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"After an injury tissues heal, but muscles learn. They readily develop habits of guarding that outlast the injury" - Janet Travell, MDGuarding after an injury is normal and it is to be expected. However, when left unidentified and untreated, guarding or protective patterns can become common reasons for chronicity and why someone "hasn't got better". This is why we must go beyond structural injury and think function in treatment rehabilitation.
From the functional viewpoint, we must evaluate for these guarding patterns that patients readily default to due to injury/pain. Identifying and treating these guarding patterns appropriately will often times enable patients to feel better almost immediately.
While yes it is important to evaluate for structural injury (fracture, dislocation, ligament sprains, tendinopathies, disc herniations, etc.) and manage them accordingly, the reality is these tissues will heal in time. However, after these injuries heal, there can be presentations within the body that create complications in achieving full recovery or become reasons for relapse.
Often times patients will complain about tight calves and hamstrings after spraining an ankle or tightness in their low back and hips after a disc rupture. Or they may have developed pain and/or sensitivities in other areas of their body seemingly unrelated to their initial site of injury.
The ankle ligaments will heal. The disc will heal. But the body will guard and protect and this becomes programmed within the nervous system. This is exactly what we need to treat for patients to get better and this new reality becomes very liberating for patients.
When patients come to understand that their injury has healed, but it's their brain and muscles that must re-learn how to work as they did before the injury, they become less fearful and more confident in a positive outcome. Essentially, they come to understand that we must reset their body so their neuromuscular function returns to pre-injury status.
To reset the right things in the body, we must assess and analyze the problem then utilize corrective measures in treatment and/or training. This system helps us develop efficiency in treatment and enables us to expect results.
What type of corrective measures? The gold standard becomes manual therapy and therapeutic exercise. When combined, these serve to get patients out of pain and improve the function in their body.
Yes these results can often times be rather immediate, however in some cases recovery can test a patient's patience as the process may be slower than they aniticipated.
When progress is slow, it is important to remember the following:
- Therapeutic exercise is the most evidence-based treatment.
- Passive treatments (tape, modalities,etc.) may offer temporary relief but are not helpful in medium and long term recovery.
- Injections and surgery have been not shown any greater effectiveness in outcomes than exercise.
- Seek advice and treatment from a licensed professional who specializes in functional movement. Ideally this would be a rehabilitation chiropractor or physical therapist with movement specializations are the gold standard here. These practitioners focus on the functional paradigm of manual/physical medicine. And no, your "functional trainer" at the gym doesn't count.
- Self-management is key. Reduce activities that provoke pain, apply gradual exposure to activities to build confidence and tissue capacity through exercise. Exercise must be tailored to you to reduce pain and improve strength and function throughout your entire body.
- Progress load and exposure gradually. The key is to be consistent with your exercise therapy. Forget about how much you were doing before the injury and what others are able to do. Everyone responds differently. Focus on your recovery and what works to get you back on track.
- Getting back on track can take a long time. In some cases, upwards of 3 to 12 months depending on a number of factors including duration of symptoms, functional deficits and patient compliance during their exercise program. Keep in mind, other treatments can offer faster recovery but nothing has demonstrated better long-term results than progressive exercise.
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Pain is incredibly complex, making the treatment and management of chronic or persistent pain a unique challenge. After reading this article, the hope is that you have a better understanding of the complexities of pain and how treatment must be directed if one is truly to overcome chronic pain.
Pain has a nasty habit of getting in the way of activities that we not only enjoy, but also the mundane tasks of everyday living. It becomes of paramount importance that treatment not only decreases pain, but also that the individual is able to resume activities that are important to them with improved function and mechanics.
To begin with, let's start with an understanding of pain and the reality behind why we perceive pain.
1) Pain is in the Brain
Pain is a message from our brain that is meant to protect us. Even though pain is meant to protect us, pain is not a reliable source of indicating the extent of an injury or even where the injury is located. The classic example here is phantom limb pain. Amputees regularly will experience this phenomenon. One may experience left leg pain, yet they do not have a left leg. If pain is purely related to damage or injury, how would one experience pain in a limb that doesn’t exist?
The reality of pain perception can be a difficult education point as this is typically a new concept for the majority of patients and one they may need some time to understand. But it’s critical as their beliefs about pain can complicate the recovery process. It’s extremely beneficial for patients to learn about pain and address fear-avoidance behaviors and other factors that will interfere with reactivation into normal movement and activities of daily living.
2) Hurt Doesn't Equal Harm
Another key component of the education process is that “hurt doesn’t equal harm”. Just because a movement or activity may “hurt” this doesn’t mean that you are doing harm to the body or damaging tissues. In fact, there is a growing body of research supporting poor correlation between pain and structural changes seen on advanced medical imaging. Just because one has degenerative joint disease, a disc bulge, or rotator cuff tear doesn’t mean they will have pain as these imaging findings are routinely found in asymptomatic individuals.
It’s important patients understand this concept because when it comes to exposure to movement through exercise, you don’t want the fear of structural damage to interfere with the ability to become more active. While not all movement will be pain free, movement isn’t causing harm. And that’s extremely powerful for patients to understand.
3) Movement is Medicine
Movement has the ability to be healing by reducing the pain response in our brain. Thus this is why movement is like medicine and why movement eventually has to take center stage in the management of chronic pain. Similar to manual therapy, graded exposure to movement through exercise will essentially teach your nervous system to “wind down” and not be as sensitive to pain. In doing so, you become more confident and reassured that you can do more without pain or the fear of a relapse in your condition.
4) The Work is Just Beginning
Unfortunately, the pain fix isn’t an overnight solution. For chronic pain patients, often times the rehabilitation process can take months of consistent work and repeated inputs to the nervous system to make a substantial change on pain and function. Repeated inputs come in the form of manual therapy and home exercise/self management strategies. Thus patient’s must understand the importance of compliance within their home exercise program as this makes a significant difference in their outcomes.
It’s important they understand the nervous system is easily tricked. It's easy to yield immediate change, but these changes should not be confused with lasting results. This concept is illustrated with any number of assessments commonly used in chiropractic and physical therapy offices – from leg length analysis to functional screens - as well as therapeutic interventions – from manual therapy to manipulation. By performing pre and post checks, it's possible to see immediate changes within one treatment. It can be easy to impact pain and create changes in range of motion or body function that have patients leaving your office feeling great.
But no single input can create lasting change. It requires multiple inputs over a period a time to create lasting change within the nervous system. This is why exercise and training is so important. If patients are not provided with the right exercises to compliment therapy, this is why they have pain relapses. Patients must exercise and must train to make a lasting change within their body. Otherwise they will get frustrated with chronic recurrences of leaving a provider's office feeling great only to experience a return of pain symptoms. And this becomes the pain cycle many become stuck in unless a change is made.
Break the Pain Cycle
If you are dealing with chronic or persistent pain or stuck in the pain cycle, the hope is that this article gets you thinking differently about how pain should be managed for successful outcomes. It’s why the management of painful conditions, especially chronic pain, must focus on pain education, the appropriate use of manual therapy (ex: joint mobilizations/manipulation, relaxation techniques such as PIR, soft-tissue and neurodynamic mobilizations) and graded movement exposure through exercise.
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Often I am asked, "What is the best exercise?" or "What is the best type of exercise?"
To answer that question, let's set the stage of what exercise really is - movement.
Teaching patients not only about chiropractic but how to move better all comes back to function and understanding how all the intricate parts of our body make up a highly complex movement system. But here are some key points to understand:
1) Function determines movement. Chiropractic and rehabilitation seek to restore proper movement function. Functional examinations determine WHY movement is painful or problematic. Utilizing the functional model of movement helps to determine who is at risk for injury, which movement patterns or body regions are dysfunctional, and what treatment or exercise strategy is needed to address those issues in combination with chiropractic/manual therapy methods.
2) Function is critical to movement and movement is critical to our health. Our bodies are designed to move. The growing list of chronic diseases and immense burden on the healthcare system associated with an overly sedentary society clearly demonstrates one conclusion – we need to move more.
3) Movement is exercise and exercise is medicine. The medicinal benefits of exercise are numerous. There is a reason why exercise and proper nutrition is being labeled as "lifestyle medicine".
For those who wish to start an exercise program, the public is told to “see your doctor” before starting an exercise program. Most patients are cleared to exercise after history and vitals are considered “normal”. Sure your organ system may be healthy enough for exercise, but nothing is mentioned about seeing a doctor to determine how well you move or how well your muscles and joints are functioning. Why wouldn’t this be considered? Why wouldn’t seeing a “movement specialist” before considering an exercise program be equally advocated?
So, in typical fashion, most of us embark on an exercise program believing we will be healthier for it. We are told to exercise and practice sound nutritional habits, but what do most of us do for exercise? How about go to the gym, sit on a machine and pull or push weights while hunched over with lousy posture. Or, after sitting for 40-60 hours per week, let’s go out and put staggering amounts of stress on our bodies through recreational activities like weekend skiing, Thursday night softball league, rec league hockey, golf, or basketball.
There's nothing wrong with those activity choices, yet what happens when pain or injury come into the picture? Most of blame the exercise or blame the activity when, in most cases, we should be blaming our own body.
When it comes to pain and injury, the reality is what our body is capable of performing cannot meet the demands we are placing upon it. The overall function of our body must be ready to handle a specific task or movement otherwise problems will eventually arise. Problems that may range from mild (muscular tightness/stiffness, joint aches) to more severe (pain and/or injury).
The beauty of the functional model is that those regions that have mechanical sensitivity (pain) and/or abnormal motor control can be identified and solutions are discovered. Exposing these compensations and correcting them plays a huge role in not only getting patients out of pain, but improving how their body functions.
Why is changing how our body functions so important?
While pain is why most people seek care, the reality is if we only change pain and fail to change how a patient’s body functions, we have our reason why so many patients relapse. But if we get them out of pain and improve how their body functions then we are doing what we need to do to keep the pain from returning.
Whether we need mobility (improved range of motion) or stability (motor control), that can be addressed with a proper functional examination through movement. After a functional examination, it just makes sense to reinforce functional movement patterns with specialized exercise to build a foundation of proper movement coordination, strength and skill. Now we are beginning to get somewhere to build form, function and fitness. Now we are getting people to move better through better exercise!
Correct movement is the best exercise
Once people learn better movement, how to project their joints and what exercises they should be performing, their bodies are much healthier for it. There is less risk of injury and most will ultimately start feeling better instantly. Rather than beating their bodies up due to poor movement, movement becomes healing. Correct exercise is the answer. Correct movement is what we need to get out of pain, feel capable and feel healthy.
That’s the essence of the functional model. It’s about promoting health and healing through therapy, movement, and patient-centered education. That’s what we pride ourselves on at Gallagher Performance as our model is truly unique in the services we provide and the results we achieve.
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In light of recent news from the Pittsburgh Penguins regarding Sidney Crosby sustaining another concussion during practice last Friday, the hockey community is a buzz. Crosby’s concussion history is well documented of recent, having sustained three in less than six years. Discussions and speculations of what this means for Crosby's season, and even career, are populating the Internet and sports talk shows.
Despite the advances in sports medicine as it relates to concussion diagnosis, management, and return to play guidelines, concussions remain a challenging condition for all involved.
The reality is concussions are truly challenging. Despite measures to "prevent concussions", concussions are not preventable. There is no such thing as concussion prevention. There is no single piece of equipment, be it a helmet or mouth guard, that is capable of preventing a concussion. Rather than prevention, the focus is on minimizing concussion rates through proper identification, management, and education.
Consider that within the United States, there are over 300,000 sport-related concussions per year and research suggests concussion rates are on the rise. If your child is in contact sports, there’s a risk of concussion. Thus making this is an extremely relevant conversation and one that shouldn't be taken lightly. That said, the goal of this article is to offer insights into what a concussion is, how they should be managed, and the chiropractors potential role in the process.
What is a concussion?
A concussion is a traumatic brain injury defined as a short-lived loss of brain function due to trauma that resolves spontaneously. With a concussion, there is no structural damage to the brain. Simply put, only brain function is altered.
Encased within the the skull, the brain floats in a pool of fluid, known as cerebrospinal fluid. These protections allow the brain to withstand many of the minor injuries that occur in day-to-day life. However, if there is sufficient force to cause the brain to bounce against the bones of the skull, then there is potential for injury. It is the impact of the brain against the inside of the skull that cause the brain to be injured and interrupt its function. This impact is often due to rapid acceleration and deceleration movements of the head and neck. Rapid acceleration and deceleration of the head and neck can be created from a direct blow to the head or from impact that results in whiplash injury common in motor vehicle accidents and falls.
How are concussions diagnosed and treated?
First and foremost, anyone suspected of having a brain injury should seek evaluation by a neurologist trained in concussion evaluation.
The signs and symptoms of concussion may be obvious or very subtle. Most concussions are sustained without the individual losing consciousness or "blacking out". In several cases, the individual may not be aware they have sustained a concussion or may not connect their symptoms with a head injury. Complicating the picture is the fact that some individuals may have delayed onset of their symptoms, not presenting with concussion symptoms for several hours or days after the initial injury.
Typical symptoms of concussion include:
- Difficulty concentrating or feeling “foggy”
- Poor recall or memory of recent events
- Changes in mood or personality
- Slower reaction times
- Dizziness, lightheadedness
- Nausea or vomiting
- Low tolerance of bright lights or loud sounds
- Changes in sleep patterns, such as being unable to sleep or sleeping more
In some cases, chiropractors can be the first point of access for individuals who recently sustained a head or neck injury, such as those occurring in sports, car accident or fall. Chiropractors, especially ones who are certified by the American Chiropractic Rehabilitation Board, regularly manage athletes who suffer sports injuries, such as concussions, and are trained in proper diagnosis and understand the importance of referral for additional medical evaluation. Gallagher Performance offers such quality in their chiropractic services and has been part of the co-managment team in a number of concussion cases.
An effective tool chiropractors may use to assess the severity of a concussion is called the Sport Concussion Assessment Tool 2 (SCAT2). The SCAT2 is used to evaluate, assess, and manage concussions in athletes 10 years and older with the end goal of safely returning the athlete back to the sport.
How are concussions treated and what is the Chiropractors role?
After evaluation, rest is the best treatment. Depending on severity, most symptoms resolve relatively quickly while treatment is directed at symptom control for headaches, nausea, dizziness, and sleep problems. Rest does not simply mean physical rest. Brain rest is equally important as physical rest. Exposure to television, computers, and smartphones and other devices can stimulate the brain and aggravate symptoms. Limiting use of those devices may be helpful in allowing the brain to recover more quickly. Brain rest may also involve student-athletes being held out of the classroom and encouraged not to read, study, or taking exams as this mental effort can aggravate symptoms and possibly delay healing.
When it comes to management and, for athletes, return to play guidelines, often a team of medical professionals are involved. Chiropractors may find themselves as part of this co-management team.
Chiropractors may not be the first medical professional you imagine when it comes to concussion management and treatment, but sport and rehabilitation chiropractors are trained to support the patient during the recovery process. Largely this is due to their focus on treating spinal joint dysfunction present in the head or neck, myofascial techniques to restore muscular and connective tissue function, and sensory-motor based exercise protocols to restore ideal neuromuscular function. For further consideration, two recent literature reviews outlined how chiropractors can effectively manage athletes with concussions (1,2).
Ultimately, the brain will recover at it’s own pace. For athletes, return to play guidelines are established to ensure they are safe to return to sport competition. This involves the close observation of the athlete to ensure no symptoms are present during gradual exposure to increased cardiovascular demands all the way to more intensive and sport-specific measures.
Dear Patient, Be Patient
While 80 - 90% of individuals who suffer a concussion will recover within 7 - 10 days, some will experience symptoms for weeks or months. The length of recovery is not necessarily related to the extent of the initial injury.
Employers or school officials should be informed of the concussion diagnosis and aware of potential issues of poor performance due to difficulty with concentration and comprehension. Return to sport is fully dependent upon complete resolution of concussion symptoms and this decision should come from the neurologist overseeing care. Remember to be patient. The brain is a delicate structure and will heal with time. Don’t rush your recovery process. Returning too quickly can put you at increased risk for worsening your previous condition. Let the brain recover and reboot.
Gallagher Performance has extensive training and experience in evaluation and co-management of patients and athletes who have sustained a concussion. Our experience allows us to assist in providing gold standard care when it comes to concussions.
This blog post was written by Sean Gallagher, DC, DACRB, PES
To schedule your appointment, call (724) 875-2657.
Johnson, C.D., et al. Chiropractic and concussion in sport: a narrative review of the literature. Journal of Chiropractic Medicine 2013 (12):216-229.
Shane, E.R., et al. Sports Chiropractic management of concussions using the Sports Concussion Assessment Tool 2 symptom scoring, serial examinations, and graded return to play protocol: a retrospective case series. Journal of Chiropractic Medicine 2013 (12): 252-9.
It seems, inevitably, we get weekly questions wanting our insights or thoughts on some training or rehabilitation method.
Regardless of the whether its the fitness industry or physical medicine profession, methods come and go all the time. Some interventions have staying power as they provide lasting results. Some trends are just a flash in the pan. The more recent or more intriguing the trend, the more it seems to generate questions.
When it comes to rehabilitation, this can be seen in a wide range of modalities and procedures from electromuscular stimulation (EMS) to low level laser therapy, machine-based exercises to the functional approach, stretching to myofascial release techniques, and kinesiotaping to cupping.
In the fitness and training industry, there is an equal (likely greater) amount of options and trends to get hung up on. From kettlebells to TRX, Curves to Crossfit, bodybuilding methods to Olympic weightlifting, and unstable surface training to over-speed training just to name a few.
While the question, "What do you think of....," may be seem to be a simple question in nature, it's a difficult question to answer without understanding the context of it's application.
Unless the application is understood, the results one gets from a specific method is left in question.
If you severely sprain an ankle during a basketball game, sure taping and bracing will help in the early stages of healing. As healing and rehabilitation progress, manual therapy and exercise begin to take more focus. Single-leg balance and sensory-motor stimulation have demonstrated successful application in the rehabilitation of certain injuries, such as ankle sprains. But if you get on a BOSU ball or unstable surface too soon - and you re-injure your ankle - is the problem the unstable surface or just poor application?
Similarly, there are many people who take on a fitness or sports training program but end up worn down and banged up because their application of certain principles is just wrong. This may be due to joining a group exercise class or working with a trainer that provides poor advice and application of training principles. Or it could be due to an individual attempting to structure their own exercise program without proper knowledge of training method applications.
We all could benefit from someone who we can trust for sound advice who it comes to applying the principles of rehabilitation or exercise. They will be able to inform you on what methods may be best for your specific goals and your unique individual considerations. You need someone who can help guide and educate you, who is able to critically think and problem solve. This is what the best trainers, coaches, and therapists are able to do for their clients and athletes.
What we do at Gallagher Performance is exactly that. We critically think and problem solve for our clients and patients. We aim to educate them and implement the most appropriate applications for their desired goals and outcomes.
Despite this, the reality is our philosophy, our approach, or our applications may not be for everyone. We won't sacrifice long-term sustainability for temporary results. We take pride in quality over quantity. We won't focus on the latest trends or what other people are doing. We aren’t concerned with this.
Our primary concern is offering the best training and therapy to the people we work with while educating them on understanding sound application so they are able to make informed decisions. And we will always educate, even if that means people have to hear the hard truth. But hopefully in hearing the hard truth, they learn lessons that provide better guidance in the pursuit of their goals.
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Lately it’s hard to find time to keep up with our blog. Life and business have a way of keeping you busy. Ignoring our social platforms may happen for a period of time, but we always revisit them. If there is one thing I’ve always hoped is that our blog would be informative, educational, and entertaining (at times).
The summer months bring on increased work load. Once May rolls around, we take it up a notch or two at Gallagher Performance. Summer is a grind, but it’s also a blast. We love the grind, love the process. With the volume of high school and collegiate athletes training for strength and performance, along with the patients we see ranging from acute care to rehabilitation to return to play, summer provides tremendous learning opportunities.
Reflecting back on the past several weeks, there are some friendly reminders and lessons learned or re-learn that I wanted to share:
- Power-speed athletes thrive on power-speed drills and exercises. Just because one can squat or deadlift 500+ doesn’t mean they are explosive and fast. Yes athletes need strength and for many they will need a primary focus on strength training. However, those newly acquired strength levels must also be displayed in more power-speed dominant means such as sprints, jumps, throws as they have greater specificity to athletics than anything barbell related.
- Athletes need to rapidly absorb force and rapidly generate force and do it on a level of unconscious activation. That brings me to another point of muscle activation. Muscle activation is a craze nowadays and rightly so. The overwhelming majority of the population will benefit tremendously from learning how to activate and integrate muscles such as their tibialis anterior, glutes, and scapular stabilizers to name a few. A lost art in muscle activation seems to be the use of isometrics. There is always an isometric contraction during the amortization phase of movement. Even during the most explosive movements, there is an isometric contraction. Isometrics are also awesome for reprogramming and generating a powerful mind-muscle connection, making isometrics a great tool for performance as well as rehabilitation. We have been utilizing a select few isometric drills for uprighting, motor control, and priming for improved force/strength generation. In a relatively short period of time, they have more than demonstrated significant value.
- There is a right way to go about training and a wrong way. The right way will always be dependent on the needs of individual and their specific goals. Don't get caught up in hype, trends, and empty promises. Trust the tradition. There is magic in the basics of the barbell, free weights, sprints, jumps, and bodyweight drills. They have stood the test of time. Fads and trends come and go, the basics remain. Using these exercises is one thing, understanding how to structure them in a training plan is another animal in itself. Find a trainer/coach that understands training specificity or else you are simply wasting your time and money.
- We are problem solvers. Either as a clinician or trainer/coach, the heart of what we do is problem solving. Maybe it’s a matter of ability or effort, but clinicians or trainers either have the ability or they don’t. The ability to problem solve comes from knowledge and experience and even instinct. When it comes to effort, frankly some are just lazy and don’t care to think hard as it complicates their job. Whether it is listening to what a patient/athlete is telling you or just simply watching, you’ve got to process the source of the problem and how you’re going to solve it. When it comes to performance or rehabilitation, everything makes sense. If it is happening there is good reason for it. If we don’t understand it, it doesn’t make sense to us, but it always makes sense. Never dismiss a client or patient as not making sense. Make the effort to make a change. Change your perspective. Learn more.
- We all need a coach. No one gets through life all on their own. We all have needed mentors and coaches at some point in our life. These may have been parents, family members, close friends, teacher, professors, bosses, etc. If we pursue something of significance, chances are someone helped us along the way. We need the help of others than have more knowledge, more experience, more accomplishments. I have had a number of mentors and coaches. For everything they did for me, I hope I can pass that on to those that I work with in the role as a coach.
- Take time to get to know your clients and athletes. Show you care about them. We do more than just simply get kids bigger, stronger, or faster. We have an opportunity everyday to connect with our clients and athletes and hopefully make a positive impact. The reward goes far beyond cash flow. It’s about making a difference for the better.
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The Gallagher Performance approach will improve the way your body moves and functions.
Simple yet effective changes to improperly functioning muscles and joints will allow the body to make immediate shifts toward working as a functional unit. Thus reducing pain and enabling higher levels of strength, speed, and power with greater resilience.
The results are incredible. Time and time again, our patients and athletes quickly change from a state of pain and tension, to a state of relaxation primed for performance. This all comes back to assessment and knowledge. When we do the right thing, the body responds immediately.
The methods used at Gallagher Performance are utilized internationally by elite athletes, sports teams, and health practitioners. Not only are we able to efficiently and effectively treat injuries and enhance sports performance, our methods are also powerful tools for stress management, quickly breaking common patterns of movement dysfunction related to chronic pain. The methods have international recognition and no provider, therapist, or trainer in the Pittsburgh area has the training and background in these methods that Gallagher Performance offers, making us truly unique.
HOW DOES THE GP SYSTEM WORK?
Our body is designed to breathe and move. In order to breathe and move, our body finds ways to accomplish these tasks, and it’s willing to do so in efficient or inefficient ways. Our breathing and movement can develop compensation patterns or “key dysfunctions” that become the target of successful musculoskeletal treatment.
These compensation patterns cannot be ignored, as they put us at risk of poor sport performance, tension, or pain. Our body’s ability to overcome the stress of life can result in reduced movement quality and energy levels. Measurable reductions in stability, strength, power, mobility, and stamina are often the result. Our body becomes less resilient, increasing the chance for fatigue and breakdown.
If you experience a traumatic event or injury, you know exactly what I’m talking about. Post injury, you’ll notice the slow and gradual decline in energy, function, and performance. Compensations begin to manifest in order for us to avoid pain and accomplish daily tasks. The result may range from noticeable decline in energy, to impaired function of muscles and joints, to chronic pain which long outlasts the initial injury.
It is almost inevitable nowadays for the majority of us to experience the effects that stress, injury, and/or compensation has on the human body. And it can be simple to reverse those effects when you focus on what your body needs to regain ideal function.
The system at Gallagher Performance starts by testing how your body is currently functioning, so that changes can be clearly measured. This is accomplished through evaluating joint restriction, muscle activation and strength, and functional patterns of movement.
Once compensations are identified, we target “zones” to help activate the body to perform better. These “zones” can be a specific muscle, group of muscles, joints, or a combination.
Once we activate, we have to integrate. In order to do this, we run through the body’s movement patterns, testing and activating along the way to enable muscles and joints to regain their ideal function. Then through cueing and exercise, the brain can integrate improved patterns of movement, allowing you to move effectively and efficiently.
A body that moves better has less stress and less pain, allowing you to work at greater capacity and with greater energy.
That doesn’t mean you’ll suddenly be indestructible for the rest of your days. That would be too good to be true. After all, it you enjoy being active and testing your body’s limits, you are going to feel it. Our movement patterns need reminding and that’s why we use targeted home exercises to help the body reinforce ideal function and keep compensations from returning.
The methods and techniques used at Gallagher Performance are proven to be effective in getting people out of pain and elevating performance. We truly offer unique, powerful tools for control over your own health and performance.
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The majority of us will not get through life without sustaining some degree of injury. The joints of the back, shoulder, hips, knees and ankles are all very common injury sites for not just athletes, but the general fitness population as well.
Most injuries that develop over time tend to have one thing in common, a breakdown in the human movement system. Meaning it could be that you are performing specific movements with sub-optimal technique or perhaps muscle imbalances are responsible for your symptom presentation. Regardless of the reason for injury, the goal is the same; to make movement more efficient to ensure that once training or competition resumes, the chance of re-injury is minimal.
Efficiency of movement is rarely a goal achieved in therapy. Incomplete rehabilitation in athletes and the general fitness population has lead to a re-injury epidemic. The problem is rooted in either the push to return athletes to the field as quickly as possible or rushing patients through the rehabilitative process.
With the ever changing landscaped of health insurance, the overwhelming majority of athletes and patients deal with increasing out-of-pocket expenses and limited number of therapy visits. Ultimately, many patients never complete their rehabilitation process.
This may be for a number of reasons, but in most cases athletes or patients are discharged once specific objective and ADL (activities of daily living) measures are satisfied. Sure you may have minimal to no pain, full range of motion and seemingly adequate strength resorted, and basic activities are easy to perform, but this does not ensure you are ready to resume training and competition.
And this is exactly where most get stuck.
They are lead to believe they are ready to resume sport training or their exercise program, but soon after resuming they realize they aren't as ready as they thought they were.
The transitional period between rehabilitation and performance-based training is the most critical period to ensure complete rehabilitation and that the transition back into training and competition carries minimal risk of re-injury.
Sadly, due to points made previously about the state of healthcare, many personal trainers and strength coaches are finishing off the rehab process.
Why do I say sadly?
Frankly, the majority of personal trainers aren’t educated enough to be overseeing such a delicate process, yet many position themselves as psedo-therapists. I’ve lost count of how many personal trainers I’ve seen giving “massage” or performing “joint mobilization” during their training sessions. They have no training or qualifications to perform such work and ultimately the person at most risk is the individual they are working on. Word to the wise: if your personal trainer is performing such work on you and has no license to perform such work, run the other way and seek out a qualified professional.
Within the fitness industry, there has been a large growth in facilities that blend rehabilitation with prevention strategies within strength and performance based training programs. Done well and overseen by qualified professionals, this is a great way to manage what is seen both in a rehab and training setting. This process should not be handled improperly. Implementing “corrective” or therapeutic exercises strategies into a performance-based training program should be lead by qualified professional(s). There used to be a gap between the professionals in the therapy and strength & performance world. Progressively though, that gap is slowly closing as more therapists crossover into the world of strength & conditioning.
Returning from injury isn’t and shouldn’t be a quick process. It’s far better to train smarter through the process. Improving on the function of the body while adding qualities such as endurance, strength, reactivity, power, etc. will help ensure successful outcomes. It’s less about isolation and more about training systematically to re-groove movement patterns. For anyone who has suffered an injury, they all want to get back to their previous level of function while also building the confidence they will not re-injure themselves. It can and will be a detailed process that involves rest, manual therapy directed at specific joints and soft tissues, as well proper exercise progressions. And yes, this means regressing, substituting, and even just slowing down exercises until they are owned.
Once movement and exercises are owned, it opens the door to further progressions in a performance-based setting to help ensure a more complete rehabilitation resulting in reduced risk of re-injury. This has become a huge part of what we do at Gallagher Performance as we successfully help our athletes and patients resume an active, pain-free lifestyle.
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Back pain was believed to be a self limiting condition for the majority of individuals, meaning that the nature of back pain is that it would "run its course" and eventually pain would go away on its own. Current research has demonstrated that this understanding of back pain is flawed; yet many clinicians still hold this belief.
In fact, 85% of people with a single episode of low back pain will likely experience future recurrences and 2-8% of those individuals will develop chronic back pain.
Chronic pain accounts for 75% of all healthcare costs related to low back pain, is second only to the common cold in missed days from work, and is the number one reason for workmen compensation claims.
Considering the burden chronic back pain places on healthcare resources, patient management appears to be an issue in need of addressing appropriately as many patients find it difficult to find effective treatment.
Low Back Treatments That Don't Help
Now many experts are questioning the model in which back pain is treated as a growing body of research suggests many common back pain ‘cures’ just don’t work. These include:
- TENS machines
- Strong opium-type painkillers, such as diamorphine
- Spinal injections
- Spinal fusion
- Disc replacement
Top spine expert, Professor Stuart McGill is the world’s leading spinal biomechanics researcher and has identified common reasons for back pain and the importance of exercise as an intervention for effective treatment.
In Dr. McGill's opinion, based on over 30 years of research, every case of back pain has a cause and the reason many treatments are ineffective is because they are used on a one-size fits-all approach, rarely targeting the underlying problem.
There are many possible causes for back pain, but you must first find the positions and stresses that trigger pain. As Dr. McGill says, finding these positions and stressors allows the provider to formulate a precise diagnosis and a roadmap to recovery. This roadmap is guided exercises that can correct the harmful patterns and build a stable, firm spine.
The importance of a firm spine can come as a surprise to many, as the common perception is that your back must be flexible in order to be healthy and pain-free.
The spine must be firm and have strong muscles surrounding it to help transmit forces from the legs and the shoulders while minimizing the stress on the spine. When the muscles of the spine aren’t strong enough, micro-movements can occur that eventually can sensitize the spine and lead to a painful back.
If you have some movements, which are comfortable to build on, this opens the door to conservative management and recovery through guided exercise
However, recommendation of exercise without a clear understanding of movement intolerances and muscles that must be strengthened can also be harmful
Guided Exercise: The #1 Intervention for Low Back Pain
Exercise is essential both to protect and repair your back, but simply hitting the gym or doing Pilates or yoga without knowing the movement patterns that are generating your pain or the ones that will protect and build a pain-free back, has little chance of being effective.
Thanks to exercises specifically targeted at a patient’s problems, we are able to help educate them on proper posture and movement so they do not put damaging load on their spine. The guided exercise model is truly about identifying a patient's underlying back pain generators and educating them on not only how they can get out pain, but also what they can do to keep it from returning.
When you consider that 85% of individuals who have low back pain will experience future recurrences, there must be a priority placed on educating patient's about proper posture, movement, and exercises that build a firm, strong spine. Guided exercises are showing clear efficacy for use in patients with low back pain and should be a staple in their treatment plan.
If you are suffering from low back pain, whatever the cause, consider Gallagher Performance for your evaluation and treatment. Our goal is to relieve your pain while teaching you what you can do to keep the pain from returning.
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What is Fascia?
The soft connective tissue, located just under the skin, is a white membrane that wraps and connects muscles, bones, nerves, organs, blood vessels of the body.
This soft tissue is known as fascia. Think of fascia like the white fuzz inside an orange peel connecting and wrapping around the orange and the individual sections or slices.
At times, muscles and fascia are can become stuck or tear, resulting in soft tissue injuries or adhesions. Adhesions restrict movement and the quality of muscular contractions resulting in either soreness, pain, and/or reduced flexibility.
For a quirky take on fascia or "the fuzz", watch this video by Gil Hedley, PhD. The video provides great visuals as to what fascia looks like, how our muscles have to slide while we move, and what muscular adhesions look like and how they limit movement.
How do you treat Fascial/Muscular Adhesions?
Treatment of fascial/muscular adhesions through manual or instrument assisted techniques have clinically proven to achieve successful outcomes in many acute and chronic conditions. Gallagher Performance offers a number of soft tissue approaches to treat painful or tight muscles, tendons, and ligaments. We have extensive training in identifying and treating muscular adhesions that compromise quality of motion and contribute to pain symptoms or reduced sports performance. Many overuse or repetitive use conditions respond well to treatment of soft-tissue structures through myofascial release, including back pain, shoulder pain, shin splints, runner’s knee (IT band syndrome), and plantar fasciitis.
Myofascial release is a manual or instrument assisted therapy targeting soft-tissue structures to reduce the presence of adhesive/scar tissue. Adhesive muscular tissue is arguably the most common yet most underdiagnosed condition in the entire human body. Muscular adhesions act like glue among muscles, fascia, tendons, ligaments, and even nerves. As a result, this reduces flexibility, strength, and stability to the body by altering movement control patterns. Adhesive tissue along nerves can cause numbness, aching, tension, tingling, and in some cases weakness. This is condition is called nerve entrapment and can happen in an estimated 150+ locations throughout the body.
How does adhesive tissue develop within the body?
Often adhesive tissue develops in result to acute injury or from overuse/repetitive trauma injury. Overuse injuries are caused by repetitive stress on the muscle and skeletal system without enough rest to allow the body to adapt. Studies show these overuse injuries account for more than half of pediatric sports injuries and often happen due to intensive focus on a single sport with an intensive practice and competition schedule. Unrecognized and untreated, they can sideline athletes from play and lead to more serious injuries.
Who is qualified to diagnose and treat fascial/muscular adhesions?
Sports medicine experts are advocating a greater role for therapists who can help athletes or active individuals recover without incurring lasting damage or hampering their activities. Specialists such as chiropractors, physical therapists, and massage therapists who specialize in sports-related injury and rehabilitation are often the first line of defense in managing and treating overuse injuries. These licensed professional are best for identifying muscular or fascial adhesions as they related to overuse injuries and movement disorders. With specialized training, these professionals are able to detect and treat muscular adhesions, expediting the healing process and minimizing downtime due to overuse injuries.
This is exactly why at Gallagher Performance we have a team which includes a massage therapist and a board certified chiropractic rehabilitation specialist. We strive to offer our athletes and patients the latest treatments and evidence-based soft tissue and rehabilitation techniques. Helping our athletes and patients achieve and sustain their best level of health and performance is our goal.
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This short video discusses the reality of overtraining as it relates to human performance when it matters most. Overtraining is not a myth. Learn more here.
When it comes to writing and keeping up a blog, demands of life and business can make it challenging to find time to sit down and put some good thought into something you hope your readers will either find a degree of value or connection with in reading. Sometimes the best inspiration for writing comes through simple conversation. In this case, I was having a conversation with a parent that generated some thought that got me to thinking I should sit and put my thoughts down.
Knowing some of the physical ailments I deal with on a regular basis from sports, this particular parent of one of our athletes asked me, “Would you do it all again?”
Essentially their implied question being, “Was it worth it?”
Easy answer. I said, “Yes.”
The sports of ice hockey, powerlifting, and Strongman have provided me numerous friendships, lessons, memories, and helped shaped how I approach life. I would never change that.
Keep in mind, while some injuries I sustained playing hockey were severe, what I deal with to this day is relatively minor compared to other athletes.
In fact, while I did sustain injuries during sport participation, I received just as many injuries and set backs in the weight room or in training. This is what I would have changed the most. I would want to go back to change my training habits and attitude when I was in high school and college.
In the late 90s and early 2000s, I was fully invested in training for hockey and had minimal resources. The Internet did not provided the amount of information it has today. I was using magazines or Arnold Schwarzenegger’s Encyclopedia of Modern Bodybuilding to find guidance on what to do when it came to working out and lifting weights. There was truly a lack of training info out there. Similar to most kids my age, reading over the monthly Muscle and Fitness was the closest thing we had to authority on all things bigger and stronger.
There were no seminars. No YouTube tutorials. No blogs or online forums. No ebooks. These didn't exist as a reference to help young, aspiring athletes guide their understanding of training.
Books on training were just as hard to find. As a kid, I absolutely hated to read books. But I had one exception. I loved reading autobiographies on athletes I looked up to. Athletes like Jerry Rice, Herschel Walker, Jaromir Jagr, and Mario Lemieux.
At times, these athletes would discuss what types of workouts they did growing up or still performed in the offseason. I recall reading that Jerry Rice, as a kid, would run after horses to get faster. During his career as the greatest receiver in NFL history, Jerry Rice was well known for always coming into the season in phenomenal condition from brutal offseason workouts. Herschel Walker did 1,000 push-ups per day and was an absolute force on the football field. Jaromir Jagr did 1,000-2,000 bodyweight squats per day as a kid growing up in the Czech Republic and he attributed that to the speed and strength on the puck which made him the arguably the greatest European-born player in NHL history.
At 14, I remember being obsessed with what highly successful athletes did as young kids and I put it all down on paper, writing up my own workouts based on what they did. Lots of bodyweight squats, push-ups, running hills and biking for miles.
So I got to work. I biked 11 miles around my hometown on some days. Others I would run a hilly 3-mile course. And everyday I did bodyweight squats and push-ups, working up to eventually doing 2,000-2,500 squats and 400 push-ups within 75-90 minutes. Plus, my brothers and I would just go outside and play for hours. Didn’t matter what it was. We just played for fun.
I got my first weight set and bench around that same time and took on more of a bodybuilding focus thanks to Arnold and Muscle and Fitness.
The mentality was pushing yourself as hard as you can. More was better. Soreness meant you were doing something right. Complete exhaustion or puking meant you had a good conditioning workout. This was my mentality through high school and into college. I figured if it worked for some of the best athletes on the planet, it surely had to work for me.
The problem became I wasn't getting much bigger or much stronger. Sure there were initial benefits during the early years. See when you are young; if you show up, train hard and keep adding weight to the bar, it works! It works so well that it’s what I figured I could keep doing. But what no one ever told me was it only works for so long. You eventually reach a point of diminishing returns.
At a certain point, I had to seek out the help of a sports-trainer and that was hard to find back in 2000. My brother and I were heading into 12th grade and had a big showcase tournament coming up that summer. My dad was able to track down a guy for my brother and I to train with in preparation for that tournament. Under his guidance and direction, I was able to see improvements in size, strength, and speed that I was unable to achieve on my own.
What did he do for me that I couldn’t figure out on my own?
He knew that I needed to get more explosive, more dynamic, better conditioned for my sport. What I didn't understand is that sometimes success from things you have done in the past is the worst indicator of what should be done next.
Then I think back on my college hockey career and the years I have spent competing as a strength athlete in both powerlifting and Strongman. The muscle imbalances and movement restrictions that started to creep in because of poorly structured training programs. There were plenty more lessons I learned about intelligent training structure and program design from a number of various injuries and setbacks.
Hockey, Powerlifting, and Strongman have all influenced me somehow from a training perspective. I wouldn't change anything about participating in these sports; I would change my preparation for them.
I feel bad for kids these days. I feel they have it worse then my generation. They have been duped into thinking they will be better athletes from participating in one sport. They are being sold speed ladders, specialty camps, and mass marketing fitness trends. I grew up with out any experts, now kids today are growing up with “experts” everywhere. They are being robbed of the option of playing multiple sports by coaches who demand their involvement in one sport throughout the calendar year. They are forced into specialization too early. And when it finally is time to specialize, they have no base of athleticism or strength because those attributes have been ignored due to lack of free play. You can’t build upon a poorly established base and that is why youth sport injuries are continually on the rise. I share the opinion that this is why the fastest growing surgery is pediatric.
So to answer the question of a concerned parent, don't be concerned about the game or the sport or whatever your kid chooses. You should be concerned about the lack of free play, the lack of movement and variability, the lack of smart training. Take interest in that. I believe this to be the important part.
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What is the purpose of the warm-up? How important is the role stretching and mobility during the warm-up process? Plenty of clinicians and trainers preach mobility, mobility, mobility. Is mobility truly the answer? We answer those questions in this short video.
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.
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.
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.
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