As a chiropractor that specializes in manual therapy and rehab protocols, I see patients dealing with a variety of problems. Now while the conditions can vary greatly, the common denominator that all my patients share is that they are either in pain or unable to perform a specific activity at a level they desire. Being able to provide a service to help people was exactly why I got into chiropractic and it is why I work to continually develop my craft and treatment philosophy. My treatment philosophy has helped to develop my system for how I go about evaluating and treating each patient that comes to me for help. As valuable as my education and residency has been to developing my treatment philosophy, the insight and knowledge I have gained on strength and conditioning as an athlete and coach has been equally valuable.

A great mentor of mine told me that with his background as a strength coach, he uses that background and mindset everyday with his patients. Some years later, I continually have a renewed appreciation for what he communicated in that statement because looking at my patients through the "lens of strength" can provide me with a refreshing perspective.

Why?

Simply put, strength matters. Strength has the ability to cover up dysfunction. Strength will directly impact movement quality. Strength will improve mobility or flexibility issues. Strength has tremendous ability to minimize or reduce overuse injuries. Strength becomes a focus in my treatment plans and the advice I provide my patients.

In my opinion, a major player in the outcomes of patient care is the quality of advice they receive. Much of the advice I provide is directed at my patient's current exercise routine. And, at times, the advice is very blunt. The type of advice that is often tough to swallow on their part because it means big changes

What does that advice look like?

Say you are dealing with low back pain that is worsened from repetitive flexion. You can’t tolerate bending forward to tie your shoes or get nervous just thinking about picking up something from the floor, yet you love your group exercise class that has you running through dozens of crunches, sit-ups, air squats, and wall-balls. Your back is not going to respond to any form of therapy until you remove the irritating factor (your group exercise class) and follow the advice of substituting in more appropriate exercises that promote a healthy back.

Say you can’t properly lift your arms overhead with ideal form and posture through the shoulders, spine, and hips. Now you want to participate in an exercise routine that includes Olympic lifts such as the snatch and overhead pressing. What you must understand is that you lack the prerequisites to perform loaded overhead exercises. This is why your shoulders or low back hurt after overhead pressing or performing a full snatch and you need to be advised accordingly.

Advice should be constructive, providing a solution. However, there is some advice that is simply unacceptable. The classic example of this is the runner who develops knee pain, decides to see a doctor and is told, "Stop running."

Unacceptable.

The solution is rarely that simple. Maybe that runner lacks movement control in joints in such as the ankles, hips, pelvis, and spine because they lack adequate strength in surrounding musculature. Maybe that should be addressed while their current running program is restructured according to their tolerances.

There are solutions and often those solutions involve strength development.

As a therapist, odds are in your favor that you are going to find a strength deficit that is playing into that runner's knee pain. Odds are in your favor that you are going to find that lack of strength is correlated with any number of common conditions.

Lack of strength is never solved by inactivity and prescribing rest. Strength requires the opposite. Strength requires focus, guided effort. Strength is a difficult pursuit and it requires that one knows what they are doing if you are going to coach the process.

On my end as a therapist, what becomes even more difficult to navigate is managing a patient who has his or her own personal trainer or strength coach. I always ask them what they are doing for "training," and most times my response is inwardly shaking my head. I don’t say anything, unless I’m asked. If I’m asked, then it is time to be brutally honest.

It is important to note that you shouldn’t just take exercises away, but substitute better ones. My job is to find the best exercise for the job. This is why developing a large exercise pool to draw from is invaluable as a strength coach and as a rehab specialist. Having a huge exercise pool will allow you to make progressions, regressions, and substitutions based on movement patterns, training goals, mechanical sensitivities, or movement limitations.

At GP, we have taken time to develop our exercise pools for lower body pushes/pulls, upper body pushes/pulls, hybrids, developmental stabilization, etc. This allows seamless transition between phases of rehabilitative care for my patients and continual development from a strength and performance perspective for my athletes because we have developed our plan for progressive development. This understanding of strength also allows me to provide the most appropriate advice when it comes to exercise selection.

As William Penn said, “Right is right even if everyone is against it, and wrong is wrong even if everyone is for it.” People are there for your expertise and knowledge as much as your skills. Remember to provide the care and treatment you would want to receive and provide them with the advice and direction you would want to understand.

More related reading:

https://gallagherperformance.com/interview-with-mike-odonnell-dc-ccsp-cscs/

https://gallagherperformance.com/the-best-exercise/

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

Injuries are a part of sport and life. It is an unfortunate reality and a lesson some encounter with greater frequency than others. I have had my fair share of injuries as well. The reason why I am writing this post is because of my most recent injury.

Over the past 14 weeks, I have been prepping for a strongman competition in Iowa on May 16. The training cycle had been going smoothly and I was feeling good heading into the final days before my taper. Four days ago, I pulled my left bicep during tire flips. The tire flip is one event that is notorious for causing bicep injuries due to the large amount of mechanical stress it places on the biceps. Fortunately, I did not suffer a complete tear, no surgery needed. However, competing is out of the question. When you are self-employed and your job requires the uses of your hands, there is no need for any further set backs.

For some, injuries mean down time from training. They see injuries as an obstacle. Not in my mind. An obstacle is what you see when you take your eyes off the goal. There are still ways to train around injuries. Sure, I will not be able to do anything stressful with my left arm for 3-6 weeks, but I can still get a powerful training stimulus from a incorporating squat and single-leg variations for lower body strength, jumps/bounds/hops for more intensive CNS stimulus, and training my non-injured arm to help maintain strength and speed recovery of my injured arm.

Wait….what? Training your non-injured arm helps to keep your injured arm strong and heal faster?

For many of our readers, you may not be aware of the specialized background that Gallagher Performance has in personal training, athletic development, chiropractic rehabilitation, manual therapies, and sports-injury care.

Whether you are pursuing professional services for personal/performance-based training or you’re thinking of seeing a health professional about a sports injury, Gallagher Performance has two board-certified specialists who are capable of addressing your goals and needs.

Meet the Staff

Ryan Gallagher LMT, NASM-CES: Head Performance Coach
Ryan Gallagher is the Head Performance Coach and a Licensed Massage Therapist at Gallagher Performance. Ryan has quickly established himself as a highly sought after coach for athletic development, helping athletes achieve new performance bests while implementing specialized strategies along with manual therapy to keep his athlete’s healthy during their competitive and off-seasons.

Ryan has been involved in the fitness and sports performance industry since 2007. During that time, he has worked extensively with youth, high school, collegiate, and professional athletes. He has also worked with competitive strength athletes in powerlifting and Strongman, as well as physique athletes (bodybuilding, figure, and bikini).

Ryan is certified as a Corrective Exercise Specialist (CES) through the National Academy of Sports Medicine (NASM) and is also a Nationally Certified Licensed Massage Therapist (LMT) through the National Certification Board for Therapeutic Massage and Bodywork. Ryan holds a bachelor’s degree in Sports Management with a concentration in Wellness and Fitness from California University of Pennsylvania.

To compliment his educational background, Ryan is an accomplished athlete in the sports of ice hockey, bodybuilding, powerlifting, and Strongman. HIs diverse athletic and educational background provide Ryan with an highly extensive and unique skill set that allows him to efficiently and effectively help his clients achieve their goals while staying healthy in the process.

Sean Gallagher DC, DACRB, NASM-PES: Director of Sports Therapy, Performance Coach
Dr. Sean Gallagher is the Director of Sports Therapy and also serves as a Performance Coach at Gallagher Performance. In 2009, Sean earned his Doctor of Chiropractic degree from Palmer College of Chiropractic in Davenport, IA. Prior to attending Palmer, he earned a bachelor’s degree in Exercise & Sports Science from Ohio University.

After graduating from Palmer, Sean entered a residency program in Palmer College of Chiropractic’s Sports Injury & Rehabilitation Department. The residency is the only one of its kind within a chiropractic college in the United States. Under the direction of former Olympian, Dave Juehring DC, DACRB, CSCS and Ranier Pavlicek DC, ATC, DACRB, CSCS, the residency provided Sean the opportunity to further the development of clinical skills in the realm of diagnosis, treatment and management of sport-related injuries. During this time, he received extensive training in manual therapies and developmental stabilization methods influenced by the German and Czech rehabilitation schools.

Sean graduated from his residency and completed his board certification in 2012, making him one of a select few chiropractors in the country that have successfully completed a rehabilitation and sports-injury residency. He is a board certified rehabilitation specialist through the American Chiropractic Rehabilitation Board (ACRB) that abides by the standards set out by the National Commission for Certifying Agencies.

To compliment his clinical training and experience, Sean also serves as a Performance Coach with years of experience working with athletes of all abilities and is a certified Performance Enhancement Specialist (PES) through NASM. He is an accomplished athlete in the sports of ice hockey and Strongman. During his time at Ohio University, he was part of the 2004 ACHA D1 National Championship team. In 2001, he was named to the NHL’s Central Scouting Service “Top 10” High School players in the US and was ranked among the top players in North America (US and Canada). As a competitive amateur Strongman, he has won or placed in several NAS sanctioned competitions since 2010 and was a National qualifier in 2010, 2011 and 2012.

Our staff welcomes the opportunity to get you back to 100% and help you reach your fitness or performance-related goals. When you think of sports performance training and chiropractic rehabilitative care in the Pittsburgh area, remember the team of experts at Gallagher Performance.

 

As a chiropractor, I often treat people who have already exhausted all of their insurance money from seeing other chiropractors and/or physical therapists. They come to me out-of-pocket and immediately expect me to do significantly more in one or two visits than the previous professional(s) did after the 12-20 visits that drained their insurance benefits.

I’ve routinely accepted the challenge and many times I’ve closed their case in 2-4 visits by having them listen to advice, advice that addresses underlying issues previously missed or ignored by other providers. Yes, I am a chiropractor and I will adjust and perform manual therapy as needed. But the difference maker time and time again has been the time focused on education directed at independence. Promoting independence on the patient’s behalf is a game changer. This is why I feel so strongly that empowering a patient should be the focus behind therapy and prescribed home programs. As patients discover how they are able to better themselves, their compliance becomes a non-issue and outcomes drastically improve.

The opportunity to educate others is a responsibility that should never be taken lightly. As a provider, the methods utilized to accurately assess a patient’s condition and direct treatment must also serve to improve provider-patient education and accountability.

Gray Cook places this perspective into words very well:

“Our current medical and physical cultures are wasting a lot of time and not creating independence in our clients or our patients. Do we want them to be well and go tell others about their experience or do we want them to keep returning as continual consumers? At what point does wasting time conflict with an oath to do no harm?”

GP: Do all of our readers out there a favor and tell us a little about yourself, your athletic background, and your coaching experience?
AS: Hey guys! My name is Andrew Stimmel & I’m a 2006 graduate of Franklin Regional. I played college lacrosse at Ohio State University where If was a Defensive MVP, captain and Major League Lacrosse draft pick. Currently, I’m an assistant coach and the Director of Player Development at Yale University where I work with our midfielders, defensive personnel and goalies.

GP: What drew you to coaching after your collegiate career came to an end?
AS: I think I always enjoyed coaching; I just don’t know if I realized I wanted to make it my profession until my 5^th year at OSU where I was able to act in a GA role for Ohio State. That year made me realize what I was truly passionate about; mentoring and teaching. Coaching at this level is a fully integrated approach not just limited to on the field strategy but dedicated to the total person development. We see these kids every day for 3-4 hours (sometimes more) so we have a tremendous opportunity to impact their future as leaders of the workplace, community and their families.

GP: Now that you’re in the collegiate setting as a coach, what are some things you see athletes struggling with in regards to physical preparation?
AS: Physical preparation is our number one goal in the offseason and also one of the biggest things we preach to our incoming freshman. If our guys are out of shape and lacking the necessary conditioning/strength to play at full speed, they don’t participate. The risks for injury are too high and it’s simply unproductive for their individual development. The lack of physical preparation with our incoming guys is usually pretty obvious; inflexible athletes who are fundamentally unprepared for the speed and physicality of the college game.

GP: We often need to have the conversation with prospective clients about the whole idea of “not playing sports to get fit, but rather being fit in order to play sports”. How often do you see this play out in your experience? How much attention do you give to general physical preparation prior to the onset of the competitive season?
AS: I can understand at a younger age parents wanting their kids to participate in sports to get fit and stay active; it’s a great way to achieve those things as well as foster the concepts of teamwork and work ethic. However, as kids get bigger, stronger and faster, that type of player is being put at a huge disadvantage that can easily lead to injury. It is imperative to have some type of intentionality to physical preparation prior to your competitive season not only to perform at a high level, but prevent injury.

GP: Taking those questions and thoughts and expanding on them, what training tactics, systems, or methods do you see most coaches and trainers utilizing that are hurting their athletes more than helping them?
AS: With the exponential growth of the sport of Lacrosse over the last 15-20 years, there is a large group of people trying to capitalize in the industry. A few of the tactics, systems and methods I’ve seen that I don’t really believe have any positive impact and may actually hurt athletes are:

1)    Any weighted “lacrosse specific” exercise. Probably one of the most frustrating things I’ve ever seen. Why are we going to strap a 20lb weight vest to a 10 year old who can’t properly execute the skill or physical mechanics as is? The best way to shoot harder as a young player is to learn the proper mechanics and execute it properly during your practice time.

2)    Any banded/weighted/resistance exercise specific to running technique or footwork. I’m not completely against resistance methodology that add bands to weights or certain exercises for top level athletes; college athletes or professional athletes who are physically prepared to execute fundamental movements properly with the added load. However, when you see younger kids working predominately with bands when, again, they can’t execute a proper body weight squat, proper running technique or transfer weight properly during change of direction, it’s hurting them more than helping them.

GP: Several of our readers are parents of young athletes. From your perspective as an accomplished athlete and collegiate coach, if you were a parent of a young athlete what specifically would you be looking for in a trainer/strength coach/physical preparation coach? 
As a parent of a young athlete I would be looking for someone who is going to be honest about what my kid needs to be doing right now. If he’s a young athlete, don’t sell me on training him like a professional athlete; train him like a teenager. Get him basics first; proper movement techniques, foundational strength, correct deficiencies that could lead to injuries and maybe more serious things in the future. As a parent, it’s easy to get attracted to weight room numbers. However, what does it mean if those numbers don’t produce a better athlete on the field? Bodybuilders care how much you bench; college coaches care how you perform on the field. That’s what I’m looking for as a parent!

 
Thank you Andrew for taking the time to share your thoughts and insights from the experience you have gained not only as athlete, but now as a coach and the role you take on in player development. We hope our readers find this as informative as we do!

More related reading:

https://gallagherperformance.com/commonmistakesindevelopingyoungathletes/

The purpose of this article is to provide some basic information about the importance of understanding the role posture and function have in pain, injury, and movement dysfunction. The hope is that you will gain an understanding of why your chiropractor or therapist must evaluate and bring into consideration issues that may not seem related to your pain.
Patients come to us with symptoms and we want to get to the source of their symptoms. In addition to providing relief through manipulative therapy and treating muscular adhesions, it can prove to be incredibly valuable to identify the source of their symptoms. In my experience, the source of a client or patient’s symptoms is often found in painless dysfunction of the motor system.

All too common, providers become reductionist in their evaluation and treatment of the motor (aka musculoskeletal) system. In order to provide long-term solutions and minimize reoccurrences, a holistic or global approach to evaluating functional capacity is needed to identify what is driving pathology in the motor system. This concept is of critical importance when you understand that the majority of motor system pathologies exist because the demands of activity exceed the individual’s capacity. If the demands upon the motor system are at a high level, then capacity must be even higher. Even if demands are relatively low, capacity still must exceed the level of the demand. If there is a capacity “shortage”, the result is a higher injury risk. In musculoskeletal care, one of the greatest challenges is identifying functional capacity “shortages” and how to address them during the course of conservative treatment to provide both immediate and sustainable results.

Professor Vladimir Janda and Dr. Karel Lewit pioneered the process of identifying functional pathology within the motor system. The model is in contrast to the traditional North American orthopedic model, which focuses on structural pathology (ex: disc herniations, rotator cuff injury, labral tears, etc.) as the reason for pain and impairment. But simply focusing on structural pathology can take your eyes away from identifying key reasons as to why they developed in the first place.

Outside of structural pathologies, the functional approach to managing motor system pathologies includes identifying joint dysfunction, muscular imbalances, trigger points, and faulty movement patterns. Faulty movement patterns are protective movements that form in response to pain or the anticipation of pain. These are often the hidden causes of injury, the reasons why many structural pathologies occur. Czech physician Vladimir Janda likened musculoskeletal pain and dysfunction as a chain reaction, thus stressing the importance of looking beyond the site of pain for the source of pain. Janda observed that due to the interactions of the skeletal system, muscular system, and central nervous system (CNS), dysfunction at any one joint or muscle is reflected in the quality and function of joints/muscles throughout the entire body. This opens the door to the possibility that the source of pain may be distant from the site of pain.

Janda also recognized that muscle and connective tissue are common to several joint segments; therefore, movement and pain are never isolated to a single joint. He often spoke of “muscular slings” or groups of functionally interrelated muscles. Muscles must disperse load among joints and provide stabilization for movement, making no movement truly isolated. This ultimately is the reason why many providers within physical medicine are catching onto the saying, “Stop chasing pain.” Chasing pain and other symptoms (ex: tightness, stiffness, restricted movement) may provide short-term relief, but are you providing long-term results?

A common intervention in the rehabilitation of motor system pathology is therapeutic exercise and resistance training. These exercises are used to help restore any number of neuromuscular qualities, such as endurance, strength, and motor control. But often, even in a rehab setting, exercises fail to progress a patient in the recovery process. Sometimes, the application of exercise can make a patient's condition worse. Similarly, many people with the intention of being healthy and wanting to help their body “feel better” will use resistance training in their exercise regimen. Working out, exercising, strength training should improve our state of muscle balance, right? Sure they get the cardiovascular, endocrine, and psychological benefits of exercise, but they start to wonder why all their exercising is only making certain areas of their body feel worse. This is why it’s important to learn that unless exercising occurs in a thoughtful manner, based on a functional evaluation of movement and capacity, the benefits of reducing injury risk, improving posture, enhancing motor control, and restoring muscular balance will be difficult to achieve.

For example, what Janda discovered is the tendency for certain muscles within the body to become tight and overactive, while others have the tendency to become weak and underactive. So if someone is performing general exercises, the brain will select the muscles that are already tight to perform the majority of the work. This is a phenomenon knows as “compensation” or “substitution”. Muscles that are already chronically overused will continue to be overused, leading to greater risk of an overload injury. The muscles that are “weak” have developed a sensory-motor amnesia that will not correct itself unless the exercise is carefully selected and tailored to activate these dormant muscles. Such exercises emphasis the quality of the movement pattern over any prescribed number of sets or reps. The eye of the provider can’t be focused on isolated impairments, but on finding the motor control error. Finding the hidden causes of injury or motor system dysfunction.

Remember, what enhances performance also reduces injury. Finding the solutions to enhancing performance will often address hidden motor system dysfunctions. If you are training for athletic performance, you must build functionally specific or sport-specific capacity. If you are recovering from injury, you must build function rather than solely focusing on palliative measures and treating the site of symptoms. In either scenario, you are building a better athlete and fast tracking the rehabilitation process by taking a functional approach to motor system dysfunction.

More related reading:

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

https://gallagherperformance.com/the-importance-of-functional-evaluation/

Evan James has had quite a journey during his baseball career.

Evan is a 2009 graduate of Penn Trafford HS. During his time at Penn Trafford, he was a standout pitcher on the baseball team. After his high school career, James moved on to play junior college baseball, receiving All-American honors in 2010 and a scholarship to play at Northwestern Oklahoma State University. During his time at Northwestern Oklahoma State, Evan developed shoulder impingement in his throwing arm and took a medical redshirt in the process. Desiring to receive therapy back in Pittsburgh, Evan transferred to Penn State Greater Allegheny (PSGA) in the summer of 2012. He returned to health and his pitching form quickly, quickly, receiving All-American honors at PSGA in 2013.

On February 16, 2014, Evan was pitching in a live pre-season pitching/hitting session at PSGA with scouts present from the Tampa Bay Rays organization. During that live session, Evan was struck in the head by a line drive. The trauma he sustained was serious and life-threatening. Later that day he underwent emergency brain surgery and reconstructive repair of fractured skull and jawbones. Surgery left Evan with 4 plates and over 190 staples in head. He was told he would have a minimum 6-month recovery process and that he would never play baseball again.

Evan had different ideas. To his doctor’s surprise, Evan flew through his speech and physical therapy. He progressed so quickly that last month he received full clearance to resume physical training. He hopes to return to the mound at PSGA either this fall or spring of 2015. Beyond his collegiate career, Evan still has the potential to sign with the Tampa Bay Rays as the organization will continue to watch him.

As an athlete, injury is unfortunately part of sports. Athletics have varying degrees of both assumed and inherent structural risk to the human body, arguably making many sports we love to compete in “dangerous”. However, injury is not simply unique to sport. Frankly, injury seems to be part of life. Sure, there are preventative measures one can take to minimize or reduce the risk of injury. The reality is, there is no such thing as complete injury prevention. Similar to the weather, an honest professional will tell you we cannot forecast injury with absolute certainty. Yes, there are athletes who carry higher or lower “chances” of injury based on their movement quality and must be managed accordingly to minimize exercise-related or non-contact injuries. In some circumstances, such as collision/contact related injuries, injury is something we have little control over. Despite the lack of control we may have when it comes to injury, we do have the potential to influence the recovery and healing process for the better. This is good news since getting back to sport or living a "normal" life as quickly as possible is something most people would sign-up for in a heart beat.
Understanding the Healing Process
When you suffer any form of injury, the site of injury enters a traumatic state and inflammation occurs. For most people, inflammation brings negative thoughts to mind and their initial reaction is to stop it in its tracks. I mean, isn’t that what we’ve been told for years? But, is inflammation really unwanted or should we consider that it is part of our body’s process responsible for healing? The truth is, the right amount of inflammation is a good thing and necessary to initiate the healing process from injury. Inflammation provides signals to the body that something is wrong with certain structures or tissues. The body responds by kicking your immune system into high gear to start repairing damaged tissue.


When injured, the body needs to recover and you must supply it with the raw materials needed to promote optimal recovery. These raw materials come in the form of calories, protein, dietary fats, vitamins, and minerals from whole food or supplement sources. Ideally, nutritional strategies for injury recovery must be customized to the individual for optimal response. However, applying some general considerations can be beneficial in speeding up your return to play.

Nutritional Strategies for Injury Recovery
1) Calories
When injured, there is an increase in what is known as your Basal Metabolic Rate (BMR). BMR is essentially the energy (or calorie) expenditure while your body is at rest. When recovering from injury, BMR has been demonstrated to increase by 15-50% since your body is using more energy to repair and regenerate damaged tissues. The rise in BMR means you must increase your caloric intake accordingly to ensure optimal recovery.

For example, if your caloric intake is 3,500 kcal/day, your new caloric requirements could range from 4,025-5,250 kcal/day (15%-50%) during the recovery process.

2) Protein
Protein is an essential component of our cells, bones, muscles, organs, connective tissues, and skin. Protein is made up of individual amino acids. Amino acids are important for the repair and remodeling process that injured bone, muscle, or connective tissue undergoes during the healing process. The amount of protein the body utilizes for injury repair is significant and your daily protein intake will need to increase accordingly. To gain an understanding of how your protein intake should be adjusted during the healing process, let’s consider the following:

The average, sedentary individual may require an intake of 0.8g/kg of protein per day.  Athletes and highly active individuals can often require 1.0-1.5g/kg of protein per day.

          Example:  200 lb athlete = 91-136g of protein per day
That same athlete, when injured, may need 1.2-2.0 g/kg of protein per day.

          Example: 200 lb athlete = 110-182g of protein per day.
3) Dietary Fat
Dietary fat consumption should be devised to promote tissue healing and minimize unwanted inflammatory responses. It is well known that trans-fats and omega 6 fatty acids promote inflammation in the body. During the initial stages of healing, it is important to consume an appropriately balance of omega 6:omega 3 fatty acids. Consuming more omega 3 fatty acids helps to keep inflammation at adequate levels.

Rather than putting on number on dietary fat consumption during the recovery process, focus on making better food choices. This means increasing the consumption of quality, healthy fats such as coconut oil, butter, fish oil, avocados, and olive oil while doing your best to minimize or avoid eating foods high in omega 6 fatty acids such as fried foods or food sources that contain safflower oil, cottonseed oil, corn oil, and soybean oil.

4) Vitamins and Minerals
Vitamins and minerals are nutrients required by the body in relatively small amounts, but are critically important for a number of metabolic reactions essential in allowing the body not only to survive, but also to thrive. The process of recovering from injury only places a greater importance on key vitamins and minerals to ensure that metabolic processes involved in cell proliferation and tissue remodeling occurs appropriately.

Micronutrients such as Vitamins A, C, D, K and the B vitamins along with minerals such as magnesium, copper, and zinc can enhance the function of the immune system, assist in inflammation control and collagen synthesis, improve the production of red blood cells, and improve healing rate. Supplementation recommendations will depend upon appropriate therapeutic doses, as well as the individual and the extent of injury.

5) Herbs, Spices, and Tea
Certain herbs and spices have demonstrated impression abilities to manage inflammation during the acute phases of recovery. Some of the herbs and spices can even help reduce dependency of anti-inflammatory drugs.

Some examples of herbs, spices, or teas that can assist in inflammation/pain control as well as tissue regeneration are turmeric, ginger, garlic, bromelain, and green tea.

Concluding Thoughts
It’s important to help your patient, clients, or athletes understand sound nutritional habits and patterns during the injury recovery process since it brings special considerations to the forefront. Consuming adequate calories to provide enough energy and sufficient amounts of building blocks (both macro and micronutrients) for tissue repair and regeneration is critical to appropriate healing. When it comes to inflammation, remember the name of the game is inflammation control not inflammation suppression. Inflammation is needed for healing, but must be kept to sufficient levels. Both too little and too much inflammation can interfere with and delay the healing process.

Allow these nutritional strategies to work for you. Not only will they promote a faster return to sport and competition, but also ensure more comprehensive healing while reducing associated risks of re-injury.

More related reading:

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

https://gallagherperformance.com/the-hidden-causes-of-sports-injury/

https://gallagherperformance.com/resetting-bodys-function-post-injury/

https://gallagherperformance.com/dietary-fat-is-not-the-bad-guy/

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

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

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

What is Biological Stress?

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

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

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

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

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

• Training Volume
• Training Intensity
• Training Frequency
• Exercise Selection

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

“I really believe….that sports, high school sports, little league sports, have become year round. And they force these kids at a very young age to pick a sport and that’s the only sport that they play, they train at. And you have these….pitching academies and your kid comes in and pays $2000-$3000 and you go in every Saturday and work on pitching. And I tell parents this, “If the best pitchers in the world don’t pitch year round, then why should your kid pitch year round?”….You have to get all these great surgeons that do Tommy John surgery, or did Tommy John surgery, they cringe when you say ‘year round pitching’ because you must let the arm rest.”

Similar to the current trend of marketing driving training (discussed in this article), marketing appears to have a similar and undeniable impact on services provided in the world of physical medicine. From the latest and greatest in modalities such as laser therapy and electrical muscle stimulation to musculoskeletal injury interventions such as kinesio tape (KT), the colorful tape that gained popularity from the Olympics.

Earlier this week, a GP client was speaking of someone they know who recently got “taped” because they were having knee pain while running. This client went on to explain that a few days after getting taped, the very same person went out for a run and felt a “tearing and pop” in the same knee that had been taped and is now in worse pain than before.

Our client wanted to know, “What's the deal with the tape? Is it effective or is it a cheap trick?”

Kinesio Tape: Legit or Hype?
What seems to be at the center of any benefit from the application of KT is something known as novel sensory input. Basically, this means when you tape someone, they feel it. Sensory input changes “output” – in this case – motor control and perception of pain.

In the case of the painful knee (or any joint/muscle), stick some tape on it and odds are in your favor that the patient will feel slightly better for a brief period of time.
But is this really “therapy”, getting at the root of the problem, or simply masking pain symptoms?

First, we must start with an understanding of pain. Pain is your body’s way a telling you something is wrong. Pain with movement indicates a movement problem and no amount of tape will ever solve a movement/biomechanical problem. However, taping is very effective at altering proprioceptive/sensory feedback. Sensory input will dampen pain perception, thus making it easier for your brain to ignore pain signals and you are now feeling “less pain”. This is known as “sensory gating”.

You feel less pain and you are happy, so what’s the problem?

You have disrupted the injured tissue’s ability to tell the truth, now you are more likely to continually overload a compromised structure and worsen the condition. To illustrate this phenomenon, one only needs to recall Manteo Mitchell, the sprinter who sustained a fracture of his fibula – wearing KT – while running the 400m in 2012 Olympics. The applied KT allowed the athlete to distribute more load on a painful and compromised ankle. The tape did its job. It blocked pain and allowed the athlete to feel capable of competing, but unfortunately the result was a worse condition than before the tape was applied. Keep in mind, this isn’t always the outcome of taping but it certainly is a risk one must understand.

Not only are companies claiming the pain relieving benefits of KT, now some are stating how their tape prevents injury or enhances performance. Just go to their websites and read for yourself. Spider Tech’s website has the tag line: “Recovery, Performance, Prevention” and Rock Tape (on their About Us page) has this to say:

“I discovered that the tape can be used to ENHANCE PERFORMANCE. I found that taping in advance of exercise promotes increased blood flow to the muscles, thereby reducing fatigue.”

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

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

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

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

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

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

Why?

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

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

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

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

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

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

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

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

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

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

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

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

High-intensity interval training (HIIT) is a system of training characterized by high-intensity resistance or metabolic training with short/incomplete rest periods in between working sets. An example of HIIT is often advocated by Crossfit WODs (workout of the day) and other similar programs.

According to the American College of Sports Medicine, HIIT is now the most popular fitness trend. HIIT has tremendous appeal to those looking to shed unwanted body fat and ‘lean up’ or ‘get in shape’ quickly because of its ability to burn body fat more efficiently. HIIT has been shown to produce greater improvements in both aerobic and anaerobic capacity with less overall training volume when compared to individuals who only perform steady-state aerobic exercise. In the public eye, a huge upside to these workouts is they typically take less than 30 minutes to complete. Sounds too good to be true, right?

However, what is rarely if ever mentioned, is the number of injuries sustained by participants.

In my opinion and experience, which may be similar to what others are also observing, the number of injuries associated with HIIT appears to be on the rise. What is especially significant to note is that these injuries are often debilitating in nature.

Not only is HIIT growing in popularity among the general population, but it also seems to be a growing trend among athletes. The point of this article is to discuss why HIIT is not an appropriate training program for athletes and provide some insight into why athletes should avoid programs that advocate high-frequency application of HIIT methods.

Why Athletes Should Avoid HIIT
First and foremost, when training with heavy weights or performing complex motor skills (i.e. jumps, throws, sprints) it is highly critical that proper technique is learned during the initial stages of training. This is the key to not only continual development in regard to strength and all other physical abilities, but is fundamental to injury prevention.

Proper technique is the key to ensuring that strength developed becomes more useful not just in athletic skills, but also in everyday activities. For athletes, proper technique serves as the foundation for efficient execution of sport-related movement skills.

So why does HIIT fail athletes?

What appears to be most important in HIIT is overcoming a prescribed amount of resistance or finishing a prescribed number of reps in a designated amount of time, regardless of how it is done. From the start, HIIT does not place technique as the number one priority. For your viewing pleasure, Youtube provides numerous examples of this. I can recall watching a Crossfit workout during which a young female participant is doing her best to finish an overhead press. She had to contort her body in every way imaginable in her attempt to get the bar locked out overhead. Needless to say, I did not like what I saw.

What was even more disturbing to me was hearing the other members of the class cheering her on and applauding her when she finally locked out the bar overhead. They were encouraging her effort with absolutely no attention or care about her technique and safety. This is just one example of many that indicates how overcoming the weight was more important than how the lift was performed.
Other daily workouts may prescribe high-intensity metabolic conditioning that often requires participants to train to the point of exhaustion and, sometimes, to the point of throwing up. The mindset and main objective is primarily focused on overcoming a specific quantity of work as opposed to expressing quality in the work.
It is this mentality that can be detrimental to athletes and the general fitness population as well. There is a reason why physical therapists and chiropractors love Crossfit and other HIIT programs. HIIT programs are pretty good at producing patients.

Another unwanted factor associated with HIIT is the high degree of fatigue and lactate training loads. For athletes, how can they master movement and skill execution or build speed and strength in a fatigued state? The answer is they cannot. This is something the majority of coaches and trainers must understand. Lactate-based training is widely over-utilized and misplaced. This ultimately cuts into more productive training methods and increases the need for recovery. When it comes to HIIT programs, recovery is often not sufficient and will potentially push participants into a chronic state of fatigue or create an over-trained individual. Keep in mind, injuries are more likely to occur in a fatigued or over-trained state.

When it comes to HIIT, training principles regarding periodization, progressive overload, mastery of technique, specificity of training, and individualization of training are completely ignored. These principles, among others, are highly important when it comes to the safety and effectiveness of training athletes. They have been proven to be foundational in producing the most effective results from any training program.

Final Words
Training and sport science tells us that HIIT programs or any randomized high-intensity program is not conducive for efficient training and development of athletes in regards to strength, speed, power, and other physical abilities. Sure it may be trendy, but ask yourself does the program or exercise routine provide the development you want? Remember, development is always specific to your training demands. Also, ask yourself if your current training methods are more likely to make you a better athlete or a patient.

Related Articles:

Interval/Sprint Training vs Cardio: Which is Better for Fat Loss and Physique Development?
Training Hard vs Training Smart
Have You Mastered Your Movement?
2 Reasons For Your Lack of Results
Training for Elite Athletes

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

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

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

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

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

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

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

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

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

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

More related reading:

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

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

https://gallagherperformance.com/commonmistakesindevelopingyoungathletes/

Working with athletes to develop their performance brings on a host of unique challenges. Arguably the greatest challenge is associated with the intrinsic motivation level of young athletes. The varying levels of self-driven motivation among the young athletes at GP is interesting to observe, especially as the character of the athlete begins to emerge. Motivation level becomes even more apparent as we progress through the training program, taking notice of what the young athlete is willing to do on their own to improve their performance. Ultimately the question becomes, can they sustain the motivation year after year if they begin a structured training program early in their career? There are several factors which can influence an athlete's dedication, below are just a few that come to mind:

•  “My son/daughter is the best athlete on their team.”
• “ My son/daughter was just voted the best player in their age group at a recent camp.”
•  “My son/daughter is a natural athlete and they always get placed on the highest level teams in the area."

• Enthusiasm and Desire - Top athletes have a hunger, a fire inside which fuels their passion to achieve an important goal, regardless of their level of talent or ability.
• Courage to Succeed -  It takes courage to sacrifice, to work out when you’re tired, to seek out tough competition, to stick to your program, to test your limits, and to overcome obstacles.
•  Internal motivation and self-direction - Direction and drive need to come from within.  The goals must be ones that you have chosen because that’s exactly what you want to be doing.
• Commitment to Excellence - Elite athletes know that to excel at their sport, they must decide to make it a priority in their life.  They make an honest effort each day to be the best at what they do.  At some point you must say, I want to be really good at this; I want this to work.
• Discipline, Consistency, Organization - Elite athletes love what they do and it is easier for them to maintain consistency in training and in competing. Regardless of personal problems, fatigue, or difficult circumstances, they can generate the optimal amount of excitement and energy to do their best.
• Being focused and yet relaxed - Champions have the ability to maintain concentration for long periods of time. They can easily let go of distractions and take control of their attention. They don't let emotions get the best of them and cause poor performance.
• Ability to handle adversity - Top athletes know how to deal with difficult situations. Adversity builds character, but adversity also reveals character. When elite athletes know the odds are against them they embrace the chance to explore the outer limits of their potential.  Rather than avoiding pressure they feel challenged by it. They are calm and relaxed under fire. Setbacks become an opportunity for learning.

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

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

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

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

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

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

 

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

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

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

When it comes to athleticism, there is a sad misconception among far too many individuals that athletes are "born not made". People that believe this will often say, “You can’t teach speed” or “That’s just a gifted athlete”. While genetics can play a role in athleticism, arguably the greatest impact on an athlete’s development (or lack thereof) is the training system that is implemented. This would include all elements from its organization to exercise selection and other variables.

While all sports have their own unique considerations, ice hockey demands high levels of athleticism. The transfer of training from off-ice preparation to on-ice performance presents a host of challenges. With the nature of today’s game, proper off-ice training can provide youth and elite level hockey players with the advantage they need to elevate their game.

Here are some tips: 
1. WARM-UP PROPERLY 
In preparation for exercise, the body should be moved through large ranges in all three planes of motion (sagittal, frontal and transverse). Movement prepares the brain and body for exercise by activating the nervous system, warming tissues such as muscles and tendons, and lubricates joints. Movements performed in all planes of motion on a consistent basis will improve stabilization patterns, mobility, coordination, balance, and movement efficiency. Making the time to properly warm-up with allow you to get more out of your training. Simply put, it makes training more productive and will reduce the risk of injury.

2. TRAIN MOVEMENTS, NOT MUSCLES 
The human body operates as an integrated system. Joints and muscles are all coordinated by the central nervous system to produce movement. Muscles never work in isolation, meaning that there is always a pattern of muscle recruitment that occurs with every movement we make. Depending on how we recruit muscles, movement will occur in efficient or inefficient ways. Athletes require mastery of movement. Unlike those who train to for basic fitness or simply to ‘look better’, athletic development and performance-based training programs aim to improve how an athlete moves. Goals focus on strength, stability, mobility, speed, and skill execution with a high degree of movement efficiency.  Sure many athletes look good, but this is often a by-product of their training, not the primary goal.

There can be a mistake in young athletes simply go to the gym and “working out”, either by themselves or with their friends. Especially when they have no plan. If most young athletes are honest, they don’t know what to do during the off-season. Even some trainers have no idea what they are doing with athletes and just “make-up” a training session as they go or select a random workout off the Internet. As the saying goes, “One program on a dry erase board for your group of clients/athletes isn’t training, it’s babysitting.” Higher quality strength and athletic development programs are becoming more available to young athletes; those athletes not involved in those programs will be left behind.

This concept was detailed in our article on Training for Elite Athletes.

3. GET IN TOUCH WITH THE GROUND
This point builds off the previous one. The majority of sport movements and skill execution are initiated by applying force to the ground with the feet/legs. As with land-based sports, the more force a hockey player applies to the ice, the greater acceleration and speed they generate. Strength and power development exercises should be selected based on their ability to enhance ground-force reaction. The same can be said for both speed and conditioning drills.

Utilizing squat and deadlift variations, Olympic lifts, medicine ball throws, jumps, plyometrics, sprints, and hockey-specific agility/change of direction drills would be the most beneficial in developing ground-force reaction. Unilateral movements such as single-leg squats and jumps, lateral bounds, split squats, and lunge variations will also help to develop the movement proficiency need for a powerful skating stride.

4. TRAIN THE CORE FOR FUNCTION, NOT LOOKS
The core is the body’s center of force transfer and movement control. The core is not simply your abs. It includes almost 30 muscles that attach to the spine, shoulders and hips, which function to stabilize the areas during movement. When the function of the core is compromised, inefficient movement results and risk of injury is increased. Hockey and its movement skills require high levels of core stabilization, endurance, strength and power transfer. The demands of athletics on the core will never be met by performing thousands of crunches. Your core training needs a more specific, specialized focus.

Stabilization exercises should focus on things such as maintaining proper lumbo-pelvic posture and the ability to resist or control movement in all planes of motion. Once proper stabilization is achieved, greater attention can be given to rotational power and force generation exercises for increased transfer of training into sport.

5. BE SMART ABOUT YOUR CONDITIONING
The sport of ice hockey places demands on both the anaerobic (alactic and lactic) and aerobic energy systems of the body. For the most part, hockey is an anaerobic game, characterized by intense bursts followed by periods of rest. The anaerobic system is challenged during these intense bursts while the aerobic system is utilized during the recovery period between shifts. This illustrates the need for both systems to be well developed for optimal performance.

Thus conditioning for hockey should focus on an interval-based approach to meet the energy system demand of the sport. Place a priority on developing the capacity and power of the anaerobic-alactic system along with the use of tempo runs/bike sessions to develop the aerobic system. Anaerobic-lactic training is extremely taxing on the body and difficult to recover from. This form of exhaustive conditioning should be used less frequently in the training program.

Remember, conditioning does not mean the same thing as speed training. For more information of developing hockey speed, read this article.

6. RECOVER, RECOVER, RECOVER
Recovery from exercise can be accelerated with proper attention to flexibility, mobility, massage, chiropractic treatment, nutrition and sleep. These approaches facilitate the body’s ability to recover from exercise. Nutritionally, ingesting the proper amounts of whole foods and supplements at the appropriate times during the day can prove to be a huge part of the recovery process. Replenishing energy stores (i.e. muscle glycogen) and providing the building blocks (i.e. protein, fats, vitamins, minerals) for tissue repair and regeneration are just some of the primary goals of proper nutrition. Self-management strategies such as foam rolling and stretching/flexibility work are valuable components in the recovery process. Maintaining proper muscle function and joint range of motion is critically important to minimize injury risk and ensure that you get the most out of your training.

Conclusion
Keep in mind the above tips serve as guidelines. Individual considerations cannot be met in an article of this nature. However, if applied correctly, these guidelines can serve to provide aspiring hockey players with a better understanding of how to go about their off-ice training. For those interested, GP specializes in the training and preparation of hockey players. Contact us for more information.

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.