[embed]https://www.youtube.com/watch?v=pmkt-yv3JZ0[/embed]

Nothing beats properly performed squats, deadlifts, lunges, and RDLs for glutes that not only look great but work even better. Proper glute function is critical to hip extension that is prevalent in every day life (walking, sit to stand, hip hinge, lifting) as well as sport (running, sprinting, throwing, jumping, skating) Problem is most people don’t perform the big exercises well and therefore resort to ways to “activate” or better “isolate” glute function. This is why hip thrusts exist. They have their place when used with a plan and purpose. The single leg hip thrust is an advanced progression that is often performed incorrectly. The biggest mistake being the unleveling of the hips that can occur during the movement. By using the external cue of a tennis ball, we can promote better technique that results in improved muscular coordination of the glutes and core. This translates into more efficient movement mechanics, not only in this exercise, but in life and sport as well. Hopefully the video explains the set-up and execution well enough for you to give it a try.

 
For more related reading:

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

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

https://gallagherperformance.com/the-essentials-of-hamstring-rehab/

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

Our brain controls our posture and our muscles. Therefore posture and muscle tone (i.e. how tight or relaxed a muscle is) is an expression of the brain. We must pay attention to this expression and how it relates to movement.

A frequent cause of disturbance in our movement quality, why muscles get tight, why we display poor posture, and why we may have trigger points or pain is due to insufficient muscular stabilization of our spine.

Insufficiency is our stabilization system is exactly the reason why patients and athletes who have poor body awareness demonstrate poor ability to simply relaxation. Believe it or not, relaxation is easier said than done. If the brain doesn't know how to relax fully certain muscles, the low-grade state of contraction will keep muscles and surrounding joints under constant stress. This constant stress will ultimately lead to trigger points in muscles, dysfunctional movement patterns, and altered posture.

This is why specific exercise progressions that respect the developmental aspects of posture and movement are so critical. Exercise should not only address muscle function, but it must also address brain control to change how our body functions.

"Brain Education" focuses on the efficiency of our postural and movement control to avoid overloading of specific tissues and joints while promoting muscular balance.

Movement and relaxation is a skill. It must be practice daily through purposeful exercise with complete awareness to the feeling of the movement. This is the gateway to change in the body. These changes are valuable to anyone who is simply looking to get out of pain or improve their athletic ability.

However, there are still those that challenge the notion that there is an “ideal” or “good” posture. They will have you believe that there is no such thing as “good” or “bad” posture. The reality is, when it comes down to determining what is “good” or “bad” posture can be simply summed up by saying….”It depends.”

What will dictate “good” or “bad” when it comes to form or posture will depend upon a number of variables specific to the individual. We can find efficient form and ideal posture that someone should respect and when they don’t, the result is excessive wear and tear on their joints and tissues, leading to pain and progression of degenerative changes.

Yes we need to be efficient in movement and have a vast movement capacity. Yes there is no single posture that we should maintain for an extended period of time, no matter how “good” it is.

But those notions go out the window when our body meets increasing external resistance to our movement or we are performing movement at increasing speeds.

What does that mean?

Yes, we should be able to flex our spines and perform a body weight squat with posterior pelvic tilt (aka the dreaded “butt wink”) and resultant lumbar spine flexion. Yes this would be considered normal healthy human motion. But that doesn’t mean that one should perform a loaded barbell squat with the same intent or form. This could be an injury waiting to happen. When increased load or speed of movement comes into the picture (ex. barbell squat), very specific considerations must be made to that individual on the form and posture they express during the squat pattern to maximize their muscular efficiency and minimize stress placed on the joints.

These are the same considerations that must be respected when it comes to rehab and the subsequent development of fitness/physical ability. According to McGill, this breaks down into two stages:

• Stabilization of the injury and reduction of pain by approaches that follow desensitization and healing.
• Development of strength and physical ability only begins when the first stage has been achieved.

[embed]https://www.youtube.com/watch?v=oZUKOz1iuhk[/embed]

This video highlights the hamstring rehab with Carter Henderson. Carter was a standout linebacker at Duquesne University, leading the team in tackles the last two seasons. Now he is in preparation for an NFL Pro Day.

Carter came to GP for rehab of a hamstring pull 12 days out from his Pro Day. His initial 5 days focused on manual therapy, eleetromuscular stimulation (EMS), with a primary emphasis on exercise progressions based on his tolerances and weaknesses. Focus was placed on exercise specificity to the stresses the hamstrings encounter during sprinting. We aimed to match joint angles, mechanics, and dynamics as they relate to his sprint form and lateral movement.

Days 6-8 on his rehab focused on tempo runs and flying 40s, keeping intensity below 75% effort. Gradually worked into higher intensities with specificity to pro day drills. Focus still on manual therapy, joint mobilizations and manipulation when indicated.

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

The act of ‘pulling’ a hamstring usually occurs at high speed running during the terminal swing phase of the gait cycle. As the hip is decelerating the forceful momentum as the leg swings forward, the hamstrings are loaded and lengthening as you are finishing the swing phase before foot strike. There are predisposing factors that ultimately cause the hamstring to be compromised such as:

1. Poor neuromuscular control of the lumbopelvic region,
2. Asymmetries in muscle length and/or hip range of motion, and
3. Sacroiliac joint dysfunction

Movement screens or testing can offer valuable insight into why you have pain or limited function.

However what tends to be more valuable is when someone help you understand your movement habits.

By observing how someone moves and the postures they assume during daily activities - walking, bending, twisting, reaching, pushing, or pulling - we can tell you more about the chronic stresses that may be the major contributors to your current problem.

Just because you are in pain or injured does not mean you are fragile. Patient advice, education, and treatment that carries an over reliance on rest, ice, immobilization, and drugs only promotes fear-avoidance behaviors in patients - leaving them feeling fragile. What they need instead is graded exposure and reactivation to physical activity through movement re-education, strength training, and re-conditioning.

Research and clinical guidelines are consistently supporting exercise as THE number one intervention for back and joint pain.

Exercise provides the best long term outcomes. Sadly most people are never introduced to proper exercise for their back/joint pain OR would rather simply mask their pain symptoms with a drug, brace, tape, or some sort of passive modality yet they wonder why their pain continues to return.

These interventions have their merit, I'm not dismissing them as useless. However, when there is an over reliance upon these interventions without a shift in focus to graded exposure to physical activity through movement and exercise - it is easy to conclude why some people fail to get out of pain.

It's one thing to change pain, it's another to change how the body functions and impact the reasons WHY you developed pain in the first place. If you don't change function, this is the reason why patients relapse often.

Exercise become our gateway to change in the body. Exercise is treated like a drug in terms of dose and response. We need to dose (i.e. how much, what kinds, how often) exercise appropriately in order to get the ideal response (i.e. reduced pain, improved function).

Proper movement and smart exercise is the best medicine so let's dish it out!

You can accomplish more than you can imagine in just 15 minutes of daily, targeted exercise that is intelligently implement to address your weaknesses and eliminate your pain generators. Or the other option is to spend the majority of your day in pain, implementing questionable interventions that will do little to solve your problem in the long term.

Exercise should be viewed as a means to improve your quality of life. A means to make every day activities easier on your body. Or a means to improve function and therefore improving endurance, strength, power, and athleticism.

If you are ready to eliminate pain, erase weaknesses, improve how your body functions, or simply get in the best shape of your life - Gallagher Performance will get you on the right track to achieve those goals.

 
More related reading:

https://www.gallagherperformance.com/blog/a-powerful-innovative-approach-to-improving-how-the-body-functions

https://www.gallagherperformance.com/blog/tendinopathy-changing-treatment-and-improving-recovery

https://www.gallagherperformance.com/blog/how-movement-improves-brain-function

https://www.gallagherperformance.com/blog/how-dns-solves-pain-and-improves-performance

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

Two common sites for pain and movement problems are the low back and sacroiliac (SI) joints. The SI joints are a common site for sensitivity due to biomechanical overload.

Once we have screened for sensitivities, pain generators and movement dysfunction, the presence of SI joint dysfunction is often found along with poor abdominal sling function. Chiropractic adjustments are great for addressing joint dysfunction, but we must train movement through specific exercise.

The combination of chiropractic/manual therapy and massage therapy paired with smart training can make a profound impact on any musculoskeletal condition you may be dealing with. There's tremendous value in care and training that focuses on the goals and outcomes you care about. You place a value on your health or performance and you should receive services that deliver value.

The challenge is finding a chiropractor, therapist, or trainer who aligns with your values and the value that you place on your body and health. There's a spectrum on which these providers exist and it becomes your responsibility to do your homework. To make sure you find someone that can deliver the care, quality, results, and value that you're looking for.

When it comes to health, fitness, or athletic goals, there is no secret. There is no special exercise class, no special equipment or supplement. There is no magic. Yet people keep looking for one.

The truth is there are no shortcuts and anyone promoting shortcuts is lying to you. And if you bought it, you were buying 'hope' only to discover you actually got a bunch of nonsense that left you disappointed and frustrated.

Chasing shortcuts is a mentality that is robbing people of not only achieving their goals, but the ability to maintain them. If you some how think that serious health and fitness goals are able to be achieved with anything less than 100% commitment, dedication, discipline, and will power to sacrifice for your goals - there is nothing anything or anyone can magically do for you.

[embed]https://www.youtube.com/watch?v=WwIba7PpgXA[/embed]

Keeping with the concept of core stability and hip mobility, the shin box has become a popular drill for improving hip rotation, eccentric loading of the hips, as well as reinforcing ideal intra-abdominal pressure (IAP) and core stability.

Ideally the shin box is performed in a progression of static to dynamic variations. Progressions are dependent upon the ability to achieve ideal external rotation in the lead leg and internal rotation in the trail leg while maintain an upright, braced torso with sufficient IAP.

You've thought about seeing a chiropractor before, but have hesitated because you:

• Heard it was "BS" or "quackery"
• Thought that once you start going, you'll have to go for life
• Were afraid of being adjusted
• Thought they just won't be able to help

1. Solve joint and muscle pain without unnecessary medication or surgery

2. Manage complicated disorders

3. Prevent future episodes of pain by changing function

• Make sense of what a patients says
• Know exactly what a patient needs
• Confidently provide gold standard advice and treatment interventions

4. Enjoy a healthier lifestyle

5. Enhanced performance

Wrapping Up

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

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

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

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

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

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

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

 
For more reading:

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

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

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

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

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

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.

[embed]https://www.youtube.com/watch?v=W6qNeTnJdyU[/embed]

In this video we discuss two deadlift variations that will build rock solid functional core strength - the suitcase deadlift and pitchfork deadlift.

The suitcase deadlift and pitchfork deadlift are two deadlift variations that will expose energy leaks and strength imbalances real quick. Building a functional core often requires unconventional methods that go beyond aesthetically driven exercises. While unconventional these exercises force the lifter to generate total body tension to complete the lift - which makes them an awesome tool to teach lifters how to generate and maintain tension during squats, deadlifts or heavier training.
Each variation offers something unique.
1) The Suitcase Deadlift -  targets the lateral stabilization system or lateral line in the body as detailed in Anatomy Trains. The lateral line will create or resist lateral bend in the body and serves as a 'brake' for lateral and rotational movements of the trunk. The lateral line runs in balance on both the right and left side of the body from the skull down to the trunk and lateral aspect of the hips, thighs, calves and mid-point of the foot.
2) The Pitchfork Deadlift - this variation of the pitchfork deadlift also targets the lateral stabilization system while forcing the lifter to resist rotation. It really hammers the spiral line detailed by Thomas Myers in Anatomy Trains. The spiral line is responsible creating or resisting rotations in the body. The spiral line is a myofascial sling that includes musculature that begins in the neck down to the opposite shoulder and then to the same side hip, knee, and foot arch, then up the back of the body to rejoin the fascia on the skull. 
The bonus is both these exercises will reinforce patterns of stabilization in the body that are essential to movement.
These exercises are advanced and it is not recommended to go try them just to see if you can do them. They require a certain level of stability, coordination and strength to be able to do. Respect the process needed to progress to these exercises.
 
More related reading:

https://gallagherperformance.com/movement-improves-brain-function/

https://gallagherperformance.com/athletes-do-not-need-balance-to-be-successful/

https://gallagherperformance.com/the-essentials-of-speed-training/

https://gallagherperformance.com/fascia_muscular-adhesions_how_they_relate-_to_pain_and_overuse_injuries/

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

 
 

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 Rest

Don’t Rely on Social Media Gurus to Solve Your Injury

Seek Out Professional Evaluation and Treatment

Recognize the Gift of Injury

Understand the Science of Pain

Wrapping Up

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

Clinically Pressed Podcast Episode 38

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

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

Website: clinicallypressed.com
Facebook: Clinically Pressed
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Newsletter: Total Athletic Therapy
From the Clinically Pressed website, here the notes from the show:

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

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

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

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

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

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

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

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

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

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

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

Scoliosis.

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

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

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

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

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

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

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

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

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

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

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

1. Observation
2. Bracing
3. Surgery

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

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

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

Some points to consider:

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

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

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

Key take home points:

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

"After an injury tissues heal, but muscles learn. They readily develop habits of guarding that outlast the injury" - Janet Travell, MD

1. Therapeutic exercise is the most evidence-based treatment.
2. Passive treatments (tape, modalities,etc.) may offer temporary relief but are not helpful in medium and long term recovery.
3. Injections and surgery have been not shown any greater effectiveness in outcomes than exercise.
4. 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.
5. 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.
6. 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.
7. 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.