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Pain-Free Training Is A Myth



There seems to be a growing number of programs and trainers touting how they offer ‘pain-free training’ and that anything less than what they offer is simply inferior by design.

Any intelligent trainer, coach, or therapist will acknowledge the value of proper training to ensure no serious orthopedic issues develop. No one wants their clients becoming pain patients. Proper training is multi-faceted from proper form to proper exercise selection to proper volume and loading parameters. These are a given. These are essential to ensuring we minimize injury risk and improve tissue resilience.

However the reality is if you are going to push your body to new levels of performance, you are going to feel it. It’s going to be uncomfortable. It’s going to hurt at times. If you aren’t looking to better yourself, why are you even training in the first place? Essentially at the heart of training is pushing your body to a place it’s never been before. There aren’t many people out there who have pushed their bodies in training who haven’t ended up ‘feeling it’ in the form of soreness, physical discomfort, and yes - at times - pain.

By all means, yes, we shouldn’t train recklessly. We should be practical and intelligent in our execution of a training plan. But we also shouldn’t be alarmed and fear we are doing something terribly wrong when we deal with discomfort, aches and pains. It comes with the territory of pushing our bodies to new levels of fitness or performance. This is why recovery methods and seeking out qualified professional care from sports/rehab chiropractors, massage therapists, and physical therapists can do wonders for helping our bodies better manage the stress of training. ——

No one wants to be in pain, but push yourself hard enough for long enough, you’ll feel it. We need to understand better pain education, how to be more realistic with training expectations, and how to manage the stress of our bodies to avoid serious pain or orthopedic problems.

 
For more related reading:

https://gallagherperformance.com/the-site-of-pain-is-rarely-the-source-of-pain/

https://gallagherperformance.com/15-minutes-of-exercise-or-8-hours-of-pain/

https://gallagherperformance.com/groin-pain-rehabilitation/

https://gallagherperformance.com/pain-indicates-a-health-problem-not-a-fitness-problem/

Pain Indicates A Health Problem, Not A Fitness Problem




As Gray Cook says, pain indicates a health problem not a fitness problem. In rehab, we deal with pain and dysfunction. In exercise and training, we deal with dysfunction. Pain and health problems should be managed by a licensed professional with appropriate training.

Exercising in pain is not the solution and you should seek proper guidance on how to get out of pain and correct dysfunctions before resuming your regular exercise or training program. Otherwise you may just get stuck in the perpetual pain cycle. The plan is to reduce pain, improve the tolerance to exercise through graded exposure, dose exercise and train to correct dysfunctions.
The management of pain should not be left to unqualified individuals in the exercise/fitness industry. With the rise of continuing education programs and certifications intended to help fitness professionals identify, through screening, an individual's level of training readiness.

Movement screens are generally performed to assess for mechanical sensitivity (aka pain with movement) and/or abnormal motor control (aka movement dysfunction). The screens are usually graded on a scale to reflect a score indicative of that individual's current performance.

A sample scoring system would look something like this:

0 = pain

1 = can't perform movement or has loss of greater than 50% range of motion

2 = performs movement with compensation

3 = performs movement without compensation

Screening provides valuable information and obviously it is ideal to work one towards a higher movement score.

The issue I have taken up with screening is the tendency for some fitness professionals to act as a pseudo-therapist when a client is experiencing pain. In my opinion, unless you have a professional license to work with the human body (i.e. chiropractor, physical therapist, massage therapist, medical doctor, etc.) you have no business providing 'rehab' or 'advice' to a client. The best advice you can provide is to have them seek a professional medical opinion from a trusted source.

Again pain is a health problem, not a fitness problem. Most people within the fitness industry simply have a personal training certification. Managing a client's pain is not within your scope. Pain is a referral to a medical professional. Once pain is managed properly, then exercise is reintroduced.


Got pain?

Give our office a call and let us help you get out of pain by providing you the tools to understand your pain, how to prevent it, and how to improve the way your body functions. The model at Gallagher Performance was developed to bring excellence in both pain management and exercise/fitness education.

 
For more related reading:

 
https://gallagherperformance.com/solution-long-term-improvement-back-pain/

https://gallagherperformance.com/receiving-value-treatment-training/

https://gallagherperformance.com/a-movement-screen-will-never-show-movement-habits/



Exercise Hacks Ep. 13 - Horizontal Pressing Alternatives for Painful Shoulders


[embed]https://www.youtube.com/watch?v=LNH6aIezqd0[/embed]

Outside of low back pain, shoulder pain is one of the most prevalent musculoskeletal complaints. For avid exercisers and athletes, shoulder pain is something most are familiar with, especially when it comes to horizontal pressing movements.

The most popular of the horizontal pressing movements being the barbell bench press. Bench press often enough, long enough, and heavy enough, you will likely experience some degree of limitation due to shoulder pain or injury.

This can be for a number of reasons that all should be considered. But there is one reason why the barbell bench press becomes unfriendly to the shoulders - the fixed position the scapula (shoulder blades) are placed into.

Creating a tight upper back and stapling the scapula to the bench is critical for a big press as this forms the foundation for pressing.

But let's consider healthy shoulder motion is dependent upon a freely moving scapula. Otherwise too much stress is placed at the glenohumeral joint (shoulder joint). Yes, accessory exercises should be programmed to maintain healthy shoulders but there is only so much that can be done to offset thousands of pounds of bench pressing volume. We absolutely should be proactive in our approach to avoiding shoulder pain and/or injury.

That's why it is important to incorporate horizontal pressing movements that allow the scapula to move more freely. Whether they are used as a primary movement, accessory movement or alternative while the shoulder is on the mend, the exercises seem in this video can offer increased shoulder stability and motor control while giving your joints and connective tissue a break from intense training. See in this video are:

1) Standing Horizontal Cable Press

2) Stability Ball Dumbbell Press

3) Stability Ball Alternating DB Press

4) Stability Ball Single-Arm DB Press

A great benefit to these exercises is the amount of core and hip engagement required which is awesome for teaching force transfer through the body and how to steer strength.

Note: if performing heavy presses on a stability ball be sure to use a properly rated ball.

 
 
 
For more related reading:

https://gallagherperformance.com/advanced-training-for-elite-athletes/

https://gallagherperformance.com/effective-treatment-shoulder-pain/

The Site of Pain Is Rarely The Source of Pain

A testimonial worth sharing:

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

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

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

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

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

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

-Zaid Alzaid

 
For more related reading:

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

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

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

15 Minutes of Exercise OR 8+ Hours of Pain?

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

Exercise Hacks Ep. 5 - Shoulder External Rotation

[embed]https://www.youtube.com/watch?v=IIIQ_DLv6kw[/embed]

In this video, we discuss shoulder external rotation commonly performed on a cable column machine. This exercise is also frequently performed with the use of bands. Regardless of whether you use the cable column or bands, these pointers will still apply.

The quality of shoulder external rotation one can achieve plays a big role in overall shoulder health and upper body strength. Shoulder external rotation is dependent upon the quality of scapular stabilization one can achieve. That said, in order to improve shoulder external rotation, we can apply a hack to reflexively improve scapular stabilization.

By placing an object such as a yoga block, small exercise ball, or folded up towel or sweatshirt between your torso and elbow, we creating a fixed point to improve scapular stabilization. In doing this, it forces pure shoulder external rotation when the movement is performed well - making it very difficult to cheat!

Some key points discussed in this video:

  • The traditional cable column external rotation can be improved to heighten scapular stabilization and the demand on the external rotators/rotator cuff of the shoulder.
  • How to create a fixed point at the elbow to improve scapular stabilization by increased activation of the serrates anterior.
  • Avoiding ulnar deviation and maintaining a neutral wrist.
  • Increased global stabilization and muscular activation by setting the feet, hips, pelvis and spine into correct posture and utilize intra-abdominal pressure (IAP).
Thanks for watching and as always, let us know your questions or comments.

More related reading:

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

https://gallagherperformance.com/finding-a-solution-to-your-shoulder-pain/

https://gallagherperformance.com/exercise-hacks-ep-4-dumbbell-press/

https://gallagherperformance.com/exercise-hacks-ep-3-hand-support/

https://gallagherperformance.com/exercise-hacks-ep-2-scapular-upward-rotation/

https://gallagherperformance.com/exercise-hacks-ep-1-dumbbell-row/

Exercise Hacks Ep. 4 - The Dumbbell Press

[embed]https://www.instagram.com/p/Bcsrzr2jLxq/?taken-by=gallagherperformance[/embed]

In this video, we discuss the dumbbell press and how the position of the wrist impacts pressing strength and shoulder stability.

Wrist position is often overlooked during the dumbbell press but is a critical part of ideal mechanics. The wrist should maintain a neutral position during the entirety of the lift. Often you'll see wrist extension and/or ulnar deviation as a compensation when the wrist falls out of neutral position. We discuss ulnar deviation and making sure to avoid this position as it can place too much stress on the wrist and feed into reducing pressing power.

As usual, the key is finding and maintaining optimal stabilization of the shoulder and upper extremity. Avoiding wrist extension and ulnar deviation will keep the wrist and shoulders more stable, healthier and stronger. The goal is to improve performance while reducing the risk of injury and pain developing in the shoulders, elbows or wrists.

Some key points discussed in this video:

  • What ulnar deviation looks like and how to avoid it while holding dumbbells.
  • How to press through the dumbbell with correct hand and wrist position.
  • How ulnar deviation will cause the shoulder to destabilize and fall into internal rotation. This isn't ideal for shoulder health and pressing mechanics.
Thanks for watching and as always, let us know your questions or comments.

More related reading:

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

https://gallagherperformance.com/exercise-hacks-ep-1-dumbbell-row/

https://gallagherperformance.com/exercise-hacks-ep-2-scapular-upward-rotation/

https://gallagherperformance.com/exercise-hacks-ep-3-hand-support/

Exercise Hacks Ep. 3 - Hand support

[embed]https://www.instagram.com/p/BcaN02NDlZg/?taken-by=gallagherperformance[/embed]

In this video, we discuss the proper way to create ideal hand support during exercises which require you to have contact with the ground. When it comes to creating ideal scapular stabilization during hand supported exercise, how well someone loads the hand or supports from the hand will directly impact their shoulder.

By creating a stable hand, the scapular stabilizers can work more efficiently at holding your shoulder blade in the proper position during exercise. This applies to exercises such as push-ups, plank variations, hand walks or row variations that involve support from the hands.

Poor hand loading is often a reason for poor scapular stabilization, shoulder pain and poor shoulder function. Learn to properly load the hand and make improvement.

Some key points discussed in this video:

  • What proper hand loading looks and feels like. More importantly what improper hand loading looks and feels like.
  • How to create an awareness of proper hand loading and make sure you are maintaining it during your exercises.
  • How the hand and elbow positioning will influence your shoulder positioning. This is important as the position of these joints can destabilize the shoulder if they aren't position correctly.
Thanks for watching and as always, let us know your questions or comments.

More related reading:

https://gallagherperformance.com/finding-a-solution-to-your-shoulder-pain/

https://gallagherperformance.com/exercise-hacks-ep-2-scapular-upward-rotation/

https://gallagherperformance.com/exercise-hacks-ep-1-dumbbell-row/

 
 

The Beginner's Guide to Injury Recovery

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

When injury occurs, it is often advocated to rest. Rest is a critical part of healing and the amount of rest one needs will be determined by the severity of the injury. Injury is a balance of load and capacity of tissues within the body. Once we exceed the capacity of a tissue (bone, ligament, muscle, tendon, disc, etc.) with a certain load, injury occurs. Rest helps restore the capacity of tissues by minimizing or removing load and thus allowing healing to occur.

As critical as rest is to the healing process, movement is equally, if not more, critical. In the absence of severe injury and conditions where movement would be contraindicated (i.e. fracture, dislocation), movement serves to facilitate healing. The majority of musculoskeletal injuries heal best when we don’t avoid activity, but rather when we modify activity. The important factor here being that one finds activities they can perform without pain and that will facilitate healing through movement. This may be as simple as walking or gentle range of motion exercises. However knowing exactly what you should do for your specific injury can be a complicated answer. This brings me to my next point.

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

When injury occurs, people want a definitive answer when it comes to what they injured and how to manage it. And there are growing numbers that are seeking this information out online without ever consulting a licensed healthcare specialist. This could be due to frustrations with the medical model, a growing consciousness to seek out “non-traditional” or “alternative” therapies, or simply wanting to avoid paying out of pocket when there is free information available online. There can be the mentality of, “Why pay someone to fix me when I can learn to fix myself?” Not that this is wrong, but please understand that there are limitations when it comes to purely trying to self-manage your injury.

Let me illustrate this point with an example of someone who may go onto an internet forum or social media page and state, “If have an L4-L5 disc bulge with sciatica, what exercises should I do to help me get out of pain?”

If you are seeking an answer out online, keep in mind the most appropriate answer you should receive is, “It depends”.

Any advice you receive from someone who hasn’t evaluated you is truly just throwing darts in the dark and hoping something sticks. Most people on the internet and social media who are offering up advice when it comes to injury rehabilitation are not licensed to do so, thus you should be skeptical. Many of these same people try to position themselves as an expert for one reason or another, but reality remains they are not a licensed professional and thus you should be skeptical. Skeptical because how can someone tell you what to do when they haven’t evaluated you – in person.

When it comes to injury rehabilitation, the evaluation process is the most critical step to ensure no time is wasted in the early phases of rehab and to minimize complications. Evaluations should consist of orthopedic and neurological testing as well as biomechanical/functional testing to evaluate for structural pathology, movement sensitivities and functional deficits.

The sharing of symptoms through some online medium is extremely limited in its value and it inherently creates bias. It will bias the feedback and direction you receive from who you are seeking advice from since all they have to operate off of is what you tell them. But when you are evaluated live, in person, by a licensed professional, bias can fall by the wayside when things are discovered that you may not feel are all that important or relevant to your present injury. Yes, history and understanding your problem is important, but it’s only a part of the puzzle.

This is because as professionals, we are trained to evaluate with our eyes and hands to assist in the diagnosis of your condition.

Seek Out Professional Evaluation and Treatment

There are numerous products and programs currently online that essentially attempt to remove the need for someone to see a licensed professional for an injury or ailment. These products or programs will draw people in as they hope to learn what they can do to fix themselves. There is nothing wrong with that, as self-management strategies are important for anyone to learn. People who are dealing with pain or injury must learn why their pain or injury developed in the first place and what they can do to help prevent it from returning.

However the limitation to these products or programs is that they are mass marketed, attempting to appeal to a large audience and, therefore, are very general in nature. They are incapable of being highly specific to the individual. These programs or products may work for some, but when someone needs more individualized solutions they need to turn to a licensed professional such as a chiropractic rehabilitation specialist or physical therapist who approaches injuries and ailments from a functional perspective, not solely based on structural pathology.

Specialists exist for a reason. When your in-home or self-management strategies fail or if you are having persistent or worsening symptoms, you should seek out professional consultation. Specialist such as sports medicine physicians, rehabilitation chiropractors and physical therapists are capable of providing solutions to pain and injury through either diagnosing your condition, devising a rehab plan, and providing treatment. Massage therapists are another specialist to consider as many ailments and injuries have soft-tissue components that respond favorably to massage therapy by reducing pain and restoring muscle function.

Recognize the Gift of Injury

The recovery from injury is as much mental as it is physical. Believe it or not, there is a gift of injury – forced discipline.

What do I mean by forced discipline?

Injury often times forces us to confront the very reasons why we got injured in the first place. The reason could be faulty mechanics, sharp increases in workout or training volume, or ignoring warning signs our brain was sending us.

Professional specialists mentioned above should assist in the process of helping you recognize the reason(s) for your injury and given you the direction needed in your recovery. But it's upon you to be disciplined and mindful during your recovery process and beyond. This new sense of discipline can apply to making better decisions when it comes to your rehab program, your posture, your movement, and the amount of stress or work you place upon your body.

Failure to do so can often lead to someone rushing his or her own recovery, returning too soon to sport or activity or frequent relapses. Be disciplined and regain control of your body.

Understand the Science of Pain

Failure to apply discipline in your recovery can also result in the feeling that your injury will never heal. The reality is all injuries heal. But long after the site of injury has healed, pain can still persist. Pain becomes a reminder to some that they aren’t healed. They will believe they are still injured.

“So if my injury is healed, then why am I still in pain?”

Pain is a message from our brain that is meant to protect us. Even though pain is meant to protect us, pain is not a reliable source of indicating the extent of an injury or even where the injury is located. The classic example here is phantom limb pain. Amputees regularly will experience this phenomenon. One may experience left leg pain, yet they do not have a left leg. If pain is purely related to damage or injury, how would one experience pain in a limb that doesn’t exist?

The reality of pain perception can be a difficult education point as this is typically a new concept for the majority of patients and one they may need some time to understand. But it’s critical as their beliefs about pain can complicate the recovery process. It’s extremely beneficial for patients to learn about pain and address fear-avoidance behaviors and other factors that will interfere with reactivation into normal movement, activities of daily living and sport.

Gradual exposure to correct movement which takes stress of tissues can help to desensitize the brain to pain signals. Movement re-education serves to reduce pain signaling in the brain. As one learns to move better, pain goes down. You need to break your pain cycle with a better movement solution. It’s that simple.

Wrapping Up

Thanks for reading. We hope this post was helpful. Please leave any comments or questions you may have. Share this post with those who you feel can benefit from understanding how to better approach recovering from injury or pain.

 
More related reading:

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

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

https://gallagherperformance.com/technique_and_performance/

https://gallagherperformance.com/nutrition-for-faster-recovery-from-injury/

https://gallagherperformance.com/improved-approach-chronic-pain-management/

https://gallagherperformance.com/effective-treatment-shoulder-pain/

 

The BEST Way to Recover from Tendon Pain

[embed]https://www.youtube.com/watch?v=yzgQdT5KcI0[/embed]

Based on updated modern knowledge of tendinopathy, tendinitis, or tendon pain, let's shed some light on the best ways to rehabilitate for complete recovery. Part of this discussion will bust several "myths" or "misconceptions" that have existed about the treatment and management of tendon pain.

  1. MOVE! It is best to avoid complete rest as movement and blood flow is the driving force to the recovery and healing mechanisms of the body. Complete rest is ineffective as it decreases the ability of a tendon to handle load. Rather, you should reduce loads to a level that the tendon can tolerate and gradually rehabilitate the tendon back to proper function. It's important to understand what your movement sensitivities and limitations are and adapt accordingly. Being told to completely rest is poor advice as medical understanding of healing tendinopathies has greatly improved.
  2. PRIORITIZE ACTIVE REHAB OVER PASSIVE TREATMENT. Again this builds off our first point. Active rehabilitation that requires the movement of your body through proper joint range of motion under appropriate pain-free loads is proving to be the golden standard in recovery from tendon and joint pain. Passive treatments such as electric stimulation, laser, ultrasound, taping and cupping have very little evidence to support their long-term efficacy in treatment outcomes. But people love them cause they are easy. They are done to you, not by you. Sure they may provide short-term symptom relief, but they do little in regards to long-term progress. Why? Because these treatments do nothing in regards of improving the ability of the tendon to absorb and handle load. Therapeutic exercises aimed at restoring proper movement patterns with progressive loading is the key to retraining the ability of the tendon to handle load appropriately. Thus resulting in successful long-term outcomes from tendon pain. The reality is, the most effective stuff is usually the hard stuff. This is true in training, nutrition, and recovery. The hard stuff is always more effective than the easy stuff. Sure you may need some passive treatment to help control pain, but you will never fully heal a tendon without long-term focus on exercise-based rehabilitation.
  3. STOP IGNORING YOUR PAIN. Pain is the your body's way of telling you that the load you are placing on your tendon is too much. You must stop ignoring this and reduce your training load, volume or frequency. Again tendon pain is caused by routinely overloading the tendon. If you continue to overload your tendon, why do you ignore the pain or expect it to magically heal? Don't ignore the pain and realize your body is sending your a message that's worth your attention.
  4. DON'T STRETCH YOUR TENDONS. Stretching your tendons will only serve to further irritate and exacerbate your tendon pain. Stretching tendons can be detrimental to their structure and health. Our tendons work like a spring, absorbing and releasing forces as we move. Tendon stress is at it's highest when we do activities such as sprinting, jumping and throwing. This is when the spring function of a tendon is most critical. This is important to understand, as for many people they may only experience tendon pain during sports or exercise. If you stretch a spring, you will compromise it's function. Springs don't need to be flexible so please don't stretch your tendons.
  5. AVOID SHORTCUTS WITH REHABILITATION. When it comes to tendon pathologies or tendon pain, there are no shortcuts in rehab. There is no magical potion or pill or modality. Treatments or interventions that promise cures often provide short-term pain relief only for the pain to come back again. Even injection therapy has shown to be effective only when exercise-based rehabilitation is not. You must realize that our tendons need time to rebuild strength and proper function. Often they need a significant amount of time and rehabilitation can take months. If exercise-based rehabilitation is not a priority, then we have our answer as to why many deal with chronic or recurrent tendon pain as they aren't addressing the reason why their tendon pain developed in the first place.
More related reading:

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

https://gallagherperformance.com/prevent-re-injury-integrated-training-rehabilitation/

https://gallagherperformance.com/improved-approach-chronic-pain-management/

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

When Should I See A Chiropractor?

[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.
 
More related reading:

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

https://gallagherperformance.com/low_back_pain_treatments_that_just_wont_help/

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

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

https://gallagherperformance.com/effective-treatment-shoulder-pain/

https://gallagherperformance.com/solving-movement-problems-entertainment-vs-effective/

How DNS Solves Pain and Improves Performance

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

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

In this video you will learn:

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

 
https://gallagherperformance.com/tendinitis-changing-treatment-and-improving-recovery/

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

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

 

Improved Approach to Chronic Pain Management

Pain is incredibly complex, making the treatment and management of chronic or persistent pain a unique challenge. After reading this article, the hope is that you have a better understanding of the complexities of pain and how treatment must be directed if one is truly to overcome chronic pain.

Pain has a nasty habit of getting in the way of activities that we not only enjoy, but also the mundane tasks of everyday living. It becomes of paramount importance that treatment not only decreases pain, but also that the individual is able to resume activities that are important to them with improved function and mechanics.

To begin with, let's start with an understanding of pain and the reality behind why we perceive pain.

1) Pain is in the Brain
Pain is a message from our brain that is meant to protect us. Even though pain is meant to protect us, pain is not a reliable source of indicating the extent of an injury or even where the injury is located. The classic example here is phantom limb pain. Amputees regularly will experience this phenomenon. One may experience left leg pain, yet they do not have a left leg. If pain is purely related to damage or injury, how would one experience pain in a limb that doesn’t exist?

The reality of pain perception can be a difficult education point as this is typically a new concept for the majority of patients and one they may need some time to understand. But it’s critical as their beliefs about pain can complicate the recovery process. It’s extremely beneficial for patients to learn about pain and address fear-avoidance behaviors and other factors that will interfere with reactivation into normal movement and activities of daily living.

2) Hurt Doesn't Equal Harm
Another key component of the education process is that “hurt doesn’t equal harm”. Just because a movement or activity may “hurt” this doesn’t mean that you are doing harm to the body or damaging tissues. In fact, there is a growing body of research supporting poor correlation between pain and structural changes seen on advanced medical imaging. Just because one has degenerative joint disease, a disc bulge, or rotator cuff tear doesn’t mean they will have pain as these imaging findings are routinely found in asymptomatic individuals.

It’s important patients understand this concept because when it comes to exposure to movement through exercise, you don’t want the fear of structural damage to interfere with the ability to become more active. While not all movement will be pain free, movement isn’t causing harm. And that’s extremely powerful for patients to understand.

3) Movement is Medicine
Movement has the ability to be healing by reducing the pain response in our brain. Thus this is why movement is like medicine and why movement eventually has to take center stage in the management of chronic pain. Similar to manual therapy, graded exposure to movement through exercise will essentially teach your nervous system to “wind down” and not be as sensitive to pain. In doing so, you become more confident and reassured that you can do more without pain or the fear of a relapse in your condition.

4) The Work is Just Beginning
Unfortunately, the pain fix isn’t an overnight solution. For chronic pain patients, often times the rehabilitation process can take months of consistent work and repeated inputs to the nervous system to make a substantial change on pain and function. Repeated inputs come in the form of manual therapy and home exercise/self management strategies. Thus patient’s must understand the importance of compliance within their home exercise program as this makes a significant difference in their outcomes.

It’s important they understand the nervous system is easily tricked. It's easy to yield immediate change, but these changes should not be confused with lasting results. This concept is illustrated with any number of assessments commonly used in chiropractic and physical therapy offices – from leg length analysis to functional screens - as well as therapeutic interventions – from manual therapy to manipulation. By performing pre and post checks, it's possible to see immediate changes within one treatment. It can be easy to impact pain and create changes in range of motion or body function that have patients leaving your office feeling great.

But no single input can create lasting change. It requires multiple inputs over a period a time to create lasting change within the nervous system. This is why exercise and training is so important. If patients are not provided with the right exercises to compliment therapy, this is why they have pain relapses. Patients must exercise and must train to make a lasting change within their body. Otherwise they will get frustrated with chronic recurrences of leaving a provider's office feeling great only to experience a return of pain symptoms. And this becomes the pain cycle many become stuck in unless a change is made.

Break the Pain Cycle
If you are dealing with chronic or persistent pain or stuck in the pain cycle, the hope is that this article gets you thinking differently about how pain should be managed for successful outcomes. It’s why the management of painful conditions, especially chronic pain, must focus on pain education, the appropriate use of manual therapy (ex: joint mobilizations/manipulation, relaxation techniques such as PIR, soft-tissue and neurodynamic mobilizations) and graded movement exposure through exercise.

More related reading:

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

 

The Most Effective Treatment for Shoulder Pain

Our approach to working with shoulder pain or injuries is very unique in that we really don’t work around shoulder injuries when properly indicated. The majority of the time, we don’t force someone to rest for several days while inflammation quiets down. Yes, it can be necessary in rare circumstances. However, rest and traditional methods of ice and anti-inflammatory meds are often over utilized when properly prescribed movement (i.e. exercise) is probably the better bet for improved recovery. At Gallagher Performance, we have a nasty habit of getting our athletes, clients and patients to work through pain and injuries by strategically incorporating exercise with specialized approaches tailored to find “the hardest thing they do well”. We want to find what they can be successful with while not posing any undue risk. And the best part? The system works.

When it comes to the shoulder, pain and injury is most commonly associated with poor shoulder function and faulty mechanics. And when I say most commonly, it’s not a stretch to say over 50% of shoulder injuries are due to these underlying problems. If muscles are unable to fire properly to provide ideal amounts of support (stability) and motion (mobility), then injury will occur regardless of how strong or flexible one is.
I have written extensively on the subject of the “hidden cause of injury” since the root cause of the overwhelming major of musculoskeletal injury is dysfunctional movement. Most doctors and trainers do not have the training or eye to look for dysfunctional movement and no amount of rest, ice, and Advil will ever provide the solution. No amount of passive modalities, taping, cupping, mobility drills, or stretching will correct dysfunctional movement. When it comes to shoulders, the solution to reducing shoulder pain and preventing injury is all about restoring proper rhythm and mechanics of the shoulder joint. This includes all it’s associated articulations – the glenohumeral and scapulothoracic. Basically we have to improve how both the “ball and socket” joint or “shoulder joint” (as most of us know it) and “shoulder blade” function together.

When it comes to improving the function of the shoulder, we’ll take an athlete or patient and have them perform variations of rows, pulls, presses, and ground-based movements with adequate loads to reinforce ideal body mechanics and correct dysfunctional movement or stability patterns. This is done through a combination of exercises, tempos, external stimuli, and progressions to essentially re-educate the nervous system. This is why it’s called neuromuscular re-education. We must teach the nervous system to do things better and break bad habits. Yes bad habits can be very challenging to break. Most people would rather pop a pill or rest until their pain disappears rather than break bad habits because breaking bad habits sounds like hard work. Popping pills and rest are great because they are easy and effective. But those who deal with chronic recurrences may want to think about a different strategy once their patience wears thin.
For example, some lifters have such poor thoracic spine posture and scapular dyskinesis that they may need 6 months+ of rehab and corrective work. But they have no interest in that. They have no interest in stepping back a little and refocusing their training for long-term development. They prefer to band-aid symptoms while they push their training and perpetuate the pain cycle.

The funny thing is breaking bad habits isn't as hard as most people think. If you work with the right person you’d be surprised what proper coaching, cueing, and exercise can do in a relatively short period of time. The reality is most people are highly resistant to breaking bad habits because of either ego or the unwillingness to take a step backward. Typically after a number of training or therapy sessions, the individual is able to perform any and all movements without pain and with improved shoulder mechanics. For those dealing with shoulder pain, improving their mechanics through sensory-motor training enables their nervous system to be re-educated. This re-education process is the most effective form of therapy and healing available. It cannot be understated that a critical component of this process is proper coaching and cueing. This is the responsibility of the coach or therapist. As much as proper coaching and cueing can be beneficial, improper coaching and cueing can prove to be very damaging. It is my opinion that many injuries occur because the athlete or patient had previously received very poor coaching or instruction.

This is exactly why performing exercise with proper technique is proving to be the single most effective form of therapy as it promotes almost immediate healing. If someone is having pain during a movement, they are doing something wrong. Correct them into the proper movement and watch their pain disappear. The key is re-educating the nervous system so movement becomes both therapeutic and performance-enhancing to one’s body rather than promoting pain and destroying joints. This is truth when it comes to the shoulder joint as well as any joint within the human body.

Tired of pain? Want to reach your full potential? Visit gallagherperf.wpengine.com
EXPERIENCE THE DIFFERENCE.

More related reading:

https://gallagherperformance.com/finding-a-solution-to-your-shoulder-pain/

Solving Pain: The Influence of Czech Rehabilitation Techniques

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more on DNS here:

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

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

The Benefits of Spinal Manipulation

Spinal manipulation, also known as Chiropractic Manipulative Therapy, is an effective and efficient way to improve joint mechanics, reduce pain, improve mobility, and facilitate the acquisition of improved movements patterns when implemented strategically into treatment plans.

Yet the benefits of spinal manipulation, or chiropractic care in general, is still met with skepticism.

We are so far past establishing that there is evidence supporting spinal manipulation. Rather, we are moving in the direction of how to best establish the use of spinal manipulation in the management of specific musculoskeletal conditions and pain syndromes. The fact is that there are so many studies, systematic reviews, and meta-analyses done on spinal manipulation that a Medline search would be overwhelming to discuss.

The evidence is well summed up by a review of international low back pain guidelines. Over the last 10 years, 12 countries have done critical reviews of the scientific literature concerning low back pain. The international consensus is that the evidence supports chiropractic spinal manipulation as an effective tool in managing low back pain, and therefore is included in the recommendations.

However, the benefits of spinal manipulation do not begin and end with back pain. There are numerous benefits to spinal manipulation that make chiropractic care an invaluable addition to one’s health related or athletic pursuits. Below is just a short list.

  1. Joint pain relief - The most obvious benefit is relief of pain. Chiropractic manipulative therapy (CMT) can almost instantly relieve pain experienced in the low back, mid-back, neck, and extremities and has demonstrated this in research.
  2. Disc Bulge/Sciatica - The European Spine Journal published the findings from a clinical trial with chiropractic manipulative therapy showing 72% success rate in treating sciatica and associated symptoms. Disc bulges respond favorably to spinal manipulation techniques which focus on resorting joint mechanics and unloading the intervertebral discs.
  3. Headaches (tension and migraine) – There are hundreds of peer reviewed research articles demonstrating the ability spinal manipulation to prevent and ease the burden of headaches and migraines.
  4. Blood Pressure - In 2007, a team of researchers published a study in the Human Journal of Hypertension demonstrating that one upper cervical chiropractic adjustment had the same effect as two blood pressure-lowering drugs. Those effects were not simply short-term, they lasted more than six months.
  5. Surgery Prevention - The Journal of the American Medical Association recently published its low back pain guidelines and suggested that people suffering from back pain first try chiropractic before resorting to surgery. When appropriate, a growing number of physicians and specialists are recommending patients pursue conservative management of musculoskeletal conditions and pain syndromes before surgical intervention. The majority of these patients avoid surgery as they respond extremely well to conservative management via chiropractic care, physical therapy, or a combination.
  6. Athletic Performance - There is a reason why countless professional and Olympic athletes receive regular chiropractic care. The physiologic and neurologic benefit of spinal manipulation is super charged when used in a comprehensive care plan to address pain and dysfunction. Simply stated, muscles just work better when proper joint motion is restored via manipulative therapy. Athletes thrive on proprioception and motor responses from sensory input. Proprioception and motor response all improve from spinal manipulation. Coupled with exercises to facilitate motor skill acquisition, the short-term responses from spinal manipulation eventually become long-term improvements in movement quality and efficiency.
Based on my knowledge and experience as a sports performance and rehabilitation chiropractor, I’ve seen some surprising improvements with pain, joint proprioception and overall movement quality due to chiropractic spinal manipulation. When appropriately indicated, I regularly use spinal manipulation for reducing joint pain, improving joint mechanics, reducing muscle tension, and improving movement.

As stated above, spinal manipulation is a power tool that can be used within a comprehensive treatment plan. These treatment plans often utilize a variety of approaches that emphasize soft tissue work, guided exercises to improve stabilization and movement patterns, and patient education. These combined approaches serve as a “gold standard” for successful management and treatment of a number of musculoskeletal conditions.

To learn more about chiropractic and how it can be a benefit to your health or athletic goals, please contact our office at (724) 519-2833.

More related reading:

https://gallagherperformance.com/solution-long-term-improvement-back-pain/

https://gallagherperformance.com/the-solution-for-chronic-back-pain/

https://gallagherperformance.com/low_back_pain_causes_and_treatment_recommendations/

Painful Back? You May Be Hurting It By Stretching

What you need to know:

  • Many healthcare providers and trainers poorly understand how movement of the nervous system relates to several common pain syndromes and musculoskeletal conditions.
  • Dealing with neural tension is not as simple as just stretching. While stretching may feel good, it very easily may aggravate symptoms.
  • Once appropriate treatment of neural tension begins, patients often normalize their movement very quickly and experience pain relief. Often this pain relief is instantaneous.
What is Neural Tension?
Neural tension is rather unheard of yet it often plays a significant role in many pain syndromes and musculoskeletal conditions. We all understand for movement to occur in the body, joints must move and your muscles must contract. But did you know that your nervous system tissue must also move freely and unimpeded during movement?

Neural tension is commonly mistaken for muscle tension. Your nerves were not designed to stretch, but rather to glide and give during movement.
If some form of obstruction (soft tissue or bony) impedes your neural tissue then pain or restriction of normal nerve movement is a common result. This normal nerve movement may only be a matter of millimeters, but nerve tissue is highly sensitive and does not like to stretch. Thus if too much stretch is placed on a nerve, the result is adverse neural tension and that can create pain, limited range of motion, as well as other classical symptoms associated with nerve tissue (numbness, burning, shooting pain, etc.)

Neural Tension Treatment
The movement of your nerves, or neurodynamics, can be assessed by a licensed chiropractor or therapist trained in the process of detecting and treating neural tension. Screens or tests commonly used to identify neural tension help identify not only which nerve(s) have adverse neural tension but also where the nerve is being obstructed during its movement. Identify where the nerve is being obstructed is critically important because treatment is tailored to the site of obstruction.

Again, this highlights the importance of an accurate assessment as treatment can be more accurately applied to the structure(s) creating adverse neural tension. Once treatment begins, patients often normalize their movement very quickly and experience pain relief. Often this nerve pain relief is instantaneous.

What Conditions Commonly Involve Adverse Neural Tension?
Some common conditions that adverse neural tension often plays a role in or is a complicating factor that must be treated include:
  • Neck Pain
  • Shoulder Pain
  • Tennis Elbow
  • Carpal Tunnel Syndrome
  • Low Back Pain
  • Hip Pain
  • Sciatica
  • Plantar Fasciitis
Stretching vs Nerve Mobilizations
A common misconception in the treatment of back pain and associated muscle tightness is the idea that one must stretch to get relief. Stretching may bring temporary relief, only for one to experience the tightness come back once again or, worse yet, an increase in their pain.

Interestingly, when neural tension is identified as the underlying reason for muscle tightness, the treatment of neural tension doesn't actually involve stretching. Excessive stretching can actually irritate your nerves and increase pain. Excessive stretching may potentially damage your nerves as well.

This should make the message pretty clear - stretching may not be the best thing for your back when it's giving you all the signs that it isn't responding favorably.

Rather than stretching, restricted nerves and the surrounding muscles require a different approach known as nerve mobilizations or nerve sliders. Qualified chiropractors and physical therapists will utilize nerve mobilizations to help entraped nerves slide better during movement. They will also treat the surrounding muscles or tissues that is obstructing your normal nerve movement. After treatment, they will retest your neurodynamics and repeat the process until your full neural movement is restored. This process may take a few treatments to clear up, or take several, depending on severity.

Research Supports Neurodynamics
The concept of neurodynamics or neuromobilization is originally based on the research of Michael Shacklock and David Butler. Over the past several years, further research has added to the scientific support of the concept that your nerve tissue requires full freedom of movement to remain pain-free.

The following excerpts are from Michael Shacklock’s book Clinical Neurodynamics: a new system of musculoskeletal treatment:
"Neurodynamics is an innovative management tool involving conservative decompression of nerves, various neural mobilising techniques and patient education techniques. Neurodynamics offers a fresh understanding and management strategies for common syndromes such as plantar fasciitis, tennis elbow, nerve root disorders, carpal tunnel syndromes and spinal pain."

"Essentially the entire nervous system is a continuous structure and it moves and slides in the body as we move and the movement is related to critical physiological processes such as blood flow to neurones. This movement is quite dramatic and it is not hard to imagine that fluid such as blood in the nerve bed, a constricting scar, inflammation around the nerve or a nerve having to contend with arthritic changes or proximity to an unstable joint could have damaging effects, some of which could lead to pain."
Final Words
Neural tension can be present with many common musculoskeletal conditions, such as back pain. Very often neural tension is easily mistaken for muscle tension, leading many to want to stretch in order to find relief. Stretching can be counterproductive and may aggravate pain symptoms. In order to treat neural tension, it must be examined accordingly. At GP, we are trained in detecting and treating adverse neural tension and why it is present.

If your pain is not resolving with other interventions, consider your pain may be associated with neural tension and you may benefit from the most appropriate course of treatment and client education.

More related reading:

https://gallagherperformance.com/why-stretching-wont-solve-your-tight-muscles/

 

Dynamic Neuromuscular Stabilization: Advancing Therapy & Performance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What's the Deal with the Tape?

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.”
Marketing with fancy words and convenient KT placement on some elite athletes does wonders for a product’s popularity. But are the claims substantiated?

There are few high-quality studies on taping, but a recent systematic review of the research literature revealed that KT had insufficient evidence to support its use for musculoskeletal injury. Studies have shown that benefits from KT are generally minor, brief and inconsistent in nature. The value of taping is unclear, with several experts dismissing the effectiveness of taping as placebo only. The systematic review conclude that KT did provide short-term pain relief and even range of motion (ROM) improvement, but failed to offer any long-term results to patients.

In Closing
For the most part, taping is a lot of marketing hype. At best, taping is mostly a minor and imprecise method of pain control. The amount of tape being used by athletes lately is silly and, in my opinion, its popularity has more to do with marketing than results. Sure taping may make someone feel better and in a “results now” society this can go a long way to keep patients satisfied. However, there is no long-term solution to be found with any amount of tape.

Where does one turn for a long-term solution?

At GP, we consider ourselves part of a growing body of providers who strive to identify the repetitive movements and postural abnormalities that cause pain and discomfort by performing thorough and detailed examinations. Assessments and individualized treatment plans aim to identify the underlying cause of your condition rather than merely alleviating symptoms.

The more accurate the assessment, the more accurately treatment will target a patient's pain generators. At GP, we stress a collective and active approach on the part of each of our patients through education. By clearly educating each patient on their condition and why they are performing prescribed exercises, the focus becomes about patient empowerment and providing them with a sense of what they can do for themselves. This typically results in great patient compliance and shorter treatment plans, with the average patient realizing fully recovery in 4-8 treatments. Many patients quickly improve in as little as 2-3 treatments.

Reference:
Mostafavifar M, Wertz J, Borchers J. A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. Phys Sportsmed. 2012 Nov;40(4):33-40.

 
More related reading:

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

https://gallagherperformance.com/technique_and_performance/

https://gallagherperformance.com/why-therapists-should-understand-strength/

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