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Posture & Movement Require Brain Education

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.
In order to desensitize the patient, we must promote postures and movement that minimize stress on the joints and injured tissues. Otherwise, as stated by Mosley, most people will “wind up” their nervous system as a way to over-protect because they are aren’t prepared for what they are asking their body to do. Desensitization and reducing perceived threat is critical in the first stage of healing.

Once pain is reduced, the development of specific fitness qualities can take center stage. This is when we address the complexity of the movement system. Panjabi established the importance of the passive, active, and neural systems for trunk/core stability and movement. Jull and Richardson found in voluntary movement, activity of the deep spinal muscles precedes activations of the superficial muscles (aka feed forward mechanism).

The integrated spinal stabilization system (ISSS) serves as the “feed forward stabilization mechanism”. The ISSS consists of the diaphragm, pelvic floor, all parts of the abdominal wall, short intersegmental spinal muscles, deep neck flexors, and serratus anterior.  We know that these muscles essentially form the “deep core” that is so important to train for efficiency of posture and movement.

The ISSS required “Brain Education” to work optimally. There is no way around it. We must focus our attention and efforts to ensuring that no matter the task, we must rely of the ISSS if we are going to realize our movement potential, maintain healthy posture, and minimize joint pain.

Don’t fall into the trap of believing someone who says “good” or “bad” posture doesn’t exist. Again the answer is it all depends. Posture and the considerations we make regarding it are always specific to the individual and task at hand. Posture shouldn’t handled in a general approach. Most rehab, training programs and online instruction is handled in an over-generalized fashion. When people need specific, when they need individualized considerations. And that’s the best approach when it comes to helping one learn how to educate their body in regards to what’s best for their posture and movement.

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Dynamic Duo - Chiropractic and DNS

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.

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A Solution to Headaches

Headaches are among the most frustrating and debilitating conditions seen by healthcare practitioners, from primary care physicians to chiropractors. When severe enough, headaches may interfere or prevent even the most basic daily activities that we take for granted, such as thinking, talking, and reading.

While a logical assumption would be that the origin of headaches is in the head itself, science suggests many of the most common headaches are generated from the joints, muscles, and nerves of the neck.

The head and neck is an inherently unstable system that requires a complex neuromuscular system to surround the spinal column for control of movement and protection from injury. 

Many daily activities, such as prolonged sitting and poor posture, can affect the function and health of the joints, muscles, and nerves of the neck. Poor posture or prolonged postures common to students and the majority of the working class can lead to muscular imbalances, restricted joint motion, and unnecessary strain on the neck and upper back often responsible for headaches.

Referred pain and micro-trauma explain how this strain often results in headaches. Referred pain is a neurological phenomenon which is responsible for the perception of pain at a location other than where the problem exists. Using the headache as our example, the problem exists in your neck or upper back, yet your symptoms and perception of pain exists in your head. Micro-trauma is cumulative, small scale damage that occurs in and between soft tissues (muscles, tendons, joint capsules, ligaments and nerves) in response to strain. The bodies response to this strain is to lay down small amounts of repair tissue. Over time, a build up of repair tissue can form adhesions or scar within the soft tissue altering function. Left untreated, these adhesions often lead to pain, tightness, stiffness, restricted motion, and diminished blood flow. The result is a negative feedback cycle, the cumulative injury cycle.

So how do we stop the cycle?

Massage therapy, myofascial release, and IASTM (instrument assisted soft tissue mobilization) techniques are just some of the tools utilized at Gallagher Performance to address scar tissue adhesions and neurological dysfunction in soft tissue. Along with these tools, we often utilize chiropractic manipulative therapy (adjustments), sensory motor stimulation, and Dynamic Neuromuscular Stabilization (DNS) to improve posture, positional awareness, and help restore muscular balance. The combination of these therapies have helped numerous patients find a solution to chronic headaches or migraines.

The next time your dealing with a headache, consider Gallagher Performance. There is a solution to headaches that doesn't involve taking medication. Call our office at (724) 519-2833 to schedule your appointment.

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Interview with Ben Gallagher DPT, FMSC

GP recently interviewed Ben Gallagher DPT, FMSC. If you happened to figure out that Dr. Ben is related to us, you are correct. Ben is a physical therapist at Somerset (PA) Hospital Rehabilitation and Wellness Center. As brothers, we share some very similar concepts in the treatment of patients. But, we also share contrasting viewpoints, which makes it fun to learn from each other and gain a better understanding of the professional roles we serve in providing improved quality of patient care.

Now, let's get to the questions.

GP: Please introduce yourself and give our readers some information on your professional, educational, and athletic background (as well as what you have had to overcome since birth in order to participate in athletics).
BG: My name is Ben Gallagher, brother to Sean and Ryan. I live in Somerset, PA with my wife and daughter. I am a physical therapist and have been working at Somerset Hospital Rehabilitation and Wellness Center for over two years. I graduated from Indiana University of Pennsylvania (IUP) with a degree in Exercise Science in 2008. Then went on to Saint Francis (PA) University to get my Doctorate in Physical Therapy, graduating in 2012. Since graduating I have become FMS (Functional Movement Screen) certified, focusing my continuing education on movement analysis and manual therapies thus far.

Athletically, I grew up playing most sports, mainly focusing on basketball until the 8th grade when I got into ice-hockey as a goaltender, then that became my passion. I played through high school and into college at IUP. As for what I had to "overcome," that would be referencing my heart condition. I was born with Tetrology of Fallot, a congenital disorder that required surgery as a young child and again in 2008, and another in about 15-20 years. The condition restricted me from some sports and it is not advised I lift max weights, placing a limitation of how I could physically train for sport. However, prior to my 2008 surgery, in which my heart was over 3x normal size, I had no issues or symptoms. The doctors attributed my training to why I could function so well with such a crappy heart. Training was a mainstay, and still is.

GP: The thought process in your evaluation and management of patients is not widely instructed in physical therapy programs. What were the biggest influences in your professional development in not only the care that you provide, but also why you sought out additional resources beyond what you learned in school?
BG: The purpose of physical therapy school is to: 1) make sure you pass the licensure exam, and 2) make sure you don't seriously hurt anyone. As for producing quality clinicians? No. School just teaches you the basics, and most practicing therapists provide you just that, the basics, which is what you could find on a Google search. So, as for what helped my professional development, honestly the biggest thing was I just thought differently. I saw things differently and I attribute that to my athletic background and training history. For example, as a PT student I would tell my class-mates, "I'm gonna have my grandmas deadlifting." My classmates would gasp, as if that was the most absurd thing they ever heard. But my thinking was, "If someone needs to build strength, why am I gonna have them lie down and lift their leg? When I want to build strength, I train the squat and deadlift, so how couldn't the same application benefit my patients?" Now let me clarify, not all movements are appropriate for all people, at all times. That's why programs need to be individualized, not cookie-cutter.

So for me, I thought, why do I want to further inundate myself with PT knowledge that is elementary and narrow-minded. I sought out other means to fill that thirst for a fuller, better understanding of how the body functions. FMS, which is for any health or fitness professional, is just one of many means to that end that I am pursuing.

Plus, I have to add this: In reference to the grandmas deadlifting story, there was a research article published shortly after in regards to the most effective exercises to strengthen the hips. The study basically ridiculed all traditional PT exercises and found the most effective was a single-leg deadlift. How 'bout them apples?

GP: You are extremely involved with your patient’s care, preferring to perform a lot of manual therapy and oversee the exercise process. This is not common of the majority of physical therapists. Can you speak to why you find this so valuable in the outcomes your patients are able to achieve?
BG: I don't even know where to begin with this issue. I get fired up about the lack of quality care there is in this field.  Most therapists treat with a shot-gun approach, meaning they're not sure what is really going on or how to treat so they will throw a ton of stuff at you hoping something sticks and works. But the best in rehab are like snipers. They isolate what the exact issue is and address it appropriately. And how can you do that if you are not present and in the mix with your patient's rehab process?

GP: As a physical therapist, you see tremendous value in what chiropractic care has to offer. Could you please give your thoughts on what makes chiropractic and physical therapy so complementary?
BG: Following off the above question, when you are involved with your patient's care, you may find that some issue(s) may be out of your scope and there may be better, more skilled hands that are able to provide effective care. How can one means of healthcare be the most effective? What is most effective is what the patient needs. How can chiropractic care be so bad, which is the view of many therapists, when chiropractors help so many? And how can therapists think we are the kings of rehab and exercise when many therapists stick you on a machine and walk away? I have referred patients to chiropractors and massage therapists. But, I do so instructing them on what they need to share with those professionals, because just going blindly to another professional does not always mean you will get quality care. Chiropractor, massage therapist, physical therapist, strength coach….I don't care what your title is; if you're good, you're good.

GP: Posture, stability, and mobility are intensely debated topics at conferences and continuing education seminars. Could you expand on your philosophy when it comes to the dynamic role between posture, stability, and mobility, what athletes and coaches should understand about these topics, and what should be left to physical medicine providers such as physical therapists and chiropractors?
BG: The first thing that athletes and coaches should understand about posture, stability and mobility is that you likely don't fully understand these concepts. Most lay people honestly don't understand how posture impacts how their body feels and the role it has in movement. Someone with good posture likely can't explain why they have good posture or how they achieved it. But, that is why we, as professionals, are here.

The stability-mobility debate is like a left-wing versus right-wing debate. My philosophy is it's a spectrum. No one physical issue is 100% in either direction, but I do believe stability is the issue the majority of the time. And if mobility is an issue, and is addressed, such as stretching or mobilizing, it should complimented by stabilization training to ensure you have control of the new motion you have just obtained.

GP: You have developed a reputation in your area as a “go-to-therapist” for athletes being referred from orthopedic surgeons because of your eye for assessing movement and your ability to successfully return athletes to competition. Besides the FMS, what other assessments do you find valuable in dealing with athletes and their competition needs?
BG: For those who don't know, the FMS is a tool used to assess a person's quality of movement using seven standardized movements. If you move poorly, you are then going to compensate, compensation leads to altered or poor biomechanics, which leads to injury. So the whole purpose of the FMS is to make sure you move well. The job of the clinician is to not only identify poor movement, but to also figure out why you are not moving well. Therefore, what other assessments do I find valuable for athletes? I want to see them go through their athletic movements: swing a golf club or hockey stick, throw a ball, jump, land, cut, sprint, run, etc.

To be able to do this effectively you must first be able to analyze the movement correctly. Is the movement efficient? If it is not, then you must be able to figure out why it is not and be able to address the problem effectively. All this said, what is really needed is knowledge of athletic movement, a good clinical eye, and the knowledge of how to fix whatever issues are present.

That’s a Wrap
Ben, thank you for taking the time to answer our questions. Your knowledge and insight is truly appreciated. We hope this was informative for our readers as well. For those in the Somerset, PA area, be sure to check out Ben at the Somerset Hospital Rehabilitation and Wellness Center for tremendous results when it comes to returning from injury or understanding how to move better for your exercise or sport-related goals.

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Posture and Movement: Linking Training and Therapy

We have noticed a problem here at GP and it’s likely a problem many others in the sports performance industry have also observed. The problem I am speaking of is rooted in the disunity that exists among specialists involved in the preparation, rehabilitation, and regeneration of athletes. From experience, I’m specifically speaking to the working relationship amongst coaches and physical medicine professionals, such as chiropractors and physiotherapists.

There are coaches who specialize in the physical preparation of athletes while others specialize in technical sport skill development. In the physical medicine world, there are professionals specializing across a broad range of rehabilitative, orthopedic, neuromuscular, manual therapy, and manipulative therapy services. The disunity seems to stem from a lack of communication and understanding as to why specific approaches or services are being provided by specialists involved with an athlete. We have heard similar stories from a number of our new athletes when they speak of previous experiences.

Commonly, the story sounds a little something like this:

Athlete X is being trained by Coach A for physical preparation purposes while also receiving private, sport skill development lessons from Coach B. Keep in mind that Athlete X underwent surgery at the end of their competitive season to repair an injury and has been seeing Therapist C for rehabilitative care. In addition to post-surgical rehabilitation, they also visit Therapist D for chiropractic and manual therapy services such as Active Release, Graston, or massage services.

Now while this may appear to be all well and good, the problem exists in that each individual specialist often has little to no understanding in regards to either the specific work loads or therapeutic interventions being made by the others, resulting in a collective degree of stress placed on the athlete far greater than any specialist is aware of because nobody is on the same page. All the while, Athlete X is either failing to progress in their rehabilitation, consistently dealing with the same nagging aches and pains, or is having inconsistent training sessions.

More In Common Than We Realize
Physical preparation of athletes, sport skill development, and rehabilitative/manual therapy share a common bond and that is the restoration or optimization of movement.

In athletics, the improvement of both sport skills and physical abilities is without question directly related to the systematic planning and organization of developmental protocols. Often these developmental protocols aim to improve qualities such as strength, speed, skill, stamina, suppleness (flexibility), and postural control as they relate to an athlete’s sport(s) of participation.

In the world of physical medicine (manual therapy, chiropractic, rehabilitation), protocols are utilized to promote the restoration, regeneration and recovery of the body’s nervous system and tissues, improve postural balance and control, and aid in the reduction of repetitive injury patterns.

Clearly, efficient movement and postural control should be of importance to coaches, therapists, and athletes alike. Efficient movement mechanics and their respective postures are dependent upon the balance and control of the body’s movement system. The movement system consists of over 200 bones, around 600 muscles, and a seemingly endless network of fascia and connective tissue. This system is monitored and controlled by a sophisticated network of proprioceptors or sensors, which serve as our brain’s guide for learning, establishing, and maintaining correct posture and movement.

Postural Training Considerations
Correct posture, as it relates to dynamic sport skill execution, is essential to athletic success. Posture is not just a static concept, associated only with sitting or standing. Posture is dynamic and must be thought of accordingly. Poor dynamic postural control will influence the development of biomotor abilities such as flexibility, coordination, strength, speed, and any combination of the previously mentioned.

Considering poor dynamic postural control is a recurring theme among many of our clients and athletes, the training and teaching philosophy at GP allows us to focus on postural improvements. This is accomplished through activities and drills that enhance the ability to hold correct postures and positions, promoting the directional strength needed for ideal force application by reducing muscular imbalances and biomechanical weaknesses. We introduce developmental posture drills in our training programs, since athletes who learn ideal postures during simple motor tasks will lay the foundation for more rapid mastery of increasingly complex motor skills while providing the long-term benefit of reduced risk of repetitive injury.

These developmental posture drills are limited only by knowledge of kinesiological principles as they relate to sport dynamics and one’s imagination. As dynamic postural control improves, the result is more advanced movement skills. Similar to any other biomotor ability, when planning for postural control drills in the training schedule, the volume, intensity, frequency, and work to rest ratios will be influenced by factors such as training age, time of the season, medical/injury history considerations, and skill/ability parameters.

Coaches and therapists would mutually benefit to be on the same page since  the goal of any physical preparatory program, including  the integration of rehabilitative or regenerative protocols when required, is nothing more than movement preparation based upon the evaluation of sport requirements. GP’s approach to physical preparation accounts for an inclusive approach when addressing proper movement. Our inclusive approach accounts for what is seen by the “eye” of the coach or therapist and allows us to adapt developmental protocols as needed. We do our best to account for all stressors each athlete is exposed to during a training week as well as over the course of a training cycle. We want to know when and how often they are working with other sport skill instructors and physical medicine professionals. We make our specific considerations for each athlete’s training not just based on their needs, but also on other factors such as outside workloads from practice, competition, skill development, and additional forms of therapy. If needed, we will consult with the other professionals involved in order to keep the athlete’s best interest in mind.

At GP, as physical medicine professionals and performance coaches, we are able to stay on the same page and promote a more seamless transition for our athletes as they progress through specific phases of training and/or therapy. Similar to other high-performance training centers, GP’s approach places a primary importance on feedback and communication between coach, therapist, and athlete to ensure quality and consistency in our services.

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