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

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

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

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

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

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

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

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

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

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

What does that mean?

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

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

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

[embed]https://www.youtube.com/watch?v=0gnAmWIjLCc[/embed]

Groin pain is a common complaint in athletes and active populations as well as a common source of frustration. What makes it so frustrating is the poor understanding of proper management because of the number complexities related to the true cause of groin pain.

15% of all injuries responsible for competition time lost in hockey players is due to groin pain from common conditions such as groin strain, femoral acetabular impingement (FAI), labral tears, and sports hernia.

Sports hernia is one of the most difficult causes of chronic groin pain to identify and manage. Sports hernia is a weakness and/or injury to the abdominal wall and supporting musculature which can result in groin pain. The difficulty in diagnosis lies the fact that most sports hernias do not produce a palpable hernia and are not seen on advanced medical imaging such as radiograph, ultrasound, MRI, or CT. Surgical exploration is generally the most excepted method in producing a definitive diagnosis of sports hernia after other potential sources of groin pain have been eliminated.

Diagnostic methods in determining the presence of sports hernia may include the identification of five classic signs and symptoms:

1. Complaint of deep groin/lower abdominal pain,
2. Exacerbation of pain with participation of sport activities that is relieved by rest,
3. Tenderness with palpation of the pubic ramus,
4. Pain with resisted hip adduction,
5. Pain with resisted sit-up test

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

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

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

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

In a Clinically Pressed podcast episode, I was presented the question of an influential purchase for under $100. I said the jump rope and Mark Bell's hip circle. If we take it a step further and go with a purchase under $10, I'd say the hula hoop.

Why the hula hoop?

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

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

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

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

Ideal movement and optimal strength development first begins with using the diaphragm as the primary muscle for respiration and for Intra-abdominal Pressure (IAP) or what is also known as the abdominal brace.

A frequent piece of feedback we receive at GP is that much of what we coach is the opposite of what most people have always heard. In regards to breathing and bracing, too many people have either heard or been coached to 'draw' or 'suck' in their abdominal wall. These tips only serve to rob people of stability and strength and play a role in low back pain.

[embed]https://www.instagram.com/p/BcSuHV9jXz4/?taken-by=gallagherperformance[/embed]

In this video, we discuss the dumbbell row and how to improve both scapular stabilization and thoracic spine rotation during the exercise.

The dumbbell row is a fantastic exercise for building mass and strength in the upper back and arms. When done for reps (and no straps), it will build a solid grip. However, an often overlooked and undervalued aspect of the exercise is how awesome it can be in developing scapular, core and hip stability in the supporting limbs.

Some key points discussed in this video:

• The traditional bench supported DB row utilizes hand support on the bench, which can be problematic for those with poor scapular stabilization.
• Scapular stabilization on the support arm and be improved by elevating the bench to an incline position and supporting from the elbow instead of the hand.
• With proper attention to posture during the support from the elbow will also improve thoracic spine rotation and mobilize the rib articulations during the exercise because of the increased spinal musculature involvement.
• This can be a great variation of the DB row for those with shoulder pain, poor scapular stability or stiff upper back.

The chiropractic profession is an interesting one to be a part of. For some, they more than accept the role chiropractic can play in not only getting them out of pain, but also elevating their overall sense of health and well-being. For others, they remain skeptical and dismissive for reasons that simply come down to myths and misconceptions that have been perpetuated for years. We can thank growing amounts of scientific evidence that has proven many common myths and misconceptions about chiropractic to be false.

In this article, we want to address some common myths and misconceptions regarding chiropractic,  addressing them from an educational viewpoint. But before we get into those, it would benefical to define what chiropractic is for those of our readers who may not be familiar with the scope of the profession.

What is Chiropractic?

#1 - There is no scientific evidence to support chiropractic

• Low back pain (1)
• Sciatica (2)
• Neck pain (3)
• Headaches (Tension and Migraine) (4)
• Shoulder pain (5)
• Hypertension (aka high blood pressure) (6)
• Certain neurological conditions (7)

#2 - Chiropractors only treat necks and backs

#3 - Once you start going to a chiropractor, you have to go for life

#4 - All you do is "crack backs", that's easy

1. MYOFASCIAL RELEASE. Myofascial release targets adhesions that develop either within a single muscle or between adjacent muscles and other forms of connective tissue such as fascia, tendons and ligaments. Many athletes and patients experience accumulative or overuse trauma (ex: plantar fasciitis due to running or carpal tunnel syndrome due to prolonged computer/desk work). The goal becomes to work a muscle to remove adhesions and restore neuromuscular function to decrease pain while increasing range of motion, strength, and coordination of movement.
2. FUNCTIONAL REHABILITATION. In addition to providing relief through chiropractic manipulative therapy and treating muscular adhesions, it can prove to be incredibly valuable to identify the source of a patient’s symptoms. The functional approach to rehabilitation includes identifying joint dysfunction, muscular imbalances, trigger points, and faulty movement patterns. These are often the hidden causes of injury. Observing how a patient moves and functions allows us to identify improper movement patterns that become contributors to pain and poor sport performance. By placing an emphasis on strategies to improve movement and function, functional rehabilitation is effective in improving qualities of endurance, strength, stability, balance, agility, coordination, and body awareness.
3. DYNAMIC NEUROMUSCULAR STABILIZATION (DNS) & VOJTA THERAPY. DNS and Vojta Therapy are advanced approaches used to not only treat a variety of neuromuscular conditions but  also used by athletes worldwide to elevate performance. By applying principles and techniques rooted in the study of child development, DNS and Vojta Therapy aim to improve and restore the activation ideal movement patterns. These techniques are used to promote the ideal postures, movements, and degree of body awareness that is essential not only to athleticism, but to also treating the underlying causes of several pain syndromes that are commonly treated by chiropractors and rehabilitation specialists. There are dozens of studies to support the effectiveness of DNS.
4. NERVE FLOSSING (NEURODYNAMIC MOBILIZATIONS). Nerve flossing is a specialized diagnostic and treatment technique commonly used to diagnose and treat neural tension, which usually expresses symptoms such as muscular tightness, pain, weakness, numbness and/or tingling. Nerve flossing is proposed to help nerves and its branches slide against adjacent structures (muscles, bone, etc.), increase blood flow, oxygen and nutrient delivery, and improve the immune response. (8)
5. THERAPEUTIC & CORRECTIVE EXERCISE. Exercise progressions and protocols are used to develop strength, range of motion, re-educate the neuromuscular system in order to address the underlying causes of dysfunction and pain.

Final Thoughts

[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.

Scoliosis.

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

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

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

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

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

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

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

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

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

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

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

1. Observation
2. Bracing
3. Surgery

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

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

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

Some points to consider:

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

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

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

Key take home points:

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

April 2017 marks four years since Gallagher Performance opened and with another anniversary passing, I thought it was time to start reflecting back on our fourth year in business.

All our services from chiropractic to massage to personal training to sports performance training continue to experience steady, consistent growth since we first opened. Growth that led us into our own facility in December 2016. The move has been a very positive and necessary one for our continual business development.

On January 2, 2017, Gallagher Performance opened in our new location. After long hours and lots of work we ended up looking like this:



The new facility has enabled us to widen our reach, both within the community and online. Being a community resource is tremendously important to us. We are now able to hold classes, lectures and have been asked to speak to area sports teams and organizations. We are also now able to provide more educational videos on our social media and YouTube channels.

Even with the transition to a new facility, we remain loyal to providing quality of service over quantity. Gallagher Performance is about individualized attention in all our services. This is why our chiropractic and rehab patients are with their doctor every minute of every office visit. This is why Gallagher Performance isn't a gym; it's a training facility. We don't offer an open gym membership, but rather different levels of training services to meet the needs of our clients and athletes. The reason why we set it up this way is because we want people to experience how supervised training by qualified professionals yields amazing results. And our clients are achieving remarkable results in private and semi-private settings that enable individual considerations to be made appropriately.

In regards to our services, it has been another great year. GP’s chiropractic and rehab therapy was recognized as one of the best in the Pittsburgh area for a third consecutive year. The results we achieve through our chiropractic, manual therapy and functional rehabilitation have helped people get out of pain and return to the activities they enjoy. There have been literally dozens of patients who have come to us after a doctor has told them they needed surgery, but we’ve helped them avoid these procedures. We've helped them understand the importance of not only getting out of pain, but why changing the function of their body is the key to a successful outcome and long-term recovery.

Our personal and performance training services continue to generate tremendous results for our clients and athletes. The results keep our clients loyal and the referrals coming in. We have truly cared about delivering quality in all services since we opened. It’s a great feeling to see how much our clients appreciate the attention, know-how, and confidence they receive while working with us. When you focus on quality of service and improving the consumer experience, only good things can happen.

During our four years, we have seen tremendous growth in our distance/online training services as we have gone international. Now while we are growing and our reach may not be that impressive by some industry standards, it is humbling to see how our distance services are being sought after by people beyond the state of Pennsylvania. We have seen the reach grow to 12 states (AZ, CT, GA, IA, IL, MT, NJ, NY, NC, OH, TX, WI), into Canada (Alberta, Ontario), and into Portugal, Italy, and Japan.



The reason for our growth isn't a big marketing budget. Rather, we work hard to set up everyone we work with for success in any way possible –  trusting that those efforts will lead to referrals and retention. At Gallagher Performance, we don’t try to just “factory line” our clients/athletes through the same program with a "cookie cutter" approach.  This is because we understand training and rehabilitation is a very individual experience and everyone we work with needs very individual considerations made for them. That's what it takes to produce lasting, meaningful results.

Our sports performance training services continue to be utilized by a variety of athletes from a growing list of amateur/club organizations, high schools, and colleges. In addition, GP continues to direct the Strength & Conditioning program for the Franklin Regional Hockey Club as we move into our fourth year.

During the past year, we've seen new names join of list of athletes who have reached the collegiate level. This is tremendous accomplishment on their behalf and we are privileged to work with such determined and hard working athletes. Here's the list we have worked with, from sports performance to chiropractic and rehabilitation, and where they are coming from:

 Collegiate Athletes

• Wes Ashley, University of Wisconsin - Stevens Point (NCAA DIII) - Hockey
• Andrew Brncic, Alderson Broaddus University (NCAA DII) - Football
• Colin Childs, California University of Pennsylvania (NCAA DII) - Football
• Ben Dipko, Slippery Rock University (NCAA DII) - Football
• Noah Dipko, Indiana University of Pennsylvania (NCAA DII) - Football
• Justin Gismondi, Robert Morris University (ACHA DI) - Hockey
• Ryan Grieco, Seton Hill University (NCAA DII) - Baseball
• Carter Henderson, Duquesne University (NCAA DI) - Football
• Evan James, Penn State University Greater Allegheny (NCAA III) - Baseball
• Colin Jonov, Bucknell University (NCAA DI) - Football
• Katie Kimmich, Seton Hill University (NCAA DII) - Soccer
• Dante Luther, Washington & Jefferson University (NCAA DII) - Football
• Jake Roberge, Northwestern University (NCAA DI) - Soccer
• Mike Roberge, Northwestern University (NCAA DI) - Soccer
• Charan Singh, University of Massachusetts (NCAA DI) – Football
• Todd Summers, Villinova University (NCAA DI) - Football
• Ryan Watson, Lake Erie College (NCAA DII) - Soccer
• Christian Wilson, Mount St. Mary’s (NCAA DI) - Track & Field

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

1. Therapeutic exercise is the most evidence-based treatment.
2. Passive treatments (tape, modalities,etc.) may offer temporary relief but are not helpful in medium and long term recovery.
3. Injections and surgery have been not shown any greater effectiveness in outcomes than exercise.
4. Seek advice and treatment from a licensed professional who specializes in functional movement. Ideally this would be a rehabilitation chiropractor or physical therapist with movement specializations are the gold standard here. These practitioners focus on the functional paradigm of manual/physical medicine. And no, your "functional trainer" at the gym doesn't count.
5. Self-management is key. Reduce activities that provoke pain, apply gradual exposure to activities to build confidence and tissue capacity through exercise. Exercise must be tailored to you to reduce pain and improve strength and function throughout your entire body.
6. Progress load and exposure gradually. The key is to be consistent with your exercise therapy. Forget about how much you were doing before the injury and what others are able to do. Everyone responds differently. Focus on your recovery and what works to get you back on track.
7. Getting back on track can take a long time. In some cases, upwards of 3 to 12 months depending on a number of factors including duration of symptoms, functional deficits and patient compliance during their exercise program. Keep in mind, other treatments can offer faster recovery but nothing has demonstrated better long-term results than progressive exercise.

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/

 

Running season is fast approaching. Spring and summer have a host of events from marathons, to half marathons, to triathlons, to various course races. Many have likely already started their training. And then of course we can’t forget those who will simply take up running in hopes of shedding unwanted body weight for the summer.

Whether you are taking up running to become healthier and lose weight, to qualify for Boston, or if you have your eyes set on crossing a race off your bucket list, your routine training will either build you toward your goal or you will be bogged down with nagging injury after nagging injury.

When you consider that 65-80% of runners will sustain an injury during the running season, clearly there is something that needs addressed to help runners cut down their chances of being sidelined or having recurrent issues during their training.

If there is one thing that most people know about me is that I’m not a distance runner. I’ll make that disclaimer up front. Never been a distance or endurance athlete and never will be. I live in the power-speed world of athletics. However, as a former hockey player and strength athlete, one of favorite past times and off-season training methods was (and still is) sprints.

Between my background as a chiropractic rehabilitation specialist as well as personal and professional experience in speed development, I’ve learned a thing or two about what it takes to build a body that is resilient to the demands of running/sprinting rather than breaking down. And at Gallagher Performance we have developed a reputation for not only building speed demons, but keeping their body healthy and ready in the process.

So what gives? Why is someone like me writing an article about running?

The name of the game in athletics is physical preparation and the same can be said of distance running. Unfortunately there seems to be a misunderstanding in that one only needs to run to be successful at running. While this may be true for some, there are numerous others who simply cannot solely rely on running in order to be prepared to run. Simply just running to be ready to run is an oversimplification of arguably the most complex human movement.

If that sounds ridiculous or confusing, let me explain my logic.

Most runners will eventually encounter their fair share of aches, pains, strains and overuse injuries. Plantar fasciitis, shin splints, tendonitis, stress fractures, runner’s knee, IT band syndrome and joint pain are common to the running community. Once training demands exceed what is one physically prepared for, this is where things start to go south.
These conditions may be present for a number of reasons, including any of the following:

• Sharp increases in training volume
• Foot wear
• Gait mechanics
• Strength deficits
• Joint dysfunction or fixations
• Improper motor control of lower extremities and/or torso
• Overtraining
• Inadequate physical preparation

The value of movement is undeniable. But the industry of movement has become a bit of a circus.

I have seen some doctors, therapists, and trainers using the label of “movement provider” lately and while I’m not quite sure what that means, I can speculate as to what they are trying to communicate. Yes there are many universal truths when it comes to human movement, health and performance, but the true pioneers of movement are few. Social media has created a tool for spreading quality information and education. I understand leveraging social media can become incredibly valuable to a business. However, when it comes to movement, exercise, and fitness, social media has become more entertainment than substance.

It’s become a sea one can easily become lost in, caught up in the wow factor of challenging movement drills and variations while others are less likely to engage with more of a simplistic focus. Movement providers from licensed healthcare professionals to run-of-the-mill trainers pop up all over the worldwide web and social media sending messages that may seem conflicting. There’s more information than ever yet many people searching for solutions are more confused than ever. The industry seems to thrive on confusion more than any other. Confusion creates dependence and the industry loves confusion because someone has to have the answers. They want to build an audience.

But are you building an audience based on your information being entertaining or effective?

Sadly it seems that he who yells the loudest, gets the most followers and gets the most attention must have the answers right? I mean they do have 62,000 followers, they must know their stuff? Not necessarily. Entertaining may score you points on social media, but effective scores you points with patients and clients. Yes there are extremely effective movement experts with massive followings, but I doubt they exist in the real world in the masses like they do on social media. If you’re chasing entertainment yet don’t know how to effectively get someone from point A to point B, it’s all smoke and mirrors.

While overhead lateral rotational lunges with hanging bands may score thousands of views on Instagram, does it have any significant relevance? From a clinical perspective, those who treat patients regularly know the majority of what entertains on social media has little transfer to patient care. The reality is that the majority of patients with musculoskeletal issues have lost the ability to perform basic human movement. There is a reason why the lumbar disc patient is a disc patient. Most of them are deconditioned and lack adequate strength, motor control, mechanics and proprioceptive awareness not only in their low back, but likely in their feet and hips as well. They need the basics. The fundamentals. Problem is the basics aren’t sexy and don’t get you likes or follows on social media. Advanced progressions of basic human movements make up 90% of what’s on social media, yet in the office 90% of our patients only need the basics. The same can be said for the population that works with a personal trainer or strength & conditioning professional. They often need the basics and just building off them.

The majority of patients and clients need to master the basics without the need of external resistance. For most, simply working against the resistance of their own bodyweight is sufficient. Problem is, if you take away the bands, the barbells, the kettlebells, the dumbells, the cables and sliders from some doctors, therapists, and trainers, they will struggle to think of exercise progressions/regressions to yield better movement by simply using one’s own body. The really good movement providers can achieve improvement without the need of equipment. This may be incredibly simplistic and not score big points on Instagram or Facebook, but you’d be surprised at how challenging the basics and their variations will be. So if you are using social media as your reference library on how to rehab your own injury, rehab a patient, or create a workout for your next training client, I would be incredibly cautious.

Sure the squat may be basic, but how many are actually capable of a proper bodyweight squat? The answer may surprise you. Yet how many are capable of a proper squat before heavier and heavier loads are introduced or they try an overhead, band-resisted, anti-rotational squat? I’m gonna bet not many. If you’re capable of performing an overhead, band-resisted, anti-rotational squat with ideal form, great. You’re part of less than 1% of the population that is capable. The other 99% need more of the basics and arguably may never need to do that advanced of an exercise. Most won’t even have the desire as they won’t see the relevance.

The basics may be boring, but they are incredibly effective. We all need them. The basics serve as the foundation. What kind of basics are we talking about? If I was to build a short list of basics to ask yourself, it would look something like this:

• Are you able to breathe without excessive chest or shoulder movement?
• Are you able to balance on one-leg for at least 60 seconds?
• Are you able to balance on one-leg (eyes closed) for at least 30 seconds?
• Are you able to hold a plank for at least 60 seconds?
• Are you able to hold a side plank for at least 30 seconds on each side?
• Are you able to perform a lunge with ideal form and control?
• Are you able to perform a squat with ideal form and control?
• Are you able to raise your arms overhead with ideal form and control?
• Are any of these movements painful?
• Are any of these movements difficult to perform due to tightness or restricted range of motion?

The insurance industry has become increasingly difficult to work with as many large carriers have limited or completely closed off providers from joining their network.

In such cases, we operate as a fee-for-service facility and offer affordable plans that truly increase the value of our patient’s experience. But rather than take my word for it, let's do the comparison between traditional chiropractic and the difference at Gallagher Performance.

TRADITIONAL CHIROPRACTIC
Most traditional chiropractors spend 5-15 minutes per patient and often attempt to have them come 2-3 times per week for an extended period of time. Most patients only experience passive modalities and adjustments with a predictable routine of stim-heat-adjust-out the door. And if there is rehab, often it is supervised by unlicensed aides who instruct patients in exercises. Most traditional chiropractors will see a patient 18-24 times in order to resolve their problem. Depending on co-pay or co-insurance, the out-of-pocket expense can add up quickly. For someone who has a $25 copay, that means they will have $450-$600 of out-of-pocket expense.
THE GALLAGHER PERFORMANCE DIFFERENCE
At Gallagher Performance, you spend 30-60 minutes with your chiropractor, enabling faster recovery in fewer visits. Most of our patients recover in less than 8 visits, spend 100% of their time 1-on-1 with a board-certified rehabilitation chiropractor, and are provided with essential knowledge and tools needed to ensure pain doesn’t come back. Our approach will actually save you money while providing you with a higher quality of treatment. That’s value you can’t compare!

 

Often I am asked, "What is the best exercise?" or "What is the best type of exercise?"

To answer that question, let's set the stage of what exercise really is - movement.

Teaching patients not only about chiropractic but how to move better all comes back to function and understanding how all the intricate parts of our body make up a highly complex movement system. But here are some key points to understand:

1) Function determines movement. Chiropractic and rehabilitation seek to restore proper movement function. Functional examinations determine WHY movement is painful or problematic. Utilizing the functional model of movement helps to determine who is at risk for injury, which movement patterns or body regions are dysfunctional, and what treatment or exercise strategy is needed to address those issues in combination with chiropractic/manual therapy methods.

2) Function is critical to movement and movement is critical to our health. Our bodies are designed to move. The growing list of chronic diseases and immense burden on the healthcare system associated with an overly sedentary society clearly demonstrates one conclusion – we need to move more.

3) Movement is exercise and exercise is medicine. The medicinal benefits of exercise are numerous. There is a reason why exercise and proper nutrition is being labeled as "lifestyle medicine".

For those who wish to start an exercise program, the public is told to “see your doctor” before starting an exercise program. Most patients are cleared to exercise after history and vitals are considered “normal”. Sure your organ system may be healthy enough for exercise, but nothing is mentioned about seeing a doctor to determine how well you move or how well your muscles and joints are functioning. Why wouldn’t this be considered? Why wouldn’t seeing a “movement specialist” before considering an exercise program be equally advocated?

So, in typical fashion, most of us embark on an exercise program believing we will be healthier for it. We are told to exercise and practice sound nutritional habits, but what do most of us do for exercise?  How about go to the gym, sit on a machine and pull or push weights while hunched over with lousy posture.  Or, after sitting for 40-60 hours per week, let’s go out and put staggering amounts of stress on our bodies through recreational activities like weekend skiing, Thursday night softball league, rec league hockey, golf, or basketball.

There's nothing wrong with those activity choices, yet what happens when pain or injury come into the picture? Most of blame the exercise or blame the activity when, in most cases, we should be blaming our own body.

When it comes to pain and injury, the reality is what our body is capable of performing cannot meet the demands we are placing upon it. The overall function of our body must be ready to handle a specific task or movement otherwise problems will eventually arise. Problems that may range from mild (muscular tightness/stiffness, joint aches) to more severe (pain and/or injury).

The beauty of the functional model is that those regions that have mechanical sensitivity (pain) and/or abnormal motor control can be identified and solutions are discovered. Exposing these compensations and correcting them plays a huge role in not only getting patients out of pain, but improving how their body functions.

Why is changing how our body functions so important?
While pain is why most people seek care, the reality is if we only change pain and fail to change how a patient’s body functions, we have our reason why so many patients relapse. But if we get them out of pain and improve how their body functions then we are doing what we need to do to keep the pain from returning.

Whether we need mobility (improved range of motion) or stability (motor control), that can be addressed with a proper functional examination through movement. After a functional examination, it just makes sense to reinforce functional movement patterns with specialized exercise to build a foundation of proper movement coordination, strength and skill.  Now we are beginning to get somewhere to build form, function and fitness. Now we are getting people to move better through better exercise!

Correct movement is the best exercise
Once people learn better movement, how to project their joints and what exercises they should be performing, their bodies are much healthier for it. There is less risk of injury and most will ultimately start feeling better instantly. Rather than beating their bodies up due to poor movement, movement becomes healing. Correct exercise is the answer. Correct movement is what we need to get out of pain, feel capable and feel healthy.

That’s the essence of the functional model. It’s about promoting health and healing through therapy, movement, and patient-centered education. That’s what we pride ourselves on at Gallagher Performance as our model is truly unique in the services we provide and the results we achieve.

More related reading:

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

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

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

https://gallagherperformance.com/the-truth-about-functional-exercise/

Recently, Shannon Perrine of WTAE Channel 4 News in Pittsburgh featured a story on a patient of ours, Karla White. The focus of the story being Karla's same-day hip replacement surgery. It was a short, yet informative piece on the work of her surgeon and the rehabilitative process with special attention to the factors that played a role in a very successful outcome. If you have not seen the story, head to our Facebook page and check it out. All of our social media links are here on the website. You'll find them at the top of the page.

After the story aired yesterday, I had a number of thoughts that came to mind. Primarily these thoughts centered around how many medical professionals and the general public have a misunderstanding of the training and qualifications of chiropractors and strength & conditioning specialists. Especially as they relate to rehab, be it from injury or surgery. Many may find it unconventional and, at times, silly that one seeks out the professional help of a chiropractor or strength coach for the oversight of their rehabilitation.

Traditionally, once a patient is ready to begin post-surgical rehab, this process is guided by a physical therapist. It’s conventional thought and accepted practice.  You have surgery, then you go to physical therapy.

That said, there are post-surgical patients who will seek out a chiropractic rehabilitation specialist to manage their rehabilitation. And, depending upon the setting and patient, strength & conditioning specialists may be involved as well.

Now there may be a few thoughts running through your mind right now. Maybe thoughts such as:

“Wait….chiropractors aren’t qualified to do post-surgical rehab!”
“Why would you use a strength & conditioning specialist for a rehab patient? Those are only for athletes!”
This news story has opened up the opportunity to help educate, so let’s address these questions or concerns.

Are chiropractors qualified for post-surgical rehab?
The reality is, when patients seek a provider for their post-surgical rehab, they may choose to seek a professional who is not a physical therapist. Some may not have the flexibility to make their own decision, but for those patients are looking for the best person for the job and they will exercise their right to make that decision. Regardless of title (PT or DC), patients must be in the hands of a provider who has the professional training and expertise to handle their rehabilitation appropriately. Providers must be competent and efficient for the sake of minimizing post-surgical complications and improving outcomes.

I’ve highlighted this before in previous writings, but my residency truly provided professional training very few chiropractors ever receive. During my 3+ year residency, I managed or co-managed numerous spinal, shoulder, hand/wrist, hip, knee, and foot/ankle post-surgical rehabilitation programs. Our department at Palmer College of Chiropractic worked with local orthopedic and neuro surgeons to co-manage routine as well as highly complicated surgical cases within the Quad City area. Meaning, we saw everything from athletic injuries to total joint replacements.

I don’t stress this to simply pump my own tires, but to convey to our audience that I’m not new to post-surgical rehabilitation and there are chiropractors out there that have similar training and expertise as well. We don’t exist on the level of physical therapists nor are we claiming to be physical therapists. Physical therapists have their own unique training and skill set. The ones I know do outstanding work for their patients.

The point I’m trying to make is that it is possible for chiropractors to have a background in functional and post-surgical rehabilitation. These chiropractic rehabilitation specialists are qualified and are capable of successful post-surgical rehab outcomes.

What is the value of Strength & Conditioning during post-surgical rehab?
For all those that want to be evidence-based, exercise and strength training literally helps more musculoskeletal conditions that all other treatments. The same can be said of post-surgical rehab as it is all about regaining range of motion, strength, and functional capacity. If you have the privilege of having a knowledgeable and qualified strength & conditioning specialist in your corner, they will provide enormous value to the post-surgical recovery process.

Yes, the involvement of strength coaches may be more commonly used in the athletic world, within the collegiate, professional and international ranks. But, when available in the private sector, they add an immense advantage as the rehabilitative process is very time sensitive and it’s critically important no time is wasted. The more quickly a post-surgical patient can regain adequate strength and movement quality through gradual exposure to the functional demands of strength training, the more quickly they are able to return to their activities of daily living, job, or sport with confidence and minimal complication.

Strength coaches are experts in what almost all musculoskeletal conditions will benefit from: exercise and strength training. Keep in mind, they must have the appropriate qualifications. Not all strength coaches are created equal and those that are capable of being involved with a post-surgical patient are rare. I can't stress that enough. These professionals understand their role and the best results are seen when they work together with the rehabilitation specialist to ensure ideal outcomes for the patient.

Post-Surgical Rehab Success is All About Team
The success of the post-surgical rehab program is not solely dependent upon any one specific individual involved in the process. Successful post-surgical outcomes take on a team dynamic. In this case, the surgeon, rehabilitation specialist, strength & conditioning specialist, and patient all had critical roles.

The Surgeon
For Karla, she had a tremendous orthopedic surgeon in Dr. Julius Huebner. Due to a congenital condition and progressively worsening degenerative joint changes to the left hip, Karla underwent direct anterior approach total hip replacement in late May 2016. This surgical approach is essentially a “surgical strike” as described by Dr. Huebner in the video. His surgical procedure resulted in no damage to adjacent tissues and structures. The procedure was a precise as you can get, enabling same-day hip replacement surgery and a faster recovery.

The Rehabilitation and Strength & Conditioning Specialists
In preparation for her surgery, she worked with the team at Gallagher Performance during the months prior to her surgery to improve her post-surgical rehab outcomes. Her pre-surgery rehab program enabled Karla to remain as functional as possible during that time. Pre-surgical rehab programs are never easy and quite challenging. However, Karla is a tremendous patient who demonstrated nothing but commitment and patience, knowing that the work she did prior to surgery meant having that much less to do post-surgery.

Likewise, during the course of her post-surgical rehab program, Karla worked one-on-one with either myself or Ryan. I managed the early phases of her rehabilitation recovery, implementing manual therapy and exercise. This continued as she progressed to more strength training focus in her rehab. That's when Head Performance Coach, Ryan Gallagher, designed and implemented her strength & conditioning program.  The collaborative focus was on developing ideal movement patterns to spare her joints, thus improving the health and relative function of her legs, hips and spine. Exercise selection and progressions were based on post-surgical guidelines, tolerances, and functional capacity all while ensuring adequate strength and movement control were demonstrated.

The Patient
As for Karla, she was the ideal patient.  She was compliant and motivated throughout the entire process. Karla loves to be active and workout, which only added to her motivation. A motivated patient is so refreshing to work with for countless reasons. The rehabilitative process can be frustrating at times, with obstacles and ups-and-down marking the road. As challenging as rehab can be physically, rehab can be even more challenging mentally. To her credit, Karla was always willing to work, even when she was frustrated or progress was slow. She always worked hard and focused on the little details. It’s because of her attitude that she demonstrated and her drive to regain the quality of life she desired that she is where she is today.

Summing Up
The combined team effort was the key to the success of this post-surgical rehab story. This theme must be present to ensure a patient has the outcomes they desire. It’s a privilege to be involved, providing our services to complement the team effort required during the post-surgical process as we recognize our role in the rehabilitative process. We thank Dr. Huebner for his medical expertise, Karla for being outstanding to work with, and WTAE’s Shannon Perrine for her excellent coverage of the story.

At Gallagher Performance, our focus is on developing the resilience of our clients and patients. We are committed to utilizing cutting-edge, patient-focused progressions to help every individual we work with not only achieve but also exceed their goals. With our extensive training and knowledge in chiropractic, manual therapy, sports injuries, rehabilitation, and performance-based training, we work with all individuals who are interested in living healthy, active, and pain-free lives.

More related reading:

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