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Busting Chiropractic Myths & Misconceptions

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?

Chiropractic is the most commonly utilized form of complementary and alternative medicine (CAM) in the United States, focusing on the musculoskeletal and nervous systems. Doctors of Chiropractic perform examinations, diagnose conditions, and determine appropriate and safe treatment plans utilizing an effective, hands-on approach without the use of drugs or surgery. Other than traditional chiropractic adjustments or manipulative therapy, chiropractors can receive additional training in rehabilitation, sports injuries, myofasical release techniques, taping, bracing, passive modalities (i.e. electrical stimulation, ultrasound, laser therapy), as well as nutrition and implement these into patient treatment plans.

Now that we've had a brief overview of what chiropractic is, let's discuss some common myths and misconceptions.

#1 - There is no scientific evidence to support chiropractic

This is probably the number one myth or misconception that I encounter on a regular basis. The reality is, there is a massive amount of scientific research that supports the effectiveness of chiropractic and chiropractic manipulative therapy (CMT) for a number of musculoskeletal conditions.

CMT has demonstrated effectiveness in the treatment of:
  • 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

On the heels of our first myth/misconception, the effectiveness of chiropractic goes far beyond simply treating neck and back pain. Yes, randomized controlled trials support the efficacy of chiropractic treatment for common acute and chronic conditions such as headaches, neck pain and low back pain. However, with specialized training, chiropractors are also capable of treating disc injuries, sciatic pain, strain and sprain injuries, nerve pain, vertigo, TMJ, ear infections, plantar fasciitis, asthma, ADHD, whiplash, scoliosis, IT band syndrome, injuries from auto accidents, and symptoms associated with pregnancy. Common overuse conditions such rotator cuff injuries, tennis elbow, carpal tunnel syndrome, and other forms of tendonitis also respond well to chiropractic treatment.

Not all chiropractors are the same in their competency and abilities. It's important that you perform your due diligence to find a chiropractor that will be able to treat your condition effectively.

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

Many of heard that once you go to a chiropractor, you have to go for life. The same thing can be said of a many healthcare providers, such as regular check-ups with your MD or your dentist. Many people choose to continue getting periodic adjustments and chiropractic therapy to help them feel better. Others may decide to see us from time to time for episodes of pain or relapses in their condition.

It’s your choice.

Now while some chiropractors and their approach to patient management have given all chiropractors a bad name, the majority of chiropractors aren't looking to make you come back regularly for the rest of your life. But what they hope for is that they have a patient for life and that when someone needs to be seen, they know were they can go for trusted treatment and advice.

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

This one is probably the most humorous to me as many will imply that what a chiropractor does is "easy". That all we do is simply "crack backs" and that is easy to do. I've had people tell me, "I can do what you do." The reality is that while yes, making a joint "crack" or "pop" is relatively easy to learn to do, the complication is finding where and how to adjust/manipulate. Palpation is the true art and skill - and it takes years to develop and fine-tune.

The chiropractic adjustment or manipulative therapy is what chiropractors are best known for, but thanks to advancements in the management of musculoskeletal conditions, chiropractors also incorporate many facets into their evaluation and treatment of patients.

Not all chiropractors will just place you in a room with heat and stim, adjust you in less than 5 minutes and send you on your way.

I can't speak for all chiropractors and why they practice the way they do. For me, I choose to incorporate a number of treatment options for the betterment of my patients and their goal-specific outcomes.

In addition to chiropractic manipulative therapy, Gallagher Performance offers:
  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

Chiropractic care can prove to be more beneficial than many may realize or want to acknowledge. When combined with manual therapy, functional approaches to rehabilitation, and sound scientific principles of exercise prescription, chiropractors have an ability to conservatively effective treat a wide array of conditions. The evidence shared in this article only scratches the surface. There is more research than I can fit into this blog post. I encourage you to research and read if you are inclined. Become educated and informed so you can make the best decisions for you and your health.

 
More related reading:

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

https://gallagherperformance.com/the-benefits-of-performance-therapy/

https://gallagherperformance.com/best-way-recover-tendon-pain/

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

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

The Solution to Long Term Improvement of Back Pain

The problem:
It’s not uncommon for people with recurrent episodes of back pain to become fearful and to start avoiding activities in life. They begin to associate pain with the activity and that the activity is doing harm. Thus, in their minds, pain equals harm and any activity that causes pain avoided. The problem becomes that as this the list of activities grow, deconditioning sets in and begins to feed into back pain. At this point, most figure they are just “getting old” or figure they will need to “learn to live with the pain”. The reality is there is a solution to help you fight against these feeling of fear and limitation and enable you to fight dysfunction in your body.

The solution:
Research tells us that exercise should be part of your back pain solution. This isn’t true of just backs, as exercise should be part of any joint pain solution. Time and time again, more than any other intervention, exercise has demonstrated the ability to provide positive outcomes in back pain relief and reduced relapses. However, too often people use different exercises to help reduce their pain only to find that exercise makes their back feel worse. The solution isn’t just simply exercise, the solution is understanding the right exercises to do while also understanding which exercises to avoid. You need to know what exercises for sciatica and disc herniation are best to do 1st to create a good foundation of movement before progressing to more difficult exercises. Where do you go for that information? Over the past several years we have put together a clinically successful exercise progression program for our patients and clients with back pain. These exercise progressions serve as the framework for rehabilitation and also serve as the foundation for improving athletic performance. Join us for our Core Training – From Rehab to Performance workshop and learn more about what you can begin doing immediately to help reduce your back pain, feel better, and improve your performance in sport or life.

 
 


More related reading:

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

Understanding Methods and Application in Training and Rehab

It seems, inevitably, we get weekly questions wanting our insights or thoughts on some training or rehabilitation method.

Regardless of the whether its the fitness industry or physical medicine profession, methods come and go all the time. Some interventions have staying power as they provide lasting results. Some trends are just a flash in the pan. The more recent or more intriguing the trend, the more it seems to generate questions.

When it comes to rehabilitation, this can be seen in a wide range of modalities and procedures from electromuscular stimulation (EMS) to low level laser therapy, machine-based exercises to the functional approach, stretching to myofascial release techniques, and kinesiotaping to cupping.

In the fitness and training industry, there is an equal (likely greater) amount of options and trends to get hung up on. From kettlebells to TRX, Curves to Crossfit, bodybuilding methods to Olympic weightlifting, and unstable surface training to over-speed training just to name a few.

While the question, "What do you think of....," may be seem to be a simple question in nature, it's a difficult question to answer without understanding the context of it's application.

Unless the application is understood, the results one gets from a specific method is left in question.

If you severely sprain an ankle during a basketball game, sure taping and bracing will help in the early stages of healing. As healing and rehabilitation progress, manual therapy and exercise begin to take more focus. Single-leg balance and sensory-motor stimulation have demonstrated successful application in the rehabilitation of certain injuries, such as ankle sprains. But if you get on a BOSU ball or unstable surface too soon - and you re-injure your ankle - is the problem the unstable surface or just poor application?

Similarly, there are many people who take on a fitness or sports training program but end up worn down and banged up because their application of certain principles is just wrong. This may be due to joining a group exercise class or working with a trainer that provides poor advice and application of training principles. Or it could be due to an individual attempting to structure their own exercise program without proper knowledge of training method applications.

We all could benefit from someone who we can trust for sound advice who it comes to applying the principles of rehabilitation or exercise. They will be able to inform you on what methods may be best for your specific goals and your unique individual considerations. You need someone who can help guide and educate you, who is able to critically think and problem solve. This is what the best trainers, coaches, and therapists are able to do for their clients and athletes.

What we do at Gallagher Performance is exactly that. We critically think and problem solve for our clients and patients. We aim to educate them and implement the most appropriate applications for their desired goals and outcomes.

Despite this, the reality is our philosophy, our approach, or our applications may not be for everyone. We won't sacrifice long-term sustainability for temporary results. We take pride in quality over quantity. We won't focus on the latest trends or what other people are doing. We aren’t concerned with this.

Our primary concern is offering the best training and therapy to the people we work with while educating them on understanding sound application so they are able to make informed decisions. And we will always educate, even if that means people have to hear the hard truth. But hopefully in hearing the hard truth, they learn lessons that provide better guidance in the pursuit of their goals.

More related reading:

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

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

https://gallagherperformance.com/the-benefits-of-performance-therapy/

The Benefits of Spinal Manipulation

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

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

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

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

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

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

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

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

More related reading:

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

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

https://gallagherperformance.com/low_back_pain_causes_and_treatment_recommendations/

Low Back Pain Treatments That Just Won't Help

Back pain was believed to be a self limiting condition for the majority of individuals, meaning that the nature of back pain is that it would "run its course" and eventually pain would go away on its own. Current research has demonstrated that this understanding of back pain is flawed; yet many clinicians still hold this belief.

In fact, 85% of people with a single episode of low back pain will likely experience future recurrences and 2-8% of those individuals will develop chronic back pain.

Chronic pain accounts for 75% of all healthcare costs related to low back pain, is second only to the common cold in missed days from work, and is the number one reason for workmen compensation claims.

Considering the burden chronic back pain places on healthcare resources, patient management appears to be an issue in need of addressing appropriately as many patients find it difficult to find effective treatment.

Low Back Treatments That Don't Help
Now many experts are questioning the model in which back pain is treated as a growing body of research suggests many common back pain ‘cures’ just don’t work. These include:

  • Ultrasound
  • TENS machines
  • Strong opium-type painkillers, such as diamorphine
  • Spinal injections
  • Spinal fusion
  • Disc replacement
Prescribing drugs or cutting people open when you don't know what's causing the pain is very unlikely to be successful in the long term. Surgery should only be used as a very last resort. There is a significant lack of efficacy for many treatments, but the deeper issue here seems to be that many healthcare providers have difficulty in accurately identifying the cause of ‘non-specific low back pain’.

Top spine expert, Professor Stuart McGill is the world’s leading spinal biomechanics researcher and has identified common reasons for back pain and the importance of exercise as an intervention for effective treatment.

In Dr. McGill's opinion, based on over 30 years of research, every case of back pain has a cause and the reason many treatments are ineffective is because they are used on a one-size fits-all approach, rarely targeting the underlying problem.
There are many possible causes for back pain, but you must first find the positions and stresses that trigger pain. As Dr. McGill says, finding these positions and stressors allows the provider to formulate a precise diagnosis and a roadmap to recovery. This roadmap is guided exercises that can correct the harmful patterns and build a stable, firm spine.

Addressing Misconceptions
The importance of a firm spine can come as a surprise to many, as the common perception is that your back must be flexible in order to be healthy and pain-free.

The spine must be firm and have strong muscles surrounding it to help transmit forces from the legs and the shoulders while minimizing the stress on the spine. When the muscles of the spine aren’t strong enough, micro-movements can occur that eventually can sensitize the spine and lead to a painful back.

If you have some movements, which are comfortable to build on, this opens the door to conservative management and recovery through guided exercise

However, recommendation of exercise without a clear understanding of movement intolerances and muscles that must be strengthened can also be harmful

Guided Exercise: The #1 Intervention for Low Back Pain
Exercise is essential both to protect and repair your back, but simply hitting the gym or doing Pilates or yoga without knowing the movement patterns that are generating your pain or the ones that will protect and build a pain-free back, has little chance of being effective.

Thanks to exercises specifically targeted at a patient’s problems, we are able to help educate them on proper posture and movement so they do not put damaging load on their spine. The guided exercise model is truly about identifying a patient's underlying back pain generators and educating them on not only how they can get out pain, but also what they can do to keep it from returning.

When you consider that 85% of individuals who have low back pain will experience future recurrences, there must be a priority placed on educating patient's about proper posture, movement, and exercises that build a firm, strong spine. Guided exercises are showing clear efficacy for use in patients with low back pain and should be a staple in their treatment plan.

If you are suffering from low back pain, whatever the cause, consider Gallagher Performance for your evaluation and treatment. Our goal is to relieve your pain while teaching you what you can do to keep the pain from returning.

More related reading:

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

 

Understanding the Benefits and Concerns of Youth Strength Training Programs

Benefits of Strength Training for Youth
Numerous studies have been published on the benefits of strength training in regards to overall fitness and health markers, muscular strength, injury reduction, sports performance enhancement, and confidence. Scientifically proven adaptations from strength training include increased neural drive, increased synchronization of motor units, and hypertrophy of skeletal muscle. These adaptations not only create a bigger, leaner, and stronger individual, but one who is able to express improved control and execution of complex sport skills while performing them at greater force and velocity outputs. So as a young athlete, if you have a desire to run faster, jump higher, or throw harder, you must first become stronger. Strength is the foundation on which all other physical abilities are built.

Experts also agree that there are many health benefits associated with strength training with research suggesting that strength training in youth can result in increased bone density, healthier body composition, and improved blood lipid profiles. Other benefits from participating in a strength training program also include reduced chance of injury during sport participation and increased self-esteem and confidence.

Now while to what degree strength and improvement in the weight room transfers into an athlete performing better on the field may be left in question, one thing that will always transfer to a competitive environment is confidence. I'm not talking having a massive ego or being cocky. Confident and cocky are completely different. Confidence is extremely important and strength has a unique way of improving confidence in children.

Concerns of Strength Training for Youth
Roundtable discussions including strength coaches, medical professionals, and researchers have focused on questions of concern pertaining to the strength and conditioning programs for young children. These concerns include injury rates, efficacy, and safety.

Among these experts, they have agreed on one common theme:

When a program is well supervised, form and technique are properly instructed, and the program is administered by someone who holds an appropriate certification, there should not be a concern for the child’s safety.

When it comes to weightlifting injuries, a large number of the reported injuries took place in a home gym or involved children who were unsupervised while they were lifting. In regards to minimizing risks in the weight room, many of the experts agreed that there should be an appropriate coach-to-athlete ratio (smaller ratios are ideal), proper education on strength training technique, and proper progressions for their training age.

Appropriate Age to Begin Strength Training
It is generally accepted that there is no specific age at which it is best to start a strength training program. However, it is recommended that children must be mature enough to accept and follow directions while also possessing an understanding of the risks and benefits associated with strength training. It is commonly accepted that if a child is participating in an organized sport, then this is an appropriate time period for them to begin a strength training program. Typically, for the majority of children this would approximately between the ages of 6-8.

Final Words
There are numerous benefits for youth to begin a strength and conditioning program. The program should be led by a qualified strength and conditioning professional and tailored to meet the needs in regards to age appropriate training, gender, and primary sport(s) of participation. Children should be willing and ready to follow instruction to ensure safety, quality training, and to meet their performance goals.

For more information on the topic of youth strength training and athletic development, please click on the links below:

Guidelines for Selecting a Strength Coach or Personal Trainer
Gallagher Performance - Staff Bios
Common Mistakes in Developing Young Athletes
Success or Failure: What Are You Setting Your Young Athlete Up For?
References
Faigenbaum, A, Kraemer, W, Cameron, J, Blimkie, R, Jeffreys, I, Micheli, L, et al. Youth Resistance Training: Updated Position Statement Paper from the National Strength and Conditioning Association. The Journal of Strength and Conditioning Research 23(suppl 5): S60-S79, 2009.
Haff, G. Roundtable discussion: Youth resistance training. Strength and Conditioning Journal 25(1): 49-64, 2003.

Does Practice Make Permanent? How Practice Rewires Your Nervous System

In our younger years, many of us likely heard the expression “Practice Makes Perfect.” This usually came from a parent, coach, or teacher. Some took the saying a step further, adding “Perfect Practice Makes Perfect.” Some even say, "Practice Makes Permanent". Regardless, still the message was clear – if you want to improve, you need to put in some time and focused effort. You need to practice.

But is all about simply practicing or do we need to have a different focus?

Research has provided a better understanding of how practice influences skill development, helping us understand how the nervous system is rewired during the process. While there are many components to consider during the process of motor learning and skill acquisition, in this article we will be discussing how a unique tissue to the nervous system called myelin plays a critical role in the acquisition and mastery of skills.

Practice Rewires the Nervous System
When we are exposed to a movement or sport skill that is new or unfamiliar, the result is typically feeling awkward and uncoordinated. To some degree, we may be apprehensive. This is normal and to be expected. But, as we practice, something happens. Things get smoother, we feel more comfortable, and the movement/skill becomes more natural.

What is happening?

What practice is actually doing is rewiring your nervous system to become more efficient during complex movement tasks through a process called myelination.

The Role of Myelin
Understanding all the intricacies of the nervous system is not the point of this article, but a little background will be helpful. Myelin is a tissue that covers our neurons, the cells that make up the nervous system. Myelin is mostly a fatty substance, with cholesterol being an essential component. It serves to insulate nerve cells and has a characteristic “white” appearance. This is why most people refer to myelin as “white matter” when discussing the nervous system. What science has helped us understand is that myelin improves the speed and strength of nerve signals, meaning that myelinated nerves transmit signals faster than non-myelinated nerves. Myelin helps our nervous system function at a higher level.

Ok, so how do we get myelin onto our nerves?

To begin with, the majority of myelination occurs during the early stages of development. These stages of development occur during the 2-3 years after birth and into early childhood. Children are myelin-generating machines. This can be seen not only in respect to movement, but also with language and comprehension skills as well. Where there is development, you will find myelin. This is why there are critical developmental stages that exist in long-term athletic developmental (LTAD) models. LTAD models help us understand that we cannot make up for lost time. Sure, as we get older we can continue to generate myelin, but it happens at a slower rate and requires more effort. This is why most young athletes who miss critical developmental stages tend to get passed up later in their athletic careers.

So what’s the big deal about critical developmental stages?

It provides children with graded exposure to skills through practice and repetition. The process of practice and repeated effort triggers a pattern of signals through our nervous system. With time and repetition, myelin is produced to increase the speed, strength, and coordination of these nerve signals. It’s a streamlining effect that your nervous system undergoes due to exposure to a repeated sensory stimulus and motor (movement) output.

Practice Makes Myelin, So Practice With Purpose
Understanding the role of myelination in skill acquisition has tremendous implications. Yes, volume and frequency of practice matters, but myelination makes a case for understanding why quality of practice matters. Practicing with an extreme focus on quality is equally, if not more important, than simply practicing a lot. Don’t just practice to practice. Corrections should be made as they are needed. You don’t want to spent the majority of your time practicing bad habits, as bad habits are hard to correct. Bad habits arguably are not permanent. However, the longer they exist, the harder they are to unlearn. Myelin is a big reason why.

In the context of training and sport skill development, if you lift/sprint/jump/practice with poor technique and no one corrects your mistakes, you will be myelinating those nerve pathways – which does you no good and only serves to lowering your athletic potential. Sure you may improve, but you will never reach your true potential. And the longer your bad habits remain, the harder it is to correct them.

The takeaway: practice of movement skills over time causes specific neural pathways to work better via myelination. To improve your performance, you not only need to practice FREQUENTLY, you also must practice CORRECTLY and receive plenty of feedback from a qualified coach so you are able to properly develop your movement and sport skills.
More related reading:

https://gallagherperformance.com/unlock_your_potential_with_this_powerful_tip/

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

Stay Strong and Heal Faster While Injured

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

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

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

Wait….what? Training your non-injured arm helps to keep your injured arm strong and heal faster?
There is truth to that statement. The phenomenon I am referring to is known as “cross-education”. It is well established that to minimize the effects of detraining, performing single-side training with the non-injured limb (upper or lower body) will allow you to maintain strength and accelerate healing in the injured limb.

Cross-education occurs when you strength train a limb on one side of the body. The result is an increase in strength in the opposite limb on the other side of the body due to neural adaptations. Cross-education appears to be effective for all muscles and joints of the body, from shoulders and hips to ankles and wrists.

A study published in the Journal of Exercise Science and Fitness demonstrated that strength gains in the untrained limb are typically in the range of 5 – 25% depending on if that limb dominance. Strength gains average around 35 – 60% increase in the trained limb. Additionally, it appears that less range of motion will be lost in the injured limb due to the cross-education effect – another major benefit.

There are other studies on the subject of cross-education, but still cross-education is not completely understood. Strength gains in the injured limb are most likely due to neuromuscular adaptations and increased neural drive to the untrained muscle. A similar hypothesis is improved motor control because training the healthy limb results in recruitment of high-threshold motor units in both limbs. Keep in mind, there is no evidence of hypertrophy (muscle growth) or changes in muscle fiber types in the injured limb following single-side training.

Cross-education highlights the importance of single-limb exercises during training and rehabilitation from injury. Helping clients or athletes understand cross-education may encourage them to continue an exercise routine during time of injury, as it can help maintain strength and speed recovery. Cross-education is a perfect illustration of how one can turn a weakness into a strength through focused training efforts.

 
Sources:
Lee, M., Carroll, T. Cross-Education: Possible Mechanisms for the Contralateral Effects of Unilateral Resistance Training. Sports Medicine. 2007. 37(1), 1-14.
Zhou, Shi. Cross-Education and Neuromuscular Adaptations During Early Stage of Strength Training. Journal of Exercise Science and Fitness. 2003. 1(1), 54-60.
 
More related reading:

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

A Few Words on Athletic Development

We get asked quite often about our training philosophy when it comes to athletes. Many parents want to know if the training their child will receive at GP is going to be sport-specific. While specificity in training matters, many of our athletes and their parents are surprised to learn how general or fundamental their training must be in the early phases. What needs to be clarified is understanding how much training experience the athlete has and the physical traits that must be developed. The vast majority of athletes we work with are involved in the sports of football, hockey, baseball, and basketball. Success in these sports are highly dependent upon power-speed qualities. We must train these athletes to develop the abilities that allow them to jump, sprint, cut, and dominate their opponents with brute strength. It's our job to make them bigger, faster, stronger, and more durable. It's our job to physical prepare them for the demands of their sport.

Aspiring young athletes are in need of building a broad foundation rooted in movements that will develop strength, speed, flexibility, and body awareness. For the evidence-based fans out there, we use movements and exercises that all have been proven through research to work. But more importantly, the exercises used have stood the test of time and have served as the backbone to athletic development programs for decades. Sprints, jumps, throws, compound strength exercises, Olympic weightlifting movements when appropriate, and general calisthenics have all play a role in the training of some of the greatest athletes in the world.

But the exercises are not simply enough. Almost every single one of our athletes must be exposed to a high volume of training without a high degree of variation. It's important to respect the neural adaptations young athletes or novice trainees undergo during the training process. High volumes of training will help ensure motor learning and skill acquisition while developing the connective tissue strength needed for more intensive training down the road.

This template serves to lay the foundation for the neuromuscular qualities required to meet the increasing needs for speed and power development. It's simple math really. If an athlete improves relative strength, that athlete will be faster and more explosive. Keep in mind that that other factors can be at play too. For instance, that same athlete must also maintain or improve movement quality to improve speed and explosiveness.

However, these are only portions of what goes into a quality athletic development program. It's much more than simple "strength and speed". This is why we feel the value of a qualified strength and conditioning coach or athletic development coach is severely under appreciated. Unfortunately, far too many people have been misinformed by either poorly educated trainers or by the internet. They haven't experienced the difference guided athletic development can make in their performance. Having a coach to guide young athletes not only in their development, but also in areas such as nutrition and cultivating the mind set needed to achieve their goals can give them a huge advantage over their competition.

That's why we love what we do at GP. Not only do we get to work with clients and athletes that have big dreams and big goals, but we also help them develop habits that create a healthier lifestyle. When we have them giving us their best, they deserve nothing less than our best!

More related reading:

https://gallagherperformance.com/understanding-the-benefits-and-concerns-of-youth-strength-training-programs/

https://gallagherperformance.com/periodization-keep-athletes-track-fo-success/

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

The Value of In-Season Training for Athletes

 



The need for focused off-season training is well accepted. However, outside of the professional and collegiate ranks, the same cannot be said for in-season training. This is truly one of the greatest sources of misinformation that exists when it comes to progressive athletic development and minimizing the number of non-contact related sport injuries. Routine in-season training can benefit young athletes in a number of ways.

With the majority of our athletes wrapping up their off-season preparation and starting camps in the next couple weeks, we get several questions from these athletes and their parents about what 'should' or 'should not' be done during the season to continue progressing in an athletic development model.

For starters, we establish how critical in-season training is for any athlete. This is not a sales pitch, it's the truth. In-season training may not have the same public acceptance as off-season training, but that does not mean it is not valuable.

In-season training has been shown to not only maintain or improve physical qualities (strength, speed, power, etc.) developed during the off-season preparatory period, but it can improve the rate of recovery between competition and maintain healthy muscle/connective tissue qualities as well.

What does that all mean?

Continue reading

How to Develop Physical Fitness

Recently, I was having a conversation with one of our clients about what it takes to be ready to compete in sport. The conversation mostly centered around athletics and how to be in the best "condition" possible. Specifically, this client was talking about certain people they know and hold in high regard as having a high level of physical fitness. All was going well until they said something very interesting.

In regards to someone they know, they said, "Man, are they fit. They are probably the most fit person I know."

When I asked them what makes that individual the "most fit" person they know, they just stared blankly back at me. There was no response and you could see the wheels churning away trying to figure out the answer.

Fitness is a craze nowadays. Women want to be fit. Men want to be fit. Athletes want to be fit. People want to be fit. Health clubs, personal trainers, smart phone apps, and infomercials want to sell you on becoming more fit. Slogans such as “Forging Elite Fitness” and titles such as “Fittest Man on Earth” or “Fittest Woman on Earth” make the concept of fitness very intriguing. Many people have come to believe fitness is a complex process. To most, the idea of “fitness” brings to mind someone who is muscular, lean, strong, and has stamina for days. This “idea” of fitness seems to be nothing but mere marketing and often leads people down the road of overcomplicating their exercise or training program.

So, that begs the questions, "What is fitness?"

Physical fitness is actually quite simple if we define fitness as “the quality of being suitable to fulfill a particular physical task”. If your task is to compete in the 100m dash, then your fitness levels must enable you to successfully compete in that event. If your task is to start in the NFL, then your fitness must enable you compete at your highest level possible week after week.

Developing Physical Fitness
Physical fitness is achieved during the process of physical preparation or how prepared you are for competition. The ultimate goal of physical preparation is to have each athlete at their best during competition and is accomplished via a systematic process to promote adaptations that raise levels of both fitness and preparedness. Fitness adaptations thus follow the SAID principle (Specific Adaptations to Imposed Demands). Meaning, if you want to gain muscle, get stronger, and be more explosive, you better be sprinting, jumping, throwing, and lifting weights to allow those specific adaptations to occur. The SAID principle also means that an athlete’s level of fitness should always be specific to their sporting demands.

Debating who is the most “fit” athlete or individual on the planet is a ridiculous conversation. How can someone say that an NHL defensemen who plays almost 30 minutes per game over an 82 game is more or less fit than an Olympic caliber decathlete? How is that Olympic decathlete more fit than a Navy SEAL? How is a Navy SEAL less fit than the “Fittest Man on Earth”? How is the winner of the Boston Marathon more fit than the World’s Strongest Man?

Do you see what I am getting at?

An athlete’s fitness levels (strength, power, stamina, energy system development, etc.) will always be specific to what is required by their primary sport form. Just because someone is the “Fittest Man on Earth” does not mean they will have the ability to withstand the demands of competing within another sport at elite levels. Personally, the “Fittest Man/Woman on Earth” title would be better renamed to “Fittest CrossFitter on Earth” because that’s all the title means. The notion that elite fitness in one event or sport is somehow superior to the fitness required in another is either arrogant or ignorant (possibly both).

Understanding Physical Fitness Adaptations
To better understand physical fitness and the specific adaptations that result from training, we must first consider the training system commonly used to achieve improvements in endurance, strength, and power. This training system is known as concurrent training. Concurrent training is defined as, “the simultaneous inclusion of strength training and endurance training within the same program.” Concurrent training may be a necessary means for some athletes and individuals. However, for most, the application of concurrent training is widely misunderstood and poorly organized in the pursuit of all things “fitness”. They want to improve endurance, so they do a lot of aerobic exercise. They may run, bike, or swim for hours each week. They also want to get lean and strong, so they lift weights 2-4 times per week. These are the people who train and train and train, yet fail to see significant improvements in any number of neuromuscular adaptations.

Aerobic and strength adaptations are very divergent. The human body is simply not capable of adapting appropriately to two very different training stimuli. You can go run for a long period of time or you can be explosive and strong from weight training. Now, I understand nobody wants to be both an elite marathon runner and Strongman. However, there are people who want high levels of aerobic capacity while also becoming muscular and strong at the same time. Unfortunately, many of these same people plateau quickly or fail to see significant improvements because concurrent training attenuates muscular growth, strength, and power gains. There is an interference effect created when one attempts to simultaneously improve both aerobic fitness and neuromuscular qualities such as strength and power. The training approach is doomed from the beginning if specificity and attention to detail in training organization does not enter the picture.

To understand why, we must then understand the competing long-term adaptations that occur from strength training and endurance training.

Competing Long-Term Adaptations
1) Strength Training (short duration, high force output)

  • Neural Adaptations – synchronous firing, recruits large populations of motor units, rapid rates of force development, improve rate coding
  • Endocrine Adaptations – Growth Hormone (GH) and Testosterone release, anabolic environment, stimulation of satellite cell activation and muscle protein synthesis
2) Aerobic Training (long duration, low force output)
  • Neural Adaptations – asynchronous firing, recruits small populations of motor units, slow rates of force development
  • Endocrine Adaptations – impaired anabolic hormone signaling, elevated Cortisol and catabolic hormone production, inhibition of mammalian target of rapamyacin (mTOR), essentially shutting down the pathways for stimulating muscle protein synthesis
This means that regardless of whether you perform aerobic exercise and strength training in separate sessions or during the same exercise session, the results can be negative depending on your “fitness” goals or needs as an athlete.

Fitness is Specific
Physical fitness is thus specific to the end goal of physical preparation. The physical preparation of an American football player should be different than that of an MMA fighter. Football players do not need to have the "fitness" levels of MMA fighters. Each of these athletes must develop their physical fitness qualities to meet the demands of their sport. Consider that American football players must develop power-speed qualities that are essential to their success at high levels of competition. Some trainers and coaches feel that some of their football players need better aerobic fitness or conditioning, so they have them perform high volumes of gassers or long distance runs in the off-season. As said before, this can prove to be a huge mistake. Being "fit" for football has very little to do with how many gassers you can complete, how fast you can run three miles, or what your Fran time is.

The same is true for other power-speed athletes (hockey, baseball, lacrosse, sprinters, throwers, etc.) Senseless and poorly implemented aerobic conditioning will have negative impacts on the neuromuscular qualities needed for successful participation in these sports. These qualities are important to their “fitness” as an athlete. Sure, go ahead and perform endless miles of running or biking. Go on with your absurd amounts of circuit-based training. But when you rob these athletes of their ability to develop higher levels of strength, speed, and power, it should be no surprise as to why it happened. Aerobic fitness cannot be prioritized to the point that more important qualities (strength, speed, and power) suffer.

But, isn’t a decent aerobic conditioning base essential for these athletes as well?

Yes. However, there are more optimal ways to develop their aerobic energy systems to meet the demands of their sport. Don't make the mistake of assuming aerobic capacity is the same as being "fit". Aerobic energy system development will always be specific to the athlete's needs. Similar to resistance training, aerobic development should be periodized and appropriately dosed to developed the specific energy system demands without impairing performance.

Conclusion
Fitness is not simply achieved by going nuts, but rather being productive in specific approaches to your sporting demands. If you are unsure of how to appropriately address your fitness goals or needs as an athlete, then first start with a knowledgeable coach who understands the complexities of physical preparation for sport and is able to guide you in the process. For some, the concept of fitness requires a bit of a “reality check”. Sure you may want it all. You want the elite level endurance, strength, speed, and power. But, often this is not realistic. Prioritize your fitness goals and address them accordingly in specific phases of training. This process requires patience.

Remember, fitness is a highly specific quality that is ultimately dependent upon the physical preparation process for your sport of participation. Understand your training must mirror your demands for sport. If training is not addressing your specific needs as an athlete, you are wasting your time. Don't let some general or poorly defined concept of "fitness" guide your training.

More related reading:

https://gallagherperformance.com/physical-preparation-vs-fitness/

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

https://gallagherperformance.com/ultimate-runners-guide-to-injury-prevention/

Gallagher Performance Training – How We Are Different

At Gallagher Performance, every client and athlete begins with a comprehensive physical assessment. The process includes looking at how you move through your entire body and is tailored based upon what the individual is capable of performing. Our physical assessment is not simply a standard movement screening process. Similar to our training process, our assessments are customized to the individual, thus providing us the greatest insight into the current abilities of our clients and athletes. Beyond the physical assessment, we take time to understand your injury history, training experience, primary sport(s) played, and several other factors. You will also have the chance to meet our staff to ensure that you are comfortable when you return for future training sessions.

The information gathered during your initial assessment is used to design an individualized training program. We take time to ensure that specialized attention is given to each program design. As a result, your individualized training and nutrition materials will be provided upon return for your second visit. Clients are closely coached through the entirety of their program to maximize results.

Gallagher Performance is all about individualizing the training process. You won't find "whiteboard workouts" or "cookie-cutter programs" here! That's because we understand each person responds differently to training due to a multitude of factors that must be accounted for. The goal of any training program at Gallagher Performance is to account for individual differences and use that knowledge to maximize training results. This routinely allows our athletes to experience the best results from their physical training and become a dominant force in their sport.

WHY Gallagher Performance?

Initial 1-on-1 Assessments

Custom and Individualized Program Design

Supervised Training Sessions

Positive and Supportive Atmosphere

Continue reading

The Essentials of Keeping Athletes Healthy

The number one priority of any coach or trainer should be the health of your athletes. At GP, we look at any and all entities that should be addressed to increase the wellness of each of our athletes. This takes into account biomechanical/movement quality considerations, exposure to inappropriate training, the compatibility of current training loads and parameters, nutritional considerations, and the coordination of therapy and restoration techniques.

The process of developing athletes and ensuring they remain healthy in the process can present a major problem and one that could be remedied with both higher coaching education standards and the utilization of performance-based therapy.

1. Raising Coaching Education and Qualification Standards
To ensure the health of our athletes while realizing their athletic potential, we spend countless hours on improving movement efficiency as well as balancing workload compatibility during each training session and block. Statistics consistently demonstrate the more mechanically efficient you are, the less injuries you have. Movement efficiency also translates into athletes having higher levels of performance while expending less energy in the process. Expending less energy means less fatigue. This is important since athletes are more likely to get injured in a fatigued state.

Workload compatibility refers to the importance of understanding compatible training methods when addressing a dominant physical ability during a phase of training. For example, this demands that the coach/trainer understand if they are trying to develop alactic sprint abilities why glycolytic or anaerobic-lactic training must be restricted or avoided.

In the attempt to improve any number of physical abilities, most coaches/trainers often fall into the trap of pushing their athletes too hard in training. They understand that in order for athletes to perform any number of biomotor abilities (speed, strength, work capacity) at higher levels, they must push them during training to create a specific adaptation. In the process of achieving adaptation, often times they manipulate variables (intensity, frequency, duration, workload, etc.) without any understanding as to why they are making the change. As a result they compromise the athlete’s ability to adapt appropriately and set the stage for injury.

Simply put, more educated coaches understand workload compatibility and the development of specific biomotor abilities as they relate to an athlete’s sport. They have a system of checks and balances that dictate training variables and they are constantly monitoring their athletes to avoid declines in performance standards and injury.

Movement efficiency and the proper management of training loads/parameters is a relatively poorly understood concept by the majority of trainers/coaches when most of them have simply taken weekend certification courses and are under qualified, with no background in sport and exercise science. This is far too common in the US, as trainers with minimal experience and knowledge of these concepts as they relate to sport often find themselves responsible for the coaching and development of athletes.

This approach is in stark contrast to the coaching qualification process in the former Soviet Union, where the development of coaches/trainers was a scientific and well-planned undertaking. Those who wished to become coaches had to be high-level competitive athletes themselves and were required to take entrance exams in subjects such as biochemistry, physics, biology, and physiology. The applicants who made the cut were entered into one of the country’s Physical Culture Institutes to undergo four to five years of a rigorous, scientifically oriented coaching curriculum. Coaching in the former Soviet Union was not something one decided to do a “whim”. Coaching and the development of athletes was viewed as a career that required specialized education, mentorship, and training.

It doesn’t take long to realize why the Soviet Union dominated international athletic competition for as long as they did once you understand the qualification criteria for their coaches was a serious and intellectual process.

Athletes should seek out coaches and therapists who have the competitive sporting background and accomplishments, educational background and accomplishments, as well as clinical competence, methods, and track record to keep athletes healthy and performing at their best. Period. Anything less, and you should be skeptical about what you are getting.

2. Integration of Performance-Based Therapy
In addition to raising coaching education and qualification standards, excellence in therapy is another component that is often missing when it comes to keeping athletes healthy. Unless you have integrated sports medicine and therapy (sports chiropractic, massage, manual therapies, recovery methods), eventually an athlete will need to reduce the overall volume/intensity/frequency of training. What you are able to learn about an athlete in a therapy session is invaluable and can serve to help guide what you do in training.

As Dan Pfaff said best,

“A top athlete is like a formula one car and have you seen how much fine tuning they do with those things? The ability to run your hands over an athlete and know what is restricted gives you immense inside information into their functioning. You cannot expect the athlete to tell you either because they are terrible barometers when it comes to knowing what they are ready for. Just asking “are you ok for today’s workout?” is not enough because their motivation is so high athletes do not necessarily listen to what their own body is telling them.”
Therapy serves to normalize joint and soft tissue (muscle, tendon, ligament) function and promote movement efficiency by removing dysfunctional movement patterns. Similar to training, therapy cannot be randomly applied. Random application always equals random results. Therapy must be strategically implemented during the training plan. It should not be ignored that therapy provides a stimulus/stress to both tissues and the nervous system and, depending upon the athlete’s needs, must be utilized appropriately.

For instance, some forms of therapy can serve to promote recovery and restoration by pushing an athlete into a parasympathetic dominant state. Conversely, other forms of therapy can up-regulate the sympathetic nervous system and will either heighten performance levels or prolong the recovery/regeneration period depending upon when therapy is applied. Another factor that must be consider is how each individual athlete responds to therapy. Some athletes may respond to intensive therapy sessions just as they do to intensive training and therefore proper rest/recovery must be accounted for accordingly during the training week.

Closing Words
Both higher coaching education/qualification standards and performance-based therapy are necessary components in the health and performance of athletes. The more coaches know, the better they are able to serve their athletes and address their needs appropriately. Failure to integrate performance therapy in a complementary manner can be a mistake, as there tends to be an increase in reliance on other forms of therapy that stress rehabilitation and recovery rather than optimizing performance.

Related Articles:

What is Performance Therapy?
Have You Mastered Your Movement?

Does Unstable Surface Training Build a Better Athlete?

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

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

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

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

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

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

Why?

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

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

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

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

“You instantly tense up, you almost literally can’t perform certain movements because the nervous system senses the instability of the environment and fires in resistant ways to keep you balanced. In this process, it also shuts down the ability to produce maximum force….Think about it, if you start to slip in one direction and your reflexes caused your muscles to fire with maximum force against that motion—a motion that may be inevitable at that point, like falling—then you risk tearing muscle or connective tissue. The body is trying to protect you by making you weaker.”
Simply put, as the body’s need for stability increases, force production decreases. You cannot build strength, speed, or explosive power in an unstable environment. What all the marketing behind products such as BOSU balls and the trainers that endorse them fail to tell you is that the stabilization action of musculature actually increases when you are on a stable surface, not on an unstable surface.

Want proof? Here are some findings from a growing body of evidence:
  1. Several researchers have demonstrated that there is significant increases in stabilizer activity during movements that require increased force (either greater resistance or higher speed) compared to activity seen in unstable environments [1-4].
  2. Performing squats on unstable surfaces will increase core activation, but not necessarily core strength [5] and definitely decreases muscle force production [6].
  3. Doing pushups on a physioball does less to activate stabilizing muscles than placing your feet on an elevated, stable bench[7].
  4. Unstable surface training contributes nothing that cannot be achieved when performing stable surface exercises [8,9].
  5. Stable surfaces are superior for some scenarios involving scapular rehabilitation [10].
The reality is unstable surface training is not an effective means of training athletes or healthy individuals. Unstable surface training has its merits in a rehabilitation setting, but the application outside that realm is questionable at best. There are far more productive means of training for athletes than performing exercises on a BOSU ball.

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

Are You in Need of More Intelligent Training?
Training for Elite Athletes
Common Mistakes in Developing Young Athletes
 
 
 

Athletes Must Understand This to Be Successful

The emphasis of many athletic development programs is typically rooted in developing the physical qualities needed in the sport of competition. Physical qualities usually emphasized are endurance/work capacity, strength, body awareness, agility, quickness, speed, and explosive power. Improvements made in any of the previously mentioned physical qualities can certainly improve an athlete’s fitness and physical preparedness for competition. But great athletes are rarely defined by their level of fitness and how ‘in-shape’ they are. They are defined by their ability to play the game and perform the skills of the sport. Great coaches and trainers understand this, being able to take an athlete’s newly developed physical qualities and transfer them to into improved skill execution or technical mastery of sport related movements.

This is accomplished by specificity of training.

In order to ensure specificity of training, it is first necessary to determine the exact physical qualities an athlete is in greatest need of. Many coaches and trainers refer to this as ‘identifying the deficiency’. Once the deficiency is identified and an understanding is developed as to how the deficiency is limiting on-field performance, the deficiency can be trained appropriately.

To identify deficiencies, the majority of coaches and trainers utilize tests to determine an athlete’s level of strength, endurance, explosiveness, and even flexibility. While these tests are often necessary and provide quantitative information that will help assess how an athlete stacks up in comparison to others, what these tests fail to indicate is how efficiently an athlete can perform sport-specific skills or maneuvers.

Physical performance tests fail to indicate an athlete’s needs in relation to game performance. To ensure transfer of training into improved sport performance, identifying an athlete’s developmental needs must take into account an analysis of all components involved in successful competition. Often, this involves a complete biomechanical analysis of movements related to sport-skill execution.

For example, the deep squat is often a staple of many strength and conditioning programs. It can be a tremendous exercise for building hip strength and power and for a variety of other reasons. But when you examine the sport-related movements of many athletes, one can come to the determination that the need to deep squat is not a priority for many athletes. Consider hockey and basketball players. These sports require hip external rotation strength and power to execute sport-specific movements (skating, lateral cuts, change of direction, etc.). Rather than placing greater and greater emphasis on improving strength in the deep squat, these athletes will be better served in developing hip external rotation through other exercises which more closely mimic the external rotation demands of the hips in competition.

Again, great athletes are rarely the strongest or the fittest. There are studies that demonstrate Olympic-level athletes and World Record holders are not the strongest athletes (with the exception being in strength sports such as powerlifting and Olympic weightlifting). Athletes on the highest levels of performance do not lift the greatest amount of weight in commonly used exercises, such as the clean, squat, bench, or deadlift.

More commonly, athletes will fall in the midrange of strength numbers. What this is demonstrating is a ‘point of diminishing returns’. Many athletes reach a point at which increases in strength or other physical qualities do not always equate to improved sport performance.

Successful athletes must be able to execute sport skills with technical mastery and precision. Regardless if you are a hockey, football, soccer, lacrosse, baseball, tennis or track athlete, you need great acceleration, speed, agility (ability to change direction quickly), and the ability to jump high (which also requires explosive power). But arguably most important is the ability to perform all sport skills with mastery and precision of movement.

An athlete will never be successful if they do not have the ability to execute sport skills successfully. This is why technique must be closely analyzed and why the training of physical qualities must directly enhance the performance of sport-specific skill execution.

Analyzing an athlete’s sport skill technique and the demands of game play becomes a necessary first step to determine exactly what their training program should consist of. Often to correct and/or enhance technique, special strength exercises are implemented to develop the specific strength an athlete needs to execute movements more efficiently.

We addressed special strength exercises in this article. Special strength exercises are intended to replicate the exact neuromuscular pathways utilized in the execution of specific sport skills.

With proper analysis and identifying the ‘deficiency’ of the athlete, it enables the training program to have greater transfer into sport performance. The training program is continually adjusted as improvements in strength, speed, agility, and explosive power are integrated into technical mastery of skill execution.

Related Articles:

Training for Elite Athletes
Common Mistakes in Developing Young Athletes

Why Athletes Should Avoid HIIT Programs

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

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

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

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

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

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

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

So why does HIIT fail athletes?

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

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

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

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

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

Related Articles:

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

Athletes Do Not Need Balance to Be Successful

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

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

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

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

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

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

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

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

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

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

More related reading:

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

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

https://gallagherperformance.com/commonmistakesindevelopingyoungathletes/

Is Weight Training Inappropriate for Young Athletes?

It seems almost routine now that we come across parents who are curious about what type of ‘training’ their child should be doing to become a better athlete. Ultimately, the majority of parents are concerned about their child lifting weights. Typically their child is 12-15 years of age and the parents feel that weight training at that age is inappropriate and could be potentially dangerous (e.g., stunt their child’s growth). Since this idea is so widespread, we felt it would be valuable to address the topic and the determining factors of whether weight training is suitable for a young athlete.

To start, let’s set the stage for our discussion by simply stating that weight training is one form of ‘resistance’ training. There are plenty of ways to apply ‘resistance’ to the body. From bands to weighted vests to body weight exercises, they are all considered resistance training. If you asked most parents if they had a problem with their child doing push-ups or walking lunges, the majority of them would likely reply, “No”. Lifting weights, at times, can provide less resistance than common body weight exercises yet lifting weights is somehow deemed more dangerous.

Why?

The majority of parents are primarily concerned about the risk of growth plate fracture and the possible result of stunted growth.

To address these concerns, the National Strength and Conditioning Association (NSCA) published a position statement. They determined that resistance training is safe, even for children as young as 6, and that the risk of growth plate fracture and stunted growth is completely unsupported. Simply put, it does not happen and weight training is safe with appropriate coaching and progression. Additionally, research has demonstrated significantly higher injury rates in youth sports (football, basketball, soccer, baseball, hockey, etc.) when compared to weightlifting.
When it comes to coaching and progression, this is where considerations from Long-Term Athletic Development (LTAD) models become invaluable in helping to understand sensitive “windows” during an athlete’s development. These windows identify when to capitalize on certain physical qualities. Looking at LTAD models, children around 12 years old are in a critical window for their speed development. This means that while they can improve in all athletic attributes (balance, coordination, rhythm/timing, relaxation, strength), speed development will experience faster rates of improvement. Speed simply comes down to putting a lot of force into the ground quickly. Explosive movement requires high power output and this relies on your “fast twitch” muscle fibers. Resistance training is one method to efficiently train “fast twitch” muscle. In this context, certain exercises aren’t always what they appear to be. For example, a young athlete performing squats may not be simply performing squats, but rather “speed training” because it’s a tool to teach them to produce force quickly and utilize their muscles in an explosive manner. Improve an athlete’s ability to produce force and they will get faster. Force production is directly controlled by the nervous system. Neural development is very sensitive for children 12-13 years of age. This means that the nervous system, which coordinates all movement, is primed for learning and improving efficiency of complex movements. This is one reason why resistance training is appropriate for athletes during this time period; it can capitalize on a sensitive period of neural development to help kids move with improved body awareness AND coordination, thus resulting in increases in qualities such as strength, power, and speed.
Concluding Thoughts
There are many factors to consider when it comes to “appropriate training” for young athletes. While there are safety concerns, age-appropriate and developmentally specific training methods can be extremely effective. For young athletes, weight training is a safe and effective means to develop body control/awareness and improve athletic qualities, such as speed. Weight training, as part of an athletic development program, should follow a structured approach under the supervision of a knowledgeable and qualified coach.

To ensure the highest quality outcomes and safety, GP understands and utilizes LTAD models in the training of their young athletes.

Related Articles:

Success or Failure: What Are You Setting Your Young Athlete Up For?
Don't Fall for the Speed Trap
Identifying Strength Needs for Athletes

Structural Adaptations: How They Impact Training and Therapy

Similar to a growing number of athletic facilities across the US, Gallagher Performance places a significant amount of emphasis on assessing our athletes in order to address structural adaptations and movement dysfunctions appropriately during the course of the athlete’s training program. This trend is seen throughout collegiate and professional athletics as organizations are recognizing the importance of keeping their athletes healthy by promoting optimal training environments.

However, this service is rarely available to young athletes prior to sport participation or a training program. This is truly unfortunate since proper screening of athletes is not available when it arguably matters most, during the early stages of athletic development. Dr. Mike O’Donnell DC, CCSP, CSCS touched on this concept in a recent interview. He states,

“In North America, athletes start playing a sport as unprepared youth with no background in general conditioning. This isn’t always true, but we have no system to condition young athletes besides just playing the sport. In an Eastern model, camps are held without a sport focus to condition young athletes, and the specialization comes later. In general, early specialization is a mistake. This has been proven to limit progress, lead to early burnout, and increase injury rate.”
Certainly in an ideal situation, young athletes would be introduced to general conditioning prior to sport participation. Likewise, prior to the initiation of a general conditioning program and/or sport participation, young athletes should be screened to provide an understanding of any structural adaptations that will require individualized considerations to ensure continual progress in the pursuit of achieving athletic mastery and minimize the risk of serious injury.

Structural Adaptations: How Common Are They?
There are numerous studies suggesting that the majority of people in the general population, especially athletes, have developed various forms of structural adaptations. What are structural adaptations? Essentially they are alterations in the anatomical structure of the body due to repeated physical stresses placed upon joints and connective tissue. These adaptations often occur during the developmental years. Keep in mind, structural adaptations are not pathological in nature, but certainly require their own unique management strategies since they will impact movement mechanics and potentially be a reason for movement dysfunction. It is also important to understand that not all individuals with structural adaptations will present with symptoms, such as pain. In fact, the majority of them will not present with pain.

Below are just some of the findings from a growing collection of evidence that suggests how frequently structural adaptations may occur:
  • 79% of asymptomatic professional baseball pitchers have evidence of shoulder labrum abnormalities on MRI.
  • 40% of dominant shoulders in asymptomatic tennis and baseball players had evidence of partial or full-thickness rotator cuff tears on MRI.
  • 34% of asymptomatic individuals in the general population had evidence of rotator cuff tears. 54% of those 60 years of age and older had evidence of rotator cuff tears - so if you’re dealing with older adults, you could safely assume they are present in almost half of this population.
  • Recent research has demonstrated that high school baseball pitchers from southern, warm weather climates have decreased shoulder internal rotation range of motion and external rotation strength compared to northern, cold weather climate players. This is likely attributed to adaptation from the number of months spent participating in pitching activities during the calendar year.
  • 64% of asymptomatic people that underwent an MRI of their lumbar region had abnormal findings. Keep in mind these are individuals with evidence of lumbar disc pathology (i.e. bulge or herniation) who have NO symptoms and NO pain.
  • 93% of youth hockey players age 16-19 have evidence of femoroacetabular impingement (FAI) and hip labral tears. FAI is the result of bony overgrowth found at the femoral head and/or acetabulum of the pelvis. FAI has been linked to increased risk of injury for osteitis pubis and sports hernias.
  • 77% NCAA D1 and professional hockey players evaluated in one study had abnormal hip/groin MRI despite being asymptomatic. Hockey players are also more likely to have a structural change known in the hip known as hip retroversion, which allows for greater hip external rotation and reduces the degree of hip internal rotation.
  • 87% of 125 NFL prospects had findings consistent with FAI on MRI. The only independent predictor of groin pain was the degree of bony overgrowth.
  • Evidence suggests that roughly 25% of men in the general population have some degree of FAI despite being asymptomatic.
Conclusion
Structural adaptations are clearly a common occurrence both in athletes as well as the general population. The impact these adaptations have on movement cannot and should not be ignored. For example, individuals with FAI will experience varying degrees of limited hip flexion range of motion. This limitation in hip flexion will impact exercises such as squats, lunges, and other considerations in lower body training methods. If this limitation is ignored or missed, it can have potentially serious implications such as the development of labral tears or lumbar disc injury due to compensations in movement through the hips, pelvis and lumbar spine.

The key point to recognize is the presence of such adaptations have their own unique impacts on posture and movement that influence the design and outcomes of both training and treatment plans. Training programs need to take these issues into account, making considerations for differences in gender, age, level of physical preparation, primary sport(s) participation, and injury history. While some structural adaptations can be impacted by corrective strategies, others simply need to be accounted for in exercise selection and movement education in order to avoid causing them to reach symptom threshold.

References
  1. Miniaci et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):66-73.
  2. Connor et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7.
  3. Sher et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-15.
  4. Jensen et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73.
  5. Kaplan et al. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med. 2011 Feb;39(2):320-328.
  6. Birmingham et al. The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012, 40(5), 1113-1118.
  7. Philippon et al. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013, 41(6), 1357-1362.
  8. Silvis et al. High Prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011, 39(4), 715-721.
  9. Larson et al. Increasing alpha angle is predictive of athletic-related “hip” and “groin” pain in collegiate national football league prospects. Arthroscopy. 2013, 29(3), 405-410.
  10. Hack et al. Prevalence of cam-type femoracetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010, 92(14), 2436-2444.
 
 
 

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  • Murrysville, PA 15668

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