Gallagher Performance Blog

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:

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.


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

Why Your Technique is Ruining your Performance

Technique is fundamental and should be the primary focus of instruction when it comes to any new exercise or sport skill. It's essential to the continual refinement of movement skills. Technique also has implications in the rehabilitation process as well.

However, there appears to be a huge gap in terms of what most people acknowledge as proper technique and the technique they actually demonstrate or coach.

1. Sure many coaches and trainers can "tell" you what proper technique is, but are they capable of identifying technique errors?
2. Are they skilled and knowledgeable enough to understand why they are seeing technique errors and how to systematically go about improving technique?
3. Do they understand the joint and muscular actions involved in the complex execution of specific movements?
4. Do they understand that technique can be dictated by your anatomical structure and that there is no such thing as a "one size fits all" approach when it comes to coaching proper technique?
Despite hearing time and time again from coaches, trainers, and clinicians preaching, "Technique, technique, technique", the reality is many in the fields of health and fitness do not understand technique as well as they should. Sure, they may claim to practice or teach 'perfect technique' to their clients or patients. They may agree that technique is important and that it should be accounted for.

But are they actually making sure your technique is what works best for you?

Take for example a high school athlete that was recently seen at GP. His primary complaint was low back tightness and pain following squatting and lower body training days. He had been seeing a local chiropractor for his back pain and training with a teammate at another local gym. He had been receiving care for almost 6 weeks with no change. Despite 2x/week adjustments and performing a routine of abdominal strengthening exercises and hamstring stretches, he continued to have 'severe' tightness and occasional pain in his low back for 3-5 days after squatting.

As I dug deeper into the nature of his low back tightness, the pattern of his symptoms made me increasingly suspicious that something was clearly wrong with his squat technique.

So I asked him, "How's your squat technique?" I wanted to get inside his head and hear his thoughts on his technique. His reply was, "I think it's pretty good. I learned from my training partner who has lifted more than I have and our football team's strength coach gave us tips."

I want to emphasize this point. He believed his technique was not an issue. He believed he had received good coaching when it came to his squat technique. Rather he kept expressing how he had been told he had weak abs and needed to stretch his hamstrings, and that this was the root of his problem. His mind wasn't focused on technique.
At GP, we have the luxury of using the gym to provide real time feedback during our evaluations. This kid looked pretty good doing a body weight squat, but I knew things would change once we got him loaded up. So we took our session to the gym floor. Needless to say, there were a number of technique issues with his squat that were ultimately at the heart of why he was routinely over-stressing his low back. Rather than addressing mobility or strength issues, we simply figured out the technique he must utilize based on his anatomical structure.

This young athlete had structural adaptations that had to be taken into consideration when figuring out the most appropriate squat technique that worked for him. These very same structural adaptations had been previously overlooked, yet they played a huge role in why he was symptomatic.

After cleaning up his technique issues, it was no surprise to me that his back was not a complaint. But it was a huge surprise to him. He had just spent weeks getting adjusted, strengthening his abs and stretching with no results. How could something so simple as technique modification resolve his issue?

Closing Thoughts
When someone is experiencing a weakness in their performance or is recovering from a musculoskeletal injury, determine if the main culprit is improper technique.

Far too often, most will think to only improve physical abilities (endurance, strength, balance, coordination, flexibility, etc.) when dealing with poor performance or injury rehabilitation. While addressing physical abilities is important, physical abilities have limited value without proper technique.

In the ideal situation, technique changes or modifications should be made simultaneously as strength or other physical abilities develop. For athletes, strength should be coupled with skill through what is known as special strength exercises. In other words, strength is developed in the same neuromuscular pathway as used in execution of their competitive skill(s).

Rehabilitation programs that primarily focus on isolated physical abilities without integrating those newly developed abilities into specific movement tasks or sport skill will fail to ensure that athletes are equipped to handle the demands of competition. When it comes to injury rehabilitation and injury prevention, failure to couple strength as it relates to technique will increase the chance of recurring injury.

Consider the relationship between hamstring injuries and sprinting. Several athletes frequently experience hamstring injuries, which can take weeks or months to rehabilitate. However, when efficient sprinting mechanics are coupled with development of the physical abilities specific to the actions involved in sprinting, the chances of hamstring injuries are essentially nonexistent.

This is why experts are convinced several common athletic injuries, not just hamstring injuries, are preventable. This also explains why having a coach and/or therapist who understands technique is invaluable to athletes.


Do You Really Need More Mobility?

Mobility is sexy and it sells.

Get your foam rollers. Get your PVC pipe. Get your stretch bands. Let’s get mobile!

Between mobility screens, mobility workouts, mobility tools, and mobility DVDs, there are plenty of opinions and products available for purchase.  The experts are convincing you of how crucial mobility is for health and performance, while doing their best to convince you to purchase their product.

Enough with it.

While some elements of mobility have merit, many of the approaches to mobility (warm-ups, DVDs, seminars, evaluation systems) are very general and cookie-cutter. A lot of it is unoriginal thought simply repackage and over-priced. Many of these products are not impressive. They are systematic programs that are easy to apply. It’s the classic, “If you see X, then perform Y” approach, providing correctives for movement errors and superficially removing a degree of critical thinking. No wonder the products are so appealing. Someone else has done the thinking for you, so just follow the instructions in the manual and you too can be an expert.

Mobility and movement so easy that seemingly anyone can be an expert?
What troubles me is the trend towards ‘simplifying’ movement, when movement is quite the opposite. Movement is complex. It should be recognized that once you add variables such as load or speed or vector/direction, movement changes. Most screens do not account for these variables and I wish more ‘experts’ understood this clearly.

One individual who has a unique, and truly expert, understanding of the complexity of movement is Stuart McGill. McGill is a spine biomechanics professor from the University of Waterloo. He has authored over 300 scientific publications that address the issues of lumbar spine function, low back injury mechanisms, investigation of the mechanisms involved in rehabilitation programs, injury avoidance strategies, and high-performance training of the back. He serves as a consultant to many medical management groups, elite sports teams and athletes, governments, corporations and legal firms. On top of all those responsibilities, he is often referred the most challenging back pain cases from around the world.

Professor McGill sees two patients per week, spending 3 hours with each patient. His evaluation is of paramount importance in relation to the success he has in treating his clients and athletes. The time he spends on evaluation is often significantly more than many providers spend with a patient on their first visit. As a chiropractor, I know doctors that see 15-40 patients a day and don’t have the time to spend on lengthy assessments. Quick and easy ‘systems’ or ‘assessments’ are exactly what many professionals in the fields of rehabilitation and fitness need.

But does ‘quick and easy’ ensure a thorough exam? Does it ensure all variables have been accounted for? Unfortunately, this is what many have to deal with, so 'quick and easy' is certainly better than no assessment at all. But keep it mind there is a huge limitation to operating in that fashion. This is exactly why my brother and I tailored the operation of GP to allow for the necessary amount of time for our assessments.

At GP, we do not perform general assessments. Every single assessment is personalized to the individual, modified to meet their objectives. What we perform during an assessment “depends” on the presentation in front of us. We understand that movement and the action of musculature is not always obvious. Muscle action will change depending on the movement task, having an effect throughout the entire body. Regarding the ability to recognize the muscular demands of movement, Professor McGill has said, “This is the transition point between a trainer and master trainer.” I’m sure he would say that this also separates a therapist and master therapist.

You will not find our approach in convenient DVD and PDF format, leading you step-by-step through our evaluation and corrective process. Why? The approach we take at GP is very difficult to teach and has taken years to develop through mentorship, experience and self-learning. Whereas, most movement screening systems have the advantage of being easy to teach.

Being ‘easy to teach’ is good for business. But is it the best service for our clients and athletes? Certification courses are designed to churn out new coaches or new trainers at a mind-numbing pace. You would be foolish to assume everyone walking away with a certification functions with ‘expert’ understanding. But that’s what they want you to believe since most attempt to position themselves as experts.

Moving beyond the initial assessment, continual re-assessment is a staple of the process at GP. Our approach focuses on continually assessing and fine-tuning the program as necessary. This is why mobility, like any ‘movement fix’, must be applied appropriately with a solid understanding as to why it's being applied.

Just because someone has a tight hip, doesn’t mean you should blindly advocate foam rolling and performing goblet squats.

Can’t maintain your arms overhead during an overhead squat?

Oh, that is totally caused by tight lats. You need some foam rolling on the lats and then band stretch the daylight out of those bad boys.

Heels come off the ground during the squat? Tight calves and limited dorsiflexion, right?

Let’s foam roll those calves and mobilize those ankles.

This thinking is widespread and too simplistic. In my opinion, it’s no different in application than simply telling someone to stretch because they are tight. Do you think it's superior or different because you applied a foam roller? Sure it may get results a percentage of the time, but often there are deeper underlying issues being missed. Let’s consider the following quotes:
“Soft tissue injuries result from excessive tension, so excessive tension in the rehabilitation setting is counterproductive…stretching of…chronically tight tissue is counterproductive. It may give an initial sensation of relief because the muscle spindles have been deadened, but this practice…weakens the tissue further because of the weakened proprioceptive response.” – Boo Schexnayder
“Stop trying to stretch and mobilize, let tissues settle and regain their proprioceptive abilities so they tell the truth.” – Stuart McGill
Movement Presupposes Stability
Rather than jumping to mobility, we frequently start the therapeutic or rehabilitative process with the emphasis on grooving motor patterns while building whole body and joint stability. Specifically, addressing proximal (core) stability. The musculature of the core is not simply your abs, but all the musculature that interconnects your spine, shoulders, and hips. There is tremendous linkage and interdependence between these key joints of the body. The inability to properly stabilize these regions of the body during movement will ultimately impact distal mobility. Distal refers to the extremities, aka the arms and legs and their respective joints (elbow, wrist, knee ankle, etc.).

As the saying goes, “Proximal stability for distal mobility.”
Through their studies, the Prague school of Rehabilitation has discovered/demonstrated that stabilization and movement are global (systemic) events involving the entire body.

One cannot move without first stabilizing, thus making the support function of the feet, hips, and core of primary importance before movement or mobility is considered.

To improve one's ability to stabilize during movement (AKA ‘dynamic stability’) one must not only train the muscles of the trunk, but also the support function of these muscles.

Dynamic Stability
Training dynamic stability is less about maximizing the loads that the athlete can tolerate and more about training (restoring) the ideal stabilization/movement patterns. Ideal movement patterns are more efficient, leading to increased performance and decreased risk of injury. This is the benefit of quality and efficient movement due to ideal support function.

So what are the consequences of inefficiency?

If you cannot stabilize with proper patterns, compensatory movement patterns dominate leading to hyperactivity of larger muscles groups. Hyperactivity of muscles will make them feel tight. You are going to feel tight. You are going to have restricted joints that are taking an unnecessary beating from the increased forces they are trying to handle. You are going to want to reach for that foam roller and mobilize all day long, but odds are you are going to do so without much success.

In other words, the majority of tightness and mobility issues are a secondary reaction to faulty stabilization patterns and poor support function of the musculature in the feet, hips, trunk, and/or shoulders.

Concluding Thoughts
While others say, "Smash those tissues" or "Mobilize that joint", we say learn to support and stabilize first. Truth is, if you are in constant need of using foam-rollers, tennis balls, and mobility drills, chances are your training is 99% to blame. You need to bring more balance (aka stability) to your body and get strong. It's amazing what can be accomplished when neuromuscular strength qualities, stabilization patterns, and synchronization of movement takes precedent over mobility drills.

This article was intended to challenge the current trend of thinking "mobility first" when it comes to movement-related problems. As mentioned previously, movement is very complex and to approach movement from a simplistic mindset arguably is not an ideal starting point. A thorough assessment, tailored to the individual, will ultimately provide the information needed to implement the most appropriate course of treatment and exercise.

For more reading on this subject, check out these related articles:

Why Stretching Won't Solve Your Tight Muscles
Dynamic Neuromuscular Stabilization: Advancing Therapy & Performance
Rethinking Tendinitis
3 Reasons You Should Train for Maximal Strength

4 Things You Need to Know About Improving Sports Performance

During my time in the fields of Chiropractic, Sports Rehabilitation and Sports Performance Training, I have had the unique opportunity to be mentored by some great minds. I know I can say the same thing for my brother and that is why he holds the title as Head Performance Coach at GP. Ryan and I are consistently working to get better in order to better serve our clients and patients. Whether that is through conversation with mentors, attending continuing education seminars, or simply reading. When it comes to rehabilitation or training of an athlete, one question we continually seek to improve our understanding of is, “How much strength is enough?”

One concern the ultimately comes to mind is whether the reward of high-intensity strength training is worth the risk? Certainly extremely high-intensity loads are necessary for the development of the strength athlete, or those who participate in the sports of Olympic weightlifting, strongman, and powerlifting. But when it comes to athletes who are not competitive strength athletes and are simply utilizing strength training as a means to enhance athleticism, how much strength is needed for optimal performance?

How Strength Relates to Sports Performance
Common sense would allow us to derive that if an athlete possesses greater levels of maximal strength and power compared to an opponent (all other factors being equal), the stronger athlete would have a distinct advantage. Suitable levels of maximal strength should include, but are not limited to the following considerations:
  1. Sport of Participation. Requirements of maximal strength levels will differ depending upon the specific sport of participation. The physical requirements of a particular sport will assist to determine the various strength levels that are necessary for the participating athlete. As an example, does the cross-country runner need the same maximal strength requirements as a hockey player?
  2. Position of Sport Participation. For athletes who participate in the same sport, the physical requirements based on their specific position will have an influence on their strength requirements. Consider the defensive lineman and defensive back positions in football. These two positions differ greatly in their physical requirements. Is the required maximal strength level going to be the same for both of these athletes to have optimal sports performance?
  3. Competitive Level of Sports Participation. Participation at specific levels of competition may require advanced levels of maximal strength. Maximal strength requirements may change considerably when evaluating the demands of a high school, collegiate, and professional level athlete. The same can be said of the differences seen in competitive levels of competition. To illustrate this, consider that NCAA athletics are divided into three divisions (levels) of competition (DI, DII, DIII). One could derive that higher strength levels would be required for athletic success at the higher levels competition and differences in maximal strength and power output levels between DI, DII, and DIII athletes have been documented.
  4. Competitive Standards. There are levels of strength that are necessary, not for guaranteed success, but necessary for an athlete to compete. This is common in the strength sports of weightlifting, powerlifting, and strongman. But adequate levels of strength are highly important in other sports as well. This is part of the reason various professional leagues (NFL, NHL to name a couple) hold annual combines. Athletes are tested on various physical and strength qualities and are then evaluated against their peers to predict athletic success. There is a physical “standard” that athletes must meet or exceed for consideration as a draft selection.
Strength and Power Development In Sports Performance
From an athletic performance perspective, there are two variables of interest in developing optimal sports performance. These variables include the peak rate of force development (PRFD) or “explosive strength” and power output. The concept of “explosive strength” is directly related to the athlete’s ability to accelerate objects, including one’s body mass.

The body’s ability to generate movement at maximal velocity primarily depends upon power production. In other words, it depends upon maximal strength in association with velocity. Activities that require a display of agility (i.e. change of direction) and acceleration are also dependent upon high power output.

If the influence of power is undeniable for optimal sports performance, then it can be reasoned that maximum strength is the fundamental physical ability that affects power output.  Maximal strength has arguable the greatest effect in sports of participation where success in sport participation is determined by the athlete’s ability to overcome maximal intensities of resistance (i.e. strength athletics). The same can be said for sports requiring a high maximal strength component based on the nature of the sport as well as the position played, such football defensive linemen, track and field throwing events, and the start/acceleration phase of sprinting.

It is equally important to acknowledge the point of diminishing returns in regards to maximal strength and the development of power output. There is a diminishing influence in simply getting an athlete stronger and focus of training must adapt accordingly.  To improve power or speed, focus may need to be placed on more important qualities, such as rate of force development.

Maximal strength is critical as a physical characteristic for improving sports performance. However, maximal strength in association with power output qualities are essential for the achievement of optimal sports performance.

During the application of high-intensity exercise, assessing the “risk vs reward” should be considered, as excessive high-intensity loads may place the athlete at increased risk of injury. Developing an appropriate level of maximal strength necessary for athletes is dependent upon a number of factors. How much is enough? Well that answer is: It depends. This is why the “eye of the coach” is invaluable and possibly the most crucial element in determining adequate strength levels. This is just one unique ability that separates the great coaches from the good ones, the ability to “see” what an athlete needs and identify the physical qualities that require development.

Fry, AC, Kraemer WJ. Physical performance characteristics of American collegiate football players. Journal of Applied Sports Science Research, 5(3):126-138,1991.
Zatsiorsky, VM. Science and Practice of Strength Training. Champaign, IL: Human Kinetics.

6 Factors That Influence an Athlete's Dedication

Working with athletes to develop their performance brings on a host of unique challenges. Arguably the greatest challenge is associated with the intrinsic motivation level of young athletes. The varying levels of self-driven motivation among the young athletes at GP is interesting to observe, especially as the character of the athlete begins to emerge. Motivation level becomes even more apparent as we progress through the training program, taking notice of what the young athlete is willing to do on their own to improve their performance. Ultimately the question becomes, can they sustain the motivation year after year if they begin a structured training program early in their career? There are several factors which can influence an athlete's dedication, below are just a few that come to mind:

1) Unrealistic pressure at an early age. Too often when parents bring their young son or daughter in to begin training at GP, some of the expectations placed upon these athletes is pretty surprising. This certainly is not unique to our business. Likely anyone involved in the sport performance industry is very familiar with this situation. During the initial consultation, parents will often state:
  •  “My son/daughter is the best athlete on their team.”
  • “ My son/daughter was just voted the best player in their age group at a recent camp.”
  •  “My son/daughter is a natural athlete and they always get placed on the highest level teams in the area."
While we aren’t here to dispute these claims, if you are 12-15 years old and have been hearing this type of ‘hype’, what is the motivation to want to continue working hard or even begin to work hard? The reality is, little priority can be placed on improving physical skills when you believe you are better than your competition or continually hear that you are better. To further complicate the matter, several of these athletes participate in multiple sports and over-compete year around, giving no substantial amount of time for physical development to occur because of the intense competition schedule. Parents can further reinforce this, believing that more competition is what their young athlete needs. We addressed the mistake of this thinking in this article.

2) Short-term focus, lack of quality coaches. Far too many programs at the youth level carry a “win at all costs” mentality. This has tremendously negative impacts on limiting physical and motor skill development as they become a secondary (at best) focus for young athletes. Coaches with little to no experience, no education of physiological adaptations or skill development are often times responsible for these young athletes. The short-term focus of winning becomes the ‘norm’ and developing young athletes becomes an after thought in the name of winning. This system favors the ‘early developers’ or simply the young athletes who develop faster at a young age. These kids become more likely to make high-level club teams at younger ages, but how does this affect their motivation to continually work hard as they mature and other athletes, or ‘late developers’, begin to catch up with them?  Does it generate a weak-minded athlete who lacks grit and determination to want to do the extra work needed to fulfill their potential?

3) Poor management of Late Developers. What happens to the kids who are ‘late developers’ as coaches who lack education in talent selection bypass them to win games? These coaches are likely not willing to spend the extra time needed to help young athletes develop because, for many of them, they don’t have a clue what to do for them. They select the ‘early developers’ and this helps to mask coaching incompetency. Some athletes will use this as motivation to work harder and smarter, as they enjoy the long-term process of improvement. Other late-developing athletes will quickly lose motivation, as frustration mounts and they quit sports because they find no enjoyment in the process. Coaches need to look at many factors when developing athletes, wins and losses should not be the primary concern.

4) Injury and burnout. How can young athletes make a difference in their careers when so many require medical intervention at increasing rates? According to statistics, of the 38 million athletes (ages 6-18) who participate in sports in the United States, 1 in 10 have significant injuries, which will have impacts on their future development. Also consider that many of these athletes at young ages (13-14), will have a competition schedule that includes 70-90 games per year. Honestly, this is not appropriate. Common sense is lacking in the process of athletic development and athletes that do succeed in these models are often “survivors” of the system in spite of it.

5) Long-Term Development. Education needs to be the focus in order for change to the current model to positively impact all involved. Coaches, trainers, parents, and athletes must understand what is required of them and begin taking a long-term approach to athletic development. Parents and coaches both want athletes to succeed in the long-term, however many are short-term in their approach. This becomes detrimental to the athlete’s success when it really matters.

6) Willingness to SacrificeThe current myth of overnight success has blinded us to the fact that the elite athletes we see on television have all sacrificed. They were not just simply "born with talent". This is where understanding the 10,000 hour rule comes into play. Elite athletes have practiced and sacrificed long hours, day after day. Even when they wanted to quit, they did one more repetition, ran one more sprint, or practiced their skills a few minutes longer. In order to do this, they sacrificed and conducted themselves with a high degree of discipline to pursue their goals. They made it hard on themselves and this is a huge reason why they make it look so easy when it comes to athletics. But the sacrifice and discipline needed is no easy task and it can place one outside of their comfort zone.

Most of the athletes we work with may never achieve their true potential because the thought of sacrificing X,Y,or Z in order to achieve athletic success is something they are not willing to commit to on a consistent basis (or even at all). You can have the greatest coaches and training in the world, yet if the athlete is not willing to commit themselves to the process, their potential will suffer the consequences.

Developing a Champion's Mindset
So what are the key characteristics of well-motivated athletes? Here are some thoughts from JoAnn Dahlkoetter, Ph.D., author of Your Performing Edge, and an internationally recognized sports psychologist. She has identified characteristics that make a champion athlete that are able to be developed by anyone who wants to excel in sport.
  • Enthusiasm and Desire - Top athletes have a hunger, a fire inside which fuels their passion to achieve an important goal, regardless of their level of talent or ability.
  • Courage to Succeed -  It takes courage to sacrifice, to work out when you’re tired, to seek out tough competition, to stick to your program, to test your limits, and to overcome obstacles.
  •  Internal motivation and self-direction - Direction and drive need to come from within.  The goals must be ones that you have chosen because that’s exactly what you want to be doing.
  • Commitment to Excellence - Elite athletes know that to excel at their sport, they must decide to make it a priority in their life.  They make an honest effort each day to be the best at what they do.  At some point you must say, I want to be really good at this; I want this to work.
  • Discipline, Consistency, Organization - Elite athletes love what they do and it is easier for them to maintain consistency in training and in competing. Regardless of personal problems, fatigue, or difficult circumstances, they can generate the optimal amount of excitement and energy to do their best.
  • Being focused and yet relaxed - Champions have the ability to maintain concentration for long periods of time. They can easily let go of distractions and take control of their attention. They don't let emotions get the best of them and cause poor performance.
  • Ability to handle adversity - Top athletes know how to deal with difficult situations. Adversity builds character, but adversity also reveals character. When elite athletes know the odds are against them they embrace the chance to explore the outer limits of their potential.  Rather than avoiding pressure they feel challenged by it. They are calm and relaxed under fire. Setbacks become an opportunity for learning.
Final Words
To develop your motivation and maximize your true athletic potential, make the most of the talents you have by stretching the limits of your abilities, both physically and psychologically. Athletics has a unique ability to become a means to both personal growth and enjoyment of the pursuit of your goals, lessons that go beyond sport alone. Try incorporating the profile above into your mental preparation to help you develop the mindset needed to bring success to any venture you choose in life.

The Importance of Functional Evaluation

In our previous article, Structural Adaptations – Not Just An Athlete’s Problem, we discussed structural adaptations and why they must be accounted for in both training and treatment plans. Clearly, structural adaptations have impacts from a sports performance and clinical perspective.  With that in mind, prior to treatment, our goal is to not simply assess from a structural standpoint, but to also assess functional capacity to determine if there is a functional capacity deficit (i.e. endurance, strength, balance, reactivity, dynamic posture control). It is my job as a clinician to choose the most appropriate evaluations to identify functional deficits. I choose not to limit my evaluations to x-rays or imaging and finding structural abnormalities. It should be evident that treatment based on the findings of imaging alone is flawed when you consider the enormous amount of false positive rates in asymptomatic people. This is why I couple structural evaluation with a functional evaluation that looks at motor patterns or movement, not just isolated joint range of motion or strength.

As a chiropractor, I tend to go against traditional approaches in how much attention I give to static body alignment compared to most of my peers. Reason being is that often times a patient can look a certain way (i.e. “dysfunctional”) in a static stance, but when asked to perform a skill, they nail it. This can be especially true of athletes. What I was able to learn over and over again during the course of my residency is that if someone can’t perform a certain movement (i.e. squat), it may be more practical to coach or educate them on better movement (i.e. motor learning) prior to isolating and treating joint or mobility “dysfunctions”. The reality is, if a patient or athlete is performing a new or unfamiliar movement, sometimes they simply lack the skill to execute it in an ideal fashion. This is the prime reason why I find functional evaluations invaluable in determining the best course of treatment.

When it comes to functional capacity, the assessment is intended to identify the relevant functional deficit of that patient. What is relevant to that patient will depend on their history. What areas are bothering them? What does their injury history tell you? What activities have they been involved in that have provided accumulated stress or strain to their body? This can provide insight into the adaptations or compensations patients may exhibit. As for athletes, it is important to remember: the higher level the athlete, the better they are at compensating. Despite being asymptomatic, those compensations will eventually catch up to them and become symptomatic. This will not only impact performance, but injury risk and longevity as well.

Once a functional capacity deficit is identified, the process of treatment can begin. For example, poor stabilization patterns during movement are a common functional deficit. Whether it is lack of stability during everyday tasks such as walking, carrying, lifting, etc., or sport-related skills such as kicking, throwing, sprinting or jumping, it’s important to understand that the functional capacity of each of these activities has different demands as it relates to stability. Our approach must be tailored to match the stabilization demands in order to normalize movement patterns and improve the load-bearing capacity of tissues involved. This is the goal of treatment. Perfection of movement is not the goal. Arguably, perfect movement does not exist. Consider elite athletes who practice their skills all day, consistently, year after year. Are they perfect with their movement 100% of the time? No. Movement has far too many variables to achieve perfection. The goal is better movement coupled with increased tissue capacity to better withstand overloads when movement goes awry.

As a chiropractor, I possess a license to manipulate and improve the function of the neuromusculoskeletal (NMS) system. I prescribe what I feel is necessary for treatment, whether it is joint manipulation, soft tissue/massage therapy, or exercise prescription. When it comes to the management of the clients and athletes here at GP, we perform functional evaluations prior to all training programs and chiropractic treatment. But the evaluation process does not end on day one. Evaluation is a continual process, from session to session. This is vital to monitor for improvement and knowing when to adapt the current training or treatment plan. Continual functional evaluation enables us to handle physical ailments appropriately when they occur. This is just part of the process of our Integrated Approach. It’s important to understand the rationale for a prescribed course of action. Thus giving both chiropractic and training services a better understanding of what to do for each individual to maximize results. So from a treatment perspective, it really isn’t just about knowing how to manipulate or perform ‘active release’ on muscles. Far too often people may know what they do; they may know why they do what they do; but do they actually understand the effects of what they just did? As a clinician, it’s important to understand the effects of the treatment you just provided and the reasons why they were provided.

Summing it All Up
Functional assessments provided at GP help to identify the most necessary intervention or treatment. It helps to identify the root cause of your symptoms and enables you to function better. Structural evaluations can be valuable, but functional evaluations should not be overlooked. There is important information to be gained from both. If you are experiencing unresolved issues such as joint pain, muscle tightness, or limitation in performing specific sport-related or daily activities, consider seeking out a clinician in your area who is credible and offers functional evaluations as part of their services.


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.
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.

  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.

3 Benefits of Integrated Training and Therapy

Athletic performance is a developmental process, one that ideally involves the integrated efforts of coaches/trainers and therapists in order to maximize results. This is often a complete paradigm shift for many of our athletes and their parents. Unfortunately being focused on short-term results over long-term development is hurting athletes more than it will ever benefit them.

After some recent conversations with our athletes and their parents about the importance of understanding the integrated approach taken to athletic development at GP, we thought we'd provide our readers with a few recommendations. Our hope is that these recommendations help guide the decision making process for young aspiring athletes when it comes to selecting who oversees their training and why an integrated approach may just be what they need.
  1. The ‘watchful’ eye of a coach/trainer and therapist is an invaluable asset to athletic development. This is a skill set that many athletes are unfortunately never exposed to. The ability to identify mechanical faults and implement collaborative strategies between coach and therapist to correct these faults sets the stage for reaching athletic mastery while minimizing injury risk. The ‘eye’ for mechanical faults is one thing, knowing how to manage and correct them is an entirely different story. Athletes require an individual(s) competent in both.
  2. Physical limitations due to anatomical/structural changes and motor control/technical deficiencies require different management strategies in an athlete’s programming. It is the job of the coach/trainer and therapist to recognize this difference. This should be a prerequisite when considering the services you are about to invest in. If they don't understand these concepts, that should be a red flag. Developing movement efficiency is arguably the best way to simultaneously enhance sport performance and reduce injury risk. Understanding how to manage physical limitations will directly impact movement efficiency and athleticism.
  3. When injury occurs, integrated models for “rehab” are better than medically driven models. This of course is dependent on the level and experience of both the coach/trainer and therapist involved. Ideally the athlete’s recovery process utilizes exercises and drills within a modified training program. This serves to minimize time away from the field or weight room and maximize technical improvement of sport-related skills. Dysfunctions of the musculoskeletal system can also be addressed through performance therapy. For more reading on performance therapy, check out this article.
These recommendations are by no means a comprehensive list. When considering the appropriate path for an athlete's development, there can be several factors to keep in mind at any one time. However, these tips cover several of the basic essentials when it comes to improving an athlete's performance while keeping them healthy.

The model used at Gallagher Performance isn't used solely for our athletes. A number of our patients and training clientele have benefited tremendously from experiencing how we integrate training and therapy. We use this model to optimize health and performance while getting to the root of many chronic pain problems. It's why we have adopted the tag line "Experience the Difference".

If you think the model of training and therapy at Gallagher Performance is for you, give our office a call at (724) 875-2657 and Experience the Difference.


Interview with Mike O'Donnell DC, CCSP, CSCS

GP recently interviewed Mike O'Donnell DC, CCSP, CSCS. Dr. Mike and his wife, Jessica, run Back in Action Chiropractic located in Fort Wayne, IN. Not only do they provide expert understanding of chiropractic and rehabilitative care, they also bring to the table the unique insight as highly accomplished strength athletes. Simply put, their accomplishments would take up an entire blog post. It's rare to find a clinician and staff not only capable of identifying with athletes and addressing their needs appropriately, but also able to apply these same concepts to improve outcomes for patients. I had the privilege of being classmates with Mike during our chiropractic education at Palmer College in Davenport, IA. Once I got the understanding of Mike's background as both a strength athlete and coach, I knew he would be an invaluable resource not only in my training as an aspiring strength athlete, but in my clinical development as well. My brother and I are truly fortunate to have him and Jess as friends and mentors.

Now on with the interview.

GP: Provide our readers with some information about your background as an athlete, competitive powerlifter and strength coach.
MO: The day after 7th grade football ended I began lifting in my basement. I competed in my first powerlifting meet when I was 15 and won the ADFPA teen nationals that same year. Through high school I played football and was team captain. To train for football I simply did more speed and plyometric work. As a high school and junior lifter, I won six national titles and went to the IPF Junior Worlds, taking the bronze in my last year, 1999. I competed against many lifters who are regarded as the best in the sport today. I have lifted in the USAPL Open Nationals several times. As an undergrad at Western Michigan I studied Exercise Science. This did not include enough sport science to make me happy, so I did tons of research on my own. After my bachelor degree I worked under Buddy Morris at Pitt for a short time. That was a great learning experience. Eventually I decided to go get my DC degree and learn much more about chiropractic and rehabilitation.

GP: You are well educated on the training methodologies utilized in the former Soviet Union and Eastern Bloc countries. Could you explain briefly how those methodologies differ from North American approaches and the impact it has on athletic development here in the United States?
MO: 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.

GP: You have worked with athletes of all ages and abilities. In your opinion, where are we still falling short in the development of athletes in America?
MO: We fall short in several ways. Early level coaches (high school and below) often have poor qualifications. Also athletes are eager to maximize their results as early as possible. This leads to poor skill development. It is extremely difficult for athletes to unlearn poor habits or a poor work ethic. All too often young athletes look to non-training means (i.e. drugs) for improvement as well.

GP: What would you identify as the fundamental components of effective and efficient programming for athletes?
MO: Once good general preparation is established, the programming should be as specific as possible. Factors like frequency, work load and intensity vary from athlete to athlete and at different phases of training. Weaknesses should be assessed constantly and addressed, but focus should never be taken off the sport form. Overall, one should train as often as possibly but remain as fresh as possible. The programming should never compromise technique.

GP: One common theme you’ll see among trainers/coaches is very little thought that is given to the order of exercise selection/variation during a training plan. It’s almost as if many trainers just ‘make-up’ workouts. Give us your thoughts on the importance of organization of training for athletes?
MO: Organization of training and exercise selection expertise are prerequisites to training anyone. Entire teams should not all be performing the same training. This would assume the entire team has the same deficiencies. There are way too many under qualified "strength coaches" and trainers out there. Even some of the highly regarded strength coaches or online trainers are a joke. This is why I personally have no tolerance for movements and training styles that are fad- based. Put some thought into what you, or your athletes, really need and address it in your training. Further, organizing training should be an ongoing process. There are no perfect programs. Just phases or training blocks. On the other hand, there are some coaches that over coach their lifters/athletes. They are so worried about their own role in the athlete's development that the athlete cannot focus on their performance, or maybe the training isn't being attacked with the mentality that it should be.

GP: What do you see as the most common mistakes coaches and trainers are making in the preparation of athletes?
MO: The most common mistakes - the coach who tries to be the athlete's friend (not hard on them); poor analysis of training needs and the current state of the athlete; and the most important aspect in my opinion (this goes for anyone seeking a great PT, DC, manual therapist or strength coach) is that the coach cannot identify with the athlete because they weren't an athlete themselves. I know several above average coaches that are held back my the mere fact that their athletes cannot identify with them. Either they weren't athletes at all, or they are an unimpressive presence altogether!

GP: What are the qualities and attributes that athletes and parents should look for in a trainer/strength coach before investing in their services?
MO: Sporting background and accomplishments, educational background and accomplishments, and clinical competence, methods, and track record. Period. Anything less, and I am skeptical about what I am getting. I don't care who has the best DVD!

GP: How has the background as a competitive strength athlete and strength coach benefited you as a chiropractor and your ability to manage patients from acute stage to reactivation through active care?
MO: This is a great question, because I tell people that ask that I use my training, coaching, and professional background everyday when treating patients. My philosophy in the clinic is the more accurate the assessment, the more accurately I can apply your treatment, whether its passive or active care. As the phases of care progress, it's important to know what type of care or movements to change to. This assessment or "eye for the deficiency" can take years to develop. Today there are systems and seminars to attend and learn these analytical methods, but learning this way can lead to a lot of limitation and misunderstanding. I would advise students, whether they are professional level yet or not, to use the gym as your lab. Lift and learn!!!

That's a Wrap
Mike, thank you for taking the time to answer our questions. Your knowledge and insight is truly appreciated. We always learn something from you and hope our readers learned something as well. For anyone in the Fort Wayne area, be sure to check out Back in Action Chiropractic for the best results when it comes to your health or sport-related goals.

6 Tips for Hockey Training

When it comes to athleticism, there is a sad misconception among far too many individuals that athletes are "born not made". People that believe this will often say, “You can’t teach speed” or “That’s just a gifted athlete”. While genetics can play a role in athleticism, arguably the greatest impact on an athlete’s development (or lack thereof) is the training system that is implemented. This would include all elements from its organization to exercise selection and other variables.

While all sports have their own unique considerations, ice hockey demands high levels of athleticism. The transfer of training from off-ice preparation to on-ice performance presents a host of challenges. With the nature of today’s game, proper off-ice training can provide youth and elite level hockey players with the advantage they need to elevate their game.

Here are some tips: 
In preparation for exercise, the body should be moved through large ranges in all three planes of motion (sagittal, frontal and transverse). Movement prepares the brain and body for exercise by activating the nervous system, warming tissues such as muscles and tendons, and lubricates joints. Movements performed in all planes of motion on a consistent basis will improve stabilization patterns, mobility, coordination, balance, and movement efficiency. Making the time to properly warm-up with allow you to get more out of your training. Simply put, it makes training more productive and will reduce the risk of injury.

The human body operates as an integrated system. Joints and muscles are all coordinated by the central nervous system to produce movement. Muscles never work in isolation, meaning that there is always a pattern of muscle recruitment that occurs with every movement we make. Depending on how we recruit muscles, movement will occur in efficient or inefficient ways. Athletes require mastery of movement. Unlike those who train to for basic fitness or simply to ‘look better’, athletic development and performance-based training programs aim to improve how an athlete moves. Goals focus on strength, stability, mobility, speed, and skill execution with a high degree of movement efficiency.  Sure many athletes look good, but this is often a by-product of their training, not the primary goal.

There can be a mistake in young athletes simply go to the gym and “working out”, either by themselves or with their friends. Especially when they have no plan. If most young athletes are honest, they don’t know what to do during the off-season. Even some trainers have no idea what they are doing with athletes and just “make-up” a training session as they go or select a random workout off the Internet. As the saying goes, “One program on a dry erase board for your group of clients/athletes isn’t training, it’s babysitting.” Higher quality strength and athletic development programs are becoming more available to young athletes; those athletes not involved in those programs will be left behind.

This concept was detailed in our article on Training for Elite Athletes.

This point builds off the previous one. The majority of sport movements and skill execution are initiated by applying force to the ground with the feet/legs. As with land-based sports, the more force a hockey player applies to the ice, the greater acceleration and speed they generate. Strength and power development exercises should be selected based on their ability to enhance ground-force reaction. The same can be said for both speed and conditioning drills.

Utilizing squat and deadlift variations, Olympic lifts, medicine ball throws, jumps, plyometrics, sprints, and hockey-specific agility/change of direction drills would be the most beneficial in developing ground-force reaction. Unilateral movements such as single-leg squats and jumps, lateral bounds, split squats, and lunge variations will also help to develop the movement proficiency need for a powerful skating stride.

The core is the body’s center of force transfer and movement control. The core is not simply your abs. It includes almost 30 muscles that attach to the spine, shoulders and hips, which function to stabilize the areas during movement. When the function of the core is compromised, inefficient movement results and risk of injury is increased. Hockey and its movement skills require high levels of core stabilization, endurance, strength and power transfer. The demands of athletics on the core will never be met by performing thousands of crunches. Your core training needs a more specific, specialized focus.

Stabilization exercises should focus on things such as maintaining proper lumbo-pelvic posture and the ability to resist or control movement in all planes of motion. Once proper stabilization is achieved, greater attention can be given to rotational power and force generation exercises for increased transfer of training into sport.

The sport of ice hockey places demands on both the anaerobic (alactic and lactic) and aerobic energy systems of the body. For the most part, hockey is an anaerobic game, characterized by intense bursts followed by periods of rest. The anaerobic system is challenged during these intense bursts while the aerobic system is utilized during the recovery period between shifts. This illustrates the need for both systems to be well developed for optimal performance.

Thus conditioning for hockey should focus on an interval-based approach to meet the energy system demand of the sport. Place a priority on developing the capacity and power of the anaerobic-alactic system along with the use of tempo runs/bike sessions to develop the aerobic system. Anaerobic-lactic training is extremely taxing on the body and difficult to recover from. This form of exhaustive conditioning should be used less frequently in the training program.

Remember, conditioning does not mean the same thing as speed training. For more information of developing hockey speed, read this article.

Recovery from exercise can be accelerated with proper attention to flexibility, mobility, massage, chiropractic treatment, nutrition and sleep. These approaches facilitate the body’s ability to recover from exercise. Nutritionally, ingesting the proper amounts of whole foods and supplements at the appropriate times during the day can prove to be a huge part of the recovery process. Replenishing energy stores (i.e. muscle glycogen) and providing the building blocks (i.e. protein, fats, vitamins, minerals) for tissue repair and regeneration are just some of the primary goals of proper nutrition. Self-management strategies such as foam rolling and stretching/flexibility work are valuable components in the recovery process. Maintaining proper muscle function and joint range of motion is critically important to minimize injury risk and ensure that you get the most out of your training.

Keep in mind the above tips serve as guidelines. Individual considerations cannot be met in an article of this nature. However, if applied correctly, these guidelines can serve to provide aspiring hockey players with a better understanding of how to go about their off-ice training. For those interested, GP specializes in the training and preparation of hockey players. Contact us for more information.

Advanced Training for Elite Athletes

The concept of sport-specific training has continually gained popularity over the years. It’s a growing market and business-minded individuals are taking notice. Similar to trends in functional exercise, you have a growing number of trainers stating they offer the “latest in sports training”. Frankly, anybody online can say their method or approach is the best. In a competitive market, people enjoy using words to attract your business. There are plenty of gimmicks that exist, namely in the world of speed training. Often times, athletes acknowledge such methods did little or nothing to improve on-field performance. If these gimmicks worked, it's simply because the athlete was a novice or of low qualification. Novices have the unique ability to respond to almost any form of training. But does this mean what was done is most appropriate? Does it mean training was efficient or effective? Not necessarily. When it comes to the training of higher level athletes, previously used methods and/or exercises will eventually fail to produce continual improvements in sport performance. There is a point of diminishing returns and training must adapt accordingly.

For any athlete, sport-specific training must ensure maximal transfer of the training program to on-field results. If exercise selection or organization has little carry over to making athletes better, you are wasting valuable time and money. Transfer of training can be summed up with the SAID Principle (Specific-Adaptations to Imposed-Demands). The SAID Principle has been proven time and time again in both research and training. This principle implies that training is most effective when resistance exercises prescribed are similar to the target activity or primary sport form/movement. Furthermore, every training method will elicit a specific (and different) adaptation response in the body. There must be compatibility between training and sport. This becomes of increasing importance as an athlete reaches higher and higher levels of athletic competition.

As mentioned before, research has demonstrated how exercises that once worked to improve sport performance for an athlete at a lower qualification level, will eventually lose training effect as the athlete gains mastery. For instance, indicators of maximal strength (squat 1RM) often have a direct correlation in low-level athletes, but lose significant correlation with enhancing sport performance in higher-level athletes. Similarly, movement abilities such as sprinting and change-of-direction (agility) are each separate motor tasks, characterized by specific motor abilities. Improvements in linear sprint speed and change-of-direction ability have limited transfer to each other and the degree of transfer decreases as an athlete progresses.

Thus, in order to enhance the sporting ability of high-level athletes, there comes a time when we must get more detailed than simply chasing increased strength and 'quick feet'. It’s inevitable. There is no way to avoid it. The world’s greatest Sport Scientists understood this and proved the need to go beyond traditional training approaches to see continual improvements in performance as athletes reached higher levels of competition. This is where the concept of Special Strength Training (SST) becomes of importance in the training plan.

Introduction to Special Strength Training
Pioneered by Dr. Anatoli Bondarchuk, SST has been incorporated for decades by coaches in other countries, mostly in the Olympic sports. Dr. Bondarchuk is most noted for his involvement in the throwing sports, particularly the hammer, and his results speak for themselves. It was Bondarchuk’s identification and implementation of special exercises with the highest degree of dynamic correspondence to the sporting movement that became the focus of his athletes' training plan. His organization of training allowed athletes to set world records and win numerous international and Olympic medals despite the fact that they did not possess the greatest strength in movements such as the clean, squat, or bench press.

Exercise Classification System
Bondarchuk classifies exercises into 4 categories:
  1. GENERAL PREPARATORY EXERCISES are exercises that do not imitate the competitive event and do not train the specific systems.
  2. SPECIAL PREPARATORY EXERCISES are exercises that do not imitate the competitive event, but train the major muscle groups and same physiological energy systems as your sport. However, movement patterns are different.
  3. SPECIAL DEVELOPMENTAL EXERCISES are exercise that replicate the competitive event in training but in its separate parts. These exercises are similar to the competitive event, not identical.
  4. COMPETITIVE EXERCISES are exercises that are identical or almost identical to the competition event.
It’s important to note that as an athlete rises from general preparatory exercises to the competitive event, each category on the list becomes more specific and will have greater dynamic correspondence to the athlete’s sport. Thus, as specificity increases, exercise selection decreases. There are hundreds of exercises that potentially could be considered Preparatory exercises. Preparatory exercises prepare the body for more specific sport training, while Developmental exercises aim to develop strength and technique. Special Developmental and Competitive exercises have the highest degree of transfer. The greatest focus from a planning and organization standpoint is placed on these exercises in order to yield improvements in sport performance. At this point, exercise selection has narrowed greatly. Often, the competitive exercise is simply the competitive event. In the case of a track athlete, the competitive exercise is considered the event (hammer, shot put, long jump, 100m, etc). This can also include subtle variations to the event. For team-sport athletes, the competitive event  is the game. The classification of exercises as they relate to specific athletes is not the scope of this article. That discussion is far too detailed and is always dependent upon the athlete, their level of qualification, and the competitive event.

In explaining SST, Bondarchuk said,
“General exercises have little relevance to the sporting action. Specialized preparatory exercises use the same muscles that are involved in a particular sporting action. Specialized developmental exercises include single joint actions that duplicate one portion of the sporting action. They also mirror the velocity and range of motion seen in the competitive movement. Competitive exercises are those that fully mimic the competitive movement in more difficult conditions and easier ones.”
Advantages of Special Strength
There are a number of advantages to programming SST within an athlete’s training program. Among many reasons, arguably the most important application of SST is the development of strength as it relates to specific movement and skill execution in an athlete’s sport. This advantage cannot be overlooked since very few approaches train physical qualities (strength, power, work capacity, etc) and technical skill development simultaneously. Programming should provide the avenue for athletes to achieve higher levels of sport mastery. Rather than applying appropriate programming, many trainers get caught chasing quantitative numbers (squat or bench 1RM, 40 yard dash time). While focus on general motor abilities is important for the novice athlete and provides performance-enhancing benefits, they lose their carryover for the more advanced athlete. SST ensures that strength gains will have a direct transfer into sport technique and skill development.

Special Strength is Task-Specific 

The effectiveness and accuracy of exercise selection within special strength training is dependent on a thorough understanding of what a given athlete is being asked to perform in competition. Selecting an exercise is great, but you have to put it into a program and a plan. You need to know your athlete and what exercise(s) works well for them. For team sports, task-specificity also takes into account that you understand the athlete’s position and the physiological/energy demands relative to their sport. Care must be taken to stay within certain parameters, above or below, the sporting movements to avoid yielding negative adaptations on the expression of sport skill. For example, applying loads that are too heavy will negatively influence technique by causing breakdown in mechanics that are important for developing speed strength. Speed strength is essential for throwing, jumping, and sprinting. Conversely, loads that are too light will also have a negative influence on mechanics since the lack of resistance with fail to promote the building of specific strength.

Summing It All Up
This article attempted to offer insight into the concept of special strength training and how it correlates with higher levels of sport mastery. Due to the nature of SST, it’s important to keep in mind that early specialization in training, similar to early specialization in sport, can occur too soon. Athletes like NHL stars Sidney Crosby, Jonathan Toews, and Henrik Zetterberg (pictured above) don't train like novice, youth hockey players and young hockey players should not be training like them. Research has proven that athletes at low levels of training and physical ability need to focus on increasing general physical qualities such as strength, as strength will carry over greatly to movement speed. In fact, novice trainees have the ability to attain simultaneous increases in strength, power, coordination, speed, core stabilization, proprioception, and reduced injury risk. However, as an athlete reaches higher levels of mastery, effectiveness of basic training methods become limited quickly due to the specificity of movement and skill related to sport.

If you are unclear on how to properly utilize the training methods of SST, you should not blindly implement SST into your training. The incorrect application of exercise and program variables would likely have a negative affect on the neuromuscular actions involved in sport movement. Athletes looking to ensure the best results from SST would be wise to have their training overseen by a coach/trainer who is knowledgeable and competent in its application.


Bondarchuk. Transfer of Training in Sports. Ultimate Athlete Concepts, 2007.
Siff & Verkhoshansky. Supertraining. Ultimate Athlete Concepts, 2009.
Verkhoshansky. Fundamentals of Special Strength-Training in Sport. Sportivny Press, 1986.

3 Ways Breathing Impacts Health and Movement

When my brother and I envisioned Gallagher Performance, one of our primary objectives was to provide a system that truly identified the structural and functional limitations of athletes, thus addressing these issues properly before they became implicated in serious injury or potential surgery. We knew the perspectives and coordinated efforts of a strength coach, massage therapist, nutritionist, and chiropractor with advanced training in manual and rehabilitative techniques could provide athletes with the avenues needed for improving sport performance and health. After all, achieving high-end sport performance is a multi-faceted and complex process.

Among the approaches and individualized considerations that are made for each of our athletes and clients, a fundamental concept within our programming is the emphasis on proper breathing patterns through focused exercises to optimize breathing and its impact on sport-specific movements.

Breathing Correctly
When we breathe, proper function of the diaphragm is the key and it should drive respiration. The question is, are you using it correctly when you breathe? To find out, simply place the web space in between your thumb and index finger firmly on each side of your abdomen in the area between your lowest ribs and your hip bones (or iliac crests). Now take a few normal breaths.  What is happening? If you're using your diaphragm correctly, you should feel a "bulge" outward into your hands. Why? As you breathe in, the diaphragm pulls the lungs down and creates compression within your abdominal cavity. It is this compression that creates the bulge outward into your hands. You can also think out it as breathing into your waistband or belt. You should feel your abdomen expand in all directions with proper breathing and this should occur normally, not only with deep breathing.

Another area of focus is how much your shoulders elevate during inhalation. Commonly, when someone wants to take a deep breathe, they have the tendency to lift their shoulders up to get more air in. But this is the exact opposite of what we want. Lifting the shoulders during breathing pulls the lungs up, which prevents the diaphragm from pulling the lungs down and will reduce the amount of air we can breathe in. It's important to note that shoulder elevation is normal with intense physical exercise; however, during normal breathing and even moderate exercise, there should be no shoulder elevation.

Don't sweat it if you didn't pass the test? Breathing has more to do with poor habits than anything else, which opens to door to retraining. The retraining of proper breathing patterns is something we spend a lot of time focusing on at GP with our clients and athletes.

Breathing and Its Influence on Athletic Performance
Previously, the role breathing has in the promotion of a healthy spine, prevention of neck and back pain, and enhancement of muscular coordination was underappreciated by many in the world of sport performance and physical medicine. Nowadays, breathing patterns have gradually gained more and more attention for the critical role they play in spinal stabilization, movement efficiency and athletic performance. Now it’s time for us to get in on sharing the knowledge. Below are three simple ways that breathing can affect your performance as an athlete.
  1. Improve Joint Mechanics There is no question that movement and range of motion needed from specific joints throughout the body is always activity dependent. For example, hip internal rotation (IR) deficits have gained a lot of attention in regards to faulty lower extremity mechanics during movement, such as the squat. To address the deficit, the idea of performing internal rotation stretches has been popular to help improve the restriction. But it is interesting to observe that simply teaching an athlete proper breathing, abdominal and hip extension/external rotation activation through exercise can improve hip IR tremendously without the application of any static stretching. This raises the question of stretching and we addressed that in the article, Why Stretching Won't Solve Your Tight Muscles. Essentially, if range of motion was improved through breathing and stabilization techniques, the limitation was due to position of the spine, pelvis, and surrounding musculature, NOT because of a limitation in the hip. The same can be said of any joint in the body. Using specific breathing exercises can restore balance to the key joints of the body (i.e. spine, shoulders, and hips) by promoting normal expression of movement and range of motion.
  2. Optimize Movement Patterns If an athlete attempts to execute a sport or skill-specific movement from a non-neutral position, they are already set-up to be inefficient and will limit their performance to some degree. The result is compensatory movement patterns and athletes may or may not be aware of how they are compensating for poor movement quality. If you consider rotational sports such as baseball, hockey, golf, and throwing sports (i.e. shot put, hammer throw), it’s easy to see that spinal rotation is a key component to the execution of movements specific to each sport. If an athlete cannot rotate adequately through their spine, the first compensation becomes lateral bend. This will limit power and efficiency and predispose the athlete to overuse syndromes. Using breathing exercises to help restore a neutral spine will potentially help restore rotation to the spine. As spinal rotation improves, this new range of motion is then re-integrated into sport-specific movements with emphasis on quality and control. The outcome of focused breathing exercises becomes improved joint mechanics, more efficient technique, more power, and less risk of overuse injury. This is just one of the reasons we want coaches to understand that our job is to make their life easier.
  3. Decrease Injury Risk, Improve Recovery Injury prevention is a challenging task. There are several factors that play into specific athletic injuries, each carrying their own unique considerations and strategies to decreased risk. There are many factors that predispose athletes to injury and with targeted approaches, appropriate steps can be taken to reduce the risk of injury by focusing on improving joint/muscle function, reducing the impact of fatigue, and ensuring adequate recovery. We already discussed how breathing can improve joint and muscle function. Utilizing optimal breathing patterns can delay fatigue by assisting in maximum air/oxygen exchange, therefore delaying the point at which aerobic metabolism ceases and anaerobic processes kick in. This is especially important during high-intensity activity, when the demand for oxygen is critical to prevent accumulation of metabolic byproducts responsible for lowering pH levels and inducing fatigue. Ideal breathing will also accelerate the recovery process between intense bouts of exercise, therefore promoting recovery of the body’s energy systems. Following training and competition, the use of proper breathing patterns will help the body shift into more of a parasympathetic state. Returning to parasympathetic dominance is the essence of recovery and breathing is one tool that can be used to enhance recovery. More detail on the importance of recovery can be read in our article, Understanding The Role of Recovery in Health and Performance.
The importance of proper breathing patterns cannot be underestimated. Karel Lewit, MD, considered by many as the father of manual therapy and rehabilitation, stated, “If breathing is not normalized - no other movement pattern can be.” This statement demonstrates the concept of regional interdependence within the body, meaning all musculoskeletal function is interrelated. Regional interdependence helps to explain how simple breathing exercises can be used to improve joint mechanics, optimize muscle function, reduce injury risk, and enhance recovery.

1. Lewit, K. Manipulative Therapy: Musculoskeletal Medicine. 2010.
2. Lum, L. Hyperventilation Syndromes. In: Behavioral and Psychological Approaches to Breathing Disorders. 1994

The Solution for Chronic Back Pain

Chronic back and joint pain is a health problem which affects a relatively small number of people within the US, but has profound impacts on society and our healthcare system. This article looks to explain why the current medical model is failing the chronic back pain patient. The goal is to provide an understanding of why a greater focus on psychosocial factors and patient empowerment through education and progressive reactivation through physical activity, rather than imaging and exam findings, may result in improved management and outcomes for the chronic pain patient.

The Problem with the Traditional Medical Model
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. How is chronic pain defined? Chronic pain is considered to be pain lasting longer than 12 weeks. Even though the percentage of chronic back pain patients remains relatively low, the impact on healthcare cost is significant. 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, effective patient management appears to be an issue in need of addressing appropriately.

When dealing with the chronic back pain patient, the primary goal within the traditional medical model is to identify the structure responsible for generating pain by means of diagnostic imaging. This could mean the use of x-ray, ultrasound, MRI, CT or a combination of these procedures to determine what specific structure is the responsible for your pain. In his text, Rehabilitation of the Spine: A Practitioner's Manual, Liebenson states this is done for two main reasons:
  1. The belief that structural pathologies seen with imaging are strongly correlated with pain symptoms.
  2. Fear of missing serious disease, such as cancer, infection, or fracture.
When put into practice, these beliefs ultimately result in an over-reliance on costly imaging procedures. This is often times futile, considering research has demonstrated that findings from diagnostic imaging, such as degeneration, has more to do with age than being the reason for pain symptoms.  Also consider that up to 64% of asymptomatic individuals have signs of abnormal lumbar disc anatomy (i.e. disc bulge) on imaging, one should wonder if relying on imaging findings to identify a patient's problem is practical or productive. Sure structures such as discs and spinal joints can be sources of pain, but failing to correlate imaging findings with clinical presentation and examination findings may result in poor diagnosis and mismanagement of the patient. As for the case of using imaging to identify serious disease as the source of back pain, serious disease accounts for less than 1% of back pain cases. The use of imaging appears to be over-utilized in this realm as well, since typically information in the patient history and physical exam can raise a clinician's suspicion of serious disease.

The take home is that if the diagnosis and/or management of chronic back pain is based on imaging findings as the reason for your pain, this can result in poor outcomes and may prove to frustrate and confuse the patient and provider, enabling the process of chronicity and disability.

Developing a Better Approach
When it comes to the management and treatment of the chronic back pain patient, psychological and behavioral factors correlate better with symptoms than imaging or exam findings.  Examples of such factors include fear avoidance behavior, catastrophizing, and lack of perceived control.

What do all these fancy terms mean and how do they relate to chronic pain?

Essentially, they are beliefs held by the patient that activity will be painful or make their condition worse. It is the anticipation of pain which results in avoidance of activity and promotes behaviors which enable deconditioning due to lack of activity, thus perpetuating the pain cycle. Ultimately, these beliefs can cause the patient to identify with their diagnosis (i.e. disc bulge or arthritis) as their problem, hindering progress since they will have a limited expectation of improvement.

For chronic back pain patients, if a fear of pain exists, it must be recognized and treated. If the fear is not recognized and dealt with accordingly, it will lead to avoidance of activity and disuse. Thus, a new model must be applied to chronic back pain which focuses on patient-centered reactivation through treatment and education. The goal becomes not only to address injury and symptoms, but also address biomechanical dysfunction and emotional or behavioral components contributing to the pain cycle. Behavioral components correlate strongly with chronicity and providing proper education to patients allows them to understand the nature of their back pain and how self-management strategies can be used to regain control through progressive physical activity. Physical activity is important for re-training of spinal stabilization muscles, decreasing fear avoidance behaviors and improving the rate of return to normal daily or sport-related activities.

The key in transitioning chronic back pain patients back to normal activity is to help them remove the fear that additional pain or re-injury will be caused by increased physical activity. This proves to be a huge obstacle since too many back pain patients are instructed by clinicians to rest and avoid activity if they feel pain. However, this advice is misplaced. Back pain patients should be provided advice that hurt does not equal harm and educated on how deconditioning from lack of physical activity is related to back pain. Utilizing progressive exposure to physical activity through therapeutic exercise can help a patient realize their symptoms did not worsen or increase as a result of movement or activity. Specific exercises and advice should be implemented to develop adequate motor control and reinforce ideal mechanics during activity. Such exercises would re-train spinal stabilization patterns and teach spine-sparing strategies to be incorporated into routine daily movements.

Managing Central Sensitization
One complicating factor in the treatment of chronic back pain patients is addressing central sensitization and neuropathic pain. These neurosensory changes occur from prolonged nociceptive (pain) bombardment, resulting in increased sensitivity of dorsal horn neurons to both noxious and nonnoxious stimuli, and thus the central nervous system’s ability to learn pain. This generates a situation in which an ongoing perception of pain occurs in the absence of any anatomical lesion, long after injury has occurred. To alleviate the role of central sensitization and neuropathic pain, spinal adjustment/manipulation may be effective. A suggested mechanism of manipulation’s role in reducing spinal pain is through the stimulation of sensory fibers, which interferes with pain function in the central nervous system and potentially leads to a reprogramming of the dysfunctional pain pathway.

Managing the chronic back pain patient with an approach which addresses emotional and behavioral components through proper education and progressive reactivation into daily and/or sport activities can prove to be an effective means to improving outcomes. The same can be said of chronic pain in any joint, such as shoulders, knees, and hips. At Gallagher Performance, we take these steps to help provide each patient with an understanding of their condition, the course of treatment, and self-management strategies to help empower them to regain control. It is our hope that this approach will demonstrate the role of spinal manipulation and active care in returning chronic pain patients to normal activity levels and improving their quality of life. We also acknowledge that in some cases, co-management with other healthcare specialists can prove to be beneficial and provided truly patient-centered care.

Liebenson C, Yeomans S. Assessment of psychosocial risk factors of chronicity. In: Liebenson C. Rehabilitation of the Spine: A Practitioner’s Manual, 2nd ed. Baltimore: Lippincott Williams and Wilkins. 2007; 9:183–200.
Andersson, Gunnar BJ. Epidemiological features of chronic back pain. Lancet. 354:581-585, 1999.
Merskey H, Bogduk N, eds. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms, 2nd ed. Seattle: IASP Press, 1994.
Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991;22:263-71.
Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. AM J Public Health. 1999;89:1029-1035.
Wainner R, Whitman J, Cleland J, Flynn T. Regional interdependence: A musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther. 2007;37(11):658-660.
Liebenson C. Putting the biopsychosocial model into practice. In: Liebenson C. Rehabilitation of the Spine: A Practitioner’s Manual, 2nd. Baltimore: Lippincott Williams and Wilkins 2007;4:72–90.
Siemionow K, Steinmetz M, Bell G, Ilaslan H, Mclain R. Identifying serious causes of back pain: Cancer, infection, fracture. Cleveland Clinic J Med. 2008; 75(8):557-566.
Jensen M, Brant-Zawadzki M, Obuchowski N, Modic M, Malkasian D, Ross J. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331:69-73.
Bogduk N, Aprill C. The sources of back pain. In: Liebenson C. Rehabilitation of the Spine: A Practitioner’s Manual, Baltimore: Lippincott Williams and Wilkins 2007;6:112-121.
Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine. 2005;5(1):24.
Severeijns R, Vlaeyen J, van den Hout M, Weber W. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain. 2001;17(2):165-172.
Koleck M, Mazaux J, Rascle N, Bruchon-Schweitzer M. Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: A prospective study. EuroJPain. 2006;10(1):1-22.
Mercado A, Carroll L, Cassidy D, Côté, P. Passive coping is a risk factor for disabling neck or low back pain. Pain. 2005;117(1):51-57.
Leeuw M, Goossens M, Linton S, Crombez G, Boersma K, Vlaeyen J. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behavioral Med. 2007;30(1):77-94.
Jacob G. Biopsychosocial perspective on low back pain: patient provider communications. J Minim Invasive Spinal Tech. 2003;3(Spring):27-35.
Liebenson C. Active care: Its place in the management of spinal disorders. In: Liebenson C. Rehabilitation of the Spine: A Practitioner’s Manual, 2nd ed. Baltimore: Lippincott Williams and Wilkins 2007;1:3-29.
Crombez G, Vlaeyen J, Heuts P, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain 1999; 80:329–339.
Middleton P, Pollard H. Are chronic low back pain outcomes improved with co-management of concurrent depression? Chiropractic and Osteopathy. 2005;13(8):1-7.
Vlaeyen J, Crombez G. Fear of movement/(re) injury, avoidance and pain disability in chronic low back pain patients. Manual Therapy. 1999;4:187–195.
Vlaeyen J, Linton S. Fear-avoidance and its consequences in chronic musculoskeletal pain. A state of the art. Pain. 2000;85:317–332.
Sung P, Yoon B, Lee D. Lumbar spine stability for subjects with and without low back pain during one-leg standing test. Spine. 2010;35(16):753-60.
Escolar-Reina P, et al. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. Arch Phys Med Rehab. 2009;90(10):1734-1739.
Liebenson C. The role of muscles, joints, and the nervous system in painful conditions of the spine. In: Liebenson C. Rehabilitation of the Spine: A Practitioner’s Manual, 2nd ed. Baltimore: Lippincott Williams and Wilkins 2007;2:30-50.
Murphy D, Morris C. Rehabilitation strategies in low back syndromes. In: Low Back Syndromes: Integrated Clinical Management, USA: McGraw-Hill 2006;26:709-726.
Seaman D, Winterstein J. Dysafferentation, a novel term to describe the neuropathophysiological effects of joint complex dysfunction: a look at likely mechanisms of symptom generation. J Manip Physiol Ther. 1998;21:267-80.

Tendinopathy: Changing Treatment and Improving Recovery

Let’s start off with illustrating a scenario that may sound familiar to many of you:

As an athlete or someone who simply enjoys being active, you put in plenty of hours working out, training, practicing and competing.  Whether it’s running, jumping, throwing, swimming, skating, shooting, or swinging, you slowly begin to notice some minor irritation in a joint or muscle. It could be a knee, a shoulder, back, quad muscle, groin, foot, wrist, or your rotator cuff. You sense things don’t feel right, but you convince yourself it’s nothing serious. After all, it may be a little painful during activity and goes away quickly when you are done. Plus, you got an important game, match, or race coming up and you can’t afford to take any down time.

You decide to put conventional wisdom into practice and take it easy, resting as much as possible. You ice the area. After all, it’s what we have been told to do for years. You may even take it a step further and do some stretches to bring some relief to the area. If the pain is bad enough, you may reach for medication to help take the edge off.

However, over the course of weeks or months, you begin to notice this pattern occurring more frequency as your pain persists. It’s got you puzzled. Now your pain is not just present during training or sport, but you notice it with everyday tasks such as walking or opening doors. You could shrug off the pain before, but now pain during simple tasks has your attention. You may now be getting concerned since it’s not only taking less to cause pain, but your pain may be getting more intense. You may even start to avoid certain activities.

What you are learning and beginning to realize is that despite the efforts to ease your pain, your symptoms persist and are getting worse. Despite rest, ice, and medication, your symptoms are not improving.

Change the Approach
Contrary to what has been preached for years, it is now known that interventions such as rest, ice, anti-inflammatory medications and electrical stimulation will not solve your problem. The application of these interventions was based upon the assumption that inflammation within connective tissue or joints was created by repetitive motions and sustained postures associated with labor, sport, or other forms of activity. However, this assumption has been proven to be wrong. New understanding of overuse injury is providing the foundation for treatment that truly addresses the root cause of your symptoms, not merely alleviating them.

New Understanding
We all know someone who has been told they have tendinitis, or inflammation of a tendon. Tendinitis is commonly referred to as an “overuse” injury.

Tendons are the structures that connect muscle to bone. They are critical in transmitting the force produced by muscles during movement. It was believed that tendons, when injured or over-stressed, became inflamed and painful. Inflammation is the body's natural response to injury. Inflammation begins the healing process. Applications such as rest, ice, and anti-inflammatory medication are prescribed to minimize the effects of inflammation.

Interesting thing is, research has demonstrated that inflammation is rarely present within tendons, thus providing a new understanding of how overuse injuries develop.

Back in 1979, a couple surgeons by the name of Robert P. Nirschl and Frank A. Pettrone examined sections of injured elbow tendons under a microscope. What they found was no presence of inflammation. None. What they did notice was how the tendons had degenerated. Their color and texture had changed. The tendons were grayish and swollen rather than white and soft.

No inflammation? No tendinitis. Tendinosis is the correct name for this condition. Tendinosis is the result of repeated or sustained muscular contraction associated with poor movement or posture, which decreases blood supply. The body begins to react in similar ways as if you had injured muscular tissue and scar tissue development is triggered. This would be a normal response if there were actual damage, but the body has been tricked. There is no injury, but scar tissue accumulates in healthy tissue due to compromised circulation. Accumulated scar tissue increases mechanical stress on tendons, limiting normal function of muscle contraction. Limited function means reduced strength, range of motion, and can lead to pain during activity.

Now that we understand the mechanism behind scar tissue production, the deeper question is, "What is the underlying reason for poor movement or poor posture that is responsible for the overload?" Because if the reason was simply just sustained postures or repetitive movements, wouldn’t we see more of the population coming down with overuse injuries?

Mobility vs Stability: Stabilizing the Confusion
Mobility seems to be the buzzword of the fitness industry and it’s certainly popular among certain camps within the physical medicine profession. There are plenty of products, assessments, and even entire workouts that are devoted to mobility. Some define mobility as the ability to achieve a certain posture or position, while others define it as the ability to achieve a certain range of motion specific to a movement (i.e. squat, push-up).

Advocates of mobility claim that mobility should be achieved first. We need mobility and lack of mobility is implicated as a predisposing factor for overuse injury. But is mobility the secret to preventing overuse injuries and unlocking athletic performance?

While mobility is important, if we consider the developmental model, stability should be the primary focus.

Enter the Developmental Model
Developmental kinesiology, or essentially understanding how we develop motor function through early childhood, emphasizes the existence of central movement patterns that are “hard-wired” from birth. For example, an infant does not need to be taught when and how to lift its head, roll over, reach, crawl, or walk. Each and every one of these movement patterns occurs automatically as the CNS matures. During this process of CNS maturation, the brain influences the development of stability before purposeful movement can occur.

The process begins with the coordination of spinal stabilization and breathing through what is known as the integrated spinal stabilizing system (ISSS). This constitutes the “deep core” and it is activated subconsciously before any purposeful movement. The musculature of the ISSS  contracts automatically under the control of the nervous system. The role of the ISSS is critical because it provides a fixed, stable base from which muscles can generate movement. The ISSS is essential to maintaining joints in a neutral position, thus maximizing muscular forces with minimal stress to structures such as ligaments, capsules, and cartilage.

Bottom line: Inadequate activation and stabilizing function of muscles may place greater stress within the body, compromising posture and movement. Mobility is DEPENDENT upon stability. You need stability first before you can achieve purposeful, efficient motion. A deficient stabilizing system is likely to lead to strain or overuse injury due to compensatory movements.

Managing Overuse Injury
Now that we have a better understanding of why scar tissue develops in the body and factors that contribute to poor movement and posture, its time to discuss what can be done in the treatment and prevention of overuse injuries.

#1 - Myofascial Release Techniques. Understanding that overuse injuries are most often degenerative scar tissue problems rather than inflammatory conditions, treatment strategies should change accordingly. Rest, ice, anti-inflammatory medication, and electrical stimulation are no longer ideal treatments. Treatment that involves myofascial release or soft-tissue manipulation becomes the focus in order to breakdown scar tissue and allow for normalized muscle/tendon function. Clinicians or therapists are able to locate scar tissue by touch. The hand is a powerful tool.  Characteristics they evaluate for may include abnormal texture, movement restriction, or increased tension. Treatment is often delivered by the hand or with the use of an instrument and is non-invasive in nature.

#2 - Improve the stabilization function of muscle. To ensure quality movement during functional activities or sport skill execution, it is critical that all stabilizers of the body are adequately activated. Insufficiency within certain muscles in the kinetic chain will result in muscular imbalances that can contribute to chronic pain or poor performance. Corrective stabilization strategies thus should always be the foundational concept of any training or rehabilitation program. Clinicians are beginning to recognize the importance of “training the brain” since the majority of motor dysfunctions may be more related to altered CNS function than local joint or muscle issues. The CNS is the “driver” and attention must be given to how it coordinates muscular patterns during movement in order to provide stability.

For example, if someone has difficulty performing a squat, rather than focusing on local “tight” or “weak” muscles or restricted movement in a specific joint, one may need to realize that the insufficiency is due to a dysfunctional ISSS pattern at the brain level.

Rather than focusing on mobilizing a tight glenohumeral capsule/joint and strengthening the rotator cuff musculature in the treatment of shoulder impingement in a baseball pitcher, should you focus on an inadequate ISSS and the "weak" link in the kinetic chain, such as poor dynamic scapular stability, proprioceptive deficits, or impaired lower extremity mobility.

The body functions as a single unit during complex movement, not in segments. The key is to maintain control, joint stability, and quality of movement. Every joint position depends on the coordination of stabilizing muscle function throughout the entire body. Through repetition, ideal stabilization patterns are achieved and then integrated in with sport-specific movements.


New information has provided a deeper understanding of how overuse injuries develop and led to improved treatment. These concepts are foundational to the patient-care and sports performance training clients receive at Gallagher Performance. Myofascial release techniques can help offset the build-up of scar tissue within tendons or muscles, promoting normal function of those tissues. Ultimately, the ability to coordinate and control precise movement will minimize stress on the body and the trigger for scar tissue development. Developmental kinesiology provides a method for both assessment and the training or rehabilitation of muscular stabilization as it relates to efficient movement. The combination of these approaches not only reduces the risk of injury and pain syndromes resulting from overuse, but impacts sport performance.

Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J. Biomech. 1999a;32(1):13-17.
Hagins M, Lamberg EM. Individuals with low back pain breathe differently than healthy individuals during a lifting task. J Orthop Sports Phys Ther. 2011;41:141-146.
Janda V. Muscles; central nervous regulation and back problems. In Korr IM (ed). Neurobiological mechanisms in manipulative therapy. Plunum Press, New York, 1978, pp 27-41.
Janda V. Muscles and motor control in cervicogenic disorders. In: Grant R (ed). Physical therapy of the cervical and thoracic spine. 1st edition. Churchill Livingstone, Edinburgh. 1994, pp 195-215.
Kibler WB. The role of the scapula in athletic shoulder function. AM J Sports Med. 1998;26(2):325-336.
Kolar P, Sulc J, Kyncl M, Sanda J, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):352-62.
Kolar P. Facilitation of Agonist-Antagonist Co-activation by Reflex Stimulation Methods. In: Craig Liebenson: Rehabiliation of the Spine – A Practioner’s Manual. Lippincott Williams & Wilkins, 2nd edition 2006, 531-565.
McGill SM, Grenier S, Kavcic N, et al. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003;13(4):353-359.
Page P, Frank C, Lardner R: Assessment & Treatment of Muscle Imbalances. The Janda Approach. Human Kinetics. 2010.
Panjabi MM. The stabilizing function of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-9.
Panjabi MM. The stabilizing function of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5(4):390-6.
Schlottz-Christensen B, Mooney V, Azad S, et al. The Role of Active Release Manual Therapy for Upper Extremity Overuse Syndromes: A Preliminary Report. J of Occup Rehab. 1999;9(3).

Health and Sport Performance Improved in 5 Simple Steps

An interesting dynamic has been developing in youth sports. The dynamic has been generated by the current nature of greater focus placed upon competition rather than athlete development. This is evident by the increasing number of games played at the youth level, commonly seen within travel or club organizations. Now, while this trend is not a favorable one and can actually be detrimental to youth athletic development, it has seemed to be the driving force for another trend.

The trend being the greater awareness and proactive nature some parents and young athletes are taking to become more educated on proper nutrition and training. The reality is, at the youth, club, and high school levels of sport, there is a competitive advantage to athletes who not only improve their athletic qualities (strength, speed, power, stamina, etc.), but also become healthier by making better food choices or finding ways to improve recovery.

When it comes to athletic development and preparation, there is no such thing as a “one size fits all” approach. There are far too many individual differences to account for. However, there are some basic principles or guidelines that most any aspiring athlete can implement and see results.

That said, here are five tips that can put you on track to experience better health and more consistent sport performance:

 When shopping for food, stay on the perimeter of the store. This is where you’ll find the best in whole food selection such as beef, chicken, fresh produce, and other food that should be the foundation of quality nutrition. The middle aisles mostly consist of processed foods. Sure they may taste awesome, but they do little to support the nutritional demands of young athletes.

 The importance of reading food or ingredient lists cannot be stated enough. It's important that you know what you are consuming. Food labels can be misleading. For example, items can read “Low Fat” or “Non Fat” in an attempt to appear as a ‘healthier’ choice. However, if you read the label closely, you will find that these foods often have added sugar and/or artificial flavors. As we discussed in this article, fats, such as saturated fat are not the bad guy. Sure, you should avoid foods with trans fat, but the over-consumption of sugar and other processed foods will do more harm to your body than quality, healthy fat ever will.

Focus on selecting foods with a short ingredient list. Food manufactures appear to be taking notice, as they are producing a greater selection of foods with few and familiar ingredients to appeal to the consumer demand for healthier, natural foods.

 When it comes to meals, you can find plenty of people who will advocate breakfast as the most important meal of the day. Others will say dinner. Some may even say lunch. Regardless of opinion, it’s more important to be consistent with your nutritional intake during the ENTIRE day. As a growing and developing athlete, simply focusing on nailing one meal won’t cut it.

It’s important to consume food at adequate levels throughout the day to replenish energy stores and promote an environment within your body that is essential for growth and repair.

 Strength and weight gains occur during the offseason. During the season, athletes need to focus on maintaining what they have built during their offseason.


With the abundance of practices and games during the season, athletes do not have the energy reserves and time to make strength or weight gains and recover in time for competition. Plus, many athletes can be banged up during the year, thus limiting what you can do with their training. This makes having a trainer or coach who understands how to work around minor injuries of tremendous value.

Establishing an in-season maintenance program can keep athletes healthier and performing at more consistent levels during the season. It also allows them to step into offseason training with greater ease and ahead of the game.

 This is contrary to what almost every athlete hears at some point in their career. Athletes are told to train hard, work hard, etc. While hard work is necessary and valuable, there comes a point when being smart about your training is even more valuable.

Training should produce results. You should be getting something out of it rather than just being exhausted. It’s not difficult to make someone tired. Anyone can make you tired. Those trainers and coaches are a dime-a-dozen. What athletes need is someone that will produce results. There should be measurable gains in strength, speed, and power. If you are not seeing gains and simply becoming more and more tired, you need to start training smarter.

For additional reading on the difference between training smart vs. training hard, check out this article.

Why Poor Recovery Will Make You Sick, Sad and Weak

Why Poor Recovery Will Make You Sick, Sad and Weak
For those of you familiar with GP, you know we take the balance between training and recovery very seriously. It's a subject we feel we cannot educate our clients on enough. Recovery is too often a poorly understood or ignore aspect of training and the organization of sport (i.e. practice, competition). Many coaches and trainers push their athletes to the brink, attempting to build physical stamina and mental resilience. This is a part of sport and a necessary component to improving physical attributes such as strength, speed, and power. However, if you miss the boat on recovery, you could be sabotaging your efforts.

Why is recovery so important?
How much time do you spend training on a weekly basis, working towards physical or athletic goals? Probably not much, at least when compared to the amount of time spent between those sessions.

Training, regardless if you run, lift, swim, or skate, is a stimulus to the body. It's a stimulus for change and that stimulus will only generate results if you recover adequately between training sessions.

When recovery is poor, health and performance begin to suffer. This is the point at which many people describe themselves as "feeling flat" or “hitting a wall.” What they are communicating is low energy levels and an overall sensation of not feeling right. Fatigue has built-up because recovery has not been adequate. This state of fatigue can be referred to as “over-reaching" and in more serious cases it is known as "over-training."

Over-training can involve signs/symptoms such as:
  • significant decreases in power or capacity of physical attributes such as strength, speed, or power
  • significant and chronic joint and muscle pain
  • significant changes in mood, such as depression
  • significant sleep disruption
  • major immune problems — frequent illness (i.e. bacterial/viral infections)
  • hormonal suppression (i.e. low thyroid, low sex hormones, amenorrhea or irregular periods in women)
Over-reaching is a much milder version of overtraining, but is a far more common and can involve:
  • low energy
  • lack of motivation to train
  • feeling "run-down"
  • persistent sore and achey joints or muscles
  • mild mood changes such as feeling more irritable, moody, or anxious
Understanding Recovery
Lack of recovery is a complex phenomenon with wide-ranging effects, with the heart of the issue being fatigue. The underlying causes of fatigue fall into two main categories:
  1. Central (CNS) - The central nervous system (CNS) serves the purpose of monitoring the body, similar to the function of a car engine regulator. If you "redline" the engine of your car too long, the engine shuts down. Your brain attempts to protect your body in the same fashion by reducing the ability of your body to "fire muscles" through nerve impulses.
  2. Peripheral (muscular) - The other form of fatigue, peripheral, is related to energy system depletion and/or metabolic byproduct accumulation. Sticking with the car analogy, this is similar to running out of gas.
There are plenty of activities and responsibilities that will consume our days and the time between workouts, or in other words, our recovery time. The activities that we choose to be involved in will have a profound impact on our ability to recoup and recover. To understand the influence our activities can have on our recovery, we must first place them into two distinct categories:
  • Sympathetic activities – often referred to as “fight or flight”
  • Parasympathetic activities – often referred to as “rest and digest”
Sympathetic activities dominate our lives. Whether it's the pursuit of educational, athletic, or career goals, trying to establish financial stability, or building relationships, these activities bring on varying degrees of stress. Your body reacts to stress by elevating levels of cortisol and adrenaline.

Stress, or over-stimulation of the sympathetic nervous system, can become chronic. If that happens, production of stress hormones begins to slow and the development of ongoing, chronic fatigue may occur. This is central fatigue. The body has been "redlining" for too long and is beginning to shut down. See the problem?

Now, I'd think we'd all be fans of simply removing all stressors from life. Doesn't that sound appealing? However, that is not a realistic option. Instead of eliminating stress, the key is to establish a balance with relaxing and invigorating activities.

Relaxing and invigorating activities stimulate the parasympathetic nervous system, which is vital to restoring balance to the body and improving recovery. Such activities include:
  • Low-intensity, aerobic-based exercise (cycling, walking, hiking)
  • Massage
  • Yoga
  • Meditation
  • Hot tub or sauna
  • Relaxing hobbies such as reading or listening to music
  • Meaningful relationships
  • Drinking tea
Depending on your tastes and what you find to be relaxing, any of the above activities can have the ability to lower stress, improve oxygenation of tissues, facilitate lymph circulation, and promote a hormonal environment that is vital to recovery.

Keep in mind, one activity is not necessarily better than another. All that matters is that you pick a specific activity that you find enjoyable. The many systems of the body are working overtime between training sessions to bring the body back to balance, the least you could do is give your body a boost.

Immunity and Recovery
Training is a stressor to the human body. The stress which training places upon the body is truly under-appreciated. Training stresses the entire body and all it's systems, such as the cardiopulmonary system, detoxification system, hormonal system, metabolic system, central nervous system, neuromuscular system, and the immune system. They are all affected by training and all these systems do not recover at the same time.

When it comes to immunity, the relationship between exercise and immunity is what researchers call a “J-shaped curve”.
  • Sedentary individuals are at moderate risk for infection. Their immune system isn’t running as well as it could be.
  • Individuals who are regularly active, using moderate intensity and variety in their training, demonstrate the most resistant immune systems.
  • Individuals who are active, but consistently pushing the limits in workout frequency, duration, intensity, or loading without proper recovery put themselves at increased risk for becoming sick.
Take home: High levels of exercise intensity with inadequate recovery can result in immunosuppression. Don't allow your lack of recovery to leave you at an increased risk of coming down with a cold, virus, or infection.

Nutrition and Recovery
When it comes to nutrition and recovery, eating real food in its unprocessed form will give your body the nutrients it needs. Make consuming whole foods, along with herbs and spices, such as turmeric and garlic, a priority in keeping inflammation to moderate levels and assisting in recovery. It's also important to consume adequate amounts of water and fluids to assist with lymphatic function.

Supplements used before, during, or after training, known as peri-workout nutrition, can enhance the recovery process. These include the use of carbohydrates, protein and BCAAs. Glutamine and creatine have also been shown to be effective in promoting recovery. It's important to understand that if recovery supplements or a nutrient dense meal aren’t consumed in a timely fashion after workouts, the regeneration process can be delayed.

Recovery Recommendations
To sum up, here is a general list of recommendations to help you improve your recovery:
  • Make a point of including 20-30 minutes of parasympathetic activity each day (i.e. meditation, massage, warm bath, good conversation, laughing, etc.)
  • Consume nutrient dense foods at regular intervals, use herbs and spices, and drink adequate amounts of water and tea
  • Consider using a carbohydrate, protein, BCAA, and/or creatine supplement as part of your peri-workout nutrition
  • Incorporate variety into your training program
  • Utilize low-intensity exercise on days between high-intensity training sessions to promote recovery (i.e. walking, cycling, swimming, flexibility work)
  • Avoid the regular use of anti-inflammatory medications
  • Make rest a priority and aim for 7-9 hours of sleep per night
Beauchamp GK, et al. Ibuprofen-like activity in extra-virgin olive oil. Nature 2005;437:45-46.
Davis JM, et al. Curcumin effects on inflammation and performance recovery following eccentric exercise-induced muscle damage. Am J Physiol Regul Integr Comp Physiol 2007;292:R2168-R2173.
Ali M, Thomson M, Afzal M. Garlic and onions: their effect on eicosanoid metabolism and its clinical relevance. Prostaglandins Leukot Essent Fatty Acids 2000;62:55-73.
Laine L. The gastrointestinal effects of nonselective NSAIDs and COX-2-selective inhibitors. Semin Arthritis Rheum 2002; 32(Suppl 1):25–32.
Feingold D, Hame SL. Female athlete triad and stress fractures. Orthop Clin North Am 2006;37:575-83.
Long CL, et al. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN J Parenter Enteral Nutr 1979;3:452-456.
Emery PW. Metabolic changes in malnutrition. Eye 2005;19:1029-1034. Review.
Hughes MS, et al. Enhanced fracture and soft-tissue healing by means of anabolic dietary supplementation. J Bone Joint Surg Am 2006;88:2386-2394.
Trappe TA, et al. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab 2002;282:E551-E556.
Newsholme EA, Crabtree B, Ardawi MS. The role of high rates of glycolysis and glutamine utilization in rapidly dividing cells. Biosci Rep 1985; 5: 393–400.
Bulus N, et al. Physiologic importance of glutamine. Metabolism 1989; 38: 1–5.
Cersosimo E, et al. Role of glutamine in adaptations in nitrogen metabolism during fasting. Am J Physiol 1986; 250: E622–E628.
Schilling BK, et al. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc 2001;33:183-188.
Greenwood M, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem 2003;244:83-88.

What You Need to Know About Preventing Knee Injuries

What You Need to Know About Preventing Knee Injuries
There is no question that knee injuries are a common occurrence among athletes. The incident of devasting knee injury, such as ACL tears, has been on the rise for years. Once considered an adult injury, ACL tears are occurring more often in children as reported by orthopedic specialists, estimating that thousands of children and teens suffer an ACL injury each year. According to statistics presented at the American Academy of Pediatrics 2011 annual meeting, over the past decade youth ACL injuries have increased 400% and girls are at eight times the risk of an ACL tear as compared to boys. Clearly, there is a problem with knee injuries among youth athletes. But where is the solution?

Mechanism of Injury and Risk Factors
To identify a solution, we must first identify the problem. In this case, the problem is the mechanism(s) of injury most commonly associated with ACL injury. Keep in mind that about 2/3 of all ACL injuries are non-contacted related. Meaning, the athlete didn’t have someone tackle them or have a player roll-up on their leg, resulting in injury. Non-contact injury opens the door to the possibility that a large percentage of ACL injuries can be reduced or prevented. Here are the most common mechanisms of injury associated with ACL injury:
  • Jumping/landing improperly
  • Planting followed by cutting or pivoting
  • Straight-knee landing
  • Stopping or landing with the knee hyperextended (too straight)
  • Sudden deceleration of movement
As far as risk factors are concerned, there have been several identified as having an association with ACL injuries, such as:
  • Weak hamstring and gluteal (hip) muscles
  • Poor neuromuscular control and balance
  • Poor dynamic biomechanics (Jumping, landing, cutting, etc.)
  • Fatigue
  • Female Gender
It is important that all risk factors be evaluated for how they play into an athlete’s risk of knee injury. Currently, there are movement screens available to help in identifying what potential risk factors may predispose an athlete to increased risk of ACL injury. Although these can prove to be valuable, one cannot underestimate the importance of simply watching an athlete move outside of a controlled environment. This means keeping an observant eye on them during training or practice and stressing them to see how their movement changes. You may be surprised by how much you learn about the physical abilities of that athlete from just simple observation.

Understanding the Female Athlete
Now that we have identified some mechanisms of injury and risk factors, we will turn our attention temporarily to the female athlete since they have their own special considerations in preventing ACL injuries. While researchers are continuing to study and gain understanding of the possible causes that may place young females at an increase risk of injury, a number of factors specific to female anatomy and development have been the focus of attention.

Female Hip and Knee Anatomy
Despite many young female athletes experiencing pain in their knees, the root of some of the problem may actually originate in the pelvis/hip structure. There is a growing trend among sports medicine specialists who focus on the pelvis/hip to reduce the incidence of knee pain and injury.

According to the Women’s Health and Fitness Guide (2006), the female pelvis has a number of differences as compared to the male pelvis for the purpose of accommodating childbirth. Among those differences, the female pelvis has a greater forward tilt and more forward facing hip joints.  These features of the female pelvis/hip result in the femur (thigh bone) being positioned with more of an inward angle and internal rotation at the knee as compared to the average male. It is this increased angle of the femur when compared to the vertical position of the tibia (shin bone). This anatomical difference is known as the "Q-angle" and is illustrated below.

What does all this mean? SImply put, it means the female knee is predisposed to having unfavorable forces placed on it and that the core, hip, and thigh musculature must be strong enough to compensate for the increased angle of the femur to the tibia, or else the female athlete may be at a higher risk for experiencing knee pain or injury.

What can be done?
Unfortunately, regardless of gender, there is no such thing as complete injury prevention. However, there are reasonable and appropriate steps that have been implement in programs that are successful in reducing the occurrence of knee pain and ACL injuries:
  1. Improve hamstring strength. The hamstring muscles have a critical role in maintaining healthy knees. Proper hamstring training and strengthening must take into consideration how the hamstrings function during the primary sporting movement(s). For example, land-based sports with an emphasis on jumping and sprinting ability will place a high demand on the hip extension action of the hamstring. The hamstrings must be trained accordingly to be able to meet and accommodate the forces generated during sport.
  2. Improve hip and core strength. The musculature of the core and hips have a tremendous amount of control on the pelvis and femur, and thus the knee. Poor hip control puts the knee in compromising positions, increasing the risk of injury. When the core and hips are weak, they needs to be a focus of treatment/exercises. This will serve to improve the stability of the knee.
  3. Improve Proprioception (Balance) and Neuromuscular Control. Sufficient proprioception and neuromuscular control is the difference between being able to ride a bike and falling on your butt every time you get on a bike. Understand that altered proprioception and neuromuscular control contribute to abnormal motion during dynamic sporting activities, such as cutting and jumping/landing. One study revealed, “Improved joint mechanics during landing were achieved regardless of the individual’s muscle strength, suggesting that strength may not always be a prerequisite for movement re-education.”  This should demonstrate the importance that mental focus and repetitive use of proper movement has on correcting mechanics.
  4. Decrease fatigue. There are 2 types of fatigue, peripheral (muscles) and central (brain).  Peripheral refers to exercise induced processes leading to decreased force production (typical muscle fatigue).  Central fatigue relates to a gradual exercise-induced reduction in voluntary muscle activation. Essentially meaning the brain gets fatigued. It is plausible to say injury comes from both, however from an injury prevention stand point; peripheral fatigue is difficult to manage because your muscles will get fatigued.  But targeted training of central fatigue might be the way to go in preventing injury. How does one train central control. As one study put it, “Exposure to more complex or cognitively demanding movement tasks may facilitate improved perception and decision making within the random sports environment.” This is were mental focus and developing an athlete's awareness of their body during drills becomes important. Mental imagery may prove beneficial in developing central control by utilizing “mental reps” to help engrain proper movement and ideal mechanics.
  1. Powers  CM, Souza RB. Differences in Hip Kinematics, Muscle Strength, and Muscle Activation Between Subjects With and Without Patellofemoral Pain. J Ortho Sports Physical Thearpy. 2009;39(1):12-19.
  2. Powers CM. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. J Orthop Sports Phys Ther. 2010;40(2):42-51.,type.2/article_detail.asp.
  3. Heiderscheit B. Lower Extremity Injuries: Is It Just About Hip Strength? J Ortho Sports Phys Ther. 2010;40(2):39-41.,type.2/article_detail.asp.
  4. Mizner R, Kawaguchi J, Chmielewski T. Muscle Strength in the Lower Extremity Does Not Predict Postinstruction Improvements in the Landing Patterns of Female Athletes. J Orthop Sports Phys Ther. 2008;38(6):353-361.,type.2/article_detail.asp.
  5. McLean SG, et al. Impact of Fatigue on Gender-Based High-Risk Landing Strategies. Medicine & Science in Sports & Exercise. October 2006.
  6. McLean SG. Fatigue-Induced ACL Injury Risk Stems from a Degradation in Central Control. Medicine & Science in Sports & Exercise. January 2009.
  7. Hilgefort M, Winchester B. Preventing ACL Injuries in Female Athletes.

What is Natural Talent?

Today's post takes on a bit of a different focus. It's more thought provoking than informational, but let's just say I had some inspiration to write this.
When I was young, you could say I was considered a decent artist.  I enjoyed drawing. So did my brothers. We preferred drawing mostly comic book characters and athletes. Our parents took notice of this artistic side and being the good parents they are, they signed us up for art classes to help us develop our artistic ability.

Outside of playing hockey, drawing was my main hobby. I did lots of drawings and many of them I still have to this day. It’s interesting to look back and see the progress in the quality of those drawings over the years. How I started out very unimpressive. Many of those early drawings are very amusing. But steadily, I developed my drawing abilities to replicate very detailed, very life-like objects or people.

I recall getting compliments such as, “You’re really talented” or “You have a gift.” I also remember hearing people saying, “I wish I could draw like that.” It was if people assumed I was naturally talented at drawing, that drawing somehow came “easy” to me.

Looking back though, I’m not so sure I was naturally talented when it came to drawing.

Yes, I produced some very realistic drawings. I did great work. But what fails to meet the eye is the understanding of how many hours and years it took for me to produce that very same artwork. Often times, hours were spent just to get a small feature to look the way I wanted it to. I wasn’t churning drawings out with effortless ease by any means. I would sit and study my subject matter. I would study each feature, the shading, the line angles, the negative space – anything and everything that made the object what it was. Then with my pencil and paper, I would work at replicating it until I got every last detail right.

Is that talent? To some, maybe it is. To me, it was not so much about talent as it was my willingness to spend more time at it than most. I wanted to get it right. I wanted my drawing to look just like what I was studying. In my opinion, the end result was the “appearance” of being good at it.

Now let’s fast-forward several years. I was considered a talented hockey player. I was pretty good. I accomplished a lot, but there are several other athletes that accomplished more that I ever did. The same can be said of my time competing as an amateur Strongman. I've won some contests and placed high in others. Yada yada yada.

What does art and all this talk about drawing have to do with my athletic accomplishments?

You see, it’s the exact same effect. I have never consider myself naturally talented as an athlete. It’s simply the attention to detail in the pursuit of my goals. It was spending countless hours skating and developing my puck skills, running sprints and lifting weights, and taking my rest and nutrition seriously.

Perhaps my only real talent is being driven and disciplined enough to achieve my goals, regardless of how long it takes me to realize them.

To sum up, I learned that if I want to be good at something, to be great at something, I needed to immerse myself in it. I learned that I need a high degree of focus and attention to detail. That I can’t waver in my pursuit. That if it takes me five hours to get a single detail right, that’s what I do. Anything less and I won’t improve. I won’t realize my potential.

Maybe you have learned the same lesson about yourself.

After all, who knows how many truly “naturally talented” people exist.


The Benefits of Performance Therapy

For those of you that are familiar with Gallagher Performance, you understand the importance we place on the integration of our sports training, chiropractic, massage, and manual therapy services. We feel this model allows for optimizing sport-based outcomes while keeping our athletes healthy and ready-to-train. The model is not completely unique, as chiropractors, therapists, physical medicine providers, and strength/physical preparation coaches are collaborating in similar models to better serve their clients and athletes.

With that in mind, one frequently asked question we receive is,
"How are these services different from sports medicine care I can receive from a physical therapist or other specialist?"
The concept of what is commonly referred to as ‘Performance Therapy’ can be seen as a unique and completely separate approach from traditional sports medicine or physical therapy. To illustrate this, here's a quick look at a comparison of the mindset behind sports medicine and performance therapy.

Traditional Sports Medicine
  • Reactive approach to sports injuries
  • Therapy and rehabilitation focused
  • Emphasis placed on passive modalities, manual therapies, manipulation, therapeutic exercise
  • Tissue-specific
  • Patient-centered
  • Occasional focus placed on "injury prevention" strategies
  • Primary goal is the return to training or sport abilities prior to injury
Performance Therapy
  • Proactive approach between coach, athlete, and doctor/therapist
  • Focus is on mechanical efficiency for skill acquisition and motor learning
  • Continual "tweaking" to optimize performance
  • Manipulation and manual therapies used for facilitation, to enhance the process of building mechanical efficiency
  • Skill-specific
  • Athlete-centered
  • “Injury prevention” is a by-product of the process
  • Primary goal is to enhance sport performance
We are very fortunate to have a skilled and knowledgable team of therapists and coaches working at GP. The dynamic created between therapist and coach allows us to not only screen each client and athlete prior to all training programs, but to also carefully watch their movement during each training session. The goal is identify specific movement qualities that could potentially have a negative impact on sport-specific movements, the acquisition of new skills, or injury prevention methods. This approach continues throughout the duration of the training program and allows movement dysfunctions to be addressed before they lead to greater issues.

Performance therapy becomes not just about normalizing function or "returning to sport", but optimizing the function of the athlete and "enhancing performance". Therapeutic intervention (or "treatment") occurs as needed during training sessions. This can include the use of a variety of exercises to improve stability/mobility or techniques that activate the nervous system to improve movement coordination. Regardless of the intervention, the goal is for athlete to adapt and improve more quickly than if training and treatment were approached separately.

The transition between training and treatment must be seamless. When it comes to performance therapy, we have noticed the following goals are achieved:
  1. Greater Body Awareness. By integrating the appropriate intervention into the training plan, there is an effect on motor control that generates greater permanence on a neurological level. Basically meaning the athlete masters new movement skills faster. The instant feedback from treatment allows the athlete to provide the coach or therapist with an understanding as to how they feel/move during training. Coaching the athlete thus becomes more specific, allowing them to learn and improve quickly.
  2. Optimization of the Training Session.  Performance therapy integrated with training typically involves a lot of “tweaking” in order to meet the demands of the athlete. It provides the framework to keep athletes performing at their best more consistently. Several athletes receive some type of treatment or practice regeneration/recovery methods prior to competition. So why would they not receive similar interventions during an important training phase?  Both serve the same purpose to optimize performance.
  3. Improved Monitoring of the Athlete. Performance therapy provides additional information on the readiness of the athlete to train. Both the therapist and the coach use this information to make educated decisions regarding the details of each training session, allowing for true customization of your training plan. It’s important that athletes are monitored for how well they have recovered between training sessions so you know how hard to push them. Also, athletes tend to have the ability to 'hide' things very well. Being able to identify slight differences in muscle tightness or movement abnormalities not only will allow us to make better decisions about the training session, but also help prevent more serious matters such as injury or overtraining.
Keep in mind that performance therapy is not intended to create athletes who are dependent on this model, but rather athletes who are held more accountable in the pursuit of their own goals. The coach or therapist is provided with the information needed to recommend the most appropriate "homework" for the athlete, such as foam rolling specific muscles, mobility or stability drills, and the use of recovery methods. Furthermore, performance therapy is not intended to serve as a replacement for other forms of therapy. It is not simply moving the treatment room to the training room. Even though the goal of performance therapy is to reduce the amount of time spent on treatment and return to sport measures, there is a time and place for other medical and/or alternative interventions that should be understood and respected.

Closing Words
Both sports medicine and performance therapy are necessary components in the health and performance of athletes. Failure to integrate therapy in a complementary manner can be a mistake. Without performance therapy there tends to be an increase in reliance on other forms of therapy that stress rehabilitation and recovery.

In sports, the term "game changer" is often used to describe an athlete or action that results in a successful outcome that changes the course of a game. The same can be said about performance therapy because of its ability to play an invaluable role in an athlete's development. If you've been experiencing lack of results or just can't seem to stay healthy, performance therapy may just be the "game changer" you have been looking for to improve your abilities as an athlete and GP is where you can find it.

We love to hear your input. Tell us about your experience on Google.


  • 4484 William Penn Highway

  • Murrysville, PA 15668

Hours of Operation

    Monday-Thursday: 9am-1pm, 3pm-6pm
    Friday: 9am-1pm, 3pm-5pm
    Saturday: by appointment only
    Hours are by appointment only