Training Injury Free Pt.I
An Interview with Dr. Patrick O'Brien

Anyone who has been actively involved in serious training for any length of time has no doubt encountered some type of injury at one time or another. So what are we athletes supposed to do when posed with this sort of situation, God forbid? Should we stop working out? Ha! Yeah right! Should we go see our family doctors? Probably not the ideal choice either since most M.D. 's I've encountered know as much about weight training as Ron Jeremy knows about monogamy. Every once in a blue moon someone comes along who truly knows training related injuries up, down, and side to side. That someone is Dr. Patrick O'Brien. Dr. O'Brien is not your average chiropractor. He walks the talk and repairs athletic injuries without missing a beat. He has focused on resolving athletic injuries for the past 6 years. I met Pat ironically through one of my own training clients and to this day I haven't sent him an injured athlete he hasn't fixed. Dr. O'Brien earned his D.C. from Northwestern College of Chiropractic Medicine. He earned his certification in Active Release Techniques through Dr. Mike Leahy (of Muscle Media 2000 fame) and is the owner of Health Architect, a private chiropractic clinic located in Minneapolis, Minnesota. The intent of this interview is to inform the readers of Shapeshifter about training-induced, soft tissue injuries as well as basic steps for injury prevention. Keep training injury free!

SSM Hi Pat. Tell us a little bit about what you do and how you initially became involved in treating sports and weight training related injuries.

Dr. O'Brien It stemmed from being involved in sports from a young age. I was always curious about how the body worked from a biomechanical standpoint. As I experienced injuries in my own training and began to learn more about the body, I knew that I wanted to work hands on with athletes. I knew there was an element to manual medicine and hands-on health care that wasn't being met and that was frustrating to me. I know when an athlete experiences an injury they want to be fixed "now". They can't afford to miss training or suffer a loss of performance, especially if they have contracts on the line that are worth alit of money. As I began to delve deeper into learning about myofascial work I was able to begin fixing some of these athletes that no one else was fixing. If you think like an athlete and have the technical background to go with it, those are the types of patients that will naturally gravitate toward working with you.

SSM What are some of the more common resistance training injuries you treat on a regular basis?

Dr. O'Brien Rotator cuff injuries are by far the most common injuries I treat in athletes. This is most often due to imbalances created by internal rotation and pushing movements without compensating with time spent on the external rotators and pulling movements. I also see a lot of tennis elbow, tendonitis, and quite often I treat psoas/hip flexor imbalances. People don't work on them and many doctors don't treat them or have the knowledge to really understand what's going on in that environment.

SSM What would be the primary cause of a psoas/hip flexor imbalance?

Dr. O'Brien A lot of athletes develop this problem from chronic overuse of certain movements in their respective sports. Most often this includes cyclists, climbers, and sprinters. Usually when there is a large extent of hip flexor involvement there will also be T.F.L. (tensor fascia latae), and glute involvement as well. Heavy squats would be a good example of this. Generally, people are overusing these muscles without getting the oil changed so to speak.

SSM What about stretching regularly? Will this help avoid these types of problems?

Dr. O'Brien To some extent stretching will help prevent injuries and loosen the individual up. Stretching tends to affect the mid belly of the muscle the most. As you diverge from the mid point of the muscle, the stretch decreases exponentially as you move toward the tendon. In other words, if an individual has an injury closer to the origin or insertion of a particular muscle, stretching will not likely solve their problems. Most of the time, fixing an injury will involve finding the muscle's biomechanical abberation or scar tissue and work it out. Many times there will be synergistic muscle involvement as well.

SSM What is an adhesion and how would an individual develop this in the muscle?

Dr. O'Brien An adhesion is an area of the muscle that has been injured or overstretched, causing scar tissue to be deposited as sort of a natural cement the body uses to repair itself. When this happens, the scar tissue will deposit in a random, cross-hatch pattern that does not align with parallel muscle fibers. This will decrease the stability, R.O.M. (range of motion), functionality, and strength of the muscle. People can develop adhesions by acute or repetitive training incurred injuries.

SSM What is the difference between an adhesion and myofascitis?

Dr. O'Brien An adhesion, like we stated would be a point where the muscle has been damaged and scar tissue has been deposited. Myofascitis would be a condition where the individual will experience an inflammation of the myofascia (muscle and fascial tissue).

SSM Pat, I've heard quite a bit over the past few years in athletic and weight training circles about A.R.T. (Active Release Techniques). Some of the results athletes have reported about their success with these techniques are almost unbelievable. Can you tell us a bit about these techniques and how they are used to treat training injuries and restore structural balance to the muscle?

Dr. O'Brien Active Release is a very specific treatment, originally developed by Dr. Mike Leahy, designed to address the removal of muscular adhesions. The doctor must first have a very thorough understanding of biomechanics so they know what to look for and how to approach fixing a patient. This usually takes a few years of experience to develop proficient, hands-on tactile senses in order to effectively treat a patient. These techniques would be an addition to a doctor's base of knowledge in treating and restoring structural integrity and balance to the injured muscle(s).

SSM Would A.R.T. have any similarities to the way accupressure or acupuncture works? For example, if an adhesion was causing a nerve entrapment in a muscle, removing that adhesion could dramatically increase the athlete's strength, even in movements that are involving other muscles. How would you explain this phenomenon?

Dr. O'Brien I have somewhat of a split diagnostic approach. In western medicine, I'll talk more about a nerve/muscle adhesion that affects another part of the body because it's impacting that peripheral nerve. It will affect that nerve's function by facilitating an increase or decrease in nerve conduction, as well as proprioception and many other factors that come into play. I don't know if I'd say A.R.T. affects the body like acupuncture or accupressure because these are dealing with meridians. Meridians are specific channels in the body that energy flows through and there are certain points in those pathways called acupuncture points. These points need to be addressed very specifically using a certain amount of pressure (accupressure) or with a needle (acupuncture) in a certain direction, depth, and with a specific treatment perspective in mind, however I wouldn't relate the two treatments. I have for example, performed subscapularis Active Release treatments where the individual's bench press increased 20-30lbs immediately because the injury to that muscle was destabilizing the general shoulder structure. I wouldn't draw a parallel between that and acupuncture as much as I'd say it was simply causing a major structural deficit in the shoulder.

SSM What are trigger points and how can these be used to treat injuries?

Dr. O'Brien A trigger point can be similar to an adhesion but is generally less involved. It will often times be a tight spot in the muscle that may experience inflammation but not necessarily contain scar tissue. It's basically a general term for a knot in the muscle. When you push on that knot it will affect the general tenicity of the muscle and cause it to relax.

SSM I've heard of some doctors using trigger point injections in athletes, what does that involve and why is it beneficial?

Dr. O'Brien Trigger point injections are used to break up some of the tenderness and tightness in the muscle. This is generally done with Lidocane as far as I know, which is a prescription pain killer. That isn't really my area of expertise, and a person must be an M.D. to perform this sort of thing.

SSM In a nutshell, what is the significance of maintaining the structural balance of agonist/antagonist muscles, in terms of longevity and preventing unnecessary training injuries?

Dr. O'Brien Balance is the key to productive training, functional strength, and injury prevention. Period.

SSM Is it safe to say that this is one of the more common causes of injuries that you treat? Athletes focusing on the Yang and neglecting the Yin?

Dr. O'Brien When there is structural/strength imbalances in opposing muscle groups it predisposes the individual to injury because the body cannot handle the same training loads or frequency with out eventually breaking down in some way.

SSM What is your opinion of supplements such as glucosamine, chondroitin, and MSM for speeding recovery of cartilage, ligament, and tendon related injuries? Do you prefer the HCl or sulfate form of glucosamine, or is there no significant difference?

Dr. O'Brien I've used glucosamine with hundreds of patients clinically and have experienced excellent results with it. Glucosamine HCl is the type I prefer because it has a higher ratio of glucosamine to binding salts versus the sulfate form. It works excellent for cartilaginous injuries.

SSM Can you explain a bit about how glucosamine lends itself to cartilage repair?

Dr. O'Brien It works in the formation of the ground substance (proteoglycans) as well as some of the other sulfates involved in the joint matrix. It will increase synovial fluid thickness, promote nourishment to the joint, as well as slowing some of the enzymatic processes that stimulate breakdown of the joint. Some studies have also shown (by using an electron microscope) that it does help to build the cartilage directly as well as indirectly.

SSM What are some basic preventative maintenance protocols that weight training athletes can follow to maintain long term structural balance and healthy joints?

Dr. O'Brien It would serve most peoples' best interest to have their body assessed from an analytical standpoint before starting a training program to find if there are any adhesions in the muscles, remove them, and restore balance to the body. I would also recommend developing a training program with strength coach or a trainer who is knowledgeable. This will help prevent bad habits and using poor biomechanics that will eventually lead to injury. I think more athletes need to also pay specific attention to performing exercises to stabilize the spine and functionally strengthen the low back and abdominals. Also, be sure to consistently perform movements to develop a solid strength base in the rotator cuff. This is especially true if an individual plans on lifting heavier loads to promote strength and mass gains, because the shoulders will have an greater than average demand for increased stability.

SSM Is A.R.T. something that most athletes and weight trainers should take advantage of on a regular basis as part of their program?

Dr. O'Brien I think if an athlete is serious about what they do, understand their body, and expect a lot out of it, they need to keep their edge. The way they keep that edge is through superior nutrition, proper training, and also taking care of the body. If you drive your car more than the average person you have to change your oil more frequently or things begin to break down and eventually your engine burns out altogether. Many competitive athletes I treat will visit me on a 3 to 4 week basis during their competitive season to maintain balance through biomechanical adjustment and myofascial treatment.

SSM What if a person doesn't have any readily apparent problems? Is it possible for an adhesion to form that would not necessarily cause pain or discomfort that could lead to larger problems?

Dr. O'Brien That is actually very common. Pain is ultimately most people's indication of whether or not something is wrong in the body. This is not always the most accurate indication. Often times an adhesion may simply decrease ROM (range of motion) in a particular muscle. The structural imbalance, even though it's not causing any perceived pain, may cause a more serious injury to occur when greater intensity is applied to the imbalanced muscles. For instance, if they have a decreased ROM in the low back, a more serious injury may occur when they attempt a heavy deadlift. It sounds crazy, but it happens.

SSM Well Pat, this has all been very informative and interesting. Thanks for your time. I'm sure many athletes will benefit from your wealth of injury prevention knowledge and more importantly begin to incorporate some of these basic protocols into their own programs to keep training injury free.

Be sure to check out part II of "Training Injury Free" in next month's Shapeshifter Magazine.