Client Background-
“I’m the type of person that when someone asks, ‘How many pull-ups can you do?’, my answer is always, ‘One more than you, if you go first! At least, that was the old me, and I’m hoping you can help me get back to that.” –Kelly Dagger
Why Chain Effect?
Kelly Dagger found Chain Effect following an explant and pectoral reattachment surgery after years-long complications from a reconstruction surgery after a double mastectomy.
When her father passed away from pancreatic cancer, Kelly did genetic testing, finding a mutation to her BRCA1 gene, which is supposed to protect you from cancer. Pathogenic mutations to the gene increase the risk of certain types of cancers, including breast, ovarian, and pancreatic cancer. Kelly made the decision to undergo a prophylactic double mastectomy with implant reconstruction. This was the beginning of a downhill slide into what she later learned was breast implant illness. Kelly eventually learned that her implants had been recalled and were making her sick, despite the run around and gaslighting from several doctors who dismissed her symptoms or blamed them on stress and hormones.
“Not only could I not exercise like I used to, I could barely drive a car even to run a quick errand due to excruciating pain in my ribs and pelvis. I laid in bed during my brother’s wedding rehearsal. It was heartbreaking.”
Kelly is a federal court trial and appellate lawyer who devotes all her energy to finding ways to win cases against the odds. She is a go-getter, so for her to be laid up in bed, struggling to work and unable to enjoy the vigor of her early 30s, was an unacceptable situation. Finally, she found an MD who took her complaints seriously and she decided to have an “explant” procedure (removal of breast implants) in hopes she could get her vitality back.
The Chain Effect-
On her first day at Chain Effect, Kelly was four months out from her explant and pectoral reattachment surgery. During her history, we also discussed that she had never fully recovered from a hip labrum repair surgery in 2019. She had persistent pain in the anterior portion of her right hip and, in addition, she just felt too weak and unstable for any type of intense activity. Part of the beauty of being out of network with insurance is that we are able to treat multiple body regions in the same session. Systemically, she was already feeling better since “she was no longer being steadily poisoned” by the implants.
In tackling her pectoral reattachment, Kelly had a lot of restriction in the anterior aspect of the shoulder. This restriction limited her external rotation and was contributing to rounding or protraction in the shoulders.
This rounding can be problematic because it puts the ball and socket part of the shoulder in a bad resting and active position which can cause impingement of the rotator cuff. A lot of people perform overhead lifts from this faulty position and it is always a recipe for pain and injured soft tissue eventually.
Using a combination of dry needling and instrument-assisted myofascial work, we were able to loosen up that tissue and improve her range of motion within just a couple of sessions. From there we began with a scapular strengthening program, including horizontal and vertical pulls, to “hit save on the hard drive” or hard code her neuromuscular system to accept her new postural and range of motion changes. This is often the missing piece in traditional physical therapy.
Due to time constraints, many clinics will have the physical therapists perform the manual work, but then pass off the critical exercise element to unskilled technicians and aides who don’t have the training to identify and correct the nuances of improper form.
Since Kelly had once prided herself on being able to do as many as 15 consecutive pull-ups, we made pull-ups an early goal, starting with assisted pull-ups using bands and the pull-up assist machine, before progressing to full body weight, and then adding weighted plates to a belt. Performing sets of 4 to 7 reps with progressively heavier loads would prioritize strength building over muscle growth, creating a strong, toned but lean aesthetic.
Continued-
Regarding Kelly’s right hip labrum repair, it is very common for patients following this surgery to feel continued complications. This is primarily due to imbalances between the anterior chain and posterior chain and the fact that traditional physical therapy settings under-load patients and thus fail to build “real strength” which is necessary for proper joint mechanics. Our lifestyle of sitting in chairs at work, in car seats while driving, and on the couch at night creates tightness in the front of our bodies (hip flexors, quads, tensor fascia latae, etc.) and weakens our posterior musculature (glutes, hamstrings).
In the physical therapy world we call this lower crossed syndrome, a crossed pattern of tightness and weakness. In Kelly’s case, and so commonly, this leads to impingement in the front of the hip between the rim of the socket on the pelvis and the head of the femur. This impingement, if not addressed, can actually cause further complication to the labral tissue (including degenerative fraying and tearing).
The treatment for this condition is to identify tight and limiting tissue in the anterior portion of the hip and use dry needling, myofascial work, and joint mobilizations to loosen up tightness in the ligamentous hip capsule. This helps to better position the femoral head slightly back in the socket. Once we gain this position again we start to hard code it by performing deadlifts and other hip dominant exercises to strengthen the glutes and hamstrings.
Not only does this have positive impacts on posture, pelvic position, and improving hip mechanics, but hip dominant programming is also critical for return to sport activities and feeling explosive.
To measure Kelly’s progress, we used a system called Output which analyzes the velocity of the barbell, or in this case the hex bar, to calculate the power the athlete is producing during the lift. We like to use this with all of our clients to establish baseline strength, vertical leap, explosive power, and stability, so that we can track progress in real time.
Success-
When Kelly, who is 5 ‘3 and weighs 115 lbs, started at Chain Effect, she was deadlifting a 40 lb kettlebell and producing about 96 watts of power. After just a month she progressed to 135 lbs and was producing 278 watts of power.
Fast forward a few more weeks and while she was lifting more weight at this time, when we looked at her power at 135 lbs, we saw that it had increased to 359 watts. This is one of the benefits of velocity-based or power-based training: we don’t always have to increase the weight to see gains session to session. Increases in bar speed and therefore power can show progress and beat obstacles without having to add more weight to the bar.
Since coming to Chain Effect, Kelly has also been able to return to one of her old passions of playing tennis (maybe even a little too much at times). She can easily knock out sets of 7 pull-ups, is performing full gym-based strength workouts multiple times per week, and maybe most importantly, was able to enjoy every aspect of her sister’s wedding as the maid of honor.
Seeing Kelly thriving now, it’s hard for us to imagine the person who was dealing with chronic illness and pain at the onset of her journey with us.
“I have my life back and with it a new appreciation for my body.”
We can’t wait to see the new personal records and life achievements that await her, and, at Chain Effect, we will be there to support her in any way we can.