Performance Sport Care - Douglas F. Cancel, DC

09/16/2026

RED-S is usually math, not motivation.

The graphic makes a straightforward point: Relative Energy Deficiency in Sport is rarely driven by a desire to be lean. Training increases. Meals stay the same. The shortfall shows up later as stalled performance, lingering soreness, frequent illness, or a second stress injury.

In a screening cohort of 464 adolescent female athletes, 80% of those affected by low energy availability had no signs of disordered eating and no intention to lose weight — yet still demonstrated lower bone density than their peers.

Common questions:
"Does this only apply to athletes who are restricting?" → No. Most cases are not intentional. Training load simply rose while food intake remained unchanged.
"If the athlete is still performing well, isn't fueling adequate?" → No. Good performance does not guarantee enough residual energy for bone remodeling and tissue repair.

At Performance Sport Care in Walnut Creek, nutritional counseling is part of the clinical evaluation when an injury will not resolve. We examine training-load changes, meal timing, carbohydrate availability, sleep, and injury history so the body has energy left to rebuild.

Read the full post: performancesportcare.com/red-s-relative-energy-deficiency-in-sport/

If this cycle feels familiar, schedule an evaluation.

09/15/2026

Can you actually reduce your risk of an ACL injury?
You can't eliminate the risk entirely, but decades of research show that structured training can reduce it substantially.
Effective ACL prevention goes beyond stretching or simply making the legs stronger. It combines better landing and cutting mechanics, plyometric training, posterior-chain strength, balance, and neuromuscular control.
That's particularly important for athletes who participate in cutting and pivoting sports, and for anyone with a previous ACL injury, one of the strongest predictors of another knee injury.
The infographic highlights some of the most useful findings from the research.
Know your risk. Train what matters.
Read the full evidence-based guide in the comments below.
If you'd like an individualized assessment of your movement, strength, and knee control, contact Performance Sport Care in Walnut Creek to schedule an evaluation.

09/11/2026

For those that have been asking, this is our approach to hip pain.

Non-surgical hip pain care in Walnut Creek for athletes and active adults. Dr. Douglas Cancel brings more than 40 years of sports chiropractic experience to a professional sports model of care: precise diagnosis, hands-on treatment, and supervised strength rehabilitation.

09/10/2026

If you've spent much time in a CrossFit gym, the three areas at the top of this infographic probably won't surprise you.

Shoulder. Low back. Knee.

What's more interesting is what the research says about who is more likely to get injured.

One of the clearest risk factors is having been injured before. Research has also found lower injury rates among athletes who train with coaching compared with those who train without it.

That changes how we think about returning to CrossFit after an injury.

Being able to get through everyday life without pain doesn't necessarily mean your shoulder is ready for high-volume overhead work. It doesn't mean your back is ready to pull from the floor under fatigue. And it doesn't mean your knee is ready for the volume and intensity you were handling before the injury.

That gap between feeling better and being prepared to train is where rehabilitation matters.

At Performance Sport Care, we work to identify what's driving the problem, restore the strength and capacity that have been lost, and progressively prepare athletes for the actual demands of their training.

We put together the infographic above from the CrossFit injury literature, and the full article takes a deeper look at what the research shows.

If a shoulder, back, or knee problem keeps returning every time you ramp training back up, schedule an evaluation. We'll help you figure out why.

09/08/2026

Ask who gets RED-S and most people will say female endurance athletes. The pooled data does not agree.

RED-S stands for Relative Energy Deficiency in Sport. It means not eating enough to cover what training costs, so the body draws against its own tissues for repair and growth.

Across 6,118 athletes in 46 studies, 44.2% of female athletes met the criteria. Among male athletes it was 49.4%.

Male athletes are screened for it far less, and there is a reason. The standard screening questionnaire cannot be used in men — about half its questions ask about menstrual periods. In female athletes there is an obvious early signal. In male athletes there is not, so it tends to be found late and often through bone.

In one group of 50 competitive male cyclists, 28% were not eating enough for their training and 44% had low bone density in the lower spine. These were trained, competitive athletes.

Awareness is the other half of the problem. In a separate group of 260 elite athletes, fewer than 10% had heard of the condition at all.

These are averages pooled across many sports, so individual teams and athletes will differ.

If you coach or parent a male athlete, this is worth two minutes.

09/03/2026

Jumper's knee usually is not bad luck. It appears when training climbs faster than the tendon can build up to handle it.

A tendon adapts, but slowly. Training volume can double in a week; capacity cannot. Where those two lines cross is where the pain begins.

Here is the part that catches almost everyone. Pain and healing run on different clocks. Pain quiets down first, often within a few weeks. The tendon needs considerably longer to recover its strength. Stopping when it stops hurting is the most common reason this returns.

That is not a discipline problem. Pain is the only signal you can actually feel, and it goes quiet while the work is still unfinished.

What sets it off: a sudden jump in practice or jump volume, going straight back to full training after time off, heavy squats stacked on high jump volume, limited ankle flexibility, and not enough recovery between sessions.

What lowers the odds: build jump volume in steps rather than leaps, keep track of how many jumps are in a week, work on ankle flexibility, practise how you land, and keep going after the pain stops.

Coming back too fast is the most common reason it returns. Capacity has to be rebuilt before the load goes back on.

09/01/2026

If the same injury keeps coming back, you may be fighting with one hand tied behind your back.

Your body uses food for two jobs. Fuel for training is the loud one. Repair and growth — bone, tendon, hormones, immune function — is the quiet one.

When training demand rises and eating stays the same, the loud job wins. The body meets the demand in front of it and draws against its own tissues for the rest. Repair gets cut first, and nothing about it appears on a standard exam. Which is why care aimed at the sore spot can work and still not hold.

Across 6,118 athletes in 46 studies, nearly 45% were not eating enough for their training load. Most were not dieting. Training demand rose. Eating stayed the same. It is arithmetic, not poor motivation.

Not every recurring injury is this — load errors and incomplete rehabilitation are more common. But it belongs on the list.

If someone you know has been treated for the same injury more than once, share this with them.

08/28/2026

You rested it. You iced it. The brace helped for about two weeks. Then you walked 36 holes over a weekend and the pain came right back.

Rest can quiet irritated tissue. It does not change why that tissue was taking more load than it could handle. In golf, the place that hurts is not always the place that started the overload.

Every swing sends force from the ground through the hips and trunk before it reaches the club. When one link cannot rotate or stabilize enough, another link takes the extra work. A common pattern: limited rotation in the lead hip shifts demand onto the lumbar spine, which is built to bend far more than it is built to twist.

Walnut Creek golfers load that chain in different ways: walking Boundary Oak twice a week, or stacking shorter rounds at Diablo Hills and Rossmoor.

New article on why the same golf injury keeps returning, and what actually has to change:

You rested it. You iced it. You bought the brace, and it helped for about two weeks. Then the pain came right back.