Performance Sport Care - Douglas F. Cancel, DC

09/24/2026

When a teenage gymnast, cheerleader, or other athlete keeps having low back pain during backbends, tumbling, walkovers, or similar skills, it can be easy to write it off as muscle soreness. But recurring pain deserves a closer look.

One condition that should be considered is spondylolysis, a bone stress injury involving a small bridge of bone in the spine called the pars interarticularis. It often develops gradually from repeated backward bending, rotation, and mechanical stress rather than from one obvious fall or bad landing.

Another important point for parents: a normal X-ray does not always rule out an early bone stress injury. An early stress reaction may be detectable on MRI before a fracture line is visible on a plain X-ray.

Dr. Douglas Cancel recommends a thorough evaluation when an adolescent athlete’s low back pain with backward bending persists beyond two weeks, and sooner if the pain changes how the athlete moves or interferes with practice or daily life.

At Performance Sport Care in Walnut Creek, evaluation looks at the athlete’s symptoms, movement, strength, neurological function, training demands, and prior imaging so the next step is based on the full clinical picture. When appropriate, treatment and supervised strength rehabilitation are planned together with a gradual return to sport in mind.

We published a new article for parents, athletes, and coaches explaining what to watch for, why imaging can be more nuanced than it seems, and how rehabilitation may fit into recovery.

Read it here:
https://performancesportcare.com/persistent-low-back-pain-teenage-athletes-walnut-creek/

09/23/2026

If you know a teenage athlete or cheerleader with lower back pain that keeps coming back, you might want to pass this article on to them or their parent.

Persistent back pain in a teenage athlete may signal spondylolysis. Dr. Cancel in Walnut Creek combines evaluation, conservative care, and strength rehab.

09/20/2026

What also makes us different is that we are one of the very few health care providers that say upfront what we can do, how we can do it and what our limitations are so that prospective patient's can make their best choice.

Common questions about sports chiropractic care, treatment plans, insurance, and scheduling at Performance Sport Care in Walnut Creek, CA.

09/20/2026

Our approach is what makes us different.

Evaluation first. Every new patient receives a written Clinical Evaluation Report within 24 hours, and rehabilitation happens on site under supervision in Walnut Creek.

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.