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Josh Heenan

@drheenan

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I develop world-class athletes & solve complex pain/neurological cases ⚡
President @advancedtherapyperformance
Clients: MLB, NFL, NBA, PGA, WLD

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I’ve been using the Wired for Performance quiz with patients for years.

And one of the most common issues I find?
Serotonin deficiency

Serotonin isn’t just about happiness, it drives mood stability, sleep, appetite, gut function, and how fast you bounce back from stress.
When it’s low, athletes spiral after one bad game. Students get irritable and can’t sleep. Adults feel down, anxious, and stuck in negative loops.

In the clinic, I see it in so many forms:
- Athletes who can’t let go of mistakes
- High performers who crave sugar and carbs every afternoon
- Teens with low mood and poor sleep who feel “off” but don’t know why
- And gut issues and pain that won’t settle down

What’s wild is how often this is dismissed as attitude, moodiness, or just a phase, when really it’s brain chemistry calling for help.

The good news?
Serotonin can be restored naturally, systematically, and without relying on quick fixes. Take the quiz and try putting some of these tips into practice to see how it positively impacts your life.

If you’re on an SSRI or other antidepressant, talk to your doctor before trying any of these tips especially 5-HTP or tryptophan. by @drheenan

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9 hours ago

I’ve been getting a ton of these posterior elbow cases this summer - for both pitchers and position players. The elbow is where the pain shows up, but usually not where the problem starts.

Liam is a HS Sr Pitcher committed to Maryland. He arrived in my office with right pec/shoulder tightness and posterior elbow discomfort.

- Pain at ball release
- Pain in the back of the elbow that travels into the triceps
- Pain reproduced at 6/10 when I pushed the elbow into full extension

I treated the right posterior shoulder and upper trap. The infraspinatus and upper trap was the primary restriction.

Treatment included:
- Fascial needling to the right infraspinatus
- Fascial needling to the right upper trapezius
- Fascial needling to the distal triceps and posterior elbow
- Fascial needling to the anterior shoulder

Why does needling a shoulder change pain at the elbow?

The posterior shoulder and the elbow sit on the same fascial and muscular chain. When the posterior shoulder is restricted the arm cannot decelerate the way it needs to. The elbow absorbs force it was never built to absorb, and ball release is the exact moment that load peaks. That is why the pain shows up at release and nowhere else in the throw.

This patients diagnosis: posterior elbow pain driven by myofascial restriction in the posterior and superior shoulder— likely both muscular and fascial.

Most athletes with this presentation get told to rest and shut down throwing. Rest drops the load for a few weeks. It does not change the restriction. The pain leaves and returns the moment volume goes back up, which in turn turns a six week problem into a two year problem. by @drheenan

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2 days ago

11-Months Post Concussion

This is a great example of why I like to utilize acupuncture for largely systemic cases. There are often so many moving parts that need to be addressed but when you zoom out and treat the underlying issues, many of the symptoms (even forgotten ones) often improve or clear on their own.

This patient never told me about the ringing in his ears. I only found out because after his treatment he texted me that it was almost completely gone.

He’s been dealing with post concussion symptoms for 11 months after a concussion and whiplash injury.

This patients diagnosis:
- Post concussion syndrome
- Cervicogenic headaches, 3 to 7 out of 10
- Visual and vestibular integration dysfunction
- Exaggerated startle response and significant anxiety

He also had brain fog, poor sleep and dizziness with a feeling of being pushed forward when he walks.

He had already tried PT with multiple providers, OT, osteopathic manipulation, chiropractic, dry needling, medication and psychotherapy. Osteopathy helped the most.

The startle response is the worst part for him. Bump the table, brush his arm or change the surface under him and his system fires like he just got hurt again. His baseline anxiety at intake was a 6 out of 10.

Treatment included:
- Acupuncture to calm the hyperarousal and settle the neck guarding
- Gentle tissue work to the neck and upper back
- VNG goggle guided our treatment

By treating a nervous system stuck on high alert, a neck that guards with every unexpected movement and a brain struggling to figure out where it is in space; we were able to calm down some of the other overactive systems including the ringing. by @drheenan

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2 days ago

I’ve been using the Wired for Performance quiz with patients for years.

And one of the most common issues I find?
Acetylcholine deficiency

Acetylcholine isn’t just about memory, it drives learning, focus, reaction time, coordination, and how your brain talks to your muscles. When it’s low, athletes struggle to pick up new skills. Students forget what they studied. Adults feel foggy, slow, and scattered. And all of these can be applicable for post concussion cases, even many years after the initial concussion.

In the clinic, I see it in so many forms:
- Athletes whose mechanics fall apart under fatigue
- High performers who lose words and lose their train of thought
- Teens who read the same page three times and retain nothing
- And slow reaction time and poor balance

What’s wild is how often this is dismissed as aging, ADHD, or just being tired, when really it’s brain chemistry calling for help.

The good news?
Acetylcholine can be restored naturally, systematically, and without relying on quick fixes. Take the quiz and try putting some of these tips into practice to see how it positively impacts your life. by @drheenan

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3 days ago

Are you wired for optimal performance?

You have done everything right… but your performance is still unpredictable and yipped up, read this.

This athlete had been battling the yips since high school.
He’s worked with psychologist.
Done cognitive therapy.
Skills training.
Sports performance work.
Red light therapy.
Meditation.
Even EFT tapping.

It all worked… for a little while.
But the symptoms always came back.

He was still struggling with:
-Anxiety
-Performance freezes
-Depression
-Sleep issues
-Focus crashes
-Chronic tension and overthinking

And it wasn’t because he wasn’t working hard.
It was because his brain wasn’t working optimally.

When we tested his neurotransmitters—dopamine, GABA, serotonin—they were all severely deficient.

This explained everything:
-Motivation flatlined
-Emotions unstable
-Vision and movement disconnected
-Nervous system stuck in overdrive

So we built a real plan:
-Cut out the inputs draining his system (nicotine, weed, caffeine)
-Loaded his brain with what it needs (targeted nutrition, natural rhythms)
-Rewired the brain-body loop with juggling and eye drills

Now, the pieces are finally coming back together.

Here’s the part that matters for you:

If you feel like your brain isn’t firing the way it used to…
If you’ve been grinding with little to show for it…
If you’re doing all the “mental work” but still stuck in a fog…

You might be missing the neurochemical piece.

I put together a free quiz to help you figure out exactly where your system stands.

Take the quiz, and I’ll also send you a free digital copy of Wired for Performance to break this all down and help you start fixing it.

No fluff at no charge, just real tools that work.

Use the linktree in my bio and you’ll see exactly what’s holding you back—and what to do next. by @drheenan

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4 days ago

RHP with Left Hip Pain and FAI

1) Evaluate the hip and vestibular system
2) Clear pain driven by neurological issues— needling the opposite arm cleared the pain.
3) Retest hip and vestibular system — both improved immensely
4) Aggressively train hip motions that have been lost from the brain preventing the movements
5) Prepare for your hip to have a deep soreness for 1-3 days but feel amazing

Why does most training and therapy skip the vestibular and nervous system in their evaluation? by @drheenan

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5 days ago

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7 days ago

Post-op Rotator Cuff Repair

@jakeobaseball came to us at about 12-weeks post-op supraspinatus surgery. He was having significant limitations with external rotation and flexion.

Every surgeons preferred progress in restoring range of motion is often a bit different, especially since each procedure can offer some uniqueness. In most cases, we want to see full passive range of motion somewhere between week 4-10. Not restoring full range during this window can create big issues down the line, especially for a thrower.

I’ve seen countless “failed” rotator cuff surgeries where the only thing that failed was the therapist not restoring the full range in an ample amount of time. With those cases we have to be cautious but very aggressive to restore the range. I’ve seen cases where we are 10-15 years post-op and one good aggressive treatment restores the range.

I’ll be sharing more videos from Jake’s sessions, but what I can tell you is that he had lots of range in the tank that his nervous system was trying to protect. Jake works his ass off and is reaping the rewards of the range he has earned.

If you look closely at the first two pictures and first video on the left, you’ll see Jake getting lots of flexion from his rib cage vs from his scap and humerus. These are normal compensation and at the initial stages of gaining flexion, I’ll allow for lots of cheating. One the final image and video to the right, you’ll see the shoulder starts to really move well and minimal compensation was needed through the neck to get his flexion.

Follow along to see how we progressed range of motion and integrate training.

Questions? Ask 👇 by @drheenan

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8 days ago

Two years of shoulder pain after a car accident and concussion. Treatment to the shoulder didn’t help his pain.

He struggles with left single leg stance, multitasking and central processing. Eyes closed on the force plates, his left leg sway increased 11.2x. He’s getting a TON of his stability from vision, not from his vestibular system. These prediction errors make it very hard for the body to move well especially at high velocities.

I like this drill for John on the Sanddune as it is constantly shifting so his foot, ankle and hip have to keep making small adjustments and better predict where he is in time and space.

Adding a ball to toss and catch forces upper and lower body to dynamically predict movements and adds a multitasks complexity that he has trouble with. And as you will see, If the lower body doesn’t get the message in time he loses his balance.

On top of that he has to track the ball with his eyes while keeping his head steady, know where his body is in space and keep the whole thing organized without thinking about each piece.

High intent throwing asks for the same thing at a much faster speed. His body has to anticipate the stride, stabilize the head and eyes, organize the trunk and transfer force through the ground into the shoulder, elbow and hand. When that prediction is off the compensations show up farther down the chain, which is often where we see pain and decreased throwing velocity.

That brings us back to his shoulder pain, which is now gone. His underlying issue wasn’t rooted in shoulder dysfunction, it was root in how his brain perceived pain and organized movement.

Questions? Happy to answer below. by @drheenan

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9 days ago

I’ve been using the Wired for Performance quiz with patients for years.

And one of the most common issues I find?
GABA deficiency

GABA isn’t just about relaxation or sleep, it controls calm, focus under pressure, muscle tension, sleep quality, and recovery.
When it’s low, athletes tighten up under pressure. Students can’t shut their brain off. Adults feel wired, tense, and overwhelmed.

In the clinic, I see it in so many forms:
- Athletes who look great in practice and tighten up in games
- High performers who can’t turn off at night
- Teens with anxiety and racing thoughts who feel “off” but don’t know why
- And tension and pain across the whole body

What’s wild is how often this is dismissed as stress, nerves, or a mental toughness problem, when really it’s brain chemistry calling for help.

The good news?
GABA can be restored naturally, systematically, and without relying on alcohol or quick fixes. Take the quiz and try putting some of these tips into practice to see how it positively impacts your life. by @drheenan

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9 days ago

Using the Eyes to Validate Training and Rehab

Allie has had dystonia neck spasms at end range for the last 16-years.

Video 1: Eye testing before initial treatment and 7-months later.

You’ll see in the initial evaluation erratic eye movements when I ask her to look straight.

Brain areas potentially impacted:

Basal Ganglia: The basal ganglia is involved in controlling and modulating movement. Abnormalities in the basal ganglia, which are often implicated in dystonia, can disrupt the normal control of eye movements, leading to involuntary and erratic saccades.
Cerebellar: The cerebellum plays a crucial role in coordinating eye movements and maintaining gaze stability. Dysfunction in the cerebellum can lead to impaired smooth pursuit, saccadic intrusions, and nystagmus.
Vestibular System: The vestibular system is integral to maintaining stable gaze during head movements. Dysfunction here can lead to abnormal vestibulo-ocular reflex (VOR), causing erratic eye movements.
Brainstem: The brainstem contains several nuclei that are crucial for eye movement control, including the oculomotor, trochlear, and abducens nuclei. Dysfunction in these areas can lead to a loss of coordinated eye movements.
Cortical: The frontal eye fields in the cortex are responsible for voluntary eye movements, including saccades. Dysfunction in this area can lead to poor control over voluntary gaze direction.

We know that with dystonia cases, there is often a large basal ganglia component. I like that the eyes being more stable, understanding where straight is and dystonia symptoms being absent we have addressed the root of her issues.

Video 2: Day 1 pre-treatment dystonia

Video 3: Day 1 post-treatment no dystonia
(Full treatment about 50 posts back)

Video 4: Treatment 90+ days after her inital treatment
(5x speed)

She has a pretty significant right shoulder/scap contractions but no pain or discomfort.

Video 5: Treatment 90+ days after her inital treatment

Big smile. No dystonia. Full neck range of motion. No Botox.

Final notes in the comments. by @drheenan

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10 days ago

MiLB RHP came in with symptoms that were confusing, persistent, and frustratingly unexplained for years but had been creeping up for months.

He was dealing with:
🧠 His mind racing every time he made a bad throw
😨 His body shutting down, like it was scared to throw the ball
⚾ Not being able to play catch without stress
💓 Rapid heartbeat and overthinking
🤢 GI issues and inconsistent bowel movements
🚫 Constipation for 2 to 3 days at a time
🌙 Weird nightmares, violent or sad dreams

He'd already seen many therapist and mental coaches in his org and outside of his org.

None of it was seen to be connected. The throwing problem looked mental. The gut issues looked digestive. The nightmares looked psychological. But no one could give him a real answer.

When I ran eye screening we found clear signs of neurological dysregulation including:
👁️ Repeated eye convergence and divergence
🔎 Pupil instability (hippus, often normal on its own but meaningful inside this pattern)
🎯 Brainstem and autonomic nervous system issues disrupting focus, target locking, and hand-eye coordination

That pattern along with his wired for performance evaluation pointed me toward one driver in particular: acetylcholine depletion. Acetylcholine runs the parasympathetic nervous system, the system behind relaxation and calm. When it is low, the body can struggle to balance fight or flight with rest and digest, and anxiety climbs. Fine motor control and focus fall apart, and throwing consistency falls apart with them.

That same autonomic imbalance may explain the erratic bowel movements and the frequent nightmares.

We did 3 sessions over the course of a week. Each session we re-evaluated his nervous system and adjusted the acupuncture and neurological treatment based on that day's presentation.

A lot of people look at a case like this and say he just needs mental skills training. Sure, we could all use more mental skills work, but you are not going to mind over matter a dysfunctional nervous system.

Look at his texts to see how he responded after those three sessions. by @drheenan

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11 days ago