Here at Athletes’ Potential, we’ve had the opportunity to work one-on-one for an hour with over 1,200 people. We’ve worked with people with all kinds of different training backgrounds and by doing so we started noticing some trends. Common weaknesses and movement deficiencies that were not only creating injuries, but hindering performance and preventing people from living an active lifestyle.
So our team of doctors and strength coaches set out to create a solution to this problem and this article highlights that solution as well as some of the problems we kept seeing that were creating injuries, decreasing performance, and preventing people from living a healthy lifestyle.
Problem #1: Lack of Training Variability
Whether your training modality is CrossFit, running, powerlifting, olympic lifting, triathlons, dancing, or any of the other infinite training options out there, there are biases in your programming that cause you to perform some movements all the time and others hardly at all. If we never leave our comfort zone with our training, there’s going to be simple movements that we miss, which overtime can lead to aches and pains and even injury.
Let’s take CrossFit for example. Now obviously we love CrossFit at Athletes’ Potential, all of our physiotherapists are CrossFit coaches themselves, but even for a training program who boasts they “employ a constantly varied approach to training, functional movements, and loads” there are still biases. Tell me...when’s the last time you gripped the bar with a supinated grip (your palms turned up) during a workout? The answer is almost never. Deadlifts, cleans, snatches, pull-ups, toes-to-bar, jerks, dips, rows, etc...all these movements have you in a pronated (palms tuned down) grip. This creates a huge movement bias, and is one of the main reasons I see patients with elbow pain in the clinic.
Try this: Next time you’re in the gym hang on a pull-up bar with your palms down and then with your palms up. You’ll be shocked at how different this feels on your wrists, elbows, and shoulders.
Problem #2: Training Volume
This graph dramatically oversimplifies the concept of training volume, but essentially training volume is based on two primary variables: load and frequency. As you can see, there is a sweet spot you want to hit called the “Zone of Supraphysiological Overload.” This is where the magic happens, meaning it’s where you get stronger, leaner, healthier, more resilient. However, more often than not I’m seeing people in the red highlighted areas, especially in the zone of structural failure. This is essentially where you get an overuse injury such as biceps tendinopathy, nagging low back pain, or vague knee pain. However, doing nothing is just as bad as doing too much. That’s even true in the medical community, which is why if your healthcare provider is telling your to just rest for a weeks as a way to treat your low back pain, you need to give us a call.
Check this out though, one of the best ways to ensure that your not overloading your muscles and joints at a frequency that is too high is training variability (see above). Training volume and training variability go hand in hand and varying up your training is a great way to prevent tissue failure.
Problem #3: Poor Mobility
What that graph on training volume above failed to mention, is that if you’re moving with poor mobility, your going to fly through those zones until you hit tissue failure. This can’t be overstated. If you’re only deadlifting once a week but your deadlift looks like crap because you lack the requisite hip mobility to pull weight from the floor, you’re tissues will fail faster and you will eventually have an injury.
Looking at people's programming, almost nobody is spending an adequate amount of time focused on improving the mobility. Which is a problem. Being able to move through a full range of motion is crucial for not just training, but for being able to get through life’s demands. Think of your body as a Ferrari, lifting with poor mechanics due to limited mobility is like driving that Ferrari with low motor oil and with the hand brake hand. Sure it’ll still drive, but you’re leaving performance on the table, and eventually it’s going to break down.
Training variability, volume, and mobility are all related and after countlessly having the same conversation with the people we see in the clinic we decided enough was enough. We decided to create a solution that would benefit damn near everyone, and that solution is the Athletes’ Potential Pain-Free Training Plan. Whether your goal is to prevent injuries at CrossFit, improve your running times, or simply become a healthier version of yourself; we’ve created a unique program that requires minimal equipment and minimal time help you reach your goals.
There is simply nothing on the market like this program. It has been developed from the ground up by new-age healthcare professionals who blend the fields of rehabilitation and human performance and we couldn’t be more excited to offer this service to you.
You only get one body, so if you’re ready to stop beating it up, click the link above or fill out a contact request form. We’d love to answer any of your questions. Until then, happy training!
The CrossFit Open is finally here. After all of the countless hours spent in the gym perfecting your craft, it’s time to see just how far you’ve come in year’s time. I’ve got some good news for you too, simply by signing up for the CrossFit Open you’ve set yourself apart from your peers as only approximately 20% of CrossFit members worldwide have the moxie to put their money where their mouth is and actually sign up for the Open.
Now that you’re here though and you’ve made it through that miserable 18.1 workout, it’s time to grind through another 4 weeks designed to push you to your absolute limit. As daunting as that sounds, there’s a secret out there that elite athletes figured out a long time ago, yet it still gets ignored by most people in the gym. Recovery.
No matter how much you train, most of your hours during the day will be spent recovering. Recovery is undoubtedly the most overlooked aspect of training. Tell me if this sounds like something you (or let’s just say somebody you know). You rush from work to get to the gym, get there barely in time to hear your coach going over the day’s workout, then after blasting through a max level workout you rack your weight, grab your keys and head out to your car to get to the responsibilities waiting for you at home. Rinse and repeat throughout the week.
I see this all the time in the gym, and quite honestly I’d be lying to you if I said I haven’t had this happen to me as well. The issue with this all-to-common scenario though is that when you do this, you are skipping out on arguably the most important aspect of any training program. If you are not recovering appropriately then you’re leaving performance on the table and setting yourself up for injury.
Elite athletes and their trainers know exactly how important it is to recover appropriately, they spend endless resources monitoring their athletes’ bodies vital signs and other physiological functions in order to objectively determine when they are ready to go full throttle. However, for those of us who don’t have the ability to measure things like heart rate variability 24/7, there are a few things you can do to optimize the speed and effectiveness of your recovery:
1. Post Workout Cool-Down: Immediately following a workout do some form of very light activity (ex: walking, light row, light bike, etc) and then take another 10-15 minutes to work on soft tissue and joint mobility. Doing these things will not only decrease the soreness you experience after workouts, but it will allow your body’s heart rate, blood pressure, and nervous system to return to baseline levels. All of which are crucial to optimizing recovery. While you should choose which soft tissue and joint mobilizations you should do based on the movements performed in the WOD, some of my favorites are listed below. Perform each drill for 2 minutes.
2. Get Appropriate Sleep: I cannot overstate how important it is to get appropriate sleep. You should be getting approximately 7-9 hours of sleep per night, and during the open you need to towards the higher end of that range. To find out more information on how to optimize your sleep, check out our previous blog article "Top Two Ways To Improve Your Sleep."
3. Eat the Right Food: As the saying goes, “food is fuel for your body” and you want to be giving yourself some jet fuel to optimize your CrossFit Open performance. What this means is you need to be eating the right foods in the right proportions to restore your body’s energy levels and to give it the needed energy it needs to repair and recover. You can find more info on how to do that by checking out out previous blog, "Which Diet is Right For Me."
4. Staying Hydrated: You should be drinking water constantly to maintain good muscle and vascular health. The general recommendations say to drink 8 eight ounce glasses of water a day. However there are plenty more variables that go into determining the appropriate amount of water for you to drink. Click here to go to a calculator that will give you a better idea of how much water you need to stay appropriately hydrated throughout the Open.
So, if you want to get your best possible score in this year’s Open AND decrease your risk of injury then you need to make recovery a priority. A lot of things factor into recovery periods that are outside of your control (age, genetics, training experience, etc.), but by doing what we covered in this article you will be setting yourself up for success by recovering like a pro and getting the most out of your workouts.
Thanks for reading,
Sprinting, rapid change in directions, lateral agility, precision footwork, and even the low profile cleats, soccer is a sport that requires an incredible about of ankle strength and stability. It’s no wonder the injury rate in soccer is so high. In fact, studies have shown that more injuries have been recorded in soccer than in volleyball, basketball, rugby, boxing, and swimming, and to no surprise, the majority of soccer injuries at at the lower extremity. In order to prevent injury and boost performance, it’s crucial that you focus on improving your ankle strength and stability.
Before we dive too deep into improving performance and recovering from injury, let's quickly take a look at the anatomy of the ankle.
The outside (lateral) component of your ankle is comprised of both dynamic (muscles) and static (ligaments) stabilizers, which are designed to keep your ankle from rolling.
Now these names and long and technical and it’s not really all the important to know what there names are, but what is important is knowing that these structures all work synergistically to keep your ankle from rolling. That means that if you’re not targeting both systems (dynamic and static stabilizers) in your programming, you are setting yourself up for increased risk of injury.
In order to best set yourself up to prevent ankle injuries, you need to focus on not just ankle strengthening exercises, but proprioception as well. Proprioception simply means your joints awareness of where it’s at in space and this predominately comes from mechanoreceptors found in the three ligaments we mentioned earlier. Below are three drills that are fantastic at improving ankle proprioception.
Half Kneeling Balance Drill: Must be able to maintain balance for 60 seconds. Progress by adding weight to one side, being on foam surface, or by closing your eyes.
Clock Balance Drill: Complete three full rotations, both clockwise and counterclockwise.
Single Leg Med Ball Toss: To improve lateral stability. Complete 30 seconds of tosses with focus on high velocity.
Now as we mentioned earlier, your static stabilizers work synergistically with with your dynamic stabilizers and are equally important to focus . This is where ankle strengthening comes into the picture. Below are three great drills to strengthen your ankles.
Banded Side Step Up: Complete 3-4 rounds of 30 seconds in each direction. The key is to keep the band at the bell of your feet.
Single Leg Jump Rope: Should be able to perform for 60 seconds and without a significant difference in difficulty side-to-side.
Single Leg Volleys
Thanks for reading,
Pain on the outside of the elbow is classically called “tennis elbow” or tendinitis. Although, people who don’t play tennis can also have this pain from grip-heavy or repetitive activity. There are also many structures that can cause this same pain, outside of the usual tendinitis.
Tendinitis is thought to be caused by increased inflammation due repetitive stress in the area and micro-tears to the muscle. It is acute, meaning it just happened. However, many folks that we see have had symptoms for months (sometimes years!!) and so the process is different and chronic. We call this tendinosis. There is no longer acute inflammation or swelling, rather long term changes to the tissues in that area from improper healing and continuous repetitive trauma.
The area that is irritated to cause the pain at the outside of the elbow is called the extensor tendon. That is, the common tendon where all of the smaller forearm muscles that extend the wrist, join at the elbow.
Often times, players who are playing frequently throughout the week without proper mobility and recovery plans will present with this issue. Over-gripping the racket is also another major cause.
If the muscles and therefore the tendon or irritated, a great place to start for self-care would be to perform the forearm release (seen below).
Doing this for two minutes, 1-2x/day, can have a positive impact on the pain you feel.
So while many tennis players have pain at their elbow, only a fraction will actually have “tendinitis”.
Another tissue that is often the culprit is the nervous tissue. Nerves course throughout our entire body for muscle function, sensation, etc. Irritation of the nerve, from repetitive activities or rubbing against another structure can send pain signals to the same area. However, treating the muscle in this case will not clear up the symptoms.
The major nerve that runs by the outside of the elbow is called the radial nerve. Muscles nearby are commonly overused in tennis and can be the cause of the symptoms. Irritation of this nerve can also begin at the neck, but that is a discussion for another time!
I often see players who are changing their grip or adding more top spin to their balls tend to have more issues with nerve irritation.
The best way to address the radial nerve irritation is a radial nerve glide (see video below). Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation!
Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation!
While both of these strategies above are a great way to decrease your pain, the best way to keep it from happening again is to address the shoulder. Shoulder weakness changes how your arm (elbow and wrist) move through space. With tennis players, overhead strokes and serving can be particularly irritating if proper shoulder position, strength and control are not achieved.
Does your back look like this? Notice how the inside edges of her shoulder blade are prominent? Not ideal. That demonstrates weakness in muscles that are essential for overhead movement.
You can begin to address this weakness and shoulder position with a simple and effective exercise called the single arm punch out. It strengthens a muscle called the serratus anterior to help normalize scapular position. Try 2 sets of 15 reps per side, 3x/week. This is a great warm up on the court or at the gym!
Thanks for reading,
This month, we focused our blogs on the pillars of health that we cover with all patients—sleep, nutrition and stress. All of these play a major role in how you feel, how your body functions and the pain you may feel.
Our society is riddled with stress due to packed schedules, short attention spans and growing involvement of technology. It may seem simple, do less and stress less. But for many, there doesn’t seem to be TIME to do LESS.
When it comes to stress, it manifests in 2 major ways: MIND and BODY
Mind(n)- the element, part, substance,or process that reasons, thinks, feels, wills, perceives, judges, etc.
The mind is a powerful thing- particularly when it comes to how your body feels, reacts, copes and heals. It is how we process the world around us. The environment in which our mind is processing will set us up for stress and anxiety or relaxation and control. When we are constantly in a stressed mindset, our nervous system ramps up the epinephrine. This is a hormone that elevates heart rate and blood pressure to enhance our awareness and prepare for an attack. You've probably heard of fight-or-flight. This is necessary for survival, but the problem is that every day we have this chronic increase in epinephrine due to stressful lives. Our bodies are staying in "fight or flight" mode for hours each day, even though we are simply sitting at desks or working a relatively low risk job. This leads to chronic fatigue, decrease immunity and various health issues.
What can you do to mitigate the effects?
For some, just deciding to put the time aside- in the morning, after work, etc- is enough for them to incorporate this in their day. Others might need a reminder or piece of accountability. Something that I suggest, at least to help you get started, is an app like Headspace. It gives you 10 minutes each day of guided meditation/relaxation. I learned that meditation & quiet time is not about just having a blank mind or taking a quick snooze, rather directing your mind to a different place, away from stress.
Try it for yourself. It might not sound like something you would enjoy or buy into, but you may be pleasantly surprised. I was!
Body (n)- the organized, physical substance of a human.
The body is what we, as physical therapists, are trained to treat and manage. However, the tissue- muscles, bones, ligaments, tendons- are all directed and supplied by the nerves. What makes this difficult, is that healing of the tissue can be slowed by a heightened neurological system. That is, chronic stress leading to poor immunity, heightened fight-or-flight hormones (epinephrine and cortisol), poor diet choices due to the stress, lack of sleep again due to stress...... Do you see how this turns into a vicious cycle or sickness, weight gain and general un-wellness?
The easiest way to stop this in its tracks is to address stress immediately. We can mobilize, offer corrective exercises, dry needle, cup, manipulation, etc endlessly, but if we don't address the state of their neurological system, then we are doing this person a disservice. My two favorite drills for this will address tissues but also has an effect on relaxing the neurological system.
The diaphragm has a close relationship to the nervous system; breathing deeply can stimulate your vagus nerve. The vagus nerve functions to trigger the “rest and digest” hormones of the body- a.k.a the opposite of “fight or flight”. This will help keep the heart rate constant and controlled.
Don’t I breathe all day? What’s different?
We often take shallow breaths throughout the day, which also falls in line with “fight or flight”. It’s not often that folks stop and take a few deep breaths! Try these out and see how it feels:
All you need for this is a wall that you can put your feet on!
For this, we like to use a soft inflatable ball. The one Danny uses in the video is from The Roll Model, or go to Target and buy a $2 kids ball with Elsa or Spiderman on it!
Stress directly affects the results that you will see in the gym, sport, health, wellness, happiness, and so on. If you don’t have time every day for an hour workout, at least take about 10 minutes to breathe deeply and clear your mind. You will see a world of difference!
Thanks for reading,
First of all, I kind of hate the word “diet.” It's often associated with a rigid way of eating for a specific time frame and usually involves giving up foods you love. Or at least that’s what most people think they have to do when they go on a diet, i.e. lose weight. And yes, eliminating certain foods may be beneficial to some people for specific health reasons, which could impact their weight loss. However, most people can dramatically change their body composition, improve their athletic performance, and feel better overall when they make simple, realistic changes by adopting healthier lifelong eating habits.
Having said all of that, do I think that tweaking what you eat to reach certain goals is a bad thing? Of course not. In fact, it’s a great skill to have. When you listen to your body and figure out how you respond to certain foods, and especially how to time your meals properly to fuel your workouts, that’s where the magic happens. For example, I have figured out that I don’t do well following a strict Whole 30/Paleo style of eating. It leaves me feeling sluggish and hangry and my gym performance suffers. This girl needs her oatmeal! Plus, I don’t feel bad when I add in a little wheat or dairy. I’d say 90-ish percent of what I eat does fall into the Whole 30/Paleo category, and I usually opt for gluten free and low sugar options, but I allow myself to add in things like cereal, yogurt, and even the occasional donut. Admittedly, sometimes my definition of “occasional” may come into question, but you gotta live your life. And if I’m still meeting my performance goals, who cares? Not me!
Here is a quick breakdown of what I feel are not only the most popular eating methods today, but also the most realistic and healthy approaches:
Paleo: This is a way of eating focusing on real, whole, minimally processed foods that support gut health, hormonal balance, stable energy, and lean body mass. Approved foods are meat, seafood, eggs, veggies, fruit, healthy fats. Banned foods include grains, legumes, dairy, added sugars, processed foods, and alcohol (although some will argue that 100% agave tequila is approved, so… just gonna leave that bit of info there).
Whole 30: A month-long elimination plan created by Dallas and Melissa Hartwig, the strategy is to help people learn about their relationships with potentially problematic foods, then develop a plan for which foods to avoid long-term and which to reintroduce. It’s basically a super clean version of Paleo. Whole 30 advises to “eat moderate portions of meat, seafood, and eggs; lots of vegetables; some fruit; plenty of natural fats; and herbs, spices, and seasonings. Eat foods with very few ingredients, all pronounceable ingredients, or better yet, no ingredients listed at all because they’re whole and unprocessed.” The same banned foods for Paleo apply here, with the added no-nos of no alcohol; no carrageenan, MSG, or sulfites; as well as no baked goods, junk foods, or treats with “approved” ingredients.
Zone: Invented by Dr. Barry Sears, the Zone advocates eating five times a day, with three meals and two snacks, and includes eating proteins, carbohydrates (those with a lower glycemic index are considered more favorable), and fats (monounsaturated fats are considered healthier) in a caloric ratio of 30%-40%-30%. Meals are made up of blocks: one block of protein is 7 grams; one block of carbohydrates is 9 grams; one block of fat is 1.5 grams (actually 3 grams, but you go with 1.5 to account for fat “hidden” in protein). This will require you to weigh and measure your food at first, but they do offer a list on their website of several foods that will always be counted as a certain number of blocks, which makes putting meals together a lot easier.
Macro Counting/If It Fits Your Macros (IIFYM): Macros is basically shorthand for macronutrients, a term used to describe the three key food groups we all require for our bodies to function: carbohydrates (to fuel energy), fats (to keep you satiated), and proteins (to build and repair muscle). To maintain, lose, or even gain weight, many people rely on counting macros to make sure they're eating correctly. When counting macros, you simply add up how many grams of fat, protein and carbs you ate that day and hit your numbers. Apps like My Fitness Pal are very helpful for this, and you will need a food scale. Like, 97% of the time.
So, how do you know what course of action is best for you? Trial and error. It’s taken me a few years to figure out on which “style” of eating I am most successful. And, to some degree, all of the approaches I tried worked, which has usually been geared toward weight loss. However, when I decided to take my performance in CrossFit more seriously, I experimented with vegetarian/vegan, Paleo, Zone, Whole 30, etc., and eventually found a healthy balance in macro counting with a loose Zone influence, eating mainly whole foods and timing most of my carbs before and after my workouts. That works for me and, most importantly, I don’t feel deprived and overwhelmed. My advice would be to give these lifestyles (again, I hate the word diet!) I’ve mentioned above a try and find out which one you like the most. Keep in mind: Success is going to come with consistency, and consistency is going to heavily depend on your sanity, so whatever option that is for you, figure it out and do it.
Thanks for reading!
Claire (Office Manager at Athletes' Potential, CrossFit Coach, Performance Nutrition Enthusiast)
To quote Dr. Kirk Parsley, renown sleep expert who improved the sleep of some of the most revered badasses on the planet, navy seals, “Sleep affects everything you do and everything is affected positively by better sleep”.
As snake oil-like as it may sound, good quality sleep literally improves everything: every marker on a blood panel, weight management, sport performance and recovery, productivity, and numerous types of disease management. The list goes on and on, yet the percentage of sleep deprived Americans, particularly in Urban areas, continues to rise at an alarming rate. In fact, the U.S Centers for Disease Control and Prevention reports that more than 30% of Americans are sleep deprived getting fewer than 6 hours of sleep per night, and that’s a problem. Study after study proves that we need 7-9 hours of sleep per night in to recover appropriately and prevent the many negative consequences that come from sleep deprivation.
I see people with sleep deprivation all the time in the clinic. Parents with young children, serial entrepreneurs and CEOs, students cramming for exams, and countless people who simply have a hard time “turning on their off switch” in order to fall asleep. However, in many of these cases when we have these patients make dedicated efforts to average 7-9 hours of sleep per night for just one week, something wild happens. All of a sudden their back pain isn’t as severe, or their elbow pain thats nagged them for weeks is no longer there, or their knees no longer hurt when they squat. The benefits of good sleep cannot be understated, and the mechanisms behind how sleep benefits you and what exactly goes on while you sleep are both complex and incredibly fascinating, but that’s for a later article.
One of the biggest reasons adults have difficulty falling asleep and staying asleep is because they lack Sleep Hygiene, which is simply having the appropriate routine to put themselves in an environment to promote sleep.
For those of you reading this who have young children, think about their night time routine. You give them a bath, brush their teeth, tuck them in, read them a story, and give them a kiss and rub on the back as you shut off the lights.
Now compare this to what we do as adults. Read emails on our computers, watch our favorite show or sports team, check our social media feeds, and then immediately try to get in bed and fall asleep. No bueno.
Just like when we were kids, we need to have good sleep hygiene as adults, and below you’ll find the top two ways to do just that put yourself in a better position to optimize your sleep.
Optimize your Environment:
In order to optimize you sleeping environment, you must do three things: Make it dark; make it cold; make it quiet.
Create A 10-Minute Routine:
This isn’t some crazy, convoluted process. In fact, it’s the exact opposite. Your nightly routine should be something that you will be able to perform on a consistent basis and be easily replicable regardless if your at your home or in a hotel room. This could literally be something as easy as drinking a cup of your favorite (non-caffeinated) drink, performing light stretches, reading a book, or working on various breathing techniques. However there are some simple rules to keep in mind with your routine.
Consistency is key with your night time routine. We are creatures of habit, and after doing the same routine a few times in a row your body will start to recognize that your winding down to sleep and will up-regulate the the portion of your brain responsible for helping you fall asleep.
At our clinic here in Decatur, Georgia, the number one excuse for poor sleep is lack of time. Well, your health is pretty important and you only get one body...you need to take care of it. Sleep is a crucial part of that process and should be made a priority in your life. Just try the steps we covered in this article for seven days straight, start optimizing your health, and feel great in the process!
If you've been struggling with a nagging injury or are frustrated with your current medical provider, give us a call. We work one on one with all of our clients and they see a highly qualified Doctor of Physical Therapy every time they come in. We help people get back to living an active life full of movement and interactions with the ones they love most.
If you'd like to set up a 15 minute phone call with one of our Doctors for free, we'd love to do that. If you're not an ideal fit for what we do, we can help get you to the right person, no strings attached. Click the image below to request a phone consultation with one of our Doctors.
Thanks for reading,
Back pain is such a common complaint that we treat, but what if I told you that back pain can be caused by pelvic floor dysfunction? First, it is important to remember that pain does not equal damage. Second, it is not unusual to experience pain in a different area from where the dysfunction lies. This could be referred from another area or a secondary effect to moving in a weird way due to the dysfunctional area.
Cause and effect in this case is very similar to asking “Which came first, the chicken or the egg?”. What we can state confidently, is that your back and your pelvic floor go hand-in-hand. Studies show that folks with low back pain have decreased pelvic floor function compared to those without back pain. Could this be pelvic floor inhibition due to the back pain? Can weakness or over-tension or control issues of the pelvic floor be causing the back pain?
For many, the pelvic floor is very nebulous. What is it anyway? Where is it? What does it look like? Do only women have them? Males do have pelvic floors, but the anatomy is different. For this post, we will referring specifically to the female pelvic floor. But guys- you too can have pelvic floor dysfunction! This image below is a great look at the female pelvic floor and it’s close relationship to the other pelvic and lumbar spine architecture.
The pelvic floor helps to support the weight of your organs, helps with toileting and sexual function, and influences posture and control through pressure within the core. Weakness, over-tension, spasm or damage to the pelvic floor will change the support of the sacroiliac (SI) joint and the forces that we create through the lumbar spine.
If you have addressed your lumbar spine without much change in symptoms, go a different route! Keep in mind, there are other signs of pelvic floor dysfunction, other than leaking urine or back pain. They include painful sex, frequent constipation, the feeling of heaviness in the vagina with jumping/running/bearing down etc.
Addressing the Pelvic Floor
There are 3 areas to cover that address your pelvic floor in a functional way -- position, breathing and bracing. All of these can be applied to any athlete in any setting.
Position- Keeping the ribcage stacked over the pelvis is an important position to maintain, regardless of activity. This sets the canister (“core”) up for optimal function- meaning the diaphragm, pelvic floor, abs and back muscles can work harmoniously to lift the most weight, support the spine and minimize pressure on the pelvic floor.
Breathing- Diaphragmatic breathing is essential for pelvic floor function and decreasing pain around the low back. The pelvic floor mirrors the movement of the diaphragm, so it is a simple way to relax a tight pelvic floor. Also, two major muscles that run from the ribs to the pelvis also have connections to the diaphragm. So deep breaths can work as a gentle mobilization!
Bracing- How do you prepare for heavy loads or challenging positions? If you simply hold your breath and go, you are missing an opportunity to create more tension! Or if you are holding your breath for a position that should not require that much power, you are increasing the workload on your pelvic floor and back for no reason. For example, preparing to lift a couch versus preparing to lift a pencil.
Put simply, if you are lifting something heavy, holding your breath is fair game. IF you do it correctly. If you experience symptoms- low back pain, leaking, heaviness- then do not hold your breath until you seek help for how to correctly brace. Knock the weight down or the mileage down to a place that you do not have symptoms and work there until your tolerance improves.
If you notice you are holding your breath with lifting a small object, such as your purse, then let’s talk breathing. Breathing out on exertion for a task like this will help the pelvic floor contract reflexively and can keep symptoms at bay. Try it out!
Big picture: Back pain does NOT equal back injury. It is very likely that back pain can be decreased and function improved with addressing the pelvic floor as it work with the low back muscles. Check out these simple ways to check your position, breathing and bracing. Often times, pain is a product of HOW you are moving.
If you take a crack at it yourself but just can’t seem to find improvement, reach out to us at Athletes’ Potential. We work with people like you every day to get them back to high functioning lives without pain and with a better understanding of how to move their body.
Thanks for reading!
It’s been well researched and well documented that surgery is over utilized in the United States. Whether for your knee, back, shoulder, or ankle, it is far too common for people to rush to the operating table when, in many cases, conservative treatment (physical therapy) has been shown to have equal or better outcomes. Let's look at back surgery as an example. If you take 3 random people off the street who have absolutely no back pain, one of them is going to a “herniated disc” show up on an MRI scan. This means disc herniations may not always be the cause of someone’s low back pain, yet 500,000 people opt to have back surgery every year, often times with minimal or no relief.
That being said, there is obviously a time and a place for surgery. Depending on a number of different variables (age, activity level, mechanism of injury, etc), sometimes surgery can absolutely be the best treatment option for you. What most people fail to understand though is that surgery is the easy part...all you have to do is get stuck with an IV and the next thing you know you wake up in the recovery room. Returning to your previous level of performance is the hard part, and it’s the hard part primarily because of the incredible amount of muscle atrophy (loss of muscle mass) that occurs after a surgery. In as little as two weeks a surgically repaired limb goes into a state of anabolic resistance and protein synthesis shuts down, leading to a 30% loss of muscle mass in that limb. Because of this rapid and extreme loss in muscle mass, muscle atrophy has a profound impact on a patient's rehabilitation, and sometimes patients never fully recover.
Historically, muscle atrophy has been a battle that physical therapists, athletic trainers, and strength coaches alike have struggled to win. Just the other day I was working with a patient who is extremely active and fit, but had a knee surgery over 15 years ago and still had a significant side-to-side difference in leg size. However, there’s a revolutionary piece of equipment that is taking the world of physical therapy by storm, on that’s allowing healthcare professionals to prevent this initial 30% loss of muscle mass from even happening in the first place, Personalized Blood Flow Restriction Training.
I go more into detail about what exactly Personalized Blood Flow Restriction Training (PBFRT) is in my previous article, but in a nutshell PBFRT is the use a modified surgical tourniquet to occlude a percentage of the arterial flow into a limb to trick your body into thinking it’s doing something much harder than it actually is.
So why is personalized blood flow restriction training so revolutionizing when it comes to surgery? It prevents the significant muscle atrophy from even happening in the first place.
In normal circumstances it takes 8-12 weeks of high intensity strength training (>65% of your one rep max) to get improved strength and muscle size from, you can see how this would be an issue for someone recovering from a surgery. When you have a surgery, you’re going to go through a period of time where it simply isn’t feasible, nor safe, to lift the weight required to increase muscle size. This is where PBFRT comes in.
Say you’ve torn your ACL. With an ACL reconstruction, for the first few weeks the “strengthening” component of your rehabilitation will include simple exercises like seated knee extensions, mini squats, and heel raises. None of these exercises are going to make you a stronger functioning human, because none of these are at a high enough intensity level to cause the biological responses needed to increase muscle size and strength. However, if we put on a blood flow restriction device, and do these exact same exercises, we cause the following:
There are about 200 published research articles in 15 different countries that have demonstrate the benefits of personalized blood flow restriction training and we are seeing those benefits every day here in the clinic. Whether it’s helping someone who has years of atrophy as a result of surgery or we’re preventing the atrophy from even happening in the first place, the results we’re seeing are simply incredible. If you’re living in Atlanta, and you’ve had surgery or are struggling to get your strength back after a surgery, we’d love to help you. Give us a call at 470-355-2106 or fill out the contact request form and we’ll contact you.
Thanks for reading,
Shoulder volume: This is the first thing that comes to mind with I have the opportunity to work with youth swimmers. A typical club or high school swim team will average around 40,000 to 60,000 yards in a week of practice and the average athlete will have a stroke count of about 12-15 strokes per 25 yards, giving you a range of 19,200 to 36,000 strokes per week...that’s a TON of volume on the shoulders!
With such a high demand on swimmers’ shoulders, injuries are incredibly common, so common in fact experts coined the term “swimmer’s shoulder” as an umbrella diagnosis. That being said though there are a number of steps you can take to prevent injury, the most crucial of which being to improve your movement efficiency. Movement efficiency is key to not just preventing injury, put to improving performance. Think of it this way. Performing 36,000 strokes a week with poor mechanics is like trying to drive a Ferrari with the handbrake on; sure, you’ll still be able move and potentially even move pretty damn fast, but you’re going to leave a ton of performance on the table and you’re going to break down way quicker and more often.
In order to know to know where a deficiency is happening, you must break down each stroke into its component parts. For the sake of this article, we will focus on freestyle. Each freestyle stroke can be broken down into five main phases:
When looking over all the different component phases that make up a freestyle swimming stroke, something becomes abundantly clear… internal rotation is crucial. From the catch phase all the way through the recovery phase, internal rotation is necessary in order to perform the freestyle stroke effectively and efficiently. That’s why you’re always hearing your coaches scream out cues like “keep a high elbow”, “drag your fingers”, “point your elbow to the the ceiling”, all those are various cues for internal rotation.
The problem is though, we see a ton of swimmers who are missing adequate internal rotation. When you’re missing internal rotation and you try to go into a “hang position” (see picture above) you will compensate by dipping your shoulder forward. This is big problem because when you dip your shoulder forward you’re putting your rotator cuff in a weakened position, putting unneeded stress on your biceps tendon and labrum, and decreasing your power output. Add all that together and multiply it 36,000 strokes you're doing in an average week and it becomes easy to see why this is a recipe for disaster.
So how do you know if you’re missing internal rotation and what can you do if you are? Well, check out the video below to assess your shoulder range of motion and see if you hit the minimum of 70 degrees of internal rotation we like to see our athletes to hit. If you don’t have the needed range or it is a struggle to get there, check out the following two videos for a couple of our favorite ways to improve your shoulder rotation.
(Internal Rotation Self-Assessment):
(Internal Rotation Superfriend Stretch):
(Banded Internal Rotation Stretch):
Lacking internal rotation is one of the main reasons why we see swimmers, especially youth swimmers, in our clinic in Decatur, GA. However, the shoulder is an incredibly complex joint and there could be a number of reasons in addition to a lack of internal rotation causing pain in a swimmer’s shoulders. If you’re still struggling with shoulder pain or noticing a decrease in performance after working on your shoulder internal rotation you live we’d love to help. Simply give us a call at 470-355-2106 or fill out the contact request form below and we’d be happy to contact you.
Thanks for reading,
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.