“Look up when you squat, Matta!” Coach Pettis, high school football coach
Most people who played sports in high school or college have received some coaching on some basic strength movements like the bench press, squat, deadlift and power clean. In fact, thanks to programs like the Bigger Faster Stronger program, high school athletes have been doing these big compound movements for years. I remember going through this exact program when I moved to Columbus, GA as a junior in high school with our football team.
The quote above is something I remember well from all of my strength coaches, but in particular one of my coaches in Columbus. He was the one that implemented using the Bigger Faster Stronger program and he would constantly yell at us to look up when we were deadlifting, power cleaning or squatting. We all got bigger, we all got faster and yes, we all got stronger. Were these changes all beneficial? Looking back it’s hard to say but I would have to say no they were not. In my opinion, we just were adding strength to dysfunction.
So what’s my problem with this cue of looking up when pulling and squatting? I think it’s a cue gone wrong in many ways. I see the rationale behind not wanting the spine to be in flexion when pulling and squatting. You want the spine to be in neutral during these movements. Cueing people to look up is designed to get people out of a flexed position. More commonly, you’ll hear the coupling of two cues, 1) look up and 2) butt back. The problem is many athletes will drive excessively into extension and this can be an even bigger problem.
When we drive our spine into end range extension it’s very stable. The reason it’s very stable is because the facet joints in the spine are getting pressed into each other and it’s literally a bone block that stops any more movement from occurring. As stable as this might be it’s very irritating to the spine and can even cause local spinal fractures called spondylolisthesis. These are most common in young female gymnasts and young male wrestlers. One sport has a ton of arch positions in it and typically landing in arched positions and the other teaches wrestlers to bridge/arch to stop someone from pinning you. Both of these put the spine into end range extension with load.
Am I saying you are going to get a local spinal fracture from squatting while looking up and arching your back? No! But you sure as hell will aggravate your back by doing this. In fact, I would say 90% of the lower back injuries that I see in my practice are directly related to extension based back injuries.
We have to fix this problem through control. The control must come from engagement and strength of the anterior torso, inparticular the internal obliques (IO) and transverse abdominus (TA). These are deep anterior stabilizers of the spine and when we put ourself into an over-extended spinal position they are essentially weakened. Strength and control in this area in particular is the best way to gain lasting control of the anterior spine.
Now let’s fix it. Below are a few videos that directly work on correcting this area and getting you out of an overextended position. Add these in daily at home to reclaim some lost control and when you do squat, actively try and mimic the same muscle contraction that you get with these corrective drills as you do when you squat.
CrossFit is polarizing. It seems like these days you either love it and it’s all you want to talk about or you hate it and you wish you could slap your friend that can’t shut up about how much he loves CrossFit.
Initially, my experience with CrossFit was something that didn’t involve lululemon shorts, chalk everywhere and some specialized pack of vitamins to help me WOD harder. I was introduced to it by two Rangers at the Center for the Intrepid in San Antonio, Texas.
The two guys were both CrossFit coaches that had been in blast injuries and both had lost a leg. They were both below the knee amputees and were very high level. I saw these guys doing muscle-ups as part of their WOD one morning and spoke with them after. They told me they were doing CrossFit and invited me to train with them the next morning. So the next morning, that's exactly what I did. I got through the training session and at the end eventually had to puke into a trash can. As I wiped the puke off my face, they both laughed because they had been there before and I realized I had found something pretty awesome!
Back when I first started CrossFit, it was more underground and less mainstream than it is today. CrossFit has grown and evolved with it’s success over the years, as it has to (and should) do. I think you need to give credit where credit is due, however, and CrossFit at least deserves credit in these 3 areas:
1. Adults started doing Gymnastics
As a parent I feel some type of movement base needs to be developed in our kids (read more here). You could use a martial art, dance or something like gymnastics. The fact that grown adults are trying to learn hands stands, hollow holds and kipping movements is phenomenal. If we can all agree that gymnastics is a great movement base for our kids, why aren’t we working on it ourselves? We absolutely should work on gymnastics skills and CrossFit made that one of the central foundations of it’s training.
2. It Saved American Weightlifting
When people say the word weightlifting most people think bodybuilding. Shit, 5 years ago I was one of those people. I couldn’t have told you the difference between lifting weights and weightlifting. Through CrossFit, I’ve been exposed to a sport that involves arguably, the hardest movement in sports, the snatch.
When the last summer olympics were on I looked specifically to see when weightlifting was going to be shown. The summer olympics before that all I would have cared about was swimming and track and field (because we dominate those sports! #merica). I only wish I could have gone back and started weightlifting when I was much younger.
So, is it fair to say that CrossFit saved American weightlifting? Yes it is and if you don’t believe me here’s a podcast I did with Glenn Pendlay and one with Don McCauley. They both give all the credit in the world to the fact that CrossFit has made weightlifting matter again.
The last bit of proof, if you even need anymore, would be the the young weightlifting phenom CJ Cummings hitting a 175kg clean and jerk (video below) at the US Nationals this month. It’s an unofficial youth world record for his weight class. Where did he get his start into the sport? At a CrossFit gym!
3. Brought Back Real Training
Last week my wife and I went to see the movie Jurassic World. As we stood in line at the movie theatre in Atlanta, we had to stand next to a gym with a ton of huge glass windows. This gave us a significant amount of entertainment and helped pass the time in a relatively long line. Why was it entertaining? It was entertaining because I look back at how I used to train and I see it’s the same as what these people were doing at the gym by the theatre.
Too often people go to a nice air conditioned facility, grab a towel for the off chance that they actually sweat and head straight for the elliptical. They plug their headphones in and watch Paula Dean describe why you need 4 kinds of cheese in your macaroni and cheese to really make it correctly. Thirty minutes later after having maintained their fat burning zone it’s time for some leg extensions, bicep curls and possibly some dumbell bench press if there’s time. Grab your post workout smoothie on the way out and in your mind you’re the fucking man!
Training should be hard. Training should encompass large compound movements. It should get your heart rate elevated; who cares what your so called fat burning zone might be. Training should allow you to go hiking, swim with your kids, do yard work for 2 hours and run away from a dog that would love nothing more than bite your leg off. Maybe there were other people that were training in this fashion before or during the time CrossFit came around. What CrossFit did was make it mainstream. I’m glad they did and so are thousands if not millions of other people around the globe.
I know this is a polarizing topic. If you have an opinion leave a comment. Thanks for reading.
-Dr. Danny, PT, DPT
“The fear of pain is worse than pain itself” Arntz and Peters, 1995.
Back in the day when I was still active duty in the Army, I had to attend what was called a Joint Operational Deployment Course. It’s a week-long course where myself and other active duty medical providers learned how to take care of trauma related issues predominantly. It was great training and I learned a ton. I also learned I’m terrible at giving an IV.
One of my colleagues was unlucky enough to have me as a partner as we learned to hook up an IV bag. To make matters worse he was deathly afraid of needles and blood. In fact I’ve been around him when he had to sit down for a few minutes after getting a routine shot otherwise he would have passed out.
The process for hooking up an IV bag is pretty straight forward. Step 1: put on tourniquet. Step 2: insert needle. Step 3: attach IV clamp/bag to needle port. Step 4: take tourniquet off and open IV. Much to my friend’s dismay, I mixed up the steps and accidentally took the tourniquet off before attaching the IV bag.
My partner was intentionally looking away the entire time because if he saw the needle he would pass out. As the blood started running out of his arm through the IV port I had just placed in his vein I said the worst thing I could have at the time, “Oh Shit!!”. He immediately looked at me and then at his arm which was now next to a rather large pool of blood on the table. He immediately passed out as I fumbled to attach the IV bag and stop the bleeding. He’s still very much alive and still very much afraid of needles. I reminisced with him about this event a few weeks ago when he and his family visited my family in Atlanta. Yes, I’m not the best person to call if you need and IV put in but the real question is why is this person so afraid of needles/blood and I can watch blood be drawn or even stick needles in myself without a similar response?
The answer is directly related to the opening quote: The fear of pain is worse than pain itself. Maybe this person had a memorable traumatic experience with a shot when he was a kid. Maybe his mom or dad were really afraid of giving blood/needles. Maybe he had a sibling that told him how terrible it would be to get a shot just to mess with him. Either way it eventually leads to a pain experience.
After a pain experience, we start catastrophizing the event, in this case shots or needles. That leads to more pain related fear and eventually avoidance of the painful event again. All of this leads to more and more perception of pain with the activity.
So why am I putting this on a blog that typically talks about performance improvement and injury treatment? Because, for people that have had pain for more than a few months they have to stay away from falling into this vicious cycle.
I had a patient recently that came in to see me for pain in the front of his knee. He had no explained onset except that he had tried to take up running and had to stop because his knee hurt whenever he would run. It also hurt to go up/down stairs if he led with the injured leg. He resorted to only going up stairs with his non-injured side one step at a time. This is an incredibly slow way of going up/down stairs and I’m sure he aggravated countless people that were behind him in stairwells.
What’s the first thing we did? Talked about how his leg was healthy and had him start going up stairs with what he perceived to be his injured leg. We also had him start box squatting the first week. When I told him we were going to squat his face looked like I had just told him we were going to fight a grizzly bear. We had to expose him to those activities he was avoiding and afraid of. Sure he gained some strength back and that is obviously a contributing factor to him getting better. However, the biggest factor was the realization that his leg wasn’t broken, it was functional and he needed to start using it correctly again.
With chronic injuries we can become very sensitized and aware of any little thing that happens in a painful area. Sometimes the best treatments are the ones that prove to our own mind that we are still functional!
-Dr. Danny, PT, DPT
June 2014 July 2015
Testosterone- 802 Testosterone- 421
HbA1c- 5.3 HbA1c- 5.7
HS CRP- 0.9 HS CRP- 2.6
Let’s face it: we live in the information age. You can find out pretty much anything by searching for it on the internet. There has also been a massive shift toward data driven decisions. I see it first hand in my business when I look at our website analytics. We even see it with things like Wodify as athletes start tracking all their workouts, strength numbers, training sessions and making training changes based off actionable data.
Think of this blood panel like a snapshot of what’s happening internally. As part of the initial testing phase to work out the kinks, my wife and I both went through the process to get blood drawn and see how long it would take to get our results back. When I got my results back, I was shocked!
Last June, as part of my transition out of Army, I requested some blood panel work from my Physician Assistant. I wanted to start doing a more in-depth panel of blood tests yearly just to see where I stood and to gauge my nutrition/training based off that. For me, I used that as my initial data to compare this lastest to. Here are the tests that were grossly different:
A good number more tests were performed besides these three but these were the ones that had the most noticeable changes. What does this even mean? In the past year my testosterone production had decreased by 50%. Testosterone is very important for recovery, building muscle, maintaining a lean body and many more very important tasks. According to a 1996 study by Vermeluen et. al, the average testosterone levels for someone my age (30 years old) is 617. To make matters worse, in the same study he found that the average testosterone levels of males age 75-84 was 471. Talk about kicking me while I was down! This basically shows me that there’s a decent chance my 90 year old grandfather and I have the same testosterone production at this time.
Next is the change in HbA1c. This is a marker of average blood sugar levels over the past 3 months. Most of you have probably heard of diabetes. It’s basically a disorder of high blood sugar levels in the body. It can either be genetic type I or developed type II. The range for HbA1c is pretty clear. Anything below 5.7 is normal, between 5.7 and 6.4 is prediabetic and over 6.4 is full blown diabetes. My number is elevated quite a bit and it technically puts me in the prediabetic range.
Lastly, was the change in my HS CRP. This is a marker of global inflammation in the body. To be clear, inflammation is not a great thing to have in the body. Increased values on this test in particular have been drawn to increased risks for cancer, heart attacks, neurologic disorders and type II diabetes. My HS CRP was elevated compared to where it was a year ago going from 0.9 to 2.6.
Now, when you see these big changes in values your physician should ask you a few things. First, did you do some crazy workout that day or the day before? Did you go out with your friends the night before, end up at the Clermont Lounge and down PBRs all night? Have you had a week of really bad sleep before this test cluster? All of these things are important to know because it can give us false values. By the way, my answer to all these questions was no.
Here’s what all this means. In the past year my health, internally at least, has slowly been trending in the wrong direction. So how did all this start to go wrong? I would have to attribute it to a number of factors. First, I started a business. For any of you that have ever started a business I probably need no further explanation. For those of you that haven’t, it’s the most difficult and stress-inducing thing anyone could ever do. Not only that, but I teach for another group (MobilityWOD) and in the past 12 months, I’ve accumulated about 70,000 miles on an airplane. I also have two small kids under the age of 4 and I typically sleep an average of 5-6 hours a night.
It’s not all bad news though. Mom, if you’re reading this don’t freak out and call an ambulance for me! I’m glad I did these tests because I had been feeling fatigued and like I was recovering poorly from my training sessions for about the past 6 months. Now I have some quantifiable data to help me make changes and retest to see what’s working. Changes will be made and I will retest in about 1-3 months. All of these markers are reversible with some supplementation changes and behavior modification. I’ll write up a follow up post once I’ve done my blood testing again. It’s time to make some changes!
-Dr. Danny, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention and sometimes other random thoughts.