 “The aim of CrossFit is to forge a broad, general and inclusive fitness supported by measurable, observable and repeatable results. The program prepares trainees for any physical contingency—not only for the unknown, but for the unknowable, too. Our specialty is not specializing.” The quote above was taken directly from CrossFit.com. It describes CrossFit’s mission, and it is undeniable that CrossFit accomplishes its mission of preparing trainees for multiple arenas of physical contingencies. The point of this article is not to argue nor neglect the many benefits associated with CrossFit training. However, even with CrossFit’s ability to program and prepare you for the many physical challenges that life may throw your way, when it comes to building a functionally strong and healthy back, there is one crucial area where CrossFit falls short: multiplanar movement. Before we talk about how CrossFit doesn't deliver multiplanar movement, first let's look at how our spine moves throughout the day. Whether we are going to the grocery store, playing softball, or hitting a round of golf, our backs do not move in one dimension. To perform movement efficiently and effectively, our spine must be able to move through a combination of movements in three different planes: frontal, sagittal, and transverse.
 In order to fully bulletproof our backs and prevent back pain from occurring, not only must we be able to move through these three planes of movement, but we must be able to strongly control our spine throughout each motion and this is where CrossFit falls short. The world of CrossFit lives in the sagittal plane. Squats, deadlifts, snatches, burpees, kettlebell swings, muscle-ups, toes-to-bar, double-unders, Fran, Murph, Gracie, and Annie. What do all of these have in common? In all these movements and exercises your back is predominantly bending forwards and backwards, meaning in all these movements your back is moving in the sagittal plane only. There are very few movements in CrossFit that require you to challenge your back rotationally or laterally and as you’ll see below, that’s a problem. Holding your child at your side, swinging a bat/club/racket, getting in and out of your car, serving a volleyball, opening a door, and kicking a ball. What do all of these activities have in common? These are all movements commonly found in sports and in daily routines and they all challenge your back rotationally and laterally. Not only are these multiplanar movements incredibly common, but because CrossFit doesn’t address frontal or transverse plane movements, if you aren’t doing any type of accessory training, you’re going to be weak in two-thirds of the required movement patterns, and you’re going to be at a greater chance of developing back pain. So does this mean that CrossFit is terrible and you should stop doing all those squats, deadlifts, and other aforementioned CrossFit workouts? Absolutely not. Sagittal plane movement is crucial to our everyday lives (i.e., bending over to pick something off the floor, getting up from a chair, etc.), it just isn’t the complete picture. You’re leaving your back vulnerable to injury if you aren’t working on getting strong in the other two planes of movement. The solution to this problem is simple though, you just have to take the time make sure you’re putting in the work. To get an idea of how to start training in the frontal and transverse planes, try adding in some of our favorite transverse and frontal plane strengthening exercises either before or after your next WOD. Perform 3-4 sets of each exercise to form fatigue. Chop and Lift (multiplanar)  Pallof Press with shoulder flexion (transverse plane) Single-Arm Farmers Carry (frontal plane) At Athletes’ Potential not only do we help CrossFit athletes with low back pain all the time, but we are CrossFit athletes ourselves. We take immense pride in thoroughly understanding your sport, what its strengths are, and where there may be some deficits. If you’re a CrossFit athlete living in Atlanta, and you’re struggling with back pain, 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, -Dr. Jake, PT, DPT, CSCS 
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 That’s a funny cartoon, but back pain is no joke. Chronic low back pain is the leading cause of disability in the world. Throughout our lives, 80% of us will experience low back pain. So why do some recover completely while others have chronic, sometimes debilitating, back pain? As movement specialists, we (physical therapists) often want to explain the why of pain with muscles, joints, and movement patterns. Sure, we can work on asymmetries in movement and perceived muscle weakness but for chronic pain this is only a small piece of the puzzle. Back pain can be particularly frustrating for a few reasons. For one, imaging does not directly correlate to pain nor does it change conservative treatment strategies. Also, improvement from back pain often has ups and downs, sometimes with no indication of what causes it. What NOT to do if you have back pain: Going straight to the orthopedic for back pain can start a cascade of chronic back pain. Lumbar spine imaging should not be the first line of care for back pain. I see it too often - either the imaging shows something that seems “scarier” than the pain the patient feels OR the pain is quite intense but the image shows nothing out of the ordinary. The latter tends to be the most frustrating. If there is nothing torn, bulging, ripped, degenerating (insert any other terrible descriptor here), then why the heck does my back hurt SO BADLY? Our nervous system is extraordinary because it has the ability to adapt and change with our stimuli- inside and out. This becomes a problem when it adapts in a way that we call “central sensitization.” Essentially, the central nervous system (brain and spinal cord) becomes extra sensitive to stimuli. So something that should cause little pain, or none at all, sends serious threat signals to the brain which leads to pain. The best analogy commonly used is the house alarm. If a burglar breaks the window in my house, I expect the alarm to sound. However, if a tree branch scrapes the window, I do not expect the alarm to sound. But with central sensitization, the alarm does go off. And this alarm is PAIN. Check out this cool video about chronic pain. It only takes a few minutes: Explain Pain Is it a false alarm? Based on the healing rates for tissues in the body, we know that after a few years into back pain, the pain is not stemming from actual tissue damage. If there continues to be pain similar to the original onset, it is likely that there are some central nervous system changes. When working through this with patients, it always starts with education so that they understand I am acknowledging that they feel the pain but also that they understand pain DOES NOT equal damage. To progress towards improved function and a pain-free active lifestyle, we focus on repetition of basic movements that may or may not be painful. The idea is to train the neurological system that simple bending over should not be threatening or painful. That being said, sometimes it is painful! In that case, I set the following rules: if the pain is low level and constant we are ok to work in that range, and if pain begins to escalate throughout the movement we will take a break. But as you build resilience and confidence through the movement range, you will experience less pain and the central nervous system will lessen the threat associated with that movement. TAKE AWAYS:
At Athletes’ Potential, we treat a lot of back pain. A story that we hear often is that people have bounced between providers, tried more severe/invasive treatments, long term use of pain meds or anti-inflammatory drugs, etc., but still have pain! We specialize in helping people maintain a pain-free, high-level, and active lifestyle. Whether this looks like running marathons, lifting heavy weights, or playing with your kids, we can help you get there. If this sounds like your past and the future you want, give us a call. We would love to help! Thanks for reading, Athletes' Potential We recently had a patient come in who had been dealing with low back pain for over a year. He was super active, training 5-6 days per week, but hurt his back one day simply standing up from a chair. He had seen his family practitioner periodically for steroid injections, which would provide some relief for a couple months but then end up right back to square one. Frustrated with his lingering back pain, he gave us a call and after a thorough evaluation, some manual techniques, and exercise programming, he left our office with decreased pain and improved mobility. We see patients like this all the time here at Athletes’ Potential… which makes total sense. Back pain can happen with some with some of the most innocuous movements, and in many cases, without warning. In fact, On average 80% of Americans will experience low back pain at some point in their lives and more than a quarter of the population currently deals with low back pain on any given day. Not only have most people had some form of back pain, but it many cases it is the result of poor movement patterns that have been abused for years causing the root of their problem to be both incredibly complex and multifactorial. Great news though! Whether you hurt your back trying to hit a new deadlift PR or simply bending over to put your kid in their car seat, there’s a profession out there, armed with years of training and knowledge, designed perfectly to help with your low back pain: Doctors of Physical Therapy. Here are some of the reasons why you should see a doctor of physical therapy the next time you’re experiencing back pain. Advanced Education: Physical therapists go through seven rigorous years of both academic and clinical training in order to become Doctors of Physical Therapy. We have spent seven years in school studying human anatomy and physiology, kinesiology, biomechanics, and tissue histology. In other words, we know how the body moves, how it heals, and how to optimally restore its strength and mobility in order to get you to your goals. Multiple Treatment Options: As I mentioned earlier back pain can be pretty complex, requiring multiple different treatment options to not only alleviate your symptoms, but correct the underlying problem that caused the issue in the first place. Unlike other healthcare professionals, doctors of physical therapy have the ability to choose from multiple different tools in their toolbox. Whether this means using corrective exercises, dry needling, joint manipulations (cracking your back), soft tissue mobilizations, taping, or wrapping, a physical therapist has the ability to customize the most appropriate treatment program for you. Patient Empowerment: More than anything else, a physical therapist's ability to educate you the patient is invaluable to your recovery. There are 168 hours in a week, at most you’ll see a physical therapist 3 times per week for an hour...that still leaves 165 hours where you’re on your own. Compliance is crucial. For true long-term changes to happen versus short-term reductions in symptoms, you have to know what you should and should not being doing, and physical therapists are second-to-none in making sure that is exactly what happens. Additionally, after you’ve had back pain once, there is a 90% chance you’ll have back pain again at some point in the future. Think of it this way, after you roll your ankle once, you’ll more than likely roll your ankle again at some point. Don’t panic though, the education and coaching you’ll receive from your physical therapist will allow you to know exactly what to do in order alleviate most future back pain exacerbations in a few days instead of weeks, months, or even years. In review, you’re not alone in your back pain. In fact, it’s more likely than not that you’ll experience some form of back pain in your life. However, this doesn’t take away the fact that back pain can hinder your daily activities and keep you from what you enjoy most. Physical therapists are highly trained musculoskeletal experts that not only help patients alleviate their low back pain, but keep it away by empowering them to take their healthcare into their own hands.
If you’ve living in Atlanta, and you’re struggling with back pain, 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, -Dr. Jake, PT, DPT, CSCS |
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