Let’s recap from last week:
Your ankles drive the squat bus and your knees are along for the ride. Unfortunately, the hip is often overlooked when pain or dysfunction with squats occurs. Strengthening targeted to the hip will improve knee position during the squat. If it hurts your knees to squat, it is likely a faulty movement pattern causing the issue.
When there is pain, do not push through. Jane Fonda might have said “no pain, no gain” during her abs, buns & thighs workout but this does not apply. The feeling of an ice pick jabbed in your knee cap is not normal. Pain with a back squat does not mean you can’t squat at all! Try these first:
I eluded to different flavors of squats in the last post. Is high bar back squat bothering the knees today? Try a low bar position, front rack or squat to a box. There are so many options! It is nearly as exciting as picking a flavor of ice cream.
Check out Noel showing us some variations of squats! Pay attention to her ankle and shin positions.
High Bar Back Squat a.k.a Traditional Back Squat
The bar rests across the top of the upper trap, on the shoulders. Throughout the movement, the torso remains upright. With this set up, the knees tend to move more forward than in other squat variations so adequate ankle mobility is essential!
Remember, those with significant ankle mobility issues will have trouble maintaining the upright torso and may try to sidestep the issue by turning the toes out wide. Another squat flavor will allow you to move in less compromising patterns while still gaining strength. Don’t forget to work on ankle mobility every day!
The bar rests across the front of your shoulder, elbows are high and in front. The torso is the most upright in this squat flavor to keep the barbell over the midfoot. Again, ankle mobility is key here!
For those who do not have glaring mobility restrictions, the front squat is a great exercise to carry over for the clean.
Low Bar Back Squat
The feet are in a wider stance than for the traditional squat. The bar rests lower across your shoulders, elbows are back and high to help create a shelf for the barbell. The torso maintains more of a forward inclination to keep the barbell over the midfoot.
This flavor of squat decreases the torque at the knees by allowing the tibia, or the shin, to remain more vertical. (Go back and look at her shin-to-foot angle in the traditional squat and compare!) More torque is placed at the hip, so the hammies and glutes are targeted. If you feel a pinching at the front of the hip, vary your squat width and work on that hip flexion mobility!
The feet are in a wider stance, similar to the low bar set up. The bar rests across your back in either high bar or low bar position. A sturdy box is behind the lower legs. The hips are allowed to travel further posteriorly during this movement which allows the tibia to remain vertical.
The box squat is great for all athletes to include in their workouts. It is helpful when just learning how to squat or trying different foot positions. After a knee or ankle injury, it is a good way to decrease torque at the knee and demand on the ankle joint. Box squats are also used for power athletes as it has been shown to increase the rate of force development, or explosive strength, more than other squat flavors.
Each of the squat flavors has something different to offer for your health and athletic development. If you are recovering from an injury or lack mobility in the hips or ankles, there is still a flavor for you! Grab an empty barbell and try each of the variations. Don’t be afraid to vary your stance width. Start with a taller box and gradually work your way down as you get comfortable.
Taking a video of yourself moving is the cheapest and quickest way to find faults and underlying mobility issues. Once you work through each squat flavor, you will have a better idea of which mobility drills to introduce daily. Get your squat moving correctly and cut out that knee pain! After all, it’s not your knees’ fault!
Thanks for reading!
Swinton P, Lloyd R, Koegh J, Agouris I, Stewart A. The biomechanical comparison of the traditional squat, powerlifting squat, and box squat Journal of Strength and Conditioning Research. 2012;26(7):1805-1816.
Simply put, no. Squatting, specifically deep squatting, is actually beneficial for your muscles and tendons. If you simply wanted to know the answer to the question, that is the abridged version. But those “why” people (it’s ok, I am one too!) should continue reading.
Research tells us:
The Knee, the Middle Child
In my experience, the knee joint seems to be the most baffling to folks. So much emphasis is put on knee position during workouts that other (more important, in my opinion) joints are virtually ignored. It may be more beneficial to understand this joint if you view it as the middle child.
The ankle is like the oldest child. It sets the scene for how the other joints are allowed to act. If the older child is rebellious and does not behave as expected, the middle and youngest child will imitate the older sibling. Without the proper ankle mobility and foot strength, who cares what your knee and hip joints can do? The foundation for these multijoint movements is already the weakest link.
The hip joint is the youngest child. By this point, the parents are exhausted from the rebellious older child who influenced the middle child into its rebellious ways. The youngest child can get away with anything. Our hip joint is a large, strong joint complex that should be the prime mover during squats. Unfortunately we get so focused on the knees and ankles that we overlook the hips and allow them to “run free”. This presents in the form of decreased pelvic control during large movements like the squat.
Finally, the knee joint is the middle child of the family. It gets pushed and pulled by its siblings but never has a moment when it’s all about the knees. During foundational weightlifting movements, the knees never work alone. They are guided by their neighbors.
So what does this mean? The ankles are the steering wheel. If you do not have sufficient mobility in your ankle joint, your knees are predisposed to faulty movement patterns. But it’s not your knees fault!!
Sad stick man on the right does not have great ankle mobility which causes his femur, the thigh, to be pushed backward. From this position the torso has nowhere to go but forward if he wants to remain standing. Throw a barbell in the front rack and the stress in concentrated on the knees, low back and upper body. With a barbell on the back rack, it will be harder to maintain spinal alignment, particularly in the bottom of the squat. This is often the position athletes attain when their hips raise well before their knees begin to straighten in a squat.
I don’t know what to do with my knees!
“Knees out!” is one of the most over-coached cues. Sure, it is a quick and easy fix in the middle of the workout but it is important that athletes understand what this means. If your knees are crashing in during a workout, the weakness is at your hip. A weak gluteus medius is often the culprit but it has an accomplice! If your hammies and glutes are weak and you attempt a heavy squat, your adductors are going to kick in to assist with hip extension. But the primary motion of these muscles is hip adduction, or knees together. Thus, crashing ensues. So strengthen your hip muscles and your knee position will improve.
If squatting is not bad for my knees, why do they hurt?
Undoubtedly, this will be the next question. There are several reasons that your knees may hurt during a squat. Some irreversible arthritis or previous injuries may be contributing but even these populations should be able to return to pain-free squatting. They just may need to try a different flavor than the traditional back squat.
Essentially, squatting is not bad for the knees but it is how you are squatting!
Do I squat through the pain?
No! Our body is very good at letting us know when something is not right. Now, I am not referring to muscle fatigue pain but true pain. If the back squat is causing knee pain today, try another variation. There are plenty of flavors of squats that can be used for training while you work on mobility or strength deficits. Be sure to look out for my next article about finding the best squat flavor to suit you!
Moral of the story: squatting, even below parallel, is not bad for your knees. The squat is a fundamental movement pattern that all humans should be able to attain. If pain arises from this movement, remember it is how you are moving. Decrease the weight, video yourself performing a squat and pay attention to which muscle groups are doing the work. If you continue to have pain, contact us at Athletes’ Potential so we can watch you move and delve deeper into your individual movement patterns! Most importantly,
Thanks for reading,
Hi, I’m Dr. Danny Matta DPT. I’m a Physical Therapist/Strength Coach and I’m the founder of Athletes’ Potential. Our company helps people just like you live higher quality, higher performance lives. That could be running your first 10K, competing in the CrossFit Games or getting rid of that lingering back pain so you can start getting back in shape! Dry needling is a technique we use frequently. I hope you have a better understanding of what it is after this article. Please email us if you have any other questions and we’d be glad to answer them for you.
When I was in the Army as a Physical Therapist, I remember first hearing about dry needling and thinking how crazy it sounded. I remember thinking PTs that were doing dry needling were searching for some kind of voodoo treatment that only had placebo effects. I actively stayed away from learning it because at the time I was a new graduate that thought I knew everything and was going to set the world on fire by getting everyone better.
Well, things changed one morning when I wrecked my back after a ruck march training session. I hurt my back so bad I could barely drive home and had to cancel all my patients that day. I threw everything at it that I knew and even enlisted the help of a few of my colleagues. Six months later, my back still hurt to pull weight from the ground, back squat or run (that was literally 80% of my training at the time!).
About that same time, a new physical therapist named Dr. Emmanuel Easterling moved to where I was stationed. Dr. E, as we called him, was a certified dry needling ninja. I reluctantly let him perform his voodoo on my back and I'm so glad that I did!
Within 2 days of Dr. E dry needling my back for the first time, I was running with no back pain. After the second time he did it, about a week later, I was squatting and deadlifting again. That was it- I was hooked and not only did I drink the Kool-Aid but I chugged it! I dove into dry needling head first and learned as much about it as possible.
So what does this technique do and why is it so effective? That’s a great question and the answer is we don’t fully know. Frankly, medicine is constantly evolving and we are always using our best evidence/knowledge at that time. Dry needling is the same way so as I answer this, understand there is probably way more to this than we even know.
First, dry needling involves placing small needles into strategic spots in the muscles. These spots were recognized and mapped out by a physician named Dr. Janet Travell, MD. She was an incredibly smart lady and was even John F. Kennedy’s personal physician during his presidency. Did you know he had chronic back pain? Yep, and what did she use to alleviate the back pain? You got it- dry needling!
The points Dr. Travell mapped were called trigger points. This trigger points in the muscle actually refer pain, not just where the “knots” in the muscle are, but to other areas of the body. Here’s an example of a trigger point in the upper trap. The X is where the trigger points are typically found. The dotted red areas are where the trigger points refer pain. Have pain on the inside of your shoulder blade? It could be just an irritated trigger point in your upper trap that dry needling would help fix really fast!
So how does a needle in a muscle cause pain to resolve quickly? There are a few theories on why this happens and I like to explain it in terms most of us understand: Think of a trigger point like a glitch in your computer. Something isn’t working right and it’s causing other things to have issues as well. What fixes most computer problems? You got it- the restart!
Dry needling is like the restart for the musculoskeletal system. If we have a irritated trigger point and we put a needle in it, it resets. This reset occurs at the muscle with what’s called the wash out effect. This basically means that a needle in a muscle causes increased blood flow to the area. Increased blood flow causes increased oxygen/healthy blood to shunt to the area. Local inflammation/stagnant fluid gets “washed out” by this effect.
There has also been evidence to support the theory that dry needling has a strong effect on the nervous system. Basically, placing a needle in a trigger point causes local opioids (our bodies own natural painkillers) to be released. This also causes a positive pain relieving effect on the spinal cord. This means we can get a local and central pain relieving effect from this technique.
Yes, most people are sore for a day. It feels like you worked out hard and the muscle is fatigued. In addition, you have to perform self-treatment work to really get the best benefit from dry needling. Picking the right home exercises and doing the right technique is where the magic is.
If you’ve been struggling with an injury or pain that’s stopping you from the activities you love, this might be a very effective treatment option for you.
You have a choice. You don’t have to wake up every morning and hope that this is the day your shoulder/back/neck or whatever areas stops hurting. It’s sad how many people are in pain daily. It stops them from playing with their kids, walking 18 holes in golf, staying in shape and living overall happier lives.
If you’re in the Atlanta area and you’d like to talk with one of our Doctors of Physical Therapy to find out if our approach is right for you, contact us. We’ll set up a free 10-minute phone consultation at your convenience.
Thanks for reading.
It’s the day after Christmas and as my wife and I break down the endless boxes that my kids' toys came in, I had some time to reflect on this past year. I’ve learned a lot of lessons this year and since we all have such short attention spans these days, I will share this with you in bullet point format!
1. Age is just a number.
If you didn’t know your age, how old would you say you are? How old do you feel? I turned 30 this year and supposedly that means it’s all downhill from there. I disagree with that, I feel like I’m just hitting my prime. Age is just a number, don’t pay attention to it.
2. Treat your body better than your car.
Because of the nature of my practice I get some very successful people as patients. Many of these clients have the newest German luxury, badass cars that’s detailed and shiny as could be. The car is taken care of as if it’s going to need to be show-ready at anytime.
Many of us treat our vehicles better than our own bodies. Listen people, you can get tons of different vehicles in your lifetime but you only get one body. That means treat it with respect. Put good food in your body. Exercise and perform some basic maintenance. That means you either do some body maintenance on yourself or go see someone to get a massage, do some dry needling or some whole body cryotherapy.
You can either put the work in now or pay the price when you’re body breaks down on you.
3. You can’t appreciate how comfortable you are unless you are uncomfortable sometimes.I read a book this year that I really enjoyed called Living With A SEAL by Jesse Itzler. I recommend you all read it. It’s a short read, hilarious and the message really resonated with me. In the book, the SEAL Jesse hires to train with him makes him sleep in a wooden chair all night. His rationale was he was too comfortable. He wanted him to experience something uncomfortable so he could appreciate what he had.
Push your body, expose yourself to uncomfortable things and have a better appreciation for how comfortable our lives really are.
4. Embrace the cold.
For the past few months I’ve been exposing myself to cold immersion work. I’ve done things like cold showers, whole body cryotherapy, ice baths and running in cold temperatures in shorts and no shirt.
I was inspired by a man named Wim Hof who is called the Iceman. He believes that cold exposure and breath control is the way to unlock our human potential.
I have to say, I hate being cold. It’s such a mental hurdle to step into a cold shower or get in an ice bath. Once you do it, it’s so cold it literally takes your breath away. This is where the magic happens. If you can expose yourself to something cold enough to take your breath away and then control your breathing, you’re in charge again. You are overriding your body’s fear mechanism.
This has been one of the coolest things I’ve learned in the past year. You might be standing in a whole body cryotherapy tube that’s -200 degrees but in your mind it can be 75 degrees and sunny!
5. You need to actually warm up before training.
I know, this sounds crazy right? Actually warming up before doing a workout- what a creative idea! Here’s the reality: very few people actually warm up before training. Some gyms run people through a structured warm up but some leave it up to the athletes to warm themselves up. I think this is too important to be left up to chance.
Take your athletes through a thorough warm up specific to the training for that day. 3 rounds of Cindy does not count as a warm up unless you are doing Cindy!
This could very well be the most important injury prevention tool you have as a strength coach, use it!
6. Your diaphragm is the second largest muscle in your body, use it.
Most of us take somewhere around 15,000- 20,000 breaths in a day. That’s a ton of breaths and you can live a long, happy life breathing like crap. If you’re an athlete you’re missing out on a golden opportunity if you aren’t working on your breathing.
I’m talking better endurance, better spinal stability and stronger lifts. I’m not selling you snake oil. Learn how to control your diaphragm along with the structures that connect into it and you will be a better athlete.
7. Everyone is deficient in Vitamin D.
Well maybe not everyone, but basically everyone who’s blood work I looked at this year was deficient in Vitamin D. Get your Vitamin D 25-hydroxy tested. Optimal values should be in the 50-80 ng/mL range.
8. Everyone should be taking a probiotic.
Probiotics have been main stream ever since Jamie Lee Curtis became the spokesperson for the probiotic yogurt, Activia. Well, in the past few years more and more research has been done on gut health, gut bacteria and the link between poor gut health and neurologic disease. A probiotic is an easy way to make sure you’re getting healthy gut bacteria. You can also throw in some fermented foods like pickles, greek yogurt with live cultures, kombucha tea and kimchi. Adding a probiotic into my daily diet has had the best health effects on me than anything else I’ve done this year.
Check out the great conversation we had about functional medicine for more info on this.
You’ve got to get high quality sleep. It’s so important for so many body functions. In the worlds of Dr. Kirk Parsley (check out our podcast with him if you haven’t listened yet) “Good sleep is the most anabolic thing you can do for your body.” Get 7.5-8.5 hours ideally. Make sure the room is pitch black and cold.
10. Do something to utilize all that time you put in at the gym.
Play a sport again. It doesn’t have to consume your life like when you were in high school and college. Pick something and start utilizing all that great training you put in at the gym. Go out there and dominate some overweight frat boys and guys with dad bods. You’re a fucking stud, go dominate!
I was challenged earlier this year by one of my patients. She bet me that I couldn’t make it 3 minutes without thinking about something. I took the bet and lost. I made it about 20 seconds into my 3 minutes of mindfulness meditation before I started thinking about my to do list. Add in just 3 minutes of mindfulness meditation everyday. If you don’t have 3 minutes to work on your own mental mindset then you have bigger problems.
12. Do or do not. There is no try.
Yes, I stole this from Yoda. We’ve been re-watching all of the Star Wars movies with my 4 year old son. He told me that I didn’t know the power of the dark side the other day. I think we’ve created a Star Wars maniac.
What this means for you is stop telling other people and yourself that you’re going to do something. Stop putting things off until tomorrow. Tomorrow is a magical place where nothing ever happens! Whatever it is that you’ve been holding off on, do it this year. Run that marathon, do that triathlon, start that business you’ve been thinking about, ask that cute girl at your CrossFit gym out on a date. Stop procrastinating, just do it already.
13. Earn your carbs
This is something I got from my friend and podcast co-host, Joe Szymanek. I love his philosophy of earning your carbs. Carbs are great! In fact, you could argue that it’s the most delicious macronutrient.
Too many carbs, along with poor intake timing and a sedentary lifestyle will turn you into a fat lazy person with type II diabetes. Timing your carb intake around your training session will help you recovery and have more energy. You’ve gotta earn your carbs.
14. A pyramid is only as tall as it’s base.
This is something that Louie Simmons has famously said. What he means by this is you have to build a strong athletic base if you want to build a serious athlete.
If you can’t control your own spine under load, do you think you’ll be squatting 1000 pounds? That’s what people that go to work with Louie Simmons do on a regular basis. They work on their base constantly so they can build a taller pyramid.
You have to prioritize the fundamentals and doing the non-sexy auxiliary work. Think reverse hyper, hollow to arch progressions, single leg deadlifts and good mornings. This stuff is just as important as doing metabolic conditioning.
15. Listen to podcasts
I might be slightly bias because I have a podcast but it’s the truth, podcasts are the best. It’s completely free and you can learn some amazing things by listening to podcasts. I can tell you without a doubt my business and my professional skill set have improved because of listening to podcasts. Try it on your commute to work. Just think, if you’re sitting in your car for an hour a day, 5 days a week and you listen to a podcast 50 weeks out of the year, you’ll listen to 250 hours of content a year. That’s a lot of information! If you don’t know where to start, check out Doc and Jock first.
Thanks for being a part of the Athletes’ Potential family in 2015. Have a great 2016!
Get Our Report 5 Movements To Bulletproof Your Back and start off the new year right!
August 2010, I remember it like it was yesterday. My family and I flew to San Antonio, I was in my dress blues and very excited to have finally graduated from the most difficult academic course I had ever studied. I graduated from the U.S Army Baylor DPT program and was ready to change the world.
I arrived at my first job as the Assistant Chief of the Schofield Barracks PT Clinic (that’s in Hawaii; not a bad military assignment). After a few months of grinding out a fairly high volume patient load, I began looking for opportunities to get out the clinic. One of these opportunities was to help teach new program called the Advanced Tactical Athlete Conditioning program (ATAC, currently run by a stud ATC/CSCS, Neil Santiago). It was great; I taught speed, agility, distance running techniques and some basic bodyweight training. I was also able to positively impact soldiers before they got hurt by improving their conditioning and movement quality.
A few months later I moved to the 2nd Brigade 25th Infantry Division as a Brigade Physical Therapist. I was given 100% say over what I did from a day to day basis. I immediately started setting up my schedule to teach all kinds of strength and conditioning courses. I taught courses on POSE running, basic programming, Olympic lifting, powerlifting, speed, agility, and advanced bodyweight training. I noticed a trend that the more I taught on strength and conditioning the fewer patients I would see for injuries. What an obvious conclusion, right? As the soldiers learned how to train their bodies to move more efficiently they experienced less injuries.
When we saw patients the emphasis focused on movement, retraining, and education on how to maintain an optimal body through mobility techniques. We saw our average visits per patient drop and people started taking ownership of their own rehab process. We didn’t count reps for people. We were teachers and expected our patients to do what we taught if they wanted to get better.
Fast forward 5 years and here I am writing this blog before I go teach squat mechanics at a local CrossFit gym here in Atlanta. I may not wear a uniform everyday or try to fix a bunch of broken soldiers, but I still teach those same core concepts. This really is the future of physical therapy: education. More specifically we have to teach movement education. This is a blend of strength, conditioning and what we learned in physical therapy school (diagnostic skills, primary care, manual therapy, neuro re-education). I’m going to make a bold statement... the hybrid strength coach/physical therapist model is the future of physical therapy.
Recently, a fellow PT colleague commented on a blog I wrote Four Keys to Picking the Right Physical Therapist. In her comment she summarized my post by stating if she doesn’t do CrossFit and deadlift, then she is not a good physical therapist. Although she was being sarcastic, she was offended by my post. I replied that you don’t have to do CrossFit to be a good PT but you have no excuse to not deadlift regularly. Why would anyone who understands even the basics of strength, conditioning and movement tell someone to not deadlift unless they had significant trauma that stopped them from doing so? What are you going to do, ask other people to pick up your grocery bags off the ground for you the rest of your life? Sorry lady, but you need to deadlift. The deadlift isn’t dangerous, being a physically weak person is dangerous.
This mindset must change and it starting. Physical therapists across the country are flocking to the “PhysioCoach” model. If you’re an athlete that is injured, you need to seek out a PhysioCoach Physical Therapists. Their knowledge will not only help you recover from injury but help you reach your athletic goals, whatever they may be.
I’m excited for the future of Physical Therapy and I’m looking forward to help lead the charge!
If you're in the Atlanta area and you want to work with one of these hybrid physical therapists let us know. Leave us you're information and we're contact you for a free 10 minute phone consultation to see if you're a good fit for what we do.
“Give a man a fish and he eats for a day, teach a man to fish and he eats for a lifetime.” -Unknown or was it Jin?
I recently had a patient that drove in from Orlando to work with me for two hours. He’s had lower back pain for about 5 years and it started while he was in the Army as a medic. He didn’t sustain any type of combat trauma that caused the back pain. It literally started while he was doing a workout one morning. The workout involved kettlebell swings and he felt a pop in his back toward the end of the workout.
Fast forward 5 years later, and he still has back pain. He’s tried physical therapy, chiropractic, acupuncture and even took up yoga in the quest to fix his back pain. None of these things worked so he made the 7 hour drive to Atlanta to see me (ironically driving was one of the activities that aggravated his back).
He showed up with a pretty classic presentation for back pain. Poor hip mobility, underactive posterior chain and really bad posture. We completed our evaluation and decided on a plan. First, we’d do some dry needling to the lower back and hips. This is a great technique for pain reduction. This allows us to work on things that would otherwise be painful to help regain strength and mobility.
Following a short bout of dry needling, we spent the rest of the time putting together a plan of what this individual needed to do everyday in order to fix his back pain permanently. We literally spent over an hour piecing together 5 exercises that I wanted him to do religiously.
So how did he do? Well I just got an email from him about a week ago that said he was able to sleep through the night and is virtually pain-free consistently for the first time in 5 years. We get a chance to help individuals like this all the time and in many cases help them get out of chronic pain permanently. So why did this guy have to drive from Orlando to Atlanta to see another physical therapist? The answer is that no one was teaching him, they were all just trying to fix him.
There are 168 hours in a week. Even if you went to see a physical therapist 3 times per week (the standard physical therapy prescription in many cases) that’s still 165 hours of the week that you are on your own. What are you doing in those 165 hours? Are you prioritizing sleep correctly to help with healing? Are you eating the right things and staying hydrated? Are you doing corrective exercises and mobility work? Are you getting out of bad positions as much as possible during the work day? Are you rounding your back every time you pick anything up off the ground?
Resolving long lasting and chronic problems comes down to compliance from you! It’s my job to teach you what you need to know and persuade you well enough to actually do it. If you’re dealing with a chronic issue and are sick of being in pain or avoiding certain activities, it doesn’t have to be that way. We see patients from all over the southeast just like you and they get better. They run 10k races again (the Peachtree race if you’re in Atlanta), they play with their kids without throwing their back out, they compete in local CrossFit competitions and they wake up in the morning without feeling like they have been hit by a truck.
At Athletes’ Potential we may be physical therapists but more than anything we are teachers. You have to learn how to take care of yourself. You have to be empowered with the right information to make huge long lasting changes.
If you’re in Atlanta or the southeast, for that matter we’d love to help you. Give us a call at 470-355-2106 or fill out the contact request below and we’ll talk on the phone to see if you are a good fit for what we do.
Full disclosure, I hate to run. There, I said it and now I feel much better. I actually have more of a love/hate relationship with running. I love the science and technique of running mechanics. I’m actually fascinated by how you can squeeze more speed and efficiency out of someone that just assumes they are a bad runner.
When it comes to my personal desire to go for a run, it’s just not there. I blame the Army. They kind of ruined it for me with the whole wake up early and do a forced run almost every morning. Because everyone in the Army is technically a runner, we would see a TON of running injuries. I would guess that 50-60% of what I typically saw was running related. That’s literally thousands of running related injuries that rolled through my office during my time on active duty.
Now that I’m out of the Army and have a private physical therapy practice in Atlanta, I’m still seeing runners. I’ve actually developed some good relationships with a few of the bigger running groups here in Atlanta and it’s been a blast to help these athletes get better fast. Healing from an injury is great but do you know what’s cooler than that? Winning!
As a runner you are competing against others when you run but for most of us we are constantly competing against yourself to get a personal record (PR) on a race. I recently had a runner come to see me for some plantar fasciitis. If you are reading this and have actually put some decent volume in training you probably cringe when you hear the words plantar fasciitis. It’s basically the kiss of death for a runner and will take you out of your sport for a long time, if not fixed.
This individual had seen everyone under the sun for this issue including, podiatry, chiropractic, massage therapy and a different physical therapy group. This problem had been going on for about a year at this point and he was obviously frustrated when he came in to see me. He was also very surprised when I told him that we had to watch him run. Can you believe that? This guy had been to multiple other medical professionals and not a single one took the time or even thought it was important to watch him run. This is crazy! What if you went to a mechanic and he didn’t actually drive your car around to see what the problem sounded like or how the car acted when it was running? That's basically what had happened to this athlete.
After watching him run it was pretty obvious he ran like crap. I won’t get into all the specifics of the running mechanics in the blog but just remember my professional diagnosis was not plantar fasciitis, it was you run like crap. My prognosis was good. It was forget about your foot pain, we are going to make you faster! He was also had really bad hip mobility and tons of hip weakness. We spent the first two visits working on run form and getting some of the pain down in the calf/foot with soft tissue techniques to include Hawk Grips work and Performance Dry Needling.
Over the next two visits we re-tooled his running form even more and added in strength/mobility work for his hips. Think of your hips as the engine of movement for running. If you have poor hip strength/mobility it’s like riding your bike around on flat tires. Sure, you can still ride a bike this way but it's a hell of a lot easier to ride with with some air in the tires. Running is hard enough, don’t make it harder than it has to be.
Below are the exact 3 exercises we nailed down for this athlete to do to help fix this chronic foot pain and none of them have anything to do with the foot directly. The order of completion was this.
Pre-run (videos below)
-Anterior Hip Mobility Opener 2 minutes per side
-Band Hip Pull Throughs 2 sets just to muscle fatigue not failure
-Band Hip Side Steps 2 sets just to muscle fatigue not failure
This athlete typically ran 3 days per week so that’s all the strength work we added in for him. He did complete the anterior hip mobility opener 2 minutes per day regardless of if he ran or not that day.
So what was the result? 4 visits over 6 weeks. 5 minute PR on his 10K time. Oh and no foot pain. If you’re having running-related problems, fix the cause of the problem not just treat the symptoms.
If you’re in the Atlanta area and are a runner that has been dealing with injuries we can help. We’d love to chat for a few minutes and see if you are a good fit for what we do. Fill in the contact request below and we’ll set up a free 10-minute phone consultation with one of our Performance Physical Therapists.
Dr. Danny Matta DPT, is a Physical Therapist and Strength Coach based out of Atlanta, Ga. He teaches on the topics of movement efficiency, mobility and injury prevention internationally. He is also the Director of the Tactical division of the renowned MobilityWOD group started by Dr. Kelly Starrett DPT.
Full bio here.
“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!
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!
It’s 5am, you’re up and getting ready for work. You got 6 maybe 7 hours of sleep last night and you’re off to crush the day at the office! Coffee in hand and listening to your favorite podcast on the drive (most likely the Doc and Jock podcast). You get through your normal day and then sit in traffic for 45 minutes on the drive home (Atlanta traffic can be rough). Once you’re home it’s family time. You haven’t seen your kids or wife all day and all you want to do is hang out with them. Before you know it, it’s 7pm. Your kids are acting crazy because they don’t want to go to bed and you’re starting to get hungry. Once the kids get to bed you have a couple choices:
I know to many of you this example may or may not resonate. This is basically my schedule 3-4 days a week. For many people lacking time is a common frustration. For me, it happens to be dictated by owning a business, having kids, enjoying spending time with my wife and creating online content like this blog post.
Of all the options above I typically go with option 4 on a day like I explained. Hitting a short but intense workout before I eat dinner is an easy way for me to keep some regular training in my schedule on busy days like this. My preference for these late evening workouts after a hectic day- the kettlebell!
I feel everyone should have at least one kettlebell at their house. We have two at mine, a 24kg bell and a 16kg bell. They don’t take up much room, are pretty inexpensive and they give you a ton of options when doing a training session at home.
Here are a few examples training sessions I like to do that just involve one kettlebell.
As many rounds as possible in 20 minutes. 24kg bell for men and 16kb bell for women.
-10 overhead swings
-run 200 m
-5 power clean and jerk each arm https://www.youtube.com/watch?v=bjKGrZ7-pWQ
-run 200 m
-10 goblet squats
-run 200 m
Perform 5 rounds of
3 Turkish Get Ups each side
20 russian swings
10 head cutters https://www.youtube.com/watch?v=tJA07NpN7pM
Rest 1 min
Every minute on the minute for 15 minutes
5 single arm KB snatches https://www.youtube.com/watch?v=g3c73NahdjU
Complete each round as fast as possible.
Throw in some midline stability work at the beginning or end and you have yourself a respectable little training session. Not only that, but in the time it would take you to drive to the gym and back, you completed a training session.
You may not be headed to the CrossFit Games doing just these type of workouts alone. Chances are, if you’re reading this you aren’t going to the CrossFit Games regardless! Staying committed to regular training sessions is important for moving well, staying fit and being able to keep up with two crazy kids.
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.