Part 1: The Lumbar Spine’s Fundamentals
If you are reading this blog post, you likely are having back pain or have had back pain in the past. You understand how debilitating it can be. You understand how much it can take away from you. You are not alone.
Eight percent of all adults experience chronic back pain. Back pain is the sixth most costly condition in the United States. Back pain accounts for over 12 billion dollars of medical expenses every year. So yes, lots and lots of people have back pain!
It is rare that a day goes by in my practice that I do not see a client with some sort of low back pain. So, in this short two-part series, I’m going to go over some quick things you can do to consider if you are having low back pain and are continuing to want to exercise or play sports.
Fundamental 1: Resume activities as tolerated
One of the biggest factors to accelerate recovery in low back pain is to resume functional activities as tolerated. It’s not bed rest. It’s not stretching. It’s using your back and body as tolerated.
This tells us three things:
First and foremost, we are resilient! Even with pain and dysfunction, if we are able to do things as tolerated, we will recover faster!
Second, it tells us that despite the pain and dysfunction, we need to look at ways we can improve our mechanics in order to return to functional activities faster. Resting for too long is not the best option to regain our activities that we’ve lost due to the pain.
And third, it tells us that we need to figure out a way to still respect the pain while not being fearful of it. Simply listening to your pain, being brave, and trying things out gently is a key part in progressing as tolerated.
Fundamental 2: Coordinated Movements
This is where my expertise as a doctor of physical therapy comes into play. I am an expert at understanding movement. Both functional and dysfunctional movement patterns come into my clinic every day, and it is my job to ensure that even with the pain that your back is experiencing, you are still able to do things as tolerated to best get you back on your feet.
So how do I do that?
I ensure that your coordination at remaining in neutral spine position is solid before anything else.
Try the “bird dog” or “dead bug” exercises to see if you have reasonable spine coordination. If your spine moves significantly from its normal resting position during these movements, you definitely have a coordination deficit.
Of course there are many more tests I use to assess for appropriate lumbar coordination; however, these are just two that are tried-and-true in my practice.
Fundamental 3: Strength
Once you have gained a reasonable amount of coordination in keeping in neutral, we add some intensity. Longer holds, more variance, more load… all are options depending on the goals of the client.
Aim for two minutes of great coordination with dead bugs and bird dogs to understand what a strength requirement standard should feel like.
The key variable is the coordination. Once coordination falters, you have to work harder or regress to something easier.
Once these three fundamentals are working at a reasonable level, your function should definitely be improving. If you’re still having difficulty after working on your day to day activities, your coordination, and your strength, you may need more guidance from a physical therapist.
My job is to guide you through low back pain that isn’t responding to basic exercises. If you think that you’ve tried all you can, feel free to reach out to receive some more specific guidance to you and your situation. We’re here to help!
Look out for Part 2: The Hip’s Role in Low Back Function - coming soon!
Thanks for reading,
Dr. Marcus Rein, PT, DPT, CF-L2
Many people run because it can be done anywhere, is a year round activity, requires minimal equipment, and has excellent cardiovascular benefits. Over half of all runners will sustain a running-related injury while training and around 90% of marathon runners will experience a running-related injury.
Reasons to increase your step rate, and reduce your step length, while running:
Small changes in your step rate, or running cadence, can have a major impact on your running resilience. Your step rate refers to how many steps you take in a minute while running. Increasing the step rate while running at a constant speed will decrease your step length. Think about walking across the room vs. jumping across the room. Taking more steps while walking requires less impact forces than hopping the same distance.
“Overuse” injuries due to running are often a result of these higher loads of force while landing. Some people can even hear themselves landing with louder steps as they run. Your speed and stride length will influence the impact forces your joints, tendons, and ligaments are required to absorb while running.
Increasing step rate has a positive impact on the ankle, knee, and hip joints. The knee joints were most positively affected by increasing step rate, with a 20% reduction in impact forces with only a 5% increase in step rate. This increase in step rate will create a reduction in stride length while maintaining the same running speed.
There are many positive benefits of running with a shorter stride and higher step rate. A smaller stride length allows for you to land with your body’s center of mass over the landing foot. This will lead to less impact forces in the knees, hips, and ankles while running. Increased step rate leads to more efficient running mechanics. Improve your running economy with reduction in “up and down” wasted motions while running. You can also reduce the risk of shin splints due to the reduction in shock absorption during landing while running with smaller strides.
Things to think about after committing to increasing your step rate and reducing your stride length:
Thanks for reading,
Sam Gillespie PT, DPT, OCS
During the month of September we focused our efforts on helping YOU combat nagging knee. It's super helpful to take the time to watch the first video before moving on to the rest. You need to understand the types of knee pain and where yours might be coming from before you can start to solve a problem. As always, reach out to us if you're not getting better, you have questions or you're ready to get out of pain and start living your life.
Knee Pain can be frustrating. However, in order to improve it, you need to know what you're dealing with. Are you having more mobility related issues or stability and control issues? Confused? Watch Dr. Danny walk you through 2 simple tests to see which category you fall into.
What if you don't have enough mobility and you have knee pain? These exercises will give you hope! Walk through these exercises with Dr. Jacob and see if you can improve your mobility and decrease your knee pain.
1. Couch Stretch- one of our all time favorite drills- but focus on the cues.
2. Knee gapping- if your pain is coming from your joints, this is the exercise for you.
3. Hamstring mobility- grab a band and work on your hamstring mobility to help improve your knee pain.
Are you having knee pain? Dr. Marcus is going to walk you through 3 exercises to strengthen your leg to decrease knee pain and get stronger.
1. The first one is a classic- wall sits. He throws in some twists for those of you that think you're too strong.
2. One way to get strong legs is to target your hamstrings with hamstring roll outs. Move out as far as you are comfortable while maintaining form.
3. Last we want you to target your glutes.
Go through these and see if you can help decrease your knee pain. If not, or these are too painful, you need an expert to help you
If you're having knee pain, here are 3 cues to help alleviate some pain.
1.The first one, is the simplest, SIT DOWN! Compare this to your squat and see how much further back your hips AND knees are.
2. Practice squatting without sitting and focus on keeping your knees back. Do not let your knee come over your toes.
3. Focus on pointing your knees out towards your pinky toes. Do not let your knees come into your big toe. Knees out!
Give these a shot and see how you can improve any lingering knee pain. Questions? Give us a call at 470-355-2106.
So here's the question, how do active people in the Atlanta area, stay pain-free and live the active fulfilled life that they deserve at any age. This is the question. And this podcast is the answer. I'm Danny Matta and welcome to the Active Atlanta Podcast.
Active Atlanta Podcast is sponsored by Athletes' Potential. And at Potential we help active adults stay that way. Pain-free and active during the sports and activities that they do. For life. We do this by working on four different areas. That's movement, nutrition, stress management, and sleep. When we optimize these four areas, you feel better, move better. You live better for life. Head over to athletespotential.com to learn how we can help you stay active for life today.
What is up Atlanta and welcome back to the Active Atlanta podcast. I'm here with yoga, enthusiastic as well as a software executive bad-ass Butler rains, guys. This guy's incredible. He's doing a lot of things and what's really cool. I love getting people like Butler on the show because the, the diversity in skillset and knowledge is.
Awesome to see. So Butler without further do, how are you doing my man? How am I doing well, man. And I'm flattered by that opening to kind of thank you. No, I hope I did it justice. Cause you know, like we were talking a little bit about the show guys. I'm excited to bring Butler on because he is just. A wealth of knowledge, as it pertains to yoga, he is, oh, wealth of knowledge as it pertains to product design.
So if you have any questions about that, I'm sure you can reach out to him on that too. But not necessarily the point of this show, but like he, he's just very passionate about a lot of different things. So I've had the opportunity to talk to him and to clinic as well. He's got a vast background in art, which is wild and crazy.
Cool. So just a wealth of knowledge. And so Butler, I guess, with, with for our audience here, can you just kind of give a background. Who you are and kind of like how you got into yoga of all things. Yeah. Wow. Yeah. That's a loaded question. Loaded question, but I'm going to, I'm going to break it. I'm going to break it.
Give me so who am I? I, I'm just a country boy from middle Georgia and had a very, very fortunate journey. How how I came to yoga or to find a passion. Enthusiasm for yoga. I'm an addict in recovery and one day out of desperation, I was 240 pounds or so I was drunk and just not well.
And I remember sitting above a garage in a room, I rent it out and. Googling up beginners because I thought, I thought it was the only kind of exercise I could possibly do because this southern boy is his understanding of yoga was like, it was stretches that people did at the health center at the hospital, in his small town.
And boy, I had no idea what ride I was about to go on. And so I accidentally found a beginners class in a stronger year. Okay. Which is a very, very physical discipline, the eight limbs of yoga. And I'm part of the secret, I just kept showing up.
So teachers that have a lot of love in their heart, I just kept showing up, kept working it and great things began to happen. So I began to explore. How yoga and the practice of yoga enabled me to recover from what was ailing me and then how it has helped me get to where I am today.
That's awesome, man. What you know, I've had the opportunity to talk to a couple different people that have used exercise and fitness and wellness as a way to overcome personal battles. So did you. Did you originally kind of look up yoga as a way to get in better shape, or was it a way to kind of help you battle your addiction or, or was that just an added bonus that kind of like bled into that scene as well?
Yeah. Great question. It was an added bonus. So I was. Again, I was very overweight, striking constantly, which I know guys, you can't see Butler right now, but he is nowhere close to what? Two 50. Yeah. Nowhere near COVID definitely has a few pounds. I'd like to shut off, but but they do take you for telling your audience that.
But no, it was really. You know, just feeling bad about yourself and like being really overweight and unhealthy, like sick looking. And I just needed to start moving for sure. I felt like it was, it was like an internal calling. Now I had no idea how this would affect me in recovery, and that's really the, the magic of yoga and I, and not to play into all the normal things people say about yoga, but the mind, the body mind connection is a real huge component for sure. And in particular with a style I do. And I think this is often lost in young and the west is it's about showing up every day, right? You show up every day and you tell your mind, I am doing this every day and that the trip would have Chagas.
It's the same poses every day.
Okay. Every day. Wow.
You do about an hour and a half of poses. It depends on where you enter the practice. So for me, 240 pounds alcoholic just had either recovery for drug addiction. It was five poses I did every day. Right. I walk in, set up. Teacher helps me to the spot.
Now I'm practicing an hour and a half. Don't stop. Just breathe in, breathe out, move, you know, 50 something poses. Yeah. That's you work through a lot of acrobatics. Oh, I, as best as I can do that, I'm 44, but yeah, but you know that, that's the, that's the part, that's the, that's why I'm so fascinated with it as a subject is because now, so this happened like.
Out of shape. I go into this yoga Shala who had started doing these same five poses every day. And I got six. Then I got seven and my breathing got better. And all of a sudden I started really being like, I think I can be completely sober. I think I can quit drinking. I think I can improve this. I started reading again.
I started writing again. Rewind or not rewind, but Paul's, I pick up the yoga sutras of Patanjali the Bible of yoga written ages ago. And you read it and it describes exactly what happened to me really. It's just like reading, like if you do these things, these things are gonna happen and you're like, there's no denying it.
Yeah. Wild. Yeah. It's it's, it's always, so it's a real experience, I guess you can say when, especially like, you know, in the world of healthcare and wellness and fitness, there's a lot of literature that's written or a lot of things that people say, but when you experience it to a T like that, it's, it's really almost gives you chills, you know, especially like when you read what kind of happened on your animal and experiment there, you know, I don't remember.
Yes. I remember it like it was yesterday. So I had tried. You start yoga, you get a little bit, you know, as anything you start, you like get a little bit more interested in, I've tried to read the yoga sutras. I'm like, this is esoteric. This sounds like a mock up to me. But then as for years, really with the only goal of, I didn't want to be overweight and I wanted to become more attractive than a bit healthier for sure.
But then all these other changes started happening and then randomly one day I picked up. And I started reading it and it all makes sense. And I'm like, it makes sense because I experienced it for sure. The timing was right. The timing is right. Timing is everything. And just about everything in life. So like the timing of finding a great fiscal year.
Hey, you know, COVID, hasn't, COVID had its purpose right now. Yeah. So that's awesome. So how long have you been practicing yoga then? Oh, man. So, so wrapped up in my story I wanna say five years, four and a half years, somewhere in there to have to go back and look, man. So we'll call it somewhere anywhere between four and five years, then 47,000 years.
Yeah. That mindset of just showing up. And it's hard to dedicate your, your brain space to anything for an hour and a half at a time, especially like, like truly being dialed in, you know, like I think people will be amazed at what you can accomplish when you can focus on one thing. Truly like in a deep mindset mindset process for an hour, hour and a half at a time can see, can accomplish a lot and to do that every day can be fatigued.
Absolutely. So do you find that your practice and being able to do that has led to your ability to kind of like branch out into some of these other things that you've become so dedicated and good at no. I might offer a different way to look at it at it. God, this might sound cheesy, but I. I can I can kind of see the yoga and the other things.
So for instance in the same way, like I didn't, I did have an appreciation of art. Sure. I grew up in again, a small Southern Georgia town and wasn't exposed to it. I came to Atlanta and I was interested, but I didn't know how to like, get the scene and all these fears you have about going to try something.
Yeah, where I really found my love for art was going to galleries and not, you know, like gallery might just be one route, someone showing their art and it's not just going in and having a beer and walking through and shaking hands and walking out, but like stopping, really stopping and looking and absorbing the piece that was in front of you.
Yeah. Right. That's kind of what yoga teaches you, right? How do you, how do you focus? Because it concentrating on what you're doing, what's in front of you shutting out everything else. Right? So I've kind of found that a century, if you will. And so, you know, that that's how those two things are related and another things like it's, it's so much of this Joeget philosophy.
I'm sure you see it with athletes who get into flow and things like that. It's really just teaching yourself, training yourself that you can, you can control your mind. You don't have to be distracted by every little thing that comes by. Like, that's what, that's what the world does to us, right? Like you're talking to you on a phone but you can train your mind to focus.
And so a lot of times people are starting out in yoga and I work with them and I'm the president of a nonprofit called The Trinity foundation that we give scholarships to people in recovery so they can go to yoga classes. Awesome. Right. Because we know there's a lot of us on the board or a parlor organization have, are in recovery.
We know that it's about retraining and rewiring your mind. It's on often say with yoga, you just show up. Yeah. I don't care if you do 50 poses. I don't care if you do it for hour and a half. I don't care if you do it for 30 minutes. You show up to top of your mat and you might just put your hands in prayer.
You might just raise your hands. Doesn't matter. The simple act that you've committed to showing up and you showed up, teaches your mind. You're in control.
For sure. Yeah. 100% I think you know, w what's really interesting about yoga and really just about it's. It's so interesting to me, where in the world of fitness and wellness and health, all these different disciplines try to act about, I try to talk about how different they are, but, you know, and, and discredit other arenas of thought, or try to discredit other things, but, you know, as the world evolves, we see more and more overlap in thought process and yoga is no different from, so like, you know, you take the, like the breath work that you're talking about when you do yoga, like that's a huge part of sports performance now, you know, and that's a huge part that that especially like sports psychologist or there's this course called art of breath.
I've mentioned a couple of times on the podcast, but they, they teach you how to like, you know, use different breathing techniques to control your breath.
And to a lot of people, myself included when I first heard the core, it's kind of groundbreaking, right. But then you start diving into the reaches of like, holy shit, this has been practicing for centuries, the other disciplines, you know, like things like yoga or, you know Pilates, even just to some degree, which is just, you know a different variation, I guess you can say.
What do you notice, do you, do you dive into any other forms of fitness or than yoga at this point? Or? Cause I know you worked out at my buddy, my buddy Sam's place or at least, you know, Sam and, you know, Smokes Fitness. Do you, do you dive into that weight training at all? Or, or do you like to stick with yoga?
No. I throw kettlebells every once in a while, you know if I, if I may expand on that a little bit, I think you'll find this interesting for sure. So you know, you've been helping me with some of my movement and mobility. So thank you for that. But you might ask, someone might ask, well, why, why would someone who practices yoga for years and has a somewhat daily practice?
Why would they need the help of a mobility coach? Right. Well, yoga's been practiced for thousands of years, but we are different as humans, right? We sit in front of a desk and I've been in this chair since eight o'clock this morning. Don't tell my doctor. And you know, in your, your shoulders are down and you don't have strength in the areas you might say, even in the seventies and yoga is really discovered and brought to the west when you discovered in the west.
And so you could go through these things all day long, but sometimes your body. One of the things we're working on right now is my internal hip rotation. Right. So four years practicing yoga, flexible as all get out how hard folding. Right. And that's blocked. That's not going to change for sure.
Right. And so sometimes you need that additional support. And also that also, plus the strength train, you do a lot of where people really get hurt, especially in a strong, in other kind of like power yoga is doing. Okay. Yeah. So like push up with your elbows by your side, if you will, right. Always get hurt.
They get hurt because they're most people's shoulders kind of come forward and you're just pounding away at your what's your bicep tendon there. Yep. Right there. Yep. Right. And so are you, you don't have the strength. You'll have to help me here. What's this called? And you're like, right. You're right.
Most people don't. And so you need to do strength training. Right to keep yourself from getting hurt and something that's supposed to be super helpful, like yoga. Right? And so there's a lot of, there's a lot of overlap there. Like I think people think yoga fixes everything. That's not true, right?
It is, it is a practice, a method that's can be super helpful, but you also have to take care of your body and protect it's education. Right. And so learning how your body should move, learning, where you might have to efficiency and strength to go support whatever practice you need. I think it's kind of a cancer, like weight training to play football, better basketball, better football, better.
Yeah. So short answers. You're not swinging some kettlebells. I do I do some exercises that kind of help open me up and yeah. And I think it's very complimentary. Yeah. Oh, for sure. You know, I think you know, it's really interesting and I get it to a point like, W with youth athletes, you it's, oh, it's almost redundant at this point.
How much we hear, like don't specialize early. You know, kids, these days are specializing too early and you know, you need to be a multi-sport athlete. You know, it helps your athleticism and helps with injury prevention helps with creativity all these different things. And then what do we do as, as adults we specialize and to the fitness realm that we love the most.
And I get it. We're all adults. We have very busy lives. We've got an hour, maybe an hour and a half to ourselves, if you're lucky. And then and you're what that timeframe, if you're going to, if you're going to do something for you, you typically want to do what you are good at, what you enjoy to do. So, you know, say I take someone with one of, some of the powerlifters that I work with and I try to tell them.
All right. I want you to go do an hour and a half a yoga, you know, like they're going to look at me like I'm crazy. And but there's components of it where it is super beneficial for a powerlifter to have some more, especially like a sport, like an Olympic lifting. Let's take that. For example, there's a ton of mobility that's required and the mandate out of that sport.
So if you're not trying to do some type of cross training, if you will. And cause that street goes both ways. You know, we hear it all all the time. You can't go wrong going or you can't go wrong getting strong, right. Like strength, training, fixes, everything it does for sure. But it's a, but it's definitely a two way street.
And in terms of you should be a little bit of, you should be able to run a little bit. If you're a runner it's going to help with your aerobic capacity. Now you should be able to have some good mobility as a, waitress, as a, an Olympic lifter as a or somebody who focuses predominantly on waitress.
And a lot of times that's where these yoga positions and these yoga styles come into play. If I might rip on that a bit so, you know, obviously the Asana, the poses and yoga can help open you up, can help them ability. A lot of things we do at your place, like can be mimicked in some of the poses and bring awareness.
But we focus a lot on ASA and yoga poses because that's your entry point to yoga. If you go to a studio, you take any of your class, you start, you raised your hand, you start falling over things, but as she's progressing yoga, Asana, pranayama, which is breathing part of your heart, which is withdrawal.
Diana, which is concentration. So you're actually using the poses to kind of climb this ladder or if you will, to get to a point of ultimate concentration. Okay. Right. But you can find that in any exercise, any fitness routine, any thing like that, that you enjoy. Right. Get it. Like if you love swinging kettlebells.
Right. Can you do it with proper breath? Can you do it without being distracted by everything? Because it's have, can you get in the state of focus and calm your mind and helps you find kindness, inner internists, inner peace, if you will. Oh my gosh. This is interesting. I never thought of it that way. In terms of like using yoga as a technique or a strategy for.
Focusing on a movement strategy. So that's over and just fun or anything that you do. Yeah, the the second Sutra yoga, the second searcher and yoga sutras of potentially yoga is the cessation of the fluctuations of the mind. It says nothing about poses, exercise, nothing it's about using these poses.
You're breathing. Withdrawal from census, so you can reach a state of concentration. That's cool. Yeah, that's right. Yeah. And so you can do these things no matter what your movement is for sure. Right. But can you control your breathing while you're moving? Right. Can you, can you cease to be distracted by other things while you're moving?
So this may sound ignorant, I guess, but is there in that, in that series of flow that you're kind of talking about there in terms of getting to a total concentration or total like centered miss, I guess you can say, what is that driven from like meditation techniques or meditative techniques, or is that a huge cup?
Is meditation a part of yoga or are those two things. That is very much a part where it might be different from what people usually ascribed to meditation is. So if you think of the eight limbs of yoga, so most people are familiar, we're just starting to Midwest. People are familiar with poses, Asana, pranayama, breathing control, probably a heart withdrawal from the consensus, Diana which is concentration Dharana, which is meditation.
And it's somebody which is. You're absorbed into the universe. And so meditation is a piece of yoga. Right. But the way yoga describes it is it's also different from just concentration. Yeah. Right. It's the next step, if you will. So you concentration, Diana is like, I'll look at a flame and I just stare at it.
The goal of doing that. I'm not seeing the things around me. I am basically teaching my mind. I can just stare at the state and not be distracted. Yeah, it does that. Then the next step is the object of which I'm concentrating as myself. Okay. Interesting. So you don't need the external object to, to focus, just focus.
Wow. Okay. Did they have to take some practice? There's no way you just jump into a class like boom. Got it.
That's the whole secret. It's always, always practice. It's just practice. You don't you don't achieve it.
Yeah, dude. That's that's speaking. You just show up. Yeah, that's great. So is there, so obviously you can become a co like a, an instructor or a coach, or a quote unquote guru with yoga, but like, what are their levels of like, is it like, is it like karate where there's there's levels and belts, maybe not belts, but are there levels of yoga expertise that you try to like, be like, I can do this pose and I can become a flame.
Is that like, so no. And yes. Let me, let me, let me talk about it a bit. Especially. So there's benefit to all yoga, if you will. And just a lot of different styles Chagas is it has a levels series that you I'm in primary series out of practice that for four years, my teacher says, well, go to second series.
And there is pride in that. Probably wish it didn't happen. Just like I do a second series. So I don't do primitive man. But the idea is, could you suspend that? The idea is if I just wanted to go in the yellow room, lay down my mat into sun salutations for an hour, we'd extreme with extreme focus and concentration.
That's good enough. I should not be attached to what series I'm in what level? I'm on. That's right. And so in many ways, I don't think you should ever judge yourself, but you would want to charge yourself like how well did I concentrate? How well did I breathe? How well was I not distracted by things outside of what I was doing versus how complex is the post data?
Do you see that? There's a, there's a nuance there for sure. Yeah. Cause it's not a. I love it. Cause you're, you're focusing more on the process and being like savagely good at the fund at the foundations versus trying to. Like just do something cool for Instagram essentially. Well, simple model for this is you talk about breathing earlier.
So if you, if you take breathing as candidate, the the gateway between poses and meditation, just to make it simple. Okay. There's kind of two things you have is known for poses and meditation breathing the, the gate. So take, remember me 240 pounds of going to Charlotte for the first time. I can barely do a sun salutation without breakout to sweat.
Right. But if I keep doing that over time, I start breathing comfortably in it. Now that I can breathe comfortably, I can concentrate in it. I could call my mind. That is, I talked about it, but that is yours, if you will, for sure. Right. You get, you get the more complex pose, but because you want to train yourself to be able to breathe in that pose, you can train yourself to calm your mind in that pose so you can reach that next state.
Right. And so really the complexity of the poses in many ways are just tools. So you convince your mind, I can breathe through this and I can focus through this and whatever's going on outside of me is irrelevant. Yeah. Yeah. I love that. I think you know, it's, it's pretty, it's pretty wild. What you. How doubting you can get or how hard it is to think about other things when you can.
Yeah. Yeah. That's right. You take that to your everyday life, right? Stuff that happens, drink too much coffee. So what excites you to get fight or flight then? All of a sudden you're making really rash decisions or reacting to things and which one it is like, calm yourself, breathe and focus and make.
Yeah. Yeah. I love that. I think I think it was NCS Atlanta Neighborhood Charter Schools or something like that, where they were talking about, or somebody was telling me that they, and this is all secondhand knowledge is in firsthand experience. So if I'm wrong on this answer. Yes. If anybody's listening, I'm sorry, but the teachers, there's, there's almost like a rule where the kids had to do.
If they're angry at someone or they're going to like tattle on someone or they're mad about something, right. They had to do like four box breathing patterns, and then they were allowed to kind of tattle on, but like what would happen is a lot of times the kid would lose interest or they would not be angry or they would talk in.
Be a little bit more comprehensive in their speech. And it was just it's. I love that because you're so right. Like the first thing we do when we get angry is we get in that fight or flight. We start breathing into our chest using our, or using our scalings, things like that and using very short breaths.
And if we can control that a little bit better than our decision making process becomes a lot easier. Yeah, absolutely. You see me? I just picked up my copy of The Dover Sutras. You said something to me, I go, you're talking to your audience. You're like, if I'm wrong here, like correctly, I fear I got Diana neurona wrong.
Oh my God. I want to correct it before I get off the podcast. Yes. I would not know the difference. You sound like you sounded great to me while I studied all the time. For sure for sure. I get that man. Polar dude.
So I don't want to keep you too long. I know you've been in that chair all day, so I want to give you some, let you enjoy your evening a little bit, but if anybody wanted to find out more about like, so, I mean, you're, you're on the board of a lot of cool things.
What was the board that you said you were a part of? Would that does the the, has like the foundation or the FA or the fundraisers or the yeah.
Trinity Foundation, T R I N. Okay. Trinity is three and Sanscript. And it's it was started by my yoga teacher. One of my yoga teachers, Taylor Himes.
He has a podcast as well when he talks to people in recovery and, and other yogis. And again, we, what we do is we raise money so that we can provide yoga classes to people starting recovery. Yeah. So it's supplements a recovery program or alcoholics anonymous or something.
Love it. Love it. So then if somebody wanted to reach out to you say you know, if they wanted to use yoga to kind of help them with their recovery process, or if they just wanted to find a bad-ass dude who, who is super knowledgeable on the topic of yoga, what would be a great way if you want to, it would be a great way for somebody to be able to reach out to you.
Yeah, absolutely. Or if you if I can help you in any way. And no matter what the topic LinkedIn, right? Butler rains on LinkedIn you can find me on Instagram. Just, my name is my handle. And so I, I encourage anyone, especially, especially if you're struggling. What's some type of addiction or kind of, we call sober, curious you know, if that's something that interests you and you can't figure out how to solve for it I'm usually keen to speak with people and I'm always keen to speak with people and, and kind of help them see that as possible.
And that, you know, it's not I just know one, it might. You know, anybody wants to drink whatever you want to do. That's cool. But if some people get to a point in your life where they want to change that, and they felt like kind of the world tells them they can't. And what I like to do is kind of put a message out there that it is real possible.
It's really possible. Thanks for giving me the space to say that. Yeah, dude, absolutely. Butler. I mean, you're doing great things for the community of Atlanta, really. And I'm happy to get you on the podcast. Love being able to give you a platform to be able to, to speak on that and enjoy the rest of your evening.
My man, thanks for having me super fun.
Hey, thanks so much for listening to the podcast today. If you want to find out more about our guests or about Athletes' Potential and how we can help you continue to be active and pain-free in life, head over to athletespotential.com to learn more.
With the CrossFit Open upon us and beach bod season approaching, people will be fitnessing. A LOT. With this, comes the opportunity for injuries to sneak up and leaving performance on the table.
People typically blame certain factors for an injury or lack of performance:
While these factors are definitely important to consider, there’s one that gets overlooked and is quite often the culprit:
I had a patient come in a month ago who was dealing with foot and ankle pain. It has been on and off for months, and she decided to get it checked out due to a recent exacerbation. She’s a ½ marathon runner who also does Orange Theory a few times a week. She was starting to increase her mileage for her ½ marathon coming up. I think you know where this is going…
Before trying to change up her running mechanics, change her shoes or blaming it on “overpronation,” we had a conversation about her training volume. I asked her how her running mileage and volume been. In this discussion, she said she went from 3 miles to 6 miles within a weeks time. BINGO. She was confused as she had previously ran this much mileage in the past, BUT... it’s been a couple months.
I also asked her about the first time she ever dealt with this same issue – she said she couldn’t really think of why it initially started – “maybe running form or my shoes?”. I asked her when she started Orange Theory – lightbulb went off. BINGO again.
Let me be clear – there’s nothing wrong with her doing both running and Orange Theory. There is when your body is not prepared for the demand of these tasks. This was and is a volume issue, and if you’re reading this, think back to a previous non-contact injury and see if you can attribute any other factors playing into that specific injury – moreso volume in this case.
Now, mobility, biomechanics, strength, etc., all play roles into whether we are operating as optimally as possible from a performance standpoint. For this patient, we did work on strength in certain areas and tweaked some things from a running standpoint, but the big component of her rehab was starting at a volume she could tolerate without pain or just a little, and progress forward from there.
Training volume falls under the umbrella of Load Management (coming in Part 2) and is a big reason why injuries occur.
Some common methods of measuring training volume include counting the number of sets to failure, the volume load (sets x reps x weight), distance, number of sprints, etc.
Here are some terms to understand:
Maintenance Volume (MV) – How much volume you need to maintain your gains
Minimum Effective Dose (MED) – Smallest amount of stimulus needed to drive positive adaptation. If we are below this threshold, then there will be no adaptation.
Maximum Adaptive Volume (MAV) – Here we are training at our optimal range of volume that we can adapt to and recover appropriately to drive optimal performance
Maximum Recoverable Volume (MRV) – This is the absolute maximum volume that your body can handle and recovery from. Sometimes it’s necessary to pass this threshold from time to time, called overreaching, in order to elicit greater adaptations. Important point here is to make sure it is not often and that deloads are accompanying this high accumulation of volume to allow for supercompensation (the point of overreaching to get the training effect you want – improved strength, power, speed, etc.). When this is not appropriately monitored or constantly overreached without recovery, you open the door for injuries to occur and performance to suffer.
(credit to Mike Israetel of Renaissance Periodization for this concept)
The way this is laid out is that you start with your MED, progress to MAV, then MRV to overreach. However, notice that you don’t dance with MRV often, nor do you want to.
Overtime, your MRV will increase, meaning you’ll get stronger and develop more work capacity, as long as you intelligently handle your training volume.
A good rule of thumb is The 10% Rule - While there can be some variability here, staying within a 10% increase from the previous week tends to work well for a lot of people. It pushes that threshold in a progressive manner and allows appropriate recovery from the increased demand on the body.
Next week, in Part 2, we’ll take a deeper dive into load management and training volume, explore exactly what this concept means, and how to practically apply it to yourself or athletes you work with.
Dr. Ravi Patel, PT, DPT, CSCS
It’s baaaaack. The largest fitness competition on Earth, the CrossFit Open, is finally here. Maybe you’ve trained all year for this, maybe you’re still new to CrossFit and are curious about all the excitement. Maybe you’re a seasoned vet, maybe this is your first Open you’ve ever participated in. Regardless of your CrossFit background, your fitness will be tested, your mental toughness will be challenged, and you will certainly have a blast working through these workouts with your crew at your local CrossFit affiliate.
That being said though, this is typically a time where we start seeing an uptick in the people we see coming in for CrossFit related injuries. Having an athletic background, where I had to personally sit out multiple seasons due to injuries, I speak from experience when I tell you there is nothing worse than working all year towards a goal/competition/test and not being able to perform at an optimal level, if at all, because of an injury. And, look, I get it. There is inherently an increased risk of injury when you're pushing yourself in a competitive environment. However, there are some very important things you can do to minimize this risk and allow you to perform your best. Let’s take a look at the three easy things you can do:
#1 Don’t Be Reckless
This is huge and something I see year after year. If you’re a CrossFit coach, or even just an observant CrossFit athlete, I’m sure you’ve seen what I’m about to explain...You’ve worked all year to create movement patterns that are both safe and effective. You know the importance of good, quality movement. However, throw in the element of an international competition and it seems like all these lessons about technique go out the window.
For example, last year’s first Open workout (18.1) consisted of three movements: toe-to-bar, dumbbell clean and jerks and rowing. Can you guess what type of injury we saw coming into our clinic after this workout? If you said back pain, you’re correct. But why? Well, with this workout people were trying to perform as many rounds as possible for 20 minutes. To get better scores people weren’t maintaining core control for a solid hollow position with their toes-to-bar, they stopped getting full hip and knee extension for optimal power production during the drive portion of the clean and jerks, and/or they started to over-extend during the rowing component. All of these create situations that are destined to increase stress on your low back. Keep in mind that this was just the first workout! Now you’re either completely unable to participate in the other workouts or will not be performing at an optimal level because you’re trying to grind through an injury.
#2: Protect Your Sleep
There are four main pillars of health care that we look at with every patient who walks in the door at Athletes’ Potential: Movement, Stress, Sleep, and Nutrition. Sleep is easily on of the biggest problems that we see out of these pillars. And check this out: Sleep affects everything you do and everything you do is positively affected by quality sleep. 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.
If you’re not getting enough sleep, you’re not giving your body a chance to recover. If you’re not recovering appropriately, then you're leaving yourself at risk for injury and decreased performance. So, bottom line: create an optimal sleeping environment, protect your night time routine, and get some good, quality sleep.
For more info on how to optimize your sleep, check out this article we wrote.
#3: Maintain Perspective
This comes full circle with tip #1. For those of you trying to make it on to Regionals, those extra few reps I mentioned could be the difference in making the cut vs staying home. However, for the vast majority of athletes competing in the CrossFit Open this is not reality. You all have careers, kids you need to take care of, and numerous other responsibilities that you need to keep rocking with once you leave the gym. Is bouncing off the top of your head to get an extra rep or two really going to mean that much if by doing so now you can’t look over your shoulder while driving? (yes, this is a real scenario that we’ve worked on at our clinic...I’m looking at you 17.4). Or is that two position jump on the leaderboard really all the important if now you can’t bend over to pick up your kids?
CrossFit is meant to be a competitive, fun, and challenging way to make all aspects of life outside the gym a little easier. This time of year is huge for all CrossFit athletes and it is truly impressive to see the physical accomplishments and PR’s that happen every single year in the Open. However, the Open isn’t an excuse to throw all safety out the window, but it isn’t something you should be afraid of either. Following these three easy tips will ensure that you have a great time, reduce your risk of injury, and maybe even hit a PR or two.
Thanks for reading,
Dr Jake, DPT, CSCS, CF-L1
Recently, I had the opportunity to present to a local soccer club and their coaches on injury risk and reduction for the sport of soccer. In order to understand this, a “Needs Analysis” must be done. A Needs Analysis is a two-part analysis breaking down the sport into two components:
Today, our primary focus will be on evaluating the sport itself. This can be further broken down into:
Movement & Physiological Analysis
Soccer is a very lower-body dominant sport involving the hip, knee and ankle joints and muscle groups including the quadriceps, glutes, hamstrings and calves. A soccer athlete must be able to run, jump, accelerate, decelerate, land, cut, kick, pass, head, shuffle, tackle – all while handling a ball and avoiding defenders. Oh, they also need the ability to sprint and jog throughout the duration of a 90+ minute game. Now, you’re talking about a dynamic athlete with a sound aerobic and anaerobic energy system. That’s A LOT.
Here’s a more thorough breakdown:
Sports injuries are inevitable. It comes with playing sports – exposure already puts you more at risk. You cannot prevent sports injuries, but you can help mitigate and reduce the risk of them happening – especially ones that are non-contact or overuse in nature.
Here’s a breakdown of the most common injuries in soccer:
A study done in 2017 by Khodaee et al. tracked detailed information on injury rates among high school soccer players over a 10-year period (2005 – 2014). You can see those below broken down by gender and injury diagnosis.
Muscle strain, ligament sprain and concussions are highest as expected.
What’s most interesting is the girls’ ligament sprain – very high for both practice and competition as compared to the boys’ group. Females are 2-5 times more likely to tear their ACL than males in a similar sport. There are a lot of factors that play into this and nothing is definitive. We do know that strength and neuromuscular control are big modifiable factors from an injury risk standpoint.
In another study from 2015, Waldén and company analyzed 39 videos for movements related to non-contact ACL injuries in professional soccer players. They found that pressing, kicking, and heading were the 3 most common movements in relation to ACL injuries.
Heading (check that right leg in D - ouch)
Cool, so now what do we do with all of this? Make some superhuman soccer athletes.
Have a plan in place to address these different components. It’s important to create a program for these athletes to develop these athletic characteristics – i.e. lower body strength, power, repeated sprint ability, cardiovascular endurance, change of direction and reactive agilities. Injuries happen all the time in soccer, but if we know what joints and muscles are most at risk, then we can better prepare these tissues to withstand the stress of the sport and build more resilient and robust athletes.
Dr. Ravi, DPT
Baechle, Thomas R., and Roger W. Earle. Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics, 2016. Print.
Turner, E., Munro, A. G., & Comfort, P. (2013). Female Soccer: Part 1—A Needs Analysis. Strength & Conditioning Journal, 35(1), 51-57.
Coming at you with the the final part of our two-part series for ensuring healthy shoulders while improving your pull-ups. In this part we’re talking about how to develop appropriate strength in the appropriate areas. For those of you who missed it, part one is super important and I highly recommend reading that before moving on with part two. For those of you who are caught up, let’s get after it.
Part II: Strength
In any training program, it’s important to make sure your movements are balanced and that your shoulders are working in multiple directions (ex: vertical pulling, horizontal pushing, horizontal pulling, etc). The pull-up is an excellent example of a vertical pull strengthening exercise. With most pulling exercises, your body is primarily moving through two movements: elbow flexion and shoulder extension. This means your primary shoulder extension (latissimus dorsi, teres minor, post delt) and primary elbow flexion (biceps brachii, and brachialis and brachioradialis) muscle groups need to work synergistically to perform this movement appropriately.
Unfortunately this synergistic relationship isn’t normally the case. More often than not I find that people way over utilize elbow flexion and underutilize shoulder extension. When this happens bad things happen and those bad things usually end up manifesting themselves as pain along the front of the shoulder. As you can tell in the picture above, the long of of your biceps tendon crosses the shoulder joint and when you rely too much on elbow flexion with pulling based exercises, you can end up agitating that tendon, which leads to shoulder pain.
I see the aforementioned situation happen all the time in athletes who do a lot of kipping pull-ups vs strict pull-ups, specifically in those who don’t have the requisite strength to perform consecutive strict pull-ups but are repping out 15+ kipping pull-ups at a time. Now I’m not saying kipping pull-ups are bad or that you shouldn’t do them, but kipping pull-ups should be an expression of strength, not a way to avoid a weakness.
To ensure you’re not overusing your biceps while doing the pull-up you want to have strong, engaged lats (latissimus dorsi). To make sure this is the case, check out our top 3 exercises below for improving shoulder lat strength and control.
Drill #1: Active Hangs
This drill is an all time favorite of mine for a couple of reasons. First, it allows you to feel how your lats should be contracting while you are going a pull up. Second, it allows you to strengthen your shoulders in a vulnerable/weak position. You’re only as strong as your weakest link and being strong in a weak position is a great way to prevent injuries.
Drill #2: Lat Pull Over
This one is a great example of “killing two birds with one stone” because not only are you able to improve lat strength with this drill, but because of the long eccentric phase (muscle contracting while lengthening) of this drill, it’s also a great way to improve shoulder mobility.
Drill #3: Single Arm Banded Lat Pull Downs
Breaking up a bilateral movement (using both arms) into a unilateral movement (using one arm) is a highly underutilized training modality that allows to balance out weaknesses. Plus, as an added bonus, you’re able to perform a vertical pulling drill at a slightly different angle which, as we talked about above, is how you train for healthy shoulders.
If you have shoulder pain while doing pull-ups, or want to prevent pain from coming, this two-part post is a great place to start. Ensuring appropriate mobility and then building appropriate strength is a common occurrence in the rehab world.
If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road.
Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult.
Thanks for reading,
Dr. Jacob, PT, DPT, CSCS
Squatting is simple- get down and get back up. It’s an essential movement for everyone. Children often hold a squat and play. We all must squat, to differing heights, to get on and off the toilet. The elderly need to be able to sit down and stand up on their own to promote quality of life and longevity- this is a squat!
But squatting actually isn’t simple. There are 101 ways to squat, some awesome and some not so awesome. However, there are five “principles” that are true across all of the barbell squats. Now, we're not sure these are the only principles - in fact, we know they are not, and we're not sure principle is the right word... But anyway, these are five pieces of the squat that we are constantly emphasizing with patients.
#1 Set up and create tension while the barbell is in the rack- Place your hands, set your feet under the bar, full grip on the bar and elbows down. Then unrack the bar and maintain this while you squat.
#2 Toes stay down- Feet should remain fully planted. Big toes and heels stay down, screw feet out into the floor and descend into your squat.
#3 Maintain Stacked Position- Use a PVC or broomstick to check your ribs and pelvic position throughout the range. The stick should remain in contact with back of your head, mid back (between the shoulder blades) and hips.
#4 Hip Below Knees- This position is not unsafe or bad for your knees. In fact, it is healthy for your knees to have full range of motion. Warning: this will lead to glute gainz that might lead you to needing new pants.
#5 Bar over midfoot- Regardless of the type of squat, the bar should still be aligned over the middle of your foot. Take some film of yourself the next time you squat and see how it looks!!
If you have pain when you squat, try applying these principles. This is a great way to find major movement deficits and clean them up.
If you can’t seem to add weight to your squat, apply these principles. Creating more tension with shoulder and foot set up can be enough to help you put up bigger numbers.
Maybe your squat is perfect...
Probably not. Apply these principles!
Thanks for reading,
Did you know that 70-85% of ACL injuries are typically non-contact? Or, that female athletes
have a greater risk of ACL injury compared to males playing similar sports?
It seems like every week you hear about another athlete who tears their ACL. In the NFL, 36
season-ending ACL injuries have been reported this year. Three took place this past Sunday,
including a non-contact ACL injury by 49er’s QB Jimmy Garoppolo.
What’s even worse is when it comes from a celebration…
A contact ACL injury seems to justify itself more so than a non-contact ACL injury.
These season-ending injuries can have a huge impact on an athlete. Not only is it a long and
costly process, but it can take a toll on you as an individual from a physical and mental
standpoint. Take it from someone who has had two ACL injuries himself.
I’ve even talked to parents who keep their kids out of sports due to the risk of an ACL tear. After
my first ACL injury, my mom begged me to stop playing football and cheer my team on from
the stands…HA! Love you Mom, but no way was that happening. I had to come back to play
my senior year and it was 100% worth it. My second ACL tear was non-contact and didn’t come
until six years later – which has fueled me on a path to help those who have suffered this same
So……Can ACL injuries be prevented?
Prevented? Not really. Reduced? Definitely.
Prevention means that we can stop something from happening, which means we can predict it.
We’re not quite there yet.
Reduction means we are making it smaller or less in amount, degree, or size. We have proof of
For simplicity's sake, you will still see prevention and reduction used interchangeably, but keep in
mind what we discussed above.
A powerful research study came out this year by Webster et al. 2018 - Meta-Analysis of Meta-
Analyses of Anterior Cruciate Ligament Injury Reduction Training Programs.
It conclusively shows that 50% of all ACL injuries and 67% of non-contact ACL injuries in
females can be reduced with the simple implementation of 2-3x per week of injury
Some important components of these programs are:
Plyometric and Power Development
In later posts, we will break down these different components of a well-designed injury
At Athletes’ Potential, we design and implement these programs often to help our athletes,
whether you’re someone who has had their first surgery or an unsuccessful rehab experience. It
is our goal for the athletes we work with to return to their sport not only physically prepared, but
mentally as well. Please feel free to reach out to our Docs if you have any questions.
Dr. Ravi, PT, DPT, CSCS
Dr. Danny and staff's views on performance improvement, injury prevention and sometimes other random thoughts.