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Are Standing Desks The Answer?

3/8/2022

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“Maybe if I just buy this standing desk, things will be better!”

Does this sound like you? If so, this article is tailor-made for you.

Let's go through many of the questions one-by-one. Maybe some of these will be of help to you if you are considering a standing desk.

Question 1: “Do you think I should get a standing desk?”
Generally speaking, yes! Though my reasoning won't be what you might think. As with any tool, it’s not really about the tool, it's about the intent behind using the tool. For many, the intent of having a stand-up desk is because they have back pain and are looking to stop sitting for most of their day. For others, it’s about improving overall health and wellness by standing more, as standing burns more calories than sitting. It all depends on what your intent is! First, find out exactly why you want a standing desk and then you can figure out why one might be for you (or not!). 

Question 2: “What are the main benefits of a standing desk?”
It allows an opportunity for changing your movement patterns throughout your day.

If you were to sit or stand with “perfect posture” at work for an entire year, both would have their own set of problems. For the person who stands all day, their feet would start to really hurt; then possibly their knees or low back. Before long, they’d need to sit!

For the person who sits at work for an entire year, they eventually need to get up because their back and knees start to hurt. 

For both parties, it’s not the fact that they are standing or sitting all day in a “perfect posture,” it’s that they need an opportunity to change their position to really feel better!

A standing desk that has the option to be both in a low and high position allows for both of these individuals to either sit or stand depending on how they are feeling. The key for them is more motion throughout the day! The key benefit for a desk that goes up AND down is that you can adjust your body more throughout the day, and more varied motion throughout your day is the KEY to longevity!


Question 3: “Why shouldn’t I get a standing desk?”
  1. If the desk is not up/down adjustable and you’ll be standing for 8 hours a day without another location to work.
  2. If you think just getting a standing desk will rid you of (fill in the problem here) without doing more exercise, stretching, strengthening, etc. as well.


So, are standing desks amazing? YES! They are a great tool in the arsenal of a healthy individual. They allow for more movement throughout your day, of which is an absolute blessing! But don’t go thinking that just because you’re standing all day long, you will automatically feel much better. The key is varied motion every day, from both the office, to the yoga mat, to the gym, and to the couch!

More movement is always better. 
Ready To Come See Us?
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​Now if you’ll excuse me, I’m gonna get to my stretches after finishing this blog post.

Thanks for reading,

Dr. Marcus PT, DPT 
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Low Back Pain - Understanding What It Needs To Improve, Part 2

8/18/2021

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Part 2: The Hip’s Role in Low Back Function
​

A car needs a good road to function at its best. A house needs a good foundation to stay strong. A tree needs solid roots to stand tall. 

By only focusing on the low back you are having low back pain, you are missing the big picture! 

The hips play an absolutely crucial role in low back pain. If they are weak or stiff (or both!), the foundation of your house has major issues in providing your low back what it needs to function pain-free. 

This is very much supported by the literature. Two major reviews found that in patients with low back pain, there was a high prevalence of weak hips (1) and that by strengthening those weak hips, you can improve your back pain (2)! Furthermore, a lack of hip internal rotation has been found to be correlated with low back pain as well (3). 

So, if hip strength is found to be directly associated with low back pain, we’ve gotta strengthen our hips! If I were to choose two exercises for you to try for hip strength that can help with low back pain, here’s the two I would choose to target these potential impairments.

Single Leg Hip Thrust:
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Keeping your core tight, squeeze your butt as you push your hips up to the sky. Try to not let your spine move. Let your hips do all the movement (no arching your back!). Try 2-3 sets to moderate levels of fatigue. If this is too hard or too uncomfortable, regress to trying these on the ground without your back elevated. 
​

Clamshells and/or Side Plank Clamshells:
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Clamshells are often looked down on as easy basic exercises (which they can be). However, if you know how to progress them, they can be downright challenging! These are two variations I enjoy in the clinic and both involve a band. Try 2-3 sets on each side to mild to moderate levels of fatigue.

Both exercises should have discomfort levels below 2/10. More is not better with these!

By combining a healthy lumbar spine and hip complex, you have the best chance to improve your low back pain for the long run. If you still feel like you’re getting stuck, feel free to reach out to us and we can get you the care you need to get your back to the place you want it to be!
Ready To Come See Us?

​Thanks for reading,

Dr. Marcus, PT, DPT, CF-L2



  1. ​de Sousa CS, de Jesus FLA, Machado MB, Ferreira G, Ayres IGT, de Aquino LM, Fukuda TY, Gomes-Neto M. Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact. 2019 Mar 1;19(1):69-78. PMID: 30839305; PMCID: PMC6454257.
  2. Tataryn N, Simas V, Catterall T, Furness J, Keogh JWL. Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports Med Open. 2021 Mar 8;7(1):17. doi: 10.1186/s40798-021-00306-w. PMID: 33683497; PMCID: PMC7940464.
  3. Sadeghisani M, Manshadi FD, Kalantari KK, Rahimi A, Namnik N, Karimi MT, Oskouei AE. Correlation between Hip Rotation Range-of-Motion Impairment and Low Back Pain. A Literature Review. Ortop Traumatol Rehabil. 2015 Oct;17(5):455-62. doi: 10.5604/15093492.1186813. PMID: 26751745.
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Low Back Pain - Understanding What It Needs To Improve, Part 1

7/29/2021

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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. 

Bird Dog:
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Dead Bug:
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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!
Ready To Come See Us?

​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





  1. Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V, et al. The treatment of acute low back pain--bed rest, exercises, or ordinary activity? N Engl J Med. 1995 Feb 9;332(6):351-5. doi: 10.1056/NEJM199502093320602. PMID: 7823996.
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Bulletproof Your Back Series

8/27/2020

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In our Bulletproof Your Back Series (follow along on our Instagram page!), we're bringing our clients 4 videos to help them improve back pain. We go through
  • Stretch exercises for back pain
  • Skill Drills for a strong back
  • How to hinge properly
  • Breathing work to improve back pain

If you are suffering from a form of low back pain, work your way through these videos and see how you can improve your back pain. 
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Memories of the Body/Mind

8/17/2020

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As you wander through your bedroom in the early morning, reaching for shelves that seem to shift as you approach, you realize how helpless you are without your eyesight. Instead of walking, you carefully scootch your feet step by step, hands forward like a zombie, into the inky outline of a bathroom door. 

Now it may come as a ‘duh’ kind of question, but why would we do this? Why would we modify our behavior to accomplish a goal that could easily have been accomplished much faster and efficiently if we just marched right through the dark towards what we thought was the bathroom?

I’ll allow these gifs to speak for me:
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We modified our behavior based on those memories of SLAMMING our toe into that damn table one too many times, just as we modify our behavior when anything incredibly painful happens to us. Remember that time you sprained your ankle when trail running? I’m sure you learned to be more careful with your steps! Remember that time you played volleyball for four hours and woke up like a train rolled over you, backed up, then body slammed you? Sure you do.

You remember. Your body remembers. And, due to these memories, we do our best to make good decisions to avoid these painful problems in the future. 

The reason I’m telling you these stories is to paint a picture that our body and mind remember injuries, and that these injuries that may have occurred decades ago are still affecting our bodies today. Don’t believe me about your body remembering injuries? Research shows a good ability to predict osteoarthritis in patients decades before it occurs… the main predictor is if they’ve had a knee surgery or injury.1,2 That osteoarthritis is your body’s ‘bad memory’ of your bad night you messed up that knee. And your mind remembers injuries just fine as well… just think of one of your many injuries and I’m sure it’s as vivid as a firework on the 4th. 
    
Growing from these painful metaphorical and literal memories is a major challenge, and that challenge is met daily with the help of proper physical therapy treatment; to reset your body’s movement and your mind’s pathologically-based control of your body in order to imprint a new patterning system that accommodates your injury. In short: Unlearn old patterns. Build new ones. Grow.

Let’s go through a typical case of how I teach my patients to build these new patterns:

Bob Smithy Jones Fake Name Jr III comes into the clinic with back pain due to  paratrooping since he was 5. He’s now 31 and his lumbar spine is comprised mostly of Legos and popcorn. He likes to deadlift small horses and fight yoga instructors to pass the time, but his lower back isn’t letting him do the things he loves. Bob is desperate. He knows he has to live with this spine for the rest of his life and is concerned with what the future holds. After going through a thorough physical movement and manual assessment, I see half a dozen regions that are contributing to Bob’s pain and dysfunction.

His mechanical memories are leaping out at me from each of my assessments, and his compensations are showing me exactly how he has been subconsciously “avoiding stubbing his toe” for decades. His mental memories are evident every time he guards, takes a sharp breath, or shows hesitation when trying a new exercise. The good news is, the more time I spend with him, the more I can help him!
    
Breaking these movement dysfunctions down, one by one, session by session, into compartmentalized pearls of digestible information for him to relearn movement is the treatment program. Some of these memories need to be processed with manual therapy, stretching, and motor control training. Some of these memories need to be processed with a good dose of strength training. Through time, grit, and trust, these memories no longer have their teeth around the throat of Bob’s aspirations. The “memories” such as osteoarthritis will always be there, but with the dozens and dozens of pearls in his toolbox, he is able to manage and grow into a new version of his old self. He is also better able to step back and contextualize the different types of pain he feels and is less fearful of his future. This is growth.

Our mind is a powerful thing. Our bodies are equally powerful. Each of them twist together into a complex story that many times involves loss, pain, fear, and sadness. As a working clinician, I see this day in and day out, which is why I am so motivated to help my patients’ minds and bodies learn new movement memories they need to better live the lives they deserve. With work, these old movement memories are reprogrammed into a new movement system that can give a fresh capacity to the function of the previously painful and weak movement patterns. 
​

Ready To Come See Us?


​Thanks for reading,
​

Marcus Rein, PT, DPT, CF-L1



  1. Friel, N. A., & Chu, C. R. (2013). The Role of ACL Injury in the Development of Posttraumatic Knee Osteoarthritis. Clinics in Sports Medicine, 32(1), 1-12. doi:10.1016/j.csm.2012.08.017
  2. Long, M. J., Papi, E., Duffell, L. D., & Mcgregor, A. H. (2017). Predicting knee osteoarthritis risk in injured populations. Clinical Biomechanics, 47, 87-95. doi:10.1016/j.clinbiomech.2017.06.001
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Improve Your Disc Pain With These Simple Tips

10/24/2019

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I remember the feeling like it was yesterday. A sharp popping sensation in my back and then an odd, almost warm tingling feeling down my left leg. I knew it wasn’t good, and I should have known better.

This was my first week at an infantry brigade I had been assigned to in 2011. I was the only physical therapist assigned to a group of 3,500 soldiers. My job was to treat all injuries, teach injury prevention classes, and help with human performance optimization. I was also attached to an infantry brigade so that meant a lot of physical training and ruck marching.

On my fourth day assigned to this group, I went on a Thursday morning ruck march. For those of you that don’t know, ruck marching is basically walking around while wearing a 50-pound backpack. This morning we had gone on an 8-mile ruck march. When I finished, I dropped my rucksack (i.e heavy ass backpack) and stood around talking with the other soldiers. As I was leaving, I bent over to pick up my rucksack and that’s when I felt the pop. 

I immediately knew something was wrong, but the last thing I wanted to do was get hurt in front of all my soldiers. I was the guy assigned to this group to make sure people didn’t get hurt and there I was in excruciating back pain trying to act like I was fine. I managed to make it to my car before collapsing into my seat. I drove straight to the troop medical clinic to see a fellow physical therapist friend of mine. There was no unringing this bell… the damage was already done.

Over the next six months, I did everything to help fix this back injury I had given myself. Fatigue from the ruck march followed by picking something heavy up, like an idiot, was a recipe for a pretty serious disc injury. I had what’s called an L4-L5 disc prolapse. This caused me to have a lot of numbness and weakness in the back of my left leg.

With a combination of dry needling, hip joint mobilizations, and time, my pain resolved in about six months. It took me roughly another six months before I could get back into deadlifting heavy. 12 months of rehab/recovery from picking up a rucksack wrong. As much as this wasn’t fun, I’m glad it happened to me, and here’s why.

I learned a lot about why I had this back injury in the first place and was able to correct those issues. This injury lead me down the path of better understanding complex movements. I became obsessed with treating my own back and developing protocols to help other people with their back injury. Lastly, I can relate to anyone I see with a back injury on a much deeper level than someone who’s never hurt their back. 


I also got to see first hand that disc injuries do heal. Even when I was in school, the thought process was that a disc injury wouldn’t heal. I have an MRI from one month after the injury and three years after the injury. The MRI from one month post injury shows a significant disc prolapse that’s pressing on a nerve. The MRI from three years post injury looks completely normal. The body heals on the inside just as it does when you get a cut on your skin. It fills in, heals, and you have a scar as a reminder of the thing that happened. 

Dealing with a disc injury can be extremely frustrating. Here’s my advice to you if you’re currently dealing with one from my own experience and from all of the back injuries I’ve seen:

  1. Even though it’s tough, try and stay positive. The brain is a powerful thing and the moment you slip into a negative state, you’ll feel it. You’ll feel more pain, you’ll feel less capable and you’ll start to think worst case scenario. None of this is helpful when it comes to healing.
  2. Focus on small wins and on things you can do. By this I mean focus on the days you have where you feel better. Maybe you were able to walk further without pain. Maybe you work up pain free for the first time in a month. Maybe you sneezed for the first time without back pain. Focus on these little wins because they are signs that your body is healing. 
  3. Avoid activities that cause more pain. I know this sounds like common sense but I think some people love pain. Isolated pain in your back with certain movements should be avoided as much as possible. No pain no gain doesn’t apply with this type of injury.
  4. Stay active. I’ve never worked with someone with a disc injury that couldn’t find something they could do without aggravating their back. Sure, maybe it’s not the CrossFit workout you’re used to but you can still stay strong, flexible and cardiovascularly fit while you heal.
  5. Work with a professional. This isn’t something you want to try and figure out on your own. The spine is complex and making sure you’re working on the right things can dramatically improve your healing time. Also, things like hands on work and dry needling are really effective at decreasing pain as you heal.
  6. Follow a plan to get back into high level activities. If you’re a runner, you probably don’t want to just start back to full on training after your back starts to feel better. You want to follow a specific plan to help get you strong in the right places, mobile where you’re tight and increase your volume in an effective manner. If you don’t know how to do that, again I recommend working with a professional. The only thing more frustrating than a back injury is a back re-injury.
  7. Work on your breathing. This was a game changer for me and for many of my patients. There are a lot of reasons that I won’t explain here for why this is beneficial. Just know that it is and this is my favorite app to work on breathing. 
  8. Read The Obstacle Is The Way by Ryan Holiday. Having a back injury sucks. This booked helped me deal with frustration and realize there was a lesson to be learned. 
  9. Shameless plug… come see us. We help people with disc and back injuries everyday. We are really good at it and have helped hundreds of people avoid surgery. 

I hope this helps and I hope you realize that you can heal. Your body is incredible and often times it just needs time and the right approach to do so.

If you’re in the Atlanta area and are currently dealing with a back injury, we need to talk. We’ve helped thousands of people in Atlanta get back to a pain-free, active life, and we can help you as well.

Click the “Get Started” button below, leave us your information and one of our team members will reach out to find out if you’re an ideal fit for what we do.
Get Started!
Thanks so much for reading,

AP Team
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Flexibility vs. Mobility: What’s the Difference?

6/20/2019

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I recently attended a continuing education course called Functional Range Conditioning (FRC). It was one that has been on my list for quite some time and it was awesome to finally check it out.

In this blog post, I’m going to expand upon some of the principles and techniques I learned and how you can start to implement this in your daily movement practice.

First, let’s define a few words. What is flexibility? What is mobility? Are they the same thing? We hear these words used interchangeably. However, they are in fact different.

  • Flexibility = Passive Range of Motion (PROM)
 
  • Mobility = Active Range of Motion (AROM) = (Flexibility + Strength/Control)

The foundation of the FRC system is based on the acquisition and maintenance of functional mobility and articular health. It is very dependent on your passive and active range of motions.

Basically, the goal is to make your AROM and PROM the same. PROM is the prerequisite which will allow you to improve your AROM.

FRC utilizes a concept called “bioflow.” While I don’t get too caught up in systems or their coined terms, I’m cool with this one. It basically talks about tissue continuity (gross tissue --> cellular --> intracelluar) calling it STUFF. Stuff being cells, fibers, and ground substance. Composition of these components dictate the type and physical properties of a certain tissue whether it's bone, fascia, ligament, tendon, muscle, capsule etc. Cell signaling and progressive adaptation is how these cells change into these different structures. Think about an ACL graft that is harvested from a patellar tendon – do you think it stays a tendon over time or evolves to becoming a ligament just like the initial ACL? Yeah, science is pretty cool.

I could geek out on this stuff all day, but let’s move on to the application of improving your mobility – there’s a few techniques used to start working on making your passive movement more active.

Insert Controlled Articular Rotations (CARS) - Active, rotational movements at the outer limits of articular motion. There’s 3 levels for CARS which are related to isolated blocking, external resistance and amount of irradation. Irradation simply put is the amount of tension you create throughout your body – in nerdy science terms this is also called Maximum Voluntary Contraction (MVC) often expressed in percentages.

The best example of irradation is to give someone a hand shake. First, squeeze using your hand, then hand and forearm, then hand, forearm and shoulder, etc. Your grip gets stronger and stronger the more musculature you recruit. The more irradation, the more force you exert. You can use this to dial in higher levels of recruitment while doing your CARS or other FRC techniques. “Force is the language of cells” – one of my favorite quotes at the course.

CARS can be implemented different ways whether that is by focusing specifically on a certain joint or you can take part in the morning CARS routine to give all your synovial joints in your body some love each day.
The next step to continue to work on improving your joint integrity and control is via PAILS and RAILS. PAILS and RAILS are isometric contraction efforts (sometimes combined with stretching) used to communicate with both the connective tissue & neurological systems.

2-3 minutes of stretching to build stretch tolerance, then:

  • PAILS: Progressive Angular Isometric Loading
    • Combines stretching with isometric loading/training at progressive articular angles in order to simultaneously expand ROM, as well as strengthen & produce tissue adaptation in the newly acquired ranges.
    • Hold for 5-10 seconds, then work into newly acquired range, then go into RAILS.
  • RAILS:
    • Combines stretching with isometric loading/training at regressing articular angles in order to strengthen, and induce beneficial tissue adaptations in progressively shorter angles.
    • Hold for 5-10 seconds, then work into newly acquired range, then go into passive 1-2 minute stretch, then repeat PAILS/RAILS as needed.
  • PAILS/RAILS
    • Stretched tissue: PAILS
    • Shortened tissue: RAILS
This is a great video by Joe Gambino from Par Four Performance going over the Hip 90/90 PAILS/RAILS.

I see PAIL/RAILS as a way to safely acquire and create control into these newly stretched positions without movement. Basically isometric holds to own a position with increased stretch tolerance.

The next and my most favorite part of the course and system is the End-Range Control techniques. End range is where we see a lot of injuries and tissues breaking down. Why? Well, from a physics standpoint, we’re just not able to produce as much force at these end ranges due to length-tension relationships. Another big factor is because we rarely go there. And when we do, we typically aren’t ready for it and are pushed there by accident – which is why we need to train these end ranges. It allows us to build better tissue resilience and reduce the risk of injury. Here’s how we break down end-range control:

End-Range Control: PALS/RALS
  • PALS: Progressive Angular Loading
  • RALS: Regressive Angular Loading


Passive Range Holds
  • Find end-range similar to PAILS and then hold position with irradation for 5-20 seconds - all based on intensity of contraction and exertion.

​Passive Range Lift-Offs
  • Go to end-range, then back off about 10 degrees then lift off and then hold position with irradation for 5-20 seconds - all based on intensity of contraction and exertion.

​Hovers
  • Go to end-range, then back off as needed to set up different hover obstacles - think about seated hip flexion with multiple kettlebells as you abduct. Same with shoulder flexion.

​End-Range Rotational Training
  • Same as Passive Range Lift-Offs but you hold and do small circles at that end range around a small object (i.e. clinician hand or safety bar of a squat rack).

My suggestion is don’t get too caught up on the wording of these different techniques, but understand the conceptual framework and you’ll be able to implement this immediately. We all know that we have certain aspects of our joints where our active and passive is not the same. If you’re wanting to improve your squat or overhead position, or if you just want to build up resiliency in different tissues, then give your joints some love with some of these different techniques.


Cheers,

Dr. Ravi Patel, PT, DPT, CSCS
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Preventing Back Pain While Deadlifting, Pt. 2: The Lift

8/2/2018

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Ok, so now that you’ve stepped up to the bar and have set yourself in a good position by following the “3 B’s” (if you don’t know what I’m talking about, see Part 1 of this series), it’s time to safely pick some weight off the floor.

There are a number of different nuances you can get into when teaching someone how to deadlift, but for this sake of this post we are going to break the lift into two main parts: First Pull and Second Pull.​

1. First Pull: This is where you lift the bar from the ground to your knees. During this part of the lift you should be keeping your spine in a neutral position by having your hips and shoulders rise at the same time until the bar reaches your knees. If you let your hips rise faster than your shoulders then you’ll end up rounding your lumbar spine, and if you let your shoulders rise faster than your hips then you’ll end up over-extending your lumbar spine. Both of those approaches increase the shear forces at your vertebra, which our spines are not designed to handle.
2. Second Pull: Once you get the weight past your knees you are entering the second pull of the deadlift. At this point in the movement your main focus needs to be “bringing your hips to the bar”, meaning your shoulders continue to move upwards as your hips move forward towards the barbell.
So the big takeaway here is that, when you initially starting lifting the weight off the floor, you need to keep your hips and shoulders moving in the same direction, at the same rate, until you get to knee height, and at that point you start to shoot your hips forward as your shoulders continue to rise. Sounds simple enough; right? Well, there are techniques you need to also remember in order to not just perform the lift correctly, but to also keep your back out of harm’s ways. ​

  • Keep your lats engaged: We discussed the importance of the lats in Part 1 and the reasoning applies here too. As you lift the weight from the ground you want to keep your lats engaged by trying to “break the bar.” Doing this will allow you to keep the bar close to your shins and thighs, which is crucial to keeping your back safe. The closer that bar stays to your body, the less shear force that go through your low back.
  • Neck Position: Don’t flex or over-extend your neck while deadlifting. You want to keep your neck in a neutral, or ever-so-slightly extended, position.
  • Push with your legs, don’t pull with your back: This one sounds simple enough; right? In theory, yes. But in practice we see this performed wrong on the time. You want to imagine that you’re pushing the ground away from you vs pulling the weight off the ground. A good way to ensure that this is the case is by creating a “wedge” position. Dr. Travis Jewett does a great job of explaining what that is in the video below.
  • Breathing: The need to breathe appropriately as it relates to keeping your back safe cannot be overstated. An entire new article could be written on how to breathe appropriately during a deadlift, but for the sake of time we’ll keep it simple. The purpose of good breathing mechanics is to increase your intra-abdominal pressure. Think of it as pressurizing a closed can. To do this, you want to brace your core, as if you’re about to get punched in the stomach. Then take a forceful inhale into your diaphragm (your braced core). As you stand up, you can perform a “power breath” by forcefully exhaling, or you can hold your breath (if medically cleared to do so) and exhale once you reach the top position. The video below is a good demonstration what good breathing mechanics look like. ​
So there you have it. By utilizing appropriate muscle activation, spinal position, breathing mechanics, and biomechanics, you’ll be able to successfully deadlift with less pain and more weight. At Athletes’ Potential we work daily with barbell and strength athletes, so if you’re struggling with pain while you deadlift and live in the Atlanta area, give us a call or fill out the contact request form below!
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Thanks for reading,

Dr. Jake, PT, DPT, CSCS
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Is Your Back Pain Caused By Your Pelvic Floor?

11/29/2017

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Back pain is such a common complaint that we treat, but what if I told you that back pain can be caused by pelvic floor dysfunction?  First, it is important to remember that pain does not equal damage.  Second, it is not unusual to experience pain in a different area from where the dysfunction lies. This could be referred from another area or a secondary effect to moving in a weird way due to the dysfunctional area.

Cause and effect in this case is very similar to asking “Which came first, the chicken or the egg?”.  What we can state confidently, is that your back and your pelvic floor go hand-in-hand.  Studies show that folks with low back pain have decreased pelvic floor function compared to those without back pain.  Could this be pelvic floor inhibition due to the back pain?  Can weakness or over-tension or control issues of the pelvic floor be causing the back pain?

For many, the pelvic floor is very nebulous.  What is it anyway?  Where is it?  What does it look like?  Do only women have them?  Males do have pelvic floors, but the anatomy is different.  For this post, we will referring specifically to the female pelvic floor.  But guys- you too can have pelvic floor dysfunction! This image below is a great look at the female pelvic floor and it’s close relationship to the other pelvic and lumbar spine architecture.
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The pelvic floor helps to support the weight of your organs, helps with toileting and sexual function, and influences posture and control through pressure within the core.  Weakness, over-tension, spasm or damage to the pelvic floor will change the support of the sacroiliac (SI) joint and the forces that we create through the lumbar spine.
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If you have addressed your lumbar spine without much change in symptoms, go a different route! Keep in mind, there are other signs of pelvic floor dysfunction, other than leaking urine or back pain.  They include painful sex, frequent constipation, the feeling of heaviness in the vagina with jumping/running/bearing down etc.

Addressing the Pelvic Floor

There are 3 areas to cover that address your pelvic floor in a functional way -- position, breathing and bracing.  All of these can be applied to any athlete in any setting.

Position- Keeping the ribcage stacked over the pelvis is an important position to maintain, regardless of activity.  This sets the canister (“core”) up for optimal function- meaning the diaphragm, pelvic floor, abs and back muscles can work harmoniously to lift the most weight, support the spine and minimize pressure on the pelvic floor.
Ready to tackle your back pain? Contact us!
Breathing- Diaphragmatic breathing is essential for pelvic floor function and decreasing pain around the low back.  The pelvic floor mirrors the movement of the diaphragm, so it is a simple way to relax a tight pelvic floor. Also, two major muscles that run from the ribs to the pelvis also have connections to the diaphragm.  So deep breaths can work as a gentle mobilization!
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Bracing- How do you prepare for heavy loads or challenging positions?  If you simply hold your breath and go, you are missing an opportunity to create more tension!  Or if you are holding your breath for a position that should not require that much power, you are increasing the workload on your pelvic floor and back for no reason.  For example, preparing to lift a couch versus preparing to lift a pencil.

Put simply, if you are lifting something heavy, holding your breath is fair game.  IF you do it correctly.  If you experience symptoms- low back pain, leaking, heaviness- then do not hold your breath until you seek help for how to correctly brace.  Knock the weight down or the mileage down to a place that you do not have symptoms and work there until your tolerance improves.
If you notice you are holding your breath with lifting a small object, such as your purse, then let’s talk breathing.  Breathing out on exertion for a task like this will help the pelvic floor contract reflexively and can keep symptoms at bay. Try it out!

Big picture:  Back pain does NOT equal back injury.  It is very likely that back pain can be decreased and function improved with addressing the pelvic floor as it work with the low back muscles.  Check out these simple ways to check your position, breathing and bracing.  Often times, pain is a product of HOW you are moving.

If you take a crack at it yourself but just can’t seem to find improvement, reach out to us at Athletes’ Potential.  We work with people like you every day to get them back to high functioning lives without pain and with a better understanding of how to move their body.

Back Pain? Tired of hurting? Contact us now.

Thanks for reading!
​
    Dr. Jackie, PT, DPT
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Bulletproofing Your Back and How CrossFit Falls Short

8/24/2017

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​“The aim of CrossFit is to forge a broad, general and inclusive fitness supported by measurable, observable and repeatable results. The program prepares trainees for any physical contingency—not only for the unknown, but for the unknowable, too. Our specialty is not specializing.”

The quote above was taken directly from CrossFit.com. It describes CrossFit’s mission, and it is undeniable that CrossFit accomplishes its mission of preparing trainees for multiple arenas of physical contingencies. The point of this article is not to argue nor neglect the many benefits associated with CrossFit training. However, even with CrossFit’s ability to program and prepare you for the many physical challenges that life may throw your way, when it comes to building a functionally strong and healthy back, there is one crucial area where CrossFit falls short: multiplanar movement.

Before we talk about how CrossFit doesn't deliver multiplanar movement, first let's look at how our spine moves throughout the day.

Whether we are going to the grocery store, playing softball, or hitting a round of golf, our backs do not move in one dimension. To perform movement efficiently and effectively, our spine must be able to move through a combination of movements in three different planes: frontal, sagittal, and transverse.
​
  • Frontal Plane: splits our body into front and back halves and is where our spine bends side-to-side.
  • Sagittal Plane: splits our body into left and right halves and is where our spine bends forwards and backwards.
  • Transverse Plane: splits our body into top and and bottom halves and is where our spine rotates side-to-side.
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​In order to fully bulletproof our backs and prevent back pain from occurring, not only must we be able to move through these three planes of movement, but we must be able to strongly control our spine throughout each motion and this is where CrossFit falls short.

The world of CrossFit lives in the sagittal plane. Squats, deadlifts, snatches, burpees, kettlebell swings, muscle-ups, toes-to-bar, double-unders, Fran, Murph, Gracie, and Annie. What do all of these have in common? In all these movements and exercises your back is predominantly bending forwards and backwards, meaning in all these movements your back is moving in the sagittal plane only. There are very few movements in CrossFit that require you to challenge your back rotationally or laterally and as you’ll see below, that’s a problem.

Holding your child at your side, swinging a bat/club/racket, getting in and out of your car, serving a volleyball, opening a door, and kicking a ball. What do all of these activities have in common? These are all movements commonly found in sports and in daily routines and they all challenge your back rotationally and laterally. Not only are these multiplanar movements incredibly common, but because CrossFit doesn’t address frontal or transverse plane movements, if you aren’t doing any type of accessory training, you’re going to be weak in two-thirds of the required movement patterns, and you’re going to be at a greater chance of developing back pain.

So does this mean that CrossFit is terrible and you should stop doing all those squats, deadlifts, and other aforementioned CrossFit workouts? Absolutely not. Sagittal plane movement is crucial to our everyday lives (i.e., bending over to pick something off the floor, getting up from a chair, etc.), it just isn’t the complete picture. You’re leaving your back vulnerable to injury if you aren’t working on getting strong in the other two planes of movement. ​

The solution to this problem is simple though, you just have to take the time make sure you’re putting in the work. To get an idea of how to start training in the frontal and transverse planes, try adding in some of our favorite transverse and frontal plane strengthening exercises either before or after your next WOD. Perform 3-4 sets of each exercise to form fatigue.

Chop and Lift (multiplanar) 
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Got Back Pain? Get Our Free Report On Exercises To Fix Your Back

Pallof Press with shoulder flexion (transverse plane)

Single-Arm Farmers Carry (frontal plane)

At Athletes’ Potential not only do we help CrossFit athletes with low back pain all the time, but we are CrossFit athletes ourselves. We take immense pride in thoroughly understanding your sport, what its strengths are, and where there may be some deficits. If you’re a CrossFit athlete living in Atlanta, and you’re struggling with back pain, we’d love to help you. Give us a call at 470-355-2106 or fill out the contact request form and we’ll contact you.

Thanks for reading,​

-Dr. Jake, PT, DPT, CSCS
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Got Back Pain? Get Our Free Report On Exercises To Fix Your Back
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