Let me start out by making this clear. I have a Doctor of Physical Therapy (DPT) degree I do not have a Doctor of Medicine (MD). If you have a rash and a fever I’m honestly useless to you. If you tweak your lower back picking something up, I’m your man! Much like our friend Stu from the Hangover, there can be a bit of confusion about what different medical professionals actually do. Yes a Dentist is a Doctor but not a Doctor of Medicine.
For the context of this post when I refer to a MD, I mean a General Practitioner or Family Practice Physician. This is typically who most insurance companies mandate you see before you can go see a specialist like an Orthopedic Surgeon. MD’s that function in the capacity fill a huge and vital role. They have to know a little bit about a ton of medical problems. They may see one patient with the flu and the next one could have a sprained ankle. They have to be able to decide what to do with that patient or if they would be better off to refer them to a different medical specialist.
One of my duties in my last jobs in the Army was actually to serve as a clinical instructor for MDs going through a Family Practice residency. They would spend a few weeks with me learning about musculoskeletal evaluation and treatment. They were always so excited to actually learn how to treat people, not just diagnose them. They especially loved the mobility techniques and dry needling I would teach them because they would get results fast. The one thing they couldn’t change however is the amount of time they would get with their patients. On average an MD will get to spend 8-10 minutes with a patient. That’s not a lot of time to establish trust, listen to what the patient has to say, do a thorough exam and then actually treat that person if it’s needed.
Many states and insurance companies want patients to see an MD first. One of the reasons for this is the very unlikely chance that your musculoskeletal pain could be caused by something internal. This could be pathology such as cancer, internal organ pain or a number of other systemic diseases. This is where red flag questions become an important part of evaluating someone. Red flag questions are asked to help rule out pain that is not coming from muscle, joint or bone problems. Also, any good medical professional, no matter what their degree should be able to tell when something just doesn’t seem right. I’ve caught cancer on two occasions, Lyme disease once, gallbladder disease once and muscular dystrophy once. That’s 5 people out of the thousands of people I have seen over the past few years.
Here is an example list of red flag questions typically asked when someone has lower back pain. If you answer no to these questions you can feel pretty confident that your pain is coming from muscle, joint or bone related issues.
So, when you hurt your back you have two options. Option one, go and see your MD, have them spend 8-10 minutes with you and ask you the above set of red flag questions. Most likely they will give you some tylenol and a referral to see a physical therapist. Or you can pick option two and go see a physical therapist. Spend 60 minutes with that individual, answer the same set of red flag questions and then start working on fixing your back.
-Dr. Danny, PT, DPT
“Mobility programming is like pizza, even when it’s bad, it’s still pretty good! “
-Danny Matta (yes I just quoted myself)
Here’s a scenario that never happens. A CrossFit athlete leaves his 9-5 job where he just sat at a desk for 8 hours. He drives to his local box and is giddy with shear joy and anticipation over what the mobility work might be for this day’s WOD. He wonders to himself if his coaches will have him work on his hip capsules or maybe he if he’s lucky the sliding surfaces of his latissimus dorsi and serratus anterior.
This is obviously a fabricated scenario because the truth is most people don’t get excited about mobility work. Even though you or your athlete’s might not like it too much, it’s kind of like having to eat your vegetables when you were a kid. You know it’s good for you and you still have a hard time accepting it (unless the vegetables were covered in cheese, then they were acceptable.) Sometimes the toughest part of programming is where to fit mobility work into a WOD. If your athletes are busy people like I am, they may get one golden hour at the gym between 3-5x per week. We want to use our time as efficiently as possible. Programming for a group of people with different mobility problems can be a bit tricky. Here are two strategies you can use to make it more effective.
We’ll use this simple programming below to show different areas you can add mobility work in to your WOD. By the way, this programming is not for competitors, this is an example of programming for a novice to intermediate CrossFit athlete.
Dynamic Warm Up: some type approx. 8-10 minutes
Back Squat: Strength Block work up to 3 sets of 5 reps
(Rest 2 minutes between sets)
Annie: 50-40-30-20-10 Double Unders and Sit Ups, cut off time of 12 minutes.
Cooldown: 3 rounds 200 M run forward, 200 M run backward 5 hand release push ups 65-75% effort on the run. Focus on keeping the forearm perpendicular with the ground during hand release push ups.
* The most basic mobility goal should be to focus on improving fundamental positions that are being challenged in that day’s WOD. *
If our athlete’s are squatting, we want to improve the bottom position of the squat. If our athlete’s are pulling from the ground, we want to improve the position in the start of a pull and so on and so forth. If you wanted to improve the position of one of the movements above, which would you, pick?
My answer to that question would be the squat. It’s the one movement we are dedicating the most time to in the WOD and is a fundamental archetype shape. So if we wanted to improve this movement we have a few options, but here are two that we use most often.
1. Exaggerate reality
By this we mean, program a mobility drill that exaggerates the squat position. This could either be a drill that drivers your knees out further than you normal do squatting, forces you into a deeper bottom position than normal or driving your knees further forward to improve the ankle range. Don’t try and get too complex here, do something that looks like a variation of the squat but exaggerates it in some way.
Here are a few videos of ideas that you could add in for this WOD’s programming.
2. Mobilize the muscles that were the primary force producers
If we take the programming from above, we could say that the quads and hip flexors are going to be the two muscle groups that are most likely to be sore over the next few days. In this second strategy, we focus on trying to help the athlete’s have less soreness by doing some fascial techniques right after the cool down. You can really set your athletes up for success this way, especially the newer athletes that might be sore for a few days after a WOD like this.
Here are a couple techniques you could add in after the WOD to get the quads and hip flexors feeling better.
Fast-forward to minute 3 if you just want the specific techniques.
Now that we have some ideas of what we might want to work on, when should you add your mobility work to this WOD?
If you’re really strapped for time and want to be super efficient I would recommend doing the mobility work during the built in rest periods of the squat block. If you have a built in two minute rest period, throw a band around a hip and open it up for a minute on each side before doing your next set. This is one of our favorite ways to save time and improve a movement position in the process. By the time you get to your last couple of sets, your hips should be nice and mobile to hit that new 5RM PR.
If you can’t add it in between sets for some reason, the next best option is to make it part of the warm up in some way. Maybe add a kettle bell to the rocking sumo technique(show nabove in the first video) and get that heart rate up while improving the bottom position of the squat.
Programming for a group can be hard but if you follow these two strategies it will help get your mobility work organized. You’re never going to be able to pick one mobility technique that’s the best mob for every person in your 5 PM class. Everyone is a bit different, so focus on improving positions used in the WOD and fascial techniques for muscles that are most likely to be sore. This will help everyone get something useful out of their mobility programming.
If you have any mobility programming questions leave us a comment or hit us up on Facebook. We’re more than happy to help you get on the right track!
-Dr. Danny, PT, DPT
Do you sit frequently? If the answer is yes, you need to work on you psoas. The psoas, technically psoas major, is a hip flexor that starts at our back and inserts into our thigh bone(femur). When we sit for prolonged periods of time, this muscle gets brutally short. It's very rare to work with a CrossFit athlete in Atlanta or around the country for that matter that doesn't have problems with this muscle group.
We can use some common strength and conditioning equipment to help get into our psoas and reset our pelvic position. Give it a try guys and don't forget to test your squat before and after you mobilize.
It's time to take your psoas back!
Dr. Danny, PT, DPT
So you learned how to hold your kids in Part 1 and then learned how to pick your kids up in Part 2. Now that you fine physical specimens have that stuff under control it's time to learn how to fix yourself!
The reality is sometimes we can't help but be in a bad position with our kids. Sometimes you have to round your back to get your toddler out of the tub. Sometimes you have to keep you neck in a flexed position for a long time when you are giving a baby a bottle or breast feeding. Shit, sometimes you even have to sit for long periods of time in chairs designed for people that are 3 feet tall and you may be 6'2, like me. In these situations it's up to us to correct some of the damage we may be doing to ourselves.
Today is about correcting the upper back and neck. A nice little addition to this is that it will also do wonders for your overhead position. It's a win win! Minimize the effect of crappy positions while chasing your kids around and snatch more!
Good luck and thanks for all the positive feedback about the parents series. Kids are awesome but so is a pain free back!
Dr. Danny, PT, DPT
So you learned how to hold a baby in Part 1 but that's the easy part. Now we have to go over how to pick these little suckers up off the ground!
It's my honest opinion that kids often times intentionally try and make it as hard as possible to pick them up. When my son doesn't want bath time to end but I'm tired of dodging wet foam alphabet letters, it's time to pick him up. Picking up a 28 lbs toddler may not sound very difficult but if you think that, you obviously don't have kids. Try this to get a better understanding of what it's like. Go to a fish market and buy a 28 lbs live salmon. Now fill the bath tub up and put the fish in the water after you cover it in soap. Now bend over and try and pick up the fish and wrap it in a towel. Let me know how that works out for you.
Today's video is designed to help you save your back while you perform your parenting activities. Whether it be getting a kid out of the tub, putting them in a car seat or getting them in and out of a crib. Parenthood is basically performing high volumes of deficit deadlifts in really awkward positions.
Best of luck with the kids!
Dr. Danny, PT, DPT
Hey guys, being a parent is freaking hard! If you have kids you know what I'm talking about. If you don't have kids, enjoy your free time and sleep while it lasts.
Over the course of the next few weeks we'll be releasing some videos on how to stay pain free as a parent. From holding your kids, to picking them up and everything in between. We can apply some of the Movement and Mobility principles to every situation. Enjoy the videos and apply the concepts to your daily lives. Don't worry guys, we can survive parenthood together!
Dr. Danny, PT, DPT
So you made the switch to a standing desk. Congratulations, you are on your way to breaking free from the ball and chain that is your computer chair.
Here's a scenario I often hear from the clients I get to switch to a standing desk. It's day one at their standing desk and the client is feeling great. Finally liberated from their chair and ready to reclaim their athletic prowess! After an hour their knee starts to ache a little bit but no worries, the body has to adjust right. After the second hour their back starts to ache a little bit. No problem, it's not as bad as sitting all day. By hour four they're leaning against their desk as if they just finished a marathon trying to off load as much body weight as possible on to their new desk. No worries guys, there are some simple fixes to help you with your transition to a standing desk.
Here's the deal people. Standing desks are awesome, but you also have to understand that standing is a skill! This second part to our standing desk series goes over how to stand at your desk and techniques to be comfortable standing all day long.
If you haven't seen part one, check it out. Also, keep your an eye out for Kelly's new book Deskbound! It's going to cover a ton of strategies to help keep your body healthy while you spend all day in your wonderful cubicle.
By the way, I'm not wearing camouflage so that I can blend in with my surroundings. I'm still active duty in the U.S Army but not for much longer. I'll be full time in Atlanta, Georgia seeing clients at CrossFit North Atlanta starting June 2014! That means all you CrossFit athletes and endurance athletes will finally have a Physical Therapist locally that specializes in working with your unique issues. In the words of the great Bart Scott, can't wait!
Dr. Danny, PT, DPT
This is for all you executive athletes, aka you people with your butt in a chair most of the day. We know prolonged sitting is not good for your health. We also know it can wreck your hip mobility, force you into a junky position and create chronic lower back issues.
If you don't care about you hip mobility or spine, how about this. IT WILL HELP YOU LOSE WEIGHT! Watch the video below to see what I'm talking about.
A friend of my Juliet Starrett referenced this on Facebook about a week ago and it's also referenced in the book The Story of the Human Body by Daniel Lieberman. I highly recommend you read this book. The numbers for this video are based off a 150 lbs person calculated at this site.
Switch to standing more and your body will thank you for it.
Dr. Danny, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention and sometimes other random thoughts.