I recently saw this chart of the players on the Ohio States football team that won the National Championship this year. I thought it was fascinating to see that 42 out of 47 players played multiple sports in high school. In fact in an article interviewing Urban Meyers, he said he prefers multi sport athletes. Obviously, he’s had some pretty good success in his coaching career.
Youth athletics can be a polarizing subject. I get it, I have kids. I want my son and daughter to win and be great at everything they try. I also realize that they won’t win everything or be great at everything. As parents, it’s our job to set our kids up to be good at whatever sports they try to be competitive in later on in life. Let’s be real, just because your kid is the t-ball champion doesn’t mean he’s going to be playing for the Braves. If you put him on the course to only play baseball from the time he’s 6 until he’s in college, it’s likely he’ll get burned out on baseball and have significant trouble with overuse injuries.
There are a few key areas we need to try to develop for our kids to help them be well rounded. If they choose to eventually focus on a specific sport, they should have a great foundation to do so with skill development in these areas.
Learn How To Fall
This may be the most under emphasized skill in youth sports. We all want our kids to be the fastest, tallest, strongest or most skilled. What we forget sometimes is that the best athletes are the ones that are the best at fundamentals. One of the most important fundamental skills is learning how to fall. If you know how to fall, you will be hurt less. If you’re hurt less you can practice more. If you can practice more you will get better.
I never had anyone teach me how to fall until I joined the Army. While in the Army I had the opportunity to go through the first level of both the Army and Marines combatives system. One of the first things we learned was rolling drills in the Army. This is heavily drawn from wrestling and jiu jitsu. The Marines system went one step further and taught many of the fundamental skills from judo. Learning how to fall correctly is a skill. I learned this the hard way being hip tossed repeatedly in practice. It can be a trial by fire sometimes. If you land wrong, it really hurts. If you land correctly, it doesn’t hurt. That’s some good incentive to learn how to fall correctly. Get your kids involved in some type of martial arts early. They will learn valuable body control skills and decrease their likelihood of injury in the future. My personal preference would be judo due to the emphasis on balance, hip control/strength and learning how to land correctly.
Learn How To Control Your Body
I love watching my kids develop in a number of ways. Seeing their speech, behavioral and reasoning skills improve is a daily occurrence. Watching my kids go from crawling to walking to now running is amazing. One thing you will notice about young kids however is that they all gain gross pattern skills like squatting naturally. The more advanced body control skills have to be developed through practice. One of my favorite sports to recommend parents get their kids involved in is gymnastics.
I recommend gymnastics for a number of reasons.
First, it’s one of the best ways to help your children develop body control. There is no external load and until your kids learn how to control their own body movement, there is no reason to add weight.
Second, it gets your kids inverted. This is great and undervalued skill. For those of you that started CrossFit as an adult, you will know first hand how difficult it can be to learn a handstand. I’ve seen 6 year old kids that go to gymnastics twice a week hold handstands longer than I ever have. Not only that, it’s a great way of developing and maintaining shoulder/thoracic mobility. This is great to offset the amount of time most of our kids end up sitting at school.
Third, it’s tiring. For those of you that are parents you’ll appreciate this one. A tired kid is a good kid!
Learn How To Be On A Team
This is an area where we can use a sport to help our kids with life skills. Learning how to fall is important from an injury prevention standpoint but I think is much more important to learn how to communicate with others. If you’re on a team, it’s no longer all about you. You have to run plays, help each other out and work together for a common goal.
My preference is to recommend parents get their kids involved in a sport that emphasizes lower extremity skill and one that emphasizes upper extremity skill. Two great examples of this would be soccer and baseball. They both do a great job of developing rotational power/coordination. Soccer also develops tons of lower body coordination and aerobic training. Baseball develops high quality hand eye coordination.
Get your kids on a team and have them learn how to work with others. It will be nothing but positive for them as they get older.
The recommendations in this post are a great way to help your kids develop an athletic base for any sport they may choose to seriously pursue in the future. They are by no means the only ways to develop baseline athleticism. I’m sure I have colleagues that may disagree with me on some of these points. Here’s something we should all agree on. Sports are a great way to learn body/movement skills and life lessons. They should also be fun. Your kids need to have fun and should be exposed to a number of different sports. They need to make mistakes, they need to lose, they need to win and they need to understand that no matter what it’s just a game and we support them.
Thanks for reading. Leave us a comment on what sports/aspects of sports you think are important for kids to develop.
-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.
Dr. Danny, PT, DPT
Two years ago was a huge transition in my life and the lives of my family. We decided to leave active duty service in the U.S Army. We did this so I could work with a mentor of mine, Kelly Starrett. I took a position on his staff as an instructor for a group called MobilityWOD and have had the opportunity to travel the world teaching people how to take care of their bodies and improve their movement.
To keep me busy during the week we decided to open a small clinic in a CrossFit gym in West Midtown Atlanta. We still have this office and, it’s funny, looking back on what we started and how it has grown.
We started in a room in the corner of a CrossFit gym. The room has no windows. It isn’t fancy and it sure as hell didn’t wow anyone when they walked in. What we did have was a desire to change the way people are treated in the healthcare system. We believe and still do believe that the most important person in healthcare is the individual that is seeking help. It’s sure as hell not the insurance companies or massive hospitals that are trying to consolidate clinics around them.
We started with the idea that we wanted to have the time to listen to our patients. We wanted the time to not just find out their name but know their kids name. We wanted to know where they grew up and if they are a dog or a cat person. (I’m a dog person if you’re wondering, my wife is a cat person. Opposites attract!) This is developing a true relationship with someone, not just poking around on their shoulder and asking them where it hurts.
With this dedication to serving the individual, we’ve seen extraordinary results with people that have had weeks, months, even decades of pain/disability. We’ve had mothers who couldn’t run without hip pain following their last child, return to and successfully complete marathons. We’ve had accountants with 20 years of sitting under their belt come in with terrible neck pain. They leave being able to breath better, get back into physical training and without numbness and tingling in their hands when they fall asleep. We’ve had military special operations soldiers come in from as far away as New Mexico and helped them resolve chronic issues that would have caused them to be discharged from the military. We’ve even been fortunate enough to help some true professional athletes continue to be successful in their sport and prolong their careers.
We did all of this in a poorly lit room with no windows in the corner of a CrossFit gym. We helped not just the people referenced above but roughly 800 other people just like them. We did this by waking up daily and striving to be better than the day before. Learning and progressing is not optional, it’s the only way to truly help others in this field.
Now we are growing and have expanded to a full stand alone facility in the Decatur area. We’ve been able to bring on more employees including another Physical Therapist (she’s insanely talented, by the way).
The real reason we’ve been able to do all of this is you. You, the person reading this right now that we’ve helped get back to CrossFit or running or tennis. The person that we’ve helped pick up their kids out of the bathtub without back pain. The person that told their friend they can trust us and they needed to come and give us a shot. We are so thankful for your support of our business. Your trust in us with your friends and family means more than you realize.
Many people look around today and say the healthcare system is broken. We feel all of the changes and uncertainty with healthcare is an opportunity to creatively grow and go against the grain of high volume, poor quality care. We will never sacrifice our core values, make a decision that is not in the best interest of our patient or have third party insurance companies dictate how we can treat the people that seek our help.
Thank you so much for being a part of the Athletes’ Potential family. We are excited to continue to grow and improve our ability to help you and your loved ones. We look forward to growing with you but will never forget where it all started. A windowless room in the corner of a CrossFit gym!
- Dr. Danny, PT, DPT
Like most kids in the United States, sports were a huge part of my life growing up. If you would have asked the 10-year-old me what I wanted to be when I grew up, it wasn't a physical therapist, it was a professional baseball player (that obviously didn't happen).
When I do look back on my athletic career (I guess you could call it that), it's riddled with injuries. Here's a list of the major injuries I have sustained playing sports to include, football, baseball, basketball, soccer and dabbling in military combatives.
Looking back all the injuries that I have sustained it's a fairly long list. Some people would say that I'm injury prone, others may blame it on my genetics. I blame it on my horrific lack of mobility!
When I was in elementary school, I can remember taking the President's Physical Fitness Test. It was a big deal to me back then, mainly because I was sure I would be a professional athlete one day. I did great on all of the events and went into the last event with my confidence at an all time high. The last event was the sit and reach and I failed it! I could not for the life of me reach forward and just touch my damn toes. I was an emotional train wreck, my whole life revolved around sports and I couldn't even pass a national standard. That's a tough pill for a 10-year-old to swallow.
I think back to that test and I think of something different that could have come out of that. An educator, my parents or a coach could have seen that as a red flag or a warning sign. Sadly, the reality is that mobility is often overlooked and brushed aside as just being "tight". If you are making all-star teams and progressing in your athletic skill sets, who cares if you are a little on the tight side, right? Wrong, that's a big mistake and it needs to change.
We as coaches, parents and physical therapists have to prioritize movement first. That comes down to two components, motor control and mobility. Motor control is the ability to perform a movement correctly aka technique. Mobility is having enough available range in your joints and tissues to perform that movement optimally and safely. You need both to have proper movement, one without the other is worthless.
For me, mobility was my greatest obstacle to achieve better movement. Working on mobility sucks! I know, both as an instructor and from personal experience. Shit, two years ago I couldn't even touch my toes and now I teach Movement and Mobility courses across the country. It's very humbling for me to teach these courses for CrossFit and it's because I know first hand how much it can change people's ability to perform at a high level and stay injury free. Since adding MWOD concepts into my training I have not been injured once. I did get hit in the face with a surfboard that broke my nose a couple years ago but no amount of mobility/technique would have changed that. Some injuries are unavoidable but they are very rare.
Here's my advice for all my CrossFit athletes in Atlanta. If you suck at something, you need to focus on trying to improve that weakness everyday. This is not what most people want to hear. If you're flexible, you will enjoy yoga. If you're strong, you will enjoy powerlifting. The reality is, that super flexiblity yoga practitioner would benefit a hell of a lot more from doing some heavy squats than working on her pigeon position.
Find your flaws, chase them down, go for the throat and don't let go until your weakness becomes an asset!
-Dr. Danny, PT, DPT, OCS, CSCS
The human body is an impressive and complex system. We are resilient, quick learners and infinitely adaptable. We also have had technological changes occur very quickly that have changed the day to day of many of us. This day to day currently involves large amounts of sitting and very little non-exercise based movement.
In our attempts to restore our movement patterns one of the first areas that is addressed is mobility. If you have issues squatting, we mobilize your ankles and your hips. If you can’t press overhead, we mobilize your shoulders and your upper back. But, what if that problem isn’t a mobility problem?
Here’s an example of a change we were able to get with one of our athletes in about 20 minutes with no mobility work at all!
I have had this scenario come into my clinic frequently: A 30-40 year old ex-athlete that is still very active doing CrossFit or training for a triathlon/marathon. They sit all day and have had a sedentary job for a very long time. They get into loaded squats because they have read in multiple publications that say squats are a great way to build strength (which is true). Their knees and lower back now both hurt them when they do loaded squats. They stumbled onto a video of Kelly Starrett talking about mobility for the hips to improve the squat. They start mobilizing their hip with a big green jump stretch band and do so daily for a few months. Very little change occurs and they get frustrated.
This person eventually ends up in my office seeking out a better mobility plan. What mobility techniques should they do and how much MORE per day do they need to do? What other ways can they smash their tissues into submission so they can finally have a normal squat again?
One of the first things I want to delve into when I see a case like this is what type of movement work have you been doing? Is there any prioritization of moving into the new range they are working on after mobilizing? Do they have any huge roadblocks that we need to address, i.e. surgery from 10 years ago to the knee that was never fully rehabbed.
Once those questions are answered, I want to assess their squat in an unloaded position. I will look at a few areas: The ability to get the hip into flexion; the knee into flexion (this is rarely an issue); and the ankle into enough dorsiflexion that we can achieve a parallel depth squat.
For hip flexion, you can use the supine test in the picture below. Leave one leg out straight and pull the other leg up to your chest. You can even use your hands to pull the knee to towards the chest. Once you feel like your butt is coming off the table, that's all the room you have in that hip. We’d like to see 125 degrees in this direction. In order to achieve a parallel squat, you really only need about 90-100 degrees.
Picture courtesy of MHHE
For the ankle, I’ll have my patient do a quick wall test. They can either do this standing or kneeling. With your foot in contact with the ground, drive your knee forward toward the wall. You want your knee to be able to touch the wall with the front of your foot 3-5 inches away. The farther away you get, the more mobility you have in the ankle.
Often, both of these correlation tests are passed showing enough movement availability to be able to perform the squat correctly. We’ll do one last test with them to see what the squat would look like unloaded in a hands and knees position.
In the picture below, the athlete is assuming what is called the quadruped rocking position. If you were to rotate the picture, this athlete would look like he was in a variation of a squat. This is an unloaded way to assess someone's ability to get their hip to parallel, or past, and see if they are able to maintain spinal neutral. His toes are up to mimic ankle dorsiflexion in the squat as well. Once I assess this and an athlete shows the capacity to get as far back in a quadruped position as the picture shows (hip crease farther back than the knee), we can move on to fixing this.
Picture courtesy of Foundry Sports Medicine
Here’s a list of all the information we’ve gathered so far:
-They have sufficient hip flexion to achieve a squat.
-They have sufficient ankle dorsiflexion to achieve a squat.
-They have the capacity unloaded to maintain a neutral spine in a squat form (in quadruped).
At this point I can be pretty confident that this is not a problem that is going to be solved with crushing a lacrosse ball into their hip or band distracting their ankles. This is a control problem and it requires a completely different approach to restore the pattern.
This is where motor control work comes into the equation. Motor control simply put is technique. Here’s a more specific definition of motor control as well.
Motor control is the process by which we use our nervous system (brain, spinal cord, nerves) to activate and control the muscles/limbs involved in the performance of a skill.
So how do we get better at motor control? The answer is practice, in particular, blocked practice when we are trying to master a skill.
If you’ve played a sport, you’ve done blocked practice. Blocked practice is fundamental work. If you were a basketball player, you could improve your skills by just playing a bunch of pick up games. If you wanted to be a really good basketball player, you wouldn’t just do that. You would spend time working on dribbling with your non-dominant hand. You’d practice shooting free throws for hours. You’d practice the subtle nuances of a bounce pass vs a chest pass vs a lob pass. These are individual components of the overall game and you practice them individually so you can master the fundamentals. This is the most effective way for beginners to learn a new skill, but it’s also very effective for advanced athletes to maintain their mastery of the skill.
For the purposes of this article we will assume we are all beginners because the reality is many of us NEED to relearn this skill. Sadly, we were all probably much more efficient squatters when we were 5 years old and now we need to relearn that skill.
We’re going to start with breathing because it’s one of the most underrated portions of the squat and it has a dramatic effect on hip/spine positioning.
To start with, we will have athletes assume what is called the 90/90 position. This is essentially an unloaded squat pattern. We want our athletes to adopt a position similar to what they are trying to improve. We’ll try and get 10 reps through on this exercise prior to any other squat practice. It’s a great way to feel what we want our rib cage to feel like when we are squatting. It’s an easy way to also get a little prep work in for the diaphragm which is also a major stabilizer of the spine. Watch the video below for a more detailed explanation of this drill.
Step two is we want our athletes to understand how we want them to organize their spine during the actual squat movement. Here’s the general explanation I use:
First, I like to cue thinking about creating a steel tank and then pressurizing it with air. Think of a propane tank as an example. Our torso should be the steel tank and the air you breath in should pressurize it.
Here are the steps:
-Squeeze your butt.
-Screw your feet into the ground.
-Take a big breath in and blow all the air out until you feel like your ribs are pulled down flat with your abdominal muscles.
-Maintain tension and breath into it.
The amount of tension you need is dictated by the task. For example, if you’re squatting something really heavy, you want to have a lot of tension. If you’re doing a bodyweight squat, you do not want or need a ton of tension. You want just enough to be able to complete the movement safely and effectively.
Now that we have breathing down and we have an understanding of how to brace our spine, it’s time to move. We’ll start with something unloaded and then move to a somewhat loaded exercise. Also, just to be clear, this is not your workout, this is practice. Treat this as practice, take it seriously and your squat will improve dramatically.
The wall squat, “squat therapy”: For this drill I’ve picked a video that Rich Froning himself put together. I think this video does a good job of demonstrating a commonly used squat drill. As an added bonus, Rich is not wearing a shirt - you’re welcome!
One subtle change I like to make to this drill, is to have my athletes pause half way down. They will pause, take a big breath in, both the air out and then breath back into the tension they create. This is essentially making them go through the torso bracing sequence twice during the squat. If you feel your spine shift significantly when you do this, chances are you are over extending your lower back. We want your spine in neutral, not in a extremely arched lower back position. Your lower back should not look like a banana!
Also, make sure to pause in the bottom and control that position. Imagine you are hovering over the grossest toilet in the world! This should be a very active position in the bottom of the squat.
Start by performing 10 of these squats a comfortable distance away from the wall. It should take you 3-5 seconds to descend, pause for 3-5 seconds and stand up in 1-2 seconds. Next, move a little closer to the wall so it’s moderately challenging for you to hold the position. Perform 10 more repetitions with the same tempo as the first 10. Lastly, move a little closer to the wall so it’s difficult for you to maintain the squat position. Again, use the same tempo. Don’t rush this, the struggle is where progress is made!
For the next drill we’ll throw in some real nervous system trickery! We’re going to use a band to help create something called Reactive Neuromuscular Stabilization. It’s a big term for exaggerating the problem.
Ever wonder why your coach or PT has you squat with a band around your knees? Well, it’s because if we force you into a bad position, the body naturally tried to correct it by firing in the opposite direction. So if we pull your knees in with a band, your body with activate the hips to engage the knee outward into the pressure.
We’ll do the same thing with your torso to help correct excessive forward leaning. In the video below, I explain how I use this with my patients. I show this with one arm at a time but you could absolutely do it with both arms at the same time.
Keep the same tempo as the squats above for this one. That would be 3-5 second decent, pause 3-5 seconds, and then stand up in 1-2 seconds.
It is also very important that you maintain control of your torso/spine while you do this. We are not trying to reinforce a bad pattern of firing too much into spinal extension. Video yourself from the side just to make sure you don’t instantly start the movement by overextending your lower back.
Perform 2 rounds of 5 reps on each side.
Lastly, let’s get some weight in your hands. We’ll use a dumbbell or kettlebell as we do a squat variation called a goblet squat.
The goblet squat is one of my favorite squat training drills. I’ve heard some coaches say they hate the goblet squat and that’s mainly because you are semi-limited on how much weight you can load with. For the purpose of building pure strength, there are definitely better squat options. For learning/improving the loaded squat pattern, I think the goblet squat is the best squat variation.
A few things happen with the goblet squat that are interesting. First, we add weight to the body in front of the torso. This creates a really unique counterbalance that allows us to be more upright and sit down a little bit deeper into the squat. It also creates some inherent need for “anterior stability” or tightness in the abdominal region. Loss of control in the abdomen is one of the biggest faults I see in loaded squatting. It creates countless issues in the hips/back/knees and can be retrained well with the goblet squat.
Pick a semi-light weight but something heavy enough to counterbalance you. 10 pounds will probably not be enough for most people but grabbing the 100 pound meatball kettlebell isn’t the best idea either.
Once you pick the up the kettlebell go through the same bracing sequence we talked about earlier:
-Squeeze your butt.
-Screw your feet into the ground.
-Take a big breath in and blow all the air out until you feel like your ribs are pulled down flat with your abdominal muscles.
-Maintain tension and breath into it.
Perform 10 reps at a faster tempo than our unloaded squats. Try 2 seconds on the decent, pause 2 seconds and then stand up. We’ll go through this two rounds as well.
Here’s the prescription:
3x per week perform this practice session:
1 round not for time
-90/90 breathing 10 reps, 5 seconds in, pause 5 seconds, exhale 5 seconds
-30 reps wall pause squat to a target, getting closer to the wall after each sequence of 10 reps
-Overhead RNT banded pause squats 2 rounds 5 reps each side
-Goblet pause squat light to moderate weight 10 reps
So, when can you plug this into your training? You have a few options, but in my opinion it’s best to do this prior to a training session. Think about incorporating this into part of your warm up on squat days. If we go back to the basketball reference, it would be like practicing shooting from different spots around the 3 point line prior to a game. There is a carry over effect in that motor pattern to the actual game where you have less than ideal conditions(people trying to stop you from shooting).
Practice the skill and then use the skill. Your workout is the game but your practice is what makes you dramatically better.
Step one is to help tease out if you have a mobility problem or not using the tests we described in the beginning of the article. If you don’t have a mobility restriction, then it’s time to practice the movement. Give it a solid 4-6 weeks of practice and see how much more comfortable it feels to squat.
Don’t spin your wheels thinking you have a mobility problem. It’s not always the case and movement really is medicine!
-Dr. Danny, PT, DPT, OCS, CSCS
Still have questions? Contact us at firstname.lastname@example.org to see how we can better help you.
Hi, I’m Dr. Danny Matta DPT. I’m a Physical Therapist/Strength Coach and I’m the founder of Athletes’ Potential. Our company helps people just like you live higher quality, higher performance lives. That could be running your first 10K, competing in the CrossFit Games or getting rid of that lingering back pain so you can start getting back in shape! Dry needling is a technique we use frequently. I hope you have a better understanding of what it is after this article. Please email us if you have any other questions and we’d be glad to answer them for you.
When I was in the Army as a Physical Therapist, I remember first hearing about dry needling and thinking how crazy it sounded. I remember thinking PTs that were doing dry needling were searching for some kind of voodoo treatment that only had placebo effects. I actively stayed away from learning it because at the time I was a new graduate that thought I knew everything and was going to set the world on fire by getting everyone better.
Well, things changed one morning when I wrecked my back after a ruck march training session. I hurt my back so bad I could barely drive home and had to cancel all my patients that day. I threw everything at it that I knew and even enlisted the help of a few of my colleagues. Six months later, my back still hurt to pull weight from the ground, back squat or run (that was literally 80% of my training at the time!).
About that same time, a new physical therapist named Dr. Emmanuel Easterling moved to where I was stationed. Dr. E, as we called him, was a certified dry needling ninja. I reluctantly let him perform his voodoo on my back and I'm so glad that I did!
Within 2 days of Dr. E dry needling my back for the first time, I was running with no back pain. After the second time he did it, about a week later, I was squatting and deadlifting again. That was it- I was hooked and not only did I drink the Kool-Aid but I chugged it! I dove into dry needling head first and learned as much about it as possible.
So what does this technique do and why is it so effective? That’s a great question and the answer is we don’t fully know. Frankly, medicine is constantly evolving and we are always using our best evidence/knowledge at that time. Dry needling is the same way so as I answer this, understand there is probably way more to this than we even know.
First, dry needling involves placing small needles into strategic spots in the muscles. These spots were recognized and mapped out by a physician named Dr. Janet Travell, MD. She was an incredibly smart lady and was even John F. Kennedy’s personal physician during his presidency. Did you know he had chronic back pain? Yep, and what did she use to alleviate the back pain? You got it- dry needling!
The points Dr. Travell mapped were called trigger points. This trigger points in the muscle actually refer pain, not just where the “knots” in the muscle are, but to other areas of the body. Here’s an example of a trigger point in the upper trap. The X is where the trigger points are typically found. The dotted red areas are where the trigger points refer pain. Have pain on the inside of your shoulder blade? It could be just an irritated trigger point in your upper trap that dry needling would help fix really fast!
So how does a needle in a muscle cause pain to resolve quickly? There are a few theories on why this happens and I like to explain it in terms most of us understand: Think of a trigger point like a glitch in your computer. Something isn’t working right and it’s causing other things to have issues as well. What fixes most computer problems? You got it- the restart!
Dry needling is like the restart for the musculoskeletal system. If we have a irritated trigger point and we put a needle in it, it resets. This reset occurs at the muscle with what’s called the wash out effect. This basically means that a needle in a muscle causes increased blood flow to the area. Increased blood flow causes increased oxygen/healthy blood to shunt to the area. Local inflammation/stagnant fluid gets “washed out” by this effect.
There has also been evidence to support the theory that dry needling has a strong effect on the nervous system. Basically, placing a needle in a trigger point causes local opioids (our bodies own natural painkillers) to be released. This also causes a positive pain relieving effect on the spinal cord. This means we can get a local and central pain relieving effect from this technique.
Yes, most people are sore for a day. It feels like you worked out hard and the muscle is fatigued. In addition, you have to perform self-treatment work to really get the best benefit from dry needling. Picking the right home exercises and doing the right technique is where the magic is.
If you’ve been struggling with an injury or pain that’s stopping you from the activities you love, this might be a very effective treatment option for you.
You have a choice. You don’t have to wake up every morning and hope that this is the day your shoulder/back/neck or whatever areas stops hurting. It’s sad how many people are in pain daily. It stops them from playing with their kids, walking 18 holes in golf, staying in shape and living overall happier lives.
If you’re in the Atlanta area and you’d like to talk with one of our Doctors of Physical Therapy to find out if our approach is right for you, contact us. We’ll set up a free 10-minute phone consultation at your convenience.
Thanks for reading.
Dr. Danny, PT, DPT, OCS, CSCS
Here’s a scenario I see all too often in my clinic:
You’re a middle-aged, ex-athlete but you still like to workout and are a weekend warrior. You bang your knee up a little doing a CrossFit workout or a long trail run so you go to see a physical therapist. You have a good job and you have health insurance through your company. You pick a clinic that you find that takes your insurance that’s near your home or office and go in for your first visit.
You get your diagnosis, they do some work on you and then you leave with some homework and a plan going forward. This plan is typically to come back 2-3x/week for 4 weeks. As you head to the front desk to check out, they present you with a bill. The bill is for $250 and is due today for the cost of your treatment session.
You’re completely caught off guard. You are almost positive that you had read you have a $40 co-pay for physical therapy. The front desk staff explains to you that is correct but it’s only a $40 co-pay after you’ve met your deductible. Your deductible is $2,000. She explains that once you’ve met that out of pocket expense which should be after the 8th visit, then you will have a $40 co-pay.
You pay the bill and leave aggravated. You wonder why the hell you’re paying $400 a month for insurance. Why didn’t anyone tell you before that you had to meet the deductible first before your insurance started kicking in?
My opinion on insurance is that you only win if you lose. What I mean by this is that you really only get a return on what you’ve been paying for if you get hurt badly or get very sick. We all need insurance for these catastrophic events but most people can expect their insurance to pay for very little if they are healthy.
It used to be that deductibles were as low as $200 and maybe $1,000 on the high side. I know individuals that have a $3,000 deductible on a single person policy. I’ve seen family deductibles in the $10,000 range. They are trending higher and the emphasis on the consumer (you) to pay more out of pocket is expected.
First, let’s clear up some confusion. In the scenario I laid out above, the $250 is an estimate. If the physical therapy practice that you go to is in network with your insurance, that means they have a contract and will charge set amounts. If you want that money to go toward your deductible, that clinic has to charge you the same amount they would bill your insurance company.
Let’s do a little bit of math here and show the true cost to you assuming you want to use your insurance and apply your physical therapy towards your deductible.
$250 a visit x 8 visits to meet the deductible= $2,000
4 more visits to meet the 12 visits recommended by the physical therapist at the co-pay amount of $40= $160.
Total cost for physical therapy= $2,160
Last thing is to factor in the the cost of your time. You have now gone to the clinic 12 visits, each for 1 hour. Let’s assume that round trip you drive 30 minutes to each visit, that would come out to 6 hours of driving back and forth from the physical therapist. Add in 1 hour for each of the 12 visits you spend there and that equals 18 total hours.
Total cost $2,160 and 18 hours of your time.
Let’s compare this to an out-of-network model like the one we use at Athletes’ Potential.
Because we have no contracts with insurance companies, we can charge whatever we want. Our office visit is $175 for an hour visit. This exclusion of being in network with an insurance company allows us to make decisions based on patient needs, instead of when you may or may not meet your deductible.
Our clinic average is currently between 3 and 4 visits. Let’s say we see this patient once a week for 4 weeks for a total of 4 visits.
$175 a visit x 4 visits= $700
We also need to factor in the time cost. Let’s say we have the same 30 minute round trip commute to our clinic. This patient makes a trip 4 times for a total of 2 hours driving. Total time commitment 4 hours of physical therapy plus 2 hours of driving= 6 hours.
Total cost $700 and 6 hours of your time.
So if it’s less expensive and costs less time to not use your insurance, why would you want to use it? That’s a tough question to answer. I think most people don’t actually know what their health plan covers or doesn’t cover. It’s also very confusing to look at your benefits sheet and try to figure out what it all means. You have a deductible, a copay, co-insurance, family vs individual and max out of pocket expenses. No wonder people show up at a clinic thinking they have a $40 copay and get slapped with a $250 bill.
So should you just dump your insurance? Well, no, you legally need it and hopefully you never have a catastrophic event but if you do, that insurance will come in handy. I also think there are a few scenarios where you should use your insurance.
The main physical therapy scenario in which you should use your insurance is if you need surgery. Surgery in most cases will be expensive enough to meet your deductible. Once that deductible is satisfied you owe that $40 co-pay for your insurance. Early on in the post surgery physical therapy plan it’s important that you get consistent treatment. It’s also not rocket science. They know why you’re there and for the first 6 weeks in many cases they are following a standard post surgery protocol laid out by the doctor.
We actually turn people away almost every week that just had surgery. Not because we don’t think we can help them but because it will be more cost-effective for them to go to an in-network clinic since they’ve met their deductible. Once they get out of the early stages of rehab and can get more into return to sport/activities, they will switch over to us for home-based programming and advanced movement retraining.
Here’s the litmus test I usually give people to see if it’s worth it to use their insurance or seek out a provider outside of their insurance contract.
Have you met your deductible?
Do you value your time?
I hope this helps navigate some of the difficult to understand territory that is our current health system. Before you decide to go see someone for physical therapy, ask yourself the questions I posed in this article.
If you’re in the Atlanta area and you want some help dealing with an injury or getting back to an activity you’ve been avoiding, give us a call. We can set up a 10 minute phone consultation with one of our Doctors of Physical Therapy to see if you’re a good fit for what we do.
Dr. Danny, PT, DPT, OCS, CSCS
How Runners should warm up, but don't.
All too often the answer is “I just run my first half mile slower and then get into my running pace.”
Paula Radcliffe, one of the greatest female marathoners in English history, does a warm up for 45-50 minutes before a marathon race! That’s longer than most of us will run for our work out.
So why is it that elite runners and athletes put such an emphasis on warming up and we do not? There are a few factors that can lead to the lack of using a warm up.
We’re going to try and solve these issues with the warm up and put something together that you can do in a short period of time (15 minutes) before your next run.
Here’s the strategy in a nutshell: we need to get tissues opened up that can be primary limiters of running mechanics and we need to get muscles firing that need to be working for proper movement. Let’s start with opening up the tissues we need for running.
One of my favorite pre-run mobilization for runners to do is a quick pressure-based technique for the bottom of the foot. All you need is a lacrosse ball, baseball or some other type of hard ball to step on. Do not use a racquetball or a tennis ball, it’s a waste of your time because it’s not enough pressure. We want to open this area up before running because every little bit of increased ankle dorsiflexion will be a mechanical advantage for us in particular on hills.
Do this technique below for 1 minute on each foot
Next, we want to open up the hips, in particular hip extension. This allows us to get our leg behind us while we run without having to compromise our back to do so. This is also a huge area of emphasis because of the amount of time most of us spend sitting. When we sit we are in a hip-flexed position. When we run, we drive into the opposite range, hip extension. If you sit all day in hip flexion, your tissues get tight in that range and cause you to lose hip extension.
This is essentially a hand brake that you have with your forward movement. By opening up your hip extension, it allows increased ease of movement in the running gait. Here is what you’re going to do. This stretch is called the world’s greatest stretch and it really might be!
Perform this sequence twice on each side. It should take you about 1 minute to go through this sequence on each side. This gets things moving at the upper back, front of the hip and hamstring/calf. It’s really a catch all for many athletic movements but in particular running.
Alright, we should have those done in about 5 minutes. On to the priming of the movement that we want to perform.
I’m a big fan of working on the skill of running. That’s right, running is a skill and if you treat it that way your body will thank you and your finish times will be better. Practicing certain movement prior to running can help us ingrain good moving patterns while we are running.
The first drill is a pulling drill that I use all the time with my athletes. Do 1 minute of pull drill work like Nate explains in the video. After that, run for 1 minute trying to emphasize the same exact pull feeling that you got doing the drill.
The last drill will be to work on your cadence. Cadence is how many foot strikes you have in a minute. Coaches and researchers have found that having a cadence around 180 foot strikes per minute is a very efficient place to run. This allows for you to pull your foot quickly off the ground and minimize some of the elongated ground reaction force that happens with a very slow cadence.
Download a free metronome app on your phone. Put the beats per minute at 90. You’ll try and have your right foot hit the ground every time it bets. This will equal 180 foot strikes per minute since you’re only counting the one side. Run for 1 minute at this cadence but try and keep a slow to moderate pace. Don’t go bananas and try to run a 4 minute mile because you’re increasing your cadence. Stride length plus high cadence is what allows us to run really fast efficiently. Shorten your stride and keep your cadence high during this drill. You should imagine you’re running on hot coals.
In summary your warm up should look like this:
Don’t be surprise if you’re breathing a little harder after your warm up. That’s why it’s called a warm up! You’ve got to prime your body for what you’re about to do. This could be the single most important thing you can do to maintain your body as a runner and improve your skill of the movement.
If you’re a runner, triathlete or CrossFitter that wants to improve your running or are dealing with a run-related injury let us know. We’ve literally helped thousands people with knee, foot, hip and back issues related to running. Don’t wake up every morning wondering if this is the day your knee will stop hurting when you run. There are answers out there and we can help.
Contact us below if you would like to set up a free talk with one of our Doctors of Physical Therapy to see how we can help you run pain free.
Thanks for reading,
Dr. Danny, PT, DPT, CSCS
Hi, I’m Doc Danny Matta. I’m a physical therapist, strength coach and an instructor on the MobilityWOD team. I’ve worked with countless CrossFit athletes, soldiers and weekend warriors over the past 6 years as a physical therapist. These are just my views. If you don’t like them, stop reading and start your own blog.
Last year during the 4th workout of CrossFit Open Week, I saw an epidemic. That epidemic was a ridiculous increase in acute neck injuries. I thought to myself, did everyone get in a car accident and sustain a whiplash injury in the same week? I quickly realized that it wasn’t car accidents crushing people’s necks, it was handstand push ups!
Don't be this guy!!
If you don’t remember the 4th workout last year it was as many rounds as possible in 8 minutes:
3 cleans (men use 185 pounds and women use 125 pounds)
3 handstand push ups
6 handstand push ups
9 handstand push ups and so on for the entire 8 minutes.
I actually really liked this workout when I saw it. It’s a nice push pull couplet. It’s moderately heavy but light enough where many people would be able to at least do a few rounds. What I didn’t expect was that I would see people pile driving themselves into the ground to get one extra hand stand push up!
Let’s be real with each other, if you’re reading this and you honestly have a shot to go to the CrossFit Regionals or Games I understand why you might sacrifice your neck to achieve a long term goal. Look, I’m as competitive as anyone. I once kicked a guy off an intramural flag football team I was on mid-game because he sucked. Do your thing, and I hope you achieve your goal.
The rest of you, honestly probably 99% of you reading this need to look at this from another perspective. You are not going to the CrossFit Regionals, let alone Games. You are doing CrossFit because you’re trying to be healthy, look good and have a supportive community to keep you motivated. You need to look at the Open as a way to test yourself, try new things, have fun and compete with your friends/family.
I only have one person that I compete against when I do the CrossFit open- my brother. I bet you thought I was going to say myself. Sorry but that’s cliche bullshit! You need to compete against another human being if you really want some competition. In my case it’s my older brother and I look forward to crushing him again this year because I know he and his wife just had a baby and he’s going to be in less than ideal shape!
So, for those of us falling into the non-CrossFit Games/Regionals category here’s my advice: Do not do something that subjects you to injury that can limit your ability to function at work or with your family. Get with your coach and get a game plan for the workouts. Maybe you do your best with the RX weight but don’t do something stupid. You still get a score. After you do that, scale what you need to scale and then get a good solid workout in.
Go to your gym’s Friday Night Lights workouts. Get involved in the fun of the Open and enjoy it. Have a fun 5 weeks, this is your season. You’ve been training all year for this. Once it’s over, get back in the gym and work on your weaknesses. Follow my advice and you’ll get to that point without breaking your neck!
-Dr. Danny, PT, DPT
It’s the day after Christmas and as my wife and I break down the endless boxes that my kids' toys came in, I had some time to reflect on this past year. I’ve learned a lot of lessons this year and since we all have such short attention spans these days, I will share this with you in bullet point format!
1. Age is just a number.
If you didn’t know your age, how old would you say you are? How old do you feel? I turned 30 this year and supposedly that means it’s all downhill from there. I disagree with that, I feel like I’m just hitting my prime. Age is just a number, don’t pay attention to it.
2. Treat your body better than your car.
Because of the nature of my practice I get some very successful people as patients. Many of these clients have the newest German luxury, badass cars that’s detailed and shiny as could be. The car is taken care of as if it’s going to need to be show-ready at anytime.
Many of us treat our vehicles better than our own bodies. Listen people, you can get tons of different vehicles in your lifetime but you only get one body. That means treat it with respect. Put good food in your body. Exercise and perform some basic maintenance. That means you either do some body maintenance on yourself or go see someone to get a massage, do some dry needling or some whole body cryotherapy.
You can either put the work in now or pay the price when you’re body breaks down on you.
3. You can’t appreciate how comfortable you are unless you are uncomfortable sometimes.I read a book this year that I really enjoyed called Living With A SEAL by Jesse Itzler. I recommend you all read it. It’s a short read, hilarious and the message really resonated with me. In the book, the SEAL Jesse hires to train with him makes him sleep in a wooden chair all night. His rationale was he was too comfortable. He wanted him to experience something uncomfortable so he could appreciate what he had.
Push your body, expose yourself to uncomfortable things and have a better appreciation for how comfortable our lives really are.
4. Embrace the cold.
For the past few months I’ve been exposing myself to cold immersion work. I’ve done things like cold showers, ice baths and running in cold temperatures in shorts and no shirt.
I was inspired by a man named Wim Hof who is called the Iceman. He believes that cold exposure and breath control is the way to unlock our human potential.
I have to say, I hate being cold. It’s such a mental hurdle to step into a cold shower or get in an ice bath. Once you do it, it’s so cold it literally takes your breath away. This is where the magic happens. If you can expose yourself to something cold enough to take your breath away and then control your breathing, you’re in charge again. You are overriding your body’s fear mechanism.
This has been one of the coolest things I’ve learned in the past year. You might be standing in a whole body cryotherapy tube that’s -200 degrees but in your mind it can be 75 degrees and sunny!
5. You need to actually warm up before training.
I know, this sounds crazy right? Actually warming up before doing a workout- what a creative idea! Here’s the reality: very few people actually warm up before training. Some gyms run people through a structured warm up but some leave it up to the athletes to warm themselves up. I think this is too important to be left up to chance.
Take your athletes through a thorough warm up specific to the training for that day. 3 rounds of Cindy does not count as a warm up unless you are doing Cindy!
This could very well be the most important injury prevention tool you have as a strength coach, use it!
6. Your diaphragm is the second largest muscle in your body, use it.
Most of us take somewhere around 15,000- 20,000 breaths in a day. That’s a ton of breaths and you can live a long, happy life breathing like crap. If you’re an athlete you’re missing out on a golden opportunity if you aren’t working on your breathing.
I’m talking better endurance, better spinal stability and stronger lifts. I’m not selling you snake oil. Learn how to control your diaphragm along with the structures that connect into it and you will be a better athlete.
7. Everyone is deficient in Vitamin D.
Well maybe not everyone, but basically everyone who’s blood work I looked at this year was deficient in Vitamin D. Get your Vitamin D 25-hydroxy tested. Optimal values should be in the 50-80 ng/mL range.
8. Everyone should be taking a probiotic.
Probiotics have been mainstream ever since Jamie Lee Curtis became the spokesperson for the probiotic yogurt, Activia. Well, in the past few years more and more research has been done on gut health, gut bacteria and the link between poor gut health and neurologic disease. A probiotic is an easy way to make sure you’re getting healthy gut bacteria. You can also throw in some fermented foods like pickles, greek yogurt with live cultures, kombucha tea and kimchi. Adding a probiotic into my daily diet has had the best health effects on me than anything else I’ve done this year.
Check out the great conversation we had about functional medicine for more info on this.
You’ve got to get high quality sleep. It’s so important for so many body functions. In the worlds of Dr. Kirk Parsley (check out our podcast with him if you haven’t listened yet) “Good sleep is the most anabolic thing you can do for your body.” Get 7.5-8.5 hours ideally. Make sure the room is pitch black and cold.
10. Do something to utilize all that time you put in at the gym.
Play a sport again. It doesn’t have to consume your life like when you were in high school and college. Pick something and start utilizing all that great training you put in at the gym. Go out there and dominate some overweight frat boys and guys with dad bods. You’re a fucking stud, go dominate!
I was challenged earlier this year by one of my patients. She bet me that I couldn’t make it 3 minutes without thinking about something. I took the bet and lost. I made it about 20 seconds into my 3 minutes of mindfulness meditation before I started thinking about my to do list. Add in just 3 minutes of mindfulness meditation everyday. If you don’t have 3 minutes to work on your own mental mindset then you have bigger problems.
12. Do or do not. There is no try.
Yes, I stole this from Yoda. We’ve been re-watching all of the Star Wars movies with my 4 year old son. He told me that I didn’t know the power of the dark side the other day. I think we’ve created a Star Wars maniac.
What this means for you is stop telling other people and yourself that you’re going to do something. Stop putting things off until tomorrow. Tomorrow is a magical place where nothing ever happens! Whatever it is that you’ve been holding off on, do it this year. Run that marathon, do that triathlon, start that business you’ve been thinking about, ask that cute girl at your CrossFit gym out on a date. Stop procrastinating, just do it already.
13. Earn your carbs
This is something I got from my friend and podcast co-host, Joe Szymanek. I love his philosophy of earning your carbs. Carbs are great! In fact, you could argue that it’s the most delicious macronutrient.
Too many carbs, along with poor intake timing and a sedentary lifestyle will turn you into a fat lazy person with type II diabetes. Timing your carb intake around your training session will help you recovery and have more energy. You’ve gotta earn your carbs.
14. A pyramid is only as tall as it’s base.
This is something that Louie Simmons has famously said. What he means by this is you have to build a strong athletic base if you want to build a serious athlete.
If you can’t control your own spine under load, do you think you’ll be squatting 1000 pounds? That’s what people that go to work with Louie Simmons do on a regular basis. They work on their base constantly so they can build a taller pyramid.
You have to prioritize the fundamentals and doing the non-sexy auxiliary work. Think reverse hyper, hollow to arch progressions, single leg deadlifts and good mornings. This stuff is just as important as doing metabolic conditioning.
15. Listen to podcasts
I might be slightly bias because I have a podcast but it’s the truth, podcasts are the best. It’s completely free and you can learn some amazing things by listening to podcasts. I can tell you without a doubt my business and my professional skill set have improved because of listening to podcasts. Try it on your commute to work. Just think, if you’re sitting in your car for an hour a day, 5 days a week and you listen to a podcast 50 weeks out of the year, you’ll listen to 250 hours of content a year. That’s a lot of information! If you don’t know where to start, check out Doc and Jock first.
Thanks for being a part of the Athletes’ Potential family in 2015. Have a great 2016!
-Dr. Danny, PT, DPT
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Dr. Danny and staff's views on performance improvement, injury prevention and sometimes other random thoughts.