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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
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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Our July Series on Instagram brought you these 4 videos to help runners improve 4 key areas:
Good luck hitting the road (or Beltline or treadmill!) 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:   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. Thanks for reading, Marcus Rein, PT, DPT, CF-L1
 Tennis is a sport that demands an incredible amount of strength, stability, and performance out of one of the most unstable joints in the human body… the shoulder. Not only do you need to drive your shoulder through some truly incredible velocities with something like a serve, but you need to be able to control that power through finely tuned movements in multiple planes of motion with an almost endless list of types of swings. The demands on the shoulder are pervasive in tennis and because of this we have successfully treated endless amount of shoulder related injuries from the tennis players we see at Athletes’ Potential. However, through all these injuries that we’ve worked with, we have started noticing some trends in common strength deficiencies and biomechanical limitations that, when addressed, can have serious impacts on reducing injury risk and improving performance. Trend #1: Inadequate Shoulder External Rotation Range of Motion Arguably the most violent swing in tennis is the serve. To generate the amount of torque required for this swing, you need to have an appropriate amount of external rotation at your shoulders. The video below goes over a quick and easy drill to assess your shoulder external rotation. Essentially you should be able to lay on the ground and get the back of your wrist to the ground while keeping your low back pinned to the floor. Some common mistakes to avoid when doing this assessment include:
If you can’t bring your wrist to the ground, or you have pain when you do or feel like you really have to fight to get there, then try some of my favorite drills to improve shoulder external range of motion. Drill #1: Front Rack Opener Drill #2: Lat Stretch Drill #3: Upper Back Mobilization Trend #2: Upper Back Strength In order to have a strong, effective swing you need to have a strong back. This may seem a little counter-intuitive, but let me explain. Your body is innately intelligent and it’s not going to let you produce more force than it feels it can control. Therefore, to have a better swing, you need to have a strong back to be able to eccentrically control your arm as you go through the swinging motion. Some of my absolute favorite exercises to make sure you have a strong upper back are listed below. Exercise #1: Deadlifts Exercise #2: Pendlay Row Exercise #3: W, Y, Negative Trend #3: Lack of Rotational Core Strength Your power in your swing comes from having a strong core. If you don’t have a strong core, then you have no foundation to deliver a strong swing, and if you are trying to have a strong swing without a solid foundation, well, you’re begging for an injury. Check out my favorite exercise to improve rotational core strength. Exercise #1: Med Ball Rotational Throws Exercise #2: Deadbug Pallof Press Exercise #3: Landmine Twists If you’re a tennis player struggling with shoulder pain (and yes, even elbow pain) or are looking to improve your performance, these drills are a great place to start. They are the three main problem areas that we find ourselves addressing with the tennis athletes who come to us for help. However, If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Thanks for reading, Dr. Jake, PT, DPT, CSCS  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.
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:
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
Passive Range Holds
Passive Range Lift-Offs
Hovers
End-Range Rotational Training
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 It’s baaaaack. The largest fitness competition on Earth, the CrossFit Open, is finally here. Maybe you’ve trained all year for this, maybe you’re still new to CrossFit and are curious about all the excitement. Maybe you’re a seasoned vet, maybe this is your first Open you’ve ever participated in. Regardless of your CrossFit background, your fitness will be tested, your mental toughness will be challenged, and you will certainly have a blast working through these workouts with your crew at your local CrossFit affiliate. That being said though, this is typically a time where we start seeing an uptick in the people we see coming in for CrossFit related injuries. Having an athletic background, where I had to personally sit out multiple seasons due to injuries, I speak from experience when I tell you there is nothing worse than working all year towards a goal/competition/test and not being able to perform at an optimal level, if at all, because of an injury. And, look, I get it. There is inherently an increased risk of injury when you're pushing yourself in a competitive environment. However, there are some very important things you can do to minimize this risk and allow you to perform your best. Let’s take a look at the three easy things you can do: #1 Don’t Be Reckless This is huge and something I see year after year. If you’re a CrossFit coach, or even just an observant CrossFit athlete, I’m sure you’ve seen what I’m about to explain...You’ve worked all year to create movement patterns that are both safe and effective. You know the importance of good, quality movement. However, throw in the element of an international competition and it seems like all these lessons about technique go out the window. For example, last year’s first Open workout (18.1) consisted of three movements: toe-to-bar, dumbbell clean and jerks and rowing. Can you guess what type of injury we saw coming into our clinic after this workout? If you said back pain, you’re correct. But why? Well, with this workout people were trying to perform as many rounds as possible for 20 minutes. To get better scores people weren’t maintaining core control for a solid hollow position with their toes-to-bar, they stopped getting full hip and knee extension for optimal power production during the drive portion of the clean and jerks, and/or they started to over-extend during the rowing component. All of these create situations that are destined to increase stress on your low back. Keep in mind that this was just the first workout! Now you’re either completely unable to participate in the other workouts or will not be performing at an optimal level because you’re trying to grind through an injury. #2: Protect Your Sleep There are four main pillars of health care that we look at with every patient who walks in the door at Athletes’ Potential: Movement, Stress, Sleep, and Nutrition. Sleep is easily on of the biggest problems that we see out of these pillars. And check this out: Sleep affects everything you do and everything you do is positively affected by quality sleep. Good, quality sleep literally improves everything: every marker on a blood panel, weight management, sport performance and recovery, productivity, and numerous types of disease management. The list goes on and on, yet the percentage of sleep deprived Americans, particularly in Urban areas, continues to rise at an alarming rate. In fact, the U.S Centers for Disease Control and Prevention reports that more than 30% of Americans are sleep deprived getting fewer than 6 hours of sleep per night. If you’re not getting enough sleep, you’re not giving your body a chance to recover. If you’re not recovering appropriately, then you're leaving yourself at risk for injury and decreased performance. So, bottom line: create an optimal sleeping environment, protect your night time routine, and get some good, quality sleep. For more info on how to optimize your sleep, check out this article we wrote. #3: Maintain Perspective This comes full circle with tip #1. For those of you trying to make it on to Regionals, those extra few reps I mentioned could be the difference in making the cut vs staying home. However, for the vast majority of athletes competing in the CrossFit Open this is not reality. You all have careers, kids you need to take care of, and numerous other responsibilities that you need to keep rocking with once you leave the gym. Is bouncing off the top of your head to get an extra rep or two really going to mean that much if by doing so now you can’t look over your shoulder while driving? (yes, this is a real scenario that we’ve worked on at our clinic...I’m looking at you 17.4). Or is that two position jump on the leaderboard really all the important if now you can’t bend over to pick up your kids?
CrossFit is meant to be a competitive, fun, and challenging way to make all aspects of life outside the gym a little easier. This time of year is huge for all CrossFit athletes and it is truly impressive to see the physical accomplishments and PR’s that happen every single year in the Open. However, the Open isn’t an excuse to throw all safety out the window, but it isn’t something you should be afraid of either. Following these three easy tips will ensure that you have a great time, reduce your risk of injury, and maybe even hit a PR or two. Thanks for reading, Dr Jake, DPT, CSCS, CF-L1 Have you ever been in the middle of a workout and feel an ache or pain? It’s completely normal if it’s something small and goes away. It’s another story if it continues to bother you or increase in pain. Sometimes we just do too much (or too little) and it pisses off some part of our body. You may start to realize it’s impacting the way you move and you may even avoid a particular movement that causes the pain altogether. Often times, people see this as a sign to take some time off and rest. This may be the case in some instances, but it’s not always the best solution. Some people go to a healthcare professional to find out what’s going on. Quite frequently, they’re told to stop that activity or exercise. We hear it all the time from new patients. “Squats are bad for your knees.” “Running will wreck your body.” “Stop doing CrossFit. You’ll get hurt.” But, what if you’re an Olympic weightlifter who has a competition coming up? What if you’re a runner who loves a good 5k? What if you have a stressful job and CrossFit is your outlet to relieve that stress? Come on, healthcare - we can do better. If these are your goals, we want to help you get there. Here’s 5 different ways to train around pain and decrease stress on that painful area:
MAIN GOAL: MAKE THE LEAST CHANGES POSSIBLE TO THE MOVEMENT Now, let’s break down each one of these using knee pain with front squats as an example.
Here are a few other examples for you:
Here’s the overall concept: Pain comes on --> scale back movement slightly --> train movement --> adapt --> progress difficulty --> adapt --> back to prior level --> continue training pain-free --> hit PR I believe that any great coach or physical therapist should be able to modify and progress/regress any movement or activity. If you have given these methods a shot and pain continues to impact your life, then find a healthcare professional who understands your goals and doesn’t tell you to stop.
Cheers, Dr. Ravi, PT, DPT, CSCS The CrossFit Open is finally here. After all of the countless hours spent in the gym perfecting your craft, it’s time to see just how far you’ve come in year’s time. I’ve got some good news for you too, simply by signing up for the CrossFit Open you’ve set yourself apart from your peers as only approximately 20% of CrossFit members worldwide have the moxie to put their money where their mouth is and actually sign up for the Open. Now that you’re here though and you’ve made it through that miserable 18.1 workout, it’s time to grind through another 4 weeks designed to push you to your absolute limit. As daunting as that sounds, there’s a secret out there that elite athletes figured out a long time ago, yet it still gets ignored by most people in the gym. Recovery. No matter how much you train, most of your hours during the day will be spent recovering. Recovery is undoubtedly the most overlooked aspect of training. Tell me if this sounds like something you (or let’s just say somebody you know). You rush from work to get to the gym, get there barely in time to hear your coach going over the day’s workout, then after blasting through a max level workout you rack your weight, grab your keys and head out to your car to get to the responsibilities waiting for you at home. Rinse and repeat throughout the week. I see this all the time in the gym, and quite honestly I’d be lying to you if I said I haven’t had this happen to me as well. The issue with this all-to-common scenario though is that when you do this, you are skipping out on arguably the most important aspect of any training program. If you are not recovering appropriately then you’re leaving performance on the table and setting yourself up for injury. Elite athletes and their trainers know exactly how important it is to recover appropriately, they spend endless resources monitoring their athletes’ bodies vital signs and other physiological functions in order to objectively determine when they are ready to go full throttle. However, for those of us who don’t have the ability to measure things like heart rate variability 24/7, there are a few things you can do to optimize the speed and effectiveness of your recovery: 1. Post Workout Cool-Down: Immediately following a workout do some form of very light activity (ex: walking, light row, light bike, etc) and then take another 10-15 minutes to work on soft tissue and joint mobility. Doing these things will not only decrease the soreness you experience after workouts, but it will allow your body’s heart rate, blood pressure, and nervous system to return to baseline levels. All of which are crucial to optimizing recovery. While you should choose which soft tissue and joint mobilizations you should do based on the movements performed in the WOD, some of my favorites are listed below. Perform each drill for 2 minutes. 2. Get Appropriate Sleep: I cannot overstate how important it is to get appropriate sleep. You should be getting approximately 7-9 hours of sleep per night, and during the open you need to towards the higher end of that range. To find out more information on how to optimize your sleep, check out our previous blog article "Top Two Ways To Improve Your Sleep." 3. Eat the Right Food: As the saying goes, “food is fuel for your body” and you want to be giving yourself some jet fuel to optimize your CrossFit Open performance. What this means is you need to be eating the right foods in the right proportions to restore your body’s energy levels and to give it the needed energy it needs to repair and recover. You can find more info on how to do that by checking out out previous blog, "Which Diet is Right For Me." 4. Staying Hydrated: You should be drinking water constantly to maintain good muscle and vascular health. The general recommendations say to drink 8 eight ounce glasses of water a day. However there are plenty more variables that go into determining the appropriate amount of water for you to drink. Click here to go to a calculator that will give you a better idea of how much water you need to stay appropriately hydrated throughout the Open. So, if you want to get your best possible score in this year’s Open AND decrease your risk of injury then you need to make recovery a priority. A lot of things factor into recovery periods that are outside of your control (age, genetics, training experience, etc.), but by doing what we covered in this article you will be setting yourself up for success by recovering like a pro and getting the most out of your workouts. Thanks for reading, Dr. Jake, PT, DPT Elbow pain can be one of the most irritating and inconvenient issues. I once had a patient say that the most painful part of his day was just cutting butter for his toast in the morning. Classically, we tend to blame the tissues at the joint—wrist extensors/flexors. Sure, the common insertion for these muscles becomes inflamed, but what causes that? I like to view the elbow similarly to the knee; it is a joint that is pushed and pulled on either side by very complex joints. The shoulders will largely influence the biomechanics of your elbow and the amount of torque that passes through the joint. Although somewhat simplified, we could group you as either tight and immobile or mobile and bendy. Each characteristic has its own pros and cons, but the cons are where pain manifests. With decreased shoulder mobility and/or control, the elbow will take the brunt of the force when lifting weights or swinging a racquet. Shoulder stabilization and control are important for correct biomechanics of the shoulder girdle and upper extremity. Lack of control upstream, allows more movement downstream at the elbow. The repetitive, small insults at the elbow joint will eventually result in elbow pain.  Hammering away at the soft tissue around the elbow is often where athletes start when self-treating. Don’t get me wrong, a little forearm smash with a lacrosse ball or barbell is great. But if it does not improve your problems, move on! In this case, we are going to check out the shoulder. Less mobile folks: To decrease the torque at the elbow, it would be ideal to improve both the external rotation (front rack) and flexion (overhead position) or your shoulder. Tight lats can often be the cause of the restrictions. Try these two mobility pieces:
  More mobile folks: Shoulder stabilization is going to be the key for you. A simple way to start on this is kettlebell carries, all variations! Here are two simple, yet effective stabilization drills:
  As always, do a movement screen/ form check first. Get a coach or super friend to watch you move and see if they notice any faults. Racquet sport athletes—if you constantly have elbow pain, check your grip size. Grips too small or too large can cause elbow issues as well. If you are a desk jockey, check out your work station and the ergonomics!
Try these mobility exercises and tips out. If you continue to have issues, come see us at Athletes’ Potential. We see elbow pain often and are able to effectively treat it with an evaluation! Keep devoting time to making your body work and feel better. Thanks, Dr. Jackie, PT, DPT, OCS, CSCS Guess what? Physical therapists sometimes have pain and dysfunction too! We are only human. Often times, people will see me wrapping a voodoo band here and there, or digging a lacrosse ball into my shoulder. It usually strikes up a conversation starting with, “What would you do if…..?” My ol’ volleyball knees tend to get creaky and achy sometimes, just as many athletes and patients often describe. So, what do I do if I have knee pain? These are my 5 favorite “quick fixes” for knee pain. Obviously, management of knee pain is more comprehensive than 5 quick tips. However, these are for when you are in the middle of weightlifting, running, playing your sport and you get that nagging knee thing. Ideally, you would consult a PT or watch a video of yourself moving to see what is causing the knee pain. But understandably, sometimes we just need it to feel better RIGHT NOW. #1 Modified Couch Stretch- This is a great stretch for the front of the hip! It is important that you stay tall and do not let the band pull your hips forward so that your back is banana shaped. Propping the foot up on a ball takes up more slack in the quad and intensifies the stretch. If you squeeze your booty, you will feel the stretch even more. Please kneel on something soft! Prolonged pressure on the front of your knee will only exacerbate the issue. #2 VooDoo Band- Using a voodoo band, wrap your knee beginning below the knee and leaving a gap for your kneecap. Be sure it wrap it tightly! After it is wrapped, any knee movement will be beneficial. I like to do air squats and butt kicks to get deep knee flexion. You could also sit down and bend and straighten your knee. Leaving it on for up to 2 minutes will give you the best bang for your buck. #3 Soft Tissue to quad- Often times, tension in the quad will cause knee pain right at the top of the knee cap or on either side. Pressure to the soft tissue in the thigh area can help the quad relax and allow more pain-free range. My favorite tool for this is the handle of a kettlebell. It allows more direct pressure than a foam roller and you can easily push down and then move it side-to-side for some release. Another option is a lacrosse ball. Just lie on your stomach, pin the ball on a sore spot on your quad, then bend and straighten your knee. Spend at least 2 minutes on this one.  #4 Knee Gapping- Everyone’s favorite! We like to use Yoga Tune Up Balls for this (as seen in the photo) but a double lacrosse ball or even a towel rolled up will work. Simply put the balls in the bend of your knee, then use overpressure form your arms to bring your heel towards your booty. This should feel good- like a stretch to your knee. Two minutes of oscillating between overpressure and releasing it will do the trick. #5 Modify- Some days, the knees just aren’t on board. If you have completed a thorough warmup and tried some self-management but the knee still feels iffy--- modify, modify, modify. Don’t work through the pain! There are plenty of ways to change a workout that will still be beneficial but not aggravating to the knees. A great example is the box squat. If I have knee pain, it’s usually with heavy back squats- ol’ volleyball knees, remember? Box squats are a good option. I am still loading in the pattern I want, hitting the lumbopelvic muscle groups, but allowing my knees to stay back further so that the shear force is less. If you've been struggling with knee pain for more than a month, it's time to get some help from a professional.
We help people just like you get back to being pain free and back to the activities they love, everyday. With our three step process, we eliminate pain, fix the root cause of the problem, and teach you how to keep yourself healthy. Click the blue button below to get started or call us at 470-355-2106. The Athletes' Potential Team |
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