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.
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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 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 your 17.4). Or is that 2 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

                                                                       [Credit: Barbell Physio]

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:

1. Weight
2. Range
3. Tempo
4. Variation
5. Different Exercise

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.

1. Weight

• This could be as simple as decreasing the weight.
• Example: Your knee pain starts when you hit 185 in your front squat, but not at 155. Dial it back, work at 155 and build back up over time.

 

1. Range
   • Change or decrease the range of motion. We use partial range of motion all the time in rehab as way to regress a movement.
   • Example: Your knee pain occurs at the bottom position of your front squat. Limit your depth to ¾ of the range, squat to a box or med ball.

                                                                   [Credit: EricCressey.com]

1. Tempo

• This is an incredibly underutilized variable in training. You can’t load much weight, but can still do the movement. Tempos allow you to create time under tension and strength through different ranges of the movement - whether that’s lowering, pausing, and/or raising during the movement. We call these the eccentric, isometric, and concentric phases of a muscle contraction, respectively.
• Example: Knee pain only occurs at 90 degrees. You can try utilizing isometric holds in that position for 30-45 seconds or doing a 3-2-3 count where you do a 3 second eccentric, 2 second isometric hold, and 3 second concentric movement. The options here are endless.

 

1. Variation
   • Use a different variation of the movement – you’re still training the same movement pattern (squat), but changing up where the load and stress is placed.
   • Example: Front squats bring on your knee pain, then try a back squat, box squat, goblet squat, zercher squat, or a spanish squat.

                                                                   [Credit: Barbell Rehab]

1. Different Exercise
   • Try a completely different exercise to help get the same training stimulus for that muscle.
   • Example: Instead of a squat variation to train your quadriceps (front thigh muscle), you do seated knee extensions, lunges or step ups.

Here are a few other examples for you: 

• Back pain with conventional deadlift:
  • Weight: decrease
  • Range: elevate on blocks
  • Tempo: pause
  • Variation: sumo
  • Different Exercise: glute bridges

• Foot pain with running:
  • Weight: decrease speed/intensity
  • Range: decrease running distance
  • Tempo: walk/run, interval
  • Variation: sprints, uphill running, downhill running
  • Different Exercise: cycling

• Shoulder pain with bench press:
  • Weight: decrease
  • Range: floor press
  • Tempo: 3 second eccentric
  • Variation: single arm dumbbell press
  • Different Exercise: Pushup

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

                                                                          [Credit: kcbi.org]

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, 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.
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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. ​

​#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. ​

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​#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.

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​#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.

If you've been struggling with knee pain for more than a month, it's time to get some help from a profession.
We help people just like you get back to being pain free and back to the activities they love everyday.
With out three step process we eliminate pain, fix the root cause of the problem and teach you how to keep yourself healthy.
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   The Athletes' Potential Team

​Last week I outlined some mobility restrictions that are likely the culprit if you have pain or trouble with squat pattern. Hopefully you have tried those mobility exercises out, even if you think you are flexible.  There is sometimes a lingering asymmetry here and there from past injuries and such.
​
So, you checked your mobility and you have the ideal mobility for a squat. What else could it be?
 
The “butt wink” is a pelvic reversal or loss of the lumbar curve at the bottom of the squat.  A few things can cause this—bony architecture and tibia to femur ratios, lack of mobility usually in hip flexion or internal rotation, and/or poor motor control throughout the squat pattern.  I will not get into the debate of the first possibility.  Yes, we are all unique snowflakes, but let’s make sure our mobility and control are up to par before we blame our parents. 

To be sure you are setting yourself up for success, check and see if your foot placement is ideal for your bony make-up and mobility. This is best done on your hands and knees with a partner watching and preferably filming. Make sure that your hands are below your shoulders.  Rock forward and backwards the finally settle at the center—ask your partner to confirm that you are actually centered.  From here, slowly push your hips back as if moving to child’s pose.

Going a step further, you can move to your forearms to mimic the forward inclination of the torso during a squat.  Perform the same steps.  In the picture below, this is right before I start to have a pelvic reversal, so this is my target depth with loaded squats. ​

Appropriate shoulder rotation is essential for overhead athletes; I want to discuss this in the context of volleyball.  My bread and butter.  Think of a volleyball player hitting a cut shot or winding up to swing away at a set.  You will see a great amount of external rotation during the cocking phase (the middle frame in the photo above). The greatest demand for internal rotation range of motion would be the follow through for a cut shot or “thumb down” (as in the photo below).    ​

​The amount of shoulder rotation range of motion for a volleyball player is that of a normal individual but you need a balance of range of motion, strength and control.
​
A quick side note worth mentioning:  as an overhead athlete, you are likely to have greater range of motion in external rotation and less internal rotation.  This is normal due to the demands of your sport.  The baseline that we look for is that total range of motion side-to-side is the same.  So you may look like the guy on the right in the picture below.  It is also common for volleyball players to demonstrate greater internal rotation rather than external rotation strength, which may lead to injury down the road if the ratio becomes too skewed.

Another muscle group that we cannot forget about is the multifidi. These small muscles live on the posterior vertebra and have short connections at each level.  Rather than acting as a strength muscle that creates movement, they are stability muscles that control rotation.  So as my torso rotates left, my right side fires more than my left to control the amount of rotation allowed. ​

Training these muscles for strength and motor control are important to maximize power through rotation and decrease the rotational load on the lumbar spine.  Rotation at your hips, trunk and then arm are the secret to a powerful throw/swing and minimize damage at these joints.  If your thoracic spine is not mobile, the hips and shoulders will take the brunt of the force.  This often results in early rotator cuff damage and impingement as well as issues up and down the kinetic chain in the elbow, back, hips and knees. 

Spinal mobility and strength is the foundation of overhead sports.
​
Check your thoracic mobility: kneel on the floor, hands and knees.  Put one arm behind your head and then rotate your shoulder and torso on that side up toward the ceiling.  How far do you get?  For an overhead athlete, it would be ideal that you elbow and shoulder could be straight up.  Be sure not to just crank your elbow back, its more about the thoracic spine and shoulder position! ​

​“Wow, people can really rotate in this position?”--if that’s you, then it’s time to begin some thoracic mobility work! Check these out:
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Better Upper Back mobility: This one is great for those who sit the majority of the day or who tend to have poor posture (that should have covered 98% of us!)  All you need is a double lacrosse ball or Yoga Tune Up balls like those that Danny has in the video.

                                                                  Nice front rack Mr. Farris!

Well maybe those aren’t his exact words but since I’m actively giving up using profanity (which is very hard to do) we’ll keep this quote the way it is. We know that Jay-Z doesn’t have wrist pain but in the last CrossFit Movement and Mobility Trainer Course I taught, about half of the class had wrist issues. Usually when I informally poll the class to see what problems most people are having,back pain comes up number one. This weekend wasn’t any different until the Sunday course. Wrist issues were a plague for this group, predominately in the front rack position. So we spent a ton of time working on the wrists right? Wrong, we fixed their shoulders!

How many of you have seen big strong guys/gals that can back squat a ton of weight but when you get them to front squat their weight drastically decreases? These are typically males that used to love bro'ing out at some globe gym where everyday is bench press day. They are pretty strong but have never put in some legitimate mobility work in their lives.

                                                                   Don't be this freaking guy!

Let’s be clear on one thing. There are many reasons for why someone could have a very weak front squat compared to their back squat. In this example however, we are going to focus on improving the front rack position and unloading the wrist. The higher you can keep your elbows during the entire range of motion of a front squat, the easier that movement will be. High elbows also allow for the wrist to be unloaded during the lift. 

How do we get those nice high elbows? By having enough shoulder flexion and lateral rotation. In coaching terms this allows us to keep our arms parallel with the ground and maintain a strong front rack position. There are multiple problems that occur when the elbows start to drop in the front rack. It’s a huge loss of force production potential but also puts the poor wrists in a terrible position. 

         A combination of these two movements at the shoulder makes up the front rack position.

​Here’s a quick test. Un-rack a decent amount of weight (75-90% of your 1RM front squat) and hold it in your front rack position like the example in the top section of the picture below. See how your wrists feel and see if you can hold it for 30-45 seconds. Now do the same test but hold the weight in the position like the athlete in the bottom of the picture below.  No wrist wraps allowed!

                                         Thanks to www.twinfreakscrossfit.com for the photo.

Which one were you able to hold longer? Which one felt more comfortable?

For the majority of athletes the first position will feel dramatically easier when holding the load. If you have terrible front rack mobility you will always end up in some variation of the dreaded lowered elbow position. This is wrecking havoc on your wrists and costing you PRs. If your wrists hurt, fix your shoulders!

Now how do we fix the shoulders? Here is an old school (2011) Mwod video of Kelly going over fixing the front rack position. If you haven’t checked out Mwod recently, you really need to. Mwod Pro is only $8 a month and has new mobility techniques to help improve your performance and resolve pain everyday. That’s about the cost of two lattes! In the words of Kelly himself “make a better decision”.

                                      This used to be me, minus the 16 year old Asian kid part.

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.

-Broken right ankle at the growth plate age 15.
-Non-contact related right meniscal tear requiring surgery age 16.
-SLAP labral tear right shoulder age 18.
-Torn disc lower back L4-5 causing nerve root compression for 6 months age 24. (High volume deficit dead lifts with poor technique, my own damn fault)
-Torn disc neck C5-6 causing nerve compression for 3 months age 26.(Army combatives, accidents happen)

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!


-Danny

​During internal rotation, the ball of the joint (humeral head and femoral head) will glide posteriorly and roll anteriorly. This movement can be restricted with a tight posterior capsule or muscles around the joint.  Unfortunately, many people will have issues here due to increasingly sedentary lifestyles and desk jobs.  As you sit all day, the hip rarely reaches full extension, allowing the posterior capsule to become tight.  This in turn decreases the posterior glide and thus decreased internal rotation.  The same deal happens at the shoulder when you sit all day at the computer with terrible posture.

Interestingly, hip internal rotation deficits have been correlated with low back and sacroiliac pain.  It is better to start improving internal rotation now rather than trying to manage back pain!

How to check internal rotation

It is easiest to accurately check internal rotation of the shoulder with a buddy.  Lay on your back, arm straight out to the side and elbow bent (as in the picture below).  Your buddy should provide solid but comfortable pressure to the front of your shoulder to avoid it from raising off of the ground. Now move your palm down towards the ground.  Ideally, you would be able to get at least a fists-width from the floor! Be sure to check both sides because noting an asymmetry is important.  Also, be sure to do this same test after practicing the mobilizations below! ​

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​To check hip IR, lay on your stomach and allow your feet to drop out to the side.  Again, we are looking for asymmetries and major deficits.  Ideally, your leg will move about 40 degrees or roughly halfway down toward the floor.

​Mobilizations to Improve Internal Rotation
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Below are a few mobilizations for the shoulder and hip to improve internal rotation.  They are by no means an exhaustive list but merely a starting point.

Bully stretch- used to mobilize the humerus into the back of the shoulder capsule, which increases internal rotation. ​

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​Internal Rotation Stretch- start with your foot flat on the ground and the other leg crossed over.  Slowly walk your foot out to the side until you feel a strong but comfortable stretch in the hip.  You should feel this in the bottom leg.