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.
Let’s recap from last week:
Your ankles drive the squat bus and your knees are along for the ride. Unfortunately, the hip is often overlooked when pain or dysfunction with squats occurs. Strengthening targeted to the hip will improve knee position during the squat. If it hurts your knees to squat, it is likely a faulty movement pattern causing the issue.
When there is pain, do not push through. Jane Fonda might have said “no pain, no gain” during her abs, buns & thighs workout but this does not apply. The feeling of an ice pick jabbed in your knee cap is not normal. Pain with a back squat does not mean you can’t squat at all! Try these first:
I eluded to different flavors of squats in the last post. Is high bar back squat bothering the knees today? Try a low bar position, front rack or squat to a box. There are so many options! It is nearly as exciting as picking a flavor of ice cream.
Check out Noel showing us some variations of squats! Pay attention to her ankle and shin positions.
High Bar Back Squat a.k.a Traditional Back Squat
The bar rests across the top of the upper trap, on the shoulders. Throughout the movement, the torso remains upright. With this set up, the knees tend to move more forward than in other squat variations so adequate ankle mobility is essential!
Remember, those with significant ankle mobility issues will have trouble maintaining the upright torso and may try to sidestep the issue by turning the toes out wide. Another squat flavor will allow you to move in less compromising patterns while still gaining strength. Don’t forget to work on ankle mobility every day!
The bar rests across the front of your shoulder, elbows are high and in front. The torso is the most upright in this squat flavor to keep the barbell over the midfoot. Again, ankle mobility is key here!
For those who do not have glaring mobility restrictions, the front squat is a great exercise to carry over for the clean.
Low Bar Back Squat
The feet are in a wider stance than for the traditional squat. The bar rests lower across your shoulders, elbows are back and high to help create a shelf for the barbell. The torso maintains more of a forward inclination to keep the barbell over the midfoot.
This flavor of squat decreases the torque at the knees by allowing the tibia, or the shin, to remain more vertical. (Go back and look at her shin-to-foot angle in the traditional squat and compare!) More torque is placed at the hip, so the hammies and glutes are targeted. If you feel a pinching at the front of the hip, vary your squat width and work on that hip flexion mobility!
The feet are in a wider stance, similar to the low bar set up. The bar rests across your back in either high bar or low bar position. A sturdy box is behind the lower legs. The hips are allowed to travel further posteriorly during this movement which allows the tibia to remain vertical.
The box squat is great for all athletes to include in their workouts. It is helpful when just learning how to squat or trying different foot positions. After a knee or ankle injury, it is a good way to decrease torque at the knee and demand on the ankle joint. Box squats are also used for power athletes as it has been shown to increase the rate of force development, or explosive strength, more than other squat flavors.
Each of the squat flavors has something different to offer for your health and athletic development. If you are recovering from an injury or lack mobility in the hips or ankles, there is still a flavor for you! Grab an empty barbell and try each of the variations. Don’t be afraid to vary your stance width. Start with a taller box and gradually work your way down as you get comfortable.
Taking a video of yourself moving is the cheapest and quickest way to find faults and underlying mobility issues. Once you work through each squat flavor, you will have a better idea of which mobility drills to introduce daily. Get your squat moving correctly and cut out that knee pain! After all, it’s not your knees’ fault!
Thanks for reading!
-Dr. Jackie, PT, DPT, CSCS
Swinton P, Lloyd R, Koegh J, Agouris I, Stewart A. The biomechanical comparison of the traditional squat, powerlifting squat, and box squat Journal of Strength and Conditioning Research. 2012;26(7):1805-1816.
Simply put, no. Squatting, specifically deep squatting, is actually beneficial for your muscles and tendons. If you simply wanted to know the answer to the question, that is the abridged version. But those “why” people (it’s ok, I am one too!) should continue reading.
Research tells us:
The Knee, the Middle Child
In my experience, the knee joint seems to be the most baffling to folks. So much emphasis is put on knee position during workouts that other (more important, in my opinion) joints are virtually ignored. It may be more beneficial to understand this joint if you view it as the middle child.
The ankle is like the oldest child. It sets the scene for how the other joints are allowed to act. If the older child is rebellious and does not behave as expected, the middle and youngest child will imitate the older sibling. Without the proper ankle mobility and foot strength, who cares what your knee and hip joints can do? The foundation for these multijoint movements is already the weakest link.
The hip joint is the youngest child. By this point, the parents are exhausted from the rebellious older child who influenced the middle child into its rebellious ways. The youngest child can get away with anything. Our hip joint is a large, strong joint complex that should be the prime mover during squats. Unfortunately we get so focused on the knees and ankles that we overlook the hips and allow them to “run free”. This presents in the form of decreased pelvic control during large movements like the squat.
Finally, the knee joint is the middle child of the family. It gets pushed and pulled by its siblings but never has a moment when it’s all about the knees. During foundational weightlifting movements, the knees never work alone. They are guided by their neighbors.
So what does this mean? The ankles are the steering wheel. If you do not have sufficient mobility in your ankle joint, your knees are predisposed to faulty movement patterns. But it’s not your knees' fault!!
Sad stick man on the right does not have great ankle mobility which causes his femur, the thigh, to be pushed backward. From this position the torso has nowhere to go but forward if he wants to remain standing. Throw a barbell in the front rack and the stress in concentrated on the knees, low back and upper body. With a barbell on the back rack, it will be harder to maintain spinal alignment, particularly in the bottom of the squat. This is often the position athletes attain when their hips raise well before their knees begin to straighten in a squat.
I don’t know what to do with my knees!
“Knees out!” is one of the most over-coached cues. Sure, it is a quick and easy fix in the middle of the workout but it is important that athletes understand what this means. If your knees are crashing in during a workout, the weakness is at your hip. A weak gluteus medius is often the culprit but it has an accomplice! If your hammies and glutes are weak and you attempt a heavy squat, your adductors are going to kick in to assist with hip extension. But the primary motion of these muscles is hip adduction, or knees together. Thus, crashing ensues. So strengthen your hip muscles and your knee position will improve.
If squatting is not bad for my knees, why do they hurt?
Undoubtedly, this will be the next question. There are several reasons that your knees may hurt during a squat. Some irreversible arthritis or previous injuries may be contributing but even these populations should be able to return to pain-free squatting. They just may need to try a different flavor than the traditional back squat.
Essentially, squatting is not bad for the knees but it is how you are squatting!
Do I squat through the pain?
No! Our body is very good at letting us know when something is not right. Now, I am not referring to muscle fatigue pain but true pain. If the back squat is causing knee pain today, try another variation. There are plenty of flavors of squats that can be used for training while you work on mobility or strength deficits. Be sure to look out for my next article about finding the best squat flavor to suit you!
Moral of the story: squatting, even below parallel, is not bad for your knees. The squat is a fundamental movement pattern that all humans should be able to attain. If pain arises from this movement, remember it is how you are moving. Decrease the weight, video yourself performing a squat and pay attention to which muscle groups are doing the work. If you continue to have pain, contact us at Athletes’ Potential so we can watch you move and delve deeper into your individual movement patterns! Most importantly,
Thanks for reading,
-Dr. Jackie, PT, DPT, CSCS
So you’ve been killing it at the gym over the past month. Your body is starting to adapt and your conditioning is improving. You can do twice the amount of rounds of Cindy that you could do when you first started CrossFit. All in all, you’re the man now!
Until, one day you try and do some ring dips. Next thing you know, you wake up the next morning and the front of your shoulder hurts. This is the first minor set back you’ve had since starting CrossFit so you ignore it and continue to do the gym programmed workout for the next week. Your shoulder pain starts to get worse. You finally say something to your coach and they recommend some mobility techniques they saw Kelly Starrett talk about on Youtube. Another week goes by and the shoulder pain continues to get worse. You’re frustrated and finally your coach recommends that you come to see someone like me and get it checked out.
By this point you’ve been inflaming your bicep tendon for a couple weeks. In all likeliness, there’s nothing wrong with your bicep tendon and it’s simply getting caught in the crossfire (now the video at the top of this blog should make sense) of scapular stability weakness and tightness in the front of your shoulder.
You’re not the only one. In fact, recently injury rates in CrossFit were studied (see reference below). The results showed that the most common injury was the shoulder; approximately 25% of all reported injuries were related to the shoulder. In my own practice I have found this to be the case as well, if not even a higher percentage. Just this week I have seen 8 new patients and 5 of them came to me for shoulder pain.
Keeping shoulders healthy while training in CrossFit can be challenging for a couple reasons:
So what’s the solution? The best answer would be to get yourself checked out before starting some significant training to see if you have any obvious deficiencies. That’s like telling people to go to the dentist so they don’t get a cavity. I understand that many people don’t see the value in prevention so I won’t try and persuade you on that.
The next best option is to try and go after the low hanging fruit first. In my practice I’ve found that common deficiencies can be cleaned up with as few as 5 exercises. Below are videos of exercises you can do on your own to resolve and/or stop an injury from happening. Make these part of your gym routine and your shoulders will thank you.
What’s the best way to fix a shoulder injury? Not getting a shoulder injury to begin with!
If you’re in the Atlanta area and have been dealing with a CrossFit related shoulder injury for a while give us a call. We can help you get back to what you love to do faster than any medical group in the area. Don’t take our word for it, check out what everyone else has to say in their testimonials.
-Dr. Danny, PT, DPT
Hak, P.T., et al. "The nature and prevalence of injury during CrossFit training."
Over the past few years, I’ve been fortunate to be exposed to an entire spectrum of different athletes- all the way from 8 year old soccer players to Olympic medalists. The biggest difference I see between amatuer athletes and professional athletes is the level at which they take care of their body. The amount of training you do and the amount of time you spend working on recovery are both linear. The more you train, the more you have to work on recovery.
I’m of the opinion that there is no such thing as overtraining. I’ve worked with athletes that put in massive amounts of training week after week. If I did a week of their training I would be out of commision for a month. So how can these athletes train so hard and continue to make improvements and not hit a state of overtraining? They work on recovery like it’s their part time job. The training is not what separates good and great athletes, recovery is the secret to success!
Most people have no idea how good their body is supposed to feel because they are constantly in pain. It’s hard to train at your optimal level when you’re always borderline hurt. Here are 4 things you can add in with your training to spike your recovery. Better recovery=more training. More training=more athletic improvement. More athletic improvement=winning and we love winning!
1. Marc Pro
I was exposed to the Marc Pro in 2012 when I was working with CrossFit 808 in Honolulu. One of my mentors, Kelly Starrett, gave me a Marc Pro to test out with the team. I’m a skeptic person at best and I need to see positive changes myself before I start buying in on things like the Marc Pro. Since 2012 I’ve recommended the Marc Pro to all the athletes I work with that are looking for help with recovery.
You’re probably asking what does the Marc Pro actually do. The answer is: it gets the muscles moving. Pretty simple, right? Essentially, the contraction the Marc Pro produces is non-fatiguing but strong enough to get fluid in the muscles moving. This constant but non-fatiguing contraction is basically a lazy person’s way to recovery. If you wanted to get on an Assault Bike and ride at a non-fatiguing speed for 30 minutes you could get a similar effect. If you don’t have an Assault Bike at your house and you want to watch Game of Thrones while you recover, the Marc Pro is a pretty damn good option.
2. Recovery Pump Boots
The Recovery Pump boots look ridiculous. I remember seeing an elite triathlete at a race I was doing in Hawaii a few years ago with these on. It was the first time I had seen the device. It’s just hard to look cool with giant puffy boots on your legs, but they work.
The rationale behind the Recovery Pump is similar in a way to the Marc Pro. Instead of using muscle contraction to help get things moving, the Recovery Pump using sophisticated compression. This compression helps move fluid from the extremities to the torso. Think of the torso as the area where we clear non-useful elements of the blood/fluid after training. It’s essentially out with the old, in with the new when you get fluid circulating more post training.
Who uses Recovery Pump? The majority of NFL, MLB, NBA and NHL teams. Also, multiple branches of military Special Operations groups, elite triathletes and endurance athletes. That’s pretty good company to be in.
3. Nutrient Timing
I recently spoke with Anthony Almada on a podcast I do with another coach called the Doc and Jock Podcast. Anthony was one of the original founders of EAS and is the founder of another supplement company called Vitargo. Vitargo is basically a super carbohydrate that’s been pre-broken down so it’s absorbed faster. It’s a pretty cool product and you can hear the whole interview here.
The reason nutrient timing is important is that you need to be able to effectively replenish your stored energy. Studies have shown endurance athletes need between 400-600 grams of carbohydrate per day. For many of our athletes that eat a very low carb diet, they may only be consuming 25-50% of this. The best way to spike recovery is to time your nutrient timing correctly so that your body has the greatest chance of rebuilding itself.
When you exercise, your body depletes muscle glycogen as this is the main fuel for movement/exercise at the muscle. When we exercise and glycogen gets depleted, insulin stimulates glucose in the blood to be drawn back into the muscle to replenish glycogen. This is important to know because if we have more glucose available in the blood at the time of training we can replenish our energy source better. More ability to replenish the main exercise energy source equals more training!
Try this combo next time you train: drink 35-70 grams of a carbohydrate like Vitargo with 10-20 grams of protien in it 30-60 minutes before training. Drink the same thing within 20-30 minutes post training. The pre-workout nutrients will give your body readily available sources while training and the post workout drink will re-supply the muscles at the key post workout window.
Here are the two supplements I like to use together.
4. Embrace the cold
There has been a big debate on the usage of cryotherapy(cold treatment) in the sports medicine and strength/conditioning community. Here’s my stance: Use whole body cold treatment to help with recovery, don’t waste your time icing a sprained ankle.
What I mean by that is local icing for an inflamed joint is not effective. It’s effective at numbing the area but doesn’t help with the healing process the way we thought it used to. In fact, the original physician that came up with RICE (rest, ice, compression, elevation) recently changed his stance on this to take icing out of use for acute injury.
When I say using whole-body cold treatment for recovery I am referring to things like ice baths and whole body cryotherapy chambers. The effects of these two forms of treatment for recovery are two-fold. First, much like the Marc Pro and Recovery Pump, we get a pushing of fluid to the torso. This occurs due to vasoconstriction of the blood vessels in the legs/arms causing more blood to be directed toward the vital organs in the torso. Increased fluid to the torso equals better nutrient/oxygen exchange and increased potential to rebuild after a tough training session.
The second positive effect is essentially a jumpstart to the parasympathetic nervous system. This is the system that helps predominantly with relaxation and recovery. Increased parasympathetic function leads to increased potential to recover and recuperate from hard training.
Neither of these are exactly something I look forward to since I don’t like to be cold. I would say between the ice bath and whole body cryotherapy the easier of the two to tolerate is the whole body cryotherapy.
If you want to train as hard as a professional athlete or Olympian you need to prioritize recovery just like they do. You have one body, you had better take care of it. If you’re really looking for that competitive edge, a better recovery strategy is your key to success.
Full disclosure, I hate to run. There, I said it and now I feel much better. I actually have more of a love/hate relationship with running. I love the science and technique of running mechanics. I’m actually fascinated by how you can squeeze more speed and efficiency out of someone that just assumes they are a bad runner.
When it comes to my personal desire to go for a run, it’s just not there. I blame the Army. They kind of ruined it for me with the whole wake up early and do a forced run almost every morning. Because everyone in the Army is technically a runner, we would see a TON of running injuries. I would guess that 50-60% of what I typically saw was running related. That’s literally thousands of running related injuries that rolled through my office during my time on active duty.
Now that I’m out of the Army and have a private physical therapy practice in Atlanta, I’m still seeing runners. I’ve actually developed some good relationships with a few of the bigger running groups here in Atlanta and it’s been a blast to help these athletes get better fast. Healing from an injury is great but do you know what’s cooler than that? Winning!
As a runner you are competing against others when you run but for most of us we are constantly competing against yourself to get a personal record (PR) on a race. I recently had a runner come to see me for some plantar fasciitis. If you are reading this and have actually put some decent volume in training you probably cringe when you hear the words plantar fasciitis. It’s basically the kiss of death for a runner and will take you out of your sport for a long time, if not fixed.
This individual had seen everyone under the sun for this issue including, podiatry, chiropractic, massage therapy and a different physical therapy group. This problem had been going on for about a year at this point and he was obviously frustrated when he came in to see me. He was also very surprised when I told him that we had to watch him run. Can you believe that? This guy had been to multiple other medical professionals and not a single one took the time or even thought it was important to watch him run. This is crazy! What if you went to a mechanic and he didn’t actually drive your car around to see what the problem sounded like or how the car acted when it was running? That's basically what had happened to this athlete.
After watching him run it was pretty obvious he ran like crap. I won’t get into all the specifics of the running mechanics in the blog but just remember my professional diagnosis was not plantar fasciitis, it was you run like crap. My prognosis was good. It was forget about your foot pain, we are going to make you faster! He was also had really bad hip mobility and tons of hip weakness. We spent the first two visits working on run form and getting some of the pain down in the calf/foot with soft tissue techniques to include Hawk Grips work and Performance Dry Needling.
Over the next two visits we re-tooled his running form even more and added in strength/mobility work for his hips. Think of your hips as the engine of movement for running. If you have poor hip strength/mobility it’s like riding your bike around on flat tires. Sure, you can still ride a bike this way but it's a hell of a lot easier to ride with with some air in the tires. Running is hard enough, don’t make it harder than it has to be.
Below are the exact 3 exercises we nailed down for this athlete to do to help fix this chronic foot pain and none of them have anything to do with the foot directly. The order of completion was this.
Pre-run (videos below)
-Anterior Hip Mobility Opener 2 minutes per side
-Band Hip Pull Throughs 2 sets just to muscle fatigue not failure
-Band Hip Side Steps 2 sets just to muscle fatigue not failure
This athlete typically ran 3 days per week so that’s all the strength work we added in for him. He did complete the anterior hip mobility opener 2 minutes per day regardless of if he ran or not that day.
So what was the result? 4 visits over 6 weeks. 5 minute PR on his 10K time. Oh and no foot pain. If you’re having running-related problems, fix the cause of the problem not just treat the symptoms.
If you’re in the Atlanta area and are a runner that has been dealing with injuries we can help. We’d love to chat for a few minutes and see if you are a good fit for what we do. Fill in the contact request below and we’ll set up a free 10-minute phone consultation with one of our Performance Physical Therapists.
Dr. Danny Matta DPT, is a Physical Therapist and Strength Coach based out of Atlanta, Ga. He teaches on the topics of movement efficiency, mobility and injury prevention internationally. He is also the Director of the Tactical division of the renowned MobilityWOD group started by Dr. Kelly Starrett DPT.
Full bio here.
“Look up when you squat, Matta!” Coach Pettis, high school football coach
Most people who played sports in high school or college have received some coaching on some basic strength movements like the bench press, squat, deadlift and power clean. In fact, thanks to programs like the Bigger Faster Stronger program, high school athletes have been doing these big compound movements for years. I remember going through this exact program when I moved to Columbus, GA as a junior in high school with our football team.
The quote above is something I remember well from all of my strength coaches, but in particular one of my coaches in Columbus. He was the one that implemented using the Bigger Faster Stronger program and he would constantly yell at us to look up when we were deadlifting, power cleaning or squatting. We all got bigger, we all got faster and yes, we all got stronger. Were these changes all beneficial? Looking back it’s hard to say but I would have to say no they were not. In my opinion, we just were adding strength to dysfunction.
So what’s my problem with this cue of looking up when pulling and squatting? I think it’s a cue gone wrong in many ways. I see the rationale behind not wanting the spine to be in flexion when pulling and squatting. You want the spine to be in neutral during these movements. Cueing people to look up is designed to get people out of a flexed position. More commonly, you’ll hear the coupling of two cues, 1) look up and 2) butt back. The problem is many athletes will drive excessively into extension and this can be an even bigger problem.
When we drive our spine into end range extension it’s very stable. The reason it’s very stable is because the facet joints in the spine are getting pressed into each other and it’s literally a bone block that stops any more movement from occurring. As stable as this might be it’s very irritating to the spine and can even cause local spinal fractures called spondylolisthesis. These are most common in young female gymnasts and young male wrestlers. One sport has a ton of arch positions in it and typically landing in arched positions and the other teaches wrestlers to bridge/arch to stop someone from pinning you. Both of these put the spine into end range extension with load.
Am I saying you are going to get a local spinal fracture from squatting while looking up and arching your back? No! But you sure as hell will aggravate your back by doing this. In fact, I would say 90% of the lower back injuries that I see in my practice are directly related to extension based back injuries.
We have to fix this problem through control. The control must come from engagement and strength of the anterior torso, inparticular the internal obliques (IO) and transverse abdominus (TA). These are deep anterior stabilizers of the spine and when we put ourself into an over-extended spinal position they are essentially weakened. Strength and control in this area in particular is the best way to gain lasting control of the anterior spine.
Now let’s fix it. Below are a few videos that directly work on correcting this area and getting you out of an overextended position. Add these in daily at home to reclaim some lost control and when you do squat, actively try and mimic the same muscle contraction that you get with these corrective drills as you do when you squat.
June 2014 July 2015
Testosterone- 802 Testosterone- 421
HbA1c- 5.3 HbA1c- 5.7
HS CRP- 0.9 HS CRP- 2.6
Let’s face it: we live in the information age. You can find out pretty much anything by searching for it on the internet. There has also been a massive shift toward data driven decisions. I see it first hand in my business when I look at our website analytics. We even see it with things like Wodify as athletes start tracking all their workouts, strength numbers, training sessions and making training changes based off actionable data.
Think of this blood panel like a snapshot of what’s happening internally. As part of the initial testing phase to work out the kinks, my wife and I both went through the process to get blood drawn and see how long it would take to get our results back. When I got my results back, I was shocked!
Last June, as part of my transition out of Army, I requested some blood panel work from my Physician Assistant. I wanted to start doing a more in-depth panel of blood tests yearly just to see where I stood and to gauge my nutrition/training based off that. For me, I used that as my initial data to compare this lastest to. Here are the tests that were grossly different:
A good number more tests were performed besides these three but these were the ones that had the most noticeable changes. What does this even mean? In the past year my testosterone production had decreased by 50%. Testosterone is very important for recovery, building muscle, maintaining a lean body and many more very important tasks. According to a 1996 study by Vermeluen et. al, the average testosterone levels for someone my age (30 years old) is 617. To make matters worse, in the same study he found that the average testosterone levels of males age 75-84 was 471. Talk about kicking me while I was down! This basically shows me that there’s a decent chance my 90 year old grandfather and I have the same testosterone production at this time.
Next is the change in HbA1c. This is a marker of average blood sugar levels over the past 3 months. Most of you have probably heard of diabetes. It’s basically a disorder of high blood sugar levels in the body. It can either be genetic type I or developed type II. The range for HbA1c is pretty clear. Anything below 5.7 is normal, between 5.7 and 6.4 is prediabetic and over 6.4 is full blown diabetes. My number is elevated quite a bit and it technically puts me in the prediabetic range.
Lastly, was the change in my HS CRP. This is a marker of global inflammation in the body. To be clear, inflammation is not a great thing to have in the body. Increased values on this test in particular have been drawn to increased risks for cancer, heart attacks, neurologic disorders and type II diabetes. My HS CRP was elevated compared to where it was a year ago going from 0.9 to 2.6.
Now, when you see these big changes in values your physician should ask you a few things. First, did you do some crazy workout that day or the day before? Did you go out with your friends the night before, end up at the Clermont Lounge and down PBRs all night? Have you had a week of really bad sleep before this test cluster? All of these things are important to know because it can give us false values. By the way, my answer to all these questions was no.
Here’s what all this means. In the past year my health, internally at least, has slowly been trending in the wrong direction. So how did all this start to go wrong? I would have to attribute it to a number of factors. First, I started a business. For any of you that have ever started a business I probably need no further explanation. For those of you that haven’t, it’s the most difficult and stress-inducing thing anyone could ever do. Not only that, but I teach for another group (MobilityWOD) and in the past 12 months, I’ve accumulated about 70,000 miles on an airplane. I also have two small kids under the age of 4 and I typically sleep an average of 5-6 hours a night.
It’s not all bad news though. Mom, if you’re reading this don’t freak out and call an ambulance for me! I’m glad I did these tests because I had been feeling fatigued and like I was recovering poorly from my training sessions for about the past 6 months. Now I have some quantifiable data to help me make changes and retest to see what’s working. Changes will be made and I will retest in about 1-3 months. All of these markers are reversible with some supplementation changes and behavior modification. I’ll write up a follow up post once I’ve done my blood testing again. It’s time to make some changes!
-Dr. Danny, PT, DPT
It’s 5am, you’re up and getting ready for work. You got 6 maybe 7 hours of sleep last night and you’re off to crush the day at the office! Coffee in hand and listening to your favorite podcast on the drive (most likely the Doc and Jock podcast). You get through your normal day and then sit in traffic for 45 minutes on the drive home (Atlanta traffic can be rough). Once you’re home it’s family time. You haven’t seen your kids or wife all day and all you want to do is hang out with them. Before you know it, it’s 7pm. Your kids are acting crazy because they don’t want to go to bed and you’re starting to get hungry. Once the kids get to bed you have a couple choices:
I know to many of you this example may or may not resonate. This is basically my schedule 3-4 days a week. For many people lacking time is a common frustration. For me, it happens to be dictated by owning a business, having kids, enjoying spending time with my wife and creating online content like this blog post.
Of all the options above I typically go with option 4 on a day like I explained. Hitting a short but intense workout before I eat dinner is an easy way for me to keep some regular training in my schedule on busy days like this. My preference for these late evening workouts after a hectic day- the kettlebell!
I feel everyone should have at least one kettlebell at their house. We have two at mine, a 24kg bell and a 16kg bell. They don’t take up much room, are pretty inexpensive and they give you a ton of options when doing a training session at home.
Here are a few examples training sessions I like to do that just involve one kettlebell.
As many rounds as possible in 20 minutes. 24kg bell for men and 16kb bell for women.
-10 overhead swings
-run 200 m
-5 power clean and jerk each arm https://www.youtube.com/watch?v=bjKGrZ7-pWQ
-run 200 m
-10 goblet squats
-run 200 m
Perform 5 rounds of
3 Turkish Get Ups each side
20 russian swings
10 head cutters https://www.youtube.com/watch?v=tJA07NpN7pM
Rest 1 min
Every minute on the minute for 15 minutes
5 single arm KB snatches https://www.youtube.com/watch?v=g3c73NahdjU
Complete each round as fast as possible.
Throw in some midline stability work at the beginning or end and you have yourself a respectable little training session. Not only that, but in the time it would take you to drive to the gym and back, you completed a training session.
You may not be headed to the CrossFit Games doing just these type of workouts alone. Chances are, if you’re reading this you aren’t going to the CrossFit Games regardless! Staying committed to regular training sessions is important for moving well, staying fit and being able to keep up with two crazy kids.
-Dr. Danny, PT, DPT
There are a few things in life that everyone knows to be true. We all have to pay taxes, we all will die one day and if you have poor extension in your upper back you will have a poor overhead position. Maybe the third one isn’t quite as obvious as the first two but it’s absolutely true!
Why is it that your upper back causes so many problems for the shoulder? That answer is very complex and for the sake of you borderline ADHD people like myself, I’ll keep this to one simple concept, scapular tilting.
Scapular tilting occurs anytime that we raise or lower our arm in front of us. In the picture below you can see the the shoulder blade of the person on the right is tilted forward more than the person on the left. This forward tilt is called anterior tilting of the shoulder blade. Anterior tilting is a problem because it creates a bone block as the arm raises overhead. You can’t push through this and force it into a better overhead position.
We can see in the person on the left in the same picture that the shoulder blade is now perpendicular with the ground. This is a good thing and called posterior tilting of the scapula. We need to get the shoulder blade into this position in order to achieve a full overhead position. This posterior tilt of the shoulder blade is primarily allowed by our upper back's ability to extend or flatten out. This is why people that have rounded or what we call kyphotic upper backs have a very difficult time with achieving a fully locked out overhead position.
So how do we get that thoracic spine to flatten out and allow the shoulder blade to tilt posterior? It's not easy if you have lost a ton of mobility, but here's a simple two-step process to start improving this movement.
1. Get the hell out of your chair!
If you sit for a long period of time everyday, chances are you have really poor mobility in your upper back. Get a standing desk or put your chair on your desk and force yourself to get out of that position. If you sit for 8 hours with a rounded upper back and think 5 minutes of mobility work will negate that, you're completely wrong.
2. Work on mobilizing to improve thoracic extension.
This is the hard part. You have to chip away at this problem daily if you have a significant loss in mobility. The good news is there's a ton of great video content out from my boy, Kelly Starrett on improving upper back mobility. Here's a great video to give you a better idea of what types of mobility techniques you need to add in to your training.
Good luck and leave us a comment if you have any questions.
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.