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Today we are going over one of our favorite treatment styles at Athletes' Potential- Blood Flow Restriction Training, or BFR. We use the Owens Recovery Delfi units in our office.
What are we doing with BFR? We are essentially restricting the blood flow that goes to a particular limb, in this case, Dr. Sam's arm by about 50%. What that does is restrict the blood flow coming out. Now when we do that, there are very interesting things that happen hormonally with exercise. You can get up to 200% increase in your human growth hormone. This won't make you look like The Rock but you will start to recover faster and build your connective tissue in a quicker way that wouldn't normally happen in a regular gym setting. If you haven't tried this or you'd like more information on this, please reach out to us! At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today!
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Today we're talking about power development, specifically, through plyometrics. How much power can you produce and control? If you can't control that power, you are increasing your risk of injury. Unfortunately, plyometrics is done incorrectly in most gym settings. True plyometrics should be full intensity- EVERY TIME. To work on your plyometrics and to gain better control, we'll start with a few basic plyometric drills. Watch Dr. Jacob walk you through: -Snap Downs -Single Leg Snap Downs -Altitude Drops -Lateral Bound Stick Give these a shot- all out intensity for for 5 or so reps and see how you progress your power/strength and control in the gym. Good luck! At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! This video piggy backs on our Power Plyometrics Part 1 video. We're covering plyometric power with load once you've learned to control your body. This is a great progression for developing power.
The first exercise is loaded jumping squats. There are two key things to remember here, go 100 percent and stop when you drop down to a 90 percent effort and REST. The weight can be a kettlebell or medicine ball, really whatever you have. Get loaded, jump as high as you can and stop when your effort decreases. This exercise will help you continue to develop power. Good luck! At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Today we're working on our running mobility issues in our feet and ankles. We all know these can get stiff after miles and miles of running. We're going to work on our big toe, or our first ray. When you toe off in a run position, you have to get about 70 degrees of dorsi-flexion in your big toe. If you do not have that much flexion in your toe, you'll start see problem creep up up stream. To prevent this, grab your favorite lacrosse ball or Yoga Tune Up ball and really warm up your plantar fascia on the bottom of your foot. After that, get into a runners stretch against a wall and focus on stretching your big toe. You can also try toe walking around your house. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Foot strength is super important for runners. Our feet are what propel us forward so in order to generate a lot of power or strength in running, we have to have strong feet. Intrinsic foot strength- simply put, it's the muscles of the foot. Far too often we neglect this part of our body a lot but we need to show it some TLC. To help us gain foot strength, we've got a simple exercise for you to try at home or the office to start building up that strength. It's called the short foot drill. We want to make our foot as short as possible. Go back and forth between squeezing that foot together and relaxing. Do about 15-20 reps at a time. Watch the video for the all tips and get after it. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Today we're covering mobility for foot and ankle issues. If you've been struggling with this or you don't know that you have been, give these exercises a shot.
Massaging and stretching are great but there's one important technique that you might be missing. The first ray needs to be mobile! In order to be an efficient runner, you need about 70% dorsiflexion in your big toe. Any less that that, will cause pain. Try these two foot exercises to improve that mobility. 1) Grab your favorite Yoga Tune Up ball or lacrosse ball and get it under you foot, moving it side to side across your plantar fascia. 2) Do a wall stretch, but lift your heel off the ground to stretch that big toe. 3) Do some toe walks around your house! Hit these for 1-5 minutes. At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Today we're working on our foot and ankle strength. These can be done around the house- it's that easy!
The first one- single leg balance. While you're brushing your teeth or standing at your work desk, practice your balancing on each leg. If that gets too easy, progress to balancing only on the ball of your foot. As that gets easy, you can progress to standing on an angled- surface to continue the single leg balance work. Get this done throughout the day and you'll notice that your foot and ankle are stronger! At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today!  A hot pan - don’t touch it! A wet slippery slope - probably should avoid it. A cactus - definitely avoid it. The experience of pain has taught us these simple rules, and we should be thankful! Burning our hand, slipping on rocks, and getting poked by a cactus’ spines are all three damaging things that we do our best to avoid to ensure our own health. These examples are the easiest way to understand pain, in that it is an alarm system that is designed to protect us from damage by giving us a quick response from which we can learn. Let’s go one level deeper. What happens if you go on a big hike and wake up the next day with your legs in pain? It’s a deep soreness that you haven’t felt before and it’s really bothering your hips and knees. Is this cause for concern? Is this damage? What kind of pain is this? What if you are simply sitting down in the gym after a workout and turn to pick up your water bottle and your back spasms, causing intense discomfort? Is this cause for concern? Is this damage? What kind of pain is this? How about just waking up with shoulder pain for no reason, but it lasts for 10 years? It won’t respond to medication or injections, and resting it just makes it worse. Is this cause for concern? Is this damage? Why the heck is this pain still around? As you can see, the alarm system pain provides is activated in all of these scenarios. This alarm system provides a symphony of sensation that plays its tune and it's up to you (and maybe the assistance of a professional) to decode the symphony. Let me share with you the things I look for in a patient’s presentation to help decode their sensations: 1. Numbness, tingling, or burning? If you are having numbness, tingling, or burning that does not resolve quickly or returns regularly, you likely need an assessment from a professional to determine its root cause. PTs are very skilled in caring for this type of pain! However, if this sensation is with progressive weakness or progressive loss of sensation, you should contact your primary care provider for assessment quickly. If it is rapidly progressive, you should go to the hospital. 2. Pain that's slowly getting better but still around? As long as the pain is getting better overall, healing is occurring. If it's slow, it's still progress, so don’t discount it! If you are frustrated in the pain’s slow speed of improvement, it might be time to come in to see us as we are also very skilled at finding ways to more rapidly accelerate your healing. 3. Pain that is not getting better for over a month? If you’ve been having pain that has not been improving for over a month, it is definitely time to see a professional. PTs are fantastic at diving into the mechanical issues that are causing your pain and improving the painful region’s overall capacity to provide you a higher healing potential. As a final note… there are SO many factors that can affect pain! Here’s a short list of proven secondary factors that have a direct effect on the subjective interpretation of the pain alarm system: Modifiable Factors Proven to Affect Pain*:
Non-modifiable Factors Proven to Affect Pain
As you can see, this complex experience doesn’t just include the local injury but so many other factors! If you would like to read more about the pain experience and its study, I highly recommend "Explain Pain." It is a short read that is well researched and provides a great contextualization of the entirety of the pain experience. So, if you are having pain and want to better understand it, start with contextualizing it as an alarm system that you must learn to interpret. If you’d like to understand your pain further, “Explain Pain” is a great option. And, finally, when you’re ready to have your pain improve, come see us at Athletes’ Potential! Thanks for reading, Dr. Marcus Rein, PT, DPT, CF-L2 * van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology - where do lifestyle factors fit in?. Br J Pain. 2013;7(4):209-217. doi:10.1177/2049463713493264 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
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.  Watch your pelvis; when you notice that is starts to rock backwards, this is where your butt wink starts when you are standing with this foot distance. Now widen your knees out a few more inches and repeat. Did the pelvic reversal look the same, better or worse? If better, a wider stance in the squat would work better for you. If worse, stay narrow. If the pelvic position was the same, check in with how your hips felt during each of the two foot positions. Say in the wider squat you felt a bit of pinching, then stay narrow. Top picture: no butt wink, so a good foot position. Bottom picture: butt wink, so I will likely have a pelvic reversal with a squat to this depth or deeper.   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.  After finding the correct foot placement, stand up and try a few more squats. Is the butt wink still there? Yes: if you are in the correct foot position and have ideal mobility, keep reading! Many of the athletes that I treat fall into these categories: Very flexible and can squat with their booty to their ankles Report feeling tightness in their hamstrings, even though they can bend forward and put their palms on the floor Have back pain with squats that increases at the bottom of the squat, often one-sided but not always Always sore in the quads after squats, rarely glutes or hammies Does this sound like you? Here are two of my favorite exercises to start working on motor control of the lumbar spine, hip and pelvis under load as well as posterior chain strengthening. The tempo goblet squat: This exercise forces anterior stabilization by adding a weight at the chest. The deep core must fire to offset the kettlebell. With a 3 second count lowering to the box, motor control of the lumbopelvic area is even more challenged. Additionally, squatting to a target allows the athlete to sit back more in the squat, engaging the glutes and hammies. This is often a new input for these athletes who are quad dominant. Check it out here: Goblet Box Squat The banded bird dog: Practicing moving your extremities while under the load of a small band is important before you try to move big weight. The bird dog requires hip and midline control with movement, made a bit harder by adding a band. Again, having a partner for a form check or performing this by a mirror is ideal. Many people will have a movement fault and not even realize! The goal is to keep the back and torso in the neutral position throughout. As soon as your form falters, take a break. Check it out here: Banded Bird Dog Add these exercises to your strength days and/or warm up a few times each week. Maintaining your core and pelvic control throughout the range of motion is the first step to easing back pain and improving your strength in the squat! If you try to self-manage for a few weeks and still see no change, let us know. We would love to help you here at Athletes’ Potential!
Dr. Jackie, PT, DPT, OCS, CSCS Flexibility is an important aspect of fitness, along with muscular strength and endurance, and aerobic capacity. However, it is not uncommon to find athletes who are unable to bend over and touch their toes! This is most likely due to sitting most hours of the day and attempting to reverse the changes by ten minutes of stretching at the gym. In the past decade, there has been much discrepancy in recommendations about stretching: how long, what kind, which muscles? Does it depend on your sport of choice? Before or after a workout? There have been countless studies published, even in the past year, with varying results. However, they all agree on one thing: Do not perform static stretches prior to exercising. WHY NOT? Static stretching alters the (microscopic) length of the muscle which can alter, and likely decrease, its firing potential. Stretching may also activate tendon structures that inhibit muscle action. Both of these proposed mechanisms will decrease power output. “Then how should I warm up?” Warm-ups are essential to performance and injury prevention. They are useful for increasing the core temperature to decrease stiffness of muscles and alerting the neurologic system to the events about to take place. This should be achieved with specific, dynamic exercises rather than static stretches or laying on the foam roller. Runners—Studies found that a dynamic warm-up increased performance of endurance runners, meaning they ran longer without exhaustion1. This warm-up consisted of movements such as high knees, butt kicks, leg swings and hopping. Total time: 4 minutes. Notice, I said nothing about running. Those athletes warming up with running had comparable results to those not warming up at all. Check out Dr. Danny’s post specifically addressing running warm-ups. Weightlifters—Other studies found that just ONE set of static stretches decreased 1RM performance by 5.4%2. That would decrease your 400 lb back squat by 21.6 lb! When performing sets for reps, static or ballistic stretching decreased amount of reps by 17-20%3. That’s 2 less reps in your 10 rep set. The most effective was a specific warm-up of 20 reps around 30% 1RM, then appropriately building to working weight. For Olympic Lifts, additional dynamic warm-ups may be warranted, specifically for the overhead movements. One of my favorite drills is thoracic rotation, performed in between light warm-up sets: CrossFitters—You fall somewhere in between; Choose your warm-up type based on the workout of the day. The same theme holds true: specific, dynamic warm-ups! Sport-Specific Athletes—Dynamic, sport specific warm-ups are the most effective to prepare for practice or competition. This includes running, cutting, jumping, ball handling, throwing or whatever your sport demands. Begin at a slower pace and then work up to competition speed movements. Your workout is over, you ran your fastest 5K, PRed your back squat or scored the winning goal... NOW you stretch. To address the earlier question: When, how long, what kind, which muscles? To receive any benefit, hold static stretches for at least 30 seconds but 2 minutes may show better results. Static stretches can work but they take a few weeks for sustainable differences. PNF (proprioceptive neuromuscular facilitation) stretches have been shown to be superior to static stretching. These can be done with a buddy or by yourself using bands or straps. A common form of PNF to increase range of motion is contract-relax. You have likely seen it before:
This would also be the appropriate time to work with the foam roller or PVC pipe on the muscles that are sore or may be lacking flexibility. Of course, the cartoon at the top is wrong. Touching your toes IS everything. Every athlete should have the flexibility to bend over and touch their toes whether or not they are warmed up. Inefficient muscle length can lead to compensation by other muscles. This causes joint pain, tendonitis, faulty movement patterns, poor form and then decreased performance or injury. Stretching is also great to incorporate into rest days. A light warm-up, then your favorite stretches or maybe your least favorite if you have some restrictions. Self-management is 100% possible when it comes to flexibility and recovery! Take the time to take care of your body and it will perform better. Remember, at Athletes’ Potential you can supplement your stretching and take recovery to the next level with full-body cryotherapy and NormaTec compression boots. Call us anytime to schedule an appointment! Thanks for reading, Dr. Jackie, PT, DPT, CSCS References
Midline stabilization is heralded as the foundation of safe and successful weightlifting. But have we been ignoring a part of the “core”? The pelvic floor is a topic that tends to be avoided. Most people do not casually discuss urinary frequency over coffee or admit to their coach that they pee every time they perform double-unders. Men- if you think this one is just for the women, stick around! I only realized the prevalence of leakage after CrossFit HQ posted a video following regionals. All of these women were saying “It’s ok, I pee during workouts too. It’s normal!” Please do not confuse normal and common. Urinary incontinence may be common in certain populations, especially of heavy lifters, but it is absolutely not normal. The pelvic floor includes a group of muscles that attach from your coccyx (tail bone) and sacrum to your pelvic ring.  These muscles are important for bowel and bladder function, organ support, and stability of the pelvis. Although pelvic floor dysfunction (PFD) was thought to be largely a problem of women, it is becoming apparent that men have similar issues. The pelvic floor may seem very foreign and uncomfortable to discuss, but when it properly functions it can improve your workouts. Here’s how: I like Mary Massery’s description of the core as a “soda-pop can”. The front of the can is the abs, the back is the multifidi, the pop top is the glottis and the bottom of the can is the pelvic floor. The core pressure is maintained by a functioning glottis and pelvic floor, with the diaphragm acting as a pressure regulator.   When you take a breath in, the diaphragm descends. This requires the pelvic floor muscles to descend and lengthen. When you exhale the diaphragm rises and the pelvic floor rises and tightens. In fit individuals, (notice I said individuals and not just women), a common pelvic floor problem is overactive muscles. Very strong back or abdominal muscles can cause increased inward pressure. It’s been shown that when your deep abdominals contract, so does your pelvic floor. Imagine squeezing the can from both sides with the pressure maintained. The bottom and top will have to withstand more pressure and bulge. If your abdominals are always squeezing in then your pelvic floor is always pushing up to withstand the pressure. It’s overworked! The diaphragm is pretty darn good at its job. If it does not work, we have a bigger issue on our hands. So often, when something’s ‘gotta give’- it’s the pelvic floor. When all of these muscles work in concert, your canister and the force it can produce is maximized. Thus, your workout improves. A conversation about breathing techniques regarding the glottis and diaphragm is essential to training the entire core. Here I am simply touching on one contribution but remember it does not work alone. Keep in mind, PFD can also manifest in ways such as pelvic pain, painful intercourse, low back pain, urinary frequency or even the dreaded butt wink. It is not just urinary incontinence. “ Pelvic floor pain is only caused by pregnancy, right?” Wrong. There has been no correlation shown between PFD and post-partum women. Sure, some moms experience issues but again, it is not normal for any population. Weakness and/or tightness of the pelvic floor can be caused by poor postural habits, extended periods of sitting, over training of the abdominals and pregnancy. Excluding pregnancy of course, men are susceptible to all of the other risk factors. “Ok, so I pee on myself at the gym and it’s not normal. What do I do to stop it?”
Thanks for reading! Dr. Jackie, PT, DPT, CSCS References: Sapsford, Ruth R, Hodges, Paul W. Contraction of the Pelvic Floor Muscles during Abdominal Maneuvers. Physical Medicine and Rehabilitation, 2001, Vol.82(8), pp.1081-1088. Healthyplace.com Presentation at CSM 2016 by Mary Massery: referencing Massery 2005 & 2006. |
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