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
Have you ever pulled a muscle or tweaked something playing a sport? Maybe overdid it in a workout and didn’t notice it till after or the next morning? Every single person has experienced a soft tissue injury before – that can be muscle, tendon, ligament, etc. There’s a lot of mixed information out on the internet about what’s the best approach to hand a soft tissue injury when you experience one.
For the longest time, it was RICE – Rest, Ice, Compression, Elevation – while this isn’t completely wrong, it doesn’t meet the full standards of what we know today with science and research.
Here’s a handy acronym to help remember the essential components of how to manage injuries better in the future: PEACE & LOVE
Immediately after injury, PEACE:
Once some days have passed, it’s good to give it some LOVE:
The thought to keep in mind is to try to play the long game. I see athletes often who come in and get out of pain then go right back to high-level activity without taking appropriate measures to progressively build it back up. What happens? Reinjury. Take the time to put in the work and I promise it’ll be worth it in the long run.
If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before.
Dr. Ravi Patel, PT, DPT, CSCS
Axe MJ, et al. Potential Applications of Hyaluronans in Orthopaedics. Sports Medicine. 2005.
Last week, we covered the training volume in part 1 of load management. If you missed it, go check it out. Today, we’re going to take a deeper dive into components of load management itself and what you as an athlete, coach or healthcare professional can do about it.
I geek out on this stuff so get ready.
Any injury ever:
FORCE/LOAD > CAPACITY
This means any force/load that exceeds the capacity of your tissue’s ability to withstand that force/load.
Enter LOAD MANAGEMENT.
The goal is simple: to protect you from injury and maximize performance
Proper training must be prescribed. Over-training and under-training both increase risk of injury.
You want to:
I’d be remiss to not give credit where credit is due: Tim Gabbett and company have been leading the front on this area and are really changing the way teams and athletes are handling training.
Now, let’s define LOAD:
It is broken down into 2 variables – external load and internal load
We use these two variables to create the:
ACUTE: CHRONIC WORKLOAD RATIO (ACWR)
This is also commonly referred to as FATIGUE compared to FITNESS. Fatigue being the acute workload and fitness being the chronic workload.
With technology nowadays, we have a number of ways to track this type of data. The most commonly cited method in the research is Session RPE (sRPE), which is time (total number of minutes) multiplied by the RPE for a given training session. The RPE is usually taken after a training session to gauge level of exertion/difficulty. This is measured as “arbitrary units” or “exertional units”.
For example, in week 5, let’s say a soccer player practices one day for 60 minutes at an RPE of 8. That gives us: 60 x 8 = 480 units. She practices 4 times during week 5 with a similar intensity. This gives us our ACUTE WORKLOAD (4 x 480 = 1920 units) for week 5.
Now we have to look at her CHRONIC WORKLOAD for weeks 1-4.
When we compare the two, you get:
1920/1808 = 1.06
Now what does this number tell us?
This ratio helps delineate whether you as the athlete are prepared for the task at hand – what you’ve done compared to what you’re prepared for – that can be a running a marathon, doing a CrossFit Open workout, playing in a professional football game or doing parkour in your living room.
In terms of injury risk, acute:chronic workload ratios within the range of 0.8–1.3 is considered the training ‘sweet spot’ where injury risk is at its lowest, while acute:chronic workload ratios ≥1.5 represent the danger zone. If you look at the trend of the curve before 0.80, you should notice the injury risk climbs back up – similar to a “U-shaped” curve. This relationship between workload and injury demonstrates that both inadequate and excessive workloads are associated with injury.
Now let’s say from the example above that week 5 workload came out to 3500 arbitrary units.
That would make the ratio: 3500/1808 = 1.94
This athlete is at an increased risk of injury.
When training load is fairly constant (ranging from 5% less to 10% more than the previous week) players had <10% risk of injury based on the study by Gabbett et al.
However, when training load was increased by ≥15% above the previous week's load, injury risk escalated to between 21% and 49%. This is commonly represented by ‘spikes’ in acute load relative to chronic load.
To minimize the risk of injury, we should limit weekly training load increases to <10%. There’s room to work within this, but a great starting point.
Athletes accustomed to high chronic loads have fewer injuries than those accustomed to lower loads, and this supports Gabbett’s assertion that higher chronic loads can act as a protective effect against future injury.
These two graphs give a great depiction of what happens when load is applied appropriately:
Compared to excessive load and/or lack of recovery:
This is something I use every day with my patients and athletes. I’ll look at their training program and see if there is a mismatch in training volume and load management. We start here then look to optimize other components of injury and performance training such as stress management, tissue tolerance, biomechanics, physiology, strength, power, etc. At the end of the day, ask yourself this question: Is your body prepared for the demand of the task?
Dr. Ravi Patel, PT, DPT, CSCS
With the CrossFit Open upon us and beach bod season approaching, people will be fitnessing. A LOT. With this, comes the opportunity for injuries to sneak up and leaving performance on the table.
People typically blame certain factors for an injury or lack of performance:
While these factors are definitely important to consider, there’s one that gets overlooked and is quite often the culprit:
I had a patient come in a month ago who was dealing with foot and ankle pain. It has been on and off for months, and she decided to get it checked out due to a recent exacerbation. She’s a ½ marathon runner who also does Orange Theory a few times a week. She was starting to increase her mileage for her ½ marathon coming up. I think you know where this is going…
Before trying to change up her running mechanics, change her shoes or blaming it on “overpronation,” we had a conversation about her training volume. I asked her how her running mileage and volume been. In this discussion, she said she went from 3 miles to 6 miles within a weeks time. BINGO. She was confused as she had previously ran this much mileage in the past, BUT... it’s been a couple months.
I also asked her about the first time she ever dealt with this same issue – she said she couldn’t really think of why it initially started – “maybe running form or my shoes?”. I asked her when she started Orange Theory – lightbulb went off. BINGO again.
Let me be clear – there’s nothing wrong with her doing both running and Orange Theory. There is when your body is not prepared for the demand of these tasks. This was and is a volume issue, and if you’re reading this, think back to a previous non-contact injury and see if you can attribute any other factors playing into that specific injury – moreso volume in this case.
Now, mobility, biomechanics, strength, etc., all play roles into whether we are operating as optimally as possible from a performance standpoint. For this patient, we did work on strength in certain areas and tweaked some things from a running standpoint, but the big component of her rehab was starting at a volume she could tolerate without pain or just a little, and progress forward from there.
Training volume falls under the umbrella of Load Management (coming in Part 2) and is a big reason why injuries occur.
Some common methods of measuring training volume include counting the number of sets to failure, the volume load (sets x reps x weight), distance, number of sprints, etc.
Here are some terms to understand:
Maintenance Volume (MV) – How much volume you need to maintain your gains
Minimum Effective Dose (MED) – Smallest amount of stimulus needed to drive positive adaptation. If we are below this threshold, then there will be no adaptation.
Maximum Adaptive Volume (MAV) – Here we are training at our optimal range of volume that we can adapt to and recover appropriately to drive optimal performance
Maximum Recoverable Volume (MRV) – This is the absolute maximum volume that your body can handle and recovery from. Sometimes it’s necessary to pass this threshold from time to time, called overreaching, in order to elicit greater adaptations. Important point here is to make sure it is not often and that deloads are accompanying this high accumulation of volume to allow for supercompensation (the point of overreaching to get the training effect you want – improved strength, power, speed, etc.). When this is not appropriately monitored or constantly overreached without recovery, you open the door for injuries to occur and performance to suffer.
(credit to Mike Israetel of Renaissance Periodization for this concept)
The way this is laid out is that you start with your MED, progress to MAV, then MRV to overreach. However, notice that you don’t dance with MRV often, nor do you want to.
Overtime, your MRV will increase, meaning you’ll get stronger and develop more work capacity, as long as you intelligently handle your training volume.
A good rule of thumb is The 10% Rule - While there can be some variability here, staying within a 10% increase from the previous week tends to work well for a lot of people. It pushes that threshold in a progressive manner and allows appropriate recovery from the increased demand on the body.
Next week, in Part 2, we’ll take a deeper dive into load management and training volume, explore exactly what this concept means, and how to practically apply it to yourself or athletes you work with.
Dr. Ravi Patel, PT, DPT, CSCS
Here at Athletes’ Potential, we’ve had the opportunity to work one-on-one for an hour with over 1,200 people. We’ve worked with people with all kinds of different training backgrounds and by doing so we started noticing some trends. Common weaknesses and movement deficiencies that were not only creating injuries, but hindering performance and preventing people from living an active lifestyle.
So our team of doctors and strength coaches set out to create a solution to this problem and this article highlights that solution as well as some of the problems we kept seeing that were creating injuries, decreasing performance, and preventing people from living a healthy lifestyle.
Problem #1: Lack of Training Variability
Whether your training modality is CrossFit, running, powerlifting, olympic lifting, triathlons, dancing, or any of the other infinite training options out there, there are biases in your programming that cause you to perform some movements all the time and others hardly at all. If we never leave our comfort zone with our training, there’s going to be simple movements that we miss, which overtime can lead to aches and pains and even injury.
Let’s take CrossFit for example. Now obviously we love CrossFit at Athletes’ Potential, all of our physiotherapists are CrossFit coaches themselves, but even for a training program who boasts they “employ a constantly varied approach to training, functional movements, and loads” there are still biases. Tell me...when’s the last time you gripped the bar with a supinated grip (your palms turned up) during a workout? The answer is almost never. Deadlifts, cleans, snatches, pull-ups, toes-to-bar, jerks, dips, rows, etc...all these movements have you in a pronated (palms tuned down) grip. This creates a huge movement bias, and is one of the main reasons I see patients with elbow pain in the clinic.
Try this: Next time you’re in the gym hang on a pull-up bar with your palms down and then with your palms up. You’ll be shocked at how different this feels on your wrists, elbows, and shoulders.
Problem #2: Training Volume
This graph dramatically oversimplifies the concept of training volume, but essentially training volume is based on two primary variables: load and frequency. As you can see, there is a sweet spot you want to hit called the “Zone of Supraphysiological Overload.” This is where the magic happens, meaning it’s where you get stronger, leaner, healthier, more resilient. However, more often than not I’m seeing people in the red highlighted areas, especially in the zone of structural failure. This is essentially where you get an overuse injury such as biceps tendinopathy, nagging low back pain, or vague knee pain. However, doing nothing is just as bad as doing too much. That’s even true in the medical community, which is why if your healthcare provider is telling your to just rest for a weeks as a way to treat your low back pain, you need to give us a call.
Check this out though, one of the best ways to ensure that your not overloading your muscles and joints at a frequency that is too high is training variability (see above). Training volume and training variability go hand in hand and varying up your training is a great way to prevent tissue failure.
Problem #3: Poor Mobility
What that graph on training volume above failed to mention, is that if you’re moving with poor mobility, your going to fly through those zones until you hit tissue failure. This can’t be overstated. If you’re only deadlifting once a week but your deadlift looks like crap because you lack the requisite hip mobility to pull weight from the floor, you’re tissues will fail faster and you will eventually have an injury.
Looking at people's programming, almost nobody is spending an adequate amount of time focused on improving the mobility. Which is a problem. Being able to move through a full range of motion is crucial for not just training, but for being able to get through life’s demands. Think of your body as a Ferrari, lifting with poor mechanics due to limited mobility is like driving that Ferrari with low motor oil and with the hand brake hand. Sure it’ll still drive, but you’re leaving performance on the table, and eventually it’s going to break down.
Training variability, volume, and mobility are all related and after countlessly having the same conversation with the people we see in the clinic we decided enough was enough. We decided to create a solution that would benefit damn near everyone, and that solution is the Athletes’ Potential Pain-Free Training Plan. Whether your goal is to prevent injuries at CrossFit, improve your running times, or simply become a healthier version of yourself; we’ve created a unique program that requires minimal equipment and minimal time help you reach your goals.
There is simply nothing on the market like this program. It has been developed from the ground up by new-age healthcare professionals who blend the fields of rehabilitation and human performance and we couldn’t be more excited to offer this service to you.
You only get one body, so if you’re ready to stop beating it up, click the link above or fill out a contact request form. We’d love to answer any of your questions. Until then, happy training!
-Dr. Jake, PT, DPT
Adrenal fatigue is the inability of the adrenal glands to carry out their normal function. The kidneys produce hormones to regulate blood sugar, blood pressure, burn fat and protein and react to stress. A disruption can cause changes in metabolism, fluid and electrolyte balance, the cardiovascular system and sex drive. The adrenal glands are the main stress control of the body and thus are affected with a stressful, overworked and under nourished lifestyle.
Some common triggers or causes of adrenal fatigue are: over-exercising, high stress levels, sleep deprivation, high sugar intake, chronic illness, depression, surgery. This is not an exhaustive list by any means but you can likely identify with a few of these.
The signs and symptoms of adrenal fatigue can be slightly different with each person. Keep in mind, one or two symptoms does not suggest adrenal fatigue. Rather, a cluster of the symptoms and lifestyle factors in an otherwise healthy adult could point towards adrenal fatigue. Unfortunately, adrenal fatigue is not on the forefront of “old school docs” minds or they were never taught this in med school. Holistic medical practices, dietitians or nutritionists are more likely to recognize the symptoms and prescribe a non-medicinal approach to working back to health.
Weight gain and inability to lose it- often abdominal area
High frequency of sicknesses that tend to last longer than normal
Reduced sex drive
Lack of energy, even with adequate sleep
Reliance on caffeine- coffee, soda, energy drinks
Chronic pain of unknown origin
Obviously, we at Athletes’ Potential are not dietitians or nutritionists but we have a strong belief that input = output. We tend to treat the output side, but you could see they are directly related! So if you train 6 days per week, crave and/or eat sugary foods, sleep 4-5 hours a night and have trouble sleeping once you lay down--- your body is TIRED. As a society wrapped up in the ‘go until you drop’ mindset, it is not often that we take time to slow down and let the mind and body recover.
Take a minute to answer these questions for yourself: How many minutes each day are quiet and calm? Meaning, no phone, no TV, no conversation, no working, no cooking. After a workout or long day at work, what do you do to ensure that your body is ready to do it all again tomorrow? How do you respond when your body sends stress signals?
Any “I don’t know” or “I don’t have time” responses? Keep reading!
Where to start?
Nutrition- Not my area of expertise, but definitely an area of interest! A friend of ours is a Nutritional Counselor at a Holistic and Integrative Medicine clinic here in Atlanta. She shared a short blog about supplements that she suggests if you are experiencing these symptoms, found HERE. There is also a delicious recipe--- you’re welcome! A dietician or nutritionist can work with you one-on-one to talk through symptoms and which food changes could impact your health.
Meditation- Meditation doesn’t have to be some mystic, religious experience unless you want it to be. By meditation, I mean taking a small chunk of time to relax the mind, breathe and calm the body. This is a new practice for me as well! The first time I tried it, I only lasted about 30 seconds before I was thinking about something else. Now, I almost always make about 10 minutes of relaxation! Check out the app Headspace. It’s free and is directed mindfulness for 10 min each day.
Journaling- Very similar to meditation, but some people prefer journaling. For those with busy minds, taking a few minutes to write down what you are thinking about can be freeing and lighten the load swirling in your mind.
Listen to your body- Although last, it is the most important and closing thought. Listening to your body while training is paramount to all practices. If you feel fatigued, foggy headed, have various aches and pains over the body, perhaps today isn’t the day to run your 10-mile loop or try to PR a lift. Take the time to slow down and be attentive to the signals your body sends!
Thanks for reading,
Dr. Jackie, PT, DPT
Hi, I’m Doc Danny Matta. I’m a physical therapist, strength coach and an instructor on the MobilityWOD team. I’ve worked with countless CrossFit athletes, soldiers and weekend warriors over the past 6 years as a physical therapist. These are just my views. If you don’t like them, stop reading and start your own blog.
Last year during the 4th workout of CrossFit Open Week, I saw an epidemic. That epidemic was a ridiculous increase in acute neck injuries. I thought to myself, did everyone get in a car accident and sustain a whiplash injury in the same week? I quickly realized that it wasn’t car accidents crushing people’s necks, it was handstand push ups!
Don't be this guy!!
If you don’t remember the 4th workout last year it was as many rounds as possible in 8 minutes:
3 cleans (men use 185 pounds and women use 125 pounds)
3 handstand push ups
6 handstand push ups
9 handstand push ups and so on for the entire 8 minutes.
I actually really liked this workout when I saw it. It’s a nice push pull couplet. It’s moderately heavy but light enough where many people would be able to at least do a few rounds. What I didn’t expect was that I would see people pile driving themselves into the ground to get one extra hand stand push up!
Let’s be real with each other, if you’re reading this and you honestly have a shot to go to the CrossFit Regionals or Games I understand why you might sacrifice your neck to achieve a long term goal. Look, I’m as competitive as anyone. I once kicked a guy off an intramural flag football team I was on mid-game because he sucked. Do your thing, and I hope you achieve your goal.
The rest of you, honestly probably 99% of you reading this need to look at this from another perspective. You are not going to the CrossFit Regionals, let alone Games. You are doing CrossFit because you’re trying to be healthy, look good and have a supportive community to keep you motivated. You need to look at the Open as a way to test yourself, try new things, have fun and compete with your friends/family.
I only have one person that I compete against when I do the CrossFit open- my brother. I bet you thought I was going to say myself. Sorry but that’s cliche bullshit! You need to compete against another human being if you really want some competition. In my case it’s my older brother and I look forward to crushing him again this year because I know he and his wife just had a baby and he’s going to be in less than ideal shape!
So, for those of us falling into the non-CrossFit Games/Regionals category here’s my advice: Do not do something that subjects you to injury that can limit your ability to function at work or with your family. Get with your coach and get a game plan for the workouts. Maybe you do your best with the RX weight but don’t do something stupid. You still get a score. After you do that, scale what you need to scale and then get a good solid workout in.
Go to your gym’s Friday Night Lights workouts. Get involved in the fun of the Open and enjoy it. Have a fun 5 weeks, this is your season. You’ve been training all year for this. Once it’s over, get back in the gym and work on your weaknesses. Follow my advice and you’ll get to that point without breaking your neck!
-Dr. Danny, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.