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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
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What if you could experience less anxiety and less stress without a pill forcing your body to calm down? What if you could exercise your heart, lungs, muscles and bones without having to step foot in an LA Fitness? Seems too good to be true... but have you tried HIKING?  To some, hiking may seem like a pointless wandering through the woods, but for many folks the benefits are numerous and welcomed. Mental Health Hiking, or even a stroll through a nature setting, has been shown to decrease anxiety and lower risks of depression. A Stanford study showed that “neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.” That means that annoying repetitive voice in your head telling you that you don’t have enough time in the day can be quieted, maybe even silenced! In the technology-driven world we live in, quiet and empty time is almost non-existent. By taking a walk through a nearby park during lunch or finding some trails on the weekend, you may notice mood enhancement and more productivity when working! Another mental health booster—try taking a friend with you sometime. Personal interactions, without large groups and distractions or cell phones in our faces can help build meaningful relationships that are valuable for mental health. Do you train really hard during the week? Take a hike on your off day/rest day as a way to keep the blood flowing and body moving while also allowing it an exercise input that is not 100% intense the whole time. Your body will thank you! Physical Health Hiking also provides a unique challenge that we don’t see often- an uneven surface. Unless we are still playing some sports as adults, like soccer or lacrosse, we tend to exercise on and spend our days on flat, hard surfaces. Navigating uneven ground challenges our foot and ankle stability, single leg control, and balance, unlike conventional fitness routines. You can search for hikes according to distance and challenge at websites or apps like “All Trails.” I suggest trying some longer and easier hikes as part of recovery from tough fitness routines or as an easy mental release. These trails usually have less obstacles so there is less focus demand for watching your step. Of course, they are not as demanding on the heart and muscles, but that may be desired for an off day! Depending on your fitness level, you can also try to push it to more challenging terrain with obstacles and steeper incline. This will get your heart pumping and lungs working hard!  As we get in our weekly routines of work, gym, dinner, repeat, I think we tend to forget to use our fitness. We are exercising to keep the heart and lungs healthy, manage a healthy body composition and release stress or worry but also to be able to continue being active throughout our lifetimes. So get out and find a nature-filled area to hike or a park to walk through! Your mental and physical health depend on it!
Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS It’s baaaaack. The largest fitness competition on Earth, the CrossFit Open, is finally here. Maybe you’ve trained all year for this, maybe you’re still new to CrossFit and are curious about all the excitement. Maybe you’re a seasoned vet, maybe this is your first Open you’ve ever participated in. Regardless of your CrossFit background, your fitness will be tested, your mental toughness will be challenged, and you will certainly have a blast working through these workouts with your crew at your local CrossFit affiliate. That being said though, this is typically a time where we start seeing an uptick in the people we see coming in for CrossFit related injuries. Having an athletic background, where I had to personally sit out multiple seasons due to injuries, I speak from experience when I tell you there is nothing worse than working all year towards a goal/competition/test and not being able to perform at an optimal level, if at all, because of an injury. And, look, I get it. There is inherently an increased risk of injury when you're pushing yourself in a competitive environment. However, there are some very important things you can do to minimize this risk and allow you to perform your best. Let’s take a look at the three easy things you can do: #1 Don’t Be Reckless This is huge and something I see year after year. If you’re a CrossFit coach, or even just an observant CrossFit athlete, I’m sure you’ve seen what I’m about to explain...You’ve worked all year to create movement patterns that are both safe and effective. You know the importance of good, quality movement. However, throw in the element of an international competition and it seems like all these lessons about technique go out the window. For example, last year’s first Open workout (18.1) consisted of three movements: toe-to-bar, dumbbell clean and jerks and rowing. Can you guess what type of injury we saw coming into our clinic after this workout? If you said back pain, you’re correct. But why? Well, with this workout people were trying to perform as many rounds as possible for 20 minutes. To get better scores people weren’t maintaining core control for a solid hollow position with their toes-to-bar, they stopped getting full hip and knee extension for optimal power production during the drive portion of the clean and jerks, and/or they started to over-extend during the rowing component. All of these create situations that are destined to increase stress on your low back. Keep in mind that this was just the first workout! Now you’re either completely unable to participate in the other workouts or will not be performing at an optimal level because you’re trying to grind through an injury. #2: Protect Your Sleep There are four main pillars of health care that we look at with every patient who walks in the door at Athletes’ Potential: Movement, Stress, Sleep, and Nutrition. Sleep is easily on of the biggest problems that we see out of these pillars. And check this out: Sleep affects everything you do and everything you do is positively affected by quality sleep. Good, quality sleep literally improves everything: every marker on a blood panel, weight management, sport performance and recovery, productivity, and numerous types of disease management. The list goes on and on, yet the percentage of sleep deprived Americans, particularly in Urban areas, continues to rise at an alarming rate. In fact, the U.S Centers for Disease Control and Prevention reports that more than 30% of Americans are sleep deprived getting fewer than 6 hours of sleep per night. If you’re not getting enough sleep, you’re not giving your body a chance to recover. If you’re not recovering appropriately, then you're leaving yourself at risk for injury and decreased performance. So, bottom line: create an optimal sleeping environment, protect your night time routine, and get some good, quality sleep. For more info on how to optimize your sleep, check out this article we wrote. #3: Maintain Perspective This comes full circle with tip #1. For those of you trying to make it on to Regionals, those extra few reps I mentioned could be the difference in making the cut vs staying home. However, for the vast majority of athletes competing in the CrossFit Open this is not reality. You all have careers, kids you need to take care of, and numerous other responsibilities that you need to keep rocking with once you leave the gym. Is bouncing off the top of your head to get an extra rep or two really going to mean that much if by doing so now you can’t look over your shoulder while driving? (yes, this is a real scenario that we’ve worked on at our clinic...I’m looking at you 17.4). Or is that two position jump on the leaderboard really all the important if now you can’t bend over to pick up your kids?
CrossFit is meant to be a competitive, fun, and challenging way to make all aspects of life outside the gym a little easier. This time of year is huge for all CrossFit athletes and it is truly impressive to see the physical accomplishments and PR’s that happen every single year in the Open. However, the Open isn’t an excuse to throw all safety out the window, but it isn’t something you should be afraid of either. Following these three easy tips will ensure that you have a great time, reduce your risk of injury, and maybe even hit a PR or two. Thanks for reading, Dr Jake, DPT, CSCS, CF-L1 Recently, I had the opportunity to present to a local soccer club and their coaches on injury risk and reduction for the sport of soccer. In order to understand this, a “Needs Analysis” must be done. A Needs Analysis is a two-part analysis breaking down the sport into two components:
Today, our primary focus will be on evaluating the sport itself. This can be further broken down into:
Movement & Physiological Analysis Soccer is a very lower-body dominant sport involving the hip, knee and ankle joints and muscle groups including the quadriceps, glutes, hamstrings and calves. A soccer athlete must be able to run, jump, accelerate, decelerate, land, cut, kick, pass, head, shuffle, tackle – all while handling a ball and avoiding defenders. Oh, they also need the ability to sprint and jog throughout the duration of a 90+ minute game. Now, you’re talking about a dynamic athlete with a sound aerobic and anaerobic energy system. That’s A LOT. Here’s a more thorough breakdown:  Injury Analysis Sports injuries are inevitable. It comes with playing sports – exposure already puts you more at risk. You cannot prevent sports injuries, but you can help mitigate and reduce the risk of them happening – especially ones that are non-contact or overuse in nature. Here’s a breakdown of the most common injuries in soccer:  A study done in 2017 by Khodaee et al. tracked detailed information on injury rates among high school soccer players over a 10-year period (2005 – 2014). You can see those below broken down by gender and injury diagnosis.   Muscle strain, ligament sprain and concussions are highest as expected. What’s most interesting is the girls’ ligament sprain – very high for both practice and competition as compared to the boys’ group. Females are 2-5 times more likely to tear their ACL than males in a similar sport. There are a lot of factors that play into this and nothing is definitive. We do know that strength and neuromuscular control are big modifiable factors from an injury risk standpoint. In another study from 2015, Waldén and company analyzed 39 videos for movements related to non-contact ACL injuries in professional soccer players. They found that pressing, kicking, and heading were the 3 most common movements in relation to ACL injuries.  Pressing  Kicking  Heading (check that right leg in D - ouch) Cool, so now what do we do with all of this? Make some superhuman soccer athletes.
Have a plan in place to address these different components. It’s important to create a program for these athletes to develop these athletic characteristics – i.e. lower body strength, power, repeated sprint ability, cardiovascular endurance, change of direction and reactive agilities. Injuries happen all the time in soccer, but if we know what joints and muscles are most at risk, then we can better prepare these tissues to withstand the stress of the sport and build more resilient and robust athletes. Cheers, Dr. Ravi, DPT Sources: Baechle, Thomas R., and Roger W. Earle. Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics, 2016. Print. Turner, E., Munro, A. G., & Comfort, P. (2013). Female Soccer: Part 1—A Needs Analysis. Strength & Conditioning Journal, 35(1), 51-57. We’ve all seen the outliers: People who are in their 70's, 80's and 90's that just look like they’ve aged better than everyone else. Not only do they seem physically healthier, but they’re mentally very sharp. Early on in my career as a physical therapist, I had the opportunity to work with one such man. His name was Charlie and he owned a mechanic shop in New Braunfels, Texas. When I saw him, he was 85 and was coming in because of some hip pain. I was blown away by how physically active and quick-witted he was. He still worked full time in his mechanic shop with his two sons. The main reason for him coming in was that his hip pain was limiting him when it came to climbing into his deer stand. To make him even more impressive, he was on zero medications; he had never had a significant health issue; and lived independently. If you’ve been around people in their 80's, being on zero medications is incredibly rare in its own right. I ended up working with Charlie for a few months and every time I saw him I picked his brain on life and how he was so healthy and active at his age. Over the course of our time, I picked up 4 Key Habits that had contributed to his remarkable physical and mental health at his age. If you want to age like Charlie, stick to these four habits: Habit 1: Move a lot Charlie never did one day of structured exercise in his entire life, except when he was in the Army early in his life. Moving is what Charlie did best. He started his mechanic shop in his 30's and had been doing that pretty much everyday for 50 years. This is a physical job to say the least, so he had a lot of movement built into his day. He also was a big believer in walking. He would walk 3-5 miles every morning with his dog. You don’t have to exercise much, if at all, when you move and are active all day long. Habit 2: Have something to wake up for I thought this was a really interesting piece of advice he gave me. He gave me this nugget of advice as he was describing the new computer software they were using for his mechanic shop. In his mid-80's, he was learning a new software program to help his shop run more efficiently. He was so excited about the changes they expected to see with this new upgrade. What I found out was that he loved what he did. He was obsessed with cars and making them run better. He had done what very few people every accomplish: he had matched up his interest in life with how he made his living. He got up early everyday so he could be at his shop to open up and greet the first customer. What really resonated with me was Charlie's ability to constantly try to improve and his drive to wake up early and seize the day. Think about how many people hate their jobs. The internal stress created with hating what you do, yet having to go and do that everyday is significant. Charlie was onto something and it was one of the big reasons for his long term health. Habit 3: Eat like you have Type I Diabetes Charlie’s wife had died about 10 years before I met him. She was born with Type I Diabetes and had lived an incredibly long life for someone born in the early 1900's with Type I Diabetes. Charlie credited the way his wife had the family eat to much of his own health. Because his wife had to be very strict about what she ate, the entire family just ate the way she did. There were two big nutrition components to how he ate: First, he ate minimal to no sugar besides fruit. He chose black coffee, a banana on his oatmeal instead of brown sugar and he never ate desserts. Second, eat nothing white. Charlie explained that his wife would have big insulin spikes when she would eat white bread, rice, or even drink milk. Recent studies have shown that a cup of milk causes the same insulin response in the body that eating a piece of white bread does. He and his wife just figured this out by tracking her insulin response to food. Other than that he ate pretty much whatever he wanted. He was a big fan of the brisket from Rudy’s BBQ, which was right down the road from our clinic. He was also an avid hunter and would eat a lot of venison as well. Habit 4: Go to sleep early Charlie swore that going to sleep early was important. To put this in context, he usually got to his shop around 7am and they didn’t open for business until 8am. He would get up around 5am every morning to take his dog on a walk before going into his shop. He would usually go to bed by 9:00pm. That meant he usually was getting about 8 hours of sleep per night. We all know sleep is important. Often one of the most difficult parts of sleep for people is actually getting to sleep at a decent time. Follow Charlie’s advice and start waking up earlier. You do that for a week or two and I’m sure you’ll be ready to go to be once it’s 9:00 or 10:00pm. I know these 4 habits seem simple, and they are. Your health doesn’t have to be complex. There’s also no magic supplement you can take that will give you longevity like Charlie. In an age of Bird Scooters, Amazon delivering your groceries, and having an app for everything, don’t forget the basics. Move often, have something you're excited to wake up for, sleep and eat well. If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Remember: If you have a body, you’re an athlete! Thanks for reading, Dr. Danny, PT, DPT, OCS, CSCS cdc.com Last week, we dove head first into concussions (sorry, I can’t help it), looking at what exactly defines a concussion and what sports populations are most at risk. If you missed it, check out Concussions, Part 1. The interesting part about concussions is that you may not see some signs or symptoms present until minutes, hours, or even days later, which is why I want to equip you with the knowledge to know what to look for in part 2 of this Concussion series. The easiest way to do this is to break it down into acute (sudden/very recent concussion) and chronic (prolonged period of time after concussion) phases. Acute: But first, a story about Billy Bob. So say it’s 3rd and goal with 10 seconds left in the 4th quarter. Your high school team is losing 22-27. This game decides whether your team goes to the state championship. The ball snaps and Billy Bob, the running back, runs towards the goal. He is instantly met by the middle linebacker with a head-to-head collision. Now, it’s 4th down. Billy Bob lays there and struggles to get up. The team Athletic Trainer (AT) runs on the field and finds that he is able to now stand up, but definitely notices something is off. Billy Bob repeatedly assures the AT that he is okay and can play the final play. What do you do as the AT? As the head coach? As the parent? – do you sit Billy Bob out? What about the game? This seems like a no-brainer (again, sorry), but can be a very controversial call, especially when there’s a game on the line. I always go by the rule: “When in doubt, sit it out.” Now, you’re probably saying, “Ravi, quit being a softy and suck it up. There’s a game to win!” But as someone who has personally experienced a concussion, I would say the risk is not worth the reward. Let me explain why… Introducing Second Impact Syndrome (SIS) – This happens when an initial concussion has occurred or not fully resolved and the individual receives another concussion, this time resulting in more severe complications including excessive swelling in the brain. That’s no bueno. If I have you freaked out, don’t worry. This is a rare occurrence, but it can happen. As long as everyone is doing their job, there should be nothing to worry about. And, statistically speaking, most concussions resolve within a matter of 7-10 days. “Can imaging diagnose a concussion?” No. This is a HUGE misconception. Currently, there is no imaging that can effectively diagnose a concussion. Typically, most concussions present as a functional issue, rather than a true structural issue (Think more of how a computer program runs rather than the wires connecting it) which is why imaging is rarely helpful. Signs and Symptoms of a Concussion:   Each concussion can present with different signs and symptoms based on numerous factors (i.e. where the impact was, number of concussions, severity, etc.), which is why every concussion must be evaluated and treated on a case-by-case basis. As you can see above, headache takes the cake for most common symptom. Recognizing these signs and symptoms can be very helpful to make sure no concussion goes undiagnosed. Chronic: Introducing Post-Concussion Syndrome (PCS) – this is categorized as a complex disorder in which symptoms – such as headaches and dizziness – continue to persist for more than 21-28 days after the initial injury. A variety of factors can play into why there are prolonged symptoms:
A team approach is most effective to tackle these acute and chronic concussion cases by utilizing a variety of treatment approaches. Next week, we’ll discuss the final part of this series where we’ll cover management and return to play for concussions. In the meantime, if you have any questions, please feel free to reach out by giving us a call at 470-355-2106 or clicking the button below! Cheers, Dr. Ravi, PT, DPT, CSCS 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 Lightheadedness Lack of energy, even with adequate sleep Reliance on caffeine- coffee, soda, energy drinks Food cravings Chronic pain of unknown origin Chronic fatigue 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 “Experts often possess more data than judgement.” General Colin Powell
Everything is data-driven these days. We track things so we can make better and more accurate decisions. This makes a ton of sense if you think about it. If you don’t have great data to back up a decision you’re pretty much guessing. In a previous blog post, I wrote about my blood test work results. This data I’ve been tracking for a few years now and was shocked when I saw the negative trend my blood data had taken. I retested my blood work on a Monday which was about 3 months after my last test. I typically recommend blood testing every 3-6 months to keep an eye on your internal data. I’ll honestly be shocked if my data isn’t significantly better. I feel better now than I have in the past 18 months. Much of this I attribute to making much needed changes in sleep and training. The only reason I made these changes was because I saw the raw data in my own blood work. If you don’t think full panels are necessary for you every 3-6 months, that’s fine. I would recommend that you at least look at these 3 blood biomarkers next time you have your annual physical with your physician. They will at least help you catch the low hanging fruit and keep you functioning at a high level. Vitamin D- Researchers estimate that almost two-thirds of the population is deficient in vitamin D. Vitamin D is pretty important and has an effect on overall health, the immune system, bone density, muscle strength and recovery. That’s some pretty important reasons to want to make sure this one vitamin is at optimal levels in your body. Researchers have even shown that VO2max (a test of oxygen consumption that correlates with cardiovascular endurance) peaks when Vitamin D levels are above 50 ng/ml. When getting this vitamin checked, make sure you get a Vitamin D 25-hydroxy test. This is the most accurate way to test your Vitamin D levels. Magnesium- “Magnesium is a co-factor in over 350 enzymatic reactions in the body. It is necessary for the transmission of nerve impulses, muscle activity, heart function, temperature regulation, detoxification factors and improving insulin sensitivity.” Charles Poliquin Magnesium is ultra important and the reality is that most of the foods we eat that should have magnesium in it, don’t. Many of the foods that are leafy green veggies have high amounts of magnesium. These veggies get the magnesium from the soil they are grown in and mineral deficiency is soil is a very common problem. It sucks, you can eat all the healthy green veggies you want and still be magnesium deficient. Knowing if your magnesium levels are low is step one to figure out if you need a supplement which most people do. Lastly, magnesium has a calming effect on the brain. For those of you that have difficulty with falling asleep, this could be the cheapest and safest way to help fix the problem. High Sensitivity C Reactive Protein (HS CRP)- HS-CRP is a blood biomarker that is typically used to gauge someone's risk of heart disease. Most recently it’s been used as a gauge for global inflammation and to determine sleep deprivation. This marker is increased by a number of poor activities; eating a ton of sugar filled foods, having a sensitivity to gluten and pounding pizzas, or working at a high stress job can all increase your HS-CRP level. Recent studies by sleep researchers reveals HS-CRP is a biomarker to track sleep debt. If you don’t sleep enough or you aren’t getting beneficial sleep this number will be elevated. We like to see our athletes under 1.0 and ideally closer to 0.5 on this test. Getting your primary care physician to order these tests can be a bit difficult at one time. The problem is that you technically are supposed to be symptomatic for specific condition for your physician to justify ordering and insurance reimbursing for testing. Also, if you really want to keep an eye on your internal data, there’s no way you’re going to sweet talk your physician into ordering an in-depth blood panel for you 4x per year. Stop guessing and start getting some tangible data on how well you’re really functioning internally. - Dr. Danny, PT, DPT 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. Vitargo Hydrolyzed Whey 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. 
“The fear of pain is worse than pain itself” Arntz and Peters, 1995.
Back in the day when I was still active duty in the Army, I had to attend what was called a Joint Operational Deployment Course. It’s a week-long course where myself and other active duty medical providers learned how to take care of trauma related issues predominantly. It was great training and I learned a ton. I also learned I’m terrible at giving an IV. One of my colleagues was unlucky enough to have me as a partner as we learned to hook up an IV bag. To make matters worse he was deathly afraid of needles and blood. In fact I’ve been around him when he had to sit down for a few minutes after getting a routine shot otherwise he would have passed out. The process for hooking up an IV bag is pretty straight forward. Step 1: put on tourniquet. Step 2: insert needle. Step 3: attach IV clamp/bag to needle port. Step 4: take tourniquet off and open IV. Much to my friend’s dismay, I mixed up the steps and accidentally took the tourniquet off before attaching the IV bag. My partner was intentionally looking away the entire time because if he saw the needle he would pass out. As the blood started running out of his arm through the IV port I had just placed in his vein I said the worst thing I could have at the time, “Oh Shit!!”. He immediately looked at me and then at his arm which was now next to a rather large pool of blood on the table. He immediately passed out as I fumbled to attach the IV bag and stop the bleeding. He’s still very much alive and still very much afraid of needles. I reminisced with him about this event a few weeks ago when he and his family visited my family in Atlanta. Yes, I’m not the best person to call if you need and IV put in but the real question is why is this person so afraid of needles/blood and I can watch blood be drawn or even stick needles in myself without a similar response? The answer is directly related to the opening quote: The fear of pain is worse than pain itself. Maybe this person had a memorable traumatic experience with a shot when he was a kid. Maybe his mom or dad were really afraid of giving blood/needles. Maybe he had a sibling that told him how terrible it would be to get a shot just to mess with him. Either way it eventually leads to a pain experience. After a pain experience, we start catastrophizing the event, in this case shots or needles. That leads to more pain related fear and eventually avoidance of the painful event again. All of this leads to more and more perception of pain with the activity. So why am I putting this on a blog that typically talks about performance improvement and injury treatment? Because, for people that have had pain for more than a few months they have to stay away from falling into this vicious cycle. I had a patient recently that came in to see me for pain in the front of his knee. He had no explained onset except that he had tried to take up running and had to stop because his knee hurt whenever he would run. It also hurt to go up/down stairs if he led with the injured leg. He resorted to only going up stairs with his non-injured side one step at a time. This is an incredibly slow way of going up/down stairs and I’m sure he aggravated countless people that were behind him in stairwells. What’s the first thing we did? Talked about how his leg was healthy and had him start going up stairs with what he perceived to be his injured leg. We also had him start box squatting the first week. When I told him we were going to squat his face looked like I had just told him we were going to fight a grizzly bear. We had to expose him to those activities he was avoiding and afraid of. Sure he gained some strength back and that is obviously a contributing factor to him getting better. However, the biggest factor was the realization that his leg wasn’t broken, it was functional and he needed to start using it correctly again. With chronic injuries we can become very sensitized and aware of any little thing that happens in a painful area. Sometimes the best treatments are the ones that prove to our own mind that we are still functional! -Dr. Danny, PT, DPT |
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