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 sleep.
For more info on how to optimize your sleep. Check out this article we wrote.
#3: Maintain Perspective
This comes full circle with tip #1. For those of you trying to make it on to regionals, those extra few reps I mentioned could be the difference in making the cut vs staying home. However, for the vast majority of athletes competing in the CrossFit Open this is not reality. You all have careers, kids you need to take care of, and numerous other responsibilities that you need to keep rocking with once you leave the gym. Is bouncing off the top of your head to get an extra rep or two really going to mean that much if by doing so now you can’t look over your shoulder while driving? (yes this is a real scenario that we’ve worked on at our clinic...I’m looking at your 17.4). Or is that 2 position jump on the leaderboard really all the important if now you can’t bend over to pick up your kids?
Crossfit is meant to be a competitive, fun and challenging way to make all aspects of life outside the gym a little easier. This time of year is huge for all CrossFit athletes and it is truly impressive to see the physical accomplishments and PR’s that happen every single year in the Open. However, the Open isn’t an excuse to throw all safety out the window but it isn’t something you should be afraid of either. Following these three easy tips will ensure that you have a great time, reduce your risk of injury, and maybe even hit a PR or two.
Thanks for reading.
Dr Jake, DPT, CSCS, CF-L1
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:
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.
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.
Dr. Ravi, DPT
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.
“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.
Over the past few years, I’ve been fortunate to be exposed to an entire spectrum of different athletes- all the way from 8 year old soccer players to Olympic medalists. The biggest difference I see between amatuer athletes and professional athletes is the level at which they take care of their body. The amount of training you do and the amount of time you spend working on recovery are both linear. The more you train, the more you have to work on recovery.
I’m of the opinion that there is no such thing as overtraining. I’ve worked with athletes that put in massive amounts of training week after week. If I did a week of their training I would be out of commision for a month. So how can these athletes train so hard and continue to make improvements and not hit a state of overtraining? They work on recovery like it’s their part time job. The training is not what separates good and great athletes, recovery is the secret to success!
Most people have no idea how good their body is supposed to feel because they are constantly in pain. It’s hard to train at your optimal level when you’re always borderline hurt. Here are 4 things you can add in with your training to spike your recovery. Better recovery=more training. More training=more athletic improvement. More athletic improvement=winning and we love winning!
1. Marc Pro
I was exposed to the Marc Pro in 2012 when I was working with CrossFit 808 in Honolulu. One of my mentors, Kelly Starrett, gave me a Marc Pro to test out with the team. I’m a skeptic person at best and I need to see positive changes myself before I start buying in on things like the Marc Pro. Since 2012 I’ve recommended the Marc Pro to all the athletes I work with that are looking for help with recovery.
You’re probably asking what does the Marc Pro actually do. The answer is: it gets the muscles moving. Pretty simple, right? Essentially, the contraction the Marc Pro produces is non-fatiguing but strong enough to get fluid in the muscles moving. This constant but non-fatiguing contraction is basically a lazy person’s way to recovery. If you wanted to get on an Assault Bike and ride at a non-fatiguing speed for 30 minutes you could get a similar effect. If you don’t have an Assault Bike at your house and you want to watch Game of Thrones while you recover, the Marc Pro is a pretty damn good option.
2. Recovery Pump Boots
The Recovery Pump boots look ridiculous. I remember seeing an elite triathlete at a race I was doing in Hawaii a few years ago with these on. It was the first time I had seen the device. It’s just hard to look cool with giant puffy boots on your legs, but they work.
The rationale behind the Recovery Pump is similar in a way to the Marc Pro. Instead of using muscle contraction to help get things moving, the Recovery Pump using sophisticated compression. This compression helps move fluid from the extremities to the torso. Think of the torso as the area where we clear non-useful elements of the blood/fluid after training. It’s essentially out with the old, in with the new when you get fluid circulating more post training.
Who uses Recovery Pump? The majority of NFL, MLB, NBA and NHL teams. Also, multiple branches of military Special Operations groups, elite triathletes and endurance athletes. That’s pretty good company to be in.
3. Nutrient Timing
I recently spoke with Anthony Almada on a podcast I do with another coach called the Doc and Jock Podcast. Anthony was one of the original founders of EAS and is the founder of another supplement company called Vitargo. Vitargo is basically a super carbohydrate that’s been pre-broken down so it’s absorbed faster. It’s a pretty cool product and you can hear the whole interview here.
The reason nutrient timing is important is that you need to be able to effectively replenish your stored energy. Studies have shown endurance athletes need between 400-600 grams of carbohydrate per day. For many of our athletes that eat a very low carb diet, they may only be consuming 25-50% of this. The best way to spike recovery is to time your nutrient timing correctly so that your body has the greatest chance of rebuilding itself.
When you exercise, your body depletes muscle glycogen as this is the main fuel for movement/exercise at the muscle. When we exercise and glycogen gets depleted, insulin stimulates glucose in the blood to be drawn back into the muscle to replenish glycogen. This is important to know because if we have more glucose available in the blood at the time of training we can replenish our energy source better. More ability to replenish the main exercise energy source equals more training!
Try this combo next time you train: drink 35-70 grams of a carbohydrate like Vitargo with 10-20 grams of protien in it 30-60 minutes before training. Drink the same thing within 20-30 minutes post training. The pre-workout nutrients will give your body readily available sources while training and the post workout drink will re-supply the muscles at the key post workout window.
Here are the two supplements I like to use together.
4. Embrace the cold
There has been a big debate on the usage of cryotherapy(cold treatment) in the sports medicine and strength/conditioning community. Here’s my stance: Use whole body cold treatment to help with recovery, don’t waste your time icing a sprained ankle.
What I mean by that is local icing for an inflamed joint is not effective. It’s effective at numbing the area but doesn’t help with the healing process the way we thought it used to. In fact, the original physician that came up with RICE (rest, ice, compression, elevation) recently changed his stance on this to take icing out of use for acute injury.
When I say using whole-body cold treatment for recovery I am referring to things like ice baths and whole body cryotherapy chambers. The effects of these two forms of treatment for recovery are two-fold. First, much like the Marc Pro and Recovery Pump, we get a pushing of fluid to the torso. This occurs due to vasoconstriction of the blood vessels in the legs/arms causing more blood to be directed toward the vital organs in the torso. Increased fluid to the torso equals better nutrient/oxygen exchange and increased potential to rebuild after a tough training session.
The second positive effect is essentially a jumpstart to the parasympathetic nervous system. This is the system that helps predominantly with relaxation and recovery. Increased parasympathetic function leads to increased potential to recover and recuperate from hard training.
Neither of these are exactly something I look forward to since I don’t like to be cold. I would say between the ice bath and whole body cryotherapy the easier of the two to tolerate is the whole body cryotherapy.
If you want to train as hard as a professional athlete or Olympian you need to prioritize recovery just like they do. You have one body, you had better take care of it. If you’re really looking for that competitive edge, a better recovery strategy is your key to success.
“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!
June 2014 July 2015
Testosterone- 802 Testosterone- 421
HbA1c- 5.3 HbA1c- 5.7
HS CRP- 0.9 HS CRP- 2.6
Let’s face it: we live in the information age. You can find out pretty much anything by searching for it on the internet. There has also been a massive shift toward data driven decisions. I see it first hand in my business when I look at our website analytics. We even see it with things like Wodify as athletes start tracking all their workouts, strength numbers, training sessions and making training changes based off actionable data.
Think of this blood panel like a snapshot of what’s happening internally. As part of the initial testing phase to work out the kinks, my wife and I both went through the process to get blood drawn and see how long it would take to get our results back. When I got my results back, I was shocked!
Last June, as part of my transition out of Army, I requested some blood panel work from my Physician Assistant. I wanted to start doing a more in-depth panel of blood tests yearly just to see where I stood and to gauge my nutrition/training based off that. For me, I used that as my initial data to compare this lastest to. Here are the tests that were grossly different:
A good number more tests were performed besides these three but these were the ones that had the most noticeable changes. What does this even mean? In the past year my testosterone production had decreased by 50%. Testosterone is very important for recovery, building muscle, maintaining a lean body and many more very important tasks. According to a 1996 study by Vermeluen et. al, the average testosterone levels for someone my age (30 years old) is 617. To make matters worse, in the same study he found that the average testosterone levels of males age 75-84 was 471. Talk about kicking me while I was down! This basically shows me that there’s a decent chance my 90 year old grandfather and I have the same testosterone production at this time.
Next is the change in HbA1c. This is a marker of average blood sugar levels over the past 3 months. Most of you have probably heard of diabetes. It’s basically a disorder of high blood sugar levels in the body. It can either be genetic type I or developed type II. The range for HbA1c is pretty clear. Anything below 5.7 is normal, between 5.7 and 6.4 is prediabetic and over 6.4 is full blown diabetes. My number is elevated quite a bit and it technically puts me in the prediabetic range.
Lastly, was the change in my HS CRP. This is a marker of global inflammation in the body. To be clear, inflammation is not a great thing to have in the body. Increased values on this test in particular have been drawn to increased risks for cancer, heart attacks, neurologic disorders and type II diabetes. My HS CRP was elevated compared to where it was a year ago going from 0.9 to 2.6.
Now, when you see these big changes in values your physician should ask you a few things. First, did you do some crazy workout that day or the day before? Did you go out with your friends the night before, end up at the Clermont Lounge and down PBRs all night? Have you had a week of really bad sleep before this test cluster? All of these things are important to know because it can give us false values. By the way, my answer to all these questions was no.
Here’s what all this means. In the past year my health, internally at least, has slowly been trending in the wrong direction. So how did all this start to go wrong? I would have to attribute it to a number of factors. First, I started a business. For any of you that have ever started a business I probably need no further explanation. For those of you that haven’t, it’s the most difficult and stress-inducing thing anyone could ever do. Not only that, but I teach for another group (MobilityWOD) and in the past 12 months, I’ve accumulated about 70,000 miles on an airplane. I also have two small kids under the age of 4 and I typically sleep an average of 5-6 hours a night.
It’s not all bad news though. Mom, if you’re reading this don’t freak out and call an ambulance for me! I’m glad I did these tests because I had been feeling fatigued and like I was recovering poorly from my training sessions for about the past 6 months. Now I have some quantifiable data to help me make changes and retest to see what’s working. Changes will be made and I will retest in about 1-3 months. All of these markers are reversible with some supplementation changes and behavior modification. I’ll write up a follow up post once I’ve done my blood testing again. It’s time to make some changes!
It’s 5am, you’re up and getting ready for work. You got 6 maybe 7 hours of sleep last night and you’re off to crush the day at the office! Coffee in hand and listening to your favorite podcast on the drive (most likely the Doc and Jock podcast). You get through your normal day and then sit in traffic for 45 minutes on the drive home (Atlanta traffic can be rough). Once you’re home it’s family time. You haven’t seen your kids or wife all day and all you want to do is hang out with them. Before you know it, it’s 7pm. Your kids are acting crazy because they don’t want to go to bed and you’re starting to get hungry. Once the kids get to bed you have a couple choices:
I know to many of you this example may or may not resonate. This is basically my schedule 3-4 days a week. For many people lacking time is a common frustration. For me, it happens to be dictated by owning a business, having kids, enjoying spending time with my wife and creating online content like this blog post.
Of all the options above I typically go with option 4 on a day like I explained. Hitting a short but intense workout before I eat dinner is an easy way for me to keep some regular training in my schedule on busy days like this. My preference for these late evening workouts after a hectic day- the kettlebell!
I feel everyone should have at least one kettlebell at their house. We have two at mine, a 24kg bell and a 16kg bell. They don’t take up much room, are pretty inexpensive and they give you a ton of options when doing a training session at home.
Here are a few examples training sessions I like to do that just involve one kettlebell.
As many rounds as possible in 20 minutes. 24kg bell for men and 16kb bell for women.
-10 overhead swings
-run 200 m
-5 power clean and jerk each arm https://www.youtube.com/watch?v=bjKGrZ7-pWQ
-run 200 m
-10 goblet squats
-run 200 m
Perform 5 rounds of
3 Turkish Get Ups each side
20 russian swings
10 head cutters https://www.youtube.com/watch?v=tJA07NpN7pM
Rest 1 min
Every minute on the minute for 15 minutes
5 single arm KB snatches https://www.youtube.com/watch?v=g3c73NahdjU
Complete each round as fast as possible.
Throw in some midline stability work at the beginning or end and you have yourself a respectable little training session. Not only that, but in the time it would take you to drive to the gym and back, you completed a training session.
You may not be headed to the CrossFit Games doing just these type of workouts alone. Chances are, if you’re reading this you aren’t going to the CrossFit Games regardless! Staying committed to regular training sessions is important for moving well, staying fit and being able to keep up with two crazy kids.
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.