I recently attended a continuing education course called Functional Range Conditioning (FRC). It was one that has been on my list for quite some time and it was awesome to finally check it out.
In this blog post, I’m going to expand upon some of the principles and techniques I learned and how you can start to implement this in your daily movement practice.
First, let’s define a few words. What is flexibility? What is mobility? Are they the same thing? We hear these words used interchangeably. However, they are in fact different.
The foundation of the FRC system is based on the acquisition and maintenance of functional mobility and articular health. It is very dependent on your passive and active range of motions.
Basically, the goal is to make your AROM and PROM the same. PROM is the prerequisite which will allow you to improve your AROM.
FRC utilizes a concept called “bioflow.” While I don’t get too caught up in systems or their coined terms, I’m cool with this one. It basically talks about tissue continuity (gross tissue --> cellular --> intracelluar) calling it STUFF. Stuff being cells, fibers, and ground substance. Composition of these components dictate the type and physical properties of a certain tissue whether it's bone, fascia, ligament, tendon, muscle, capsule etc. Cell signaling and progressive adaptation is how these cells change into these different structures. Think about an ACL graft that is harvested from a patellar tendon – do you think it stays a tendon over time or evolves to becoming a ligament just like the initial ACL? Yeah, science is pretty cool.
I could geek out on this stuff all day, but let’s move on to the application of improving your mobility – there’s a few techniques used to start working on making your passive movement more active.
Insert Controlled Articular Rotations (CARS) - Active, rotational movements at the outer limits of articular motion. There’s 3 levels for CARS which are related to isolated blocking, external resistance and amount of irradation. Irradation simply put is the amount of tension you create throughout your body – in nerdy science terms this is also called Maximum Voluntary Contraction (MVC) often expressed in percentages.
The best example of irradation is to give someone a hand shake. First, squeeze using your hand, then hand and forearm, then hand, forearm and shoulder, etc. Your grip gets stronger and stronger the more musculature you recruit. The more irradation, the more force you exert. You can use this to dial in higher levels of recruitment while doing your CARS or other FRC techniques. “Force is the language of cells” – one of my favorite quotes at the course.
CARS can be implemented different ways whether that is by focusing specifically on a certain joint or you can take part in the morning CARS routine to give all your synovial joints in your body some love each day.
The next step to continue to work on improving your joint integrity and control is via PAILS and RAILS. PAILS and RAILS are isometric contraction efforts (sometimes combined with stretching) used to communicate with both the connective tissue & neurological systems.
2-3 minutes of stretching to build stretch tolerance, then:
This is a great video by Joe Gambino from Par Four Performance going over the Hip 90/90 PAILS/RAILS.
I see PAIL/RAILS as a way to safely acquire and create control into these newly stretched positions without movement. Basically isometric holds to own a position with increased stretch tolerance.
The next and my most favorite part of the course and system is the End-Range Control techniques. End range is where we see a lot of injuries and tissues breaking down. Why? Well, from a physics standpoint, we’re just not able to produce as much force at these end ranges due to length-tension relationships. Another big factor is because we rarely go there. And when we do, we typically aren’t ready for it and are pushed there by accident – which is why we need to train these end ranges. It allows us to build better tissue resilience and reduce the risk of injury. Here’s how we break down end-range control:
End-Range Control: PALS/RALS
Passive Range Holds
Passive Range Lift-Offs
End-Range Rotational Training
My suggestion is don’t get too caught up on the wording of these different techniques, but understand the conceptual framework and you’ll be able to implement this immediately. We all know that we have certain aspects of our joints where our active and passive is not the same. If you’re wanting to improve your squat or overhead position, or if you just want to build up resiliency in different tissues, then give your joints some love with some of these different techniques.
Dr. Ravi Patel, PT, DPT, CSCS
Breathing. Seemingly, the most innate skillset you have as a human being. So innate that it’s used as a benchmark for being a healthy newborn and your first time taking in a breath happens within 10 seconds of entering the world. Fast forward to adulthood and you’re breathing an average of 12 to 20 times per minute without a single thought. With all that practice, we must be pretty good at it; right? Not exactly. Stress, lifestyle choices, and mechanics all play a huge role in how we breathe, and all breath is not created equal.
Just like any skill, practice makes perfect, and I routinely see the opposite. I constantly see people who can only breathe into their chest, who don’t know how to take appropriate deep breaths, and who have no control over their diaphragm. This is a problem for many reasons and let me tell you why.
First and foremost, deep breathing has profound effects on your autonomic nervous system. Your autonomic nervous system includes your sympathetic and parasympathetic nervous systems which control your fight-or-flight responses and your rest-and-digest responses, respectively. In the world we live in, it’s easy to feel the weight of stress - stress from your job, driving in traffic, relationships, finances, etc. Here’s the crazy part though: our brain can’t decipher between the stress of being chased by a bear and the stress of being behind for an important work deadline. To the brain, stress is stress and breathing short, shallow breaths is one of the main ways our brain interprets stress.
All this to say that shallow breathing is both a cause of increased stress and a symptom of increased stress responses, creating a vicious negative feedback loop leading people to live in a chronically stressed state of mind. No bueno. Not only are there serious cardiac, mental, and metabolic diseases linked to chronic stress, but chronic stress can also put you at a higher risk of injury AND slow down your rate of recovery from current injuries.
Here’s the good news though: Something as simple as taking longer, deeper breaths using your diaphragm has been demonstrated time and time again to not only prevent the effects of chronic stress, but also significantly decrease non-specific mechanical low back pain. But don’t take my word for it:
Training your diaphragm is relatively easy. Below I’ve listed my three favorite drills to do so. While doing these drills, I’ll often have my patients perform something called an “apnea breathing” pattern, which is designed to slow down your breathing, increase your parasympathetic nervous system, and decrease your levels of chronic stress.
In review, taking deep, long breaths could be an effective treatment option for you if you’re dealing with low back pain and, at a minimum, will help your live a healthier life. However, diaphragmatic breathing is just a piece of the ever elusive puzzle.
If you’re dealing with low back pain, reach out with any questions. We design and implement programs to help people just like you, 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 get out of pain and return to their sport or activity performing better than they did before.
Thanks for reading,
Dr. Jake, PT, DPT, CSCS
June 6th, 2014 was a hot day in Columbus, GA. That’s pretty normal for Columbus in June and I remember this day well because it was the last day of my service in the U.S. Army. I had spent the past seven years on active duty, either in school or serving as a Physical Therapist on an Army post. I’ve never had more mixed feelings of excitement, nervousness, joy, and fear at the same time. I remember giving my final out processing packet to a Sergeant that I had only spoken to once or twice. He asked me what I was going to do and I told him I was starting a Physical Therapy practice in a gym in Atlanta. His responded with, “Hmm, that sounds interesting. Good luck with that, sir,” and then he was back to filing the huge stack of other packets he had on his desk.
If I learned anything while I was in the Army, it’s that you’re not as special as you think you are. You don’t deserve special treatment, and you have to earn respect from others. Respect comes from being remarkable at what you do.
My goal for Athletes’ Potential was to create an environment that was remarkable - a level of healthcare quality and true attention to the patients that was, and in many cases is, still missing. June 9th, 2014 was the first day I actually saw a patient at Athletes’ Potential. His name was Sam, and he was a defense contractor that had driven in from Alabama to work with me. We had a lot to work on due to his years in the military and police departments. I worked with him for three hours straight that day. At the end of the visit, he paid me and what he did next surprised me. He gave me a big bear hug and thanked me for being the first healthcare professional that had actually listened to him and taught him how to take care of himself.
At this point, I had been a Physical Therapist for years and I never had a response like this from a patient. That day, I knew Athletes’ Potential was going to be different. It was going to change a lot of people’s lives and it was going to be worth all the hard work we had to put in.
Ashley and I like to think of Athletes’ Potential as our third kid. Our kids obviously come first, but our business is something very special to us. It’s allowed us to help thousands of people in the Atlanta area and live an incredible life.
Over the past five years, I’ve learned a lot of lessons about business, healthcare, and developing meaningful relationships with people. If you’re reading this, I know I’m basically fighting for your attention against Instagram, Netflix, and HBO. That’s some steep competition, so I’m going to keep this relatively short by highlighting the 5 Most Important Lessons I’ve learned over the past five years.
1. Make decisions based on how you would want your family treated.
Zig Ziglar once said, “You can have everything in life you want, if you will just help enough other people get what they want.”
Helping others achieve their health and wellness goals is one of the core pillars at Athletes’ Potential. This also doesn’t always mean we are the right people to help individuals reaching out to us.
I remember seeing a patient about six months into starting Athletes’ Potential. She came to see me for some shoulder pain she was having. Within 10 minutes of talking to her, it was obvious that this shoulder pain did not sound like it was musculoskeletal. In particular, she had recently changed some medication she was on around the same time her shoulder started hurting.
I ended up taking her through an exam and it reaffirmed the fact that I didn’t think she actually had a shoulder problem.
I told her she needed to go back to her doctor because I thought she was having a reaction to this medication change. We ended up spending about 30-40 minutes together, and she left a little confused but happy to hear her shoulder was fine.
This is the first time I had to decide if a visit like this warranted a charge. I decided it didn’t since I couldn’t directly help her and she wasn’t appropriate for my skill set. She was pretty surprised that I refused to charge her for the visit and that I followed up directly with her physician about what I found.
Two weeks later, she emailed me to let me know her shoulder felt fine now. Her doctor switched her to a different medication and everything was fine. She was also emailing me to let me know she was setting up an appointment for her husband to get some help with his chronic lower back pain.
Years later we still get the occasional person referred from her and it’s because of a decision I made the day of her visit to focus on long-term decision making.
I didn’t do it in hopes that she would send someone else our way. I did it because it’s what I hope someone else would do if my mom went to see them for a similar issue. We make decisions based on how we would treat our family and because of that we have been able to develop an incredible level of trust with our patients.
2. Comparison is the thief of joy.
This is a quote credited to Teddy Roosevelt and it’s spot on. This applies to basically any element of our life.
For me, early on in business, I struggled with comparing our business to others. If you’re competitive at all, you probably struggle with comparing yourself to others as well. Over the past few years, I’ve realized that this is an utter waste of time.
For me to sit here and try to figure out who has more patient visits per month, who has more traffic to their site, or who’s using a new app on their website, is a waste of time.
The same can be said with anyone comparing themselves to others in their personal life. We can sit there and look at a friend, sibling, neighbor, or colleague and compare any number of variables. It’s so easy to do this now with social media and our kids have to deal with this on a level that many of us never had to when we were growing up.
Nothing but wasted time and stress comes from comparing ourselves to others. My advice is to focus on what you can change and that’s yourself. I look back five years ago and barely recognize myself. I didn’t know shit about business, being a parent, or developing meaningful relationships in life. I’m better in all of these areas today, but I’m nowhere near what I need to be.
This is a good thing and it’s one of our human superpowers. We can make a conscious decision to improve, progress, and work on ourselves. The more you focus on working on yourself and the less you compare yourself to others, the better off you will be five years from now.
3. Show up and listen.
According to the Journal of General Internal Medicine, the average doctor listens for 11 seconds before interrupting their patients.
I know many of you have been there. You show up to your visit 15 minutes early to fill out a ridiculous amount of paperwork. Next, you sit there and wait. They finally call you back 30 minutes after your appointment time and bring you to a small treatment office. You proceed to wait there for another 30 minutes while counting the cotton balls in a jar since you have no cell phone service in the building. Finally, your doctor shows up. You are so excited to finally get out what’s worrying you and they stop you dead in your tracks by interrupting you. You barely get any time to explain what’s going on and within 10 minutes the doctor is out the door. You’ve been at the facility for 90 minutes and are lucky if you get 10 minutes of facetime with the doc.
This scenario is all too common and it’s the exact opposite of how we wanted to set up Athletes’ Potential.
There are a lot of things you can’t control in life but being on time is one of them. When you are late you are showing others that you value your time more than their time. This is not ok and it’s one of the reasons we work so hard to keep everything functioning on schedule even when we are very busy.
The other common frustration is a lack of time with the doc. This is the primary reason we have our visits set up for 60 minutes per visit. In particular, this allows our patients to explain to us in great detail what’s going on. Half of the time we barely do anything else but talk the first visit because of how important that information is toward making the right long-term decision.
There’s a reason why people pay behavioral health specialists and psychologists $200 an hour to listen to them and have a conversation. This is incredibly healthy and you have to verbalize your frustrations/fears. When you’ve been dealing with pain for five years, you’re going to be frustrated.
We are here to listen, support, and help you achieve the long-term change you want.
4. Focus on the whole person not just the injury.
Early on when I was a new Physical Therapist, I would ask patients, “So how’s your __________ (insert injured area) feeling today?”
Now my line of questioning is, “So, how are YOU feeling today?”
In the last five years in particular, I’ve learned a lot about dealing with people. There are so many factors in people’s lives that can directly affect how they feel and the decisions they make. This is why we focus on 4 Core Areas of health/wellness no matter what type of injury we are dealing with.
Those 4 areas are:
Look, your back might hurt, but if you’re sleeping four hours a night and living off coffee, you’re going to have a really tough time healing. Too often, other variables in health/wellness are missed because of tunnel vision we get on the injury bringing someone in to see us.
You cannot fix a problem in isolation unless you have ruled out the other contributing factors from the four areas listed above.
I recently saw a prior patient who came back with an unexplained hip injury. He had pain in the front of his hip and it hurt so bad he had to use his arms to help get his leg in and out of his car.
When he came in to see me, we spent 80% of the time talking about mindfulness work for stress management and how to improve sleep.
To give some context, he had just switched jobs and he was getting crushed at work. He also has two young kids at home and one wasn’t sleeping so well recently. This was taking a toll on his sleep as well as increasing stressors in his life. He had also been so busy he barely had worked out over the prior four weeks.
He left that day with some homework exercises we wanted him to do, and, more importantly, a game plan of how to optimize sleep and deal with stressors.
He came back a week later and his pain was completely gone. We barely touched his hip but all of his hip pain had resolved. This isn’t voodoo. It’s how the human body is designed. Pain in many ways is like a check engine light turning on in your car. It’s telling you something is wrong. Other variables can have very strong effects on how you feel and how you heal. They must be addressed and improved.
The goal for most people we work with is to lead a healthy life, stay active and maintain strong relationships with their loved ones. In order to do that you have to do an at least decent job with your sleep, nutrition, stress management, and movement.
5. Surround yourself with amazing people.
Easily my favorite thing about Athletes’ Potential has been the people that I’ve met along the way. I love meeting people and learning not just about what injury they have, but about their lives in general.
As soon as you shut up and start listening to people tell their story, you realize just how interesting seemingly normal people can be. We are so lucky to be able to work with the amazing people we call our athletes.
Here’s a snapshot of some of the awesome people we’ve worked with:
When we say, “If you have a body you’re an athlete,” we mean it. The human body is amazing and we get to see it uses for so many cool things.
Being around amazing people also applies to our entire staff. I’ve never been around a more selfless and dedicated group of people. They show up everyday to help our athletes achieve their goals. Our staff are not a group of employees. We are a family and I hope that is apparent to people who come to see us.
I can’t imagine doing anything else. I’m so proud of our team and what they’ve accomplished in the past five years. I’m not sure what the next five years holds for us, but I can promise you we will continue to serve our community to the best of our abilities.
If you're reading this and you’ve worked with us, I just want to say thank you. If it wasn’t for you, there wouldn’t be an Athletes’ Potential.
If you’re reading this and you’re a Physical Therapist thinking about starting your own practice, I hope this encourages you. This decision could very well change your life in many ways going forward.
If you’ve made it this far, thank you for your time and attention. I know that’s a very rare and valuable thing. At least for the last few minutes, I have beaten HBO, but I think the final season of Game of Thrones will have the last laugh.
Thank you for reading. Thank you for being a part of our world in some way. Most importantly, thank you for taking a chance on a company with an odd name for a physical therapy practice that is trying to do things differently.
Danny Matta, PT, DPT, OCS, CSCS
Running has been around for a long, long time… you could even make the argument that it’s been around since the beginning of time. It’s a fundamental movement that humans perform and officially became a sport all the way back in 776 B.C. when a foot face was the FIRST ever event in the FIRST Olympic games. Then, fast forward to 490 B.C when Pheidippides ran roughly 25 miles to deliver news of a victory against the Persians at the Battle of Marathon, which gave way to the marathon race being added to the first-ever international Olympics in Athens, Greece (which only 9 out 25 athletes finished!).
This entire blog post could be on the history of running. It’s an integral part of being human. So we should be pretty good at it; right? Well… not really. Running related injuries are some of the most common injuries that we see in the clinic. When you look at the literature, anywhere from 36% to 57% of the running population will experience an injury every year and upwards of 75% of all running injuries can be related to overuse.
That’s a lot of people who are getting injured every year. Too many. We see a lot of those people every day at Athletes’ Potential, which has allowed us to pick up on something - something that is criminally absent from running programs: Strength Training.
This. Is. Huge. No matter how you try to look at it, the lack of strength training in the running community is astonishing and unwarranted. Time and time again research is proving the injury reducing and performance boosting benefits of strength training for runners, yet I still hear things like, “I don’t want to get bulky,” or, “it will slow me down,” or, “I’ll get too stiff.” All of these are based on archaic midsets and need to be changed. Nowhere in the literature are these thoughts supported and, in fact, it finds the exact opposite.
However, all that being said, strength training has to be specific to the performance goals of runners. You shouldn’t go out and try to do the exact same training program as a bodybuilder if your goal is to be able to run a marathon. Movements that are going to improve single leg loading and train in multiple planes of motion is the name of the game for runners. Below are some of my favorite exercises to do just that.
Bulgarian Split Squats
Single Leg Romanian Deadlifts
Step Ups with Knee Drive Finish
Band Resisted Side Steps
If you’re dealing with an injury and looking to boost your performance as a runner, reach out with any questions. We design and implement 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.
Thanks for reading,
Dr. Jake, PT, DPT, CSCS
What do you call a pig’s leash? A HAMSTRING
Now that I have your attention, let’s dive into this much-needed blog post.
I’ve been seeing a number of hamstring injuries in the clinic and on the field, so this blog will focus on what you can do to recover from a hamstring injury.
Disclaimer: This should not be used as medical advice. If you are dealing with an injury, please seek out a local Physical Therapist or healthcare provider.
So, let’s get started:
Anatomy of the Hamstrings:
The hamstrings are comprised of 4 different muscles (5 if you include the adductor magnus, but we’ll keep it simple here). These 4 muscles are:
All cross both hip and knee joints except for the short head of biceps femoris and are innervated by the tibial/fibular divisions of the sciatic nerve. These muscles work together to extend the hip and flex the knee.
Mechanism of Injury:
If you watch any video with a hamstring strain, it typically occurs when an athlete is decelerating (slowing down). The muscle is being loaded while it is lengthening (eccentric loading) – which is where we tend to be the weakest.
When someone first strains their hamstring, there’s a few things you can do to help optimize the recovery process.
Follow the guidelines of POLICE:
Once you’ve put some of this in play, you can start to implement some soft tissue and mobility techniques. It’s important to note, loading is going to be the most important component in this process.
Soft Tissue and Joint Mobility
The goal here isn’t to release any adhesions or scar tissue. We’re just trying to decrease some sensitivity and pain to allow other movement opportunities and progressive loading.
Tack and Stretch
This is where we build strength and resiliency in the hamstrings.
Here’s our loading progressions in a nutshell:
Isometric Loading 🡪 Isotonic Loading 🡪 Heavy Slow Resistance Training (high load/low velocity exercise) 🡪 Slow Stretch-Shortening Cycle 🡪 Fast Stretch-Shortening Cycle
Glute Bridge – Isometric Hold Variations
(Dosage: 3-5 sets x 15-45 second holds)
(Dosage: 3-4 sets x 10-20 reps)
Straight Leg Glute Bridge
Band Pull Through
Hamstring Roll Out
Heavy Slow Resistance Training (high load/low velocity exercise)
Nordic Hamstring Curl
Half-Kneeling Hamstring Slide
Slow Stretch-Shortening Cycle 🡪 Fast Stretch-Shortening Cycle
Band Step Down
Supine Band Kickdown
Standing Band Kickback – Slow
Standing Band Kickback – Fast
Single Leg Plyometrics
Hamstring Tantrum – Supine
Hamstring Tantrum – Prone Knee Bend
What’s the biggest risk factor for a hamstring injury you ask? A previous hamstring injury. Make sure to take the appropriate steps to get your hamstrings taken care of. You don’t want to be that person that looks like a sniper took them out.
If you’re dealing with an injury, 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
What’s up, everyone. One of the many treatment options that we offer at Athletes’ Potential is something called Personalized Blood Flow Restriction Training (PBFRT). This is something I remember being blown away about while in physical therapy school and seeing the results that research was showing. To put it simply, it’s one of the best evidence supported treatment options out there and we are thrilled to be able to offer it to the Decatur and greater Atlanta area.
There are a ton of awesome benefits with PBFRT, but first let’s take a look at what exactly BFR is. PBFRT is the brief and intermittent use of a tourniquet in order to restrict the amount of blood flow from coming into your limb (arterial flow) while performing low-load resistance training. The way PBFRT works is it reduces the amount of oxygenated blood reaching a working muscle in order to trick your body into thinking it’s working at a higher intensity than it actually is. By using this form of engineered suffering, you’re able to use extremely light resistance and still get the same increases in size and strength as lifting at higher intensities with heavy weight! Exactly how this happens is laid out below:
Essentially, PBFRT is a true biohack that allows people to work at loads that are non-stressful on the tissue but still get improved size and strength. A true game-changer in the world of strength and conditioning.
But just like everything else in the world of sports medicine, PBFRT has to be used appropriately and with the right population. Otherwise, you could risk wasting your time and resources. So, who exactly would benefit? Below are three of the most common scenarios that people see the best results.
Muscle breakdown (atrophy) after a surgery or injury happens incredibly fast. For example, when you’re injured or you’re not allowed to put any weight through one of your limbs, in as little as two weeks that limb goes into a state of anabolic resistance and protein synthesis shuts down leading to a 30% loss of muscle mass in that limb!
This is obviously extremely problematic and slows down recovery from an injury dramatically. However, with PBFRT we now have the ability to combat that significant muscle loss because we are able to use low intensity and weight levels that are safe and tolerable to the patient and get the same increases in muscle size and strength as lifting at 65% of your one rep max or higher.
A great example of just how beneficial PBFRT can be for patients rehabbing from injury comes from Dr. Zach Long who was working with an elite level olympic lifter after tearing his ACL. With this type of injury, more than 65% of patients demonstrate quadricep weakness even a year out from surgery. However, Dr. Long’s patient’s surgical leg became one inch larger than his healthy leg in just three months time after his surgery!
PBFRT has shown numerous benefits to enhancing sports performance, but perhaps the most documented is the ability for athletes to maintain muscle size and strength without the dip in performance caused by muscle soreness. This is possible because there is no muscle tissue breakdown associated with PBFRT since the intensity is kept so low.
PBFRT has also been shown to have a profound effect on your aerobic capacity as well by increasing your VO2 max and capillary beds.
Imagine this. You’re training for an upcoming triathlon and are starting to feel a little banged up from the volume pulling, or you’re gassed trying to prepare for a CrossFit competition, or maybe you’re midseason in soccer and have been trying to push through some nagging issues.
Now, imagine during your recovery day you rode for just 15 minutes, at a pace well below a typical recovery ride pace, and we’re able to give your tendons that increased HGH we mentioned above, all while boosting your VO2 max AND letting your tissue continue to recover.
Sounds pretty cool; right? We have people do that all the time here in the clinic and we are consistently seeing people hit PR’s and feel good doing it.
Rehab, Performance, Recovery. That covers a vast majority of the population, and that’s on purpose. The research (over 600 published studies) is incredible and the results we are getting wiht people speak for themselves. However, as the old adage goes, “If all you have is a hammer, everything looks like a nail.” Personalized blood flow restriction training isn’t for everyone, and that’s okay. At Athletes’ Potential we firmly believe we have the most skilled doctors of physical therapy who can use a vast array of treatment options to help you reach your injury or performance goals. Whether you are training through a nagging injury or looking to improve your performance, we would love to help you achieve your goals. Give us a call at 470-355-2106 or fill out the contact request form below and we will be happy to contact you.
Thanks for reading,
Dr. Jake, DPT, CSCS
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
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:
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.
Dr. Danny and staff's views on performance improvement, injury prevention and sometimes other random thoughts.