5 Common CrossFit Injuries

“WOD, Box, Kipping, muscle-up”.

When you first enter the crossFit world it seems like they’re speaking a different language. Then, you bravely take a step into a “box”, learn some new terms, and you realize, it is a different world. Take your next step into this world and now you’re doing “wall-ball’s, box-jumps, and dominating your WOD (workout of the day). But, like any high level physical activity, there are some common injuries to look out for, prevent, and treat if you are, or are going to be a crossFit athlete.

Let’s get one thing straight before we start talking common crossFit injuries. CrossFit is awesome. The sense of camaraderie and competition has helped tens of thousands of people move and exercise. CrossFit and the common injuries associated with it are far superior to the common injuries and diseases associated with a sedentary lifestyle. Look at other forms of recreational and competitive exercises including running, cycling, playing football and basketball; all are great forms of exercise, but they all have common injuries as well. Move better, listen to your body, and exercise smartly. Get in touch with a good physical therapist to help you initiate and maintain a healthy lifestyle.

With that disclaimer out of the way and without further adieu, here are the 5 most common injuries associated with crossFit, as well as tips you can do to treat and prevent them.

1) Low Back Pain

If you are going to participate in crossFit, get ready to squat. The squat is simply the best exercise to work the whole posterior chain (glutes, hamstrings), a vital area of the body that is typically ignored. For this reason, the inclusion of the squat in any exercise program is a great idea, as long as you have the flexibility and strength to pull it off. When one lacks hip flexion, or has poor abdominal and glut activation, or weakness of the glutes, the compensation is excessive trunk flexion and overuse of the lumbar spine paraspinals. This muscle group is simply not made to support the trunk during a squat, let alone several repetitions of the squat, and especially not with weight over the shoulders.

Treatment / Prevention

– Have your physical therapist check your hip flexion ROM as well as the strength and activation of your glutes during a squat.

– Ensure proper squat form without weight before adding weight. You may require corrective exercise for flexibility and muscle coordination before performing a multitude of squats with weight or for time.

2) Anterior Shoulder Pain

Shoulder pain amongst this group is due primarily to one of two factors (or a combination of the two). One factor is that many crossFit exercises including the overhead squat, the snatch, and the thruster all require the shoulder to move to its end range of motion into flexion and external rotation. If you don’t have this range of motion, then aggressively throwing your shoulder towards the end range of motion can result in shoulder impingement. The second factor is that many crossFit exercises place the weight anterior to the body which may result in excessive recruitment of the biceps and pecs. This imbalance between anterior musculature and slap stabilizers can, once again result in impingement at the shoulder.

Treatment / Prevention

– Have your passive ROM assessed by your therapist. If you don’t have 180 degrees of passive flexion while lying on the table, don’t expect to lift to 180 degrees during a snatch.

– Assess the activation and strength of your middle trapezius, lower trapezius, and serrates anterior. These guys should be working to counteract the pull of the biceps and pecs.

3) Wrist Pain

Once again, crossFit is bound to incorporate squats, and lots of them. One version of the squat is the front squat where you place the barbell in front of you in the rack position. This position places your wrist into maximal wrist extension while holding a load. This is very similar to any plank work you may do, again a favorite amongst crossFit trainers.

Treatment / Prevention

This one is pretty simple. You need full wrist extension range of motion to get into this position. Without it, you will have discomfort every time you place your wrist in maximal extension.

4) Knee Pain

Squats, squats, and more squats. And some times lunges. Once again, squats are great for the posterior chain and they are a very functional exercise. That myth that squats are bad for your knees is completely false. Let’s change the phrase to “bad squats are bad for your knees”. Squatting with excessive knee flexion compared to hip flexion, and/or excessive femoral adduction, and/or poor gluteal activation can result in a high amount of stress on the knee joint. Read this previous blog for more specifics on Physical Therapy and knee pain here.

Treatment / Prevention

– Have your physical therapist assess your squat

– Have your glute strength assessed and perform corrective exercises to activate your glutes in order to avoid the excessive knee flexion and/or femoral adduction compensations.

5) Elbow Pain

One of the most common causes for elbow pain is excessive gripping, something crossFit athletes do a lot of when they begin adding weight to their exercise program. All of the muscles responsible for gripping originate at the elbow. Repetitive gripping therefore results in overuse injuries at the elbow.

Treatment / Prevention

A new focus for treatment of lateral epicondylitis, or elbow pain with gripping, is strengthening of the scapula stabilizers. Improving the stability at the proximal shoulder has resulted in a decreased amount of stress at the elbow and may therefore eliminate elbow discomfort with gripping tasks. For more on scapula stability for the lateral elbow, check out this article.

How can Physical Therapy help with my Low Back Pain?

This post continues the discussion on how we as physical therapists can best treat our patients’ ailments. Check out the previous post regarding treatment and communication of a patient with knee pain here.

“Well, the reason for your low back pain is that you have degenerative disc disease.”

or,

“You have a slipped disc at L4/L5 which is compressing a nerve.”

or,

“the arthritis in your back is equivalent to a 90 year old.”

Pretty scary huh? How can physical therapy help with diagnoses like these? Can physical therapy remove the arthritis found on imaging?

No it cannot. But perhaps there are more important questions to ask. I would assume that the more meaningful question(s) may be; Can physical therapy eliminate the low back pain I experience when I am walking my kids to school. Can physical therapy allow me to lift items from the floor, and therefore allow me to perform my household duties? Can physical therapy eliminate the discomfort I experience while sitting for prolonged periods at work, and therefore allow me to be more productive? Can physical therapy eliminate the discomfort I have while I play recreational sports so that I can get back to playing basketball?

The answer to these questions is yes. But, look at the disconnect that many patients experience. Originally, they seek out a healthcare professional with a complaint during some type of meaningful activity. Rather than receiving an answer or a long term intervention, the original complaint gets warped into a diagnosis of “degenerative disc disease”, “arthritis”, or “stenosis”. Could it be that what’s causing the discomfort is not the diagnosis, but rather faulty movement?

Why do we rely on imaging to dictate the cause of our discomforts? Look at this research article performed on individuals without low back pain. This study utilized MRI images on individuals without low back pain. Only 36 percent of individuals without low back pain had “normal” findings. 52 percent had a disc bulge, and 27 percent had a disc protrusion. This, once again, begs the question, could it be that what’s causing the discomfort is not the diagnosis, but rather faulty movement?

This is actually great news for individuals suffering from low back pain. Nobody can treat  a diagnosis of stenosis or arthritis. But a movement expert can assess and implement a program to help individuals who have pain with specific activities. Treatment begins with identifying faulty movement, understanding the reasons for the poor movement, and specific corrective exercises to eliminate the poor mechanics.

For example, take a look at this diagram;

No diagnosis is causing this discomfort. Poor movement places a high amount of stress on the joint, the disc, the muscles, everything. Change the movement, change the pain. 

That being said, sometimes the desired activity requires more strength and flexibility than an individual has.

This individual likely does not have the core strength to lift appropriately given this quick movement screen. In order to lift appropriately, she may require a strengthening regimen. Every body is different and requires an individualized assessment and program prescription.  In order to get here, push your diagnosis to the side and begin identification of movements which may cause the discomfort.

Optimal Movement Physical Therapy is dedicated to helping individuals identify and treat their movement faults. Visit our website or e-mail us at alan@optimalmovementpt.com so that we may help answer any questions.

World Physical Therapy Day!!!

World Physical Therapy Day is September 8, 2014!!!

World Physical Therapy Day is a day to recognize the profession and all the benefits a Physical Therapist provides to the community. Are you currently participating in therapy? Have you had therapy in the past? How has therapy helped you? How could therapy help you?

For most individuals who have participated in therapy they are aware of the importance of the Physical Therapist as well as the role a therapist can provide in improving movement and function. For those of you who are not aware, the benefit therapy can provide is different for every individual. Every person you encounter has their own concerns and fears. My profession gives me the time to really understand and empathize with concerns and fears, which opens a window into making a real change on the individual level.

Whether it’s running that extra mile, picking up a grandson, getting up the stairs at night, or simply making it through the work day, Physical Therapists help individuals meet their specific goals. A Physical Therapist is a specialist on movement and can help optimize performance, return from an injury, and prevent future injuries from occurring. Imagine the health benefits of having a Physical Therapist who knows you. Think about it, most individuals have their own personal Physician and Dentist. Why not having your own Physical Therapist who can screen and educate on proper movements to maintain optimal health.

Optimal Movement Physical Therapy provides these benefits to many resident in the Redlands area. If you need someone on your team, we would be happy to listen to your concerns. Check out our website here. If you would like to learn more about World PT day, check out the World Confederation for Physical Therapy website.

In celebration of World PT Day we’re holding a contest! If your life has been significantly impacted by a Physical Therapist, let us know in the comments for a chance to win a $25 gift certificate to one of our favorite stores that encourages movement – REI! Follow us on Facebook, Instagram and Twitter for additional entries! Please leave individual comments letting us know where you’re following us! Giveaway ends Monday, September 15th at noon PST. Winner will be chosen by random draw and will be posted Monday evening!

Disclaimer: we are not affiliated with REI in any way. We just really like them and what they stand for!

http://www.OptimalMovementPT.com

A winner has been chosen for World PT Day contest. Thomas has been selected via the website random.org. Please email me at alan@optimalmovementpt.com.

Screening and Preventing ACL Injuries

This may be my favorite time of the year. Fall in Redlands is beautiful, and we finally move away from the heat of Summer into to crisp air of Fall. Cyclists and runners no longer have to get their workouts in early to beat the heat, and we get to look forward to playoff baseball. The aspect of Fall which I enjoy the most is the return of Football and Soccer. These sports showcase some incredible athletes performing at a high intensity level during nearly every play. The unfortunate side effect of this level of play is a multitude of anterior cruciate ligament (ACL) tears. So far in the NFL preseason alone (3 weeks of games) there have been 16 ACL tears: the most notable being Sam Bradford’s second tear. The average lost wage per NFL player who has suffered an ACL injury is 1.6 million dollars!

So what if some professional football players have had an injury? After all it should be expected for athletes in a heavy contact sport, especially in a league with the biggest and fastest athletes in the world, right? Well, are you aware that there are approximately 300,000 ACL injuries per year? Further, according to the Sports Surgery Clinic (SSC) in Dublin, 70% of ACL injuries occur during non contact injuries. Per the last stat from the SSC, female athletes are up to 8 times more likely to have an ACL injury than their male counterparts. This coupled with an average soccer player making approximately 726 cutting maneuvers in a game results in women’s soccer being the sport in which an ACL injury is most likely to occur.

70% of injuries occur without contact. This means that a tear occurs because of a biomechanical stress an athlete places on their ACL during cutting and/or running. Wouldn’t it be nice if we could screen for and prevent such a horrible injury from occurring?

The truth is, we can.

1) We know the population that typically has a non contact ACL injury. It will happen to young female athletes between the ages of 15 and 20. Every year, one in ten female collegiate athletes will have an ACL injury. Further, soccer and football athletes are most likely to have the injury given the demands they place on their knee.

2) We know the mechanism of injury. The injury occurs during periods of cutting or changing directions. Typically the knee is slightly bent, and there is a large valgus force placed on the knee.

Since we know these two facts, we can effectively screen for these injuries. We simply have to analyze the movements of the at risk population. With video analysis, we can determine if an athlete places a high amount of valgus stress at the knee during cutting and jumping drills. With a simple quick screen, athletes who are at a risk for an ACL injury can be identified.

So then what? A study performed by Mandelbaum et al in 2005 showed that athletes invoked in a Prevent injury and Enhance Performance program (PEP) were approximately 80% less likely to have an ACL injury. This program is made up of exercises focusing on flexibility and proximal hip stability.

So, a short screen of athletes, followed by prescription of individualized strengthening exercises can prevent 80% of the 300,000 ACL injuries that occur each year.

One more blurb on ACL injuries. A shift in the rehabilitation after an injury has been occurring of late. No longer are physical therapists following a set protocol. Instead, rehab is being progressed based on biomechanical testing. Biomechanical testing is now being done to clear athletes to return to sport in order to prevent the 12% chance of a re-injury. Given that we are screening athletes who have had an ACL injury before they return to sport, doesn’t it make sense that we begin using biomechanical testing to avoid injuries in the first place?

At Optimal Movement Physical Therapy, we focus on screening and preventing injuries. The video analysis and screening for ACL injuries, as well as ACL rehabilitation and return to sport are all services provided. Call us today to schedule your free consultation at 909-335-7402!

http://www.optimalmovementpt.com

Low Back Pain Paradigm Shift

Ten years ago, if you had low back pain and saw a Physical Therapist, you would most likely be prescribed “core strengthening” exercises. In fact, even today, you will most likely be given some exercises for the muscle group which provides stability at the low back. It’s not a bad idea, it works and there is a lot of research to support this paradigm. It’s become so commonplace that the argument is no longer whether you should train the abdominals, but more on how you should strengthen this muscle group. Brace or hollow? Sit-up or plank? There is multitude of articles and blogs on which exercises are best for persons with low back pain, and professionals often prescribe them without a second thought.

But, what happens when getting stronger doesn’t work? What are we missing?

The truth is, nobody has a “strong” core. It’s something we all have to work on. That’s why we can get away with prescribing it to everyone, because it always tests weak. Sure, some people have a stronger core than others, but in relation to the stiffness of the hip or shoulder, the trunk is often less stiff. Further, some people with a strong core still have back pain. So, again, what do we do when simply getting stronger doesn’t work?

That’s when it’s time to look at the movement. Look at the person’s function. Which movements are they required to do? What are their preferred movement patterns? Are they using the strength they already have?

Case in point: This client complained of low back pain and sciatica for the past 6 months. We began looking at abdominal strength as part of our objective exam only to find that she had great strength. When pointing this out to her, she noted that she is quite active. She hikes, does yoga, runs, stand up paddle boards, does pull-ups and planks. How could she have back pain?

Standing posture with measurements showing mild swayback posture.

The examination did not show many treatable impairments. When a client has a fairly clean strength and mobility examination, we get to move on to function. This client is very active, but the activity she does the most is holding her one year old son who weighs nearly twenty pounds. So, it’s time to check out her function.

Increased swayback posture when standing with twenty pound load (aka her son).

As you can see, the standing posture changes dramatically. The shoulders are no longer lined up with the hip, but they have shifted posteriorly. This client has shifted into extension when she holds her child. This excessive extension is just enough stress through her low back to cause some discomfort.

So, if she has enough strength, then, what is the treatment?

There is no exercise that will magically cure this shift. The only exercise or treatment for her is awareness. After a few small corrections, we are able to prescribe her only “exercise”.

Improved standing posture with 20 pound weight.

No rehab exercises needed. In fact, she is already doing more than I ask most patients to do anyways. She just needs to use what she already has and contract her abdominals while holding her son. She has all the moving parts to perform this movement optimally, and her rehab sessions have been cut from several to one.

This client is a great example of a client with low back pain who will not respond to abdominal exercises. The paradigm has shifted. It’s time to look at function. It’s time to look at movement. At Optimal Movement Physical Therapy, we assess, diagnose, and treat movement.

www.optimalmovementpt.com

Rebecca is the owner of be. Her mission is to inspire and educate people to live healthier and happier lives by spreading knowledge about the importance of nourishing their bodies with the best food. Check out her site at http://www.benourishedbehealthy.com.

Higher Quality Physical Therapy and How We Are Able To Provide It

“Why don’t you take insurance for the services you provide?”

I get this question a lot.

It is a fair question. Most people expect that they can use their insurance for Physical Therapy (and you probably still can – we touch on that a bit later). But, let me provide some insight into the difference between a therapist that relies on insurance and one that doesn’t.

It used to be that healthcare was an individual physician who provided a service to a community. Individuals requiring healthcare paid a fee to the physician, received the necessary care, and the provider turned a small profit allowing them to practice.

Then, came the 3rd party payer (insurance). Somehow, someway, a 3rd group realized that they could make a profit from the service being provided. The simple pay for service became much more complex. Rather than paying for what you needed, when you needed, a 3rd group began saying when, how and where one could receive healthcare. Why is this important? The goals of this 3rd group is not to ensure the best patient results, or to maximize patient outcomes. Their goal is simply to make money.

So what happens when your insurance gets involved? Quality of care goes down. This occurs via a variety of strategies, rules, and regulations set in place by the insurance company, but typically in the Physical Therapy world, it goes something like this:

The Physical Therapist and the insurance company enter a contract. The Physical Therapist treats a patient with a specific insurance. The Physical Therapist then submits a claim for reimbursement for services the patient received. The insurance company requires the therapist to submit documentation that follows several rules and regulations. Lengthy documentation that takes extensive time to prepare and submit. Oftentimes, even with appropriate documentation, the insurance companies will deny payment. The therapist realizes that in order to keep up with the denials, proper documentation, and time required to dot the “I’s” and cross the “T’s” that he or she will need to hire “help” to ensure proper payment. This of course is all coupled with the insurance companies’ limitation on reimbursement (i.e. – paying only a fraction of actual billed services).

A result of hiring extra staff means the Physical Therapist needs to treat more patients per day. Treating more patients per day results in less one on one time per patient. Further, a Physical Therapist actually gets paid more for amount of visits a patient makes, not for the quality of service provided. When factoring in all of this, it only makes sense that a PT practice that accepts insurance will likely recommend a high amount of visits, while providing little to no results, and spend a fraction of the time with each patient during those many visits.

When eliminating insurance companies, the Physical Therapist and the patient are allowed to collaborate and establish appropriate goals in order to relieve pain and optimize movement. The patient only pays for the value provided by the therapist and will no longer attend “extra” visits that provide little to no value. The Physical Therapist and patient are held accountable for outcomes. This results in higher care delivered, less overall visits to receive the higher care, and a longer duration of one on one time with your therapist.

So, wait, what about my insurance? Most of my clients utilize their insurance for reimbursement. The difference is that rather than my clinic utilizing a staff to provide the billing, we provide documents and instruction to the patient to submit to his or her insurance company for reimbursement. This maintains the high quality of care while still providing a low-cost option for healthcare. Further, HSA and FSA accounts are often provided by employers allowing employees to spend healthcare dollars on the services they deem necessary. This essentially acts as cash and is, of course, a hassle free option at Optimal Movement Physical Therapy.

Optimal Movement Physical Therapy has been established to offer a difference; offering what Physical Therapy can and should be to the Redlands community. We maintain high quality care by ensuring at least one hour of one on one time with your therapist in order to identify appropriate goals and plan of care. Hold your Physical Therapist and yourself accountable and achieve Optimal Movement and pain-free functioning.

This is only the beginning.