Dutch Lowy

Note:
It is important to understand that all bodies are different and all injuries are different. My reason for these posts is to possibly open you eyes to alternative ideas for therapy. It is NOT to diagnose YOUR injuries. If you have similar pains, you should talk to a professional to verify that there is not further damage and you will not be causing permanent injury by treating it in some way.
Crossfit has a huge potential for injury, as it does for amazing results. Be smart with your training and you will last longer as an athlete and a human.

The problem:

As i get older i am challenged by not only motivation for training but also the challenges associated with aged cells and the fact that they are less willing to do what i want them to do.  Specifically here i am talking about my shoulder.  A very complex joint with many articulations and muscles controlling it.  As is my nature, i like to simplify things as much as possible.  My specific issue was a sharp pain in the anterior(front) portion of my shoulder just above the arm pit.  It hurt when i snatched and jerked.  It was a sharp pain and really hindering my training.

The fix

I was a little jammed up by this one for a while like the knees.  It started to make sense after a visit to a local massage therapist who decided that i had tight lats and that was contributing to the malfunction in my shoulder.  This makes sense with the huge volume of pullups in crossfit.  Your lats are your pullups muscles.  In an effort to simplify this we will consider 3 main muscles of the sholder.  First is the Deltoid, the guy that covers the shoulder joint.  The one that is superficial  (outside) to all the other shoulder muscles and joints.  The latissimus dorsi (lats) are under your arm pit and spread across your back like wings.  They attach to your arm bone just outside the shoulder joint and pull the arm down (think pullup or row).  The pectoralis is the third one i will talk about.  It also attaches to the arm just outside the shoulder joint.  It pulls the arm and shoulder forward (think push up or bench press).  Now remember this is highly simplified.

After my visit to the massage therapist i started with stretching of the chest and lats.  The chest stretch was the traditional “door stretch”  think about placing the forearm against the door frame and turning away from the frame.  This is coupled with rolling with a lacrosse ball or trigger point ball.  I do it against the wall rolling from my sternum to my shoulder joint (you shouldn’t really roll across joints).  I would stretch my lats by putting one hand on the pullup bar with feet still on the ground, or a box and relaxing into a stretch.  Don’t force any of this.  You can also play with contract and relax stretching to get a bit deeper.  For those of you with shoulder flexibility issues this should help with the overhead position.  My friend Darin has some good thoughts on this but i will let him explain them later.  I also rolled the lats pretty hard core by using the wall and ball again.  This time standing with my shoulder to the wall and arm by my ear like an overhead squat and the ball pressed against the lats under the armpit.  Very painful but very effective.

I coupled this with some shoulder prehab work both before and after workouts.  I did the traditional shoulder raises, flys and kick backs but with super light weight (nothing over 2 kg).  This helped get my shoulders warm and ready to move each day.  I also cut my volume of pullups since i think this was part of the malfunction.  Too much of anything can be a bad thing so be careful with massive amounts of pullups if you have super tight shoulders.

Note:
It is important to understand that all bodies are different and all injuries are different. My reason for these posts is to possibly open you eyes to alternative ideas for therapy. It is NOT to diagnose YOUR injuries. If you have similar pains, you should talk to a professional to verify that there is not further damage and you will not be causing permanent injury by treating it in some way.
Crossfit has a huge potential for injury, as it does for amazing results. Be smart with your training and you will last longer as an athlete and a human.

The problem

Over a year ago i attempted and completed 15 deadlifts at 2x bodyweight.  This is where my hate for deadlifts exploded.  About 12 deadlifts in, i felt a sharp cooling feeling splash across my back.  At the moment is wasn’t super painful (that would come later) it felt really strange.  Obviously i had to finish….  You can see the video here and i think you will be able to tell when the injury happened.  Look closely.

As you can see i was immediately on the floor.  The rest of the day was miserable with sharp pain in my low back and even shooting numbness down my leg.  We went to the circus that night with the cert crew and i was absolutely miserable!!  For the next 3 months i was wrecked.  I had trouble sitting for long periods of time without shooting pain in my back.  i also couldn’t hinge at the hips without my toes on my right foot going numb.  Deadlifts were out of the question for a good 3-5 months but surprisingly i was able to clean and snatch pretty heavy about a month out from the injury.  Well, i had to, i was spending aot oftime in socal.  You all know you can’t hang out down there without heading to Coach B’s right??

The Fix

I was actually in San Fransisco the week after the injury which was lucky because Kelly Starett lives out there and was happy to give me some tips.  He had me squatting and pressing with light weights but full depth and perfect form.  He along with Adrian Bozman had me doing reverse hypers along with the squats and presses.  I was also stretching and rolling pretty hard core on my quads.  This helped loosen the pressure on my back from the constant old man forward tilt i had.

Once i got home it was time to start training pretty hard for the Games 2009.  I was still having issues with numbness in my leg and toes so i figured it had to do with some flexibility issues.  I found a pilates instructor, because it is good shit, and i worked with her for 6 weeks on basic flexibility and a bit of core strength.  It really helped with recovery as well as got me back to a comfortable place with my back.  I would attribute much of the success i had with recovery to the fact that i didn’t go out and try to rush the recovery.  I took my time and listened to my body.  I swallowed my pride many time because i was on the road most of the time after the injury and just watched alot of workouts.

I am currently free from all pain and numbness although my back still tightens up a bit.  I am pretty sure my super tight quads were part of the reason for the injury in the first place, along with the knee issues i had around the same time.  Crazy how its all connected huh??

Note:
It is important to understand that all bodies are different and all injuries are different. My reason for these posts is to possibly open you eyes to alternative ideas for therapy. It is NOT to diagnose YOUR injuries. If you have similar pains, you should talk to a professional to verify that there is not further damage and you will not be causing permanent injury by treating it in some way.
Crossfit has a huge potential for injury, as it does for amazing results. Be smart with your training and you will last longer as an athlete and a human.

The Problem:
So i finally converted my girlfriend to weightlifting and was immediately presented with an injury. I got so excited that i had her sqaut just about everyday. If she wasn’t cleaning or snatching she was front squatting or back squatting. She has these legs that go on forever so it is hard for her to build strength in her legs, so i figured we would just squat, and squat then squat some more.
Well, it worked, she got stronger but she also got injured.

Here is the issue.
She was having pain when she squatted (surprise!) in her hip. It was right at the crease where the hip bends to the outside of the hip. basically a hip abductor or one of the gluteus muscles.

Pain generating from the anterior capsule and joint space due to impingement from lack of lateral stability from the gluteus medius, glutes and hip ext rotators. This was complicated by over recruitment of the adductors and tightness.

Fix:
A good friend of Mine, Darin Deaton of CF Fort Worth, is a physical therapist and someone we go to all of our little aches and pains. This was very helpful to me because Darin is like the 50 mile expert. he has a title and therefore more clout when it comes to healing injuries. This is especially important when it comes down to training my girlfriend (you all know the rules right??).
Darin first had Meggie quit squatting so much, down to maybe once a week depending on her pain. He also showed her a couple stretches to help loosen the associated muscles.
The first one is lying on her back take the injured leg and pull the knee to her opposite shoulder. Next she would cross her ankle of her injured leg over the other knee and pull the other leg to her. See video. The last one you will start on your hands and knees. Take the non injured leg and stretch it straight behind you, reach across the other leg and reach away from your body so you will be sitting on your injured leg. You should feel the stretch in the outside of your leg. I think its called pigeon pose in yoga.
The next step is to strengthen the specific muscles required to keep your alignment during the squat. For this specific problem the abductor (outside of leg) is weaker than the adductor (inside of leg) which allows the knee to come in when squatting. This is a very common problem. We solve this by loosening the adductor by stretching and foam rolling and strengthen the abductor with accessory exercises. For this we took some theraband and tied the ends together. We then put it around the ankles and did side steps into the squat position or a bit wider followed by an air squat with perfect form and most importantly making sure the knees tracked the toes.

Our goal was to maintain alignment of the hip knee angle in the same plane during the weakest range of the squat, the bottom. If at any time, the knee deviated medially, the squat was stopped, corrected and trialed again. If proper alignment not maintained, then go lighter or improve.

Darin also had her roll on a trigger point ball before and after training.  This helped loosen the abductor

external rotator and avoid potential impingement of the anterior joint due to malalignment

and made training and rehab easier.

The last part of this, like any injury is time.  We squatted light but with perfect form that didn’t hurt her.  Anytime there was  a little bit of pain, we stopped and moved on.  This meant lots of power movements and overhead work.

First of all, if you don’t have goals, Get SOME!!

Second of all check this out.  I got an email this morning when i woke up from one of my clients about a huge goal she hit last night.  2 Handstand Pushups!!  If you watch the video, you will notice that she probably has a couple more in her…

Handstand Push-ups from Becky Garza on Vimeo.

I am so proud of Becky for working hard and doing what she said she was gonna do.  Also, check her blog, she has some interesting thoughts and recipes you may be interested in.

When was the last time you hit your goals?  What are your goals?  Does your coach know what your goals are?  Do you have a Coach?  Post to Comments.
For help, look here.

The announcement of the first Black Box Summit of 2010 is coming soon so stay tuned…

Thoughts?

Note:
It is important to understand that all bodies are different and all injuries are different. My reason for these posts is to possibly open you eyes to alternative ideas for therapy. It is NOT to diagnose YOUR injuries. If you have similar pains, you should talk to a professional to verify that there is not further damage and you will not be causing permanent injury by treating it in some way.
Crossfit has a huge potential for injury, as it does for amazing results. Be smart with your training and you will last longer as an athlete and a human.

Ok, so almost 5 years deep into crossfit i have had my fair share of injuries caused by training. Some have been obviously my fault, and by that i mean being careless in training, forgoing a warm up, not taking care of myself post workout, or being just flat out lazy. Others have been flukish. Think about falling off the pullup bar or missing a box jump, or even receiving a jerk a little off and tweaking your neck. These are expected in training and have to be handled when they come up. I have recently been exposed to a couple injuries that seem to be recurring in our population so i will do my best to tell you how i have fixed them or seen them handled.
This may be a two part post to spare you from reading an extended essay. Oh, and don’t worry i’ll stay as low tech as possible. I’m not a fan of all the sciency talk.

Injury #1: Tendonitis below the knee cap.
This one got me for the longest time till i, by a fluke, cured it in a week. I’ll get into that in a bit. I can’t really pinpoint the exact time the injury popped up, which is common with tendonitis (basically a localized inflammation (swelling) that causes pain usually during movement). It tends to just get worse and worse till one day you really notice it and then its all over.
First, some treatments i tried and recommendations i got. I had been told by physical therapists, ART practitioners and top level coaches that i just needed to stretch and roll out my quads and hip flexors. Like i said i talked to anyone that would listed, phone, email, in person… When i am in pain everyone needs to know and be working to fix it for me. Thats just the way i am.
A couple months go by and i’m stretching and rolling about a week on and a week off just out of laziness. I would feel immediate relief but the pain would creep back as soon as i quite treating it. At the time i was traveling quite a bit so i had some free time at random gyms so i could stretch and roll regularly. The one place its ok to look like you are taking a shit around other people is while you are rolling on a lacrosse ball at a crossfit gym. I will save the stretches i did for another post or possibly a video.
Basically everyone was in consensus that it was my damn tight quads and hip flexors. I had a couple ART sessions and let me tell you… That was not fun! It gave a bit of relief but like everything else, it would come back within 24 hours.
At the time i was healed i was spending some time at John welborns house on Balboa Island and training with Max Mormont.
The first day i felt total relief was the day after spending a couple days with Brian McKenzie learning how to run. Any of you that have been to his cert realize how “woken up” your hamstrings become after just a couple hours or minutes in my case. We spent an hour working drills and such and then he decided i should do a tabata run on the treadmill with everyone watching… Not fun.
I wake up the next day and my hammies (hamstrings, the things just below your ass) are feeling it. That day Max had me do Stiff Legged Deadlifts with 225 for something like 21-15-9 but it could have been a bit different. He had me do those because that whole week i was bitching and moaning about my knees. Stairs hurt and i’m not kidding. I wake up the next day and besides the sharp soreness coming from my hammies, my knees are 100% cured.
Moral of the story:
Make sure you are sharing the load with your posterior chain. I’m not sure where i went wrong but i shifted to being anteriorly (front) dominate which is not a bad thing so long as your posterior (back) doesn’t go to sleep.
Fix:
Continue to roll, stretch and work mobility before and after workouts. Add in some posterior chain strength post workout. Keep it simple. Good mornings, SLDL’s, Glute Ham Raises. Keep reps a bit higher and weights lower till you feel confident with the movements then slowly increase weight or range of motion. I have to add that my knees felt fine if i took advil but i did not want to be dependent on drugs so i rarely took them. With the exception of being in excruciating pain.
Additional issues:
I have seen additional tendonitis in the knees above the knee cap and am still working on solutions for that. If anyone has experience here please post how you fixed it or how you are fixing it.

Wow! I got a bit carried away. I will continue this series with more common injuries and fixes. The hips are next.

From the Doctor:

Good stuff Dutch! Tendonitis below the knee cap is commonly known as patellar tendonitis and usually caused from repetitive trauma, acute injury or biomechanical deficiency otherwise known as movement in-balance. The primary thing to look at first is how old is the condition. This significantly affects how it might respond to care or treatment. Chronic conditions give us cause to look at lack of cellular primary healing and why the condition has not resolved through primary healing. Acute conditions can be gotten on top of immediately and hopefully we can promote healing through the primary system. Chronically inflamed tissue has different morphology than acutely inflamed tissue and has to be view differently. So, treatment of this condition has to consider where we are in the healing or lack of healing process. From clinical experience and what I have seen in CF, I would agree with Dutch that posterior chain insufficiency, poor sequence firing of the anterior chain (quad, rectus femoris, VMO) and flexibility deficiency of the post/ant chain need to be addressed. But, some athletes can get this condition from just “too much of a good thing, ie/ over training and repetitive trauma and lack of rest.” Which, as we all know is not uncommon for athletes in all arenas. The key with this treating this condition is early detection, movement analysis, and then correction of any problems. This condition when not acutely inflamed, responds well to stretching, foam rolling, muscle re-education, posterior chain development and lighter load anterior chain, pain free tendon rehabilitation. I also like to use cold laser immediately @ 830nm direct to site coupled with ice, DTFM. Not all conditions are the same, and thus need to be treated differently. But, I stress that early detection, determination of history and length of time with condition is crucial to outcomes.