Great CrossFit Injury Prevention and Performance Exercise

The workout movement CrossFit has exploded in recent years and with good reason…this program rocks at getting athletes into great shape. Unfortunately the intense workouts and complexity of some of the exercises performed may increase the risk of overuse injuries in CrossFit athletes.

I was recently introduced to the Face Pull Y-Press, which I quickly fell in love with (click the link or see video below for demonstration). During one of my recent CrossFit workouts, I realized this may be the best accessory and injury prevention exercise out there for CrossFitters. Let me explain why I think this exercise is so good:

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CrossFit Performance and Injury Prevention Exercise

The workout movement CrossFit has exploded in recent years and with good reason…this program rocks at getting people into great shape. Unfortunately the intense workouts and complexity of some of the exercises performed may increase the risk of overuse injuries in CrossFit athletes. Perhaps more importantly to most people, imbalances within the shoulder complex can severely limit movement efficiency and performance during athletic movements.

I was recently introduced to the Face Pull Y-Press, which I quickly fell in love with (click the link or see video below for demonstration). During one of my recent CrossFit workouts, I realized this may be the best accessory and injury prevention exercise out there for CrossFitters.

The Face Pull Y Press
The Face Pull Y Press

As I’ve already mentioned, injuries can be common in CrossFit, especially to the shoulder complex as it is highly taxed in most CrossFit workouts. What are two of the best ways to treat and prevent shoulder injuries? Strengthening the rotator cuff and scapular stabilizers, which the Face Pull Y-Press does very well.

Martin Tesovic (Slovakia) - London 2012 Olympi...

From the performance perspective, think of the top position of many exercises used in CrossFit such as snatches, military press, overhead squats/lunges/holds, and jerk movements. With these overhead exercises, stability of the weight overhead comes from a coordinated co-contraction of the pecs and lats which can pull the weight forward and the muscles of the posterior upper back which pull the weight back. If you’ve ever watched athletes perform a snatch and fail you’ll see that more times than not they fail with the weight falling forward. This is because the weaker of the two forces in the overhead stability equation is that of the posterior upper back muscles (rhomboids, traps, posterior delts, rotator cuff muscles). The Face Pull Y-Press is fantastic at targeting these muscles and as you can see, has the near the same shoulder position as the exercises mentioned earlier.

So, if you’re looking to kill two birds with one stone and address potential injuries while improving your performance then give the Face Pull Y-Press a try!

Here is Chris Melton’s version of the FPYP with a cable stack instead of rings: http://www.youtube.com/watch?v=_o_cSKD35Gs

Elbow Extension Test & Radiology Referral

Had a recent patient come to the clinic that has been previously treated with excellent results with some manual therapy. 40-year-old male fell onto outstretched hand 2 weeks prior while playing soccer. His team’s athletic trainer thought little of his injury the following day. As the next two weeks went on, pain remained high and was unchanging. During the elbow extension test, he was unable to fully extend his elbow. I referred him to his GP and X-rays revealed a radial head fracture.

The Elbow Extension test is very easy to perform. Simply have the patient to fully extend their elbow. Inability to fully extend the elbow would be considered a positive test and warrant imaging.

Elbow Extension Test

Several studies have examined the sensitivity and specificity of this test:

Hawskworth & Freeland: Sensitivity 90.7%, Specificity 69.5%

Appelboam et al. Sensitivity 96.8%, Specificity 48.5%

Docherty, Schwab, & Ma: Sensitivity 97%, Specificity 69%

Lamprakis et al: Sensitivity 92%, Specificity 61%

Appelboam et al concluded their study: “The elbow extension test can be used in routine practice to inform clinical decision-making. Patients who cannot fully extend their elbow after injury should be referred for radiography, as they have a nearly 50% chance of fracture. For those able to fully extend their elbow, radiography can be deferred if the practitioner is confident that an olecranon fracture is not present (Appelboam et al).”

 

References:

Docherty, Schwab, & Ma. Can elbow extension be used as a test of clinically significant injury? South Med J, 2002.

Hawskworth & Freeland. Inability to fully extend the injured elbow: an indicator of significant injury. Archives of Emergency Medicine, 1991.

Appelboam et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ,  2008.

Lamprakis et al. Can elbow-extension test be used as an alternative to radiographs in primary care? Eur J Gen Pract, 2007.

Snatch Set Up and Catch

Biomechanics of The Olympic Snatch

The Olympic snatch is a frequently used exercise is strength & conditioning programs, and for good reason.  This exercise allows the athlete to lift very explosively and with biomechanics similar to that seen in many other athletic movements such running and jumping.  However, this exercise is highly technical and requires time and a good coach to learn how to master.

The simplest explanation of the snatch is that it is a weightlifting exercise in which the athlete lifts a barbell from the ground to an overhead position in one explosive and continuous movement.

Snatch Set Up and Catch

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Bodyweight Overhead Squat Test

One of my favorite tests to use in the clinic has to be the overhead squat test. I have used this test for years since learning the NASM’s Performance Enhancement Specialist system while an undergrad (I use an altered version of their test now). This test is very simple and quick, yet provides a good deal of information regarding an individual’s movement deficiencies. Add in a step down test, some hopping/landing, a trunk stability pushup, and running analysis you will have a great picture of how an athlete moves.

To perform this test, have the athlete/patient raise their arms overhead so that it is in line with their ears (if able). With a shoulder width and barefoot stance, have them squat down as low as they are able 3-5 times while observing them from the front, side, and back.

Overhead Squat

From the front and back view look at the following:

A. Knee valgus (aka medial knee displacement) – the knees moving towards each other as the athlete descends or ascends. Compare the below picture to the above.

B. Feet rotating outwards

C. Feet collapsing – often associated with knee valgus

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A) Knee Valgus Collapse B) Feet Out C) Foot Collapse

Feet turning outwards may indicate a dorsiflexion limitation, tight hamstrings or TFL, and weak glutes. Knee valgus may be from dorsiflexion restrictions, adductor overactivity, and weak glutes. Foot collapse may indication overactivity of peroneals, gastrocs, TFL or under activity of the tibialis muscles or glute med.

From a side view watch for the following faults:

A) Arm Drop B) Excessive Arching C) Low Back Rounding D) Heel Rise E) Forward Head F) Excessive Forward Lean
A) Arm Drop B) Excessive Arching C) Low Back Rounding D) Heel Rise E) Forward Head F) Excessive Forward Lean

A. Arm drop may indicate tight lats or other shoulder mobility restrictions. It may also indicate a weakness in the scapular musculature.

B. Excessive arching is often the result of tightness in the erectors, hip flexors, or lats. Glute weakness and core instability often accompanies this as well.

C. Low back rounding may be due to hip joint range of motion restrictions, dorsiflexion limitations, and under activity of the core/glutes.

D. Heel rise is most likely from restrictions of dorsiflexion.

E. Forward head is likely due to a combination of cervical muscle and joint restrictions, as well as weakness/under activity of postural stabilizers.

F. Excessive forward lean is often from excessive activity of the calf muscles, hip flexors, and abdominals. Weakness of the anterior tibialis, glutes, and erector spinae may also be the cause.

Muscle Activation Patterns During Sprinting

World Athletics Championships 2007 in Osaka - ...

In order to best train to improve maximum sprinting, a good understanding of the requirements of the muscles involved in this motion must be understood.  The muscles must perform two tasks during sprinting: first, they must produce force to propel the body horizontals; second, they must produce a vertical force to counteract the pull of gravity.  These forces must be produced during the support phase of sprinting. Continue reading

Imaging of the Lumbar Spine – What Does It Really Tell Us?

Screen Shot 2014-02-28 at 3.55.44 PMPreviously, I’ve written on the knowledge of MRI results and its impact on treatment outcomes. Results of a study by Modic et al. found no prognostic value of MRI over that of the clinical assessment. Size, type, and location of disc herniations were not associated with outcome.  At the six-week follow-up, improvements were not significantly different between groups that knew the results of their MRI and those that did not.  One of the more interesting findings of that study was that those who knew their MRI results had a lesser sense of well-being despite similar outcomes to those without knowledge of their imaging.  This supports the importance of  medical professionals emphasizing that patients not obsess with results of imaging and instead focus improvements in functional status.

Further research looking at the results of imagining of the lumbar spine provides further evidence for the medical community to be more cautious in their reliance on imaging. Wtt, Vestergaard, and Rosenklint compared X-rays of people with lumbar spine and sciatic pain to those without low back pain. Their results found no significant differences in the X-rays between these two groups in regards to disc degeneration and spondylosis. Boden et al. took MRIs of participants without history of lumbar spine pain. In their asymptomatic patients under the age of 60, 20% had at least one disc herniation. 57% of participants over the age of 60 had abnormal findings. Middleton and Fish reported disc protrusions in 80% and spinal stenosis in 20% of asymptomatic individuals over the age of 60. They also provided evidence for significant levels of disc degeneration in asymptomatic women in their twenties.

Screen Shot 2014-02-28 at 3.55.35 PMJensen and colleagues reported that of asymptomatic participants in their study, 36% had normal lumbar discs on MRI, 52% had at least one disc bulge, 27% had a disc protrusion, 1% had an extrusion, 38% had more than one level of abnormality. They concluded their article stating that “given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”

Please don’t mistake these results as proof that imaging is worthless as it very frequently is needed in the treatment of back pain. Instead, us this research as evidence in the education of patients who worry about their long term quality of life following diagnosis following imaging.

References

  • Wtt, Vestergaard, & Rosenklint. A Comparative Analysis of X-ray Findings of the Lumbar Spine in Patients With and Without Lumbar Pain.
  • Boden, Davis, Patronas, & Wiesel. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.
  • Middleton & Fish. Lumbar spondylosis: clinical presentation and treatment approaches.
  • Jensen, Brant-Zawadzki, Obuchowski, Modic, Malkasian, & Ross. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain.
  • Modic, Obuchowski, Ross, Brant-Zawadzki, Grooff, Mazanec, Benzel (2005). Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on Outcome.  Radiology, 237.

Tips for CrossFit Beginners

How To Perform The Squat

CrossFit is one of the best and most rewarding exercise programs right now.  Newbies to this style of training quickly become hooked by this community based system.  Starting CrossFit, however, can be a daunting task. Here are a few tips for beginning CrossFit and staying safe while starting.

Master the basics – squat and deadlift

Cleans, snatches, and thrusters are great but it’s best to focus first on mastering the squat and deadlift.  Learning these two first will make progressing to more advanced exercises easier.

Start Slowly (no multi-workout days)

It’s easy to get hooked to CrossFit and want to workout more frequently to improve faster.  Lots of new CrossFitters see others performing multiple workouts per day but they don’t understand that these people built their conditioning up over a long time to do this.  Jumping into multiple workouts per day early may increase your risk of overuse injuries, which will bring your progress to a quick halt.  Four workouts per week are enough for most CrossFitters.

Compete with yourself before worrying about competing with others

The competitive aspect of CrossFit can be great.  But don’t get hung up initially on what others are doing.  Work at your own pace, focusing on good technique and enjoying yourself.  Get better each day regardless of your score compared to everyone else’s.

Find qualified coaches…and use them!

English: July 2007 CrossFit Trainer certificat...

A great coach can mean a world of difference.  Speak to people at the box you are thinking of joining.  Ask about their coach’s programming and teaching style.  Are they able to teach the exercises to people of all skill levels?  Do they effectively scale the workouts?

Once you find a good coach, don’t be hesitant to ask them for help… that is why you are paying them.  Get help with your technique and properly scaling the workout.

Address mobility and stability

Many injuries are the result of poor mobility.  CrossFitters tend to work very hard on maintaining and improving mobility.  But stability cannot be forgotten when performing injury prevention work.  Focus on strengthening the glutes, abs, rotator cuff, and scapular muscles.

If your goal isn’t to compete – don’t let technique breakdown

A lot of times you will hear CrossFitters talk about an acceptable amount of form breakdown and encourage that as a form of increased intensity.  My argument would be, why do this when it may increase the risk of injury if you goal isn’t to compete.  Focus on proper form, a steady pace, and getting a great workout WITHOUT INCREASING INJURY RISK.

Good example of Crossfit Weight lifting - In C...

Constantly reassess your form (coach and videos and forums/online)

Once you’ve learned basic exercises such as air squats and are progressing to weighted versions, don’t think your form is always perfect.  Constantly reassess your form by having your coach watch you or take videos to examine yourself (or upload to the CrossFit boards to get help from others).

If a movement doesn’t feel right…don’t do it (yet)

If you aren’t comfortable with a movement work on it outside of the metcons.  Perfect your technique and build some confidence.  When you feel good with it then add it in to your workout.

If a movement is painful, your body is telling you not to do it.  Seek out the appropriate help to correct the potential problems instead of further damaging your body.

Don’t neglect the warm up

Warm ups are essential for injury prevention.  Don’t ignore them or perform them lazily.

Crossfit Trainer trying to lift  weights

CrossFit strives to address all domains of fitness – the most important should be remaining injury free!

While CrossFit may be the best program for addressing all domains of fitness (strength, endurance, flexibility, etc) you can’t improve any of these if an injury keeps you from being able to work out.  That is why remaining injury free is the most important aspect of fitness.  Take care of yourself so you can continue to improve!

Preventing Shoulder Injuries With One Simple Exercise

Anticipation: A baseball player making a pitch...

The human shoulder is an amazing structure.  Baseball players can transfer forces allowing them to throw upwards of 90 mph, weight lifters can lift and support hundreds of pounds over their heads, and shot putters can toss a 16 lb. piece of metal over 70 feet.  Unfortunately, for any athlete performing overhead activities, the structure of this joint makes it incredibly susceptible to injuries that can impact performance or put them on the sideline.

Two things are needed for the shoulder to perform optimally.  First, it must have enough mobility to move through its’ full range of motion.  Second, there must be a balance in the strength of the various muscles that move and stabilize this joint.  Minor imbalances in either of these factors can increase the risk of injury and potentially decrease performance.  For any athlete whose sport relies heavily on overhead movements, a solid Prehab routine is imperative to stay at the top of their game.

Shot Put Women Combined Competition - Heptathlon

The Face Pull Y-Press (FPYP) is a fantastic exercise that should be part of any Prehab program designed for overhead athletes.  This exercise is a combination of several common shoulder exercises allowing it to efficiently work many of the shoulder muscles needed to help reduce risk of injuries and improve performance.

To perform the FPYP, start with the resistance (resistance bands or cable stacks both work well) at lower chest level directly in front of the athlete. The athlete’s palms should face inwards with the elbows straight.  The movement is begun by bringing the hands back and out so that the forearms are vertical to the ground and the upper arms are parallel to the ground. Next, the elbows are straightened while the hands are pushed upwards creating a 135 degree angle between the ground and the arms, as if making a “Y” with your body. Finally, return to the starting position by slowly bringing the hands down and towards each other while keeping the elbows locked out.

The Face Pull Y Press
The Face Pull Y Press

English: Picture of the arm and shoulder muscles

So what makes this exercise so great?  The combination of movements hits nearly every muscle needed for stability and controlled movement of the shoulder including the rotator cuff, deltoids, and muscles surrounding the shoulder blades.  This exercise also closely resembles many positions and motions performed by overhead athletes.  The top portion of the exercise is similar to the top position of many exercises performed by competitive weight lifters such as the snatch or jerk.  The descent mimics the deceleration portion of throwing a ball or serving a volleyball.

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