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The modifications started sooner than expected! Once I hit 13 weeks, a lot of things started to change! That week, I started noticing lower abdominal discomfort with running (sometimes even walking) and coning/bulging of my abdominals with certain movements that involved my core like toes to bar and even the end of the rowing position. Here’s a little glimpse into some of my modifications and my experience with this trimester...
Rowing, Toes to Bar, Planks The next couple of days I started to have some “pregnancy symptoms” with rowing, toes to bar, and planks. While rowing, I started to notice that as I leaned back at the end of the row, there was a glimpse of “coning” that started to occur. What exactly is “coning”? When you’re pregnant, it’s normal for your abs to separate in order to accommodate your growing belly and baby. Coning is what occurs when you see a ridge or bulge popping out down the midline of your belly. This typically occurs when doing an exercise incorrectly or an exercise that puts too much stress on the abdominals and should be avoided. I finished the row using mainly legs and eliminating the backward lean at the end. Next, I tried out some toes to bar to warm up for another workout and after attempting one rep and seeing the glimpse of coning again, I decided not to do them. I did 30# slam balls instead. I’ve also noticed that if I’m not holding perfect plank form, the “coning” would occur with planks too, especially as I get more fatigued! I started this trimester out with planking on my elbows, but now have transitioned to planking on my hands because I feel like it’s easier to control for the coning when on my hands.
Handstand push ups A controversial topic that I want to mention is going upside down when pregnant. I’ve heard people say you can flip the baby and it’s dangerous and you shouldn’t do it. I asked my doctor her opinion and I brought up the “flipping of the baby” and she said it was very unlikely. She said that the baby will probably change positions multiple times before delivery so not to worry about it. The only thing she did have to say was to be mindful of things that could make me lose balance or fall. I know a lot of pregnant women that still handstand walked and did handstand push ups when pregnant and everything was fine with their pregnancy and delivery. I’ve been continuing to do handstand push ups, but I will say they’ve gotten significantly harder. I’m usually pretty efficient with them, but now they take a lot more effort. Same thing with ring dips. I’ve never been good at ring dips, but they’re now SIGNIFICANTLY harder for me. I’m hoping that if I keep doing them as I get heavier and heavier, no matter how difficult, that it’ll pay off in the long run and I’ll be better at them after pregnancy. It’s almost like training in a weight vest! Competitions At 18 weeks, I competed on a 4 person team in a competition at my home gym. The competition was supposed to take place earlier this year, but due to COVID, it was postponed by a couple months. The competition announced the first 3 workouts ahead of time and if you placed top 8 after those workouts, then they announced another hidden workout. Knowing that I could do everything in the first 3 workouts, even with following my new modifications, I decided to still compete. My team ended up doing really well after the first 3 workouts and actually finished top 5! But when they announced the hidden workout, it ended up being synchronized chest to bar pull ups and synchronized bar muscle ups….movements that I had already stopped doing. This was really hard mentally. It was hard because I knew that if the competition was when it was supposed to be, it would have been before my modifications began and I could have done all of those movements. Also, those are some of my favorite Crossfit movements and I really wanted to do them! Lastly, knowing my team was counting on me, I didn’t want to let them down! Thankfully, I had the best team ever and they were ok with forfeiting since I chose not to risk putting my body through those riskier movements just for a quick little workout, even if it meant getting eliminated. They were the best!
Mindset My mentality has definitely gotten stronger over the course of this pregnancy. I’m not going to lie, I was a little disappointed throughout the first week of this trimester because of all of the modifications that I felt obligated to make so early on (in my opinion it was early). I’ve talked to a couple of other women (that I’m so thankful to have in my corner) and of course everyone’s experience is different and they all make modifications at different points in time. I know that it’s not the end of the world to see coning and I know women that have done sit ups and have rowed well into the 3rd trimester. I personally don’t feel comfortable doing some of those movements and want to do everything I can to ensure a fast recovery, so I choose not to do them. Body image has been another challenge. Throughout the first trimester and first half of this second trimester, I’ve just felt bloated, not pregnant. In my opinion, I haven’t really looked or felt like I’m pregnant other than the fact that I’ve gained some weight. I don’t have a belly and actually didn’t start to develop a little baby bump until 22 weeks. So up until the point when I started showing, the body image I had of myself wasn’t great. Some days were better than others, but when you’re used to looking a certain way and doing certain things in the gym and then all of a sudden can’t...it’s mentally tough! It’s hard knowing that you can physically do an exercise/activity, like in my competition, but knowing that you shouldn’t. I’m competitive and love to hit that “RX” button and love to win, but 90% of the time, I have to scale or modify at least one thing in each workout. My mentality has definitely improved as the pregnancy has progressed and I’ve now gotten used to scaling/making modifications. What’s made it even better/more real is finding out the gender! We had our gender reveal at about 19-20 weeks and found out we are having a little girl! I really wanted a little girl so we’re super stoked and I’ve already started planning her cute little nursery (: Bottom Line: Everyone’s pregnancy is so different. Your belly size, the amount of weight you gain, when you feel your baby kick, the modifications you have to make...they’re all different! Don’t get hung up on comparing your experience with anyone else’s, you’ll drive yourself crazy! To make pregnancy experiences easier and less challenging on any other pregnant women that are looking for scaling options/modifications, I’ve created a little cheat sheet that I have been using throughout this trimester that has allowed me to still get the desired stimulus of the workout while working similar muscles as the prescribed movement! Hope it helps!
Thanks for reading!
-Dr. Aerial
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Let’s set the stage… First and foremost, I am a firm believer that the squat should be a part of everyone’s training program. Yes, there are always exceptions, however those are few and far between. The squat is one of the most foundational and functional movements we as humans can do. Think about it. From going up and down to a chair, to getting in/out of cars, to even getting on/off the toilet! We are already performing them on a day-to-day basis, so it makes sense to train it! Not only is it functional but the overall strength and power benefits are immense. It’s a skill that everyone should master in order to live a healthier, more resilient life. Here’s the issue. Depending on what you read, you may hear one thing from one source and something completely different from another. There is incredible controversy on what correct squat form should look like. My goal with this post is to dive into some of the biggest squat technique topics and clear some of these muddy waters. Let’s spend the next few minutes together diving deep, so you can confidently master the squat!  Myth 1: Don’t let your knees travel in front of your toes This became popular among trainers and health enthusiasts in the 80's with poor research to back it up. It’s less about if and more about when. If the knees translate at or below 90 degrees from the bottom – that’s pretty normal – I’m not freaking out. If they translate early or above 90 degrees, then I’m a bit concerned. The goal with the squat is to be efficient, straight down and straight back up. If you prevent/ control your knees from advancing forward, you’ll end up with a wavering bar path – not good. If an athlete sits on their heels, and tries to prevent forward translation of their knees over their toes, our squat efficiency plummets. Our knees insufficiently bend and our torso comes forward, which completely throws a clean vertical bar path. From a side view, an inefficient bar is one that shifts forward excessively rather than straight up and down. When we deliberately try to alter the position of our knees instead of going straight down with the lift, as you can imagine, the path gets a little wonky (not straight).  However, don’t initiate the squat with your knees either, just think about: 1. Keeping the heels firmly planted 2. Making sure your weight is distributed in the center of your foot (tripod stance) 3. Keeping the bar path vertical over the center of your foot Similarly, recent research compared the differences in stress placed upon the knees and hips/low back when performing two types of squats: (1) a regular back squat where knees are allowed to travel forward freely, and (2) a squat that restricted forward knee travel. They concluded that when athletes limit the forward knee travel, it simply shifted the stress from the knees to the hips/low back. The restricted knee travel decreased stress on the knee by 22%...But increased the stress on the hip/low back by 1070%! Which do you prefer? While decreasing stress on the knees is great, there’s a significant trade-off with the amount of stress placed on the back, greatly increasing the risk of associated low back injuries. So yes, it is true that there is increased stress on your knees during squats if you let them move naturally, however, it’s important to know that this is WELL within the limits of what the knees can handle. Think about this: Did you go up or down stairs today? Well your knees most likely went over your toes… and this (for the majority of the population) doesn’t cause pain.  Lastly, the distance your knees travel over your toes also relates to our morphology, aka the way our bodies were made. The longer our femurs (the big thigh bone), the more likely our knees are to go over our toes. This is fine! Research has proven this to be safe and normal. Myth 2: Squatting below parallel is dangerous! This is a big one! We have a couple of options here: 1. Should I bottom out and go a$$ to grass? 2. Should I transition right at parallel? 3. Should I transition below parallel? Option #1: Bottoming out and going a$$ to grass. Deep squats are natural, age-old positions that people from the non-air-conditioned world still use to this day and are taught to use from birth. They do the vast majority of their everyday activities in a deep squat position. They are working on their natural hip and ankle mobility from a young age, which are major components of the squat. If you measured the ankle dorsiflexion (toes to nose movement) of a baby, you’d see ~70 degrees. Normal dorsiflexion around our parts of the world is ~20 degrees.  Needless to say, humans are born with the ability to squat; some of us just lose the ability when we stop trying. Our strength and mobility are limited because we aren’t taught or forced to use this deep squat. We don’t need it for day-to-day activities like other countries do. Going a$$ to grass has the potential to make you expend more energy because of the greater range of motion you’re performing. If you’re looking to increase your strength in a fuller range of motion, then a$$ to grass is may be the way to go. Usually, athletes can squat more weight when they transition right below parallel because of the lesser range of motion and decreased time under tension as compared to going a$$ to grass. Highly trained athletes can take advantage of this deep squat position by using the “bounce” out of the bottom to help propel up. However, diving into the bottom of a squat to use that “bounce” is never a good idea unless you’ve trained the back squat using strict full range of motion without the bounce first. Once you’ve built the strength and coordination and have practiced the bounce with integrity, it may be ok to use sparingly. However, one should understand that you’re placing a great amount of stress upon the connective tissues in your joints. The repetitive bouncing out of the bottom, due to the increase in compressive forces in the deep squat, could potentially damage the meniscus and articular cartilage in your knee. Nevertheless, there are currently no guidelines that dictate the magnitude of force that would cause this to happen. Like every other lift or exercise, there are proper mobility drills and progressions that teach body control, stability, and strength. It’s recommended that you practice and train these areas to improve your mechanics and ensure safety before using it. Option #2: Transitioning right at parallel Parallel squats are more quad dominant, meaning there’s a lot more activation from the muscles on the front of your thighs as compared to your glutes. This is because activation of your glutes is greatly influenced by the depth of your squat. Researchers have found that the average muscle activity of the glutes were similar in both a partial and parallel squat, but increased significantly during performance of the full squat. The glute has a direct attachment onto the IT (iliotibial) band, which then attaches to the knee. So your IT band provides more stability to the knee with deeper depths because of the increased contractility from your glutes. When you squat deeper and your weight is centered in your foot, you get activation of not only your quads on the front side of your body but also the glutes/hamstrings on the backside of your body. So the knee is typically more stable because of the coactivation of muscles on the front and back, preventing excessive movement of the structures in the knee.  Similarly, researchers have found that the greatest torque on the knee occurs when you transition above and right at parallel. Those forces decrease right below parallel. However, even though the torque right at parallel is increased, this is still <50% of the estimated strength capacity of young healthy persons ligaments. So no, transitioning right at parallel will not blow up your knees. But transitioning below parallel has been proven to be healthier and safer and is the option I would personally choose to improve the longevity of my joints. Option #3: Transitioning below parallel. This is the goal! This is the healthiest, most functional position to achieve. As mentioned above, the forces placed upon the knee are less when you go below parallel. During the deep squat, when performed correctly, your joints are more stable because of the muscular contractions surrounding your knee. This results in less torque, which protects your ligaments and sensitive structures within the knee.  But what if I can’t get down there? If you never go below parallel, then you’ll soon lose your ability to. The old saying holds true… “If you don’t use it, you lose it”. Taking up squatting all of a sudden can, over time, damage the muscles and cartilage around the patella (the knee cap) in your knee. If you are fit, these muscles remain taut and healthy. But if it unexpectedly has to handle too much pressure, the cartilage can start eroding. Initially, you won't feel any pain. But eventually it can lead to osteoarthritis, a disorder that is usually irreversible. So it’s important to train and ease your way into the squat. This is done by working on your mobility, working on your strength in those newer ranges, and most importantly, using the appropriate drills and techniques like some of the ones listed below to get you there…video #1 is for the hips, #2 is for the ankles, #3 is for strength.
Myth 3: Having a butt wink is bad! Let’s start with what exactly this “butt wink” thing is. The squat requires motion from multiple joints in the body (hips, knees, ankles, etc). When we squat and use or take up all the available motion from our hips, motion has to come from somewhere else to continue to get deeper. This is where the butt wink occurs. When there’s no more motion left in the hips, your pelvis posteriorly tilts and rotates backwards. This can then disrupt the neutral position of the lower back. Now let’s talk about a hotter topic...IS THIS BAD? First off... it’s normal! But more importantly (similar to knee translation over the toes), it’s less about if and more about when. If it happens above or right at parallel, we need to work on it. Yes, butt winks can be improved! It not only is dangerous to frequently squat with very early butt winks, but many athletes deal with chronically tight lower backs. To fix it we most commonly need to address the hips and ankles. Try out these awesome mobility drills before the next time you squat!
Moral of the story... Just SQUAT! Don’t worry so much whether you look exactly like someone else while squatting, just simply practice getting your hips lower and keeping your weight over the midline of your foot. If you’re not able to get down there, be patient, don’t push it. Over time, by working on your mobility and strength, you’ll likely get there. Don’t know where to start or feeling stuck in your training? We, at The Charlotte Athlete, help athletes and active individuals dealing with these same issues. Email us for more information at info@thecharlotteathlete.com and we’ll get you on the right track! Thanks for reading! - Dr. Aerial   Yes, I’m one of the “soon to be moms” that is going to continue Crossfitting throughout my pregnancy, baby bump and all. In fact, I came in 2nd in an individual competition at 6 weeks pregnant and I am actually competing in a 4 person team competition in April (18 weeks into pregnancy). At this point, you may be looking at me like I have 3 heads and thinking “how unsafe and dangerous!”. It can be easy for new moms to get lost in a sea of conflicting information—not just on the internet, but also from doctors and well-intentioned friends and family members. So, the point of this blog is to provide you with the most recently updated research as well as my personal experience of Crossfitting while pregnant. Thankfully, there have been a lot of elite athletes that have continued their pre-pregnancy workout routines throughout their pregnancies and have delivered perfectly healthy babies while doing so. For instance, Serena Williams won the Australian Open while 2 months pregnant and continued to play tennis and workout at a high intensity even at 8 months pregnant. Similarly, Olympian Alysia Montano ran an 800-meter race while 34 weeks pregnant! And the list keeps getting longer and longer.
My Story I’ve been doing CrossFit for almost 5 years now (6-7 days per week consistently), and I am 12 weeks pregnant. At my 8 week check-up I made sure to tell my doctor that I liked to do CrossFit (alot) and asked him if there were any precautions or guidelines that I needed to follow in regards to working out. The only information he gave me was to limit my heart rate to 140 bpm once I got into the 2nd trimester. As you can probably guess, my doctor wasn’t very familiar with CrossFit and didn’t have any specifications or recommendations on movements I should or shouldn’t do. And naturally, as soon as people found out I was pregnant, I received a couple of comments like “you better lift while you can, you won’t be able to for much longer” and questions like “when are you going to stop lifting heavy?”. So, wanting the best for myself and my baby’s health, I dove into research instead of listening to what other people’s comments, questions, and concerns were. The more I researched, the more I came to realize that most of the information out there was based on the more “conservative/traditional” view of pregnancy. For years and years, medical professionals have erred more on the cautious and careful side when it came to exercising while pregnant due to lack of research and evidence. But, thanks to elite athletes and the women in CrossFit that have continued to workout throughout their pregnancies, I’ve found that it’s actually MORE beneficial for pregnant women to remain active. For instance, labor and delivery are probably one of the most physically demanding tasks our bodies will ever go through and this task is somewhat comparable to competitions, meets, and/or marathons where we exert the most effort. You wouldn’t compete in these events without training and preparing! Exercising during pregnancy is almost like training for delivery!
Do I have to monitor my heart rate? In regards to my doctor’s recommendation, I’ve found that the more recent research says that if you’ve been working out regularly before pregnancy, then there’s no need to be concerned about heart rate during pregnancy. “For healthy women, the Department of Health and Human Services recommends [AT LEAST] 150 minutes a week of moderate-intensity aerobic activity — preferably spread throughout the week — without any specific heart rate limits. This recommendation also advises that pregnant women who were previously engaged in vigorous-intensity aerobic activity or who are highly active can continue their activities, provided they remain healthy and talk with their health care providers about any needed activity adjustments over time.” “Heart-rate precautions do not have scientific backing and gynecologists no longer recommend even monitoring a pregnant woman’s heart rate if she exercises because heart rates vary so much from pre-pregnancy levels, as do the heart rate’s responses to exercise. Dr. Shangold recommends using perceived effort as a guide and making sure that the effort remains moderate. But, she said, there are no rigorous studies to back that up [either]”. While heart rate isn’t a huge concern, it is important to understand that our bodies are working overtime during pregnancy and our natural abilities will diminish. So instead of finding that dark place that leaves us lying on the floor from exerting so much effort, workouts should be more about moving intentionally, sweating, and staying active and healthy.  What I’m Doing Now At this time, I haven’t scaled or changed anything about my workouts. I am still working out 6-7 days a week, performing ring muscles ups, handstand push ups, burpees, toes to bar, box jumps, and all the other fun stuff that comes with Crossfit. I’m currently still doing all of the workouts as they are prescribed (with high intensity), not out of persistence and stubbornness, but because my body feels great (besides the fact that I have to pee more often) and I haven’t experienced any weird aches, pains, or discomfort. I still feel fully capable and good about these movements without feeling like I am putting the baby at risk and I plan on performing these movements for as long as my body can handle it. I know I may have to scale back and modify at some point in the near future and I am fully willing to do so. After all, the baby is my number one priority and I want he/she to be as healthy as they can be. My Nutrition Another common question I’ve been getting is whether I’ve gotten sick or if I’ve had to change anything with my nutrition. Well, there was one week during my first trimester where I did feel nauseous everyday and didn’t want to eat my typical foods, but I never actually got sick. Once that week passed, I was back to normal and have been eating my regular meal prep ever since. A lot of other women have told me that the first trimester is the worst (when it comes to sickness), so I’m thankful that I’ve made it through with minimal sickness so far! I also haven’t felt the need to eat more than usual nor have I had any cravings yet. I do know these things can change in the blink of an eye, so I’ll keep y’all updated with any changes! Bottom Line The best thing you can do is listen to YOUR body. Your heart rate, your ability to continue certain exercises, and your nutritional needs are all variable and dependent on your history and pre-pregnancy health and ability. There’s no “one size fits all” piece of advice, so if it doesn’t feel right, don’t do it! Your body is smarter and more resilient than you think.  It often starts with slight pain or a tweak on a rep. Then with every repetition or workout the pain gets stronger and your lifts get weaker. Eventually you start feeling pain with everyday activities like getting out of the car or after a nights sleep, until you reach a point where you feel like one wrong movement will cause your back to explode. Sound familiar or heard something similar from a friend? Tiger Woods showed that even a great athlete whose body can't handle the demands of their sport can do it with risk, and still get injured, just like a beginner stepping foot inside a weight room or CrossFit gym for the first time.  More often than not however, lower back pain begins without a specific identifiable cause. This means that you are doing something (or many things) day in and day out that are either making your pain worse, or preventing from getting better. If you don't change your routines, the pain will eventually come back. Back pain is super common for a number of different reasons, but in order to truly get rid of it once and for all.... without it coming back down the road.... the key is to treat the underlying root cause. I’ve had the distinct honor of working with a wide variety of patients with lower back issues. Some fresh out of surgery, some with congenital abnormalities they were born with, and others with standard lower back pain. My rare blend of residency and fellowship training along with many years experience as a Sports Doctor have taught me what works and what doesn’t. Today I want to give you some insight as to why lower back pain is so common, as well as provide practical advice and tips on how to reduce your back pain and prevent it from returning or happening in the first place. Reason 1 - Poor Sleep Quality and QuantityAdequate sleep is not only a key part of a healthy lifestyle but a critical component to a healthy back. We spend 7-8 hours (hopefully) each night sleeping and recovering. Key word - recovering. Many important processes take place within the body during these critical hours. Most importantly, this is the time when your body heals. When it comes to lower back pain, it's not just that quantity of sleep that’s critical, but the position you are in as well. If you sleep in a poor position, your back will not only fail to heal and recover, but it may even get worse.  WHAT TO DO ABOUT IT - Stay out of the bad positions and get into the right one. Positions to avoid: Stomach or side-lying mountain climber (on side with top knee touching mattress) Positions to shoot for: Lying on your back with pillows (2-3) under your knees or on either side with a pillow between your knees Reason 2 - Sitting For Too LongSitting for prolonged periods can be a major contributor to lower back pain. People will often sit for long hours at work, go immediately to the gym for a workout, and then hit the couch for monday night football or their favorite netflix show. Unfortunately I hear this story far to often. Long periods of sitting can cause some major imbalances within the body, causing certain muscles to tighten up and others to weaken, which can lead to poor movement patterns and ultimately lower back pain.  WHAT TO DO ABOUT IT - Get moving! The most important thing to do if you find yourself sitting or driving for long periods is to take more breaks and move around. A general rule is to not allow yourself to sit for more than an hour at a time, however if symptoms come on before then, try to move around before pain sets in. If able, I also recommend an adjustable stand-up desk. This simple change can have a large impact on the health of your back and in most cases is well worth the investment. Reason 3 - You Have Tight Hip FlexorsPoor movement patterns, extended periods of sitting, poor sleeping positions, and weak core and hip muscles can all contribute to tight hip flexors (also known as the iliopsoas). The iliopsoas actually combines two muscles (the psoas and iliacus) which run from in the hip, attach to the pelvis, and insert deep to each of the lumbar spine segments. When this muscle is tight it will literally tug and pull on the lumbar spine, greatly increasing compensatory movement patterns and the chance of lower back pain. 
Reason 4 - Ineffective Warm-UpIt’s safe to say that why this happens is pretty self explanatory. After sitting all day, you rush to get to the gym, arrive right on time or even a little late, and jump right into the workout. Or, you are just flat out lazy and skip the warm-up. With this approach you're asking for injury, and if it hasn’t happened yet, it will in the near future.  WHAT TO DO ABOUT IT - Follow these 3 steps While this concept applies to all areas of the body, it is especially important to allow the lower back to safely perform demanding CrossFit and weightlifting movements under fatigue. Every warm up should consist of the following 3 steps: 1) Get your heart rate up - It doesn't matter much how you do it, but try to relate towards that day's workout. Example: 5 minutes of jogging, biking, rowing, elliptical, or ski erg. 2) Improve specific mobility needs - Include movements and exercises to improve joint mobility and muscle flexibility as it relates to your workout and your specific limitations. Example: mobilize your mid/upper back to prepare for overhead shoulder work. 3) Prime the muscles - Include exercises that prepare the muscles to perform that day’s specific workout. Example: Perform PVC pipe overhead squats to prepare to snatch. Reason 5 - You Continue To Aggravate ItEvery time you go into a deep squat or every time you perform a power clean, you feel that sharp lower back pain, yet you continue to force your way through it. This can be go on for days or even years. Pain is signal from your nervous system conveying a warning or that something incorrect is happening. Often this is movement related. Continuously putting your body through these painful movements not only feels awful but is delaying your recovery, and potentially feeding into the underlying problem.  WHAT TO DO ABOUT IT - Listen to your body and adjust accordingly You only get one body and you need to take care of it. Think of it like your dream car. If the check engine light comes on, you take to the shop. Why? Because you don't want it to fail on you while on the road. Same thing with your body. If you feel repetitive tweaks, unusual tightness, or continued pain you shouldn’t continue to work through it. You need to address the issue before it keeps you out of the box for a lengthy period. Now i’m not suggesting you take extended time off, I’m recommending that you listen to your body and make the necessary adjustments until you address the underlying reason your pain keeps coming back. The last thing you want to do is rest completely, as this has been found to actually make things worse. Reason 6 - You Lack Core StabilitySix pack = strong, stable core right? Not necessarily. There is a big difference between core strength and core stability. Working on your six-pack abs will not help your training if your core is not stable and functional. A core with poor stability is a leading cause of lower back pain. Even some of the highest level athletes like Gronk and Tony Romo can have back pain. Why? These athletes likely lacked the stability necessary for demands in their respective sports. When you lack stability from your active systems (i.e. muscles), increased demand gets put on your passive systems (i.e. joints, ligaments), which can lead to pain. Often, a gym’s programing includes too high an emphasis on the “ego” lifts and not enough attention towards core stabilization and midline control, or the athlete without back pain is to lazy to perform the “boring” but necessary accessory work.  WHAT TO DO ABOUT IT - Train your core to do what it's meant to do: Stabilize The core is designed to prevent motion, not create motion, meaning exercises such as crunches, sit-ups, and medicine ball russian twists train the core to do something it's not meant to do. These exercises improve core strength, not stability. It is more appropriate to include exercises that prevent spinal motion such as planks, farmer's carries, and the pallof press series. Core stability is essential in maintaining a neutral spine and pelvis, and should be part of every athlete’s training program, from weekend warriors to professional athletes. Reason 7 - You Lift With Your BackYou start a grueling metcon or set out to hit a big PR. Then you start to fatigue or attempt to lift to heavy and technique breaks down, greatly increasing your chance of lower back pain. Losing a “neutral” lumbar spine (excessive lumbar extension or lumbar flexion) during a fatiguing metcon or during a big “ego” lift is one of the most common mechanisms of injury for the lower back. However, even more common, is when an athlete falls into the pattern of simply “using your back” to not only perform basic, lighter-weight lifts, but with all daily activities like getting out of a chair or picking up something off the floor. You don’t have to be a new athlete to experience a painful lower back. At some point in life, nearly everyone will struggle with it. In fact, about 80% of Americans will experience low back pain at some point in their life and nearly a quarter of the population will experience it on any given day.  WHAT TO DO ABOUT IT - Understand Lumbar Neutral Proper lifting technique under fatigue or during big lifts can be complex. The take home message is that you need to maintain “lumbar neutral.” This is basically the middle ground between over-arching (aka lumbar extension) and over-slouching/ rounding (aka lumbar flexion) of the lower back. When we lose this middle ground, we run into trouble. It is extremely important to not only apply the neutral spine concept to exercise-related movements, but also with all your daily activities (ex: long periods of sitting, putting something heavy on the top shelf, doing your laundry). Final Word.. If you’ve experienced back pain you're not alone. Implement these strategies and tips as soon as you can to help get you down the right path. If you have any concerns, feel like something isn’t right, or just want to get better as fast as possible, call a Sports Physical Therapist today! Our profession is armed with years of extensive knowledge and training and we specialize in getting athletes like you back to your sport without pain or limitations. We provide solutions to specific problems. As an athlete myself, I take pride in understanding the mindset and demands of athletes. If you are struggling with lower back pain, hit the button below. Thanks for reading,
Dr. Andrew  There's no doubt that strong and healthy shoulders are absolutely essential for the athlete and active adult. From personal experience, (and according to the literature) shoulder health is often neglected, causing it to be the most commonly injured area in athletics. When you ask your shoulder to perform a movement without the prerequisite range of motion and the required stability, you're pretty much asking for an injury to occur. And that's the key - having a happy marriage between shoulder MOBILITY and shoulder STABILITY. You don't want to be the body builder that can't touch his head nor the gymnast that can touch her elbows to the ground. You want that healthy middle ground. Keeping your shoulders healthy while training can be challenging for many reasons. In this special report, I will reveal to you the top 8 reasons shoulder pain occurs in athletes, and most importantly, what to do about it! They are in no particular order, but they all have one thing in common - they all work! Whether you have no pain at all or have been suffering from shoulder pain for years, these concepts will help you take control of your health and keep you in the gym. From CrossFit and weight lifting, to reaching to the top shelf in your kitchen - these concepts WORK. I recommend that you implement these tips immediately to ensure you perform at your best and stay healthy inside and outside the gym! Reason 01 - Our LifestyleWhat we do throughout the day and night can have a profound impact on the health of our shoulders. Sitting slouched for hours on end can affect the flexibility of some muscles and the strength of others. This position is often accompanied by forward shoulders and a rounded upper back. While positions typically don’t cause shoulder pain in the moment, they set the stage for an injury to occur. They affect the positioning of the shoulder blade, the efficiency of the surrounding muscles (how well they work together), space available within the shoulder for movement, and positioning of the arm as it raises.  In addition to what you do during the day, what you do at night is equally as important. It has actually been shown that sleeping on your shoulder cuts off the blood supply to the rotator cuff tendons preventing them from healing and recovering. Stomach sleeping won’t help your cause either, as this position comprises the shoulder in many ways depending on where you put your arms, none of which are good. WHAT TO DO ABOUT IT - Move More & Adjust Your Sleeping Position Simple enough, right? This reason is more of a reminder than anything. Take a 30 second break every 30 minutes. If you find yourself in the same position for hours on end, you have to move around. And get in the habit of sitting correctly (upright)! Sleeping positions to avoid: Side-lying on the injured shoulder or on the stomach Healthy sleeping positions: On your back or on the non-injured side Reason 02 - Insufficient Warm-UpAppropriate warm up is absolutely CRITICAL, especially when it comes to a healthy shoulder. You are asking for trouble if you try to perform a snatch or pull-up without first addressing mobility restrictions and priming your stabilization muscles. It's far to common for athletes to sit all day long, show up to the gym late, and dive right into their workout without appropriately warming up; OR, they complete a warm-up that has nothing to do with their specific needs and limitations that doesn’t relate to their workout at all. Sound familiar? WHAT TO DO ABOUT IT - Warm Up Appropriately I am a strong advocate of a dynamic warm-up routine specific to the workout you are about to perform. Static stretching can increase short-term range of motion but it’s also been found to decrease power and force output, so it's not ideal. When it comes to the shoulder, your warm-up should be individualized to your specific needs. Since we can’t identify these needs without an assessment, I recommend you follow these general guidelines. Step 1: Get your heart rate up. Ex: 5 minutes of assault bike, rower, ski erg, running, or jump rope Step 2: Mobilize your areas of need. Ex: Typical tight areas include pec minor, pec major, lats, and thoracic spine (upper back) Step 3: Prep the muscles involved in the workout. Ex: Perform inch worm for handstand pushups, or wall slides for overhead pressing Reason 03 - Imbalance Between Internal And External Rotation Shoulder StrengthThe programming and exercises in CrossFit and most classic gym programs tend to focus more on the large muscles of the upper body such as the lats, deltoids, and pecs. Unfortunately, when the large muscles become over dominant compared to the smaller ones, the scapula doesn't move as efficiently and the ball fails to stay centered in the socket. Over time, these imbalances create faulty movement patterns and compensatory mechanisms which put a lot of strain on the shoulder, greatly increasing your chance of injury. WHAT TO DO ABOUT IT - Include Accessory Exercises In Your Programing You MUST supplement your workouts with strengthening exercises that focus on the little guys, meaning the rotator cuff muscles and muscles that surround and attach to the scapula. I typically advise AGAINST isolating specific muscles (ex: arm at side shoulder external rotation) because isolation interferes with muscle firing patterns, muscle coordination, and won’t translate well towards the most common movements we do in our CrossFit workouts and everyday life. Some examples of smart accessory exercises include overhead carries, inch worm, or wall slides.
Reason 04 - Poor Thoracic (Mid / Upper Back) MobilityHere’s an easy way to understand how your thoracic spine can influence the available motion and biomechanics of your shoulder. First, sit with a slouched posture and raise your arm as high as you can. Do you feel tightness and pain with this motion? Now sit up tall and perform the same motion. Does your motion improve? Does your pain change? Now imagine attempting an overhead press or toes to bar with a stiff thoracic spine. Adequate thoracic spine extension and rotation is a critical component of raising your arm overhead. The human body is one big dynamic chain and when one area is stiff or not moving well, another will compensate or overwork beyond what it's used to. Overworking areas are common sources of pain, and the shoulder is usually the victum. WHAT TO DO ABOUT IT - Keep Your Thoracic Spine Mobile Having adequate thoracic mobility is an essential component of a healthy shoulder, especially when your perform demanding athletic movements. I would recommend you perform at least one thoracic spine mobility exercise in your warm-up routine regularly, and if you're stuck sitting in a desk all day, even more often than that. There are many ways to work on this area. Check out the video below for 3 solid choices. Perform 15 reps in each direction with a 1-2 second pause at the furthest point
Reason 05 - Insufficient Scapular (Shoulder Blade) MobilityAs previously mentioned, sufficient movement of your scapula is KEY for a healthy shoulder. Lack of sufficient scapular upward rotation is the most common reason impingement and rotator cuff tendonitis occurs. Overdominance of the muscles that downwardly rotate the scapula (levator scapulae, rhomboids, pec minor), rounded shoulders (tightness of the pec minor), and weakness of the muscles that upwardly rotate the scapula (serratus anterior, upper trap, lower trap) all contribute to this dysfunction. In addition, abuse of scapular retraction (the cue “bring your shoulders down and back” or “pinch your shoulder blades together”) can actually feed into this extremely common cause of shoulder pain and make the problem worse. WHAT TO DO ABOUT IT - Don't Always Squeeze Your Shoulder Blades Together.... And Work On Pec Minor Using the “shoulder blades down and back” cue is fine every once in a while when performing certain exercises like deadlifts for instance but I wouldn’t recommended using it during most exercises, especially overhead pressing. Working on your pec minor muscle can make a SIGNIFICANT difference in most, if not all, individuals struggling with shoulder pain. Here’s how I like to work on it:
Reason 06 - Poor Overhead MobilityThe shoulders obviously play a huge role in many of the lifts performed in CrossFit and weightlifting, especially the snatch, clean and jerk, overhead press, and overhead squat. If your shoulders aren’t mobile enough to get into the positions required for these lifts, you will compensate and lose efficiency. This both increases your chance of injury, and reduces your overall performance. With less than optimal mechanics, you will lose power and expend more energy than you otherwise would, slowing down your workout progress. As I mentioned previously, often times exercise programming emphasizes the big muscles of the upper body, especially the lats and deltoids. When these muscles are trained excessively, they become stiff and prevent full overhead mobility. Poor mobility not only increases your risk of injury when trying to go overhead, but decreases efficiency and power output. WHAT TO DO ABOUT IT - Work On Your Limitations (Duh!) There are many reasons why overhead mobility can be restricted (upper body muscle tightness, poor thoracic spine mobility, tight hips, even poor ankle mobility). The most commonly affected muscle in athletes that prevents full overhead motion is your lats. Give these two mobility drills a try:
Reason 07 - Poor Overhead StabilityAs mentioned previously, the shoulder joint has very little passive stability (joint contact, ligamentous support, etc.) compared to most joints, and therefore relies heavily on active stability (your muscles). The shoulder joint is unlike any in the body in that it allows for extreme ranges of motion in many different planes of movement. This inherent complexity of the shoulder is what enables you to do so much with your arms, however, in order to control this large range of motion you must have adequate stability. CrossFit, for example, is a particularly demanding sport when it comes to stability since often times the movements require stability at the extreme end ranges. A perfect example is the snatch or overhead squat. If you lack the control to appropriately catch the snatch or don’t engage your shoulders during an overhead squat, it's just a matter of time before an injury occurs.mThis concept applies to non-CrossFit athletes as well. Really it applies to everyone. If you don't use it, you lose it! WHAT TO DO ABOUT IT - Always Engage Your Shoulder Overhead How do you engage your shoulders? Whenever your arms are fully overhead, actively press/reach towards the sky, almost like your shrugging towards the ceiling. Never let the barbell sit overhead with shoulders resting (i.e. OH squat and snatch) - this creates excessive shear forces and ultimately dysfunction. In addition, try to finish all your presses all the way through, with a locked out elbow and arms directly overhead. If you fail to fully extend over and over you lose end range stability. Then when you attempt an exercise like the snatch or OH squat that demands end range, your lack of stability will show its true colors.
Reason 08 - Exercise Under Fatigue With Poor TechniqueThe basic idea of fatiguing and tiring out your muscles while working out is the hallmark feature required for gains. But as we know, the more tired we get, the more our technique tends to suffer, making you vulnerable to injury. Don't be that guy! (or girl)! WHAT TO DO ABOUT IT - Don't Get Sloppy! So yes, this last tip is super simple and may seem obvious, but I had to put in here to remind ya'll - NEVER sacrifice sound technique for faster time. It becomes more important to focus on your technique towards the end of your workout when you fatigue, when most injuries occur, compared to the beginning. Final Word..Nearly all workout regimens involve shoulder exercises, making it absolutely essential that an athlete takes appropriate measures to keep their shoulders healthy. The issue isn’t always what we’re doing in the gym that’s detrimental to our shoulders, but equally important is what we’re doing (or not doing) the other 23 hours of the day that make us vulnerable to shoulder dysfunction. How many times throughout the day do you actually lift your arms overhead? Being that the shoulder region is one of the most complex areas in the body, the need to address the aforementioned topics, especially mobility and stability, cannot be emphasized enough. Imbalances place unnecessary levels of stress on tissues which decrease an athlete’s performance and increases their risk of injury.
Keep in mind - there’s a reason why your shoulder hurts. Implement these strategies and techniques as soon as you can to help get you down the right path. If you have any concerns, feel like something isn’t right, or just want to get better as fast as possible, call a performance physical therapist today! I have always considered the shoulder to be my strongest body region to treat and the results speak for themselves. As an athlete myself, I understand the unique demands it puts on the shoulder. If you're struggling with shoulder pain, I can help. Contact us at (704) 848-6466 or send us an email at andrew@thecharlotteathlete.com Thanks for reading, Dr. Andrew  The front rack position can be very uncomfortable for many athletes, whether during a clean, front squat, or receiving a shoulder press. Part 1 detailed mobility drills to improve the specific areas needed for a solid front rack. I’m a firm believer that this is only part of the story. While performing specific mobility drills are without a doubt beneficial, the best way to adapt and improve a position is to spend time in the position, under load. When cold, using just an empty barbell, the front rack can be difficult. The bar will sit on the clavicle/ shoulders or even off the clavicle/ shoulders, and the elbows will barely be in front of the bar. In this position if you were to go into a front squat, you would likely dip forward significantly, or even lose the bar forward. We’ve all been there where we catch a clean and we need to try 2 or 3 times to “hop” the bar up and try to get our hands under it. Then you think to yourself – “I have to jerk this thing?” No way is that gonna happen. The solution sounds easy, right? – just drive the elbows up. But for whatever reason, athletes are just unable to do that. And if they force the positioning, either the bar comes off the shoulders, the bar jams into their throat, or they start doing the ole T-rex front rack where you lose your fingers.  So what do we do? Regardless of where you are – whether novice or more seasoned athlete – we always want to first recommend you start with your full hand around the bar as best as you can. Now this doesn’t mean that you start with your whole hand and as you transition your fingers start to slide off and your back into the T-rex grip. Full hand means full hand. My favorite front rack mobility drill is the front rack itself. I like to add load to the bar, finagle your way into it, and practice this way. Here is step by step what to do: Step 1: Set up a loaded bar, minimum #155 for men and ladies, at normal rack height. Step 2: Grab the bar with both hands, thumb and all. Step 3: Drop a level, and almost a quarter squat (so bar is at forehead height) and step forward Step 4: Use the roll of the bar to drive your elbows forward first (parallel with the floor). In this position you are below the bar and your elbows are where they need to be. Step 5: Now, slowly drive your body up to meet the bar, striving to keep your elbows where they are Step 6: Go as high as you can (goal is for bar to hit the shoulders) and hang there. If you don’t make it to the bar, take a big exhale, and drive elbows forward, and stand up further
It’s also very important to talk about that upper back position. In the front squat and the clean, its very important to be able to stack the pelvis and the rib cage in the upright position. Upper back positioning can be improving by working on getting your hips in front of you and practicing standing tall. Its less about gaining a crazy amount of extension, but more about being able to resist flexion. Most of us have the extension necessary unloaded, however under load, we collapse. Check out this thoracic spine exercise below – it serves as a great drill to improve thoracic positioning during the front squat and teaches the body positional awareness. Perform sets of 4-5 reps, holding for 10 seconds. With the plate on the top work on exhaling and keeping the elbows tight. The goal is to exaggerate the position you want.
Make sure to where lifters at first, or even lifters + change plates if this is a struggle for you. Yes, the plates act as a crutch, but if your front rack looks like the hunch back of Notre Dam, then you need a little help. The goal is to decrease the heel lift as your ability to perform this exercise improves. What's important to recognize is that the mobility work is great, however these should not take the place of specific positional mobility or actual front rack mobility practice. These will have much more carry over because it’s actually in the restricted position. You want to be active and expose the body to the position that’s restricted. I definitely recommend adding in the mobility drills from part 1 either before or even during your front rack positional work, however they shouldn’t take the place of the actual loaded front rack position. Very important! If you’re an athlete in Charlotte and need help with your front rack position or have pain associated with it, you need a practitioner that knows the athlete and knows the language. Shoot me a message at info@thecharlotteathlete.com and we’ll get you moving down the right path fast. Thanks for reading, -Dr. Andrew Credit: Quinn Henoch and Juggernaut Training Systems One of the problems I see all the time at the gym and get a lot of questions on is the front rack position. Being able to get into a good front rack position is vital for many movements in the gym – front squats, cleans, and pressing/ jerking/ receiving the bar to and from the overhead position. If you lack the ability to get into a solid front rack position, you’re not only going to limit progress, but also putting yourself at risk for injury.  Just to make sure we are all on the same page, the front rack position is when you rack or hold the barbell on your shoulders in front of you. Why is it that so many athletes struggle to accomplish and maintain a good front rack position? More often than not it comes down to mobility issues in the upper body. Many lack the mobility and flexibility to fully achieve the position. The biggest contributing factors are thoracic spine (mid back) restrictions, lat and teres major tightness, stiff triceps, and poor wrist mobility. However, a solid, stable core as well as hip and ankle mobility can play a role as well. As you can see, there are a lot of reasons why an athlete can suck at the front rack, and it’s easy to go from exercise to exercise and spin your wheels. So, I decided to put together this post to help streamline improving your front rack. Essentially there are two parts: 1 – mobility drills to help improve individual components limiting the front rack, and 2 – mobility drills done in the front rack position itself. I can’t express enough how important it is to spend time in the front rack position itself to improve the front rack. No different that sitting in a deep squat to improve deep squat mobility!  As we start to think through this problem, I want to first call out the most common reasoning error from athletes that I see time and time again. When they struggle with achieving the front rack position, they often feel like their wrist are going to explode! They feel like the wrists are the problem, and immediately begin engaging in various self wrist extension mobilization exercises. The reality, however, is often the wrists are the victim, and not the actual cause of the issue. Forcing the front rack when you don’t have it not only jams the joints and ligaments in the wrist but can cause an extreme amount of neural tension through the carpel tunnel (located right at the base of the wrist) from extreme compression. Ever experience pins and needles the night after a day of high-volume front rack work? Your likely forcing a position your body can’t handle. 9 times out of the 10, it’s not the wrist that’s the issue, so we need look elsewhere. The following exercises/drills have been beneficial for many of my athletes, clients, and training partners for improving the front rack positioning in weightlifting and CrossFit movements, so I’ve outlined them for you below in order of most common limitations to least common. 1. Thoracic Spine Extension/ Rotation Many of us sit behind a desk all day in a slightly rounded or hunched thoracic position, making it difficult to extend and achieve a strong, neutral position in their trunk with solid core stability. Thoracic (mid/upper back) extension is a key component of a healthy front rack. While its extension that needs improvement, the thoracic spine facet joints are built more for rotation. Improving thoracic rotation can actually indirectly improve thoracic extension better than directly attacking thoracic extension. Therefore, I recommend you perform an exercise that targets both. Here’s a great example:
2. Latissimus Dorsi Flexibility The lats (and teres major) play a major role in achieving a full front rack position. In CrossFit especially, these muscle often are over worked and flat out beat up on a regular basis, increasing stiffness over time. Stiff lats can not only prevent you from getting your elbows up, but also limits shoulder external rotation – a KEY component of achieving a solid front rack. Here are two exercises I love to improve this:
3. Wrist Extension Mobility Last (and probably least), its worth briefly discussing wrist extension mobility. While this is motion is usually not the issue, it can contribute in some cases. Especially if you’ve had a previous wrist injury, and developed some excessive scar tissue, the wrist can get pretty stiff and lead to front rack limitations. Here are two options to help open them up.
Now it’s also important to note that there are other factors can limit the front rack position as well. If you can achieve a solid position in standing, but struggle at the bottom of a front squat or while catching the clean, you likely have a hip or ankle mobility issue (check out our YouTube Channel for great example to improve these). Limitations in core stability, technique and form errors, and inability to generate intra-abdominal pressure, called the Valsalva maneuver, can play a significant role as well.
There you have it. I recommend you pick 1 exercise per body region (choose whichever you fell produces the biggest change for you specifically), make a check list, and spend a few minutes a day 3-5 times a week rolling through them. They are not only effective as a warm-up, but feel free to add them in during rest breaks throughout your front squat or clean session for added mobility work. Now, this is only half the battle! While adding some additional accessory mobility drills are great, I’m a firm believer that using the loaded front rack position itself, may actually be even more beneficial in achieving that solid front rack position. Not only is working in the front rack obviously going to carry over to using the front when lifting weights, but will have more long term carry over, which is of course most important. No one wants to spend 10 minutes a day for months on end with mobility programs, right? Part 2 dives deep into this topic, see be sure to check it out! Thanks for reading, Dr. Andrew In a society where sitting has become the norm, it’s time we take a STAND! (see what I did there?) But seriously, we as Americans spend way too much time sitting. We sit when we drive to and from work, we sit behind computers at work (or at home), we sit to eat, we sit while we wait, we sit while we watch our kids play sports, and you’re likely sitting while reading this right now haha. The list goes on and on. Not to mention, most of you reading this post probably like to workout. So we go from all that sitting, head straight to the gym (or home gym), and expect to workout and move in a healthy way without pain. I’m sorry to say but our bodies are just not made to be handled this way, which is why I’ve created this post...to outline how sitting is wrecking your body, and what to do about it. A big thing sitting does is limit your mobility and strength. How? Let’s start from the top down. When we sit, we tend to slouch. This creates rounded shoulders and promotes a forward head position, which in fact is the leading underlying cause of most types of neck pain. Forward head posture leads to stiffness in the uppermost portions of our neck, and weakness of the muscle in the front of our neck. Our bodies will compensate for stiffness with extra mobility elsewhere, often leading to pain.  Additionally, sitting puts the hip flexors (iliopsoas), a muscle that attaches from the lower back (lumbar spine) to your upper thigh (femur), in a shortened position. So after sitting all day, you stand, and your shortened hip flexor ends up pulling your lumbar spine into a more arched position. And one of the most common causes of back pain is due to excessive extension/arching. Similarly, a shortened hip flexor can pull your thigh (femur) forward, which causes the back of your actual hip joint/capsule to become tight causing jamming of the structures in the front of your hip. This is what often leads to that “pinchy” feeling when you squat deep.  Along those same lines, sitting puts your glutes in a lengthened or slightly stretched position. Muscles like to function at a specific length, so if they’re longer than they should be, they can’t contract as well as they should. And the glutes, being one of the biggest and most powerful muscles of the human body, need to be strong! When your glutes don’t fire adequately, you compensate, which leads to poor movement patterns and potential injuries. You end up using other muscles such as your quads, low back, and hamstrings. This often leads to low back pain, hip pain, and even knee pain. Lastly, typically when you sit, your feet aren’t directly underneath you, they’re in front. Why is this important? Well one of the most common causes of ankle injuries and pain is due to decreased ankle mobility - specifically in the toes to nose direction (dorsiflexion). This is needed to climb and descend stairs, squat deep, lunge comfortably, run properly, etc. With insufficient ankle mobility, we often see tendinitis or overuse type injuries due to the muscles around that joint being overworked while trying to move a stiff ankle. When we sit, we end up sitting with our feet out away from our body or stretching our legs out in front of us which only makes that “toes to nose” direction that much further away.
Besides these few examples of how sitting can affect your mobility and strength, there are alot of other health benefits that you get from standing. Standing has been shown to increase productivity, increase blood flow and oxygen to the brain helping you concentrate longer, and has a positive influence on mood, energy, and overall well being. It has also been proven to reduce blood sugar levels and decrease your risk of developing heart disease. Reducing sedentary time can improve physical, metabolic and even mental health. With all of the issues that sitting causes, there’s a solution, the good old standing desk. But wait! There are a few things you need to know before buying an using a standing desk.
How to Pick and Choose There are many different types of standing desks out there. These range from inexpensive stacking of a couple of books underneath your monitor, to simple adapters that you place on top of your own desk, to fixed standing desks, hand-cranked, and powered automatic self rising desks. How do you choose? The bottom line is that you don’t have to spend thousands of dollars to achieve the benefits of standing. As long as you’re able to adjust the height to meet your specific ergonomic needs...mission accomplished.  How To Set Yourself Up for Success Adjustable standing desks are preferred because of just that...they’re adjustable! You can adjust the height to fit your ergonomic needs. It’s important that the top of your computer screen is at eye level. This will prevent you from having to strain your neck or from falling into the forward head posture that often leads to pain. Your keyboard should be positioned low enough to have a comfortable 90 degree bend in your elbow (making laptops not ideal). Your forearms should be able to rest on a stable surface. If your arms aren’t supported, this can lead to neck and shoulder pain from increased tension or prolonged stretching of those muscles surrounding those joints.  Aiming for Symmetry Most of us that go and try to stand for long periods of time, end up standing in what’s called “swayback”. This means you let your hips drift forward causing your body to “hang out” on the ligaments in the front of your hips (not good), all while your muscles are not well engaged. This is very efficient from an energy standpoint and is what allows us to stand for a long time, but causes strain and creates issues throughout the body. One big issue is that it places enormous strain on your lower back because of the extension moment it creates. Similarly, it isn’t healthy to stand asymmetrically on just one side all day. If your weight is shifted to one side too much or you have only one leg propped up all the time, this can lead to a lot of other imbalances and issues. If you do this, keep things balanced from side to side, spend time on both legs. The best way to stand is to “unlock” your knees (a.k.a. keep a tiny bend in your knees) and stay symmetrical. This engages your muscles and helps protect your joints.  A Different Type of Interval Training
As you’ll notice, this new active way of standing will get tiring! That’s why we recommend easing your way into this whole standing thing. The benefits are GREAT, but you won’t get those same benefits if you’re doing it wrong. So if you suddenly go from sitting all day to standing all day, you run the risk of developing back, leg, or foot pain; it’s better to ease into it by breaking it up into intervals such as 30 min sitting / 20 min standing / 10 min walking (or whatever you find works best for you!). Okay lets pick up right where we left off! Part 1 covered important mobility and stability concepts for pain-free running, part 2 will dive deep into footwear and running technique! Footwear Let’s start off with footwear. There’s no one size fits all when it comes to shoes. So when trying to figure out how much support your shoes should have, without getting too in depth, you need to determine what kind of arch you have. A simple way to find out is to just look at your feet. If that’s not clear, then you can do the “wet feet” test by stepping in some water and observing your foot print.  If you have a high arch, your foot is often more stable and you’ll need less structural support. This also means that your feet may have a hard time absorbing impact and may need extra cushioning. But if you have high arches and wear shoes that also have a high arch, you’re more likely to develop weakness and poor arch strength because your arch muscles aren’t being used. If you have a low arch or flat feet, you’ll likely need more support because you have an unstable foot/arch that likes to collapse or fall inward when you run making you more likely to experience plantar fasciitis and ankle sprains. So you’ll want some type of shoe that helps prevent “overpronation,” and offers structural support for your arch. But if you continue to use your shoe as a crutch or quick fix for your lack of arch, you’ll cause the muscles to weaken even further over time, because they simply have to work less. If you lie somewhere in between, then lucky you! You have a normal foot that is properly aligned with the appropriate amount of pronation and the weight and shock of every step you take is distributed evenly, making it less likely that you’ll experience injuries. So as a general guideline, if you have normal or high arches, you likely need more flexible, minimalist shoes. However if you have flat feet, you likely could benefit from more supportive shoes to help relieve some pain while you get them stronger. However, in either circumstance you need solid arch strength. This can be done by performing these exercises below: 1. Toe yoga: 3 minutes (video 1) 2. Arch Lifts: 3 minutes, hold 5 sec (video 1) 3. Floor sweeps: 3 sets of 15-20 reps (video 2)
Technique: Lastly, let’s address running technique. How to be the most efficient because let’s face it, we don’t want to waste any energy if we don’t have to. More efficiency means you’ll get less tired, be able to run further, and have a decreased injury risk. The recommendations below are for your average novice runner, not the more seasoned vet as advanced techniques are often involved more. Is the correct part of your foot contacting the ground? In general you should focus on striking the ground with your midfoot. This will make your strides shorter and you’ll land closer to under your center of gravity making your technique more efficient.  Is your arm swing effective? While looking forward, your hands should disappear below and behind your peripheral vision on each of your backswings. If your arm swing is poor, then it won’t cue a backward-driving leg action (hip extension) or your arms will tend to swing left and right, rotating the torso to maintain balance and diverting energy sideways that could be propelling you forward. Are you a “bobber”? You should also aim to propel yourself as horizontally as possible, don’t bob up and down. What do I mean? Well a common method runners use to develop propulsion is the upward thrust. As they toe off, the knee is straightened forcefully, thrusting the body up and forward which wastes a tremendous amount of energy. This up and down method of running, employed to some degree by most runners, is extremely inefficient. Learning to use the glutes to extend the hips and create horizontal propulsion with minimal vertical oscillation will help you run farther and faster.  Are you leaning forward?
Leaning forward while you run can help you become more efficient by creating forward momentum. If you’re leaning too little, you’ll find it’s hard to move your body forward as you fatigue, your legs will have to work harder to push you forward. If, on the other hand, you’re leaning too much, you’ll find it’s difficult to bring your legs forward as you fatigue, they’ll feel like they drag behind you and your hip flexors will have to work harder to pick your feet up. Bottom Line Running is a great workout, especially while we’re all stuck at home. But it shouldn’t be your only source of exercise. Just like with everything else in this world, it’s all about balance. Make sure you’re doing enough supplemental and accessory work to fill in the gaps running has. If running is your passion, accessory work is KEY. Let’s make sure we’re still healthy and pain free when we’re allowed to get back to our regular choice of exercise. Do this by working on your mobility and strength, choosing the right footwear, and being aware of your technique. Everyone’s needs, choice of footwear, and form will look different, but choose the one that feels best for you and gives you the best results. Happy Running! -Dr. Aerial Whether you’re a typical globo gym-goer, a CrossFitter, a yogi, hiker, or anything else, we all have one thing in common right now...all of our gyms and parks are closed! Our usual preference for exercise is now altered and we’re being forced to be creative. So if you’re like me, you’re trying to turn your home into the best gym you can so you don’t lose all of your progress you’ve been making in the gym. Being cooped up inside our homes can make us go a little stir crazy and there’s only so many body weight exercises we can do! The solution we’ve resorted to? Running. I’ve seen a lot more athletes take up running to try to keep up with their cardio, endurance, and fitness. So with this new increase in mileage and frequency of running, whether you’re a novice or an elite runner, comes new aches, pains, and injuries. This post will address some of the most common things new runners should be aware of to improve performance and steer clear of injury, such as important mobility and stability drills, appropriate footwear, and proper technique - help keep ya'll running for days! (and maybe even beyond quarantine).  Let’s start with the hips; from a mobility perspective. Hip flexor tightness is one of the most common things we see. Your hip flexor (iliopsoas) does exactly what it sounds like it does - it flexes your hip, aka brings your thigh toward your stomach. Cnsider this, if you were to run an 8 minute mile, you’re taking an average of 1,500 steps! That’s a lot of times that you’re asking your hip flexor to work, especially when you multiply that 1 mile by 2..3..even 4 miles or more. When hip flexors are worked to that degree, they become tense and often tight, causing your pelvis to rotate anteriorly (forward) which then negitvely affects the muscles on the opposite side, your glutes. And when muscles are lengthened, they’re typically weak.  This brings me to stability. Let me first say that running is technically a one-legged sport (both feet are never on the ground at the same time). One leg has to support the entire load of your body and much of that single leg stability comes from your glutes - gluteus medius in particular. Similarly, because running is a uniplanar motion (meaning you commonly go in one direction... forward), you’re rarely training your glutes the way they need to be trained. Your glutes wrap around to the sides of your hips, so they need lateral movement to strengthen them. How does this affect your foot and ankle? Glad you asked. Your glutes control the amount of rotation of your thigh, which then (since everything in the body is connected) contributes to the amount of inward collapse happening, not only at your knee, but also in the arch of your foot (a movement known as pronation), which is what common culprit to pain and injury. So if you’re not doing supplemental lateral movements and glute strengthening, then you won’t be able to control your arch, counteract the pull of your hip flexors, or actively support your body the way you need to while running. Here's what we recommend: 1. Start with this KB psoas release for 2 minutes per side:
2. Then follow it up with: a. Banded side step/squat combo. Shoot for 3 sets of at least 20ft of side stepping followed by at least 10 squats
b. Kettlebell Deadlift. Make it hard, make it heavy. Atleast 3 sets.
3. Single Leg Kettlebell Deadlift. Also make it hard, make it heavy. Atleast 3 sets.
Now let’s talk about the ankle and big toe. Hypomobility or joint stiffness can commonly develop in athletes. Because of the repetitive propulsion that is required from your feet and ankles, your calves and achilles tendons are likely to become tight. Over time, this tightness will affect the mobility of your ankle joint and limit your ability to bring your ankle in the opposite direction, the “toes to nose” direction known as dorsiflexion. With insufficient ankle mobility, the muscles surrounding your joint become overworked and can lead to overuse or “tendonitis” type injuries because they’re trying to move a joint that’s unable to be moved. Additionally, with months of running without supplemental mobility work, activities that require this “toes to nose” motion (which can also be thought of as decreasing the angle between your shin and foot), such as any kind of squatting or even going up and down stairs may be more difficult. Similarly, the big toe (aka your body’s kickstand!!) is also an important part of that propulsion. It acts by what’s known as the “windlass mechanism”. As you propel yourself forward, your big toe is supposed to be able to extend. This winds up the plantar fascia underneath your foot in order to create a more rigid foot capable of maintaining your arch, withstanding your body weight, and allowing for a strong push off as you run.  With a stiff big toe, your plantar fascia can’t support your foot as it needs and your foot is more likely to overpronate or collapse inward. This excessive mobility in the midfoot alters the mechanics of your ankle-foot complex and is what commonly leads to injuries  What to do about your mobility: 1. Ankle dorsiflexion self mobilizations: perform 20 reps each side 2. Great toe extension self mobilizations: perform 20 reps each side
While mobility and strength are important elements you need to consider, there are other components that have just as big of an impact on your ability to stay pain free. Two of the biggest are choice of footwear (arch dependent) and your running technique. Check out part 2 of this series where we dive deep in each!
Dr. Aerial |
This is where we share our expert opinion on hot topics in physical therapy, injury prevention, sports performance, strength and conditioning, nutrition, and sometimes other random thoughts. Enjoy.
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