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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
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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  OKAY, now that I've got your attention haha. Raise your hand if your guilty of this - your upper trap is all fired up from a tough workout, from a few miles pounding the pavement, or after a long day sitting behind a desk at work - so for treatment you end up smashing it, stretching it, and/or massaging it until the cows come home. You smash it from different angles with a lacrosse ball, get your significant other to massage it out into a nice cookie dough complexity (if this is you, you picked a good one), or stretch it by bringing the chin to opposite armpit and pulling your head in that direction…. and it feels a little better, perhaps even resolves the pain. But then…. IT COMES BACK, time and time again, and it you can’t seem to shake it. PS - if you actually raised your hand, mad props.  Why does it come back? Why is the muscle such a pain to deal with? Well, its because were attacking it all wrong! I regularly hear physical therapists telling patients that this muscle is 'too tight' or ‘over active’ and so it's the cause of their chronic pain. I hear massage therapists explaining how they can feel or see that this muscle is knotted and tense, and explain how it needs to be released, loosened and stretched. I also see and hear many practitioners (chiros, PTs, trainers) choosing exercises to help reduce upper trap activity, by focusing on the lower traps to restore the balance between them. Well I argue the exact opposite approach is needed.  The upper trap is rarely actually short and tight, even if it feels that way. All the mashing and smashing won’t do anything. Sure, the soft tissue work will trigger a neuromuscular response causing momentary improvement, but its not doing anything in the long run. Simply because that's not the root of the problem. The root of the problem is typically one of two things:
Let's talk deeper about each of these. The primary role of the upper trap muscle is to elevate and upwardly rotate the scapula (shoulder blade) to produce healthy overhead arm movements. I can’t tell you how many times I look at someone's shoulder girdle and see downward sloping clavicles (collar bones), and depressed/ downward sloping scapulas -- both indicative of lengthened, overstretched traps. To put things into perspective, the number one most common impairment associated with shoulder impingement (the most common shoulder issue) is scapular related. What attaches to the scapula? The traps! SO if the scapula is not positioned appropriately or moving efficiently around your rib cage as you raise your arm overhead, the upper traps won’t be able to function as they want to, resulting in that tense, overworked feeling you get.
The “tightness” feeling that athletes complain of is actually protective tension - it's their body doing anything it possibly can to avoid dropping lower into scapular depression/ downward rotation. The tight and tense ‘feel” is because they are overloaded due to being weak. The upper traps are working to elevate the scapula against gravity all the time, and if they’re weak, they won’t be able to keep up. If you give him a bunch of massage and stretching, it's like picking a scab; he'll feel better for 15 minutes, and then in rougher shape over the long haul. You never want to stretch out protective tension. So what do we do?  Stop smashing, poking, rubbing, and stretching and start strengthening. We need to get them stronger, more resilient, more robust. Now, when I say strengthening I don’t mean shoulder shrugs, that can actually make things worse. As I previously mentioned, the role of the traps is to raise the arm overhead, so that means we need to train them overhead. If we strengthen them below shoulder height, i.e. dumbell shrugs, power cleans, we are training the traps to perform an action they aren't designed to do. So you want to choose drills that drive upward rotation - such as wall slides, straight arm sled work, inchworm, overhead walking lunges, overhead squat, or landmine presses.
It would also benefit you to slow down on anything that tugs the shoulders down such as deadlifts, dumbbell lunges (weights at sides), or farmer’s walks. Lasty, forget the shoulder blade to back pocket “down and back” cue. This might be one of the most overrated and overused cues of all time, often getting athletes in trouble and leading to pain. In fact, I may circle back in the near future and write an entire blog post on this cue. If you’re using it with everything you do, stop it. Especially if you have shoulder pain. Sorry to go off on a tangent but the amount of mis-information out there is absurd, and this cue is up there with the most over-rated cues out there. Anyways, train the upper traps as I outlined above and they will thank you for it. The second most common cause of the upper trap tension feeling is actually not from the upper trap at all, but what lies just beneath it - the 1st rib. 1st rib dysfunction is very common, and can closely mimic upper trap issues. To improve this, first we need to get to the root of the issue, which relates to your neck.  Here’s what happens: Forward head posture → fires up your scalene muscles → pulls on 1st rib → pain Excessive amounts of forward head posture, whether from sitting behind a computer all day or poor lifting technique (for most of you athletes it might be the later - think forward head with deadlifts, double unders, squatting, rowing, pull-ups, etc, etc,), can fire up the scalenes, which are muscles that run down the sides of the neck. Over time, the scalenes become tight and hypertonic and start to excessively pull and tug on their attachment point - you guessed it, the 1st rib. The 1st rib then gets pulled into an elevated and dysfunctional position, causing that deep dull “upper trap” tension feeling. This common joint restriction is another reason why smashing and stretching the upper trap doesn’t help. So how do we treat the 1st rib? Easy. First, we need to improve the underlying cause which is essentially how we hold our head (head positioning) throughout the day and when we work out. See my previous blog post “Neck Pain in Crossfit: Why it happens, and what to do about it!” for an in depth review on this topic. However, the main thing to think about is to try to reel your head in from that nasty forward head position, and try to keep the neck neutral. Essentially, you want to try and keep the chin close to the neck. This will take the scalenes off tension and reduce its menacing pull on the 1st rib. Secondly, you want to work on self mobilizing the 1st rib into a better position. Here is an example of a great exercise to achieve this: While this is a great exercise to improve 1st rib dysfunction, you must improve your neutral cervical spine positioning for lasting results. These simple concepts can make a huge difference for long term relief.
In summary, I hope I have given you some food for thought about the poor old upper trap muscles and what to do about it. Hopefully you won’t be so quick to blame this poorly misunderstood muscle as being tight and short, and think twice before you dive in so quickly with massage, stretches, or lacrosse ball smashing. And I hope that you can see that strengthening actually improves the function of the upper traps. If you have any questions, please comment below, or reach out to us! Thanks for reading, Dr. Andrew One of the most common faulty movement patterns we deal with as athletes is overpronation, aka a collapsing arch in our foot. A solid arch must be able to maintain solid integrity during your day-to-day activities and stand up to environmental demands. Flat feet, or overpronators, are not uncommon. In fact, nearly a quarter of the population deals with it. Most of the time having flat feet doesn’t cause any significant problems, however in some causes it can not only lead to foot and ankle pain, but cause issues up the chain and contribute to knee pain, hip pain, and even lower back problems. If you have flat feet or dealing with pain associated with collapsing arches, read on.  Flat feet are actually normal in infants and toddlers, however, during childhood, most people develop an arch. Some do not. Research published in the Journal of Bone and Joint Surgery found that kids who wore shoes were three times more likely to develop flat feet than those who spent most of the time bearfoot. This link is tied directly with development of the strength of the muscles within your foot. Shoes act as an external support, causing the foot intrinsics to not need to work as hard. While you can be born with flat feet, more often than not it's acquired through the years. It’s estimated that about 20% of adults deal with it. However, if you’ve noticed your once-sturdy arches have started flattening over time, you might be in for more pain. More often than not, this is caused by chronic stretching, tearing, and weakening of the posterior tibial tendon—the tendon most responsible for supporting the arch. If you do nothing, adult-acquired flatfoot tends to get progressively worse and worse. You may not feel much pain now, but the likelihood is high that it may be coming in your near future..  The influence of shoes and flat feet The foot/ankle complex needs to serve as a rigid lever for weight bearing and propulsion during movement, and at the same time, be a flexible structure to adapt to altering surface areas. In addition, the foot/ankle complex works to support body weight, provide proprioceptive feedback (awareness of where your body is in space), and absorb shock. This flexibility is needed to allow the foot to conform to varying surfaces, especially when walking barefoot. When adding shoes to the equation, these natural mechanics can be altered. A shoe that is to stiff and doesn’t bend much can provide too much support and potentially weaken the arch muscles over time. Everyone’s specific circumstances are different depending on the integrity of your arches and what forces you subject them too, causing everyone's footwear needs to vary from one person to the next. Most traditional shoes, including athletic shoes, are over-supportive, increasing the potential for weakness over time. If you have decent arches and you wear supportive shoes, you could be putting yourself at risk for developing foot weakness and poor arch strength, simply because your arch muscles don’t need to do anything. On the flip side, if you have severely collapsing arches, and you pop on minimalist shoes, you may be in trouble. These athletes may benefit from a more supportive footwear to provide some temporary relief. The word temporary is in there for a reason. This can be a double edged sword, since adding external stability (the stiff shoe) to your foot will cause the muscles to weaken even further over time, because they simply have to work less. 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, which we’ll dive into deeper in these next few paragraphs. In addition to most traditional shoes being more rigid, many also have a raised heel relative to the toes (and even worse with women’s high heels are men’s work/business shoes). This places the foot in a relative position of plantarflexion -- the ankle pointed down -- position. Over time, this can cause the upward motion, dorsiflexion, to become stiff, causing restrictions in the ankle joint and calf muscles and achilles tendon. Lack of ankle dorsiflexion is one of the leading causes of excessive stress on the arch and other regions around the foot and ankle. Especially if you engage in activities that require a lot of it - think squatting, running, etc - you could be in a lot of trouble.  Spending more time outside your shoes helps not only maintain adequate dorsiflexion but helps to strengthen the arch muscles. But before you throw away all your shoes I should mention that the role shoes play in flat feet and overpronation still is not entirely clear. There are likely many other contributing factors such as genetics, weight, hip strength, and other environmental factors that play a role. So let's dig in a bit further. The Effect of Body Weight and Flat Feet The basic structure of the foot is formed by the shape of the bones, connected by ligaments, and supported by muscles forming a bridge. The bones wedge together in a way to provide a firm foundation from the forces coming down from above. The ligaments provide resistance to these bones separating. The muscles that connect in and around the foot have the ability to lock and unlock the bridge. For instance when we want to push off we need our foot to be locked for propulsion and when we land we need our foot to unlock to absorb impact and conform to the ground.  The connection between arch (bridge) integrity and weight is straight forward. The more weight we carry, the stronger the bridge needs to be, and the harder the arch needs to work to support its shape. The ligaments and muscles then need to be stronger to hold firm, however, because of the amount of time we spend in shoes, and the subsequent hip weakness that occurs in overweight individuals, this rarely happens. So, to not beat around the bush anymore, if you've got a dad bod or you've been carrying excess weight, consider working on losing some lbs. The Effect of Hip Strength and Flat Feet The body moves and functions as one big machine, on big unit. If one part isn’t pulling its weight, others will suffer the consequences. There is clear evidence that hip weakness can lead to a host of problems, including excessive pronation. Hip weakness, particularly with your glute max and glute med (your booty muscles) lead to poor movement patterns and poor control of what's happening downstream. For you science nerds out there, it essentially causes femoral internal rotation, leading to genu valgus, and further causing that inward collapse of the arch! What About Orthotics? Overall, I am not a big advocate of orthotics, however, they can be helpful in certain situations and more severe cases. Using an artificial arch support can prevent the arch from excessive collapsing and significantly reduce pain. As we mentioned previously, however, this can further weaken the arch over time, and potentially lead to more frustrating and involved issues down the road. I would recommend to only go to an orthotic as a last resort, not as your first option. And if you do, make sure you continue to work on strengthening the arch muscles and spend time barefoot within tolerance.  The Takeaway
Our constant use of over-supportive footwear, poor hip strength, extra lbs, and other environmental factors can lead to the development of painful flat feet. The bottom line is that 9 times out of 10 this is a strengthening issue (check out my youtube channel and instagram for arch exercises), nothing more. If you want to reduce the pains associated with an excessively collapsing arch, you must take an active, not passive approach (i.e. ice, stretching, massage, estim, laser, etc. etc.) in your treatment. We, at The Charlotte Athlete, help athletes and active individuals dealing with flat feet and collapsing arches all the time. If this is you, and your foot pain is affecting your workouts or your day to day life, shoot me an e-mail at andrew@thecharlotteathlete.com, and we’ll help get you rolling down the right path! THanks for reading, Dr. Andrew As we mentioned in Part I, the deadlift is arguably one the best exercises to improve total body strength and fortitude. As simple as the movement seems to be, it's very complex and athletes often plateau and get frustrated. Below i’ve listed 7 tips to help improve performance. Add each one every time you train, be consistent, and your numbers will no doubt improve!  Tip 1: Don’t Stretch Prior To Lifting
Static stretching major muscle groups (such as hamstrings or glutes) prior to lifting can be detrimental to your lift, as it decreases power output and can actually increase your chance of injury. Of course, it's always important to properly warm-up and mobilize tighter joints, just make sure to avoid prolonged stretching of the glutes or hamstrings. Stick to a dynamic warm-up with bodyweight exercises like squats and banded good mornings before deadlifting. Tip 2: Stay On Your Heels Plain and simple, keep your weight on your heels throughout the entirety of the lift. Try not to allow yourself to drift forward onto your forefoot or toes. This exercise is meant to develop posterior chain strength, not the quads. Tip 3: Don’t Wear High Heels I mean, lifters, or running shoes for that matter. Save your tennis shoes for the tennis court! Wearing lifters or athletic shoes while deadlifting causes a forward weight shift increasing stress on the lower back and decreasing posterior chain activity. Ideally, you want to avoid footwear consisting of any kind of heel lift or cushion. The main purpose of this exercise is to activate the posterior chain, so you need to stay on your heels. I recommend deadlifting in flat shoes with flat soles or simply go barefoot. Tip 4: Take The Slack Out Of The Bar Taking the slack out of the bar pre-lift allows the lifter to generate maximal muscle tension in the spinal erectors. This is extremely important to not only reduce rounding in the lower back, but prime neuromuscular stiffness in the involved muscles. After you set up properly, pull your chest up and simultaneously pull the weight of the bar till you feel the generated tension, then explosively perform the lift. Tip 5: Push The Ground Away From You The deadlift is not a pull exercise, but rather a push. By pulling the bar, you lose engagement in your lats, failing the lift and putting noticeably more stress on your lower back. By pushing the ground away and standing up, you maintain lat engagement and use the posterior chain. For many, fixing this issue is the single biggest factor towards improving their deadlift. Tip 6: Struggling To Lock Out With A Max Out? Train With An Elevated Bar The deadlift lock out is driven by glute and low back strength as well as the upper back. Often times a poor lock out can be related to problems in the starting position or loss of hip position throughout the lift. But for this tip, we will assume your technique is stabilized and you just need to improve strength on those specific areas. Elevating the bar on the blocks, typically 2-4 inches high can be a useful way to strengthen the lock out. Block pulls are typically weaker than lifting from the floor -- this is due to the lifters inability to generate leg drive with the bar in the elevated position, causing the hips and back to work harder to move the weight. Overloading these areas will help strengthen the lock out for conventional deadlifts. Other exercises to consider are the barbell hip thrust and barbell good morning - but make sure to focus on full strict lockout with sound technique. Tip 7: Place Your Shoulder Blades In Your Back Pocket Proper setup is everything. Placing your shoulder blades in your back pocket will help ensure a solid start position and set the stage for a successful lift. Keeping them down and together will keep the chest tall, puts the hips in an advantageous position, and keeps the upper back tight and ready to lift. Simple, but effective. Heavy deadlifts will put muscles on places you didn’t even know existed. Keep these cues in mind everytime you deadlift, and not only will that annoying lower back tightness and pain subside over time, but you’ll likely hit a PR in no time! If you're in the Charlotte area and are dealing with lower back pain or need help safely executing the deadlift, i’d love to work with you to help you get reach your goals. We work with athletes and active individuals all the time who are trying to improve their fitness and overall health so they feel great long term. If this is you and you’re struggling with pain or recurring issues, I can help. E-mail me andrew@thecharlotteathlete.com to get started! Thanks for reading, Dr. Andrew Deadlifts are bad for your back… just kidding. They’re not. Deadlifting with bad form and technique is bad for your back. The deadlift is THE must-have exercise to build total body strength, pack on slabs of muscle, and sculpt awesome athleticism. It is arguably one of the very best exercises out there, and is almost indispensable for developing a well-rounded, muscular physique. And for many guys, it is also the exercise where they are lifting the most weight, in terms of sheer poundage, which can be very satisfying, almost reputation building. So I mean, how complicated could it be? In theory, you perform a deadlift by simply bending over and picking something heavy up off the floor. Just like Arnold famously once said…. “I pick things up and put them down!”  However, anyone who's spent any time above the bar knows how complex this “simple” movement can be. It's amazing how often I see athletes screwing this movement up. Compared to many other exercises, it is extremely easy to do it incorrectly if you have poor form. In fact, I would say that the vast majority of guys and gals that I see deadlifting are doing it wrong. This means that they are inefficient, not getting as much out of the exercise as they could be, not lifting as much weight as they could be, and are often really risking injury in the process. But not to worry - for all you deadlifters out there (and aspiring deadlifters), I’ve outlined below 7 of the most common deadlifting errors to be careful of, along with a few bonus tips at the end. Apply these principles, and don’t be surprised if you can pull much more weight—with less pain—the next time you deadlift. Error #1: You Squat Your Deadlift The deadlift and squat are two very different movements, performed differently, for different reasons. And I get this: the 2 exercises have their similarities – but make no mistake about it, the deadlift is not simply a squat in reverse. The squat is geared more towards quad development, whereas the deadlift is geared more towards posterior chain (glutes and hamstrings) development. Therefore the chest up, butt down position cue is not ideal for the deadlift. The deadlift is a hip hinge based movement, with a much lesser degree of knee bend, and a much greater focus on the hips themselves. When you see someone attempt to perform a heavy deadlift from a squat set-up, outside of constantly scabbing their shins, you'll notice that the body will actually attempt to reorganize its starting position before the weight actually leaves the floor. This happens because squatting a deadlift is inefficient. The brief moment it takes to re-adjust body position from an incorrect setup, however, may not allow enough time for the lats to generate maximum tension, which means they may lose the ability to properly support the lumbar spine. This greatly increases the chance of experiencing excessive lower back tightness and pain. Not to mention the glutes are much stronger than the quads, so you will not only fatigue faster, but won’t be able to move as much weight.  Error #2: Your Hips Shoot Up Too Fast As I mentioned, the glutes are the primary movers during the deadlift exercise. If your hips are shooting up to fast, that means you are extending your knees and engaging your quads prematurely. The movement then becomes more of a stiff leg deadlift rather than a conventional deadlift. As weight increases, this pattern becomes more common - lifters drive through and extend their legs, with the bar hardly moving at all - which leaves the back to perform more work, greatly increasing the chance of undo stress and irritation. This will also increase the chance that your back rounds before completing the lift. Keep your core tight and make sure the bar rises as your legs and hips extend simultaneously. The back angle should remain the same when the bar leaves the floor and throughout the first segment of the lift.  Error #3: Your Grip Is Too Wide When you grip the barbell too wide, you lose the ability to properly engage your lat muscles, which is an integral part of the deadlift. Not to mention it feels awkward too. Really, your grip position should be just outside of hips, right next to your legs. With a closer grip, you can keep the barbell closer to your body which creates a more efficient, more controlled lift.  Error #4: The Bar Path Is Too Far From Your Body. This is a big one, and largely related to your setup. In order to perform an efficient deadlift, the bar path needs to be as short as possible from start to finish, which means the bar needs to travel in a perfect vertical line. Far too many athletes start too far away from the bar. Then, when they execute the lift, the bar travels too distant from the body, greatly increasing lower back strain. Start with the bar directly over the midfoot. As you execute the lift, make sure the bar travels directly vertical and stays close to your body all the way to the top. The final position of the bar should be directly over where it was on the floor.  Error #5: You Excessively Round Your Back Experienced deadlifters don’t make this mistake, however it's quite common among new and novice lifters or those who have never been coached properly. Similar to the early hip rise error, this often occurs when the lifter allows their knees to extend too quickly at the initiation of the lift. This causes you to lose the natural (slightly curved) position of the lower back much easier and increases the likelihood of rounding your back. Keep your barbell weight evenly distributed throughout your spine, and be sure include a slight bend in your knees to help keep the lower back in its neutral alignment throughout the lift.  Error #6: You Set Up Your Deadlift Stance Too Wide When you set up your deadlift stance too wide, and the feet are outside of hip width, there’s no place for the knees to go except in. You will see valgus (collapse) at the knee and pronation (collapse) at the foot, which is the last thing you want when trying to generate force to lift a heavy weight off the ground. Keep your feet hip width apart, no wider, and toes pointed forward.  Error #7: You Lean Back At The Top Of Your Lift This error occurs when you complete the lift but continue to arch and extend your lower back after lockout, jutting your pelvis forward. This is totally unnecessary and a useless addition to the deadlift. In some cases, you may simply be unaware of how to properly use your hips during the deadlift, so you resort to a compensation pattern by hyper-extending the low back. In other cases, the glutes may just be too weak to finish the movement, so you rely on using your lower back excessively to help complete the lift. In either scenario, using less weight and/or going over technique will help to reinforce the correct movement pattern and stop this monstrosity from ever happening again. If not, the added lumbar stress will one day catch up with you. In the name of safety, efficiency, and performance, finish the lift strong, stand tall, and resist the urge to lean back! Correct those errors and you’ll greatly reduce the likelihood of an injury. Add these tips below and you’ll bust through performance plateaus!  Heavy deadlifts will put muscles on places you didn’t even know existed. Keep these cues in mind every time you deadlift, and not only will that annoying lower back tightness and pain subside over time, but you’ll likely hit a PR in no time! If you're in the Charlotte area and are dealing with lower back pain or need help safely executing the deadlift, I’d love to work with you to help you get reach your goals. We work with athletes and active individuals all the time who are trying to improve their fitness and overall health so they feel great long term. If this is you and you’re struggling with pain or recurring issues, I can help. E-mail me andrew@thecharlotteathlete.com to get started!
PS - Make sure to check out next week's blog for 7 ADDITIONAL tips to improve your deadlift! Thanks for reading, Dr. Andrew Neck pain, upper trap tightness, and headaches are very common issues in CrossFit athletes. I’ve heard the story far to many times - you’re good heading into the workout of the day, but afterwards, you’re dealing with severe neck stiffness and pain. Why is this? What’s causing this to happen? The health of our cervical spine (neck) is directly related to how you position your head while you workout, and your form and technique while exercising. Let's talk briefly on anatomy so you can gain a clear picture on what's going on. The cervical spine is made up of a series of joints stacked on top of each other. In the ideal world, each of these levels contribute to motion. However because of the prolonged positions we put ourselves through throughout the day (sitting, computer work, driving, reading, texting) we can develop stiffness in certain areas. These stiff areas then cause adjacent segments to compensate and move excessively to pick up the slack. Over time, this compensation leads to irritation of the joints, muscles, and nerves associated with the neck.  How does this relate to CrossFit? In CrossFit, we perform a lot more movement in our neck than you would think. Some of the obvious ones include pull ups (getting your chin over the bar), Olympic lifts (eyes straight ahead), wall balls (looking up), and burpees (looking up or to the side). Some less obvious ones include squats, deadlift, jump rope, and shoulder press. If we take the stiffness and imbalances we develop throughout the day, then workout with exercises that involve neck motion, excessive movement will occur the non-stiff segments, potentially leading to some serious stiffness and pain. Let’s dig deeper… What neck movements should we be mindful of when we workout? Nearly all neck injuries that I see in CrossFit are related to cervical extension or excessive forward head posture. When we jut our head forward to much, we get excessive shear forces and irritation of the joints and ligaments in the neck resulting in tense and hypertonic muscles and potentially an irritated nerve. Here are some examples of what i’m talking about.
What about Olympic Lifts? There are certain instances where a quick “pez dispenser-like” cervical extension movement is an important part of a lift like the Jerk. This is fine for most, however if you’re dealing with neck irritation, it might be smart to hold off for a bit to allow things to settle down. What about the “head through” cue? The “head through the hole” coaching cue is a great cue to help complete overhead lifts, however it can also backfire and contribute to neck pain. It’s not the coaches fault though. This cue can lead to neck pain when there are mobility issues elsewhere… whether within the neck itself as I mentioned earlier, or in the shoulders or thoracic spine (mid back). If you lack mobility in either of the aforementioned areas, your head will need to work extra hard to get through “the hole.” What can I do if I have neck pain? Of course, i’m going to be bias and recommend you see a performance physical therapist who specializes in CrossFit athletes. However, you can start here: 1. Work on keeping your neck more neutral with ALL CrossFit movements 2. Improve your shoulder and thoracic spine mobility
3. Improve deep neck flexor strength
We, as physical therapists, have even more tools in our toolbox to help you improve the health of your neck, so let us know what you need help with! Try to avoid quick fixes like manipulations or just rolling it out. We help you figure out what the root cause is on WHY you are experiencing neck pain.
Thanks for reading, Dr. Andrew Lower back pain is the single leading cause of disability worldwide, with about one-half of all working Americans admitting to having back pain symptoms each year. These numbers are astounding. So the question is not if you get lower back, it's more like when you get lower back pain -- what should you do about it? Most of the time we aren’t sure why what caused our lower back pain to start in the first place, much less what to do to make improvements. The following are things you SHOULDN’T do to help get you back on the right track. Lower back pain can be like an old scab -- if you continue to do things don’t allow it the opportunity to heal, it wont! Fail to acknowledge that its there Don't settle because your old, fat, out of shape, tried therapy, or someone said you had a herniated disc. Don't let it become a part of your identity. Having pain is not normal, and sometimes we struggle to recognize this. If you experience lower back pain or extreme tightness after your workouts, something's not right. It's always better to take action now before it turns into a more frustrating, more painful issue that can lead to unnecessary costly injections and procedures down the road. If you have pain, even minor pain, take action to eliminate it.  Continue doing things that aren’t helping I actually had a patient once who severely injured her back performing an overhead squat. She saw a chiropractor, was was told she will need to do prone press ups the rest of her life. Seriously? This isn’t a hit on chiropractors because I see it happening all the time in the physical therapy profession too. After 2 weeks of simple treatment specific to her injury, she was back to working out without issues. If you’ve been told something like this, or if you’ve been doing the same lower back routines day in and day out without long term relief, it might be time for a change. When it comes to the lower back, “rehab” or “conditioning” exercises should not be painful, and typically it don’t take long before patients start experiencing significant relief (if you select the right ones). If you’ve been doing the same movements or exercises for weeks or months, it's time to consider some different avenues.  Sit or rest for long periods First rule of thumb → after a lower back flare up or aggravation, that last thing you want to do is sit on the coach, binge on Netflix (unless it's Game of Thrones) and try to wait it out. If it’s really bothering us, sometimes we don’t want to move at all, however if we avoid movement, we allow the problem to fester. It may be uncomfortable to get started, but exercise has been proven to be beneficial for nearly all low back pain cases. The best action is to find a simple form of exercise that feels okay. Examples might include going for a walk, spending time on the stationary bike, or doing some light rowing. When we move around, important healing hormones are released which circulate throughout the body, and nutrient rich blood flow is directed to the healing areas. It also causing increased muscle activation, thus providing more stability to aggravated area.  Do things that are painful While this may seem like common knowledge, when our back tightens or flares up, often we continue to engage movements or positions that aggravate the area. It's almost like picking a scab. If we continue to aggravate it, it simply will be slow to recover. If a particular lift or movement (i.e. deadlift, burpee) continues to cause pain, it’s time to take a break from it. Pain is a signal that something isn’t right. Either sub the exercise out or modify it so its pain free. Just as its important to consider activities in the gym, is to consider painful activities outside of the gym. Sitting for extended periods, sleeping on your stomach, driving for long periods, lifting heavy objects with poor form, and twisting awkwardly are all common activities that tend to increase your pain. Be smart and listen to your body.  Lift with poor body mechanics Speaking of lifting, If your going through a period of lower back pain or tightness, it's important to recognize if you’re putting unnecessary stress on your back… whether from poor body mechanics when picking something up from the floor or poor technique when weight lifting. Allowing your weight to shift towards your toes when performing these activities puts increased strain on your back. Recognizing this simple concept can significantly reduce lower back pain and pressure. It's also important not to bend at your back throughout the day. If you need to pick something up, make sure to keep it close to the body and use your legs, even go down to one knee if you have continued pain.  Don’t seek help from a back pain expert (physical therapist) when you know you need it
If you’ve had an acute flare-up or experienced pain for more than a week or two, stop wasting time and see a doctor of physical therapy. Lower back pain is the most common thing we treat. Do you need a referral from an MD? No. Do you need imaging (x-ray or MRI) before treatment? No. Research studies have shown that 60%+ of people WITHOUT lower back pain have imaging studies that show bulges or degenerative changes. While it is noble to try to manage the pain yourself, the earlier you start treatment, the better your chances are of making a smooth recovery and quickly returning to normal activities, and keeping it at bay for good. If you’re a CrossFit athlete, check out my FREE ebook on the most common reasons CrossFit athletes suffer from lower back pain, and what to do about it. Just click the link below! Thanks for reading, Dr. Andrew |
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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