 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
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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 one of the most common questions I get so I thought it would be good to expand on it today. It's the all to common story -- you’re mid wod, doing great, then all the sudden your back gets tighter… and tighter... and tighter… and so tight to the point where you’re forced to grab a weight belt or take extra long rest breaks. Your lower back muscles eventually get so tight you quit the workout in fear that you might do some long term damage. Now your on the sidelines frustrated and wondering why. Well, you’re essentially overloading the muscles of the lower back leading to the excessive “pump” feeling. This can happen from a number of causes, but here are the reasons why: You have tight hip and a stiff thoracic spine (mid/upper back) Our daily habits OUTSIDE of the gym play a tremendous role in your ability to workout safely. If we develop stiffness in the areas above and below the lumbar spine - the thoracic spine and hips - our bodies will cause the lower back to work harder to pick up the slack. And we all know happens when we overwork our lower back. If you sit all day, whether at work, while driving, or binge watching NetFlix, chances are you have tight hips, specifically the hip flexors (known as the iliopsoas). This muscle has a direct attachment to all the lumbar spine vertebrae and is one of the top contributors of lower back pain and tightness. It is absolutely essential that you spend extra attention here. Add both the world's greatest stretch (video below) and kettlebell psoas release (video below) to your warm-up routine. Also spend extra time warming up as a whole - being warm and loose increases the your bodies ability to circulate blood and fluid, which will help to mitigate the pump feel and decrease the chance it will fire up.
You use your back when you shouldn’t If you’re dealing with lower back tightness, chances are your failing to hip hinge. Meaning in instances where you should be using your hips and legs to complete tasks, you’re using your back. This can range anywhere from picking up heavy plates and loading the bar to rounding during a deadlift or dumbbell power snatch. Speaking of the dumbbell snatch - how many times have you “blown up” your back with high reps of this exercise?? You are likely not thinking about your legs enough and bending at the back with every rep. Take your time (as fast as you can of course haha), and use your legs more. Bend at the hips and try not to round at the back.  You lack weight shift control while lifting This one is HUGE. How often do you pay attention to how your weight is distributed within your feet? When performing an exercise, every time you shift towards your toes you increase pressure and demand on the lower back. This can happen with any exercise but especially when the weight (or your weight; ie running) is in front of your center of mass. This commonly occurs with front squats, cleans, overhead squats, deadlifts, dumbbell snatches, barbell thrusters, wall balls, kettlebell swings, and burpees. I bet these are some of the most common movements that tighten up your back, right? Pay attention to how your weight is distributed in your feet! Ideally your weight should be evenly distributed between your heel, the ball of your foot, and just behind the pinky toe OR shifted more towards the heel only depending on the movement (ex: deadlift). Being conscious of this tip alone will make a huge difference.  You lack core strength and control
Essentially you’re allowing too much spinal motion during your CrossFit movements -- both extension backwards and flexion forwards. A great example of when this occurs is when pushing weight overhead. If your shoulders are tight, you’ll likely extend at the lower back to get the weight fully overhead. Not good. Another example is the power clean -- when the load starts to get heavy, an athlete will often extend forcefully at the lower back, and even worse, catch the load in the extended (over arched) position. Here's where athletes go wrong. They are often told by Dr. Google or another healthcare practitioner to strengthen the lower back with movements like supermans, reverse hypers, or bird dogs. What you should be doing is training stability of the anterior core. And i’m not talking the 6 pack exercises like crunches, russian MB twists, or sit ups. I’m referring to “anti-motion” exercises like the plank, pallof press, or ball slam. These exercises will give you the stability you need to prevent the overworking tightness on the posterior side. Add them into your routine. It sucks when your lower back starts to tighten because it can often ruin a workout. Paying attention to these key 4 concepts will make a huge difference when implemented regularly. What doesn’t work includes inversion tables, hot packs, e-stim, gravity boots, hamstring stretching, foam rolling, or other passive modalities. If you want a long term fix, take action. Lower back pain is the number 1 area we treat at The Charlotte Athlete and we would be glad to help. If you’re in the Charlotte area and are interested in working with a unique professional that can help you improve your lower back health long term, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Thanks for reading, Dr. Andrew Have you ever seen someone squat in the gym with their knees about to touch? What about that time you were running behind someone and watched their knees give in whenever their foot hit the ground? A voice deep inside of you says that doesn’t look right. Their knee is basically caving in. Then, you are at the gym one day and record yourself squatting or watch yourself squat in the mirror, and then suddenly you realize YOUR knees cave in too! Is this normal??  The short answer is no – as this movement pattern has been highly correlated with an increase in both traumatic (ex: ACL tear) and non-traumatic (ex: patellar tendinosis) injuries. However, this movement pattern is so common, some might consider it normal. Let’s first talk about what’s going on here. Firstly, this movement pattern is known as dynamic knee valgus, also referred to as valgus collapse or knee caving. The knee joint functions generally as a hinge joint; however, it also rotates subtly both in internal and external rotation as we flex and extend out leg. This mild rotation cannot be overlooked. If we develop excessive amounts of rotation in either direction, shear forces increase, and pain can result.  Knee valgus occurs when we combo this excessive rotation with hip adduction and often opposite side pelvis/hip drop. Now, many athletes will display this movement pattern without pain – this relates directly to their tissue tolerance. These athletes haven’t created enough shear yet to reach the pain threshold, and often they can get away with it, sometimes for a long period of time. However, if left untreated, it can lead to patella-femoral pain syndrome, IT band syndrome, patellar tendinosis, hamstring tendinopathy, meniscal tears, ligamentous injuries and a host of other issues up and down the chain. So what causes excessive rotation at the knee? For starters, women are more likely than men to display this movement pattern during activity, much of which is related to their anatomy (wider hips and “Q” angle – see below). It’s also commonly seen in sports or activities that require ‘toeing out’ such as with ballet dancers, soccer, basketball, and ice skaters. Some people may have structural factors such as natural bone structure in their hips, knees, and ankles which may predispose them to have more knee valgus than others. However, the knee valgus we refer to the most is dynamic knee valgus which occurs during movement, and often due to a variety of modifiable risk factors. It’s often correlated with squatting, jumping, running, lunging, but can be present anytime we bend our knee while weight bearing.  Here are the top reasons dynamic valgus can occur:
Knee valgus could initiate from a combination of these factors, but once it “sets-in,” it becomes a brain/nerve problem (muscle memory) and not just a strength or flexibility problem. Therefore, you’ll always have to re-groove squat patterns even after restoring impairments or imbalances.  If your dealing with this movement pattern, you need to put in effort to correct it. Understand that just because you may not have pain at the moment, it doesn’t mean that its normal. Making efforts to keep your knees in relative alignment with your hips and ankles when your workout can go a long way. First see if you can correct the movement pattern by simply paying more attention to your technique. If it still feels very difficult, it may be related to your mobility (hips and/or ankles) or your strength balance (glute max and glute med primarily). Check out our YouTube channel for great hip and ankle mobility exercises. For strengthening; exercises like deadlifts, lunges, step ups, side steps, or KB swings – all of which target the glutes – are great options. If you’re dealing with knee pain and want the fast track back to 100%, we can get you there. E-mail andrew@thecharlotteathlete.com or click the button below to get started! Thanks for reading, Jesse Xiong Edited by Dr. Andrew The diaphragm! The diaphragm plays a major role in trunk stabilization and posture by creating and modulating the correct amount of IAP to minimize excessive spinal motion during movement in sports. As the intensity of any activity increases, the tendency is for less diaphragmatic activity and increased thoracic breathing, or "chest breathing.” Chest breathing is produced by the accessory muscles of respiration, which includes the upper traps and many of the neck muscles. It becomes problematic during breathing when these dominate over the lower muscles such as the diaphragm. Over-activity of these accessory muscles have been also linked to many postural and motor control issues, especially in the neck and shoulders, and reduces the ability to produce sufficient IAP for proper stability during activity.  Okay, so what exactly is diaphragmatic breathing? Let's first talk about what it’s not. Diaphragmatic breathing is NOT the same as belly breathing. When someone takes a deep breath and you see only their belly rise, many people think this is the proper cue because it appears they are using the diaphragm correctly – but it’s actually incorrect. The key to proper diaphragmatic breathing is what we call 360 breathing – where you get 360 degrees of abdominal expansion. We don’t just want a forward distention of the belly as in belly breathing, we want a 3 dimensional expansion – forward, backward, and side-to-side. We want to see this without too much upward movement of the chest. 360 breathing is key for IAP development, and that’s true core stability. The better you can perfect 360 breathing, the more effective those big breathes prior to a 1RM squat will be, and the more efficient your CrossFit workouts will become.  When it comes to our CrossFit and weightlifting workouts, we need to be able to do 2 things well. We need to achieve what the experts call: (1) synchronization with movement and (2) coordination during recovery. Synchronization with movement is basically the ability to have the diaphragm create the necessary IAP to provide core stability for that specific movement demand. For example – when you are doing a heavy lift, let’s just say a deadlift. Prior to the lift, you inhale. As you initiate the lift, which is typically the heaviest part, you hold that breath which creates your IAP to stabilize. Some people maintain this hold throughout the lift, and some people slowly exhale throughout the lift. Doesn’t matter. The most important aspect was the synchronization of the most IAP with the most difficult part of the lift, which was the initiation. Ideally, we want really good synchronization of breathing during any kind of performance. A great example is the barbell thruster. You all know how important it is to exhale in rhythm at the top of the lift. The key is to take that same concept and apply it to all our movements. In regards to coordination during recovery, this refers to recovery both during our CrossFit workouts, and afterwards. The goal is to maximize the total amount of air we breathe both in and out as much as possible, which will allow the most oxygen intake and carbon dioxide output. This occurs if the diaphragm is allowed to move through the zone completely….which means minimizing chest breathing.
SO during our workouts we need focus on controlled 360 diaphragmatic breathing, not just when were tired, but from the get-go. Remember – the diaphragm is a muscle, so it responds to stimulus and it can be trained. The more you practice, the better it will function and the better you will feel! Thanks for reading, Dr. Andrew Other than bracing for a heavy lift, most CrossFit athletes don’t pay much attention to the way they're breathing—inside or outside the gym. How many times a day do you think we breathe? Typically over 20,000 times! Breathing is a foundational movement that plays a critical role in not only oxygen in and carbon dioxide out, but..
 Shallow breathing, which is using the chest and not the diaphragm, is a very common dysfunctional breathing pattern that doesn't allow you to get as much oxygen as you otherwise would — it mimics the type of breathing common during stressful situations. You see this all the time in athletes. They will perform a tough workout, and they will partially hinge over, hands on their knees, and drop their head down and try to catch their breath. And you will see their shoulders are up by their ears. I’m guilty of this at times as well – over the past few months as I’ve revisited these concepts I’ve been able to adjust my ability to recover through proper breathing, and it’s made a HUGE difference. There's nothing worse than being dead out of breathe during these workouts without muscle fatigue. Okay so what exactly is going on here? Well, dysfunctional breathing can have many negative consequences on respiratory chemistry which can have a huge effect on a wide range of system functions….. respiratory chemistry meaning the balance of chemicals in your lungs and breathing systems: 1). Chest breathing causes an increased amount of CO2 in your body, which increases the acidity of your blood. The more acidic your blood becomes, the more inefficient your muscles will be, and overall performance will suffer. 2.) Elevated CO2 levels also put your body in what's called a “fight or flight” state -- which is a stress response that occurs in your body during a threatening situation. This can increase HR, increase anxiety, increase stress, impair reflexes, and impair focus. 3.) Speaking of focus – How many of you have pile-drived through a workout and midway through suddenly can’t remember what round you’re on or what your rep count is? Breathing affects this as well. Being focused on the task at hand is just as important as performing the task. Focusing on breathing correctly (think quality vs quantity) will create:
 Now, we talked a bit about performance, but what about injury? Dysfunctional breathing patterns have been shown to play a significant role in posture, technique, and movement control associated with back, neck, hip, and shoulder pain. Here are some examples: The spine is one of the most frequently injured body regions in CrossFit. There are a few things happening here with excessive chest breathers (these are related to non-acute injuries):
It’s important to recognize that dysfunctional breathing has been recognized for many years as a potential source of a wide variety of unexplained symptoms. If you're one of those people that’s had continued issues in any of these areas, you’ve received treatment, but things still linger or come back, I highly recommend you consider your breathing patterns and implement some of the concepts I'm about to talk about.  What’s also important is to recognize that your breathing patterns play a crucial role in core stability. Core stability must come from the inside out, not the outside in -- such as weight belts for example. A healthy spine is dependent on strong core stability and the dynamic coordination of many muscles especially the deep abdominal muscles. Are you familiar with what IAP is? – it’s that big breathe you take prior to big lifts, and it’s the smaller controlled breathes you take to do burpees for example so you don’t flop like a worm. Simply put, it’s the pressure your body generates from within to keep you safe during workouts.  Intra-abdominal pressure (IAP) is an important parameter that influences spinal mechanics and stiffness….. And its generated by the muscles of respiration aka breathing. What muscle is main key driver of breathing? Check out Part 2 to find out, AND learn how to breath correctly to boost performance! |
This 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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