By: Dr. David Bokermann, PT, DPT, C-PS

​
If you or someone you know is dealing with a recent concussion or one that hasn’t recovered the way they would like please don’t hesitate to reach out or call so we can identify the profile, prescribe specific exercises based upon the examination and tailor a return to play/life protocol that is based on tests and measures supported by research! 

You can reach out to us via email: info@recoverrxpt.com
                   or reach us by phone: 331-253-2426
​

​What’s going on people! It’s been a minute since our last blog post, but we are back at it trying to get more regular here. In today’s blog, we are going to discuss the Top 3 CrossFit injuries not healed with rest. If you don’t CrossFit, well this might not be the article for you, but there are certainly parallels to other exercise modalities such as Olympic Lifting, Powerlifting, Bodybuilding, Gymnastics, and Sports Performance Training that may entice you enough to keep reading on! 


First off, it goes without saying that there is an inherent risk of injury with CrossFit (yes this is true). However, generally speaking incidence is not more common than things like distance running, biking, or weekend warrior sports. Like many sports and high level activities though, injuries occur, and there is generally a common pattern or mechanism of injury for most of the injuries we come across in the box and gym. For the most part, the CrossFit community tends to preach injury reduction tactics such as being smart with your weights, warming-up, staying in your lane when it comes to competition during workouts, and of course the recovery component. But... even with all these tools and education thrown at us CrossFit athletes and weightlifting athletes, INJURY OCCURS. There is no ultimate method that will prevent all injuries, believe it or not. They happen! But, if we continue to educate people on the most common causes of injury in the box and gym, then hopefully we can continue to mitigate the risk for serious injury or loss of gym time that will occur. No one gets into CrossFit with the intention of doing everything they can to get stronger even if that means injury, so let's try to do our best to not get injured. Ok, ok. enough with the soap box about injuries occurring. Oh wait, did I mention diet, sleep, and overall stress levels can also contribute?? Well, maybe that is best saved for another post. 

Let’s dig in to the top 3 CrossFit Injuries not healed with rest and how we can hopefully decrease these occurrences. 

1. First and most common injury in CrossFit is the dreaded “Shoulder Impingement Syndrome.” I use this term in parenthesis because I’m not a fan of the term but it is best recognized by the general public so we will stick with it for now. Most of us that have been CrossFitting or lifting for sometime have experienced that episode of “pinching” pain at the top of the shoulder when pressing overhead, attempting to do a pull-up, or any movement with load and demand at the shoulder. Can this get better with rest though?  When this acute injury occurs only once, there is a chance that it was just a freak occurrence of something not moving like it should or your body was not warmed-up well and prepped for that highly demanding movement. In this case, yes. But, if the episodes are repetitive in nature and continue to occur over the course of a couple days or even weeks, the likelihood that it is just going to resolve on its own is poor. The pain you are feeling is an output from the brain in response to a signal from the shoulder that something is not right. There needs to be an action to alleviate the symptoms and restore the normal movement in the shoulder sooner rather than later. This is important in order to not develop compensatory and chronic movement asymmetries that could lead to further more severe injury down the road. So what should you do, besides initially attempting some self soft tissue mobilization (see Kelly Starrett’s Stuff) with a lacrosse ball, basic stretching, and low load exercise, you should see a specialist like a Performance Physical Therapist who can help you address the acute inflammatory symptoms, restore normal active shoulder motion, and then retrain the shoulder blade and shoulder complex to move correctly in these specific movements that initially hurt it, and then load it in class. That is the progression back to normal. Rest is not the answer, unless you are wanting to rest for an extended period of time  (>6 months) then relearn to move correctly. I really don’t know a lot of people that want to do that though. So be proactive to your response to this type of pain! 

 

1. The second most common injury, acute low back injury. Typically the mechanism of injury here occurs during a heavy lift from the floor while your body is fatigued. Think of a heavier deadlift or power clean at the end of an AMRAP where you have fatigued the other systems of your body. Throw some “race against the time” in there, and the risk increases. The typical presentation is central or one sided low back pain that can refer a bit in to the buttocks. This pain worsens as the day goes on and into the next couple days. Rest is needed early on for the first day or two, but then active recovery should begin to take place. Walking is great for this injury, and should be your go to active recovery. In any case though, your best avenue is to see a specialist (the aforementioned Performance Physical Therapist) to get your acute inflammation down, provide guided active stretches specific to your movement preference and needs, and then develop a progressive loading plan that will get you back safe and efficiently to the gym. Remember, injuries occur and this one likely is a result of core fatigue leading to poor form and stress on spinal tissue that is not made for loading that weight. In any case, be proactive and seek help! 

 

1. One that many of us have experienced, non-specific knee pain, specifically around the knee cap and front of the knee. This generally prevents us from squatting, jumping, lunging, among other movements. Swelling can occur here. The mechanism of injury here is generally not associated with one specific incident, but is a build up overtime of chronic overload, poor hip strength, and/or poor flexibility and mobility around the knee and ankle as you progress through heavy load and dynamic activities required for CrossFit. This syndrome is one that people really tend to try and wait out or modify the movements to avoid the pain. The problem with this approach is that you slowly begin to eliminate many of the movements and activities that you got into CrossFit to perform and that are actually healthy for the knee. Yes, bending your knee past 90 degrees under load is healthy :). Many people want to jump to imaging or medication for resolution of symptoms, and in some cases this may be part of the equation, but generally speaking, I’ve seen this presentation hundreds of times in my career, and a combination of acute inflammatory control via manual hands on care, a targeted self mobilization and flexibility routine, and gradual progression of loaded exercises to strength the supporting musculature of the knee can return you back to the gym and movements that you want to perform. So again, be proactive and seek help from a specialist to help you come up with a plan to tackle your issues. The guessing game is a tough one to win. 

To Conclude, I want you as the reader to understand again that injuries do not mean you have to stop or go get imaging or take up knitting for fun instead of CrossFit. Injuries occur (you’re not alone)  and a majority of the time do not have to have medical intervention such as medication, injections, or surgery to help you return. Identification of early symptoms and help from a specialist can take care of 95% of your issues that you may run across during your life. Also, understanding these common issues and the common mechanism will hopefully help you be more cognizant of your movements during CrossFit and reduce your chances of injury down the road. 

As always, I’m available via social media @recoverrxpt or via email Luke@recoverrxpt.com to answer any questions you may have.

All the best,
Dr. Luke

By: Dr. Jesse Espe, PT, DPT, CSCS, CIDN

So... What Is BFR exactly? 
​
In order to fully understand what blood flow restriction (BFR) training is and how it works, first we need to brush up on how the cardiovascular system works. In a nutshell, your arteries carry oxygenated blood to your working muscles, then your veins carry the deoxygenated blood back to your heart. BFR was originally developed in the 1960’s in Japan, known as KAATSU training there, to play with this system and try to hack your physiology. Essentially it involves applying a band or cuff proximally to the muscle(s) being trained, typically upper arms and legs. The cuff is then inflated to a determined pressure. This pressure then will limit the amount of venous return out of the muscle while still allowing the arteries to carry oxygenated blood to the working muscles. Once applied, the athlete will complete a low load (20-30% of 1 RM), with high repetitions (15-30) with a short rest interval between sets (30 seconds).

​

We are currently in a day and age, where people want to know exactly what is going on with their body and the "why" behind it. We want answers and we want them now. Look at the increasing number of "wearable technology," DNA tests, rapidly accessible blood panels, and different imaging scans available. This is especially true when it comes to pain and lack of performance. Many times when an injury occurs in an area of the body or lack of strength or mobility is apparent in a certain area, we have tunnel vision in looking only at the area directly related to where the pain or lack of strength is located. Many times the area of pain or weakness is not the source of pain or weakness. Where should we be looking and why?

Think about this, 26 bones, 33 joints, and over one hundred small muscles and small tendons; and that’s just one of them. The human foot is one of the more intricate, complex and fascinating parts of the human body. 

I mean we really only get 2 of these things to walk on for the entirety of our human existence. These are the two things that keep us in contact with the Earth. They are our main connection, but do we really pay attention to this connection? Are we in tune with foot/ground connection and how it plays a role in our every day function as well as performance in whatever sport we like to partake in. 

There are many reasons why we need to pay attention to our foot and ankle in this kind of way. 

Thanks for checking back in to the blog. I hope the last month has treated you well. 

Today I wanted to talk about the topic of mobility, no not your ability to move around the country, but your ability for your body to move freely and without pain. Many of you have at one point in your life been told you are "too stiff" or "too flexible" or that you need to "Stretch more" or "stop bending like that." I, for example, had the nickname of "Gumby" because I was tall, lanky, and pretty flexible (which by the way lead to some injuries including chronic ankle sprains). Anyways, these are general terms directed at our physical "mobility." Now many different anatomical structures can effect our mobility such as our joints, muscles, ligaments, and tendons as well as other clinical conditions, but in general when people start to refer to your mobility, they are referring to how much range of motion you have in your joints. 

Physical Therapists are trained professionals in assessing your mobility and how it is effected by all these different anatomical structures, but you for the most part are not and don't/can't have a physical therapist there for you to assess it every time. So it is a good idea to have a general understanding of where you are at on the "spectrum of mobility." ​

Welcome back everyone!

I'm finally discussing some current research on the diagnosis and treatment of a specific injury. In this week's blog, I'm discussing the current Clinical Practice Guidelines for diagnosing and treating Patellofemoral Pain Syndrome (PFP). So if you have ever had knee pain related to squatting, running, descending stairs etc.. then this should be an informative read for you, providing you some direction in your ability to address your symptoms. 

PFP is commonly referred to as "Jumper's or Runner's knee." This condition involves, typically, insidious onset of pain behind or around the knee cap. This is a very common syndrome with an estimated prevalence of 25% up to 50% in the general population over their lifespan and does account for anywhere between 2-7.5% of people presenting for medical care. This syndrome most commonly affects youth athletes between the ages of 12-19 but some studies indicate a higher prevalence in the 50-59 year old age group. 

Symptoms usually present with no specific injury and can come on slowly overtime. Typically there is worsening of pain with lower-limb loading (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running, especially with hills). There is poor correlation between internal derangement of tissue or cartilage damage and symptoms, and therefore a clinical diagnosis based on a cluster of symptoms associated with pain reports during squatting, descending stairs, and knee flexion positions like prolonged sitting should be used. Your medical provider and rehab specialist should be looking at these things as the best supported way to diagnosis this condition. ​