Meghan Rovig, Author at Breaking Muscle

10 Short Daily Drills to Combat Back Pain

Meghan Rovig — Sat, 24 Jun 2017 10:00:00 +0000

The discs that make up our spine are super-hydrated and fat when we wake in the morning. Sounds good, right?

But as we sit through the day, our hip flexors tighten, our glutes quit working, and our discs lose fluid. In this position, we don’t engage our transverse abdominis, so our lumbar spine has little muscular support. Needless to say, if we go all day in this scenario, our lumbar spine has a bad time.

Our superincumbent mass is comprised of everything above L5S1, where our lumbar spine and sacrum come together. The entire weight of this mass is borne on the vertebral body of L5. That means for an average 200-pound man, 60% of his body weight is borne on an area that is about 1.5 inches in diameter.

In order for this to work, we need stability. Stabilization of the lumbar spine and pelvis is necessary for any athletic endeavor or even just being healthy. And since we’ve established that our discs and ligaments can’t accomplish this all on their own, I’ve created a saucy list of exercises that will help to:

Lengthen the muscles that become tight from sitting down
Provide muscular stability during athletic activity

What We Know About Human Physiology

There are a multitude of receptors in the musculature that sense changes in muscle tissue length. Golgi tendon organs (GTO) reside in our tendons and respond to changes in tension at high and low intensity. Muscle spindles reside in the muscle fibers themselves. They act as a gauge for tendon and muscle length. These two receptors work together to measure changes in tension and then cue the muscle to fire effectively. When muscle strains or tears occur, the tension applied outweighs the muscular tensile strength and these receptors fail.

Golgi tendon organ.

There is great debate as to whether we should do static or dynamic stretching. Static stretching involves holding a position for a prolonged period of time, usually greater than thirty seconds. Dynamic stretching occurs when you move in and out of positions without holding. The prevailing research wisdom suggests that dynamic stretching is best prior to athletic activity, while static stretching is more useful following activity as a cool down.

In the upcoming exercises, there are specific prescriptions for each movement based on what we now know about muscle physiology, disc and lumbar spine health, and research. Static stretches should be a component of your daily gym cool down, and dynamic movements like the lunge with reach, dead bugs, and plank holds can be part of your warm up or just a supplement to your daily workout routine.

Couch Stretch

With an AbMat or something similar under your knee, place your foot against a wall in a lunge position. Try to straighten your torso as much as possible. Hold for 20-30 seconds. Do 3 times on each side.

Downward Facing Dog

Starting in the top of your push up, pull your belly button toward your spine and raise your glutes up toward the sky. Press through the heels of your hands and squeeze your shoulder blades together. Hold 3-5 breaths. Repeat 5 times.

Table or Bench Piriformis Stretch

Using a table or workout bench, place one leg on the bench with your hip and knee at a ninety-degree angle. Slowly try to straighten your back leg into a lunge. Keeping your abdominals engaged, lean your chest forward. Hold 20-30 seconds. Repeat 5 times on each side.

Medicine Ball Thoracic Spine Extension

Place a medicine ball behind you and position your body so the ball is aligned with the bottom of your ribcage. Holding a PVC pipe in your overhead squat position, use the medicine ball as a pivot point and reach overhead. You might even get a couple thoracic spine cracks! Repeat 10-15 times. Do 2 rounds.

Goalie Stretch

From all fours, take each knee out to the side, with hips and knees bent to ninety degrees. Make sure to flex your feet up toward your head. Slowly try to move your butt closer to your heels until a stretch is felt in your adductors. Hold 20-30 seconds. Do 5 times.

Learn Where Your Transverse Abdominis Is

Side Plank

Lie on your side, feet together. Press yourself up through your hand and feet, keeping shoulder, hips, and knees aligned. Hold 20 seconds. Work up to 3 minutes.

Prone Plank

Squeeze your glutes, pull your belly button toward your spine, and hold. Try to keep your butt from poking up to the sky. This can be done in push up position or on your elbows. Start with 20 seconds. Work up to 3 minutes.

Lunge With Anterior Reach

Step into a deep lunge with your abdominals in tight, and reach forward toward your feet. Return to start. Repeat 10-15 times each side. Do 3 rounds.

Left: Step into a deep lunge with your abdominals in tight; Right: Reach forward toward your feet.

Dead Bugs

Lying on your back with your belly button tight towards your spine, slowly lower one leg and take the opposite arm overhead. Switch sides. Make sure your low back doesn’t arch off the ground. Repeat 10-15 times each side. Do 3 rounds.

Left: Lie on your back; Right: Slowly lower one leg and take the opposite arm overhead.

Fire Hydrant

On all fours, pull your belly button toward your spine. Keeping your pelvis level, raise your knee out to the side. You might place a foam roller across your low back to make sure you keep your pelvis and lumbar spine stable. Repeat 8-12 repetitions each leg. Do 3 rounds.

Left: On all fours, pull your belly button toward your spine: Right: Raise your knee out to the side.

Check out these related articles:

The Best Back Workouts
Why Your Approach to Fixing Your Low Back Is Making It Worse
Understanding the Brain Is the Key to Being Pain-Free
What’s New on Breaking Muscle Today

Photo 1 courtesy of Shutterstock.

Photo 2 “Gray938.” Licensed under Public Domain via Wikimedia Commons.

Photo 8 “Illu trunk muscles.” Licensed under Public Domain via Wikimedia Commons.

The post 10 Short Daily Drills to Combat Back Pain appeared first on Breaking Muscle.

4 Common Foot Injuries That Plague Athletes

Meghan Rovig — Sat, 18 Feb 2017 15:00:00 +0000

I love feet. They are a truly fascinating part of the body. In the foot, there are 26 bones, 33 joints, and over 100 ligaments and muscles. The irony lies in the fact that the rest of the lower extremity only has four bones (femur, patella, tibia, fibula), four joints, and 41 muscles.

Basically, the foot dictates the rest of the movements that occur in the lower body. And I would argue that poor foot positioning could, in fact, cause someone neck pain.

The foot functions not only to absorb shock as we walk, squat, run, and jump, but also to provide a rigid surface from which we can push off and do it again. Many of the muscles that control foot movements have attachment higher in the leg, at the tibia and fibula.

The high stress placed on the feet during athletic participation can cause imbalances in these muscles, leading to biomechanical dysfunction. When dysfunction arises, it can lead to significant pain and poor movement ability for the athlete.

In this article, I’ll highlight some of the most common overuse foot conditions that I treat. Additionally, we’ll discuss appropriate ways to manage the dysfunction until you finally decide to seek out someone smarter than you.

Turf Toe

Turf toe is a condition that occurs due to repetitive hyperextension of the big toe. This is seen in people who wear light flexible shoes (minimalist shoes, like Nanos and Inov8s) or with movements that require repeated, forced hyperextension of the great toe (box jumps, double unders, triple extension in the Olympic lifts).

Symptoms are pretty cut and dried: pain and tenderness at the big toe joint, pain during pushing off, and pain with passive movement of the big toe joint. Most often, it’s a good idea to get an X-ray to rule out the possibility of a fracture. If you’re not into that, then rest and ice.

There are a couple of great taping techniques you can also do to limit the motion of the toe and provide a little support. In the long run, a stiff-soled shoe or turf toe inserts may also be a wise move.

Bunions

Bunions! AKA “Old Lady Toe.” This is probably the most common foot problem I encounter. Often, people who develop bunions over-pronate. This means that instead of using the muscles that support the arch, you are relying on ligaments and bones to support the foot with each step, allowing your arch to collapse, and push off is occurring from the great toe rather than the ball of the foot.

Symptoms include tenderness and pain at the inside of the great toe, and are worsened by wearing shoes with a narrow or pointy toe box. Over time, the angulation of the great toe in reference to the foot increases.

When this begins, you can use ice and rest to decrease inflammation, get a shoe with a wider toe box, or seek out an orthopedist who specializes in the foot. The orthopedist will likely take films to measure the degree of angulation, recommend orthotics, or (worst case scenario) repair it surgically, rendering your high heel wearing days a thing of the past.

Stress Fractures

Over the last year, I’ve seen my fair share of metatarsal stress fractures in CrossFit athletes. A stress fracture is usually the result of a combination of poor diet and overtraining. There are two groups of bone cells that are responsible for bone turnover.

One group breaks bone down and the other builds it up. When that balance is disrupted, the rate of break down overrides the rate of build up and the bone becomes weakened. This is the mechanism of osteoporosis and osteopenia as well. Typically, this occurs in the second and third toes.

Symptoms include tenderness over the middle or most distal portion of the metatarsal (long foot bone) with moderate swelling on the top of the foot. Any loading or weight bearing is usually quite painful, and often athletes will have continued pain with rest.

Initial X-rays are negative because the stress fracture is so small. A good ortho will take repeat films at three to four weeks to see if the body has started to develop a callous along that stress fracture. If that isn’t visible and pain persists, a bone scan or MRI may be warranted. Stress fractures are best managed with ice, decreased loading or non-weight-bearing, and casting in severe cases.

Plantar Fasciitis

The plantar fascia also becomes a source of pain and dysfunction in athletes who over-pronate or wear flexible, minimalist shoes without the appropriate amount of strength in their foot muscles.

Plantar fasciitis is inflammation and micro-tearing of the plantar fascia. This presents as pain with first steps in the morning, tenderness along the arch and heel, and thickening of the plantar fascia.

Different from plantar fasciitis, athletes can also strain the plantar fascia. This strain usually occurs in the early stages of training and is associated with running, jumping, and other repetitive stresses.

Athletes who are overweight, have tightness in the muscles of the calf, and weakness in the supporting muscles in the foot are at highest risk. If untreated, a strain will develop into a nasty case of plantar fasciitis, taking upwards of eight months to resolve.

Take home message? Stay mobile in your lower half, wear good shoes, and be smart in your training. A good way to see if a minimalist shoe is right for you? Grab a piece of butcher paper and get your feet wet. Stand on the paper with bare, wet feet. Take a look at your footprint. Which does it look like?

If you have a normal foot or high arch, you’ll probably be okay in Nanos or something similar. If you have a flat foot, you may require something with a little bit more support. Find a good running shop in your hometown (even if you aren’t a runner).

Most independently owned shops are operated by individuals who know a thing or two about athletic shoes. When in doubt, seek out a podiatrist, orthopedist, or physical therapist. And if it keeps hurting – rest.

The post 4 Common Foot Injuries That Plague Athletes appeared first on Breaking Muscle.

Simple Mobility for a Healthy Lower Back

Meghan Rovig — Thu, 12 Feb 2015 10:00:00 +0000

If you’ve ever experienced lower back pain, then you know it’s potentially expensive. We miss work, file insurance claims, and seek out countless passive therapies to feel better. On top of that, we end up with gym memberships for which we pay exorbitant fees and don’t use.

So what is lower back pain? Is it always the dreaded, four-letter word “disc”? Or can it be something different? And is it always a bad thing?

Let’s talk about the disc, and then we’ll get on to why you feel what you feel and what to do about it.

Disc Anatomy

The intervertebral disc is comprised of a nucleus and annulus. The nucleus is to the disc what cream filling is to an Oreo (the best part). It is 85% water and has a high concentration of proteoglycans, collagen, and elastin. These properties help the disc to distribute hydraulic pressure across the vertebrae.

The annulus surrounds the nucleus, is made up of 60% water, and has a smaller concentration of proteoglycans, collagen, and elastin. However, the annulus also has chondrocytes and fibroblasts. These comprise the fibrocartilage that protect the disc and further attenuates shock absorption across the nucleus.

As we age, the water and proteoglycan concentration of both the nucleus and the annulus decrease, resulting in decreased nutrition and shock attenuation. Furthermore, there is a component of the vertebrae known as the endplate. This is the interface of the disc and vertebrae at the top and the bottom.

“The time of day that you exercise matters when it comes to having a healthy back and making proper exercise selection.”

Endplates act to contain adjacent discs and provide additional shock attenuation and a semipermeable membrane for further disc nutrition. The endplate degrades with aging, becoming weak and unable to support the disc. Combine that with muscular weakness and poor body mechanics and what do you have? A sick disc.

In addition to failure to support the disc, the endplate changes may also contribute to chemical consequences within the disc, allowing inflammatory factors to enter the disc at a rate that exceeds healing. Meaning, the pain in your back does not have to be mechanical in nature. It is related to chemistry. And how do we treat chemistry? Pharmacologically.

The Origin of Back Pain

So where is this back pain coming from? In a 1991 study, examiners studied the response of stimulation of tissues in 193 patients under local anesthesia. The findings were staggering:

Sciatica (aka buttock pain that radiates down the posterior thigh and leg) could only be produced by stimulating a swollen, stretched, or compressed nerve root.
On the contrary, back pain was produced through stimulation of a variety of tissues, most frequently the annulus and posterior longitudinal ligament.
Pressure at the endplate also resulted in deep, non-specific low back pain.
Buttock pain was produced through simultaneous stimulation of the annulus and nerve root.
Finally, stimulation of the facet joint (the joint created by vertebrae sitting on one another) rarely produced any low back pain. If it did, the pain stayed local to the back, never referring to the buttock or leg.

Translation: the source of most low back pain is chemical and occurs primarily in the disc and supporting ligamentous structures. The good news is we have an ability to influence our chemistry and provide more support through strengthening our musculature.

Mobility for a Healthy Low Back

The time of day that you exercise matters when it comes to having a healthy back and making proper exercise selection. Time of day affects the nutrition and water concentration of your discs, thereby improving your chemistry and giving the disc what it so desires.

When you wake in the morning, your disc height and therefore fluid has increased. If you plan on lifting, you are at a slight disadvantage as there is increased pressure on the disc. If you move wrong or move poorly, you place the annulus and endplates at a disadvantage and your lumbar spine is vulnerable. To mitigate this, choose to warm up in a fashion that will help to “dehydrate” your overhydrated disc. Some good examples are standing back bends and supine lower extremity rotation.

Back bends to help alleviate morning disc pressure.

Supine rotations are also a great movement for morning mobility.

Throughout the day, the effect of gravity assists in disc dehydration. If you lift in the evenings, you are also at a slight disadvantage as there is less water and disc nutrition available. Less water and nutrition equals less cushion between the vertebrae and nerve roots. To mitigate the potential for compression and shear forces, lying supine with your knees and feet supported, followed by bending from side to side can assist with “rehydration.”

Make side bends a part of your warm up routine if you lift at night.

The Role of the Core

The discs in your spine are vulnerable, fragile, and may often be the problem when it comes to your lower back pain. But that isn’t the end of the world. Many people with lower back pain find relief through physical therapist intervention, chiropractic care, massage therapy, and acupuncture. These are all excellent ways to address your symptoms, but in order to address the source of the problem, it is necessary to alter the way you move.

“In addition to failure to support the disc, the endplate changes may also contribute to chemical consequences within the disc[.]”

There are two muscle groups that play a major role in your lumbar spine health and stability. The transverse abdominis is your deepest abdominal muscle. As it lies beneath the rectus abdominis and external and internal obliques, it runs along the same line of application as a weight belt. But the problem is we often don’t know how to use it. This little muscle attaches posteriorly to the thoracolumbar fascia, which helps to lock down the lumbar spine. It’s a good helper.

Try this to find your transverse abdominis:

While sitting or standing, place your hands on your hips. Your fingertips should be lying on your abdomen just inside your hipbones.
Pull your belly button towards your spine, like you are trying to zip up a tight pair of jeans. Don’t hold your breath!
You should feel little muscles pop up under your fingers. This is your transverse abdominis, and it should be engaged any time you move. Maximal contraction when you lift, 20-30% engagement as you move throughout the day.

The second muscle group to pay attention to is your hip flexors. Your hip flexor group runs superiorly and posteriorly from your femur, across your hip joint, and attaches onto the transverse processes of your lumbar spine. If you think about a string running along the same line, and you tighten it, can you imagine what happens? The tightness in that string pulls the lumbar vertebrae forward, compressing the discs, and decreasing the available space for nerves to pass through.

One of the best ways to mobilize and lengthen your hip flexors is a lunge. You can make the lunge even saucier by reaching your arms overhead, rotating your arms from one side to the next, or rotating your arms across your body. Using your upper extremity as a driver, keeping your pelvis and lower extremity stable, you are asking the more proximal component (attachment at the lumbar spine) to lengthen. If you deepen your lunge, you are asking the more distal component (attachment at femur) to lengthen.

Learning to strengthen and lengthen these muscles in conjunction with the principles of dehydration and rehydration will give your lumbar spine the love it so desperately craves.

References:

1. Kuslich SD1,Ulstrom CL,Michael CJ. “T he tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia.” Orthop Clin North Am.1991 Apr;22(2):181-7.

Photo 1 courtesy of Shutterstock.

Check out these related articles:

The post Simple Mobility for a Healthy Lower Back appeared first on Breaking Muscle.

You Don’t Need Medication to Maintain a Healthy Low Back

Meghan Rovig — Mon, 09 Feb 2015 10:00:00 +0000

If you’ve ever experienced low back pain, then you know it’s potentially expensive. We miss work, file insurance claims, and seek out countless passive therapies to feel better. On top of that, we end up with gym memberships for which we pay exorbitant fees and don’t use.

So what is low back pain? Is it always the dreaded, four-letter word “disc”? Or can it be something different? And is it always a bad thing?

Let’s talk about the disc, and then we’ll get on to why you feel what you feel and what to do about it.

Disc Anatomy

“The time of day that you exercise matters when it comes to having a healthy back and making proper exercise selection.”

The Origin of Back Pain

So where is this back pain coming from? In a 1991 study, examiners studied the response of stimulation of tissues in 193 patients under local anesthesia. The findings were staggering:

Sciatica (aka buttock pain that radiates down the posterior thigh and leg) could only be produced by stimulating a swollen, stretched, or compressed nerve root.
On the contrary, back pain was produced through stimulation of a variety of tissues, most frequently the annulus and posterior longitudinal ligament.
Pressure at the endplate also resulted in deep, non-specific low back pain.
Buttock pain was produced through simultaneous stimulation of the annulus and nerve root.
Finally, stimulation of the facet joint (the joint created by vertebrae sitting on one another) rarely produced any low back pain. If it did, the pain stayed local to the back, never referring to the buttock or leg.

Mobility for a Healthy Low Back

Back bends to help alleviate morning disc pressure.

Supine rotations are also a great movement for morning mobility.

Make side bends a part of your warm up routine if you lift at night.

The Role of the Core

The discs in your spine are vulnerable, fragile, and may often be the problem when it comes to your low back pain. But that isn’t the end of the world. Many people with low back pain find relief through physical therapist intervention, chiropractic care, massage therapy, and acupuncture. These are all excellent ways to address your symptoms, but in order to address the source of the problem, it is necessary to alter the way you move.

“In addition to failure to support the disc, the endplate changes may also contribute to chemical consequences within the disc[.]”

Try this to find your transverse abdominis:

While sitting or standing, place your hands on your hips. Your fingertips should be lying on your abdomen just inside your hipbones.
Pull your belly button towards your spine, like you are trying to zip up a tight pair of jeans. Don’t hold your breath!
You should feel little muscles pop up under your fingers. This is your transverse abdominis, and it should be engaged any time you move. Maximal contraction when you lift, 20-30% engagement as you move throughout the day.

Learning to strengthen and lengthen these muscles in conjunction with the principles of dehydration and rehydration will give your lumbar spine the love it so desperately craves.

Check out these related articles:

Why Your Approach to Fixing Your Low Back is Making It Worse
Get the Low Down On Your Low Back
How to Stop Your Lower Back Pain
What’s New On Breaking Muscle Today

References:

1. Kuslich SD1, Ulstrom CL, Michael CJ. “T he tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia.” Orthop Clin North Am. 1991 Apr;22(2):181-7.

Photo 1 courtesy of Shutterstock.

The post You Don’t Need Medication to Maintain a Healthy Low Back appeared first on Breaking Muscle.

Back Pain: Get Educated and Let It Go

Meghan Rovig — Mon, 19 Jan 2015 10:00:00 +0000

The other day I was sitting in a waiting room in a radiology department. We were there with my son to figure out if he had stomach flu or appendicitis (thankfully, it was just stomach flu, although my thanks may be different if I’m puking in a few days).

I picked up a waiting room magazine bearing the headline: Healing Your Own Back Pain. Being a physical therapist, my interest was piqued. After ten minutes of reading and looking for my jaw on the floor, I was dismayed about several things:

In describing common low-back ailments, rather than educate the consumer, the magazine left me (an educated consumer) wondering if I had a herniated disc or cancer. Fail.
The “Top 3” ways to “cure” back pain were passive therapies. So now Johnny Back-Pain feels better, but the problem is still there.
Aside from Pilates, which is a great way to strengthen your abdominal and spinal muscles, there were no suggestions for active treatments for low back pain.

So instead of getting suckered by this pseudo-science, let’s take a real look at why your back behaves the way it does, how it moves, and what simple techniques you can perform prior to working out to give your spine the love it needs.

A Painful Reality

Back pain is the second most frequent reason people miss work after the common cold. In 2010, according to the American Academy of Pain Medicine, lost work productivity cost the United States $297.4 billion. This cost is related to medical expenses, temporary employment replacements, insurance and workers’ compensation claims, and payments for permanent disability.

“Since none of the spinal supporting structures are actually supporting anything, we rely on our connective tissue (disc, ligaments, etc.) and spinal integrity to do the work.”

According to the American Academy of Orthopedic Surgeons, one in five people will experience low back pain in their lifetime. One in twenty will be unable to work because of an acute occurrence or recurrence.

READ: The Rabbit Hole of Back Pain: What Your Doctor Doesn’t Want You to Know

What if we could start out this year a little differently? What if instead of spending money on passive therapies like acupuncture and massage and sinking even more money into Pilates classes we’ll stop attending in a month, we figured out why our back hurts, fixed our movement, and Let it Go? (cue Frozen music)

The Real Culprit Behind Low Back Pain

Musculoskeletal low back pain happens due to one culprit – poor movement. All the junk that comes along (herniated discs, nerve impingement, and muscle strains) is just a result of that. Our poor movement patterns start with our lifestyle. We sit down.

THINK OUTSIDE THE DESK: Desk Workouts, Cycle 1

The illustration below depicts the three natural curves of a standing upright spine. Our spine moves in three dimensions: flexion/extension, side bending, and rotation. Each segment of the spine has the ability to move upon one another independently so we may adapt our movement to tackle the tasks placed in front of us.

Furthermore, we have an intricate system of muscles and ligaments that support our spine, like guy wires on the San Francisco Bay Bridge. Below, you can see a disc between each segment, a little space for nerve roots to pass, and ligamentous attachments. Each segment also has a joint above and below, referred to as the facet joint.

Low back pain often originates from the facet, the nerve root, or a disc that’s been compressed or herniated. Since none of the spinal supporting structures are actually supporting anything, we rely on our connective tissue (disc, ligaments, etc.) and spinal integrity to do the work. It’s like asking the man who won the Boston marathon to enter a weightlifting competition and expecting him to win.

“Even when we sit in a ‘better’ position, we provide constant tactile sensation to the glutes and hamstrings, sending a neurologic signal for them to not fire anymore. We have lengthened the spinal erector muscle group and cued them to stop firing.”

Look at the images below. The fellow on the right is sitting with slouched posture. Note the loss of curvature in the lumbar spine, the increase in angle of the thoracic spine, and the straightening of the cervical spine. Additionally, note the tilt of the pelvis.

LEFT: Sitting with good posture; RIGHT: Sitting with slouched posture

Even when we sit in a “better” position, we provide constant tactile sensation to the glutes and hamstrings, sending a neurologic signal for them to not fire anymore. We have lengthened the spinal erector muscle group and cued them to stop firing. What happens when we leave our cozy little cubicle, drive (yet again sitting) to our local gym, and ask our bodies to perform feats of amazing athleticism?

READ: Sleep to Win: How Your Mattress Could Be Affecting Your Training

In addition, as we sleep, our intervertebral disc height increases. By lying supine, we allow good, healing nutrition and water to enter the disc. When we wake up, our discs are chubby with fluid and vulnerable. There is more cushion, but it is in a confined space and can press on nerve roots.

Make Things Right With Your Spine

If you tend to be a morning exerciser, your top priority is to wring out some of that fluid before you lift something heavy. A few sets of ten standing back extensions and a few sets of supine lower extremity rotation are key prior to killing your morning workout.

“As we stand and sit throughout the day, all that healthy fluid is squeezed out due to the effect of gravity. That means there is less cushioning between your vertebrae and nerve roots.”

If you are an evening exerciser, your disc state is much different. As we stand and sit throughout the day, all that healthy fluid is squeezed out due to the effect of gravity. That means there is less cushioning between your vertebrae and nerve roots. Your job is to reestablish some of that nutrition and fluid. Lying supine with your feet up for about five to ten minutes, followed by bending from one side to the next will provide your discs with what they need.

Consider this rant a little snippet of a three-part series. Next, we’ll address signs and symptoms, as well as learning the difference between when to seek help and when you can help yourself. Finally, we’ll come up with a sexy top-ten list of preventive exercises. And this year, maybe you’ll truly “Let it Go.”

Photos courtesy of Shutterstock.

The post Back Pain: Get Educated and Let It Go appeared first on Breaking Muscle.

Stop Peeing Yourself During Workouts: The Science Behind Stress Urinary Incontinence

Meghan Rovig — Thu, 13 Feb 2014 14:00:00 +0000

The CrossFit Games Open presents a truly exciting time of year for the CrossFitter, with the opportunity to push your physical and mental limits like never before. But sometimes, that means our bodies do the craziest things – like pee during a workout.

Do you guys remember this video?

Quite frankly, I found the concept amusing at first. So many times had I commiserated with others about double unders, heavy cleans, and the correct color of pants one should wear when faced with any potentially offending movement.

But wait a minute – I’ve never had children (that’s called being nulliparous, by the way).

Why am I losing urine when things get tough? Does this happen to other nulliparous athletes? What about women who’ve had multiple children (multiparous) or abdominal surgeries? And why on earth is a gynecologist condoning that losing urine during exercise is okay?!

PERFORMANCE BOOST: In Pursuit of the Elusive Double Unders

It’s Called: Stress Urinary Incontinence

In the video, Rory McKernan calls the condition exercise-induced urinary leakage. In science, we call it stress urinary incontinence (SUI).

SUI is defined as an involuntary loss during coughing, sneezing, or physical exertion.

In a 2001 study, scientists in Norway examined the prevalence of SUI in their elite female athletes.

Researchers studied almost 600 women from the Norwegian national team and found that, of the 87% who answered the survey, 26% of elite female athletes recalled instances of SUI.

Additionally, 49% of those elite athletes were identified as having an eating disorder by the DSM-IV. Of those women, half of them had SUI.

The Anatomy Behind Peeing Yourself

The female pelvic floor (the basement) is made up of fascia, ligaments, and muscles that provide a “hammock” to the bladder and uterus.

The endopelvic fascia is continuous with the visceral fascia of the trunk (that’s the stuff that keeps your insides where they belong) and functions to encapsulate your organs and respond to changes in volume and displacement as you move.

LEARN MORE: The Top 5 Ways Fascia Matters to Athletes

The connective tissue of the endopelvic fascia supports the urethra, bladder, uterus, and cervix, extending into the diaphragm.

By this connection with the diaphragm and visceral fascia, changes in lung volume will increase pressure placed on these structures.

This increase in intra-abdominal pressure is what we want when we take a big lift, securing our insides and providing support not only to them, but the lumbar spine.

The muscles that create the hammock are the levator ani (in red, to the right) and coccygeus, which are referred to collectively as the levator plate. When we are standing, these muscles lie on the horizontal and function just like a hammock supporting a person.

Weakness in these muscles may be due to a multitude of reasons: multiple vaginal births, multiple pregnancies, peripheral nerve injury during vaginal delivery, or generalized idiopathic weakness.

Clinically, I have seen women who have had one vaginal delivery without complication, and weakness in the levator ani due to substitution from the anal sphincter.

This movement pattern dysfunction may lead to stress incontinence because the woman can’t engage the basement and is instead using the posterior third of the levator plate.

When the levator plate does not function as one continuous group of muscles, the hammock on which the pelvic organs sit becomes weakened, and something not good is bound to happen – like falling out of a hammock.

How to Stop Peeing Yourself

To be continent (i.e. not pee on yourself), a person must have a quiescent (dormant) bladder, functioning musculofascial support, and a functional urethral sphincter. When a person is incontinent, either due to stress or urgency, one of these elements has failed.

In the case of SUI that we experience in CrossFit, it usually is due to weakness in the hammock and poor urethral sphincter control.

Occasionally, there may also be a physiologic reason that a person is incontinent, at which point it is wise to seek out a gynecologist or urologist – one that believes peeing your pants isn’t acceptable.

Like any other muscle group, we know if we train it for function, it will improve. If SUI is something that you are dealing with, laugh about it with your friends, but get it addressed.

Pelvic floor muscle training with a women’s health physical therapist is often the first line of treatment, followed by behavioral modification, and perhaps pharmaceutical intervention. Losing urine during a workout isn’t okay, and isn’t a badge of honor as to how hard you worked.

Treatment resources or to find a women’s health practitioner:

FURTHER READING: Stop Doing Kegels: Real Pelvic Floor Advice

References:

1. Bo, K and Borgen, JS. 2001. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med Sci Sports Ex, 33(11), 1797-1802

2. Herschorn, S. 2004. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Rev Urol, 6(5), S2-S10.

Pelvic diagram by OpenStax College [CC-BY-3.0], via Wikimedia Commons.

Levator ani diagram modified by Uwe Gille (Gray408.png) [Public domain or Public domain], via Wikimedia Commons.

The post Stop Peeing Yourself During Workouts: The Science Behind Stress Urinary Incontinence appeared first on Breaking Muscle.

The AbMat Is Awesome – Here’s Why

Meghan Rovig — Thu, 30 Jan 2014 14:00:00 +0000

I love Annie. Actually, I admire the two human Annies (Annie Sakamoto and Annie Thorisdottir) for their fortitude and cheerful display of the human spirit under duress, but today I’m talking about my love for the girl, the WOD, the benchmark. 50-40-30-20-10 sit ups and double unders.

Every time that I do this workout, there is always someone in the class who asks, “Why do I need an AbMat?” This is usually followed by a discussion as to what shorts or pants students have worn and how bad their monkey-butt is going to be when they are finished. What’s sad is that no one can seem to truly answer this elusive question. Why do we need an AbMat? And for goodness’ sakes, which way do we turn it?

Quick Anatomy Lesson: Your Abdominal Muscles

Before we even get into the reason for the AbMat, let’s talk about the abdominal muscles. Yes, they’re super hot and sexy when developed, and we all want them without having to give up beer and gluten. (Good luck with that.) But there’s some basic anatomy that needs to be understood. The anterior and lateral trunk muscles function in multiple ways: they support the abdominal viscera (that’s what holds your insides together), breathing, and they are concerned with trunk movements of flexion, lateral bending, and rotation. Perhaps one of the most fascinating parts of this design is that the fibers in different layers run in different directions, contributing to their gross strength.

The rectus abdominis is the most superficial of these muscles and attaches the ribcage to the pelvis. Its primary role is trunk flexion. The internal and external obliques also attach the ribs to the pelvis, and are responsible for rotation and side bending of the trunk. There is another muscle, and it’s one that like the gluteus medius goes on vacation frequently. It’s called the transverse abdominis. This muscle also connects the ribs to the pelvis, but has a line of application much like a weight belt. It’s fibers run on the horizontal and it is responsible for abdominal compression during movement.

As I have described with other muscles in other articles, most of our muscles work in three planes of motion. By functioning in three planes of movement, a muscle group can stabilize in one plane and exert movement in another.

What Happens in a Sit Up

In a sit up, like any other movement we do, it is imperative that our body moves through a complete and full range of motion. What this means is that if you lie on the floor, your spine is in a neutral position, or perhaps has a little flexion. To get the most out of a sit up, the abdominals must go from a position of maximal length to a position of minimal length. This is achieved by creating two pivot points, one in the spine and another in the pelvis. The lumbar spine should be extended fifteen to thirty degrees, and the pelvis should be in an anterior tilt of ten to fifteen degrees.

Image courtesy of Koch, Blom, and Jacob. Sit Ups Revisited, 2004.

What happens next is nothing short of amazing human movement. A group of fully-extended muscles with attachments at two joints creates tension. When the individual flexes the trunk from that position, the muscle is able to generate a large amount of power and force. We like that, and it makes us stronger.

The Beauty of the AbMat

The AbMat, when placed under the lumbar spine with the higher portion towards your bum creates this beautiful environment for the abdominals to move through their full and available range of motion. It allows for the extension needed in the lumbar spine and the anterior tilt in the pelvis, thereby giving the abdominal muscles what they yearn for – full range, elongation, and forceful contraction.

As I was searching the literature for this article, I came across several discussions damning the AbMat sit up. I think one of them listed the movement as the “most worthless CrossFit exercises ever” or something. But let me ask you this, do you think that Globo Gym Joe can come into a CrossFit box and hop on a glute-ham developer (GHD) and do a correct GHD sit up? Didn’t think so. The AbMat sit up is wonderful to develop full spinal range of motion abdominal strength so that a person can start to think about getting on a GHD. It also helps develop cursory strength for toes-to-bar and knees-to-elbows, and gets the abdominals thinking about midline stability during barbell movements and pretty much everything else we do.

Use your AbMat correctly (but be aware of the type of pants you choose to wear because no one likes monkey-butt) and get yourself midline strong. When the zombies come out, you’ll be happy you used an AbMat. Globo Gym Joe isn’t going to know how to fight them with his crunches and partial range of motion bicep curls.

References:

1. Smith, Weiss, and Lehmkuhl. Brunnstrom’s Clinical Kinesiology. F.A. Davis. 1983.

2. Koch, Blom, and Jacob.Sit Ups Revisited, 2004.

Photo 1 courtesy of CrossFit Impulse.

Anatomy chart by OpenStax College [CC-BY-3.0], via Wikimedia Commons.

The post The AbMat Is Awesome – Here’s Why appeared first on Breaking Muscle.

Learning to Recognize the Signs of a Depressed Athlete

Meghan Rovig — Thu, 23 Jan 2014 21:00:00 +0000

I love the New Year. It’s like a giant, clean, fresh whiteboard, just waiting to be written upon. Many of us set goals or resolutions for how we are going to be better – better athletes, better parents, better spouses, better people. As I ponder this drive to be “better,” I wonder how that influences our general mental wellbeing as athletes and what implications it has for our relationships with ourselves, our coaches, and our families. I see many athletes who start out eager and driven, but over time they become disenchanted with the prospect of fitness and do just enough to get by. As coaches, it is our responsibility to notice this behavior.

In a study at San Jose State, psychology researchers examined the incidence of depression in female athletes. Their hypothesis was that despite the known mental health benefits of fitness and athletic participation, female athletes are at risk for depressive symptoms due to the number of extrinsic stressors they face. Extrinsic stressors are things that come from the outside world, as opposed to intrinsic factors, which comes from within an individual.

The San Jose study found that the female collegiate athlete is exposed to an increased number of stressors, including time demands, loss of autonomy, pressures of meeting expectations of their coaches and teammates, pleasing those around them, negotiating relationships, increased competition, and performance anxiety. In addition to identifying these stressors, the study also found weariness, feelings of self-doubt, being out of control, and having nowhere to go were common themes in the mental wellbeing of such athletes.

It is interesting that this study also found that women were two times more likely than men to suffer from depression. This may be due to an increased willingness to report it, but women also reported feeling more extrinsic stressors than men. In a separate study, men reported similar feelings of being out of control, leading to uncertainty and powerlessness to manage their depressive symptoms and their lives.

In this newest study, ten current and former collegiate female athletes were interviewed. One of the common themes found in these interviews was that being an athlete had become a significant part of the person’s identity. They also reported positive feelings related to camaraderie with their teammates and the ability to manage negative experiences through the outlet of athletic participation. However, the majority of the participants described experiencing weariness, exhaustion, and feelings of being overwhelmed. Furthermore, these athletes placed significant pressure on themselves while they were struggling with their depression, and reported feeling like there wasn’t room for mistake or injury.

While those stressors are certainly valid in the collegiate athlete, they are also applicable to the average fitness buff. How many of us juggle work demands, expectations from our families and children, meeting expectations we set for ourselves, and negotiating meaningful relationships? When we are constantly working towards an “end” or trying to find the solution to a problem or conflict, while simultaneously balancing the demands of life, something will eventually bend and break.

Athlete or not, a depressive episode in any individual should never be discounted. Early identification, support, and intervention are vital to the athlete’s prognosis for recovery. This study also highlights the necessity for coaches to provide support and encouragement. Several athletes interviewed stated that they were hesitant to reach out to their coaches for fear of retribution or retaliation. In the gym, we may find that our clients are less inclined to reach out for fear of embarrassment or judgment, or maybe because they just flat out don’t feel comfortable or close enough to us as coaches.

This year, let’s all strive to not be better, but be good every day. Help your clients develop reasonable goals, praise them for their achievements, and encourage them when they fail. Recognize the signs of depression and listen with an open mind and an open heart. You just may find excellence in your gym that you didn’t even know was there.

References:

1. Jones, Alyson L., et Al., “A Phenomenological Examination Of Depression In Female Collegiate Athletes.” The Online Journal of Sports Psychology, Vol15Iss1

Photos courtesy of Shutterstock.

The post Learning to Recognize the Signs of a Depressed Athlete appeared first on Breaking Muscle.

Why Athletes Need to Understand the Concept of Torque

Meghan Rovig — Thu, 21 Nov 2013 11:00:00 +0000

The concept of torque is a foundation of human movement and is a core principle in physical therapy, personal training, and weightlifting. All movement generates torque to varying degrees and, in reality, it’s what makes the world of biomechanics tick. Torque. It’s a cool word, really. Say it. Out loud. Five times fast.

Torque is defined by kinesiologist Signe Brunnstrom as the product of a force times the perpendicular distance from its line of action to the axis of motion (or potential motion). In layman’s terms, more torque means a more effective lever. Think about opening a heavy door. If you push on the door close to the hinges, it will be more difficult to open than if you push on the side of the door furthest from the hinge (hinge = axis). A force is more effective when applied further from the axis because the length of the moment arm is greater.

You push and pull countless objects in all directions every day in the gym, and the human musculoskeletal system is nothing more than an intricate system of levers and pulleys. While we must generate torque to operate these levers and pulleys, we need to gain awareness of how to minimize torque to avoid injury. This brings us to the need to move soundly and resolve forces.

The resolution of forces occurs when we can:

Visualize the potential effect of a force on our body.
Determine how much torque we should generate.
Make our muscles and joints act in proportion to this awareness.

This doesn’t happen in a clunky, calculated fashion as I just described. It is an intuitive process, and as such we do it with minimal conscious thought, moving from point A to point B as efficiently as possible. To the contrary, our “awareness” and desire to move with speed and efficiency may create dysfunctional movement patterns.

So how can you get your torque on? The answer is simpler than the explanation of torque may lead you to believe: use your muscles. Often in the gym, I see people move into a position without regard for the joint position or joint support. They place ligaments and fascia in charge of holding a joint together (wrong), rather than engaging some of the 642 muscles they have at their disposal (right). Muscles need to do the work of supporting the joint under the strain of torque.

The snatch is among the most complex movement in all of sports. In a well-executed snatch, a lifter has hit all of the requisite positions, kept the bar close to the body, and dropped beneath it, perfectly centered. For the average amateur athlete, this is hard achieved. A successful snatch is all about torque and how quickly you can move your body around the bar, not the bar around your body. By keeping the bar close to you, extending your hips, keeping your elbows high and outside, and dropping underneath the bar when it reaches the sweet spot, you have generated torque in a series of planes so complex as to be indescribable.

There is a moment at the apex of extension when the sum of all up and down forces are zero. At that point in time, you are exerting no torque, which is precisely how humans are able to lift the amount of weight that we do and avoid the pain and suffering of an annihilating injury. We generate torque at the necessary moments, in rapid succession, move around the object, and move from point A to point B with exacting efficiency.

The bottom line is, torque is not necessarily just cuing an athlete to “screw their feet into the ground” or “rotate your arms so your elbow pits are facing the ceiling.” Torque is about generating force with your muscles to support your joints, ligaments, and fascia, while simultaneously exerting that force upon an object. It is vital to our success as coaches that we present the concept of torque to our athletes in a consistent and digestible fashion. While the average CrossFit Josephina may not readily latch on to the concept of levers and moment arms, she will likely grasp the feeling of tension generated by showing you her elbow pits when she sets for the first pull.

Physical therapist, athletic trainer, and author Kelly Starrett wrote an entire chapter in his book Supple Leopard about torque. He did a great job distilling the concept down to comprehensible and repeatable nuggets. Seek out his book, read the chapter on torque, and add the knowledge to your coaching or training toolbox. The health of your joints and your ability to move mass will reflect your understanding of the ability to generate torque.

Special thanks to coach Forrest Rohde for his help and contributions to this article.

References:

1. Smith, LK, Weiss, EL, and Lehmkuhl, LD. 1996. Brunnstrom’s Clinical Kinesiology, 5th Ed. F.A. Davis Co. Philadelphia, PA.

2. Anderson, T and McNiff, M. 2011. Becoming Bulletproof: An uncommon approach to building a resilient body.

Graphic 1 by Ilevanat (Own work) [CC-BY-SA-3.0], via Wikimedia Commons.

Graphic 2 by YaweYawe (Own work) [Public domain], via Wikimedia Commons.

Graphic 3 by User:Evdcoldeportes [CC-BY-SA-2.5-co], via Wikimedia Commons.

The post Why Athletes Need to Understand the Concept of Torque appeared first on Breaking Muscle.

The Handstand Push Up: How Things Go Wrong and How to Put Them Right

Meghan Rovig — Thu, 07 Nov 2013 14:00:00 +0000

I recently moved and started working in a new physical therapy office. Lucky for business, my new office is in the same complex as a CrossFit gym. Initially, I determined that this particular gym must be pretty good, given that in my first two weeks of employment, I only treated three CrossFitters from that gym.

But wait. Let’s do some math on that. In two weeks, I’ve worked six shifts. In those six shifts, I’ve seen three new patients from that gym. That’s a 50% chance that I’m going to have a CrossFitter on my schedule. Hmm.

How Things Go Wrong

One of these CrossFit patients presented to me with a herniated disc in her neck. She reported injuring it about six months ago and not doing anything about it. Then, when she started having symptoms down her arm, she decided to go see someone. If you’ve read any of my articles, you know my opinion of such “problem solving.” And her reported mechanism of injury? Handstand push ups.

Deadlifts, Handstand Push Ups, And Who I Am

How many of you have done “Diane”? To refresh your memory, “Diane” is 21-15-9 deadlifts and handstand push ups. As with most workout in that repetition scheme, the fifteen-rep round is the worst. I often find myself crashing down to the top of my head in that second round because my arm strength has left me. I end up doing handstand push ups in sets of one and two, rather than calculated and mechanically sound sets of five. So what does “Diane” or the handstand push up tell us about ourselves?

Nothing. My “Diane” time a year ago and my “Diane” time today are different. One may be faster, but they are two different days. Did I sleep well, eat well, or drink enough water? Am I on my third day of training? How much overhead work did I do this week? And, at the end of it all, did it change me as a person? No. I am no better or worse a human being in the ten-ish minutes it took me to bust out “Diane.”

So why do we, as CrossFitters and humans, continue to do things that are:

Not functional
Have potential to cause harm
And don’t make a hill of beans difference in the grand scheme of life?

But, I digress. Let me now step down from my soapbox and break apart the handstand push up, as was my intention at the beginning of this article.

Dissecting and Correcting the Handstand Push Up

In the handstand, you must possess the ability to control yourself in a hollow body position while upside down. You must bear the weight of your body plus gravity, and pack your shoulder girdle into a position of strength. This requires thoracic spine mobility, lat flexibility, shoulder girdle mobility, and the ability to stabilize the scapula against the thorax under the load of body weight. Once you have all of that dialed in, it’s time to push your body weight up into the air against gravity. Repeatedly. For time.

Your Head Is Not A Ram

So what happens when you get tired? Instead of relying on your shoulder girdle and core strength (which is now gone because you’re exhausted), you’ve realized there is a nice, cushy Abmat underneath you. All of a sudden you are content with letting your head come crashing down onto it, with your body weight, gravity, and acceleration on top of you. The cervical spine is not designed to accept that kind of load, and something is going to break down.

When the cervical spine is in a neutral position, the vertebral column is relatively extended and can dissipate force through ligamentous and muscular tension. With slight cervical spine flexion, the normal curvature of the spine is eliminated, and the force cannot be dissipated through ligamentous or muscular structures. This results in a significant amount of energy transfer to the vertebrae and discs themselves, rather than the surrounding supporting structures.

Best-case scenario, you tweak the muscles in your neck trying to provide stability to your now unstable cervical spine. Of the worst-case scenarios, the list is endless. The force placed upon the vertebrae can result in disc herniation, compression, and burst fractures, as well as a spinal cord injury that leaves you paralyzed and using mechanical assistance to breathe.

Consistency Before Intensity

How important is the handstand push up, really? If you are new to CrossFit, swallow your pride, get your upper extremity and core stronger, and start with piked handstand holds off a box or even banded handstand push ups. Realize that the Abmat is not there to save you. Keep your neck neutral, your shoulders packed, and your core engaged. When you get tired and start failing, come off the wall and rest. The handstand push up will still be there tomorrow. Let’s make sure you show up too.

Breaking Muscle has a number of progressions for the handstand push up, such as David Ayres excellent Handstand Push Up and Mobility video.

References:

1. Banerjee. R., M.A. Palumbo & P.D.Fadale, “Catastrophic Cervical Spine Injuries in the Collision Sport Athlete, Part 1: Epidemiology, Functional Anatomy, and Diagnosis” Am J Sports Med. 2004 32: 1077

Photos 1 & 3 courtesy of CrossFit Impulse.

The post The Handstand Push Up: How Things Go Wrong and How to Put Them Right appeared first on Breaking Muscle.

What Your Butt-Winking Dog-Squat Is Doing to Your Poor Innocent Knees

Meghan Rovig — Thu, 26 Sep 2013 13:00:00 +0000

Being a physical therapist and CrossFit coach allows me to look at movement from a unique perspective. In the CrossFit box, that look is visually painful most of the time. For those coaches who have devoted their focus to expanding their knowledge about kinesiology, I’m sure the same is true.

As coaches, we have the opportunity on a daily basis to positively change the way someone moves. It is our responsibility to ensure quality movement prior to loading. I ask you this: raise your hand if you have allowed an athlete to load up a bar and move that weight with shit mechanics? Don’t be coy. All of you look silly, sitting at your computer or smartphone reading this article with your hand up in the air. What a disservice we have done to our athletes.

Meet Mr. RowHard

About a month ago, I was talking with a fellow coach about the reasons why most of our athletes have poor mechanics. A new member had started CrossFit and in his second week rowed 500m in 1:35. Impressive, right? The kid certainly is motivated to become better.

A few nights later, I watched the class do a modified Fight Gone Bad. Expecting greatness in all movements from Mr. RowHard, I was astonished at what I saw. Wall balls with a rounded back, butt wink, and weight in the toes. The medicine ball was completely owning this poor kid. With every box jump, his knees clapped together audibly over James Hetfield’s screams in Battery. This particular box does not do the sumo deadlift high pull (perhaps an idea for another article), so when he transitioned to power cleans, my eyes and brain were prepared for some stellar reverse globo-gym bicep curls (which is what I observed). Only when he got his ass on the erg did I start to see greatness. So why is it that he can row like a fiend, but moves poorly otherwise?

After Mr. RowHard picked himself off the ground, he noticed us two coaches discussing him and his performance. While we remarking about his poor squatting, he interrupted us and said, “Will you help me fix it?” Angels from heaven came down and began singing. This kid was wasted from one of the most demanding WODs in CrossFit, yet was dedicated enough to stay after class for two-on-one squat instruction. Hallelujah! Thirty minutes later, we were able to take a squat that looked like a dog taking a bathroom break in Saigon to a flat back, chest up, weight in the heels, knees pushing out thing of beauty.

I’m not going to bore you with squat instruction or progression. You’re all coaches or athletes in some capacity and should already know that information. What I will do is tell you what can happen to the knee if you don’t take that extra time with your people and help them to move with integrity.

The Sad Story of the Knees

The knee is the redheaded stepchild in a nasty divorce between the hip and the foot. It did nothing wrong, yet is the victim. If the muscles of the hip do not operate efficiently to control the femur, the knee suffers and will collapse medially. Medial collapse stresses the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial meniscus. It places far more load through the medial aspect of the joint than what is favorable. It’s also the mechanism of injury to all of those structures, the Terrible Triad (super menacing!).

Furthermore, medial collapse and failure to engage the posterior chain (glutes and hamstrings) contributes to quad dominance with movement. When the hamstrings cannot counteract the quads, the tibia is given the opportunity to glide anterior on the femur, placing stress on the ACL and slamming into the articulation with the patella. Enter patellofemoral pain, AKA “I don’t know why your knee hurts but it does, so go do some PT and it will be fine.”

When all of these biomechanical nightmares are ignored, you’re looking head-on into early joint arthritis, pain, and eventually giving up the things you enjoy – like training to be better at life.

So, here are a few ideas of what to do:

Foam roll that shit.
Train your glute medius.
Stretch your calves.
Push out your knees.

Yes, it’s painful, and hard, and uncomfortable. So is life. What are your goals? Do you want to squat heavy shit or just sit on the toilet without pain? Do work. Get better. Quit beating up on your knee. It didn’t do anything wrong. Get your hip stronger, tell your foot to quit being lazy (see photos below) – and squat like you mean it.

Left: Active foot position; arch elevated by bringing great toe closer to the heel.

Right: Poor relaxed foot position. Arch is collapsing.

Ever heard of the Couch Stretch?

Couch Stretch: Small, But Important Ways You’re Doing It Wrong

The post What Your Butt-Winking Dog-Squat Is Doing to Your Poor Innocent Knees appeared first on Breaking Muscle.

A Pain in the Groin: Types of Groin Injuries and When to Seek Treatment

Meghan Rovig — Thu, 29 Aug 2013 16:00:00 +0000

Groin injuries are nagging, difficult to diagnose, and inconvenient for athletes when they do not resolve. These injuries are most frequently seen in soccer, hockey, martial arts, hurdling, and skiing; however, they may also plague CrossFitters and Olympic weightlifters.

What Causes Groin Injury and Pain?

Groin pain is often due to overuse or repetitive specific use of the lower abdominals and proximal thigh. But there is a broad spectrum of differential diagnosis in groin injuries. While most often the pain stems from soft tissue dysfunction, such as a muscle strain, tendonitis, or contusion, occasionally groin pain may be referred from the lumbar spine, osteitis pubis, neural entrapment, “sports hernia,” and true hip pathology, to name a few.

Acute groin pain is common in sports that involve kicking, running, or rapid changes in direction, such as soccer, football, and martial arts. Athletes will associate pain with a specific movement and may feel or hear a pop in their groin. Physical examination might reveal tenderness, bruising, and muscle swelling. Usually, these resolve with rest and physical therapy in four to six weeks. If there is tenderness along the inguinal ring, hip joint, or lumbar spine, the matter will warrant further investigation.

What About Chronic Groin Pain?

Chronic groin pain presents a more elusive challenge in diagnosis. This condition may be due to an ignored acute injury that continues to be irritated by activity. An original injury that doesn’t go away points to a more severe pathology.

Stress Fractures

Stress fractures are an injury at any bony site in the body and arise due to repetitive load and overuse. The most common stress fracture sites that refer pain to the groin are those of the pubic ramus (#4b in the illustration to the right) and femoral neck (the femur, just below the hip joint). A stress fracture presents as gradually worsening pain, intensified with weight bearing and usually decreases with rest.

Avulsion Fractures

Avulsion fractures occur when load is so strong that the muscular attachment tears away from the bone. These injuries are associated with a forceful muscular contraction, and a palpable defect at the insertion of the muscles on the pubic rami may be felt.

Osteitis Pubis

Osteitis pubis is a chronic inflammation of the pubic symphysis (#5 in the above illustration) and adjacent bony structures as a result of repetitive stress of the muscular attachments during running. It is characterized by groin pain, tenderness at the pubic tubercle (#4d and also illustrated to the right), and pain with running, sit ups, and squats.

Sports Hernia

Athletic pubalgia, or “sports hernia,” presents similarly to an acute groin injury with sharp pain during rapid change in direction or forceful kick. It usually does not resolve completely with rest, and, while there is no palpable bulge like with an inguinal hernia, the opportunity exists to allow some of the abdominal organs to press against the weakened tissue.

LEARN MORE: Sports Hernias May Be Caused By a Hip Disorder

Hip Pathology

Two conditions of the hip that may cause hip pain and most certainly should not be ignored are Legg-Calve-Perthes disease (LCP) and slipped capital femoral epiphysis (SCFE):

LCP is avascular necrosis of the proximal femoral epiphysis, occurring in boys between the ages of eight and thirteen. Avascular death means that bone tissue dies off due to a lack of blood supply. As youth are becoming more active in unconventional sports (i.e., Harrison Maurus in weightlifting), as parents and coaches, it is our responsibility to figure out when our children are experiencing simple soreness and when something really wrong. A kid with LCP will complain of gradually worsening groin pain that refers to the abdomen or thigh. Over time, they may also develop a decrease in mobility and pain with movement.

SCFE occurs in boys ages ten to seventeen, who are tall, lanky, and thin, or morbidly obese. Groin pain in these athletes will either come on quickly with an acute incident, or gradually due to repetitive stress. As the condition progresses, the athlete will have pain referring into the hip and medial knee, as well as a limp.

Both LCP and SCFE warrant further investigation by an orthopedist and possible surgical intervention.

When to Seek Treatment

As with all injuries, anything that continues to persist beyond a few days or does not go away with rest requires medical evaluation. Groin injuries related to soft tissue, while annoying, have the ability to progress into a more sinister pathology due to the altered movement and mechanics that ensue to protect the area.

In acute cases, rest, ice, and anti-inflammatory medications are a good place to start. As always, if it doesn’t resolve, find someone you trust who knows more than you and get it checked out. An injured athlete isn’t an athlete; they’re just an injured person.

Photo 1 by Wiechers at nl.wikipedia (Transfered from nl.wikipedia) [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5], from Wikimedia Commons.

Photo 3 by BruceBlaus (Own work) [CC-BY-3.0], via Wikimedia Commons

The post A Pain in the Groin: Types of Groin Injuries and When to Seek Treatment appeared first on Breaking Muscle.