Pull your head in

The past weekend was spent at the Australian Crossfit Regionals watching the best Crossfit athletes from Australia and New Zealand battle it out for for a ticket to the Crossfit Games in July. While for the most part I saw efficient and skilled movement, there was one workout in particular where I saw a number of competitors displaying what I call "poke neck".

Poke Neck aka Upper Crossed Syndrome

Poke neck can be the result of shoulder/upper thoracic mobility issues and/or weakness of the deep neck muscles and scapular stability muscles, otherwise known as Upper-Crossed Syndrome. This syndrome is particularly evident in people who have desk/computer jobs. It has been found that for every inch (or 2.54cm for the metric peeps) your head is forward of your spine, an additional 10lbs (or 4.5kg) is added to the weight of your head (Kapandji, 2008). This additional weight places stress on the muscles of the neck and upper back and can put extra pressure on the suboccipital nerves, causing headaches.

To combat poke neck, mobilize the following areas:
- Thoracic spine
- Neck: particularly upper traps, levator scapula & scalenes
- Chest: pectoralis major/minor

And, strengthen the following areas:
- Deep neck flexors
- Middle back: lower trapezius & rhomboids (Bulletproof shoulders by Crossfit New England is a great resource).

http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&cad=rja&ved=0CC0QtwIwAA&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DACAz6HFj1xE&ei=UOSmUcHIG8qCkQXM7YGIDw&usg=AFQjCNFrYsBdOTd65IYqEZ6ryttYOm1qVA&sig2=8f8_zkSmcG3e4pa5ZM2S0g

 In addition, have a look at your biomechanics while you are training. Get your coach to film you from the side the next time you are doing a pressing movement, kettlebell swings or thrusters/overhead squat to see if you are excessively throwing your head through at the top of the movement.

Throwing your head through is a green light to a neck injury.

So pull your head in.

Knee pain?

There are a few different types of knee injuries and my goal here isn't to discuss every single knee injury, but more to make you aware of the structures that may be contributing to your pain. Acute injuries, such as ligament tears, meniscus injuries, patellar dislocation etc. are probably not as common in Crossfit as those of more a chronic/repetitive type injury (patellar tendinopathy, bursitis, etc).

The knee is actually made up of two joints: the tibiofemoral joint (the joint between your tibia and femur) and the patellofemoral joint (the joint between your patella and your femur) which are stabilized by the collateral ligaments, cruciate ligaments and mensicus. The quadriceps, gracillis, iliotibial band, popliteus, sartorius, hamstrings and calves provide muscular stability and assist in movement of the knee (flexion, extension and some rotation).

Knee pain can be associated with injury to any of the structures directly connected to the knee, but can also be from other structures upstream (lumbar spine, SIJ, hip) and/or downstream (ankle).

Two of the most common causes of knee pain (anterior/front of knee) is patellofemoral joint problems and patellar tendinopathy. The signs and symptoms of each problem help to distinguish the diagnosis.

Patellofemoral Pain
- comes on with running/weight bearing activity involving bending of the knee
- pain aggravated by activities that load the knee eg. squatting, jumping
- sometimes associated with clicking and "crunchiness" under the kneecap
- knee sometimes gives way
- weak VMO (inner quads)
- tight vastus lateralis (outer quads), TFL
- often associated with foot pronation (flat feet) and valgus knees (knock knees)

Patellar Tendinopathy
- comes on with jumping/change of direction/squatting
- pain is at the base of the kneecap
- pain aggravated by decline board squats
- tenderness of patellar tendon
- associated tightness of quads, hamstrings, possible pelvic biomechanical issues
- calf weakness commonly found

Treatment of each of these conditions varies so it's always best if you get a Physio to do an assessment. Self diagnosis via "Dr Google" can be misleading, not to mention you could be wasting your time barking up the wrong tree. In any case, addressing the tissues around the knee can be a good place to start.

Try rolling out/trigger pointing the quads, hammies, calves, adductors and glutes and see if it changes your knee pain. Make sure to test first (whatever movement causes the pain) and re-test post rollout to see if you have made change. No change = see a professional. Change = keep it up!

Shoulder rotation - do you have enough?

The shoulder is an amazing joint, capable of great things...when it is all functioning properly!

The shoulder is comprised of 4 joints - the sternoclavicular, the acromioclavicular, the scapulothoracic(ScTJ) and the glenohumeral (GHJ). The GHJ is quite unstable due to its lack of bony stability but is held in place by numerous ligaments, the joint capsule and rotator cuff  and scapular muscles.

Normal shoulder ROM is as follows:
Flexion 180 degrees (the top of a push press)
Extension 40-60 degrees (lifting your arm straight behind you)
Abduction 180 degrees (lifting your arm out to the side)
Internal rotation 60-70 degrees (rotating the arm in towards the middle)*
External rotation 80-100 degrees (rotating the arm outwards)*
* tested with the arm abducted and elbow flexed to 90 degrees

In Crossfit (and in normal day to day life) our shoulders also need to be able to hit combined ROM - for example reaching for a seat belt involves shoulder abduction and external rotation, putting your wallet in your back pocket involves shoulder extension and internal rotation.

Lets take a look at the shoulder position in an overhead squat - full shoulder flexion, abduction and external rotation. The overhead squat is a demanding movement that requires not only good mobility and stability at the shoulder joint, but a mobile thoracic spine and hips, plus great core control. Take a look at the two photos below, one of which demonstrates a good overhead position.


   Which one would you rather look like?

 

I often see people complaining of shoulder pain and they are usually missing some degree of shoulder internal and/or external rotation. Lack of external rotation at the shoulders causes you to look like the guy on the right (he's probably also missing full range shoulder flexion and some degree of thoracic extension. I won't get started on the hips...)

Try the Apley Scratch test to see if you have adequate shoulder rotation:

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Apley scratch test. The patient attempts to touch the opposite scapula to test range of motion of the shoulder. (Left) Testing abduction and external rotation. (Right) Testing adduction and internal rotation.

If you can't achieve full shoulder external rotation due to tight lats, pecs and teres major, your overhead movements are going to suffer. Try mobilizing your lats (foam roller or band), pecs (lacrosse ball) and teres major (lacrosse ball) for 3-4 minutes each side before your next WOD that includes an overhead squat/snatch component and see if you notice a difference.