Hip mobility in Crossfit

So I put out the call yesterday on our MobilizeMe Facebook page to find out what you wanted me to discuss in my next blog posts - and a lot of you asked for hips. So here goes.

Hip mobility is essential for developing a good squat. If you read that article I posted yesterday by Spencer Arnold, you'll see that he mentions mobility a lot. I think a good deal of problems with LACK of hip mobility in the population stems from the fact that we spend most of our day in sitting. Sitting requires about 90 degrees of hip flexion. Squatting requires at least 100 degrees of hip flexion (just breaking parallel), not to mention hip abduction and external rotation.

Sitting is also a PASSIVE activity, meaning that it requires little to no activation of any of the muscles in your lower limbs - you are being held up by the chair (I'm not going to get into a Physics discussion with this statement so don't get all science-y on me :-) Sitting for long periods causes our hip flexors to become short, and our hip extensors to lengthen and become weaker. In essence, we become the shape of a chair.

The Thomas test is a measure of hip flexor length and is shown in the two photos below:

Tight hip flexors - Positive Thomas Test - the knee is higher than the hip




Normal hip flexors - Negative Thomas Test - the knee is lower than the hip with knee flexed to near 90 degrees
 
 
Which of these two do you think would have issues attaining depth in a squat? I'll give you a hint, it's not the second photo....
 

Good hip mobility also includes rotational components; with a squat we are more concerned with the ability to externally rotate the hip/thigh. This puts our hip into a stable position and engages the gluteus maximus. Have you ever seen someone squat and let their knees cave in, then miss the rep or look like they're about to give birth trying to squeeze that rep out? Poor hip external rotation. Now, that can be due to poor mobility or poor hip stability/strength. It's up to your Physio (or really good coach) to figure that one out. But here's a tip: if you honestly, truly, consistently work your mobility and you are getting nowhere, it's a stability problem. All the mobility in the universe won't cure poor stability.

 

So where is this all going - I would have to reiterate what was said in the Spencer Arnold blog post - learn to squat properly from the start and don't add weight until you are proficient. Load is NOT going to help you squat properly. Do your mobility - sit on the lacrosse ball until it no longer hurts (not all at once), get out the band and do hip mobility with the band (it's in the MobilizeMe app and about a kazillion K-starr MWOD's), get up off your ass at work at least every hour. Like I said before, if none of this is working, you need a professional to look at it. Pony up and book into a Physio for an assessment. You can't assess yourself (believe me I have tried and I AM a physio!!).

 





 

Duck feet and squatting

Ever notice what your feet are doing while you're squatting? Probably not, but I DO. And I see it all the time. It makes my ankles, knees, hips and lower back HURT just looking at this.

Poor LEFT ankle mobility

What is actually going on when your feet are turning out during a squat (like the photo above)?

I would generalize and say it's coming from issues at one or two (maybe both) places: your ankles and/or your hips.

For this post, I will concentrate on the ankles.

Squatting requires good dorsiflexion mobility at your ankle joint. In other words, the ability to bring the top of your foot closer towards your shin. Any problems with this means that your body may compensate and find a way around the issue. In most cases, the compensation involves turning the foot outwards.

Lack of ankle mobility may be due to tightness of the calf muscles, the gastrocnemius and soleus and the long toe flexors, or stiffness in the ankle joint/s.

Try this knee-to-wall test to see if your ankle range of movement is adequate:

1. Measure 10cm away from the wall with a ruler/measuring tape and mark the spot on the floor.
2. Place your big toe of one foot at the 10cm mark, with the other leg behind you. Ensure your hips stay square to the wall.
3. Bend the front knee, making sure to keep your heel absolutely flat on the floor. The knee should be tracking over the middle of the foot (and not dropping in towards the midline).
4. If your knee cannot touch the wall without the heel coming off the floor, move the foot forward in centimeter increments and repeat until your knee touches the wall without the heel lifting.
5. Compare to the other side.

   

   Knee-to-wall test

If your score was less than 9-10cm from the wall, you have restricted ankle range of movement.

Try doing some mobility for the sole of the foot, the calves and hamstrings - stretch, foam roller, lacrosse/trigger point ball - prior to squatting. If this fails to make a difference, the problem may be more with restriction in the ankle joint/s. 

The use of an Olympic style lifting shoe can make a massive difference with squatting if your joint mobility isn't so flash. But get that ankle restriction looked at by a Physio. Old injuries like ankle sprains can have an impact on your joint range of movement, so if in doubt, get it checked out!

Deadlifts and Back Pain

Horse & carriage, wine & cheese, Simon & Garfunkel....these things go together. Deadlifts & back pain DO NOT go together. However, more often than not, when I get a Crossfit athlete presenting to me complaining of back pain the movement they were most likely performing when they felt their pain was DEADLIFTS.

Why is this the case?

There can be a million different reasons why you are experiencing back pain with deadlifts. I don't have all day and would probably get carpal tunnel from trying to delve into all of them so we'll just examine a few reasons why.

1. You are not using the right muscles: a deadlift is a functional hip extension movement that involves the posterior chain (hamstrings, glutes and lumbar erector spinae plus latissimus dorsi). The glutes and hamstrings are the primary hip extensors and if they are not activating correctly - the load will shift to the muscles of the lower back. I always tell people they should be sore in their glutes & hammies after deadlifts, if not, they aren't using the right muscles.

2. You aren't engaging your lats: your lats assist with maintaining lumbar extension and shoulder extension. Activating your lats before and during the lift will help keep your back in a good position and also keep the bar close to the body.

3. The bar is too far away from your body: the bar path in a deadlift should be a straight line off the floor. The further away the bar is from your body, the "heavier" it is. Keep the bar against the legs for the duration of the lift.

4. You are rounding your back: you need to maintain a flat thoracic spine during a deadlift. When the weight gets too heavy, we have a tendancy to round the upper back. If you find yourself rounding your back, drop the weight.

5. Your hamstrings are too tight: your hamstrings attach to the bottom of your pelvis and if they are too tight, will pull your pelvis into posterior rotation (butt wink) which is an effective position to be deadlifting in. Also, tight muscles are WEAK muscles.

6. Fatigue: workouts with multiple rounds/reps that have deadlifts and other hip extension movements (think kettlebell swings, running, etc). Once you get tired, you probably are no longer thinking about which muscles should switch on a what point. You just want to get the bloody workout over with already! If you have a tendancy to get back pain with these types of workouts, think about reducing the rounds/reps/weight and focus on your technique. Your back will thank you for it.

Try getting your coach to video you while you are doing your deadlift (Coach's Eye) and watch it frame by frame to see where you may be going wrong. The deadlift should  be a basic movement to perform but it is often done poorly. Get the foundation/technique correct before loading excessive weight on the bar.

Gluteus Maximus...or not-so-gluteus maximus?

Gluteus maximus...or not-so gluteus maximus?

Your gluteus maximus is the largest and strongest muscle in the body and is what gives you a ‘booty’. Having good glutes is not only important for filling out your pants but for nearly every lower body related movement in Crossfit – deadlift, squats, thrusters, Olympic lifting, kettlebell swings, box jumps, running, rowing – you get the idea.

They are responsible for extending and rotating the hip and also play a role in stabilizing the pelvis during walking/running and transferring force from the legs to the pelvis and spine. Poor endurance and delayed activation of the glute max has been found in individuals suffering with low back pain (Brukner & Khan, 2009). So, if you suffer from lower back pain, you may need to look at fixing a dysfunctional glute max.

How do you know if your glutes aren’t working properly? Soreness in the lower back after deadlift day is a giveaway in my eyes but here is another way of checking it out.

TEST: Glute Bridge – lie on your back with your knees bent and feet flat on the ground. Keeping your knees together, lift your hips toward the ceiling, making sure not to overextend the lower back. Aim to hold for 10 seconds. Where do you feel the tension – a) your lower back? b) your hamstrings? c) your glutes? If you answered yes to either/both a & b – you need to work on your glute max. If your hamstrings cramped – you DEFINATELY need to work on your glute max. This test can also be used as an exercise to improve glute max strength and activation – just ensure that you are feeling it IN YOUR GLUTES and not in the lower back or hamstrings.

 



MobilizeMe

Hello!

I know it has been quite awhile since I last posted but I have been busy!!!

I am so super excited to announce that the project I have been working on for oh, about the last 8 months has finally been launched - the FIRST and ONLY mobility App for Crossfitters!

My main goal for this application is to empower Crossfitters with the knowledge and how-to of correctly mobilizing for workouts, all available on your phone! I hope that it provides everyone the information in an easy to understand format which allows you to improve your flexibility which WILL in turn, improve your performance.

My intention with MobilizeMe has never been to take away what others have done previously but reinforce what seems to be largely lacking in the Crossfit community.

As a Physio who is treating a large number of Crossfit athletes, too often I see people not reaching their full potential due to poor mobility and getting unnessessarily injured. Poor form and technique due to restricted range of movement will hopefully soon be a thing of the past!

I hope that you find MobilizeMe beneficial! Head to the our page on Facebook and LIKE/SHARE us please! We would love to hear any feedback you have about the App.

Happy Mobilizing :)

http://www.facebook.com/mobilityforcrossfitters#!/mobilityforcrossfitters

Core stabilty and Crossfit

Welcome back!

Ahhh, good ol' "core stability". Everyone I am sure has heard the term before, but really what is "core stability" and how does it apply in Crossfit??

Core stability is the "the muscular control required around the lumbo-pelvic and hip area to maintain functional stability" (Brukner & Khan). In other words, it is the muscles around your lower back, pelvis and hip and how they work to support you while you are moving.  The core muscles are located close to the spine/pelvis and are responsible for providing stability during movement and include the multifidus, transversus abdominus, diaphragm, quadratus lumborum and psoas major. In addition, gluteus maximus and gluteus medius provide stability around the hip/trunk and pelvis. Weakness or altered muscle activation of any of these muscles may contribute to poor core stability which may lead to lower back/pelvic injury.

What does all this mean in regards to Crossfit??

Basically, if your core is crap, you will struggle with Crossfit and may end up with an injury or re-aggravating a previous injury that was not rehabilitated properly. Keep in mind that a strong core is essential for creating midline stability, which is required for pretty much every movement we do in Crossfit. Ever see someone do a push press and look like this?

 Ouch. I cringe just looking at this photo. This person needs some help pronto.

May I suggest the following....
1. Keep head in line with spine
2. Fully extend the hips by squeezing the glutes
3. Lock the ribcage down by tightening abdominals/core
4. Slightly bring the arms forwards so they are over the midline of the body.


Looking good, Annie T. You don't get to win Crossfit games TWICE with poor midline control!!!

Here are a couple ways to test your core/midline stability:
The Two-Hand Rule Test (Greg Glassman & Kelly Starrett)

Place one hand at the level of your belly button (thumb to belly button) and the other hand (with the thumb) just under your chest around your xhypoid process (at the bottom of your sternum). Your hands should be parallel. Now squat and pay attention to the distance between your hands at the bottom of your squat. Have your hands become further apart? Or are they touching? If you said yes to either of those statements, chances are good that your core is not functioning properly...or you have some work to do with mobility.

This test looks at your ability to maintain lumbo-pelvic control in a squat, without load. Now, imagine you are doing your Crossfit total, you've got 100kg+ loaded on the bar to do your back squat and you collaspe at the bottom of your squat, violating the 2-hand rule, what do you think might happen next? Yep, lower back injury. Crap. That sucks.

Next up -

Prone bridge/Plank Test

How long can you maintain this position for without losing good position (neutral pelvis without the lower back sagging) or feeling tension in the lower back? If you cannot hold this position for minimum of one minute, things aren't looking so good...

So, how did you go? Good, bad, ugly?

If you tested poorly, I would suggest that you get a Physiotherapist to assess your core stability, particularly if you are prone to low back pain and/or have an injury. In the meantime, try to get your core working; start by lying flat on your back with your knees bent and feet flat. Find your hip bones on both sides with your hands, then go inwards towards your belly button about 2cm (approximately where your pants sit, unless you are a homey and wear your pants around your knees...). Then gently draw in your lower abdominals and pull up on your pelvic floor (Girls - imagine you are stopping yourself from weeing midstream. Guys - imagine you have your boy bits on a cold steel table and you want to lift them off of said cold steel table). You should feel as though your lower tummy is "drawing inwards". If you feel your tummy bulging under your fingers, you are using the incorrect muscles. Once you have your core "switched on" try and lift one foot off the floor and see what happens. Does your stomach bulge out? Does your pelvis shift?

If you answered yes to any of the above, you have some work to do my friend. Go see a physio. Before you blow a disc in your back.

The importance of rehabilitation exercises after shoulder injury

After suffering from a shoulder injury and doing modified workouts at Crossfit, the last thing you probably want to do is a *boring* rehabiliation exercise program, right? Well if you  want a long career in Crossfit, you better get used to it. Otherwise you are likely to re-injure yourself again, inevitably causing an even longer hiatus from the sport you love.

There are different phases of rehabilitation: acute, recovery and functional with different goals and type of exercises for each phase. It is important that you fufill certain criteria of each phase before moving onto the next to enable a smooth transition back into training. One of the biggest problems I encounter is that people tend to only do the exercises prescribed for a short period of time. You need to keep in mind that although the shoulder may not be painful or niggly, chances are good that it is not 100% repaired unless you have put in 100% to rehabilitate it. Proper rehabilitation takes time and effort on your part. Consider it part of your training and treat it with the same level of importance as you do your training and I can promise you that it WILL improve.

Starting a rehabilitation program should be done under the guidance of a trained physiotherapist or exercise physiologist and for best results I would recommend they get in touch with your Crossfit coach so your coach knows what you can/cannot do.  At the beginning it is important that your pain is well under control. This is essential as pain will alter the way that your shoulder functions and you may even hold your shoulder in unnatural positions which can lead to muscle inhibition. Exercise should start within pain-free range of movement and then progress onto larger ranges of movement as pain is controlled. 

All in all, shoulder injuries suck and can take a long time to recover from. But if you get it diagnosed properly in the acute phase (i.e. not waiting 6-12 months for the problem to "go away on it's own"), get adequate physiotherapy treatment and be compliant with rehabilitation, there is no reason why you can't return to Crossfit at 100%. Get it fixed RIGHT the FIRST time, otherwise it will take you out of the game for longer.

And who wants to miss out on Crossfit for any longer than we have to?