Why does it feel like I'm walking on shards of glass?

Earlier this week on the MobilizeMe Facebook page I shared an article regarding plantar fasciitis and just wanted to share a few tips/mobility ideas to help prevent and treat this painful foot problem.

Plantar fasciitis is actually an overuse condition of the plantar fascia. The plantar fascia is a thick band of tissue that provides support for the longitudinal arch of the foot and assists with shock absorption (like when running, doing double unders or box jumps).


Causes of plantar fasciitis are numerous and can include:

• low arches in the foot (pes planus)
• high arches in the foot (pes cavus)
• over-pronation (flat foot)
• excessive plantarflexion of the foot with dorsiflexion of the toes (eg. running, box jumps)
• unsupportive footwear
• being overweight
• tightness of the calves, hamstrings and glutes

The introduction of flat-soled footwear (eg. Nano's, innov-8, etc) into mainstream wear can be partly to blame, especially if there no period of adaptation. Most people are used to wearing shoes that have moderate arch support. Going from these type of shoes to a minimalist-sole type of shoe can lead to conditions like plantar fasciitis. If you pronate/have flat feet and want to wear these types of shoes, I would advise that you wear them 1-2x/week initially, and build up slowly over time to give your feet and lower limbs a chance to build the muscular strength and stability required.

If your feet are already suffering and you feel like you're walking on glass, I would recommend getting back into a pair of supportive shoes and avoid walking barefoot or in thongs.

Treatment can include the following:

• avoiding activities that aggravate the pain
• ice post activity (a frozen water bottle is great for this - roll out bottom of foot with the frozen bottle)
• stretching/trigger point release/foam rolling of the plantar fascia, calves, hamstrings and glutes
• self massage with a golf or lacrosse ball (we have some awesome blue ones on our Facebook shop!!)
• strapping of the foot
• Kinesio-tape
• acupuncture/dry needling
• Scenar therapy
• massage
• night splints
• biomechanical correction (orthotics)
• strengthening exercises for the intrinsic muscles of the foot (see links below)

https://www.youtube.com/watch?feature=player_detailpage&v=GY-mJjXmeIc








If you are in need of a lacrosse ball, head to our Facebook shop and get yours!
https://www.facebook.com/mobilityforcrossfitters/app_251458316228
 

Shoulder extension - the missing link?

Over the weekend I was at a Crossfit competition where there was 2 big pull up workouts (team event). While watching one of the events I had a conversation with someone who said they couldn't do butterfly pull ups because their shoulder didn't like the movement. Further into the conversation I found out that they had suffered a bicep tendon rupture performing a front lever and in a previous life had spent a lot of time doing bicep curls. I asked them to show me their shoulder extension ROM and they had about 20 degrees...normal shoulder extension should be 40-60 degrees.  They were missing at least HALF to 2/3 of normal ROM. Any wonder why butterfly pull ups were not their friend?

 

 What muscles are involved with limited shoulder extension?

• Long head of biceps brachii
• Coracobrachialis
• Pectoralis major
• anterior fibers of deltoid

What movements will be affected if lacking shoulder extension?

• Pull ups (particularly chest to bar and butterfly)
• Muscle ups
• Ring dips
• Push ups
• Burpees
• Bench press/floor press

Biceps trigger point referral pattern

The long head of biceps in particular is prone to overuse and trigger points can cause referred pain into the shoulder itself. This is due to the fact that its tendon inserts into the labrum of the shoulder joint. The biceps is responsible for flexing the elbow and shoulder and also supination of the forearm (turning the palm upwards).

Some people complain of a snapping or clicking sensation with long head of biceps problems. Often, rotator cuff injuries and issues with the long head of biceps go hand in hand.


Try rolling out/trigger pointing the biceps, front of the shoulder and pecs and stretching prior to workouts that involve pull ups, muscle ups, ring dips, push ups or burpees and see if it makes a difference. I saw a lot of people over the weekend making good use of the barbell to smash out their biceps!

If improving the mobility of these muscles isn't helping, you may have a problem with scapular stability and/or shoulder joint positioning (like a forward head of humerus) and you should make an appointment with your Physio for an assessment!

No more excuses

There is so much information out there these days with regards to training, mobility, stretching, recovery, nutrition, etc. We have everything we need at the  palm of our hand, at the touch of a screen and yet it is still hard to get the things done that we really need to work on.

When is the last time you heard someone say "Well, I just PR'd my snatch so I'm done! Don't need to keep working on that!" Probably never. But when it comes to doing rehabilitation exercises or mobility, it gets easily left off the list of things to do. Why is this the case? I think I have maybe heard all the excuses in the world: it takes too long, it hurts too much, I have no time, I forgot, I didn't know what/how to do it, I couldn't remember how, I had to cook dinner/watch the kids/mow the lawn. The list of excuses goes on and on.

If you want to get better at something, you need to practise it. I don't know of anyone that could pick up the barbell and snatch perfectly the first time. It takes time, practise, sweat, tears. Mobility is no different. If you want to get better at it, you need to practise at it. And once you get better at it, you don't just stop.

If you have time to Facebook, Twitter, Instagram or watch TV, you have the time to do mobility. Stop making excuses and just do it. If not, stop complaining about your increasing number of injuries and how you can't overhead squat.

Get your roller, lacrosse ball or other favorite instrument of torture and put it in front of the TV. Whenever an ad comes on, roll out something that hurts. Take your lacrosse ball to work and mobilize your hammies. Get to the box 10-15 minutes early or stay after class. Stop making excuses and start putting the work in.

Tight abs = lower back pain?

The rectus abdominus = the 6-pack that we all want, strive for and drool over. But tightness/overuse of this show pony muscle can be driving lower back pain.

The rectus abdominus is a broad, flat muscle that runs vertical on the wall of the front of the abdomen. It extends from the pubic symphysis, pubic crest and pubic tubercle to the xyphoid process and costal cartilages of the 5th to 7th ribs. This muscle is important posturally; it's actions include flexing the lumbar spine (like when doing a sit-up), posteriorly tilting the pelvis and assisting in hip flexion. It also assists with breathing, as in forceful expiration (breathing out), keeping the internal organs intact and creating internal abdominal pressure.

Trigger points or tight spots in the lower rectus abdominus have been found to refer pain into the lower back - like a thick band of pain around the lower back and into the top of the glutes. Trigger points higher up near the ribs have been found to refer pain higher up in the back, closer towards the bottom of the scapula.



A. Trigger points in rectus abdominus and their referral pattern in the mid/lower back.

It is important to note that if you have tightness in your rectus abdominus, your iliopsoas (long hip flexor) is most likely going to be tight also.



Trigger points in iliopsoas and referral pattern in lower back and front of hip/thigh.

 

If you are suffering from lower back pain, try releasing both your rectus abdominus and iliopsoas. Lie on with a lacrosse ball, baseball or softball under your abdomen, off to the side, about a fist length away from the belly button. Contract/relax your abs as you lie on the ball and make sure to move it up/down the length of your abs.

 

Another method is to get a heavy kettlebell and place the handle lengthways or crossways under your tummy. Then get on all fours and jam the handle of the kettlebell into your stomach, trying to find any tender/tight spots. Contract/relax your abs as you need to.

 

This is a highly unpleasant and somewhat interesting position to be in; I was told that it's referred to as the "Kettlebell Hump" because that's what it looks like when you're doing it....but it is very effective. (Thanks Antony Lo - The PhysioDetective for this one!!!)

 

Maybe try it in private first....and good luck.





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:

---

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.