Why does your leg hurt again?

There are hundreds and thousands of therapists and trainers, that, when confronted with your hurting hamstring or your terrorised tendon will simply dive in and rub that bit! Maybe they will give you a specific stretch and maybe a reassuring “There there, therapist kiss it better”

The reality is that your body is a global system and highly interrelated. Leg issues can be caused by core issues, how you chew your food can screw your knee!

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An anti-inflammatory vinaigrette for your tendons

According to the tales of “old housewives” and the assurances of hippies, food does have a supportive role in helping tendon pain resolve itself.

There are famous anti-inflammatory foods that, when combined with a healthier lifestyle and actually doing specific exercises, really, really helps.

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DWF: 3 day metabolic conditioning cycle, fixing pain, weight loss stuff!

The DWF, or daily workout and food is aimed at giving you some basic conditioning ideas. For some it’s the only thing they do, for many it’s just part of your training day.

Most days you also need to work on skill ( I often focus on gymnastics), Strength and therapy drills: I need always focus on my vulnerability to Plantar fasciitis, Patello-femoral and back pain. By having a sensible self applied therapy regime, you can stop the problems before they start.

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Muted Hip Function

Effective exercise can generate powerful  huge forces  if they are initiated controlled and dominated by the hip.

Many untrained athletes  have a muted hip which  creates postures and mechanics that reduce power output, promotes postures and mechanics that are considered by  many  to be unsound.

In simple terms the Muted Hip Function (MHF) results from the legs  compensating for the failed of the hip, in effect using leg extension  to compensate for non existent hip extension.

According to the Crossfit Journal the causes and consequences of MHF include but are not limited to:

• structurally disadvantaged spinal posture

• low glute recruitment

• low hamstring recruitment

• pelvis abandoning the spine and chasing the legs

• centre of gravity shifting dramatically backward

• centre of balance shifting toward toes

• knee experiencing unsound shear force

• leg extension being the only productive effort

• hip extension not being possible with low hip angle

• pelvis rotating the wrong way

The cure is deliberate and focused training. Thats why you probably need a trainer like me. Why not join the mailing list a get useful information

To keep up to date with fitness, physical therapy and mindfulness tips join my mailing list here:

More Placebo, less con

In the old days, drug companies used to test their new fanged expensive products against  a PLACEBO.

According to wikipedia  placebo  “is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient. Sometimes patients given a placebo treatment will have a perceived or actual improvement in a medical condition, a phenomenon commonly called the placebo effect or placebo response. The placebo effect consists of several different effects woven together, and the methods of placebo administration may be as important as the administration itself”.

These days its often not. I think the drug companies got miffed that their new fangled ( very expensive drug) only got 1 or 2 % better results than a sugar pill.

Very annoying if your corporate mission is to screw cash out of our NHS.

The reality is that getting our body to believe it can be cured has remarkable effects. Let’s face it, often the body cures itself, with no outside help from the drug companies what so ever.

Often “cures” like Reiki, magnets,  supplements  are raved about on social media.

Clearly, these things  have no physical effect (as yet, discoverable). Adding less than .001%  extra  glucosamine to the bodies natural store of  glucosamine really wont cure your shoulder issues.  A deluded fanatic holding their hands 2 inches from your shoulder thinking happy thoughts  wont apply any physical effect to fix your shoulder

But clearly, things like this actually work. Amulets don’t stop bullets, but give one to a boy  soldier  (add  a few tokes of a good spliff  and  a motivational speech:obviously) and they will charge  people firing machine guns at them.

People believe the weirdest things.

That placeboes work is beyond doubt. They often work well as pain relief, because often , after 2 or 3 weeks, pain is no longer an indication of the state of the tissue. Its simply an alarm bell that continues to ring because we don’t know how to switch it off. Ever heard of the guy whose amputated leg still hurts????

People in pain, often feel no pain after placebo  “treatment”

Anything that rallies your subconscious into believing that a wrist band, or blue socks, or vitamin C, or an evangelical prayer will cure cancer, or improve performance ,is probably worth trying out as long as  its only  £10 (ish) or less.

I guarantee you that somewhere, someone, has been cured by a wrist band, or blue socks, or vitamin C, or an evangelical prayer. Ive  cured people like this myself !

I have one plea.

If you respond to placeboes, try and find a cheap one to respond to.

Believe that drinking a glass of tap water  cures pain, or that  touching  trees gives you healing powers. Believe that by simply adding your ailment to the comments below, our online community will send out universal love and fix it .

Try not to believe that a racoon paw improves  virility , or that a Panda’s big toe cures aids.  The animals concerned are rather fond  of the bit remaining on their body just as it is. Thank you

That said, sometimes the most effective  placebo is you spending lots of money and getting lots of attention!

Ce la vie

Ofcourse this is nothing but a shoddy advertorial for me as a personal trainer …………..but dont you feel better already

Email me for your session in Bethnal Green or Blackfriars andrew@andrewstemler.com

Crossfit injury rates

At any time, somewhere in the world, an inadequate sport scientist or deluded therapist is about to initiate another defective study on injury and injury rates in CrossFit.

Let’s face it; if they didn’t tag their post as “CrossFit Injuries ” no one would care, no one would look at it. It would go as un-noticed as it actually deserved.

As CrossFitters, we are fascinated by injury rates but appalled by poor and shoddy sports science and therapy babble. The major problem is this: in CrossFit, as in life, unless there is a fall or an accident, most injuries are simply  “the straw that broke the camel’s back”.

Normally, clients tweak their back because they misuse their back all the time.  To push this proposition into the light, and to be a  bit silly,  if a client leaves a sports session, goes to hospital and is diagnosed with cancer, no one seriously suggests that the sport session gave them cancer.

Often, injury reviews make no attempt to correctly trace the aetiology of injury. Often, bad form is a result of constant poor posture, not of failure under fatigue. According to McGill, injury is often the result of a long term misuse and reduction in capacity. The actual activity that brings on a bad back is something as innocuous as brushing your teeth.

But there are lots of issues in studying CrossFit and injuries: what does CrossFit mean?  Often, in what passes as the literature, the implication is that injury is a result of high rep induced fatigue.  However at CrossFit London, for example, we have gymnastics, periodised strength sessions and Olympic weightlifting sessions, many of which are carried out at ” normal ” speeds.

If I tweak a knee in a back flick landing, at CrossFit London, is that a CrossFit injury?

Let’s explore an injury. One of my recent ones!

I’ve tweaked my right wrist and it hurts. It started the day after I missed a snatch. Is CrossFit to blame?  I was training on my own, at a very lazy pace. Was that injury caused by the poor snatch or the fact that my right upper limb always tries to compensate for my left side?  Why? Because I’m deaf in my right ear, meaning that I sleep with my left ear on the pillow, which means that for 55 years I’ve slept on my left arm, every night, which has weakened it.

So, was it those factors or the fact that I decided to solidly practice handstand walking for 9 days in a row?  Can any of this be laid at CrossFit’s door, apart from the fact that it was CrossFit which inspired me to improve myself?

Hak et al (2013) found that 73.5% of  CrossFitters had sustained an injury that prevented them from training (based on an injury rate of 3.1 per 1000 hours trained, just like gymnastics and weightlifting). Weisenthal et al (2014) reported that shoulder, low back and knee injuries were most common. Low backs were commonly injured during power- lifting movements.

Frankly, I’d ask if these people sat at desks or hunched. I see more seating injuriesthan I do deadlift ones.

But, lets follow the line of thought. CrossFitters, allegedly,  injure themselves during fatiguing workouts. Doing a lot of work with an eye on the clock is, therefore, wrong.

CrossFitters, at their core, view their workout movements as work. The aim of all work is to relate the work done, with time. How long did it take?

This  holds true in academic exams, running, rugby and life. Winning performances consist of doing good work, in a faster time

I’m not so sure about sex.

As we have discovered from life, activity can fatigue. The more emails you write, the more chance of a poor phrase slipping in. Morgan et al, 2009 (not really a report, more an article) Nachemson (1965) and Dreischarf et al. (2016) all observe the possible consequences of lifting with a flexed lumbar spine. I’m surprised sitting hunched at work hadn’t given them a clue. However, GOOD NEWS . There IS money in stating the bleeding obvious.

Overhead arm movements are problematic. Impingement of the rotator cuff muscles can occur if the space between the coracoacromial arch and the humeral head is reduced (Morgan et al 2010). Defective scapular positioning could be to blame (Kibler 1998). The scapulae should retract and tilt posteriorly in order to maintain the subacromial space during an overhead arm movement.

That scapula retraction is affected by the mobility of the thoracic spine and rib cage is once again stating the bleeding obvious, but well done Strunce et al (2009) for writing it up. Years of hunching, texting, peering at computer screens mean that our overhead positions need work.

Therefore, it can be suggested that without good mobility of the thoracic spine no one should risk putting their hands over their head.

No one should stock the upper shelves of your kitchen, no curtain hanging, no singing along to rock groups or holding up your lighter at a Prog Rock gig.

There is a line of thought that demands perfection in movement, without for one second conceding that the pathway to learning good movement is poor movement.

I get to watch, weekly, people swim, play football, walk and sit. 98% do so appallingly. The better athlete starts with poor movement and develops. The poor athlete is happy with more poor movement.

I don’t mind sport science hysteria, but the dangerous sports are contact ones; Rugby, boxing, jumping of cliffs with bits of cloth tied around some sticks. See this BBC Article.  I should say that I boxed and loved it: I personally don’t like sports that make me focus on a ball then encourage someone to pull my legs away or high tackle me.

Maybe I’m a coward.

I suspect if we really analysed injury, it would correlate with long term poor form. What identifies it is the health drive of the sub group. Casual pub footballers, probably won’t spend the money to see a  therapist. The average CrossFitter, passionate about their sport, will see a therapist to get back to fitness asap.

So what is the applicable morality here? If someone moves badly, should we ban them? If you walk poorly, taking 10,000 steps surely has a higher risk factor than lifting a bar 45 times. Sitting for 8 to 12 hours is, surely, more dangerous that a kipping pull up. Running to get a ball and crashing into a team member, or falling off skis, has a real risk of death. Maybe you can tweak a shoulder if you miss a muscle up.

According to my good friend Dale Saran: “You have to accept a risk of injury as a reality of playing a sport, or just living a life. A 100-percent safe exercise has a zero percent chance of getting you fit. It’s you sitting on the couch with a helmet and kneepads on.” I sort of agree, but I’d say “sitting on the couch with a helmet and kneepads on” is the most dangerous thing you can do. Sitting is  basically suicide for those who like to do things slowly (and watch TV in the process).

I suspect that  mental attitude has a role in all this. Frequently, aggressive people injure themselves. This is from a blog post: “Determined to perform well, he doubled down on his training, working out twice a day, upping his max dead lift to 375 pounds and doing 53 pull-ups at a time. The tough regimen took its toll – tennis elbow, golfer’s elbow, shoulder woes, knee pain, a persistent trick in his neck”

I think aggressive people have always injured themselves.

~So what are we to do? As Crossfit London, the UK’s 1st ever Crossfit affiliate we have a duty to lead the way in this research as,f rankly, those sport scientists that have  looked at injury rate in crossfit  are not up to the task. Im sure there are great  sports scientists out there btw. We intend to carefully record all of our injuries over the next year and  review the back ground and nail the aetiology. We will, where possible interview the  injured client, the coach and any witnesses.

So if you injure yourself, don’t be surprised if you get a very inquisitive email from me or one  the Crossfit London sports injury team.

Just sayin

 

References

“Consortium for Health and Military Performance and American College of Sports Medicine Consensus Paper on Extreme Conditioning Programs in Military Personnel”   Bergeron et al.

http://library.crossfit.com/free/pdf/CFJ_111200_Bergeron_Champ.pdf

Injury Rates and Profiles of Elite Competitive Weightlifters
Gregg Calhoon J Athl Train. 1999 Jul-Sep; 34(3): 232–238

Dreischarf M, Aboulfazl SA, Arjmand N, Rohlmann A, Schmidt H. Estimation of loads on human lumbar spine: a review of in vivo and computational model studies. J Biomech. 2016;49(6):833-45.

Gross ML, Brenner SL, Esformes I, Sonzogni JJ. Anterior shoulder instability in weight lifters. Am J Sports Med.1993;21(4):599-603.

Hak P, Hodzovic E, Hickey B. The nature and prevalence of injury during crossfit training. J Strength Cond Res. 2013; DOI:10.1519/JSC.0000000000000318. [Published ahead of print]

Kibler BW. The role of the scapula in athletic shoulder function. Am J Sports Med.1998;26(2):325-337.

Morgan WE, Feil C. Cross-Fitness injury prevention: Protecting the lumbar disc in squatting motions [online]. California; Dynamic Chiropractic; 2009 [last updated Oct 2009; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54148

Morgan WE, Feil C. The Importance of the Thoracic Spine in Shoulder Mechanics [online]. California; Dynamic Chiropractic; 2010 [last updated May 2010; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54622

Nachemson AL. In vivo discometry in lumbar discs with irregular nucleograms. Acta Orthop Scand. 1965;36(4):426

Neviaser TJ. Weight lifting: risks and injuries to the shoulder. Clinical Sports Medicine.1991;10:615-621.

Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther. 2009;17(4):230- 236.

Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among crossfit athletes. Orthop J Sports Med. 2014;2(4): 2325967114531177

http://ojs.sagepub.com/content/2/4/2325967114531177.full

 

Back Pain: Cure your back with the Sorensen test

“The race has always been on to firstly predict,  then inoculate against,  back pain. A test known as the “Sorensen test” based on the work of Hansen in 1964, has been popular since 1984.

According to Demoulin et al 2006  ”The test consists in measuring the amount of time a person can hold the unsupported upper body in a horizontal prone position with the lower body fixed to the examining table”

The test is accepted in its discriminative validity, reproducibility, and safety. However debate continues to surround its ability to predict low back pain. No firm explanation, beyond “women rock” , has been offered as to why “chicks” can hold it longer than guys.

Naturally motivation and discomfort tolerance are confounding factors.

A interesting review is available in PDF form at Isometric back Extension tests: a Review of Literature Maureau et al Journal of Manipulative and Physiological Therapeutics Volume 24 • Number  2001, But in essence,this report says this….(yawn….)

For men, the mean endurance time is 84 to 195 seconds; for women, it is 142 to 220.4 seconds. For subjects with LBP, the mean endurance time range is 39.55 to 54.5 seconds in mixed-sex groups 80 to 194 seconds for men, and 146 to 227 seconds for women” whether thats remotely useful lm not sure, but if you suffer or are prone to lower back pain, (you tend to know by your appalling posture), im going to suggest you move this figure up.

References
Demoulin C, Vanderthommen M, Duysens C, Crielaard JM.  2006.  Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. Joint Bone Spine. 2006 Jan;73(1):43-50.”

 

My name is Andrew Stemler.  Im a london personal trainer working in Bethnal Green E2 and the City of London