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The Three Stretches You Should Avoid After a Car Accident

After a car accident muscles progressively shorten and tighten in the days that follow.  It is a protection mechanism that the body uses to guard against the next possible unexpected impact.  Most patients mistakenly take that sensation of “tightness” as sign that prolonged stretching is needed.  In reality, those tissues were likely injured by excessive stretching and the last thing that will help them is more stretching.  What is needed is a medical examination, a diagnosis and a comprehensive treatment plan including massage and progressive active range of motion and exercise.

If you google searched “neck stretches” the following three stretches were in the top post listed:

img_20160930_140730389 img_20160930_140621907img_20160930_140853536

These 3 stretches would aggravate the typical auto accident whiplash by compressing the spine and pulling injured tissues that are trying to heal.

 

To initiate self-care, instead of stretching, mobilize.   Work your spine through the range of full, pain-free active range of motion.  Also, begin to reintegrate spinal stabilizing musculature.  Begin with Cat-Camel, Quadruped and Dead bug.

 

Even what appears to be a minor injury from a car accident can result in permanent changes to the spine so be sure to have an experienced staff perform a full medical exam as one of your first steps of action following a car crash.

 

Assault – Studies show that it won’t help you 1RM but it could help you PR your Fran.

assault

Many CrossFit types dabble in pre-workout to get mentally (or physically?) prepped for heavy 1RM lifts.  The attached studies surprisingly demonstrate that the caffeine laden supplement has no impact on 1RM bench press, leg press, vertical jump or medicine ball put (MBP).  These are all measures of 1RM power output.

 

The supplement did however, measurably improve Anearobic capacity and delayed muscle fatigue in submaximal bench press, leg press, and in the Wingate Anaerobic Power Test, and intermittent anaerobic running capacity.  Check the linked studies.  While they lack a large sample size, 13 is considered to be large enough to yield reliable information and they have the proper controls in place.

Study Link #1– assault-improves-muscular-endurance

Study Link #2– assault-study

New Study Shows Peak Muscle Activation at 90 Degree Squat

The elephant in the room is that this study was performed using isometric maximal effort squats rather than a dynamic range of motion.  If these findings are only relevant in static positions, the concepts could be useful in the post-surgical setting.

If what is true for these isometric findings holds true for dynamic motion, it would direct box height selection in Box Squats as well as point out the need for some athletes to cultivate additional recruitment at end range.  Perhaps the use of Pause Squats or 1 and 1/4 squats at full depth for athletes (olympic lifters) who find themselves at angles approaching 140 degrees flexion.

Also, this could validate the use of partial depth squats and walkouts at above 1RM weight. . . interesting. . .

Here’s the link to the full text article-

Knee Pain and the Kipping Handstand Pushup

If your knee is hurting after last week’s 16.4 workout, don’t be so quick to blame the wall balls.  Your kipping handstand pushups may be to blame.  

When an athlete does a good job of recruiting the hips in the hspu kip, a violent end range knee extension at lockout is the result.  This differs from the crisp knee extension in other movements such as the kettlebell swing because the lower extremity meets no resistance making it an open chain movement with with zero resistance to guide the normal screw-home mechanism of the tibia.  The result can be repetitive hyperextension of the knee through the course of say 55 handstand pushups.  Add the fact that leaning into the wall to achieve a legal rep further levers the knee into extension, and it should be no surprise that many athletes are limping their way into week 5 of this year’s Open.  

Biomechanics of knee extension in hspu-

The likely source of knee pain following a set of kipping handstand pushups is the anterior cruciate ligament.  The ACL comes to tension when limiting anterior translation of the tibia at end range flexion.  In hyperextension, the ACL is vulnerable to impingement by the intercondylar notch roof of the femur.   See article HERE.

The Take Home-  Explosive knee extension in a kipping hspu is different than in other movements.  The legs are flailing into the sky without any resistance to prevent hyperextension.   The result is like the ACL getting slammed in a door.

Presentation-

The result of this repetitive ACL impingement is inflammation within the joint space and pain at end range flexion.  The inflamed joint feels unstable, clicks and pops but should not lock up or give way.  Getting into the bottom of a squat is very difficult in the week that follows this injury as the joint is swollen on the posterior side and the aggravated ACL is at tension at end range flexion of the knee.

Preventative measures-

Knee sleeves and Rock Tape

  • Neoprene knee sleeves
  • Hamstring Rock Tape
    • Adds some tactile awareness of knee end-range

Joint Prep-

  • Coactivation Exercises-  Russian Swing/ Power Swing
    • Focus on coactivation of glutes with quads to avoid end range extension.
  • Hamstring prep-  Death March/ Kang Squat

Technique-

  • Coactivate glutes, hamstrings, and quads during knee extension.
  • Stay on the wall.  Striking the heel into the wall at the top of the motion increases hyperextension forces.  If possible, glide the heels up the wall as the knee approaches lock out.
  • Closer hand placement-
    • The further the hands are from the wall, the greater the knee is leveraged into hyperextension at lockout.

Recovery-

It is unlikely that serious mechanical damage has taken place.  If you have apprehension or are experiencing locking up or giving way of the joint, have it assessed by your local knee specialist.  Otherwise you are dealing with painful inflammation of the ACL.

Inflammatory measures-  4-7 days

 Heat / Ice contrast therapy.  6/1 ratio

Normatec vasopneumatic compression

  • 20 minute sessions level 8

Wobenzyme Proteolytic enzymes

  • 3x/day on empty stomach

Voodoo Floss

  • The poor man’s normatec

Pray that there are not pistol squats in 16.5.

What Exercises are Safe After an Exertion Headache?

I am often asked the question “What exercises are safe after an exertion headache?”   Assuming that your headache is a primary exertion headache or exercise headache it is safe to reintroduce progressive exercise after a 4-7 day rest.  Here are some guidelines to and progressions to follow in the early reintroduction phase:

You begin with low-threshold activities.  Those are the movements least likely to bring about a relapse of symptoms.  Those are low intensity movements that keep the athlete upright, keep the neck neutral, are low impact and do not require aggressive upper trap activation.

High Threshold activities that are re-introduced last include:

1) Bearing down or valsalva monouvers.

2) Increasing intracranial pressure by lowering the head below the waist. (Bench press, burpee, deadlift)

3) Extending the neck during a lift. (Burpee, The bottom of an overhead squat)

4) Aggressive Upper Trap Activation. (Clean grip shrug, power snatch, deadlift)

5)  Jarring impact (Reboundig box jumps)

Early on in the process it is important to eliminate all of these factors and slowly re-introduce these challenging elements phase by phase WITHOUT reproducing any headache symptoms. This is critical to avoid chonicity of these episodes. Picture letting a scab heal without ripping it off and causing scar tissue formation.

Today’s post will focus on safe initial re-introduction movements.

Keep the above criteria in mind with all of the following movements as all can be done in a way that will trigger a vulnerable condition.  To keep it simple, apply this guideline to the following movements for best success:  Exhale during the concentric phase of all motions, keep the head and neck neutral, avoid shrugging motions  and eliminate jarring impact with the ground.

Phase one introductory movements:

Belted Sled Drags and Reverse Sled Drags

  • Reverse or backwards sled drags are at the core of your exertion work this early phase.  Use them as the base and integrate the following low-threshold movements in alternating fashion
    •  Reverese Sled Drag- Belt the sled off from the hips and walk backwards looking back at the sled with the hips sitting back and the neck in neutral.
    • Sled Drag- Belt the weight from the hips and walk forward with a consistent, slow and even pace focusing on hamstring recruitment and neutral neck position.
  • Banded Shoulder traction cervical stretches
  • Supine Deep Neck Flexor Drills 3 planes, 10 reps
  • Towel traction
  • Isometric Supine extension
  • Upright Towel Isometric Extension

What is Shoulder Impingement?

If you have been told that your shoulder pain with overhead movements is the result of “Shoulder Impingement Syndrome” the next questions are: “What is Shoulder Impingement?” and “How can get rid of it?”

Supraspinatus Tendon Impingement


1- What is Shoulder Impingement?

Shoulder Impingement Syndrome is typically diagnosed with orthopedic tests that closely resemble a poorly executed sumo deadlift high pull. Shoulder impingement is caused by the joints of your shoulder moving in a way that causes it to bind upon its own soft tissues. A single incidence easily becomes a chronic condition as the swollen and irritated soft tissues then become a likely pinch point for future impingement. The same mechanics are at work when you continually bite the same place on your tongue. This is a common problem for novice weight lifters and crossfit athletes who have recently made rapid gains in overhead strength without cultivating equal overhead stability and middle back flexibility.

The Sumo Deadlift High Pull puts the shoulder in the same position as the Hawkins Kennedy Test for shoulder impingement. Photo courtesy of becomethebull.blogspot.com

2- How do I get rid of it?

Your family practitioner will tell you to ice the shoulder, take 800mg ibuprofen/ day and to stop lifting heavy objects overhead. That is fine for the short-term, but the only way to resolve the condition is to address the faulty movement patterns within the shoulder that created the initial impingement. The process that we use at Sports Medicine Northwest is two-fold: 1- We address any motor imbalances that are identified in exam, and 2- We optimize joint centration. We achieve both of these objectives through corrective exercise prescriptions.

With shoulder impingement syndrome “Optimizing Motor Imbalances” can mean everything from treating a rotator cuff muscle injury to scapular dyskenisia and a rigid upper back. In the absence of an acute tissue injury, joint centration movements such as the kettlebell arm bar, turkish get-up, and the kettlebell windmill are useful for regaining joint centration. At Northwest Strength and Performance and at Sports Medicine Northwest, we acclimate the injured athlete to the kettlebell windmill with the banded version demonstrated below.

After initiating these movements under traction, overhead lifts are progressively reintroduced and weight is added. When progressive weight is increased, the athlete is often stronger and more stable than they were before their initial injury.