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Treating CrossFit Athletes - Talk For APA Sports Physios


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A simple presentation about how to treat CrossFit Athletes from a Physiotherapists / Physical Therapist's point of view. Included are what CrossFit is about, what it is not, some of the effects of CrossFit, What CrossFit Coaches (and athletes) want you to know and some clinical things you can do to help these athletes.

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Treating CrossFit Athletes - Talk For APA Sports Physios

  1. 1. A Guide For Physiotherapists Antony Lo APA Musculoskeletal Physiotherapist CrossFit Level 1Trainer
  2. 2. IntroductionTo CrossFit What Do CrossFit CoachesWant YouTo Know? What CanYou DoTo Help CrossFit Athletes? Some Case Studies
  3. 3. What is Fitness? “Increased work capacity over broad time and modal domains” What is CrossFit? A methodology that optimizes fitness “Constantly varied functional movements performed at relatively high intensities” The community that is formed when doing these workouts together Source:
  4. 4. What CrossFit is NOT New More dangerous than other sports A cult (but doesn’t mind if it is) A fad Irresponsible CrossFit Does Challenge beliefs Pushes the envelope Work
  5. 5. The Effects Of CrossFit Physical – improved work capacity over broad time and modal domains Social working out with these people sometimes up to 12 times a week or more means you are like family. It is rare, extremely rare to walk into a CrossFit gym, do your workout and walk out again without acknowledging someone or someone having a conversation with you – it is the opposite of a typical suburban gym. Psychological – Many, many people use exercise to relieve CrossFit, you do that with your community, your suffer together
  6. 6. CrossFit and Injuries Mainly typical MSK/Sports injuries Shoulders, hips, knees, backs, necks Myofascial – muscle/tendon Articular – usually cartilage and ligament Lots of overactive muscle motor patterns Rhabdo – it happens, it shouldn’t 3.1/1000hrs injury rate (Hak PT et al 2013) Similar to Oly weightlifting, powerlifting and gymnastics and less than contact sports Self reported data – 73.5% had an injury Only 136 survey respondents Running has 2.5-33.0/1000hrs (Videbaek S et al 2015)
  7. 7. CrossFit and Injuries That study... Smith et al 2013 JSCR 27 (11) 3159-3172 10 weeks CrossFit program Body Fat % and VO2Max both improved Claimed 16% injury rate despite NOT checking if those that couldn’t complete testing were injured Lawsuit pending with claims of fraud and journal editor not fulfilling their duties That injury – Kevin Ogar 107kg Snatch – a relatively easy weight for him It was supposed to be a triple (3RM) It was his first rep Theories?
  8. 8. There is CrossFit the GPP and CrossFit the Sport Don’t say you love CrossFit because of all the work it gives you – it is BS CrossFit patients are the best because they want to get better The coach really wants to help...and can Better communication between physio and coaches – including a plan for rehab! Return to CrossFit Goals, not just no pain in their ADLs You don’t have to stop training when injured
  9. 9. Look at their problem movement! Understand the movements so you can give more specific advice “Scaling” is a real thing – give good substitution movements If you want them to change something (eg:technique), PROVE it is betterYOUR way Better explanations on how to prevent injury, not just avoiding the pain Give appropriate exercises – “clams” isn’t going to help their knee pain during 5x5 at 80% of their 1RM Physios should do CrossFit
  10. 10. Subjective Examination “extras” to ask What level of CF do they do? What are their lifting numbers? What movements are the ones that hurt? When in the movement do they get the pain? How far into the workout? Pelvic Floor Questions Stress urinary Incontinence Pelvic Organ Prolapse Pelvic Pain What are their goals for this session? What do they define success of treatment as?
  11. 11. Objective Examination “extras” to do Find test/retest movements to “prove” success Watch the movements that cause problems or get footage of it – Coach’s Eye or Ubersense Nail down the mechanism of injury and its contributing factors – telling the person what is sore won’t satisfy them *** PROOF that your intervention and suggestions are worthwhile go a long way with CrossFitters *** There is a lot of biomechanical model of pain stuff out there – resist and go biopsychosocial
  12. 12. Treatment “extras” to do Proof Avoid passive treatment where possible Exercises and stretches in functional positions “Mobility” aids – balls, rollers, bands, gadgets Mechanics, consistency, intensity RefineTechnique Get it reproducible Add reps/load/time pressure Rehab plan Permissible Exercises including scaling options/suggestions Specific rehab program EMAIL the coach!!!
  13. 13. Dear Neil, Dear Dave, Thanks for referring Neil for an assessment about his right elbow pain today He presented with 6-8 weeks history of right elbow pain with some left elbow I/T symptoms. It hasn't gotten better with rest.The chiro he saw recently said to rest and she will look at it next time. He has scaled all the way back to the bar only for weights and pullups are painful. Push ups had some pain/tension too. From my assessment, I found that neil's nerves on the right were irritated from his neck.This seems to be the major contributing factor to his pain in the right elbow. We worked on pullups, strict press, dumbbell press and push ups today. I also did some neural mobilisation and neck mobilisations (no manipulation this time).
  14. 14. Pullups - we scaled it back to feet supported with elbows out, elbow at 45deg and elbows forwards. no pain. No chin raising to achieve chin over bar.Set a box or stool or plates up so chin is over bar at the top (or kill 2 birds with one stone and set it up for strictCTB PU) Strict Press -These were still tension in the right elbow. It may take some time to settle this down (about a week). So long as there is no pain, I am happy. It will fatigue quickly.Allow the elbows to fly for now and progress towards "proper" technique later. it is more important that Neil actually just moves and it isn't that heavy so no harm, no foul. Dumbbell press - best for this was old school dumbbells with wide elbows into a military press.Work in 3-5 sets of 5-15 reps NO PAIN.The effort should feel equal on both sides. Progress from elbows at 90degABD to 45deg to elbows forwards please Push ups - long neck setup BEFORE loading up onto hands and toes Alternate arm and leg swim with scap movements - in push up position - long neck - work on gaining that strength and endurance to keep your balance.
  15. 15. Work bags - set the neck in a long position and try to pull from the back of the shoulder blades instead of letting your arms get dragged out of the scaps and rounded.You dictate where the bags are, don't let the bags dictate where you are Neural mobilisations - i taught you how to roll into and out of the nerve mobilisation on the wall- fingers pointing down, palm on wall, NO STRETCHING or altered sensation please! - watch and do this "dance" please - Training - you can train in whatever you want that doesn't hurt. ideally there should be equal effort and tension in both arms. You may find anti-inflammatories useful but if you do take meds, check with your GP or pharmacist first and still treat the exercise gently...the idea is to retrain the brain to move pain free and meds can help achieve that goal and break the pain cycle. be sensible in your scaling - if it is 25 pullups in aWOD, maybe do 5 good quality strict or band up so you can do 25 to get the cardio benefit or do ring rows without pain etc etc. Just keep moving albeit pain free as much as possible please.
  16. 16. I would like to see you again in about 1-3 weeks. Come sooner if you are feeling worse or a lot better - if worse, then I need to do more to settle things down. If a lot better, I would like to progress your exercises a lot more. If progress is steady, then in 2-3 weeks will be fine. Thanks again. If you have any questions about training, work, scaling options or anything else, please don't hesitate to email me. Cheers
  17. 17. Give PROOF The Neural System is the Key (Performance and Recovery) “30secs rule” #tensiontotask #spreadtheload Variability is King – Can you do all the variations? External Cues are best – avoid “activation” cues Ask about PF symptoms and refer toWH Physios Believe the RESULTS, not the BS story we make up to try explain why things happen
  18. 18. Posture Core Activation Squat Deadlift Others?
  19. 19. Results are really what matter to the client All explanations (including mine) are just stories we make up to try explain a result Believe the result, not the stories Do what it takes to get the right result Challenge your own beliefs about CrossFit and many clinical beliefs – the results are there
  20. 20. – articles and courses Most Popular =