Movement Rx has been the go to crossfit physical therapist in San Diego since 2013. In that time our team has treated over 5,000 Crossfitters, meaning we have provided physical therapy to more crossfitters than all but a handful of clinics WORLDWIDE. With each of our staff being a CrossFit physical therapist and a CrossFit movement expert, it’s always bothered us that so many healthcare professionals (doctors, physical therapists, chiropractors, etc) think CrossFit is bad and should be avoided. It’s a mindset based on fear and an outdated or lack of understanding of fitness.
So we were quite pleased to see a recent article from New Grad PT, a website targeting new doctors of physical therapy. We’ve excerpted the most relevant pieces of that article below and added some commentary based on our experience and approach (you can read the full article here).
The CrossFit physical therapist is one of the most underutilized avenues of rehab among conventional fitness athletes and CrossFitters. Physical therapists are movement specialists with a deep understanding of human anatomy. PTs are also the main point of contact for physical medicine and unlike many primary care physicians, PTs usually won’t tell athletes to give up the sports they love. Instead, PTs will provide athletes with the tools they need to understand how their bodies can perform better in those conditions.
Very true…generally speaking.
- In California, PTs can be accessed without a doctor’s referral, and they are trained to look at musculoskeletal issues in depth. Primary care physicians aren’t trained in movement patterns, and will bias recommendations towards rest and anti-inflammatories or pain killers. Seeing a crossfit physical therapist first actually leads to a far lower cost of overall care than seeing a primary care physician. In the case of back pain, this cost is 66% lower.
- However, while PTs do focus on movement, there are very few who can adequately break down the movements of a squat, snatch, kipping pullup, etc. To effectively treat and educate you as the CrossFitter, the PT must understand these specific movement patterns and be able to cue you to move properly. If the PT cannot effectively demonstrate and cue you to fix the movement problem that led to your pain, your shoulder/back/hip/whatever issue won’t get better in the long run. What does this mean? Find a crossfit physical therapist. (Our friends at MobilityWOD have started a nationwide database of such practitioners.)
The article continues…
Where do all of the CrossFit injuries come from?
CrossFit isn’t the problem. The problem is that we don’t fully understand the stress we are imposing on our bodies when we perform movements incorrectly. Oftentimes we are performing complicated movements under the stress of a heavy barbell, or we are racing the clock to squeeze a workout in.
Our bodies go into default in these situations because they are compliant vessels for whatever we demand of them. #ourbodiesareamazing. They will adjust for performance. This embodies survival. However, it can also result in injury. It’s not so much the movements that are to blame as it is the physical asymmetries and underlying weaknesses that are uniquely inherent to each of us.
Any sport is dangerous if you don’t do it properly. I wouldn’t expect someone who has never played soccer to compete at a D1 level and I wouldn’t expect someone who hasn’t walked more than a mile in the past year and sits at a desk every day to perform Grace Rx.
Amen. Amen. Speak it, gurrrl!
- This starts with a loaded topic – injuries in CrossFit. The reality is that most people new to any activity are at higher risk of injury as their body gets used to that set of movement patterns and demands. For several years, CrossFit was the fastest growing fitness activity in the U.S., so there were tons of newbies. Additionally, because the movements in CrossFit are so varied, there are a lot of movement patterns to pick up. However, injury rates in CrossFit aren’t as high as is often suggested. I guarantee you that a healthcare practice focusing on runners will see more injuries per capita than one focusing on CrossFit. So why is it that we so rarely hear of a physician telling someone to “stop running?”
- Our bodies are totally asymmetrical, despite what you think. Your imbalances might be invisible to you, but as a crossfit physical therapist they’re so friggin’ obvious to us once we evaluate your movement. Even if you’re not injured, evaluating your movement patterns while your are healthy is a great idea. Read more about the importance of movement screens.
The article then moves onto the biggest issue we see, which is how to quickly get information into the hands of the CrossFit Coach and the Crossfitter.
There is little to no dialogue between these two bodies of knowledge at many of the gyms I have been to. The fitness athlete often comes to the table with some body of knowledge about fitness, movement, nutrition, sleep, stress, and how all of these things interact. Sadly though, many PTs cringe when they see a CrossFitter coming. Which in my opinion, is…well we know my opinion.
These athletes want to be educated on how to manage their impairments in order to be able to do what they love. They have been on google, they have utilized IG, asked their coach, and consulted their doctor. They need physical medicine. When physical therapy and CrossFit come together, amazing things can happen.
Not all, but many CrossFit coaches underutilize the physical therapist in their community. The crossfit physical therapist can counteract injury before it occurs, or at the very least manage someone’s symptoms before that gym loses a member or needs to put an athlete on hold.
At Movement Rx we emphasize movement education for CrossFitters and their Coaches. To illustrate, we were one of 6 groups worldwide selected to teach the CrossFit Movement & Mobility Trainers Course when it was still offered through MobilityWOD, and we continue to run our own workshops at boxes throughout San Diego. Contact us to learn about upcoming courses.
We also have created several hundred videos and articles to help provide San Diego Crossfitters a resource. Search the Movement Rx Blog and Movement Rx youtube channel. However, keep in mind that nothing beats 60 minutes of 1 on 1 time with one of our Crossfitting Doctors of Physical Therapy.
Identify the Cause of Pain in CrossFitters
Physical therapists possess the innate ability (taking many patients on the journey through the injury continuum on a daily basis) to be able to identify and replicate a patient’s pain in order to treat it. Your hip hurts? Ok, let’s make sure that it’s not coming from your back. Your shoulder hurts? Let’s make sure that’s not coming from your neck. The physical therapist is the one that can rule diagnoses in and out in order to help athletes safely achieve their fitness goals.
Pain is a powerful instrument. It can tell us when something is wrong. It is the body’s way of checking back in to let us know something we did is “not cool”. If pain comes on fast or out of nowhere, that is all powerful information your therapist can use to arrive at a diagnosis. The PT can then make a game plan with the athlete for workouts and injury management.
Because of the variety of movement patterns required in CrossFit, understanding regional interdepenency is quite important. In basic terms, regional interdependency means the place of pain is often not the source of the issue. While over 70% of Crossfitters we see complain of pain in the shoulder or back, the cause of that pain comes from as far and wide as the foot and the hand. You need a crossfit physical therapist to help decipher this.
The author continues with a short discussion of what her go-to technique is.
Where I treat right now, I often use muscle energy techniques (MET) in my treatment programs. I believe more is less and that therapy does not need to be painful to be effective. The body likes to fall into a position of comfort. It compensates for weakness, tightness, and poor joint play in a variety of ways. Muscle energy techniques allow the body to move into more symmetrical movement patterns.
There are a variety of treatment techniques a PT can use. At Movement Rx, those include manual therapy, postural restoration, active release, scraping tools, neurokinetic therapies and many, many more. It’s an alphabet soup of acronyms which in the end is meaningless if the PT can’t identify and instruct you in quality movement patterns. Our team has the benefit of experience in teaching 1,200+ CrossFit Coaches and health practitioners how to correct movement patterns. We endeavor to apply that experience to you when you visit us.
Crossfit Neuromuscular Re-education
You can squat. You can burpee. Sometimes with pain and sometimes without. So you don’t exactly know what is wrong. Usually, pain comes from muscles that are tight, muscles that are weak, faulty joint mechanics, or a combination of all three of these things.
Underlying weakness can be difficult to identify without specific testing. We can still perform functional movements because of compensation. Our bodies are the masters of compensation, but after enough time they will start to break down. Muscles need to be re-educated at the core of their neural connections in order to work properly in conjunction with other muscles.
The author nails it here. Re-training Crossfit movement patterns is the basis of remaining injury free.
Let’s think about that…
You join a CrossFit affiliate and gain some initial instruction in the 9 foundational movements. Your Coach cues you at the beginning of class and during the warm-up.
But you want to work out, to sweat, maybe even to collapse on the floor when done.
Any technique you learned gets compromised when speed and volume ramp up. The very things that makes CrossFit such an effective fitness and wellness tool – variety and intensity – are what expose your faulty mechanics and imbalances.
The expert CrossFit physical therapist will identify those movement faults and help you rectify them.
This is simple. Find the underlying weakness and treat it. Isolate the muscle and strengthen it. Many people do not know how to isolate muscles or identify which muscles are truly weak. A physical therapist can help with that!
Yep. To illustrate this, try some banded lateral monster walks. Go 50 feet in both directions, slowly and with control.
That burns, right? Your squat game may be on point since you’ve been working the larger muscles in the posterior chain. But the supporting muscles? The ones that keep your pelvis aligned and support movements outside of your normal planes? They’re coming to get you unless you take care of them, too.
Stretching, Mobility & Stability in Crossfitters
I have so many patients who believe that stretching is the solution to all of their problems and that limited flexibility is the root cause of their pain. However, it’s usually a combination of weakness and tightness that is causing their issues.
Stability precedes mobility, always. Work with a physical therapist to achieve a stable core before addressing your range of motion (ROM) impairments. There are SO many movements in CrossFit that require an insane amount of core stability. A physical therapist has the tools to assess what level of lumbar stabilization is appropriate for you and will progress you in a safe way..
Thanks to folks like Dr. Kelly Starrett, the CrossFit community in general is more aware than other fitness communities of the limitations of traditional stretching and the importance of mobility. However, the concepts of stability and its close cousin, motor control, are still rarely discussed in the gym.
What is also poorly understood is how and when to apply various dynamic stretching, mobility, and stability drills. That’s to be expected, as there are hundreds of these self-care techniques and guidelines to follow for their use. As an example, at Movement Rx, we’ve created a library of over 500 video drills for our patients to follow.
Why a Crossfit Physical Therapist is Necessary
We’re stoked that awareness is building within the physical therapy community about the positives of CrossFit. However, we’re concerned that most physical therapists (and chiropractors, too), despite their musculoskeletal training, aren’t yet equipped to effectively identify, cue, and educate crossfitters in their movement patterns.
If you’re a Crossfitter in San Diego County and are in need of expert guidance or treatment from a crossfit physical therapist, give us a call at 619-210-0945 or schedule an appointment.