In Medical/Injuries

January 16, 2010

PDF Article

Can’t get into a squat? Lacking power in your snatch? Daniel Christie suggests that aggressive bodywork may help you unlock your full potential.

Trainers often see horrible, awkward movements that limit performance and can’t be corrected with a simple cue. Why? It can often come down to poor strength and stability levels or poor memorized motor patterns, but it can also result from short, tight, facilitated musculature.

The sight of a forward head position, rounded shoulders, internally rotated arms and anterior-tilted pelvises is commonplace in gyms, offices and CrossFit boxes. If these patterns are left unchecked, recovery rates can be impeded, injury rates increased and performance diminished.

The combination of postural traits listed above is commonly known as “upper crossed syndrome” and “lower crossed syndrome, descriptions popularized by Dr. Vladimir Janda. Via research, Janda identified a predictable pattern of muscles prone to tightness or shortness and weakness or inhibition. The muscles that predictably tighten reduce the ability of CrossFitters to adopt ideal postures during the deep squat, clean and jerk and other such exercises. Common inhibition patterns can also be detrimental to midline stabilization during heavy axial loading, as well as stability around the shoulder and knee.

In Part 1 of this article, I’ll talk about how a therapist can help address upper and lower crossed syndrome, and in Part 2 I’ll illustrate several highly effective self-stretches and soft-tissue techniques to help with the muscular-imbalance issues highlighted here.

Download

Comment

17 Comments on “Part 1—Tuning the CrossFit Athlete”

1

wrote …

This is awesome stuff. Can't wait for part two. Every day in the gym my clients and I fight against these long unchecked imbalances striving for proper form and better performance. Any ammo we can use is greatly appreciated. Thanks to Daniel and the CFJ.

2

wrote …

Is there an evidence-base for any of the claims in this article? It seems filled with (what Rippetoe calls) Silly Bullshit.

Here's a few tidbits:
1) "The illiopsoas is one the key hip flexors and spinal stabilizers,". Well, Rip and others would argue that it's more of a spinal stabilizer once the torso is already flexed, but doesn't do much from an extended position due to the tiny moment arm.

2) The article quotes Coach as saying it can take 3 years to resolve a 'muted hip'. Always? Mostly? Or did one person take 3 years and others can be fixed in 3 months? It's a misleading broad statement, not a definitive fact.


3)"athletes whose scapula are in the abducted position concomitant with upper crossed pattern will go on to suffer pain between the scapula and tenderness on the anterior and medial deltoid and have associated impingement of the rotator-cuff tendons. All this will be exacerbated with overhead activities" Numerous sources (including numerous crossfit coaches) associated shoulder impingement with failure to maintain active shoulders with weight overhead. Shoulders shrugged up, pinching your ears. Rip outlines this in another CFJ article how shrugging raises the clavicle and increases the space for the tendon. Maybe if you do the movement properly, you won't have to bother with MAT.

This article feels no different to stuff being peddled by homeopaths in a bad magazine.

3

wrote …

Well, I met a therapist that focuses on working with athletes (Rob Wilson) at th box I am a member of (CFVB). He asked me a few questions, did a little eval, followed by a little torture. I got on the rower later in the afternoon and my 500m was faster by 8 seconds from the day before.

I reccommend getting bodywork done, but not just a feel good rudown. I mean some serious near-torture therapy.

4

wrote …

3)"athletes whose scapula are in the abducted position concomitant with upper crossed pattern will go on to suffer pain between the scapula and tenderness on the anterior and medial deltoid and have associated impingement of the rotator-cuff tendons. All this will be exacerbated with overhead activities" Numerous sources (including numerous crossfit coaches) associated shoulder impingement with failure to maintain active shoulders with weight overhead.


This describes me to a T. I have been having chronic pain and impingement for almost a year and have been to the ortho, done the rehab exercises etc, with very little improvement. Just 2 weeks ago a massage therapist let me know that my problem was caused by extremely tight pecs which were pulling my shoulder into internal rotation. By doing the stretching exercises he recommended,a miracle has taken place. I have done several shoulder intensive WODs after a good warm up and stretching and have had no problems at all. Thanks for this article. Good information.

5

replied to comment from Matt Solomon

Matt,

You are in medical school, yes?

Do yourself a favor and take time at some point in your education to delve into Dr. Janda's material. It is truly impressive and the result of his life's work.

One article cannot cover the depth of his work. A one semester course I took based mostly on his material was merely a survey. If you decide to pursue physical medicine, you will no doubt come across his research, and would be wise not to write it off.

Below is not a study, but a tribute, by "a multinational, multiprofessional group" in a journal you may be familiar with.

Spine. 2006 Apr 20;31(9):1060-4.

Should you have any interest, I can put you in contact with someone who studied directly under Dr. Janda in Czechoslovakia, who has practiced for a couple of decades, and who could no doubt add as much depth as you would ever want to hear on the subject.

6

wrote …

Yes.


I wasn't really writing it off, just wanting more proof. And anecdotal stories about improved rowing times are nice, but not overly significant. I'm going to go read about it right now...

7

wrote …

Daniel, awesome article - I can completely relate to it -

Especially the trouble that the Psoas gives to my Glutes, Hammies and other leg muscles...

That darn tight Psoas - I've seen it reek back pain havoc in my clients - even after being to 'Specialists' and being told stretch your Hammies - pain still persisted - low and behold stretching the Psoas has made a real positive change to reducing their pain and discomfort

Looking forward to part 2!!! :-)

8

wrote …

This kind of stuff is why I am in chiropractic school. Awesome stuff that more people need to know about.

9

wrote …

Get Rolfed. Perform better. Live better. Also known as Rolfing/Structural Integration. Pairs with a good chiro nicely!

http://www.rolf.org/about/index.htm WFS

10

wrote …

Great article. While some folks choose to question all of the information provided I am glad that the general 'gist' is that seeing an athletic therapist can be very helpful to many Crossfitters. My newest thing is to 'heal thyself' and part of that is seeing a local Osteopath that treats me but then puts the owness on me to perform several exercises and stretches on my own to help fix my structural issues. The s$%t works.

11

wrote …

Matt,
Is there any research, are you kidding me?
A simple search on pub med or Google scholar would have given reams of references:

Barker, Priscilla J. Briggs, Christopher A. (1999) Attachments of the Posterior Layer of Lumbar Fascia Anatomy. Spine Volume 24(17),1757-1762

Barr, Karen, P, Grigg. (2005). Lumbar stabilization: Core Concepts and Current Literature, Part 1. American Journal of Physical Medicine & Rehabilitation. 84 (6) 473-480

Bergmark A. (1989). Stability of the lumbar spine A study in mechanical engineering Acta Orthopaedica Scandinavica 230(60): 20-24
Bono, Christopher M. MD (2004) LOW-BACK PAIN in ATHLETES CURRENT CONCEPTS REVIEW. The Journal of Bone and Joint Surgery. Volume 86- 2, p 382–396
Broadhurst, N.A (1999). Deep –seated low back pain- a triad of symptoms for pelvic instability. In A. Vleeeming, V. Mooney, T. Dorman, C. Sniijders & R. Stoecart (eds). Movement stability and low back pain: The essential role of the pelvis. London. Churchill livingstone. P547-552

Bogduk, N. (1997) Clinical Anatomy of the Lumbar Spine and Sacrum 3rd edition. Churchill Livingstone. UK
Comerford M J, Mottram S L 2001 Functional stability retraining: Principles & strategies for managing mechanical dysfunction Manual Therapy 6(1): 3-14
Danneels,A. Vanderstraeten GG. Cambier DC. Witvrouw EE. Bourgois J. Dankaerts W. De Cuyper HJ. (2001).Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. British Journal of Sports Medicine. 35(3): 186-91.

Gardner-Morse M, Stokes IA. (1998).The effects of abdominal muscle coactivation on lumbar spine stability. Spine; 23:86–92
Calguneri C, Bird HA, Wright V. (1982) Changes in joint laxity during pregnancy. Ann Rheum Dis.41(2):126-128
Ebenbichler GR, Oddsson LI, Kollmitzer J. (2001): Sensory motor control of the lower back: Implications for rehabilitation. Medical Science Sports Exercise. 33:1889–98
Farfan HF. (1995). Form and function of the musculoskeletal system as revealed by mathematical analysis of the lumbar spine: An essay. Spine. 20: 1462–74.

Fairbank JC, O’Brien JP. (1980) The Abdominal Cavity and Thoraco-lumbar Fascia as Stabilisers of the Lumbar Spine in Patients With Low Back Pain: Engineering Aspects of the Spine. London: Mechanical Engineering Publications,: 83–8.

Granata KP, Marras WS. (2000). Cost-benefit of muscle cocontraction in protecting against spinal instability. Spine. 25:1398–1404.
Gracovetsky S, Farfan HF, Lamy C. (1977) A mathematical model of the lumbar spine using an optimized system to control muscles and ligaments. Orthop Clin North Am; 8: 135–53.
Gibbons, S.G.T. Comerfort, M.J. (2001a). ‘Strength versus stability: Part 1: Concept and terms’. Orthopaedic Division Review. March / April, p. 21-27.
Hansen FR Bendix T. Skov P. Jensen CV. Kristensen JH. Krohn L. Schioeler H. (1993) Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. A randomized, observer-blind trial. Spine. 18(1):98-108

Hides J, Richardson C, Jull G. (1996). Multifidus recovery is not automatic following resolution of acute first episode of low back pain. Spine. 21: 2763–9
Hides JA, Jull GA, Richardson CA. (2001). Long-term effects of specific stabilizing exercises for first episode low back pain. Spine. 26: E243–8.
Hodges, P, Kaigle,H, Allison Holm, Sten Ekstrom, L, Cresswell, Andrew Hansson, Tommy, Thorstensson. (2003). Intervertebral Stiffness of the Spine Is Increased by Evoked Contraction of Transversus Abdominis and the Diaphragm: In Vivo Porcine Studies. Spine. 28(23):2594-2601
Hungerford, Barbara P, Gilleard, Wendy, Hodges.(2002) Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain:Exercise Physiology and Physical Exam. Volume 28(14), pp 1593-1600

Kankaanpaa, M. (1999) The efficacy of active rehabilitation in chronic low back pain. Effect on pain intensity, self experienced disability and lumbar fatigability. Spine, 24 1034-1042

Kavic, Natasa, Greiner. (2004) Determining the Stabilizing Role of Individual Torso Muscle During Rehabilitation Exercises. Spine. 29 (11): 1254-1265

Lee, D. (1999) The Pelvic Girdle An approach to the examination and treatment of the lumbo-pelvic-hip region. Churchill and Livinstone. UK

Laasonen, EM (1984) Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology. 26: 9-13
Manniche C. Lundberg E. Christensen I. Bentzen L. HesselsoeG.(1991) dynamic back exercises for chronic low back pain: aclinical trial. Pain. 47(1):53-63.
McGill SM: Low back stability: From formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev 2001;29:26–31
Melzack , R. (1987). The short form McGill Pain Questionnaire. Pain. 30:191-197
Mooney, V. (1987) ‘Where is the pain coming from’ Spine. 12 p754-759
Nutter P.( 1988). Department of Physical Medicine and Rehabilitation, Northwest Hospital, Seattle, WA 98133 Aerobic exercise in the treatment and prevention of low back pain. Occupational Medicine. 3(1):137-45,

O’Sullivan PB , Twomey L, Allison G. (1997).Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylosis or spondylolisthesis. Spine. 22(24):2959–2967

Panjabi M, Abumi K, Duranceau J, et al. Spinal stability and intersegmental muscle forces. A biomechanical model. Spine 1989; 14: 194–200
Panjabi MM: (1992) The stabilizing system of the spine: Part 1. Function, dysfunction, adaptation, and enhancement. Journal Spinal Disorder. 5:383–89; discussion, 397
Peter, B. O’Sullivan, Twomey, L.(1997) Dynamic Stabilization of the Lumbar Spine. Physical and Rehabilitation Medicine. 9 (3&4): 315-330
Peterson, L. Renstorm, P. (2001) ‘Sports Injuries: their prevention and treatment (3rd edtion). London. Martin Duntiz

Porter, J. L, Wilkinson. (1997). ‘A comparative study between asymptomatic and chronic low back pain in 18-36 year old men’. Spine. 22 (13) p 1508-1514
Radebold A, Cholewicki J, Panjabi MM. (2000). Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine.25:947–54
Richardson, Carolyn A. ; Snijders, Chris J, Hides, Julie A. Damen, Léonie. (2002) The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain: Exercise Physiology and Physical Exam. Volume 27(4), pp 399-405

Richardson, C. Jull, G. (1995). Muscle control-pain control. Whatexercises would you prescribe? Manual Therapy. 1:2-10
Richardson CA, Jull GA, Hodges PW. (2004). Therapeutic exercise for lumbopelvic stabilization: A motor Controlo Approach for the Treatment and prevention of Low Back Pain. Churchill Livingstone. London:
Sakia, N.,Z. P. Luo, J. (2000) The influence of weakness in the vastus medialis oblique muscle on the patellafemoral joint: an in vitro biomechanical study. Clinical Biomechanics. 15:335-339,

Schmidt, R.A. Lee, T.D (1999) Motor Control and Learning: a Behavioural Emphasis. 3rd edition. USA. Human Kinetics
Sherry, Marc, Thomas. (2005) The Core: Where Are We Going? Clinical Journal of Sports Medicine.15 (1) 1-2
Smith, K; Smith, E. (2005). Integrating Pilates-based core strengthening into older adult fitness programs: implications for practice. Topics in Geriatric Rehabilitation; Jan-Mar; 21(1); p. 57-67.
Snijders CJ, Vleeming A, Stoeckart R. (1993) Transfer of lumbosacral load to iliac bones and legs. Part I - Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clinical Biomechanics;8:285-294.
Snijders CJ, Ribbers MTLM, de Bakker JV. (1998). EMG recordings of abdominal and back muscles in various standing postures: Validation of a biomechanical model on sacroiliac joint stability. J Electromyogr Kinesiol; 8: 205–14.
Stuge, Britt Ms, Lærum, Even ; Kirkesola, Gitle, Vøllestad, Nina. (2004)The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle PainAfter Pregnancy: A Randomized Controlled Trial. Spine. Volume 29(4),351-359Swärd, F Hellstrom M, Jacobsson B,(1990). Back pain and radiologic changes in the thoraco-lumbar spine of athletes. Spine. 15: 124–9.
Tesh KM, Shaw-Dunn J, Evans JH.(1987). The abdominal muscles and vertebral stability. Spine. 12: 501–8.
Vleeming, Mooney, Dorman, Sniijders & . Stoecart (1999). Movement stability and low back pain: The essential role of the pelvis. London. Churchill Livingstone.

Vleeming A, Pool-Goudzwaard AL, Stoeckart R. (1995). The posterior layer of the thoracolumbar fascia: its function in load transfer from spine to legs. Spine. 20(7):753-758.

Waddell, G.,(2000) The back pain revolution. 1st ed. London. ChurchillLivingstone
Wilke H-J. Wolf S. Claes LE. Arand M. Wiesend A.Bendix T.(1995).Stability increase of the lumbar spine with different muscle groups: A biomechanical in vitro study. Spine. Vol. 20(2) pp 192-198.
Bullock-Saxton JE. 1994. Local sensation changes and altered hip muscle function following severe ankle sprain. Phys Ther. 74(1):17-28.
Bullock-Saxton J, Janda V, Bullock M. 1993. Reflex activation of gluteal muscles in walking with balance shoes: an approach to restoration of function for chronic low back pain patients. Spine. 18(6):704-708.
Freeman MA, Dean MR, Hanham IW. 1965. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 47(4):678-85.
Guanche C, Knatt T, Solomonow M, Lu Y, Baratta R.1995. The synergistic action of the capsule and the shoulder muscles. Am J Sports Med. 23(3):301-6.
Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. 1994. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 19:165-172.
Ihara H, Nakayama A. 1986. Dynamic joint control training for knee ligament injuries. Am J Sports Med. 14:309.

Janda V. 1968. Postural and phasic muscles in the pathogenesis of low back pain. Proceedings of the 11th Congress of International Society of Rehabilitation of the Disabled”, Dublin, Ireland. Pp 553-54.
Janda V. 1979. Die muskularen hauptsyndrome bei vertebragen en beschwerden, theroetische fortschritte und pracktishe erfahrungen der manuellen medizin. International Congress of FIMM. Baden-Baden. pp. 61-65.
Janda V. 1987. Muscles and motor control in low back pain: Assessment and management. In Twomey LT (Ed.) Physical therapy of the low back. Churchill Livingstone: New York. Pp. 253-278.
Janda, V. 1988. Muscles and Cervicogenic Pain Syndromes. In Physical Therapy of the Cervical and Thoracic Spine, ed. R. Grand. New York: Churchill Livingstone.
Janda V, Va’Vrova’. 1996. Sensory motor stimulation. In Liebenson C (ed). Rehabilitation of the Spine. Williams & Wilkins: Baltimore. pp. 319-328.
Konradsen L, Ravn JB. 1990. Ankle instability caused by prolonged peroneal reaction time. Acta Orthop Scand. 1990 Oct;61(5):388-90.
Lewit, K., Simons DG. 1984. Myofascial Pain: Relief by Post-Isometric Relaxation. Arch Phys Med Rehabil 65(8): 452-6.
Mannion AF, Nuntener M, Taimela S, Dvorak J. 1999. A randomized clinical trial of three active therapies for chronic low back pain. Spine. 24(23):2435-48.
Panjabi MM. 1992. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 5(4):383-9
D, Novosadova K. 2001. [Contribution to the objectivization of the method of sensorimotor training stimulation according to Janda and Vavrova with regard to evidence-based-practice.] Rehabil Phys Med. 8(4):178-181.
Sherrington CS. 1907. On reciprocal innervation of antagonistic muscles. Proc R Soc Lond [Biol] 79B:337.
Staud R, Vierck CJ, Cannon RL, Mauderli AP, Price DD. 2001. Abnormal sensitization and temporal summation of second pain (wind up) in patients with fibromyalgia syndrome. Pain. 91(1-2):165-75.
Stokes M, Young A. 1984. The contribution of reflex inhibition of arthrogenenous muscle weakness. Clin Sci. 67:7-14.
Tsuda E, Okamura Y, Otsuka H, Komatsu T, Tokuya S. 2001. Direct evidence of anterior cruciate ligament-hamstring reflex arc in humans. Am J Sports Med. 29(1):83-87.
Umphred DA, Byl N, Lazaro RT, Roller M. 2001. Interventions for neurological disabilities. In Neurological Rehabilitation (Umphred DA, ed). 4th ed. Mosby: St. Louis. pp. 56-134.

12

replied to comment from Rick Gutierrez

Blog 11 was sent by Danny Christie!

13

wrote …

Looking forward to part two with the stretches, though a google search of Myoskeletal Alignment Technique has lead to some interesting material, thanks.

14

wrote …

I would like to know why the Neurological aspects of improper muscle tone and body alignment wasn't addressed in the article. I have found that weak Psoas or Illiopsoas muscles is usually due subluxation (nerve impingement) of L3 L4 spinal segments. Basic neurology 101 Tight Pec muscles and weak rotator cuff muscles usually T1-T2 nerve roots which I have found to be compensation for C2-C3 subluxations (nerve impingement), that is why the Occipitals would be tight and the SCM's would be weak. This would also lead to coordination and balance problems to due the muscle imbalances. Like I said, most people and professionals are focused on the muscles & not the neurological. I think a more balanced approach would prove to be more productive. Try looking up Active Release technique and Chiropractic Neurology. google ART Technique.

15

Jim Pascucci wrote …

Daniel, very nice article. Thanks. I'm new to CrossFit--4 months--but not new to body therapy--Advanced Rolfer, BCSI for 16 years--I really appreciate your work here. Dr. Dalton is a colleague, he's also an Advanced Rolfer, and friend. I think he's done a great job of introducing these techniques to the body therapy community through his workshops and writing.
Often times people are frustrated with seeing a Rolfer since we don't generally work with symptoms like Upper or Lower Cross, in isolation, but take a more whole body approach to organizing the body in gravity. If you see that your specific intervention isn't holding you may want to take a step back and look at the whole body, especially the feet.
I got seriously interested in CrossFit when I noticed that my son--who's been doing CrossFit for a couple of years--was really strong but not bulky and his posture was great! And it wasn't from my Rolfing him! What I realized was that CrossFit--functional movement--could, on its own, really help people's posture and was synergistic to good body work. Of course I also see pictures of people recruiting scalenes to do a pullup, which is not healthy. Contrary to what some people think, good body therapy doesn't have to be "torture" if the practitioner is skillful.
Keep up the great writing. I'm looking forward to your next segment. For those looking for research try www.fasciaresearch.com.

16

replied to comment from Jim Pascucci

Jim I like your thoughts - as my friend and old school martial arts instructor said, there are many paths up the mountain. I find that CrossFit creates good movement in a way similar to the Feldenkrais Method that my wife practices. I assume that other methodologies will also work given a competent practitioner. If you are a chiro, that's the hammer you have and every nail looks like a chiro nail. If a rolfer, ditto. If a CFer, you have the unique situation of chasing performance, and getting some significant doses of feedback in terms of performance change and/or associated pain/pain relief. I think there's significant synergy to be gained in the crossbreeding of different modalities for tweaking human performance. Part of my "CF Affiliate" dream is being able to pursue a level of competence in more than one discipline - CF and something else - as many of you already have. Potent brew for creating impact on human life and life mastery.

Looking forward to part II.

17

wrote …

Great article but I also appreciate Matt questioning it. It is always a benefit for someone to question what is being proposed. Otherwise we would end up like a lot of other sports just going along with what is new and not necessarily what is best.

I appreciate the responses just a much...solid research Rick! I also look forward to the second part!

Leave a comment

Comments (You may use HTML tags for style)