Lower back workshop Crossfit anywhere Feb 21 2016

     This took too long to get to.  Been busy!!

Things to know:

• Lower back issues tend respond best to exercise interventions
• In general I find 3 things that most lower back issues require: A. Soft tissue release B. Stabilization/movement control C. Hip flexibility
• Purpose of the spine is stability (limiting motion) around powerful movers (hips)
• Worst things: 1. Loaded extension with a spine that is not rigid  2. Loaded flexion of the spine

Screening:

• Figure out what hurts.  Is it bending, twisting, reaching, squatting?  Are you moving right or is something limited?  What are your triggers?

Soft tissue release

• Supple leopard book, smashwerx (youtube channel), and many other sources.
• Lower back- release with a lacrosse ball (or tennis ball).  Basically find the painful spots and hang out on them for 30-60" and then find another.
  
• Psoas-Releases with a kettle bell on top of a lacrosse ball.  Same thing, hunt for the painful spots
  
   Or using a lacrosse ball or even larger softball
  
  
  
• Glutes-Release with a ball or foam roller.  This is less trigger point and more of a rolling through the muscle for several passes to loosen.

Stabilization

• This article is fantastic as it relates to core activation.  Essentially we want to learn to use the diaphram to push out and stabilize while also allowing us to breathe.  Versus the model of just tightening the abdominals.  It is a skill and must be attained. 
  

Hip Flexibility

• Hip flexibility is crucial to taking the pressure off of the spine.  If they move more, it will need to move less.
• The 2 things I prefer are as follows:

Ido Portal Squat routine-This sequence is amazing.  For some, sitting on a medball or small type volleyball may be a progression until they can support the stretches free.

Couch stretch-The Ido Portal routine can sometimes make your hips feel closed up and the couch stretch will open that back up

• Hamstrings, piriformis can be added if that is a particular area of tightness.  I'm a big fan of dynamic hamstring stretching in the form of a kick type stretch as follows:

however static stretching is also a fine way to stretch and has its place.

Ankles and calves

• For crossfit, if we want to squat and take pressure off of the spine, we must have flexible ankles and calves to allow the most upright torso.  Calf stretching and ankle joint stretching are easy enough as follows:

Pretty easy to hold for 30-60" a few times each side as needed

Shoulders and T-Spine

• Finally if we are looking at lumbar movement and the ability to control it, we must discuss the implications of raising the arms over head and tightness through the thoracic spine.  If your shoulders or midback are tight, your lower back will often arch to compensate when trying to go overhead with weight.  So as a movement prep to protect your lower back, we advise stretching out the shoulders into over flexion as well as the extension of the thoracic spine.

Movement specific technique and scaling

• Squats.  1. Without proper hip hinge and stabilization control you will have a hard time squatting without excess spinal movement.  This generally is a source of pain.  2. Without adequate mobility (hips and ankles), your torso will be difficult to maintain more upright and this will cause you to lean forward more and expose the back to stress.  3. Great scaling options are front squats, goblet squats, lunges with DB instead of in rack, etc...

• Ballistics.  Box jumps, double unders, coming down from the rig or bar after pullups or toes to bar.  1. These all require care to land with both feet simultaneously.  2. These all require adequate stabilization during the impact portion.  3. Scale with step ups/downs, smaller boxes to gain proficiency, single unders, building up steps to the rig, etc...

• Rowing.  Can be great, can be trouble.  1. If you like the rower and it causes no issues, row.  If it does give you back problems, consider shortening the forward flexing when reaching for the catch.  There is no issue with being less efficient on the row but more protective of your back position.  2. Stabilization in and away from positions of pain become important.  A lower damper setting will reduce torque allowing you to learn to build stabilization abilities over time.

• Running.  Heel strike and vertical displacement.  1. If you are a heel strike type of runner, you will tend to transfer force through chain that can find the weakest link and that can be your spine.  Smaller, more rapid strides tend to help reduce the tendency to heel strike  2. A general way to tell if you are transferring force up through the ground (versus dissipating it through your lower extremities) is if your head seems to be bouncing up and down while you run.  You should imagine running under a line with your head staying as level as possible.

• Deadlifts and Olympic lifting.  1. Working from the hang and doing power versions of Snatch and Clean & Jerk can make it much easier to manage heavier loads and control back pain.  2. Deadlifts off of blocks may be a reasonable scale/starting point until proficency is achieved with proper hip hinging, load tolerance, and/or mobility to achieve pulling from the floor.  3. Must keep a rigid spine throughout entire movement.

• Situps-I prefer the frog situp version (feet together, knees bent) with an ab mat.  Straight leg sit ups are discouraged.

• GHD situps-If you are not going to regionals, I would not do these.  

• L-sits, Hollow holds/rocks-As discussed, the spine was meant to limit movement.  These exercises are fantastic static movement limiters.

• Banded decompression-This is a fantastic way to unload the spine.  It also works well laying on a bench.

The blessings of my mothers last days

     I haven't really discussed this much since it occurred.  My mother passed away at the end of April 2015.

     First a backstory: 

     I had a very chaotic childhood, is probably the best way to put it.  My father was never part of the picture after the age of 3.  Prior to that, he wasn't "really" part of the picture because he was incarcerated most of the time.  By the time I was 8 he had died in prison.

     My mom married a guy when I was about 7 or 8 I'd guess.  He was my mom's husband and I literally do not remember him trying to parent me ONCE.  We lived together is how I recall it.  These two had a lifestyle of lots of partying is all I will say.

     After high school graduation, I went in the Air Force and moved to California.  After high school, I saw my mother a few times a year or less.  Once I had children I tried to see her a little more but she never lived too close (AZ or FL).

     My mom and my step dad split shortly after I left and she went on to marry a man that was battling addiction.  That lasted a handful of years and they split and he succumbed to his illness.  She then married another man, with a similar story, battling addiction.  He went on to die from this as well.

     I say all this to say that a parent can love you more than the world itself and still be so terrorized by their own demons and choices that the legacy they leave you is love PLUS a heavy dose of let down and disappointment.

     Now the actual story:

     In September of 2014 my mother was living alone in AZ and was diagnosed with stage 4 lung cancer with metastases to the bone.  At one point she told me that she felt suicidal due to the pain.  I immediately knew that I needed her to move to CA to live with me so that I could help her battle this disease.

     In October we were told the average was 2 years based on her diagnosis.  She lived in my living room on a pull out sofa for the first month or so.  She was a mess of pain.  It seemed that every weekly appointment brought an increase in her pain medications as she was suffering so much.

     Finally she was on the right mix of medicines, radiation, and chemo that she was no longer in constant pain.  The most amazing part is that this little 105 lb woman had NO sense of grogginess or "high" or anything from the heavy pain meds.  She was able to move into my houses detached casita (spare room thing).

     It seemed like about every month there was a problem that needed to be addressed with the medications getting mixed up or side effects or not eating when supposed to and throwing the meds off.  So I would need to take on the nightly responsibility for a little while of waking, feeding, medicating, etc....to right the ship.

     Every 6 or 12 week check up we had showed the cancer was spreading.  But we kept going with treatment hoping for a change.

     On April 22, she had a chemo treatment and came home unusually tired (they often would energize her and make her feel quite good).  The next day she was very clearly disoriented.  Even she knew it.  We brought her to the hospital and found out Friday night that her cancer had spread to a kidney and that the other one got overwhelmed filtering the chemo and they both shut down.  We were told that the 2 year prognosis had just dropped to basically 2 days.

    I stayed the night in the hospital after finding out that she fell out of the bed.  Turns out that kidney failure kept the pain meds and chemo drugs accumulated in her system and caused her to hallucinate, slip in and out of lucidity, and lose her coordination.  Through the night and next day I would hear her hallucinating, trying to get out of bed, and have conversations with people that weren't there.

     Then out of the blue....she would call out for me....look right in my eyes....and tell me she loved me, tell me I was a good son.  And then just as quickly slip right back into confusion or sleep.

     We took her home Sunday and hospice was ordered.  There was no way she was swallowing pills at this point and so I was using the dropper to give her the meds.  In a repeat back to the beginning, the medication dosage was WAY too low and she was agitated all through the day and night.  We didn't have a hospital bed and so she was back on the pull out sofa with me sleeping next to her.  I figured out a system of tying a belt from a robe to her waist and the other end to my arm.  Everytime the meds started to wear off or for whatever reason, she would spring upright and try to get up.  Which with her lack of coordination and lucidity meant that she was going to face plant on the floor.  So the robe would pull on me and I'd grab her and try to calm her down.

     We got a hospital bed Monday and after numerous medication increases and home visits the hospice folks decided that on Tuesday morning they would station a nurse with us for the whole day to try to get things under control.  Which they finally did and my mom was at long last resting peacefully.  Those nights I slept next to her on the sofa and still had the robe trick going just in case and woke regularly to give her the droppers of meds.

     On Wednesday morning I went to wake the kids for school at 7 and noticed my mom stirring.  I called in Kathy and we sadly watched as she had her final moments and died.  It was finally over.

The blessings:

     My mom was able to spend the last 6 and a half months of her life with my family.  We spent more time together than we had since I was in high school.

     We had deep conversations about our love for one another, our forgiveness of each other, and the wonderful treat it was for her to watch her grandkids live life over those months.

     My kids were able to hear sweet (and many not so sweet) stories of who I was and who I am in my mother's eyes.  It allowed me to open up honest conversation with them about my life, my shortcomings, and my efforts to overcome things in my life.  I hope and believe that it will allow them to see me as human, fallible, and redeemable when they are struggling in the world.

     I had a renewed relationship with her that allowed me to spend more time with her in those 6 1/2 months than I likely would have had she lived another 15 years in AZ.

     I had the opportunity to love and forgive and move past any let downs I might have had in the past with her.  This is a beautiful thing.

     I love her and miss her and feel lucky that I had the chance to be there for her.

Crossfit injuries...

   
     The sport of fitness is no different than the sport of football, the sport of running, the sport of basketball.  If you decide to play those sports 5 days a week, you will likely get hurt overtime with injuries of over use or trauma.  It's not a surprise at all.  So when there is talk about Crossfit being dangerous, I agree.  It's as dangerous as any other sport you commit to.  And if you pick up those sports as a mature adult....then it should REALLY be no surprise if you have sports related injuries along the way.

     I missed a clean years ago (2012) and broke my wrist and tore the scapho lunate ligament.  Now it will dislocate if I'm not careful to really brace it up.  I can still HS walk, do MU's, clean heavy weights, etc...but I need to be careful.  If it dislocates (which it has done 3-4 times since 2012) I have to stop and pull and wiggle the hand until the bones "clunk" back into place.  Surgery would fix the problem but cause others in my "sport".  So I'm not ready for that.

     I felt a click in my knee on the back foot a few years ago (2013) on a light split jerk.  It immediately felt weak and unstable and painful.  I wasn't careful and didn't keep my back heel firmly turned out and it tweaked the meniscus.  I had to make a few changes, now I split jerk with my right foot forward.  It took a little time (4 months) but I can still squat full depth, do pistols, box jumps, etc...I just need to warm up well.  And if I sit still too long without walking around the knee stiffens up when I get up and walk the 1st 10+ steps.  It's just a little sore, but otherwise I can function in my "sport".

     I recently found out I have a probable SLAP lesion (torn labrum) in my left shoulder.  It's an irritant when doing push ups or muscle ups and things like that.  Hurts over my AC joint.  It clunks when I mobilize it pre-workout.  It's not operative at this point because its still stable.  (These issues are common with overhead athletes.)  I think it all started with a missed muscle up last year where I didn't let go of the rings fast enough and my shoulder got hyperextended,  Not terrible, just a little sore.  Then in a pressing cycle a few months ago it started to be much more sore and hasn't gotten much less sore.  Provided I focus on rotator cuff exercise and proper warm up, I can still play my "sport".

     So how do you avoid these injuries?  

     How do other dedicated athletes stay healthy?  The short answer is they don't.....Seriously, MOST athletes get injuries from their sports over time.  They rehab and get back to it.  There are very few Cal Ripken's in the world of sports.  Most athletes spend some time on the disabled list.  It's almost inevitable.  

     The long answer is:

Work on weak links-If you are prone to low back pain then you need to make supplemental core work and hip mobility part of your everydays.  If you get an injury, you need to prioritize it.

Warm up for you-On my drive to the box I stretch out my wrists and have a little yellow theraband I warm up my left shoulder rotator cuff with.  I hit the X-over symmetry a little bit, I have a shoulder and lower body mobility warm up I do.

Have good coaches-Good coaches will be able to take into account your problems and problem areas and modify WOD's for you and on top of that give you homework to address these areas.

Use good judgement- This may be one of the hardest parts for many because of the nature of our sport.  We are constantly competing against ourselves and others.  The internal pressure to do better must always be measured by the risks of failure to do it safely.  Take the outfielder who runs with reckless abandon into the centerfield wall while catching likely home run.  He might just hurt himself on that, but its a risk he is taking.  Should he give up the home run?  Only he can answer that. But he might end up sitting out the next 3 weeks if he hits the wall just right....

     So fellow athlete's, I hope your sport is still fun for and that you stay healthy!