DOC'S CORNER

Doc's Corner Vol.16, march 2008 "No Pain, No Gain At one point or another, we have all heard the saying, "No pain, no gain" in regards to workout intensity. I think the underlying meaning behind this statement is true, which is to say that the lifter should push and challenge themselves as hard as they can. To take this statement literally however, is a whole different ballgame. Anyone involved in strength training or rehabilitation of any kind knows that the line of how hard we should push ourselves to achieve performance gains, versus the point at which breakdown will occur is like a razor's edge. The course along this line must be plotted very carefully. In all my years of strength training, be it CrossFit, or otherwise, have consisted of that point of no return. There is the point during training where your body is telling you to stop, but your mind will not give in. It is an instinctive and very primal property that is part in parcel of most lifters thought processes. To me the big difference is the state at which the lifter enters the workout. Have you licked your wounds, and feel fresh and ready to go, or are there chronic, nagging injuries to major muscle groups that may hinder performance? This is where the interpretation of the above slogan gets tricky. Researchers Hodges and Richardson looked at the relationship between muscles of the trunk and how they fire in relation to movement in the extremities. In an otherwise healthy person or athlete, the core muscles (here the Transversus abdominis, and Internal obliques) fire first to stabilize the trunk in order to generate force to deliver to the extremity, as well as to stabilize the spine and pelvis. In athletes tested that reported minor low back pain prior to training, this was not the case. In fact, the opposite happened. The trunk muscles fired after the force from the extremity was already delivered. This scenario altered overall spinal control, and significantly reduced the capacity of the trunk muscles to protect the spine. The conclusion is that in these athletes their low back pain caused altered coordination of trunk muscles, which will put them at greater risk for injury due to poor spinal stabilization. In a similar study by Hungerford, when athletes with SI joint pain were asked to balance on one leg, the result was very similar. It showed that the gluteus maximus, internal obliques and multifdi all fired in an improper sequence thus resulting in improper stabilization of the spine and pelvis during the performed task. The facts are that the central nervous system controls the appropriate amount of muscular force, as well as the proper timing of firing of these muscles, all which are significantly affected if the athlete has nagging low back complaints. This situation only sets up the athlete for further injury, or at very least, less than optimal performance gains. Regular chiropractic adjustments align these structures of the spine, which will create a clear channel of information from the brain to the target tissues, as well as remove the pain signals that disrupt the stabilization and recruitment patterns. So, pushing oneself to physical limits during training is a must, and is acceptable, as long as the proper rehabilitative and preventative measures are taken to ensure that you can handle those stressors. This would include regular chiropractic adjustments, a dynamic warm-up, specific warm-up, proper technique, stretching and icing. These will put you in the best position to stay healthy and achieve your desired goals. Dr. Jason H Davidson DC, CSCS References: 1. Hodges, PhD, Richardson, PhD. Arch Phys Med Rehab 1999; 80 (Sept): 1005-1012 Study of Trunk Muscle Coordination in Subjects with and without History of LBP. 2. Hungerford, PhD, Gilleard, PhD, Hodges, PhD. Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain. Spine; 2003 28(14); 1593-1600. back to top

Doc's Corner Vol.15, January/February 2008 SPINAL FLEXION AND FUNCTIONAL TRAINING This week we are going to talk about some principles that pertain to our weight training on a daily basis. If you don't think much about the role of proper spinal alignment in CrossFit training, you will after reading this journal entry. In teaching the slow lifts and Olympic lifts on a daily basis, one of the key factors that I point out regularly is that the lifter should always have a nice "flat back." In other words, when addressing the bar, especially when pulling from the floor, it is critical to the lifter's safety to eliminate lumbar flexion. This means that one must make certain that the lifter is not rounding the back in any way before lifting. There is a lot more to this than just common sense. Understanding the Physiology behind it is enough to make you correct your form immediately. There are a number of tissues involved in this process that are susceptible to injury. The lumber vertebral bodies, discs, muscles, and, ligamentous structures on the posterior of the spine are all subject to a tremendous increase in mechanical load in the flexed or even partially flexed position. The load and muscle activity increases in direct proportion to the increase in the tilting angle (forward bending) of the lumbar spine. According to Takahashi; 2006 if the load in the upright position is regarded as 100%, the mechanical load of the disc when the trunk is bent forward 30 degrees increases to an astonishing 360% without any weight involved. If the lifter is then asked to bend to 30 degrees while holding a pair of 10kg plates the load jumps to 430%. This flexion causes a strain of the interspinous ligaments and multifidi as they fight to reduce shearing forces, and protect the discs. A study by McGill concludes that a fully flexed spine is up to 40% weaker than if it were in a neutral posture. The numbers listed above are based on the magnified load on the spine under normal conditions. If we then factor in the amount of lifters who have numerous joints of their spine that have subluxated from their proper position, we are setting ourselves up for disaster. Without the joints of the spine in proper anatomical alignment, we greatly reduce the ability of those structures to withstand the loads indicated above, let alone those induced by training. Like I mentioned in last month's article, these subluxations also cause a decrease in neural connectivity, which can dampen the appropriate response of a muscle to an external load. Attempting to correct these misalignments with anything other than a chiropractic adjustment is like trying to get fit by doing bicep curls and bench press. Only a physical manipulation of the joint will restore anatomical and neurological integrity, and yes, just like CrossFit, repeated treatments will be necessary if the desired result is to be expected. So as always, keep up your functional training, good nutrition, and chiropractic care and you will be on the road to better performance, and wellness. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit II drdavidson@crossfitnc.com References: 1. Takahashi, I, MD, Kikuchi S, MD, PhD, et.al. Mechanical Loading of the Lumbar Spine During Forward Bending Motion of the Trunk. Spine 2006; 31:18-23 2. McGill S, PhD, Ultimate Back Fitness and Performance. Waterloo, Canada: Wabuno Publishers, 2004: 134-7. back to top

Doc's Corner Vol.14, October/November 2007 STABILIZING THE SPINE to REDUCE INJURY and INCREASE PERFORMANCE In this month's article we are going to look at some anatomy and physiology of what we do as CrossFitters, and try to understand the human body a little bit better so we can maximize performance when we train. Stabilization of the spine occurs via neuro-muscular control, and passive stability through the design of anatomical structures. First, receptors in the joint capsules, ligaments, muscles, and vertebral discs have the ability to monitor position, load, and movement, to allow them to determine what the requirements for spinal stability are at any given moment. The muscles are controlled and regulated until the desired level of stability is achieved. Through coordination from the central nervous system, these muscles are able to consciously, and sub-consciously generate the forces that supply stability. The design of the vertebrae, facet joints, discs, and other inter-segmental connective tissues help to keep the spine within its safe range of motion. There is constant communication between the receptors surrounding the spinal column and the brain, as it is imperative that this sensory information is processed so that the forces generated by the spinal stabilizers can be constantly updated to adapt to external forces. The body is amazing at adapting to different external forces, providing that this information can be communicated without any interruption or aberration up and down the spinal column. If a subluxation is present within the spinal column, this information can be greatly distorted, and that's when injury can occur. A subluxation is a slippage of one or several vertebrae which causes a disruption in neural connectivity, as well as compromised spinal biomechanics. This interruption is usually responsible for acute low back pain when relatively light loads are used. For example, "I just bent down to pick up a piece of paper when…" The sensory information was distorted which caused stabilizing musculature, i.e. multifidi, and spinal erectors to fire too much, too little, too early, or too late to adjust to the external force on the body. As a result, the external forces, or the muscles may have overloaded the passive structures of the joints themselves. So what does this all mean? It means that in our overall view of fitness and wellness, we must address these issues through the way we train, and how we take care of our bodies. CrossFit training encourages the development of normal neuro-motor control under dynamic conditions. It allows the CrossFitter the ability to exert strength and power with perfect synergy and precision, while in a highly varied environment. This helps to develop the all too critical motor control systems that we need to perform and prevent injury. Regular chiropractic care will restore proper alignment to the spine and restore balance and symmetry to the surrounding connective tissue to assure that these neural programs can communicate effectively. In addition, developing these neuro-motor pathways early on in training has been proven to show massive gains in performance, as the systems respond well to training stimuli. So keep up with your current CrossFit NC and Performance Chiropractic regimen. If you don't have access to our facilities, you can always use the workouts provided on our website, and see a Chiropractor in your area. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit II drdavidson@crossfitnc.com 1. Panjabi, PhD. The Stabilizing System of the Spine. Part I. Journal of Spinal Disorders 1992; 5(4): 383-9 2. Ultimate Back and Fitness Performance. McGill, S, PhD. Wabuno Publishers. Waterloo, Canada 2004 back to top

Doc's Corner Vol.13, August/September 2007 CrossFitNC on the GO One of the beautiful things about CrossFit philosophy and training methodology is its simplicity. I've often said that we can't be given credit for re-inventing the wheel, we just do many movements that most of the world has abandoned for some reason. We have a common scenario that occurs often in our gym. In any given week there is a hard working client that for personal or work-related reasons must travel for several days or a week, and is so upset that they will be missing out on their daily routine. This is where CrossFit simplicity meets modern day practicality. We're going to look at some very simple ways to get your "CrossFit-to-go" so when you return from that business trip; you'll find you haven't missed a beat. What most people seem to forget very easily is that they always have the most important piece of equipment with them; their body. Bodyweight, gymnastic, and plyometric components are a huge part of CrossFit, and all can be done easily on the road. My favorite is the most obvious of all. If your staying in a hotel with more that one level, you have stairs to climb. If you happen to be in a nicer hotel these stairs may even span several stories, and be indoors. With stairs you can step up, sprint up, sprint up skipping steps in between, skip up one leg at a time, or do hops. They can be done from the first floor to the 50th and back down, or just in intervals from one floor to the next. They can also double as your box jumps. The basic movements you can do very easily are push-ups, sit-ups, squats and yes, burpees. Even within these movements are many variations that can make for a tough workout. You can make your push-ups more dynamic by clapping, or tapping your opposite shoulder upon each upward movement. Sit-ups can be full or partial range of motion, and can target various abdominal regions. Squats can be bodyweight, one legged, or jumping. Then there are lunges and jumping lunges. If there is any kind of "fitness center" then there's a good chance that there is a pull-up bar. If that's the case you just added another dimension to your routine. If you're lucky enough to encounter a pair of dumbbells, then you've just expanded even more. The point is, you won't be as lost as you think. Play with the reps and rounds to keep it interesting. You can keep all of the reps the same each round, make them ascending, or descending. You can do timed intervals of a particular movement, or you can just repeat a certain pattern for pre-set workout duration. You can change the amount of rounds, and also combine strength, plyometric, and cardiovascular components together. Be as creative as you want to be and have fun with it. Don't worry, you'll be back at CrossFit soon enough to "get some more." Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit II drdavidson@crossfitnc.com back to top

Doc's Corner Vol.12, May/June 2007 Shoulder Anatomy and Kinesiology 101 The shoulder girdle is an amazing, multi-functional structure. It has a unique design which allows it to be omni-directional; moving freely throughout all planes of motion. The same design which allows for all of this freedom of movement can on occasion make it more susceptible to injury than other joints of the body. Obviously for the CrossFit community, the shoulder is excessively important for all of the functional movements that we perform on a daily basis. In this issue of "The Corner" we will look at basic shoulder girdle anatomy, and function. The shoulder girdle is actually four different joints. They are the sternoclavicular joint (SC), acromioclavicular joint (AC), glenohumeral joint (GH), and scapulothoracic articulation. The SC joint is formed by the union of the medial end of the clavicle and the manubrium portion of the sternum. The space between this joint is occupied by a single disc. This joint performs ranges of motion such as elevation/depression, protraction/retraction, and rotation. This small joint is held together by two ligamentous attachments. Common injuries to the SC joint are sprain, subluxations, or dislocation. Misalignment of this joint usually comes from a force that is applied through the clavicle from the lateral end, as in falling on your shoulder with your arm across your body. The AC joint is comprised of the distal end of the clavicle, and the acromion process of the scapula. It has the support of four ligaments. The AC joint allows for three measurable ranges of motion. The first is rotation around the end of the clavicle as in abduction of the shoulder joint. When the humerus is abducted past 120 degrees, the acromion slides on the end of the clavicle moving in the same direction as the scapula. The AC joint also performs "winging" and "tipping".The former is when the scapula moves laterally around the rib cage, but without abduction, and the latter is when the inferior angle of the scapula rotates in the coronal plane. The AC joint can also sprain, subluxate, and dislocate. A subluxation, partial dislocation, or "separation" of the AC joint is usually measured in grades I-III. Each represents the distance that the clavicle moves away from the acromion, and the amount of ligament damage present. III is the most severe. This injury commonly occurs when falling on an outstretched arm, but can happen in a number of ways. The GH joint is slightly more complex. It is a ball and socket joint comprised of the head of the humerus, the glenoid fossa of the scapula, the glenoid labrum, muscles of the rotator cuff, a joint capsule and extensive ligamentous connective tissue. It can perform flexion/extension, ab/adduction, and internal/external rotation. The motion in each of these planes greatly varies depending on whether or not the humerus is internally or externally rotated. For example, if you use proper technique, you will notice that if you rotate your arm inward and try to do a lateral raise, going past 80 or 90 degrees is challenging. If you get it up there all the way you are cheating by shifting your shoulder anteriorly which will use scapular motion to take it the rest of the way. You'll now notice if you externally rotate your arm, the range of motion increases drastically. The Scapulothoracic articulation is an important part of the shoulder, even though it is not a true joint. It is more a proximity, or relationship between the scapula and the thoracic wall. The scapulae are usually located superior to inferiorly from the second through seventh ribs, and are held there by muscular attachments as well as force applied by the other articulations of the shoulder girdle. Elevation/depression, protraction/retraction, winging and tipping are all scapular ranges of motion. That is just skimming the surface of the inner-workings of the shoulder girdle. Hopefully this either refreshes your memory, or educates you a little bit about this all important structure. I know this stuff can be dry sometimes, but it is good to understand and will help you in your training and injury prevention. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I 1. "Textbook of Clinical Chiropractic. A Biomechanical Approach" Plaugher, Gregory, and Lopes, Mark A., Extravertebral Disorders: Upper and Lower Extremities, p.468-475, Williams and Wilkins, 1993. 2. Turek S. Orthopedic Principles and Their Application, 4th Edition, Philadelphia: JB Lippencott, 1984 back to top

Doc's Corner Vol.11, March/April 2007 "Uncle Rhabdo" Those of you familiar with the CrossFit world may have heard of "Uncle Rhabdo" before. Although we have attached a fun name to it, this uncle is no laughing matter at all. What we are referring to is a condition known as Acute Exertional Rhabdomyolysis (AER), and it can be life threatening. Rhabdomyolysis is defined as a clinical and biochemical syndrome resulting from skeletal muscle injury that alters the integrity of the muscle cell membrane sufficiently to allow the release of the muscle cell contents into the plasma. (1). This disorder is usually accompanied by myoglobinuria (dark urine), and can cause renal failure, heart attack, and death. AER is usually caused by extreme physical exertion, in individuals who are not used to such a high training load or volume. The most common population where it shows up, but is not at all limited to is the military, endurance athletes, and weight training. There are other training conditions that have been known to come into play, but don't necessarily have to be present. Humidity usually plays a factor, and also strenuous eccentric contractions have been known to contribute as well. The signs and symptoms can often be lumped in with DOMS (delayed onset muscle soreness), which can be very dangerous as DOMS in not life threatening whereas AER can potentially be. Usually, the person will present with bilateral muscle soreness, loss of range of motion in the affected muscle, diffuse swelling, myoglobinuria (tea, or cola colored urine), and pain. You should raise a red flag if you notice pain, bilateral muscle soreness, swelling, and it has been 24-48 hours post training. If cola colored urine is present, go directly to the emergency room for immediate treatment. The CrossFit regimen if being done correctly is usually more physical stress than the average person has encountered in a previous exercise regimen. It is because of this reason that anyone beginning CrossFit should seriously consider taking advantage of the scalability of the workouts, and gradually ease themselves in. One of the wonderful things about this gym is the accessibility of the training routines online, on a daily basis. Although this may help shake the monotony of your workouts, people very frequently attempt the lifts, volume, and intensity, without having been properly educated or introduced. It is in these situations that one is not only susceptible to various sprain/strain type injuries, but it puts you in a perfect position for something potentially more serious. I know what the nay-sayers are thinking. "Doesn't this make CrossFit dangerous? Why would I want to do that?" The answer is no. CrossFit is not dangerous. Abuse of CrossFit can be dangerous. Heck, baking cookies is dangerous, if you put your head in the oven. Just be smart, know the warning signs and symptoms, and appropriate action to take, and you'll be fine. Rehabilitation after a bout of AER is basic, but regimented and should not begin until levels of CPK (creatine-phosho-kinase) and myoglobin normalize. Once this happens, the person should attempt to acquire normal range of motion of the affected muscle under supervision of a trained professional. Once this is achieved, light interval training, or cycling can be performed. When the person has no pain and full range of motion, they can be introduced to light weight training and progress at a tolerable level. I decided to write on this because although I have spoken with many of you about it, I felt it would be a good idea to educate the masses, being that a visit with "Uncle Rhabdo" can be very serious. If you ever have a visit with "Pukie", which many of us have, we'll probably just laugh with you. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I 1. Poels, P., and F. Gabreels. Rhabdomyolysis: A review of the literature. Clinical Neurology and Neurosurgery. 95:175-192 1993. 2. Brudvig, Tracy J. and P. Fitzgerald. Identification of Signs and Symptoms of Acute Exertional Rhabdomyolysis in Athletes: A Guide for the Practitioner. Strength and Conditioning Journal vol.29 Number 1, Feb. 2007, p 10-13. back to top

Doc's Corner Vol.10, January/February 2007 Plyometric Training If you're an avid CrossFitter, than you're very familiar with box jumps, dynamic push-ups, medicine ball sit-ups and other similar movements. All of the above would technically fall under the category of plyometrics. In this issue I will be explaining the basic physiology and mechanisms involved in these movements, and explain why we do them in the first place. Plyometric exercises are those which allow a muscle to reach maximal force in the shortest amount of time possible. All of these movements will involve a countermovement, and a cascade of events involving the series elastic component (SEC), stretch reflex, and stretch-shortening cycle (SSC). "Functional movements and athletic success depend on both the proper function of all active muscles and the speed at which these muscular forces are used." There is one word to describe the previous statement; power. Plyometric training is essential and has been shown to be a driving force behind power development in athletics. The series elastic component (SEC) of plyometric movements describes a spring-like mechanism that occurs at the musculotendinous junction. When the tendons of a muscle are stretched in an eccentric contraction the SEC lengthens and elastic energy is created and stored. If this stretching of the muscle is immediately followed by a powerful concentric movement, that stored energy is released and multiples the amount of force delivered by that muscle. If there is no immediate concentric motion, or the eccentric contraction is too long, that elastic energy will be lost as heat from the body. The stretch reflex is a neurological mechanism that also plays a part in this type of activity. In the stretch reflex, muscle spindles are activated by rapid lengthening of the muscle. This is what happens in the initiation of a plyometric movement. The innate response of this reflex is to protect the joint by increasing the output of the agonist muscle. When this happens, the force of the muscle is increased, and more power is produced. The stretch-shortening cycle (SSC) contains three phases which incorporate the ideas that we just discussed. The first phase is the eccentric phase. In this phase the muscle in question (agonist) is preloaded, which stimulates muscle spindles. This in turn generates the elastic energy needed for whatever movement is being performed. The next phase is the amoritization phase. This is defined as the time between the end of the eccentric phase and the beginning of the concentric phase. This step must be kept short as to not lose the collected energy as heat. Lastly is the concentric phase, where the stored elastic energy is used and the muscle explosively contracts to perform its function. The power generated in this cycle exceeds by far, the amount of power that can be created by contracting the muscle in isolation. The purpose of this brief explanation was to get you understand and appreciate the science and physiology behind the things that we do here at the gym. On any given day what we do in the gym may appear random in nature, but it always has a specific purpose, technique, and application. Here we begin to understand the complexity of a movement as simple as the box jump. It isn't just a device that we enjoy torturing you guys with. With that particular exercise, we are trying to develop explosive leg power. With plyometrics in general, we are trying to drastically increase the output of the particular muscle, or muscles. By performing these repetitive explosive movements, we also build tremendous flexibility, and strengthen any given joint's ability to withstand impact. These help to develop overall athleticism, and healthy musculo-skeletal function. Dr. Jason H. Davidson, DC, CSCS, USAW I, CrossFit I 1. Essentials of Strength and Conditioning, Second Edition, Baechle, Thomas R. and Earle, Roger W, CH. 19, p 427-431, Human Kinetics, 2000, 1994. back to top

Doc's Corner Vol.9, November/December 2006 Back Squat Essentials The back squat is another one of those lifts that always seems to carry some kind of stigma attached to it. I'm sure many of us have heard the arguments that the squat is an un-safe exercise, and should be eliminated from the training routine. These same people will claim that the squat causes knee, back and even neck injury. In my opinion, these people must be doing the squat incorrectly, which is evident by the type of injuries they report. The truth is that the squat is one of the innate functional movement patterns that we as humans have, and it is ridiculous to say that it is an un-natural or un-safe movement to perform. Many of you have seen infants and toddlers who unprompted, and untaught, will descend into a perfect rock-bottom squat to pick an object up off of the floor. They will often stay and play in that position as well before returning to the standing position. This is further proof to back my defense that this is an in-born pattern. So, hopefully we are in agreement that this lift is a necessary and natural movement. Now let's break down how to perform it correctly to maximize strength, efficiency, and safety. The first thing the lifter must address is the lifting area, rack, or platform from which they are squatting. This is often where the first mistakes are made. The height of the bar should be set around mid-chest. Many people set the bar at the level of their traps, or where they feel the bar will rest on their back. This does not accommodate for the fact that the bar has to be lifted up and out of the rack before squatting (Monolift racks and similar being the exception). This becomes very taxing and dangerous when the weight load increases. By placing the bar low, the lifter can place both feet together under the bar, pop the weight up free and clear of the rack, and step directly into his/her stance with minimal effort. This is much more safe and efficient. The bar itself should be placed across the lower portion of the traps, roughly in line with spinal segments T3 and T4, and not on the lower cervicals. Folks, it's not rocket science; if you place 300 lbs of weight on your neck, it will probably hurt your neck. The lower position offers many more layers of muscle as cushioning and support for your squat. Now, with proper bar, and rack placement, the lifter can step directly into their stance and begin to squat. There is no need to take multiple steps backward here. Just clear the rack and squat. This will also make racking the bar after a heavy set much easier. The squat stance is basic. Once the lifter has the bar placed on their back, the head should be in a neutral position, with the chest up, and scapulae in a retracted position. The feet are hip width or slightly wider, with feet externally rotated slightly. The biggest thing to realize when performing the squat motion is that the squat is not a quad-dominant exercise. Trying to move the barbell with your quads will put the force straight through your knees causing hip adduction, ankle extension, and an extremely unstable, and weak position. These groups of lifters are the ones who say that squatting hurts their knees. The muscles of the hips and buttocks are the prime movers of this lift, and the lifter must squat in a way to maximize use of these muscles. Upon descent, the hips should shift back slightly so that the weight shifts to the heels. By doing this, the force goes through the hip joint, and not the knee, which will be safer, and much stronger. With the ascent, the trunk position remains the same, the weight is still on the heels, and the glutes and hip flexors are engaged. Now you have a nice, strong and safe squat. Remember, proper breathing is important as well. Before your descent, you should fill up with air to maximize intra-abdominal pressure. This will help to keep everything on the inside where it's supposed to be. I'll usually exhale about half way up, or if doing reps, it is not uncommon to perform multiple reps on the same breath. Practice these tips and your squat and overall performance are sure to increase. back to top

Doc's Corner Vol.8, September/October 2006 Therapeutic Ultrasound One of the modalities commonly used in the Performance Chiropractic office is Therapeutic Ultrasound. Although it is sometimes not considered to be a true part of the Chiropractic regimen, ultrasound has proven to be an excellent adjunct to the adjustment in promoting the growth and repair of sport related soft tissue injuries. This month I will explain this modality, and some of its applications in the Chiropractic practice. Let me preface this by saying that this modality is only part of the solution to musculo-skeletal problems. Let's say we have a lifter in the gym for example, pulling a heavy deadlift. Perhaps the load is too much for the lifter, forcing them to break form, and put an excessive load on the right sacro-iliac joint. This then forces the sacrum forward and down on the involved side, and fixating it in that position. Now we have pain, inflammation, muscular asymmetries, and the cascade of soft tissue injuries is unfolding before our eyes. Ultrasound can aid in the acceleration of the healing of these injuries, but remember, ultrasound cannot remove the sacrum from its fixated position. That is the job of the adjustment. Hand in hand, they work wonders. Ultrasound is the most commonly used modality in all of sports medicine. Its primary uses are for stimulating the repair of soft tissues, and for pain relief. By definition ultrasound is an inaudible, acoustic vibration of high frequency that may produce either thermal or non-thermal physiologic effects. Within the sound head or transducer of the ultrasound machine is either quartz or synthetic ceramic crystals. When an alternating current is passed through the crystal it will vibrate and contract, which produces the desired ultrasound frequency. So what does it do? Basically, ultrasound has thermal and non-thermal physiologic effects on soft tissue. Depending on the nature of the injury one of the above will be more applicable. That determination is made by the health care professional. For sub-acute or chronic injuries, a thermal effect is usually more desirable. With the correct frequency, and depth of penetration, deep heat can be produced. Heat causes an increase in the extensibility of collagen within the joint, a decrease in joint stiffness, reduction of muscle spasticity, increased blood flow, and a modulation of pain. For acute injuries, heat is usually not recommended. For these injuries the ultrasound unit will be set up differently as to not produce heat. Here the sound wave will cause an increase in fibroblast activity. Fibroblasts will in turn cause an increase in protein synthesis, tissue regeneration, increased blood flow, and bone healing around the treatment site. All of these factors will help the tissue to return to its pre-injury state. Ultrasound treatments are usually relatively short duration (several minutes), and painless for the patient. In going back to our lifter from before, if we first return the sacrum back to its proper position (which will restore proper joint mechanics), and now treat with ultrasound, we have fixed the cause of the problem, and are working to accelerate the healing of the surrounding tissues. This will ensure that the individual will be back training at 100% as soon as possible. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I 1. Therapeutic Modalities in Sports Medicine, 4th Edition, Prentice, William E., McGraw- Hill 1999, CH.10, p. 207-224. back to top

Doc's Corner Vol.7, August 2006 The Snatch for Beginners: Overhead Squat With this month's issue I hope to explain the bits and pieces of functional movements which combine to become the world's fastest and most powerful lift; the Snatch. The snatch is one of the two Olympic lifts, the other being the Clean and Jerk. Just like learning the clean variations, the Snatch also requires that you start from the very beginning. The lifter must break the movement down into smaller, and more digestible segments, before progressing to the finished product. Failure to do so will yield very little in terms of speed and power development, and more importantly, can lead to serious injury. The place that I recommend we start is with the good old back squat. The reason this is the starting point is because being able to hit a nice, deep, squat is going to be critical when we shift the focus to the overhead squat, which is next. The lifter must have the hip and back flexibility to be in the down position while keeping both heels on the ground, and with the torso upright. I would not even attempt to move on until these requirements are met. In the bottom position the knee joint is going to be higher than the hip i.e., breaking the parallel plane. With the O-lifts, you won't have the luxury of controlling the depth. The weight will sit you down into the bottom position, so you'd better be ready. The overhead squat is our next progression. Remember, you shouldn't be here until you've already mastered the back squat. With the overhead squat, the mechanics of the lower extremity are the same as in the back squat. Above the waist however, is entirely different. The lifter will be holding the bar overhead with a snatch grip. The snatch grip can be determined a number of ways, but for simplicity, the hands should be at a distance that keep the bar 6-8" above the head with the elbows in full extension. From the lateral view, the bar should pass right through the ear or slightly behind it for the entire range of motion. The lifter should feel every muscle in the upper back and shoulders flex, as they are constantly pushing upward under the bar. You can also think of it in terms of trying to pull the bar apart from the center. The most common mistakes we see in the gym and across the board are the heels coming up, or the bar coming forward during the descent. Of course it is not uncommon to see both of these happen at the same time. If your heels come up, see the staff about fixing your squat. If the bar comes forward, talk with the staff about some back extension/spinal mobility exercises you can do. Otherwise, attempt to drop into a full, deep squat and return back up to the standing position. When those steps become easy, then we are ready to move on to the snatch progressions. We will do it in similar fashion to the clean progressions. We'll pull from the hang, mid-thigh, knee, and floor, and then add the squat at the end. You can also do a power snatch, hang power snatch, pressing snatch balance, heave-pressing snatch balance, and more. I'm going to leave these progressions for another article, because I want everyone to understand the complexity of this lift. Start working on your deep back squats, and overhead squats with PVC, or an empty bar. I'd rather see perfect form with an empty bar than attempting too much weight, too soon. Remember, just like Jiu-Jitsu and MuayThai, one class in each doesn't mean you're ready for the UFC. Practicing the basics, conditioning your body, and honing your sport-specific skills are what get you there. It's the same thing with the Snatch. Learn it in pieces, and take your time. The speed and the power will be there if you do it right. If you don't do it right, you shouldn't even include it in your training. If you are already sound in the lifts mentioned above, then you can see me about beginning some of the other progressions in class. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I back to top

Doc's Corner Vol.6, July 2006 Chiropractic FAQ's In trying to address things that come up on a daily basis in the gym, this month we're going to shift the focus back to Chiropractic. More and more of you have been coming in, and I appreciate your patronage. At the same time, I'd like to take this opportunity to bring some clarity to some of the more frequently asked questions that I get from patients on a daily basis. This will hopefully not only answer your questions, but shed some light on how Chiropractic and functional strength training go together, and perhaps enable you to explain it to someone else on the street. COMMENT # 1: "I heard that once you go to the Chiropractor, you have to go the rest of your life." I love this one, because it implies that the patient is perfect and that I did something to break them, and now they need perpetual fixing! Wrong. The way I usually address this situation is by explaining that you should be going to the Chiropractor all the time whether you are hurt or not. This is a preventative, and performance enhancing profession. You should not wait until you are hurt to get adjusted; rather get regular spinal alignments to make sure your body is functioning at its optimal level. Movement is life. You have 24 moveable segments in your spine, and if you think that you can lift heavy loads, do CrossFit, train jiu-jitsu, work, be with your kids, and whatever else you do without ever disrupting their alignment, you're crazy. COMMENT # 2 "I think it's just muscular." For this one I'll refer you to the archives. Check volume 2 of "Doc's Corner" for the detailed response to this beauty. The response is 99% "No. It's not just muscular at all." It is of course possible to have a muscular injury by itself, but the overwhelming majority of cases , whether they be neck, back, or other, have their origin from spinal misalignment. COMMENT # 3 "Why do I have to come all the time?" There are a number of ways to address this question. I will attempt to break it down with an analogy or two. You can equate Chiropractic care to your diet or your strength and conditioning program. If one is to initiate a diet, to undo dozens of years of horrible eating habits, is it expected that the person will be at their goal weight in 1 day? How about 2 days, or 1 week? Obviously, the answer is that it will take a tremendous amount of time and dedication to receive the desired result. The same is true with your exercise regimen, be it CrossFit or anything else. The results take hard work and time. There exist ways to cheat and speed them up, i.e. diet pills, laxatives diuretics, and steroids for your workouts. Likewise the patient can reduce their pain and discomfort with pain killers, NSAID's, and muscle relaxers, but they have only addressed the symptoms, and not the cause of the problem. The individual who uses "magic" diet drugs will put the weight back on. The athlete on steroids will over train and injure themselves, get caught and ruin their careers, or without the drugs go back to having sub-standard training results. The same is true for the Chiropractic patient who tries to mask symptoms instead of fixing the problem, or decides their own course of treatment. They'll always be coming back with the same ailment, but each time it will be a little worse. The relief they get from drugs is only temporary. The bottom line is that doing things naturally and correctly takes time. It's just like anything else you do. I plan on continuing this particular topic in another future volume of "Doc's Corner." There are tons of other things that come up on a regular basis that I will be talking about. In the mean time, let that sink in. It makes perfect sense. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I back to top

Doc's Corner Vol.5, June 2006 KIPPING PULL-UPS VS. EVERYONE ELSE I would be crazy to think that I am the first one to write about this, but it keeps coming up in the gym, so I'll give my opinion. There exists a huge debate over whether or not doing a kipping pull-up is cheating, as compared to a dead-hang pull-up. For the sake of this article, "kipping" will be in reference to a pull-up where the shoulder, hips, and back are used to propel oneself up to the bar, and a "dead-hang" pull-up will be the one with strict form. People will argue that the kipping pull-up is cheating because the lifter appears to be jerking their bodies up to the bar, flailing their hips and back. They will say that one should be able to perform a pull-up using only the lats, and forearm muscles. With this much I agree, and that's about all I agree with. From a strength standpoint, it would be nice if everyone could do a pull-up, with minimal motion, from a static, hanging position. The question is why? My point is this. If my task is to get my chest up to the bar as quickly as possible, I'm going to kip. If my task is to be able to do the most work, and have the most power output generated, I'm going to kip. If I want to train my body to be explosive, I'm going to kip. If I want pretty lats, I'll do a dead hang. Still skeptical? Let me shed more light. Here's the scenario. I line up three otherwise equal lifters beside each other. They each will perform an overhead press, only one will military press, one will push press, and one will push jerk. They start out in similar fashion moving right along. Suddenly, the lifter doing military presses begins to fatigue, and eventually quit. The others are still going strong. Next, the push press lifter begins to fail as well, leaving only the lifter doing the push jerk. Why did this happen? The first lifter failed because he was using only his shoulders to move the bar and nothing else. He was using strength and not POWER to move the weight. He was doing "strict form" and look where it got him. The next lifter was more efficient in using his hips and shoulders but still got tired. It was the last lifter who generated the most power that was able to move the same load, the most reps, in the shortest amount of time, i.e. the definition of power. This lifter used a combination of large muscle groups, with specific technique not to just move the weight, but to accelerate it. The same is true for the pull-up. Using your shoulders, hips, and back to get your body up to, and over an object, is much more efficient and powerful than pulling from a dead hang. Ask anyone whose life or livelihood depends on getting up and over an object and see what they tell you. The beauty of it is that good kippers will have the strength to do a dead hang should the task require that they do so. The bottom line is that in this and any CrossFit gym kipping is encouraged, and is not in any sense of the word cheating. There is a great amount of skill involved in this movement, so like anything else, be patient and ask for help. Once it clicks, you'll wonder why you ever did anything else. Now accepting new patients, and appreciating your referrals! All insurance accepted and filed for you! Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I back to top

Doc's Corner Vol.4, May 2006 LEARNING TO CLEAN Coming off last month's article about the bench press and its application, I thought a good follow up would be on a much more functional exercise; the clean. The clean is actually part of one of the two Olympic lifts, Clean and Jerk, and Snatch. It is a much more complicated lift than it seems, and therefore needs to be broken down into several smaller components before attempting the entire lift. When we break the lift down to a more simple form, we can see it is really a combination of smaller compound movements. There is the first pull, which is similar to a deadlift. The second pull, is a jump with a shrug at the top. The landing position is like breaking down into an athletic stance, and then there's the front squat. Not to be overlooked is the front squat. This is where I would start. Once you start to clean a moderate amount of weight, you will have to drop all the way under the bar in a rock-bottom position. You will not have the luxury of stopping in a quarter-squat, or even at parallel. You will also have to get used to the bar being in front of your center of gravity, and squatting with your shoulders flexed and your elbows up. Initially, your clean will be largely dictated by what you can front squat. Next, the lifter has to understand that the path of the bar is entirely vertical, and is jumped up the body, and not reverse curled. When looking at the lifter from the side, the path of the bar should not deviate at all from front to back, but only up and down. This is where the jump and shrug comes into play. The only elevation that the bar gets is by jumping it up into the air. The completion of the movement is done by pulling yourself under the bar, and rotating your elbows around. In the "rack position" the lifter should receive the bar across the shoulders with the elbows pointing forward. The lifter's arms should be parallel with the floor. Once you understand the above concepts, you can begin to train the full lift, as well as the lift in all of its progressions. Front squat, clean pull, hang power clean, power clean, hang squat clean and so on. Pulling from the floor is technically the most difficult, so you may want to incorporate those variations later. This is an EXTREMELY over-simplified explanation of this lift. Elite weightlifters spend countless years trying to master this skill among other things. Don't get frustrated in learning this and other Olympic-lifting techniques. Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I

Doc's Corner Vol.3 April 21, 2006 Every guy who has ever lifted a weight has either asked or been asked the magic question, "Hey man, what do you bench?" It's as if this one lift makes or breaks your physical being as a man. It is believed that no other movement, upper or lower body has any value if your bench is sub-par. Well, I've got news for you. You're wrong. You see, the bench press is not even a functional exercise. For starters it's from a non-weight bearing position. This eliminates about half the body's musculature from the movement alone. Next, I can think of very few sports where this movement even translates directly. I've had this conversation time and time again with many football coaches who swear on the bench press for their guys. They'll tell me that their linemen have to drive forward, like during the bench press, therefore they need to bench. Well, if the offensive lineman is lying on his back in the middle of the field, then he'll be able to push himself out from under the pile the best, if he has a good bench; otherwise he's in a bad position. The bench press involves driving weight off the chest while your body remains in constant contact with an immovable surface. You don't see this in sport to often. There hasn't been any direct correlation that I've seen with the best max bench making the best overall performance. In fact, after visiting with many Division I football programs, I have observed one consistency; the guy with the best bench usually doesn't even start. In fact, some of the coaches even agreed that the bench press doesn't do anything functional for their athletes, but that the kids just like to bench. If you want to impress me, how about a good power clean, or vertical jump? Better yet, a good time on "Fran" or "Helen." Those are good examples of wide-open, functional power. The bottom line is that in my opinion, unless you are a powerlifter, (where the lift is required for the sport) or training for the NFL combine, the bench is not as effective lift as people once thought it to be. Dr. Jason H. Davidson, DC,CSCS,USAW I, CrossFit I back to top

Doc's Corner Vol.2 April 10, 2006 One of my personal favorite phrases to hear as a Chiropractor is the "It's just muscular" phrase. This is often spoken to me by a patient who is trying to tell me that the injury they sustained has absolutely nothing to do with the spine, but that it is "just muscular." I guess in these special people, their muscles just float freely and un-attached in their bodies, and just perform whatever task they feel like at that moment. You and I both know this to be untrue. I am not saying that purely muscular injuries aren't possible, I'm just saying that most of what I see can be directly related to spinal alignment and are not just muscular at all. I can go on and on about this, but here are some examples to help clarify. When performing a sit-up (lumbar flexion from a supine position) the psoas major and rectus abdominis are the prime movers. They are not the only muscles that help to perform this action however. During roughly the top third of this range of motion, your erector spinae perform an eccentric contraction which helps to control the motion and complete the action in a fluid manner. The erector spinae are actually a group of very deep back muscles that take their origins from the base of your spine and continue up through almost your entire trunk. Now imagine that it has been determined that your spinal curvature in that region is too great, or too little, or that a series of vertebrae have shifted due to physical stress of training, or job related tasks. All of a sudden the anchors for these muscles have become unstable, which cause them to become too tight, too loose, inflamed, torn, etc. You now have a misalignment problem, and a muscular symptom, and most likely, a weak sit-up. The Psoas major and Iliacus (Iliopsoas) are prime movers of the hip and trunk. They take their origin on the lumbar vertebrae and discs before they descend downward to your hip. Squat variations, Olympic lifts, thrusters, KB swings, ball slams and many more rely heavily on this muscle to perform various skills. Again, if lumbar and pelvic positioning is incorrect, the output of this muscle is compromised, and the muscle itself will be under tremendous strain. The cause of the problem is skeletal misalignment. The symptom is muscle strain or fatigue. Do you think spinal alignment can affect your breathing? You better believe it. The diaphragm itself is connected to the first three lumbar vertebrae as well as the transversus abdominis. Next time I row 5000 meters, I'll keep that in mind. The moral of the story is that the body is an amazing machine where more things are inter-connected than you think. Be sure to check with your Chiropractor to make sure there isn't another underlying problem, before you decide that "it's just muscular." Dr. Jason H. Davidson DC, CSCS, USAW I, CrossFit I References: 1. "Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS", Cramer, Gregory D., Darby, Susan A., 1995 Mosby-Yearbook, Inc., Ch. 4 Muscles That Influence the Spine, p. 72-94 back to top

Doc's Corner Vol. 1 April 3, 2006 Pi Ilium: How Pelvic Distortion is Affecting Your Performance There have been many references made in past CrossFit Journals, and in other literature in regards to MHF, or Muted Hip Function. This is a term used to describe a situation of poor pelvic biomechanics such that the legs begin to compensate for the hips inability to perform adequately through its normal ranges of motion. In the Jan. 2003 CFJ, it was even reported that MHF can be responsible for a lack of power, stability, and introduced an increased susceptibility to injury. Can a soldier, athlete, or everyday person afford this mechanical breakdown? The answer is absolutely not. There is a term that I use frequently in my office, which will take this entire scenario one step further; PI Ilium. This term describes a situation where the innominate, or Ilia, (hip), has rotated posteriorly (backwards) and inferiorly (down) due to mechanical and/or other stresses. In doing so, the head of the femur is pulled superiorly (upwards), which elevates one leg higher than the other. This is sometimes referred to as LLI (leg length inequality). Leg length inequality as a result of your hip being rotated backward causes a multitude of events all of which will have an immediate impact on your performance. Increased ground-reaction forces on the side of the long leg will further fixate the SI joint into the incorrect position. This can cause immediate pain and discomfort, as well as sciatica and lumbar scoliosis, if left un-attended. It also puts into play a series of compensatory mechanisms. It has been reported that the leg imbalance causes excessive foot pronation on the short-leg side, which subsequently causes undue strain on the medial collateral ligament, SI joint and hip. This does not sound like the scenario with which I want to enter into "Fight Gone Bad", or "Murph." These workouts are challenging enough with normal pelvic biomechanics. The way this is addressed with our athletes is through a high-velocity, low-force Chiropractic adjustment. The adjustment is designed to return the ilia to its correct anatomical position, thus interrupting the cascade of events listed above. An adjustment is the only way to truly address the underlying cause of this problem, and the best way to return the soldier, athlete, or everyday person back to their full physical potential. Jason Davidson DC, CSCS, USAW I, CrossFit I References: 1. CFJ January 2003 p. 4-6 2. Clinical Chiropractic. A Specific Biomechanical Approach, Gregory Plaugher, p.156-160 back to top