Dr. Tyler Ideus
December 19, 2019
Justin came to the clinic complaining of long-standing low-back pain during and after Crossfit workouts. He was an avid lifter and had been for several years. Justin was confused and frustrated because he had done all the mobility work, was very careful with his technique, took time off and tried different types of therapy ranging from physical therapy to chiropractic to massage. He noted that he loved the workouts and the community and really felt the pros outweighed the pain he was experiencing.
Justin’s issues are very common and not isolated to people doing CrossFit. No matter the level of physical activity, when I assess a patient, several areas must be considered that are unique to each individual.
First: What is this person’s structure? Long torso vs. short torso, long femur vs. short femur, anteverted hip vs. retroverted hips, etc. Based on this structure certain movements will be better or worse than others and programming needs to be done accordingly.
Second: What are the characteristics of this person’s connective tissue? Some people are more prone to hypermobility and loose connective tissue and others are stiffer. Both types of people will feel tight but for very different reasons and require very different treatment.
Third: How do the muscles coordinate to move the body? From an outside perspective “technique” can look perfect but that does not guarantee coordination of muscles is occurring efficiently. This can be considered one’s “muscle memory” or “movement habits.”
Fourth: What is the technique? This is the position the person puts the body in during movement. For example, where are the knees in relation to the feet in a squat? Where is the position of the pitching hand during stride leg contact in baseball?
It is my opinion that very often these different areas aren’t always considered by one provider. If you go to someone that is only looking at the technique but misses the coordination, changes won’t be effective. If you seek advice from someone who doesn’t understand the technique and that is the issue, treatment won’t be effective. If the patient is lucky enough to have the issue caused by the problem the provider addresses then that patient hit the lottery.
In Justin’s case, no one had appropriately addressed two important things — his coordination of muscles that controlled stabilization of his spine even though he was mobile and his technique “looked really good.” Fortunately, he did not have any connective tissue disorders or significant structural issues that needed to be addressed.
After Justin was made aware of exercises that would focus on the coordination of his muscles and given him a plan to appropriately “stair-step” back to heavy lifting he made a full return.
Also important to consider is the fact that the issue was not due to any type of muscle weakness. It is way too common for a person to think, “If I have pain the I must be weak or tight somewhere else.” While this can be the case, it is actually more common to be uncoordinated in a way that relief comes from decreasing muscle activity or “weakening” its contribution in movement.