CrossFit open 2018 and managing injuries…

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The CrossFit open 2018 is almost upon us…

Over 500,000 people will likely participate this year and it will be a test!

Managing acute soft tissue injuries!

I suppose this is as good a time as any to talk about managing acute (and in some cases chronic) soft tissue injuries when is competition and training. As a Physiotherapist that has been involved in sport, who treats athletes of all levels and also worked in A&E for four years, I think that I am well placed to comment. Plus the fact that ‘what should I do if I injure myself?’ is probably one of the most common questions that I get asked! Depending on who you speak to you, you will probably get a number of suggestions.

Most people have heard of PRICE (Protect, Rest, Ice, Compression, Elevation) but have we moved on from this?

Let’s classify soft tissue as muscle, tendon or ligament and acute as an injury less than 48 hours old. This would include muscular back or neck pain, peripheral joint strains (ankle, knee, elbow etc), tendon (muscle-to-bone) issues (achilles, rotator cuff etc) and ligaments (bone-to-bone) such as the collateral ligaments of the knee or fingers.

The basic healing cycle

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Pain relief – Paracetamol V NSAID (Non-steroidal anti-inflammatory drugs)

Concern has been raised over the use of Non-steroidal anti-inflammatory medications (NSAIDs – Ibuprofen, Naproxen, Diclofenac etc) in the early stage of injury management. This is largely due to the theory that the natural healing cycle requires the first inflammatory phase (see image below) to effectively repair injured tissue therefore trying to stop this stage too early may result in a delay overall. Evidence suggests that using NSAIDs too early (the first 24-48 hours) may compromise long-term healing. In addition, when specifically talking about muscular injuries, the early use of NSAIDs may promote increased bleeding and swelling due to decreasing platelet aggregation. This awareness of adverse thrombotic events is to be considered when weighing up risk v benefit. The use of Paracetamol as the first line of pain relief is therefore more universally accepted. It is just as effective an analgesic without the adverse effects. Obviously, you should always seek advice from your Doctor, prescribing therapist or Pharmacist before taking things especially if you have other medical issues.

Protect

Significant ligament and tendon injuries need to be immobilised. We are talking about a high-grade tear – most of the tissue is disrupted. You will know if it is a bad injury if you get immediate swelling (ie. you have fluid aggregating within a few hours), if you have a physical restriction and if you can’t bear weight on the joint. Lesser grade tears will benefit from being immobilised for a short period (48-72 hours) to prevent further damage before being re-assessed.

Rest – when and for how long?

General rule of thumb, if something is very painful and / or swollen, the body is telling you to rest. Allow the swelling and pain to reduce by offloading the structures (use a crutch, tape, support or modified position). If there is significant swelling or restriction on movement certainly 48- 72 hours is a must before you start to load the area by stretching or exercising. Look again at the stages of healing as to why this is important. Tendons take the bulk of the force whilst doing ballistic movements (running, jumping, kipping) and need ample time to recover after intense sessions and on performing new movements. Respect this.

Ice – has this treatment been debunked now?

CrossFit movement guru Kelly Starret has done a nice little discussion on topics including Ice (based around Gary Rienl’s work – links below) and really it is very similar to the discussion around the use of NSAIDs. The advice now is actually not to use ice in the initial stages of an injury however it may be more useful to use it as you start to rehabilitate. As you start to move more, we would consider any residual or further swelling to be a waste product that you want to remove. There is still a real lack of quality studies to date, particularly randomised control studies. There isn’t even a general consensus about how often and for long you ice the area for currently.

https://www.youtube.com/watch?v=0UmJVgEWZu4

http://garyreinl.com/

I would advocate the use of heat for muscular injuries and spasm to allow the muscles to settle and allow you to start moving more quickly.

Compression

There seems to be good evidence that compression can prevent further bleeding, prevents seepage into surrounding tissue and help disperse fluid. Compression increases hydrostatic pressure and increases the effectiveness of the muscle pump, increasing venous return. Early compression is advocated in the first 72 hours, from distal to proximal in direction. Apply the compression a minimum of six inches above and below the main injury site. Do not keep compression on when lying down (sleeping)

Elevation – transient effect?

Elevation lowers capillary hydrostatic pressure (think about the effect of the body as you descend in a pool of water). Capillary flow to the soft tissues is reduced and the buil-up of edema is consequently lowered. Unfortunately, the pressures return almost immediately when the limb is returned to below heart level. Again, there is very little clinical research on elevation. I suggest in the absence of harmful effects, elevate the limb when possible and overnight.

Return to training / modifications

Once you have managed the acute first stage, pain is negligible, and you are moving the area normally it may be safe to start loading the tissue. I would suggest gentle stretching, foam rolling and tissue mobilisation with bodyweight functional movements. For example – if you have a shoulder injury, start trying to regain normal shoulder overhead movement, before trying to do a handstand or overhead press (sounds sensible huh? You’d be amazed at the amount of people that simply head back to training to test it out or just chance it hoping for the best).

If you still have some pain, take you time and train around it. If your ankle is still sore and swollen, don’t do box jump, burpees, heavy squats – choose to modify or do some upper body stuff? The coaches are the best people to talk to this about and help you scale.

When to seek advice / investigation?

If in doubt, ask. Most sports practitioners will be happy to give you five minutes of advice over email or in person. Expect minor muscular strains to improve significantly over three to four days if given the right environment to do so. Expect ligament and tendon strains to improve over three to four weeks. Expect higher grade sprain and tears to take six to eight weeks to start feeling normal again.

If you injure yourself and you cannot weight-bear, are in excruciating pain, can see that something is obviously misplaced or missing and /or if the area is hot or looks infected (you will likely feel unwell and have a temperature) then get yourself to A&E and get checked out.

If you think you have a soft tissue injury and it doesn’t improve as expected after three to four days, book in to see someone to get a proper diagnosis. Worth the money and will get you back lifting quicker and more safely in the long run. Advice on the correct management of injuries is the key to recovery!

Have a great open guys and stay injury free!

Emerson

Pec mobility drills… for everyone!

Shoulder problems?

With many injuries and restrictions I find the the pectoralis minor is often very tight and more importantly weak.

Whether this is the symptom, cause or just a secondary factor, mobilising this region is very useful.

This is a nice routine to work on the #mobility of this often tight and prohibited region.

Try:

– 10 reps arm @ 90 degrees palm up

– 10 reps @ 90 degrees palm down

– 10 reps @ 100, 110, etc Palm down depending on your restriction

– Finally you can lift the shoulder off the ground for 30 seconds to stretch out.

Test length / movement before and retest after. I like this pre and post-lifting, especially for any overhead movements #pullups #snatch #OHP # muscleups #physio #crossfit #rehab #WOD

 

New Canary Wharf clinic – CrossFit Thames!

Thanks!
Emerson

Physiotherapy @ CrossFit Thames

Sunday 13/08/17

 10-12 noon

 Emerson (XPhysio) is a sports Physiotherapist and CrossFitter. He works regularly with weightlifters, gymnasts, athletes and weekend warriors to assist them in staying healthy and reaching their training and competitive goals.

He will be running a FREE injury clinic on Sunday 13th August between 10-12 noon. These are 20 minute appointments for injury assessment and advice. So, if you are having any aches and pains that you are not sure about, new or are simply re-occurring, then pop in for a chat! The session will consist of a movement screen with emphasis on any specific injuries with advice.

I will then be holding regular weekly clinics at CrossFit Thames – WEDNESDAY PM!

You can book in by emailing:

emerson@xphysio.com

 For information about how to book in for Physio, please speak to Coach Phil!

Free injury advice clinic 14/05/16 @ CrossFit Hackney!

Injury clinic – Saturday 14/05/16

Hi all!

I’m running a free ‘niggles’ clinic on Saturday 14th May between 9-11am. They will be approx. 20 minutes injury assessment and advice sessions. So if you are having any aches and pains that you are not sure about, new or simply niggling then pop in for a chat!

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First come, first served so please contact me at emerson@xphysio.com or on 07903 247247 to book in. Open to all CrossFitters!

 

Momentum (CrossFit Hackney) |Arch 328 Stean Street | Hackney | E8 4ED

Thanks, Emerson (Physio)

New East London clinic location – Body Studio EC2A!

Excited to start working with the body Studio this month in the heart of Shoreditch!

I will be there initially Tuesday AM and Thursday PM.

Great space, trainers and knowledge!

Come and check it out: http://bodystudio.co.uk/

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Emerson

Physio / yoga @ Royal Docks CrossFit this Saturday 07th February 2015!

Royal Docks CrossFit is the 10,000th box to open!

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Royal Docks CrossFit is located next door to the Excel center just a 100m walk from Custom House DLR station. The Box occupies a 3500sq ft unit in a Grade II listed ex-tobacco factory. Door to door we are just 10 minutes from Canary Wharf.

In terms of facilities, they offer competition-grade Wolverson equipment and flooring throughout. Plus top quality male and female changing facilities complete with showers, lockers and hair dryers. Members will also have access to our quality on-site treatment room and car parking.

The coaches are aiming to build a community of positive and ambitious people regardless of athletic ability.

See more at: http://www.royaldockscrossfit.com/

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So having chatted to David (owner) and Sarah (head coach) we have decided to put on a physio-yoga morning for all the members!

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Physiotherapy @ Royal Docks CrossFit

Saturday 07/02/15

0900-1030

As Royal Docks CrossFit grows, people are getting stronger, more confident and inevitably pushing themselves harder!

I am running a FREE injury clinic for members on Saturday 07th February, between 0900-1030. These are 20 minute appointments for injury assessment and advice. So if you are having any aches and pains that you are not sure about, new or simply re-occurring, then pop in for a chat!

I am sports Physiotherapist and CrossFitter, working regularly with weightlifters, gymnasts, athletes and weekend warriors to assist them in reaching their training and competitive goals.

You can book in by emailing: emerson@xphysio.com

First come, first served!

XPhysio | XPhysio.com | +44 (0)7903 247247 | Angel | Shoreditch | Dalston | Royal Docks

Plus…

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YOGA @ ROYAL DOCKS CROSSFIT!

Saturday 07/02/15

1100-1200

Do you do enough stretching and mobility work?

Katrina Kurdy will be running a free CrossFit specific power Vinyasa flow Yoga session for members following morning class / Physio! Katrina has taught in the US, UK and Asia, and her students include CrossFItters, MMA fighters, athletes and dancers.

The 60 minute trial class will focus on preventing common CrossFit injuries by increasing flexibility, building core strength, and creating a spatial awareness of movement and the body.  Vinyasa Yoga (like CrossFit) is designed to be accessible and scaled, so even if you have yoga experience or want to improve your gymnastic ability, you will be able to push yourself in this class.

This session will be an introduction to Vinyasa Yoga and aim to teach you the basic postures. Vinyasa means ‘breath to movement’ and is a ‘flowing’ exercise that will provide a good cardiovascular workout in addition to improving balance, strength and flexibility.  You will notice the similarities between some of the CrossFit warm-ups (gymnastic movements, stretches, and core exercises) and Vinyasa Yoga. In addition you will also learn about meditation and mind-body awareness to expand the benefits of yoga beyond the physical. We will also practice some inversions to improve your hand stands and balance!

Regular yoga practice will improve your skill set, confidence, strength and flexibility! It’s no surprise that many of the most respected athletes / boxes in the UK / USA now include Yoga in their training schedules!

For more information visit katrinakurdy.com or email: info@katrinakurdy.com

For information about how to book in for either Physio or yoga please speak to coaches David or Sarah!

Don’t miss out on our FREE marathon preparation evening!

Complimentary Marathon Preparation Evening with Complete Physio!
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Following the success of the last three years, Complete Physio is hosting its fourth annual Complimentary Marathon Preparation Evening to prepare both your body and mind for the grueling 26.2 miles.

Join Sports Physio, Chris Myers and the Complete Physio Team for an evening of marathon preparation. The evening will be packed with insight, experience and education which will aid novice runners through to regular marathon competitors.

The topics being discussed are:

  • Injury prevention with physiotherapist Chris Myers
  • Marathon training plans with personal trainer Ben Leach
  • Optimum nutrition with sports dietitian Rick Miller
  • How to train your brain for success and how to use mental rehearsals to improve performance with hypnotherapist Phil Dobson

The event is totally free and will be held on Wednesday 28th January 2015 at 6:30 p.m. on the 30th Floor of the CityPoint building.

Please click the EventBrite link to find more information and to RSVP, and we look forward to seeing you on the 28th!

http://www.eventbrite.com/e/complimentary-marathon-preparation-evening-tickets-15274201548?ref=ebtn
Best of luck with your marathon training!

Emerson

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