HOW TO TRAIN WHEN YOU HAVE AN UPPER BACK INJURY FOR THE CROSSFIT, F45 AND HIIT ATHLETE

If you are a cross fitter, f45…er, boxer or just love that type of high intensity training and you have an injury then this post is for you.

At align we know that getting back to exercise is likely your number 1 priority!

Please watch our video or read the transcript below the video to get our tips on getting you back on track as soon as possible and learn how to maintain your gains despite injury.

As we said in our last posts on back pain and neck pain, taking time out of training is boring and can seriously impact on the gains that you have made.

When you have put the time and effort into your training to a level where you are really enjoying your high intensity exercise, taking time out for recovery can be tedious but can also hold you up on your way to achieving your goals.

The reality is, the better you allow your body to heal, the quicker you can be back to 100% and the less likely you are to have recurring injury, and the rehab is going to take some effort on your part, so what CAN you do to get back into it at full speed?

The first thing to work on is recognising that just like gains you have made, THERE ARE NO SHORT CUTS in healing your injury.

It is important to know what you CAN do to stay moving and enjoy your HIIT training without setting yourself back.

In the video below, Martin outlines some of our possible recommendations for managing upper back injury while still keeping up your training.

As always, if you have any concerns, upper back issues, be they old or new, or just want to get the most out of your training, we are here for you so don’t hesitate to get in touch!

Hi, I'm Martin here from Align Chiropractic and today's video what I’m going to talk about is a really common thing that we see in our practice which is: people who love doing high-intensity exercise. 

We're talking people who do CrossFit, people who do f45, and all the other versions of HIIT like boxing those type of things where the whole idea of it, is that it's something that people love doing and they want to do it regularly and obviously, it's something that you're doing at a high level of intensity so does create some pretty specific demands on your body.

Sometimes people have an injury and then they've got this sort of challenge where, they want to keep training, they don’t want to lose the gains in fitness that they've created but they’re also managing an injury and our experience is that there's a lot of things you can do where you can keep getting a lot of that metabolic effect, you can keep losing weight, can keep your cardiovascular fitness and you can keep a lot of your muscle mass by keeping training while you're having the injury addressed through chiropractic care. 

So one of the areas that we commonly see are people who have an injury in the upper back, so it might be that the vertebrae are jammed up there, which is a really common thing we see, can be a problem with the way rib is joined onto the vertebrae, can be a problem with the muscles in the area, there's a bunch of different things, a bunch of different types of injuries that you could have there but the common thing is that it makes a lot of high intensity movements uncomfortable and can actually be exacerbating the injury by doing certain movements. 

So there are things that we suggest you don't do to manage these injuries. Firstly you’re not doing things where it's really high highly dynamic, so burpees can be really uncomfortable, box jumps can be really uncomfortable, anything with jarring can be uncomfortable as well as things where you’re demanding a lot of range of motion from your upper back that you don't necessarily have. 

Within a CrossFit context, kipping pull-ups, within F45, battle ropes and those sort of things where there's a lot of movements for in that area that isn't moving properly it can create a demand that your body's not able to correct. 

The sequence that we look at is that early on if you've got an injury and we're actively trying to get things back on track we’re going to get a shift focus to doing a lot of the lower body exercise because you can work your lower body without having that impact on your upper body. 

For most people, air squats are completely comfortable and lunges are really good and that’s because of that single leg aspect to it it's a really good opportunity to develop that sort of balance and stability in your lower body when you're taking the load off your upper body. 

As far as not losing all your upper body strength, often what most people notice is while overhead stuff, pushing overhead and pulling overhead can be really uncomfortable, often reducing the load and going horizontally so we’re talking things like really slow controlled push-ups or a dumbbell press chest press or even a barbell chest press can be okay as long as you’re super conscious of your posture. 

We’re making sure that a head is staying over our shoulder because often the reason that people end up with these mid-back injuries is that it's not from the exercise it's from too long spending time at the computer in this crappy posture. 

Therefore, if you're wanting to maintain some upper body stuff we're going to do some horizontal pushing and we might do some horizontal pulling as well. 

In doing those actions, we’re going to work on pulling our shoulder blades back by doing actions like a ring row, where you’re lying down when you're pulling back towards yourself or you doing them with a machine, some sort of rowing exercise. So rowing is good and also push-ups can be good.  

The next level up from there let's say we've got some improvement but things aren’t 100% in terms of function and we're not out of the woods yet but once we've got some improvement and movement in that area, and we're starting to change in overall posture, we can start reintroducing some things. 

So what we might do in the early phase, while we've taken out jarring activities like box jumps out, we might get back into doing a step up or we might go back to doing some pull-ups.

Pull ups are where we are going overhead and doing a pulling movement, but rather than doing a more dynamic movement, like kipping pull-ups, we will make it a little less dynamic and only do strict pull-ups - even if that means that we are applying a band.

Another option that we could look at is some overhead pressing movement with a dumbbell but we're not going to have the dynamic ones where we're using momentum and that faster cadence that we might normally use in high intensity training. So we are just going to slow things down focus on very slow movements that are a little bit easier to stabilise through that area. 

The bottom line with this video is that - yes you love your training and yes it's inconvenient to have an injury but for most people they can maintain the momentum, they can maintain their gain, if they just tweak a little bit what they do, shift focus to the lower body, shift focus to slow controlled movements, cut out the overhead work initially and keep going when you training when you’re managing an injury. 

I hope you found the video interesting leave a comment if you've found it valuable, and we hope to catch you soon.

How to train when you have a low back injury for the Crossfit, F45 and HIIT athlete.

For all you CrossFitters, F45 junkies and HIIT people, we hear you: injuries are boring and no matter what, you need to be back training like…yesterday.

Taking time out of training is boring normally, but when you have become used to (read as “addicted to”) getting the most out of your body, training with intensity and seeing the huge improvements in your health and performance that style of training brings, injuries take on an altogether more frustrating element.

The reality is, the better you allow your body to heal, the quicker you can be back to 100% and the less likely you are to have recurring injury, and the rehab is going to take some effort on your part…but surely as a HIIT training person, you aren’t afraid of a little hard work are you?

The first thing to work on is recognising that just like gains in training, THERE ARE NO SHORT CUTS.

Sadly we cannot immediately heal injuries without letting your tissues repair themselves, but you CAN work smarter to reinforce healing, strengthen what you can strengthen, and make sure that you’re healing things properly to minimise risk of recurrence.

In the video below, Martin outlines some of our possible recommendations for managing back pain while still keeping up your training.

For those of you who miss the old school romance of reading, the video is transcribed below!

As always, if you have any concerns, low back issues (old or new) or just want to get the most out of your training, we are here for you so don’t hesitate to get in touch!

Hi, Martin here from Align Chiropractic and in today's video what I wanted to talk about is a question that we really commonly get asked in our practice from people who are involved in high intensity training. 

So commonly people who do CrossFit, people who do f45, people who are at the gym they're doing resistance training but they're ramping up the number of repetitions, a lot of research shows that it's a great way of getting fit, and it's something that people really love and enjoy doing. 

So what we're really about in terms of taking care of people who into those types of training, is giving them what they really value, which is that they want to keep training, even if they happen to get an injury. 

A really common situation that we have with these people is they’ve come to see us because they’ve got a lower back injury, they're getting some low back pain and they want to know;

“what can I keep doing because I don't want to stop everything, and in particular, what can I do that is lower body oriented?"

“Obviously there's lots of things that I can do in my upper body but I still don't want to lose everything that I gained in terms of strength and conditioning through my legs hips etc” 

The clinical process that we work on with people is we use the acronym ‘M.A.B.S’ in terms of what we prioritise. 

That is, we want to make sure we get proper Movement back into joints before we are concerned about Alignment, as you can’t really change alignment until you have proper movement. 

Again before we deal with Balance, we need to have proper

movement and alignment and before we can even really think about Stability, we need to address those other issues. 

So while a lot of people want to talk about stability as something that they want to have, the key to effectively building stability is actually to prioritise movement first. 

Same thing in terms of exercising your lower body. 

When you've got a lower back that's painful that's not working well and the joints aren't moving the way they should, we want to reduce particular movements.

The number one moment that we get people to reduce when they having issues and they do any form of training is lower back flexion. 

Flexion is when you are tipping forward, like would happen if you are doing a deadlift, you were doing a kettlebell swing, you were doing any sort of squat variation, they involve some form of low back flexion, so we want to reduce that or take that out altogether. 

So, when you’re talking to your trainer, the type of exercises that we suggest that you DO do, that you CAN include for most people who are having low back issues are lunge variations. 

Your trainer will have a bunch of different ones; front lunges, rear lunges, weighted lunges, front rack lunges, there's endless variations there.

Also, step ups, where you're stepping up onto a plyometric box, so they're the

two that allow you to have a really good workout, both get your heart rate up as well as improve your strength, but in a way that keeps your lower back nice and neutral and not introduce that low back flexion. 

So, then when people get further down the process of recovery from an injury, that's where we start to reintroduce some flexion movements, but again we're going to prioritise movement before we start adding load. 

We’re going to start people back doing something like an air squat, before they’re going to start doing a heavy back squat.

And certainly, probably the last exercise that we tend to add back in for people who have lower back issues are deadlifts, when you're picking things up off the ground, because that's the movement we have the most low back flexion.  

I hope this tip has been useful, if you're having troubles with your back but you want to keep training, make sure to give us a call and we'll be able to help you hit your goals both in training as well as get back on track doing the things that you love to do.

Ice Ice Maybe?

Before I get into this, I need to clear up two things.

1. When I use the term 'Ice' or say, 'use ice' I am of course ONLY referring to frozen water. Whatever you do, DO NOT take those terms out of context.

2. let's just get it out of the way:

An obvious yet somehow necessary gag to put at the top of a discussion on anti-inflammatory protocol

There, now that this blog has a soundtrack, we can get started. 

Should I use ice or heat?

As Chiropractors, we get asked this a lot. There appears to be a lot of confusion out there about what you should use, when and why, and that confusion is not just limited to the general public! 

There is a lot of debate and conflicting info about ice vs. heat amongst different health care professions and even between practitioners within the SAME profession, so it is little wonder that when people are injured, they aren't sure what to try. 

In this post I will attempt to explain a bit of the ins and outs of the issue, as well as some of the  the common sticking points in the discussion and ultimately, try to give a summary of the basic approach you could try, based on the best and most current research I am able to get my hands on. 

So, if you are the type of person who just wants to get a few tips WITHOUT having to go through the rest of it (and to be honest, I don't blame you if you do), then please feel free to skip down to the bottom of this post where I will summarise the main info in bullet point form. 

However, if you're like me and you're kind of into the back ground of things, then please read on. 

So why would I use ice or heat anyway?

Full disclosure...this will not be an exhaustive explanation of how inflammation works because that would be WAY too much info to put in this blog and to be honest I really couldn't do the topic justice with my explanation anyway (however, if you would really like to geek out and marvel at just how incredible the human body is, and get a much more complete picture of what is happening at a cellular level in detail, I suggest you check out a video called "Basic Inflammatory Response". Be warned though, videos like this are only the start of a fascinating rabbit warren so be sure to have a clear afternoon for all the other info you'll want to follow it up with).

To EXTREMELY oversimplify the situation: 

1. You injure yourself
2. Your body detects the injury
3. Chemical signals are released to signal to your body to begin healing and cleaning the injury up.
4. The chemicals also cause more healing factors in your blood to come to the area/slow down in the blood stream at the site of injury and help to clean up/heal
5. The resulting 'inflammatory Soup' causes redness, swelling and alterations of movement at the affected site as well as activation of nerves that carry information about the damage to your brain where it is registered as being painful.

As stated above, this is a very simplified version of events that skips many steps in the process but I feel gives you an idea of the situation. 

The most important take home message though? The body is very smart and so it does all this to HELP you, so we want to allow healing to occur as much as possible without hindering the healing process too much.

The reason then that we employ heat or ice is to limit the levels of swelling and discomfort you have to experience, while allowing all these steps to occur and let you live your life while your body gets on with the task at hand. The cooling or heating of tissues is used to constrict or dilate blood vessels in order to modulate the inflammation to inhibit or help the healing factors to arrive at and move on from the site of injury.

Heat and ice have the added bonus of having relatively few side effects compared to their pharmaceutical counterparts, something I find clients are generally very keen to avoid having to take where possible.

Kieran, you haven't answered the question yet, do I use heat or ice? 

That depends on the injury. 

Generally speaking, we use ice for acute injuries (i.e. injury that has only occurred in roughly the last 48 hours) and heat for more chronic injuries (i.e injuries arising more than 2 weeks ago). 

In yet another simplification, we use different modalities because in the early stages of injury, the inflammatory soup is different to one that has been around for a longer period of time. In the gap between 2 days and 2 weeks, you can use ice or heat, or ice AND heat. 

You can however have a chronic injury that you exacerbate, in which case you might need to act like its a new injury and switch back from heat to using ice on it again. 

By now I am sure you can see why so many people can become confused as to what they should do. Don't worry, Ill still give that summary below. 

Does it matter where the injury is? 

No, that shouldn't be a factor.

In the past, some health professions have prescribed ice for acute inflammation for everywhere on the body EXCEPT the spine. For some reason they appeared to have forgotten that the spine is made up of joints, ligaments, tensions, muscles, blood vessels that have the same characteristics as other areas of the body. 

So, in cases of acute injury and pain in the neck and/or back, you should still use ice like you would on a knee. 

Some important points to remember...

As I have said, this is not an exhaustive discussion of this topic, and there is still a lot of argument among researches and practitioners as to the best practice for ice or heat (just type ice vs heat into Google and you'll get a sense of what I am talking about) I am just attempting to summarise what I have discovered from the best sources of research information I can find, as well as my experience with clients with acute and chronic injury in practice. 

Other important points to remember are:

• It appears that crushed ice in a bag is more effective than traditional cooling packs
• Do not return to activity immediately after using ice
• Don't use ice for more than 20 minutes of constant contact/ 
• If you have any questions or concerns about your injury, contact your health practitioner immediately.
• If either of the approaches make you feel worse, stop using them immediately and contact us to discuss your options. 

In Summary:

• Ice for acute injury (roughly under 48 hours old).
• Use ice for 10 minutes on, 10 minutes off, repeat as often as you like.
• Heat for more chronic issues (especially for injuries over 2 weeks old)
• You can alternate heat and ice for 10 minutes of one, 10 minutes of the other 
• There is no hard and fast rule, these are tools designed to make you more comfortable so let your body be your guide. 
• I would still recommend avoiding heat for acute inflammation.
• Do not just put up with pain or even just hope for the best with an injury, the earlier you act the better your prognosis. 
• Call us at Align to have a chat about your injury and discuss how to get back on track. 

If you're the type of person who would like to know where the information I have talked about here came from, please feel free to contact me at the practice at any stage and I will send you through the details of the research articles I have used, 

I will be keeping my eye out for newer, more definitive research and promise to update this post if anything new comes to light.

If you have any other questions or concerns, please do not hesitate to get in contact. 

Kieran

Ankle Sprains...are you doing it wrong?

I don't know if its the time of year or if I have just been noticing it more, but it feels like there has been a lot of ankle injury limping into the practice in the last few weeks.  

Ankle sprains and strains are common, they are not just for sports people and most importantly, are usually really poorly managed when they happen. 

Sure, getting people out of pain doesn't usually take too long but there is a lot more to it than that. 

As a lot of you already know, at Align a big part of our practice is looking after families. There are a few things you notice when you have families with school aged kids coming in and one of the more common injuries we will see is ankle sprain or strain.

So what do I mean by poorly managed? The problem is, getting on top of these very common injuries is at the same time, very important but very BORING to deal with. 

If you are lucky enough to have avoided issues with your ankles, I am willing to bet we all know SOMEONE we went to school with who rolled their ankle early on in high school, and by year 12, nearly overtime they took to the field, court or even walked next to you down the street, they would put their foot down at one point and over they would go!

In practice, we often here this described as their "bad ankle".

Structurally there is usually nothing "bad" about their ankle, so why do they have such a problem? 

A "Bad Ankle"

In my experience, up until recently, treatment for most ankle injury would consist of people would ice on their ankle till the swelling went down and they could walk on it without pain, then they would hope for the best until inevitably, the next episode of the "bad ankle" would happen, increasing in frequency, leaving them with no confidence in their own body and an inability to enjoy playing sports or exercise how they should be able to. Sound familiar?

The reality is, when you really sprain your ankle, what you are actually doing is causing damage of specific ligaments around your foot and ankle. The pain from these injuries is just one part of the issue. The other, equally important part is the movement issues that a sprain will introduce into our ankle's support systems. 

I touched on these movement issues in my last blog about posture but in a nutshell, when we injure tissues it can cause movement control issues in the affected joint, making it harder for our nervous system to be certain of how to position and manage that joint in the future. 

This is why it's so important that any management of these injuries includes longer term rehab thinking, as well as care for the immediate area and work on the connected support structures. 

In my next blog, I plan to outline some important points you want to be thinking about if you have an acute ankle sprain, as well as what you can do if you already ARE someone with a "bad ankle"