Friday, August 31, 2018

TMJ Home Exercise Program

Normal range of mandibular motion is between 40-50 mm.  To achieve the initial 25mm of opening, rotation occurs between the mandibular condyle and the disk.  The last 15-25 mm is the result of anterior translation between the disk and the temporal bone.

TMJ is characterized by hypermobility of the joint as a result of early or excessive anterior translation.  This excessive movement results in laxity of the surounding capsule and ligaments.  This may also contribute to disc degeneration.

Signs of TMJ Hypermobility Include:
  • Clicking, popping, or cracking with mandibular depression or elevation
  • closed or open locking
  • pain
  • lateral deviation of the mandible during depression or elevation
  • tinnitus or ear stuffed sensation

Treatment includes physical therapy, splint therapy, and stress management

Restoration of normal resting position of the head, neck, jaw, and shoulder girdle is accomplished through the initial exercise:  RTTPB which is an acronym for:
  1. Relaxation - allow tension in your body to be released
  2. Teeth apart-  say the word "Emma".  Let your jaw and mouth drop open slightly and remain in this position
  3. Tongue on palate- hold your tongue in the "clucking" position
  4. Posture
  5. Breathing - use diaphragmatic breathing.

Wednesday, August 29, 2018

WOD Wednesday #85

Complete as many rounds as possible in 12 minutes of:35-lb. dumbbell thrusters, 9 reps
15-foot rope climb, 1 ascent


The couplet starts with 9 Thrusters using a 35lb. Dumbell (DB) in each hand. A thruster is a front squat, both DB held on the shoulder, with a push press at the top (stand up and thrust the DB’s overhead). The bottom of the squat is the same as all of our other squats, crease of the hip below the knee. At the top of the Thruster your elbows should be locked out with some part of your ear visible in front of your elbow as you stand straight up.

Scaling this is straight forward: use a lighter DB! Duh, right? What if you don’t have any DB’s chez you? The sub is to use a barbell. Experienced CrossFitters should use 95lb, with beginners using 75 or 65 or less. By the way, an accepted women’s weight would be 25lb. DB’s and 65lb. barbells.

After doing 9 Thrusters grab a rope and climb 15 feet. Up. Our CrossFit ropes don’t have knots so there’s a bit of technique involved Briefly, the trick is to use your foot to trap the rope on top of your other foot with your legs bent, then stand up. Using your legs is much more efficient than just pulling with your arms.

The sub for a rope climb is towel pull-ups, doing a PU with a towel draped over the PU bar, with one Towel PU for each foot of rope.  Some folks opt to do 1 PU for each 3 ft. of rope. That’s a pretty good measure: 5 Jumping Towel PU per round. If you have a rope and want to do a scaled climb you can grab the rope as high as you can reach and just pull yourself up 5X per round.

Monday, August 27, 2018

Pulmonary - Chest Physical Therapy

Goals for Chest Physical Therapy include:

  • Improve overall function
  • improve ventilation throughout all lobes
  • improve breathing patterns
  • mobilize secretions
  • expel secretions
  1. Percussion:
    1. A technique using cupped hands that strike over a particular lung segment in alternating fashion during inspiration and expiration in order to mobilize secretions.  This rhythmic sequence should last for several minutes and not be painful
  2. Vibration:
    1. A technique using both hands (one on top of another) directly over the chest wall to provide pressure and manual vibration during exhalation.  Vibration should be used in conjunction with percussion and only during expiration.  Pressure should be applied in the same direction as chest wall movement during expiration.
  1. Trendelenburg Position:
    1. This position places the person in a "head down" position in supine with the bottom of the bed inclined to approximately 45*.  This position is ideal to assist with secretion drainage from the lower lobes of the lungs.  It can also assist with increasing blood pressure in the case of hypotension.  Patients with congestive heart failure, pulmonary edema, hypertension, shortness of breath or other circulatory problems will not tolerate this position
  2. Reverse Trendelenburg Position:
    1. The reverse Trendelenburg places a person in supine with their head raised above their trunk and lower extremities.  This position may be used with patients diagnosed with hypertension or other cardiac conditions.  This position also decreases the weight of the abdominal contents on the diaphragm providing it with less resistance to movement during breathing.
  3. Semi-Fowlers Position
    1.  This position places a patient in supine with the head of the bed elevated to 45* and pillows under the patient's knees for support and maintenance of a proper lumbar curve.  This position is used quite often for patients with CHF or other cardiac pathologies.
Examples of Chest Physical Therapy for Bronchial Drainage:
  1. Anterior Segment Left and Right Lobes
    1. In SUPINE, lie flat on back with pillow under knees for comfort, clap on both sides just below the clavicles and above the nipple line.
  2.  Left Posterior Segment
    1. In SIDE lying, lie on right side with head and shoulders elevated on pillows.  Make 1/4th turn forward and clap over the left scapula.
  3. Right Middle Lobe
    1. In SIDE lying, elevate bottom of bed 14-16 inches.  Lie on left side.  Place pillow behind from the shoulders to the hips and slight back onto it; clap over selected lobe.
  4. Posterior Basal Segment of Left and Right Lobes
    1. In PRONE, elevate bottom of bed 18-20 inches.  Lie on stomach and place pillow under the hips, clap at the lower ribs on both sides.
Image result for Posterior Basal Segment of Left and Right Lobes bronchial drainage

Friday, August 24, 2018

Voodoo Compression Floss Bands Part 2

When to Use a Floss Band:
  • The Floss can be used really at anytime, warm up, cool down, and in between workouts. 
  • I usually floss before a workout utilizing exercise specific movements, depending on the workout, I get more out of it than a lacrosse ball or foam roller. Second, I’ll use after a lift, it really seems to keep soreness down and help initiate and speed up recovery. 
  • Finally, I use the day(s) after a tough workout. When I’m really sore, and laying down on a foam roller sounds miserable, I’ll use the floss.

How to Use a Floss Band:
  • Wrap anchor strip around the joint or soft tissue area. 
  • From there, use roughly 50% tension or pull and overlap the bands. 
  • Tuck the end of the band under. 
  • Move in OPEN chain, all ranges of motion. 
  • Move in CLOSED chain, loaded and exercise specific ranges of motion. 

Fast Results and Versatility: If you have varying levels of inflammation, especially in your joints (elbows, knees, and shoulders), you’ll be amazed at how much relief the bands can provide in just a few minutes. After using the bands, you can have dramatic “test and retest” before and after results that get you back to training or finally rehabing from a nagging minor injury. Also, a flossing session only takes a few active minutes, so it’s very minimal commitment for fast results.

These flexible bands have no problems wrapping around most joints on your arms and legs. If you’re experiencing discomfort in your knees, shoulders, elbows, ankles, or even wrists, it’s easy to work on these joints using the floss. The bands won’t replace your foam roller for your back and between your shoulders, but they’re very effective on releasing crepitus and impingement in your arms and legs.

To work shoulders, wrists, ankles, elbows and the little pieces within, wrap a band tightly around the joint (sometimes it might take two bands to cover the area) and put it through ROM like push-ups, PVC pass-throughs, squatting, lunging, etc. For knees, wrap one band above and one band below the joint, then do some squats. When you put the joint through ROM with bands anchored on either side, they stretch everything in between, which can greatly improve not only joint ROM but also pain, stiffness and tendonitis.

Wrap the compression band starting midfoot working up over the ankle, then move the ankle thru its full range. This can be done actively by pointing your toes and then bring the back up as far as you can. I like to perform my ankle mobility lunging with the compression bands on.

Wrap the compression band around the knee, start just below the patella (kneecap) and wrap firmly working way up to just above the patella. Then squat 20-30 times.

Wrap the compression band around the upper thigh as high as possible. You can squat or sit on a box straightening and bending your knee.

Wrap from just below the elbow up to above the arm. Move the elbow through full range using your other hand or even better get someone else to bent and straighten your arm. Bend and straighten for a couple of minutes or until you feel like you need to rip the band off as your hand is going numb!!! You might have had it wrapped a little too tight.

Place the other person’s straight arm on your shoulder. Wrap using 50% tension clockwise on the person’s right arm and counterclockwise on his left arm around the deltoid muscles (or shoulders). Start from the top of the shoulder down to mid arm. When you’re done wrapping, tuck the end under the band. Lay the person on his/her back. Place the ball of your foot on the person’s shoulder that has been wrapped. Have the person on the floor internally rotate his/her arm. Apply pressure with your foot as the person rotates his/her arm

Normally, you take the band off after two minutes. But if you experience any of the three:
  • A rise in blood pressure and/or claustrophobic 
  • Pale looking limb 
  • You start feeling tingling 
  • Take the band off immediately. The purpose of compressing is to mobilize not de-mobilize. And that’s what will happen if you keep the band on for too long. 
  • If you’re flossing for the first time, you might want to go lighter on the tension than you think until you get used to it. 
Floss compression bands can deliver near-magical results for specific mobility issues by allowing you to work through your full range of motion while compressing a targeted area. For minor strains and general maintenance for overuse, you’ll find that a few minutes of flossing can put you well on the path to a more mobile version of you. The bands are most effective with the help of a friend, but the fantastic grip that floss compression band products have quickly become known for make it effective to use on your own.

Wednesday, August 22, 2018

WOD Wednesday #84

10 rounds, each for time:
5-10-15-yard shuttle sprint

Each sprint is 5 yards out and back, then 10 yards out and back, then 15 yards out and back (60 yards total).

Rest as needed between sprints.

ScalingEach sprint is short and should be done at max effort. All skill levels can complete this workout as prescribed. Newer athletes might want to reduce the number of intervals.

Beginner Option7 rounds, each for time:
5-10-15-yard shuttle sprint

Tuesday, August 21, 2018

What is Trigger Point Dry Needling?

Trigger Point Dry Needling (TDN) is a physical therapy treatment technique that utilizes thin filament needles to make changes in myofascial trigger points.  Myofascial trigger points can contribute to pain and decreased muscles function.  TDN is an effective tool in the hands of a physical therapist who manages soft tissue injuries, disorders, or pain.  TDN utilizes very fine acupuncture needs to "shut down" painful areas in muscles.  This causes the muscles to briefly contract and then produce immediate and long lasting relaxation.  TDN is particularly effective when used as part of manual physical therapy treatment approach.

What TDN Can Do -
  • TDN is used only to augment evidence based therapy and does not replace it.  Often, TDN allows patients to more effectively perform their therapy exercises.
  • Resolve chronic issues, particularly in individuals who are dealing with chronic pain
  • Allows patients to perform daily tasks, attend work, and participate in normal activities without pain.
  • Initial responses are often seen immediately.
What to Expect-
During treatment patients may feel a cramping sensation, but then feel immediate improvement of their symptoms.

TDN can significantly decrease or completely reduce spontaneous electrical activity causing muscle dysfunction TDN has been shown to improve range of motion, decrease pain, and improve muscle function.

Common Conditions that Respond Well to TDN-

Upper Extremity Conditions:
  • Thoracic Outlet Syndrome
  • Carpal Tunnel Syndrome
  • Tennis Elbow
  • Golfers Elbow
  • Rotator Cuff Injuries
Lower Extremity Conditions:
  • Patellar Femoral Syndrome
  • Patellar Tendonitis
  • Hamstring Strain
  • Groin Strain
  • Shin Splints
  • Compartment Syndrome
  • Achilles Tendonitis

Monday, August 20, 2018

Voodoo Compression Floss Bands Part 1

The floss compression band is an essential performance tool and should be a staple in the gym bag of every athlete looking to improve range, restore joint mechanics, or unstick matted down or previously injured tissue. Compression tack and flossing (compression "flossing") works on many levels; including re-perfusing tissues that have become stiff or gone cold after injury, and by compressing swelling out of tissues and joints.

It is simply a neuro-physiological response. Beyond occlusion-- what is happening is a forced gliding of the myofascial structures. With conventional soft tissue mobilization and manual therapies tissue displacement compromises effectiveness; with tack and flossing the compression forces tissue adhesions to forcefully slide against each other with minimal tissue displacement. This forced glide not only resolves myofascial dysfunction due to aberrant tissue formation, but also indirectly (or very directly depending of the therapist's intent) acts as an effective neurodynamic tensioner technique. The increase of ROM is not only driven by inhibition of tonus, but also by increased neural drive.

Because the floss band can be used while actually performing the movement the athlete is trying to change, its effect on sliding surface and restoration and tissue mobilization is unmatched. Floss Bands help make positive subjective changes to our joints and soft tissues through compression, tension and movement.

Used for treating tendinitis: This doesn't cure inflammation based injuries like tendinitis, or prevent all forms of it from ever bothering you again. However, it does provide some relief and allow you to continue training. Any time you are suffering from inflammation based problems like tendinitis or bursitis there is something you are doing that is causing the problem. Until you deal with that, you will be forced to repeat the triage over and over.

Essentially, what's happening is that the constriction prevents further inflammation of joints and connective tissue, as well as constricting blood flow for a bit. Once the compression band is removed, the blood flows back in to the area. For joints with large amounts of connective tissue, such as elbows and knees, this allows the blood to flush away some of the excess white blood cells that are further making the inflamed area worse.

Please Note: If you actually tore a ligament, sprained a joint, etc., you need to see a doctor. Usually rehab involves staying off the injured limb during the healing process, and re-initializing work with low weight high reps to strengthen the connective tissue and get blood flowing through the joint until it is completely healthy again.

Used for Mobility:
The floss band isn't going to make you stronger, however it does change the way the muscles orient themselves when you are doing various different movements. What that means is you can intensify the movement using the compression band. Again, when you take the floss off, you have that rush of blood into the mobilized area. The best bet is the rush of blood helps recovery. For a limited time your muscles may be a little larger similar to a bodybuilder pump, but that effect is strictly due to the extra blood post mobility work.

· The bands are made of latex rubber, do not use if allergic.
· Avoid using on head, neck, chest, belly, or back.
· The band is compressing, if you feel like your blood is being occluded too much, your limbs are turning purple or faint, or your have numbness/tingling… please stop using immediately.
· Can leave marks: The positive mobility effects of flossing outweigh any compression and discomfort that you may experience with this level of compression, but it’s worth noting that the bands can leave the occasional line or mark on your skin, depending on how your wrap your joints. They’ll go away, but you could be left with a few temporary battle scars.

Wednesday, August 15, 2018

WOD Wednesday #83

5 rounds for time of:
Run 800 meters
75-lb. overhead squats, 25 reps
75-lb. sumo deadlift high pulls, 25 reps

5 rounds for time (task-specific WOD) of the triplet Run 800M, 25 Overhead Squats (OHS) with 75lb., and 25 Sumo Deadlift High Pulls (SDHP), also with 75lb on the bar.

25 OHS with 75lbs. This is 75 total pounds including the weight of the bar, 55 for women. A men’s Olympic bar weighs 45lbs. so put 2 10lb. plates on each side of the bar for an Rx’d weight. Women’s bars weigh 35lbs. so a single 10lb. plate on each side gets you Rx. Take the bar off the rack in a back squat position, spread your hands out well beyond shoulder width and press or jerk the bar above your head. Alternatively, since this is a relatively light weight feel free to just snatch it (ground to overhead with a wide grip in one movement) in order to get into position. From here you just squat, just like every other squat we’ve done this month. Load the posterior chain (send your butt back), squat down keeping your knees from tracking inside your feet until the crease of your hip is below your knees. Stand straight up. Do it 24 more times.

The Sumo Deadlift High Pull is a movement that invites scorn outside of the CrossFit community, but it is actually a rather elegant exercise that illustrates a very basic element of functional movements: a pattern of core to extremity as you move through the parts of the exercise. Spread your legs apart wider than shoulder width, the sumo stance. Bend your knees, bend at the waist while maintaining the lordotic (lower back) curve and grasp a loaded barbell (or KB). Straighten your legs, rapidly open your hips, and raise the bar by bringing your hands to your chin with your elbows higher than your hands. To return the load to the ground simply reverse the movement: hands lowered, hips close slightly and legs bend. It’s like a row: legs->back->arms->arms->back->legs. 25 per round.

Monday, August 13, 2018

Cast Iron vs. Competition Kettlebells

Now that kettlebells have grown in popularity and become a fitness industry buzzword, there are dozens of different types being sold on the internet – which can be daunting for a first-time kettlebell purchaser! But have no fear: this article will shed light on the differences between different types of kettlebells and help you determine which type is right for you. Two of the most common options on the market are cast iron kettlebells and competition kettlebells. Each has a unique set of characteristics ideal for different types of training. Both are incredible tools that will last a lifetime if purchased from a reputable manufacturer

First and foremost, avoid plastic or vinyl kettlebells as well as kettlebells that are cast as two pieces of material. Both competition and cast iron kettlebells are constructed from one piece of steel. This single cast means movements are more stable and you can more reliably swing, clean, and flip your kettlebell without worrying about the base and handle separating. Competition kettlebells are composed of steel, as opposed to cast iron, meaning they are slightly more durable than cast iron kettlebells. However, cast iron kettlebells have more coating options that are not usually available for competition kettlebells. These options include powder coating or cerakote coating, which can increase the durability of your cast iron kettlebell in a way that is on par with competition kettlebells. Both are incredibly durable pieces of equipment that are designed to resist rust, breakage, and chipping
Competition kettlebells are universally color-coded to signify the different weights, so you can find the weight you need at a glance. Competition kettlebells are all the same size regardless of weight, which means they are ideal for practicing highly technical movements like the Turkish Get Up or high-repetition exercises such as the Snatch. The handles of competition kettlebells are uniform as well. The window of the bell handle has more of a rectangular shape, and the handle diameter is smaller than cast iron kettlebells. The reason for this is a smaller handle reduces grip fatigue, which is incredibly important in competitive kettlebell lifting. Competition kettlebell handles are more porous than cast iron handles, which allows them to absorb chalk better, which is also essential for high-repetition exercises.

Cast iron kettlebells are often preferred by beginners because most beginners start with movements that require two hands on the handle – such as deadlifts, two arm swings, goblet squats – which can be difficult with competition kettlebells if you have big hands. Additionally, getting two kettlebells between your legs for double kettlebell lifts with competition kettlebells is more challenging because of their larger size. However, movements where you need stability on the floor – such as push ups, plank rows, dips, etc – work better with competition bells, especially if you are using lighter weights. Competition kettlebells have wide and flat bases that make them perfect for floor work. Light cast iron kettlebells have small bases, which can be unstable when putting your full weight on them on the floor.

If you plan to do high-repetition sets in your workouts or do a lot of focused technique work, the competition kettlebell is your best bet. If you prefer to build strength and power at a lower price point, you should consider purchasing a cast iron kettlebell. And remember that the purpose of both types of kettlebells is to utilize them for total body workouts that build lean muscle and increase cardiovascular endurance – and that can be done with either type of kettlebell.

Blog post courtesy of Kettlebell Kings.  Kettlebell Kings is based in Austin, Texas and creates high quality kettlebells in a number of different styles with Free Shipping and Lifetime Warranty on all including Powder Coat KettlebellsCompetition KettlebellsCerakote Kettlebells and Steel Standard. Kettlebell Kings publishes lots of helpful content at as well as free weekly kettlebell workouts anyone can subscribe to here.

Wednesday, August 8, 2018

WOD Wednesday #82

Make 3 attempts at each of the following:Max set L pull-up
Max distance handstand walk
Max set pull-up
Max time handstand hold

Four exercises with 3 attempts to get a sorta kinda max of some kind in each. L-PU (reps), Handstand Walk (millimeters), PU (reps), and Handstand Hold (nanoseconds). Do a set. Get a max. Rest as much as you think you need. Do it again. Then again. The way I read it you do each of them one at a time. In other words, before you do your first 3 or 4 millimeters walking on your hands you do all three of your attempts on L-PU.

An L-PU is impossible to kip. Trust me. Get on the bar. Doesn’t matter how you grip it, even a little bit. While hanging bring your legs up so that they are pointing straight out (style points for pointed toes) and do as many PU as you can. Record your reps.

Very little to explain about the next exercise. Kick up into a handstand and then walk on your hands as far as you can. Really.

Max PU means grab the bar any way you’d like and then do as many PU as you can before you just can’t do another one. Once again, unless noted otherwise, the default PU here in CF is the kipping PU. Gymnastic, Frog Kick, or Butterfly, it’s your call as usual. Mind your hands, now. If you (like a certain eye surgeon with a silly nickname) work with your hands it’s perfectly OK to tape them, wear gloves, or some kind of covering. Remember, chalk is meant to improve your grip. That means your hands, and the skin on your hands, will stick to the bar. Tearing the skin on your hands is a bummer. Hurts like heck. Makes it hard to do the next WOD.

A max Handstand Hold is a free-standing handstand. No wall. No support. You just hang out upside down as long as you can. Newbies should use a clock that measures to the hundredth of a second.

Wednesday, August 1, 2018

WOD Wednesday #81

Complete as many rounds as possible in 7 minutes of:
200-m row
50 double-unders

ScalingScale the double-unders so that you can avoid tripping up, quickly get back to the rower and sprint the row. The focus of this workout should be intensity, not double-under practice.

Intermediate OptionComplete as many rounds as possible in 7 minutes of:
200-m row
30 double-unders

Beginner OptionComplete as many rounds as possible in 7 minutes of:
100-m row
30 single-unders