Wednesday, October 31, 2018

WOD Wednesday #91

Three rounds for time of:
12 Muscle-ups
75 Squats

A muscle-up is a foundational exercise in gymnastics, a ring exercise that is so simple and basic that it doesn't even rate a difficulty score for gymnasts. Here, a MU is a milestone for most of us, the first MU a notable achievement. Hanging from rings using a false grip do a ring pull-up, quickly transition to chest over our hands, and then push out a ring dip. Lower yourself to arms fully extended under the rings. One MU. No rings available? 1 bar MU = 1 ring MU.

Can't do a MU, or as we say in CF, don't "have" a MU? The sub is Pull-ups and Dips. The FULL sub is 4 PU and 4 bar dips for each MU. I usually do 3/1, freely admitting that is is not only a sub but also a scale. Let's be honest here.. You're not going to do 48 PU and 48 dips each round for 3 rounds. Not gonna happenDo 1:1 or 2:1. Do whatever type do PU scaling you've been doing all month (bands, Gravitron) but DO NOT DO JUMPING PU WITH NEGATIVES. Same with dips; scale as you need with bands, Gravitron, one leg on ground for assist.

When you see "Squats" on a CF WOD that means air, or unweighted squats. Just you and gravity. Nothing on your shoulders, on your rack (heh heh), or overhead. Good form is essential. Full squats with the crease of your hip below your knee on each one, a fully open hip at the top. 75 per round. Scale reps here if this is too much, and it MAY be. How about 50, or even 25/round?

Monday, October 29, 2018

Product Review: PowerDot Duo

Product Details:
  • WIRELESS PODS FOR EASY USE: While other EMS pods only leave you tangled in wires and ruin your workout, the POWERDOT pods connect wirelessly to your phone. Leaving you free from distractions and focused solely on working out. You can take them wherever and even use them at home to recover while you watch TV!
  • YOUR ENTIRE WORKOUT CONTROLLED FROM YOUR PHONE: Use the free iPhone & Android compatible app to control the pods. Select target muscles and intensity at the touch of a button. No need for WiFi or data, just use your phone’s bluetooth function. The encrypted app runs independently from other phone apps so your workout won’t be interrupted.
  • SCIENTIFICALLY PROVEN TO COMPLEMENT YOUR TRAINING: Effective as a post-training tool to speed up muscle recovery, as a rehabilitation tool for physical therapy and even as a boost to your regular strength training routine. Multiple studies have shown that EMS users perform better after incorporating it into their training routine.
  • DESIGNED FOR YOUR FITNESS GOALS: Unlike other EMS products that only perform one job, the POWERDOT muscle stimulators have 9 different workout programs to choose from. With 4 everyday programs to help you recover, leading to faster progress towards your fitness goals. Plus 5 performance programs designed to increase your muscle strength and endurance - each with their own progression levels. There are also custom manual settings for you to create your own workout.
  • FDA APPROVED & A NO HASSLE WARRANTY: At POWERDOT, we believe in getting you the best possible results! You can count on durability and high quality with Powerdot

PowerDot Duo includes:
  • (2) PowerDot devices (available here in black or red)
  • (4) sets of electrode pads (last for 4 months of active training)
  • (2) 10cm and (1) 25cm lead cable
  • (2) Micro USB charging cables
  • (1) Carrying case
  • Mobile App with numerous preset programs
Additional Specifications:
  • (2) Independent Stimulation Channels
  • Bi-phasic square waveform
  • Peak voltage of 110V provided in small <1V increments (under 1k Ohm load)
  • FCC-approved Bluetooth 4.0 Low Energy module
  • Supports Android 4.4+/iOS 7.0+ mobile devices

My Review:
The best thing I can say about the PowerDot is its portability. Its small and compact design allows you to bring it almost everywhere and even wear it under your office shirt to warm up your muscles in the office secretly before hitting up a great training session.
The PowerDot is the name given to this red little device that uses Electrical Muscle Stimulation (EMS) to improve athletic performance. Simply stick the electrodes on your target muscle and let the PowerDot do the work for you.

Image result for powerdot duoI've thoroughly enjoyed my Power Dot since getting it. I've probably uses it for over 30 sessions so far within the 1st month of getting it. At one point it was the only thing I was doing while dealing with strep throat sickness and it really helped my muscles from stiffening up while just laying in bed for 2 days. The different programs, ease of intensity changes and pad applications have made it an incredible versatile and easy still device to use. I only wish I had purchased more pads right away.

The one negative has been the issue of activating the dots to my phone for use. I've followed the directions and there have been a number of times when it has taken nearly 15 minutes for my phone to activate both dots. At one point I had both dots activated and connected in the start up page but when I switched to the workouts, it wasn't registering both. Very frustrating. But if that's the only negative, that's pretty good.

I do a variety of different sports: triathlons, CrossFit, OCR, and hiking. Efficient recovery is critical for me to stick to my training schedule. The device is very easy to quickly set up with the intuitive iOS app. My muscles felt amazing and much more relaxed even after the first session. The POWERDOT will be instantly integrated into my recovery routine

Lastly, I have had the pleasure of owning many different units. When I purchased the Compex, I did like it but felt lost in the using of the device. It gave no direction on where to place the pads, when to use which program and then I was also connected to a bunch of wires. Oh and the cost is a rip off. When PowerDot came out, I tried that device. From the very beginning it seemed to answer all my missing questions. It provides direction and guidance on when to use each program and where to place the pads. It actually provides a real life image of where the pads actually go. Now some people say you can always get the wireless version of the compex ...yeah if you want a huge bulky device plus bulky transmitters on your body. The PowerDot is small, and unique. Oh and a lot less in price. I would say over all the devices run very similar, with the exception of MyPowerDot being less expensive, smaller, and more user friendly.

Friday, October 26, 2018

Upper and Lower Extremity Screening Cheat Sheet - Part 2

After assessing for active range of motion and muscle strength:

Step 3:  Assess light touch in dermatomal patterns.  Almost every nerve in your body originally branches out your spine at specific places between the spinal vertebraes. This branching of nerve or the dorsal root from the spine has a particular area of skin that is associated with it. This pattern of skin and associate nerve root is known as the Dermatomal pattern.

Step 4: Assess deep tendon reflexes.  A reflex is a motor response to a sensory stimulus and is used to assess the integrity of the nervous system at various spinal nerve root levels.  Deep tendon reflexes will elicit a muscle contraction when the muscles tendon is stimulated.

Deep Tendon Reflexes Procedure Guidelines:

  • Patient should be relaxed
  • Muscle should be placed in a slight stretch
  • Use reflex hammer to tap tendon
  • Assess both sides
  • Reflex should be graded as normal (+2), Hyper active (+3 or 4), or diminished (0-+1)
When completing an Upper Extremity Quarter Screen the therapist should test your reflexes for C5 nerve at the Brachioradialis,  C6 nerve with the bicep tendon, and C7 nerve with the triceps tendon.

When completing a Lower Extremity Quarter Screen the therapist should test your reflexes for L3 nerve with the Quadriceps (also called patellar tendon) and S1 nerve with the achilles tendon.

**Please note that while this is a 2 part blog post with a lot of information for visual aid, these tests should take no more than a couple minutes by a trained therapist/coach.  These screens are very basic tests designed to provide a rapid assessment of mobility and neurological function of the upper and lower extremities.  If a test shows any problems with AROM, Myotomes, Dermatomes, or reflexes this essentially narrows down the problem and directs further testing.  These tests can also be used as a prescreen for athletes during physical examination to establish a baseline of function.

Monday, October 22, 2018

Upper and Lower Extremity Screening Cheat Sheet - Part 1

Explanation of Procedure and Rationale:  The therapist should explain to the patient they are conducting an assessment of the patients neck and arms (Upper Extremity, UE) or back and legs (Lower Extremity, LE).  The patient will be asked to perform UE or LE movements to the best of their ability.  The patient is instructed to tell the therapist if/when they feel pain, numbness, tingling, or weakness.  The rationale behind this is that these tests provide a rapid assessment of mobility and neurological function of the neck, UE's, lumbar spine or LE's.

Step One: Check active range of motion for the desired screening quarter (UE or LE), check for range of motion and assess for pain during AROM.  If symptoms do not increase apply slight over pressure to gauge passive range of motion and reassess symptoms.

AROM Norms for Cervical Spine:

  • Flexion - 80 - 90 degrees
  • Extension - 70 degrees
  • Side Bending - 20 - 45 degrees
  • Rotation 70 - 90 degrees
AROM Norms for Upper Extremities Tested:
  • Flexion/Abduction: 180 degrees
  • Extension: 45 - 60 degrees
  • Internal Rotation 70 degrees
  • External Rotation: 90 degrees
AROM Norms for Lumbar Spine:
  • Forward Flexion: 40 - 60 degrees
  • Extension: 20 - 35 degrees
  • Side Bending: 15 - 20 degrees
  • Rotation: 3 - 18 degrees
AROM Norms for Lower Extremities Tested:
  • Hip Flexion: 120 degrees
  • Extension: 30 degrees
  • Abduction 45 degrees
  • Adduction 30 degrees

Step 2:  Test the Myotomes (or resisted movements) to assess strength. Test to be done bilaterally
Myotome Tests UE:
  • C1, C2 nerve roots: Test resisted cervical flexion
  • C3: Test resisted cervical side flexion
  • C4: Test resisted shoulder elevation
  • C5: Test resisted shoulder abduction
  • C6: Test resisted Elbow Flexion
  • C7: Test resisted elbow extension
  • C8: Test resisted Thumb extension
  • T1: Test resisted finger abd/adduction
Myotome Tests for LE:
  • L1, L2 nerve roots: Test resisted hip flexion
  • L3: Test resisted knee extension
  • L4: Test resisted ankle dorsiflexion
  • L5: Test resisted Great toe extension
  • S1: Test resisted ankle plantar flexion

Thursday, October 18, 2018

Orthotics: How to and Considerations

A client wearing a new orthosis may adopt the following schedule:

Wear orthosis for approximately 30-60 minutes per day; may break this time up into the morning and evening times

Days 3/4
Increase morning and evening time to about 1 hour each or 2 hours total per day
Days 5-10
Increase wearing time to approximately 2 hour in the morning and evening, or 4 total hours a day
Days 11-14
Apply the orthosis first thing in the morning, remove, checking skin before lunch.  The orthosis may be put on again and checked after school/dinner;  it may be applied a third time and worn untill bedtime

Note:  Patients, caregivers and therapists should perform a skin check each time the orthosis is removed.  Check for redness, skin irritation, blistering of the skin.  Any redness school disappear within a few seconds after removing the device.  If it persists longer than a few minutes or if skin breakdown develops, the patient should immediately stop wearing the orthosis, and the supervising Physical Therapist and Orthotist should be immediately contacted.

Skin and Orthosis Care:
Clients wearing orthoses should be told to notify the orthotist or other health care provider if the following problems are noticed:
  • The orthosis rubs, causing skin discoloration that does not disappear after a few minutes.
  • After removal of the device, blistering or skin breakdown is evident
  • The orthosis is cracked, broken, loose, or has missing parts
  • The orthosis is uncomfortably tight
  • Excessive swelling develops within or around the trimlines of the orthosis
  • Pain becomes a symptoms, or intensifies.
  • Toes, fingers become discolered
  • An odor or exudates develops
Caring for the orthosis:
The orthosis should be cleaned with mild soap and water.  It should not be soaked in water or dried with a blow dryer, or placed near a heater as heat may cause its shape to change.  It may be towel dried or left at room temperature.  A little talcum powder may help reduce odor.
  • Cotton socks should be worn under the orthosis to prevent friction and protect the skin from perspiration.
  • Seams of socks should be kept away from bony areas
  • Avoid wrinkles or folds in socks.
  • A white cotton t shirt is preferable to wear under spinal orthoses for the same reason as above.
  • For LE orthotic, sandals, high heels, loafers, or other slip on shoes should be avoided.
In general, orthosis should be easily applied and performed independently by the patient.  However children, and others may require additional assistance, and given instruction in how to perform as well.

Friday, October 12, 2018

Product Review: Ikonfitness Pull Up Bar

Product Details:

  • No screws - ready to use - no need to assemble! Simply hook right into the doorframe, get a full body workout, and fold away for storage!
  • Raised bar - Suitable for tall people. Designed for wide doorframes with a maximum width of 36.22” (92 cm) and depth of 8.27” (21 cm) - Made for wider doorframes: fits a door width of 27.56” - 36.22” (70 - 92 cm).
  • Maximum stability, robust, high quality construction. Heavy duty design prevents movement of the bar during exercise. Safe weight limit of up to 440 lb (200 kg). Cushioned pads prevent damage to doorframe.
  • Comfortable - no more blisters on your hands! Soft foam grip - durable and nonslip. Extra thick rod ensures firm grip.
  • 100% satisfaction guarantee! If you do not like the Ikonfitness pull up bar for any reason, just send it back within 60 days. Our friendly customer service members will refund you for the full amount! 
  • Almost 8” higher than competing products thanks to raised bar design
  • Train on the floor for pushups, sit ups, dips, and more: complete upper-body training
  • Deeper pushups and increased range of motion for better results
  • Maximum stability: solid, high quality construction
  • Thick rod for firm grip
  • High quality foam: no blisters on your hands
  • Made for wider doorframes: fits a door width of 27.56” - 36.22” (70 - 92 cm) - Measure the space inside your door frame. The Ikonfitness Pull Up Bar is designed for spaces between 27.56-36.22 inches (70-92 cm)
  • Just fold and store to save space
  • Safe weight limit of 440 lb (200 kg)
  • Specially designed rubber pads protect doorframe from damage

The bar itself was shipped in a very thin box which is due to its genius design. It has these two hooks that fold in and out and are spring supported. The metal itself feels like quality and I doubt it will bend (if it does I will update this). The bar looks very simple and pleasing to the eye. It stays put even when you are not hanging from it. Finally the most important thing, it was designed by someone who had a good grasp of basic physics and considered torque and application of force. The angles are just right, as I said it stays put without any force applied to it, but once you hang from it and there is a downward force, the bar will feel like it is part of the wall itself, you will feel very sturdy. It also requires ZERO assembly, its not that the last bar was hard to put together, no they usually take only a few minutes, but if you are buying one of these it's probably because you are renting and so are likely to move, taking the bar apart and putting it together is a pain and losing screws and parts is a real problem. This thing just comes down and folds away so moving it or storing it when it's not up is real easy.

What is smart hook technology and how does this bar compare to other pull up bars?  Smart hook is an unique design to solve the problem of traditional pull up bar easily falling down and causing damage to door frame. During the usage, the hook extends over the door to the back door frame, so the downward force when you grab on to the top bar doing pull ups is decomposed into the horizontal forces on the cap ends of the lower bar towards the vertical strip of the door frame and the downward vertical forces between the teeth of the tool and the top strip of the door frame. In such a way, your force is balanced by 6 smaller forces, each is much smaller, and saves the surface of your door, as well as making it safer.

One "bad" thing I haven't seen mentioned in other reviews yet is the bar diameter is much bigger than every other pull up bar I've ever seen. This is "bad" in the sense that it requires a much, MUCH stronger grip, even with the padding it has, to do proper pull ups. A thicker bar translates to a far more difficult workout. So, for a beginner that struggles to do even a single pull up, this bar is going to make that struggle even worse. The upside is that if you stick with it, you'll be far stronger than you would have on a smaller bar. Similarly, if you're someone that's already really good at pull ups, this might be your answer to increasing the difficulty of your pull ups without having to risk injury or damage with belts, chains, and extra weight.

Monday, October 8, 2018

PT Pathologies: Guillain-Barre Syndrome

Guillain-Barre Syndrome (GBS) or acute polyneuropathy is a temporary inflammation and demyelination of the peripheral nerves myelin sheaths, potentially resulting in axonal degeneration.  Motor weakness results in a distal to proximal progression as well as sensory impairment and possible respiratory paralysis.  The cause of Guillain-Barre Syndrome is not exactly known, but, according to the National Institute of Neurological Disorders and Stroke, scientists do know that "the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease."  It is not fully understood why it strikes some people but not others or what it is that sets the disease in motion.

Guillain-Barre Syndrome can occur in individuals at any age, but it tends to have the highest frequency in young adults and adults 50-80 years old.  Also males typically have a higher incidence of GBS than females.  Those affected by GBS initially present with "distal symmetrical motor weakness and will likely experience mild distal sensory impairment and transient paresthesias."  Weakness eventually progresses proximally toward the upper extremities and to the head.  Along with motor weakness, the patient could present with muscle and respiratory paralysis, the absence of deep tendon reflexes, and the inability to speak or swallow.  If there is respiratory involvement GBS can be life threatening.  Laboratory and imaging studies can be done to confirm GBS as well as the use of additional information such as a physical and neurological examination, strength testing, and a review of the patients relevant medical history.

In order to medically manage GBS, hospitalization may be required.  Pharmacological interventions are used to treat the symptoms, as well as PT, OT, and SLP.  Each of these different types of therapies facilitate neurological rehabilitation.  As soon as the patient is admitted to the hospital, physical therapy treatment should be initiated.  The focus of the physical therapy should be PROM, positioning, and some light exercise.  While the patient is in the acute phase of GBS, the PT should ensure they are not overexerting or causing too much fatigue for the patient.  This could cause exacerbations of the patients symptoms. "As the patient progresses, intervention may include orthotic, wheelchair or assistive device prescription, exercise and endurance activities, family teaching, functional mobility and gait training, and progressive respiratory therapy".  A therapeutic swimming pool may also be indicated for the patient.  This allows initiation of movement without the effects of gravity.  Once the patient goes home, he/she should continue therapeutic exercise, functional mobility training, endurance activities, and other breathing activities.  Physical therapy can assist in the recovery of GBS but cannot alter the course of the disease.

Wednesday, October 3, 2018

WOD Wednesday #90 - Powered by Treign Apparel

Complete as many rounds as possible in 10 minutes of:
10 burpees
20 wall-ball shots, 20-lb. ball

Monday, October 1, 2018

Quotes and Food for Thought

- "Effectiveness is doing the right thing. Efficiency is doing things the right way.  But doing something well, does not make it important."

- "If you feel like you don't have time, then it actually means you just don't have clear priorities."

- It is en vogue these days to be a PT and write a big dissertation style post about how people have different bones. If you walk into my gym and lead with "but I've got long femurs" I'll say "that's nice, but it doesn't excuse you from squatting in a stable and efficient manner." If you as a coach can't understand how to get anyone you come across to start squatting well for them regardless of their bones you are missing something.

-  Think of the curl as a way to work flexion and external rotation of the elbow and shoulder a little different way. Slow controlled curls can actually be a way of helping improve you crap front rack. It is also another way to work on keeping a solid trunk with a load away from your center of mass. Many will find it incredibly difficult to actually be fully supinated.   How do you think about a one arm row? Do you think about it as a back exercise or do you think about it as a way to work on a stable foot and trunk while maintaining abdominal volume and proper breathing while in a staggered and hinged position?

The heavy suitcase carry. What is it to you? I like it because I can ask someone to pick up that heavy thing for me and bring it over here and instantly I can see how well they can maintain trunk stiffness, abdominal volume, and manage breathing under load while doing something. I don't need to much else. If you let go of tension and I get this weird sideways ab bulge. Then I reset tension and get back to an even abdominal volume. This is what makes 1 armed carries so powerful if you coach them well and get the person to understand what they should be focusing on. What you start to realize is a lot of strength and conditioning is really just training your ability to stabilize your trunk a bunch of different ways in a bunch of different shapes. If you see weird sideways ab, the person has yet to achieve fencepost status. Sturdy like an oak.

- One of the things we cannot always control is structural symmetry. We can, however, control how the system moves as a whole. You'll note that my right side looks far different than my left side. But, my gross motor control is constant and symmetrical. Fascial and muscular systems will always reflect the realities of playing a uni-lateral sport (like baseball or golf or, in my case, canoeing). And yet, the body has a miraculous way of managing these imperfect system strains into a cogent whole. We need to remind ourselves always that our brains are wired for movement, not muscles, or connective tissues. We don't chase asymmetrical structural compensation. We plan for it, manage it, expect it, and adjust load and practice accordingly. Don't loose the forest for the trees.

- It is all about shifting mindset. What do you do with a saw horse and railroad tie when you are in your 70's and suffering from lower back pain and are contemplating getting an appointment with a surgeon and some injections? You get to work dragging the tie around your yard and deadlifting the one end and figuring out how to do sit ups and back extensions with your saw horse. Seeing me in the beginning for a little manual work may be the catalyst but in the end you are in control. Sometimes you need someone to tell you that. Notice how simple this stuff is. Things are often made purposely complicated to keep people in the dark.

-  Monday I tweaked my back doing some one arm swings with a 24kg kettlebell. Got lazy. Pretty minor pain but enough to interfere with some things. Did some very minor joint and soft tissue stuff to myself for about 10 minutes the next day then got right back to training with the KB, bar, and sled. Thursday I was good to go. I think to myself other people may have went to some kind of professional and maybe some x rays would be taken and maybe they would have been convinced to take on some extensive 3 time a week plan because they have some "misalignment" or "degenerative disease." You are not as fragile as you think and maybe some manual work is needed for a very short time as a small fraction of the solution but you need to get back to doing stuff. There is nothing fancy that needs to be done. Fancy is bullshit. You are in control.