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Open WOD 18.2

1-2-3-4-5-6-7-8-9-10 Reps For Time of:

Dumbbell Squats – 50/35 lbs.

Bar Facing Burpees

 

18.2 A

1-rep-max Clean

Time Cap: 12mins to complete 18.2 and 18.2A

 

Well, dumbbells again. This workout feels like the ghost of CrossFit past coming back to haunt the new-age Sport of Fitness. Among the original tenets of CrossFit during the formative days, Coach Glassman repeatedly expressed his love for dumbbells because of their propensity for creative usage. Some advice he would give early adopters would be “invest in dumbbells before kettlebells” and if you can’t afford a barbell, try doing Fran with a pair of 45’s… (trust me, it’s worse).

This workout essentially hits on every aspect of the spectrum that 18.1 did not. 18.2 is a dead- glycolytic- sprint to the end, and 18.2A affords you the chance to load it up and display some downright animalistic strength (should you have the capacity to do so). If 18.1 was the CrossFit version of the 5k, this is the CrossFit version of “Run 1 mile as fast as you can, then try to out-lift everyone who outran you”. Poetic.

While the movements may seem simple, performing them with efficiency will be the major key to crushing this one.

 

MOVEMENT TIPS

Dumbbell Front Squats

  • I Heard You Like Front Racks… – I honestly don’t think there is a single MOST efficient place to rack the DB’s. Keeping your hands around the center of the bells will give you the most control, and will allow you to place them down exactly where you want to, which will save you seconds during the next transition out of the burpees. This will require a good front rack position, and the shoulder “shape” to comfortably let the ends rest on your deltoids or traps. HOWEVER, if it is a struggle for you to keep a grip on them, consider just resting them over your shoulders like two sandbags. The only rule is that your hands must remain in contact with the dumbbell at all times during the squats. You do not have to grip the dumbbell during the squats.
  • Down Fast, Up Fast – Don’t waste any time getting down to below parallel. If you are a good squatter, or a seasoned Olympic-style weightlifter, you will most likely benefit from controlled “dropping” and “bouncing” out of the bottom. The eccentric (lowering) part of this movement will be responsible for blowing your quads up, so try to minimize that as much as possible.
  • Wear Lifting Shoes, if you Always Wear Lifting Shoes – If you haven’t done a squat session or weightlifting session in recent memory without wearing a pair of high-heeled weightlifting shoes, this probably is not the time to change that. Most Reebok “lifters” have a fairly flexible fore-foot of the shoe, which really does not impede burpees at all. In other words: if you squat and clean better in weightlifting shoes, wear them in this workout. If it doesn’t really matter to you, then don’t worry about it. Squat efficiency will save your legs and heart rate during this workout, so do what you feel most comfortable with. Personally, I am better at pulling than squatting, so I will use my lifting shoes to maximize my efficiency with squatting the dumbbells, especially in the later rounds. It really isn’t going to take much away from my burpees, and I will already be wearing my favorite shoes to clean in.

Burpees

  • Keep Those Feet Together – If you are doing this workout as Rx’d, you need to focus on keeping the feet together during the sprawl and rebound. CrossFit made it very clear this year that “walk-out” and “step-up” burpees are no longer allowed as a viable Rx’d option. This goes into my second point…
  • No Missed Reps – A No Rep on the burpee will not only cost you an extra 2-5 seconds, it will also cost you a significant increase in heart rate, overall fatigue, and mental breakdown at the time you need it the least. Pay close attention to the movement standards on the website, and it will be WELL worth it to take them a half-second slower just to make sure you get every rep right the first time. (Vellner and Ohlsen were tied in the final round, then Vellner got no-repped on 1-2 burpees. Noah beat him by 15 seconds, 6% of the entire workout time.)
  • Stay Tight Through the Trunk – It’s only 55 burpees total. Never more than 10 at a time. This means that it is NOT a long, slow, march to the finish. It is a springy, explosive, sprint to the end of the set. If you are going to rest, rest BETWEEN burpees. Don’t waste your time or energy trying to make the burpee itself slower. You will expend MORE energy doing the drop-down, worm-up type of burpee than you will if you make every one crisp. The beauty of this workout is that you can always walk up to the bar and jump over, but no matter where you start the burpee, you should try to get back on your feet as soon as possible. The best example I could find of this on YouTube is this clip of Mat Fraser:

https://youtu.be/2FL1NnAns6E?t=8s

In the video, you’ll notice that Mat does several very efficient things:

  • He drops to the ground quickly, using his arms to absorb just enough force to land.
  • His back doesn’t round or arch on the way up (no “worming” before he kicks his feet)
  • Hips come up BEFORE his shoulders, or at least at the same rate.

Now, I’m not saying you have to do reps as quickly as Fraser. That would be ridiculous, and a poor strategy for us mortals. But you should try to get down to the ground and back up as fast as possible, THEN take a breath, step forward if needed, and jump over the bar with both feet. Rest happens between movements, not during them.

Clean

  • Do What You Can – Unfortunately, if you are reading this post with the goal of learning for technique tips on how to do your first 1RM Clean, this isn’t the time or the place to safely learn that movement. What I will recommend, however, is the style of clean that suits you best.
  • Power vs Full (aka caught below parallel) – “Athletes don’t rise to the occasion, they fall to the level of their preparation.” At the end of 18.2, I will guarantee your quads will be on fire, along with the rest of your perceivable body. We just saw Noah get pinned with a weight that was about 80-85% of his 1RM. And he is a freak. That is a testament to how exhausting the first part of this workout will be on the legs. If you are hoping to make it to Regionals, you already know that you will most likely have to put together a very good FULL Clean in order to score something respectable.

 

If you are simply trying to beat all of your friends and earn bragging rights for an extra 5 days, you have a couple different options:

  • If your max Power Clean is >85% of your Full Clean, you should probably plan on ripping out a couple of good Power Cleans for your 18.2A Score. Your quads will be fatigued, and you should go with the movement that is most efficient FOR YOU. For Example: If your max Power Clean is 250, and your max Full Clean is 265, I wouldn’t worry about trying to catch your reps below parallel. Adrenaline will be your only saving Grace (pun intended) at this stage in the workout, and you shouldn’t be expecting a miracle of amazing technique during the full lift to save you. Warm up with the power clean, get your mind set on power cleaning when under fatigue, and be ready to pull the bar like there is no tomorrow.
  • If you are a REALLY good weightlifter, and you rely on pulling yourself under the bar to catch the weight, then the Full Clean is the way to go. Rely on your technique, and pull yourself under the bar as fast as possible. Just be prepared to have very little juice left in the tank to stand it up, so make it flawless.

 

  • Time It Right, and Know Who You Are – This workout separates people into 2 different categories: Good at 18.2, or Good at 18.2A. You should plan to maximize your score in ONE of these workouts. Don’t try to go slow at 18.2 just to get a mediocre Clean at the end. On the Flip Side, don’t try to set 18.2 on fire if you know you won’t have anything in the tank to even hit 50% of your 1RM clean. (See below for more Pacing Tips)

 

PACING STRATEGIES

For Those Who Love Seeing Burpees Come up in a Workout:

  • Set It on Fire – Come out hot on 18.2, and don’t let up. Be confident that your burpees are your strong suit, and know that the dumbbells are not REALLY that heavy. During the squats, get the DBs racked, and just move. Hit the standards on every rep, and KEEP moving until all the reps are done. Then, remember, this is your time to shine. As Patrick said, you CAN do the burpees faster, you just don’t want to.
  • Rest, then Pull – You should have at least 1-2 minutes of good, quality rest between the two pieces, so take your time, get your mind right, and hit quality reps. Your opening weight should be about 65-70% of your TRUE 1RM, and you will have about 3-5 attempts to make some small jumps up to your best possible score on 18.2A. Both Vellner and Ohlsen opened at 63% of their max Clean and Jerk (as posted on their profiles). And they finished with 92% and 88%, respectively. They took some big jumps as far as total weight goes, but the percentages should be a pretty good template for what most people should attempt during this workout

For those “Heavy Singles, ErryDay” Folks:

  • Fly Through the Squats – This is the equivalent of a 115lb barbell Front Squat for the same rep scheme. Not that bad, so take advantage of it. Rack them, and knock out the reps like they are air squats.
  • Bare Minimum Over The Bar – If you did 1 burpee every 5 seconds, that would add up to 5 total minutes of work. If you need to, set a metronome during the warmup to practice that pace. When you’re fresh, that is a slow burpee pace. You should be aiming to complete 18.2 in 10 mins, which gives you 2 minutes of time to post that beast-mode strength on the leaderboard. This is achievable, as long as you keep your eye on the prize and don’t let that negative self-talk creep in during rounds 7-10. Each burpee should be followed by a deep breath, step up to the bar, hop over, calmly turn, and repeat. (Go back and look at Movement Tips on the burpee to remind yourself how to do them efficiently.)

 

THE WARMUP

General Warmup:

  • 5-10min Easy Assault Bike (or Jog, or Rower, if you still don’t have a bike)
  • Bike Intervals:

3 Rounds: 15sec Sprint, 45sec Moderate Intensity. Active Rest 2mins after completion.

2 Rounds: 30sec Sprint, 90sec Moderate Intensity. Active Rest 2mins after completion.

**During the Active Rest, do any stretching or foam rolling that you specifically need

Dynamic Movement Prep:

3 Rounds:

  • 1min Deep Squat Hold – get into a deep squat, focus on getting your back upright, and driving your knees out to exaggerate the demands of the squat. Hold each rep for 15-20 seconds, stand up, and repeat. Use a rig or band around hips for support if needed.
  • Deficit Pushups – 10 reps. Get your hands set up on top of 25-45lb plates, laid flat of course. Then do slow, controlled pushups with a nice pause at the bottom.
  • Ab-Rollouts or GHD Sit-ups (your preference) – 10 reps. Your anterior chain (“core”) will need to be turned on to make the burpees as efficient as possible.

 

Specific Workout Prep:

Clean – Work up to a heavy Single, either Power or Full. Your quads should already be warm and you should have an idea of how that will affect your lifting. NO MISSED LIFTS. The minute it turns into a struggle, that is where you stop. Take 75-80% of that lift, depending on which part of the workout you are prioritizing, and plan to open with that. There should be a 0% possibility that you miss your opening lift on 18.2A.

3 Rounds:

5 DB Squats – Lighter than you will use in the workout

5 Bar Facing Burpees – Focus on hitting EVERY standard, and making the burpee crisp

 

3 Rounds For Time:

4 DB Squats – Workout Weight

4 Bar Facing Burpees

 

**Focus on Transitions during these two warmup pieces. Set the DBs down fast, but calmly. Don’t waste valuable time chasing down rogue dumbbells across the gym.**

 

At this point, you should have a good idea of how the movements will play off each other, and how you will feel when it hits the fan. Get your mind right, move around, but don’t get cold. Ideally, you should have about 10mins between your last warmup round and Go Time.

 

 

-Go crush it.

 

Sean Jacobs, PT, DPT, CSCS, CF-L2

 

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Open WOD 18.1

20min AMRAP:

8 Toes To Bar

10 DB Hang Clean Jerk – 50/35 lbs

14/12 cal Row

MOVEMENT TIPS

Toes-to-Bar:

  • Efficient Kipping – Sorry to ruin the surprise, but your biceps will probably blow up during this one. Even though there aren’t many T2B in each round, 8 will still add up over the course of a 20 minute workout (I believe Sam and Kristin both just did 160ish). Even if you happen to get super-fatigued in the mid- to late stages of the workout, don’t waste time hanging from the bar. This will fatigue out all of the small stabilizing muscles around the shoulder joint and upper back, and cause even more chaos with your kip. Rest until you’re absolutely ready to get as tight as possible, get some good reps in, and then come back down before things get sloppy.
  • Break Early – This is the movement that will get none of the credit if it’s on point, but will get all of the blame if it ruins your workout. Nobody will win this workout because of amazing toes to bar, but plenty of CF’ers will find themselves standing under the bar staring up wondering “why didn’t I go 4-4 or 3-3-2 earlier?!” Each person’s gymnastics capacity will be different. That being said, if your max set of toes-to-bar is <20, go hard in the other two movements, and plan on taking a good amount of “planned rest” during this one. Even if your max set of T2B is measured in hours instead of reps, you may want to consider only doing the first 4-5 rounds unbroken. Basically, once you feel any sloppiness in your trunk (aka “core”), and your kip starts to get funky, break it down into a smaller rep scheme of your choosing.

DB Hang Clean + Jerk

  • 1 Armed DB Swing – I really feel like that sums it up. Sit those hips back, load up the hamstrings and the glutes, and swing that sucker up to your shoulder. The only movement your arm should be doing would be to pull you down under the DB after the hips come through. The weight should be light enough that a simple dip+drive from shoulder to overhead will not be an issue.
  • Stay Tight – This movement will challenge you in the transverse plane, something we rarely train in CrossFit. As the dumbbell comes back down from overhead between the legs, you will need to resist the rotational force with your trunk and hips. If you get loose, you’ll quickly feel a massive back pump that will be miserable on the rower. Stay tight, Keep your Chest Up, and Hips Back.
  • Don’t Curl The Dumbbell – I don’t think I really need to elaborate on this one, but I couldn’t sleep at night without adding it in. This will blow you up, and make your toes-to-bar miserable. Try to avoid using your arms as much as possible during this workout.

 

Rower:

  • Open the hips up – This is crucial. If your hips are stiff, you will need to rely on your low back and spinal erectors to do the majority of the pulling. This will not only make the DB’s much more challenging and fatigued, but will also throw off your rhythm on the T2B. Get into a good squat or deadlift position at the catch (beginning) of each stroke, and drive with your legs.
  • Big Pulls, ALL THE WAY THROUGH – One of the first things I noticed when Sam started gaining ground on Kristin (other than Sam figuring out how to do a DB Hang Clean on the spot) was that Kristin repeatedly kept trying to short-change the row calories. Do you ever do that thing where you tell yourself “1 more pull….okay, maybe just 1 more small pull…” and so on? In a workout with this many transitions, this will be a huge time waster. I would say she probably wasted 2-4 seconds per round doing small arm pulls hoping the rower hit 12. Sam was rowing like she was aiming for 14, and just jumped off when it hit 12. It is worth it to do one extra “big” pull and use those extra seconds for resting or transitioning.

 

PACING STRATEGIES

Pacing here is going to be highly individual based on strengths/weaknesses, so I’m going to break up two different strategies into two different “avatars” of people.

  • “Toes-to-Bar Monster, Somewhat Slow of a Rower” – Unbroken T2B (or at least 5-3 or 4-4), Go easy on the rower and just try not to spike your heart rate. Think: 100%, 90%, 80% efforts on the three movements, respectively.
  • “Rowing Animal, but Just Trying to Get Away From The Rig” – Be prepared to let people pass you in the beginning. Your not the most gymnasty person in the gym, but that’s okay (I’m talking to myself here, too). Break the T2B early into 2-3 sets, because there’s a good chance you’ll be doing doubles or singles past minute 15 if you don’t. If you read the movement tips above, get fast, crisp sets in, then drop down, breathe, and go again. Then try to crush the DB’s and the Rower, because there will be plenty of built-in rest breaks under the pull-up bar.
  • Either way, the dumbbell should NOT hit the floor until you’re either done with 10 reps, or done with 5 reps at least. You can’t switch hands until you’ve done 5 on your first arm, so just try to get 5 done as fast as possible, and rest between arms if needed. Personally, I am going to try to limit the number of times I have to bend over and pick it up off the ground, so I will be resting a little bit extra both before and after those 10 reps.

Now, let’s talk overall pace per round.

Basically, the rule for this one is pick a pace that might seem slow at the beginning, because it won’t feel slow at the end. You can always decide to pick up the pace once you’ve got the adrenaline butterflies out of the way in round 2-3, but if you blow up early, there’s no coming back.

I think Sam put up one of the top 10, if not top 5, scores of this workout. Other than a few missteps on the DB hang cleans in the first 2 rounds, I don’t see where much more time can be made up. She paced the first several rounds to make sure she could hold on, and then gradually started going faster each round. Kristin Holte started off flying. Then her pace dropped off 24 seconds in the FIRST HALF of a 20 minute workout. (For any stat-nerds like me who might be interested, I laid out Kristin’s progress through the workout.)

To find your individual pace, I’m actually going to recommend that you do 1 full round of the workout, at near-max intensity as the last real piece of the warmup. See how long that takes you, then plan on starting out at 75% of that speed per round. If you’re someone who paces things really well over long bouts of time, but isn’t that explosive through one round, you may start out closer to 80-85% of that max speed. If you can knock out one round in around 60 secs, you may want to start out somewhere around 60-65% to save some of that energy.

Like I said, if you feel good after the first 2-3 rounds, you can start increasing your speed. But it rarely works the other way around – if you blow up by minute 6, its going to be a long 14 minutes.

 

Kristin Holte – Pace of 18.1

Round Time per Round Time at Each Completed Round
1 79 1:19
2 86 2:45
3 87 4:12
4 96 5:48
5 92 7:20
6 97 8:57
7 103 10:35
8 101 12:16
9 103 13:59
10 100 15:39
11 102 17:21
12 99 19:00

 


 

THE WARMUP

20 minutes is going to be a long time. For that, we need to really tap into both the oxidative and the glycolytic energy systems. This is CrossFit’s version of the 5k run for this Open year (I’m assuming they won’t have another 20min workout, but you never know).

General Warmup:

  • 10min Easy Assault Bike, Jog, or Jumping Rope – Go 45 seconds Easy, 15 seconds Moderate Intensity. Just break a sweat, but don’t start burning or gasping for air.
  • 20-30 Band Pull-Aparts – Get that upper back and shoulders warm.
  • 10-15 Pushups to Downward Dog – Pause at the top to get a good stretch, and make sure your chest, shoulders, and upper back are opening up in prep for the toes-to-bar.
  • Foam Roll or Lacrosse Ball (if necessary): Lats, Shoulders, Chest, Thoracic Spine (extend your upper back over the roller)

 

Dynamic Movement Prep:

30sec Each Movement x 3 Rounds:

  • Spiderman’s – in a pushup position, bring one leg up and outside your arm. Try to sink your elbow down to the ground, then reach back up to the ceiling. Switch sides, and repeat.
  • Deep Squat Hold – get into a deep squat, focus on getting your back upright, and driving your knees out to exaggerate the demands of the rower. Use a rig or band around hips for support if needed
  • Twisting Lunges – lunge left, twist left, lunge right, twist right, repeat.
  • 1-Arm Russian KB Swings – Light-Moderate Weight, Focus on driving those hips through
  • Scap Retractions on Pull-Up Bar

 

Specific Workout Prep:

1 Round:

8 Hollow-Arch kips on Pullup Bar

8 DB CJ’s (4 each arm) – use a lighter weight than you plan to use in the workout

10/8 cals on Rower

Rest 1:1

1 Round:

6 Knees-to-Chest or Toes-to-Bar (depending on skill level)

8 DB CJ’s (4 each arm) – use the weight you plan to use in the workout

12/10 cals on Rower

Rest 1:1

 

1 Round for Time:

8 Toes-to-Bar

10 DB CJ’s (5 each arm) – workout weight

14/12 cals on Rower

 

At this point your heart rate should be spiked pretty high. Allow 10-15 mins to let it come back down. Grab some water, but don’t get cold. Keep doing any general movements that you feel work for you before a workout. If you have 15+ minutes of down time after you finish the warmup, you may need to hop back on the Assault Bike and just keep it spinning to keep from getting cold.

At this point, you should have a good idea of how this workout will make you feel, and what pace you are actually capable of maintaining. All that’s left to do execute.

 

-Go crush it.

 

Sean Jacobs, PT, DPT, CSCS, CF-L2

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Doc and Jock Podcast

Dr. Vaughn was recently interviewed on the Doc and Jock Podcast.

Some of the topics discussed:

  • The Vertex PT Specialists business model
  • Running gait correctives
  • The pec major tears at this year’s CrossFit Games Regionals
  • Tiger Woods
  • Lumbar spine surgeries
  • The opioid epidemic
  • and more…

Click this link to listen.

Or click this link to download on iTunes.

 

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TMJ Dysfunction Case Study

Temporomandibular Joint Dysfunction Case Study

14 year old male baseball player presented to Vertex with a chief complaint of left sided jaw pain that occurred after being hit on the chin by a ground ball at practice.  Additionally, he complains of his jaw “locking” and “clicking” with end range mouth opening, specifically while eating.

Clinical Exam:

Palpable Click with opening and 25mm left mandibular deviation (ipsilateral)

Apical breathing pattern

Decreased left upper cervical rotation (+ left cervical flexion rotation test)

Tenderness to palpation left masseter and left medial pterygoid with patient reported familiar pain

 

Treatment:

HVLAT directed to bilateral C1/C2 with + cavitations.

Upper and mid thoracic HVLAT

DN with electrical stimulation to left masseter, medial pterygoid, and joint capsule.

Manual TMJ distraction

Home Exercise Program:

Cervical SNAGs, cervical retraction with over-pressure applied to maxilla, postural resets, diaphragmatic breathing

Patient Education:

Postural considerations; specifically with school and smart phone use consisting of spending less time in forward head posture in order to minimize mandibular retraction.

Result:

Chief complaint of “click” and “locking” resolved within session. 25mm deviation reduced to <5mm.  Patient followed up 6 weeks later and maintained treatment effect.

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Owens Recovery Science BFR Course

Lifters Clinic and Vertex PT Specialists are partnering up later this year to bring you an Owens Recovery Science Blood Flow Restriction (BFR) course!

The course will be held at Vertex PT Specialists on August 5, 2017. Register here:

www.owensrecoveryscience.com/certification/columbia-sc/

 

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Sissy Squat Variation for Patellofemoral Pain

Quick video of Dr. Faile experimenting with Donnie Thompson’s sissy squat variation.

One of the reasons why we like this for patellofemoral pain patients is because it allows for a more vertical shin (which = less patellofemoral compression) and you get the added close chained terminal knee extension moment at the top.

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Four Exercises to Improve Dance Technique and Strength

 

1. Hip Flexor Pulse
a. Purpose: Improves strength in hip flexors, especially Iliopsoas, to increase leg height. This exercise works best in combination with stretching the hamstrings to allow greater mobility and active range of motion.
b. How to do: start sitting with legs extended and leaning back on hands. Perform a posterior pelvic tilt and lift one leg with the knee bent. Pulse the leg closer to your body for about 4 reps while concentrating on using the Iliopsoas. Repeat 4-6 times.

2. Attitude Raises
a. Purpose: To increase turn out (external rotation of hips) and leg height in second position (to the side).
b. How to do: Start lying on one side. Raise top leg (both knees facing forward and knee bent). Turn out the leg into attitude al second (to the side with knee facing ceiling). Repeat this while bringing the leg closer to the trunk with each rep. Repeat 4 reps 4-6 times.

3. Hip Flexor Stretch
a. Purpose: To stretch hip flexors more efficiently
b. How to do: Start in lunge with both knees at 90 degrees. Perform strong posterior pelvic tilt. Add more of a stretch by bending the trunk to the same side as the front leg. Hold for at least 30 seconds.

4. Calf Raises with ball
a. Purpose: To improve strength and control of plantar flexion in heel raises without inverting at the ankles.
b. How to do: Place small ball in between the ankles. Raise heels off the ground while squeezing the ball. The goal is to not let the ball fall to the ground. This helps train the muscles to not invert, but to remain neutral in plantar flexion.

 

-Lauren Rowell

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Words that Harm

How many times have you been given a phrase by a physician that, perhaps, wasn’t phrased as well as it could be? “You’ve got a time bomb in your chest” or “I don’t know how you’re walking around with that spine!” As I venture through all the information that’s required in my Orthopedic Residency, this is the one subject that I wish more healthcare providers understood.

 

Too often, I hear a new patient tell me that their referring physician told them their spine is “riddled with bulging discs” to the point that they “shouldn’t be able to move.” Put yourself in that patient’s shoes. In that moment, how would you feel? You’ve been in pain for a long time, you’ve maybe had failed alternative treatments, perhaps you’re on pain medication that you don’t like taking. And the medical professional you’ve been sent to says they can’t even fathom how you’re able to move based on what they’ve seen on your images. There’s no way in that moment you feel great about your situation. And likely you have no hope for a more conservative treatment to finally get some relief.

 

Why would a medical professional say such words to their patients, if there were the possibility of being more supportive or hopeful? It’s suggested that possibly we no longer hear the words we say; we’ve become desensitized to the anxiety or fear that they cause. Perhaps we don’t have time to think of better phrases or words to say; with the way healthcare has gone in recent years, doctors don’t have a ton of time to spend with each patient. Physical therapists, who would typically have the most time with their patients, in many clinics are seeing multiple patients at a time. So instead of explaining how MRIs have shown bulging discs in patients who are asymptomatic or how patients with debilitating pain have no significant findings on MRI, they rush through the exercises for the day and hope that patient doesn’t have any questions. It was further suggested that maybe we use fear-evoking words as a method of getting compliance out of the patient. If we tell the patient that the only way to make sure “this heartbeat isn’t the last” is if they start exercising or begin taking their medication, the fear becomes helpful to that professional. But none of these reasons are acceptable for using language that has been shown to cause undue anxiety and poor results in our patients.

What we’re learning now is how important the brain is in how we perceive pain. Many new approaches in physical therapy seek to retrain the brain and our thoughts about pain.  One of the best ways I think we can seek to provide that re-training is through better use of language. Instead of getting stuck in these negative connotation words or phrases that cause fear, I think we should seek to determine words that evoke inspiration in our patients.

So, what words should be used by healthcare professionals? Words that allow patients to feel comfortable enough to ask questions are a good place to start. Miscommunication between healthcare professionals and patients due to the patient being afraid to ask a question about their condition is unacceptable. Clear, precise language that helps the patient understand exactly what is going on in their body, while taking into consideration the patient’s understanding and educational level. Metaphors that don’t cause negative emotional reactions can be helpful, too – as the car alarm analogy that is used to explain chronic pain situations (Neuroscience Pain Education). Healthcare professionals should seek to find and use words that will boost a patient’s self-confidence in their ability to control their situation and to inspire hope for recovery or rehabilitation.

As a physical therapist, I hope to never lose the humility that allows me to talk to a patient on their level. I hope to be able to always inspire patients to take control of their situations (within their means) and to be able to manage their symptoms without dependence on me. I hope to never get caught up on medical jargon that evokes fear in my patients, and instead build a trusting relationship where all questions can be asked and answered comfortably.

Bedell, S., Graboys, T., Bedell, E., Lown, B. Words that Harm, Words that Heal. Archive of Internal Medicine, 2004; 164:1365-1368.

Louw, A., Zimney, K., O’Hotto, C., Hilton, S. The clinical application of teaching people about pain. Physiotherapy Theory and Practice, 2016. http://dx.doi.org/10.1080/09593985.2016.1194652

Dr. Tristan Faile, PT, DPT
tristan@vertexpt.com

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Concussion Nutrition (Part 2)

Patients with concussions or Mild traumatic brain injury often complain of stress and have been shown to possess higher plasma cortisol levels. Vitamin C supplementation has been shown to decrease cortisol which is commonly known as the “stress hormone”. A 1500mg daily dose of oral Vitamin C may decrease the production of the the adrenal hormones, cortisol and adrenaline, which are immunosuppressive at high levels.

Be sure to consult with your physician before taking dietary supplements.

Peters, E. M., Anderson, R., Nieman, D. C., Fickle, H., & Jogessar, V. (2001). Vitamin C supplementation attenuates the increases in circulating cortisol, adrenaline and anti-inflammatory polypeptides following ultramarathon running. International journal of sports medicine, 22(07), 537-543.

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Electrical Dry Needling for Plantar Fasciitis

This is a quick video of a runner who was experiencing an acute bout of plantar fasciitis.  This treatment was successful when combined with joint and soft tissue mobility, as well as heavy slow resistance.

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