Columbia Advanced Chiropractic, LLC
I got the idea for this blog when one of my patients told me that he had just had his physical and the doctor said he was very healthy. He was very happy about this.
I told him this was great and then I started thinking to myself…how does the doctor know that he is healthy? He had no complaints? His heart rate was good? His blood work did not show any off the chart numbers? He told the doctor he felt good? How did his doctor know that he was healthy, really?
April 19th and 20th are the dates for the Mid-Atlantic CrossFit Challenge. Luke Espe, owner of Syndicate CrossFit, is hosting this event. It will have over 600 competitors, making it one of the biggest CrossFit events on the East Coast. Dr. Manison will be there with a group of hand-picked healthcare providers to help with care for the athletes.
I have to admit that I am quite fond of Dr. Andrew Weil…well, at least, usually. He is generally holistic with his approach but there are times when I read his articles and scratch my head. Is he actually writing his pieces or is not reviewing them? He has written several articles about antioxidants and he does reiterate certain points. This is both a good and bad thing. One such article on antioxidants that has thrown me for a loop makes me think he is either confused, or is trying to confuse us. Here is the URL for the article… http://www.drweil.com/drw/u/ART03370/Antioxidants.html
A few points in this article actually caught my attention.
When assessing a patient who presents with lower extremity pathology, we tend to get fixated on the chief complaint. A person complains of knee pain, and we look at the knee…they have right calf pain, we look at the calf. A hip is tight/sore, we look at the hip.
The longer I practice and the more well-versed I get with movement assessments, a certain pattern of dysfunction seems to dominate over others. Now, we know that no one condition is an absolute, but this one does play in significantly, and it will throw off your entire movement.
Elise Sole’s piece in Healthy Living on April 8, 2013 about ‘The Paleo Diet, Debunked’ is an interesting attack on a rather healthy lifestyle. In fact, I’m not convinced she even understands what ‘debunk’ means. What is she debunking…what claims does she think those on the Paleo diet make? It always seems that people on the outside of something find it easy to attack that which they truly do not understand. By definition, ‘debunk’ means to expose the falseness or hollowness of a myth, idea, or belief. Okay, uh, what is false or hollow about the Paleo diet’s insistence on eating naturally and avoiding processed foods?…
In part II of Mr. Stoddard’s assessment of Crossfit, ‘Inside the Cult of Crossfit’, we will address the final 3 points of my critique of his assessment.
These final three topics are:
3. Concern for injury
4. Pukie the clown?
5. The problem with group workouts
Before I begin with the final three topics, I do want to add just a bit more about our discussion regarding intensity. Mr Stoddard appears to think that outside appearance determines the health of an individual. He goes as far as saying that ‘If Glassman’s brand of functional fitness produces better aesthetic results than the traditional approach does, why did the gelatinous bodies at my gym often outperform those who appeared to be in better shape?’
I don’t know what to say about this other than to say that Mr. Stoddard appears intent on offending those who don’t have I guess what he would consider to be an ideal physique. My response is to question why he even goes there? Why does someone have to have a six-pack to be fit, lift heavy weights, etc..? Does ‘looking fit’ make you more fit? I think not…just something to think about…
Okay, onto our last 3 topics…
3. Concern for Injury. I could go in 100 different directions with this topic, but I don’t think anyone wants to read that much! I would like to say that any workout program has its inherent risks. The bottom line is that a person who is ‘training’ another needs to have optimal training in anatomy, kinesiology, biomechanics, and injury prevention. I work with trainers certified by most all of the licensing boards in the country…these include the likes of ACE, AFAA, NSCA, NASM, and more. I can attest to the fact that many personal trainers, who are likely implementing programs that Mr. Stoddard would find to be acceptable, are at the same (and in many times likely greater) risk of injuring their clients. Until personal training certifications from all agencies are governed by essentially university standards, this field will have significant shortcomings.
Mr. Stoddard quotes Pr. Stuart McGill, who I consider to be the top spinal bio-mechanist in the world. I do correspond with him from time to time myself. Pr. McGill voices his concern about complex movements that go to failure. He includes Olympic Lifts in this category and I cannot refute this. The Professor has been published over 145 times! The risk for injury is greater with exercises that require weighted ballistic movements and a high level of core stability. It does make sense that as fatigue sets in, loss of proper form can lead to a greater risk of injury. This topic does not apply solely to CrossFitters.
I do question if these above mentioned activities are any worse than a personal trainer or ‘coach’ in the gym teaching someone how to squat with the butt coming out, dead-lifting with straightening the legs first (effectively lifting with the back) and hyper-extending at the midpoint of the movement (OUCH!), or showing someone middle deltoid raises in the coronal plane (for dozens of reps)? How about trainers who supervise high school kids with power movements with weight far greater than they should be doing? It’s true…in high school gyms across the country, students are being improperly trained and injured by less than properly educated coaching staffs. They are not CrossFitters.
I can say from clinical experience that any gym exercise, if performed incorrectly, can create injury. This is where instruction comes in. I think the clients who work out at the CrossFit facilities I work with have the benefit of instructors who make ‘proper form’ a high priority. As I mentioned in Part I, many CrossFit facilities have specific strength classes, which differ from the CrossFit classes. Those who wish to work on strength can do so in a more traditional setting. Mr. Stoddard might not have been aware of this as the facility he was at might not have been the best representation of CrossFit.
Mr. Stoddard goes on to discuss Rhabdomyolysis, a condition for this discussion that is created basically by over-training. This condition can be seen in any activity that incorporates high levels of exertion under load without adequate rest. It is nothing that anyone should try to achieve, be it in CrossFit or not. It is also not unique to CrossFit. All CrossFit staff should be educated about the signs and symptoms of Rhabdomyolysis, as it can be a life threatening condition. For that matter, trainers in any sport should be aware of the signs and symptoms of this condition. It would be a good idea for the intensity of CrossFit workouts to be increased over time so that each new Crossfitter can get used to the workout format. Just as if I put on pads and a helmet and went through a tough outdoor summer football clinic day after day without ever doing so before, too many intense workouts of any kind over a short period of time can have deleterious effects.
4. Pukie The Clown? In the 3+ years I have been working closely with CrossFitters, I have never seen or heard any mention of Pukie. Mr. Stoddard discusses Pukie as being almost the mascot for the rough and tough CrossFit workouts, claiming that CrossFit embraces hard-core workout practices that essentially allows for looking down on those who are too weak to get through workouts. Again, did I mention that I have never had any CrossFitter (facility owners included) ever even mention this funny/sick character. I was able to find an article in 2005 with Pukie in it when corporate CrossFit put out a piece on Rhabdomyolysis, but I can honestly say that the dangerous, meat-head mentality does not exist with the facilities I work with. Please keep this in mind if you are new to CrossFit or are thinking of starting up as each facility is unique and it would behoove you to find a CrossFit facility where proper form and movement patterns are important in the education process.
5. The Problem With Group Workouts Mr. Stoddard admits to not having a competitive mindset. So be it. There are pros and cons to group workouts and CrossFit facilities act almost as a community. I have never seen a fitness facility before where people not only work out together, but also care about one another and many times, socialize together. Being Mr. Stoddard stated that he has apparently become a misanthrope, I guess any class program would be an issue for him. A CrossFit facility tends to be the place where you can leave your wallet and keys out in the open and nobody will take them. There tend not to be thousands of members at any given CrossFit facility and one of the benefits of this is that the environment is very safe and friendly. (On that note, I would never leave my things laying around in a large gym setting where I don’t know anyone). As far as Mr. Stoddard becoming an misanthrope, that’s fine…to each their own.
Mr. Stoddard’s defining CrossFit as a cult, multi-level marketing, and any other negative thing he can think of simply goes too far. I do not see the harm in groups of people pushing themselves with tough workouts…for the record though, I do not believe in beating your body to a point where it can no longer function. (Instruction, instruction, instruction!!) Mr. Stoddard should have gone to several other CrossFit gyms to see the differences between them before coming out with such a strong stance against CrossFit as a whole. His slanted piece serves no other function than to scare people and give out misinformation. His article would have had much more credibility had he dug deeper and discovered more about CrossFit as opposed to just blanketing CrossFit as a whole with his single experience (N=1). I understand he was humiliated by a dozen women in a class…get over it.
He concludes with a story about a woman asking him if he goes anymore…well, we know the answer to that…guess he’s not part of what he calls the ‘cult’ anymore and is enjoying Zumba somewhere…well, maybe not…Zumba is too much movement for an hour straight, right?
On February 7, 2012, Grant Stoddard wrote a rather critical assessment of CrossFit (on Yahoo Health and licensed by Men’s Health). Although I understand his concerns, I think a lot of what he wrote about generalizes CrossFit too much and does not present a fair representation of what CrossFit is all about!
As a sports medicine doctor, I have the pleasure of working closely with 3 area CrossFit facilities. Each is run by highly motivated, intelligent, and hard working individuals who pride themselves on proper form and technique. I have a lot of experience dealing with CrossFitters and as an educator of Fitness Professionals, I feel as though I can comment better than most on many of the aspects of different types of fitness.
Dr. Manison was published in the Journal of Chiropractic Medicine (JCM), one of the two medically indexed chiropractic journals. This is a huge accomplishment and he is very excited about this. Writing the paper and going through the editing process took about 100 hours of time. It was a very tough and humbling experience, and he is very happy with the end result.
Most clinicians, or field doctors, do not have the time or skill to write a paper for medical publication. Dr. Manison feels that it is important to continue to work hard to be the best doctor he can be as well as give back to the field. If there are no studies on the successes of chiropractic, it is hard to justify the care. The more those in the chiropractic field publish the good work we do, the better.
Dr. Manison would like to thank his wife and editor extraordinaire, Jennifer Hepps, MD, for her help with the paper. Dr. Hepps is very accomplished in her field and her insight and direction were critical to the success of his paper. When they say behind every man there is a great woman, this is truly the case!
We would include the entire study here but are not allowed to do so…however, please click the link below to view the abstract.
If you’re interested in a shoe to help you with toning up and you’re considering purchasing an expensive pair of one of those new and cool rounded shoes on the market, please read on.
Sketchers and MBT lead the way in this category with their ‘shaping’ shoes, or shoes that are supposed to help you tone up while you walk. In theory, this sounds great…work on an activity that should tone you up just by doing it, and tone up because of the footwear you choose versus the activity you are performing…and, of course, there is no downside??
MBT (and Sketchers similarly) has set out to copy the feel of walking on soft ground…and by making the ground feel as though it is not flat. In effect, the shoes try to create a feeling of instability. The makers say that by altering your gait and creating instability, your body will adapt by creating more stability. Really? Where does this come from?
The little video on the MBT website shows a depiction of someone wearing their shoes and walking upright, while those of us who do not wear their footwear lean forward (of course, there is a disclaimer that says results will vary). I don’t know where to start with criticism of this as I could go on for pages, so I’ll keep it simple by saying that there is a lot more to gait than simply what you wear on your feet. There is no hard science that has shown that wearing a rounded shoe makes you walk upright while the rest of humankind is hunched over simply due to a traditional shoe…for that matter, I’ll argue that such shoes are NOT good for you. Here are just a few of the reasons…
1. Gait begins with heel strike, proceeds to mid-foot loading, and ends with toe off (Windlass Effect of Hicks that involves the Great Toe). The idea of a shoe creating instability while you walk in no way contributes to helping to ensure that your gait cycle is correct. In fact, the compensation that they are looking for may just be that…compensation…meaning, you are not functioning properly and your body will do whatever it can to just simply function…does this sound beneficial?
2. The primary shock absorber of the body is foot pronation, followed by unlocking of the knee. With these shoes, the emphasis is not on the PROPER biomechanics of the foot, but rather on the instability notion…do your feet properly pronate with these shoes or do you just quickly roll over the mid-stance phase? (more likely the latter)
3. About that instability…most of us cannot even balance on one foot on a stable surface. Why would we want to use a shoe that effectively stresses out our body and may actually NOT help build stability, but lead to injury. I wouldn’t take a patient who is rehabilitating from pain and dysfunction due to a two level disc herniation and start them with core balance work on a bosu ball. This simply wouldn’t make sense and further injury would likely occur. They would start with level one exercises and proceed from there. With these shoes, I cannot figure out why creating instability is the goal…just because you create instabiliy does not mean the body will appropriately adapt by becoming stable. The end doesn’t justify the means.
4. Who thinks the foot ‘rolls’ when you walk? I’ve never seen anything that says this. If you accelerate the foot though the gait cycle in a fashion that it is not supposed to, you will likely create more harm than good. The foot is made to strike the ground in a particular fashion, load in a certain manner, and come off the ground in a very specific way. Failue to do this will lead to injury. With these shoes, you are likely bypassing critical cycles of gait that are there so that you absorb impact properly. It is not a good idea to alter the gait cycle.
The list goes on…
The bottom line is that any footwear should be geared toward allowing your foot to work as it is programmed to do. Those who have excessive pronation or supination should have functional orthotics to help with restoring proper gait mechanics (as much as possible). The notion that these shoes help to tone you more than just being active has no merit. Period! If you feel your calves more when you walk with these shoes, it’s because you are altering your gait…and this is something you really don’t want to do.
Putting celebrity names, like Kim Kardashian and Joe Montana, on ads and in commercials does not a good product make. We’re dealing with force transmissions through the body that can lead to potential injury all the way up your legs and into your spine. If you want to get toned up…exercise…don’t look for a shoe without hard science to do the work for you…it’s likley not worth the injury risk.
