Gout – my personal journey

This is bot a typical blogpost. This is about my personal suffering and pain (which is nothing in the big scheme of things). If you don’t want to read it, I don’t mind. I think part of me is writing this because I feel miserable right now.

It is 3am in the morning. I am in LA, here for the CrossFit games as a physiotherapist in support of Aussie athletes and to watch this awesome spectacle. I am also currently lying here awake because my foot feels like someone has a knife in it and it is sore just lying here doing nothing. I don’t even have to move and it is sore.

But let me start at the beginning.

Gout is simply an inflammatory arthritis – Uric acid crystals form because it precipitates from the blood into my tissues. When it gets into the joints, those crystals cause pain and inflammation due to the immune response to deal with them. Now, I might be technically wrong here but that is how the doctor explained it to me.

Genetically, I have high Uric acid levels. That is against me. Secondly, the breakdown of purines produces Uric acid. That is basically eating meat :/

Now none of this is usually too much of a problem because you can take allopurinol and control the Uric acid levels…to a degree.

You see, it is the flow of Uric acid in or out (the gradient) that can cause the immune reaction and subsequent pain.

So, diet-wise I have tried all sorts of things but I am fat/overweight/obese. It is what it is. I am not being dramatic. I should be about 105kg (about 93kg lean body mass which I currently am and 12-15% fat…I would look like a weapon! Hahaha. But I am not. I am 120kg at the moment. I eat poorly because of laziness but there has been A LOT of negative reinforcement.

You see, I can eat junk food every day and I might ache a bit from the gout here or there but I am like an addict – I really can’t find an in-between level of junk food. It is either clean or I start to slip back into bad eating.

Don’t get me wrong, I am not blaming gout for my poor self discipline.

But since I was a kid, I have loved junk food. That is typical and normal. My parents fed me well and we had junk good for a treat. That is also normal. I was the stereotypical skinny Asian-looking kid. I didn’t become bigger and taller until later. Then, I started eating a lot of junk food. Too much. And I began to put on too much weight.

But here is the thing, I can lose weight. I know how to. I can eat well. I know how to. I have lost 30kg before by doing the old weight watchers point system on my own at home (never been to a meeting). I was as weak as piss and couldn’t do a bench press for 8reps at anything more than the 20kg bar. I was a cardio guy. I weighed 82kg and could 3 les mills classes back to back – body attack, body pump and body combat. No problem.

Even then, at my healthiest, I had Uric acid kidney stones. I had gout attacks.

Eventually, I put weight back on again because, remember, with me, it is all or nothing. I slowly put that weight back on just by starting with a can of drink here or a bit of chips there.

But my gout felt better.

And then the cycle continued. I would lose weight (I did vision PT) – I lost 15kg in 12 weeks but again, I would ache or get gout eating clean. And then I would fall off the wagon and I would feel better.

So then I started CrossFit. There was The Zone but lots of my friends were doing paleo. I lost 18kg in the first few months of CrossFit and maintained between 103-105 for over a year. But I would get gout attacks in my feet, toes, knees, hands. I was eating paleo but then wouldn’t but then get back on the wagon again. It got to a point where I was suffering gout in one joint or another for months on end with only a week or so relief from the pain. I swear I think my coach thought I was lazy or something. It really interrupted my training.

Eventually a doctor who I was observing operate sat me down and set me straight about taking the meds and pushing ahead with eating better. I did and I was pretty good for a while but I wasn’t eating clean. So I was still putting on weight. I was pretty proud of my 19:28mins in the CrossFit open wod 14.5 (thrusters and bar over bar-over-burpees). That was just below the average score of 19:30mins. I know fitter people than me who took longer than that! But do you know how hard it is to drag this rig up and down off the ground?

So those who saw me when I first started CrossFit will have seen me go from being pretty weak (80kg Deadlift was my first 1RM test) to being pretty strong for an average person but still slow…but getting stronger. I am currently 120kg and the strongest I have ever been but I have been eating poorly since a trip to the USA last sept/oct. Trying to come clean from that has been a nightmare.

Every time I try to go clean, BOOM! Gout attack. People have tried to help. But the bottom line is that every time I go clean, I get an attack.

Imagine every time you walk through a certain door, you get knifed in the body somewhere. That is basically what happens. I then use THAT as an excuse to continue to eat poorly because when I eat clean, I get headaches, I get gout, I feel lousy. If I keep eating the chemical shitstorm that is junk food, I actually feel RELATIVELY better.

I know that if I can just weather the storm, I can train better and continue to eat better. I can lose the fat and improve the fitness. But it seriously takes over a month or more of pain and I am not sure I had the will or the self discipline to do that.

It is embarrassing to be this weight.

I love my CrossFit. I love workouts. I want to run and do burpees and lift weights fast and quick and many times and I want more pull-ups and my first muscle up. I don’t want took at photos and think that I should be fitter than I am. I have never been stronger than I am now. Ever. But they are “dirty gainz”. I don’t talk too much about it. I laugh about the fact I am built to lift and not run but secretly, I want to run and be that cardio guy again but with muscles and strength.

So, in the land of California, I thought I would come over and because I have a different routine, I will eat cleaner. And I have. Compared to what I normally eat, I am doing pretty well.

And now I lie here with what feels like a knife through my foot. It is now 4am and I resorted to taking prednisone before I wrote this blog because I am here to work and help people. And I am. But prednisone comes with side effects – insomnia (brilliant! Perfect with the jet lag I was just getting over :/), increased appetite and weight gain through bloating and too much food.

So I am going to try to stay clean. I know what will help…eating dirty again will help. It will tip those scales back to slowly increasing my blood concentration of Uric acid and the gradient between my blood levels and in the joints won’t be so bad and I won’t have such a bad reaction.

Iif I can’t walk, I can’t get around. I know what this week involves and it involves a lot of running around and stairs and walking to and from car parks and working on my athletes – all of which is fine, except when every step is painful.

So if you see me eating dirty, please understand that my life in the short term is just simpler that way. I know that if I have junk food for the next 3 days, I will be right. If I keep eating clean, I will be in pain and it won’t let up. But junk food and prednisone is up to a 5kg gain almost in a week! Eating carbs and fried food helps my neck pain and headaches. I am a better Physio when I eat carbs, fat and meat but carbs and fat together, especially the junk food that works best, is not good for you…it seems the pro-inflammatory things I like to consume such as sugar and grains, are the very things that make me feel better.

So there you have it. Why do fat, overweight people who have gout keep doing the things that make them fat and overweight? I suspect for some, it is just like my story. Because I don’t feel as bad as when I eat clean.

I am going to try weather the storm. I am going to see if I can put up with the pain. This is the better way, just a REALLY PAINFUL way.

If you have read this far, thank you. I hope one day I can write a story about how I am 12-15% fat, no gout symptoms and still strong.

The meds are kicking in…the pain is easing. It is 4.30am. It still hurts. So what? I will push on.

Why 99% of people misunderstand “Stability” – are you one of them?

Stability. It could be that you lack it. I am sure you have been told you don’t have it at some stage of your life. Maybe you don’t have a good “core”. Or maybe you need better “midline stabilization”.

I began my Physiotherapy career right when Paul Hodges et al were writing about this thin muscle called transverse abdominis. I hadn’t heard of this stability mechanism before then but there it was. Then “core stability” took off, Swiss ball training became all the rage, Pilates became popular and modified by physios and the rest is history.

I also witnessed a lot of the pelvic floor changes to exercise and have been able to watch the development of pelvic floor training and different approaches…

…and then the integration of the pelvic floor into the “core”…

…and then watching the slow train wreck that became “core stability” as different professions got a hold of the idea and basically bastardize it…along with some researchers who didn’t help.

For the past 20 years, I have been training all sorts of patients, from Olympians and Paralympians, all the way through to beginners and children. I have treated world champions in different types sports and been able to improve their performance and pain. I have trained people using gym based exercises, weights, body weight programs, Pilates, Swiss balls and all sorts of devices and gadgets. I have been around the block a few times now.

All of this introduction is to say that I have a fair idea how to improve stability in my patients…and I believe that so many people have the WRONG idea about stability – even physios, doctors, chiros, osteos etc etc.

The common belief is that “the core” is all important but really, you have local stabilization muscles at every joint. They all work to prevent shearing and excessive motion in the joints.

The local muscle system provides the firm foundation for the big force/torque producing muscles to generate their force (torque is simply force x radius).

Let’s take 3 common examples – the “core”, the shoulder and the hip.

The core is defined as the diaphragm, the pelvic floor, transversus abdominis and lumbar multifidus. It is promosies that they work together to maintain lumbopelvic stability. But now every other muscle is being included – abs (obliques and rectus abdominis), lats, glutes, erector spinae etc etc. But these other muscles don’t stabilize. They may hold position but the control of shear and segmental stabilization is the work of the 4 core muscles.

In the shoulder, we have all heard of the rotator cuff but why don’t people claim the lats, teres major, pecs and deltoids as stability muscles? We seem to understand how the shoulder stability at the glenohumeral joints work…maybe not the scapulothoracic stability though 😕

In the hips, we go back to being bipolar again. The hip “cuff muscles” get augmented with glutes but the TFL is a problem muscle even though it is similar to glute medius. We claim glute Maximus as a stabiliser but not the quads or even just rectus femoris. We claim psoas as a back AND hip stabilizer but piriformis is a problem muscle.

It is all so confusing isn’t it?

And here is why…

…stability is NOT a rating of 0-10 where 0 is no stability and 10 is the most stable it can be. This is WRONG! If you can understand how this works, you will realise how screwed up the subliminal education, the beliefs of your teachers and coaches and the whole fitness industry in general is screwed up. I call this strategy “Harder-er is better-er!” (…I deliberately want to make it sound stupid!)

You see, people (probably you), think that stability is like this. You think that if activating the glutes a bit makes me stable, then activating the glutes MORE will make me MORE stable! And I can understand this. We are used to working hard for our gains. We believe that in life, you get what you put into it. We want a good meritocracy where hard work is rewarded. We ridicule those who don’t work as hard in the hope they will work “harder”.

All of your cues that have been taught to you have been like “knees out”, “shoulders down and back”, “back straight and chest up” etc etc. The problem with these cues are that if you haven’t been coached about them, you can end up “overcooking” the cues and end up with your knees too wide out past your feet and ankles (this Diane Fu photo of squats).

Stability is much more like a target. A range to hit. It requires the Goldilocks principle – not too little and not too much…just the right amount of stability at just the right time and with just the right amount of force.

Rather than stability being a scale of 0-10, think of it as being a scale from -5 to +5. You are trying to get the right amount of force happening. Too little and it won’t stabilize you. Too much and you will be overly compressed and unable to adapt to changes in loading requirements at all your joints.

Touch your nose. Your brain sorted it all out. You don’t have to think about contracting ANYTHING because your brain has got all that figured out for you! You don’t think of every muscle, every joint, how many degrees each joint has to move nor the ability to change the angles and adapt to load differences…you just think “touch your nose” and it happens!

Try this one. Get a dumbbell that is 5-10kg. Front raise it (straight arm forward flexion to 90deg). Now context your glutes as hard as you can, or tense your core, or put your shoulders down and back, or turn on your pelvic floor, or do whatever thing you want to test as a stability cue and front raise that dumbbell. If the cue is helpful, it will feel lighter. If it feels heavier, your AUTOMATIC strategy is BETTER than contracting the muscles. If it feels the same, it isn’t helping…you don’t necessarily need to do it!

I genuinely feel that this misconception about stability is rife. I know you are sitting there reading this going “duh, that’s pretty bloody obvious”…but then why do I have to retrain coaches, elite athletes, amateur athletes and basically everyone every day about this? Why is it that people tell me they understand stability the way I talk about it and want it but then when I watch them do the exercises, I have to sort out all the erroneous stability strategies they have.

This is part of the reason why I have been talking about matching the tension to the task (#tensiontotask) and relaxing before movement…I test to see if the brain can sort this out BEFORE I give you a cue to do!

If you disagree with me, let discuss it. I am keen to learn more and love a good debate!

Summary: Harder-er is NOT better-er!” Stability is a target to achieve with the Goldilocks principle – not too little and not too much…it has to be JUST RIGHT!

When is a muscle REALLY weak? #Physiorant

It’s been a while – sorry – big plans with seminars and mentoring so I apologise…but I had to wrote about something today because I am fed up with this problem. If i had hair, it would be pulled out by now!!

Just because a clinical/muscle test shows something is “weak” doesn’t mean that it really is weak…

e.g. a glute can test weak on hip extension isometric muscle testing in different positions…fine. but if I ask the patient to think about something different or a different cue, and THEN the muscle tests normally or performs better, is it REALLY weak?

Far too often I hear my patients tell me they have a weak this or a tight that…it might FEEL weak, it might LOOK underactive, it might PERFORM weakly, but it might actually be because you have poor coordination!

This is not an easy concept for some health professionals, fitness professionals and the public to understand…I know that…so I will say it again S L O W L Y

Just because a test result is poor DOES NOT MEAN your muscles are weak.

For example, I had a guy who can squat 150+kg tell me he has weak glutes. Wha!!?? he had a rounded bum. He had obvious tone in the muscles. He can squat and deadlift. He can do weighted lunges and step ups…but someone told him he has weak glutes. So he showed me how his one leg bridge was “weak”…I then showed him how to set his hip a bit differently (less than 1mm I suspect) and suddenly he is busting out reps with ease and no more hip flexor pain (which is what he came to see me for).

So, did his poorly performing glutes suddenly improve their neuromuscular capability? Did they suddenly grow more muscle fibres and got stronger? Did I magically release something that was preventing them from working properly?

No!!!

All I did was help him place the hip differently in the socket and let the brain sort the rest out.

If he was truly WEAK, then no matter what I do, he would test positive for weakness…and I do a LOT of things to exclude other causes for a poorly performed test – pain, nerve irritation or compression, referred pain, poor coordination etc.

The truly hard part of my job is breaking into YOUR BRAIN. I have to quickly figure out how you think and work (your conscious self) AND how your brain (your unconscious self) thinks and works and get both to do what I want to improve your performance…but that is where the fun is!!

So next time someone does a test on you and tells you that you have a weak Glute or some other muscle, DO NOT BELIEVE IT unless many other options have been tried!

#rantover – thank you!

 

How Deep Should I Squat – To 90 degrees For Safety? [Rant Warning!]

quarter squatOK, I don’t often rant online…but I have to on this one. The pictures/memes I have posted should give you an idea of where I sit on this topic – to squat to 90deg or lower?

Too many patients get told not to squat past 90 degrees knee bend. This is supposedly to save their knees from the horrors of arthritis and strengthen their knees…

…OH…MY…LORD…Spare me!

 

 

 

 

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CrossFit Open Workout 14.5 – Tips and Suggestions

Well, burpees and thrusters were left on the list and that is what we got…with spice! You won’t be saved by the clock…you will either finish or you will quit/scale the workout.

This blogpost will attempt to help you warm-up, consider some strategies for the workout and how to recover.

It seems so simple but for many of us plebs, this workout will be like a chipper…

Here are some earlier blogposts I wrote on Burpees and Thrusters.

Burpees

Thrusters

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CrossFit Open 14.4 – Tips and Suggestions

A chipper! I love chippers. not because I am good at them but because there is work to be done. I might keep going until I get to muscle ups, even if the time cap elapses, just to finish the cleans!

Here are my suggestions including recovery from 14.3. I have also included links to the movements I have written about in the past.

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CrossFit Open WOD 14.3 – Tips and Suggestions

20140209-215525.jpgSo finally the heaviest weights ever come out! This is going to jack your back and it is going to test your mental fortitude. This is one that you don’t want to have to do again. Please be careful out there!

Why don’t you subscribe by email for more tips?

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So You Wanna Get To Regionals? Let’s Think About That For A Sec. A Guest Blog By Brent Fikowski and Antony Lo

Wanna get to The CrossFit Games Regionals? Let’s think about that for a sec… Written by Brent Fikowski…with some editing and opinion from Antony Lo at the end.

It is my pleasure to have Brent Fikowski guest write this blog about making it to Regionals. in case you don’t know, Brent came in 6th in the Australian Regionals with only 3 points between him and 4th placed Matt Healey. He is now competing in Canada West and killed 14.1 with a score of 443…

What Brent wrote:

Trying to make it to Regionals? How many people have you heard say “I think I’ve got a shot this year” or “I’m training for Regionals”? I know I have heard everyone and their uncle tell me this. Do some have a shot? Absolutely! But some are being unrealistic.

Lets go over some things you need to realize before you make this lofty goal.

  1. Every year it gets more and more competitive. If you have been doing CrossFit for a while and you haven’t made it yet, you need to have made some VERY large improvements in the last 12 months. Or if you are new you need to have a background in power/endurance/strength and have learned all the skills quickly.
  2. Last year the 48th placed individual male in Australia finished with 372 points. So on average he placed 74th in all the WODs. Now compare your previous Open scores to the 74th rank score. How close were you? Which one were you the farthest off and why? Are these weaknesses gone?
  3. Still think you have a shot? Pick your two worst movements and decide whether you prefer short or long WODs. Put those two movements together in your least ideal WOD length. How well would you place in that WOD against the best in your region? Or make the same comparison but with your ‘perfect’ WOD. Would you rank in the top 74 with your performance? Remember these are Open-Style AMRAPs, 4-17min long with repeating movements, standard equipment, easily judged.
  4. STOP FOCUSING ON YOUR 1RMS! Quit comparing your strength numbers to Games athletes. You need to spend your training time becoming better for The Open. If you can’t do 50 unbroken double unders because you have spent every extra minute this year increasing your PRs by 5kg, you probably failed miserably at 14.1. When you qualify for Regionals, focus on becoming stronger so you can be more successful at that level. Until then become good at Open workouts. Do lots of wall balls, burpees, and high repetition barbell movements with medium weight.
  5. 48 individual athletes qualify each year… but realistically how many spots are there available? -In each region there are probably 10-20 individuals that are a LOCK into Regionals. The top athletes. The athletes that have been to the Games, the athletes that have been to Regionals three years in a row. The ones who were in the top 10 last year. The ones sponsored by some brand. Make no mistake, they WILL qualify. -Then there are the other 28-38 athletes that qualified last year to Regionals. They made it last year, they know what it takes to get there, and they have been training to try and get there again. -After that you have 20-30 athletes or more that have made Regionals in previous years. Maybe they were out due to injury, a new life commitment, or they ranked a few places too low last year. But they are training hard all year, and are ready. -Don’t forget the individuals that have never made it, but have been very close to qualifying. Maybe they would have made it last year if their muscle-ups were more efficient, or their overhead strength was better. They’ve worked all year and you can bet those weaknesses are but a memory now.
  6. Lastly there are all the unknown newbies! Every year there will always be a new face at Regionals. This is one reason why The Games process is so exciting. -So be honest with yourself, where do you fit in? Can you beat enough of those other athletes to steal one of those 48 spots? Because you do not have to ‘qualify’ in the top 48, you have to beat out the rest to get there.

This is not meant to discourage but rather to give you a realistic look at what lies ahead so you can enjoy the most exciting time of the year as a CrossFiter. Stop staying up late ‘Leaderboarding’ and just enjoy exercising with your friends. Getting upset after the 3rd week because you are 200th is not where you want to be right? All you can do is give 100% in the Open WODs. That is it. In an interview with Chad Mackay at Regionals 2013 they asked him about what his goals were halfway through the weekend. Did he say win? Got back to the Games? No, he said he was just trying to give his best every WOD.

Brent Fikowski

What Antony thinks:

I back Brent 100% on these points. What I would like to add are the following points as a PT who specializes in improving the performance of CrossFitters from Games-Level Athletes to the newbie…

  1. Technique, technique, technique. I simply cannot stress this enough! I have seen seriously good competitors (Games Level Athletes) improve simply because I corrected their movement a little or gave a different cue. These little things might be awkward to start with but they are for training…if you train to move well, you will move well during competition time. Far too many people trying to break into Regionals push themselves to go harder and faster and rarely consider that they need to back off the weight and intensity and fix their form issues. When you get your house in order, your performance will soar!
  2. Stop wasting time on routines that can take an hour to get through because you are “prehabbing” this and “rehabbing” that. In my experience, I can usually cut down your accessory work and “mobility” work down to about 15-30mins per day. When you combine that focused, mindful training, that is what will help you achieve high-level performances. You need to see someone who can pull all the threads together and consdense your warm-up, rehab, prehab and accessory work into a tight, focused program. If you can’t find someone, ask me…I now do Skype consults!

Let us know what you think. Brent and I are happy to take any questions or comments you have.

CrossFit Open WOD 14.2 – Tips To Help You

Kat OHS

Kat Dalecki coming out of a 75kg Overhead Squat

Well, that escalated quickly…

Dave Castro has thrown in some advanced moves fairly early on in this CrossFit Games Open – Double Unders were first on the menu and now Chest to Bar Pullups – typically they have been used to sort the wheat from the chaff in the back half of Open events in the past.

One downside is that people might feel discouraged that they can’t do that movement – they shouldn’t feel that way – you can still do the workout and scale it…take each Open WOD as a challenge to get better. Each of the past 2 Opens saw me achieve a new PB at something…have a go!

This blog will be broken into advice for those close to CTB pullups and for those who have CTB. If you are not even close to CTB pullups, that’s ok – get your 10 OHS and then scale and work on your pullups.

For my previous advice on OHS and CTB Pullups, read by clicking on the links below…

Overhead Squat Advice

CTB Pullups

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Does CrossFit Have a Hole In It’s Typical Movements?

I have been doing CrossFit for just over 2 years now…and I am loving it. But I have some questions that I am genuinely interested in getting answers for…they relate to movement in 3 dimensions.

Typically, a CrossFit Workout of the day (WOD) require us to many different things – in fact, it could be argued that any movement is fair game to be included in CrossFit. I am OK with that. However, we certainly do a LOT of sagittal plane motion, not much rotation (transverse plane motion) or side bending (coronal plane motion).

Let’s back up a second here and define what those movements are:

  1. Sagittal plane motion is basically if  bent forwards and backwards…or running forwards in a straight line, toes to bar, sit ups, clean, etc etc. This is by far the most common plane of motion that CrossFit works in.
  2. Transverse plane motion is basically like discus throwing. You rotate around an axis that is like a spear through your spine. A roundhouse kick or punch, Swinging a sledgehammer sideways, Russian twists, etc are examples of transverse plane motion.
  3. Coronal plane motion is basically leaning side to side as if you were trapped between 2 planes of glass. Cartwheels, Side bending, and side planks are examples of movements and exercises that are in the coronal plane.

My question to everyone is this…what exercises can you do in CrossFit that are easily judged and can be practiced by everyone that include rotation and side-bending/lateral motion?

If we are to stay healthy, we need movement in all 3 planes. Lateral bar-over-burpees are a good exercise. Russian twists with a plate or ball have the complication of people with low back pain risking a flare up. You can do torture twists on the GHD or use a “Torsonator” but otherwise what else is there to do? The Double Banger event at the 2012 CrossFit Games was pure inspiration because I do wonder how many people program for rotational motion…and you can see on the videos that a lot of athletes just aren’t comfortable with twisting.

For coronal plane motion, there aren’t many things I can think of that fit sideways movements. You are string 2 ropes like in obstacle course racing and have them move across sideways. There are always the lateral jumps over broomsticks at 20″ or 24″ (let us pause a moment for all the broomsticks that have passed from this earth as a result of people landing on them…). Lateral bar-over burpees is another that can probably considered as combining coronal plane motion with sagittal plane motion. But what else is there left? Would a Kettlebell “windmill” pass the test? I guess “The Worm” could be classed as using some coronal plane motion – again, genius programming that showed up some athletes’ weaknesses…

All of these motions can be completed with a resistance band or Theraband. You can use a cable-cross machine at the globo gym to assist. You can pass medballs around to a partner but will we see anything like this in the CrossFit Games?

So, in my ignorance, please let me know what your favourite rotational and side-bending exercises are and whether these can be programmed into a CrossFit WOD or will they forever remain in the realms of “Accessory Work”?

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