1. Because I can! It is my blog
2. I tell this story so many times that it is time-efficient to write it down
3. I was inspired by this article to write it
4. I get asked by a lot of high school students about what they need to do to get into Physiotherapy at uni

What follows actually happened to the best of my memory

Let Me Set The Scene…

So, I am in year 11 at Trinity Grammar School in Summer Hill. I am in the 2nd of 3 maths classes doing 3 unit maths – the classes are arranged based on your ranking. I have Mr Mirrington – a good, funny teacher.

I had no excuses – good school, good teacher, supportive parents.

I was lazy. I did the bare minimum for homework to avoid getting into trouble (detention). I didn’t ask for help if I needed it. I was pure and simply lazy. I knew I was smart enough and I had gotten by before. Why would Yr11 be any different?

Well, I guess I should have gotten worried when I got into the 60-70% range…ah, just silly mistakes I said. By the end of the year, the proverbial hit the fan.

Failure

I got 27/50 (54%) – never before had I come so close to failing a maths or science subject.

It hurt. Badly. I felt sick in stomach. I started to doubt myself (those of you who know me personally know I don’t lack confidence!).

Getting Up Off The Canvas

Soon after that (early January), I decided I would need a new strategy. My final year of high school will not be a maths failure (I didn’t apply this logic to the rest of my studies until 6 weeks before the final HSC exam…dumb huh?)

Anyway, I decided that I would do every question in the book. Nick Tsai was a friend in the year above me who did 4Unit maths. We used to get to school early and I would read the papers and he would do his 4unit maths. I would do badly at a test and ask him what I should do…he said “do every question in the book”. I of course scoffed – why would I do that? That sounds like a lot of work!

I had my year 12 textbook for maths already (I actually don’t remember why – maybe I was supposed to do something over the holidays…yeah, right!). What is the first chapter you do in the first week back at school? That’s right, the revision chapter!

Back to School

So I thought “I will do every question in the revision chapter…and have a cruisy week”. And I did… and I did.

I went back to school and found myself dropped to the bottom class. Never happened to me before. It fired up my determination.

My teacher was Mr French – he was a nice guy. Passionate and fair. So I went up to him and I asked to make a deal with him. I proposed that I do every question in the book, I asked that he leave me alone and in return I would not disturb his class, I would work hard and I wanted to stay at least a week or two ahead of the class – so he would have to tell me what chapter we were doing after the one we were currently on. To his credit, he agreed to this on the proviso that my grades increase.

What Have I Become?

And thus began the great maths experiment. I asked my dad to take me into school early – like 7am – on his way to work. He agreed. I secretly kept a window unlocked in my maths room so I could climb in every day and do at least an hour of maths in the morning. If the windows got locked, I would find the Marshall who would let me in (we had a good understanding). I did every question of every section of every chapter (except one small subsection – more on that later).

Who would have believed it? It worked!

My marks crept up off the floor. It was slow but tracked consistently upwards. I was at ~42/50 by the mid years and 47/50 at the HSC trials. I was on track (in my mind) for a perfect score in 3 unit maths.

I was doing maths everywhere. Before school, in free periods, during English (I hated English – I got 67% without reading the novel or finishing the play – it wasn’t until after school I appreciated what they were trying to teach). I did my maths when I came home from school. I had become a perfect little Asian maths machine!

I simply tried to understand the examples in the textbook. What I didn’t understand, I asked Mr French. Then I did every question in that textbook.

You see, it takes failure or the prospect of failure to get my butt in gear sometimes. At my trial HSC, I got a total of 395/500 – 79%!! That was terrible for me. I hadn’t really been below 80% in general except for languages. And here I was staring down the barrel of what I considered failure.

(OK, I know that 79% is not the end of the world and there are plenty of people who would be happy with that mark but I was a high achiever…honestly, getting 1 wrong every 5 questions feels like failure)

So I had to then apply my maths discipline to my other subjects. I had carefully chosen my subjects to minimise the amount of study I had to do – typical! 3unit maths, 2unit related (advanced) English, 2unit physics, 2unit chemistry, 2unit computer studies, 1 unit general studies. The HSC takes your best 10 units to get your Tertiary Entrance Score (TES) – these names changed over the years but basically it is a rank based on the total student population in the state.

So in my mind, my subject choices simply meant that I had to understand the material, get it right and I would get good scores…problem was that I didn’t study enough – I was doing maths!!

So, 6 weeks before the final exams, I was hitting the books. I did every past paper available to me – from other schools, from the Board of Studies, from textbooks. I went through reams of paper.

The only subsection I did not study was some obscure polynomial section that I didn’t really understand and we never really got to in class. I had NEVER seen it in the previous 12 years of HSC papers. I was hitting near perfect scores in those trial papers. I decided to leave that subsection and focus on physics and chemistry as well. I didn’t have to study for computers or general studies. Computers came naturally to me (you should see the syllabus from back then – too simple!) and General Studies was basically current affairs and I could BS my way past 80%.

Results?

And of course, that was the worst decision of my maths comeback. A 6 mark question on that stupid subsection. I nearly cried. I reckon I nailed EVERY other question except that one. I only got 47/50 – I reckon those 6 marks were the only ones I lost

In the end, my best 10 units totaled something like 447/500 – 89.4%. I scraped into physiotherapy, relied on a good friend to supply me with notes and graduated with a Credit average. I righted the wrongs of my undergrad life during my masters and I can proudly report that I got a High Distinction average.

So what do you need to get into Physiotherapy…I tell all the students who ask me they need an average of 90% or more in their subjects…but now there is the back door entry of Exercise Sports Science and then a Graduate Entry Masters in Physiotherapy…a much longer but easier path.

Summary

So what is the moral of the story?

Do every question in the book. EVERY. SINGLE. ONE.

I tell students this and I recognise the “yeah, right” look they give me. Educators tell me that understanding is more important than volume. I think they don’t understand that once you have understanding, you have to hit the volume every day. It is the only way unless you are a genius.

My recommendation is that you do every question in the book. And once you have done that, do them again. And again. If something is so familiar that you can “do it in your sleep”, that is exactly the feeling you want when you open up an exam paper…isn’t it?

Thanks…

My thanks must go to Mr French who honoured our agreement. He only ever forgot once when the whole class was mucking up. I was working on my maths as usual and he got mad at me for not looking at the board…I didn’t protest. I just sat there until I could get back to what I was doing (which was next week’s topic). Thanks also to the teachers and the Marshall (Disciplinarian) who turned a blind eye to me breaking into different rooms to study And thanks to Nick who told me to do every question in the book…it took a while before I understood why, but I got there!

I would love to hear your stories of school and maths…leave a comment below!

GCS Athlete Kat Dalecki demonstrating strict Chest to Bar Pull Ups

The 2013 CrossFit Open is now finished. You may have made it to this next level…now it gets real! So how do you prepare for this event? Is this the main game for you or are you a serious contender for the Games?

Over the next 5 weeks, I intend on helping you prepare your body to be the best it can be for your next major competition…The CrossFit Regional Competition.

1. Goal Setting for your body

You and your coach should have your strength and conditioning program worked out – this is not my job. My job is to help you optimize your performance.

What is your mobility and stability like in the following joints?

• Feet and Ankles
• Knees
• Hips
• Low back
• Ribs (twisting)
• Shoulders
• Neck
• Elbows
• Hands and Wrists

In my experience, people are “tight” in their ankles, knees, hips, wrists and shoulders. They are TOO mobile in their low back and mid spine (snaking on your burpees and push ups!) and girls tend to be hypermobile in their elbows.

GCS Athlete Ev Dalecki demonstrating as close to perfect overhead squat position

Since most of you hold down regular jobs or study, you want to use your time efficiently so my recommendation for you is this.

1. Test and Restest your squats – air squat and overhead squat at the very least – note all the tension in all the areas
2. Release the back of your hips for 30-60secs
3. Retest your squats – what is the tension like now?
4. Release your ribs in sidelying over a roller for 30-60secs
5. Retest your squats – what is the tension like now?
6. Release your Abs using a kettlebell or spikey ball to mash those abs up for 30-60secs
7. Retest your squats – what is the tension like now?

GCS athlete Ev Dalecki demonstrating a perfect air-squat

You will notice you released hips then ribs then abs. Choose the release that seemed to give the BIGGEST change and note that for next time.

Next time (later that day or after the WOD or the next day), repeat the routine but start with the release that gave the biggest change last time…and release the hips last if it wasn’t the biggest change…so it would be abs, ribs, hips or ribs, abs, hips.

By now, you should have a good idea which combination of the 3 produces the best outcome for you – if none of them help, then let me know below and we can see what we can do…

Please note I have chosen the squat as the main exercise here. That is because so many movements that will come up for you in the regionals will rely on a good squat and hip mobility with back stability – cleans, snatch, all the squats, wall balls, thrusters, deadlifts, pistols, rowing, Kettlebells, etc.

GCS athlete Brendon Walsh using a foam roller for his ribs

The other key area are the shoulders – pulls ups, hand stand push ups/walks, muscle ups, all overhead bar and kettlebell work, etc. The sequence I suggest you try for the shoulders are: back of shoulder in the posterior capsule, pecs, ribs/lats in sidelying. It might also be your neck – if those 3 don’t make a big difference, then look to your neck. Choose something like an overhead squat or strict press or whatever movement annoys your shoulders.

3. If the above doesn’t work…

Ask your questions here and I will do my best to help you!

4. Book in to see me or your health professional

Sometimes you just need someone to take a look for you.

Why not come along to a mobility seminar and practice these things with expert guidance – www.mypteducation.com - if we don’t have one near you, contact me and we can arrange one at your box

To see me, you can contact me at www.myphysios.com.au or book online at http://clinicofficediary.co.uk/physiodetective.

Future Posts Will Include:

• Technique refinement – how to maximize your power through mobility and muscle activation
• How to cope with injuries
• How to recover optimally
• Anything else you want me to post on.

I would really love to hear from you about issues you are working through, questions you may have or topics you want to discuss. Post them below NOW!

Special Thanks: I would like to thank Ev, Kat and Brendon from Reebok CrossFit GCS. Darren Coughlan’s programming and attention to good form and technique have  made working at Reebok CrossFit GCS a pleasure. Details of the GCS program can be found at www.givemcoldsteel.com.

Sweat Angels – there will be lots of them!

Open Workout 13.5

Dave Castro promised blood, sweat and tears and he was right…the elite athletes will be doing it tough while most of us will have a nice 4mins AMRAP to complete…rewarded for your awesomeness by having more time to show how awesome you are!

This article will look at how to prepare for this workout to maximize your potential in this workout.

13.5 looks like this…

4 minute AMRAP of:
15 Thrusters (100 / 65 lbs)
15 Chest to bar Pull-ups
*4 minute bonus for every 90 reps (3 rounds) completed.

General comments:

• For the good to elite Crossfitters, the thrusters aren’t the major issue…getting the work done in the time allocated will be about how fast you can do Chest-To-Bar (CTB) pullups.
• The key to higher scores will be in how tight you can keep your technique under fatigue. Both Sam Briggs and Jason Khalipa had their form break down before Camille Leblanc-Bazinet and Rich Froning’s did.
• Camille’s form in her thrusters and CTB pullups was the most impressive of the lot. She had maximum efficiency and did not waste a lot of energy or time with aberrant movements.
• Your hands will probably tear – make sure they are taped up as best you can for this one.
• Discuss your strategy with your coach…I think a planned approach would be better than a go-as-fast-as-you-can approach but that is a personal opinion. I think small time goals and planned rests will help.

Thrusters:

+ The basis for a good thruster is a great front squat – so good, mobile hips and ankles and then shoulders that can carry the load in the press portion.

+ Mobilize your hips – this really is where most CrossFitters are too restricted – use a Lacrosse/Massage Ball in your hips – the key point here is to have your knees bent up, knees together and feet apart. This will stretch out your hip rotators and hip capsule better. (See Brandon and Ev demonstrate this in the pictures below)

+ Mobilize your ankles – the easiest way is to lunge and have a resistance band pulling your ankle behind you (See Ev demonstrate this in the pictures below)

+ Maintain good form – see the pictures below for a nice example.

+ Use a foam roller to release your lats (behind), your serratus (side) and your obliques (front) (See Brandon demonstrate this on the roller below)

+ Keep your elbows UP – if they crash into your knees, you can sprain or even fracture your wrist! You have been warned!

Massage ball in posterior hip

Keep your knees together and your feet apart!

Resistance band lunge – get that knee past the toes

Nice Thruster (Front Squat) – note the straight back and high elbows

Chest to Bar Pull Ups

Chest To Bar Pull Ups:

+ Stretch your pecs out – pulling into your chest will need shoulders that can roll back

+ Use a spikey ball to release the back of your shoulders – this will give you room to press as well as pull strongly

+ Stretch your forearms, wrists and fingers

+ Tape your hands up well

Spikey ball into the posterior capsule/muscles

Conclusions:

• For most of us “enthusiasts”, this will be a 4 minute AMRAP with some number below 90
• For regional level athletes, I expect them to be getting at least 90 reps in 4mins – probably 135 reps in total
• For games level athletes, I expect them to get 170+
• Warm up well, be consistent in your technique and a good score will be possible

Good luck, stay safe and go hard!

You comments on the workout, this blog or any questions you have are more than welcome

Here are my initial thoughts, tips, prep and strategies.

Overall impressions:

• This is a like a 1500m race – feels like forever for slugs like me but for the top guys, this will be a sprint where every dropped bar, every broken toes to bar, and even the transition time will make a difference.
• I think the Toes to Bar will be a major difference at the top end…this is assuming the top end athletes find 135/95lbs relatively easy.
• Grip endurance is key – consider using a 15kg bar…

Clean and jerk at 135lbs/95lbs

• Heavy enough for me but will it be heavy enough for those at the top? It is Grace weight which means that if up have a 1:30 grace, you should hit that by 2:30-3:00 (3+6+9+12). That means you have the round of 15 and 18 to get to in the final 4-4:30mins.
• To hook grip or not? I will be. My grip is weak so the TTB will get me so I will need all the help I can get in getting that bar up It may even be worthwhile considering using the 15kg bar to give your hands a different grip range…
• Lastly, the longer you can pump out the multiple reps, the better.

Prep:

• Shoulders: make sure your shoulders at the back are freed up so you can get into front rack efficiently. Stretch out your median, ulnar and radial nerves. Make sure your lats, pecs, serratus anterior and external obliques are freed up so you can lock out overhead and avoid a no-rep!
• Neck and Back: Please keep your back and neck flat and still in your cleans. This will help prevent the repetitive strain soreness I will no doubt be dealing with after Easter. Keeping your back straight will be hard because TTB encourages flexion in your spine. If your face is parallel to the wall in your setup for cleans, IT IS A WEAK POSITION. Keep the distance from your chin to your sternum the same height. If you let your chin poke out, you will put the anterior muscles in a position that is hard to generate force from.
• Hips and knees: – most people can power clean this weight – so while you won’t go into a full squat, make sure your hips are freed up. In your power clean catch position, let the hips take the weight into the back of the hip. This will help spare your hip flexors in the TTB.
• Forearms/arms: – stretch them out. It is too late to develop your grip strength :-/ I suggest you push jerk as the top guys will be pushing 60+ reps of of each exercise and us weaker “enthusiasts” will need all the help we can get. A 15kg bar has a different grip size which may be useful.

Toes To Bar:

• Like the box jumps, this may be where the top athletes come undone. The longer you can maintain unbroken reps, the better.
• Make sure, especially if you are being filmed, that you meet the standards.

Prep:

- Shoulders: The prep for the C+J should be good. Get some kips in to free the shoulders up but the best TTB don’t swing around too much – Jessica Coughlan’s 21, 21, 11-10 unbroken in last year’s regionals is still fresh in my memory!

- Neck and Back: Try to keep your head aligned and watch for excessive lumbar extension if you have a sore back. Hollow rocks, Wall walks etc will activate the positions you should hit.

- Hips and knees: The warm up for cleans should be good enough. Make sure you can maximise the hips flexion component as this will spare your back from repeated flexion and extension…and thus soreness!

- Forearms/arms: Grip will be difficult to maintain. Between rounds, move those fingers and work those callouses

Good luck everyone. I am about to do it in about 90mins time so if I have any further insights, I will pass them on

Until then, stay safe

I have outlined some of my initial impressions and ideas concerning advice for the elite athletes and “enthusiasts” (aka the rest of the world). Otherwise, please take care and if you are new to CrossFit, find someone to help you sit on the toilet!

In case you don’t know what 13.3 is…

As Many Repetitions/Rounds (!) As Possible in 12 minutes of:

150 Wall-ball shots

90 Double Unders (skipping)

30 Muscle-Ups

150 wall-Ball Shots to 10ft/9ft target:

General Advice:

• Use the narrowest stance you can – this will help wind your hips up and help you out of the bottom. Remember to squeeze those knees out!
• Use your legs to thrust the ball up and onto the wall
• Rest before your arms burn out and you get no-repped – I have found that once you hit fatigue, you need a longer rest. Take a predetermined rest before fatigue and then punch some more reps
• Last year, I couldn’t sit down properly for a week – use your favourite strategies to deal with muscle soreness/DOMS – for me, it is ice baths, Skins Compression Garments, and very light, gentle massage – don’t beat up your calves and quads with aggressive rolling until at least a  couple of days after the WOD

Suggested Prep/Warm-up:

• release the posterior hip to improve your squat
• 15/20kg bar thrusters
• front squat

Injury Concerns:

• Low Back – tight, fatigued hips will ‘butt-wink’ your hips under your back. Avoid this by keeping as upright as possible
• Necks – looking up at the target – support your neck, don’t let it loll around in extension or it will jam up. Also, obviously, don’t let the wall-ball hit you on the face!
• Shoulders – your shoulder will fatigue – be smart how you pace yourself through 150 wall balls
• Wrists – if you don’t get your elbows out of the way, you can fracture a small bone in your wrist. This happens when your elbows crash into your knees – same as thrusters, front squats, cleans etc

90 Double-Unders:

General Advice:

• If you sustained a small calf tear after the box jumps, be careful
• this is only a transitional arrangement to make it harder for the guys that can do Muscle-ups…and weed out those that can’t do double-unders
• If you are injured, ease in slowly
• Use a rope your are comfortable with – now is NOT the time to try a new rope “just for kicks”!
• If you can’t do muscle-ups, go for broke here because your time will be what splits you from the rest of your non-muscle-up competitors

Suggested Prep/Warm-up:

• If you aren’t warm from the Wall-Ball shots, then something is wrong…
• Skipping before the WOD is a good way to remember what you are meant to do
• If you do stretch the calves before the WOD, make sure you end your warm-up by bouncing a few times on your toes to ensure the best muscular function during the WOD

Injury Concerns:

• Calves – these may still be recovering from 13.2
• Jarring a joint because of fatigue
• lower limb injuries from self-inflicted whipping by poor skipping rope control

Muscle-Ups:

You either have these or you don’t. Some people will get their first muscle-up during this WOD…I wish I could be one of them but alas, I have neglected my strength since last year!

General Advice:

• Aggressive pull – the high you can catch, the less fatigued you will be
• Big kip – why not let momentum help you up – just ensure you know what the movement standards are with relation to what constitutes a legal kip during a muscle-up
• Obviously stringing as many as you can together is useful from an efficiency point of view.
• Take smart rests – Doing 2-3 in a row will likely be quicker than doing 6-7 in a row but then having to wait because you fatigued yourself too much

Suggested Prep/Warm-up:

• Release the BACK of the shoulder – you need room for the shoulder to sit properly
• Roll out your ribs and thoracic spine – they need to provide a nice strong foundation for your shoulders to work
• Release your pecs

Injury Concerns:

• Shoulders – Losing it in the catch phase – this will often put lots of weight on one hand causing a shoulder injury
• Ankles – Just watch your landing – it sounds obvious but when you are in the middle of a WOD, things happen!

Crossfit athletes never cease to amaze me. I love our enthusiasm, determination, encouragement and community. I have seen lives change, bodies change, goals hit and lots of personal bests and records achieved. But as a physio (physical therapist), I have seen the injuries, niggles, plateaus in performance and, let’s face it, when a Crossfitter can’t improve on something they are desperate to improve in, they get frustrated!

To help these people back to their best, I have noticed I have used the same framework over and over. Like everything I do, it isn’t particularly special or “secret” in knowledge…the real secret is in the implementation! So let’s get back to basics…

The Basics – Mechanics, Consistency, Intensity

Keep reading for the love of God! DO NOT SKIP THIS PART!!

I will guarantee you that nearly every Crossfitter I have met knows these concepts or something like it… but knowing it and doing it properly are 2 very different things. It is the reason why you see poor squats, poor barbell technique and, eventually, a plateau in performance.

I am going to break this up into theory and practice because I have seen some pretty limited mobility in athletes that would make me think they shouldn’t be doing anything at all if we got all technical about things!

Mechanics and Consistency

Theory: This is getting the movement right. Every time. Absolutely perfect technique. Your goal should be to execute every single repetition perfectly. That means a perfect squat – now I can confidently tell you now that the average Crossfitter does NOT have a good squat. I have pretty good flexibility, better than most for a big guy, and even my squat is not up to my standards. Getting your technique right is a journey of a lifetime and one which you should think about daily.

Now I am not your coach and to be honest, I don’t want to be. I am a very good Physio and consultant. Your coach is no doubt a good coach. I prefer to work with coaches, not be the coach. Your coach can see things that don’t look right to them. I see things that don’t look right to me. TOGETHER, we address the concerns that we each have. The bottom line is that both I and your coach will give you things to work on. Take these suggestions seriously. Organise a program of mobility and technique practice that you do before and after your WOD.

If you WOD alone, then watch technique videos and video yourself. Something like the Coach’s Eye App is worth the money – you want to see what you are doing. The best athletes in the world ALL need coaches simply because they can’t see themselves in action. Send your video links to me – I will look at them – post them on facebook at www.facebook.com/physiodetective.

Until you can master each exercise PERFECTLY, I do not suggest you go too heavy. If you cannot do more than 80% of your reps correctly and controlled, then the weight is too heavy or the rep numbers are too high for you. You need to swallow your pride and scale the exercise back to a level you can do properly. This is arguably the HARDEST thing to get a Crossfit athlete to do…but it works. My athletes that have scaled back or even completely rested (rare) for a time and have come back stronger and started breaking their old Personal Bests (PBs).

If you allow technique flaws to be practiced over and over at high repetitions, you will be at an increased risk of injury AND it will be harder to change your technique later. It is better to get it right and keep it right.

Practice: Although most people don’t possess a squat that will pass muster with me, I don’t have people only doing half squats all the time (unless they REALLY need to!). You can scale your exercise to a level such that your squat will still achieve the standard but you are really working hard to maintain good form. It might only be an air squat that you can manage.

If you understand the risks of injury, then do the workout at whatever weight you think you should. You can always increase the reps at a lighter weight to get the same intensity or increase the weight with reduced range. You may actually have to do an accessory movement like a lunge instead of a squat. There are ways around your limitations. However, I still recommend that you should be doing more good reps than bad ones – I don’t mean “acceptable” reps, I mean good form at least 80% of the time. Scale your exercise back to a level so you can achieve this.

Ideally, you will have a pre-WOD mobility routine and warm up and a post WOD time to work on your technique and mobility. Consistently working on your weaknesses will allow you to make them strengths. It will take a few months, I won’t lie to you…but if you do this properly and consistently, with good coaching, you will blast through your previous plateau levels and continue to improve.

A Caveat:It is close to the Open season and Regionals. It may not be possible to scale back your training based on what the coaches are trying to achieve. The above suggestions are the ideal but in practice, we are always balancing other issues…this increases the risk of injury but sometimes it raises that risk very slightly compared to the gains that are made. This is something between you and your coach. Again, I am not your coach but will work with your coach. I will go in to bar for you if I think it is dangerous to your health – my patients are my first concern…in the 16 years I have been a Physio, I haven’t had too many problems at all with coaches or athletes in danger

Intensity

Theory: This is where you increase the effort, the speed, the load. You try to do more reps unbroken than before, a little faster than before with a little more weight than before.

The total work you perform is based on the time it takes to move the load and the repetitions you do. If the load and reps are the same, then the time taken will determine your intensity. If the Time is set (like a 15mins AMRAP (as many reps/rounds as possible), then the reps and load will determine your intensity.

This is also where everyone, including myself, falls down. We need to ensure we don’t progress too quickly into loads that are unmanageable, rep ranges that have more bad reps than good ones and going so fast that we sacrifice good form for speed.

Practical: I think gaining strength is probably the best way to increase intensity. For example, your Fran time will be a lot better if your 1RM thruster is 70kg vs 40kg. Once you have the strength to do more, you will be able to decrease the time it takes to do it. Then it becomes small goals…take 5 secs off your 400m run during Helen, string together 2 more pullups than you normally can, go unbroken in a set of kettlebell swings, etc etc. During ALL of this, your MUST maintain good form at least 80% of the time. By making your intensity goals just right, you will improve with safety…the trick is not to overdo it so you get injured nor under-do it so you don’t improve

The Four Key Areas

As a physiotherapist (Physical Therapist for you USA readers), I think every joint is important! But the 4 key joints I seem to have to deal with are (in a loose sort of order):

1. Hips
2. Shoulders
3. Ankles
4. Lower back

The knees, thorax, neck, wrists, elbows and feet round out the list.

Please note: These are the problem regions, NOT the PAINFUL ones!

Quite often people come to me with pain in a region somewhere e.g. the shoulder and they have seen every man and his dog, gotten it massaged, doing lots of rehab, even seen if the neck is the problem… but they get to me and it turns out to be a rib/thorax issue. Just because one region is painful, it doesn’t mean that the problem is there.

I will be devoting a blog post to each of the 4 key areas this month…what to look for and 2 simple exercises you can try to help…please remember that you may have seen these exercises before but it actually in the execution of the exercises that makes all the difference!

I would love to hear what troubles you have had or your favourite exercises for the 4 key areas are – please leave a comment below

Because I sold my business, I needed to find rooms to rent. Unfortunately, CFX is within the area that I cannot work in under the terms of the sale contract – and fair enough too. I have been negotiating with some different places where I can rent a room and continue to see my patients. Because of this, I will be leaving CFX to train where I work (the subject of another blog – this blog is about CFX).

The purpose of this blog post is to clearly outline that I am leaving CFX on good terms, to acknowledge how much it has changed my life and to encourage others who want to try Crossfit to try it at CFX.

Things I like about CFX

• The Technique Coaching – Mick runs a tight ship and is always coaching us on correct technique. Being a physiotherapist, I love this aspect as I firmly believe that getting your technique right will maximize your performance potential and reduce the risk of injury.
  
• The Community – The people that go to CFX are friendly, encouraging and do stuff outside of the box (Crossfit gym). I have learned a lot from them, I have been privileged to help them and I will stay in touch with them – The Community it what makes the Crossfit environment so addictive (to the lovers of Crossfit) and the reason why the haters call Crossfit a “cult”. It isn’t a cult, it is just a bunch of positive, friendly people wishing the best for you while they are trying their best as you work towards common goals together.
• The Equipment – CFX has some good quality equipment. Mick is always upgrading bars, boxes, rigs, weight plates, etc. I have seen other Crossfit boxes – the gear Mick has is first class… this alone makes it good value for money!
• The New Faces – CFX always has new members coming through and it is great to meet new people and watch how they improve. It is inspiration to keep getting better. It is also a sign that Mick is doing something right
• The Location – CFX is less than 5mins from my house – who wouldn’t want a top quality facility so close to home?
• Mick Shaw – Those who have been around Crossfit in Australia for a while know how much hard work Mick has put into the Community. I saw first hand last year how many hours he was putting in to make the Regionals the success that it was. He is just as dedicated to his business and his clients and runs a good business – as someone who has run businesses for over 12 years, I can appreciate the work that goes into making things happen. He is a top quality, knowledgeable coach and a generous with his time. It should be remembered how much he has contributed to Crossfit in Australia.

The future for me and CFX

I have already told Mick about where I am going and why. I still intend to keep going to CFX once or twice per week if possible as I love my friends and want to keep in touch. I will still recommend people to try Crossfit there.

CFX is where I got started on this journey and it will always be a place of happy memories, hard workouts, PBs and good times…and I plan to have that continue into the future…

…so while you may see me mention where I will be working more often, I want to make it clear that I still love and support CFX.

Thanks

Penshurst Physio before Antony Lo sold it to Colin Phillips.

A short history…

On April 13, 2001, I took over Penshurst Physiotherapy Centre from Ralph Geary. We eventually bought a building nearby and gradually expanded our business into multidisciplinary centre. During my ownership, we basically quadrupled the business.

In 2012, Colin Phillips (the new owner of Penshurst Physiotherapy Centre) asked if we were willing to sell him the practice. We were and so negotiations commenced and an agreement was met.

On Oct 2, 2012, I handed over the business to Colin. I had agreed to stay on and really wanted to continue to be a part of the business. However, I found it more difficult that I had imagined. However, even until I went away on holidays, I still intended to stay on.

What will I be doing?

Treating Crossfit athletes of all standards is a passion of mine and I will be continuing to pursue this

It wasn’t until my first week back at work did I decide to leave. I think it will be best for Colin and the rest of the staff at Penshurst Physio to have a clean start and a fresh shot at making it on their own.

I have already had plenty of opportunities to work in many different locations and clinics however I haven’t finalised any plans at this stage. Due to the usual contract restrictions of working within a certain radius, I will be looking at renting some rooms in the Inner West, Parramatta and Sutherland Shire regions. I will finalise these locations and make them publicly available when they are confirmed.

I will be continuing in providing “second opinion” work, Crossfit specialised assessment and treatment and running seminars for health professionals and the public. I will certainly also be available for any of my past patients who choose to follow me – as usual, my goal/desire/mission is to go “above and beyond” in providing the best quality services I can. I won’t be setting up a clinic like I have run before – my new work will be a different type of business model to Penshurst Physio.

Thank You’s:

I wish Colin and the staff at Penshurst Physio all the best. Within 3 months, I expect that the shadow of my presence will have diminished and he will have a practice built on his own reputation.

The staff at Penshurst Physio at the 2012 Christmas Party

I would like to thank my staff throughout the years who have made both Sans Souci Physiotherapy Centre and Penshurst Physiotherapy Centre an enjoyable place to work, a friendly place for the patients to come to and get healed at and for ultimately being the reason why we ran 2 very successful practices.

I would like to thank those who have helped me immensely with ancillary services such as Plumbing, Electrical, cleaning and IT services. Particular mention must be made of Peter and Shona Ross who are amazingly generous people…thank you!

I would like to thank my patients who have been very loyal and understanding as I made mistakes throughout the years and learned from them. Without my patients, their word-of-mouth referrals and their advocacy for me and the practices, we wouldn’t have had our businesses grow by so much. Thank you for your support.

Lastly, I would like to thank my family and my wife Dianne. Without my parents, I would not have bought my first practice – they took a punt on a 25 year old who said he could do it…without any experience! My brother Adrian who is now a doctor – he basically ran Sans Souci Physio for me while I took care of Penshurst. My sister Amanda for the graphic design work over the years. My children who taught me through the school of hard knocks how to relate to my ante-natal and post-natal patients on a whole new level! And to Dianne who righted the ship in the early days and then ran a tight outfit. Without her tireless work, I would be in an administrative nightmare.

Thank you to my family – without their support over the years, I would not have been able to achieve all that I have!

Useful Links:

Website: www.myphysios.com.au

Facebook (business): www.facebook.com/physiodetective

Facebook (personal): www.facebook.com/antonylo

LinkedIn: www.linkedin.com/in/antonylo

Twitter: www.twitter.com/physiodetective

Education Website: www.myPTeducation.com

One of the most difficult tasks I have with prospective new clients is convincing them that I am different to other Physiotherapists that they have seen in the past. This is generally because people simply don’t know that there are different types of Physiotherapists out there with different levels of recognised experience and skills.

So who should you see and when should you see someone else?

The General Physiotherapist

This is the physiotherapists you will most likely come across in most private practices. They have graduated with a Bachelor Degree in Physiotherapy or a Graduate Entry Masters in Physiotherapy. They range from the recent graduates to very experienced physiotherapists who never bothered to get their experience recognised.

Pros: They are fine for simple conditions and can be quite experienced (but that is hard to tell)

Cons: They may lack the experience to deal with complicated problems or get to the root cause of recurring injuries

The Titled Physiotherapist

This is the Physiotherapist who has gone on to do a Post-Graduate Masters degree in their chosen field – usually in Musculoskeletal or Sports Physiotherapy. Alternatively, they may have had their prior experience recognised. They will usually have at least 3 years experience behind them in their chosen field and have demonstrated a commitment to learning more about Musculoskeletal or Sports Physiotherapy. The training to become a Titled Physiotherapist is usually at least 1 year full time study. Some General Physiotherapists attempt the study to become Titled Physiotherapists but find it isn’t for them – that is ok, it isn’t for everyone. You need a certain ability to read the research, be able write scientifically and demonstrate your skills at a certain standard in written and verbal examinations. The process of gaining your Titled status should make you a better quality Physiotherapist.

Pros: They are more experienced and have advanced training in more complicated conditions which has been recognised by a formal examination process

Cons: For the very complicated, chronic cases, they may still lack the specialist knowledge on how to manage these patients.

The Specialist Physiotherapist

This is the Physiotherapist who is recognised by their peers as having a certain standard of knowledge, experience and ability. The process to become a Specialist Physiotherapist is at least 2 years long and requires written and verbal examination. The training process itself is quite intensive and will make you a better Physiotherapist even if you do not go on to complete your exams. There are currently only 7 Specialist Musculoskeletal Physiotherapists in NSW – Antony is hoping to be the 8th.

Pros: They are the most experienced and proven at dealing with complicated cases in their field of study. If they don’t know how to manage a case, they will know the right people to refer to. They should possess the ability to evaluate any new physiotherapy research, technique or theory and determine how it integrates into the world of Physiotherapy.

Cons: Whilst they are Specialists, they will not know everything. Innovative physiotherapy practices are evolving all the time. Specialists are not always the “end of the line”

How should the Physiotherapy System work?

Ideally, you would see a general physiotherapist for most acute (less than 3 weeks old) conditions. They are equipped to handle most cases that present to them. However, if after a few treatments you do not seem to be getting better, then having a Titled Physiotherapist to review your case is appropriate. They can then report back to your (general) physiotherapist about their opinion on what is wrong and how to proceed. If the problem continues to be difficult to treat, then referral to a Specialist Physiotherapist may be required for an opinion.

The system is very much like the medical model. You see your GP for problems but get referred to specialists for the cases that need specialist care. In the Physiotherapy world, the Titled and Specialist Physiotherapists are often your second opinion providers.

So what is Antony’s story?

Antony believed for a long time that it would be ok to be a great general physiotherapist. At the time, there was no real perceived benefit from undergoing post-graduate study. However, the desire to influence, mentor and shape the profession meant that formal recognition of Antony’s skills would be required. He achieved an average mark of 87% in his Masters Degree and is currently studying in the specialisation process. Simply undergoing the specialisation training has impacted on his knowledge, skills and ability – it won’t matter if he undergoes his exams or not, he has become a better Physiotherapist for the training.

What should you do?

Antony’s recommendation is to see your physiotherapist 3-5 times. If you do not see measurable improvement in that time, it may be worthwhile seeking an opinion from a Titled or Specialist (or Specialist-in-Training) Physiotherapist to guide your condition.

‎”It is worth emphasizing that, by definition, HVLA impulse, or thrust, involves high velocity, not high force.” – Leon Chaitow, ND, DO

I have always been confused by this type of statement… it doesn’t seem to make sense to me from a physics point of view. Perhaps you can check my reasoning below?

Force = mass x acceleration. Assuming the mass is constant and you start from a relatively still position, then to move from a stationary position to one of high velocity, then acceleration has to be high (v2-v1/t). Therefore successful manual therapists, IMHO, actually achieve higher forces as they can more easily generate rapid speed in a localised area.

Having said that, they also produce (usually) less displacement (s) (that would be the low amplitude bit in HVLA): s=u.t + 0.5.a.t^2. Since initial velocity (u) = 0, then it is the acceleration and time that makes the difference. Since the required distance to achieve manipulation is small, then it takes less time.

Unskilled/novice manual therapist “look wrong” because they are slow (takes more time), move the patient too much (increased distance), and “try too hard” in general.

Therefore, perhaps instead of saying “Force”, people actually mean “Work”: Work = Force x Distance. Power = Work x Time. So whilst the force has increased (mass x acceleration), the Work and Power has decreased when compared to novices…

…however, if you say “force increases”, then students will just try to push harder (increase power and work) because they don’t understand physics…

Truth vs Pragmatism?