Internal Program Review: Strength Programming For a CrossFit Athlete with Patellar Tendonitis – Day 1
Since our Internal Program Review Series has been getting consistently positive feedback, I’m going to continue today with a look at a Day 1 from one of our comprehensive programming athletes. This particular client is a CrossFit enthusiast and upland hunter who has been regularly supplementing his training with Ruthless Performance programs for some time.
Though this is more of a general look at the Day 1 of his strength programming, we’ll be addressing some modifications we’ve made along the way with regards to the patellar tendonitis.
From the perspective of the training lay-out, we’ve cut back his strength programming to 3 days (which has been as high as 4-5 days in the past). We’ve also supplemented with some training that’s been inspired by our in-house Posture Restoration & Injury Prevention Training protocols. The athlete can choose to perform those and forego his traditional strength programming in the case of a day in which there’s a high prevalence of knee pain.
Those supplemental workouts consist largely of stretches, mobility drills, and activation drills of varying intensities designed to enhance kinesthetic awareness and proprioception while minimizing the impact and input required of the affected joints.
Furthermore, the Day 2 workout consists of a lower body dominant day, with exercise designed to keep knee strain to a minimum, while encouraging blood flow for a more expedient recovery. Day 3 is a full body day designed around the primary goals of maintaining size and enhancing strength even under the reduced workload of this phase. The athlete is still undergoing 3-4 CrossFit workouts / week with various exercise modifications designed with his knees in mind; namely substitutions for the olympic lifts, plyometrics, and burpees.
But now onto the subject of today’s Internal Program Review, Day 1…
1. Stimulation through Antagonistic Training
We’ve all seen programs before with two antagonist exercises paired together (i.e. push & pull, bi’s & tri’s, etc…), this is a time-tested way to get more work into a shorter period of time, while building some muscle. To take this a step further, we’ve manipulated the rep range of the Floor Press in such a manner that we’ll see a quick adaptation and supercompensation to the exercise. This will make for enhancements in strength while still stimulating growth.
What we’ve also done here with the A2 is add a contralateral stance. So not only is our athlete getting some good lat work in, but he’s also stabilizing and strengthening the musculature of the foot on the support side.
As opposed to a regular unilateral band row, a contra-lateral band row implies that the athlete is standing with his weight resting on the non-working side. This further enhances trunk activation, glute development, and more. Adding a contralateral position to various exercises where feasible (much like adding the half-kneeling position for hip mobility) can serve to achieve these secondary goals.
2. Make Glutes not Low Back Pain
The Tall Kneeling position is something we don’t use all that much at Ruthless Performance. In fact, Tall Kneeling Overhead Press is one of the select few exercises we advocate in this position. The tall kneeling, when added to the overhead press helps engage the glutes, as the skeletal system can’t so passively stabilize as it may otherwise be able to do from standing.
As far as the reps are concerned on the Tall Kneeling Overhead Press, we are keeping the volume rather high. The reps here are the primary variable that we are manipulating. This does a few things that we find rather advantageous to performance and longevity: the extended time under tension further enhances gluteal stimulation, contributes a greater degree to resting posture (as the shoulders and traps tend to respond better to higher reps), and also takes some strain off of the shoulder when compared to higher loads and lower reps.
Load on this may remain consistent for the entirety of a 4-week cycle. This will more than likely be the case here as this comes with a particularly steep influx of repetitions throughout the cycle (going from 2×10 to 4×20 in a matter of 4 weeks)…
Since we are so concerned with the athletes on-going knee issues, we’ve directed most of our lower body strength work to be hinge-dominant. With this in mind, we’ve gone out of our way here to design this ‘B’ set to lessen the requirements of the low-back. Though the B1 (Tall Kneeling Overhead Press) will require some low-back involvement, we’ve moved the B2 into a split stance position; this is a rather universal modification to help lessen the requirements of the low back in most exercises.
The Face Pulls are a constant in most of our training programs. The high volume of work on these is nothing special, as we’re constantly trying to stimulate that mid-back and undo some of the damages of daily sitting during commutes, work, and even downtime.
3. A 3×8 Protocol is Rarely Ideal on Supplemental and Single-Joint Exercises
Corrective exercise is frequently thought of as unfamiliar and even bizarre body contortions meant to pull and stretch soft tissue from the bone… Very frequently, particularly in the CrossFit world, some very common exercises can be highly corrective. Humeral abduction in the frontal plane can stimulate the rotator cuff in some ways that are rarely replicated in a traditional CrossFit WOD.
With this DB Lateral Raise as a stand-alone exercise, we’re targeting the deltoids for hypertrophy in a manner that happens to be conducive to not only rotator cuff function, but posture as well. This makes for a very efficient exercise choice when we’re trying to help an individual move better while adding some strength and size.
We’ve told the athlete to start with a weight in which he could complete the totality of the reps in approximately 3 sets. The goal here is to progressively do more reps in the same amount of sets as the weeks go on. Ideally this is with the weight remaining consistent from week 1. As many coaches that advocate these high rep ranges for shoulder exercises will point out, athletes that most commonly have large shoulders are those who train the shoulder with a very high frequency and to fatigue like in swimming or gymnastics.
CrossFit is a Sport, Treat it as Such
Many coaches and athletes from the strength sports are quick to assume that since strength is implicit in their sport that they do not need outside strength and conditioning (in this case more specifically outside technique correction and individualized programming). CrossFit participants looking to attain a high level must realize that the highest levels of performance in CrossFit come from highly individualized programming, with CrossFit WODs being a sport-specific skill rather than a fitness challenge (take Fran for example, this should be viewed as an event, not a series of exercises). By customizing training to the needs of the athlete and matching that with the demands of CrossFit as a sport, we can enhance athletic performance far beyond what we can expect with the existing standalone CrossFit model.
Most of the programs that we design and implement at Ruthless Performance have some meticulously detailed cool-down for an athlete to do following their last exercises of the day. And in most cases these are some combination of mobility drills, breathing techniques, or myofascial release strategies.
Past all of the very significant reasons that a proper cool down in crucial for athlete development, there’s a handful of additional benefits an athlete will receive by doing their prescribed combination of mobility drills at this particular time. When an athlete does these drills early on in the workout, likely in their warm-up or as an accessory drill between main sets, more mobility (active use of ROM) is required of the articulations themselves–like in the spine or at the hip.
But after a workout, while there is more blood circulating in the muscles, the mobility drills will more specifically target these areas–even if it is the same exercise that is done pre-workout.
There also seems to be more lasting changes in range-of-motion when these exercises are completed post-workout. Whereas in the warm-up, these drills serve to enhance proper movement and function during the workout, but the lasting effects seem to be negated by the workouts themselves.
This is why we recommend including high-priority mobility drills in the pre and post-workout time period.
Throughout the entirety of my college tenure and time as a collegiate strength & conditioning coach, I was extremely averse to CrossFit. Though my stance hasn’t changed much regarding CrossFit as a means of enhancing athletic prowess, it has changed considerably towards using CrossFit as a means of enhancing fitness in the general population as well as CrossFit as a sport unto itself. My thoughts on CrossFit as a whole are best saved for another day, but my opinions on it have been trending more positively as of late.
During this time in my life, I would have never anticipated that moving forward I’d have a wonderful working relationship with a handful of CrossFit affiliates, as well as having a roster on-hand of over 300 CrossFit athletes that I actively assess, program, and am generally accountable for with regards to health and longevity in the sport.
With all this said, I wanted to do a break down of one of the Ruthless Performance Ex Phys Interventions, one of our flagship corrective exercise protocols. This internal program review will vary slightly from some in the past, as some information has been redacted/blurred. I don’t have any problems answering any questions, or providing explanations for these programs, but because of the highly individualized and semi-clinical nature of these programs, sharing the entirety of these programs can be counterproductive as many exercises that work for the client may not work for others.
I’ve only left the information visible on this program that I want to share (and am capable of covering) within the scope of this article. The Ruthless Performance Ex Phys Interventions are largely just corrective in nature and do not comprise the entirety of an athlete’s program. These are usually done in conjunction with our Remote Programming, Athlete Development Training, or in conjunction with other sports (like CrossFit, powerlifting, or weightlifting).
Ex Phys Interventions typically have a handful of components meant to mend well with existing programing. Programs are almost always comprised of warm-up, cool-down, activation work, and then from here may include some combination of at-home work, daily mobility circuits, weekly totals, etc..
So let’s dig in…
1. To Fix Something Rapidly, Do it Frequently
The daily exercises typically involved in our Ex Phys Interventions seek to address some underlying physical deviation causing undue strain on the musculoskeletal system. By assigning these exercises to do frequently, but with low-intensity, these can be completed shortly before bed, upon waking, during lunch breaks, and so on…
In this case, we’re dealing with an athlete that has prominent Anterior Pelvic Tilt (APT), slight Upper Cross Syndrome, and flexion-intolerant back pain (read more on flexion vs. extension intolerant back pain here). The at-home exercises were largely meant to remedy these issues, while requiring relatively little input from the CNS, allowing the athlete to perform these with a greater level of frequency.
This exercise circuit is listed to be performed 3x / week. More is better in the case of these exercises, but 3x / week is a frequency that an athlete can adhere to with relative ease.
2. Breathing Drills are Making a Come-Back
Breathing Drills are one of those topics that deserve their own article (if not their own book). There are many great resources to learn about the significance of proper breathing in greater specificity, but suffice it to say that in a cool-down, we are looking for activation of the diaphragm to help pull the athlete into a more parasympathetic-dominant state (the CNS should be the focal point of Exercise Science curricula rather than the muscular system, again another post, another day…).
The Deep Squat Belly Breathing w/ Lat Stretch drill is useful specifically with this athlete as we’re attempting to alter the CNS, while simultaneously helping the client feel better overhead, minimize input from various accessory breathing structures, and get some extra post-workout work on that deep squat position; mobility drills done post-workout seem to have longer-lasting effects on range of motion and function.
Additionally, I’ve left in the header of her assigned myofascial release work for a quick note… The effects of myofascial release seem to be slightly overblown BUT myofascial release is still important enough to make our corrective programs. By drastically cutting down the time on the rollers & lacrosse balls, but maintaining frequency, we can experience the benefits of myofascial work without it taking up more time than is needed. 15 seconds on the roller and LAX ball per muscle group as a standard and doubling this only for trouble areas.
3. Corrective Exercises Aren’t Always Crazy Stretches
I’ll be the first to admit that many of the exercises within our corrective protocols are complex and can be viewed as a novelty. This theme can encapsulate athletes’ perceptions generally towards correctives, but this isn’t always the case.
Both biceps femoris (legs) and biceps brachii (arms) tend to be an issue for CrossFit athletes… Since many CrossFit facilities tend to avoid use of machines, the hamstrings (biceps femoris) tend to be neglected, specifically the short head of the muscle, whose primary responsibility is lower leg flexion. In the case of the arms (biceps brachii), which are stimulated by exercises like traditional dumbbell or barbell curls, there again tends to be an imbalance between the long head and short head, leading to problems at the shoulder, elbow, and even wrist.
By adding in a weekly total for barbell curls, we can ensure the athlete is getting sufficient short-head activation without much complexity. Barbell curls, no weights, hit this total every week; that’s it.
4. Multi-Function Joints Need Multi-Function Stimulation
The joint-by-joint theory popularized by Physical Therapist Gray Cook can appear invalid at the shoulder, as it is comprised of two primary joints. But as the data points to, the theory fits as one joint provides stability (acromioclavicular joint) and the other yields greater range of motion (glenohumeral).
With this in mind, we’ve focused the athletes Day 1, 3, and 5 activation drills around ensuring these various functional components of the shoulder and thoracic spine are being stimulated.
The Half-Kneeling 90/90 External Rotation stimulates the Supraspinatus in isolation. I reference the significance of the Supraspinatus regularly, but its significance is largely rooted in its function as one of the few muscles that externally rotates the humerus. Bench T-Spines are ideal for wedging the shoulder blades into the thoracic spine, thus forcing some sagittal plane mobility (thoracic extension). And of course, this variation of carries works the rotator cuffs of the shoulder independently of one another, while ensuring large amounts of irradiation (tension directed upwards in the kinetic chain) because of the bottoms-up grip. This further supports the desired outcome of very active, healthy rotator cuffs.
For more details on any of our corrective exercise programs, send us an email at info@RuthlessPerformance.com. Program facilitation available in-person and online.
Of the individuals that participate in either the Ruthless Performance Ex Phys Interventions or our Posture Restoration & Injury Prevention Training, there is no across-the-board origin of pain or movement dysfunction at the hip or low back; in fact, client training histories run the gamut in activity level, training history, limb length, and so on.
So what is the common denominator among individuals with low back pain?
In short, there isn’t one singular origin, but rather there are two.
The more frequent of which is extension intolerance. This is common among what we in the Strength & Conditioning world refer to as ‘desk jockeys’, or any individual who is regularly in a resting position of spinal flexion. This includes desk workers, individuals with extended work commutes, TV watchers, and so on… Given our societal predisposition to these patterns, it should be relatively straightforward as to why this is so common.
In opposition to this is flexion intolerance. This is common among highly active individuals such as weightlifters, american football players, backpackers, manual laborers, and so on.
Assessing which category you fall in can usually be done simply with the above information, however there are some easy to perform physical tests as well. A hip extension machine is a great tool for diagnosing the more common extension intolerant back pain. Simply perform a standard hip extension, from here take notice to your range of motion and comfort levels. To assess flexion-intolerant back pain, perform several repetitions of the traditional sit-up or crunch. From here, reevaluate pain, comfort, and ROM. If a hip extension machine is unavailable, any exercise in which spinal extension occurs (or spinal flexion for the flexion intolerant assessment) can be used.
These tests in congruity can determine a great deal about the cause and symptoms of any dysfunctions or abnormalities in the spine. Oddly enough the solution for both of these issues starts with the same series of correctives…
To gain more mobility in the requisite spinal segments (for extension and flexion), start with rotational spinal mobility to help ensure that as these capacities develop, the movement is coming from the correct areas of the spine (primarily thoracic rather than lumbar). Some exercises and drills which may assist here are quadruped t-spines, cross-over stretch, russian med ball twists, and so on.
From here you can progress into more specific drills to focus on your specific type of intolerance (i.e. focusing more on adding range to spinal extension drills or vice versa).
Spinal health can be simplified into a system of mathematical averages; to regain extension, flexion, or even to maintain a more neutral spine, adequate steps need to be taken to pull the posture in that direction.
For more information on our Posture Restoration & Injury Prevention Training or the Ruthless Performance Ex Phys Interventions, send us a message at RuthlessPerformance.com/contact.