5 Tips To Avoid Injury At CrossFit

 By: Elizabeth A Dungan, PT, DPT


Below are five essential tips from a PT’s perspective to remember when performing your basic CrossFit movements:


1.)  CORE: From an air squat, to a heavy back squat, a power clean, to a shoulder overhead press; one’s core should always be engaged. Many CrossFit athletes feel like they activate their core, but in reality many are activating their core incorrectly or not at all. Engaging your core does not mean “sucking in.” It is about abdominal bracing. This involves activating transverse abdominus muscle, keeping the spine in neutral, and making sure the pelvic floor is strong. To active transverse abdominus one needs to draw their spine into neutral and pop their abdominal muscles outward. By palpating the top of your iliac crest or pelvis, you can feel if this muscle is harder and “turned on.” This core activation should be used with every heavy lift. This is the container that provides stability and strength to your entire body and prevents low back pain, disc problems, and lower extremity injuries.


2.)  THE SQUAT: The air squat is one of the most common movements in CrossFit. It’s important to make sure one has a proper form and doesn’t push their limits just so they can reach a new 1 rep max. When completing a squat with or without weight make sure the back is flat and low back and shoulders are not rounded at all (this is key). Keep feet are a little wider than shoulder width, feet facing forward, back and shoulders flat, hip hinge backwards (like you’re about to sit in a chair), and then bend knees (knees never over the toes). As soon as the sacrum or tailbone area starts to dip down and tuck under you, you’ve gone too far. As the sacrum tucks under you, it’s gapping your lower lumbar spinal segments and allowing those discs to be pushed outward, causing potential injury. Have a partner or coach make sure you’re performing the squat properly.


3.)  THE DEADLIFT: Similar to a squat, it’s essential to engage your CORE first. Secondly, while you’re keeping feet at shoulder width, facing forward, slightly bend knees and keep the back flat the entire time. As you lower down to grab the bar, do not round the low back or upper shoulders. Both of these could cause disc injuries to your spine or disengagement of your core due to poor posture. Once you are about to grab the bar, look down and make sure that shins are perpendicular to the floor (knees not over toes), back is straight, hinging at the hips first, squeezing glute muscles and standing up to neutral. The low back and shoulders should remain straight as a board through the movement, especially when lifting a weight that’s causing you to round your back to get the weight up. If you’re feeling soreness in your low back during the movement or a day or two after, you are not doing them properly. Hamstrings should be sore but no low back pain should be felt with a deadlift!


4.)  THE KETTLEBELL: Here, it’s important to make sure that your back remains neutral and flat and that you limit the amount of shoulder involvement during the movement. This should be a movement that the hips perform, not the shoulders or arms. To start, make sure feet are in squatting stance and the back is flat. Hips sink backwards like a mini squat, momentum is created by swinging the bell using your hips, and when the bell continues to move upward snap your hips open, squeezing the glutes and standing tall. Be careful not to round the shoulders when bringing the kettlebell above your head. Keep the neck stable when the bell is overhead and don’t shift it forward. If your back is not flat when starting, just like with the squat and deadlift, you are at risk for disc injuries. If your neck and shoulders round when weight is overhead, you’re more prone to a shoulder injury or cervical issues and pain.


Lastly, it’s important to recognize the difference between soreness and pain. Delayed onset of muscle soreness is real and natural. Recover, stretch, mobilize, and take a rest day. Form is everything, not just because it looks good, but because it is what keeps you injury free and able to stay active for years ahead.


A Lesson In Patience On Marathon Monday

By: Megan James, PT, DPT


One year ago today, I was running the most sought-after 26.2 miles through the streets of Boston with at least one million cheerleaders – including some of my family – alongside me all the way to the infamous “right on Hereford, left of Boylston.” It was absolutely the most incredible experience in my running career.


About one month later, I was still living on the “high” of completing the Boston Marathon and had resumed my normal training schedule after only a few days of rest. I woke up one morning to go for a run and realized I could not walk due to severe pain in my left foot. Between my own knowledge and consulting with other physical therapists, we had a pretty good idea about what was going on. After seeing a podiatrist and having X-rays and an MRI, I was diagnosed with a stress fracture on my 4th metatarsal with deep bone bruising on my 5th metatarsal. My summer would be spent on crutches and in a walking boot – no running and no biking.


It wasn’t until the end of September that I was able to return to running, and that was only for a few minutes at a time to start. By the end of October, I was up to running 3-4 miles at a time and was feeling optimistic about being able to resume my training, but my eagerness to return overcame my patience, leading me to push it too hard. I had a recurrence of foot pain in early November that sidelined me for an additional week. From that point on, I made a promise to myself to be more patient and cognizant with my training to ensure my body was fully recovered.


After almost a year off of racing, I found myself back on the starting line at the Syracuse Half in March. I bested my half marathon time by six minutes and broke the 1:30 barrier for the first time. The past 10 months were a true test of my patience – if not for recognizing the importance of taking a step back in the fall, I would likely be back at square one right now. As a physical therapist and a competitive distance runner, I cannot stress enough to myself, my friends and my patients that patience is a virtue, and a very important one at that. Next up on my race schedule? Bennington Marathon, followed by a week of REST.


Pelvic Floor Dysfunction: How Does PT Help?

By: Ashley Zaroogian, SPT


Are you currently experiencing low back pain, hip pain, or stomach pains? Have you experienced urinary leakage after coughing, sneezing or laughing? If you answered yes to either one of these, you are not alone. There are many people who are noticing signs of dysfunction in their pelvic floor muscles and convince themselves this is normal. Many people will even find ways to self-treat in order to prevent this awkward conversation with healthcare providers. It’s easy to convince yourself you drank too much water or just didn’t make it to the bathroom in time. What you may not know is that there are physical therapists who specialize in treating patients with pelvic floor involvement.


Approximately 1 out of every 5 American experiences some type of pelvic floor dysfunction? Additionally, 1 out of every 4 women aged 18 years or older experiences urinary leakage. Research shows two thirds of men and women between 30 and 70 years old have never talked about their bladder health with their physicians. Many people are concerned signs of pelvic floor dysfunction can mean it’s something more than the muscles not working properly. In reality, there are a lot of muscles involved in the pelvic floor which help us all to walk around, sneeze, cough, run and jump without having to run to the bathroom. Stress, diets, pregnancies, and/or prior surgeries can contribute to dysfunction in these muscles. This is where physical therapists specialized in this area can help.


You may be wondering why physical therapists are trained to treat an area which is is so intimate. Aren’t physical therapists trained to treat problems with muscles? Treating symptoms such as urinary leakage can likely be due to problems with the muscles, in which physical therapists are most certainly trained to treat. Many people who have been diagnosed with IBS, constipation, endometriosis, or frequent UTIs have shown positive responses to pelvic floor physical therapy. These physical therapists will talk to you to find out what symptoms you have been experiencing, and do as much of an assessment you are comfortable with. They will also assist with training your muscles to work properly, begin strengthening them and then teach you how to continue to work these muscles properly at home in order to prevent you from continuing to have these symptoms.


4 Tips To Improve Your Seated Posture

By: Allison Pulvino, MSPT, CMP


Research shows that the seated professional is at much higher risk for low back injuries, since sitting places 2.5 times your body weight on your spine. Below are easy tips for improved seated posture:


  1. When sitting during the work day, make sure your computer screen is at eye level and directly in front of you to prevent any unnecessary forward leaning or rotational stresses.
  1. When sitting at a computer desk, the arms should be relaxed at one’s side during typing and operating a mouse, and not reaching forward, to prevent forward slouching and possible upper and lower back pain.
  1. When sitting in any type of chair, the shoulder blades should be back against the chair to prevent any increased stresses to the lumbar spine or to the neck and shoulders.
  1. If there is any uncomfortable pressure in the lower back from prolonged sitting, use of a lumbar roll can help to maintain the spine’s natural curve and decrease the unwanted stress.

If you experience pain from poor posture, contact us here.


Tendonitis vs. Tendinosis: What’s the Difference?

By: Cory Hall, SPT


Tendonitis and Tendinosis


Tendonitis is the inflammation of the tendon resulting from micro-tears that happen when the tendon is overloaded with too much weight or loaded too quickly. Tendonitis shows very evident signs of inflammation with cells invading the area to carry out the healing of the tendon and may be red, swollen or hot.


On the other hand, tendinosis is represented by degeneration of the tendon’s collagen in response to chronic overuse (even at benign levels of force) without allowing the tendon time to heal. The chronic nature of this injury means inflammatory cells and active inflammation do not respond to the tissue’s demands.


This pathology is noted by the following findings:


  • Immature type III collagen vs. type I – The tougher type I collagen is replaced in a non-effective pattern by type III collagen that weakens the tendon and exposes it to further damage.
  • In order to help the repair process the body starts to lay down new blood vessels and nerves to the area. However, the added vessels typically do not end up carrying any blood just congesting the area further and the nerves just cause pain.
  • The changes above result in an increase in the bulk of the tendon and represents a significant loss of tendon strength.




It is important to differentiate the pathology because it changes the treatments and the timelines for prognosis. Tendonitis care consists mostly of anti-inflammatory medication, rest and deep tendon massage to reduce adhesions during the inflammatory and healing process. The timeline for this injury varies from several days to 6 weeks depending on chronicity.


The treatment of tendinosis mostly utilizes physical therapies to combat the pain and weakness. Research suggests that, “tendons require over 100 days to make new collagen,” so the prognosis for tendinosis should be longer than tendinitis, ranging from 6-10 weeks for acute to 3-6 months for chronic.


Suggested physical therapies include:


  • Exercises emphasizing eccentric muscle contractions – These contractions are thought of as “negatives,” during which the muscle is contracted as it is lengthened. For example, slowly lowering a weight or your body to the ground.
  • Deep friction massage – Rubbing across or around the area of the tendon stimulates cells called fibroblast to increase activity for collagen production to repair the tendon.
  • Blood platelet replacement or Platelet rich plasma (PRP) – Since there’s no inflammatory process present in the tendon, the body doesn’t know to repair itself.  Here, physicians take blood and separate the cells and growth factors located in blood plasma. Once they have “platelet rich plasma,” they inject it back into the tendon to stimulate healing.
  • Sclerosant agents or high tendon injections – This therapy is aimed at decreasing the excessive neural growth that accompanies the formation of new incompetent blood vessels in order to decrease pain.
  • Extracorporeal shock wave therapy – This is the method of using high frequency sound waves to decrease the excessive neural and vascular growth in to the tendon.
  • Nutrient supplementation – Adding vitamin C, manganese or zinc to your diet have all been shown to be integral to the synthesis of collagen and may be beneficial.


It may be as important to note that the use of non-steroidal anti-inflammatory drugs (ex: ibuprofen) or corticosteroids should be avoided since they can inhibit collagen growth, even though they can provide short term relief from pain.


In conclusion, tendinosis is incredibly more common than true tendonitis and may respond better to therapies that do not focus on the reduction of inflammation. Tendinosis is more challenging to recover from, but there are numerous options being researched to clarify the best interventions to return individuals to activities.




Bass, Lmt Evelyn. “Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters.” International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice 5.1 (2012)

Kardouni, Joseph. “Neovascularization Prevalence in the Supraspinatus of Patients With Rotator Cuff Tendinopathy.” Clinical Journal of Sport Medicine 23.6 (2013)

Khan, JM. “Overuse Tendinosis, Not Tendinitis Part 1: A New Paradigm for a Difficult Clinical Problem.” Physical Sports Medicine 25.5 (2000)

Rees, J. D., M. Stride, and A. Scott. “Tendons – Time to Revisit Inflammation.” British Journal of Sports Medicine 48 (2014)

Talk More About Your Pelvic Floor!

By: Erin Duffy, SPT


What is it? The pelvic floor consists of the muscles that make up the base of the pelvis providing support for all our pelvic organs and is found in both males and females.


What does it do? The pelvic floor provides support to carry our pelvic organs, as well as control the sphincters for both our bowel and bladder movements. It contributes to our sexual function and is a key component in stabilization and support of the spine as part of our deep core.


Why you should talk about it! When the pelvic floor is not functioning properly, it can result in many complications for both men and women. It may present as sensitive issues such as bowel and bladder incontinence, or pain and dysfunction during intercourse. It can also contribute to common orthopedic complaints such as low back pain, groin pain, and hip pain. What’s important to know is that you don’t have to live with these issues, you can take control of them. Just like any other muscles in the body, muscles that make up the pelvic floor can be trained.


The muscles of the pelvic floor, in conjunction with the deep core, should turn on to provide stabilization for the spine before we perform any voluntary movements. When these muscles are not activating at the right time, it can result in things like low back pain when lifting, hip pain when walking, and leakage when running. By learning to activate these muscles properly, we can reduce and eliminate these symptoms. Talk to your physical therapist today to start taking back control of your body!


For more information on activating the muscles of the deep core visit: http://activebodypilates.com/pdf/core.pdf