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Archive for November, 2015

An Open Letter to Parents and Coaches of Girls Who Play Sports

Dear Coaches and Parents,

For more than 30 years I have had the good fortune to be a volunteer assistant coach for boys and young men playing football, basketball, and lacrosse, sports I played in high school and/or college. In this capacity I became very familiar with the particular dangers of concussions suffered while playing these contact sports. Indeed, one of my sons suffered a severe concussion as a high school lacrosse player, effectively ending his competitive career. I applaud the recent efforts being made at all levels of competition, especially in the area of gratuitous headshots in football, lacrosse, and hockey.

As a fitness coach for the last 10 years or so I’ve learned of another, all too common injury in sports, one that is disproportionally concentrated in the younger athletes: ACL tears in girls and young women. There is a veritable epidemic of ACL injuries in soccer, basketball, and volleyball. Girls are 4-6X more likely to tear their ACL playing these sports than boys. The numbers are quite simply appalling, and yet I hear not a word about this from any media source. Girls are being felled by this injury in droves but it seems no one is talking about how to prevent it.

Can anyone tell me why that is?

It’s not like this is a new phenomenon. A brief Google search turns up academic articles published in 1999. It’s also not as if these injuries are only of historical importance. The daughter of a friend was the third girl playing the same position for the same U17 soccer team for the same coach to suffer a non-contact ACL tear in 2015. Nor were they the only girls on that team so afflicted. When asked what changes had been made by the team or the coach in response to these injuries my friend shook his head. Crickets.

Can anyone tell me how this is OK?

The answer, of course, is that it is not OK. Not even a little bit. The causes underlying the increased risk to suffer an ACL tear in which a female athlete does not come into contact with another player are relatively well known. Studies have been done examining the way girls jump and land. As it turns out, girls tend to change direction and land with an outstretched, straight leg. Boys, on the other hand, do so with a flexed leg, reducing tension on the ACL.

If you watch girls running you can’t help but be struck by the valgus position of the knee when their foot lands on the ground; the knee is markedly inside the foot.  Girls tend to have stronger anterior muscles and therefore tend to be quad-dominant runners. They pull their upper leg forward through the contraction of the thigh muscles. Boys, on the other hand, are posterior chain-dominant runners, pulling their legs up through the contraction of their glutes and hamstrings. Without a strong posterior chain to counteract the effect of the quadriceps, the ACL is again under increased tension, magnifying the risk caused by knee position.

We know why the injuries occur, and as it turns out we also know how to prevent them, or at least reduce their frequency: teach young female athletes safer movement patterns, and put them in strength and conditioning programs that specifically train their posterior chain. If you see this type of training you will recognize it immediately: it’s how we train boys.

Can anyone explain to me why this is not occurring with young female athletes right now?

Even at the highest level of women’s sports we still see non-contact ACL injuries. For example, in 2011, 6 of the 21 members of the U.S. Women’s National Soccer Team had suffered an ACL tear at one point in their careers. However, in more recent years there has been a decrease in these injuries at the professional level because teams are training their female athletes in better neuromuscular recruitment patterns, which creates sounder movement. Athletes are doing strength and conditioning programs that emphasize strengthening their glutes and hamstrings. Hence, we are seeing dramatically fewer ACL tears at the highest levels of women’s sports. There is no way to justify not doing the same thing for girls early in their careers.

Proven templates already exist to do just this. Simply utilizing the off-the-shelf PEP program of stretching and plyometrics has demonstrated meaningful decreases in the incidence of ACL tears. Rather than use such a basic program when it comes to high quality movement patterns, why not look to someone like San Francisco’s Dr. Kelly Starrett? The founder of Mobility WOD and author of “The Supple Leopard”, Dr. Starrett is a consultant to dozens of collegiate athletic departments. He recently took over training for an elite 150-member girls volleyball program with the specific aim of reducing ACL injuries in those athletes. His teachings on proper movement mechanics are peerless, as a quick perusal of his book will attest. Perhaps we should be looking at what he is doing.

Jeff and Mikki Martin have been training kids in Southern California, the epicenter of youth soccer, for well over a decade. Their protocols include meticulous attention to the type of mechanics taught by Kelly Starrett and emphasize the importance of strengthening the posterior chain beginning around age 10. As the developers of the original CrossFit Kids program and more recently founders of The Brand X Method™, they have trained hundreds of young girls who play soccer without a single one of their athletes suffering an ACL injury while under their care. They arguably have the longest track record of successfully and safely training youngsters. Perhaps we should be looking at what they are doing.

One thing is for sure: it is not OK to continue with the status quo. Simply doing what you have always done is nothing less than condemning a high percentage of your girls and young women to suffering an ACL tear and all that goes along with it. The nature of the sports in which we see an epidemic of concussions is such that the only way to prevent them is not to play those sports. This is not the case with non-contact ACL tears in soccer, basketball, volleyball and other sports played by girls. Prevention is possible through the institution of training programs that emphasize the teaching of new, safer movement patterns, as well as strengthening the muscles of the posterior chain.

I’d like to propose a 3-part solution to this problem. First, we would like to offer training to coaches in how to teach better basic movement patterns. One of the most fundamental goals for those of us who utilize The Brand X Method ™ to train kids and teens is to create a cadre of coaches who can do this. We hope that this can become a core part of in-season team training. Secondly, we wish to make available our coaches, and coaches who share our concerns and philosophy, to train your athletes to have a stronger posterior chain. The data supporting the inclusion of weighted squats, deadlifts, and power cleans both in season and out of season is compelling. Our coaches are experts in teaching the proper mechanics involved, and our athletes progress in a safe and measured fashion.

Lastly, the data supporting the inclusion of full-body functional movements executed at relatively high intensity is equally compelling when it comes to not only injury prevention, but also in developing stronger, faster, more durable athletes. The Brand X Method ™ is a proven program that emphasizes proper mechanics and safety. It is the latest version of a program that has been creating highly athletic youngsters and teens for more than 10 years. This type of physical fitness directly translates to more capable and confident athletes in all of the sports mentioned. At CrossFit Bingo our Alpha X Youth Athletics program is available to train your athletes all year round, either individually or in team settings.

It’s time we all start talking about these non-contact ACL injuries in girls’ sports, just like we have been talking about concussions in boys’ sports. Parents should be asking what is being done on behalf of their daughters. Coaches should be committed to stopping the epidemic of non-contact ACL injuries in their female athletes.

We can help.

 

Darrell E. White, M.D.

Co-Founder, CrossFit Bingo

Co-Founder, Alpha X Youth Athletics

 

 

Gratitude May Be An Essential Part of Success (From Sunday musings…)

So much we could talk about this morning. Religious extremists and their violence. Intolerance of various kinds expressed in various ways and in various places. Friendship, and those who would impose restrictions thereupon. Financial models both micro and macro, and how they affect those downstream from the “decisioners”. I could go on and on before I even start.

Rather than contemplate any of these in the kind of depth they deserve, let’s rather consider a bigger theme and look at it from different altitudes. My friend Dave posted a little thoughtlet on “success”, and it started a very nice conversation about what actually constitutes success and why. Thinking about success may provide us with a platform from which we might think about the other issues that may be orbiting our little personal planets.

Dave’s post was this: “Successful people have a sense of gratitude. Unsuccessful people have a sense of entitlement.” To parse this one must begin with a definition or at least an understanding of what success is, and equally importantly, what it is not. There are many terms that are often associated with success, things like wealth and power and fame. Is it necessary to have any, or all, of these to be a success? Can you be successful in the absence of any, or all, of these? Where would one fall on the gratitude/entitlement continuum if one were to have any, or all?

This is really tricky, and I’m afraid that when I’m done you will likely have more questions than answers, maybe even more than you had when you started. That may actually be the point now that I think of it. Success probably relates to what I shared last week about “All” or Everything” in that the proper definition of success emanates from within, not without, and this I think is what Dave is implying when he makes the distinction based on gratitude vs. entitlement.

Let’s use an example, a very famous example, to try to illustrate this and prompt some thought: Steve Jobs. Mr. Jobs as you know was cut down in the prime of his life by a disease that has no known cause. Was he a success? He was wealthy, famous, and wielded great power both inside and outside his company. He was married to his only spouse, and together they had healthy children (2, if memory serves). A life to be envied, no? One to which many (most?) might aspire.

A deeper dive at least suggests another story, though. It appears that Mr. Jobs, unlike his one great peer Bill Gates, had few if any close friends. Indeed, within his company and his industry he left behind a trail of despair. All one reads about is how hard it was to work with or for him. He won…for sure he won way more than he lost…but did he succeed? Was he successful? I never once read or heard anything from Mr. Jobs that implied that he was grateful for either any of his wins, or any of the spoils of his victories. There were a couple of whispers about an end of life wistfulness about a paucity of connection, though.

I don’t mean to pick on Mr. Jobs, and Heaven knows his family surely misses him. I think his example might soften the “entitlement” part of the equation a bit as I never really got a sense of that from him (as opposed to, say, your favorite rich and famous Kardashian). Being grateful, however, bespeaks connection, a very certain acknowledgement that the concrete parts of success–money, fame, power–are without any real value unless they somehow allow you to share them. This, in turn, brings with it the humility that comes from realizing that you can’t be truly successful if success is only something you can count rather than something you can feel.

No one is entitled to victory, let alone success. In order to feel successful you must be able to admit that you neither did it alone, nor can you truly enjoy it alone. The gratitude felt by the successful is one born of thankfulness for the opportunity you must have been given, and borne aloft by the desire for your success to be one that is felt by not only you, but by others you are thankful to have in your life.

What does being successful mean to you? Rich or poor, famous or anonymous…are you successful?

 

You Can’t Have Everything

“I want to grab the big brass ring…”

There are a number of artists who hold dear philosophical and political views with which I can find little common ground, and yet I still find great pleasure in their art. Springsteen, of late, is a good example. An older, longer enjoyed example is Barbara Streisand. After breakfast this morning I found myself humming one of her classics, “Everything”, as I headed off to my next meeting.

[As an aside, I am presently at a huge convention for my day job. Did you know that 3 out of 4 doctors say that Las Vegas is bad for your health?]

You see, I’d just spent some time with a 30-something CEO of a really cool company who just returned to work after the birth of her first child, and just outside the restaurant I’d bumped into a 30-something rockstar among eye surgeons with whom I’d shared a drink last night and discussed how she was managing the work life balance of being a mother of two, busy surgeon, and in-demand expert in our field. We all agreed that balance was unobtainable for any of us, but all the more so for the women; the bar is pretty low for the family side of the balance for men. Old news.

Then, an epiphany. I’ve oft written that you can’t have it all, no matter who you are or what you do. Man or woman. But one of the women, the CEO, after a bit of thought disagreed. You CAN have it all, you just can’t have everything. The trick is in defining what “all” means for you and those closest to you. “All” must be examined, its content vetted and negotiated among the parties involved. Once fleshed out in this way “all” becomes an obtainable entity.

“All” is about balance; everything is about never, ever being in balance.

Needless to say the conversation with both of these very impressive, highly accomplished women pivoted instantly, all of the pressure and intensity of the balance challenge dissipated. Seriously, this is the first time I’ve been able to feel comfortable with some of the very famous women–think Sheryl Sanders, for example–who proclaim loud and long that you can, indeed, have it all. They are at the same time just as wrong as I’ve long held, but they may be more right than I’ve given them credit if they are talking about “all” and not “everything”.

I think my young friends are right, you can have it all as long as you are very clear about what having it all comprises. It’s when you confuse having it all with having everything that makes it not only impossible to have a life in balance, it may actually mean eventually not having much of a life at all.

“…give me everything, every thing.”

 

 

Sunday musings 11/8/15

Sunday musings…

1) Chignon. American Pharoah. Still.

2) Kindness. “The world breeds monsters, but kindness grows just as wild.” –Mary Karr

3) Varied. It’s quite amazing to me, after all these years, that there still exists such a misunderstanding about the difference between variability, randomness, and frequency when it comes to CrossFit WOD programming. People both laud and criticize a program for having too little or too much of any of the three. Worse than that, all too typically an evaluation of one particular program usually follows at most a week or two of evaluation and inspection.

Look for instance at CrossFit.com. For 15+ years now we have before us the sine qua non of CrossFit programming, a bright shining beacon to constantly varied functional movement. Major exercises come up regularly, but they are presented in a dizzying array of formats. Peripheral, ancillary movements come up in general programming seldom, if at all. There is a form and there is a pattern here: 3 on/1 off, with variability in load, duration, and complexity. There is a style here: for example, mono-structural strength is presented as a stand alone WOD. After as little as a month of study you should be well aware of what type of CrossFit programming will be found here.

So, too, should it be at a CrossFit Affiliate. Constantly varied should be just that, but programming in this manner does not preclude the inclusion of a “bias” in the training. Whether it be strength, endurance, or competency in gymnastic maneuvers, it is perfectly OK to express this sort of tendency. Indeed, it may be a way for an Affiliate to differentiate itself in the ever-crowded space the commercial version of CrossFit has become.

The point is this: it is pointless to make a statement about a particular version of CrossFit without examining it over many weeks. Once examined it is quite reasonable to state that the style of programming does not suit you, or does not fit your needs, but it is equally unreasonable to smear that programming because it does not match your personal desire regarding frequency or style. For example I find no use for WODs dedicated to movements seen in Strongman competitions, and yet you’ll not find me speaking poorly of either this type of programming or gyms that have this bias.

Heaven knows there are so many CF gyms in most locales that you should be able to find pretty much anything you need. If not, there’s always a return to our roots, a return to the days of the garage gym. You could do much worse than following Coach’s programming on CrossFit.com in your own little cave. Just remember, the proof of any program, at least a CrossFit program, is not in the process but in the results.

You can’t fake increased work capacity across broad time and modal domains.

4) Veteran’s Day. What do we owe the men and women who served our country? I guess more specifically, what do we owe those who served in a capacity in which their lives were threatened? This is a question that has meaning both as a society of citizens and also as a nation of individuals.

We will celebrate Veteran’s Day on Wednesday. I like to think that in my little corner of the world Clan bingo expresses a collective thanks in all walks of our lives. More importantly, though, is the fact that we all acknowledge that each of our service men and women had a uniquely personal experience, and we try very hard to respect that when we engage them as Veterans.

Perhaps it’s generational on the part of either the Vets or in general, but there is certainly a very different ethos surrounding each of the wars or conflicts they survived. This may say more about us, we who did not see conflict, than it does about them. My exposure as a physician to WWII, Korean, Viet Nam, and now Iraq/Afghanistan/Kuwait literally seems like 4 wholly different experiences. My reaction is simple and straightforward: I make no assumptions, and I offer goodwill and kindness.

One of my football coaches broke down and sobbed over what he’d seen and done in Viet Nam, and my Dad wouldn’t touch a gun, categorically refusing to speak about Korea. No matter. I, we, are indebted to both, and all who came before and after them. We are a stronger, richer society because men and women like them stepped forward and stood tall.

Happy Veteran’s Day to each of you who served, here chez CrossFit. Happy Veteran’s Day Cat. I owe you a call. Happy Veteran’s Day Pop. I owe you everything.

I’ll see you next week…

bingo

Sunday musings 11/1/15

Sunday musings…

1) Fall Back. Needed that.

2) Pharoah. A champion goes out on top. Not a dry eye chez bingo. Google “Tim Layden” for a great review.

3) Jacket. The motorcycle jacket has been alternately called an iconic male look, and a caricature of masculinity. I do not own a motorcycle jacket. Am I somehow not masculine, or am I subtly making a statement about inclusivity?

Or do I just look stupid in a leather motorcycle jacket?

4) ACL. There is a veritable epidemic of non-contact ACL tears among young female athletes. Unlike concussions in young male athletes, the collective response from media sources of all kinds to this: crickets. Also absent, any hint of a change in how girls are training for their sports.

Why is that? How is that OK?

5) Relative. “Constantly varied functional movements performed at relatively high intensity.” What exactly does that mean? For whom does this apply? I’ve been perusing the programming of some CrossFit Affiliate (and a couple of recently de-affiliated gyms still programming CrossFit-type WODs), watching videos and looking at pics of their athletes, and it looks like there’s a bit of confusion out there.

The “relative” in that definition of CrossFit speaks to the universal scaleability of the physical part of the CrossFit prescription. Load can be moved up or down. Duration can be increased or decreased. Movements that maintain the desired stimulus of the posted WOD can be substituted where a particular skill has yet to be acquired. Intensity is relative to the individual athlete in question, and in the classic application of the CrossFit prescription it is only “high” after that athlete demonstrates mechanical proficiency on a consistent basis.

Watching last year’s Games and Regionals footage one of the things that impressed me was the tight correlation between the virtuosity of movement and the resulting work performed in the more accomplished athletes. One cannot help but notice at all levels of competition the movement flaws seen in athletes who could not sustain enough intensity to place highly in an event. If you go back in time and watch videos of the early days of CrossFit you are struck by the emphasis on proper mechanics as a vehicle to increased efficiency and therefore more work or power output. Form is the gateway to intensity.

At my Alma Mater there is a saying about teaching that goes like this: the perfect classroom is Mark Hopkins on one end of a log, and a student on the other. I always had that image when I watched videos of Coach at the original CrossFit Santa Cruz, when I read his earliest writings in the CFJ. You know, the perfect gym is Greg Glassman on one side of a barbell and a CrossFitter on the other. CrossFit, at least the CrossFit I learned from Coach, is more than just writing a WOD on the whiteboard and opening the garage door. Every solo CrossFitter I’ve ever met, even those doing Coach’s own programming, was better after being actively coached.

“Relatively high intensity” is both a highly personal, individual metric, and a constantly moving target. It requires a shared knowledge of an athlete’s mechanics and consistency by both athlete and trainer. Programming must not make high intensity either unobtainable or unavoidable. There is only one Greg Glassman, just as there was only one Mark Hopkins. Williams College today is much larger than that single log, and Heaven knows CrossFit is much larger than CrossFit Santa Cruz ca. 2003. There is, however, a lineage that we should be able to trace back to both men.

If a gym is training people according to the CrossFit prescription, shouldn’t we be able to look at that gym and see that lineage?

I’ll see you next week…

bingo

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