If you believe the data, over 50 percent of the U.S. adult population are dealing with back problems. Having a personal history of lower back issues and frequently working with athletes in the same boat, I have been motivated to find effective movements to keep the back strong and functional.

In this installment of my dumbbell series, I present two movements that I have found to be effective in my training practice. The two movements I speak of are the Romanian deadlift (RDL) and Tommy Kono's back-loosening deadlift. I refer to these two movements as the yin and yang of the back; together, they complement one another to work the back through both extension and flexion, in both fixed and dynamic positions, and both in isolation and in concert with the rest of the posterior chain of muscles.

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As a CrossFitter you have likely been: fatigued, sore and generally beat up at one time or another, or perhaps continuously! This is a result of training. What will largely determine the results you obtain from training is a multifaceted concept, recovery. Adequate recovery allows for more training and ultimately improved performance. In some respects recovery is the Night to our exercise Day (this analogy will be more true than we can imagine). In exercise we release hormones, mount immune responses, cause inflammation and use things like glycogen and lipids for fuel. Recovery complements this process. Accelerating the things we want and mitigating the less desirable processes will provide more return on our exercise investment.

Much in the spirit of "World Class Performance in 100 Words" recovery comes down to: Eat a Zone favorable or other hormonally intelligent diet with predominantly antioxidant rich "Paleo" foods. Sleep 8–10 hrs per day in a completely dark room. Go to bed as early as possible. Laugh. Avoid excessive stress.

This is admittedly a black box approach to the recovery issue. One need know nothing about why these recommendations will optimize recovery to reap ALL the benefits. Occasionally however understanding some "whys" will improve both implementation and compliance, so let’s look at these topics a bit more closely.

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According to some statistics, skeletal muscle accounts for 40-50 percent of body weight, and about 85 percent of human pain complaints. In athletes, most chronic pain issues are of myofascial (muscle- or sinew-related) origin. This is not surprising, since athletes tend to use their muscles and sinews much harder than the average population.

What is surprising is that when athletes go to the doctor because of some annoying pain that won't go away, hardly ever are their muscles examined and screened for problems. Instead, the doctor usually looks at their tendons and joints, and, in the end, the problem is likely to be blamed on some type of "-itis" —tendinits, bursitis, arthritis, you name it. In this article, I want to draw your attention to a more likely cause of your pain—one that is directly related to your muscles. I am talking about trigger points.

Trigger points are small, localized muscle cramps with a variety of causes, most notably excessive loads, direct trauma, or repetitive or prolonged muscle contractions. The cramp does not normally affect the whole muscle but is usually confined to one or two small muscle fibers within the main body of the muscle. You can actually feel the cramp as a hard lump or knot in your muscle. Sometimes, especially in small muscles, the whole muscle will feel like a cable made from hard rubber.

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We warned of rhabdomyolysis in a previous issue (CrossFit Journal 33, May 2005) and return to the topic this month not only to repeat our warning but to share the lessons we’ve since learned about “exertional rhabdo.”

Before the first rhabdo case was brought to our attention, we regularly warned of CrossFit’s potency wherever we had the opportunity. In the January 2005 issue of the journal, we offered the following caution for newcomers tackling the WOD (workout of the day): “Countless bad-asses from sporting and special operations communities, long regarded as bulletproof, have been burned at the stake of ego and intensity.” As it turns out, the burning is rhabdo, and we now find ourselves obligated not just to explain CrossFit’s potency but to warn of its potential lethality.

We can dispense with much medical detail with a quick and easy description of rhabdomyolysis as a potentially lethal systemic meltdown initiated by the kidneys in response to the presence of shed muscle-fiber debris and exhaust in the bloodstream. There are several causes and types of rhabdo, classified by the underlying cause of muscle breakdown. With CrossFit we are dealing with what is known as exertional rhabdomyolysis. It can disable, maim, and even kill.

To date we have seen five cases of exertional rhabdo associated with CrossFit workouts. Each case resulted in the hospitalization of the afflicted. The longest hospital stay was six days, the shortest two days. All have made full recoveries. The hardest hit was extremely sick, the least afflicted had no complaints other than soreness. All were extremely sore. Soreness doesn’t adequately explain the discomfort of rhabdo, however. The worst hit, a SWAT guy, recounts that six days of intravenous morphine drip barely touched the pain.

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One of the paradigms in physical therapy is the notion that once range of motion (ROM) is restored, the patient is considered healthy. The American Medical Association quantifies the severity of back problems mostly on the loss of spinal ROM (McGill, 2002). While this is a laughable definition of “healthy,” we need not dwell on it because our goal is to pass by “healthy” faster than prunes through a goose.

Part of the definition of CrossFit is that sickness, health, and fitness fall into a continuum (see the “What is Fitness?” issue of the CrossFit Journal [October 2002]). A person with bad shoulders generally has weak, tight shoulders. A person with healthy shoulders (according to health codes) will have adequate range of motion, but not necessarily strength. Truly “fit” shoulders must be strong throughout the full range of motion. This article describes a progression of exercises that has been proven effective at restoring ROM and strength in the shoulders. A lot of doctors tell patients with shoulder problems to never lift anything over their heads. I disagree.

This article is not intended as medical advice. As always, we suggest that you consult a doctor, and then another doctor, until you find one who will sign off on this type of work.

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Injury, like illness, is an ineluctable fact of life. In sport, elite performers are more marked by the attitude and manner with which they deal with injury than by their elected course of treatment or by the severity or frequency of their injuries.

Whereas treatment and rehabilitation receive considerable attention and focus in discussing injury, compensatory strategies for maintaining or improving fitness while recovering from injury are generally given short shrift.
This month we reveal the CrossFit approach to training with injury through the hypothetical case of an athlete medically restricted from all weight bearing movements for eight weeks following surgical repair of the meniscus in his right knee.

Remember, our concern here is not how to “rehab” the knee specifically but how to keep the athlete training to ensure that he continues to develop while he is injured and unable to use the affected limb.

This entire article is available in the CrossFit Store.

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