For Medical Professionals
WHY US & WHY THIS PROGRAM – SOME HISTORY
This is not a typical “CrossFit Gym”, but it IS a CrossFit Gym and we’re proud of the foundations of CrossFit and the functional development we see in our athletes. As a healthcare professional for the past 30+ years, I would not continue representing the brand of CrossFit if I didn’t believe in it for my own personal health and athletic development as well as for my athletes.
My name is Ed Farina and I have been a physical therapist for 40 years. My practice has taken me from hospital to outpatient to administration. Mostly having dealt with orthopedics and joint replacements through my career, I can tell you that my profession is missing the mark in the athletic development of seniors – SERIOUSLY MISSING THE MARK.
The priorities for any senior, from 55 years of age to 94 (our oldest athlete) should be to first remain independent and functional, and then, of course, feel good and be healthy. My definition of functional and independent is probably a little different than simply documenting the ability to independently perform ADLs. My definition of functional and independent is a robust, active, healthy, and happy retirement, regardless of age. This requires more than our current standard for living independently:
According to NCBI
The basic ADLs include the following categories:
- Ambulating: The extent of an individual’s ability to move from one position to another and walk independently.
- Feeding: The ability of a person to feed oneself.
- Dressing: The ability to select appropriate clothes and to put the clothes on.
- Personal hygiene: The ability to bathe and groom oneself and to maintaining dental hygiene, nail, and hair care.
- Continence: The ability to control bladder and bowel function.
- Toileting: The ability to get to and from the toilet, using it appropriately, and cleaning oneself.
Learning how each basic ADL affects an individual to care for themselves can help determine whether a patient would need daily assistance. It can also help the elderly or disabled determine their eligibility to attain state and federal assistance programs.
While this is a “nice, medically based list of functions one must possess”, pardon me if I believe at any age we should be able to do much more. The above listed are “surviving”…not thriving! This is a sad representation of “activities of daily living” and we need to upgrade our expectations…and how we get our seniors to a higher quality of life.
We have way too many “younger” seniors focused on accomplishing these things and not living out their retirement years actively. Obesity, sedentarism and the mainstream media’s peddling of drugs and supplements over lifestyle changes is funneling our younger (and older) seniors into a bad place.
OUR GOALS ARE SIMPLE
- Strength is king – the stronger you are the better your ability to do more things…period!
- Aerobic and anaerobic capacity – I know, I know, don’t use those words with seniors, right? B.S.! Capacity is relative to both the individual’s age and their current fitness level, which we know can be low to start. But progress happens – more quickly (and safely) than you’d think.
- Mobility – the ability to get up off the floor is paramount. Strength plays a very important role in this task, but so does mobility. A half kneel lunge position could be the key to saving one’s life.
- Socialization – the small group setting is crucial to not only the success of the program, but many times it fills a large void in an athlete’s life.
- A Challenge – probably the most underplayed of our assets here. Our society is not challenging our seniors. Rather, we coddle them and over-provide tools and resources “so they don’t have to do ____________”. Not only are we robbing them of their independence, but we’re robbing them of the victory that occurs when they actually “win” (sit-to-stand to a 14″ box or rise from a half kneel independently – for the first time).
A NEW PERSPECTIVE
I am a huge proponent of education and continuing education, pertinent to our subject. Couple that knowledge with experience and I believe you become an asset to those you care for.
My training prior to becoming a licensed physical therapist in 1984 was extraordinary. My experience specializing in the athletic development of seniors since 2015 has given me a refreshing and new perspective on dealing with “the aging athlete”. And by aging, I’m speaking of ages 79 years old and up. Treat them like old people and that’s what you get. Treat them like athletes…and that’s what you get.
“Skipper” is 92 years old. Her shoulder pathologies are longstanding. After just a few months, not only CAN she do 10# ball slams, but she enjoys it. Strength, ability, accomplishment = freedom.
Osteoarthritis, sarcopenia, osteoporosis, balance disorders and the fear of falling, high blood pressure, congestive heart failure, diabetes, neuropathy, dementia and memory loss are not new to me or those who care for our seniors. Statistics reveal that the increase in obesity, poor nutrition, and lack of physical activity in this age group accelerates the above-mentioned diseases. What has changed since I joined the medical field is that life expectancy has increased but NOT necessarily “healthy” life expectancy.
I praise the pharmaceutical industry for the development of so many critical advances. However, I’m frustrated that the most underutilized, cheapest, and most effective means to a healthy, independent, and happy life is through diet and exercise – lifestyle.
Specifically, my expertise is in the exercise portion.
I have personally overseen over 40,000+ athlete encounters in the past 6 years. Our program has grown solely by word-of-mouth to almost 100 members/athletes. It has evolved as needed and proven to be highly successful in improving not only their quality of life but many other indicators of health.
On a regular basis, we see:
- increased strength
- improved body composition
- improved mobility
- improved joint range of motion
- reduced blood pressure
- lowered resting heart rates
- increased bone density (without medication intervention)
- improved blood markers (including cholesterol/A1Cs and blood sugar)
- improved balance
I know, I know…if I’m reading this information, it sounds too simple considering we’re dealing with numerous difficult health conditions AND in a group setting to boot! I agree.
So, what’s the trick?
BACK TO BASICS
#1 Have high expectations
Do not treat this generation like old people! Don’t allow these truly exceptional individuals to define themselves by their ailments! Do not take the bait and let them sell you on what other’s their age are doing. They have plenty of others in their lives that coddle them…that is NOT your job and quite honestly, they don’t want you to do so. They want you to help them get healthier, to maintain or become independent, and do so in a safe but progressive way. They will amaze you with their progress and celebrate victories, large & small. Trust me, you will be marveled by their outcomes.
#2 Understand aging
Understand the human anatomy of an aging body. No, not everyone is alike but we recognize that there are similarities that occur as we age and as physical therapists, health coaches and trainers, we have to look at the “analytics” when discussing the hot points of training. For example:
- The knee is the largest joint in the body and a weight-bearing joint as well. Is it no wonder that our athletes often suffer from knee OA?
- How about the hip and shoulder? What happens at the acromioclavicular joint of the shoulder on overhead activities?
- Does the aging spine suffer from degenerative disc disease with spinal stenosis?
- Is back pain coming from facet hypertrophy and are there specific movements/exercises that irritate that particular area of the spine?
While there are outliers, and unique snowflakes, most of our athletes, after an initial health and movement screening, fall into one or more categories of an orthopedic, neurologic or metabolic category. We know how to navigate through, around and many times rapidly improve their conditions. I suppose it’s like DRGs, just for exercise.
#3 Protocol / Programming
Exercises, load, and intensity. What type, how much, how often?
Here’s where the rubber hits the road; the “special sauce” if you will. Here’s what separates our program from so many others out there.
Everything matters when discussing exercise programming for our senior athletes…EVERYTHING!
It starts with selecting the right movements. Critical to this age demographic are strength, full range of motion, and functional patterns. Squat (sit to stand within a pain-free range), pressing (frontal and the transverse planes), and hip hinging are all compulsory. Shortened, explosive movements like power & squat cleans help with balance, proprioception, and the development or “re-development” of fast-twitch muscle fibers, which are the first to go as we age. Movements that challenge range-of-motion, joint positioning, and life-saving postures like the half kneel, pushup, high-knee-march, and burpee are also…compulsory. Safe pulling taking into consideration the aging shoulder requires creativity and multiple planes of movement. Finally, accessory movements to stimulate muscles and tendons through movements in a full range and that focus on some functionality, like bicep curls (carrying a bag of groceries in elbow flexion) are also useful
Progressions and Regressions
Traditional CrossFit programming sets a high-level standard (weight, movement) and scales down. We don’t do the opposite, but we program in a middle range and then scale up to progress the exercise if the athlete is competent and able, or we scale down and regress the movement to something that’s achievable yet a progression toward the specific standard we are looking for.
Progressions and regressions are essential, and they are somewhat standardized so that we can control the progress: not too fast, not too slow.
The simplest example would be a squat. If an athlete cannot achieve depth without pain, we use a target for several reasons:
- it lessens the ROM
- it sets a tactile target
- it provides feedback, consistently
- it provides a measurement, so we know where to lower the box to after a period of time assisting the athlete to be successful
Progressions are mostly for load, and when a basic movement like a half kneel is achieved, to keep the athlete stimulated, we can advance that to a traveling lunge, then a weighted traveling lunge.
MECHANICS & CONSISTENCY
The goal: Performing the exercise correctly in a manner that promotes the stimulus we are trying to achieve without causing irritation or an enhancement of asymmetrical tendencies. Get it right – that’s the goal.
This age group may not be able to get into the position we are requesting of them, at least intially. Patience is more of a prerequisite here than with a younger age demographic. With patience and consistency, and the frequency at which we see them, we see solid results over time and can correct imbalances that may cause asymmetries.
- I have seen kyphotic thoracic spines and forward head positions transition to within normal limits over time.
- I have witnessed athletes that cannot touch their knee to the ground while attempting to half kneel, over time develop a beautiful forward and reverse lunge.
- I have lost bets to athletes setting a time goal for full shoulder flexion. I lose a lot! I’ve found myself taking them to Hooters for chicken wings and beer…on my tab and my lost bet!
The frequency at which they train is to our benefit as it relates to watching for progress and advancing or regressing movements.
Patience & persistence (time)
We are patient yet relentless with our demands.
“This is the goal. We work it until we achieve it. It may take a year, but we’ll achieve it if it’s “achievable”.
The relationship we establish with our athletes is one of honesty with good intentions. We tell them when they are performing the movement correctly and when they are not upholding the standards we have set and expect of them. And if they aren’t getting it, we work with them until they do. We encourage small improvements weekly. We challenge them. The result is a motivated and appreciative athlete. We have to believe in them in order for this to work, and they know it. I know, this is more subjective than clinical, but what the mind believes the body can often do.
I am overly confident that what we have designed is the best methodology for enhancing the lives of the greatest generation of all time.
Ed Farina, P.T., Ph.D., M.B.A.
Licensed Physical Therapist PT#4162
Functional Movement Systems 1 & 2
Mark Rippetoe Starting Strength (expired)