It has been a beautiful summer and I hope you all had a chance to enjoy yourselves and play some really good Capoeira.  With the change of the seasons come a time to refocus your energies, rethink and restart.  You want to create good habits for the holiday season and the upcoming winter months.  What can you do to improve your skills as a Capoeirista and to grow as an individual?  I may sound like a broken record but there is always room for improvement.  The actions you take upon yourself to continue your learning and growth in life will lead you to become a wiser and better Capoeirista in the long run.

 

Fall is a great season to get rid of bad habits and set some new goals for yourself.  Here are 7 ways to make the most out of this season.

 

1. Rejuvenate Yourself. 

Fall is the time to rejuvenate your mind, body and spirit.  Have you been going into Capoeira overdrive doing nothing but eating, sleeping and breathing Capoeira? This often tends to be the case especially with all the batizados during the summertime.  It's good to take a break every now and then so you can come back refreshed.  Treat yourself with other forms of activities that promote wellness, ie: swimming, biking, running, tennis, soccer,etc. so you can feel good mentally, physically, emotionally and spiritually.  Or you can learn to meditate or finally get that massage your body has been aching for.

 

2.  Travel

If you didn't get a chance to travel the last few months, plan a trip to your heart's desires.  If you are not able to take a long trip, even a day or a weekend getaway out of your normal environment can be a great stress reliever.  Sometimes we get so caught up in the hustle and bustle of every day life that we get easily get swallowed in it.  Eventually you can get worn out and even lose motivation or concentration.  I am a firm believer of traveling to revive necessary energies in order to maintain balance and happiness.  Everyone needs a mental break and traveling is great for your soul.



3. Change Up/Incorporate a Good Cross Training Program

Good Capoeiristas know you must incorporate a good cross training program in order to improve your skills and to prevent injuries.  If you were not already doing this, now is a good time to start.  Please see previous article on Capoeira and The Importance of Cross Training.  If you have been cross training, it is important to evaluate your program every month in order to make improvements.  What is it that you are lacking in your game?  Is your inflexibility getting in your way? Do you need to work on your strength, speed, balance or timing?  We all have our weaknesses.  In order not to plateau, you must always analyze your strengths and weaknesses and work on balancing them out.

 

4.  Implement the 3 C's:  Commitment, Consistency, Convenience

All three factors will lead to a successful training program.  Perhaps you were a bit lax during the summer.  I'll admit the same happened to myself between work and play.  During the colder months, many of us work very hard to maintain our commitment to Capoeira but you also need to find the time to relax especially when the weather is nice.  Now you can get back to business with the busy fall season and plan ahead for consistency.  Time is always an issue.  There is never enough of it but you can make it work to your advantage.  What is it that you need to cut back on?  Throw those excuses out the door and refocus on what was lacking.

 

5.  Improve Your Nutrition

Soon those meals will start to get heavier as daylight fades.  Many of you are leaner during the summertime as you are more motivated to get into better shape and have less of an appetite than you do in the wintertime.  On the flipside, the rest of you have been drinking, partying and eating too much with all those never ending functions and weddings. Food also changes with the season and you may start to crave heartier meals.  Cut down on the alcohol and the junk food and incorporate more vegetables, lean protein and complex carbs.  Eat more wholesome foods, organic if possible and detox your body by starting fresh.  Smaller consistent meals throughout the day will keep your energy levels up.  Hydration is extremely important as well.  Try to scale back on the overdose of caffeine, soda and juice and drink more water and coconut water.   Please see previous article A Capoeirista's Guide to Energy and Nutrition.

 

6.  Think Outside the Box and Get Out of Your Comfort Zone

How you play in the roda often depicts how you live life.  If you are always in your comfort zone, you will never grow!  You need to put yourself in uncomfortable situations so you can continue your growth.  Take a dance class, boxing or do something completely random which you would never do.  Place yourself in situations where you will constantly be challenged so you don't get "stuck" in life whether it's work, personal or social.  Fall is a great time to learn something new and what you learn in one area, you can always apply it to other areas.  Challenging yourself mentally as well as physically will also build up your self-esteem and confidence, both of which are important elements in playing a good game.



7. Find Your Motivation

Different people are motivated by different things.  What are your individual goals? Do you want to lose weight, increase muscle mass, rehabilitate that injury, strengthen your moves, sharpen up your skills or prepare for another batizado?  These are all valid reasons to improve your training.  Once you have identified your motivation, set short term goals to accomplish them.  If your goals are too extreme and difficult to achieve, you will only end in setting yourself up for failure.  Smaller goals along the way are much more reasonable to a successful training program. 

 

The new season can become very fruitful when you apply a refreshed and new attitude towards capoeira and life.  It is time to get rid of the negativity  and bad habits and give yourself a clean slate to start with.  Balance is what you need to become a better individual and a wiser Capoeirista.  Take the time you need to reset yourself and evaluate what exactly you need to accomplish.  Relaxa, respira...so many of you have forgotten how to do just that which makes all the difference in the world.  Move forward with your new mentality and prepare yourself for some very positive changes.  Axe!


Previously:
How TRX Training Can Strengthen Your Capoeira Training
Capoeira and the Importance of Back Strength
How Plyometrics Improve Your Capoeira Fitness
Eating Right for an Excellent Batizado Season
Poor Posture and Its Affects On Your Capoeira Game
10 Reasons A Capoeirista Should Use Kettlebells
A Capoeirista's Guide to Energy and Nutrition
Overtraining - Symptoms, Dangers, and Remedies
Core Strength
Why You Should Warm Up (Especially Now)
A Happy Holiday Survival Guide
Issues Facing Active Females
The Importance of Stretching and Flexibility
Joint Pain & Common Capoeira Injuries (Part 2)
Sprains, Strains & Common Capoeira Injuries (Part 1)
Capoeira Nutrition (Part 2)
Capoeira Nutrition (Part 1)
Capoeira and the Importance of Cross Training


Cindy Lai is a NASM certified Personal Trainer and runs Cindy Lai Fitness Bootcamp, a bootcamp in Central Park that incorporates all the above elements, a kettlebell bootcamp on the West Side Highway for non-traditional strength training, and a seasonal kettlebell conditioning and strengthening class for Capoeiristas. She has been certified by Kettlebell Concepts for the past several years and continuously attends workshops and conferences dedicated to this unique training method of kettlebells. Check out her site for more details.

Photos by Leonardo Ré Jorge, tombothetominator, and familymwr via CC BY-SA 2.0

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On Tuesday, we discussed acute back injuries: strains, sprains, and disc herniations-injuries producing pain that lasts a month or less.  When you have a back injury that produces pain or limitation of movement that lasts 4-12 weeks, we refer to this as sub-acute back pain.  When it persists beyond 3 months, the back pain is referred to as chronic.  For treatment purposes, sub-acute and chronic back pain are very similar, and similarly difficult to effectively treat.  This final installment of Doctor Capoeira (for now) will focus on the causes, therapies, and general tips for managing sub-acute and chronic low back pain.  Also, you'll find out how my personal story of low back pain ends! 

The precise causes of a longer lasting back injury are harder to pin down.  The pain can be due to persistent spasm from a sprain or strain, it can be caused be a degenerated or herniated inter-vertebral disc, or less often in the young, athletic population, it can be due to bone injuries (such as a fracture) or bone changes (such as spinal stenosis, briefly discussed below).  However, usually the cause is multi-factorial, and may even have a psychogenic component (whether you realize it or not).  We often refer to this as "non-specific back pain."



Spinal Imaging and Sub-acute/Chronic Low Back Pain

I would recommend that if 6 weeks or longer has passed and you are still dealing with low back pain, you consult your doctor about obtaining plain X-ray imaging of the spine.  As I discussed in Part I on Acute Low Back Injuries (hyperlink), X-rays are usually not performed initially for acute back injuries where a simple strain or sprain is suspected.  However, when you have prolonged pain or worsening pain, an X-ray may demonstrate a vertebral compression fracture, loss of disc space implying disc generation, or degenerative changes of the spine which are a clue to the presence of spinal stenosis.  Spinal stenosis is a condition in which abnormal bone forms, narrowing the canal for the spinal cord and the passageways out of the spinal cord through which nerves pass.  As the condition is rare in people under age 60, I won't discuss it further here. 

Capoeiristas often ask me when they should seek out a Magnetic Resonance Imaging (MRI) study for evaluation of their low back pain.  MRI is the imaging study that gives doctors the most information about the spinal cord, ligaments, inter-vertebral discs, and other surrounding soft tissues.  It make sense that people would want this test as a way to "get an answer" to explain their symptoms.  However, physicians look at MRIs a little differently.  They are costly (to you and the hospital), they are time-consuming to perform, and tough to handle if you are claustrophobic (imagine lying for 30-45 minutes in a tunnel the size of a coffin with loud noises all around you).  If everyone who had an episode of back pain got an MRI, the entire American health care system would collapse; thus, doctors try to act as gatekeepers of this study, limiting it to those who may actually benefit from it.

There is an even more important reason why MRI is not performed on most patients with back pain.  Imagine you performed X-rays of the spines of every person you met walking down the street, even if they have no back pain.  You would undoubtedly find all sorts of small abnormalities.  If you took it a step further and performed MRIs of their spines, you might even see disc herniations that some people did not know about, because they had no symptoms!  This is the main reason why physicians generally try to perform spine imaging with discretion.  X-ray and MRI findings don't necessarily correlate with the physical state of the person to whom they belong.  Would you want to be rushed to surgery to have your back cut open if you had no symptoms of pain?  No way!  And, knowing about spine abnormalities that aren't causing you any symptoms is likely to only cause you needless worry. 

So, who does need this imaging? Certainly it is of value in the right patient.  If you have long-standing pain, or if you have a radiculopathy that is persistent or worsening, there may be surgical procedures available that can help you.  An MRI would be necessary in this case to confirm your diagnosis, and map out the anatomy of your spine for surgical planning.  Also, if any of the "red flags of back pain" are present (see Part I), your doctor may recommend an emergency MRI.  Consult with a doctor you trust who can help you to understand if this test will be helpful for you.  Hopefully the discussion above provides some insight as to why it might, or might not.



Management of Sub-acute/Chronic Low Back Pain

Diagnosis of the specific cause of sub-acute and chronic low back pain is usually less important than determining a treatment regimen that keeps it at bay.  In fact, most back lasting a month or longer is categorized by physicians as "non-specific low back pain," meaning that no specific cause can be blamed for the pain.  The good news is this type of pain usually isn't harmful to you, nor a reason why you can't participate in Capoeira training. Thus, treatment focus appropriately shifts towards managing the pain.

Treatment of long-standing back pain with medications is a dilemma.  For acute injuries of most joints including the back, I recommend use of over the counter ibuprofen in 600-800 mg doses.  However, long-term use of these medicines is likely to lead to stomach irritation and even ulcer formation.  Thus, in chronic back pain, I would avoid this medication except to treat occasional flare-ups, when the pain becomes worse.  Opioid pain medications (which carry trade names like Vicodin, Percocet), and muscle relaxants of different varieties (common trade names are Valium, Flexeril) are often prescribed by physicians to help with back pain.  I would highly discourage the long-term use of these medications.  Besides being addictive, they are central nervous system depressants and can decrease your response time, making it potentially dangerous to train Capoeira while taking them.  Steroid medications such as prednisone may also be offered to calm back pain flares; these may be of benefit for a short course, but any doctor worth his/her salt will warn you that the side effects and risks of these types of medications taken long-term mean they are not the solution for long term back pain.



Non-Medication Treatments for Low Back Pain

Since medications are not the answer to low back pain, you'll have to explore some of the alternative therapies out there. I'll briefly touch upon some of the treatment modalities used, focusing on the science supporting them and debunking some common myths.

Back supports.  Some studies have looked at the ideal choice of mattress to sleep on to reduce back pain.  There is no clear consensus here, but a medium-firm mattress is probably better than a firm mattress.  It's not clear if there is benefit from a conforming mattress such as a waterbed, but there is no proven harm.  Using back support braces during routine activity for non-specific low back pain has not been proven to be helpful.  On the contrary, they tend to be uncomfortable and limit movement-thus making them hard to stick with.

Spinal manipulation.  This therapy, generally performed by chiropractors or Doctors of the Osteopathy ("D.O.s" rather than "M.D.s"), involves adjustments performed passively to your spine.  When used for chronic low back pain, there is a small proven benefit, though it is not any better than other treatments such as exercise and physical therapy, which we'll discuss below.  One word of caution, if you do have a spine adjustment performed, make sure it is only performed by a licensed professional, as serious harm can be caused by incorrectly performed back adjustments.

Acupuncture/pressure.  Acupunture involves placement of needles just under the skin at specific points contacting and stimulating connective tissues in the body.  These connective tissues are thought to be inter-connected along "meridians" throughout the body.  The idea is that stimulating certain meridians can help heal pains and other problems in specific areas of the body.  Low back pain is a very common use for acupuncture.  Acupressure is the same concept, but involving use of deep pressure rather than needles.  The jury is out on the effectiveness of these treatments.  Multiple studies have been done, and their results are conflicting-some show benefit, others do not.  Interestingly, one study showed that acupuncture was more likely to be beneficial to people who go in with the belief that it will make feel better.  Thus, my advisement is that it may or may not work; but if it works for you, or has worked for you in the past, give it a try.

Massage.  The effectiveness of massage to relieve low back pain is a difficult thing to study.  This is because there are so many different types of massage, and the quality of massage is dependent on your therapist.  Furthermore, even if it is of benefit, no one knows how many sessions or how frequently sessions are needed to maintain long-term relief of pain.  Science aside, I think few people would disagree that having your back rubbed is relaxing and feels good.  However, for most people, the cost of massage sessions prohibits this therapy from being their optimal long-term solution to back pain.

Exercise/Physical therapy.  Another "hard to prove" therapy for back pain is the use of physical therapy and exercise therapy.  Your physician can often make a referral for you to be seen by a physical therapist, which is covered or offered at low cost to you by most medical insurance companies.  A physical therapist can then tailor a specific regimen of stretching, core strengthening, range of motion exercises, and aerobic therapy.  The goal is to help you stay functional and work towards a goal of getting rid of or at least controlling your low back pain.  Like massage, the regimens of physical therapy are difficult to compare, so scientifically studying the effectiveness of this intervention for low back pain is difficult. However, I will say that this is far and away my strongest recommendation for you as a way to get better when suffering from low back pain.  As an athlete, your goal is not just to get rid of your pain, but also to re-train your body to perform the ginga, esquivas, and other movements of Capoeira in a way that supports your low back and protects you from further injury.  The personal touch of a physical therapist is an avenue to achieve this, as they will keep your injury, your body type, and your goals in mind. 

I won't make any specific recommendations on specific exercises, stretches or strengthening exercises for chronic low back pain in this column.  The topic is vast, and the right answer to the types and combinations of exercises right for you is largely dependent on the nature of your injury, your body type, and your goals in Capoeira.  Suffice it to say that seeing your doctor and getting a referral to see a physical therapist are great first steps in healing low back pain.



In Part I of this article, I lead in with my personal story of struggling with a low back injury.  As you recall, a spine surgeon had recommended that I have urgent back surgery.  I was terrified of doing this, as I thought having surgery would mean the end of my Capoeira career.  However, after reviewing my own MRI and considering my situation, I followed his recommendations.  He performed an L4-L5 microdiscectomy and hemi-laminectomy, a minimally-invasive surgery in which a piece of bone is removed and the part of the disc pressing on the nerve root is removed.  I had almost immediate recovery from the radiculopathy (the shooting pains and loss of strength), but the pain caused by the surgery itself was like nothing I had ever experienced.

 For a short while, I used painkiller medications I had been prescribed to relieve the pain, but stopped them as soon as I could handle it as I knew this wasn't the solution for me.  Initially, I wasn't even close to getting back in to training Capoeira, so I used the time to improve my berimbau-playing and teach myself some basic Portuguese. 

Soon after the injury, I got in touch with a physical therapist.  I told him about the details of my injury and my surgery, then I showed him a video of Capoeira.  I made it clear that getting back to training Capoeira was my goal.  He gave me a look of disbelief, and hesitated.  He then smiled and stated, "Well then, we have a lot of work we're going to have to do."  (Yes, I'll admit it-part of the reason I advocate for physically therapy was my personal success with it...)

For 6 months I worked with the therapist, adhering to a daily regimen of stretches and range of motion exercises.  Slowly, I was able to get back to Capoeira classes, training carefully within my limitations.  I was no longer there to wildly perform floreios-I was there to grow and train as a Capoeirista.  Each day, I found I was able to do more and more of what I could before, until one day I was able to play in the roda and not even think about my previous injury.

It's been almost 10 years since my surgery, and I am training harder than ever.  I still enjoy entering the roda with a headslide or completing an au sem mau (only after extensive warm-up) during a regional game now and then, but my goals and understanding of the Capoeira jogo have definitely changed.  I have progressed from a yellow cord with delusions of grandeur to a humble monitor, and from a medical student trying to diagnose myself with every disease under the sun to an attending physician in the ER trying to help others through their own injuries and ailments.  And truly, trying to help others like me who have experienced difficult injuries in Capoeira has been the goal of this column for me.  I hope that something I have written over the past few months has been of value to you and helped you in getting past an injury, and back in to your own Capoeira game. 

For now, I'll be signing off of this column (I'm getting married, then heading to Brasil for our group's Batizado in Aracaju and my lua de mel;), but I hope to be back with more articles in a few months.  Please post comments and send along any ideas on topics you would like to see discussed when Doctor Capoeira returns.  Until then, train hard, and train smart. Muito Axe!


Previously:
Doctor Capoeira - Back Injuries (Part 1)
Doctor Capoeira - Neck Injuries (Part 2)
Doctor Capoeira - Neck Injuries (Part 1)
Doctor Capoeira - Hip and Thigh Injuries (Part 2)
Doctor Capoeira - Hip and Thigh Injuries (Part 1)
Doctor Capoeira - Wrist Injuries (Part 2)
Doctor Capoeira - Wrist Injuries (Part 1)
Doctor Capoeira - Elbow Injuries (Part 2)
Doctor Capoeira - Elbow Injuries (Part 1)
Doctor Capoeira - Knee Injuries (Part 2)
Doctor Capoeira - Knee Injuries (Part 1)
Doctor Capoeira - Shoulder Injuries (Part 2)
Doctor Capoeira - Shoulder Injuries (Part 1)
Doctor Capoeira - Ankle Injuries (Part 2)
Doctor Capoeira - Ankle Injuries (Part 1)


Brian Lin, MD, FAAEM, is a Board-Certified Emergency Physician. He practices Emergency Medicine at Kaiser Permanente, San Francisco. He is an Assistant Clinical Professor with the Department of Emergency Medicine at UC San Francisco. In Capoeira circles he goes by the apelido Cebolinha. Brian is an estagiario a graduado (Blue/Red Cord) with Grupo Capoeira Brasil, San Francisco, and has trained Capoeira since 2001. He currently trains under Profesor Aranha, supervised by Mestre Cabeca.

Photos by Marcelo Beltrão, Simon Davison, Dean812, and ~ggvic~ via CC BY-SA 2.0

Photo of Dr. Brian 'Cebolinha' Lin head-spinning provided by Dr. Brian Lin

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Welcome to the 8^th and final installment in the Doctor Capoeira Joint Injuries Series!  This month, we'll be discussing a topic of special interest to me: low back injuries and low back pain.  I thought I would kick off this discussion with a personal anecdote, which bridges my training in medicine to my Capoeira training, and explains my passion for writing this column.

I remember it well:  I was a second year medical student, and fairly new to the world of Capoeira.  I was 22 years old, living in New York City, and feeling pretty invincible.  So when I learned how to perform an au sem mao, I became addicted to doing the movement at every opportunity in every roda...often times without properly warming up or stretching.  Never mind that I still didn't quite know how to esquiva in the right direction when a kick was coming towards my head.  It wasn't long before I started to notice some minor aches and pains in my lower back.  This minor aching progressed over a few weeks to more severe pains, until one morning I woke up in so much pain I could barely bend over to put on my shoes before I headed to my medical school class. 

This went on for a few weeks.  The pain was progressing, and was so severe I couldn't sit down for more than 5 minutes in my medical school lectures, let alone try to train Capoeira.  Serendipitously, I was learning the subject of Neurology and Neuro-Anatomy in my classes at the time.  As we learned the anatomy and pathophysiology of spinal cord and nerve root injury, it became clear to me what was happening.  A point came when I could no longer lift my left big toe-and it was then I knew that I had herniated my L4-5 inter-vertebral disc.  Soon after, I made an appointment with a spine surgeon, who confirmed the diagnosis with an MRI.  He recommended that I have urgent back surgery.  I thought my Capoeira career was over.



I'll leave you with this cliffhanger for now, as we begin the heart of an important discussion on low back pain and injuries.  In the United States, 85% of the population will experience a flare up of low back pain in their lifetime.  Low back pain is one of the most common reasons for visiting a doctor's office.  It's also the most common cause of disability in young people.  Thus, this is no small topic.  Chances are, if you are reading this, you've suffered from low back pain at some point in your life as well. 

This month's discussion, as per the usual format, will be divided in to two parts.  First, we'll focus on acute low back injuries, focusing on causes and treatment.  In the second part, we'll discuss sub-acute and chronic low back pains, their etiologies, and treatment.  As you'll see, many of the same principles which we discussed last month in regards to neck injuries also apply to injuries of the low back.

Low Back Anatomy      

Firstly, an anatomy primer.  For the purpose of this discussion, we'll define the low back region as: the lumbar spine; that is, the last 5 vertebrae in the spinal column before the sacrum & pelvis; and all of the associated ligaments, tendons, inter-vertebral discs, and muscles which provide stability to the spine.  The above figure shows a basic schematic of the lumbar spine structure.  The vertebral bodies are separated by inter-vertebral discs, made of cushioning cartilage.  Behind the vertebral bodies is the spinal cord, which tapers in to the cauda equina (a collection of nerves which end the spinal cord).  The vertebrae form a protective bony casing around the spinal cord.  Spinal nerve roots exit from openings in the sides of this bony casing.  These exit points are called foramina.  Many strong ligaments (not pictured) add an additional layer of structure and support to the spine.  Providing further protection and support to the low back are columns of strong paravertebral muscles (pictured below).  There are actually 3 layers of these muscles, facilitating flexion, extension, and lateral rotation of the spinal column.  Additionally, the muscles of the abdominal region act as stabilizers to the spine for many movements.  This is why we emphazise the importance of having a strong core in Capoeira.  Think about how your Mestre always reminds you to tighten your abs when kicking armada.



Many of these elements that make up the low back can contribute to painful conditions-muscle strains are most common; however, injured discs and ligaments may also cause pain.  Often times, low back pain is multi-factorial, so no one muscle, ligament, or cartilage can be pinned down as the source of the problem.  For example, an intervertebral disc can become displaced and press on a nerve root, and this may lead to acute spasm of the back muscles as a protective response.  Your body is attempting to stabilize the injury, but in doing so, the muscles cinch up tightly, worsening the cycle of pain. Now, let's try to break down the different types of acute injury.

Low Back Muscle Strains

As I said, this is one of the most common presenting complaints that physicians see-and boy, do I see a lot of it in the Emergency Department.  Sometimes, the mechanism of injury is impressive.  However, more often low back pain is the result of a simple odd twisting or bending movement.  In Capoeira, many movements put the low back muscles under significant stress: compression forces, such as occur with headstands; lateral bending forces, such as au sem mao and canarinho; and flexion/extension forces, which occur with many types of esquivas and evasive movements. 

When I assess a low back injury in the emergency department, the most important part of the assessment is to determine that the patient does not have any of the "red flags" of back pain; that is, any symptoms or findings that suggest that the injury could progress to paralysis or severe disability.  For a back injury related to athletic activity, these include:

• A loss of ability to control bladder function or bowel function
• Weakness in the lower extremities. Note, weakness implies a true inability to fully contract a muscle group in a lower extremity; this is distinct from pain limiting the ability to move.
• Loss of sensation in the lower extremities. Note, this is different than shooting pains in the lower extremities; loss of sensation implies an actual absence of ability to feel or decrease in ability to feel.

Back pain that includes neurologic symptoms such as numbness, weakness, or bladder/bowel dysfunction is concerning.  If you are experiencing back pain and think you are experiencing these symptoms, make an urgent appointment with a qualified medical provider or report to your local emergency department for evaluation.  There, you can explain your symptoms in greater detail, receive a formal examination, and have appropriate imaging ordered as recommended by the provider.

In the absence of these red flags, most back pain can safely be treated as a strain or sprain initially.  The low back muscles are so closely associated with each other that it's of little consequence which particular muscle or muscles are actually strained, as treatment is similar for all types of strains.  Physicians will rarely need X-rays or any specialized testing to confirm the diagnosis.  Treatment is largely based on the RICE therapy regimen, which we have discussed before.  Ice may be useful for symptomatic relief in the first 24-48 hours.  Use of NSAIDs is also an important part of treatment.  I usually recommend ibuprofen at a dose of 600 mg (3 over-the-counter 200 mg tablets) for the average female (50-60 kg) or 800 mg (4 over-the-counter 200 mg tablets) for the average male (60-80 kg) every 8 hours around the clock for the first 2-3 days after an injury occurs.  After this, they can be taken on an "as needed" basis.  These medications can be hard on the stomach, causing stomach inflammation and less commonly stomach ulcers.  Don't take these medicines until you've spoken to your doctor if you have a history of stomach problems. 

Avoid any strenuous activity or heavy lifting in the immediate post-injury period.  I usually recommend lifting nothing heavier than 10 lbs (about the weight of a one gallon milk carton) while the back is healing from an injury.  However, I also advise continuing routine daily activities as much as possible.  Complete bed rest actually makes the back more stiff, and can prolong recovery time.  After about 48 hrs, the application of moist heat can be helpful in relieving residual back muscle spasm.  Commercial one-time use and reusable heating pads can be purchased in most drug stores over the counter. 

The healing time for an acute back strain is a little longer than for most other joints of the body.  There is really no way to immobilize or to totally keep weight off of the back and still be functional.  Thus, acute injuries of the low back often require up to 4 weeks to resolve.

Lumbar Radiculopathy (Sciatica)

Occasionally, back pain will be associated with, or will progress to, a shooting or searing pain that radiates down the back of the thigh or one of the legs.  There may also be abnormal sensation in the leg, such as pins and needles, tingling, or a dulling of sensation (in medical terminology, parasthesias).  In this case, the back pain you are experiencing has likely progressed to an inter-vertebral disc herniation.  The anatomic explanation for this is essentially the same as what we discussed last month in our discussion of Neck Injuries.  Herniation is a fancy medical word for when something in the body bulges out of its usual position through a hole in a wall.  Herniation usually occurs due to increases in pressure, or weakness of the wall.  In the case of lumbar disc herniation, it's usually a bit of both to blame.  As shown in above from a top-down view, a weakness in the ring-shaped annular ligament surrounding a jelly-like intervertebral disc creates a hole.  Increases in pressure on the disc, which occur with compression forces on the spine, lead to herniation or bulging through that hole.  The bulging disc then presses on the spinal cord or more commonly nerve roots that are exiting the spinal cord, thus causing abnormal signals to be sent along these nerve roots.  The below figure demonstrates this same concept in a side view.

 

The lumbar spine is the most common area where symptomatic disc herniations (also termed "compressive radiculopathies") occur, as this part of the spine is responsible for a large degree of mobility of the low back. In fact, 90-95% of compressive radiculopathies occur at the junction between the last two Lumbar vertebrae (Numbered L4 and L5) and the last lumbar vertebra and the sacrum (numbered L5 and S1).  Compression at these levels will reliably cause pains that shoot down the posterior thigh and side of the leg, commonly called sciatica.

Even when sciatica occurs, the initial treatment for the pain is the same as with a back strain or sprain.  This is because most cases will get better no matter what you do-irrespective of how acutely painful your back is.  However, if you have persistent symptoms of shooting pains and abnormal sensation lasting greater than 6 weeks, or progression to weakness, you should seek out medical consultation.  Oral steroid anti-inflammatories or even injections of steroids directly in to the spine to decrease disc inflammation may be a recommendation when symptoms progress to this level.  At this time, your provider is highly likely to schedule you for imaging to better determine what's going on.  Sometimes, if a severe disc herniation is present that is unlikely to resolve on its own, you may be considered a candidate for surgery to relieve the pressure.  It's worth noting that recovery from back surgery is a long, difficult road, rather than an instant solution-if possible, I recommend trying to avoid it unless absolutely deemed necessary.

In some cases, low back pain that was initially treated as a strain or sciatica does persist beyond a four week period.  Part II of this article will focus on sub-acute and chronic back pains, and the science behind many treatments you may or may not have tried. Also, you'll find out how my personal story of back pain ends!


Previously:
Doctor Capoeira - Neck Injuries (Part 2)
Doctor Capoeira - Neck Injuries (Part 1)
Doctor Capoeira - Hip and Thigh Injuries (Part 2)
Doctor Capoeira - Hip and Thigh Injuries (Part 1)
Doctor Capoeira - Wrist Injuries (Part 2)
Doctor Capoeira - Wrist Injuries (Part 1)
Doctor Capoeira - Elbow Injuries (Part 2)
Doctor Capoeira - Elbow Injuries (Part 1)
Doctor Capoeira - Knee Injuries (Part 2)
Doctor Capoeira - Knee Injuries (Part 1)
Doctor Capoeira - Shoulder Injuries (Part 2)
Doctor Capoeira - Shoulder Injuries (Part 1)
Doctor Capoeira - Ankle Injuries (Part 2)
Doctor Capoeira - Ankle Injuries (Part 1)


Brian Lin, MD, FAAEM, is a Board-Certified Emergency Physician. He practices Emergency Medicine at Kaiser Permanente, San Francisco. He is an Assistant Clinical Professor with the Department of Emergency Medicine at UC San Francisco. In Capoeira circles he goes by the apelido Cebolinha. Brian is an estagiario a graduado (Blue/Red Cord) with Grupo Capoeira Brasil, San Francisco, and has trained Capoeira since 2001. He currently trains under Profesor Aranha, supervised by Mestre Cabeca.

Capoeira photo by imprensalauro via CC BY-SA 2.0
Back Pain photo by chispita_666 via CC BY-SA 2.0
Medical figures from SkinnyBulkUp.com and eSpine.com

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A wise Capoeirista understands that training does not only involve Capoeira.  As much as you need to practice your martial art, cross training is crucial in improving your physical capabilities and health.  Cross training helps to strengthen those neglected muscles, even out muscle imbalances, increase endurance, increase flexibility, mobility, balance, speed and to prevent injuries.  These elements are all essential in making you a stronger Capoeirista. I would like to introduce a very effective form of cross training which can take your fitness level up considerably.



What is TRX^® training? 

TRX^® is a suspension training system developed by former Navy Seal Randy Hetrick as an invention of necessity to keep the Navy Seals in peak condition while they were away on missions.   TRX^® training uses your own bodyweight and gravity to build strength in all the elements previously mentioned including core and joint stability.

The apparatus comes in the shape of two parachute-like nylon straps which you can hook up to any pullup bar, tree or behind a door.  It is basically a portable gym which you can take anywhere and uses minimal space.  The straps are easily adjustable to increase or decrease the load your body can handle.  The resistance is determined by how far away you are from the anchor point.  By changing foot, hand position, and distance you can determine how challenging you want the exercises to be.  There are over 300 exercises which cover total body conditioning.  Also, you can easily move from one exercise to the next without major adjustments which you would need to do in the gym.

TRX^® training requires several muscle groups to work together and your core to be constantly active.  The effect is even greater because you are working against gravity and need to apply tension to the TRX^® to hold it in place.  At the same time, your muscles will be lengthening.   Therefore flexibility and mobility are other components which are also factored in.  Whether your body is suspended in the air while you are doing planks or your posterior chain (all your back muscles) needs to stay contracted with any backward pulling movements, your body is working much harder to keep the form of the exercises intact.  The design of the TRX^® allows for many different elements to work in unison which why this training method is very different and functional unlike traditional strength training.

TRX^® training is a very dynamic modality of training which teaches your body to move and become stronger in all different planes of motion.  This type of functional training can definitely enhance your Capoeira since it is all about establishing a strong base while you are constantly moving around.  You are twisting, turning, changing directions from one movement to another which requires power and endurance amongst skill.



Types of Exercises

Since there are over a several hundred exercises, I will only name a few.   There are all many different variation of exercises, squats with rows, overhead squats, lunges combined with upper body, suspended balance lunge, back extension, back row, t,x,y, deltoid fly, suspended plank, suspended pushup, suspended pendulum, pike.  The unique aspect of these exercises is that you are always working with tension and gravity without loading your spine.  Because you are applying tension to the TRX^® the entire time, your muscles need to work even harder to maintain proper form.  Therefore, you are also lengthening your muscles and improving your flexibility and mobility at the same time.

Method of Training

With TRX^® training, you will normally execute a circuit of exercises for anywhere from 45 seconds to a minute with minimal rest in between. This will also depend on your fitness level.  You may need to start with a shorter time period until your body adapts to the exercises. 

Where can I find the TRX?

TRX^® has their own website, www.fitnessanywhere.com, where you can purchase the TRX^® and take a look at their promotional videos.  Since this is still a fairly new style of workout, it can be found in select gyms.  There are also many personal trainers who are TRX^® certified.



Conclusion

As a personal trainer certified in TRX^® and Kettlebells , I passionately believe in the effectiveness of these two different methods of functional training.  There are things you can do with kettlebells that you cannot do with the TRX and vice versa.  (Please see previous article 10 Reasons A Capoeirista Should Use Kettlebells)  As a Capoeirista, you need to train according to your martial art.  Traditional strength training at the gym will not give you the maximum benefits you are looking for to improve your Capoeira.

In the roda, you need to change directions swiftly, execute take downs, and increase your power or speed while you're switching movements.  Other times, you may do some floreios or throw in some kicks.  The entire time, you need to stay strong and balanced and keep your base. We all have our weaknesses.  Some of us lack the strength for some of the movements, others lack speed or endurance while others have poor flexibility or no mobility.  You can fortify your foundation by incorporating those elements missing in your training.  Everyone will benefit from dynamic cross training while preventing injuries at the same time. 

I wince over the number of injuries I have seen in the past years by those Capoeiristas who do not attempt to balance out their training.  More often than not, the inevitable needs to happen...the injuries must first occur before they change their outlook in life.  Physical therapy can be a long and painful process but avoidable if you learn to balance out your weaknesses in your program.

TRX^® training is an excellent way of preventing injuries by developing a strong and stable core while you are moving in multi-planes of motion through different exercises.  Not only are you training your body for daily activities but you can also tweak your program to benefit your martial arts training.

It has been tested by the military to ensure operation readiness in the field.  Today, the TRX^® is used by everyone from the military, police, elite athletes, to Olympians.  It is great for all fitness levels and one of the best inventions out there.  Just like the kettlebell, this is no passing fad.  It is a serious workout for serious people and it can be as tough as you want it to be.  Make no mistake, it will hurt, just ask my clients.

If you want to become a powerhouse in Capoeira, I would highly suggest you check out this form of cross training.  You will not be disappointed.  Train smart, train right and train wisely!


Previously:
Capoeira and the Importance of Back Strength
How Plyometrics Improve Your Capoeira Fitness
Eating Right for an Excellent Batizado Season
Poor Posture and Its Affects On Your Capoeira Game
10 Reasons A Capoeirista Should Use Kettlebells
A Capoeirista's Guide to Energy and Nutrition
Overtraining - Symptoms, Dangers, and Remedies
Core Strength
Why You Should Warm Up (Especially Now)
A Happy Holiday Survival Guide
Issues Facing Active Females
The Importance of Stretching and Flexibility
Joint Pain & Common Capoeira Injuries (Part 2)
Sprains, Strains & Common Capoeira Injuries (Part 1)
Capoeira Nutrition (Part 2)
Capoeira Nutrition (Part 1)
Capoeira and the Importance of Cross Training


Cindy Lai is a NASM certified Personal Trainer and runs Cindy Lai Fitness Bootcamp, a bootcamp in Central Park that incorporates all the above elements, a kettlebell bootcamp on the West Side Highway for non-traditional strength training, and a seasonal kettlebell conditioning and strengthening class for Capoeiristas. She has been certified by Kettlebell Concepts for the past several years and continuously attends workshops and conferences dedicated to this unique training method of kettlebells. Check out her site for more details.

Photos by Ben30 and The U.S. Army via CC BY-SA 2.0

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On Tuesday, we began our discussion of Capoeira neck injuries.  Today we'll continue, focusing on some of the subacute and chronic injuries that can affect the capoeirista. Chronic neck pain is a problem that may afflict the capoerista due to the nature of the movements we train.  Stress on the neck from repetitive axial loading forces caused by headstands, cabecadas, and other movements can lead to wear-and-tear on the cervical spine that may manifest as aching pains that are tough to control.  In this segment of the column, we'll discuss some of the anatomical considerations for chronic neck pains, the symptoms and signs of inter-vertebral disc herniation, and when you should seek medical evaluation.  To make this discussion easier to understand, we'll start by discussing neck anatomy in greater detail.



Neck Anatomy

The neck is a relatively small, yet extremely complex, region of the body.  It functions as a conduit for nerves (the spinal cord), air passageways (the trachea), and large blood vessels which head to and from the brain.  However, in capoeira we focus more on the muscular functions of the neck.  It's an incredible joint-actually, a combination of several incredible joints.  Seven stacked cervical vertebrae (neck bones) connect with the base of the skull. A number of small and large muscles connect the skull, the vertebrae, and the bones of the shoulder girdle to allow for a range of complex neck movements.  These include neck flexion, extension, and lateral rotation to the right and left. 

The support system for the neck is the set of cervical vertebrae (above).  These bones form the upper portion of the spinal column.  In between each of these vertebral bodies is a disc made of cartilage, which acts as a shock absorption system to protect the bones from damage.  These are appropriately called "inter-vertebral discs."  Behind the vertebral bodies lies the spinal cord, an information superhighway for nerves that travel to and from the body.  When the inter-vertebral discs become displaced from wear-and-tear or injury, they may push back on the spinal cord or nerve roots that are exiting the spinal cord, causing the symptoms commonly referred to as a "herniated disc."

Spinal compression is the usual mechanism of disc herniation.  The capoeirista will often use the neck to support movements that involve spinal compression: au de cabeca, headstands, headslides, and headspins.  These types of movements are pretty unusual for the neck to tolerate-the cervical spinal column is designed to supporting the weight of the head (about 10 lbs), but not the weight of the rest of the body (your weight minus 10 lbs!).  Add to that a compressive axial loading force, and you have a set up for some of the common injury patterns seen in the neck. 

Inter-Vertertebral Disc Disease and Herniation

Above is a schematic of the different problems related to disc injuries of the spine.  The stacked vertebral bodies provide the main structural support of the spine. Between these vertebral bodies are inter-vertebral discs, made of cartilage.  These cartilaginous discs act as shock absorbers for the spine (A).  With aging, the disc will naturally begin to degenerate, and this process may be accelerated by aggressive athletic activity (B).  Sometimes the pressure on the spine may be severe enough to cause the disc to be squeezed out of position.  The disc bulges backwards in to the spinal canal, causing pain symptoms in the neck (C).  If the disc herniation is severe enough it can press on the spinal cord and lead to symptoms of weakness, numbness, and balance problems (D).  Ongoing overuse, aging, and genetic factors contribute to thinning of the disc, and eventually abnormal bone (osteophytes) form (E).

Symptoms of intervertebral disc herniation in the cervical spine are variable.  The primary symptom is often pains shooting down the arms.  Parasthesias in the arms may also occur-this is the medical term for abnormal sensations, most commonly described as a pins and needles sensation in the arm, akin to what happens when your arm "falls asleep" from prolonged pressure.  Most concerning are symptoms of weakness in the upper extremities, termed motor symptoms.  It should be noted that true weakness from a medical perspective is different than a relative weakness caused by pain (eg, full muscle strength is actually present, but it's too painful to move). 

Management of disc herniations in the neck is complex.  Often times with rest, a disc herniation will resolve on its own.  Thus, if you seek evaluation by a physician in the first few days after symptom onset, your treatment may consist of an examination, maybe X-rays, and pain medications.  Though an MRI is required to visualize and confirm a disc herniation, this test is not often initially ordered.  The reasoning? It is costly (to you and the hospital), it's time-consuming, and in most cases, symptoms resolve without any specific treatment-thus obviating the need to confirm the diagnosis.  However, if symptoms progress, cause motor weakness, balance problems, or last longer than 6-8 weeks despite rest, it may be time to get in touch with your doctor for more detailed neck imaging.  They may want to get you in touch with a spine surgeon for an evaluation.

I would encourage those suffering from long-standing neck pains related to capoeira to speak with a physician about their symptoms, and determine if imaging the spine is really the next best step in evaluation.  Sometimes rest and symptomatic treatment are all that are needed.  Adjuncts to treatment including massage, acupuncture, and acupressure may also be of value.  Though there's not much in the way of hard scientific evidence for or against these treatments, anecdotally people tend to get good results.  That's all for our discussion on neck injuries.  Next month, we'll work our way down the spine and talk about low back injuries, an area of personal interest for me.  Until then-train hard, but train smart! Muito axe!


Previously:
Doctor Capoeira - Neck Injuries (Part 1)
Doctor Capoeira - Hip and Thigh Injuries (Part 2)
Doctor Capoeira - Hip and Thigh Injuries (Part 1)
Doctor Capoeira - Wrist Injuries (Part 2)
Doctor Capoeira - Wrist Injuries (Part 1)
Doctor Capoeira - Elbow Injuries (Part 2)
Doctor Capoeira - Elbow Injuries (Part 1)
Doctor Capoeira - Knee Injuries (Part 2)
Doctor Capoeira - Knee Injuries (Part 1)
Doctor Capoeira - Shoulder Injuries (Part 2)
Doctor Capoeira - Shoulder Injuries (Part 1)
Doctor Capoeira - Ankle Injuries (Part 2)
Doctor Capoeira - Ankle Injuries (Part 1)


Brian Lin, MD, FAAEM, is a Board-Certified Emergency Physician. He practices Emergency Medicine at Kaiser Permanente, San Francisco. He is an Assistant Clinical Professor with the Department of Emergency Medicine at UC San Francisco. In Capoeira circles he goes by the apelido Cebolinha. Brian is an estagiario a graduado (Blue/Red Cord) with Grupo Capoeira Brasil, San Francisco, and has trained Capoeira since 2001. He currently trains under Profesor Aranha, supervised by Mestre Cabeca.

Capoeira photo by isaacclodfelter via CC BY-SA 2.0
Illustration by Bedirhan Cinar
Wrist photos by Brian Lin

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Neck injuries and pain are almost inevitable during a Capoeirista's career.  Movements including ao de cabeca, headslides, and headspins make for some great looking floreios in a benguela roda, but may leave you with considerable pain and tension in the neck when the heat of the moment has passed.  Additionally, unanticipated falls and blows to the neck can lead to acute injuries that threaten the integrity of the vertebral bones, blood vessels, and the spinal cord--in the worst-case scenarios, these injuries lead to risk of severe chronic pain, paralysis, and even death. 

This month's discussion of neck injuries in Capoeira is not meant to frighten you; rather, I want to impress upon you just how serious injuries of the neck can be.  In Part I of the article, we'll discuss the basics of neck anatomy; how to decide whether to go to the hospital for immediate evaluation when a neck injury occurs; and treatment for acute injuries that happen in your roda. In Part II, we'll discuss management of some of the chronic pains that can occur through training Capoeira; what might be causing your pain, and treatments that may help; and when to seek professional medical advice.



Someone just went down in my roda! What do I do?

It's a scary and uncommon situation, but I have heard plenty of stories of Capoeristas striking or landing on their neck in the roda, falling to the ground, and complaining of concerning symptoms ranging from numbness and shooting pain in the arm to sudden onset of total paralysis.  Everyone present wants to help, but in the ensuing frenzy it can be difficult to know what the right thing to do is.  Here are a few tips on emergency stabilization.

(1)  Designate someone to call 911. Sounds silly, but it's surprising how often that step is delayed.

(2)   DO NOT attempt to move or help the injured Capoeirista get up off the floor.  In the moments after a serious injury, it's difficult to know what type of injury has occurred.  If a fracture of the spine is present, moving the injured person is one of the worst things you can do.  It can result in conversion of a stable injury in to an unstable injury, cause further trauma to the spinal cord, and irreversible damage. Allow the person to lay flat on their back in the location of injury.

(3)   Provide immobilization of the cervical spine.  The injured Capoeirista should keep his/her neck in a neutral position.  Designate someone to secure his/her neck and shoulders as a reminder to discourage unnecessary movement.  The above photo demonstrates the proper way to perform this technique, what we call "in-line stabilization of the cervical spine" in medical terminology.  Again, this measure is taken to reduce risk of any further spinal cord trauma.  Have the designated person maintain in-line stabilization until Emergency Medical Services arrive.  They will evaluate the injured person and likely place them in a special cervical spine immobilization collar (below) prior to providing them transport to the hospital for definitive evaluation.

These measures may seem pretty extreme, but again, I've seen a handful of very serious injuries to the neck occur in the roda, including spinal shock (transient total paralysis from a spinal cord contusion) and facet dislocations (slippage of the connections between vertebrae).  Knowledge of how to properly protect someone after a possible spinal cord injury may prove to be critically important if the situation arises. 

Now, we'll discuss some of the more common sports-related neck injuries that we treat in the Emergency Department.  Many of the actions that result in these injuries are common to Capoeira practice, and may occur in everyday training.


Cervical Strains/Sprains

A set of strong, strap-like paraspinal muscles (above) run along each side of the spine, providing strength and stability to the spinal column.  Sprains occur when the attachments of these muscles to the spine are injured, and strains occur when the muscle fibers themselves become injured or torn.  These injuries are usually caused by jamming the neck.  Symptoms include pain and stiffness that limit neck movement.  A simple strain or sprain should not cause numbness or weakness of the arms-these are neurologic symptoms, and should be a red flag that something more serious may be going on.



Initial treatment of a strain or sprain of the neck is based on the RICE therapy regimen, which we have discussed before.  A soft cervical collar (above), which may be purchased at a drug store or obtained from a physician's office, will provide comfort and support for the neck while healing. Ice may be useful for symptomatic relief in the first 24-48 hours.  Use of NSAIDs is also an important part of treatment.  These injuries can cause significant pain, but are generally harmless and will resolve with conservative treatment.  If pain does not resolve, or is not significantly relieved by the above measures, see a physician or other qualified health care provider for assessment.  Fractures of the cervical spine, dislocations of the facets (connections between the bones of the spine), and slippage of the spinal bones relative to each other (termed "anterolisthesis" in medical speak) may sometimes be subtle, and require X-rays for diagnosis.

Stingers

A step beyond the simple strain or sprain is a cervical spine injury that causes loss of function with searing or lancing pain radiating down one of the arms.  This type of injury is commonly referred to in the world of American football as a "stinger" or "burner."  The at-risk movements for the Capoeirista are forceful cabecadas, misplaced rastaos, and movements that involve twisting the neck to the side as force is applied in the axial plane of the spine (such as performing a headstand or handstand, then exiting the movement in to queda de rins). 

Those afflicted with this injury usually experience an initial total weakness of the arm accompanied by a burning sensation radiating down the same arm.  This resolves fairly rapidly, but a sensation of numbness along the lateral part of the arm (the thumb side) often persists for much longer.  Weakness of specific muscle groups from the arm all the way down to the fingers may also persist.  Symptoms typically last anywhere from minutes to 24 hours. 

Though the exact cause of a stinger is not known, it is thought to be due to stretching of the nerves somewhere between their exit from the spinal cord and the brachial plexus.  (The brachial plexus is a collection of nerves in the neck and shoulder region.)  Fortunately, most stingers are self-limited injuries.  If you experience the symptoms of a stinger, stop training immediately.  Rest and observe treatments as described above for cervical strains and sprains.  If symptoms persist beyond 24 hours, or progress, seek immediate medical attention.  A qualified medical professional will need to assess whether a more serious injury (such as a spine fracture) may have occurred.

That's all for now... On Thursday, we will have a more detailed discussion of neck & spinal anatomy, as well as some of the sub-acute and chronic neck injury patterns that can occur.


Previously:
Doctor Capoeira - Hip and Thigh Injuries (Part 2)
Doctor Capoeira - Hip and Thigh Injuries (Part 1)
Doctor Capoeira - Wrist Injuries (Part 2)
Doctor Capoeira - Wrist Injuries (Part 1)
Doctor Capoeira - Elbow Injuries (Part 2)
Doctor Capoeira - Elbow Injuries (Part 1)
Doctor Capoeira - Knee Injuries (Part 2)
Doctor Capoeira - Knee Injuries (Part 1)
Doctor Capoeira - Shoulder Injuries (Part 2)
Doctor Capoeira - Shoulder Injuries (Part 1)
Doctor Capoeira - Ankle Injuries (Part 2)
Doctor Capoeira - Ankle Injuries (Part 1)


Brian Lin, MD, FAAEM, is a Board-Certified Emergency Physician. He practices Emergency Medicine at Kaiser Permanente, San Francisco. He is an Assistant Clinical Professor with the Department of Emergency Medicine at UC San Francisco. In Capoeira circles he goes by the apelido Cebolinha. Brian is an estagiario a graduado (Blue/Red Cord) with Grupo Capoeira Brasil, San Francisco, and has trained Capoeira since 2001. He currently trains under Profesor Aranha, supervised by Mestre Cabeca.

Photography provided by Brian Lin
Illustration by Bedirhan Cinar

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The back, the second biggest and the strongest muscles in the body, is often neglected.  People focus so much on building the visual muscles; chest, biceps and abs but forget about the back, the key to many exercises that help to grow and support other target areas.  A strong and healthy back is essential in developing a more functional strength and improving your physical capabilities in your Capoeira training.  These muscles are key in strengthening your movements and important in preventing muscle imbalances which may result in injuries.  It will help to improve your posture and prevent lower back pain as well.  Throughout daily life and physical activities, the back is performing many complex movements involving the muscles in the stomach, hips and low back.  Therefore, building a strong back is crucial in establishing balance and ensuring longevity while training Capoeira for the long haul.

Composition

The back contains a group of muscles that support and link the shoulders and spine.  The  main muscle groups in the back are:

• Trapezius (traps) - which draws the shoulder blades upwards and together
• Rhomboids - which assist the traps and pull the shoulder blades backwards
• Latissimus dorsi (the lats) - the muscles down the side of the back which pull your arms downwards from above. The also stabilizes the torso during many movements.
• Erector Spinae (Lower back) - group of muscles that attach  to the vertebrae, ribs and pelvis which help support the spine

Exercises

Here are some of the most effective exercises for your back.

Pullup - this is one of the most challenging but effective exercises in strengthening your back.  It's considered by some to be the ultimate back builder and possibly the biggest test for your upper body strength.  It is the squat for your upper body as it is a compound movement which works several muscles at one time.  Grab a pull up bar with an overhand grip, hands slightly wider than shoulder width apart.  Pull your bodyweight up so that your chin is level with the bar.  Make sure you are not engaging your traps or your necks.  Drop your shoulders and squeeze your shoulder blades back and down as you pull up.  Extend your arms and lower yourself down slowly.  Use your full range of motion.  The biggest mistake I see all the time is that majority of guys will do half range of motion.  To get the best effect out of this exercise, you must execute the entire range of motion.  Focus on quality and not quantity.  To build strength, you can do anywhere from 6-10 reps and work your way up for 2-3 sets.

Modified pullups - can be done with assist machines found at the gym.

If you cannot do a pullup at all, start by just hanging off the bar with your arms extended.  You can start by learning how to activate your lats, pulling your shoulder blades down and back. With time, you will eventually build up the strength.

Another method of building the strength is to perform "negatives".  You can start from the top either with assistance or use a bench to step up so that your chin is over the bar.  Slowly lower yourself with control.  As you get to the end, step up again so that your chin is over the bar.  This method is very effective in building strength as it focuses on the negative contraction of the exercise which is much more demanding.

Deadlift - one of the most popular of all back exercises great for building power.  This is an excellent compound movement where you are engaging several major muscle groups in your body; hamstrings, quads, hips, glutes, lower back, traps, and arms.  Grab an Olympic bar and start off with the bar as a warmup.  Place the bar on the floor at your feet which should be approximately shoulder width apart.  Bend forward from your hips as you squat down sending your hips and your glutes back at the same time.  Place your hands about shoulder width apart in an overhand grip position.  You should feel tension on your hamstrings and your shins should be up against the bar.  Look straight ahead as your keep your spine straight and flat.  Make sure your lower back is not rounded nor your shoulders. Bring the bar up towards your hips by extending your legs to your waist. Push up explosively through your heels as your contract your hamstrings and glutes.  The bar must remain close to your body at all times.  Pause, bend your kness and lower back and return to starting position.  Start with a bar to get the form right and adjust your weights accordingly.  Start with 2-3 sets of 10-15 reps.

Hyperextension -  position yourself on a Roman chair facing forward.  Cross your arms in front of your chest and slowly lower your upper body down bending forward from the hips.  Imagine touching your nose to the floor.  Once your torso is completely bent over and practically perpendicular to the floor, slowly return to start position and repeat.  Make sure you contract your glutes and hamstring as your upper torso is in line with your lower torso.  Do not arch your back at the top. Do 2-3 sets of 10-15 reps.  As you get stronger you can add weight accordingly.

Superman - this is a bodyweight exercise which is similar to the hyperextension except you are lying prone (face down on the floor).  As you lie on your stomach, place both arms in front of your head.  Pull your lower ribcage to the floor while contracting your abs.   Take a deep breath and lift your arms and legs off the floor a few inches.  Make sure you squeeze your glutes and hamstrings as well.   Keep your head neutral and think about forming a slight "u" with your body.  You can start with 2-3 sets of 15-20 reps.



Pilates bridge - strengthens the glutes, lower back and abdomen, great for torso and core stability and for those who have a weak or injured back.  Lie on your back with your knees bent and your feet flat on the floor, approximately hip width apart. Feet should not too far from your glutes and not too close.  Keep your spine neutral with abs pulled in and a flat back.  Take a deep breath expanding into your back and lungs.  As you exhale, keep your torso in the same position, press your feet into the mat and squeeze your butt as you lift your hips off the floor.  Come up high enough so that your shoulders to your knees form a straight line. Inhale to maintain position, exhale and slowly bring your hips down to the floor.  Do 2 sets of 10-15 reps.

Conclusion

The back is the 2^nd biggest muscle in your body and is very important because it helps to generate power and improves your physical performance.  A healthy and strong back is necessary for you to perform many of the movements in Capoeira such as handstands, ponte, macaco and s-dobrado.  If these muscles have been neglected in training, then it stands to reason that this may be the place any injuries and pain will come from.  A chain is only as strong as its weakest link.


Previously:
How Plyometrics Improve Your Capoeira Fitness
Eating Right for an Excellent Batizado Season
Poor Posture and Its Affects On Your Capoeira Game
10 Reasons A Capoeirista Should Use Kettlebells
A Capoeirista's Guide to Energy and Nutrition
Overtraining - Symptoms, Dangers, and Remedies
Core Strength
Why You Should Warm Up (Especially Now)
A Happy Holiday Survival Guide
Issues Facing Active Females
The Importance of Stretching and Flexibility
Joint Pain & Common Capoeira Injuries (Part 2)
Sprains, Strains & Common Capoeira Injuries (Part 1)
Capoeira Nutrition (Part 2)
Capoeira Nutrition (Part 1)
Capoeira and the Importance of Cross Training


Cindy Lai is a NASM certified Personal Trainer and runs Cindy Lai Fitness Bootcamp, a bootcamp in Central Park that incorporates all the above elements, a kettlebell bootcamp on the West Side Highway for non-traditional strength training, and a seasonal kettlebell conditioning and strengthening class for Capoeiristas. She has been certified by Kettlebell Concepts for the past several years and continuously attends workshops and conferences dedicated to this unique training method of kettlebells. Check out her site for more details.

Photos by gillesklein, didbygraham, Rocket Surgeon, and adrian valenzuela via CC BY-SA 2.0

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