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Box 101

Prehab: The Athlete’s Secret Weapon

Prevent injuries, correct imbalances and improve performance with this emerging trend.


Your shoulder has been bothering you on and off for weeks. It’s nagging, and a WOD with kipping pull-ups the day before didn’t exactly help. So when you walk into your box for your daily sweat, you grab a lacrosse ball and jam it under the shoulder blade, maybe between you and the wall or you and the gym floor.

Or perhaps you grab a band and loop it on a rig to try to create a little space before you push your shoulder through more activities that require full range of motion.

But what if the problem isn’t that your shoulder is tight? What if that on-again, off-again ache isn’t because you have poor shoulder mobility? What if it’s a strength issue? Or better yet, strength in that end range of motion?

That’s the issue Dr. Sean Pastuch, owner of Active Life Athletics (CrossFit King of Island Park in New York), started to see over and over in his practice and at his gym. Pastuch, a chiropractor, had dabbled in soft-tissue work and active-release techniques, but nothing specific to prevent some of the problems he saw. At the same time, his good friend, fellow chiropractor Jeremy Todd, was in Croatia at his affiliate trying to incorporate strength-based rehab training despite many of his athletes having little interest in it.

When Pastuch recruited Todd to come back to Island Park as his partner, their two styles merged and, about a year-and-a-half ago, Performance Care was born. And it’s taking the CrossFit world by storm.

Go ahead, check the über-popular Instagram account of CrossFit Games darling Brooke Wells, who started Pastuch and Todd’s “Bulletproof Shoulders” program right before the Open, singing the praises of the programming. There’s former CrossFit Games champion Sam Briggs thanking Performance Care for helping her lunge pain-free and CrossFit team competitor Jared Stevens, who has a history of labrum tears, claiming this stuff gave him a new lease on competition life.

But what exactly is Performance Care? At its most basic, it’s improving the way your body moves by correcting imbalances and getting strong in certain ranges of motion. It’s smart prehab and joint health, something CrossFitters can use to avoid injury and improve performance.


“[We felt there was a need for this] because we kept hearing, ‘You need to become more mobile. If you were more mobile, you wouldn’t have more pain.’ That drove me crazy, personally,” Pastuch said. “We’ve had yogis and dancers come in here. They have all the mobility in the world but the inability to stabilize and find balance in end ranges. Mobility in that person wouldn’t help.

“Sometimes the answer is mobility. But it shouldn’t be just add mobility, add mobility. There’s no-body out there measuring it for improvement.”

With the CrossFit Games’ popularity exploding and competitor programming and high-volume training becoming more and more prevalent, the quest to move better — and smarter — is para-mount to staying healthy. Performance Care is leading the way, along with programs like The Movement Fix and Clinical Athlete, in taking a diagnostic approach to improvement.

“When somebody comes in, we are not guessing,” Todd said. “We have a systematic evaluation to say, ‘How much range of motion do you have in your hip, leg, ankle, with your knee straight? We are quantifying it and saying, ‘This is a pass or fail. If you pass, your mobility is fine. If you still have pain, you have some deficiency in your contractile somewhere.”

Deficiencies will be exposed quickly in Performance Care’s programming. When was the last time you held the bottom of a loaded front squat for a minute or did max distance single-arm overhead carries? How about hanging from a pull-up bar with a supinated grip for two minutes? Those are a few of the surprisingly difficult tests that Pastuch and Todd use to determine whether the issue is mobility or strength and what “track” of Performance Care is needed.

“People will say, ‘My PT says my glutes don’t activate, and we work on glute activation drills.’ We ask them, ‘Why isn’t your glue activating? You were squatting — that’s a glute activation drill. Why are they turning off?’” Pastuch said. “Why did they deactivate in the first place, and why did they not reactivate when you squat?

“We may say, you are good squatter and a terrible hinger. You need to do more hinging. If we know why, we can fix it.”

Still, sumo deadlift good mornings and front-rack step-ups aren’t exactly a sexy sell to the average CrossFitter hoping to squeeze in a good WOD for an hour. It was equally tough in the beginning to get competitive athletes to see Performance Care as something that could help them. Pastuch and Todd spent the first few months pitching their services to people, giving away online programming free and doing workshops for a mere $20 a person. Now they have more than 16,000 Instagram followers, four different payment programming options and six Bulletproof programs, that typically run about 20 minutes daily.

“You don’t have to have as much raw strength when you have great range of motion and stability,” Todd said. “It’s that take a step back to take three steps forward. It’s a hard pill to grasp for an athlete, but it works.”

Want to give Performance Care a shot? Try the sample workout by Pastuch below:

5 Rounds for Time:

(Every rep has a slower eccentric and faster concentric)

Weight 50% of 1RM shoulder press

• 10 behind-the-neck presses (jerk grip)

• 10 front-rack step-ups each leg alternating (box height must be above knee height)