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Learn more about Rehab, Sports Medicine & Performance

Michael

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Train your hip adductors and bulletproof your legs by following the advice in Mike O’Hara’s article Adductors Galore.  Video demonstration and explanation included.  Mobilize your upper body by foam rolling.  In Foam Roll T W I, Mike explains the importance of adding foam rolling to your exercise program.

Download Here

Spinning Wheel

HIIT Methods: Air Assault Dual Action Bike

The Air Assault dual action bike is a challenging metabolic disrupting machine.   For older fitness clients, heavier folks, and those of us with legs that are less tolerant of impact, the Air Assault improves cardio-respiratory capacity and minimizes joint stress.  If you are seeking an intense training experience, look no further than the Air Assault bike.

The number two reason people give for not exercising is limited time–lack of results is number one.  The Air Assault solves both of these problems.  Training sessions on the Air Assault are brief and very effective.

Set your seat for height and reach so at the bottom of the pedal stroke, the knee is bent about 20 degrees.  The arms should not fully extend at the elbows.  The bike is simple– increase the pedal speed and you push a greater volume of air.  Go slow—less resistance.  Go fast—more resistance.  Keep a tall posture to effectively drive with the arms and assist the legs.  I have outlined four of my favorite HIIT Air Assault training routines.  As usual, remember to perform a movement preparation warm up before launching into a HIIT session.

30 seconds on / 30 seconds off

Ride at an exertion level of 7/10 (1 is a stroll and 10 is sprinting away from a lion) for 30 seconds and then pedal slowly at a 1/10 exertion level for 30 seconds.  Repeat the cycle for ten intervals.  You are done in ten minutes.

45 seconds on / 15 seconds off

Ride at an exertion level of 7/10 (1 is a stroll and 10 is swimming to escape the alligator) for 45 seconds and then pedal slowly for at a 1/10 exertion level for 30 seconds.  Repeat the cycle for five intervals.  This workout takes five minutes.

Tabata Protocol

Twenty seconds on at an exertion level of 9/10 followed by ten seconds off at 1/10.  Repeat eight times.  This format is built right into the Air Assault bike timer.  Do not get discouraged if you have to stop well before completing eight intervals.  Work your way up to completing all four minutes of the session.

1.5, 1.0, 0.5 Mile Intervals

Ride for one and half miles and then rest 90 seconds.  Ride for one mile and rest for 45 seconds.  Ride for a half mile.  Record you overall time.

View Mike’s video on the assault bike: https://youtu.be/8Y3rmX2cF3s

For more information on the many benefits of HIIT read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

Pushing For Performance

HIIT Methods: Sled Training

A good high intensity interval training (HIIT) session creates a disturbance of metabolic homeostasis while minimizing stress on the joints and / or compression of the spine.  Pushing a sled meets both of those goals.  Sled sessions are time efficient, and they have the added benefits of improving leg strength, core stability, and they make you better at nearly every daily challenge.  A well designed HIIT sled training protocol allows you to assess performance and track progress.  Presented below are four of my most frequently prescribed sled HIIT protocols.   Ditch the elliptical, cancel your Zumba sessions, and for the next month, give these a try.

I cannot tell you how much weight to use on the sled.  In general, men can start with bodyweight and women with half to two thirds bodyweight loads.  You will quickly learn if you have too much or too little on the sled.  Any progressive gym will have several sleds and plenty of open space.  The trainers at Fenton Fitness can get you started.

30 / 30 Protocol: Place a stopwatch so it is visible on the sled.  The load on the sled should create a thirty second interval exertion rating that feels “easy”.  Push the sled for thirty seconds and then rest for 30 seconds.  Perform eight intervals.

10 – 20 – 30 – 10 – 20 – 30 – 10 – 20 – 30 Yard Interval: Load your sled and start the timer.  Push the sled for 10 yards and rest twenty seconds.  Push the sled 20 yards and rest twenty seconds.  Push the sled 30 yards and rest twenty seconds.  Repeat 10, 20, and 30 yards two more times.   Finish all of the intervals and you will have covered 180 yards.  Record your time.

60 – 30 – 15 Yard Interval: Be careful that you do not use too much load for this HIIT sled session.  Push the sled 60 yards.  Rest thirty seconds.  Push the sled 30 yards.  Rest thirty seconds.  Push the sled 15 yards.  Record your time.

15 Yards Times Ten: Use a load on the sled that allows you to move at a fairly steady pace.  Think racehorse, not plow horse.  Place a stopwatch so it is visible on the sled.   Start the timer and push the sled fifteen yards.  Rest ten seconds and then push another fifteen yard push.  Perform ten, fifteen yard intervals.  Record your time.

View Mike’s video on sled training here: https://youtu.be/PfOccHMmzF4

For more information on the many benefits of high intensity interval training, read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

Many of life’s activities involve using our legs in a reciprocal pattern.  Find out why training in half kneeling position can help.  Exercise instruction and demonstration included in a video link. Learn the four steps to a successful fitness program and how to correctly use the Concept 2 rowing ergometer.

Download Here

How Do They Know What Is Wrong Without An MRI?

This is a fairly common question in physical therapy.  Patients with lower back, leg, neck, and arm pain know the test they need is an MRI.  They have friends and relatives that tell them they should have an MRI.  They are concerned that something is being overlooked and that the pictures from the MRI will make treatment more beneficial.  I have some research information on the limitations of a spinal MRI.

In 1994, the *New England Journal of Medicine published a study on physician evaluation of lumbar spine MRIs.  The MRIs of 98 asymptomatic individuals –-no pain, feelin’ good people, were found to have disc abnormalities (82% of the MRIs).
-52% had a bulged disc at one level
-27% had a disc protrusion
-1% had a disc extrusion
-38% had an abnormality at more than one disc

Since that publication, several other studies have backed up these results.  Bulged, protruding, and extruded lumbar discs are a fairly common finding on a lumbar MRI.  Changes in our lumbar discs are probably no different than the wrinkles on your face or the gray in your hair.  Changes in a disc’s shape is not a indicator of pain problems

Another **MRI study of athletes revealed spondylolysis (vertebral fractures) are fairly common, yet less than 50% of the athletes with these fractures ever report any episode of lower back pain.  It appears that lumbar spine fractures do not always produce pain.

In my years in the physical therapy clinic, I have received the MRI reports of many neck and lower back pain patient’s spines that show disc protrusions and foraminal stenosis on one side of the spine but the patient has all of his or her symptoms on the opposite side.  I have treated patients with severe lower back pain and completely normal spinal MRIs.

MRI research has demonstrated that “abnormalities” in our spines are fairly common and difficult to accurately link to any specific pain problem.  We do know that once a patient has an MRI, they are far more likely to progress to ***surgery.  Please read, The Myth of Accuracy in Diagnosis, by Dr. Ron Fudala.  In physical therapy, the resolution of a spinal pain problem starts with a history and thorough physical evaluation.  Imaging tests are a small part of the “big picture” and often provide nothing but confusion.

*Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people with and without back pain, New Engl J Med. Jul 14

**Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete.  Am J Sports Med, 2000 Jan – Feb.
***Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003;28:616 –20.

Read more here: http://spineline.net/spine-pain-the-myth-of-accuracy-in-diagnosis/

Michael S. O’Hara, PT, OCS, CSCS

Training Your Inner Fireman

HIIT Methods: Jacob’s Ladder

At one time, we could all crawl and we did it very well.  An infant develops the strength and coordination necessary to stand upright and walk by crawling.  The reciprocal arm/leg crawl pattern of the Jacob’s Ladder helps restore joint stability, coordination, and balance.  All of us have established neural pathways for crawling.  They are just cluttered up and inhibited by prior injuries, poor posture, bad training habits, and a sedentary lifestyle.  Performing some Jacob’s Ladder intervals will bring those pathways back to life.

The Jacob’s Ladder is a 40 degree inclined total body conditioning activity.  The ladder is self-propelled, and your position on the ladder sets the pace of the climb.  Wrap the belt around your waist with the emblem set over the side of your right hip.  Adjust the white section of the strap so that it matches your height.  Step onto the ladder and start climbing.  Initially, place the hands on the side rails and get use to climbing with just the legs.  Once you get comfortable with the stride pattern, progress to using the hands on the rungs.  Work on improving your coordination and form during the initial Jacob’s Ladder sessions.  When you are ready to stop, simply ride the ladder to the bottom and the ladder will stop.  Listed below are some of the HIIT sessions that work well with the Jacobs Ladder.

Five Climbs
Pick a distance, 100-200 feet works well for most fitness clients.  Start the stopwatch and climb 100-200 feet and  then rest.  Repeat four more times and record your time to complete five climbs of 100-200 feet.

50 feet / 20 seconds rest
Climb fifty feet at a fast pace.  Rest twenty seconds and repeat.  Repeat for a total of six intervals.

Ladder Ladders  
This routine will help you develop better endurance.  Climb 100 feet and rest 60 seconds.  Climb 200 feet and rest 60 seconds.  Climb 300 feet and rest 60 seconds.  Climb 400 feet and rest 60 seconds.  Climb 500 feet and rest 60 seconds.  If you feel strong enough, climb back down; 400-300-200-100 feet.

Save My Baby Sprints
You are the fireman.  The building is on fire and the lady with the baby is at the window of the high rise.  Hold onto the side rails and sprint up to that baby in the window 200 feet up.  Rest 30 seconds and then go get another baby.  Your job is to save four babies.

View video of Mike on the Jacob’s Ladder here: https://youtu.be/rqYz0tmPIc8

For more information on the many benefits of high intensity interval training, read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

Think About This

The Latest Science on the Prevention of Alzheimer’s

Over the last 30 years, more than two hundred experimental drugs have failed to produce any success in the fight against Alzheimer’s.  It does not appear we are going to have a pharmaceutical for the treatment of Alzheimer’s any time in the near future.  A recent *article in the April issue of Scientific American discusses a treatment option that does appear to work.  This is currently our only hope in the fight against this terrible disease.  The good news is the treatment that prevents cognitive decline helps with so many other problems.

The study’s researchers demonstrated that an interventional program of exercise, proper nutrition, and cognitive training produced significant improvements in brain function.  The **Finnish Intervention Study to Prevent Cognitive Impairment and Disability (FINGER study) enrolled 1260 men and women between ages 60 and 77.  Over the course of two years, participants demonstrated improved cognitive test scores in processing speed (up 150%), executive function (up 83%), and complex memory (up 40%).

The exercise program in this study was not complex or time consuming.  The routines were developed by physical therapists and performed four or five days a week.  The exercise sessions involved strength training, balance skills, and aerobic activities.  As the participants became fitter, their training regimens were progressed–more challenging activities, more resistance, and/or more volume.  The time spent in training was four to five hours a week.

If your goal is to maintain or improve cognitive capacity and remain independent, then the prescription is a consistent routine of exercise.  Take the time to read the article, lace up your sneakers, and make a progressive program of fitness a lifelong habit.

* A Rare Success Against Alzheimer’s, Scientific American, April 2017

** The FINGER study, Alzheimer Prevention. Download the article here: http://r.search.yahoo.com/_ylt=A0LEViMTIfZYurkAQNsnnIlQ;_ylu=X3oDMTBybGY3bmpvBGNvbG8DYmYxBHBvcwMyBHZ0aWQDBHNlYwNzcg–/RV=2/RE=1492554131/RO=10/RU=http%3a%2f%2fwww.alzheimersprevention.org%2fdownloadables%2fFINGER-study-report-by-ARPF.pdf/RK=0/RS=fHWCrTAi9LEEDrH5jWfmRvAI7LU-

Michael S. O’Hara, PT, OCS, CSCS

Very Short Term Running Preparation

I was recently asked by a fitness client to post exercise recommendations that would prepare her for outdoor distance running.  This person was two weeks away from being out on the road, running two or three miles a day.  She is middle aged, has a prior history of lower back pain, and her goal was to lose fifteen pounds and “tone up”.   Given such short notice, these are my recommendations.

Perform soft tissue work on a daily basis.  Foam roll the legs and use a lacrosse ball on the plantar fascia.  The vast majority of overuse injuries in runners happen in the lower legs and feet.  Attempt to unwind the myofascial distress created by 600-700 foot impacts a mile.

Improve your reciprocal hip pattern–one hip goes back and the other goes forward.  Most general fitness clients have glaring deficits on one side.  Perform some split squats, posterior lunges, step ups, and or walking lunges.  If you struggle with these activities, I would reconsider running as a fitness activity.

Wake up your gluteals.  Every day, perform fifty or sixty bridges, hip lifts, or leg curls.  You need super gluteal strength / endurance to run distances and avoid lower extremity injury.  If your butt gets sore from fifty bridges, you need to do them more often.

Running is a skill and most recreational runners need some practice.  Running hills will improve gait mechanics, enhance hip extension, and decrease deceleration forces.  Find a fifty-yard hill.  Run up the hill and walk back down.  Perform five hill runs.

You are always better to run too little than to run too much.   Start with very short runs– no more than half a mile.  Increase your total weekly mileage by no more than five percent a week.

You can’t do this in two weeks, but this is my big recommendation to all future runners.  Lose the extra weight before running.  As a method of fat loss, distance running has a poor track record.  It tends to elevate the hormones that make you hungry, and physiological adaptation to distance running happens fairly quickly.  Extra adipose makes you far more likely to develop a running related injury.  I know the guys and gals you see running miles and miles every day are lean.  Please remember that lean runners are successful with running because they possess the optimal body mass to run long distances.  They did not start heavy and become lean.  Put a fifteen pound weight vest on that guy or gal and everything will change.  Their gait will lose efficiency and become less graceful.  The extra fifteen pounds of load creates the biomechanical overload that makes them much more likely to suffer an injury.

My final recommendation is that you not become disappointed if you develop pain.  A runnersworld.com poll conducted in 2009 revealed that 66% of respondents reported a running related injury that year.  The statistics indicate that one third of the participants at you local 10k fun run will require medical attention for a running related injury over the next year.  Have the good sense to stop when the pain begins.

Michael S. O’Hara, PT, OCS, CSCS

Aging Muscles and Exercise

Fast Reaction and Helpful Hormones

New technology has produced some surprising information on the cellular response of muscle to various types of exercise.  Super blood analyzers and computers have enabled scientists to monitor gene expression and hormonal release in muscle cells during and after sessions of exercise.  The information from this research is revolutionizing our understanding of optimal exercise prescription for health and longevity.  It appears that older individuals derive the most beneficial muscle cell response with fairly intense interval training sessions.  Please take the time to read Gretchen Reynolds article in the New York Times, The Best Exercise for Aging Muscles.

Dr. Martin Gibala, a professor at the kinesiology department at McMaster University in Hamilton, Ontario recently released an outstanding book, The One Minute Workout.  Dr. Gibala explains the science behind high intensity interval training (HIIT) and why it is safe and effective for older fitness participants.

Skeletal muscles produce beneficial biochemicals called myokines that stimulate a response in cells throughout the body.  Myokines are a fairly new scientific discovery and we have only recently begun to understand their remarkable effect on human physiology.  Myokines enhance blood vessel development, promote beneficial hormone levels, stimulate greater mitochondria production, and improve the metabolism of fat.  In the older individual, myokine levels are enhanced with strength training and high intensity interval training.

The best method of creating more of the beneficial myokine biochemistry is to consistently perform some progressive resistance training followed by a brief but intense interval training session.  This regimen of training is similar to that of track athletes involved in sprinting.  These athletes have high levels of muscle mass and very low body fat levels.

Michael S. O’Hara, PT, OCS, CSCS

Read the NY Times article here: https://www.nytimes.com/2017/03/23/well/move/the-best-exercise-for-aging-muscles.html

Americans are far behind the rest of the world when it comes to the number of steps we take in a day.  The body mass index numbers and mortality rates of our fellow citizens are rising in direct proportion to time spent seated.  Human physiology operates optimally under the physical demands of a significant amount of standing and walking.  Much of the now rampant obesity, heart disease, diabetes, and metabolic syndrome can be linked to our species sudden fall into sustained sitting.  Standing for most of your workday and a daily habit of walking pays huge health and fitness benefits.

We are de-evolving into a nation of sitters.  Between internet, television, driving, and computer work, it is not uncommon for many of my physical therapy patients and fitness clients to sit for ten hours a day.  Unfortunately, you cannot train away the metabolic and physical damage created by prolonged sitting with a few 45 minute exercise sessions every week.

Seventy years ago, the London Transit Workers Study provided the initial scientific insights into the powerful health benefits of sitting less and standing more.  Take the time to read the recent *article by Gretchen Reynolds in the March 23, 2017 edition of the New York Times.  Ms. Reynolds’ provides some valuable information on the benefits of standing up and moving as much as possible.  Now go for a walk and then Google Varidesk.

–Michael S. O’Hara, PT, OCS, CSCS

*Should 15,000 Steps a Day Be Our New Exercise Target?, Gretchen Reynolds, New York Times, March 23, 2017

Read the article here: https://www.nytimes.com/2017/03/22/well/move/should-15000-steps-a-day-be-our-new-exercise-target.html

 

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