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Learn more about Rehab, Sports Medicine & Performance

Foot and Ankle

David Epstein is my favorite Sports Illustrated writer.  Last year he published his first book, The Sports Gene.  I highly recommend it to anyone who works with athletes on a regular basis.

Mr. Epstein has traveled the world and has consulted with hundreds of scientists, coaches, and experts on the training environment that produces optimal results.  If you are the parent of a youth athlete, I urge you to take a look at the June 10, 2014 article he wrote in the New York Times.  I can personally vouch for the injury information in this article.

To read the article, click on the link below:

 http://www.nytimes.com/2014/06/11/opinion/sports-should-be-childs-play.html?_r=1

ACTIVITY GOAL:
Enhance single leg power production and prevent injury

OBJECTIVE:
Build explosive single leg power in your hips and legs
Improve coordination and core stability

STARTING POSITION:
Start in a half kneeling position, making sure the knee of your front leg is behind your toes.
Rest your arms at your sides.

PROCEDURE:
From the ½ kneeling position, drive through the front foot’s heal and explode into the air. Once in the air, quickly switch your legs so that you land with the opposite foot forward. Land in the same ½ kneeling position with the back knee stopping 1-2” above the ground.

COMMON MISTAKES:
Not landing deep enough
Not spreading the feet far enough apart
Not jumping high enough

-Jeff Tirrell, B.S., CSCS

30 Minutes Of Fitness

Remember, You Asked For It

“I don’t have enough time” is the big excuse people give for not exercising.  At FFAC, we can get you in and out of the gym in thirty minutes.  Our movement based training sessions produce excellent results with minimal time commitment.  We program in high value exercise activities that produce optimal gains.  This is the second of six, 30 Minutes of Fitness, sessions.  The best workouts are short, intense and frequent.  Intensity is usually the missing factor in most gym goer’s training.
 
Session Two
1.    Four point thoracic rotations x 10 each side.
2.    TRX “Stoney Stretches” x 10 each leg.
3.    A. Sled Push 3 x 50 yards.
B. Kettlebell Swings 3 x 12 repetitions.
4.    A. TRX Atomic Push-ups 3 x 6-10 repetitions
B. Dumbbell Row right / left 3 x 6-10 repetitions.
5.    Medicine Ball Rotation Throws 3 x 4 repetitions each side.

One and Two:  Start with the two mobility drills for ten repetitions on each side.  If you sit all day, these two drills should be part of your daily mobility routine.
Three:  Load up a sled with + /- 10% of your bodyweight and push it 50 yards.  Rest for no longer than thirty seconds and then perform twelve good kettlebell swings–lots of hip motion and minimal knee bend.  Remember a swing is a hip dominant explosive throw, not a slow squat pattern lift.  Repeat this circuit three times.  
Four:  Set up a TRX for Atomic Push-ups followed by a dumbbell row on each side.  Move back and forth between the two exercises for three sets.
Five:  Finish with some rotational medicine ball throws off the wall for three sets of four on each side.  You should be done in well under thirty minutes.

Session Two 30 Minute Synopsis
Effective mobility training.
Twelve sets of strength training exercises.
Explosive power production training.

Watch the attached video and if you are still unsure of how to perform any of the exercises get with one of our trainers for some instruction.

Michael S. O’Hara, P.T., OCS, CSCS

Skeletal Strengthening

Exercise Training That Prevents Osteoporosis

bending_the_age_curveI recently heard a talk by Dr. Joseph Signorile on the latest and greatest research in regards to exercise that prevents and reverses osteoporosis.  Dr. Signorile is a professor of kinesiology at the University of Miami.  He is an expert on fitness for older adults and conducts research in the field of geriatrics.  Based on what field proven research is telling us today, Dr. Signorile has these suggestions:

Bone reacts best to dynamic mechanical stimulation.  The best bone building exercises create a stress that changes as we move, rather than a static force.  Progressive resistance training involves moving your body against a resistance.

If a bone is to respond to training, the stimulus must be at a suprathreshold level.  The participants in the studies that got the best results carried, lifted, pulled, and pushed some serious loads.  “Suprathreshold level” means it has to be physically challenging.  Elliptical training and those five pound chrome dumbbells will not produce a bone building response.

Optimal bone building skeletal loading.  What the research studies have found is that the best gains occurred with forty repetitions of loading at each skeletal region per training session.  Less than forty is less than optimal.  More than forty repetitions have no further bone building benefit.  Two or three properly executed exercises can take care of loading the entire skeleton.  An appropriate skeletal training session can be made up of 80-120 repetitions.  You can get that done in fifteen minutes.

The response of bone to exercise is improved by brief but intermittent exercise.  Loading your skeleton more frequently creates a stronger mineralization response in the bone.  Five or six training sessions per week will produce more bone density than two or three sessions per week.

Bone responds best when you employ a loading pattern that differs from the usual loading pattern.    I have been ranting about this for years.  Bone only adapts–gets stronger–when the exercise stimulus is a challenge beyond what you have subjected the bone to in the past.  If you have been performing the same activity at the same load for months on end, the bone building stimulus is minimal.   To improve bone health, you should alter the exercises you perform every three to four weeks.

What the research recommends….
Based on what the research is telling us, Dr. Joe recommends you perform a program of dynamic weight training that delivers forty repetitions of loading at each section of your skeletal system.  You will see better results with more frequent training sessions and consistent alteration in exercise activities.  Pick two or three exercises and load them aggressively for forty repetitions each.  Perform your exercise three to five times a week and change your exercises every month.  To learn more, talk to our trainers for some bone building exercise suggestions.
Michael S. O’Hara, P.T., OCS, CSCS

30 Minutes Of Fitness

Remember, You Asked For It

“I don’t have enough time” is the big excuse people give for not exercising.  At Fenton Fitness,  we can get you in and out of the gym in thirty minutes.  Our movement based training sessions produce excellent results with minimal time commitment.  We program in high value exercise activities in a layout that produces optimal gains.  This is the first of six, 30 Minutes of Fitness, sessions.  The best workouts are short, intense, and frequent.  Intensity is usually the missing factor in most gym goers’ training sessions.

Session One
1.    Moving knee to chest mobility drill x 20 yards
2.    World’s Greatest Stretch x 20 yards
3.    Sled Push x 100 yards
4.    A. Push ups 3 x 8-12 repetitions
B. Inverted row or TRX row 3 x 6-10 repetitions.
C. Kettlebell Goblet Squat 3 x 6-10 repetitions.
5.    Medicine Ball Overhead Throws off wall 3 x 5 repetitions.

One and Two:  Perform the two basic movement preparation drills for twenty yards each.
Three:  Load your sled up with +/- 20% of your body weight and give it a push for 100 yards.  You can rest as needed, but try to get the entire 100 yards completed in less than five minutes.
Four:  You should be warmed up, breathing faster, and ready for some strength training.  Perform the next three exercises in a circuit fashion.  A set of push ups followed by a set of rows and then a set of goblet squats.  Between the different exercises, rest as little as possible, and then after you get through an entire circuit, you can take a longer 90 second break.  Repeat the circuit three times.
Five:  Work on power production with three sets of overhead medicine ball throws.  Use a weight that lets you throw a line drive and not a lob.
Choose the appropriate exercise variation and load for your strength exercises.

Session One Synopsis:
Effective mobility training.
Total body conditioning.
Twelve sets of strengthening exercises.
Explosive power training.

See the video for more information.

Michael S. O’Hara, P.T., OCS, CSCS

What Women Need

Needs Are Different Than Wants

Rosei The RiveterI get to discuss fitness goals with women nearly every day.  They want to lose weight, get rid of musculoskeletal pain problems, have more energy, and “get arms like that girl”.  Many of them have been doing their favorite exercise activity for years and have been unsuccessful at achieving any of their stated fitness goals.  What they tell me they want to do is yoga, elliptical training, and Pilates.   What they need to do is start on a program of strength training.  

Ramping Up Your Metabolism
We all know that a body with more muscle burns more calories all day long.  You can get away with eating more food and not develop greater fat deposits.  Much more significantly, greater muscle mass positively influences fat metabolism, insulin levels, glucose processing, hormone profiles, and disease resilience.  These changes influence the “more energy” feeling you develop with strength training.  

Training To Abolish Pain
Nearly every patient that comes to physical therapy with a chronic pain problem has a glaring strength deficit that is perpetuating the pain.  They have gluteals, scapula retractors, or cervical stabilizers that are not functioning at a level that permit them to perform normal activities of daily living and remain free of pain.  What makes these patients better is a program of targeted strength training.  If you have chronic hip, knee, lower back, or neck pain, your best method of permanently resolving the problem is strength training.  

Bone Health
All of the current research says you need bone jarring, compressive, and aggressive loading of your skeleton to enhance or prevent further loss of bone density.  Over the last year, two government panels of experts have told us that taking more vitamin D and calcium does not appear to make any difference in bone density.  Better bone biology requires that the exercise stimulus be strong and consistent.  Low skeletal stress activities such as yoga, Pilates, and elliptical training do not create the forces needed to have a positive effect on bone density.  Read Bending the Aging Curve by Dr. Joseph Signorile.

Staying Independent
I am sorry Ladies, but muscle mass, strength, and power production all leave you at a far faster rate than your male counterparts.  It is not fair, but it is the truth.  As you age, training to restore these physical capacities becomes much more important if you wish to remain independent for a lifetime.  Ask any physical therapist who works with geriatric clients and they will tell you that weakness is the driver of debility.  The good news is that a properly designed program of strength training can work wonders.  

Motivational Goal Setting
Strength training provides motivation by having clear goals.  “I want to tone up” is not a clear goal.  Any psychology major will tell you that reaching defined goals reinforces positive behavior.  You improve from three to eight solid push ups, carry ten more pounds for fifty yards, press twenty pound dumbbells instead of tens, and it motivates you to stay with the program.  Numerous psychological studies have found that a lack of goal achievement is the number one reason people fail to succeed in staying consistent with an exercise program.  The girl with the arms you like has strength goals.  

Michael S. O’Hara, P.T., OCS, CSCS

The Lunge Matrix

Three Dimensional Leg Training

Twenty-five years ago, I participated in a three day “functional movement” seminar given by physical therapist, Gary Gray.  Gary got the entire class involved in a morning exercise class he called Pump and Praise.   One of the activities he taught was the lunge matrix.  I was 30 years old and had been exercising fairly regularly, yet I found the lunge matrix much more challenging than expected.  Since that time, I have used the lunge matrix with physical therapy patients, fitness clients, and in nearly every session of my own training.  Almost everyone can benefit from a little lunge matrix training.

The muscles in our trunk and hips are inter-twined, aligned in a spiral and diagonal fashion.  They are neurologically connected and work as a team to drive movement in three dimensional patterns.  The lunge matrix neurologically activates all of the muscles in all of the possible movement patterns.

The lunge matrix is ideal for anyone involved in a multi-directional sport.  Tennis, volleyball, basketball, soccer, and football require efficient transition in all directions. Injury prevention is the most important aspect of any athletic training program.  Your gym program should make you more bullet proof on the field of play.

The lunge matrix can be used as a movement preparation activity with just bodyweight (my favorite) or as a stand-alone strengthening exercise.  When performed as a strengthening exercise, use functional level loads, dumbbells, or medicine balls that equal the weight of the bag of groceries or the grandchild you are going to lift.  The loads should not alter the quality of movement or shorten the range of your lunges.  Choose shoes with flatter soles as some of the more cushioned running shoes can make lateral and rotational movement patterns difficult.

Lunge Matrix Series
1. Anterior lunge R / L
2. Lateral lunge R / L
3. Rotational lunge R / L
4. Posterior lunge R / L

Watch the attached video, and then give the lunge matrix a try.

Michael S. O’Hara, P.T. OCS, CSCS

Stripe Hype

The Good And Bad Of Kinesio Taping

In 2008, Kinesio tape (KT) was donated to 58 countries for use during the Olympic games.  Since that marketing effort, its presence in televised sports has exploded.  The athletic fashion statement found at many competitions is the brightly colored strips of tape across elbows, knees, shoulders, and hips.  At Wimbeldon, Novak Djokovic had green tape on his elbow.  Many of the soccer players at the last Euro competitions had tape on shoulders and hips.  Female beach volleyball players seem to be wearing more tape than clothes.

Kinesio tape was invented by chiropractor Dr. Kenzo Kase in the 1970s.  KT is made of cotton with an acrylic adhesive that permits it to stretch 40-50% of its resting length.  The website for Kinesio tape claims that it can alleviate pain, reduce inflammation, relax muscles, enhance performance, and help with rehabilitation.  Rock tape, a competing product, makes similar claims and uses the slogan Go Stronger, Longer.

Does Kinesio Taping work?
Serena Williams with Kinesio TapeA meta analysis performed by Wilson in 2011 looked at all of the studies performed with KT and found some evidence that it helped improve range of motion, but no evidence that it helped reduce inflammation, relax/activate muscles, or improve performance.  There is no evidence that it “off loads sensitive tissues” or improves “lymph drainage”.  The number of high quality studies was small.

How Might Kinesio Taping Work?
What we do know is that the elastic, compressive nature of any band, brace, or tape placed on the body stimulates receptors in the skin.  The receptors modulate the perception of pain and as a result, pain decreases.  An example is a research study in which the patients that wore a neoprene sleeve during a series of tests 12 months post anterior cruciate repair produced significantly more force and had better balance than without the neoprene sleeve.  The sleeve created a constant pressure on the skin surrounding the knee.

Should You Use Kinesio Tape?
If you have a minor ache or pain and no structural musculoskeletal damage, then go ahead.  The KT can make you feel better, and this will make exercise and activities of daily living easier.  The tape can provide some control over the symptoms, and it has no side effects other than occasional skin irritation.

Remember that your body sends pain signals for a reason.  Any type of musuloskeletal damage should be dealt with more comprehensively than just KT.  It is a bad idea to use KT to reduce pain and then participate in activities that create even greater tissue trauma.  A small and easy to rehab rotator cuff tear can become a big, full thickness, surgical repair tear if you tape it up and practice your tennis serves.

We do lots of things in medicine that have no solid, double blind research that proves efficacy.  The manufacturers of KT products need to spend more money on research and less on marketing.  I am hopeful that in time, more evidence will develop for the use of KT.  If some strips of KT make you feel better, go ahead and use it.  The best approach is to get to the cause of the problem and enact a treatment plan that resolves the pain or functional limitation.

Michael S. O’Hara, P.T., OCS, CSCS

If Frankenstein Had Glutes, He Could Have Run Away

Get Fit With Monster Walks

Frankenstein in chainsMost of the exercises performed in the gym emphasize the sagittal (front/back) plane of motion.  Squat, lunge, elliptical, and treadmill are all sagittal plane activities.  In athletics and life, we must be able to move efficiently in all planes of motion.  Our gluteal muscles are the primary producers of lateral and rotational movement in the lower extremities.  Strong and responsive gluteals keep your knees and lower back safe from injury during athletic activities.  A simple exercise to improve gluteal function and move better in the often-neglected frontal plane is a band monster walk.

You will need a mini resistance band or a lateral resistor.  Place a mini band loop around your ankles.  Assume an athletic stance with the feet straight ahead, knees bent, and hips flexed.  The band should be held taught throughout the exercise.  Try to keep the hips and shoulders level throughout the exercise.  Your torso and pelvis should not wobble side to side.  Move the right foot 12 to 18 inches to the right, and after planting the right foot, follow with the left.  Remember to keep some tension on the band.  When you have completed the prescribed number of repetitions, rest and then lateral step back to the left.

As you get better at this exercise, try performing the drill moving forward and backward.  The backward monster walk is an excellent gluteal activation exercise for runners.  Try performing one or two sets of eight to ten repetitions.

Michael S. O’Hara, P.T., OCS, CSCS

Front Squats

Stability, Mobility, And Better Posture

The squat has been described as the king of all exercises.  The large amount of muscle recruited during squatting makes it a very metabolically demanding exercise.  In athletics, the capacity to perform a full squat with proper torso, hip, and knee position has been correlated with greater durability–fewer injuries.  The overhead squat test is one of the patterns assessed in the Functional Movement Screen and is used in physical therapy and athletic training.  Squatting with the load placed on the front of the body is an excellent way to enhance mobility, stability, and strength.  Compared to leg presses, seated leg curls, and knee extension, front squatting creates much more carry over to activities of daily living and athletics.  The problem is most people do not know how to get started with front squats.

When you squat with the load across the front of the body instead of on the upper part of the back, the stress on the spine is reduced.  You can “cheat” a back loaded squat by leaning forward, but you cannot lean forward with a front squat.  Leaning forward on the front squat causes the load to fall from your shoulders or hands.  Front squatting creates a greater core stability demand and reduces shear force on the lower back.  Full depth front squatting will improve your posture and restore mobility in the hips, shoulders, and thoracic spine.

Front squatting is an exercise that is more equivalent to daily tasks and athletics.  Lifts in real life rarely place the load across your shoulders.  When you lift the grandchild, carry the groceries, or hoist the wheelbarrow, the load is in front of the body.  During athletics, the opponent is in front of you, and you must stay upright and tall to dominate the activity.

Front Squat 101
Before loading the squat, practice bodyweight squats to a depth target.  I like to use a 12 inch box or a Dynamax ball (12 inches in diameter).  You should be able to perform a body weight squat to a thigh below parallel position with a stable spine before attempting a loaded front squat.  When you perform a loaded front squat, initiate motion from the hips by sitting down and back.  Push the knees out and descend so the thighs travel to below a parallel to the floor position.  Keep the chest up and torso tall as you push back up.  Finish at the top by contracting the gluteal muscles and keeping the front of the rib cage down.

Choose A Proper Implement
While the barbell offers the greatest loading capacity, many individuals do not possess the shoulder mobility to hold the bar on the shoulders.  The Goblet Squat position with a kettlebell or dumbbell works just as well.  A sandbag hugged close to the body in the high Zercher position or bear hug hold has a high degree of athletic carry over.  Avoid the Smith machine variation.  You end up leaning on the machine and this eliminates much of the core stability demands and exposes the spine to greater shear force.

Michael S. O’Hara, P.T., OCS, CSCS

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