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Hand and Wrist

Advice From The Experts At Fenton Fitness/Fenton Physical Therapy

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#1—Don’t do dumb stuff

snapshot-1-1-11-2017-10-09-amThe cumulative injuries you suffer in your twenties echo through a lifetime.  My long and busy career as a physical therapist has taught me that this is true.  The 20 year old with a knee arthroscopy returns as a 32 year old with a ligament reconstruction and then again as a 50 year old knee replacement patient.  Surgery and rehab can only do so much.  Resist participation in the “hold my beer” events that inevitably present themselves in the social lives of 20 year olds.  Think twice before you enter that Gladiator Challenge Race, swing from that rope suspended over a river, or text and drive.  Your sixty-year old self will thank you.

-Mike O’Hara, Physical Therapist for the last 32 years.  Fitness coach and board certified orthopedic specialist 

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?

Listen to Mike’s advice: https://youtu.be/8JCtFzj539M

Kettlebell Swings and Push Ups

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.   

Swings and Push Ups

Strength coach Dan John got me started on kettlebell swings/push up sessions.   This pairing challenges core stability as the swings create an anti-flexion core stabilization demand and the push ups an anti-extension demand.  If your goal is fat loss, this exercise pairing produces a total body metabolic boost.  A hidden benefit is getting up and down off the floor during the training session.  It is a basic mobility skill we need to practice in order to maintain our independence.

Kettlebell Swings
kb_swingA swing is not a squat and a squat is not a swing.  A kettlebell swing is a hip dominant motion; the hips move a lot and the knees just a little.  The handle of the kettlebell should stay above the knees.  At the bottom of the swing, the forearms should contact the upper thighs.  You swing the kettlebell forward with an explosive contraction of the gluteal and hamstring muscles.  Do not lift the kettlebell with the arms.  Project, or throw, the kettlebell to shoulder level and no higher.  The swing is an exercise that is worthy of some coaching.  Find an instructor that can help you with proper performance.

Push Ups
Keep the shoulder blades down the back and tight against the rib cage.  Hold the head in a retracted position and relax the neck.  The shoulders should not ride up into a shrugged position. Start at the bottom of the push up (flat on the floor).  Place the hands under the shoulders and keep the elbows tucked in to the side of the body.  Grip the floor with the hands and activate the muscles in the back of the shoulder blades.  Brace the abdominal muscles, tighten the glutes, and maintain tension between the legs by drawing them together.  Push up while maintaining spinal and shoulder position.   Hold at the top for two counts and repeat the push up.

Swing/Push Up Sessions
The great thing about these sessions is that you need minimal equipment—just a single kettlebell and a willingness to work hard.

This is a good place to start.  You will need a kettlebell and a stopwatch.
Swings x 20 seconds
Push ups x 6 repetitions
Rest 30 seconds
Repeat for fifteen minutes
As you get stronger, increase the push up repetitions.

This is one of my favorite swing/push up training sessions.
20 swings
20 push ups
20 swings
15 push ups
20 swings
10 push ups
20 swings
5 push ups
20 swings
You will finish with 100 swings and 50 push ups.

Try a push up “countdown” session.  Follow this pattern:
10 swings
10 push ups
10 swings
9 push ups
10 swings
8 push ups
Work your way down to 7-6-5-4-3-2-1 push up.  You will complete 100 swings and 55 push ups and transfer up and down off the floor 10 times.  If that is too much, modify the program and start at five push ups.  You will complete 50 swings and 15 push ups.

View video of Mike performing these exercises here: https://youtu.be/Vq3VYg847Xs

-Michael S. O’Hara, P.T., OCS, CSCS

Turkish Get Ups and Waiters Walks

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.   

Turkish Get Up and Waiter Walk Complex

How you move says more about your fitness than how you look.  The pairing of the Turkish Get Up (TGU) and Waiter Walk is an exercise complex that improves gait mechanics and the survival skill of getting up and down off the ground.  You will be performing a TGU and immediately move into a Waiter Walk so you need twenty yards of open space.  As you get stronger at this complex and use a heavier implement, some interesting things start to happen.  You get better at controlling respiration and have an intense focus on how your body moves during the TGU and Waiter Walk.  My yoga friends tell me this is the focus of their practice sessions: better respiration, improved motor control, and increased strength.

Turkish Get Up

t_get_upsThe Turkish Get Up (TGU) is generally performed with a kettlebell, but you can use a dumbbell.  A medicine ball can help teach body alignment to beginners.

Exercise activities that produce the greatest rewards are the ones that take the most time to master.  You can learn a barbell curl in five seconds but a TGU can take weeks to master.  Developing proficiency with the Turkish Get Up will require some patience and instruction, but for the time spent, the pay off is tremendous.  Complete instruction on the TGU is not possible in this short article.  Watch the accompanying video and work with a qualified trainer on this exercise.  Steve Cotter and Gray Cook both have excellent YouTube tutorials on the TGU.

Waiter Walk

You must have adequate shoulder range of motion and good balance to perform this exercise safely.  Hold the kettlebell overhead like a waiter carrying a tray.  Keep the chest proud and the neck relaxed.  The upper arm should be adjacent to the head and your walk should be smooth and free of any lean or limp.

Complex
I like to train TGU rookies with a soft Dynamax ball.  If they drop the ball it will not damage any aspect of their anatomy.  Balancing the ball on the hand tends to teach proper alignment.  Progress to a kettlebell as you become more proficient.  Start on the floor and perform the TGU ascent.  Once at the top of the TGU, perform a Waiter Walk for twenty yards and then lower back down to the floor with a TGU descent.  Switch the implement to the other side and repeat.  Perform two trips on each side.

When you perform this complex, strive to move more gracefully before adding more resistance.   Get up and down off the floor and walk in a coordinated and efficient manner.  Only then increase the load of the ‘bell.

View video of Mike performing these exercises herehttps://www.youtube.com/watch?v=s0U9GWMI4bU&t=8s

-Michael S. O’Hara, P.T., OCS, CSCS

Crawl and Bearhug Sandbag Carry

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.   

Crawl and Bearhug Sandbag Carry

A finisher is a short but intense, high metabolic cost, training event performed at the end of an exercise session.  The best finishers create carry over to real life activities and can be made more challenging as you become more fit.  When linked to proper diet, finishers produce the “metabolic hit” that stimulates fat loss.  As the name implies, you always perform finishers at the end of your workout because, afterwards, you will not want to do anything else.

Crawl
Crawling is all about the spiral, diagonal force connection that happens through the middle of the body.  Crawling is the primal exercise that enabled us to stand and walk.  The “core muscles” neurologically connect the left hip with the right shoulder and the right hip with the left shoulder.  They stabilize the pelvis and spine so you can transfer force from the hips to the shoulders.  Crawling keeps that connection healthy and strong.

Bear Hug Sandbag Carry

sandbagThe bear hug sandbag carry is the cure for the epidemic of device disability syndrome (DDS).  This exercise reverses all of the weakness that is created by endless hours planted in a chair, staring into a screen.  Sandbag carries are functional core stability work.  The abdominal muscles interact with the muscles in the legs and shoulder girdle to hold a stable upright position.  Walking with a sandbag kicks starts your postural reflexes, the neural feedback mechanism that holds us up against gravity.  Do not go too heavy on the sandbag.  You should be able to stay tall and not stagger or lean forward.

The routine is simple:  Crawl for twenty yards—ten yards down and ten yards back.  Try to keep the knees close to the floor and the back flat.  Immediately after finishing the crawl, pick up the sandbag with a bear hug hold- no hands linked- and carry it for twenty yards.  Rest as needed and repeat.  Start out with three circuits and increase to five.  Try to keep the rest periods under thirty seconds.  Once you get up to five circuits, add a weight vest and then a heavier sandbag.  Modify the distance, load, and cycles to suit your needs.  Give the crawl/bear hug carry combo finisher a try and let me know how it goes.

View video of Mike performing sandbag carries here: https://youtu.be/Ygg2vbf-Uoo

-Michael S. O’Hara, P.T., OCS, CSCS

 

Three Gifts I Would Give And Three I Would Take Away

Santa Gives You Gluteal Activation
You need a responsive and strong set of butt muscles to function at optimal levels. Many gym goers have gluteal muscles that are neurologically disconnected.  The term physical therapists and strength coaches use is “gluteal amnesia.”  Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the butt muscles.  We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement.  Most fitness clients are in need of some intensive gluteal training.  The hip lift is a simple exercise activity that produces a superior response.  See the attached video for a demonstration.

Scrooge the Lumbar Spine Flexion
Drop the sit ups, stop doing crunches, ditch the glute ham developer sit ups, and forgo the toes to bar competitions.  Father time, gravity, and the stress of prolonged sitting are already bending our lumbar spines forward all day long.  The last thing you need to do is accelerate degenerative breakdown of the lumbar segments with more repetitions of spine flexion.  Please forget about isolating abdominal muscles.  Instead learn how to control the team of muscles that hold the lumbar spine stable.  It is a neural event that is worthy of all your efforts.

Santa Gives You Medicine Ball Throws
medballLife is an up tempo game.  What you do in the gym is reflected in how well you can move during activities of daily living.  If you continually exercise at slow tempos you will get better at moving slowly.  The capacity to decelerate a fall requires fast reactions.  Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power and speed of movement.  Medicine ball throws are the easiest way to improve power.  Medicine ball throws can be scaled to all fitness levels and are safe as long as you use a properly sized and weighted ball.  The large, soft Dynamax balls are a good choice for beginners.  They rebound well off of the block walls in the gym and are easy to catch.  Do not overload your medicine ball throws, a two to eight pound ball is best for most gym goers.  Get with one of the trainers for instruction on adding medicine ball throws to your training program.

Scrooge Sitting Down in the Gym
Movement happens in an upright, standing position.  “Seated exercise” is an oxymoron.  If you want to improve how your body functions, you must stand up and defy gravity. Every athletic endeavor is performed in a standing position. Seated exercise reinforces poor postural habits and diminishes your capacity to move.  I call it the “illusion of exercise” and it will always be highly visible in commercial gyms because it is easy to sell.

Santa Gives You Four-Point Training
Crawling is the neurological training tool an infant uses to develop the capacity to stand and walk.  It is the pathway to better motor control and less pain.  Nearly every physical therapy patient and most fitness clients benefit from a healthy dose of four-point position exercise.  In your fitness program, reinforce the patterns of spinal stability and reboot the postural reflexes with some horse stance horizontal, crawling, and Jacobs Ladder training.   Four-point training can be scaled to any fitness level.  Watch the attached video for some examples.

Scrooge Elliptical Training
I know you love the elliptical.  It is the no impact, cardio darling of the gym but it should be used as a fitness dessert and not a main course.  Elliptical training has multiple drawbacks.  Ergonomically, it is a one size for everyone apparatus that does not work well for taller or shorter people.  When you walk or run, you improve the important skill of stabilizing your body over one leg.  An elliptical keeps both feet stapled to the machine and deadens any neural enhancement of balance or single leg stability.  Hip extension keeps our back healthy and our body athletic.  Maintaining or improving hip extension should be part of every training session.  There is no hip extension produced when you train on an elliptical.  Many people maintain a flexed spine when they use an elliptical.  Sitting produces the flexed forward spine we all need to work against in our fitness programs.  The repetitive use of the shoulder girdle is a frequent generator of referrals to physical therapy for head and neck pain.  Metabolic adaptation to elliptical training happens fairly quickly.  In January, a 30 minute session burns 330 calories, but by June, your body becomes more efficient and that same routine creates only a 240 calorie deficit.  The low impact, reduced weight bearing nature of an elliptical makes it a poor choice in your fight against osteoporosis.

I am happy when people are more active.  Patients and fitness clients love the elliptical and they believe it helps.  Use that belief to keep you motivated and training.  I just want everyone to manage the drawbacks of this type of training.  Injured people always say “Why didn’t someone tell me?”  Before you jump on the elliptical, take ten minutes and improve your core stability and hip function with some four-point exercises and hip lifts.  Learn how to throw a medicine ball and stay standing through the rest of your training program.  Next Christmas you will thank me.

Merry Christmas and a Humbug to you.

See video of Mike in the gym demonstrating these exercises here: https://youtu.be/H0my94BPHNQ

Michael S. O’Hara, PT, OCS, CSCS

Goblet Squats and Pull Ups

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:

Train efficiently—You get much more work done during your training time. 

Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations. 

Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition. 

Move better—Training neurologically related movement patterns improves motor control.  

Goblet Squats and Pull Ups

The more inefficient you are when performing an exercise activity the greater the metabolic demand.  Inefficient exercise is the key to fat loss.  Most gym goers become efficient in their selected exercise activities and body composition improvement comes to a standstill.  This pair of exercises creates a systemic response that ramps up the metabolism and drives the hormonal response that creates better body composition numbers.

Goblet Squats
toes_to_fingertipsHold a kettlebell by the horns, with the elbows down and the kettlebell held against the sternum.  Keep the chest proud and relax the neck.  Place the feet at shoulder width and initiate the squat by pushing back the hips.  Keep the torso tall and descend to at least a thigh parallel to the floor position.  Let your pelvis fall between the legs. The elbows should drop down between the knees.  As you get stronger, use two kettlebells held in the double rack position.

Pull Ups
If you are unable to perform a pull up with your own bodyweight, use a band for assist or better yet, one of the machines that assists a pull up.  Use a pronated grip (hands facing away) or a neutral grip (hands facing one another).  I like a set of rings as it affords the shoulders more freedom of movement.  Attempt to get your elbows tight to your side at the top of the pull up.

Perform ten goblet squats, then perform six pull ups, rest sixty seconds, and then cycle back through.  Perform four total trips through this pair of exercises and you will have completed 40 goblet squats and 24 pull ups.  There is something about the pull ups that makes my upper back feel more stable and I move through the goblet squats with greater ease.  As your body composition improves, the pull ups get easier.

View video of these exercises here: https://youtu.be/3L13W9VpqXk

-Michael S. O’Hara, P.T., OCS, CSCS

A physician friend sent me this recently released research article on the benefits of maintaining strength and muscle mass as we age.  I think everyone should take the time to read this article.  We are keeping people alive for longer periods of time, but how well are they living?  The discussion of the extension of life span compared to enhancement of health span is worthy of consideration.  Improving muscle mass and strength dramatically improves quality of life, a factor often not given enough consideration.

10522_2015_9631_Fig1_HTMLAge-related sarcopenia is the loss of muscle mass as we age.  Sarcopenia and functional disability travel hand in hand.  Combating sarcopenia has become a hot research topic as greater numbers of the American population pass through old age and the cost of their care becomes an issue.  The good news is that age-related sarcopenia is a very treatable condition.  The bad news is that it takes some education and effort.   When discussing the need for strength training, these are the top questions/concerns I get from physical therapy patients and fitness clients:

OK, how much, how difficult, and how often?
After the eye rolling, this is the question I get from most of my sarcopenic patients.  The research training programs that successfully reversed age-related sarcopenia involved four to seven progressive resistance exercises performed for a total of twelve to twenty sets.  The participants trained two or three times a week and the level of perceived exertion fell into the mild to moderate regions.  You are looking at 90 – 150 minutes a week of mild to moderate exercise.  The important, and often completely missed, aspect of progressive resistance training is that you increase the resistance or load lifted as you become stronger.

Can’t I just do yoga, golf, tennis, hot yoga, swim, walk, chair yoga, tiddly-wink, Pilates, underwater yoga?
I am sorry but the research studies have not found that these training modalities produce the necessary stimulus to combat age-related sarcopenia.  You can still perform all of these activities– just include a consistent program of progressive resistance strength training.

I don’t know what to do…
Poor exercise selection and beginner’s enthusiasm are the biggest reasons people fail with progressive resistance strength training.  Exercise is like medicine, administer the correct prescription at the proper dose and the results will be good.  Just like a visit to your physician, it all starts with an evaluation.  You need to start at a level that makes you better and not broken.  Get instruction from a qualified coach and follow his/her plan.  A big warning- the world of fitness is filled with many “certified experts” -–it took them a full weekend to complete their training.  These experts keep us busy in the physical therapy clinic.

You can view the research article here: http://link.springer.com/article/10.1007%2Fs10522-015-9631-7
-Michael O’Hara, P.T., OCS, CSCS

There are many studies that show a correlation between grip strength and longevity, and some of them even show a correlation between grip strength and overall body strength. Grip strength is fundamentally important as it is needed to do many daily tasks: carrying the groceries or a suitcase, opening a jar or a gallon of milk.

How to Measure Grip Strength

A Dynamometer, or a “gripper,” is a useful tool for gauging grip strength. To test, you simply grip the tool and squeeze as hard as you can, closing the handle as much as possible. This is what I would call “crushing grip strength.” There is, however, another type of grip strength known as “support grip.” Support grip is the ability to keep your hand closed around an object (carrying luggage, holding a pull up bar, moving furniture, etc.). While both types of grip strength are important, I would argue that supportive grip strength is much more functional and plays a vital role in many more tasks than crushing grip strength (unless you are trying to impress someone with your handshake). The ability to hold onto an object once it is grasped has limitless function and, in my opinion, is a much better gauge to true strength.

001If you find yourself struggling to hold onto objects, whether in the gym or performing tasks outside in the real world, I would encourage you to incorporate some training which targets supportive grip strength. My top 3 exercise picks for this purpose are:

  1. Farmers walks (as heavy as you can carry for 2-3 sets of 20-50 yards)
  2. Higher rep (8-20) deadlifts using the fat grippers
  3. Pull ups (add weight if you can do more than 10)

-Jeff Tirrell, B.S., CSCS, Pn1

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

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