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Learn more about Rehab, Sports Medicine & Performance

Hand and Wrist

Super Recovery

Super Bowl Quarterback Peyton Manning

Peyton_ManningPeyton Manning, the Denver Broncos quarterback, will cap off a miraculous recovery from a serious neck injury with his appearance in the Super Bowl this weekend.   Mr. Manning has undergone numerous surgeries and procedures on his cervical spine.  The details of his medical treatment and rehabilitation are the topic of speculation on many sports talk shows.  We do know that he underwent an anterior fusion of his sixth and seventh cervical vertebrae.  An incision is made in the front of the neck and the two bones are fused together using screws and a titanium plate.  The fusion removes compressive forces off the nerve root that exits between the vertebrae and eliminates any movement between these two spinal segments.

Compression on the seventh cervical nerve root creates all kinds of problems for someone who throws a football for a living.  This nerve root carries the signals that fire the triceps muscle (back of the arm) and muscles that help grip the ball.  Trauma to the seventh cervical nerve root can cause loss of sensation in the fourth and fifth fingers of the hand.  Loss of neural control not only has an effect on muscle strength, but also on power production.  You need to be able to create muscle contractions quickly to throw a pass with any velocity.  If the signal that is sent down the seventh cervical nerve root is impeded by compression or inflammation, the pass will be slow.

There are risks associated with playing professional football with a fused cervical spine.  When you fuse the sixth and seventh vertebrae together, you lose about 10% of the range of motion in your neck and you also lose some of the shock absorption capacity in your spine.  The compressive forces and range of motion lost at the fused C6-7 segments are transferred to the vertebrae above and below the fusion.  In the general population, thirty percent of the patients who undergo a cervical fusion require a second fusion in 10 years.  I was unable to find a statistic on pro football players, but I am certain this percentage has to be much higher.

Cervical fusions are not uncommon in professional football, and 70% of the players who have a fusion are able to return to competition.  Mr. Manning plays at the high skill position of quarterback and his passing numbers this year have been amazing.  Win or lose this weekend, Peyton Manning, surgical medicine, and physical rehabilitation deserve applause.

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

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

Heads Up

The Downside Of Upside Down Exercise

H_HoudiniExercise activities that place the head below the heart have become more popular in fitness programs.  In almost every gym you see decline bench pressing, incline sit ups, glute-hamstring developer exercises, and more recently, hand stand push ups as a regular part of many exercise programs.  While these activities may have some value, you might want to reconsider training in an inverted position for some other reasons.

Esophageal Reflux
When you invert your torso, the contents of your stomach can more readily travel back up into your esophagus.  Head below your belly with a hiatal hernia, a little extra mesenteric fat, and some strong contractions from the abdominal muscles, and you have the perfect environment for gastroesophageal reflux disease (GERD).  Millions of Americans (14%-20% depending on the study) take medications to manage the symptoms of GERD—heartburn, chest pain, persistent cough, difficulty swallowing, hoarseness.  Prilosec and Nexium are the biggest moneymakers the pharmaceutical industry ever created.  Many Americans (10%-15%) have GERD, but are unaware of the problem because the tissue damage has not reached symptomatic levels.  Erosive esophagitis or Barrett’s esophagus is a clinical finding of cellular change in the esophagus and a precursor for esophageal cancer.  Esophageal cancer is one of the more deadly types of cancer.

Glaucoma or Retinal Disease  
The head down position raises pressure inside the eyeball.  As little as 30 degrees of decline has been shown to increase intraocular pressures.  It is estimated that 2.2 million Americans have glaucoma, but only half of these know they have the problem.  Individuals with glaucoma already have elevated intraocular pressures and should avoid these positions.  The back of the eye (retina) is susceptible to changes in vascular pressures, so if you have any retina issues, avoid the head down position.

High Blood Pressure / Hypertension
Your heart, lungs, and arteries are conditioned to pump blood with your body in an upright position.  Many vascular alterations occur when we flip into a heads down position.  When you assume the head below your heart position, the arterial pressures inside the skull increase.  Elevated cranial blood pressures can lead to headache and much more severe problems such a stroke.  One in three Americans are walking around with high blood pressure.  Add in an exercise induced elevated heart rate and some less than pliable carotid arteries and you have the ideal environment for a big bad brain event.  If you have hypertension, I would not go about using any inverted positions in the gym.

Bottom Line
Apart from going blind, having a stroke, and developing an incurable cancer, you should be fine.

Michael S. O’Hara, P.T., OCS, CSCS

Multi Directional Power Training

Surge 180

We have recently added a new training tool to our physical therapy clinics.  The Surge 180 is a simple and incredibly effective training device for rehab patients.  The patient stands on the platform, grasps the handle, and works against resistance provided by three pistons.  The physical therapist can use the Surge 180 to improve many different areas of performance.

Safe and Effective Power Training
Most physical therapy patients are severely underpowered.  Not only do they need to get stronger, they must also get better at creating force quickly.   The patient can accelerate against the handle of the Surge 180, and because the overall mass is so small, there is no damaging inertia to overcome.  The mass of a weight stack, barbell, or dumbbell creates so much inertia that when you attempt to move the load quickly it creates damaging joint stress.

Multi-Directional
In life and athletics, our bodies move in all directions.  The Surge 180 handle moves forward–backward, right–left, diagonally, and into rotational movement patterns.  The handle excursion is big enough to accommodate patients of all heights.

It Demands You Stand
Rehabilitation is all about getting better at functioning in standing positions.  Patients need to learn how to efficiently transfer forces from the ground up through their body.  On the Surge 180 platform, the patient can be positioned in-line, split, straddle, or single leg stance.  Connecting the shoulder to the opposite side hip, through an active core is the essence of rehabilitation training.

Core Coordination
The coordinated performance of the team of muscles that control the hips, pelvis, and spine is more important than simple strength.  Standing, walking, climbing stairs, and carrying all require the synchronous transfer of forces from right to left and back again.  The resistance provided by the Surge 180 creates the neural feedback to fire those reciprocal motor patterns.

Michael S. O’Hara, P.T., OCS, CSCS

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