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Knee

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

Fracture Facts For Men

osteoporosisJane Brody of the New York Times wrote a great article on the risks men have for osteoporosis related fractures.  The general public views osteoporosis as a “women’s health issue,” but management of osteoporosis and prevention of falls is just as important for men.  Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled, or die, from the fracture.

In 2012, an international team of researchers and clinicians launched Too Fit to Fracture, an initiative aimed at developing optimal exercise recommendations for individuals with osteoporosis.  In October of 2014, they released a booklet that is available through osteoporosis.ca on managing osteoporosis through exercise.  Everyone should read this booklet and osteoporosis patients should follow their exercise prescription.  Their work brings clarity to an issue that is currently clouded with poor understanding and a lot of bad fitness advice.

The Too Fit to Fracture researchers recommend that individuals with osteoporosis (with or without vertebral fractures) should engage in a multi-component exercise program that includes resistance training in combination with balance training.  Balance train for ten to twenty minutes every day of the week and strength train for 30 to 45 minutes twice a week.  Make sure your strength training teaches you how to move correctly and improves the endurance in your back muscles.  If you have mild to moderate osteoporosis, balance train and strength train first and foremost, and use any extra time on some low impact cardio training.  If you have been told you are at high risk for fracture, keep your focus exclusively on balance and strength training and keep the cardio activities to a minimum.

We know that individuals who participate in consistent resistance training exercises are more likely to have better bone density.  Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it.  The best bone building exercise activities produce a growth promoting stimulus through your skeleton.  Bone building exercises are easy to understand but they do require more effort than swallowing a pill or having an injection.  Everyone can perform some form of bone reinforcing exercise.  Proper exercise prescription and consistent progression can work wonders.  See the trainers and physical therapists at Fenton Fitness and Fenton Physical Therapy for guidance.

-Michael S. O’Hara, P.T., OCS, CSCS
View the NY Times article here: http://www.nytimes.com/2016/10/04/well/live/men-get-osteoporosis-too.html?_r=0

Bear_PawGetting up and down off the ground is a movement skill we need to maintain.  It is the functional exercise activity that keeps us safe and independent for a lifetime. Developing proficiency in getting up and down off the ground has multiple benefits.  It takes away fear, builds confidence, and increases activity in other areas of life.  Your fitness training should involve activity that makes you better at moving gracefully in and out of the positions necessary to get up and down off the ground. 

Getting up and down off the ground is largely a neural activity.  Nearly everyone has enough strength, range of motion, and balance—you just need some practice.  Physiologically, we know that movement practice makes transmission of neural signals more efficient.  Research on motor learning has taught us that repetition, ascending challenge levels, and coaching produces the best results.  The bear paw exercise is a good starting point for improving from the ground up movement skills.

Bear Paw Performance

You need a medicine ball and some open space.  Get down on the ground in an all four stance with the medicine ball under the left hand.  Brace the abdominal muscles and lift the knees up off the ground about six inches.  Maintain that suspended position and roll the ball forward and backward with the left hand, like a bear pawing the ground.  Keep the right shoulder blade down the back and the neck free of tension.  Perform ten repetitions, lower down, and rest.  Switch to the right hand and repeat the drill.  Perform three times on each side.

View video explanation of the bear paw exercises here: https://www.youtube.com/watch?v=gGcsbv-BqfU

Michael S. O’Hara, PT, OCS, CSCS

Fitness training for those of us past 40 years of age is more complicated.  Physical performance and recovery capacity is dramatically different.  If you need proof, look around for the forty year olds in the NBA or NFL.  The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime.  I have compiled a collection of tips for the forty plus fitness client. 

Manage Eccentric Muscle Loading

sledDuring the concentric portion of a lift, the muscles shorten as the load is moved.  In the eccentric phase, the muscles gradually lengthen as the load is lowered in a controlled manner.  Eccentric muscle activity (lengthening under tension) produces more muscle micro trauma and, therefore, requires more recuperation time.  It is the eccentric aspect of a resistance exercise that creates delayed onset muscle soreness.

Older fitness clients do not possess the same recovery capacity as younger individuals.  Utilizing exercise activities that reduce eccentric stress is a valuable training tactic.  Concentric biased training allows older trainees to perform a greater volume of work and be ready a day or two later for the next training session.
Sled work is my favorite “concentric only” fitness activity.  The muscles shorten to propel the sled and never have to lengthen against resistance.  You can push, pull, row, and press a sled at fairly high levels of exertion and still sufficiently recover between training sessions.

Loaded step ups are a predominantly concentric contraction, lower extremity strengthening exercise.  It teaches balance, core control, and improves single leg strength. The eccentric aspect of a loaded step up is minimal and this makes it an essential exercise for older fitness clients.

My favorite upper extremity eccentric only training device is the Surge 360.  The Surge provides resistance through a series of multi-directional pistons.  All exercise activities on the Surge are concentric only.

Resistance tubing is another tool that can help manage eccentric muscle activity.  The force curve (increased load as the tubing is lengthened and decreased as it gets shorter) helps reduce muscle activity during the eccentric aspect of many exercises.
-Michael S. O’Hara, P.T., OCS, CSCS

In an effort to get back into shape, Monica added some stadium step running to her fitness program.  She went to the high school stadium and made twenty trips up and down the bleachers.  The initial sessions went well but after the first few weeks her knees started aching and the pain began to interfere with activities of daily living.  Monica tried some anti- inflammatory medications and ice but neither produced any relief.  She recently arrived at our physical therapy clinic for some help with her knee pain.

Running stadium steps is a demanding exercise activity that will produce a strong metabolic response.  Unfortunately, stadium steps are too stressful for most people.

Risk/Reward Ratio of the Stadium Steps
shutterstock_385922764For deconditioned individuals, stadium steps fall on the risk side of the risk reward ratio.  Most overweight and “out of shape” fitness clients have tight and weak hips.  They are inefficient in the skill of decelerating their body down the stairs and that skill deteriorates as they fatigue.  They need to use training methods that reduce orthopedic stress and limit biomechanical overload.

Stadium steps are a high level fitness activity.  It is the calculus of mathematical learning.   Deconditioned and overweight individuals need to start with basic algebra before venturing into quantum physics.  The better approach is to get fit first and then add stadium steps to your workout after you have improved strength, body composition, and mobility.

Run hills instead.  I have switched many stadium stepping physical therapy patients to running up and walking down hills.  It is a more forgiving form of fitness training than stadium steps and the benefits are superior.

Your Inner Gladiator
If you insist on stadium step training, I have some suggestions.  Spend six weeks strengthening your hips.  Most deconditioned folks, sit all day and have poor strength/strength endurance in the hips.  Weakness in the hips permits the knees to collapse inward on your downward bound through the steps.  I like bridges, hip lifts, mini band squats, and walking lunges.  See my recent article and video on my favorite gluteal strengthening exercises.

Foam roll the outside, inside, back, and front of your hips, thighs, and hip rotators.  Most stadium stepping pain patients are a big basket of myofacial restrictions.  They writhe around on a soft roller and look at me like I am crazy.  Restoring the mobility of the fascia that encapsulates the deceleration muscles of the hip will help improve performance.

Run up and walk down, softly.  It is the step descent that causes the biomechanical stress on the muscles and joints.  As you travel down the steps, think about actively engaging the gluteal muscles and decelerating with the hips and not the knee.  The louder the impact on the descent the more likely you are an inefficient decelerator.  Have someone watch you as you travel down the steps.  If your knee collapses inward, you need to get off the steps.
Build up slowly.  Do not start with twenty flights.  Start with three trips and gradually build up your work capacity–once a week is more than enough for most folks.  Find other training modalities that are less stressful.  Being too aggressive with a training program is one of the big reasons people fail with fitness, and it keeps me busy in the clinic.

Monica was, by her own account, twenty pounds overweight.  Her hip mobility was less than ideal and she had prior history of hip pain problems.  She had diminished hip range of motion and limited strength in her hamstrings and glutes.  During assessment of her deceleration skills, Monica tended to land in a collapsed inward knee position.  We had Monica perform a program of mobility and strengthening exercises for both hips and rest from all “cardio” activities.  Her knee pain resolved and she was able to return to a program of fitness training.
-Michael 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

Fitness training for those of us past 40 years of age is more complicated.  Physical performance and recovery capacity is dramatically different.  If you need proof, look around for the forty year olds in the NBA or NFL.  The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime.  I have compiled a collection of tips for the forty plus fitness client.

Improve the Function of Your Legs
115“You are as old as your legs” is the common quote in boxing.  Strong legs make you more durable (fewer injuries) and healthier.  Think of your legs as the engine that enables you to train the heart and lungs.  Most of the metabolically active muscle mass that stores glycogen and keeps our insulin sensitivity fine-tuned is located in the legs.  Despite this, many older gym goers spend little time training their lower extremities.

Older legs (40+) have special needs.  Most clients will get the best results with daily performance of mobility drills and two strength training sessions a week.  Choose exercises that reduce compressive forces on the spine and minimize eccentric muscle tension.  Eccentric muscle loading and compressive spinal loads make recovery more difficult for older clients.  A good lower extremity training program improves balance, core stability, strength, mobility, and has a very positive effect on body composition.  I am a big believer in single leg training as it covers all of these areas and minimizes the chances of exercise induced injury.

Give your body time to recover between strength training sessions.  Look at your weekly training routine and use a Monday and Thursday or Saturday and Wednesday split.  I would not perform any long duration cardio activities the day after a strength training session.  Perform some easy mobility work every day of the week.  It will take less than five minutes.
-Michael S. O’Hara, P.T., OCS, CSCS

Heel Drops Keep You in the Game and Out of the Therapy Clinic

heel_dropsIrritation of the Achilles tendon is one of the more common and debilitating injuries in the recreational runner population.  It is theorized that cellular changes in the Achilles tendon happen because the level of tendon loading exceeds the body’s capacity to create appropriate cellular repairs.  Achilles tendinopathy is such a common and difficult problem that I recommend all recreational runners perform heel drops, twice a week, as part of an injury prevention program.
A Swedish study from 1998 kicked physical therapy into a frenzy of heel drops.  This exercise is used to enhance the Achilles tendon’s tolerance of loading.  The initial studies recommended three sets of thirty repetitions, performed three times a day.  Experience in the clinic and gym has demonstrated that most people do better with less volume.
To perform a heel drop simply stand with the ball of your foot on a step and the heel off the step.  Use both feet to rise up on the toes with heels elevated as far as possible.  Remove one foot and then lower the body down slowly for a count of five.  The heel should end up well below the top of the step.  Use both feet to rise back up on the toes and repeat.  Start with five repetitions with the knee straight and the same number with the knee slightly bent, for a total of ten heel drops.  If you are unable to lower slowly, you must perform this drill with the foot flat on the floor and progress to the full heel drop as you become stronger.  Reduce the repetitions if your Achilles tendon becomes more symptomatic.  If all goes well, add a repetition every session until you reach twenty repetitions, ten with the knee straight and ten with a bent knee.
Perform heel drops twice a week as part of your strength training/injury prevention program.  If you are a recreational runner and you do not perform a strength training/injury prevention program, my number at Fenton Physical Therapy is 810-750-1996.

You can view video demonstration of heel drops by clicking here.
-Michael O’Hara, P.T., O.C.S., C.S.C.S.

PDFIn this month’s issue, Mike O’Hara presents tips for preventing shoulder pain and injury.  Jeff Tirrell addresses the secret to maintaining a successful workout program, and the benefits of single leg hip thrusts are described.

Download Here

For injury prevention, athletic perforpower_productionmance, and general health, a regular program of lower extremity power training is beneficial. Traditional exercises that improve explosive leg power—jumps, hops, bounds, and skips—are too challenging for many fitness clients. Limited leg strength, poor balance, joint problems, and a high body mass index all make traditional plyometric training problematic. The assistance of a suspension trainer creates an environment that permits everyone to succeed in exercises that improve leg power.

Older fitness clients may not possess the balance to perform traditional plyometric power production exercises. The stability assist from the TRX is the balance “training wheels” necessary for beneficial jump, split jump, jump squat, and lunge exercises. The suspension trainer unloads an exercise and allows the client the opportunity to practice explosive movements with less joint stress. TRX power exercises require no set up time, and a full complement of explosive enhancing drills can be completed in five minutes.

Older fitness clients are in special need of training to improve leg power. Between the ages of 65 and 89 lower limb power (the ability to move the legs explosively) declines at a rate of 3.5% per year. Strength declines at a slower 1-2% per year rate in this same group. Power is the ability to create force in a short period of time and is different than raw strength. Lower extremity power capacity keeps us safe. It is the component of fitness that enables you to react and save yourself from a fall or sudden disturbance in balance. As leg power falters, injuries increase. As injuries increase, pain, mobility and independent living decreases.

Exercise is like medicine, administer the correct prescription at the proper dose and the patient thrives. The “exercise medicine” that is missing in many training programs is a consistent dose of power training. Watch the video for some examples of simple power production exercises you can add to your program.

-Michael S. O’Hara, PT, OCS, CSCS

To view a video demonstration of multiple exercises completed with TRX, click on the link below:

View_Video

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