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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.

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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

02misconception-bones-superJumboI recently received an email on an article in The New York Times.  The article stated that moderate exercise did not produce an improvement in bone density.  The article went on to state that only medications have been found to be effective at reversing bone loss.  The fitness client that sent me the email was understandably concerned because the article presented information that was dramatically different than what she had been told.  In her battle against osteoporosis, she had placed a lot of faith in exercise and dietary modification.  She had been given advice from her doctor, physical therapist, and trainer that she was on the proper path to better bone health.   I read The New York Times article, looked up the referenced research, and I have a reply.

The New York Times author is correct that moderate weight bearing activities do not produce a change in bone density.  Walking, running, yoga, and Zumba do not produce enough bone stress and muscle tension to improve Continue reading

Babe_Ruth

Daniel Norris, a pitcher for the Detroit Tigers recently suffered multiple spinal fractures during an attempt at the clubhouse “box jump record” (See the Detroit Free Press article link below). He will be out of the line up recovering from his 57 inch leap for glory. The popularity of the YouTube, uber high, box jump has been great for the physical therapy business and terrible for athletic performance. Please take the time to read my article on appropriate box jump training. (See link below).

Professional athletes are no different than the general population in the mistakes they make in training. Pro basketball players have fractured arm bones falling off a physioball while bench pressing. A professional tennis player recently created an ankle avulsion fracture jumping onto a bosu. I witnessed a high level fitness trainer tear his Continue reading

Suspension_LandingMost physical therapy patients are injured in a failed attempt to control deceleration. Most sports injuries do not involve contact from an opponent or any force greater than bodyweight. The athlete just plants a foot and attempts to move in a new direction. When an athlete is unable to properly control deceleration, he or she becomes much more prone to ankle, knee, hip, and even upper extremity injuries. Teaching physical therapy patients and athletes how to properly manage deceleration forces is an essential component of training.

For many people, it has been years since they have performed any jumping or hopping. They do not possess the core stability, balance, and proprioception necessary to control full bodyweight activities. A suspension trainer permits a gradual introduction on landing mechanics. You can slowly and steadily add load as you become more proficient.
Suspension Landing Performance

Use a TRX or similar suspension trainer attached at least nine feet up the wall. Grab the handles and face the attachment point. Place the feet at least hip distance apart. Bend at the ankles, knees, and hips. You will perform an easy jump and use the assist of the suspension trainer to support your landing. Attempt to land softly and hold a flexed ankle, knee, and hip position. We call this “sticking the landing.” Keep the knees in line with the feet and the torso upright.

Focus on landing in a smooth and efficient manner. The height of the jump is not important. Perform this exercise at the beginning of your workout, when you are rested and fresh. Five landings or less is a good start for most people.

This is the practice progression that I have found works well:

1) Basic bilateral landing
2) Rotation landing
3) Split landing
4) Single leg landing

Deceleration training is important for keeping older individuals free from falls and living independently for a lifetime. I recommend you take the time to get some instruction on proper deceleration mechanics.

For video demonstration of suspension landing performance, click here: Video_Practicing_Landing

-Michael O’Hara, P.T., OCS, CSCS

Training to develop lower extremity power is important for staying safe on the playing field and functional in everyday life. More important is the ability to efficiently and properly absorb force during a landing. Box jumps are a basic power exercise that will improve these skills. If you are a snow skier, volleyball player, or runner then box jumps should be in your fitness program.

Competition vs. Athletic Enhancement

Box jumps have become popular in fitness competitions. The goal during these games is to get a number of jumps finished in a prescribed period of time. During these events the box jump is the field of play and not a training tool. Athletes who wish to improve performance and reduce the chance of an injury perform box jumps to retrain the neural system and enhance mechanics. Training for a box jump competition and training to improve performance are very different.

Box Jump Prerequisites

You should score a 2 or better on the straight leg raise, squat, and in-line lunge portion of the functional movement screen before you perform box jumps. See one of our trainers if you have not had a movement screen assessment. You should be able to perform a solid stable landing on a “step and catch” off a twelve inch box.

Box Jumps

Box jumps are performed on a plyometric box. At FFAC, we use the Plyosafe boxes made by UCS. These twelve, eighteen, and twenty four inch boxes are made of layered foam padding to absorb much of the force when landing a box jump.

  1. Start in front of a twelve inch box. Your toes should be about six inches from the side of the box with the feet shoulder width.Box_Jumps
  2. Hip hinge–bending a little at the ankle and knees and more at the hips. Do not permit the knees to crash inward. Use the arms to aggressively drive the jump. Throw the arms up as you drive off the floor with the hips.
  3. Do not look down. Keep the eyes up and think about jumping up and extending the legs out long. Do not pull the knees up and turn the jump into a hip flexion exercise. You want to displace the hips vertically and not flex the hips forward in an effort to reach the top of the box. You should never land on the top of the box in the “cannonball dive” position.
  4. Your take off position should be the same as your landing position.   “Stick the landing” by staying stationary for two counts.
  5. Land soft with minimal noise created when you impact on the top. Good plyometrics are seen and not heard.
  6. Use a mirror to assess your landing position. The knees should line up with the feet and never buckle inward. Keep your torso tall and eyes up. Make an effort to get rid of any wobble in your landing.
  7. Step down (do not jump down), reload your stance, and repeat. We want to avoid the eccentric stress and impact of jumping down and remove any influence of the stretch-shortening cycle.

Perform three to five box jumps and then take a short rest to let your neural system recharge. Three sets of three to five repetitions is a good start. Box jumps stress your nervous system so stay with a low volume of high quality box jumps. As you become more proficient, work on using a higher box (most of us will never need a 30 inch box). Avoid the high box jumps you see on the internet that are mostly a measure of hip mobility and sponsored by the local spinal surgery center. Holding a kettlebell, weight plate, or wearing a weight vest and performing a box jump offers little reward and carries lots of unnecessary risk.

We all have limited time to train so choosing the proper training activities is important. The combination of box jumps and some properly performed kettlebell swings will go a long way to prevent injuries, improve strength, and enhance vertical leap.

For video demonstration of the box jump, click on the link below:

-Michael O’Hara, P.T., OCS, CSCS

“Hamstrings” is the name given to the series of muscles on the back of the thigh that connect the pelvis to the lower bone of the knee. The hamstrings cross two joints, and like all bi-articular muscles, they are more prone to injury and create more difficulties when they become weak. Properly functioning hamstrings work at the knee like the reins on a horse. They tell the knee to slow down, speed up, turn in, and turn out. Lack of hamstring control at the knee makes you more susceptible to injury and pain problems.   At the pelvis, they work in concert with the gluteal muscles to produce hip extension and control the position of the pelvis. As anyone who has had a hamstring tendonitis will tell you, running, jumping, climbing stairs, and getting up off the floor suddenly becomes very painful.

Your friendly neighborhood gym has an answer in the form of a leg curl machine. Leg curl machines are designed to strengthen the hamstrings by bending the knee against a plate loaded resistance. While leg curl machines will make your hamstrings bigger, they produce little carry over to better functional performance. Leg curl machines do not train the hip extension component of hamstring function, and they completely separate the hamstrings from their functional teammates the gluteal muscles.

The saying in neurology is “What fires together, wires together.” Every time you perform an exercise, you neurologically reinforce the movement pattern of that exercise. It is like hitting “save” on your computer. If you reinforce faulty movement patterns with enough frequency and intensity, the pattern becomes your method of moving during stressful situations. Seated and prone leg curl machines reinforce a faulty motor pattern that will not save you from a fall, improve your performance on the field of play, or make you more durable.

Roller Leg Curl

With the Sorinex Roller Leg Curl, you can train the hamstrings to work at both the knee and the pelvis at the same time.   As in all aspects of locomotion, the gluteals and hamstrings fire together. Just like when you run or sprint, a strong core stability demand is necessary. If you get strong enough to perform the single leg version, a challenge of rotational control at the pelvis is created.

In the supine position, with the knees extended, place a Sorinex Roller underneath both feet. Contract the gluteal muscles and lift the hips off the floor. Tighten up the hamstring muscles and pull the sliders up toward the hips. Slide back out to full knee extension but keep the hips up off the floor. Keep the ankles pulled up into dorsiflexion throughout the exercise. Perform two sets of five to ten repetitions. As your strength improves, you can add resistance in the form of a band attached to the roller or a sandbag on the hips. The ultimate goal is to progress to single leg training. We travel through life one leg at a time.

To view video demonstration of the Roller Leg Curl, click on the link below:

-Michael O’Hara, P.T., OCS, CSCS

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