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Body Parts

Toddler Fitness

Why Squatting Properly Makes Everything Better

A healthy squat pattern keeps your lumbar spine happy.  The ability to squat with strong, flexible hamstrings and gluteals keeps you lifting and carrying safely and efficiently.  If you are unable to squat, then every time you move toward the floor, you use your lumbar spine instead of the bigger and more powerful hips.  Just like the tread on a tire, you only have so many cycles of flexion in the lumbar spine.  Once you use those cycles up, the back problems begin.

If you enjoy water skiing, snow skiing, volleyball, or other lower extremity intensive recreational activities, you need a full, solid squat pattern.   If you are unable to efficiently decelerate force across all of the lower extremity joints, you are far more susceptible to injury.  The Functional Movement Screen Overhead Squat Test has become one of the best predictors we have for future injury.  Athletes that score poorly in this test get hurt more often and the injuries are more severe.

For those primarily interested in training for aesthetics, a set of loaded squats will do far more for your lower extremities than nearly any other exercise.  The metabolic boosting response from a set of twenty full depth squats is unbeatable.  Try three sets of twenty kettlebell goblet squats and let me know how you feel.

The squat exercise can be done anywhere and it requires no fancy equipment.  It is not overly complex and can be progressed with different types of exterior loading.   It builds better communication between the feet, legs, and torso than any seated machine based training and has far greater carry over to real life.

Unfortunately, due to deconditioning, injury, or a lifetime of sitting, many of us have lost any degree of squat capacity.  The good news is that regaining this pattern of motion is easy.  Listed below are some methods of retraining your squat.

Start At the Bottom
Babies learn to squat from the floor up.  As adults, we reverse this and try to relearn from the top down.  Lets go back to the baby method.  Try sitting on box or bench about sixteen to eighteen inches high.  Slide the hips to the edge and bring the feet back so the knees are bent.  Place the feet as wide as your shoulders.  Lean forward and push the knees apart as you stand up.  Do not push up with your arms on the bench or legs.

Push the Knees Apart
Many of us have sleepy gluteals (butt muscles) and are unable to push the knees apart effectively.  The knees collapse inward into a damaging valgus position.  Try placing a resistance band around the knees and push out on the band as you rise off the box.  This will reinforce activation of the gluteus medius muscles and improve your performance.

Keep a Long Lumbar Spine
If you slouch forward when you squat, try holding a stick overhead as you rise up off the bench.  Grip the stick like you mean it and pull the shoulder blades tight across the upper back.  This will help activate the muscles surrounding your spine and pelvis that have become disassociated from their isometric stabilization duties during a squat.

Load From the Front
When loading the squat pattern, I believe it is far more beneficial to load from the front.  Front loading will make the pattern stronger and it is far safer.  The sheer force on the lumbar spine is less in a front loaded squat than a back loaded squat.  Front loading does a better job of improving squat mobility, core strength, and functional carry over.


Michael S. O’Hara, P.T., OCS, CSCS

Sooner Is Always Better

Recent Research On Early Physical Therapy Intervention For Lower Back Pain

Physical Therapists play a key role in the management of lower back pain.  The lower back pain patient often must travel a long and irregular road on the way to a physical therapist for care.  Patients often have multiple doctor visits, imaging tests, various medications, epidural injections, and worst of all– rest.  So when is the best time for a lower back pain patient to see the physial therapist?  A recent research study has answered that question.

Scheduled to be published in the journal Spine, this study* of over 32,000 patients has concluded “Early physical therapy following a new primary care consultation was associated with a reduced risk of subsequent health care compared with delayed physical therapy”.  Early physical therapy was defined as less than fourteen days.  Early physical therapy lowered costs, reduced the number of visits to the physician and decreased the use of injections, diagnostic imaging tests, and surgery.

Industry and business has figured this out.  Computer chip maker Intel has a program that gets their injured employees with back pain to the physical therapist in 48 hours.  Since utilizing this program, the cost of care has dropped by 30%.  The number of lost workdays has fallen from 52 to 21 days and patient satisfaction with the program is better.  Since 2006, Starbucks has been using a program that gets their employees with back pain to the physical therapist in twenty-four hours.  They have achieved lower costs, earlier return to work, and greater satisfaction from the patients.

In 2009, I spent three days with WorkSmart Solutions in two different industrial plants in Rockton, Illinois.  The physical therapist from WorkSmart visited the plant three days a week and consulted with the employees on any problems with pain.  They provided treatment as needed and assisted with work site ergonomics and activity modification.  The Human Resource departments in both plants remarked on the reduction in administrative hassle and the lowering of work compensation claims for lower back and neck pain.  The employees raved about the care for from the physical therapist and the ease of access to ongoing help.

The earlier we can intervene with physical therapy treatment the more likely we are to prevent the deconditioning that occurs with rest, the development of hypersensitive pathways, and fear of activity.  Lower back pain is a mechanical injury that requires the management of all mechanical forces in the patient’s life.  Education on proper posture, body mechanics, and fitness activities as well as modification of the work site are all part of comprehensive physical therapy intervention.

*Spine, Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary car referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs.

Michael S. O’Hara, P.T., O.C.S., C.S.C.S.

 

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

Suspended Push Up Animation

Atomic Push Ups Are A Fitness Blast

Your muscles work as a team to carry you through the day.  They never function alone, so training them with isolation exercise will produce less than optimal results.  The muscles over the front of the body are linked together through interwoven layers of fascia to form what Thomas Myers, in his book Anatomy Trains calls the “superficial front line”.  The shoulder girdle is slung onto the body in a basket weave pattern of muscles.  One of the best exercise activities to activate this team of muscles is the Atomic Push Up.

The guys and gals at TRX named this exercise because of the metabolic response it produces.  Although the TRX company popularized the Atomic Push Up, you can use any type of suspension trainer that has foot straps.  This exercise helps build a better connection between your shoulders and hips.  It will strengthen the push pattern and activate the frequently neglected hip flexors.  Unlike a bench press type drill, the Atomic Push Up requires core control and the active participation of your legs.  Atomic Push Ups require a great deal of neural control as you must coordinate muscles from the hands to the feet to properly perform this drill.  The Atomic Push Up is not a bodybuilding type exercise that will “sculpt your outer pectorals” but it will help you move better.

Atomic Push Up Performance
Attach the suspension trainer overhead with the foot straps eight inches off the floor.  Sit on the floor and place the feet in the straps.  Roll over and assume a push up position with the feet suspended off the floor in the straps.  The top of the suspension trainer should be directly over your feet.  Descend toward the floor, and as you push back up, pull the knees up toward your chest.  Use a steady cadence of lower down–push up–knees in–knees out.  Beginners should aim for sets of five repetitions.  Stop before the performance of the drill deteriorates.  Common faults are sagging in the middle, lack of depth during the push up, and poor head position.  For men, twenty repetitions of Atomic Push Ups is a worthy fitness goal.  For women, eight is great.

You generally do not see Atomic Push Ups performed in commercial gyms because suspension trainers are rare and this exercise is difficult.  Beginners may wish to place a mat under the torso and head in case of a sudden face plant.  You can use a pair of parallellettes if you find weight bearing on your hands is difficult.  Moving the body forward so the suspension strap is pulling you backward makes the exercise more challenging.

Michael S. O’Hara, P.T., O.C.S., C.S.C.S.

A Step Up In The Right Direction

Anterior Step Ups

Most of the lower extremity training in the gym occurs with both legs working at the same time.  Leg press, leg extensions, squats, and deadlifts all train both lower extremities simultaneously.  In life, we almost always function in a single leg, or predominantly single leg manner.  All athletic activity requires a high degree of single leg control to be proficient and remain free of injury.  Your fitness training should include activities that improve balance, proprioception, core stability, and strength while on one leg.  One of the best single leg exercises to add to your training program is step ups.

Connecting Your Lateral Subsytem
When you stand on one leg, the team of muscles that keep you upright and tall are collectively called the lateral subsystem.  They consist of the groin muscles (muscle on the inside of the thigh), the gluteus medius (outside of the hip), and quadratus lumborum (side of the spine).  These muscles must work in a coordinated fashion to keep you straight and stable.   A step up exercise places a strong demand on the lateral subsytem.  Seated machine based exercises have no effect on this essential neuromuscular interaction.

Keeping You Safe
When I start clients on step ups, the most glaring deficit is almost always single leg stance balance.  Many of these people run, bike, and regularly attend group exercise classes, yet they have very limited control when they stand on one leg.  I do not care how much weight you use on the knee extension machine or how flexible your hamstrings have become; if your balance is poor, you are at a far greater risk for a fall and/or injury.  Anterior step ups will help improve single leg stance balance.

No Squishy
Deadlifts, squats, and leg press all create spinal compression.  The anterior step up exercise creates much less in the way of compressive force on the lumbar spine.  Fitness clients and athletes with a history of lower back pain can strengthen the legs with less spinal stress.

Real Life Carry Over
There is specificity to training.  The exercises you perform in the gym must look and feel like the activities you must perform in real life.  Your performance on a step up is far more likely to carry over to real life than your performance on a leg press or leg curl machine.

Anterior Step Ups
If you perform this at home, make sure you use a stable step up box—I would not use a padded lifting bench, milk crate, or old air conditioner.  A mirror can be very useful in monitoring your performance.  Most people can start with an eight inch household step.

Stand facing the box with one foot completely on the box–from heel to toes.  When you perform a step up, use your gluteals and hamstrings to push through the foot and drive up into single leg stance.  Do not jump up on to the step by leaning over and “popping up” with the rear leg.  Bring the rear leg up to 90 degrees hip flexion, and hold a single leg stance for two counts.  Try to abolish any wobble in your single leg stance position.  Lower back down using the stance leg to control the descent.  Perform all of the repetitions on one leg and then repeat on the other leg.  If you find one leg is significantly weaker, then start with that limb first.  Perform two or three sets of eight to ten repetitions.

Master your bodyweight on the eight inch step first and only then move to a higher box.  A good goal is to move up a box height that places the top of the thigh just below parallel when the leg is placed on the box.

You can load the anterior step up many ways.  I like using a medicine ball held at chest level as the first progression of loading and then progress to using an Iron Grip plate.  For athletes the Barbell Step Up is a great functional exercise.  It is best to perform this exercise in a power rack in case you lose control of the weight.

Michael S. O’Hara, P.T., O.C.S., C.S.C.S.

Pushing Through Fitness Barriers

How Sled Pushing Can Produce Big Results

Most of us have busy schedules and limited time to exercise at the gym.  We want the most benefit possible for our time spent working out.  Sled Pushing is a high value activity that can be utilized by almost all fitness clients.

True Core Stability
How our “muscles in the middle” truly work is in a standing position with our legs in contact with the ground.  The legs are usually in an asymmetrical stance, transferring force from the ground through our body into the arms.  Most “core stability” exercise performed in the gym put you in a supine position with no leg to arm connection.  Sled pushing more closely emulates the demands place on our spinal stabilizers during daily activities.

Training Acceleration
In sports performance, the development of acceleration—the first four or five strides– is critical.   Weight room training with box jumps, barbell squatting, and hang cleans has been shown to produce better vertical leap numbers, but not nearly the same gains in 40 yard dash times.  Sled pushing places the body in the forward lean position you need to properly accelerate out of the blocks when sprinting.  It trains the neural pathways that turn on your acceleration muscles.

The Road to Easy Recovery
Sled pushing is all concentric muscle activity and no eccentric.  Eccentric muscle activity, the muscles lengthen against a resistance, creates much of the muscle soreness brought on by exercise.  Your body needs more time to recover from eccentric muscle activity.  You can perform a greater volume of work with a sled, and not be terribly sore the next day.  For older trainees, whose bodies require more recovery time, sled work is a valuable training tool.

The Injured Athletes Rehab Training
If you have a knee, lower back, or hip injury you may not be able to perform squats, lunges, deadlifts, or kettlebell swings.  Sled pushing is an alternative rehabilitation exercise for the lower body.  I have had great success treating runners with knee pain using sled work as a recovery exercise.  The core stability demands of sled pushing are helpful in restoring lumbar function in lower back pain patients.

Scalable to Any Fitness Level
Beginners can start with an empty sled and gradually add weight.  I have been able to progress physical therapy patients from 25 pounds to 125 pounds in as little as four week’s time.  Pushing is a very primal movement pattern, so most people catch on after two or three attempts.

Michael S. O’Hara, P.T., OCS, CSCS

SUSPENSION ROWS

Our shoulders and spine must endure prolonged computer input, extended commuter drives, sustained television staring, and way too much general slumping.  The important postural muscles that keep us tall become weak and the muscles in the front of the shoulders get tight.  The spinal muscles that hold our 24 vertebrae upright and stable functionally fall asleep and forget how to work together as a team.  Prolonged sitting creates all sorts of neuromuscular problems that can be managed with restorative exercise.  One of the best exercises you can perform to mitigate the damaging effects of prolonged sitting is the suspension row.  

Better Than Seated or Bent Over Rows
Suspension rowing requires your spine to stay in a neutral position from the head to the pelvis.  Most of the bent over rowing I witness in the gym involves the same slumped sitting posture you see in every office in America.  Rows performed with a flexed thoracic spine are far from optimal and often help reinforce postural deficits.  Properly performed suspension rows improve communication between the spinal stabilizers and strengthen the muscles that retract the shoulder blades.  

Mastery Of Your Bodyweight
Being able to maneuver your body using the arms makes you functionally fit.  During suspension rows, the resistance is not a plate or weight stack, but rather the weight of your body.  You alter the resistance by moving the feet and changing the angle of the body in relation to the floor.   

Friendly Force Curve
Suspension rows produce an accommodating resistance that is easier when you are at the weakest part of the rowing motion.  The force necessary to perform a suspension row decreases as you move from the arms fully extended to the arms pulled in close to the body.  This makes it a good exercise for people with weaker than average shoulder muscles.  

Cervical Proprioception
Many people have no idea of how to correct the posture of their head and neck.  Prolonged sitting, driving, and computer work have damaged their positional awareness or proprioception.  The movement of the head and neck during suspension rows produces a neurological training of the cervical proprioceptors that can help fix this problem.

Suspension Rows
Improve the strength and endurance of the team of muscles that keep your posture tall and shoulders strong with suspension trainer rows.  At FFAC, several TRX suspension trainers are located throughout the gym.  For home use, attach the suspension trainer to the top of a doorway.  Adjust the suspension trainer length so the handles are at your waist level or lower.  Stand facing the TRX and grip the handles firmly.  The position of your feet will determine the amount of resistance.  Move the feet forward and the exercise is more challenging.  Keep the entire torso straight, one long line from ear to ankle.  Brace the abdominal muscles and gluteals and lean back.  From the arms extended position, pull the handles into your side.  As you perform the rowing motion, focus on moving the shoulder blades down and back.  Return to the starting position and repeat.  Perform two or three sets of six to ten repetitions.  As you get stronger, progress to a full inverted row with the legs on a bench.  

Caution:  Make sure you use a solid suspension trainer product when performing this exercise.  I have treated two patients with injuries that occurred when their homemade units malfunctioned and sent them flying to the floor.  Do not skimp on safety with suspension training exercise.  The emergency room visit and CT scan of your skull will be far more expensive.  The TRX and Lifeline USA suspension trainers are the most well known units on the market.    

Michael S. O’Hara, P.T., OCS, CSCS

ROLLERPALOOZA

Soft tissue mobilGrid rollerization with foam rolls has become popular in physical therapy, sports training, and fitness.  Foam rolling helps decrease pain, improves mobility, and can enhance recovery from exercise.  For an old gym rat like myself, it helps me bounce back from a tough training session, a long golf weekend, or too much computer time.   More varieties of rollers have come on the market, and whenever we are faced with a lot of choices, it becomes more difficult to make a decision.  In this short presentation, I have some suggestions on the proper roller for the job.  

Rollers are available in three foot and one foot lengths.  I find the longer versions easier to use, but I own a short pipe style roller that I take with me when I travel.  Bigger guys generally do not do well with a short roller.  

Standard Foam
foam rollerThe best roller for you will depend on your tissue tolerance and how sensitive are you to the compressive forces of the roller.  If you are new to foam rolling, a low density white Styrofoam roller is softer and will create less discomfort.  As you develop better tolerance to rolling, you can progress to a firmer black foam roll.  It has been my experience that the white rolls break down faster than the firmer black rolls, so be prepared to replace a white roll fairly often.  

Pipe Style
rumble rollerHollow pipe style rollers are newer to the market and I have had good results with two products.  The Grid Trigger Point roller is a cushioned hollow pipe with a grid pattern across the surface or the roller.  Many smaller clients and patients report they like the short version of the Grid roller.  Another hollow pipe version is the Rumble Roller.  This product has a series of projections that extend from the roller surface.  Self-soft tissue mobilization with a Rumble Roller is more uncomfortable than any other roller I have used.   It is a more aggressive treatment but I have found it works well for individuals with thicker and denser muscles.  

Not So Good
The hollow rollers that are covered with Styrofoam tend to break down fairly quickly.  The rollers with fabric covers often create slippage problems with several types of clothing.  The fabric interactions tend to make rolling less than efficient and are more difficult to control.  The fabric covers tend to lose their fit after a few washings.  The air inflated style rollers are a balance training device and are ineffective as a soft tissue mobilization tool.  

Michael S. O’Hara, P.T., OCS, CSCS

PROPER TECHNIQUE–HIP HINGE

With their newest release, BODYPUMP is going back to basic, simple, weight training techniques and principles.   New exercises are part of the lunge track, and greater focus on strengthening the gluteals and hamstrings are in the squat and deadlift tracks.  BODYPUMP 85 will kick off in April at Fenton Fitness.

BODYPUMP TECHNIQUE: PROPER HIP HINGE

The hip hinge is a basic movement pattern we all should master.  It keeps stress off the lumbar spine and improves strength in the hamstrings and gluteal muscles.  The BODYPUMP row, deadlift, and clean all require a proper hip hinge.  Many pump participants perform these lifts with way too much spinal motion.  When you hip hinge the spine stays still and you tilt forward at the pelvis.  The pelvis rolls around the femur to create flexion at the hip.  The gluteal muscles and hamstrings create the motion that moves the bar, and the core stabilizers hold the spine stationary.  The best view of your hip hinge performance is from the side.  Practice the drill below to help improve your hip hinge. 

Hip Hinge Stick Drill

You need a mirror and a pvc pipe, golf club, or yardstick.  Stand sideways to the mirror and place the stick along the length of your spine.  The stick should touch your gluteal muscles, thoracic spine, and head.  A space between the stick and your body should be present at the lumbar spine and neck.  Maintain those spaces as you push your bottom back and tilt forward.  The knees should bend a little (20-30 degrees) and you should feel some tension in the back of the thighs.  The motion happens at your hip and the lumbar and thoracic spine stays still.  Use the mirror side view to assess your performance.  The stick acts as feedback mechanism to help you keep the spine stable and initiate the movement at the hips.  Progress to using your BODYPUMP barbell with a proper hip hinge motion. 

Michael S. O’Hara, P.T., OCS, CSCS

 

TEST FOR SUCCESS

Easy Answers With The Y Balance Test

We are always looking for better ways to measure our physical therapy patients’ progress.  You want to know if the treatment you prescribe is producing positive changes in the patients’ pain and functional mobility.  You want to be able to identify weaknesses and focus efforts on the most significant problems.  One of the best functional assessment tools is the Y Balance Test. 

The Y Balance Test is a stance platform with three moveable reach boxes.  Each box travels along a measuring stick.  The patient stands on the platform and with the opposite foot, pushes the reach boxes down the measuring stick.  A successful test involves reaching as far as possible and then successfully returning to a stable single leg stance position. 

Measurements of the distances the patient was able to reach are recorded.  Comparisons are made between the right and left legs.  As the patient moves through therapy, he or she can be reevaluated on the Y Balance Test to measure the success of treatment intervention.  A great effort is made to train away any asymmetry in reach distances between the right and left leg.  Asymmetries in reach scores are correlated with greater incidences of future injury.  

The Y Balance Test is a true measure of how we use our legs.  Most activities of daily living and nearly all sports are all about single leg control.  Unfortunately, most clinical tests look at only one joint segment, in non weight bearing positions.  The Y Balance Test gives the clinician and patient a real world assessment of the interactive function of the foot, ankle, knee, hip, and torso in a standing position. 

Patients like the test because it is easy to understand and gives them a clear training goal.  The Y Balance Test takes minimal time to perform and patients do not have to be strapped into a machine or tethered to a computer.  Patients often report that as their scores improve, they notice a decrease in pain. 

Y BALANCE TEST
Functionally relevant.
Research proven: Repeatable and reliable.
True measure of real world lower extremity function.
Easily understood scoring system.

Michael S. O’Hara, P.T., OCS, CSCS

 

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