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Body Parts

SINGLE LEG STANCE OPPOSITE
 ARM REACH AND ROW

A Long Name For A Great Exercise

In life, most of the challenging tasks happen in either single leg stance or with much more of our weight on one leg.  We must be able to support, decelerate, and change directions with one leg.  Our muscles are aligned so that the hip is mechanically linked to the opposite shoulder.  In physical therapy, we know that having one side of the body function efficiently and the other side falter sets you up for injury.  Your exercise program should revolve around training to meet these physical demands.  One of my favorite life enhancing exercises is the single leg stance opposite arm reach and row.   

Exercise Benefits
Fall preventative activity that helps improves single leg balance.
Sure cure for the epidemic of gluteal amnesia.
Gives athletes the hip to opposite shoulder connection they need for performance.
Identifies any asymmetry in single leg control.
Enhances the single leg deceleration skill necessary for injury prevention.
Makes you stronger when you lift, carry, push, and pull.

Single Leg Stance Opposite Arm Reach and Row
You need a cable column machine or resistance tubing anchored at knee level or lower.  Hold the tubing or cable handle in the right hand and stand on the left leg.  You must be at least five feet away from the attachment point of the tubing or cable.  Initiate the movement simultaneously at the ankle and hip and reach forward with the right hand.  Attempt to get the hand down to knee level.  Return back to standing and pull the handle toward the body in a rowing motion.  Perform five to ten repetitions and then repeat on the other side.

Common mistakes are bending at the hip only and slouching over at the spine.  The ankle, knee, and hip all move together, and the spine should stay stable.  Holding the handle on the same side instead of the opposite side.  Performing repetitions past the point of technical failure.  If you start wobbling around, stop the exercise.  Getting the arm and legs out of sync.  Do not reach with the arm and then move the legs—the motions should happen together.  Remember to come all the way back up to a tall standing position before starting the next repetition.  Start with light resistance and try to create a steady smooth pattern before adding more resistance.  Watch the video  and give this exercise a try.  

Michael S. O’Hara, P.T., OCS, CSCS

THE WALL SQUAT

Turn Around And Improve Your Squat Performance

For most people, wall squats are an exercise that involves placing your back against the wall (or on a physioball placed against the wall) and performing squats with a supported torso.  The assistance from the wall permits you to stay up taller and shifts much of the workload onto your quadriceps.  While this exercise will make the muscles in the front of your thighs burn, it does little to improve your mobility or strength.  My advice is to turn around and face the wall to develop better squat mechanics, balance, and functional mobility.   

The ability to perform a full squat is an important basic movement pattern.  The overhead squat is one of the seven critical tests in the Functional Movement Screening process used to assess an athlete’s readiness to compete.  Squatting is a basic mobility pattern that is important for long term independent living, a healthy lumbar spine, and a calorie hungry metabolism. The restoration and preservation of the ability to move through a proper squat pattern should be a part of every fitness program.

As infants, we mastered a full, steady squat.  A baby must develop control of the squat in order to progress to the next level of mobility–standing and walking.  Prolonged sitting, weakness in the muscles that stabilize the pelvis, and the lack of basic spinal and hip mobility in daily activity restricts our ability to move into this basic pattern of movement.  Add in some well meaning but mobility reducing fitness activity and you produce an environment that fosters immobility.

Wall Squatting 101
The wall serves as instant feedback to prevent most mistakes.  If you let the knees collapse inward, slouch over at the spine, or lean the head forward ,you hit the wall and are unable to descend any further.   

Face the wall and position the toes twelve inches away from a wall.  The toes should point out no more than thirty degrees.  A mirror that provides a side profile can be helpful for visual feedback on your performance.  The basic wall squat starts with the hands placed across your chest or out to the side of your shoulders.  Push the hips back and lower into the squat.  The wall keeps your posture tall and forces the knees out.  If you find the wall squat difficult, then you need to perform it often and improve you performance.  Start with three or four sets of five to ten repetitions.

As your mobility improves, simply move closer to the wall.  Holding the hands behind the head or holding a band overhead increases activation in the thoracic spine and shoulder girdle muscles.  You can add resistance by holding a kettlebell suspended from both arms.  Watch the video that accompanies this article.  

Michael S. O’Hara, P.T., OCS, CSCS

 

GET IN YOUR CAGE

Stretch Station Mobility Restoration

Invented by Gary Gray, a physical therapist from Adrian Michigan, the Stretch Station has been a primary piece of equipment at all of our facilities.  It enables the physical therapy patient or fitness client the ability to perform three dimensional mobilization of the major peripheral joints and spine. I have not found another piece of exercise equipment that is as beneficial for improving movement as the Stretch Station.

It Has To Happen In Standing
The Stretch Station allows you to mobilize joints and move in the anti-gravity, standing upright position that it functions in every day. Gravity eliminated, floor stretching programs often fail to produce better movement when gravity comes back into play. Any new movement you develop with mobility training is only beneficial if it can occur in a standing position.

A Little Lift Goes a Long Way
Traction force (pulling apart) of a joint is a key component of all manual medicine. It helps relieve pain and makes greater joint mobility easier to achieve. The overhead bars of the Stretch Station enable you to lift up and partially decompress the spine, hips, knees, and even ankles during mobility training.  This low level traction force assists in the development of better mobility. Deconditioned and overweight patients can perform hip and knee mobility training and remain pain free with the assist of the Stretch Station.

One Good Turn…
Most floor mobility training does little to develop better rotation at the joints that are supposed to produce
rotation–thoracic spine, hips, and ankles. The Stretch Station has an angled floor and multiple handle sites that enable users of all sizes to work on improving rotation. Thoracic spine and hip mobility work is particularly beneficial for athletes that must swing a club or throw a ball.

Identification of Asymmetries
Using the Stretch Station, patients and fitness clients can immediately identify when one side of the spine, one hip, or one shoulder is more restricted than the other. Training away asymmetries at a single joint or movement pattern is important for injury prevention and optimal performance.

A Bridge to Better Performance
I have fitness clients perform thirty seconds of mobility training on the Stretch Station followed by a complimentary strengthening exercise. The idea is to neurologically reinforce the new motion achieved with the Stretch Station using an appropriate strengthening activity. This pairing of the Stretch Station work with a strengthening drill has been very effective in restoring movement and decreasing pain.

Michael S. O’Hara, P.T., OCS, CSCS

SLOUCHER SOLUTION SERIES

Restoring The Function of Your Upper Body

Our lives revolve around driving, computer time, and television.  We sit in front of a monitor all day, drive for hours every week, and often spend our leisure time slouched on the couch.  Age and gravity rounds the upper back, pulls the shoulders forward, collapses the rib cage, and reduces range of motion.  Throw in some well meaning, but inappropriate fitness training and you create the environment that produces neck, shoulder, and upper back pain problems.   

Correcting upper body posture along with the restoration of mobility and strength in the thoracic spine and shoulders should be a goal of every fitness program.  It is difficult to develop proper movement patterns and functional upper body strength with tight shoulders and a slumped spine.  A collapsed rib cage inhibits full inhalation and exhalation cycles.  Proper posture and full mobility improves respiration efficiency and produces better exercise endurance.    

In the accompanying video, I take you through a series of exercises that I have been using with physical therapy patients and fitness clients for years.  Your upper back and shoulders work as a team so you will be training them together.  Many of these drills will produce some discomfort.  Any pain should cease soon after you complete the exercise.  

Each of these exercises builds on the benefit derived from the previous exercise, so perform them in the order prescribed.  When you initially start with these drills, you may only be able to perform the first three or four.  As you become more proficient, work your way up to the more challenging exercises.  The weaker and tighter you are, the more you need to train with this program.  Five times a week if you struggle and three times a week if you are able to move through the program fairly easily.  The entire series of six exercises should take no more than ten minutes to complete.  Pay attention to the common mistakes portion of the presentation.    

To perform these exercises you will need a foam roll ($25.00), a proper physioball ($35.00), resistance tubing ($25.00) and a suspension trainer ($95.00) or pull up bar ($30.00).  If you own a $400.00 television and a $500.00 recliner, your spine and shoulders are asking you to spend $200.00 on some basic fitness tools.  

1. Foam Roll Thoracic Spine
2. Foam Roll “T”s
3. Four Point Rotation
4. Belly On Ball “touchdown”
5. Half Kneeling Rows
6. Suspension Rows or Pull Ups

Michael S. O’Hara, P.T. OCS, CSCS

SHAPE SHIFTERS

The Average American From Age 25-55

After the age of 25, the average American gains a pound of fat and loses a ½ pound of muscle every year.  If no action in taken to reverse this trend, the average American will have gained 25-30 pounds of fat and lost 12-15 pounds of muscle by the time they reach 55 years of age.  The average 55 year old American will stand on the scale 12 to 18 pounds heavier, but the true alteration in body composition is far more dramatic.  

America does not have “an obesity epidemic”, it has a muscle atrophy epidemic.  We are not so much over fat as we are under muscled.  The simplistic notion of “just losing weight” is failing to improve health and fitness in this country because it accelerates muscle loss.  This middle age muscle loss is the catalyst for many of the illnesses that plague us later in life.

Lose muscle and your metabolic engine slows, it becomes more difficult to move, you store less glycogen, become more insulin resistant, lose the beneficial bone enhancing pull on your skeleton, and become more prone to injury.  The only metabolic process that becomes more efficient is that it takes less food to produce more fat.  

Drs. Evans and Rosenburg coined the term age related sarcopenia in their 1991 book Biomarkers.  The research they performed at Tufts University ranked the measurable biomarkers for healthy aging.  The top four are:

1.  Muscle Mass.  What percentage of your body is made of muscle.
2.  Strength.  Can you use that muscle to push, pull, lift and carry.
3.  Basal Metabolic Rate.  The number of calories your body expends at rest.
4.  Bodyfat Percentage.  What percentage of your body is composed of fat.

The authors named these top four biomarkers, the decisive tetrad.  They are the prerequisites to maintaining healthy numbers in the other biomarkers such as lipid levels, insulin sensitivity, bone density, aerobic capacity, and blood pressure.  

Most people have limited exercise time.  Keeping your muscle mass up and improving total body strength will create the greatest benefit.   Be obsessive about the number of push ups or pull ups you can perform and forget about the deceptive numbers on a scale.  Six weeks of dedicated strength training can work wonders. 

Michael S. O’Hara, P.T., OCS, CSCS

MYSTERY MUSCLE–FULL RECOVERY
WITH MULTIFIDUS TRAINING

The multifidus is the name of the series of muscles that travel the length of your spine.  They run from vertebrae to vertebrae and function to control the segmental motion of your spine.  They guide the spinal joints during motion and hold the spine stable when under shear stress or compression.  Recent advances in ultrasound imaging enables us to measure the size and health of the multifidus muscle at each spine segment level.  These studies have revealed shrinkage (atrophy) at the same level and side as patients’ lower back pain.  Tissue tests of the atrophied multifidus muscles show changes in the cell types and density.  These changes occur fairly quickly after back pain onset, and the multifidus muscles do not return to normal after back pain has resolved unless stimulated with proper rehabilitation exercises.  Poor control by the multifidus results in compromised segmental control, pinching of the facet joint capsules, and abnormal compressive forces on the spinal joints.  

Multiple studies have been performed on low back pain patient populations where one group trained with spinal stabilization exercises and the other received no exercise.  The researchers measured the recovery of the muscle with ultrasound imaging and tissue sampling.  Both groups were followed for as long as four years.  Results in every study demonstrated the recurrence rate for low back pain was much lower in the exercise group.  The exercise patients had recurrence rates of less than 20 percent, while the non exercise group had 90 percent plus recurrence rates.  

The size and health of the multifidus muscles has demonstrated the best correlation to lower back pain recovery and recurrence.  MRI imaging shows herniated discs are present in a large percent (some studies greater than 60%) of the pain free population.  Myelogram imaging reveals compressed lumbar nerve roots in 24% of the pain free population.  Neither has turned out to be as good a predictor of lumbar pain or recurrence of that pain as atrophy in the multifidus muscle.  No other treatment whether manual therapy, injection, or medications has produced the recovery rate as that found with spinal stabilization exercises.   

This long term research has validated that if you have an episode of lumbar pain, you should perform a program of exercise to improve the function of the multifidus muscles.  The exercises used in these studies are simple and require minimal or no equipment.  A daily time investment of five minutes is all that is required to restore multifidus function and reduce the possibility of pain recurrence.  One of the easiest and most effective multifidus training exercise is the horse stance horizontal exercise.

Michael S. O’Hara, P.T., OCS, CSCS

LUMBAGO FIASCO

The Top Three Things You Do In The Gym To Screw Up Your Lower Back

Therapeutic exercise has consistently been proven to be the best way to manage lower back pain.  It has a better long-term outcome than injections, medications, and surgery.  Unfortunately, many people end up injuring their lower backs in a well intentioned, but misguided effort to get fit.  Below are the top three lumbar spine mistakes I see people making in the gym.  

You Exercise Sitting Down
The muscles and joints of the lumbar spine, pelvic girdle, hips, and knees are an interconnected team.  To get the team playing more efficiently, your body needs to be challenged by gravity and trained in an upright position.  A basketball team would never get better if they practiced while sitting at a desk.  You should run away from anyone who straps you into a machine in an effort to help you with a back pain problem.  By the way, you already sit way too much.  You drive, computer, television, and sometimes sleep in a seated position.  Prolonged sitting creates much of the tissue shortening and muscle weakness that makes you more prone to lower back pain.  

No Consideration For Compression
This is an issue that is particularly important for individuals with prior episodes of lower back pain.  Most people are unaware of the many gym activities that create compressive forces on the lumbar spine.  Treadmill running (more if you hold on the handles), leg press, crunches, and leg lifts create a compressive loading of the lumbar joints and discs.  Be aware of the cumulative loading on the lumbar spine, and alter your training schedule so that you perform certain exercise activities on different days.  Do not perform squats on the same day you run on the treadmill.  If you are going to perform 50 incline sit ups, do not do it on the same day you deadlift.  If you are uncertain of what activities place a compressive load on the lumbar spine, you need to work with a physical therapist or certified trainer.  

You Are A Flexibility Freak And A Stability Geek
Creating spinal flexibility without the strength to keep your spine stable sets you up for injury.  Many lumbar pain patients I evaluate are able to flex the spine forward and palm the floor.  They can bend their spine like an overcooked noodle, but they are unable to summon the muscle control to hold the lumbar joints in a stable position.  These patients often report a long history of dedicated stretching, yoga, and Pilates training.  They fail the lumbar stability tests, and are often unable to perform the overhead squat or in line lunge functional mobility tests secondary to a lack of core stability strength.  These same patients are often surprised at their poor performance in the core stability tests because they “strengthen their abdominal muscles” with crunches and leg lifts.  Training to improve spinal stability and exercising your abdominal muscles are completely different things.  Every gym goer needs to learn the difference.

Michael S. O’Hara, P.T., OCS, CSCS

 

KICK THE KICKBACK TO THE CURB

In our physical therapy clinics, we get to treat elbow pain every day.  The pain is usually brought on by some kind of repetitive activity.  Tennis players get pain on the outside of the elbow.  Throwers and golfers get pain on the inside of the elbow.  Fitness clients commonly end up in physical therapy with complaints of elbow pain.  The cause of the pain is usually some sort of triceps isolation training, and the biggest offender is the “triceps kickback” exercise.  The kickback is a Shape magazine standard that appears to be a favorite with female gym goers.  The triceps kickback is more likely to give you elbow pain, than to produce thinner and more shapely arms.  

Three things make this exercise problematic for the elbows.  The kickback exercise creates a bad force curve.  The resistance is the strongest when the triceps muscle is at its least advantageous position, and this places the majority of the load on the elbow joint in a fully extended position.  When I see this exercise performed in the gym, it is usually executed with a swinging of the dumbbell.  The momentum of the weight forces the elbow into excessive end range extension.  Kickbacks are often performed for high repetitions.  It is not uncommon to witness someone perform three or four sets of twenty repetitions.  That is sixty to eighty high speed, end range repetitions under a stressful force curve on each elbow.  

From the elbow pain patient I hear, “But I don’t feel any pain when I perform the kickback exercise.”  Most golfers, tennis players, and throwers don’t feel pain during their participation in sports.  The elbow pain usually sets in later that day or the next morning.  Another common concern is that they will not be able to reduce fat on the back of the arm without direct triceps work.  This is the “spot reduction myth” that just won’t die and keeps many a physical therapists employed.  Avoid the trainer that tells you a specific exercise will take subcutaneous fat off an area of your anatomy.  

Elbow irritation that creates scar tissue and inflammation is often difficult to eliminate.  The pain in the elbow can get so bad that it limits other training activities.  The good news is that elbow pain is often self-inflicted, and with a little education, we can avoid the pain.  Watch the video, dump the kickback exercise, and start training your triceps with some push ups and presses.  Your elbows will thank you.  

Michael S. O’Hara, P.T., OCS, CSCS

HIP LIFTS

The Sure Cure for Gluteal Amnesia

Your hamstrings and gluteal muscles always work together as a team.  Strong, coordinated hamstrings and gluteals are your lower back’s best friend.  They anchor the pelvis and hold a stabilized spine in a tight and tall position.  They work with the other posterior chain muscles to keep stress off of the sensitive structures of the lumbar spine.  Patients with chronic lower back pain often have weak and even atrophied gluteal muscles.  Building strength and coordination in the hamstrings and gluteals is often difficult for patients with lumbar spine pain problems.  Hip lifts are lower back friendly exercises that can restore the function of hamstrings and gluteal muscles.  

Hip Lifts
There are many different types of hip lifts and all are beneficial.  The two basic hip lift drills discussed below work well for most fitness clients and physical therapy patients. 

Feet On Ball Hip Lifts
FOB Hip Lifts photo

This exercise will strengthen your posterior leg muscles and spares your spine any stress.  Lay supine with a physioball under your heels.  Place the arms at the sides and push down into the floor with the arms to stabilize the body.  Keep the feet together and aimed up at the ceiling.  Brace your abdominal muscles and squeeze the legs together.  Use the butt muscles (gluteals) and posterior thigh muscles (hamstrings) to lift you up off the floor.  Hold the suspended position, in one long line from ankle to shoulder, for three counts.  Lower with control and repeat for five to fifteen repetitions.   

Bench Hip Lifts
Bench Hip Lifts photoThis drill coordinates hip extension and lumbar spine stability.  It is very beneficial when progressed to the single leg version.  Lay with your shoulders across a bench with the head supported.  Place your arms out to the sides.  Plant the feet on the ground with the knees bent 90 degrees.  Drop the hips to the floor and then push back up with the gluteals and hamstring muscles.  Hold at the top for three seconds and repeat.  Perform five to ten repetitions.  As you get stronger, progress to performing the exercise one leg at a time.  From the same starting position, lift the left leg up off the ground.  Lower slowly and using just the right leg, lift back to the starting position.  Make sure the right foot stays flat on the floor and you push up through the heel.  Perform five to ten repetitions on each leg.  Switch over to the left and repeat.  If you find one side is more difficult, perform an extra set on that side.  Eliminating performance asymmetries in this exercise often resolves long standing back pain. 

Michael S. O’Hara, P.T., OCS, CSCS

 

 

GETTING THE ARROW OUT OF YOUR HEEL

Physical Therapy Treatment of Achilles Tendonitis

Tom started having pain in the back of his left heel after working out at the gym.  He had no pain while exercising, running, or water skiing, but symptoms would occur later in the day.  By the end of the summer, he was unable to walk a round of golf secondary to heel and lower leg pain.  Tom was treated by his family physician with medications and rest, but the pain did not go away.  He received two injections in the Achilles tendon that temporarily relieved his pain, but symptoms returned in two or three weeks.   Tom was referred by his podiatrist to Fenton Physical Therapy for treatment of his Achilles tendonitis.  

The left Achilles tendon was sensitive to pressure, and Tom had a build up of scar tissue in the middle of the tendon.  His left ankle dorsiflexion range of motion (ROM) was half that of his right ankle.  He had pain in his heel and the back of his left lower leg with attempting to rise up on his toes and with squatting.  His physical therapy treatment consisted of ASTYM and a program of home stretching drills he performed three times a day.  After six sessions, the pain was gone and left ankle active ROM was full range.  Four months after discharge, Tom reports that he has been pain free and continues with his daily stretching exercises.  

ASTYM photoInflammation and scarring in the Achilles tendon can be a debilitating and difficult problem to deal with.  Over the last few years, aggressive conditioning programs involving repeated box jumps and obstacle course type races have brought more Achilles tendonitis cases to our physical therapy clinics.  Achilles tendon problems often flare up and then go away with rest and icing.   The repeated cycle of trauma and recovery results in a non-flexible scarring of the Achilles tendon.  This is believed to be the precursor to a more traumatic Achilles tendon rupture.  At our physical therapy clinics, we have found great success with the Augmented Soft Tissue Mobilization (ASTYM) method.  ASTYM treatment consists of twice weekly treatment with specialized tools to aggressively mobilize the scar tissue that develops on the Achilles tendon and “kick start” the healing process.  This approach encourages the patient to be active and engage in a functional stretching program instead of immobilizing and resting the lower leg.  The ASTYM tools allow greater intensity and accuracy with manual therapy treatment of the lower extremity.  The patient generally participates in eight sessions of therapy and is instructed on a home regimen of mobility exercises.

Fenton, Linden, and Milford Physical Therapy all utilize the ASTYM treatment technique.  Fenton Physical Therapy was the first clinic in Michigan to offer the ASTYM method.  We continue to bring our patients the most innovative and up to date Physical Therapy care.

Michael S. O’Hara, P.T., OCS, CSCS

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