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Body Parts

Chair Check Up

How Functionally Fit Are You?

Image chair testCoaches, trainers, and scouts all want the number of inches in an athlete’s vertical leap test.  The athlete simply jumps up and taps a lever that indicates how many inches he or she can jump straight up off the ground.  This test has proven to be an excellent indicator of how well an athlete will perform in the competitive arena.  NBA players hit impressive vertical leap numbers, so we understand how simple it must be for them to elevate over the rim.  The equivalent test for the 60-year plus population is the Chair Stand Test (CST).  The score you get on the CST is a very reliable indicator of how well you will perform in the game of life.  

Leg power, strength, and lower extremity functional mobility are measured with the CST.  The ability to repeatedly move through the sit to stand transfer without the assist of the arms pushing down on the legs or the armrests of the chair is an important skill everyone needs to maintain an independent lifestyle.  An improved CST score creates carry over to other functional skills. Patients who improve their CST scores develop better gait patterns and standing balance.  

Chair Stand Test: You need a stopwatch, a stable chair with a 17 inch high seat, and an evaluator to monitor your performance and start and stop the timer
1.    Sit in the middle of the chair.
2.    Place your hands on the opposite shoulder with the arms crossed over the chest.
3.    Keep your feet flat on the floor.  
4.    Keep your back straight and your arms against your chest.  
5.    On the order “GO”, rise up to full standing and then sit back down.  
6.    Repeat for as many repetitions as you can in thirty seconds.  
7.    If you are halfway to a standing position when time expires, count that as a repetition.  
8.    Record your results and be concerned if you score below average.

The age adjusted scores for the CST listed below are a composite of the data gathered from several research studies since 2001.  The CST has proven to be a reliable assess-ment of fitness in older adults for over a decade.  Individuals who score below average on this test are more likely to suffer falls and require assisted care in their advancing years.  For the older fitness participant, knowing your Chair Stand Test score is just as important as knowing your blood pressure numbers. 

Men’s Results
Age                    Below Average       Average       Above Average
60-64                       < 14                   14 – 19                > 19
65-69                       < 12                   12 – 18                > 18
70-74                       < 12                   12 – 17                 > 17
75-79                       < 11                    11 –17                  > 17
80-84                       < 10                  10 – 15                 > 15
85-89                       < 8                     8 – 14                  > 14
90-94                       < 7                     7 – 12                  > 12

Women’s Results
Age                    Below Average       Average       Above Average
60-64                       < 12                   12 – 17                > 17
65-69                       < 11                   11 – 16                 > 16
70-74                       < 10                   10 – 15                > 15
75-79                       < 10                   10 –15                 > 15
80-84                       < 9                      9 – 14                > 14
85-89                       < 8                      8 – 13                 > 13
90-94                       < 4                      4 – 11                 > 11

Michael S. O’Hara, P.T., OCS, CSCS

The Lunge Matrix

Three Dimensional Leg Training

Twenty-five years ago, I participated in a three day “functional movement” seminar given by physical therapist, Gary Gray.  Gary got the entire class involved in a morning exercise class he called Pump and Praise.   One of the activities he taught was the lunge matrix.  I was 30 years old and had been exercising fairly regularly, yet I found the lunge matrix much more challenging than expected.  Since that time, I have used the lunge matrix with physical therapy patients, fitness clients, and in nearly every session of my own training.  Almost everyone can benefit from a little lunge matrix training.

The muscles in our trunk and hips are inter-twined, aligned in a spiral and diagonal fashion.  They are neurologically connected and work as a team to drive movement in three dimensional patterns.  The lunge matrix neurologically activates all of the muscles in all of the possible movement patterns.

The lunge matrix is ideal for anyone involved in a multi-directional sport.  Tennis, volleyball, basketball, soccer, and football require efficient transition in all directions. Injury prevention is the most important aspect of any athletic training program.  Your gym program should make you more bullet proof on the field of play.

The lunge matrix can be used as a movement preparation activity with just bodyweight (my favorite) or as a stand-alone strengthening exercise.  When performed as a strengthening exercise, use functional level loads, dumbbells, or medicine balls that equal the weight of the bag of groceries or the grandchild you are going to lift.  The loads should not alter the quality of movement or shorten the range of your lunges.  Choose shoes with flatter soles as some of the more cushioned running shoes can make lateral and rotational movement patterns difficult.

Lunge Matrix Series
1. Anterior lunge R / L
2. Lateral lunge R / L
3. Rotational lunge R / L
4. Posterior lunge R / L

Watch the attached video, and then give the lunge matrix a try.

Michael S. O’Hara, P.T. OCS, CSCS

Stripe Hype

The Good And Bad Of Kinesio Taping

In 2008, Kinesio tape (KT) was donated to 58 countries for use during the Olympic games.  Since that marketing effort, its presence in televised sports has exploded.  The athletic fashion statement found at many competitions is the brightly colored strips of tape across elbows, knees, shoulders, and hips.  At Wimbeldon, Novak Djokovic had green tape on his elbow.  Many of the soccer players at the last Euro competitions had tape on shoulders and hips.  Female beach volleyball players seem to be wearing more tape than clothes.

Kinesio tape was invented by chiropractor Dr. Kenzo Kase in the 1970s.  KT is made of cotton with an acrylic adhesive that permits it to stretch 40-50% of its resting length.  The website for Kinesio tape claims that it can alleviate pain, reduce inflammation, relax muscles, enhance performance, and help with rehabilitation.  Rock tape, a competing product, makes similar claims and uses the slogan Go Stronger, Longer.

Does Kinesio Taping work?
Serena Williams with Kinesio TapeA meta analysis performed by Wilson in 2011 looked at all of the studies performed with KT and found some evidence that it helped improve range of motion, but no evidence that it helped reduce inflammation, relax/activate muscles, or improve performance.  There is no evidence that it “off loads sensitive tissues” or improves “lymph drainage”.  The number of high quality studies was small.

How Might Kinesio Taping Work?
What we do know is that the elastic, compressive nature of any band, brace, or tape placed on the body stimulates receptors in the skin.  The receptors modulate the perception of pain and as a result, pain decreases.  An example is a research study in which the patients that wore a neoprene sleeve during a series of tests 12 months post anterior cruciate repair produced significantly more force and had better balance than without the neoprene sleeve.  The sleeve created a constant pressure on the skin surrounding the knee.

Should You Use Kinesio Tape?
If you have a minor ache or pain and no structural musculoskeletal damage, then go ahead.  The KT can make you feel better, and this will make exercise and activities of daily living easier.  The tape can provide some control over the symptoms, and it has no side effects other than occasional skin irritation.

Remember that your body sends pain signals for a reason.  Any type of musuloskeletal damage should be dealt with more comprehensively than just KT.  It is a bad idea to use KT to reduce pain and then participate in activities that create even greater tissue trauma.  A small and easy to rehab rotator cuff tear can become a big, full thickness, surgical repair tear if you tape it up and practice your tennis serves.

We do lots of things in medicine that have no solid, double blind research that proves efficacy.  The manufacturers of KT products need to spend more money on research and less on marketing.  I am hopeful that in time, more evidence will develop for the use of KT.  If some strips of KT make you feel better, go ahead and use it.  The best approach is to get to the cause of the problem and enact a treatment plan that resolves the pain or functional limitation.

Michael S. O’Hara, P.T., OCS, CSCS

If Frankenstein Had Glutes, He Could Have Run Away

Get Fit With Monster Walks

Frankenstein in chainsMost of the exercises performed in the gym emphasize the sagittal (front/back) plane of motion.  Squat, lunge, elliptical, and treadmill are all sagittal plane activities.  In athletics and life, we must be able to move efficiently in all planes of motion.  Our gluteal muscles are the primary producers of lateral and rotational movement in the lower extremities.  Strong and responsive gluteals keep your knees and lower back safe from injury during athletic activities.  A simple exercise to improve gluteal function and move better in the often-neglected frontal plane is a band monster walk.

You will need a mini resistance band or a lateral resistor.  Place a mini band loop around your ankles.  Assume an athletic stance with the feet straight ahead, knees bent, and hips flexed.  The band should be held taught throughout the exercise.  Try to keep the hips and shoulders level throughout the exercise.  Your torso and pelvis should not wobble side to side.  Move the right foot 12 to 18 inches to the right, and after planting the right foot, follow with the left.  Remember to keep some tension on the band.  When you have completed the prescribed number of repetitions, rest and then lateral step back to the left.

As you get better at this exercise, try performing the drill moving forward and backward.  The backward monster walk is an excellent gluteal activation exercise for runners.  Try performing one or two sets of eight to ten repetitions.

Michael S. O’Hara, P.T., OCS, CSCS

Scoliosis, Schmoliosis

Lamar sAnt

Lamar Gant

In physical therapy, we treat patients with spinal problems every day.  Very often, we hear patients state that their activities are limited because they have scoliosis—a lateral curvature of the spine.  It is particularly concerning to hear this when it involves a younger patients with a long life ahead of them.  The truth is that having spinal scoliosis does not make you more likely to develop back pain or become disabled.  The diagnosis of spinal scoliosis should not inhibit anyone from leading a very active life.

Simply put, the statistics do not show any greater incidence of back pain in people with spinal scoliosis.  When an injury does occur, the patient with scoliosis does not take longer to recover or face greater disability than the person with a “normal spine”.  Workers with scoliosis are not more likely to be injured while on the job.

Progressive spinal scoliosis problems in children and teens will require surgical correction to prevent respiratory and other biomechanical problems.  However, many young people with stable scoliosis measurements of greater than 20 degrees live active and athletic lives.

What we do know is that “fear of activity” (kinesiophobia) or “activity avoidance” in people who have sustained a back injury is a major predictor of future disability.  Young people with a diagnosis of scoliosis need to hear that they can be as active and vital as anyone else.

One of the best athletic examples is Lamar Gant.  Despite having a pronounced spinal scoliosis, Lamar is one of the most accomplished power lifters of all time.  He has set more world records than any other power lifter.  At a 132 pound bodyweight, he deadlifted 672 pounds—five times his bodyweight, with a scoliotic spine.  Lamar has stayed injury free for many years, and is a world champion in multiple weight classes.

If you need another example watch Usain Bolt—his spine seems to be functioning fairly well.

Michael S. O’Hara, P.T., OCS, CSCS

No, No Row Your Boat

Why I Don’t Row And Neither Should You

Equipment manufacturers have produced an endless selection of cardiovascular conditioning machines.  We have access to treadmills with shock absorbing decks, elliptical units with stationary and moving arms, escalator stairways, and every imaginable variety of bike.  The simple rowing machine has recently become more popular in fitness classes and training gyms.  I purchased a state of the art rowing ergometer in 1986.  While the training sessions always left me gasping for air, I developed several problems when my rowing sessions became more intense.  Four years later, I abandoned the rower as an exercise modality.  Over my thirty years as a physical therapist, I have treated numerous patients with rowing machine related injuries.  I have come to believe that some individuals can use a rowing machine and achieve excellent results, but the vast majority of us should stay away from a rower.

Lower Back Pain History
The rowing motion produces a compressive load on the lower lumbar joints and discs while subjecting the spine to many cycles of end range flexion.  This is the ideal formula for a posterior disc derangement.  If you have a history of debilitating lower back pain (80% of the American population) or a lumbar disc related problem, you should find another mode of exercise.

You Sit All Day
For many of us, work and daily commute time combine to account for six to ten hours of sitting a day.   In your fitness program, the last thing you want to do is chose an exercise activity performed in a seated position.  The deleterious effects of prolonged sitting must be trained away and not enhanced by your exercise activities.

A History of Anterior Hip Pain
With every repetition of a row, you fold the front of the hips into full end range flexion.  This can create all kinds of impingement/tissue distress problems on the front of the hip joint.  I have treated several patients with labral tears of the hip and “sports hernia” pain problems developed after a series of rowing sessions.

You Are a Postural Mess
If your mother always told you to “sit up straight” and you never managed to listen, the rower is probably a less than ideal training tool for you.  Age, wear and tear, and the passage of time tend to pull our skull, shoulders, and thoracic spine forward.  If you already have a head start on the slumped forward rounded over upper body, I would nix the rower.

Big Belly
If your abdomen protrudes to the point it inhibits the motion of your hips and the draw of the erg’s handle, you will not be able to row with a mechanically efficient stroke.  The knees out, 20 inch pull you so often see performed on the row ergometer is at best ineffective and often injurious.

Clueless on Technique
For many people, the rhythm of a proper rowing motion is difficult to learn and even more difficult to maintain in a fatigued state.  When your row technique falls apart, the stress on your peripheral joints and spine increases dramatically.

Cumulative Compressive Load
If your training week consists of deadlifts on Monday, box jumps on Tuesday, Olympic lifting on Wednesday, squats on Thursday, and then rowing ergometer on Friday, you will have performed five consecutive days of high spinal compression activities.  The older you are, the stronger you are, and the more intense you train, the more you need to be considerate of the cumulative compressive load placed on your spine over the course of a training week.  The rower is probably not the ideal training modality in this training scheme.

Michael S. O’Hara, P.T., OCS, CSCS

Go, Baby

The Tiger Crawl Brings It All Together

We all owned this move at one time.  We all could crawl, and we did it very well.  Infants can motor along at a full speed crawl, but many adults are unable to even get in the crawl position.  Getting back to performing some four point crawling helps restore mobility, coordination, and balance, and it makes you a better runner.

Rebooting Your Neural Software
The crawling we did as a child helped develop the neural connections that enable us to walk.  All of us have established neural pathways for crawling.  They are just cluttered up and inhibited by prior injuries, poor posture, bad training habits, and a sedentary lifestyle.  Performing some crawls brings these pathways back to life.

Reciprocal Gait Pattern
We move in an opposite arm, opposite leg pattern.  Walking, jogging, and sprinting all involve this cross body connection that efficiently propels our body.   Most fitness activities have minimal or no activation of the reciprocal pattern of walking and running.  You activate this reciprocal pattern of motion with the crawl.

Better Hip Mobility, Core Stability, and Posture
We are a nation of sitters.  Prolonged sitting is not a normal activity.  It promotes tight and weak hips and shoulders, inhibits the function of the core stabilizers, and destroys your posture.  We need some training that moves us out of the sitting position, activates our core, takes the hips through their normal range of motion, and drives the postural muscles.

Cross Body Core Stability
Our muscles are arranged in an interconnected, spiral, and diagonal fashion.  They are wired to connect your left hip with the right shoulder and the right hip with the left shoulder.  The “core muscles” are designed to stabilize your middle so you can produce a better shoulder to hip connection.  Crawling creates the anti-rotation and anti-extension force these muscles must control.

Tiger Crawl
I like to perform all crawl activities on a turf surface or carpet.  Grass fields hide rocks, broken glass, and other objects to avoid.  Get down on all fours.  Lift the knees off the floor and bring the right knee up to the right elbow.  The left arm is extended forward and the left leg back.  Pull the left leg up to the left elbow and move forward with the right arm as you extend the right leg.  Your pelvis must stay stable as you move the hips into alternate flexion and extension.  Try to keep the butt down and maintain a consistent and even reach with the limbs.   Strive for full extension and flexion at the hips.  Three sets of fifteen to twenty yards is a good start.

Tiger Crawl Progressions
Weight Vest Tiger Crawl
Put on your weight vest and go.  This progression is an upper body intensive activity.  I find my shoulders and upper back are the weak link in the chain.  Many collegiate wrestling, football, and rugby programs use this drill.

Sled Tiger Crawl
Load up a sled and use a belt or shoulder harness and crawl.  This variation helps develop better hip mobility and hip adductor strength.  Keep the weights conservative and maintain proper spinal posture and full hip drive.

Michael S. O’Hara, P.T., OCS, CSCS

Pushing Through Fitness Barriers

Pushing For 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.  Sled pushing more closely emulates the demands placed 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 a better vertical leap number, but not nearly the same gains in 40 yard dash times.  It trains the neural pathways that turn on your acceleration muscles.  Sled pushing places the body in the forward lean position you need to properly accelerate out of the blocks when sprinting.

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 weeks time.  Pushing is a basic movement pattern that most master after two or three attempts.

Michael S. O’Hara, P.T., OCS, CSCS

Grip, Rip, And Lift

An Introduction To Sandbag Training

Every training tool in the gym is solid and fixed.  Kettlebells, dumbbells, and barbell implements are symmetrical, balanced, and have handles that make for efficient maneuvering of the load.  In life and athletics, the forces you face are asymmetrical and come at you from all directions.  No convenient handles are attached to your opponent, bag of groceries, grandchild, or grandma.  Fitness activities that carry over to real life are what you need in your gym programming.  Sandbag training meets all of these needs.

Farm Boy Strong
An implement that is unstable in your hands is more valuable than an implement that is unstable under your feet.  Sandbags are inherently floppy–the load moves as you maneuver the bag through space.  This requires coordinated recruitment of the core, shoulder, and pelvic girdle stabilizers.  Central nervous system (brain) neural recruitment also increases as more muscular coordination and co-contraction is brought into play.  Lifting, carrying, and gripping a sandbag is the same type of training that makes the farm boy strong.

Ageless Grip
Gripping a sandbag works all of the muscles of the forearms and hands.  In real life, you must be able to maintain a strong grip in order to express any of the strength you have gained in the gym.  Research has linked grip strength to longevity.

All Angles Are Covered
Josh Henkin has created a superior product called the Ultimate Sandbag.  These modern sandbags come in a variety of sizes and have a durable vinyl covering.  The shape of the bags and the multiple handles enable movement of the bag through all planes of motion.  Unilateral and triplanar loading are what happen in the real world.

Be A Better Shock Absorber
In life and athletics, the ability to absorb an impact and remain upright, stable, and uninjured is crucial.  Sandbags are much softer than any other implement in the gym.   When they impact your body, they do not produce pain or tissue trauma, but your body feels the force as it travels to the ground.  Sandbag shouldering, cleans, and snatches are just some of the drills that require you become more efficient at absorbing an impact.

Starting With Sandbag Activities
Start with one or two exercises and work on perfecting your technique.  Sandbags work well for metabolic complexes–you perform multiple exercises in a row without putting the bag down.  Watch the attached video for some examples of my favorite sandbag training exercises.

At Fenton Fitness we have 20, 30, 40, 50, 60, 70 and 85 pound sandbags.  Start with an easy weight and work your way up.  See the video for demonstration of Sandbag Training.

Michael S. O’Hara, P.T., OCS, CSCS

It’s Rotator Cuff–Not Rotor Cup

Proper Strengthening Of The Rotator Cuff Muscles

In the gym, I see all kinds of shoulder exercises that I believe are meant to strengthen the external rotators of the shoulder.  Unfortunately, many of the moves are more harmful than helpful.  They are performed at fast speeds, in positions that foster shoulder impingement, and with no attention to spinal or shoulder posture.  A simple and highly effective exercise to strengthen the rotator cuff muscles is the band “no money” drill.   This exercise is time efficient–you train both shoulders at the same time.  Resistance is provided by tubing or a resistance band and is easily altered to suit all strength levels.  The best thing about this exercise is that it is hard to perform improperly.

Many of us are walking around with horrible upper thoracic, cervical, and shoulder girdle posture.  Poor posture makes using your external rotator muscles properly very difficult.  For the external rotators to work effectively they need to be on a solid, well anchored launch pad.  Elevated and rounded shoulder blades are poor platforms for your external rotator cuff muscles—supraspinatus, infraspinatus, and teres minor.  A forward head posture closes off the narrow neural openings between the cervical vertebrae.  Compression on the fifth cervical nerve root can unplug the neural drive to both the external rotators and the deltoid muscle.  Before you begin any rotator cuff strengthening exercise, always attempt to correct your posture before starting.  If you cannot correct your standing posture this exercise is made for you.

Band “No Money” Drill
You need some resistance tubing or a band for this exercise.  Stand up tall with the chest proud and the head pulled back.  Hold the tubing in each hand with the elbows at the side and bent to 90 degrees.  Keep the palms facing up and the thumbs pointed out.  Tighten the muscles in back of the shoulder blades and pull the tubing apart.  Hold at end range for three counts.  Return slowly to the starting position—this should take at least three counts.  Each repetition should take at least six seconds.  Repeat for five to ten repetitions.  This exercise should always be pain free.  Start with a resistance level that permits you to perform at least five repetitions and do not take this exercise to failure.

If you are unable to perform this movement with shoulder blades pulled down and in, head pulled back, and chest proud, you need to regress the exercise to a foam roll.  Position in supine and length-wise on a foam roll and perform the band “no money” just like you would in standing.  Positioning on the foam roll will allow gravity to pull you into a better posture and create the proper stimulus necessary to strengthen the external rotators of the shoulder.

Strengthening the external rotators is only a part of keeping your shoulders healthy and strong.  You must train the shoulder muscles as a team to produce more coordinate stabilization of the glenohumeral and scapulo thoracic joints.  The more athletic and active you are, the more important coordination and timing exercises become for comprehensive shoulder rehabilitation.

Michael S. O’Hara, P.T., OCS, CSCS

 

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