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Body Parts

“It’s what you learn after you know it all that counts.” –John Wooden

Amy Warner, Jeff Tirrell, and I recently attended the three day Perform Better Summit in Chicago.  This gathering showcases presentations from experts in the fields of fitness, sports medicine, athletic training, nutrition, and rehabilitation.  All of these presenters work with clients and patients on a daily basis and, as is often the case, their “in the trenches” experience precedes the findings of research studies.  I attend the Summit every year and always walk away with new ideas and knowledge.  We present a brief review of some of the more memorable aspects of the presentations.

Training Athletes In GroupsIMG_1847

Mike Boyle, Body By Boyle Performance Centers and Strength Coach for the Boston Red Sox

  • Know and be able to teach a progression and, more importantly, a regression of every exercise.
  • Don’t put load on top of poor movement.  If the movement looks bad you must fix it before you load it.
  • If you are not foam rolling your athletes, you are a dumbass!
  • Power training is essential if you train older adults, but you must choose the appropriate method.  Know the risk / benefit ratio of your power activity selection.
  • The purpose of the program is to reduce injuries and improve performance.  We are not trying to create power lifters, Olympic lifters, bodybuilders, or strongmen.  We are trying to create athletes.  Strength training is simply a means to an end.

The Best Functional Exercises In the World

Gray Cook, MPT, OCS, CSCS, Co-Founder of the Functional Movement Screen

We need functional exercise because we erode our environment to make life easier:

  • Posture fails because we slouch in chairs.
  • Endurance falters because we simply do more of it instead of performing it better.
  • Coordination dissipates because we train in a supported state or, worse, sitting down.
  • Strength is blunted as we perform all tasks with exterior support and easy access handles.


1. Balance beam

2. Bottoms up kettlebell activities

3. Farmers carry

4. Indian club exercises

5. Jump rope

6. Bear crawl—especially uphill

7. Turkish Get Up

8. Overhead carries


1. Push ups

2. Pull ups

3. Deadlifts

4. Push press

5. Sprints

6. Agility work—physical jigsaw puzzle

Cracking the Coordination Code: Pre Pubescent Athletes

Brett Klika, CSCS, Creator of Spiderfitkids

  • Coordination is how the brain synchronizes and controls movements through muscular activation. It is a set of physical skills that can be practiced, learned and improved.
  • Neural plasticity is at a high point between ages six and twelve.
  • PAWs–Preferential Adaptation Windows– are age phases in which certain coordinative skills can be preferentially developed.
  • Accelerated periods of brain maturation: 15-24 months, 6-8years, 10-12 years, 18 years.
  • If you take children and enhance their movement efficiency and performance, then you increase the likelihood of participation, reduce the propensity to become obese, and make injury less of a concern.

How To Develop Agile Strength

Michol Dalcourt, University of Alberta Exercise Physiologist, Founder and Director of the Institute of Motion, Creator of the Vipr

  • The shape and stability of the human body is produced by the myofascia systems that are woven through the body.
  • The layers of fascia are connected to the nerves that transmit signals of tensile stress and compression that occur as we move.
  • Muscles rely on nerve sensitivity and nerves rely on the fascial sensitivity.
  • Agile strength involves loading and unloading the myofascial lines is a three dimensional activity that trains the muscles, nerves and fascial systems to work together as a team.
  • Athletic activities are multiplanar and three dimensional, but most training is uniplanar and one dimensional.
  • Get better at creating better fascia-nerve-muscle communication and you become better at all activities.  Not just weight room strong but farm boy strong.

Paleo, Vegan, Intermittent Fasting: What’s the Best Diet?

Dr. John Berardi, PhD, CSCS, Founder of Precision Nutrition–my favorite source for nutrition information

  • There’s no such thing as a universal best diet.
  • Most popular diets have a lot in common.
  • Coaches should never lock into a single philosophy.
  • Habit-based coaching is better than diet-based coaching.
  • Proper nutritional coaching involves formulating a plan based on your needs, what you want to accomplish, how you live, and what is personally important.

-Michael O’Hara, P.T., OCS, CSCS

One of the more common questions I get from fitness clients is:  What is the best exercise to get rid of my Muffin Top? Belly Fat? Love Handles?  The answer is always the same.  The table push away is the single most important movement pattern you can practice on a daily basis if you wish to decrease stored subcutaneous body fat.  Great abs are made in the kitchen and not the gym.  Exercise alone does not stand a chance of “making your middle ripped” if the base of your food pyramid is Doritos and Oreos.  The good news is, that once you get your dietary life in order, a proper exercise program creates the magic that makes you leaner for a lifetime.Ice_cream

Breathing Fire

Once you have become proficient at the table push away you are ready to begin the fitness activities that produce the hormonal changes (more growth hormone and less cortisol) that assist in metabolizing body fat and increasing muscle.  These activities are simple and require a short time commitment, but they are unfortunately difficult.  There are many great fat metabolizing modes of exercise.  These are simply my favorite five.  Give each of them a try and let me know how the experience goes.

Dual Action Bike Intervals

This is a good, fat-burning activity for those returning to fitness.  It creates minimal joint stress and extreme metabolic disruption.  Perform this at the end of a strength training session.  Adjust the seat, hop on the bike, and give it all you’ve got for eight cycles of 40 seconds with 30 seconds of recovery.  Perform this program two or three times a week.

Sled Push

Load up a sled with a weight that you can push at a pace that is slower than a sprint but faster than a plow horse.  Push the sled twenty yards and then move the handles to the other side and push the sled back.  Rest as needed.  Record how many trips you can make in ten minutes.

Five Minutes of Kettlebell Swings

If you are proficient with kettlebell swings, give this routine a try.  Grab a kettlebell (men 20-32 kilos and women 12-20 kilos) and set a timer.  See how many swings you can complete in five minutes.  Do not start too fast.  Perform sets of ten swings and take a brief rest.  Once you can get 100 repetitions in five minutes, increase the weight of the kettlebell.

Overhead Slams

If you are able to perform a proper squat (see Jeff to get a functional movement screen assessment for the answer) you can get into slam ball throws.  Choose a slam ball (non- bouncing ball) that allows you to perform ten overhead slams without much difficulty.  Perform ten sets of ten throws with fifteen seconds of rest in between.


Most fitness clients want a body that looks more like a sprinter and less like a marathoner.  Sprinting does create some joint stress, so venture into this area of training slowly.  All distances work well.   Most fitness clients will do better with a gradual increase in running pace that ramps up to an 85-90 percent max effort.  Sustain that effort for fifty to sixty yards.  Better yet find a 30 degree incline and perform hill sprints.  Warm up with some movement prep and perform a program of six to ten sprints once or twice a week.

Each of these activities takes less than fifteen minutes to complete.  No need to spend 45 minutes in the “fat burning zone”.  Invest the time you save in food preparation and a program of strength training, and you will see even greater body composition changes.

-Michael O’Hara, P.T., OCS, CSCS

I was driving home from work last week and found four bicyclists down on the side of the road. One of the riders had moved over to avoid a car and that was enough to create a chain reaction with his fellow riders.  Of the four riders, only two were wearing helmets.  One of the riders had a fairly bad gash on the side of his head.  An ambulance took the two without helmets off to the hospital.

After witnessing the aftermath of that car-bicycle interaction, I traded in my ten year old bicycle helmet and purchased a new Bern helmet.  During a recent trip to New York City, I saw many bicycle riders wearing these helmets.  Bern helmets are low profile and fit better than any other helmet I have tried.  This new helmet covers more of my head, yet it feels well ventilated and cool.  I do have the advantage of not being insulated by hair.

Helmetless bike riders tell me they are “extra careful” and that they “stay off busy roads”.  They are making a major mistake.  The problem is not the bike rider.  The problem is the car driver.  People driving cars are not looking for bicyclists.  They are on autopilot–listening to the radio, talking on the phone, and texting.  Most of us never see something unless we are actively looking for it.  Watch this video and assess your level of awareness.bike_car

As a physical therapist, I get to work with individuals who have suffered closed head injuries.  Nothing creates a more sudden and long lasting change in your world like an impact to your cranium.  It does not take that much in the way of force to permanently alter the way you move, think, react to stress, and generally function during the day.  Falling off a bicycle can create more than enough force to scramble your neurons for the rest of your life.  If in the past you did not use a helmet because of the appearance, I urge you to look at a Bern and some of the new low profile helmets.  Buy your kids a good helmet and make them wear it whenever they get on their bikes.  Be a good example and use a helmet whenever you ride.

To test your awareness, click on the link below:


David Epstein is my favorite Sports Illustrated writer.  Last year he published his first book, The Sports Gene.  I highly recommend it to anyone who works with athletes on a regular basis.

Mr. Epstein has traveled the world and has consulted with hundreds of scientists, coaches, and experts on the training environment that produces optimal results.  If you are the parent of a youth athlete, I urge you to take a look at the June 10, 2014 article he wrote in the New York Times.  I can personally vouch for the injury information in this article.

To read the article, click on the link below:


Enhance single leg power production and prevent injury

Build explosive single leg power in your hips and legs
Improve coordination and core stability

Start in a half kneeling position, making sure the knee of your front leg is behind your toes.
Rest your arms at your sides.

From the ½ kneeling position, drive through the front foot’s heal and explode into the air. Once in the air, quickly switch your legs so that you land with the opposite foot forward. Land in the same ½ kneeling position with the back knee stopping 1-2” above the ground.

Not landing deep enough
Not spreading the feet far enough apart
Not jumping high enough

-Jeff Tirrell, B.S., CSCS

Intensity Know How

Exercise Intensity Is a Mystery For Most Fitness Clients

Cheryl trained in the gym three days a week and went to yoga class twice a week.  At the gym she used the elliptical machine for thirty minutes and did the “ab circuit”.  The yoga classes lasted an hour and she was always very tired after a session.  Despite six months of this program, she had not lost any fat and her blood pressure remained elevated.  After recovering from a heel pain problem, Cheryl began training at Fenton Fitness.  After her first session, it was evident what was stopping Cheryl from reaching her goals.  She had no idea what constitutes effective exercise intensity.

Cheryl’s problem is not an uncommon one.  Many fitness participants overestimate how hard they are exercising.  What they perceive as a moderate or intense work level is actually a low exertion level.  As the body accommodates to the same exercise stress repeated day after day, the intensity level falls even further.  A recent article by Gretchen Reynolds in the June 12, 2014 issue of the New York Times discusses a recent study on the overestimation of exercise intensity.

Many fitness clients and rehab patients are not comfortable with being uncomfortable.  They stop an exercise activity well before they reach a level that will produce a training effect.  They require guidance and reassurance that the feelings they get when heart rate and body heat elevate are normal and necessary.  Heart rate monitors are often the solution for these clients.  Gradually introducing ten second intervals of exercise at 70% of age adjusted maximums on a bike or treadmill followed by a fifty second recovery will get the client accustomed to the feeling of more intense exercise.  Having the client wear a heart rate monitor while walking and monitoring sensation while making an effort to push up the rate with faster paces and uphill walks is effective.

Cheryl felt lightheaded and short of breath during her first five exercise sessions but, after using a heart rate monitor and becoming accustomed to the intensity of each session, she started feeling better.  Four months later, she was able to stop taking one of her blood pressure medications, and she had lost eight pounds.  Cheryl now knows what mild, moderate, and intense exercise sessions feel like and no longer uses her heart rate monitor.

To view the New York Times article, click the link: http://well.blogs.nytimes.com/2014/06/11/judging-badly-how-hard-we-exercise/

Michael O’Hara, P.T., OCS, CSCS

Falling In Love With Fitness

Fall Prevention And Intervention

fallMrs. J. had pain in her lower back and left hip.  The problem had been present for over a year, and she sought treatment in physical therapy because the pain was making it difficult to get in and out of her car and work in the garden.  At 73 years of age, Mrs. J. lived in Michigan during the summers and traveled south for the winters.  She enjoyed working in her garden, visiting with friends, and walking on the beach in Florida.  On further discussion, Mrs. J. reported that she had fallen three times over the previous year.  Two falls occurred while getting out of bed and once while working in her yard.  She did not bother to tell her doctors about these falls because she had not been injured.

Mrs. J. had all of the factors that placed her at high risk for falling in the future.  She was over 65 years of age.  She took four medications, two of which had psychoactive effects.  She had a prior history of falls in the past and she was weak.

Falls are the leading cause of accidental death for those 65 years and older.  Just over a third of the population over 65 falls every year.  One half of those falls happen to individuals who have fallen before.  It is the most common injury related hospital admission.  In 2012, we had over 340 thousand hip fractures from falls in this country.

Risk Factors For Falls
A prior history of falls.  If you have fallen in the past you are more likely to fall again.

Balance impairment.  If you are unable to balance on one leg or you lose your balance easily when you close your eyes, then you are at greater risk.

Strength deficits.  The weaker you are, the more likely you are to fall.

Postural hypotension.  A twenty point fall in systolic and/or a ten point drop in diastolic blood pressure on changing position from supine to standing places you at a greater risk of falling.

Visual impairment.  If you are unable to see the dog, curb, or chair, you are more likely to have a collision and subsequent fall.

Multiple medications.  Taking more than four medications is related to more frequent falls. The risk is amplified if the medications have a psychoactive component.   Several studies have identified antiepileptic medications as more problematic.

Dementia.  Cognitive impairment doubles the risk of falling.

Post hospital stay.  For the two weeks after a hospital stay, you are four times more likely to fall.

What Definitely Helps
Home assessment and modification.  In my experience, peace in the Middle East may be more readily attained than getting grandma to move her rug and install a grab bar in the bathroom, but it is what has been shown to reduce falls in higher risk individuals.

Exercise programs.  Strength, balance, mobility, and power production activities.  The activities should take place in a standing position and should be tailored to the specific needs of those at risk.  These programs work–you just need to do them.

What is Likely to Be Beneficial
Vitamin D supplementation.  Several studies have documented fewer falls in individuals that supplement with Vitamin D.  The mechanism for the decrease in falls is not known, but it seems to work.

Medication review.  If possible, minimize psychoactive medications and reduce the total number of medications.  Discuss this with your physician before making any changes in your medications.

Assessment and awareness of postural hypotension.  If blood pressure drops with transfer from supine to sit to stand, you are at higher risk for falls.  A simple blood pressure test performed in the doctor’s office can determine if you have this problem and enable management of this risk factor.

Vision assessment and management program.  Get your eyes checked and consult with your doctor on a treatment plan to keep your vision as healthy as possible.

Better footwear.  This is the most common sense advice, but it gets the lowest level of compliance.  Ladies those shoes look nice, but that pin in your wrist looks a lot worse.

Mrs. J. had a blood pressure assessment that showed her systolic pressure dropped twenty-two points with transfer from supine to standing.  We contacted Mrs. Js’ family physician to alert her of her patient’s recent fall episodes and blood pressure findings.  Mrs. J. was taken off one of her medications and her blood pressure improved.  The pain in her hip and lower back resolved, and she was able to perform a program of exercise to improve balance, strength, and mobility.  Mrs. J. completed five weeks of therapy and then continued with her exercise program at our fitness center.  She has been exercising three times a week for the last two years and has not had another fall episode during that time.

Michael S. O’Hara, P.T., OCS, CSCS

Box Squats

Improve squatting mechanics, alleviate stress from knees, and build hamstring and gluteal strength/control.

Strengthen gluteal muscles, hamstrings, and core musculature.  Improve gluteal and hamstring activation during the squat.  Decrease knee discomfort compared to traditional squats.

STARTING POSITION:Snapshot 1 (6-13-2014 1-04 PM)
Start by standing approximately 4-6 inches in front of a box.  Feet should be slightly wider than shoulder width apart.  The toes should be straight ahead or angled slightly outward.  If using weight, a barbell can be held in the front “rack” position, placed behind the neck, or you can hold a Kettle Bell in the Goblet position.  If using a barbell on your back your shoulder blades should be pinched together.

Start by pushing the hips back.  The knees will naturally start to bend, continue to push your hips back as you sit onto the box.  You should move slowly and with control during the eccentric (descent) portion of the exercise.  Once your butt touches the box you need to briefly relax your legs.  However, you must keep bracing your core, and keep your upper back tight if applicable.  Once your legs have been completely relaxed you need to re-engage your glutes and hamstrings by pressing your heels into the ground and “spreading” the floor.  Do not rock backward or forward in order to generate momentum to get up.  Stand up at a normal speed.

Using a box that is too short so that you can’t control the eccentric portion due to weakness in the glutes or hamstrings. This causes you to fall/plop onto the box.  Allowing the knees to bend first and not pushing the hips back far enough.  Rocking on the box once you are seated in order to generate momentum to help yourself up.

Jeff Tirrell, B.S., CSCS

How Less Is More

Get Bored And Get Better At A Few Basic Exercises

The weight room at my high school was small and had only basic equipment.  It consisted of two Olympic weight set, some mismatched dumbbells, a squat rack, and a chin up bar.  In the gym, we had a pegboard and a rope for climbing.  No bench press, curl bar or pulldown machine.  It was the ultimate blessing in disguise.  We did not have the temptation of exercise variety for varieties sake.  What we did have was solid instruction on basic lifts.  We performed the same exercises repeatedly and became more proficient at squats, hang cleans, overhead presses, and pull ups.  Four simple activities performed consistently with an effort to add weight to the bar on a regular basis.  The results were magic.

The television fitness gurus have brought forth the latest craze of “muscle confusion”.  You change your exercise activity often in an attempt to stimulate a greater adaptation response.  The problem is that you never get the chance to practice the exercise long enough or with enough resistance to get stronger.  Getting stronger is the performance parameter that preserves muscle mass, speeds up your metabolism, and makes you more durable–less likely to get hurt.
I never want any of my muscles, nerves, joints, or any other part of my body to be “confused” when training.  I want the bodies of the athletes I train to perform better at every session.  My suggestion is that you pick five or six exercises and set a goal of getting better at each of them over the next six months.  The exercises you chose do not have to be a barbell or dumbbell exercise.  Bodyweight exercises will work just as well and are a better choice for most fitness clients.  Keep a record of your performance and work on improving the number of inverted rows, pull ups, or push ups you can perform.  Single leg strength training is a good choice for nearly everyone and works wonders for athletes. Athletes should choose exercises that not only improve strength but also mobility—front squats.  Long term dedication to the mastery of an exercise will reward you with better body composition, enhanced mobility, less pain, and the strength you need to perform in athletics and daily activities.

This training approach requires mental toughness and a willingness to at times be bored.  Toughen up and get after the challenge.  Read this recent article in the New York Times.   Better yet go out and buy the book Starting Strength.

Read the NY TIme’s article here: http://www.nytimes.com/2014/05/25/opinion/sunday/fitness-crazed.html?_r=0

Michael S. O’Hara, P.T., OCS, CSCS

Spine Unwind

An Exercise That Prevents Lumbar Rotation

Your brain is a master of physical manipulation.  It has the capacity to move your body by any means necessary.  If your hips and thoracic spine are stiff, weak, and unable to rotate, it will demand rotation from your lumbar spine.  Frequent and excessive rotation at the lumbar spine is never good.  The five lumbar vertebrae are only able to handle 10-13 degrees of total rotation before bad things start happening.  In our treatment of patients with chronic lower back pain, our physical therapists work to restore thoracic spine / hip mobility and reduce rotational movement in the lumbar spine.  Lower back pain can be trained away with better control of excessive lumbar rotation.  One of our favorite anti-rotation core stability exercises is the Pallof Press.  This exercise deserves a greater presence in the programs of the general fitness population.

Why You Should Do It
Nearly everyone can perform a Pallof Press.  If you can stand up without assist, you can perform the Pallof Press.  Physical therapy patients start with light loads and usually progress quickly.
It is one of the few exercises that will strengthen the abdominal / back muscles that resist rotation of the lumbar spine and improve hip stability at the same time.
The Pallof Press develops the proprioceptive awareness you need for better posture.  It is a great exercise for those suffering from the epidemic of SNSS -soggy noodle spine syndrome.
It can also be used to teach better breathing patterns.

You need a cable machine or resistance tubing set at mid torso level.   Position your body at a 90 degree angle in relation to the pull of the cable.  Assume an athletic posture with the feet at least shoulder width apart and the spine neutral.  Push the hips back a little and keep a slight bend in the ankles and knees.  You should look like a tennis player preparing to return an opponent’s serve.  Use a strong overlap grip on the handle and set the hands in the middle of the chest.  Brace the midsection and hips and move the handle out in front of the body and then back to the chest.  Select a resistance level that permits execution of all repetitions without losing the set up posture.  If one side is more difficult, start the exercise on that side.  Perform fifteen repetitions on each side.

Many of us have terrible respiratory patterns.  We are unable to fully inhale and exhale when under any physical stress.  The Pallof Press can be used to improve respiratory control.  Use the same set up and press the cable out.  Hold the cable with the arm fully extended while inhaling for four seconds and exhaling for six seconds.  Bring the arms back in and then repeat.  Perform four of five inhale / exhale respiration repetitions on each side.
You can make the exercise more difficult by adding more resistance, but I like to use a change in the base of support as the initial progression.   Assume a split stance and perform the Pallof Press with one leg forward and one leg back.  The half kneeling Pallof Press is an excellent injury prevention exercise.  During this exercise you want a firm anchor to the ground so avoid the Bosu, Physioball, and other circus versions of this exercise.

Michael S. O’Hara, P.T., OCS, CSCS