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Body Parts

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

 

Front Squats

Stability, Mobility, And Better Posture

The squat has been described as the king of all exercises.  The large amount of muscle recruited during squatting makes it a very metabolically demanding exercise.  In athletics, the capacity to perform a full squat with proper torso, hip, and knee position has been correlated with greater durability–fewer injuries.  The overhead squat test is one of the patterns assessed in the Functional Movement Screen and is used in physical therapy and athletic training.  Squatting with the load placed on the front of the body is an excellent way to enhance mobility, stability, and strength.  Compared to leg presses, seated leg curls, and knee extension, front squatting creates much more carry over to activities of daily living and athletics.  The problem is most people do not know how to get started with front squats.

When you squat with the load across the front of the body instead of on the upper part of the back, the stress on the spine is reduced.  You can “cheat” a back loaded squat by leaning forward, but you cannot lean forward with a front squat.  Leaning forward on the front squat causes the load to fall from your shoulders or hands.  Front squatting creates a greater core stability demand and reduces shear force on the lower back.  Full depth front squatting will improve your posture and restore mobility in the hips, shoulders, and thoracic spine.

Front squatting is an exercise that is more equivalent to daily tasks and athletics.  Lifts in real life rarely place the load across your shoulders.  When you lift the grandchild, carry the groceries, or hoist the wheelbarrow, the load is in front of the body.  During athletics, the opponent is in front of you, and you must stay upright and tall to dominate the activity.

Front Squat 101
Before loading the squat, practice bodyweight squats to a depth target.  I like to use a 12 inch box or a Dynamax ball (12 inches in diameter).  You should be able to perform a body weight squat to a thigh below parallel position with a stable spine before attempting a loaded front squat.  When you perform a loaded front squat, initiate motion from the hips by sitting down and back.  Push the knees out and descend so the thighs travel to below a parallel to the floor position.  Keep the chest up and torso tall as you push back up.  Finish at the top by contracting the gluteal muscles and keeping the front of the rib cage down.

Choose A Proper Implement
While the barbell offers the greatest loading capacity, many individuals do not possess the shoulder mobility to hold the bar on the shoulders.  The Goblet Squat position with a kettlebell or dumbbell works just as well.  A sandbag hugged close to the body in the high Zercher position or bear hug hold has a high degree of athletic carry over.  Avoid the Smith machine variation.  You end up leaning on the machine and this eliminates much of the core stability demands and exposes the spine to greater shear force.

Michael S. O’Hara, P.T., OCS, CSCS

Chicken Run

Viscosupplementation For Your Painful Knees

When the knees start aching, activity levels fall, fitness recedes, weight is gained, and cardiovascular problems follow.  The baby boomers are reaching the time of life when knee joint breakdown begins.  Many patients have knees that show arthritic changes on imaging tests, but they are too young for a knee replacement.  While we know losing weight and improving leg strength and mobility will help decrease knee symptoms, many people have so much knee pain they cannot move enough to exercise.  One of the medical treatments that can help these patients is viscosupplementation.

Viscosupplementation is an intra-articular knee injection of hyaluronic acid administered by a physician.  Hyaluronic acid is a natural substance found in the synovial fluid of our joints.   Its function is to act as a joint lubricant and shock absorber.  Patients with knee arthritis have less hyaluronic acid in their joint.  The idea is that by adding some hyaluronic acid to the knee, the pain will decrease and the body will be stimulated to produce more of its own hyaluronic acid.

chicken 200
The FDA approved viscosupplementation injections as a treatment for knee arthritis in 1997.  These medications are derived from chicken combs and are now available from several pharmaceutical companies.  They are given in a series of three to five injections over a number or weeks and can be repeated every six months.

Viscosupplementation works best on patients with mild to moderate knee arthritis.  It is a treatment and not a cure for the arthritis in your knee.  The injections do not produce an immediate relief of knee pain.   It usually takes three or four weeks and several injections before patients report a decrease in knee pain.  Manufacturers claim six month’s of pain relief.  Clinically, the patients I talk to report three to six months of pain control.

The big benefit of viscosupplementation is that it can reduce knee pain and permit the physical therapy or fitness client the opportunity to begin exercising and work on the fitness goals that reduce stress on the knees.  The three to six month window of pain free knees is enough time to improve strength, restore functional mobility, and decrease bodyweight.  For people with knee arthritis, reducing loading and improving strength is the best life long method of managing knee arthritis.

Michael S. O’Hara, P.T., OCS, CSCS

Heads Up

The Downside Of Upside Down Exercise

H_HoudiniExercise activities that place the head below the heart have become more popular in fitness programs.  In almost every gym you see decline bench pressing, incline sit ups, glute-hamstring developer exercises, and more recently, hand stand push ups as a regular part of many exercise programs.  While these activities may have some value, you might want to reconsider training in an inverted position for some other reasons.

Esophageal Reflux
When you invert your torso, the contents of your stomach can more readily travel back up into your esophagus.  Head below your belly with a hiatal hernia, a little extra mesenteric fat, and some strong contractions from the abdominal muscles, and you have the perfect environment for gastroesophageal reflux disease (GERD).  Millions of Americans (14%-20% depending on the study) take medications to manage the symptoms of GERD—heartburn, chest pain, persistent cough, difficulty swallowing, hoarseness.  Prilosec and Nexium are the biggest moneymakers the pharmaceutical industry ever created.  Many Americans (10%-15%) have GERD, but are unaware of the problem because the tissue damage has not reached symptomatic levels.  Erosive esophagitis or Barrett’s esophagus is a clinical finding of cellular change in the esophagus and a precursor for esophageal cancer.  Esophageal cancer is one of the more deadly types of cancer.

Glaucoma or Retinal Disease  
The head down position raises pressure inside the eyeball.  As little as 30 degrees of decline has been shown to increase intraocular pressures.  It is estimated that 2.2 million Americans have glaucoma, but only half of these know they have the problem.  Individuals with glaucoma already have elevated intraocular pressures and should avoid these positions.  The back of the eye (retina) is susceptible to changes in vascular pressures, so if you have any retina issues, avoid the head down position.

High Blood Pressure / Hypertension
Your heart, lungs, and arteries are conditioned to pump blood with your body in an upright position.  Many vascular alterations occur when we flip into a heads down position.  When you assume the head below your heart position, the arterial pressures inside the skull increase.  Elevated cranial blood pressures can lead to headache and much more severe problems such a stroke.  One in three Americans are walking around with high blood pressure.  Add in an exercise induced elevated heart rate and some less than pliable carotid arteries and you have the ideal environment for a big bad brain event.  If you have hypertension, I would not go about using any inverted positions in the gym.

Bottom Line
Apart from going blind, having a stroke, and developing an incurable cancer, you should be fine.

Michael S. O’Hara, P.T., OCS, CSCS

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