A Step Up In The Right Direction
Anterior Step Ups
Most of the lower extremity training in the gym occurs with both legs working at the same time. Leg press, leg extensions, squats, and deadlifts all train both lower extremities simultaneously. In life, we almost always function in a single leg, or predominantly single leg manner. All athletic activity requires a high degree of single leg control to be proficient and remain free of injury. Your fitness training should include activities that improve balance, proprioception, core stability, and strength while on one leg. One of the best single leg exercises to add to your training program is step ups.
Connecting Your Lateral Subsytem
When you stand on one leg, the team of muscles that keep you upright and tall are collectively called the lateral subsystem. They consist of the groin muscles (muscle on the inside of the thigh), the gluteus medius (outside of the hip), and quadratus lumborum (side of the spine). These muscles must work in a coordinated fashion to keep you straight and stable. A step up exercise places a strong demand on the lateral subsytem. Seated machine based exercises have no effect on this essential neuromuscular interaction.
Keeping You Safe
When I start clients on step ups, the most glaring deficit is almost always single leg stance balance. Many of these people run, bike, and regularly attend group exercise classes, yet they have very limited control when they stand on one leg. I do not care how much weight you use on the knee extension machine or how flexible your hamstrings have become; if your balance is poor, you are at a far greater risk for a fall and/or injury. Anterior step ups will help improve single leg stance balance.
Deadlifts, squats, and leg press all create spinal compression. The anterior step up exercise creates much less in the way of compressive force on the lumbar spine. Fitness clients and athletes with a history of lower back pain can strengthen the legs with less spinal stress.
Real Life Carry Over
There is specificity to training. The exercises you perform in the gym must look and feel like the activities you must perform in real life. Your performance on a step up is far more likely to carry over to real life than your performance on a leg press or leg curl machine.
Anterior Step Ups
If you perform this at home, make sure you use a stable step up box—I would not use a padded lifting bench, milk crate, or old air conditioner. A mirror can be very useful in monitoring your performance. Most people can start with an eight inch household step.
Stand facing the box with one foot completely on the box–from heel to toes. When you perform a step up, use your gluteals and hamstrings to push through the foot and drive up into single leg stance. Do not jump up on to the step by leaning over and “popping up” with the rear leg. Bring the rear leg up to 90 degrees hip flexion, and hold a single leg stance for two counts. Try to abolish any wobble in your single leg stance position. Lower back down using the stance leg to control the descent. Perform all of the repetitions on one leg and then repeat on the other leg. If you find one leg is significantly weaker, then start with that limb first. Perform two or three sets of eight to ten repetitions.
Master your bodyweight on the eight inch step first and only then move to a higher box. A good goal is to move up a box height that places the top of the thigh just below parallel when the leg is placed on the box.
You can load the anterior step up many ways. I like using a medicine ball held at chest level as the first progression of loading and then progress to using an Iron Grip plate. For athletes the Barbell Step Up is a great functional exercise. It is best to perform this exercise in a power rack in case you lose control of the weight.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Pushing Through Fitness Barriers
How Sled Pushing Can Produce Big Results
Most of us have busy schedules and limited time to exercise at the gym. We want the most benefit possible for our time spent working out. Sled Pushing is a high value activity that can be utilized by almost all fitness clients.
True Core Stability
How our “muscles in the middle” truly work is in a standing position with our legs in contact with the ground. The legs are usually in an asymmetrical stance, transferring force from the ground through our body into the arms. Most “core stability” exercise performed in the gym put you in a supine position with no leg to arm connection. Sled pushing more closely emulates the demands place on our spinal stabilizers during daily activities.
In sports performance, the development of acceleration—the first four or five strides– is critical. Weight room training with box jumps, barbell squatting, and hang cleans has been shown to produce better vertical leap numbers, but not nearly the same gains in 40 yard dash times. Sled pushing places the body in the forward lean position you need to properly accelerate out of the blocks when sprinting. It trains the neural pathways that turn on your acceleration muscles.
The Road to Easy Recovery
Sled pushing is all concentric muscle activity and no eccentric. Eccentric muscle activity, the muscles lengthen against a resistance, creates much of the muscle soreness brought on by exercise. Your body needs more time to recover from eccentric muscle activity. You can perform a greater volume of work with a sled, and not be terribly sore the next day. For older trainees, whose bodies require more recovery time, sled work is a valuable training tool.
The Injured Athletes Rehab Training
If you have a knee, lower back, or hip injury you may not be able to perform squats, lunges, deadlifts, or kettlebell swings. Sled pushing is an alternative rehabilitation exercise for the lower body. I have had great success treating runners with knee pain using sled work as a recovery exercise. The core stability demands of sled pushing are helpful in restoring lumbar function in lower back pain patients.
Scalable to Any Fitness Level
Beginners can start with an empty sled and gradually add weight. I have been able to progress physical therapy patients from 25 pounds to 125 pounds in as little as four week’s time. Pushing is a very primal movement pattern, so most people catch on after two or three attempts.
Michael S. O’Hara, P.T., OCS, CSCS
Our shoulders and spine must endure prolonged computer input, extended commuter drives, sustained television staring, and way too much general slumping. The important postural muscles that keep us tall become weak and the muscles in the front of the shoulders get tight. The spinal muscles that hold our 24 vertebrae upright and stable functionally fall asleep and forget how to work together as a team. Prolonged sitting creates all sorts of neuromuscular problems that can be managed with restorative exercise. One of the best exercises you can perform to mitigate the damaging effects of prolonged sitting is the suspension row.
Better Than Seated or Bent Over Rows
Suspension rowing requires your spine to stay in a neutral position from the head to the pelvis. Most of the bent over rowing I witness in the gym involves the same slumped sitting posture you see in every office in America. Rows performed with a flexed thoracic spine are far from optimal and often help reinforce postural deficits. Properly performed suspension rows improve communication between the spinal stabilizers and strengthen the muscles that retract the shoulder blades.
Mastery Of Your Bodyweight
Being able to maneuver your body using the arms makes you functionally fit. During suspension rows, the resistance is not a plate or weight stack, but rather the weight of your body. You alter the resistance by moving the feet and changing the angle of the body in relation to the floor.
Friendly Force Curve
Suspension rows produce an accommodating resistance that is easier when you are at the weakest part of the rowing motion. The force necessary to perform a suspension row decreases as you move from the arms fully extended to the arms pulled in close to the body. This makes it a good exercise for people with weaker than average shoulder muscles.
Many people have no idea of how to correct the posture of their head and neck. Prolonged sitting, driving, and computer work have damaged their positional awareness or proprioception. The movement of the head and neck during suspension rows produces a neurological training of the cervical proprioceptors that can help fix this problem.
Improve the strength and endurance of the team of muscles that keep your posture tall and shoulders strong with suspension trainer rows. At FFAC, several TRX suspension trainers are located throughout the gym. For home use, attach the suspension trainer to the top of a doorway. Adjust the suspension trainer length so the handles are at your waist level or lower. Stand facing the TRX and grip the handles firmly. The position of your feet will determine the amount of resistance. Move the feet forward and the exercise is more challenging. Keep the entire torso straight, one long line from ear to ankle. Brace the abdominal muscles and gluteals and lean back. From the arms extended position, pull the handles into your side. As you perform the rowing motion, focus on moving the shoulder blades down and back. Return to the starting position and repeat. Perform two or three sets of six to ten repetitions. As you get stronger, progress to a full inverted row with the legs on a bench.
Caution: Make sure you use a solid suspension trainer product when performing this exercise. I have treated two patients with injuries that occurred when their homemade units malfunctioned and sent them flying to the floor. Do not skimp on safety with suspension training exercise. The emergency room visit and CT scan of your skull will be far more expensive. The TRX and Lifeline USA suspension trainers are the most well known units on the market.
Michael S. O’Hara, P.T., OCS, CSCS
Soft tissue mobilization with foam rolls has become popular in physical therapy, sports training, and fitness. Foam rolling helps decrease pain, improves mobility, and can enhance recovery from exercise. For an old gym rat like myself, it helps me bounce back from a tough training session, a long golf weekend, or too much computer time. More varieties of rollers have come on the market, and whenever we are faced with a lot of choices, it becomes more difficult to make a decision. In this short presentation, I have some suggestions on the proper roller for the job.
Rollers are available in three foot and one foot lengths. I find the longer versions easier to use, but I own a short pipe style roller that I take with me when I travel. Bigger guys generally do not do well with a short roller.
The best roller for you will depend on your tissue tolerance and how sensitive are you to the compressive forces of the roller. If you are new to foam rolling, a low density white Styrofoam roller is softer and will create less discomfort. As you develop better tolerance to rolling, you can progress to a firmer black foam roll. It has been my experience that the white rolls break down faster than the firmer black rolls, so be prepared to replace a white roll fairly often.
Hollow pipe style rollers are newer to the market and I have had good results with two products. The Grid Trigger Point roller is a cushioned hollow pipe with a grid pattern across the surface or the roller. Many smaller clients and patients report they like the short version of the Grid roller. Another hollow pipe version is the Rumble Roller. This product has a series of projections that extend from the roller surface. Self-soft tissue mobilization with a Rumble Roller is more uncomfortable than any other roller I have used. It is a more aggressive treatment but I have found it works well for individuals with thicker and denser muscles.
Not So Good
The hollow rollers that are covered with Styrofoam tend to break down fairly quickly. The rollers with fabric covers often create slippage problems with several types of clothing. The fabric interactions tend to make rolling less than efficient and are more difficult to control. The fabric covers tend to lose their fit after a few washings. The air inflated style rollers are a balance training device and are ineffective as a soft tissue mobilization tool.
Michael S. O’Hara, P.T., OCS, CSCS
PROPER TECHNIQUE–HIP HINGE
With their newest release, BODYPUMP is going back to basic, simple, weight training techniques and principles. New exercises are part of the lunge track, and greater focus on strengthening the gluteals and hamstrings are in the squat and deadlift tracks. BODYPUMP 85 will kick off in April at Fenton Fitness.
BODYPUMP TECHNIQUE: PROPER HIP HINGE
The hip hinge is a basic movement pattern we all should master. It keeps stress off the lumbar spine and improves strength in the hamstrings and gluteal muscles. The BODYPUMP row, deadlift, and clean all require a proper hip hinge. Many pump participants perform these lifts with way too much spinal motion. When you hip hinge the spine stays still and you tilt forward at the pelvis. The pelvis rolls around the femur to create flexion at the hip. The gluteal muscles and hamstrings create the motion that moves the bar, and the core stabilizers hold the spine stationary. The best view of your hip hinge performance is from the side. Practice the drill below to help improve your hip hinge.
Hip Hinge Stick Drill
You need a mirror and a pvc pipe, golf club, or yardstick. Stand sideways to the mirror and place the stick along the length of your spine. The stick should touch your gluteal muscles, thoracic spine, and head. A space between the stick and your body should be present at the lumbar spine and neck. Maintain those spaces as you push your bottom back and tilt forward. The knees should bend a little (20-30 degrees) and you should feel some tension in the back of the thighs. The motion happens at your hip and the lumbar and thoracic spine stays still. Use the mirror side view to assess your performance. The stick acts as feedback mechanism to help you keep the spine stable and initiate the movement at the hips. Progress to using your BODYPUMP barbell with a proper hip hinge motion.
Michael S. O’Hara, P.T., OCS, CSCS
TEST FOR SUCCESS
Easy Answers With The Y Balance Test
We are always looking for better ways to measure our physical therapy patients’ progress. You want to know if the treatment you prescribe is producing positive changes in the patients’ pain and functional mobility. You want to be able to identify weaknesses and focus efforts on the most significant problems. One of the best functional assessment tools is the Y Balance Test.
The Y Balance Test is a stance platform with three moveable reach boxes. Each box travels along a measuring stick. The patient stands on the platform and with the opposite foot, pushes the reach boxes down the measuring stick. A successful test involves reaching as far as possible and then successfully returning to a stable single leg stance position.
Measurements of the distances the patient was able to reach are recorded. Comparisons are made between the right and left legs. As the patient moves through therapy, he or she can be reevaluated on the Y Balance Test to measure the success of treatment intervention. A great effort is made to train away any asymmetry in reach distances between the right and left leg. Asymmetries in reach scores are correlated with greater incidences of future injury.
The Y Balance Test is a true measure of how we use our legs. Most activities of daily living and nearly all sports are all about single leg control. Unfortunately, most clinical tests look at only one joint segment, in non weight bearing positions. The Y Balance Test gives the clinician and patient a real world assessment of the interactive function of the foot, ankle, knee, hip, and torso in a standing position.
Patients like the test because it is easy to understand and gives them a clear training goal. The Y Balance Test takes minimal time to perform and patients do not have to be strapped into a machine or tethered to a computer. Patients often report that as their scores improve, they notice a decrease in pain.
Y BALANCE TEST
Research proven: Repeatable and reliable.
True measure of real world lower extremity function.
Easily understood scoring system.
Michael S. O’Hara, P.T., OCS, CSCS
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.
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