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Learn more about Rehab, Sports Medicine & Performance

Body Parts

Triathlon Success: Myofascial Management

Triathlon training is a vigorous and demanding athletic endeavor. The successful triathlete is often the one with the fewest injuries and the best recovery capacity.  Soft tissue mobilization with a roller helps decrease pain, improve mobility, and will speed up recovery between bouts of exercise.  Few of us can afford or dedicate the time to a daily massage.  The roller is the best do-it-yourself method of enhancing myofascial recovery.  Triathletes should begin every training session with five to ten minutes of roller work.

In the book, Anatomy Trains, Thomas Myers describes the interconnected webs of fascia and muscles that move our joints and hold us upright.  The human body is not just isolated muscles, but rather a series of interconnected lines of muscles and fascia that are reliant on one another to produce efficient movement.  The mechanical stress created by a roller keeps the tissue lines sliding and gliding across one another.  It removes neural and mechanical inhibitors of movement and makes exercise easier.

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.  Bigger and taller athletes generally do not do well with a short roller.

The best roller for you will depend on your tissue tolerance or how sensitive you are to the compressive forces of the roller.  If you are new to foam rolling, a low density white foam 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 versions, 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 of 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.

So how often should you, a triathlete, use a roller?  I like to stay active, pain free, and maintain my posture, so I use a roller every day.  Physical therapy patients with painful myofascial restrictions may need to foam roll two or three times a day.  Including five to ten minutes of foam rolling prior to a training session is the preventative medicine that will keep you on the road and out of the doctor’s office.  Watch the video that accompanies this article and get going on a roller.

View video here: Roller Video

Michael S. O’Hara, PT, OCS, CSCS

Spring Trap

Preventing Gardener’s Trauma

After a long, snowy Michigan winter, the first warm and sunny day, we charge outside and clean up the yard.  The months snow bound in the house have made the gardeners eager to start the spring clean up and prepare for the summer to come.  Most of us will spend the winter in a fairly sedentary physical state and with no physical preparation to launch into hours of challenging outdoor work activity.  Every year at our clinics, we treat patients with gardening and yard work induced injuries that could have been prevented with some modifications of activity and preventative exercise.  These are my four hints to help safeguard my gardener friends from an unintended trip to the doctor’s office.

#1: Set a Time Limit.

Most of the patients we see with gardener trauma report that they worked “all afternoon” in the yard.  It is not uncommon to hear patients report they were bending, pushing, or pulling for five or six hours.  Use some caution and limit the duration of your weeding, raking, and shoveling.  Set a time limit of two hours and then stop–the garden will be their tomorrow and you will be less likely to have to undergo a springtime MRI.

#2: Use Proper Ergonomics.

Many gardening tasks place your body in challenging positions.  Ergonomic experts go to great lengths to eliminate forward trunk flexion and sustained knee flexion from industrial work settings.  Pulling weeds and cleaning out flowerbeds combines both of these positions and can create mechanical back and knee pain.  Avoid being in the “hands and knees” position for extended periods of time by changing positions frequently.  Use knee pads to reduce compressive forces on the knee joints and purchase gardening tools with extended handles so that you need not bend as far or as often.

#3: Avoid Lifting Heavy Objects.

After a sedentary winter spent indoors watching television and knitting, the last thing you should attempt is to hoist the 40 lb. bag of fertilizer into the back of the wheelbarrow. Lifting injuries increase dramatically with loads greater than 25 pounds.  Lifting any object from the floor to standing is risky, and carrying unstable loads that can shift around increases stress on the body.  Divide heavy loads into smaller portions and avoid lifting directly off the floor.  Get a bigger, stronger, and fitter neighbor or family member to help with heavy lifting tasks.

#4: Prepare For Battle.

Gardening and yard work are challenging tasks that should be met with a degree of preparation.  If you want to work for five hours in the garden and remain pain free, you must train your body for that level of activity.  I have selected three simple exercises you can do to get yourself ready for action in the yard.  Simple modification of ergonomics, limitations on work duration, and preparatory exercise can prevent a summer of pain.

Getting Ready To Toil In The Soil.

These three exercises can help you avoid injury and make your spring gardening safer and more productive.  Ideally you will perform these drills three times a week for two or three weeks before getting outside and working.

Hip Flexor Stretches

This stretch elongates the large muscle that runs across the front of the hip and attaches to the spine.  This region tends to tighten with prolonged sitting and can restrict hip and spinal motion.  Place one knee up on a cushioned chair and the other foot slightly forward on the floor.  Keep the spine tall and bend the front knee to stretch the hip flexor muscles.  Hold for five to ten seconds and repeat five times.  Perform the stretch on the other side.

Four Point Fold Ups

If you are going to spend time on all fours, it is a good idea to train your body for this task.  Assume a four-point position, knees under the hips and hands under the shoulders.  Keep the hands stationary and drop the hips back toward the heels.  Go back to the point you feel a stretch and hold–do not stretch into pain.  You may feel this in your hips, shoulders, lower back, or upper back.  Hold for five to ten seconds and repeat five times.

Bodyweight Squats

Gardening and yard work involves a lot of squatting.  Being able to safely squat allows you to lift with better body mechanics.  Simple bodyweight squats will strengthen the legs and trunk in preparation for these tasks.  Place your feet at least shoulder width apart.  Check the foot width with a full length mirror– most people squat with the feet too close together.   Keep the heels flat on the floor and squat down by pushing the hips back.  Work on maintaining balance and control during the motion.  Practicing this movement pattern will also improve your flexibility.  Perform a series of ten repetitions and then rest and perform another set of ten.

Michael O’Hara, PT, OCS, CSCS

Training For Less Fat, More Muscle

How To Induce A Growth Hormone Response

Human growth hormone (hGH) has been a newsmaker because of athletes’ illicit use of synthetic versions of this hormone to help them perform better on the baseball diamond, football field, or bicycle race.  Bodybuilders inject synthetic hGH to help sink bodyfat levels to single digits, all the while maintaining optimal muscle mass. The last ten years of exercise science has shown what type of fitness activities induce the greatest natural growth hormone response.  Specific exercise and recovery activities have a positive effect on our body’s daily hGH production.

Human growth hormone (hGH) is secreted in a pulsatile fashion throughout the day.  A number of physiological stimuli can initiate hGH release, the most powerful of which are sleep and exercise.  Human growth hormone has many varied roles throughout your life.  For adult athletes and fitness clients, hGH helps increase fat metabolism–you get leaner, enhance muscle recovery from challenging exercise or injury, you stay stronger, and produce a healthier body composition as you age.

Resistance Training

Resistance training produces a significant exercise-induced growth hormone response (EIGR) that can last for 24 to 36 hours.  The response is greatest with full body training sessions that involve multi joint lifts and carries.  EIGR is not limited to traditional barbell or dumbbell training, but is also produced with the performance of bodyweight resistance training.  The post training hGH response gets better as the trainees became more proficient (gets stronger) with strength training.

Anaerobic Exercise

The exact mechanism that causes EIGR with anaerobic exercise is not known, but it appears to be related to higher lactic acid levels in the blood.  The activities that produce the greatest EIGR are high intensity exercise intervals lasting at least 30 seconds.  The researchers’ current recommendations for optimal EIGR are six to eight 30 second intervals of high intensity activity.  Bicycle sprints have been the most commonly used exercise modality in research studies, but other activities can be used as long as your joints and muscles can tolerate the stress.  Treadmill, stairclimber, rower, as well as track sprints and hill runs are good interval training choices.

Sleep

Human growth hormone is released in response to our natural circadian rhythms.  If your sleep-wake cycle is disturbed, the cyclical release of hGH is blunted.  Maintaining good sleep hygiene is important for optimal hGH production.  Avoid stimulants such as caffeine and alcohol before retiring to sleep.   Falling asleep and waking at consistent times creates more consistent hGH blood levels.  Just a few nights of interrupted or decreased sleep duration have been shown to reduce fat metabolism, slow muscle recovery, reduce insulin sensitivity, and decrease hGH levels.

Natural HGH Production Activity

Inducing optimal human growth hormone production is easy:  Get adequate and consistent sleep.  Every week, perform two or three high intensity interval style training sessions for six to eight sets of 30 seconds duration.  Two or three times a week perform a full body strength training program made up of full body multi joint exercises.

Michael S. O’Hara, PT, OCS, CSCS

Progression Know How

Carries, Crawls, and Core

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Carries, Crawls, and Core

Push Up Position Plank: Goal of 1 minute

Plank: Goal of 30 seconds

Side Plank: Goal of 30 seconds/side

Side Plank w/ outside foot elevated: Goal of 30 seconds/side

Side Plank w/ inside leg elevated: Goal of 30 seconds/side

Anterior Baby Crawl: goal of 15 yards with stable torso

Anterior Crawl: Goal of 30 yards with stable torso

Farmers Walk: Goal of 60 yards with body weight

Turkish Get Up (¼): Goal of 8/6kg (men/women) for 10 reps/side

Turkish Get Up (½): Goal of 10/12kg (men/women) for 6 reps/side

Turkish Get Up (full): Goal of 25% body weight for 4 reps/side.

See video demonstration of these exercises here: https://youtu.be/5OkXbOWx4mw

Progression Know How

Vertical Pull Patterns

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Pull Patterns

X Pulldowns: Goal of 50% bodyweight for 10 reps

Isometric Pull/Chin up holds: Goal of holding for 1 minute at both the top and bottom position

Eccentric Pull/Chin ups: Goal of 10 eccentric reps with a 3-5 second descent

Pull/Chin ups: Goal of 10/5 reps (men/women)

See video demonstration at: https://youtu.be/Xidv7HlNtWE

 

Progression Know How

Horizontal Pull Patterns

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Pull Patterns

TRX Row: Goal 45 degree angle for 10 reps

One Arm DB Row: Goal of 50% bodyweight for 10 reps per arm

Inverted TRX Rows: Goal of 10 reps with full range of motion

Watch Jeff demonstrate these exercises: View Video

Progression Know How

Vertical Press Patterns

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Press Patterns

Tall Kneeling Bilateral Landmine Press- Goal of 45# for 10 reps (men), 25# for 10 reps (women)

½ Kneeling 1 arm Landmine Press- Goal of 45# for 5 reps/arm (men), 25# for 5 reps/arm (women)

½ Kneeling 1 arm KB Overhead Press- Goal of 20kg for 5 reps/arm (men), 12kg for 5 reps/arm (women)

Standing 1 arm DB/KB Overhead Press- Goal of 25% bodyweight for 10 reps/arm

Barbell Overhead Press- Goal of bodyweight for 1 rep (men), or 75% bodyweight for 1 rep (women)

Watch Jeff demonstrate these exercises: View Video

Progression Know How

Horizontal Press Patterns

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Press Patterns

Push Ups- Goal of 20/10 reps (male/female) with chest touching floor.

Alternating DB Bench Press- Goal of 50% body weight per arm for 5 reps/arm (men) or 33% body weight per arm for 5 reps/arm (women).

Bench Press- Goal of 75% bodyweight (women) or bodyweight (men) for 3-5 reps

See video demonstration of these exercises here: View Video

Progression Know How

Hinge Patterns

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Hinge Patterns

KB Deadlift- Goal of 10 reps with 40kg (88lbs)

Single Leg Reaching Deadlift- Goal of 10 reps/leg with perfect form

Single Leg Deadlift- Goal of 10 reps/leg with 50% of bodyweight

Trap Bar Deadlift- Goal of 2x bodyweight (men) or 1.5x bodyweight (women) for 3-5 reps

See video demonstration of these exercises here: Hinge Pattern Video

Finding Fitness With Lower Back Pain

The number of USA emergency room visits, pain medication orders, injections, imaging studies, and surgical interventions directed at lower back pain continue to rise.  I frequently meet people who report their fitness efforts have been hampered by low back pain.  I have five recommendations that can help fitness clients with lower back pain have more success in the gym.

#1 Do not exercise first thing in the morning:  Ergonomic experts have found that many more industrial lower back injuries happen in the morning.  The theory is that the discs in the lower back imbibe or gain fluid overnight and are more likely to deform with a physical challenge.  Give your lower back one or two hours of walking around time before starting an exercise session.

#2 Isometric strengthening of the spinal stabilizers:  The function of your “core” muscles is to limit movement of the lumbar spine and pelvis.  Stop all crunches, toes to bar, sidebends, sit ups, seated twisting, and learn how to perform bird dogs, side hovers, Pallof press, planks, and carries.  Compliance with this single hint would reduce USA expenditures on lower back pain dramatically.

#3 Enhance the function of your hip flexors and gluteal muscles: Please cease all the forward spine flexion, toe touching, spine twisting activities.  Greater lumbar spine range of motion is associated with more–not less, lower back pain problems.  Learn how to foam roll and mobilize the hip flexors and gluteal muscles.  Prolonged sitting and most popular “cardio training” deadens these muscles.  Properly functioning hip flexors and gluteal muscles keep the pelvis stable and take stress off the lower back.  Reawakening dormant gluteals and hip flexors is the magic that resolves long term lower back pain.

#4 Focus on single leg strength training:  Ditch the front loaded hip hinges–deadlifts, cleans, snatch, and drop the loaded squats.  Swear off the lower lumbar deranging leg press.  Reduce spinal compression and train the legs, one at a time.  Single leg training reveals the right / left side movement asymmetries that drive lower back pain.  Resolving these asymmetries and sparing the spine goes a long way to abolishing back pain.  You will need some guidance on exercise selection and execution- this brings me to #5.

#5 Get some help:  Exercise is the most powerful medication on the planet.  Nothing else comes close.  Take the proper dose of appropriate training and the results will be amazing.  Take the wrong dose of an inappropriate activity and the results can be devastating.  This is especially true for people with a history of lower back pain.  Find a qualified physical therapist to guide you through your fitness journey.  One way or the other, you are going to spend time and money on your health.  Proactive spending is always cheaper and more beneficial than reactive spending.

Michael S. O’Hara, PT, OCS, CSCS

 

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