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Shoulder

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Standing Desk Exercise Rx

Work Station Transition Training

As a physical therapist making his living taking care of people with pain problems and physical limitations caused by prolonged sitting, I am an avid promoter of standing desks.  Over the last five years, the prices of standing desk products have come down and the variety has increased.  Manufacturers now permit a 30 day “no risk” trial.  Try a standing desk for thirty days and then ship it back if it does not meet your needs.  I encourage anyone who must sit for more than five hours a day to convert some of those sitting hours to a stand up desk.  Employers are now aware of the benefit of standing desks and actively encouraging their use.  It can take some time to become accustomed to working at a standing desk.  I have three training tools that can help make working at a standing desk easier.  Read this article and watch the video for a demonstration of how to use each product.

Foot Care With a Spiky Ball

The bottom of the foot is a busy intersection of muscles, tendons, ligaments, fascia, and nerves.  Heel and plantar pain are common reasons we see patients in the physical therapy clinic.  Foot pain problems can take months to fully recover.  A little proactive soft tissue treatment will bulletproof the feet from overuse injury and pain.   A spiky ball is a small sphere with fairly aggressive projections.  Take off your shoes and give your peds a little love by rolling the bottom of your foot over a spiky ball.  Spiky balls come in various sizes and resistances.  I have found the smaller (2 ½ – 3 inch) and firmer models work the best for my foot.  Most people report that it “hurts good” and often get one for work and one for the home office.  Most spiky balls cost around seven dollars.

Posture Correction With Resistance Bands

If you have been a long-term seated data input warrior, you have probably been infected with the i-hunch virus.  As we get older, the muscles that hold the thoracic region tall and pull the shoulder blades back tend to get weaker at a faster rate than other muscles.  Prolonged standing is going to be challenging without some remedial rebooting of the software that holds you tight and tall.  I keep a ¼ inch superband (nine dollars from performbetter.com) at my desk and perform two upper body postural strengthening exercises.  Posture restoration takes some time so work on these drills every day for at least three months.

Band Pull Aparts

Choose a resistance band that allows you to perform a complete set without reaching failure.  The force produced by the band becomes greater as you travel through the movement so avoid a band with a strong resistance.   The tempo of the movement should stay smooth and steady.

Stand tall with the chest proud and the head pulled back.  Do not arch the upper back.  Tighten the abdominal muscle and keep the front of the rib cage down.  Hold the elbows fully extended and the wrist in neutral.  You can use either a palms up or a palms down arm position.  Individuals with some shoulder wear and tear may feel better with a palms up position.  Hold the arms up to 85 degree shoulder flexion and start with a low level of tension on the band.  Concentrate your efforts on the muscles between your shoulder blades as you pull the band apart and bring the hands out to the side.  Let the band stretch across the chest and pull the hands behind the body.  Tempo: Two counts- pull the band apart. Two counts- hold at end range. Two counts- return to the starting position.   Repetitions:  10 – 20 repetitions.

Postural Band Aid

One of the most convenient and easy to perform postural correction activities is an exercise I call the postural band aid.  Take a short length of therapy resistance band and stand up.  Assume a tall posture with a proud chest and the head pulled back.  Hold one side of the band in each hand with the palms up.  Keep the elbows by the side and bent to 90 degrees.  Pull the band apart so that your arms form a letter W with your arms and body.  You should feel a tightening of the muscle between your shoulder blades.  Hold the band apart for three counts and then slowly release back to the starting position.  Perform ten repetitions.

Dynamic Core Stability With Dynamax Medicine Ball

Physical therapy patients and fitness clients often complain of lower back fatigue when using a standing desk.  Solve this problem with some dynamic stabilization training.  Place a Dynamax medicine ball or an under inflated basketball under the desk and take turns elevating one leg up onto the ball.  The round ball creates a degree of instability that kicks in the stabilizers of the pelvic girdle and lower back.  Changing position and relieving stress on the joints in the pelvic girdle and lumbar spine can help abolish symptoms of fatigue.  It is one of the reasons your local saloon has a place to rest your foot when you belly up to the bar.  The majority of standing desk users report an improvement in symptoms using this simple alteration in stance.

Watch the video here

Michael S. O’Hara, PT, OCS, CSCS

 

Non Traditional Tweaks to Old Time Favorites–Bonus

In the fitness world, there are several exercises which have stood the test of time.  These movements have remained because they work, require little equipment, and give you a lot of bang for your buck. The movement patterns these exercises use are very important and you should continue to train using them throughout the duration of your life for optimal function. However, as we age, our joints lose space between them.  This makes spinal compression and shear forces more problematic in many individuals.  This decreased space in the joint also makes impingements in the hip and shoulder more likely, as well as discomfort in the knee and elbow.  When this begins to happen, many individuals just shy away from the movements all together leading to loss of strength, stability, and mobility throughout the body.  One solution we have found to this problem here at Fenton Fitness is reducing overall system load by altering range of motion, balance/stability, or load placement.  In some cases, these lower load alternatives completely replace the standards and in others, they are rotated in based on client history, goals, and adaptation.  For the next few weeks, I will be giving some alternatives to some traditional exercises.

Jeff Tirrell, CSCS, CSFC, Pn1

Bonus:

The last four exercises I want cover are not traditional resistance training exercises, but they can have a dramatic impact on your movement, decrease discomfort, and just help make you a more awesome and higher functioning individual.

Lateral Squat– Most standard exercises are done bilaterally (2 hands or feet moving together) and in the sagittal plane of movement.  We want to make sure to also incorporate the frontal and transverse planes when training.  The Lateral Squat gets us into the frontal plane and strengthens the often neglected adductor muscles (groin/inner thigh muscles), as well as hitting the glutes in a direction they normally don’t get worked.

Crawling– Crawling is fundamental to human development.  We learn to do it before we walk or run.  We also start to lose this ability as we age.  By continuing to crawl, we can keep important neurological pathways working, as well as strengthen our core, upper body, and legs in a relatively low stress way.

Get Ups– The best-known form of this exercise is the Turkish Get Up.  However, it doesn’t need to be that complicated or technical.  Simply lying on the floor and getting up a variety of different ways can go a long way in maintaining core strength, and whole-body mobility.

Farmers or Suitcase Carry– The Farmers and Suitcase Carry are great tools for building a stronger gait, improving grip strength, core strength, and stability.  The Suitcase Carry, because of its asymmetrical loading, adds a great anti-lateral flexion component that really challenges the obliques to lock down and hold the ribs in place.

View video of these exercises: View Video

Non Traditional Tweaks to Old Time Favorites–Part 6

In the fitness world, there are several exercises which have stood the test of time.  These movements have remained because they work, require little equipment, and give you a lot of bang for your buck. The movement patterns these exercises use are very important and you should continue to train using them throughout the duration of your life for optimal function. However, as we age, our joints lose space between them.  This makes spinal compression and shear forces more problematic in many individuals.  This decreased space in the joint also makes impingements in the hip and shoulder more likely, as well as discomfort in the knee and elbow.  When this begins to happen, many individuals just shy away from the movements all together leading to loss of strength, stability, and mobility throughout the body.  One solution we have found to this problem here at Fenton Fitness is reducing overall system load by altering range of motion, balance/stability, or load placement.  In some cases, these lower load alternatives completely replace the standards and in others, they are rotated in based on client history, goals, and adaptation.  For the next few weeks, I will be giving some alternatives to some traditional exercises.

Jeff Tirrell, CSCS, CSFC, Pn1

Hinge:

Traditional- Barbell Deadlift

Alternatives- One Leg Deadlift or Kettlebell Swing

Both the One Leg Deadlift and KB Swing reduce the load being used.  Both have less shear forces going through the low back.  The One Leg Deadlift introduces a great balance component, as well as anti-rotational component to the hips.  The KB Swing introduces high velocity and power production which can’t be matched by a Barbell.

View video of these exercises: View Video

Non Traditional Tweaks to Old Time Favorites–Part 5

In the fitness world, there are several exercises which have stood the test of time.  These movements have remained because they work, require little equipment, and give you a lot of bang for your buck. The movement patterns these exercises use are very important and you should continue to train using them throughout the duration of your life for optimal function. However, as we age, our joints lose space between them.  This makes spinal compression and shear forces more problematic in many individuals.  This decreased space in the joint also makes impingements in the hip and shoulder more likely, as well as discomfort in the knee and elbow.  When this begins to happen, many individuals just shy away from the movements all together leading to loss of strength, stability, and mobility throughout the body.  One solution we have found to this problem here at Fenton Fitness is reducing overall system load by altering range of motion, balance/stability, or load placement.  In some cases, these lower load alternatives completely replace the standards and in others, they are rotated in based on client history, goals, and adaptation.  For the next few weeks, I will be giving some alternatives to some traditional exercises.

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Pull:

Traditional–Bent over Barbell Row

Alternatives–Suspension Trainer Row or Horse Stance DB Row

The Suspension Trainer Row requires only your body weight and places no external load on your lower back.  It also better activates the lats.  The Horse Stance DB Row introduces a component to the movement in a position known to reduce back pain and strengthen the core musculature.

View video of these exercises: View Video

Non Traditional Tweaks to Old Time Favorites–Part 4

In the fitness world, there are several exercises which have stood the test of time.  These movements have remained because they work, require little equipment, and give you a lot of bang for your buck. The movement patterns these exercises use are very important and you should continue to train using them throughout the duration of your life for optimal function. However, as we age, our joints lose space between them.  This makes spinal compression and shear forces more problematic in many individuals.  This decreased space in the joint also makes impingements in the hip and shoulder more likely, as well as discomfort in the knee and elbow.  When this begins to happen, many individuals just shy away from the movements all together leading to loss of strength, stability, and mobility throughout the body.  One solution we have found to this problem here at Fenton Fitness is reducing overall system load by altering range of motion, balance/stability, or load placement.  In some cases, these lower load alternatives completely replace the standards and in others, they are rotated in based on client history, goals, and adaptation.  For the next few weeks, I will be giving some alternatives to some traditional exercises.

Jeff Tirrell, CSCS, CSFC, Pn1

Squats:

Traditional- Barbell Back Squat

Alternatives- ½ Racked KB Squat or Rear Foot Elevated Goblet Split Squat

Both the ½ Racked Squat and RFE Split Squat reduce load, easing the stress to the low back, hips, and knees.  The ½ Racked KB Squat introduces rotational & lateral flexion forces to the equation causing the core to work very hard to resist these forces.  The Rear Foot Elevated Goblet Split Squat leads to a more upright posture reducing shear and compressive forces on the lumbar spine.  This exercise also tends to better target the glutes and put the quad under a more stretch and larger range of motion.

View video of these exercises: View Video

Non Traditional Tweaks to Old Time Favorites–Part 3

In the fitness world, there are several exercises which have stood the test of time.  These movements have remained because they work, require little equipment, and give you a lot of bang for your buck. The movement patterns these exercises use are very important and you should continue to train using them throughout the duration of your life for optimal function. However, as we age, our joints lose space between them.  This makes spinal compression and shear forces more problematic in many individuals.  This decreased space in the joint also makes impingements in the hip and shoulder more likely, as well as discomfort in the knee and elbow.  When this begins to happen, many individuals just shy away from the movements all together leading to loss of strength, stability, and mobility throughout the body.  One solution we have found to this problem here at Fenton Fitness is reducing overall system load by altering range of motion, balance/stability, or load placement.  In some cases, these lower load alternatives completely replace the standards and in others, they are rotated in based on client history, goals, and adaptation.  For the next few weeks, I will be giving some alternatives to some traditional exercises.

Jeff Tirrell, CSCS, CSFC, Pn1

Lat Pullovers:

Traditional- Flat Bench DB Pullover

Alternatives- Decline Bench KB Pullover OR Alternating DB Pullover on Table or Foam Roller

The Decline KB Pullover actually increases the range of motion of this exercise and causes the Lats and Pecs to work longer and harder.  This makes this a superior exercise and reduces load so it’s a win-win.  This version also causes your anterior core to work very hard as an anti-extension component.  The Alternating DB Pullover on Table of Foam Roller increases shoulder stability, and if using the Foam Roller, also increases stability demands of the whole body.  Both of these versions will reduce strain on the shoulder, and increase core activation.

View video of these exercises: View Video

Non Traditional Tweaks to Old Time Favorites–Part 2

In the fitness world, there are several exercises which have stood the test of time.  These movements have remained because they work, require little equipment, and give you a lot of bang for your buck. The movement patterns these exercises use are very important and you should continue to train using them throughout the duration of your life for optimal function. However, as we age, our joints lose space between them.  This makes spinal compression and shear forces more problematic in many individuals.  This decreased space in the joint also makes impingements in the hip and shoulder more likely, as well as discomfort in the knee and elbow.  When this begins to happen, many individuals just shy away from the movements all together leading to loss of strength, stability, and mobility throughout the body.  One solution we have found to this problem here at Fenton Fitness is reducing overall system load by altering range of motion, balance/stability, or load placement.  In some cases, these lower load alternatives completely replace the standards and in others, they are rotated in based on client history, goals, and adaptation.  For the next few weeks, I will be giving some alternatives to some traditional exercises.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Press:

Traditional- Barbell Military Press (Overhead Press)

Alternative- ½ Kneeling One Arm KB OH Press, One Arm One Leg KB OH Press, or Stability BB Overhead Press

Both these alternatives reduce overall system load.  This can help reduce neck, shoulder, and elbow pain. The half kneeling option adds a great core strength/stability component, while the One Leg Press adds a great balance component to the movement.  The Stability BB Overhead Press introduces instability to the bar which increases the dynamic stability demands on rotator cuff muscles.

View video of these exercises: View Video

Non Traditional Tweaks to Old Time Favorites–Part 1

In the fitness world, there are several exercises which have stood the test of time.  These movements have remained because they work, require little equipment, and give you a lot of bang for your buck. The movement patterns these exercises use are very important and you should continue to train using them throughout the duration of your life for optimal function. However, as we age, our joints lose space between them.  This makes spinal compression and shear forces more problematic in many individuals.  This decreased space in the joint also makes impingements in the hip and shoulder more likely, as well as discomfort in the knee and elbow.  When this begins to happen, many individuals just shy away from the movements all together leading to loss of strength, stability, and mobility throughout the body.  One solution we have found to this problem here at Fenton Fitness is reducing overall system load by altering range of motion, balance/stability, or load placement.  In some cases, these lower load alternatives completely replace the standards and in others, they are rotated in based on client history, goals, and adaptation.  For the next few weeks, I will be giving some alternatives to some traditional exercises.

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Press:

Traditional- Barbell Bench Press

Alternative- Alternating DB Bench Press, One Arm DB Bench Press, Stability BB Bench

The Alternating DB Press, the One Arm DB Bench, and the Stability BB Bench reduce the load you are capable of handling.  This can reduce overall stress on the shoulder, elbow, and wrist.  The Alternating Press has the added benefit of greater stability demands on the shoulder which better strengthens the rotator cuff musculature while the One Arm Press introduces some rotational forces which force the core musculature to resist the rotation.  The Stability BB Bench introduces instability to the bar which increases the dynamic stability demands on rotator cuff muscles.

View video of these exercises: View Video

The Cumulative Effect of Activity

Many people are put off from starting an exercise routine because they are overwhelmed by the time commitment they feel is necessary.  Fitness magazines, exercise experts, and everything on youtube preaches–

–30 minutes of cardio three times a week

–45 minutes of strength training twice a week

–150 minutes of exercise per week

Most of this well-intentioned advice is wrong.  Nearly everyone can derive significant benefit from short bouts of fitness activity that are performed on a consistent basis.  Walk for five minutes twice a day.  A simple routine of two strengthening exercises will take no more than five minutes.  Climb the stairs in your home three times once a day.  Practice getting up and down of the floor.  Stay consistent with a routine of short exercise bouts and you will be healthier and stay independent for a lifetime.

More research has demonstrated the beneficial effect of short exercise sessions interspersed throughout the day.  Read the March 28, 2018, New York Times article by Gretchen Reynolds, Those 2-Minute Walk Breaks?  They Add Up.  View the article: https://www.nytimes.com/2018/03/28/well/move/walking-exercise-minutes-death-longevity.html

Mike O’Hara, PT, OCS, CSCS

The Coldest of Shoulders

Understanding and Not Understanding Adhesive Capsulitis

Marilyn first noticed the right shoulder pain when she was sleeping on her right side.  Over the next month, the pain became more frequent and more intense.  Her shoulder ached in the morning and after any repetitive activity.  Marilyn tried medications and ice, but the pain persisted.  After eight weeks, the pain decreased, but her shoulder movement had become restricted.  Her shoulder became so tight that she developed difficulty with activities of daily living such as fixing her hair, dressing, and bathing.  Marilyn had developed a “frozen shoulder” and the frustrating thing was that she had no idea why it had happened.

No one fully understands why a frozen shoulder develops.  For some reason, the envelope of tissue that surrounds the glenohumeral joint–the joint capsule, shortens and develops thickened adhesions or scar tissue.  The medical term is “Adhesive Capsulitis”.  This tissue restriction limits the ability of the humeral head (upper arm bone) to rotate and glide properly so your shoulder becomes tight and painful.

Most of the time, a frozen shoulder occurs with no associated injury or activity.  Frozen shoulder most commonly affects patients between the ages of 40 and 60 years old.  It is far more common in women than men.  Individuals with diabetes are at far greater risk.  If you have undergone a surgery or sustained a trauma to the shoulder, you can develop a frozen shoulder.  This is especially true if you have held the joint immobile for a period of time.  Several studies have linked Parkinson’s disease, thyroid problems, and heart disease to a greater incidence of frozen shoulder.  Patients that develop a frozen shoulder are more prone to getting it in the opposite shoulder.  Despite all of this knowledge, we continue to see many frozen shoulder patients that have none of these predisposing factors.

I would add another condition to the commonly mentioned predisposing risk factors for frozen shoulder.  In my career as a physical therapist, it has been a rarity to find a frozen shoulder patient who was strong.  From grip strength in the hand to the muscles that hold the shoulder blade on the rib cage, these patients are usually weaker than their same age and sex peers.  The strength in the unaffected arm is often as limited as the arm with the frozen shoulder.  My belief is that the most common risk factor for developing a frozen shoulder is upper body weakness.  The glenohumeral joint is a fairly unstable joint that relies on the integrity of the muscles to kept it free from trauma.  If the shoulder muscles are unable to properly control the joint, then excessive stress is transmitted to the joint capsule and an inflammatory response ensues that scars and tightens the capsule.

Physical therapy for a frozen shoulder consists of manual therapy to stretch out the shortened joint capsule and a program of exercise to restores shoulder range of motion, coordination, and strength.  Most of the time, we get the patient when the shoulder is at its tightest point and recovery takes six to ten weeks.  As with so many conditions, the patients that get to therapy earlier or before the shoulder is fully frozen do better with therapy.

In many ways, Marilyn is the typical frozen shoulder patient.  She is the correct, age, sex, and fitness level.  Further medical work up revealed that she was prediabetic and in need of some ongoing medical attention.  Marilyn was a model physical therapy patient and her shoulder function was restored with six weeks of physical therapy.

Michael S. O’Hara, PT, OCS, CSCS

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