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Shoulder

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Pulls

Just like the vertical press exercises, vertical pulls can be hard to execute due to their mobility requirements, but are the most effective and efficient movements when trying to build a strong and healthy upper body. The broadest posterior chain muscle in the body, the latissimus dorsi, has the primary actions of humeral adduction, extension and internal rotation, but also contributes to posture due to its attachment points. Vertical pulls also work the arms (brachioradialis, biceps brachii, triceps long head), shoulders/back (trapezius, posterior deltoid, teres major, rhomboids), and pelvic floor (rectus abdominis, internal and external obliques).

Pull Up/Chin Up: Pull ups/chin ups work the majority of the muscles in the mid/upper back and flexors of the arm. The rotator cuff muscles and core musculature play a more stabilizing role.  In both variations, think about keeping the core engaged.  There should not be extension in the lower back and if there is, you will notice yourself swinging back and forth during reps. When pulling up, think about leading with your collarbone and actually touching it to the bar. Another useful cue is to think about pulling the elbows to your pockets. Avoid rounding the upper back over the bar when reaching the top of the movement.  If you are having trouble touching your chest to the bar, it is either a strength or mobility issue.

½ Kneeling One Arm Pull Down
Set up at the Cybex machine or any cable hook up. Grab just one handle and put that same side knee down on the ground with the toe dug in.  Make sure the arm is angled in such a way that you have to reach across your body when the arm is flexed overhead. Your palm should be facing forward, and as you pull down, turn the hand towards the body and keep the elbow close to your side. Concentrate on squeezing the muscles in the back and keeping the rest of the body still with the core braced. Switch legs when you switch arms.

View video of vertical pulls here: https://youtu.be/knAFry9p-LM.

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Pulls

A horizontal pulling exercise is any exercise that involves moving a weight in towards your torso horizontally from straight out in front of you. A good exercise routine should incorporate both pushing and pulling movements in order to keep a healthy balance, better posture, and prevention of shoulder injuries. Muscles involved in pulling exercises include biceps, latissimus dorsi, rhomboids, posterior deltoid, and middle trapezius.

Arm DB Row
There are a couple different variations that could be done with the one arm row. In the first and most common variation, set up with one dumbbell and put the opposite hand and knee on a flat bench. The back should be flat and the weighted arm should be straight with full extension in the shoulder. Keeping the core braced, bring the dumbbell straight up to the side of your chest, keeping your upper arm close to your side. Concentrate on squeezing the back muscles once you reach the full contracted position. In the second variation, we are going to get a little more athletic and functional. It is called three stance row, or straddle stance row. Stand with the legs a little wider than shoulder width apart. Bend the knees slightly and make sure the feet are equally distributed and the back is flat (think linebacker).  Put one arm on the end of the bench or a 16-20” box. The hand with the dumbbell should be directly under the shoulder and centered. Row as described previously.

PUPP DB Row
Set up with two dumbbells in a push-up position plank. Keep the feet further apart to make the exercise easier, keep feet closer together to make it harder. Pull up one dumbbell, keeping the elbow close to the body and avoiding the tendency to dip the opposite hip. The body should stay still throughout the exercise. This variation is going to challenge the core as well as the rowing muscle groups. Alternate arms.

Horse Stance DB Row
This variation of the DB row is going to be more challenging than just a regular row as it is going to test your core stability and balance. Set up with one dumbbell and a bench. Put the opposite hand and knee on the bench and extend the free leg out horizontally, with the ankle dorsiflexed. The other arm is holding the dumbbell straight down as with any other row variation. Keeping the core braced, bring up the dumbbell in the same pattern as previously stated. Avoid the tendency to dip the opposite hip down. The weight used in this variation is going to be lighter than usual.

View the video here: https://youtu.be/gSMvrJGVeN4

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Presses

The vertical press targets the sternal and clavicular head of the pectoralis major to a small degree as well as the anterior deltoids in front of each shoulder. The triceps are the prime movers.  This is a tough movement for beginners to grasp because it requires a certain degree of mobility, but can be very beneficial to overall strength with a huge carry over to other pressing exercises. These movements can be performed kneeling or standing with one arm or two arms. Start from the ground and work your way to standing.

Tall Kneeling Bilateral DB Press: By starting in the tall kneeling position, we remove the hips, knees, and ankles from the equation.  This makes it easier to focus on what the upper body and core are doing along with eliminating common compensation patterns.  Kneel down on both knees with your toes dug into the ground.  Make sure your hips are fully extended (not sitting back on your feet).  From there simply bring the weights up to shoulder level with a neutral grip (palms facing each other).  Squeeze your grip and press upward while rotating your palms forward.  Stop when your elbows are locked and your biceps are by your ears.

Tall Kneeling Alternating DB Press: In this progression, the setup is the same as for the Tall Kneeling Bilateral Press, except you are going to alternate pressing one arm overhead at a time.

Tall Kneeling One Arm DB Press: This movement will require the same setup as the former two movements.  However, you will only use one weight and do one arm at a time.  This will require more rotational and lateral stability out of the core musculature.  Make sure to brace your core and don’t allow yourself to twist or shift your weight to one side.

½ Kneeling Bilateral DB Press: By lowering the center of mass, it is easier to practice moving through the hips and shoulders with less movement through the pelvis and lumbar spine, which is a common mistake and more difficult to fix in the standing position.  Assume a ½ kneeling position with the kneeling side toe dug in.  The front leg should be in line with your hip (not out to the side), and the ankle should be under or slightly behind the knee.  The knee that is down should be under your hip.  Bring a pair of dumbbells up to your shoulders with a neutral grip and press them overhead just as with the tall kneeling press.

½ Kneeling Alternating DB Press: Same setup as the ½ Kneeling Bilateral Press.  This version simply alternates the pressing.

½ Kneeling One Arm DB Press: Same setup as the previous two exercises.  For this version, you will only use one arm.  Grab a weight on the same side that you are kneeling on.  Start with a neutral grip and press overhead.  The asymmetrical loading will place a large stabilizing demand on the obliques and rectus abdominal musculature.

Standing Bilateral DB Press: Standing tall with the feet about shoulder width apart, bring the dumbbells up to shoulder level and press both at the same time. Make sure to keep core engaged and feet grounded. A common mistake is to arch the back and lean back just to get the weights up.  Make sure the weight being used isn’t forcing your body into extension just to lift them up.

Standing Alternating DB Press: The same setup as the previous exercise, just press one arm up at a time while the other stays at shoulder height. Try to avoid tilting in the shoulders.

Standing One Arm DB Press: The same setup as the previous exercise, just use one dumbbell and do one arm at a time.

Contralateral Standing DB Press: For this variation set up with one dumbbell, stand on the opposite leg than the dumbbell side. This movement will require core stability and balance and due to this, the weight used does not need to be heavy, which is ideal for those who suffer with shoulder pain as they can still feel challenged without lifting a heavy weight.

Video of vertical presses can be seen here: https://youtu.be/2-7T0ebGIkM

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Presses

The Horizontal Pressing variations primarily work the pectoral musculature, anterior deltoid, and triceps.  The rotator cuff musculature plays a stabilizing role.  As we progress through this series, the core musculature, particularly the anterior core and glutes play even more of a stabilizing role.  The strength of the stabilizers will be your limiting factor on these movements, not the prime movers.  These movements can be performed on the floor, bench, or incline bench.

DB Bench Press: Set up with both feet planted firmly on the floor, slightly wider than shoulder width apart.  Lie down on the bench bringing the dumbbells to your shoulders as you do.  As soon as you are lying down, press the dumbbells straight up.  Try to keep your elbows at roughly 45 degrees from the side of your body.

Alternating DB Bench Press: With the same setup as the DB Bench Press, start with both arms extended straight and dumbbells touching. Lower one arm at a time keeping the other arm fully extended. This variation builds endurance and promotes stability in the chest, triceps, and shoulder muscles.

One Arm DB Bench Press: Performing a DB Bench Press with one arm really engages the core and stabilizer muscles in the chest. This is a great exercise for athletes as they are often required to throw, shoot, or hit a ball with one arm and this variation mimics that motion. Set up in the same position as the previous variations except only use one dumbbell. The other arm can extend out to the side or rest on the stomach. Lower the one arm down slowly and make sure to extend fully at the top, avoiding the tendency to lean to the opposite side.

Contralateral DB Bench Press: This variation of the dumbbell bench press requires the core to brace and stabilize while having one hip flexed and the other extended (just like it would be when throwing a ball). With one dumbbell that is lighter than one you would usually use for pressing, lay flat on the bench and bring the leg up on the same side as the dumbbell. Bend the knee at a 90 degree angle, flex the hip, and dorsiflex the ankle. The other foot is firmly planted on the floor. Place the free hand on the stomach or straight out to the side for balance. The core should be braced and the low back should be pressing into the bench as you press the dumbbell straight up just as in the other variations.

Watch video of press progressions here: https://youtu.be/4ihkyIOXi4g

Heat Or Ice For My Shoulder?

Try Standing Upright

In the gym, at the golf course, and during a visit to the hardware store, I am asked my advice on abolishing shoulder pain.  What everyone wants is the magical exercise, miracle ointment, or newest thermal treatment.  What they need–and what they do not want to hear–is that they have to fix their horrible posture.

Sustained poor posture can alter the function of your shoulder complex.  The shoulder girdle has only one, very small, bone to body connection.  The entire system is an interconnected series of muscles and ligaments.  Sustained slouched over postures create a faulty length-tension relationship in these structures that places adverse stress and strain on the four joints of the shoulder and the nerves in the neck and upper back.

OMG I sit lmGm (like my GrandMa).  

Shoulder posture pain problems are happening earlier.  I do not know if it is more tech toys, less physical education in schools, or a change in youth activity levels, but in the physical therapy clinic we are seeing younger people with older people postural shoulder pain.  They sit on the treatment table in extremely slouched over positions and are unable to pull themselves up into a correct position.  Most are unconvinced that how they sit and stand could be the generator of their pain problem.

What exercises can I do?

Stronger muscles will help restore posture.  The shoulder evolved to pull, lift, and carry.  The muscles that keep the shoulder strong and happy are in the back of the shoulder.  They hold the shoulder in a healthy position on the body.  Most of us never perform any pulling or lifting activities other than hoisting our laptop or toting our smart phone.   Making your shoulder girdle muscles stronger will help, but being mindful of your posture during the day is the most important factor.  Physical Therapist and US Soccer Team Trainer Sue Falsone says “You can’t out rep poor posture.”

Start with how you work and live.

Eight hours a day for five days a week equals 2080 hours of computer / desk time a year for the average office worker.  Add in a daily one hour car commute and another two hours of television a day and we push the Monday through Friday slump numbers to 2860 hours a year (120 days).  We have spent millions on state of the art chairs, elevated monitors, slanting keyboards, wrist rests, and lumbar supports.  Office modifications, while well intentioned and generally a good idea, cannot compete with 2860 hours (this number is probably low) of sitting in a year.  In order to fight against the postural stress that creates pain, we need to get up and move.

Recent research on prolonged sitting has demonstrated that the amount of movement we need to stay healthy is greater than we once thought.  To combat the adaptive changes of prolonged sitting, it is suggested you get up and move every twenty minutes.  Set a timer, enlist the help of your coworkers, and work at this every workday for a month.  I believe you will be surprised by the results.

Michael S. O’Hara, PT, OCS, CSCS

Movement You Should Master

Step Ups

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that I have found to be very helpful in restoring the capacity to get up and down off the floor is the Step Up.

Step Ups

The ability to go up and down steps will almost always be needed.  Losing this ability is a sure sign that one’s quality of life and independence are quickly fading.  Step Ups can be done in a variety of different directions and loaded a number of ways making them easily progressed or regressed based on goals and fitness level.  Step Ups improve balance and strength in the glutes, quads, and hamstrings.  Depending how you load, they can also challenge the core and shoulders.  The average step in the United States is 7 inches tall.  Strive to work up to a 14 inch box so that no flight of stairs will ever intimidate you.

Here Coach Katie demonstrates two different versions we like to use and the benefits of each along with some progressions.  Watch the video and give it a try: https://youtu.be/iGXtKyGlKMg.

1) Anterior Step up (Progression: Anterior Step Up with Racked Kettlebell hold)

2) Lateral Step Up (Progression: Lateral Step Up with one side loaded)

-Jeff Tirrell, CSCS, Pn1

 

Movement You Should Master

Weighted Carries

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that I have found to be efficient and effective is a Weighted Carry.

Weighted Carries

Very few things are more functional than a carry.  You’d be hard pressed to get through daily life without having to carry something at least a few times per week.  While basic, a carry is an efficient and effective full body exercise.  Depending on the carry you choose, the load is virtually limitless.  Performed for time or distance, carries will always improve gait and core stability.  Depending on which version you use, they can also be an effective tool for improving shoulder mobility/stability, grip strength, balance, and overall awesomeness.  Watch the video and give it try: https://youtu.be/PaP4-IlVAOA

Coach Chad demonstrates my top four carry picks:

1) Farmers Walk (gait, core stability, grip strength, upper back, legs)

2) Suitcase Carry (gait, core anti-lateral flexion, grip, upper back, balance)

3) Waiters Carry (gait, core stability, shoulder stability, balance)

4) Double Waiters Carry (gait, core stability, shoulder mobility, shoulder stability, balance)

-Jeff Tirrell, CSCS, Pn1

 

Movement You Should Master

Pull Ups

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that helps build upper body strength and maintain shoulder mobility is the Pull Up.

Pull Ups

If you are a superhero and find yourself hanging off the edge of a cliff or a building, you’ll need to pull yourself up.  All kidding aside, the pull up is a fantastic exercise to build strength in the lats, biceps, rhomboids, and rear delts, while helping to maintain shoulder mobility.  Pull ups can be done with a variety of grips.  The most important thing is to use a full range of motion and maintain control (avoiding excessive movement to reduce injury risk).  I utilize one of three pull up versions with most clients depending on their fitness level.  Watch the video and give it a try.

1) Eccentric Pull ups: Use a box to start in the top position, and slowly lower yourself with complete control down to the bottom position.  Once you can complete 10 of these with a good 4-6 second descent, then it’s time to move on to a standard pull up.

2) Standard Pull up:  Start hanging from a bar (or rings) with your arms completely straight.  Pull yourself up until your clavicle touches the bar.  Slowly lower yourself back down until your arms are completely straight and your body is motionless.

3) Xiphoid Pull ups: Start as you would for a standard pull up, but rather than pulling to your clavicle, you want to lean back and pull yourself up until your xiphoid process (bony part at the bottom of your sternum) touches the bar.  Then, lower yourself in a controlled manner back to the start.

See video of pull ups here: https://youtu.be/Cyvp4X2MRC0

-Jeff Tirrell, CSCS, Pn1

Are You Ready?

Spring At The Physical Therapy Clinic

The weather is warming up and soon we will leave the heated, insulated, safety of our home gyms and fitness centers.  The spring migration back to tennis, soccer, pickleball, golf, fitness running, ultimate Frisbee, and stadium steps will begin.  My physical therapy question is– Are you ready for these new challenges?  Has your fitness program prepared you to withstand the rigors of these spring endeavors?  This checklist should help you answer the question.

Have you been performing most of your fitness activities in standing?
Nearly every sport and most household chores are performed in a standing position.  During most of my visits to commercial gyms, the majority of the activity I witness is in the supine, seated, or heavily supported positions.  If your goal is to move better and remain free of injury, then 90% of your exercise should be performed in standing.

Do you practice moving in all directions?
Nearly every sport involves moving side to side, forward-backward, and in a rotational pattern.  Basketball, soccer, golf, and tennis all require you to accelerate and decelerate movement in all directions.  Most gym activities are predominantly sagittal plane– forward and backward.  You ride on the elliptical, spin the bike, and run on the treadmill for months, and your spring visit to the tennis court results in a twisted ankle because you are unfamiliar with side to side movement patterns.

Have you been working on better balance?
Balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle.  Many commercial exercise machines take all balance demands away.  The elliptical, spin bike, recumbent bike, rower… all are heavily supported.  Proficiency with single leg stance balance prevents injuries and improves performance.  The older and more deconditioned you have become, the more your fitness program should include single leg stance balance training.

Do you perform any explosive exercises?
We get slower before we get weaker, and life is an up-tempo game.  We need to perform exercise that enhances quickness and improves control of deceleration forces.  What you do in the gym is reflected in how well you can move during activities of daily living.  If you continually exercise at slow tempos, you will get better at moving slowly.  If you train explosively, you get better at moving at faster speeds.  The capacity to decelerate a fall requires fast reactions.  Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power production and speed of movement.

Michael S. O’Hara, PT, OCS, CSCS

Advice From The Experts At Fenton Fitness

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#10–Establish A Veggie And Protein Habit

One of the biggest deficits I see in many food logs is the lack of protein consumed.  We have been conditioned to snack on high carb/highly processed food, so eating more protein can be a difficult shift.  When I do see protein, it’s in the higher fat varieties of sausage, bacon, burgers, etc.  It would benefit younger individuals to start adding healthy doses of protein to their diets as soon as they are responsible for their own food preparation.  Shoot to have some form of lean protein as the base of your meal along with a couple of servings of vegetables. Once you have that base (taking up ½ to ⅔ of your plate), then you can add in whole grains, starchy carbs, fruits, dairy, healthy fats, etc.  Protein increases your metabolic rate more than any other nutrient, aids in recovery, helps build and maintain muscle mass, and much more.  We recommend 25-35% of total calories to come from protein, or 0.8-1gram/pound of body weight.  Most individuals should shoot for 4-8 servings of vegetables per day as well.

-Jeff Tirrell, CSCS, Pn1

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?_r=0

 

 

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