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Shoulder

Fracture Facts For Men

osteoporosisJane Brody of the New York Times wrote a great article on the risks men have for osteoporosis related fractures.  The general public views osteoporosis as a “women’s health issue,” but management of osteoporosis and prevention of falls is just as important for men.  Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled, or die, from the fracture.

In 2012, an international team of researchers and clinicians launched Too Fit to Fracture, an initiative aimed at developing optimal exercise recommendations for individuals with osteoporosis.  In October of 2014, they released a booklet that is available through osteoporosis.ca on managing osteoporosis through exercise.  Everyone should read this booklet and osteoporosis patients should follow their exercise prescription.  Their work brings clarity to an issue that is currently clouded with poor understanding and a lot of bad fitness advice.

The Too Fit to Fracture researchers recommend that individuals with osteoporosis (with or without vertebral fractures) should engage in a multi-component exercise program that includes resistance training in combination with balance training.  Balance train for ten to twenty minutes every day of the week and strength train for 30 to 45 minutes twice a week.  Make sure your strength training teaches you how to move correctly and improves the endurance in your back muscles.  If you have mild to moderate osteoporosis, balance train and strength train first and foremost, and use any extra time on some low impact cardio training.  If you have been told you are at high risk for fracture, keep your focus exclusively on balance and strength training and keep the cardio activities to a minimum.

We know that individuals who participate in consistent resistance training exercises are more likely to have better bone density.  Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it.  The best bone building exercise activities produce a growth promoting stimulus through your skeleton.  Bone building exercises are easy to understand but they do require more effort than swallowing a pill or having an injection.  Everyone can perform some form of bone reinforcing exercise.  Proper exercise prescription and consistent progression can work wonders.  See the trainers and physical therapists at Fenton Fitness and Fenton Physical Therapy for guidance.

-Michael S. O’Hara, P.T., OCS, CSCS
View the NY Times article here: http://www.nytimes.com/2016/10/04/well/live/men-get-osteoporosis-too.html?_r=0

Fitness training for those of us past 40 years of age is more complicated.  Physical performance and recovery capacity is dramatically different.  If you need proof, look around for the forty year olds in the NBA or NFL.  The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime.  I have compiled a collection of tips for the forty plus fitness client. 

Manage Eccentric Muscle Loading

sledDuring the concentric portion of a lift, the muscles shorten as the load is moved.  In the eccentric phase, the muscles gradually lengthen as the load is lowered in a controlled manner.  Eccentric muscle activity (lengthening under tension) produces more muscle micro trauma and, therefore, requires more recuperation time.  It is the eccentric aspect of a resistance exercise that creates delayed onset muscle soreness.

Older fitness clients do not possess the same recovery capacity as younger individuals.  Utilizing exercise activities that reduce eccentric stress is a valuable training tactic.  Concentric biased training allows older trainees to perform a greater volume of work and be ready a day or two later for the next training session.
Sled work is my favorite “concentric only” fitness activity.  The muscles shorten to propel the sled and never have to lengthen against resistance.  You can push, pull, row, and press a sled at fairly high levels of exertion and still sufficiently recover between training sessions.

Loaded step ups are a predominantly concentric contraction, lower extremity strengthening exercise.  It teaches balance, core control, and improves single leg strength. The eccentric aspect of a loaded step up is minimal and this makes it an essential exercise for older fitness clients.

My favorite upper extremity eccentric only training device is the Surge 360.  The Surge provides resistance through a series of multi-directional pistons.  All exercise activities on the Surge are concentric only.

Resistance tubing is another tool that can help manage eccentric muscle activity.  The force curve (increased load as the tubing is lengthened and decreased as it gets shorter) helps reduce muscle activity during the eccentric aspect of many exercises.
-Michael S. O’Hara, P.T., OCS, CSCS

A physician friend sent me this recently released research article on the benefits of maintaining strength and muscle mass as we age.  I think everyone should take the time to read this article.  We are keeping people alive for longer periods of time, but how well are they living?  The discussion of the extension of life span compared to enhancement of health span is worthy of consideration.  Improving muscle mass and strength dramatically improves quality of life, a factor often not given enough consideration.

10522_2015_9631_Fig1_HTMLAge-related sarcopenia is the loss of muscle mass as we age.  Sarcopenia and functional disability travel hand in hand.  Combating sarcopenia has become a hot research topic as greater numbers of the American population pass through old age and the cost of their care becomes an issue.  The good news is that age-related sarcopenia is a very treatable condition.  The bad news is that it takes some education and effort.   When discussing the need for strength training, these are the top questions/concerns I get from physical therapy patients and fitness clients:

OK, how much, how difficult, and how often?
After the eye rolling, this is the question I get from most of my sarcopenic patients.  The research training programs that successfully reversed age-related sarcopenia involved four to seven progressive resistance exercises performed for a total of twelve to twenty sets.  The participants trained two or three times a week and the level of perceived exertion fell into the mild to moderate regions.  You are looking at 90 – 150 minutes a week of mild to moderate exercise.  The important, and often completely missed, aspect of progressive resistance training is that you increase the resistance or load lifted as you become stronger.

Can’t I just do yoga, golf, tennis, hot yoga, swim, walk, chair yoga, tiddly-wink, Pilates, underwater yoga?
I am sorry but the research studies have not found that these training modalities produce the necessary stimulus to combat age-related sarcopenia.  You can still perform all of these activities– just include a consistent program of progressive resistance strength training.

I don’t know what to do…
Poor exercise selection and beginner’s enthusiasm are the biggest reasons people fail with progressive resistance strength training.  Exercise is like medicine, administer the correct prescription at the proper dose and the results will be good.  Just like a visit to your physician, it all starts with an evaluation.  You need to start at a level that makes you better and not broken.  Get instruction from a qualified coach and follow his/her plan.  A big warning- the world of fitness is filled with many “certified experts” -–it took them a full weekend to complete their training.  These experts keep us busy in the physical therapy clinic.

You can view the research article here: http://link.springer.com/article/10.1007%2Fs10522-015-9631-7
-Michael O’Hara, P.T., OCS, CSCS

PDFIn this month’s issue, Mike O’Hara presents tips for preventing shoulder pain and injury.  Jeff Tirrell addresses the secret to maintaining a successful workout program, and the benefits of single leg hip thrusts are described.

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A Landmine is a simple modification of the use of an Olympic bar. The bar is anchored onto the floor at one end and you lift the free end of the bar with the load of your choosing. At FFAC, we have five landmine set ups that can be used with either a standard 45 pound Olympic bar or a 15 pound half_kneeling_landmine_presstraining bar. One of the best push pattern strengthening activities is the Half Kneel Landmine Press. Take a minute to read this article and then give this exercise a place in your training program.

Hip to Opposite Shoulder Core Connection
Your shoulder girdle works together with your opposite side hip through an interwoven series of muscle and fascia known as your core. The power in a punch and the speed in a fastball are generated from the hip and travels through your torso to your shoulder girdle. Training activities that enhance this hip-torso-opposite shoulder connection will help you function better during daily activities and athletics. Pressing in a half kneeling position creates that hip to shoulder connection.

Trigonometry Training
The force created by the load on the landmine decreases as you raise the bar off the floor. At a forty-five degree angle, the force drops by 15% and as you push the bar upward to a sixty degree angle it falls to 30%. One hundred pounds becomes 85 pounds at 45 degrees and then 70 pounds at 60 degrees. This gradual reduction in force is helpful in clients who have limited overhead shoulder girdle stability and less than optimal core strength. They are able to be successful in training a single arm push movement pattern and use the half kneeling landmine single arm press as a bridge to more challenging drills.

Shoulder Saver
Pressing directly overhead is a beneficial exercise but a vast number of fitness clients and athletes do not possess the shoulder anatomy or mobility to press overhead and maintain a healthy and pain free shoulder. The athlete involved in high repetition overhead sports such as pitching in baseball, serving in tennis, and or swimming should be wary of loading an overused movement pattern. If you have a prior history of shoulder rotator cuff problems or impingement issues, you may want to rethink pressing directly overhead. The landmine press is a hybrid exercise that requires the gluteal and core stabilization of an overhead press but reduces shoulder stress by changing the angle of the pressing movement.

Injury Prevention
Performance asymmetries make us more susceptible to injury. The half kneeling landmine single arm press will quickly reveal right versus left performance deficits. If you notice six repetitions are easy with the right arm but you are barely able to perform four with the left, you need to work on resolving that asymmetry.

Half Kneeling Landmine Press
You need a landmine attachment for an Olympic bar and an Airex pad to cushion your knee. Load the Olympic bar on one end and set up with the bar directly in front of the right side of your body. Assume a half kneeling position facing the end of the Olympic bar. Place the right knee down on the Airex pad and the left foot directly in front of the left hip. Both knees should be bent to 90 degrees flexion. Place the end of the Olympic bar in the right hand and grip the bar tightly. Grip the floor with the toes of the right foot and the entire left foot. Contract the gluteal muscles and brace the abdominal muscles. Make a strong fist with the left hand and tighten the left shoulder. Keep a tall and tight torso as you push the bar up with the right arm. Keep the elbow underneath the end of the bar during the press. Hold for two counts at the top of the press and then lower with control. Repeat for five to ten repetitions. Switch leg positions and perform the exercise on the left side.

 -Michael S. O’Hara, PT, OCS, CSCS

To view a demonstration of the half kneeling landmine press, click on the link below:

Half_Kneeling_Landmine_Press

PITCHER ISSUES
A True Baseball Insiders Safety Suggestions.Eric_Cressey

Mr. Eric Cressey is a strength coach who specializes in making baseball players better athletes. He rehabs and develops multiple millions of dollars worth of throwing arms. Eric has worked with baseball players at all competitive levels and is the ultimate insider. Mr. Cressey is an “in the trenches” coach that has witnessed how the present system is operating. I have heard him speak on four different occasions. He is articulate and always informative. If you are a baseball player, or the parent of a baseball player, Mr. Cressey has some suggestions on how to stay healthy.

Take the time to read his January 3, 2016 blog, Preventing Shoulder Injuries: Actions Speak Louder Than Words. I often send parents of injured baseball players to Mr. Cressey’s site for the valuable information they have not been hearing.

-Michael S. O’Hara, PT, OCS, CSCS

View Cressey Article

A Landmine is a modification on the use of an Olympic bar. The bar is anchored onto the floor at one end with a Landmine device and you lift the free end of the bar with a load of your Landmine_Ichoosing. At FFAC, we have five landmine set ups that can be used with either a standard 45 pound Olympic bar or a 15 pound training bar. These are the reasons to use a Landmine.

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scapular_touchdownMost shoulder pain problems are brought on by the cumulative effect of poor posture and weak scapula muscles. Sustained slouched over postures create a faulty length-tension relationship in the scapula muscles. This produces adverse stress and strain on the joints of the shoulder and the nerves in the neck and upper back.

The muscles that keep the shoulder healthy and pain-free attach to the scapula (shoulder blade). They hold the shoulder girdle in a mechanically advantageous position on the body. They pull the scapula inward, toward the spine and downward, toward the hips. Making your scapula muscles stronger will help, but being mindful of your posture during the day is the most important factor. I like the quote from Physical Therapist and US Soccer team trainer Sue Falsone “You can’t out rep poor posture.”

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02misconception-bones-superJumboI recently received an email on an article in The New York Times.  The article stated that moderate exercise did not produce an improvement in bone density.  The article went on to state that only medications have been found to be effective at reversing bone loss.  The fitness client that sent me the email was understandably concerned because the article presented information that was dramatically different than what she had been told.  In her battle against osteoporosis, she had placed a lot of faith in exercise and dietary modification.  She had been given advice from her doctor, physical therapist, and trainer that she was on the proper path to better bone health.   I read The New York Times article, looked up the referenced research, and I have a reply.

The New York Times author is correct that moderate weight bearing activities do not produce a change in bone density.  Walking, running, yoga, and Zumba do not produce enough bone stress and muscle tension to improve Continue reading

Press_pressing_powerPressing Power:
Three New Ways to Press

If you’ve been around the gym for any significant amount of time, odds are that you’ve included some sort of pressing movements in your routine. I typically group presses into two categories: Vertical (pushing overhead) and Horizontal (pushing away from chest). Most commonly, the Bench Press with a barbell or dumbells and sometimes push ups are used for horizontal pressing, and a seated Military Press or standing Overhead Press are used for vertical pressing. These are all great exercises assuming you have no serious shoulder injuries. I strongly believe that the Bench Press, Push ups, and standing Overhead press should be staples in any program where maximal strength, hypertrophy, or power are primary goals (which should be most training programs).

If, however, your training program stops at these few foundational movements, then you are leaving a lot on the table when it comes to maximal performance and functionality (particularly for athletes). Your upper body and lower body are only as good as your weakest link when it comes to running faster, jumping higher/farther, throwing harder/faster/farther, punching harder, etc. For the vast majority of individuals, this weak link is often the core musculature. Incorporating proper core training that works on resisting rotation and extension is a great addition to your program, but training the core to brace and stabilize when making athletic type movements is even better. Below I will outline three great pressing movements that will tie your upper body into your core, hips, and lower body to better help you transfer your strength in real life situations and athletics.

Contralateral Dumbbell Bench Press: This is a great exercise to supplement traditional Bench Press training. It is a horizontal 1 arm press that 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). Grab 1 dumbbell (pick a weight 5-15lbs lighter than you’d use for a standard dumbbell bench press) and lay on a flat bench. The leg on the same side as your weighted arm will be down on the ground with the foot firmly planted. The leg on the opposite side will be flexed to 90 degrees at the hip, knee, and ankle. From this position, you will take a big breath to brace your core and press the dumbbell straight up into the air. If there is a big difference in the weight you can handle on this exercise vs a normal bench press, then you have work to do.

Half- Kneeling 1 arm DB or KB Press: This is a great supplemental exercise to go along with the Overhead Press. This is a 1 arm vertical press that will tie the strength of the upper body into the core, hips, and lower body. Unlike the Contralateral Bench Press, this exercise also allows for upward rotation of the shoulder blade which is an important athletic/throwing quality. Assuming a half-kneeling position, bring a DB or KB to shoulder level. The weight should be on the same side as the knee that is down. Contract your glute strongly on the side the leg is down and brace your core while pressing the weight up overhead. Make sure you straighten your arm all the way by bringing your bicep up to your ear. Repeat on the opposite side.

Staggered Stance 1 arm Cybex Punch: This is a very unique exercise in that it is a horizontal press done from the standing position. This obviously has a huge carryover to athletics and overall functionality as most of what we need to do is from the standing position. However, because of this positioning, it is also one of the more challenging movements in regards to the amount of weight you will be able to use. Using the Free Motion Cybex machine, adjust one arm so that it is roughly shoulder level. Assume a staggered stance and hold the handle in the hand on the same side as your back leg. Brace your core to ensure that your hips and lumbar spine don’t move. Extend your arm as if you were punching something, and allow your thoracic spine (upper back) to rotate as you do this. Perform on the opposite side.

-Jeff Tirrell, CSCS, Pn1

Pressing_Video

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