What Women Need
Needs Are Different Than Wants
I get to discuss fitness goals with women nearly every day. They want to lose weight, get rid of musculoskeletal pain problems, have more energy, and “get arms like that girl”. Many of them have been doing their favorite exercise activity for years and have been unsuccessful at achieving any of their stated fitness goals. What they tell me they want to do is yoga, elliptical training, and Pilates. What they need to do is start on a program of strength training.
Ramping Up Your Metabolism
We all know that a body with more muscle burns more calories all day long. You can get away with eating more food and not develop greater fat deposits. Much more significantly, greater muscle mass positively influences fat metabolism, insulin levels, glucose processing, hormone profiles, and disease resilience. These changes influence the “more energy” feeling you develop with strength training.
Training To Abolish Pain
Nearly every patient that comes to physical therapy with a chronic pain problem has a glaring strength deficit that is perpetuating the pain. They have gluteals, scapula retractors, or cervical stabilizers that are not functioning at a level that permit them to perform normal activities of daily living and remain free of pain. What makes these patients better is a program of targeted strength training. If you have chronic hip, knee, lower back, or neck pain, your best method of permanently resolving the problem is strength training.
All of the current research says you need bone jarring, compressive, and aggressive loading of your skeleton to enhance or prevent further loss of bone density. Over the last year, two government panels of experts have told us that taking more vitamin D and calcium does not appear to make any difference in bone density. Better bone biology requires that the exercise stimulus be strong and consistent. Low skeletal stress activities such as yoga, Pilates, and elliptical training do not create the forces needed to have a positive effect on bone density. Read Bending the Aging Curve by Dr. Joseph Signorile.
I am sorry Ladies, but muscle mass, strength, and power production all leave you at a far faster rate than your male counterparts. It is not fair, but it is the truth. As you age, training to restore these physical capacities becomes much more important if you wish to remain independent for a lifetime. Ask any physical therapist who works with geriatric clients and they will tell you that weakness is the driver of debility. The good news is that a properly designed program of strength training can work wonders.
Motivational Goal Setting
Strength training provides motivation by having clear goals. “I want to tone up” is not a clear goal. Any psychology major will tell you that reaching defined goals reinforces positive behavior. You improve from three to eight solid push ups, carry ten more pounds for fifty yards, press twenty pound dumbbells instead of tens, and it motivates you to stay with the program. Numerous psychological studies have found that a lack of goal achievement is the number one reason people fail to succeed in staying consistent with an exercise program. The girl with the arms you like has strength goals.
Michael S. O’Hara, P.T., OCS, CSCS
The Good And Bad Of Kinesio Taping
In 2008, Kinesio tape (KT) was donated to 58 countries for use during the Olympic games. Since that marketing effort, its presence in televised sports has exploded. The athletic fashion statement found at many competitions is the brightly colored strips of tape across elbows, knees, shoulders, and hips. At Wimbeldon, Novak Djokovic had green tape on his elbow. Many of the soccer players at the last Euro competitions had tape on shoulders and hips. Female beach volleyball players seem to be wearing more tape than clothes.
Kinesio tape was invented by chiropractor Dr. Kenzo Kase in the 1970s. KT is made of cotton with an acrylic adhesive that permits it to stretch 40-50% of its resting length. The website for Kinesio tape claims that it can alleviate pain, reduce inflammation, relax muscles, enhance performance, and help with rehabilitation. Rock tape, a competing product, makes similar claims and uses the slogan Go Stronger, Longer.
Does Kinesio Taping work?
A meta analysis performed by Wilson in 2011 looked at all of the studies performed with KT and found some evidence that it helped improve range of motion, but no evidence that it helped reduce inflammation, relax/activate muscles, or improve performance. There is no evidence that it “off loads sensitive tissues” or improves “lymph drainage”. The number of high quality studies was small.
How Might Kinesio Taping Work?
What we do know is that the elastic, compressive nature of any band, brace, or tape placed on the body stimulates receptors in the skin. The receptors modulate the perception of pain and as a result, pain decreases. An example is a research study in which the patients that wore a neoprene sleeve during a series of tests 12 months post anterior cruciate repair produced significantly more force and had better balance than without the neoprene sleeve. The sleeve created a constant pressure on the skin surrounding the knee.
Should You Use Kinesio Tape?
If you have a minor ache or pain and no structural musculoskeletal damage, then go ahead. The KT can make you feel better, and this will make exercise and activities of daily living easier. The tape can provide some control over the symptoms, and it has no side effects other than occasional skin irritation.
Remember that your body sends pain signals for a reason. Any type of musuloskeletal damage should be dealt with more comprehensively than just KT. It is a bad idea to use KT to reduce pain and then participate in activities that create even greater tissue trauma. A small and easy to rehab rotator cuff tear can become a big, full thickness, surgical repair tear if you tape it up and practice your tennis serves.
We do lots of things in medicine that have no solid, double blind research that proves efficacy. The manufacturers of KT products need to spend more money on research and less on marketing. I am hopeful that in time, more evidence will develop for the use of KT. If some strips of KT make you feel better, go ahead and use it. The best approach is to get to the cause of the problem and enact a treatment plan that resolves the pain or functional limitation.
Michael S. O’Hara, P.T., OCS, CSCS
It’s Rotator Cuff–Not Rotor Cup
Proper Strengthening Of The Rotator Cuff Muscles
In the gym, I see all kinds of shoulder exercises that I believe are meant to strengthen the external rotators of the shoulder. Unfortunately, many of the moves are more harmful than helpful. They are performed at fast speeds, in positions that foster shoulder impingement, and with no attention to spinal or shoulder posture. A simple and highly effective exercise to strengthen the rotator cuff muscles is the band “no money” drill. This exercise is time efficient–you train both shoulders at the same time. Resistance is provided by tubing or a resistance band and is easily altered to suit all strength levels. The best thing about this exercise is that it is hard to perform improperly.
Many of us are walking around with horrible upper thoracic, cervical, and shoulder girdle posture. Poor posture makes using your external rotator muscles properly very difficult. For the external rotators to work effectively they need to be on a solid, well anchored launch pad. Elevated and rounded shoulder blades are poor platforms for your external rotator cuff muscles—supraspinatus, infraspinatus, and teres minor. A forward head posture closes off the narrow neural openings between the cervical vertebrae. Compression on the fifth cervical nerve root can unplug the neural drive to both the external rotators and the deltoid muscle. Before you begin any rotator cuff strengthening exercise, always attempt to correct your posture before starting. If you cannot correct your standing posture this exercise is made for you.
Band “No Money” Drill
You need some resistance tubing or a band for this exercise. Stand up tall with the chest proud and the head pulled back. Hold the tubing in each hand with the elbows at the side and bent to 90 degrees. Keep the palms facing up and the thumbs pointed out. Tighten the muscles in back of the shoulder blades and pull the tubing apart. Hold at end range for three counts. Return slowly to the starting position—this should take at least three counts. Each repetition should take at least six seconds. Repeat for five to ten repetitions. This exercise should always be pain free. Start with a resistance level that permits you to perform at least five repetitions and do not take this exercise to failure.
If you are unable to perform this movement with shoulder blades pulled down and in, head pulled back, and chest proud, you need to regress the exercise to a foam roll. Position in supine and length-wise on a foam roll and perform the band “no money” just like you would in standing. Positioning on the foam roll will allow gravity to pull you into a better posture and create the proper stimulus necessary to strengthen the external rotators of the shoulder.
Strengthening the external rotators is only a part of keeping your shoulders healthy and strong. You must train the shoulder muscles as a team to produce more coordinate stabilization of the glenohumeral and scapulo thoracic joints. The more athletic and active you are, the more important coordination and timing exercises become for comprehensive shoulder rehabilitation.
Michael S. O’Hara, P.T., OCS, CSCS
The Downside Of Upside Down Exercise
Exercise activities that place the head below the heart have become more popular in fitness programs. In almost every gym you see decline bench pressing, incline sit ups, glute-hamstring developer exercises, and more recently, hand stand push ups as a regular part of many exercise programs. While these activities may have some value, you might want to reconsider training in an inverted position for some other reasons.
When you invert your torso, the contents of your stomach can more readily travel back up into your esophagus. Head below your belly with a hiatal hernia, a little extra mesenteric fat, and some strong contractions from the abdominal muscles, and you have the perfect environment for gastroesophageal reflux disease (GERD). Millions of Americans (14%-20% depending on the study) take medications to manage the symptoms of GERD—heartburn, chest pain, persistent cough, difficulty swallowing, hoarseness. Prilosec and Nexium are the biggest moneymakers the pharmaceutical industry ever created. Many Americans (10%-15%) have GERD, but are unaware of the problem because the tissue damage has not reached symptomatic levels. Erosive esophagitis or Barrett’s esophagus is a clinical finding of cellular change in the esophagus and a precursor for esophageal cancer. Esophageal cancer is one of the more deadly types of cancer.
Glaucoma or Retinal Disease
The head down position raises pressure inside the eyeball. As little as 30 degrees of decline has been shown to increase intraocular pressures. It is estimated that 2.2 million Americans have glaucoma, but only half of these know they have the problem. Individuals with glaucoma already have elevated intraocular pressures and should avoid these positions. The back of the eye (retina) is susceptible to changes in vascular pressures, so if you have any retina issues, avoid the head down position.
High Blood Pressure / Hypertension
Your heart, lungs, and arteries are conditioned to pump blood with your body in an upright position. Many vascular alterations occur when we flip into a heads down position. When you assume the head below your heart position, the arterial pressures inside the skull increase. Elevated cranial blood pressures can lead to headache and much more severe problems such a stroke. One in three Americans are walking around with high blood pressure. Add in an exercise induced elevated heart rate and some less than pliable carotid arteries and you have the ideal environment for a big bad brain event. If you have hypertension, I would not go about using any inverted positions in the gym.
Apart from going blind, having a stroke, and developing an incurable cancer, you should be fine.
Michael S. O’Hara, P.T., OCS, CSCS
Poor choices in exercise selection are often the cause of injury and pain. Most gym members are unaware of the damage that is created until it is too late. The joint stress produced by activities that manipulate body position in an effort to isolate a certain muscle very often create significant articular irritation. If your fitness goals are to stay strong and injury free for an entire lifetime, I suggest you avoid certain exercise activities.
A staple of Self and Shape magazine, this exercise probably will make your triceps muscle work hard if you possess enough shoulder mobility to drop down and bend the elbow 90 degrees. Unfortunately, bench dips also produce excessive stress on your neck and shoulders. During a bench dip, your neck is forced forward and the shoulder girdle is pushed into extreme positions of extension and internal rotation. Most of us have poor neck and shoulder posture and this activity feeds into the forward head–rounded shoulder posture that is epidemic in today’s computer based world. The movement of the shoulder joint during a bench dip pushes the humeral head forward and makes the long bicep tendon take a severe twist over the front of the humerus. This position stretches the anterior capsule of the glenohumeral joint making you more susceptible to shoulder subluxation or dislocation. Biceps tendonitis, tendonosis, and complete ruptures are one of the more common injuries we see every day in physical therapy. At the top of this exercise (elbows extended), the shoulder is loaded in a manner that compresses the subacromial space, making you more prone to impinge on the superior rotator cuff tendons.
Women typically have less stable shoulder joints and more sensitive necks, yet they seem to gravitate to this drill. MRI imaging tests of non-symptomatic shoulders reveal that many of us are unaware that we are walking around with rotator cuff tears and bone spurs in our shoulders. An exercise that places the shoulder into a stressful position may be all that is needed to make that tear or spur start waking you up at night. For athletic performance purposes, the bench dip movement is worthless as it is not similar to any movement pattern you ever perform on the field of play.
The gym is full of exercises to train triceps that are safer than bench dips. Try getting better at push ups, and remember that you cannot preferentially “burn fat off” the back of your arm with direct triceps training. If you speak with any of the strength and conditioning coaches that make their living getting athletes ready to perform at optimal levels, none of them use the bench dip.
Michael S. O’Hara, P.T., OCS, CSCS
Multi Directional Power Training
We have recently added a new training tool to our physical therapy clinics. The Surge 180 is a simple and incredibly effective training device for rehab patients. The patient stands on the platform, grasps the handle, and works against resistance provided by three pistons. The physical therapist can use the Surge 180 to improve many different areas of performance.
Safe and Effective Power Training
Most physical therapy patients are severely underpowered. Not only do they need to get stronger, they must also get better at creating force quickly. The patient can accelerate against the handle of the Surge 180, and because the overall mass is so small, there is no damaging inertia to overcome. The mass of a weight stack, barbell, or dumbbell creates so much inertia that when you attempt to move the load quickly it creates damaging joint stress.
In life and athletics, our bodies move in all directions. The Surge 180 handle moves forward–backward, right–left, diagonally, and into rotational movement patterns. The handle excursion is big enough to accommodate patients of all heights.
It Demands You Stand
Rehabilitation is all about getting better at functioning in standing positions. Patients need to learn how to efficiently transfer forces from the ground up through their body. On the Surge 180 platform, the patient can be positioned in-line, split, straddle, or single leg stance. Connecting the shoulder to the opposite side hip, through an active core is the essence of rehabilitation training.
The coordinated performance of the team of muscles that control the hips, pelvis, and spine is more important than simple strength. Standing, walking, climbing stairs, and carrying all require the synchronous transfer of forces from right to left and back again. The resistance provided by the Surge 180 creates the neural feedback to fire those reciprocal motor patterns.
Michael S. O’Hara, P.T., OCS, CSCS
Suspended Push Up Animation
Atomic Push Ups Are A Fitness Blast
Your muscles work as a team to carry you through the day. They never function alone, so training them with isolation exercise will produce less than optimal results. The muscles over the front of the body are linked together through interwoven layers of fascia to form what Thomas Myers, in his book Anatomy Trains calls the “superficial front line”. The shoulder girdle is slung onto the body in a basket weave pattern of muscles. One of the best exercise activities to activate this team of muscles is the Atomic Push Up.
The guys and gals at TRX named this exercise because of the metabolic response it produces. Although the TRX company popularized the Atomic Push Up, you can use any type of suspension trainer that has foot straps. This exercise helps build a better connection between your shoulders and hips. It will strengthen the push pattern and activate the frequently neglected hip flexors. Unlike a bench press type drill, the Atomic Push Up requires core control and the active participation of your legs. Atomic Push Ups require a great deal of neural control as you must coordinate muscles from the hands to the feet to properly perform this drill. The Atomic Push Up is not a bodybuilding type exercise that will “sculpt your outer pectorals” but it will help you move better.
Atomic Push Up Performance
Attach the suspension trainer overhead with the foot straps eight inches off the floor. Sit on the floor and place the feet in the straps. Roll over and assume a push up position with the feet suspended off the floor in the straps. The top of the suspension trainer should be directly over your feet. Descend toward the floor, and as you push back up, pull the knees up toward your chest. Use a steady cadence of lower down–push up–knees in–knees out. Beginners should aim for sets of five repetitions. Stop before the performance of the drill deteriorates. Common faults are sagging in the middle, lack of depth during the push up, and poor head position. For men, twenty repetitions of Atomic Push Ups is a worthy fitness goal. For women, eight is great.
You generally do not see Atomic Push Ups performed in commercial gyms because suspension trainers are rare and this exercise is difficult. Beginners may wish to place a mat under the torso and head in case of a sudden face plant. You can use a pair of parallellettes if you find weight bearing on your hands is difficult. Moving the body forward so the suspension strap is pulling you backward makes the exercise more challenging.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Our shoulders and spine must endure prolonged computer input, extended commuter drives, sustained television staring, and way too much general slumping. The important postural muscles that keep us tall become weak and the muscles in the front of the shoulders get tight. The spinal muscles that hold our 24 vertebrae upright and stable functionally fall asleep and forget how to work together as a team. Prolonged sitting creates all sorts of neuromuscular problems that can be managed with restorative exercise. One of the best exercises you can perform to mitigate the damaging effects of prolonged sitting is the suspension row.
Better Than Seated or Bent Over Rows
Suspension rowing requires your spine to stay in a neutral position from the head to the pelvis. Most of the bent over rowing I witness in the gym involves the same slumped sitting posture you see in every office in America. Rows performed with a flexed thoracic spine are far from optimal and often help reinforce postural deficits. Properly performed suspension rows improve communication between the spinal stabilizers and strengthen the muscles that retract the shoulder blades.
Mastery Of Your Bodyweight
Being able to maneuver your body using the arms makes you functionally fit. During suspension rows, the resistance is not a plate or weight stack, but rather the weight of your body. You alter the resistance by moving the feet and changing the angle of the body in relation to the floor.
Friendly Force Curve
Suspension rows produce an accommodating resistance that is easier when you are at the weakest part of the rowing motion. The force necessary to perform a suspension row decreases as you move from the arms fully extended to the arms pulled in close to the body. This makes it a good exercise for people with weaker than average shoulder muscles.
Many people have no idea of how to correct the posture of their head and neck. Prolonged sitting, driving, and computer work have damaged their positional awareness or proprioception. The movement of the head and neck during suspension rows produces a neurological training of the cervical proprioceptors that can help fix this problem.
Improve the strength and endurance of the team of muscles that keep your posture tall and shoulders strong with suspension trainer rows. At FFAC, several TRX suspension trainers are located throughout the gym. For home use, attach the suspension trainer to the top of a doorway. Adjust the suspension trainer length so the handles are at your waist level or lower. Stand facing the TRX and grip the handles firmly. The position of your feet will determine the amount of resistance. Move the feet forward and the exercise is more challenging. Keep the entire torso straight, one long line from ear to ankle. Brace the abdominal muscles and gluteals and lean back. From the arms extended position, pull the handles into your side. As you perform the rowing motion, focus on moving the shoulder blades down and back. Return to the starting position and repeat. Perform two or three sets of six to ten repetitions. As you get stronger, progress to a full inverted row with the legs on a bench.
Caution: Make sure you use a solid suspension trainer product when performing this exercise. I have treated two patients with injuries that occurred when their homemade units malfunctioned and sent them flying to the floor. Do not skimp on safety with suspension training exercise. The emergency room visit and CT scan of your skull will be far more expensive. The TRX and Lifeline USA suspension trainers are the most well known units on the market.
Michael S. O’Hara, P.T., OCS, CSCS
SINGLE LEG STANCE OPPOSITE
ARM REACH AND ROW
A Long Name For A Great Exercise
In life, most of the challenging tasks happen in either single leg stance or with much more of our weight on one leg. We must be able to support, decelerate, and change directions with one leg. Our muscles are aligned so that the hip is mechanically linked to the opposite shoulder. In physical therapy, we know that having one side of the body function efficiently and the other side falter sets you up for injury. Your exercise program should revolve around training to meet these physical demands. One of my favorite life enhancing exercises is the single leg stance opposite arm reach and row.
Fall preventative activity that helps improves single leg balance.
Sure cure for the epidemic of gluteal amnesia.
Gives athletes the hip to opposite shoulder connection they need for performance.
Identifies any asymmetry in single leg control.
Enhances the single leg deceleration skill necessary for injury prevention.
Makes you stronger when you lift, carry, push, and pull.
Single Leg Stance Opposite Arm Reach and Row
You need a cable column machine or resistance tubing anchored at knee level or lower. Hold the tubing or cable handle in the right hand and stand on the left leg. You must be at least five feet away from the attachment point of the tubing or cable. Initiate the movement simultaneously at the ankle and hip and reach forward with the right hand. Attempt to get the hand down to knee level. Return back to standing and pull the handle toward the body in a rowing motion. Perform five to ten repetitions and then repeat on the other side.
Common mistakes are bending at the hip only and slouching over at the spine. The ankle, knee, and hip all move together, and the spine should stay stable. Holding the handle on the same side instead of the opposite side. Performing repetitions past the point of technical failure. If you start wobbling around, stop the exercise. Getting the arm and legs out of sync. Do not reach with the arm and then move the legs—the motions should happen together. Remember to come all the way back up to a tall standing position before starting the next repetition. Start with light resistance and try to create a steady smooth pattern before adding more resistance. Watch the video and give this exercise a try.
Michael S. O’Hara, P.T., OCS, CSCS
GET IN YOUR CAGE
Stretch Station Mobility Restoration
Invented by Gary Gray, a physical therapist from Adrian Michigan, the Stretch Station has been a primary piece of equipment at all of our facilities. It enables the physical therapy patient or fitness client the ability to perform three dimensional mobilization of the major peripheral joints and spine. I have not found another piece of exercise equipment that is as beneficial for improving movement as the Stretch Station.
It Has To Happen In Standing
The Stretch Station allows you to mobilize joints and move in the anti-gravity, standing upright position that it functions in every day. Gravity eliminated, floor stretching programs often fail to produce better movement when gravity comes back into play. Any new movement you develop with mobility training is only beneficial if it can occur in a standing position.
A Little Lift Goes a Long Way
Traction force (pulling apart) of a joint is a key component of all manual medicine. It helps relieve pain and makes greater joint mobility easier to achieve. The overhead bars of the Stretch Station enable you to lift up and partially decompress the spine, hips, knees, and even ankles during mobility training. This low level traction force assists in the development of better mobility. Deconditioned and overweight patients can perform hip and knee mobility training and remain pain free with the assist of the Stretch Station.
One Good Turn…
Most floor mobility training does little to develop better rotation at the joints that are supposed to produce
rotation–thoracic spine, hips, and ankles. The Stretch Station has an angled floor and multiple handle sites that enable users of all sizes to work on improving rotation. Thoracic spine and hip mobility work is particularly beneficial for athletes that must swing a club or throw a ball.
Identification of Asymmetries
Using the Stretch Station, patients and fitness clients can immediately identify when one side of the spine, one hip, or one shoulder is more restricted than the other. Training away asymmetries at a single joint or movement pattern is important for injury prevention and optimal performance.
A Bridge to Better Performance
I have fitness clients perform thirty seconds of mobility training on the Stretch Station followed by a complimentary strengthening exercise. The idea is to neurologically reinforce the new motion achieved with the Stretch Station using an appropriate strengthening activity. This pairing of the Stretch Station work with a strengthening drill has been very effective in restoring movement and decreasing pain.
Michael S. O’Hara, P.T., OCS, CSCS