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Learn more about Rehab, Sports Medicine & Performance

Spine

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Bad Man Break

Men Need To Be More Aware Of Bone Density

Allen was getting out of his fishing boat when he twisted his left leg and fractured two bones in his ankle.  Six weeks after ankle surgery, he landed in our clinic with considerable pain and a very limited lifestyle.  Allen reported lower back pain that he attributed to his limping and use of the boot on his left leg.  On recommendation from his physical therapist, Allen had further medical assessment of his lower back pain.  An x- ray of his lumbar spine revealed two lumbar vertebrae fractures.

On a recent vacation, Mike went on a horseback ride with his grandchildren.  During the ride, he developed pain in his upper back that “took his breath away”.  A visit to the emergency room with what he thought was a cardiac issue revealed a three-level compression fracture in his thoracic spine.  Further assessment showed significant osteoporosis in his hips, pelvis, and lumbar regions.  Allen started on some bone rebuilding medications and physical therapy.  It took over four months to fully recover from this injury.

Randy was working on his garden and fell onto the lawn.  He had right hip pain and was unable to stand.  His wife called the ambulance and he was diagnosed with a hip fracture.  Four days after the surgery to repair his hip, he suffered an embolism and at the age of seventy-one, he passed away.

All three of these older guys had testing that revealed a significant loss of bone density.  Unfortunately, the tests occurred after and not before injury onset.  We are getting better at keeping men alive longer–less smoking and better medications.  As men get older, the need to monitor bone density becomes a crucial aspect of healthy aging.  Men need fewer commercials for the latest in testosterone replacement and ED medication and more awareness of how brittle their bones can become.

The general public views osteoporosis as a “women’s health issue”, but management of osteoporosis 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.  Since 2008, the rate of osteoporosis related hip fracture in the American male population is going up at an alarming rate.

Osteoporosis is a silent disease.  Most people do not realize they have a problem until something breaks and they are in the middle of a medical crisis.  Even after a fracture, many physical therapy patients are reluctant to follow up with a bone density screening.  Being proactive is the only method of managing osteoporosis.

We know that individuals that 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 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.

Jane Brody of the New York Times wrote a helpful *article on bone density testing. It covers the latest medical guidelines for testing and the when and why of testing for both men and women.

Michael S. O’Hara, P.T., OCS, CSCS

*New York Times, July 16, 2018, Jane Brody, When to Get Your Bone Density (View Article:here)

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

Progression Know How

Carries, Crawls, and Core

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

Jeff Tirrell, CSCS, CSFC, Pn1

Carries, Crawls, and Core

Push Up Position Plank: Goal of 1 minute

Plank: Goal of 30 seconds

Side Plank: Goal of 30 seconds/side

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

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

Anterior Baby Crawl: goal of 15 yards with stable torso

Anterior Crawl: Goal of 30 yards with stable torso

Farmers Walk: Goal of 60 yards with body weight

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

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

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

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

Progression Know How

Vertical Pull Patterns

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

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Pull Patterns

X Pulldowns: Goal of 50% bodyweight for 10 reps

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

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

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

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

 

Progression Know How

Horizontal Pull Patterns

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

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Pull Patterns

TRX Row: Goal 45 degree angle for 10 reps

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

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

Watch Jeff demonstrate these exercises: View Video

Progression Know How

Vertical Press Patterns

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

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Press Patterns

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

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

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

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

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

Watch Jeff demonstrate these exercises: View Video

Progression Know How

Horizontal Press Patterns

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

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Press Patterns

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

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

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

See video demonstration of these exercises here: View Video

Progression Know How

Hinge Patterns

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

Jeff Tirrell, CSCS, CSFC, Pn1

Hinge Patterns

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

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

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

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

See video demonstration of these exercises here: Hinge Pattern Video

Finding Fitness With Lower Back Pain

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

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

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

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

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

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

Michael S. O’Hara, PT, OCS, CSCS

 

Progression Know How

Squat Patterns

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

Jeff Tirrell, CSCS, CSFC, Pn1

Squat Patterns:

Goblet Box Squat- Goal is 50% body weight down to a 12” box for 10 reps (if under 5’2” go to 10”, if over 6’ 2” go to 14” box)

Goblet Split Squat- Goal is 50% body weight for 10 reps/leg

Rear Foot Elevated Goblet Split Squat- Goal is 50% body weight for 10 reps/leg

Rear Foot Elevated Split Squat w/DBs at sides- Goal of 100% body weight for 10 reps/leg

One Leg Squat- Goal of 25% body weight down to 12” box for 5/leg (shorter or taller based off goblet box squat standards)

Front Squat- Goal of bodyweight for 10 reps

BB Back Squat- Goal of 1.5x bodyweight (women) or 2x bodyweight (men) for 2-5 reps

See video demonstration of these exercises here: https://youtu.be/vkrtWkNx8pg.

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