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Spine

standing-desk-pro-plus-36_main-1I have known Tracy for at least seven years.  She is an active mother of three children and works full time as an accountant.  Over a four-year span, Tracy was a patient in our physical therapy clinic three times for the same problem of leg and lower back pain.  Tracy always recovered and was able to return to work but her last bout of pain lasted three months.  I ran into Tracy at a restaurant recently.  She stated that she was ashamed to admit it, but after four years of listening to me preach about the benefits of a standing work station, she finally got out of the chair and started working at a stand up desk.  This is her standing desk story.

Her legs “felt tired” for the initial eight weeks and she went back and forth between standing and an office chair.  Tracy kept performing her hip mobility exercises and lumbar stability drills and gradually became more accustom to her new workstation.  She has been using the standing desk for three years, and in that time, she has not been bothered by any back or leg pain.  An additional benefit has been an eight-pound weight loss and “surprisingly” her “sinus headaches” have resolved.  Tracy told me she sits for at most three hours of a workday and could not imagine going back to a seated workstation. Tracy stated that three of her coworkers have made the standing desk transition and all report similar results.

Prolonged sitting creates multiple postural pain problems.  Postural Stress Disorder (PSD) is the new term given to the pain created by seated office work.  In our physical therapy clinics, we are seeing more and more patients with face, head, neck, shoulder, back, and hip pain associated with prolonged sitting.

We are de-evolving into a nation of sitters.  Between internet, television, driving, and computer work, it is not uncommon for many of my physical therapy patients and fitness clients to sit for ten hours a day.  Unfortunately, you cannot train away the bad effects of prolonged sitting with a 45 minute session of exercise.

While it takes some effort, and a little office remodeling, the benefits of using a standing workstation cannot be ignored.  I was happy to hear Tracy’s story and recognize her as one of my reluctant, but now pain-free converts.  If you have an occupation that places you in front of a computer, you should invest in a stand up style workstation that allows you to be upright for most of the day.  Many large corporations have recognized the benefit and have made the switch to standing workstations.  Standing desks are now more affordable and several of my converts have one at work and one at home.
-Michael O’Hara, P.T., OCS, CSCS

Halos And Around The Worlds Are The App For That

halosMuch like the collision avoidance computer systems built into automobiles, our brains run neural software that prevents us from overloading and damaging the spine.  If we are unable to adequately stabilize the spine, our neural injury avoidance system prevents us from loading the arms and legs in positions that will produce a spinal injury.  Developmentally, we master the capacity to control the muscles in the middle of the body first.  What this means for the average fitness participant is that hip/shoulder exercise activities have little value if we do not possess adequate spinal/pelvic girdle stability.  Training that enhances the coordinated control of the “muscles in the middle” enables our neural system to produce more efficient, graceful, and pain-free movement.

Halos and Around the World drills improve the coordinated control of the pelvic girdle and spinal stabilizers.  They act as a “neural reboot” of the software that controls stabilization of the spine and pelvic girdle.  These exercises are easy to learn and require minimal equipment.  An Airex pad under the knees makes the exercise more comfortable and you can use a kettlebell, sandbag, or an Iron Grip weight plate for resistance.

Kettlebell Halos in Tall Kneeling
Assume a tall kneeling position on the Airex pad.  The knees are under the hips and the toes should grip the floor.  Grip the kettlebell by the horns in an inverted position.  Make the shoulder girdle muscles active by pulling out against the horns of the ‘bell.’  Brace the gluteals and abdominal muscles and maintain a tall and stable posture during the exercise.  Start with the ‘bell’ in front of the chest and circle the kettlebell slowly around the head in the shape of an angel’s halo.  Perform three to five halos in clockwise and then three to five counter clockwise.

Sandbag Around the World
Assume a half-kneeling position on the Airex pad.  The left knee is under the hip and the toes of the left foot should grip the floor.  The right knee is in front of the hip and the foot is flat on the floor.  I like the unstable “shifting resistance” provided by a sandbag for this exercise but you can also use an Iron Grip weight plate.  Make the shoulder girdle muscles active by pulling out against the handles of the sandbag or Iron Grip plate.  Brace the gluteals and abdominal muscles and maintain a tall and stable posture during the exercise.  Start with the bag or plate in front of the body at belly button level.  Take the implement around the body in a very slow and steady fashion.  Each repetition should take at least six seconds to complete.  Do not permit the body to shift or shake.  Perform three to five cycles in clockwise and then three to five counter clockwise.  Switch the leg position and repeat with the right knee down and the left leg forward.

For the next six weeks, perform one of these exercises at every training session.  It is surprising how many people report improved capacity to squat, lunge, overhead press, and get off the floor with some dedicated neural retraining of the “muscles in the middle.”

Video demonstration of kettlebell halos and sandbag around the worlds can be seen here: https://youtu.be/LGodn9ImRqc

Michael S. O’Hara, P.T., OCS, CSCS

PDFThe September 2016 newsletter contains information on preventing ankle sprains.  Mike O’Hara, PT demonstrates exercises to prevent ankle inversion.  Meet Fenton Fitness member Gay Adams and read her story on staying strong during a difficult time, and learn about the suitcase carry–a better alternative to weighted sidebends.

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Bear_PawGetting up and down off the ground is a movement skill we need to maintain.  It is the functional exercise activity that keeps us safe and independent for a lifetime. Developing proficiency in getting up and down off the ground has multiple benefits.  It takes away fear, builds confidence, and increases activity in other areas of life.  Your fitness training should involve activity that makes you better at moving gracefully in and out of the positions necessary to get up and down off the ground. 

Getting up and down off the ground is largely a neural activity.  Nearly everyone has enough strength, range of motion, and balance—you just need some practice.  Physiologically, we know that movement practice makes transmission of neural signals more efficient.  Research on motor learning has taught us that repetition, ascending challenge levels, and coaching produces the best results.  The bear paw exercise is a good starting point for improving from the ground up movement skills.

Bear Paw Performance

You need a medicine ball and some open space.  Get down on the ground in an all four stance with the medicine ball under the left hand.  Brace the abdominal muscles and lift the knees up off the ground about six inches.  Maintain that suspended position and roll the ball forward and backward with the left hand, like a bear pawing the ground.  Keep the right shoulder blade down the back and the neck free of tension.  Perform ten repetitions, lower down, and rest.  Switch to the right hand and repeat the drill.  Perform three times on each side.

View video explanation of the bear paw exercises here: https://www.youtube.com/watch?v=gGcsbv-BqfU

Michael S. O’Hara, PT, OCS, CSCS

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

I am often asked about my fstir_the_potavorite “core exercise.” My response is Stir the Pot, an exercise I learned at a lecture given by spine biomechanics expert, Dr. Stuart McGill. Most people have never heard of this exercise, and I have never witnessed it performed in a commercial gym. It is a challenging drill that is worthy of your training time.
But first I need to make a disclaimer: If your training goal is to reduce the layer of fat across your abdomen and develop a six pack, the Stir the Pot exercise is far from the most beneficial exercise. The best exercise for that is the table push away. One strict repetition of the table push away, performed midway through each meal, is the only exercise that will make the six pack visible. If your training goals are to improve your posture, reduce back pain, and function more efficiently, try adding Stir the Pot to your training program.
The abdominal muscles operate as a team to reduce, not produce, spinal motion. They hold the torso upright and transmit forces from the lower to the upper extremities. You need to develop the isometric strength/endurance that enables the team of abdominal muscles to turn on, and stay on, for an extended period of time.

Stir the Pot Performance

You need a properly inflated physioball for this exercise. Place your elbows on the physioball with the shoulders directly over the elbows. Dig your toes into the floor and set the feet at least shoulder width apart. Lift up into a solid plank position—one long line from the ear to the ankles. Tighten up the gluteal muscles and the pull the shoulder blades down the back. The pelvis should not drop or rise up during the exercise—a mirror and some instruction can help with this common problem. Rotate the ball with the arms clockwise and then counter clockwise for five repetitions, each direction. Try to perform this exercise for time. Work up to sixty seconds of Stir the Pot, and as you get stronger, try elevating the feet on a bench.

-Michael O’Hara, P.T., O.C.S., C.S.C.S.

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A Demanding Drill for Core Stability

The addition of handles to the simple weight plate was a brilliant idea that made maneuvering plates on and off bars and weight machines much safer.  I am certain thousands of toes and fingers have been spared since these new plates became standard equipment in most gyms.  Plates made by Iron Grip are encased in urethane and have large diameter handles that make them more user friendly than traditional plates.  The grips on the Iron Grip plates are parallel to one another and the handles are rounded and ergonomically correct.  One of my favorite Iron Grip plate exercises is the Overhead Plate Carry.

Overhead Plate Carry

overhead_plate_carryThis is a challenging drill that builds hip strength, core stability and scapulothoracic control.  Start with no more than a twenty-five pound plate and hold it directly overhead.  You must have sufficient shoulder girdle mobility to get the arms next to the head and keep the elbows straight.  Maintain a tall torso and walk forward 30 yards while keeping the plate overhead and torso tall.  Lower the plate, take inventory, and if able, attempt a second trip of thirty yards.  Gradually work up to a heavier plate and greater distances.  A mirror is helpful to monitor your posture.
Try greater distances before adding greater load to this exercise.  A five pound plate joiner can be used to increase a forty five pound plate up to ninety pounds.
-Michael O’Hara, P.T., O.C.S., C.S.C.S.

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PDFIn this month’s issue, Mike O’Hara discusses hypermobile joints and exercise, 4 steps to fitness success are given, and information on how to stop back pain from disturbing sleep is presented.  Check out page three for a description of the latest class offered at Fenton Fitness– Suspension Shred.

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Nothing slows down your progress toward greater fitness and better performance than an injury. Bad combinations of exercises during a training session can set you up for a big crash. Poor exercise programming produces the joint overload or connective tissue stress that produces pain. Lumbar flexion activities combined with an exercise that compresses the lumbar spine is one of the more Hernaited_Disccommon killer combinations.

Here are some examples of lumbar flexion activities combined with exercise that increase lumbar intervertebral pressure. I am seeing these killer combos more frequently during my visits to the gym.

-Ten GHD sit ups followed by fifteen American Swings.

-Twenty medicine ball rotational crunches followed by a sixty yard farmers carry.

-Rowing machine for 500 meters followed by barbell on back walking lunges.

-Five toes to bar and then five barbell cleans.

-Five minutes of super slumped power texting followed by three heavy deadlifts.

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