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Health Information

The Incredible Shrinking Man

The How, Why, And What To Do About Getting Shorter

Starting at about age 40, we begin losing height at a rate of four tenths of an inch every decade.  The trip from 40 to 80 years of age can easily take two and a half inches off of your height.  Some of the loss occurs as part of the normal aging process, and some because of disease and deconditioning.  The reasons we get shorter are well understood, and the good news is that we can do something about many of the causes.

Thinning Discs
One third of our spinal height is made up of the intervertebral discs.  The disks are made up of the same type of tissue as your nose.  The capacity of the discs to deform and bounce back to their starting shape permits one vertebrae to move on the other vertebrae.  The discs have a fluid filled center that helps attenuate force in multiple directions, similar to a shock absorber.  As we age, the discs between the vertebrae tend to become thinner.  If the distance between the top of your sacrum and the base of your skull is 33 inches, you have a potential 11 inches of disc height you can lose to father time.  Sitting increases the load on the tallest discs and a lifetime of prolonged sitting can accelerate your shrinkage.

Strength and Spinal Changes
Strength deficits in the postural muscles of the neck, posterior shoulders and upper back permit the head and thoracic spine to fall forward.  Extreme changes can create the hyperkyphotic spine or Dowagers Hump in the upper back.  Poor core stabilizer control will cause the pelvis to fall forward and the lumbar spine to collapse.  Obesity accelerates these alterations in spinal posture, as the weak muscles must support greater loads.  The muscles are the guy wires that hold the spine tall.  Lose tension on those wires and the tower starts to twist, bend, and get shorter.

Compression Fractures
The body of each spinal vertebrae resembles a cylindrical can with a webbing of reinforcing bone on the inside of the can.  As we age, osteoporosis can take a toll on the bone density of the vertebral body.  A compression fracture of the vertebral body is similar to standing a soda can on end and crumpling the can.  A crushed vertebrae is much shorter, thereby reducing overall spinal height.  Many people suffer small spinal compression fractures and are unaware of the damage until they undergo an imaging test.

The Fight For Height
So what can you do to maintain your elevation?  Keep your body strong and your weight under control.  Pay particular attention to the muscles on the posterior aspect of the body.  These muscles must fight the war against gravity every day.  They keep your spine tall and prevent the postural collapse that is all too common in the elderly.  Sit less and stand more.  The compressive forces of prolonged sitting on your spine are just one of the many bad things that sitting does to your body.  Exercise caution in regards to activities that compress your spine.  I would not recommend a sixty year old take up motocross or begin an exercise program that consists of deadlifts and Olympic lifting.  Be proactive about getting your bone density assessed, especially if you are a woman who went through menopause at an early age.  Have your vitamin D level checked, and if necessary, start supplementing on a consistent basis.  If you are diagnosed with osteopenia/osteoporosis, work closely with your physician on  medical treatment.

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

No Guts, No Glory

Exercise, Ibuprofen, And Colonic Seepage—Ewwww!

A new study* joins other evidence that ibuprofen taken before a workout may be causing disagreeable physical damage to the intestines and inhibiting muscle recovery.  Many runners, cyclists, and general fitness enthusiasts often down a dose of ibuprofen as a preemptive strike against post exercise soreness.  The habitual use of ibuprofen appears to have some significant health considerations for those of us who exercise.

Research studies have shown that strenuous exercise alone commonly results in a small amount of intestinal trauma.  Blood flow during prolonged exercise is shunted away from the gut to the laboring muscles, heart, and lungs.  This produces a transient blood flow ischemia in the sensitive intestinal lining and some degree of intestinal cell death.  Markers for this intestinal damage have been measured in the blood of endurance runners and cyclists.  This damage is generally short lived and resolves in a few hours.

A recent study of cyclists found that those participants who downed ibuprofen before a session of exercise had significantly higher levels of “intestinal leakage” into the blood stream than those who did not use the ibuprofen.  The concern the research physicians have is that chronic use of ibuprofen and strenuous exercise can lead to the leakage of digestive enzymes and bacteria into the blood stream.  Damage to the intestinal lining reduces the absorption of nutrients that are critical to recovery from a strenuous exercise session.  Tired muscles are unable to sufficiently regenerate because the gut cannot supply the nutrients necessary for muscle tissue rebuilding.

A study from a few years ago** found that runners from the Western States 100 Mile Endurance Run who were regular ibuprofen users had small amounts of colonic bacteria in their bloodstreams.  The bacterial incursion caused by “colonic seepage” actually causes higher levels of systemic inflammation.  The ibuprofen taken to reduce inflammation instead had the reverse effect and created more inflammation.

So, the next time you watch the drug company’s commercial of the woman who pops two pills and is able to run without pain, think about the bacteria sprinting through her bloodstream after her training session.
*Aggravation of Exercise Induced Intestinal Injury by Ibuprofen in Athletes, Medicine and Science in Sports and Exercise, December 2012, Van Wijck et. al.

**Ibuprofen Use, Endotoxemia, Inflammation, and Plasma Cytokines During Ultramarathon Competition, Journal of Immunology, November 2006 Nieman et. al.

Barbara O’Hara, RPh

Year 55 Scorecard

Fitness is a motivational mind game.  Setting achievable goals provides the ongoing positive reinforcement needed to keep at the fitness habit.  I no longer set as many performance goals.  As I get older (55), it is more difficult to get stronger, run faster, or jump higher.  I try to set attainable process goals.  I want to stay injury free, metabolically healthy, fight off postural deterioration, and train consistently throughout the year.  If I happen to lose some fat, get stronger or faster, it is a happy by product.  Every birthday, I do a fitness goal review and this is my year 55 fitness scorecard.

Two Hundred Training Sessions a Year
My goal is to get in 200 training sessions in a year.  I managed to fit in 212 sessions for the past year.  Setting specific attendance goals is critical.  In fitness, all of the significant long-term benefits happen when you show up on a consistent basis.

Maintain Proper Movement
This is how the downward spiral starts.  You lose some mobility in your lunge, squat, or overhead reach.  Limited mobility means you no longer can work the muscles through a full functional range of motion.  The muscles move less, atrophy takes hold, and the metabolism slows.  You gain fat more readily, and because you are weaker and heavier, you move less.  Less total movement activity leads to even less mobility.  Less muscle mass leads to far less stored glycogen and insulin sensitivity suffers.  Insulin sensitivity problems lead to diabetes, obesity, metabolic syndrome……. You get the idea.  Mobility is a key component to remaining injury free and staying metabolically healthy.  This past year finds me better in all lunge patterns, and my sprint strides no longer look like Barry Sanders on one side and Colonel Sanders on the other.

Better Single Leg Motor Control
This has been the biggest challenge and the biggest change.  My single leg balance is better and the strength in my hips and lower back has improved.  Single leg training becomes more important as you get older or have a history of injuries.  I enjoy the variety that single leg programming brings to my training.

Power Up
In 2012, I did much more power type training.  In athletics and daily survival, power is more important than strength.  As we get older, the ability to fire muscles rapidly recedes.  The last decade of research studies have shown that this trend is reversible.  My scores in the medicine ball throw and the standing long jump both improved.  I believe the drills that helped the most were the hurdle jumps and kettlebell swings.  I became more proficient in both of these exercises.  My vertical leap did not get any better, but it did not get any worse.

No Injuries
I started with a sore shoulder, but some dedicated mobility work and rehab training set that straight.  I made it through the rest of the year with no dings or dents.

No Medications
This is a goal of mine every year.  I consider it a fitness victory if I am able to go another year and not have to take a blood pressure pill, statin drug, or an anti-inflammatory. I can think of no better fitness goal than being able to eliminate medications because your health is better.

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

Sooner Is Always Better

Recent Research On Early Physical Therapy Intervention For Lower Back Pain

Physical Therapists play a key role in the management of lower back pain.  The lower back pain patient often must travel a long and irregular road on the way to a physical therapist for care.  Patients often have multiple doctor visits, imaging tests, various medications, epidural injections, and worst of all– rest.  So when is the best time for a lower back pain patient to see the physial therapist?  A recent research study has answered that question.

Scheduled to be published in the journal Spine, this study* of over 32,000 patients has concluded “Early physical therapy following a new primary care consultation was associated with a reduced risk of subsequent health care compared with delayed physical therapy”.  Early physical therapy was defined as less than fourteen days.  Early physical therapy lowered costs, reduced the number of visits to the physician and decreased the use of injections, diagnostic imaging tests, and surgery.

Industry and business has figured this out.  Computer chip maker Intel has a program that gets their injured employees with back pain to the physical therapist in 48 hours.  Since utilizing this program, the cost of care has dropped by 30%.  The number of lost workdays has fallen from 52 to 21 days and patient satisfaction with the program is better.  Since 2006, Starbucks has been using a program that gets their employees with back pain to the physical therapist in twenty-four hours.  They have achieved lower costs, earlier return to work, and greater satisfaction from the patients.

In 2009, I spent three days with WorkSmart Solutions in two different industrial plants in Rockton, Illinois.  The physical therapist from WorkSmart visited the plant three days a week and consulted with the employees on any problems with pain.  They provided treatment as needed and assisted with work site ergonomics and activity modification.  The Human Resource departments in both plants remarked on the reduction in administrative hassle and the lowering of work compensation claims for lower back and neck pain.  The employees raved about the care for from the physical therapist and the ease of access to ongoing help.

The earlier we can intervene with physical therapy treatment the more likely we are to prevent the deconditioning that occurs with rest, the development of hypersensitive pathways, and fear of activity.  Lower back pain is a mechanical injury that requires the management of all mechanical forces in the patient’s life.  Education on proper posture, body mechanics, and fitness activities as well as modification of the work site are all part of comprehensive physical therapy intervention.

*Spine, Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary car referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs.

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

 

Multi Directional Power Training

Surge 180

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.

Multi-Directional
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.

Core Coordination
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.

SUSPENSION ROWS

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.  

Cervical Proprioception
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.

Suspension Rows
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

ROLLERPALOOZA

Soft tissue mobilGrid rollerization with foam rolls has become popular in physical therapy, sports training, and fitness.  Foam rolling helps decrease pain, improves mobility, and can enhance recovery from exercise.  For an old gym rat like myself, it helps me bounce back from a tough training session, a long golf weekend, or too much computer time.   More varieties of rollers have come on the market, and whenever we are faced with a lot of choices, it becomes more difficult to make a decision.  In this short presentation, I have some suggestions on the proper roller for the job.  

Rollers are available in three foot and one foot lengths.  I find the longer versions easier to use, but I own a short pipe style roller that I take with me when I travel.  Bigger guys generally do not do well with a short roller.  

Standard Foam
foam rollerThe best roller for you will depend on your tissue tolerance and how sensitive are you to the compressive forces of the roller.  If you are new to foam rolling, a low density white Styrofoam roller is softer and will create less discomfort.  As you develop better tolerance to rolling, you can progress to a firmer black foam roll.  It has been my experience that the white rolls break down faster than the firmer black rolls, so be prepared to replace a white roll fairly often.  

Pipe Style
rumble rollerHollow pipe style rollers are newer to the market and I have had good results with two products.  The Grid Trigger Point roller is a cushioned hollow pipe with a grid pattern across the surface or the roller.  Many smaller clients and patients report they like the short version of the Grid roller.  Another hollow pipe version is the Rumble Roller.  This product has a series of projections that extend from the roller surface.  Self-soft tissue mobilization with a Rumble Roller is more uncomfortable than any other roller I have used.   It is a more aggressive treatment but I have found it works well for individuals with thicker and denser muscles.  

Not So Good
The hollow rollers that are covered with Styrofoam tend to break down fairly quickly.  The rollers with fabric covers often create slippage problems with several types of clothing.  The fabric interactions tend to make rolling less than efficient and are more difficult to control.  The fabric covers tend to lose their fit after a few washings.  The air inflated style rollers are a balance training device and are ineffective as a soft tissue mobilization tool.  

Michael S. O’Hara, P.T., OCS, CSCS

PROPER TECHNIQUE–HIP HINGE

With their newest release, BODYPUMP is going back to basic, simple, weight training techniques and principles.   New exercises are part of the lunge track, and greater focus on strengthening the gluteals and hamstrings are in the squat and deadlift tracks.  BODYPUMP 85 will kick off in April at Fenton Fitness.

BODYPUMP TECHNIQUE: PROPER HIP HINGE

The hip hinge is a basic movement pattern we all should master.  It keeps stress off the lumbar spine and improves strength in the hamstrings and gluteal muscles.  The BODYPUMP row, deadlift, and clean all require a proper hip hinge.  Many pump participants perform these lifts with way too much spinal motion.  When you hip hinge the spine stays still and you tilt forward at the pelvis.  The pelvis rolls around the femur to create flexion at the hip.  The gluteal muscles and hamstrings create the motion that moves the bar, and the core stabilizers hold the spine stationary.  The best view of your hip hinge performance is from the side.  Practice the drill below to help improve your hip hinge. 

Hip Hinge Stick Drill

You need a mirror and a pvc pipe, golf club, or yardstick.  Stand sideways to the mirror and place the stick along the length of your spine.  The stick should touch your gluteal muscles, thoracic spine, and head.  A space between the stick and your body should be present at the lumbar spine and neck.  Maintain those spaces as you push your bottom back and tilt forward.  The knees should bend a little (20-30 degrees) and you should feel some tension in the back of the thighs.  The motion happens at your hip and the lumbar and thoracic spine stays still.  Use the mirror side view to assess your performance.  The stick acts as feedback mechanism to help you keep the spine stable and initiate the movement at the hips.  Progress to using your BODYPUMP barbell with a proper hip hinge motion. 

Michael S. O’Hara, P.T., OCS, CSCS

 

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