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Spring Trap

Preventing Gardener’s Trauma

After a long, snowy Michigan winter, the first warm and sunny day, we charge outside and clean up the yard.  The months snow bound in the house have made the gardeners eager to start the spring clean up and prepare for the summer to come.  Most of us will spend the winter in a fairly sedentary physical state and with no physical preparation to launch into hours of challenging outdoor work activity.  Every year at our clinics, we treat patients with gardening and yard work induced injuries that could have been prevented with some modifications of activity and preventative exercise.  These are my four hints to help safeguard my gardener friends from an unintended trip to the doctor’s office.

#1: Set a Time Limit.

Most of the patients we see with gardener trauma report that they worked “all afternoon” in the yard.  It is not uncommon to hear patients report they were bending, pushing, or pulling for five or six hours.  Use some caution and limit the duration of your weeding, raking, and shoveling.  Set a time limit of two hours and then stop–the garden will be their tomorrow and you will be less likely to have to undergo a springtime MRI.

#2: Use Proper Ergonomics.

Many gardening tasks place your body in challenging positions.  Ergonomic experts go to great lengths to eliminate forward trunk flexion and sustained knee flexion from industrial work settings.  Pulling weeds and cleaning out flowerbeds combines both of these positions and can create mechanical back and knee pain.  Avoid being in the “hands and knees” position for extended periods of time by changing positions frequently.  Use knee pads to reduce compressive forces on the knee joints and purchase gardening tools with extended handles so that you need not bend as far or as often.

#3: Avoid Lifting Heavy Objects.

After a sedentary winter spent indoors watching television and knitting, the last thing you should attempt is to hoist the 40 lb. bag of fertilizer into the back of the wheelbarrow. Lifting injuries increase dramatically with loads greater than 25 pounds.  Lifting any object from the floor to standing is risky, and carrying unstable loads that can shift around increases stress on the body.  Divide heavy loads into smaller portions and avoid lifting directly off the floor.  Get a bigger, stronger, and fitter neighbor or family member to help with heavy lifting tasks.

#4: Prepare For Battle.

Gardening and yard work are challenging tasks that should be met with a degree of preparation.  If you want to work for five hours in the garden and remain pain free, you must train your body for that level of activity.  I have selected three simple exercises you can do to get yourself ready for action in the yard.  Simple modification of ergonomics, limitations on work duration, and preparatory exercise can prevent a summer of pain.

Getting Ready To Toil In The Soil.

These three exercises can help you avoid injury and make your spring gardening safer and more productive.  Ideally you will perform these drills three times a week for two or three weeks before getting outside and working.

Hip Flexor Stretches

This stretch elongates the large muscle that runs across the front of the hip and attaches to the spine.  This region tends to tighten with prolonged sitting and can restrict hip and spinal motion.  Place one knee up on a cushioned chair and the other foot slightly forward on the floor.  Keep the spine tall and bend the front knee to stretch the hip flexor muscles.  Hold for five to ten seconds and repeat five times.  Perform the stretch on the other side.

Four Point Fold Ups

If you are going to spend time on all fours, it is a good idea to train your body for this task.  Assume a four-point position, knees under the hips and hands under the shoulders.  Keep the hands stationary and drop the hips back toward the heels.  Go back to the point you feel a stretch and hold–do not stretch into pain.  You may feel this in your hips, shoulders, lower back, or upper back.  Hold for five to ten seconds and repeat five times.

Bodyweight Squats

Gardening and yard work involves a lot of squatting.  Being able to safely squat allows you to lift with better body mechanics.  Simple bodyweight squats will strengthen the legs and trunk in preparation for these tasks.  Place your feet at least shoulder width apart.  Check the foot width with a full length mirror– most people squat with the feet too close together.   Keep the heels flat on the floor and squat down by pushing the hips back.  Work on maintaining balance and control during the motion.  Practicing this movement pattern will also improve your flexibility.  Perform a series of ten repetitions and then rest and perform another set of ten.

Michael O’Hara, PT, OCS, CSCS

World’s Best Diet Part 3–Weight Watchers

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

Weight Watchers

Claims: Weight Watchers markets itself as being flexible and livable.  They assign food points based on their “Smart Points System”.  They encourage the consumption of fruits, vegetables, and lean proteins, and discourage the consumption of sugar and unhealthy fats with this points system.  They even list 200 different foods as being “zero points foods”.  They encourage tracking of food and claim to be successful at helping people achieve long term sustainable weight loss.

Reality: Tracking your food intake in any way is usually helpful when it comes to weight loss–if done accurately.   The points system is really just a complicated marketing scheme similar to simply tracking calories, which anyone can do on their own for free.  There are no zero foods in existence that have no caloric impact, so the notion of “zero points” foods is ludicrous.  Any food eaten in excess can and will slow weight loss and/or lead to weight gain.  Every person I’ve ever met who was a lifelong Weight Watchers client had success with the program, but was 40+ pounds overweight..

Pros: Allows for dietary flexibility which should improve long term adherence.  Requires tracking of food and portion sizes.  If you opt into monthly meetings, there is an accountability factor built into it.

Cons: No minimum requirement given for protein intake.  Allows certain foods to be eaten with no limit.  Not a good long term success rate (think Oprah’s weight swings).

 

Jeff Tirrell, CSCS, CFSC, Pn1

World’s Best Diet Part 2–The Zone Diet

If you google the word diet, you will come up with over 200,000 results.  Every week, month, year, and decade a new study or article comes out claiming certain foods are killing us, or that some other food or nutritional approach will lead us to the promised land.  Unfortunately, articles are written to create traffic, so scientific research is often misreported or spun to sell magazines or generate website traffic.  The truth is, there are many ways to skin a cat.  All of the evidence on nutrition (in regards to weight loss) points to two undeniable truths.  First, that dietary adherence is king.  It doesn’t matter how perfect or evidence based a nutrition plan is, if you can’t follow it, it doesn’t matter.  Before starting any eating plan, you must ask yourself how easy it will be to maintain long term.  Second, you must achieve an energy deficit to lose weight (eat less energy than you expend each day).  Though “calories in, calories out” may be slightly over simplified, it is still the underlying rule to any weight loss success.   For any weight loss plan to work, you must consistently follow the pla, and you must be in a caloric deficit.  This series will highlight the nine most popular current nutrition approaches, and the pros and cons of each.

The Zone Diet

Claims: The Zone diet was built around the idea of keeping your macronutrients in a specific ratio.  The prescription is 40% carbohydrates, 30% fat, and 30% protein.  There aren’t as many robust claims with the zone diet that you find with many other trendy diets out there.

Reality: The Zone diet is a sensible diet approach.  Most Americans tend to overeat carbohydrates, and sometimes fat, and under eat protein.  This approach increases protein intake and typically reduces carbohydrate and overall calorie intake.  If calories are reduced, then this diet will work.  The simple act of giving people macronutrients  forces them to track their food intake, which in and of itself often reduces intake.  We typically recommend carbohydrate intakes of 35-60%, fat intake of 15-30%, and protein intake of 20-35%.  As you can see the Zone approach fits this nicely.

Pros: Doesn’t take any food off the table entirely.  Allows flexibility with food choices.  Tends to increase protein intake in most people.  Creates awareness of food intake and requires monitoring intake.

Cons: Doesn’t directly require attention to overall caloric intake.  Ignores micronutrient intake (vitamins and minerals) and food quality isn’t necessarily monitored.

Jeff Tirrell, CSCS, CFSC, Pn1

How To Start Working Out

*How to Start Working Out, is a great article by Anahad O’Connor.  Most media articles on developing the fitness habit are fairly flawed, but Mr. O’Connor has done well.  I am encouraged because he discusses two of the more important aspects of fitness success: process goals and strength training.

Process Goals

Developing and maintaining the fitness habit is a motivational mind game.  Having a goal provides the emotional reinforcement necessary to be successful.  Most fitness clients set outcome goals—they want to lose twenty pounds, get stronger, or run a 5 kilometer race in record time.  Outcome goals are achieved through proper nutrition and consistent training.  Outcome goals are achieved through the development of a better life process.  I try to steer clients toward process goals—eat more protein, sleep better, daily mobility sessions, etc…  Process goals are the building blocks of fitness success and focus on your life outside of the gym.  Setting and achieving process goals creates the environment for achieving nearly everyone’s outcome goals.  Stronger, leaner, pain free, and faster will all follow when you have better life processes working in your favor.

Every expert on habit development recommends a paper and pen.  Writing it down is part of the commitment to fitness.  Record your process goals in an exercise log book or a nutrition diary.  Process goals that have worked well for fitness clients are listed below.

-Perform a daily five minute foam roll / mobility session for the next forty days.

-Weigh every serving of food you consume for the next two weeks.

-Take a thirty-minute walk for forty consecutive days.

-Get an extra hour of sleep every night for the next two months.

-Drop all sweetened drinks (juice, soda, sports drinks) for three months.

-Learn how to prepare a new healthy meal every week for six months.

Older, deconditioned, and metabolically challenged fitness clients will develop the fitness habit more readily with a dedication to process goals.  Build on the habits created by achieving ever more challenging process goals and you will reach all of your outcome goals.

Strength Training

When you get stronger, the magic happens.  It is really that simple.  If you want to be leaner—get stronger.  If you want to chase away the pain—get stronger.  If you want to improve your performance—get stronger.  If you want to prevent injuries—get stronger.  If you want to be active and vital into old age—get stronger.  The problem is that many barriers exist to the strength solution.

For best results, we need to start early.  An adequate strength level keeps you functioning well for a lifetime.  If in your early years, you were fairly sedentary, you need to get busy and strength train.  As we age, we lose a portion of our lean tissue, and if you have less muscle and bone “in the bank” you will reach your fifties and sixties in a weak and frail body.  Age related sarcopenia (loss of muscle mass) is one of the primary drivers of metabolic problems such as diabetese, hyperlipidemia, and chronic inflammation.  Today’s children are growing up with fewer episodes of bone and muscle building lifting and carrying activities.  I see teens nearly every day with lower back, knee, and hip pain all related to glaring strength deficits.

A lack of proper coaching and progressive programming are barriers to your strength training success.  Strength training is like medicine; given the proper prescription and dose, the results are consistently good.  Many of the people that have tried strength training and had bad results have taken the wrong medicine at the wrong dose.  They utilize advice from magazines, celebrity trainers, and the internet.  They confuse pharmaceutically assisted bodybuilding programs as appropriate strength training for a forty year old.  The best results are achieved when you work closely with a qualified coach who can monitor your results and teach you how to get stronger.

Michael S. O’Hara, PT, OCS< CSCS

*New York Times, Health Section, Anahad O’Connor, How to Start Working Out. View here.

Training For Less Fat, More Muscle

How To Induce A Growth Hormone Response

Human growth hormone (hGH) has been a newsmaker because of athletes’ illicit use of synthetic versions of this hormone to help them perform better on the baseball diamond, football field, or bicycle race.  Bodybuilders inject synthetic hGH to help sink bodyfat levels to single digits, all the while maintaining optimal muscle mass. The last ten years of exercise science has shown what type of fitness activities induce the greatest natural growth hormone response.  Specific exercise and recovery activities have a positive effect on our body’s daily hGH production.

Human growth hormone (hGH) is secreted in a pulsatile fashion throughout the day.  A number of physiological stimuli can initiate hGH release, the most powerful of which are sleep and exercise.  Human growth hormone has many varied roles throughout your life.  For adult athletes and fitness clients, hGH helps increase fat metabolism–you get leaner, enhance muscle recovery from challenging exercise or injury, you stay stronger, and produce a healthier body composition as you age.

Resistance Training

Resistance training produces a significant exercise-induced growth hormone response (EIGR) that can last for 24 to 36 hours.  The response is greatest with full body training sessions that involve multi joint lifts and carries.  EIGR is not limited to traditional barbell or dumbbell training, but is also produced with the performance of bodyweight resistance training.  The post training hGH response gets better as the trainees became more proficient (gets stronger) with strength training.

Anaerobic Exercise

The exact mechanism that causes EIGR with anaerobic exercise is not known, but it appears to be related to higher lactic acid levels in the blood.  The activities that produce the greatest EIGR are high intensity exercise intervals lasting at least 30 seconds.  The researchers’ current recommendations for optimal EIGR are six to eight 30 second intervals of high intensity activity.  Bicycle sprints have been the most commonly used exercise modality in research studies, but other activities can be used as long as your joints and muscles can tolerate the stress.  Treadmill, stairclimber, rower, as well as track sprints and hill runs are good interval training choices.

Sleep

Human growth hormone is released in response to our natural circadian rhythms.  If your sleep-wake cycle is disturbed, the cyclical release of hGH is blunted.  Maintaining good sleep hygiene is important for optimal hGH production.  Avoid stimulants such as caffeine and alcohol before retiring to sleep.   Falling asleep and waking at consistent times creates more consistent hGH blood levels.  Just a few nights of interrupted or decreased sleep duration have been shown to reduce fat metabolism, slow muscle recovery, reduce insulin sensitivity, and decrease hGH levels.

Natural HGH Production Activity

Inducing optimal human growth hormone production is easy:  Get adequate and consistent sleep.  Every week, perform two or three high intensity interval style training sessions for six to eight sets of 30 seconds duration.  Two or three times a week perform a full body strength training program made up of full body multi joint exercises.

Michael S. O’Hara, PT, OCS, CSCS

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

 

The Coldest of Shoulders

Understanding and Not Understanding Adhesive Capsulitis

Marilyn first noticed the right shoulder pain when she was sleeping on her right side.  Over the next month, the pain became more frequent and more intense.  Her shoulder ached in the morning and after any repetitive activity.  Marilyn tried medications and ice, but the pain persisted.  After eight weeks, the pain decreased, but her shoulder movement had become restricted.  Her shoulder became so tight that she developed difficulty with activities of daily living such as fixing her hair, dressing, and bathing.  Marilyn had developed a “frozen shoulder” and the frustrating thing was that she had no idea why it had happened.

No one fully understands why a frozen shoulder develops.  For some reason, the envelope of tissue that surrounds the glenohumeral joint–the joint capsule, shortens and develops thickened adhesions or scar tissue.  The medical term is “Adhesive Capsulitis”.  This tissue restriction limits the ability of the humeral head (upper arm bone) to rotate and glide properly so your shoulder becomes tight and painful.

Most of the time, a frozen shoulder occurs with no associated injury or activity.  Frozen shoulder most commonly affects patients between the ages of 40 and 60 years old.  It is far more common in women than men.  Individuals with diabetes are at far greater risk.  If you have undergone a surgery or sustained a trauma to the shoulder, you can develop a frozen shoulder.  This is especially true if you have held the joint immobile for a period of time.  Several studies have linked Parkinson’s disease, thyroid problems, and heart disease to a greater incidence of frozen shoulder.  Patients that develop a frozen shoulder are more prone to getting it in the opposite shoulder.  Despite all of this knowledge, we continue to see many frozen shoulder patients that have none of these predisposing factors.

I would add another condition to the commonly mentioned predisposing risk factors for frozen shoulder.  In my career as a physical therapist, it has been a rarity to find a frozen shoulder patient who was strong.  From grip strength in the hand to the muscles that hold the shoulder blade on the rib cage, these patients are usually weaker than their same age and sex peers.  The strength in the unaffected arm is often as limited as the arm with the frozen shoulder.  My belief is that the most common risk factor for developing a frozen shoulder is upper body weakness.  The glenohumeral joint is a fairly unstable joint that relies on the integrity of the muscles to kept it free from trauma.  If the shoulder muscles are unable to properly control the joint, then excessive stress is transmitted to the joint capsule and an inflammatory response ensues that scars and tightens the capsule.

Physical therapy for a frozen shoulder consists of manual therapy to stretch out the shortened joint capsule and a program of exercise to restores shoulder range of motion, coordination, and strength.  Most of the time, we get the patient when the shoulder is at its tightest point and recovery takes six to ten weeks.  As with so many conditions, the patients that get to therapy earlier or before the shoulder is fully frozen do better with therapy.

In many ways, Marilyn is the typical frozen shoulder patient.  She is the correct, age, sex, and fitness level.  Further medical work up revealed that she was prediabetic and in need of some ongoing medical attention.  Marilyn was a model physical therapy patient and her shoulder function was restored with six weeks of physical therapy.

Michael S. O’Hara, PT, OCS, CSCS

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Lower Body

Split Squat

To set up for the split squat, put one foot in front of the other with the heel of the back foot off the ground. 85% of the weight should be on the front foot. An airex pad can be placed under the body for the knee to come down on when lowering to the floor. When in the bottom position of the exercise, the front knee should be in line with the toe creating a slight shin angle. Make sure to push through the front heel on the way up instead of the toe. This exercise can be made easier by holding onto a railing, or can be made harder by adding weight such as a kettlebell in a goblet hold. The split squat displays greater hamstring, external oblique, and gluteus medius muscle activity than the back squat, but less quadriceps muscle activity.

RFE Split Squat: RFE stands for “rear foot elevated”. With this variation of the split squat, set up with the back foot elevated on a bench or a padded stand created for this exercise. An airex pad can be used under the knee if necessary. Squat down, touching the knee to the floor or airex pad.  When in this bottom position, the shin angle should be angled forward just as before, not straight up and down. Common errors include sitting too far back on the rear foot, touching the glute to the heel, or the back foot can tend to roll off the padded stand on the way up and move more onto the shin. Avoid this by putting more weight into the front leg and dropping the knee straight down instead of back. This exercise can be made more difficult by adding dumbbells in each hand, a kettlebell in the goblet, racked, or double racked position, or a barbell in the front or back position. Make sure to descend slowly, creating an eccentric load instead of dropping down fast.

FOB Hip Lift: FOB stands for “feet on ball”. Lay on the floor or table on your back and place the arms out to the side. Push down into the floor with the arms to stabilize the body. Keep the feet together and brace your abdominal muscles. Use the glutes and hamstrings to lift yourself up off the floor, making sure to keep everything tight at the top of the movement. Hold 3-10 seconds at the top and lower slowly and controlled. You can remove the arms from the floor and rest them on your stomach or behind your head to create more of a challenge.

One Leg FOB Hip Lift: Same setup as before except one leg will be used. The other leg will be pointed up to the ceiling as the other presses into the ball to lift the body. This creates more of a stability challenge.

FOB Leg Curl: This variation starts out just like the FOB hip lift, except at the top of the movement when the body is raised, the knees are bent and the ball is pulled in towards the body creating more work for the hamstrings. Keep the hips extended by activating the glutes and moving the hips upward, avoiding the tendency to bend at the hips. It should look like your hips move up and then return to a straight body position.

One Leg FOB Leg Curl: The hardest variation for the FOB series is the one leg curl. Use one leg instead of two, extending the other leg up to the ceiling. Make sure to still avoid bending at the hips in this variation as well.

One Leg Deadlift: When starting out with this exercise, it is best to just use bodyweight. Stand with 95% of your weight on one leg. Extend the arms and free leg out to a “T” position, bending the standing leg slightly. The extended leg should be reaching backwards as far as it can go.  Think about sitting into that hip just as you would during deadlifts. As this exercise becomes easier and balance is not an issue, it can be progressed by holding a kettlebell. The kettlebell should be held in the same side as the leg extending back. Reach the kettlebell straight down by the big toe; the weight should not go in front of the toe but rather by the instep of the foot. If you have progressed pass the kettlebell, two kettlebells can be used or a barbell with weight. The primary muscles being used in this exercise are the posterior leg muscles including the glutes and hamstrings.

One Leg Squat: Stand in front of a 12-18” box (start higher, and work your way to a lower box).  You will want to have 5-10# of weight to use as a counter balance (dumbbell, plate, or med ball).  Standing on only one leg, slowly lower yourself to the box.  As you descend, reach forward with the weight to help with balance.  Control the descent until your butt taps the box and then stand back up.  Work for 3-12 reps before switching legs.  Over time, try to get to a lower box so that your hip is slightly below your knee at the bottom position.

Watch video of these exercises: https://youtu.be/SqFqf81UnIk

 

 

 

 

Be Happy and Feel Good

Watch The Ted Takj by Dr. Stephen Ilardi

The number of Americans with depression has increased dramatically over the last ten years.  Depression is usually managed with medications and at present, one in five Americans is taking an antidepressant medication.  A modality of depression treatment that is often overlooked is exercise.  Daily movement has a restorative effect on brain health.  For decades, we have known that bed rest, induced by illness or injury, can change our physiology in a fairly short amount of time.  A sedentary lifestyle can have just as big an impact on how the brain functions.  Take the time to watch Stephen Ilardi PhD *Ted Talk on the management of depression.  If you have the time read the **article he wrote in the October 26, 2017 issue of the Wall Street Journal.  Dr. Ilardi has some insight on how technology enhancements are making us unhappy.

Consistent exercise restores brain health, immunizes us from depression, and greatly reduces pain.  Physical therapy patients and fitness clients frequently say the most beneficial aspect of a renewed devotion to exercise is the improvement in their mood.  Hundreds of studies have demonstrated the positive effects exercise has on brain chemistry.  All of the happiness and pain suppressing molecules antidepressant medications attempt to increase are developed and maintained sooner and stronger with exercise.  Mood improving serotonin, dopamine, and BDNF–Miracle Gro for you neurons–all increase with exercise.  Some of the most revealing research on pain science has shown that the brains “pain circuitry” changes when a patient is depressed.  Pain is perceived as more intense, widespread, and emotionally challenging.  Now put down your iphone and watch Dr. Ilardi.

Michael S. O’Hara, PT, OCS, CSCS

*TedxEmory, Dr. Stephen Ilardi.  See the ted talk on youtube here: https://www.youtube.com/watch?v=drv3BP0Fdi8

**Wall Street Journal, Why Personal Tech Is Depressing, Dr. Stephen Ilardi, October 26, 2017.

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Pulls

Just like the vertical press exercises, vertical pulls can be hard to execute due to their mobility requirements, but are the most effective and efficient movements when trying to build a strong and healthy upper body. The broadest posterior chain muscle in the body, the latissimus dorsi, has the primary actions of humeral adduction, extension and internal rotation, but also contributes to posture due to its attachment points. Vertical pulls also work the arms (brachioradialis, biceps brachii, triceps long head), shoulders/back (trapezius, posterior deltoid, teres major, rhomboids), and pelvic floor (rectus abdominis, internal and external obliques).

Pull Up/Chin Up: Pull ups/chin ups work the majority of the muscles in the mid/upper back and flexors of the arm. The rotator cuff muscles and core musculature play a more stabilizing role.  In both variations, think about keeping the core engaged.  There should not be extension in the lower back and if there is, you will notice yourself swinging back and forth during reps. When pulling up, think about leading with your collarbone and actually touching it to the bar. Another useful cue is to think about pulling the elbows to your pockets. Avoid rounding the upper back over the bar when reaching the top of the movement.  If you are having trouble touching your chest to the bar, it is either a strength or mobility issue.

½ Kneeling One Arm Pull Down
Set up at the Cybex machine or any cable hook up. Grab just one handle and put that same side knee down on the ground with the toe dug in.  Make sure the arm is angled in such a way that you have to reach across your body when the arm is flexed overhead. Your palm should be facing forward, and as you pull down, turn the hand towards the body and keep the elbow close to your side. Concentrate on squeezing the muscles in the back and keeping the rest of the body still with the core braced. Switch legs when you switch arms.

View video of vertical pulls here: https://youtu.be/knAFry9p-LM.

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