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kneerehabFitness training for those of us past 40 years of age is more complicated. Physical performance and recovery capacity are dramatically different. If you need proof, look 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.

Reduce the Presence of Pain in Your Life
You will reach all of your fitness goals much sooner if your brain is receiving fewer signals of pain. Your muscles and joints are slaves to the orders from the central nervous system. The presence of pain alters movement patterns and blunts the benefits of training. Do not accept pain as part of your life. In my work as a physical therapist, I have heard many euphemisms for pain. Physical therapy patients and fitness clients are not limping because of pain– they have a “discomfort,” “ache,” “spasm,” or “numbness”. When asked about pain, any answer other than a “no” is a “yes”. Resolving pain problems goes a long way toward restoring function and improving quality of life.

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Fitness training for those of us past 40 years of age is more complicated. Physical performance and recovery capacity are dramatically different. If you need proof, look 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.



Do the Most Important Thing First and Do It More Often

Older gym goers have a work capacity “gas tank” that is smaller than their younger friends. Their neural and energy pathways give out sooner and take longer to recover. Older fitness clients need to place the most important training activities early in an exercise session before fatigue degrades performance. Make your weakest movement pattern the first one you train. If you lack mobility in a specific movement such as a squat, hip hinge, or lunge, train that first. Activities that demand more neural control, such as balance and power drills, should be placed early in the training session.

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One of the best reasons to develop the habit of fitness is that it can reduce your reliance on medications. It makes my day when fitness clients inform me that they have been able to discontinue a medication because of the improvement in their blood pressure, lipid, or sugar levels. Pain relief medications are no longer necessary when joints and muscles work more efficiently. Exercise has been shown to work as well or better for the treatment of depression. The quality of sleep is enhanced and brain neurochemistry improves when you exercise on a consistent basis. The habitual performance of exercise is the most effective method of reducing medications.

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A True Baseball Insiders Safety Suggestions.Eric_Cressey

Mr. Eric Cressey is a strength coach who specializes in making baseball players better athletes. He rehabs and develops multiple millions of dollars worth of throwing arms. Eric has worked with baseball players at all competitive levels and is the ultimate insider. Mr. Cressey is an “in the trenches” coach that has witnessed how the present system is operating. I have heard him speak on four different occasions. He is articulate and always informative. If you are a baseball player, or the parent of a baseball player, Mr. Cressey has some suggestions on how to stay healthy.

Take the time to read his January 3, 2016 blog, Preventing Shoulder Injuries: Actions Speak Louder Than Words. I often send parents of injured baseball players to Mr. Cressey’s site for the valuable information they have not been hearing.

-Michael S. O’Hara, PT, OCS, CSCS

View Cressey Article

In the summer of 1968, the Detroit Tigers were on a tear. They were headed for an Americmcauliffe_fightan League pennant and a heart-stopping three game deficit. World Series victory over the St. Louis Cardinals. On August 22 of that season, a young pitcher for the Chicago White Sox named Tommy John decided to brush back the lead off hitter for the Tigers, shortstop Dick McAuliffe. After some discussion as to the intent of his throws, Mr. McAuliffe rearranged Mr. John’s left shoulder ligaments in a basebrawl that sent Mr. John to the disabled list and Mr. McAuliffe to a five game suspension—and a two hundred and fifty dollar fine. As a ten year old Tiger fan, I can recall getting in trouble reenacting the McAuliffe vs. John fight with my younger brothers.

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A Landmine is a modification on the use of an Olympic bar. The bar is anchored onto the floor at one end with a Landmine device and you lift the free end of the bar with a load of your Landmine_Ichoosing. At FFAC, we have five landmine set ups that can be used with either a standard 45 pound Olympic bar or a 15 pound training bar. These are the reasons to use a Landmine.

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Many times patients, employers, rehab nurses, athletes, coaches, and insurance companies have unrealistic expectations in regards to rehabilitation recovery times. It falls to the physical therapist to explain the healing and recovery “time line.” These guidelines are applicable to the patient who undergoes a rotator cuff repair, lumbar fusion, tibia plateau fracture, humeral head fracture, etc… Understanding the duration and the level of effort required to fully regain function can keep a patient focused and eliminate disappointment.

Recovery Reality
If you have systemic health issues such as rheumatoid arthritis, diabetes, etc…. your recovery will take longer. The older you are, the longer your recovery will take. That professional athlete who went back to basketball, three weeks after a knee arthroscopy—he is 24 years old and you are 48 years old. It is going to take you much longer. The weaker you are at injury onset, the longer your recovery will take. If this is a second, third, or fourth injury of the same joint—the recovery will take longer.

Consistency is king in recovery. The individual who follows the program and performs the work will recover sooner. Many patients want to order off the rehab menu—I will have this and this but none of that. In these cases, recovery will take longer and be less effective.

You will probably have to work on more than your injured / post surgical joint during your recovery. The body is an interconnected machine and weakness / limited movement in one area can create the tissue breakdown in other areas. The post ACL repair patient often needs extensive strengthening of the hip. The shoulder pain patient will have to address postural issues in the neck.

Very often you have to change your lifestyle during the recovery period. Yoga after a back surgery may be on hold for nine months. Road running after a surgical repair of your ankle can be off the program for up to a year. After a reverse total shoulder replacement, you may not be able to chop firewood for twelve months.

Progress is never linear. You have good days and bad days—this is normal. You feel and move better for three or four therapy sessions and then you have a few sessions of greater symptoms and more limited function. Do not collapse, despair, call the president–stay with the program and realize that time is on your side.


Onset – Three Months
This is the in the physical therapy clinic rehabilitation phase.

The inflammatory phase of the injury / surgery resolves.

Active and passive movement of the joint improves.

Depending on the injury / surgery, pain resolution occurs later in this phase.

A protocol of rehabilitation activity may be in effect for certain surgical procedures.

Most patients have regained 60-70% of the function at the end of three months.

People with sedentary work can return to their occupations. More strenuous occupations will require further conditioning.

Three – Six Months
You exercise three or four times a week. Ideally, you visit the physical therapist for progressions of the training program.

You can expect some level of discomfort. The post surgical shoulder will still not feel like the non surgical shoulder. The lower back will have days of stiffness. These episodes are normal and part of the recovery process.

Strength is still limited and you will have to work on corrective exercises for the next three months. Resist the temptation of an early return to your Olympic lifting, Warrior Run, or Zumba class.

Individuals with strenuous occupations undergo a work conditioning program.

Most patients have regained 85-90% of their function at the end of six months.

Six – Nine / Twelve Months
This is the point that most people stop all formal rehab exercise activity.

The more active you are and the more demanding your lifestyle the more you need to continue to train through this phase.

I personally believe this is the most important recovery phase for spinal patients. You never completely recover from a spinal injury—you actively manage the problem.

I encourage everyone to work with a trainer on your fitness program. Exercise is like medicine. Take the proper dose for your specific problem and the results are magic.

The focus of your training should be to get stronger.

Nine / Twelve Months – Death
Consistent maintenance of the machine that carries you through life can dramatically improve the quality of that existence.

The biggest predictor for a future injury is a prior injury. Stronger individuals are less likely to get injured and have to travel back through the nine month rehab process.

Michael S. O’Hara, PT, OCS, CSCS

Strength training

High intensity interval training

Eat adequate amounts of protein

Sleep long and well

FFAC has been making these recommendations forever. Take the time to read the article by Kathleen Hughes, “How Athletes Can Stay ‘Fast After 50’,” in the October 18, 2015 edition of the Wall Street Journal. If you are over fifty and are not following these fitness guidelines, you are missing out on the magic.

Click on the link below to read the article:


-Michael O’Hara, P.T., OCS, CSCS

It has been reported in many studies that older individuals who take benzodiazapine medications have more car accidents, falls, emergency room visits, and a much higher rate of hospitalization.  The American Geriatric Society has been warning patients and physicians about the pitfalls of these medications for years.

Benzodiazapines are some of the more commonly prescribed drugs and include: Ativan, Xanax, Valium, Restoril, Klonopin, Halcion, Ambien, and Lunesta.  They are used primarily to treat depression, anxiety, and sleep disorders.

Now more bad news has come to light.  Recent research has linked benzodiazapines to the development of Alzheimers.  Please read this recent article, Study Links Anxiety Drugs to Alzheimers,  in the NY Times.  Researchers followed patients for over six years and the development of Alzheimer’s  disease went up dramatically with greater use of these drugs.

The good news is that an effective alternative to these medications is available.  Since 2003, a growing body of medical research has demonstrated that exercise is very effective in combating depression and anxiety.  In study after study, exercise has been shown to produce results as good or better than medications.

The website of the American Psychological Association has a full page on the use of exercise to treat depression.  The Mayo Clinic website has a section devoted to using exercise to manage depression and anxiety.  I urge everyone to read a recent article in the LA Times, Exercise As a Treatment for Depression: Here’s How It Works, on the exercise induced biochemical changes that help alleviate depression.

So what amount of exercise is recommended to control depression?  The optimal duration and frequency dosage is thirty to forty minutes a day, seven days a week, or a minimum of three hours a week.  As expected, better results occur with more consistent compliance to an exercise program.  Daily training sessions produce the best control of symptoms.

The side effects of exercise are directly opposed to that of benzodiazapines.  When you exercise regularly you fall less, have fewer visits to the emergency room, become less likely to be in the hospital, and preserve cognitive function.  If we could just turn forty minutes of exercise into a pill…

-Barb O’Hara, RPh

To read the articles mentioned, please click on the links below:



“It’s what you learn after you know it all that counts.” –John Wooden

Amy Warner, Jeff Tirrell, and I recently attended the three day Perform Better Summit in Chicago.  This gathering showcases presentations from experts in the fields of fitness, sports medicine, athletic training, nutrition, and rehabilitation.  All of these presenters work with clients and patients on a daily basis and, as is often the case, their “in the trenches” experience precedes the findings of research studies.  I attend the Summit every year and always walk away with new ideas and knowledge.  We present a brief review of some of the more memorable aspects of the presentations.

Training Athletes In GroupsIMG_1847

Mike Boyle, Body By Boyle Performance Centers and Strength Coach for the Boston Red Sox

  • Know and be able to teach a progression and, more importantly, a regression of every exercise.
  • Don’t put load on top of poor movement.  If the movement looks bad you must fix it before you load it.
  • If you are not foam rolling your athletes, you are a dumbass!
  • Power training is essential if you train older adults, but you must choose the appropriate method.  Know the risk / benefit ratio of your power activity selection.
  • The purpose of the program is to reduce injuries and improve performance.  We are not trying to create power lifters, Olympic lifters, bodybuilders, or strongmen.  We are trying to create athletes.  Strength training is simply a means to an end.

The Best Functional Exercises In the World

Gray Cook, MPT, OCS, CSCS, Co-Founder of the Functional Movement Screen

We need functional exercise because we erode our environment to make life easier:

  • Posture fails because we slouch in chairs.
  • Endurance falters because we simply do more of it instead of performing it better.
  • Coordination dissipates because we train in a supported state or, worse, sitting down.
  • Strength is blunted as we perform all tasks with exterior support and easy access handles.


1. Balance beam

2. Bottoms up kettlebell activities

3. Farmers carry

4. Indian club exercises

5. Jump rope

6. Bear crawl—especially uphill

7. Turkish Get Up

8. Overhead carries


1. Push ups

2. Pull ups

3. Deadlifts

4. Push press

5. Sprints

6. Agility work—physical jigsaw puzzle

Cracking the Coordination Code: Pre Pubescent Athletes

Brett Klika, CSCS, Creator of Spiderfitkids

  • Coordination is how the brain synchronizes and controls movements through muscular activation. It is a set of physical skills that can be practiced, learned and improved.
  • Neural plasticity is at a high point between ages six and twelve.
  • PAWs–Preferential Adaptation Windows– are age phases in which certain coordinative skills can be preferentially developed.
  • Accelerated periods of brain maturation: 15-24 months, 6-8years, 10-12 years, 18 years.
  • If you take children and enhance their movement efficiency and performance, then you increase the likelihood of participation, reduce the propensity to become obese, and make injury less of a concern.

How To Develop Agile Strength

Michol Dalcourt, University of Alberta Exercise Physiologist, Founder and Director of the Institute of Motion, Creator of the Vipr

  • The shape and stability of the human body is produced by the myofascia systems that are woven through the body.
  • The layers of fascia are connected to the nerves that transmit signals of tensile stress and compression that occur as we move.
  • Muscles rely on nerve sensitivity and nerves rely on the fascial sensitivity.
  • Agile strength involves loading and unloading the myofascial lines is a three dimensional activity that trains the muscles, nerves and fascial systems to work together as a team.
  • Athletic activities are multiplanar and three dimensional, but most training is uniplanar and one dimensional.
  • Get better at creating better fascia-nerve-muscle communication and you become better at all activities.  Not just weight room strong but farm boy strong.

Paleo, Vegan, Intermittent Fasting: What’s the Best Diet?

Dr. John Berardi, PhD, CSCS, Founder of Precision Nutrition–my favorite source for nutrition information

  • There’s no such thing as a universal best diet.
  • Most popular diets have a lot in common.
  • Coaches should never lock into a single philosophy.
  • Habit-based coaching is better than diet-based coaching.
  • Proper nutritional coaching involves formulating a plan based on your needs, what you want to accomplish, how you live, and what is personally important.

-Michael O’Hara, P.T., OCS, CSCS