(810) 750-1996 PH
Fenton Fitness (810) 750-0351 PH
Fenton Physical Therapy (810) 750-1996 PH
Linden Physical Therapy (810) 735-0010 PH
Milford Physical Therapy (248) 685-7272 PH

Learn more about Rehab, Sports Medicine & Performance

Learn

Testing Fitness Readiness

Isometric Spinal Extension Strength Test

A big problem in the fitness industry is that there are no standardized performance evaluations that participants must achieve in order to begin or progress in an exercise activity.  Anyone, no matter how deconditioned, posturally flawed, and orthopedically challenged can walk into the gym and get a workout.  As a strength and conditioning coach, the present “free for all” system is a challenge that at times can be very frustrating.  As a physical therapist treating orthopedic injuries on a daily basis, the present system keeps me busy.  Performance tests and movement assessments identify asymmetries, strength deficits, and potential pain problems.  A good coach uses assessments to determine the appropriate exercise prescription for their client.  I will be posting some basic user-friendly performance assessment tests that should be a part of all fitness programs.  If you pass the tests, congratulations and keep up the good work.  If you did poorly on the tests, you need to get to work on improving your performance.

Isometric Spinal Extension Strength Test
The muscles around your spine and pelvic girdle are designed to reduce and not create motion.  They are isometric muscles that brace the torso and pelvis to create the pillar strength you need to carry in firewood, lift the wheelbarrow, or push the lawn mower.  The Isometric Spinal Extension Strength Test is an assessment of the component of core stability that isometrically resists spinal flexion.  This test is used in industrial medicine to assess a worker’s ability to return to material handling tasks.  In my evaluation of fitness clients, it is often the stability test with the most significant deficits.

You need a Roman Chair or Glute-Ham Developer Bench to perform this test.  The support pad of the bench should be on the front of the thigh just set below the pelvis.  Position your body so that the ankles, knee, hips, and lumbar spine are in one long line that is parallel to the floor.  Cross the arms across the chest and hold a solid, floor parallel position as long as you are able.  Pain with the test is a fail and you need to be evaluated to find out why the test is painful.  Less than thirty seconds is a poor grade.   You need to improve your performance, and in the meantime, avoid activities that require you to resist spinal flexion-resisted squats, deadlifts, kettlebell swings, and bent over rows.  Thirty to sixty seconds is a fair grade and clears you for most resistance training.  Athletes and those involved in occupations that require lifting and carrying need the isometric strength that permits a sixty-second hold.
Michael S. O’Hara, P.T., OCS, CSCS

Skeletal Strengthening

Exercise Training That Prevents Osteoporosis

bending_the_age_curveI recently heard a talk by Dr. Joseph Signorile on the latest and greatest research in regards to exercise that prevents and reverses osteoporosis.  Dr. Signorile is a professor of kinesiology at the University of Miami.  He is an expert on fitness for older adults and conducts research in the field of geriatrics.  Based on what field proven research is telling us today, Dr. Signorile has these suggestions:

Bone reacts best to dynamic mechanical stimulation.  The best bone building exercises create a stress that changes as we move, rather than a static force.  Progressive resistance training involves moving your body against a resistance.

If a bone is to respond to training, the stimulus must be at a suprathreshold level.  The participants in the studies that got the best results carried, lifted, pulled, and pushed some serious loads.  “Suprathreshold level” means it has to be physically challenging.  Elliptical training and those five pound chrome dumbbells will not produce a bone building response.

Optimal bone building skeletal loading.  What the research studies have found is that the best gains occurred with forty repetitions of loading at each skeletal region per training session.  Less than forty is less than optimal.  More than forty repetitions have no further bone building benefit.  Two or three properly executed exercises can take care of loading the entire skeleton.  An appropriate skeletal training session can be made up of 80-120 repetitions.  You can get that done in fifteen minutes.

The response of bone to exercise is improved by brief but intermittent exercise.  Loading your skeleton more frequently creates a stronger mineralization response in the bone.  Five or six training sessions per week will produce more bone density than two or three sessions per week.

Bone responds best when you employ a loading pattern that differs from the usual loading pattern.    I have been ranting about this for years.  Bone only adapts–gets stronger–when the exercise stimulus is a challenge beyond what you have subjected the bone to in the past.  If you have been performing the same activity at the same load for months on end, the bone building stimulus is minimal.   To improve bone health, you should alter the exercises you perform every three to four weeks.

What the research recommends….
Based on what the research is telling us, Dr. Joe recommends you perform a program of dynamic weight training that delivers forty repetitions of loading at each section of your skeletal system.  You will see better results with more frequent training sessions and consistent alteration in exercise activities.  Pick two or three exercises and load them aggressively for forty repetitions each.  Perform your exercise three to five times a week and change your exercises every month.  To learn more, talk to our trainers for some bone building exercise suggestions.
Michael S. O’Hara, P.T., OCS, CSCS

30 Minutes Of Fitness

Remember, You Asked For It

“I don’t have enough time” is the big excuse people give for not exercising.  At Fenton Fitness,  we can get you in and out of the gym in thirty minutes.  Our movement based training sessions produce excellent results with minimal time commitment.  We program in high value exercise activities in a layout that produces optimal gains.  This is the first of six, 30 Minutes of Fitness, sessions.  The best workouts are short, intense, and frequent.  Intensity is usually the missing factor in most gym goers’ training sessions.

Session One
1.    Moving knee to chest mobility drill x 20 yards
2.    World’s Greatest Stretch x 20 yards
3.    Sled Push x 100 yards
4.    A. Push ups 3 x 8-12 repetitions
B. Inverted row or TRX row 3 x 6-10 repetitions.
C. Kettlebell Goblet Squat 3 x 6-10 repetitions.
5.    Medicine Ball Overhead Throws off wall 3 x 5 repetitions.

One and Two:  Perform the two basic movement preparation drills for twenty yards each.
Three:  Load your sled up with +/- 20% of your body weight and give it a push for 100 yards.  You can rest as needed, but try to get the entire 100 yards completed in less than five minutes.
Four:  You should be warmed up, breathing faster, and ready for some strength training.  Perform the next three exercises in a circuit fashion.  A set of push ups followed by a set of rows and then a set of goblet squats.  Between the different exercises, rest as little as possible, and then after you get through an entire circuit, you can take a longer 90 second break.  Repeat the circuit three times.
Five:  Work on power production with three sets of overhead medicine ball throws.  Use a weight that lets you throw a line drive and not a lob.
Choose the appropriate exercise variation and load for your strength exercises.

Session One Synopsis:
Effective mobility training.
Total body conditioning.
Twelve sets of strengthening exercises.
Explosive power training.

See the video for more information.

Michael S. O’Hara, P.T., OCS, CSCS

If Frankenstein Had Glutes, He Could Have Run Away

Get Fit With Monster Walks

Frankenstein in chainsMost of the exercises performed in the gym emphasize the sagittal (front/back) plane of motion.  Squat, lunge, elliptical, and treadmill are all sagittal plane activities.  In athletics and life, we must be able to move efficiently in all planes of motion.  Our gluteal muscles are the primary producers of lateral and rotational movement in the lower extremities.  Strong and responsive gluteals keep your knees and lower back safe from injury during athletic activities.  A simple exercise to improve gluteal function and move better in the often-neglected frontal plane is a band monster walk.

You will need a mini resistance band or a lateral resistor.  Place a mini band loop around your ankles.  Assume an athletic stance with the feet straight ahead, knees bent, and hips flexed.  The band should be held taught throughout the exercise.  Try to keep the hips and shoulders level throughout the exercise.  Your torso and pelvis should not wobble side to side.  Move the right foot 12 to 18 inches to the right, and after planting the right foot, follow with the left.  Remember to keep some tension on the band.  When you have completed the prescribed number of repetitions, rest and then lateral step back to the left.

As you get better at this exercise, try performing the drill moving forward and backward.  The backward monster walk is an excellent gluteal activation exercise for runners.  Try performing one or two sets of eight to ten repetitions.

Michael S. O’Hara, P.T., OCS, CSCS

Front Squats

Stability, Mobility, And Better Posture

The squat has been described as the king of all exercises.  The large amount of muscle recruited during squatting makes it a very metabolically demanding exercise.  In athletics, the capacity to perform a full squat with proper torso, hip, and knee position has been correlated with greater durability–fewer injuries.  The overhead squat test is one of the patterns assessed in the Functional Movement Screen and is used in physical therapy and athletic training.  Squatting with the load placed on the front of the body is an excellent way to enhance mobility, stability, and strength.  Compared to leg presses, seated leg curls, and knee extension, front squatting creates much more carry over to activities of daily living and athletics.  The problem is most people do not know how to get started with front squats.

When you squat with the load across the front of the body instead of on the upper part of the back, the stress on the spine is reduced.  You can “cheat” a back loaded squat by leaning forward, but you cannot lean forward with a front squat.  Leaning forward on the front squat causes the load to fall from your shoulders or hands.  Front squatting creates a greater core stability demand and reduces shear force on the lower back.  Full depth front squatting will improve your posture and restore mobility in the hips, shoulders, and thoracic spine.

Front squatting is an exercise that is more equivalent to daily tasks and athletics.  Lifts in real life rarely place the load across your shoulders.  When you lift the grandchild, carry the groceries, or hoist the wheelbarrow, the load is in front of the body.  During athletics, the opponent is in front of you, and you must stay upright and tall to dominate the activity.

Front Squat 101
Before loading the squat, practice bodyweight squats to a depth target.  I like to use a 12 inch box or a Dynamax ball (12 inches in diameter).  You should be able to perform a body weight squat to a thigh below parallel position with a stable spine before attempting a loaded front squat.  When you perform a loaded front squat, initiate motion from the hips by sitting down and back.  Push the knees out and descend so the thighs travel to below a parallel to the floor position.  Keep the chest up and torso tall as you push back up.  Finish at the top by contracting the gluteal muscles and keeping the front of the rib cage down.

Choose A Proper Implement
While the barbell offers the greatest loading capacity, many individuals do not possess the shoulder mobility to hold the bar on the shoulders.  The Goblet Squat position with a kettlebell or dumbbell works just as well.  A sandbag hugged close to the body in the high Zercher position or bear hug hold has a high degree of athletic carry over.  Avoid the Smith machine variation.  You end up leaning on the machine and this eliminates much of the core stability demands and exposes the spine to greater shear force.

Michael S. O’Hara, P.T., OCS, CSCS

Chicken Run

Viscosupplementation For Your Painful Knees

When the knees start aching, activity levels fall, fitness recedes, weight is gained, and cardiovascular problems follow.  The baby boomers are reaching the time of life when knee joint breakdown begins.  Many patients have knees that show arthritic changes on imaging tests, but they are too young for a knee replacement.  While we know losing weight and improving leg strength and mobility will help decrease knee symptoms, many people have so much knee pain they cannot move enough to exercise.  One of the medical treatments that can help these patients is viscosupplementation.

Viscosupplementation is an intra-articular knee injection of hyaluronic acid administered by a physician.  Hyaluronic acid is a natural substance found in the synovial fluid of our joints.   Its function is to act as a joint lubricant and shock absorber.  Patients with knee arthritis have less hyaluronic acid in their joint.  The idea is that by adding some hyaluronic acid to the knee, the pain will decrease and the body will be stimulated to produce more of its own hyaluronic acid.

chicken 200
The FDA approved viscosupplementation injections as a treatment for knee arthritis in 1997.  These medications are derived from chicken combs and are now available from several pharmaceutical companies.  They are given in a series of three to five injections over a number or weeks and can be repeated every six months.

Viscosupplementation works best on patients with mild to moderate knee arthritis.  It is a treatment and not a cure for the arthritis in your knee.  The injections do not produce an immediate relief of knee pain.   It usually takes three or four weeks and several injections before patients report a decrease in knee pain.  Manufacturers claim six month’s of pain relief.  Clinically, the patients I talk to report three to six months of pain control.

The big benefit of viscosupplementation is that it can reduce knee pain and permit the physical therapy or fitness client the opportunity to begin exercising and work on the fitness goals that reduce stress on the knees.  The three to six month window of pain free knees is enough time to improve strength, restore functional mobility, and decrease bodyweight.  For people with knee arthritis, reducing loading and improving strength is the best life long method of managing knee arthritis.

Michael S. O’Hara, P.T., OCS, CSCS

Heads Up

The Downside Of Upside Down Exercise

H_HoudiniExercise activities that place the head below the heart have become more popular in fitness programs.  In almost every gym you see decline bench pressing, incline sit ups, glute-hamstring developer exercises, and more recently, hand stand push ups as a regular part of many exercise programs.  While these activities may have some value, you might want to reconsider training in an inverted position for some other reasons.

Esophageal Reflux
When you invert your torso, the contents of your stomach can more readily travel back up into your esophagus.  Head below your belly with a hiatal hernia, a little extra mesenteric fat, and some strong contractions from the abdominal muscles, and you have the perfect environment for gastroesophageal reflux disease (GERD).  Millions of Americans (14%-20% depending on the study) take medications to manage the symptoms of GERD—heartburn, chest pain, persistent cough, difficulty swallowing, hoarseness.  Prilosec and Nexium are the biggest moneymakers the pharmaceutical industry ever created.  Many Americans (10%-15%) have GERD, but are unaware of the problem because the tissue damage has not reached symptomatic levels.  Erosive esophagitis or Barrett’s esophagus is a clinical finding of cellular change in the esophagus and a precursor for esophageal cancer.  Esophageal cancer is one of the more deadly types of cancer.

Glaucoma or Retinal Disease  
The head down position raises pressure inside the eyeball.  As little as 30 degrees of decline has been shown to increase intraocular pressures.  It is estimated that 2.2 million Americans have glaucoma, but only half of these know they have the problem.  Individuals with glaucoma already have elevated intraocular pressures and should avoid these positions.  The back of the eye (retina) is susceptible to changes in vascular pressures, so if you have any retina issues, avoid the head down position.

High Blood Pressure / Hypertension
Your heart, lungs, and arteries are conditioned to pump blood with your body in an upright position.  Many vascular alterations occur when we flip into a heads down position.  When you assume the head below your heart position, the arterial pressures inside the skull increase.  Elevated cranial blood pressures can lead to headache and much more severe problems such a stroke.  One in three Americans are walking around with high blood pressure.  Add in an exercise induced elevated heart rate and some less than pliable carotid arteries and you have the ideal environment for a big bad brain event.  If you have hypertension, I would not go about using any inverted positions in the gym.

Bottom Line
Apart from going blind, having a stroke, and developing an incurable cancer, you should be fine.

Michael S. O’Hara, P.T., OCS, CSCS

Robin Anthony McKenzie

1931-2013

“My patients taught me all I know.”

r_mcknzie_bookOn May 13, 2013, world renowned physical therapist, Robin McKenzie died.  Robin was an astute observer of his patients’ signs and symptoms.  Early in his career, he realized that many of his patients with back or neck pain would get better only to suffer the same problem months or years later.  To solve the problem of recurrence, he devised a very successful program of spinal therapy based on patient education and continued self-treatment with daily home exercise.  He developed a system of evaluation and treatment of mechanical spinal disorders that has gained a worldwide following.  His books, Treat Your Own Back and Treat Your Own Neck have sold over six million copies–more than any other medical self-help books.  In 1982, he founded the McKenzie Institute to educate fellow physical therapists on his evaluation and treatment methods.  I consider his most recent book, 7 Steps To a Pain-Free Life a must read for anyone who must lift, carry, or sit all day, or for patients with recurrent neck / lower back pain.

Thank You, Robin
Fresh out of college in 1984, I quickly realized that I had no idea how to help patients with lower back and neck pain.  Thirty years ago, I completed my first McKenzie course and became a much more effective and confident clinician.  Over the next two years, I completed three more of the McKenzie courses and went on to attend three of the McKenzie Institute’s International Symposiums.  The education from the McKenzie Institute has been priceless.  All of the physical therapists at our clinics have studied Mr. McKenzie’s teachings, and over the years, Fenton Physical Therapy has been fortunate to sponsor several of the McKenzie Institute educational courses.  Our entire professional staff is grateful for the insight and knowledge Mr. McKenzie has brought to our profession.

Michael S. O’Hara, P.T., OCS, CSCS

Unlucky Me

In my sports and fitness life, I have some regrets.  I spent too much time in activities that turned out to be worthless or worse, unhealthy.  I missed some opportunities to learn new skills and have more fun.  Looking back, I would change several aspects of my fitness life.

Bad Coaches
Growing up, I had some great coaches—Dad, Coach Sharpe, Coach Boulus, Coach Ross–Thank you.   However, some of my coaches were horrible.  They had no idea what they were doing or how they should interact with young kids.  They usually had a child on the team and this was their true motivation for coaching.  They smoked, obviously did not practice what they preached in regards to exercise, and were poor role models.  I was taught not to quit on a team, but looking back, I should have opted out.  The drills we performed were often punitive.  They denied us water, gave us salt pills, and made us participate in ridiculous training exercises.  Unfortunately, many of my friends dropped completely out of organized sports at early ages because of these coaches.  I think this is still happening today.

Too Much Team and Not Enough Solo Sports
From grade school to high school, I played team sports–baseball, football, and basketball.  In retrospect, I should have tried more solo athletic activities.  I did not start playing golf until my mid forties and I really enjoy it.  I did not try snow skiing until I was in my twenties.  You can participate in these sports through an entire life span.  My big wish is to be able to play golf, tennis, or frisbee with my grandchildren.

Nautilus Stupidus
When Arthur Jones came out with the incredibly intricate “cam gear” driven Nautilus machines in 1977, I jumped in head first.  They were big, shiny, and complicated, so they had to be good for me.  The Nautilus sales pitch was that 30 minutes of intense training twice a week would turn you into a physical super hero.  I bought a membership at a Nautilus equipped gym, and spent two years wedging my body into all sixteen of these mammoth machines.  I got better at moving a lot more plates on each of the machines, but I saw no improvement in my vertical leap or performance on the basketball court.  During that two year period, I became more and more physically limited.  When my shoulders started to ache at night, I had to give up the pullover machine.  When I developed tendonitis in my knee, I had to give up the leg curl and “squat” machine.  I suffered an abdominal strain working on the “torso trainer”.  I ended my Nautilus Era limited to only six of the sixteen machines.  I learned the hard way that seated, strapped in, muscle isolation resistance training is a waste of time.

Synchronized Drowning
My body is not made to swim—I am too dense (no jokes please).  I don’t float–my body sinks like a stone.  In my early twenties, I spent six months trying to learn how to be a proficient swimmer.  I never became any better at moving horizontally through the water—just vertically.  I had great coaching, but the harder I tried, the more my shoulders hurt and my neck ached.  The sensory isolation of looking down at the line in the pool was more than I could psychologically bear.  In the future, I will spend less time on trying to master an activity that physically is inappropriate for my body type.

Road Running Era
I spent three years distance running.  My goal was to run a sub forty minute ten kilometer race time.  I liked being outside and enjoyed the camaraderie of my fellow runners.  In three years of running, my body composition changed from 195 pounds at 12% bodyfat to 175 pounds and 16% bodyfat—I got smaller and fatter.  I went from ten pull ups to three, sixty push ups to twenty two, and my strength in the weight room plummeted.  My vertical leap went down and I got pushed all over the basketball court.  I did get faster in the ten kilometer run, but the running left we weak, tight., and slow.  It took me two years to fully recover.

Michael S. O’Hara, P.T., OCS, CSCS

Pushing Through Fitness Barriers

How Sled Pushing Can Produce Big Results

Most of us have busy schedules and limited time to exercise at the gym.  We want the most benefit possible for our time spent working out.  Sled Pushing is a high value activity that can be utilized by almost all fitness clients.

True Core Stability
How our “muscles in the middle” truly work is in a standing position with our legs in contact with the ground.  The legs are usually in an asymmetrical stance, transferring force from the ground through our body into the arms.  Most “core stability” exercise performed in the gym put you in a supine position with no leg to arm connection.  Sled pushing more closely emulates the demands place on our spinal stabilizers during daily activities.

Training Acceleration
In sports performance, the development of acceleration—the first four or five strides– is critical.   Weight room training with box jumps, barbell squatting, and hang cleans has been shown to produce better vertical leap numbers, but not nearly the same gains in 40 yard dash times.  Sled pushing places the body in the forward lean position you need to properly accelerate out of the blocks when sprinting.  It trains the neural pathways that turn on your acceleration muscles.

The Road to Easy Recovery
Sled pushing is all concentric muscle activity and no eccentric.  Eccentric muscle activity, the muscles lengthen against a resistance, creates much of the muscle soreness brought on by exercise.  Your body needs more time to recover from eccentric muscle activity.  You can perform a greater volume of work with a sled, and not be terribly sore the next day.  For older trainees, whose bodies require more recovery time, sled work is a valuable training tool.

The Injured Athletes Rehab Training
If you have a knee, lower back, or hip injury you may not be able to perform squats, lunges, deadlifts, or kettlebell swings.  Sled pushing is an alternative rehabilitation exercise for the lower body.  I have had great success treating runners with knee pain using sled work as a recovery exercise.  The core stability demands of sled pushing are helpful in restoring lumbar function in lower back pain patients.

Scalable to Any Fitness Level
Beginners can start with an empty sled and gradually add weight.  I have been able to progress physical therapy patients from 25 pounds to 125 pounds in as little as four week’s time.  Pushing is a very primal movement pattern, so most people catch on after two or three attempts.

Michael S. O’Hara, P.T., OCS, CSCS

Categories