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Learn more about Rehab, Sports Medicine & Performance

Performance

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Movement You Should Master

Segmental Rolling

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that I have found to be very helpful in restoring the capacity to get up and down off the floor is Segmental Rolling.

Segmental Rolling

Rolling over seems simple, but many people over 60 struggle to roll from their back to their stomach and stomach to back. This doesn’t necessarily need to be an exercise within your training program but should be practiced at least 2-3x/week and is easily added to your warm up or cool down routine.

1) Segmental Roll led with arm

2) Segmental Roll led with leg

See video of rolling here: https://youtu.be/VttWNcN-g0o

-Jeff Tirrell, CSCS, Pn1

A Plea For Your Knee

In our physical therapy clinics, we treat patients with knee pain on a daily basis.  It has become more common to train younger clients with a history of knee injury and ongoing knee pain.  Jane Brody’s recent *article in the New York Times has some excellent advice on the care and management of knee pain problems.  I have some further suggestions and clarifications.

Less Mass

The mass portion of the Force = Mass x Acceleration formula needs to be at an appropriate level for your knees to stay healthy.  Carrying extra body fat creates an environment that invites knee wear and tear.  The common knee pulverizing mistake is to perform high impact exercise activities in an effort to lose fat.  If you are twenty pounds overweight, do not run, stadium step, soccer, tennis, or pickleball.  Start with strength training and low impact cardio.  Lose the fat first, and even then, the lower impact activity will be healthier for your knees.  From the overweight client limping into the clinic I get the “I need to move around to lose weight” protest.  I am sorry, but fat loss is primarily a function of dietary alteration.  Exercise has very little impact on body fat levels if you do not eat properly.

Train the Way You Wish to Play

A properly planned fitness program makes your knees more durable (fewer injuries) when you participate in your favorite recreational activity.  The training must be tailored to your activity goals.  If your goal is to play tennis, then you must perform three dimensional deceleration / acceleration activities as part of your training program.  Yoga will not prepare your knees for tennis.  If you want to water ski, then you must perform strength training for your back, hips, and knees.  Distance running will not prepare your knees for water skiing.  If hockey is your recreational past time, you need to be strong, well conditioned and competent in all planes of motion.  Long duration recliner intervals will not prepare your knees for hockey.

Look Above

If your hips do not move well, your knees will pay the price.  In this age of all day sitting and minimal physical activity, hip function is at an all time low.  Physical therapy patients with knee pain nearly always present with glaring restrictions in hip range of motion and strength.  If your knees hurt, dedicate some training time to restoring hip rotation and hip extension movement.  Learn how to perform some remedial gluteal activation drills.  Learn a proper hip hinge, squat and a pain free lunge pattern.

Think First

Participation in a single inappropriate activity can produce a lifetime of knee trouble.  That box jump workout of the day- maybe not.  The warrior, electric shock, mud hole, death run–bad idea.  Trampoline with the grandchildren–what were you thinking!

Be Proactive and Seek Treatment For Knee Pain

“Training through the pain” can take a graceful athlete and turn them into a lifelong speed limper.  The presence of pain changes the way your brain controls movement.  Left untreated, it can permanently alter neural signals and produce movement patterns that linger long after the pain has resolved.  Live with enough cycles of inefficient movement and you develop early breakdown in the knee.

Michael O’Hara, PT, OCS, CSCS

*What I Wished I’d Known About My Knees, Jane Brody, New York Times. July 3, 2017

Read the NY Times article here: https://www.nytimes.com/2017/07/03/well/live/what-i-wish-id-known-about-my-knees.html?_r=0

Movement You Should Master

Step Ups

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that I have found to be very helpful in restoring the capacity to get up and down off the floor is the Step Up.

Step Ups

The ability to go up and down steps will almost always be needed.  Losing this ability is a sure sign that one’s quality of life and independence are quickly fading.  Step Ups can be done in a variety of different directions and loaded a number of ways making them easily progressed or regressed based on goals and fitness level.  Step Ups improve balance and strength in the glutes, quads, and hamstrings.  Depending how you load, they can also challenge the core and shoulders.  The average step in the United States is 7 inches tall.  Strive to work up to a 14 inch box so that no flight of stairs will ever intimidate you.

Here Coach Katie demonstrates two different versions we like to use and the benefits of each along with some progressions.  Watch the video and give it a try: https://youtu.be/iGXtKyGlKMg.

1) Anterior Step up (Progression: Anterior Step Up with Racked Kettlebell hold)

2) Lateral Step Up (Progression: Lateral Step Up with one side loaded)

-Jeff Tirrell, CSCS, Pn1

 

Motrin Mayhem

More Research On Effects of Exercise and NSAID Medications

Millions of Americans take a non-steroidal anti-inflammatory drug (NSAID) every day.  Many use these over the counter drugs to reduce the discomfort / pain of fitness activities.  Big Pharma marketing makes the use of these chemicals look harmless.  In the commercial, the lady pops three pills and glides effortlessly through her run.  The basketball player takes his gel capsules and bounds through the game with his buddies.  Most of us view these drugs as harmless and beneficial.  Ongoing studies have shown that the use of NSAIDs as a pre-exercise activity preparation can limit your muscle recovery and damage your internal organs.  A recent New York Times *article by Gretchen Reynolds should scare everyone away from medicating with NSAIDs prior to a training session.

Exercise induced inflammation is a critical biochemical process that helps us recover from a bout of training. You do not get fitter while training, you get fitter during recovery from a bout of exercise.  The inflammatory biochemicals that make you sore and stiff after a vigorous exercise session are called prostaglandins.  NSAIDs work by interrupting the chemical assembly line that makes various prostaglandins.  No prostaglandin production means you have no delayed onset muscle soreness (DOMS), so you feel better.  Prostaglandins are the chemical signal that tells your muscle cells to get busy repairing and reinforcing your skeletal muscle cells.  No prostaglandins, no beneficial adaptation during recovery.  Take a NSAID before training and it’s like you never exercised at all.

Prostaglandin production creates vasodilation– more blood can get where it needs to go during a session of exercise.  The studies cited in the New York Times article have demonstrated that inhibited prostaglandin production creates diminished blood flow to your kidneys.  Limited kidney function dramatically blunts progress toward all fitness goals.   It is very difficult to run further, get stronger, or become leaner while undergoing dialysis.

Take the time to read the article by Gretchen Reynolds and rethink that pre-exercise NSAID protocol. You can view the article here: https://www.nytimes.com/2017/07/05/well/move/bring-on-the-exercise-hold-the-painkillers.html?

*Bring On the Exercise, Hold the Painkillers, Gretchen Reynolds, New York Times, July 5, 2017

Barbara O’Hara, RPh.

Movement You Should Master

Weighted Carries

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that I have found to be efficient and effective is a Weighted Carry.

Weighted Carries

Very few things are more functional than a carry.  You’d be hard pressed to get through daily life without having to carry something at least a few times per week.  While basic, a carry is an efficient and effective full body exercise.  Depending on the carry you choose, the load is virtually limitless.  Performed for time or distance, carries will always improve gait and core stability.  Depending on which version you use, they can also be an effective tool for improving shoulder mobility/stability, grip strength, balance, and overall awesomeness.  Watch the video and give it try: https://youtu.be/PaP4-IlVAOA

Coach Chad demonstrates my top four carry picks:

1) Farmers Walk (gait, core stability, grip strength, upper back, legs)

2) Suitcase Carry (gait, core anti-lateral flexion, grip, upper back, balance)

3) Waiters Carry (gait, core stability, shoulder stability, balance)

4) Double Waiters Carry (gait, core stability, shoulder mobility, shoulder stability, balance)

-Jeff Tirrell, CSCS, Pn1

 

Movement You Should Master

Pull Ups

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that helps build upper body strength and maintain shoulder mobility is the Pull Up.

Pull Ups

If you are a superhero and find yourself hanging off the edge of a cliff or a building, you’ll need to pull yourself up.  All kidding aside, the pull up is a fantastic exercise to build strength in the lats, biceps, rhomboids, and rear delts, while helping to maintain shoulder mobility.  Pull ups can be done with a variety of grips.  The most important thing is to use a full range of motion and maintain control (avoiding excessive movement to reduce injury risk).  I utilize one of three pull up versions with most clients depending on their fitness level.  Watch the video and give it a try.

1) Eccentric Pull ups: Use a box to start in the top position, and slowly lower yourself with complete control down to the bottom position.  Once you can complete 10 of these with a good 4-6 second descent, then it’s time to move on to a standard pull up.

2) Standard Pull up:  Start hanging from a bar (or rings) with your arms completely straight.  Pull yourself up until your clavicle touches the bar.  Slowly lower yourself back down until your arms are completely straight and your body is motionless.

3) Xiphoid Pull ups: Start as you would for a standard pull up, but rather than pulling to your clavicle, you want to lean back and pull yourself up until your xiphoid process (bony part at the bottom of your sternum) touches the bar.  Then, lower yourself in a controlled manner back to the start.

See video of pull ups here: https://youtu.be/Cyvp4X2MRC0

-Jeff Tirrell, CSCS, Pn1

Slant and Pant

HIIT Methods: Incline Treadmill Walking

Fitness centers present the client with an endless array of cardio training entertainment.  You can spin a bike, wheel around on an elliptical, run on a treadmill, row, ski,…  My recommendation is that we all start performing more incline treadmill walking intervals.  There are three big benefits you get from incline treadmill intervals that you do not get from any of the other cardio contraptions.

Single leg stance stability is a skill we all need to keep in our fitness programs.  Our independence and well-being is based upon being able to repeatedly balance, load, and then drive forward off a single leg.  Since we are all sitting more, we need to make an effort to practice the elaborate leg to leg “game of catch” that happens when we walk.  It is a sad fact that most of the more popular training devices in the gym have made exercise easier by eliminating the single leg stability demand.

Hip extension is the movement of your thigh bone (femur) behind your body.  Hip extension keeps your hamstring and gluteal muscles strong and responsive.  Well functioning hamstrings and gluteals keep your knees and lower back healthy and happy.  In the age of perpetual sitting and very little squatting and sprinting, hip extension has become a lost movement pattern.  Improving hip extension strength should be part of every training session.

Walking on an incline reboots the postural reflexes that hold us tight and tall.   Prolonged sitting, improper training, and weakness shuts down the team of muscles that keep our spine stable and upright.  As fatigue sets in, you can slouch over on a bike, slump onto the elliptical, or fold into a rower and continue to exercise.  If you lose your posture on the incline treadmill walk, you slide down the belt.  Many fitness clients report this is the hardest part of an incline treadmill session–their muscles in the middle fatigue before their legs.

Finding your initial incline and walking pace will be a trial and error endeavor.  My suggestion is that you start easy.  I find most newbies to incline treadmill intervals do well with a 5% incline and a 3.5 mph pace.  Incline treadmill training makes you stronger in all of the most neglected places.  Many people report they are able to significantly advance incline and speed with four months of dedicated training.  For the best results, frequently vary the intervals that you perform.  These are some of the sessions I have found work well for fitness clients.

90 seconds on / 45 seconds off

Walk for ninety seconds.  Step off the treadmill and rest for forty five seconds and repeat for three to six intervals.  The two to one work / rest ratio works well for nearly all fitness clients that are new to incline treadmill walking.

Quarter Mile Repeats

Get a stopwatch and track your performance on this interval session.  Set the treadmill speed and incline.  Walk ¼ of a mile.  Rest as needed and then repeat.  Perform four ¼ mile incline walks.  Record your time to complete all four ¼ mile walks.  I find this to be a good test of cardiorespiratory recovery capacity.  Work toward a faster performance.

10 seconds on / 10 seconds off x 10

This comes directly from Dr. Gibalas research on HIIT.  This protocol has been shown to be as or more effective at improving insulin sensitivity and cardiorespiratory capacity than longer training sessions.  Set the treadmill at a slightly higher incline.  Walk ten seconds and then step off and rest for ten seconds.  Perform ten of these ten second intervals.

2/10th, 3/10th, 5/10th Mile Interval Session

Get a stopwatch and track your performance on this interval session.  Set the treadmill speed and incline.  Walk 2/10th of a mile.  Rest as needed and then perform 3/10th of a mile.  Rest as needed and then perform 5/10th of a mile.  Record your time to complete all three intervals.   As you get stronger your times will improve.

For more information on the many benefits of HIIT read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

The Best Practices for Fat Loss

As the weather warms up, I get more questions from gym goers on the best way to lose body fat.  In the physical therapy clinic, we treat patients who have injured themselves with their exercise efforts to eradicate the extra pounds of adipose they gained over the winter.   For both populations, I direct them to an excellent article written by Alwyn Cosgrove, *The Hierarchy of Fat Loss.  View the article here: https://www.t-nation.com/training/hierarchy-of-fat-loss

Nearly all fitness clients say they have busy schedules and limited time available to spend in the gym.  At best, they can spare two or three hours a week.  In great detail, Alywn explains the optimal fat loss training schedule so that you make the best use of your training time.  For the deconditioned or orthopedically challenged individual, following a plan that focuses foremost on nutrition and strength training will decrease body fat levels and prevent injury.

Michael S. O’Hara, PT, OCS, CSCS

Hills Make It Happen

HIIT Methods: Hill Sprints

Hills sprints are an amazingly effective method of improving fitness and keeping the lower extremities strong.  Sprinting up a hill reduces impact on the joints, improves running mechanics, creates a profound metabolic disruption, and your training session is over in twelve minutes.  Walter Peyton was a huge believer in hill sprints and no one could argue with his results.

Hill sprints are safer than flat surface sprints because the ground rises up to meet the foot.  Maximal lower limb speed and impact is reduced when you sprint up a hill.  Hill sprints make you lean forward into the posture of acceleration.  In order to produce more of the force that lifts the body up the hill, the athlete must pump the arms and drive back through the hips.  Hill sprints are arguably one of the most functional training activities you can perform.

Hill sprints are not for everyone.  They are not appropriate for the physically deconditioned population.  If you have a history of lower extremity orthopedic issues, you want to use another, less aggressive form of HIIT.  Hill sprints take some discipline to complete.  They are not the same as running uphill on an inclined treadmill.  I would argue that hill sprints are the most effective method of disrupting physiological homeostasis–you will get leaner and fitter faster.

The ideal hill is a five to seven percent grade and 100 to 150 yards long.  Most of the hill sprints you will perform are for distances sixty yards or less.  Listed below are some of my favorite hill sprint routines.

20 Yard Hill Sprints

Sprint up the hill for twenty yards.  Walk back down and rest.  Beginners start with three sprints and work your way up to eight sprints.

20 – 40 – 60 – 40 – 20 Yard Hill Sprints

Sprint 20 yards and then rest, 40 yards, rest, 60 yards, rest 40 yards, rest, 20 yards and you are finished.  Recover sufficiently so the next hill sprint does not suffer a breakdown in performance.

40 Yard Hill Sprints

Warm up and perform a 40 yard hill sprint at 80% of full effort.  Walk back down the hill and then perform another 40 yard hill sprint at 85% full effort.  Perform the next three hill sprints at 90-95% full effort.  Five good sprints are all you need.

Watch Mike explain hill sprinting on his favorite hill: https://youtu.be/AHJjmT87g7g

For more information on the many benefits of HIIT read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

Fitness Success Secrets

WSJ and My Fitness Success Suggestions

A member at the gym brought in this *article from the May 20, 2017 issue of the Wall Street Journal.  The article had some good tips on exercise compliance but fell short in other areas.  Take the time to read my suggestions.  These habits have been time tested, proven winners in multiple studies on real world people who were successful in making fitness a lifelong habit.

Get Some Help.

Numerous studies have shown that individuals that seek the assistance of a personal trainer or fitness coach are more successful in long term exercises compliance.  The guidance from a fitness expert improves motivation, goal attainment and is more time efficient.  Scientific understanding of fitness and the best training practices have changed dramatically in the last fifteen years, and your knowledge is probably behind the times.  A good coach will temper your “beginner’s enthusiasm” and make it less likely you will over train and/or injure yourself.  A professional helps you reach goals despite physical limitations or prior fitness challenges.

Personal Performance Evaluations.

In school, you have tests to see if you are gaining knowledge and ready to advance in a specific subject.  The same should be true of your training program.  The minimal requirement is a Functional Movement Screen.  This simple test can prevent 90% of the fitness related injuries we see in the physical therapy clinic.  Keep a record of relevant performance evaluations—a good trainer can help you with this.  Your initial successes with exercise will come in the form of better strength, mobility, and work capacity.  An ongoing record of “fitness victories” strongly reinforces the exercise habit.

Have Reasonable Goals.

The infomercials for fitness products promise big changes in extremely short periods of time.  Television shows document massive fat loss in a single month.   The healthiest changes in body composition occur slowly and steadily.  Make those body composition goals, but also make performance goals such as being able to perform a pullup, twenty lunges, or a full pain free squat.  I can think of no better goals than being able to eliminate blood pressure medication, normalize blood sugar levels, or decrease the use of anti-inflammatory medications.

Place Your Exercise Session At the Beginning Of the Day. 

The University of Michigan department of psychology found that individuals that are successful with long-term exercise compliance train in the morning before other aspects of life have a chance to interfere.  Consistency is King–an exercise plan will never work if you are not able to maintain a schedule.  The most consistent attendance happens when gym members train in the mornings.

Michael S. O’Hara, PT, OCS, CSCS

*Wall Street Journal, May 20, 2017, Rachel Bachman, Five Secrets for Steadier Workouts

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