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Performance

Heat Or Ice For My Shoulder?

Try Standing Upright

In the gym, at the golf course, and during a visit to the hardware store, I am asked my advice on abolishing shoulder pain.  What everyone wants is the magical exercise, miracle ointment, or newest thermal treatment.  What they need–and what they do not want to hear–is that they have to fix their horrible posture.

Sustained poor posture can alter the function of your shoulder complex.  The shoulder girdle has only one, very small, bone to body connection.  The entire system is an interconnected series of muscles and ligaments.  Sustained slouched over postures create a faulty length-tension relationship in these structures that places adverse stress and strain on the four joints of the shoulder and the nerves in the neck and upper back.

OMG I sit lmGm (like my GrandMa).  

Shoulder posture pain problems are happening earlier.  I do not know if it is more tech toys, less physical education in schools, or a change in youth activity levels, but in the physical therapy clinic we are seeing younger people with older people postural shoulder pain.  They sit on the treatment table in extremely slouched over positions and are unable to pull themselves up into a correct position.  Most are unconvinced that how they sit and stand could be the generator of their pain problem.

What exercises can I do?

Stronger muscles will help restore posture.  The shoulder evolved to pull, lift, and carry.  The muscles that keep the shoulder strong and happy are in the back of the shoulder.  They hold the shoulder in a healthy position on the body.  Most of us never perform any pulling or lifting activities other than hoisting our laptop or toting our smart phone.   Making your shoulder girdle muscles stronger will help, but being mindful of your posture during the day is the most important factor.  Physical Therapist and US Soccer Team Trainer Sue Falsone says “You can’t out rep poor posture.”

Start with how you work and live.

Eight hours a day for five days a week equals 2080 hours of computer / desk time a year for the average office worker.  Add in a daily one hour car commute and another two hours of television a day and we push the Monday through Friday slump numbers to 2860 hours a year (120 days).  We have spent millions on state of the art chairs, elevated monitors, slanting keyboards, wrist rests, and lumbar supports.  Office modifications, while well intentioned and generally a good idea, cannot compete with 2860 hours (this number is probably low) of sitting in a year.  In order to fight against the postural stress that creates pain, we need to get up and move.

Recent research on prolonged sitting has demonstrated that the amount of movement we need to stay healthy is greater than we once thought.  To combat the adaptive changes of prolonged sitting, it is suggested you get up and move every twenty minutes.  Set a timer, enlist the help of your coworkers, and work at this every workday for a month.  I believe you will be surprised by the results.

Michael S. O’Hara, PT, OCS, CSCS

Movement You Should Master

Squats

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 from a seated position is the Squat.

Squats

Squats prepare us to get up out of a chair, into the car, and up from the floor.  These are daily tasks often taken for granted until they can no longer be done with ease.  The ability to squat down deep, remain there for some time, and get back up creates functional carryover to real life activities.  I recommend a mixture of three different squat variations.  Pick one variation to include in your training every day.  Watch the video and give all three a try.

1) Box Squats:  Set up with a box behind you and slowly lower yourself onto the box with control.  Once on the box, sit and relax completely before re-engaging the legs and standing back up. To maintain complete control of the movement all the way into the seated position, start with a tall enough box.  Increase the difficulty by lowering the box height or adding a load.  A 12”-14” box should be the goal for most people.

2) Deep Breathing Paused Squats:  Find a stance that allows you to squat down as low as possible without your heels coming off the ground or your tailbone tucking under.  Some individuals may need a wider or narrower stance.  You may also need to play with the angle of your toes.  Squat down to your lowest point (maintaining pelvic control and heel contact), take 2-5 deep breaths into your abdomen, and stand up.  These are best done for sets of 3-5 reps for 2-5 total sets.  To increase the challenge, external load can be added.  Just remember that the goal is depth.  If the increased load causes your range of motion to shorten, you’ve gone too heavy.

3) Split Squats: Assume a split stance, and lower your back knee down to the ground with control.  Extend the legs and return to the standing position.  You may find yourself in this position when picking something up off the floor or doing yard work.  Add weight to this movement as you are able.  You can also elevate the front or rear leg to increase the range of motion.

View video of squat variations: https://youtu.be/4gormcwHr5A

-Jeff Tirrell, CSCS, Pn1

Less Is More

Understanding The Requirements Of Rest

The weight room at my high school was small and had only basic equipment.  It consisted of two Olympic weight sets, some mismatched dumbbells, a squat rack, and a chin up bar.  In the gym, we had a pegboard and a rope for climbing.  No bench press, curl bar, or pulldown machine.  It was the ultimate blessing in disguise.  We did not have the temptation of exercise variety for variety’s sake.  What we did have was solid instruction on basic lifts.  We performed the same exercises repeatedly and became more proficient at squats, hang cleans, overhead presses, and pull ups.  Four simple activities performed consistently with an effort to add weight to the bar on a regular basis.  The results were magic.

The television fitness gurus have brought forth the latest craze of “muscle confusion”.  You change your exercise activity often in an attempt to stimulate a greater adaptation response.  The problem is that you never get the chance to practice the exercise long enough or with enough resistance to get stronger.  Getting stronger is the performance parameter that preserves muscle mass, speeds up your metabolism, and makes you more durable–less likely to get hurt.

I never want any of my muscles, nerves, joints, or any other part of my body to be “confused” when training.  I want the bodies of the athletes I train to perform better at every session.  My suggestion is that you pick five or six exercises and set a goal of getting better at each of them over the next six months.  The exercises you chose do not have to be a barbell or dumbbell exercise.  Bodyweight exercises will work just as well and are a better choice for most fitness clients.  Keep a record of your performance and work on improving the number of inverted rows, pull ups, or push ups you can perform.  Single leg strength training is a good choice for nearly everyone and works wonders for athletes. Athletes should choose exercises that not only improve strength, but also mobility—front squats.  Long term dedication to the mastery of an exercise will reward you with better body composition, enhanced mobility, less pain, and the strength you need to perform in athletics and daily activities.

This training approach requires mental toughness and a willingness to at times be bored.  Toughen up and get after the challenge.  Read this recent article in the Wall Street Journal, “We Need To Relax Like Roger Federer”.   Better yet, go out and buy the book Starting Strength.

Michael S. O’Hara, PT, OCS, CSCS

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

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