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Easy Answers With The Y Balance Test

We are always looking for better ways to measure our physical therapy patients’ progress.  You want to know if the treatment you prescribe is producing positive changes in the patients’ pain and functional mobility.  You want to be able to identify weaknesses and focus efforts on the most significant problems.  One of the best functional assessment tools is the Y Balance Test. 

The Y Balance Test is a stance platform with three moveable reach boxes.  Each box travels along a measuring stick.  The patient stands on the platform and with the opposite foot, pushes the reach boxes down the measuring stick.  A successful test involves reaching as far as possible and then successfully returning to a stable single leg stance position. 

Measurements of the distances the patient was able to reach are recorded.  Comparisons are made between the right and left legs.  As the patient moves through therapy, he or she can be reevaluated on the Y Balance Test to measure the success of treatment intervention.  A great effort is made to train away any asymmetry in reach distances between the right and left leg.  Asymmetries in reach scores are correlated with greater incidences of future injury.  

The Y Balance Test is a true measure of how we use our legs.  Most activities of daily living and nearly all sports are all about single leg control.  Unfortunately, most clinical tests look at only one joint segment, in non weight bearing positions.  The Y Balance Test gives the clinician and patient a real world assessment of the interactive function of the foot, ankle, knee, hip, and torso in a standing position. 

Patients like the test because it is easy to understand and gives them a clear training goal.  The Y Balance Test takes minimal time to perform and patients do not have to be strapped into a machine or tethered to a computer.  Patients often report that as their scores improve, they notice a decrease in pain. 

Functionally relevant.
Research proven: Repeatable and reliable.
True measure of real world lower extremity function.
Easily understood scoring system.

Michael S. O’Hara, P.T., OCS, CSCS



A Long Name For A Great Exercise

In life, most of the challenging tasks happen in either single leg stance or with much more of our weight on one leg.  We must be able to support, decelerate, and change directions with one leg.  Our muscles are aligned so that the hip is mechanically linked to the opposite shoulder.  In physical therapy, we know that having one side of the body function efficiently and the other side falter sets you up for injury.  Your exercise program should revolve around training to meet these physical demands.  One of my favorite life enhancing exercises is the single leg stance opposite arm reach and row.   

Exercise Benefits
Fall preventative activity that helps improves single leg balance.
Sure cure for the epidemic of gluteal amnesia.
Gives athletes the hip to opposite shoulder connection they need for performance.
Identifies any asymmetry in single leg control.
Enhances the single leg deceleration skill necessary for injury prevention.
Makes you stronger when you lift, carry, push, and pull.

Single Leg Stance Opposite Arm Reach and Row
You need a cable column machine or resistance tubing anchored at knee level or lower.  Hold the tubing or cable handle in the right hand and stand on the left leg.  You must be at least five feet away from the attachment point of the tubing or cable.  Initiate the movement simultaneously at the ankle and hip and reach forward with the right hand.  Attempt to get the hand down to knee level.  Return back to standing and pull the handle toward the body in a rowing motion.  Perform five to ten repetitions and then repeat on the other side.

Common mistakes are bending at the hip only and slouching over at the spine.  The ankle, knee, and hip all move together, and the spine should stay stable.  Holding the handle on the same side instead of the opposite side.  Performing repetitions past the point of technical failure.  If you start wobbling around, stop the exercise.  Getting the arm and legs out of sync.  Do not reach with the arm and then move the legs—the motions should happen together.  Remember to come all the way back up to a tall standing position before starting the next repetition.  Start with light resistance and try to create a steady smooth pattern before adding more resistance.  Watch the video  and give this exercise a try.  

Michael S. O’Hara, P.T., OCS, CSCS


Turn Around And Improve Your Squat Performance

For most people, wall squats are an exercise that involves placing your back against the wall (or on a physioball placed against the wall) and performing squats with a supported torso.  The assistance from the wall permits you to stay up taller and shifts much of the workload onto your quadriceps.  While this exercise will make the muscles in the front of your thighs burn, it does little to improve your mobility or strength.  My advice is to turn around and face the wall to develop better squat mechanics, balance, and functional mobility.   

The ability to perform a full squat is an important basic movement pattern.  The overhead squat is one of the seven critical tests in the Functional Movement Screening process used to assess an athlete’s readiness to compete.  Squatting is a basic mobility pattern that is important for long term independent living, a healthy lumbar spine, and a calorie hungry metabolism. The restoration and preservation of the ability to move through a proper squat pattern should be a part of every fitness program.

As infants, we mastered a full, steady squat.  A baby must develop control of the squat in order to progress to the next level of mobility–standing and walking.  Prolonged sitting, weakness in the muscles that stabilize the pelvis, and the lack of basic spinal and hip mobility in daily activity restricts our ability to move into this basic pattern of movement.  Add in some well meaning but mobility reducing fitness activity and you produce an environment that fosters immobility.

Wall Squatting 101
The wall serves as instant feedback to prevent most mistakes.  If you let the knees collapse inward, slouch over at the spine, or lean the head forward ,you hit the wall and are unable to descend any further.   

Face the wall and position the toes twelve inches away from a wall.  The toes should point out no more than thirty degrees.  A mirror that provides a side profile can be helpful for visual feedback on your performance.  The basic wall squat starts with the hands placed across your chest or out to the side of your shoulders.  Push the hips back and lower into the squat.  The wall keeps your posture tall and forces the knees out.  If you find the wall squat difficult, then you need to perform it often and improve you performance.  Start with three or four sets of five to ten repetitions.

As your mobility improves, simply move closer to the wall.  Holding the hands behind the head or holding a band overhead increases activation in the thoracic spine and shoulder girdle muscles.  You can add resistance by holding a kettlebell suspended from both arms.  Watch the video that accompanies this article.  

Michael S. O’Hara, P.T., OCS, CSCS



magician photoWhat I do all day is attempt to get people stronger. Whether I am addressing the needs of physical therapy patients or fitness clients, all of their problems will resolve when they get stronger.  The progressions and approaches will vary, but the training goal is the same.  Improve strength and 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 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 weaker and frailer body.  Age related sarcopenia (loss of muscle mass) is one of the primary drivers of metabolic problems such as diabetes, hyperlipidemia, and chronic inflammation.  Today’s children are growing up with fewer episodes of bone and muscle building lifting and carrying.  I see teens nearly every day with lower back, knee, and hip pain all related to glaring strength deficits.

For many patients and clients, I do not even use the words “strength” or “stronger”.  They have developed inappropriate beliefs regarding strength training.  Lifting a barbell will give them huge muscles, tight joints, and an Adams Apple.  They are concerned that a dumbbell that weighs less than the laptop computer they carry every day will somehow damage their joints.  Often these phobias are so long standing and ingrained that the best approach is to “disguise the programming” by adopting tools that do not look like traditional strength training.  Using a suspension trainer instead of a dumbbell, a physioball instead of a kettlebell, and any type of Pilates training.

A lack of proper coaching and progressive programming is the biggest barrier.  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 bodybuilding exercises with strength training.  The best results are achieved when you work closely with a qualified coach who can monitor your results and teach you how to strength train.

Michael S. O’Hara, P.T., OCS, CSCS


Stretch Station Mobility Restoration

Invented by Gary Gray, a physical therapist from Adrian Michigan, the Stretch Station has been a primary piece of equipment at all of our facilities.  It enables the physical therapy patient or fitness client the ability to perform three dimensional mobilization of the major peripheral joints and spine. I have not found another piece of exercise equipment that is as beneficial for improving movement as the Stretch Station.

It Has To Happen In Standing
The Stretch Station allows you to mobilize joints and move in the anti-gravity, standing upright position that it functions in every day. Gravity eliminated, floor stretching programs often fail to produce better movement when gravity comes back into play. Any new movement you develop with mobility training is only beneficial if it can occur in a standing position.

A Little Lift Goes a Long Way
Traction force (pulling apart) of a joint is a key component of all manual medicine. It helps relieve pain and makes greater joint mobility easier to achieve. The overhead bars of the Stretch Station enable you to lift up and partially decompress the spine, hips, knees, and even ankles during mobility training.  This low level traction force assists in the development of better mobility. Deconditioned and overweight patients can perform hip and knee mobility training and remain pain free with the assist of the Stretch Station.

One Good Turn…
Most floor mobility training does little to develop better rotation at the joints that are supposed to produce
rotation–thoracic spine, hips, and ankles. The Stretch Station has an angled floor and multiple handle sites that enable users of all sizes to work on improving rotation. Thoracic spine and hip mobility work is particularly beneficial for athletes that must swing a club or throw a ball.

Identification of Asymmetries
Using the Stretch Station, patients and fitness clients can immediately identify when one side of the spine, one hip, or one shoulder is more restricted than the other. Training away asymmetries at a single joint or movement pattern is important for injury prevention and optimal performance.

A Bridge to Better Performance
I have fitness clients perform thirty seconds of mobility training on the Stretch Station followed by a complimentary strengthening exercise. The idea is to neurologically reinforce the new motion achieved with the Stretch Station using an appropriate strengthening activity. This pairing of the Stretch Station work with a strengthening drill has been very effective in restoring movement and decreasing pain.

Michael S. O’Hara, P.T., OCS, CSCS


Six months ago, I started using a standing desk for almost all the work I do at home.  After years of reading about all of the bad things that happen to the human body with prolonged sitting, I decided to give the standing desk a try.  The results have been surprisingly good and I wish I started using the desk years ago.

My Lower Back and Neck Feel Better
I was having lower back stiffness when I sat at the desk in the morning and any prolonged (>30 minutes) of computer work was bothering my neck.  None of these problems are present with the standing desk.  I can work for hours at the standing desk and remain pain free.  

My Focus Is Better
Working at the desk has improved my productivity.  I focus much better on my work and feel better at the end of my computer time.  I find that I fatigue and get distracted more easily when I work in a sitting position.  Standing keeps me more awake and aware.  I also find that my limited word processing skills are better when I am standing.  

Foot Fatigue
At the end of a long day on the job, the standing desk can create some foot fatigue.  It is not pain, just some soreness that goes away quickly with some tennis ball rolling on the bottom of each foot.  I have noticed these symptoms are worse on the days I have performed some high intensity conditioning activities such as jump rope or sprints.

Prolonged Sitting Is Physically Destructive
More and more we are de-evolving into a nation of sitters.  Between television, driving, and computer work, it is not uncommon for many of my physical therapy patients and fitness clients to sit for ten hours a day.  Unfortunately, you cannot train away the bad effects of prolonged sitting with a 45 minute session of exercise.  Check out juststand.org for information on the deleterious effects of prolonged sitting and what you can do to fight back. 

Michael S. O’Hara, P.T., OCS, CSCS


Restoring The Function of Your Upper Body

Our lives revolve around driving, computer time, and television.  We sit in front of a monitor all day, drive for hours every week, and often spend our leisure time slouched on the couch.  Age and gravity rounds the upper back, pulls the shoulders forward, collapses the rib cage, and reduces range of motion.  Throw in some well meaning, but inappropriate fitness training and you create the environment that produces neck, shoulder, and upper back pain problems.   

Correcting upper body posture along with the restoration of mobility and strength in the thoracic spine and shoulders should be a goal of every fitness program.  It is difficult to develop proper movement patterns and functional upper body strength with tight shoulders and a slumped spine.  A collapsed rib cage inhibits full inhalation and exhalation cycles.  Proper posture and full mobility improves respiration efficiency and produces better exercise endurance.    

In the accompanying video, I take you through a series of exercises that I have been using with physical therapy patients and fitness clients for years.  Your upper back and shoulders work as a team so you will be training them together.  Many of these drills will produce some discomfort.  Any pain should cease soon after you complete the exercise.  

Each of these exercises builds on the benefit derived from the previous exercise, so perform them in the order prescribed.  When you initially start with these drills, you may only be able to perform the first three or four.  As you become more proficient, work your way up to the more challenging exercises.  The weaker and tighter you are, the more you need to train with this program.  Five times a week if you struggle and three times a week if you are able to move through the program fairly easily.  The entire series of six exercises should take no more than ten minutes to complete.  Pay attention to the common mistakes portion of the presentation.    

To perform these exercises you will need a foam roll ($25.00), a proper physioball ($35.00), resistance tubing ($25.00) and a suspension trainer ($95.00) or pull up bar ($30.00).  If you own a $400.00 television and a $500.00 recliner, your spine and shoulders are asking you to spend $200.00 on some basic fitness tools.  

1. Foam Roll Thoracic Spine
2. Foam Roll “T”s
3. Four Point Rotation
4. Belly On Ball “touchdown”
5. Half Kneeling Rows
6. Suspension Rows or Pull Ups

Michael S. O’Hara, P.T. OCS, CSCS


The Average American From Age 25-55

After the age of 25, the average American gains a pound of fat and loses a ½ pound of muscle every year.  If no action in taken to reverse this trend, the average American will have gained 25-30 pounds of fat and lost 12-15 pounds of muscle by the time they reach 55 years of age.  The average 55 year old American will stand on the scale 12 to 18 pounds heavier, but the true alteration in body composition is far more dramatic.  

America does not have “an obesity epidemic”, it has a muscle atrophy epidemic.  We are not so much over fat as we are under muscled.  The simplistic notion of “just losing weight” is failing to improve health and fitness in this country because it accelerates muscle loss.  This middle age muscle loss is the catalyst for many of the illnesses that plague us later in life.

Lose muscle and your metabolic engine slows, it becomes more difficult to move, you store less glycogen, become more insulin resistant, lose the beneficial bone enhancing pull on your skeleton, and become more prone to injury.  The only metabolic process that becomes more efficient is that it takes less food to produce more fat.  

Drs. Evans and Rosenburg coined the term age related sarcopenia in their 1991 book Biomarkers.  The research they performed at Tufts University ranked the measurable biomarkers for healthy aging.  The top four are:

1.  Muscle Mass.  What percentage of your body is made of muscle.
2.  Strength.  Can you use that muscle to push, pull, lift and carry.
3.  Basal Metabolic Rate.  The number of calories your body expends at rest.
4.  Bodyfat Percentage.  What percentage of your body is composed of fat.

The authors named these top four biomarkers, the decisive tetrad.  They are the prerequisites to maintaining healthy numbers in the other biomarkers such as lipid levels, insulin sensitivity, bone density, aerobic capacity, and blood pressure.  

Most people have limited exercise time.  Keeping your muscle mass up and improving total body strength will create the greatest benefit.   Be obsessive about the number of push ups or pull ups you can perform and forget about the deceptive numbers on a scale.  Six weeks of dedicated strength training can work wonders. 

Michael S. O’Hara, P.T., OCS, CSCS


Simple training tools are always the best training tools.  A weighted ball, a steel bar with iron plates on each end, and a round iron ball with a handle are all examples of elegantly simple and time tested training tools.  You cannot get any simpler than a bag full of sand.  The magic of Velcro, bulletproof fabrics, and composite materials have been brought together to create sandbags that are user friendly and eventually will be part of every training center.    

Farm Boy Strong
Sandbag training more closely replicates the actions of things you must handle in activities of daily living.  Kettlebells, dumbbells and barbells are stable systems.  The load on the kettlebell or barbell does not shift around as you move the object.  Bags of dog food, groceries, and small children all tend to be fairly loosely packed, and these objects can shift around while you are performing what industrial rehabilitation experts call “material handling activity”.  In combat sports, the opponent you face on the field of play is the ultimate shifting object.  Sandbag training permits you to more closely mimic daily activities and athletic events.  

Growing a Greater Grip
While most sandbags come with composite grips, for most drills you simply sink in your fingers and grip the body of the bag.  In life, most of the objects we have to move do not come with a convenient handle.  The grip demands of a sandbag more readily replicate the real world activities of daily living and sports.  

Absorbing an Impact
Impact absorption is a learned skill.  The pliable and conforming nature of a sandbag permits impact against the body with no soft tissue trauma.  Unlike a barbell or dumbbell, the force of impact is spread over a wider area of the body.  Training for better impact absorption efficiency is an anti injury activity.  With a sandbag, the athlete learns how to dissipate impact force by controlling respiration and decelerating force across the ankles, knees, and hips while maintaining a supportive bracing of the spine.  Contact sports require that the body be trained to absorb impact and many recreational sports such as downhill skiing also have a big shock absorption component.  

Asymmetrical Loading and Balance Demand
Most strength training activities performed in the gym are symmetrical and require little in the way of balance.  In athletics and life, almost everything is asymmetrical and has a huge balance demand.  Sandbag training allows us the opportunity to design resistance drills that develop these important areas of performance.  

Start Slow And Be Consistent
Start with one or two of the beginner exercises in the attached video.  Do not move up in weight too quickly.  Work on proper form and add exercises slowly.  Josh Henkin has put together some great demonstration videos at ultimatesandbagtraining.com.  

Michael S. O’Hara, P.T. OCS, CSCS


The multifidus is the name of the series of muscles that travel the length of your spine.  They run from vertebrae to vertebrae and function to control the segmental motion of your spine.  They guide the spinal joints during motion and hold the spine stable when under shear stress or compression.  Recent advances in ultrasound imaging enables us to measure the size and health of the multifidus muscle at each spine segment level.  These studies have revealed shrinkage (atrophy) at the same level and side as patients’ lower back pain.  Tissue tests of the atrophied multifidus muscles show changes in the cell types and density.  These changes occur fairly quickly after back pain onset, and the multifidus muscles do not return to normal after back pain has resolved unless stimulated with proper rehabilitation exercises.  Poor control by the multifidus results in compromised segmental control, pinching of the facet joint capsules, and abnormal compressive forces on the spinal joints.  

Multiple studies have been performed on low back pain patient populations where one group trained with spinal stabilization exercises and the other received no exercise.  The researchers measured the recovery of the muscle with ultrasound imaging and tissue sampling.  Both groups were followed for as long as four years.  Results in every study demonstrated the recurrence rate for low back pain was much lower in the exercise group.  The exercise patients had recurrence rates of less than 20 percent, while the non exercise group had 90 percent plus recurrence rates.  

The size and health of the multifidus muscles has demonstrated the best correlation to lower back pain recovery and recurrence.  MRI imaging shows herniated discs are present in a large percent (some studies greater than 60%) of the pain free population.  Myelogram imaging reveals compressed lumbar nerve roots in 24% of the pain free population.  Neither has turned out to be as good a predictor of lumbar pain or recurrence of that pain as atrophy in the multifidus muscle.  No other treatment whether manual therapy, injection, or medications has produced the recovery rate as that found with spinal stabilization exercises.   

This long term research has validated that if you have an episode of lumbar pain, you should perform a program of exercise to improve the function of the multifidus muscles.  The exercises used in these studies are simple and require minimal or no equipment.  A daily time investment of five minutes is all that is required to restore multifidus function and reduce the possibility of pain recurrence.  One of the easiest and most effective multifidus training exercise is the horse stance horizontal exercise.

Michael S. O’Hara, P.T., OCS, CSCS