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Learn more about Rehab, Sports Medicine & Performance


The most popular method of exercise in commercial exercise equipment rental centers is the treadmill. Several studies have shown that treadmill training gives us the greatest cardiovascular challenge with the lowest rate of perceived discomfort. The modern treadmill allows us to train free of the dangers of inclement weather, angry dogs, and poor pavement. However, the way we use the treadmill often places us at risk for injury. In an effort to keep you productive and injury-free, I have some recommendations as to how to properly use a treadmill.

Home Treadmill Safety

Modern treadmills have powerful electric motors with exposed belts underneath the unit. Any object that gets under the unit while it is operating can actually liftreadmillt the unit off the ground with you on it. Pediatric friction burn injuries are becoming more common with greater home treadmill ownership. I know of two family pet fatalities brought on by treadmill accidents. When setting up the treadmill in your home keep this in mind. Be aware that a treadmill makes noise, and if you are concurrently listening to your i-device, you may not hear everything that is happening around you.

Kick the Holding Habit

Holding onto the rails, control console, or heart rate monitor handles of the treadmill significantly alters the reactive forces that travel through your body. It inhibits the reflexes that make walking/running automatic and prevents a normal gait pattern. Holding on exerts greater compressive forces on the shoulders, lumbar, and cervical spine. I have treated many patients whose cervical and lumbar pain abolished when they stopped holding on while using the treadmill. Holding on greatly reduces the amount of work you perform (35% to 60% decrease) and devalues the time you spend exercising. The saddest sight in the gym is the guy or gal trying to lose weight by walking uphill on the treadmill while clinging to the front of the machine. If you cannot walk on the treadmill without holding on, you are better served by staying off the treadmill.

Pay Attention

Think about what you are doing while on the treadmill. Your posture should be tall with the head back and gaze forward. The arms should swing by your sides and the pelvis should rotate with each stride. Studies demonstrate that reading while walking or running on a treadmill shortens the stride, inhibits rotation, and alters posture. Listening to music increases lateral sway and widens foot placement in novice treadmill walkers. I have treated many headache patients whose pain symptoms can be traced back to reading while on the treadmill. Pay attention because falling off a treadmill is a painful and embarrassing experience that can dramatically impair your efforts to become more fit.

Whoa Thunderfoot

If your neighbor can hear you running on the treadmill from his front porch, you should rethink using a treadmill as a training method. Modern treadmills have suspended decks that absorb force. Anyone who runs on a treadmill and creates a lot of deck noise does not possess an efficient gait and is much more susceptible to overuse injuries. To land softer, try limiting the vertical component of your gait. Improving hip extension mobility, posterior chain strength, and postural awareness can make you a quieter and more efficient runner.

-Michael O’Hara, P.T., OCS, CSCS

At one time, we all had a very stable and pain-free squat pattern. As toddlers, we could transfer up off the floor through a deep and complete squat. Deconditioning, prolonged sitting, and injuries take their toll until we lose so much movement that many of us are unable to properly descend into a chair. Regaining a functional squat pattern reduces the incidence of injury, enhances functional mobility, and maintains lifelong independence. One of the most effective squat restoration drills is the suspension overhead squat.

The suspension overhead squat is like riding a bike with training wheels. The resistance provided by the suspension trainer acts as an assist to make the squat easier to perform. With consistent practice you reconnect with the neural signals that create an efficient and pain-free squat movement.

Suspension Overhead Squat Performance

Anchor the suspension trainer at least nine feet up on a wall. Face the anchor point and hold the handles overhead. The palms face inward and the shoulder blades are pulled down the back-similar to the football official signaling touchdown. Position the heels at least shoulder width apart. A mirror that provides a side profile can be helpful for visual feedback on your performance. Push the hips back and lower into the squat. Keep the chest proud and the spine tall as you descend. Drive through the hips and rise back up to the starting position. Perform two sets of ten repetitions.

Most people need to work on squat stability first and then attempt greater depth. Initially, I have clients progress through a five second isometric contraction at the bottom of the squat. As the pattern improves, slowly work into greater squat depth.

Valgus collapse and the butt wink are the two most common flaws. During valgus collapse the knees buckle inward instead of staying lined up with the feet. A butt wink involves the pelvis tucking under at the bottom of the squat. If you are unable to monitor and correct these problems, you need to get some coaching.

To watch video demonstration of the suspension overhead squat, click on the link below:


-Michael O’Hara, PT, OCS, CSCS

All of our muscles work as a team to create movement. Postural stress, injuries, and poor training practices can cause some of our muscles to lose communication with the rest of the team. One of the more common problems we find in physical therapy and performance training is fondly termed “gluteal amnesia,” or an inability to use the gluteal (butt) muscles properly. In a strong, well-functioning body, the gluteal and hamstring muscles fire in a synchronous fashion to create motion. Strong, well-developed hamstrings and gluteals are the hallmark of an athletic body. Just look at any sprinter, speed skater, or high jumper. An extremely effective exercise to strengthen and reinforce the connection between these muscle groups is the suspension Supine Hip Extension Leg Curl (SHELC).

Why You Should SHELC

Unlike other gluteal and hamstring exercises, such as the good morning, barbell deadlift, and cable pull through, the SHELC does not put any shear stress or compression forces through the lumbar spine. The SHELC forces you to use the gluteals and hamstrings as a team. Strong and coordinated gluteal and hamstring muscles safeguard the knees and lower back. The SHELC trains hip hyperextension– a key component of efficient acceleration. The best athletes are the ones that get up to top speed the fastest.

SHELC Performance

Set the TRX straps so the bottom of the strap is at the mid-calf level of your leg. Lay supine and place the heels in the foot straps of the TRX. The feet should be directly under the overhead attachment point of the TRX. Place the arms on the floor at a 45 degree angle. Brace the abdominal muscles and keep the head down. Push the arms against the floor for stability. Lift the hips off the floor and keep them up for the duration of the set. Bend the knees so that the feet travel toward the body. Keep the hips up and extend the knees in a controlled manner. Perform ten to fifteen repetitions. Common mistakes are turning the feet outward and allowing the hips to fall to the floor between repetitions.

The SHELC can be made more challenging by moving the entire body out from under the suspension point or by adding a weight across the front of the body. Another challenging progression is the Single Leg SHELC.

To view video demonstration of the SHELC, click on the link below:


-Michael O’Hara, PT, OCS, CSCS

Your muscles work as a team to carry you through the day. They never function alone so training them with isolation exercises will produce less than optimal results. The muscles over the front of the body are linked together through interwoven layers of fascia to form what Thomas Myers, in his book Anatomy Trains, calls the “superficial front line.” The shoulder girdle is slung onto the body in a basket weave pattern of muscles. One of the best exercises to activate this team of muscles is the Atomic Push Up.

The guys and gals at TRX named this exercise because of the metabolic response it produces. Although the TRX company popularized the Atomic Push Up, you can use any type of suspension trainer that has foot straps. This exercise helps build a better connection between your shoulders and hips. It will strengthen the push pattern and activate the frequently neglected hip flexors. The Atomic Push Up requires core control and the active participation of your legs. The Atomic Push Up is not a bodybuilding type exercise that will “sculpt your outer pectorals,” but it will help you move better.

Atomic Push Up Performanceatomic_Pushup

Attach the suspension trainer overhead with the foot straps eight inches off the floor. Sit on the floor and place the feet in the straps. Roll over and assume a push up position with the feet suspended off the floor in the straps. The top of the suspension trainer should be directly over your feet. Descend toward the floor and as you push back up pull the knees up toward your chest. Use a steady cadence of lower down–push up–knees in–knees out. Beginners should aim for sets of five repetitions. Stop the set before movement quality deteriorates. Common faults are sagging in the middle, lack of depth during the push up, and poor head position. For men, twenty repetitions of Atomic Push Ups is a worthy fitness goal. For women, eight is great.

You generally do not see Atomic Push Ups performed in commercial gyms because suspension trainers are rare and this exercise is difficult. Beginners may wish to place a mat under the torso and head in case of a sudden face plant. You can use a pair of parallelettes if you find weight bearing on your hands is difficult. Moving the body forward so the suspension strap is pulling you backward makes the exercise more challenging.

To view video demonstration of the Atomic Push Up, click on the link below:

-Michael O’Hara, PT, OCS, CSCS

Our shoulders and spine endure prolonged computer input, extended commuter drives, sustained television staring, and way too much general slumping. The muscles that move the shoulder blades become weak and unresponsive. The spinal muscles that hold our vertebrae upright and stable neurologically shut down and are unable to work as a team. One of the best exercises you can perform to mitigate the damaging effects of prolonged sitting is the suspension row.

Better Than Seated or Bent Over Rows

Suspension rowing requires your spine to stay in a neutral position from the head to the pelvis. Most of the bent over rowing I witness in the gym involves the same slumped sitting posture you see in every office across America. Rows performed with a flexed thoracic spine are far from optimal and often help reinforce postural deficits. Properly performed suspension rows improve communication between the spinal stabilizers and the muscles that retract the shoulder blades.Suspension_Rows

Mastery of Your Body Weight

Being able to maneuver your body using the arms makes you functionally fit. During suspension rows, the resistance is not a plate or weight stack but rather the weight of your body. You alter the resistance by moving the feet and changing the angle of the body in relation to the ground.

Friendly Force Curve

Suspension rows produce an accommodating resistance that is easier when you are at the weakest part of the rowing motion. The force necessary to perform a suspension row decreases as you move from the arms fully extended to the arms pulled in close to the body. This makes it a good exercise for people with limited pulling strength.

Cervical Proprioception

Prolonged sitting, driving, and computer work can destroy positional awareness of the head and neck.   Many people have a great deal of difficulty correcting head and neck posture. Suspension rowing creates a neurological response that can help improve postural awareness.

Suspension Row Performance

At FFAC, suspension trainers are located throughout the gym. Stand facing the trainer and grip the handles firmly. The position of your feet will determine the amount of resistance. Move the feet forward and the exercise becomes more challenging. Keep the entire torso straight, one long line from ear to ankle. Brace the abdominal muscles and gluteals and lean back. From the arms extended position pull the handles in so that the thumbs end up adjacent to the armpits. Hold the shoulder blades back in a fully retracted position for two counts and then lower back down to the starting position. Perform two or three sets of six to ten repetitions. As you get stronger, progress to a full inverted row. Simply elevate the feet on a bench.

Click on the link below for video demonstration of  suspension rows:


-Michael O’Hara, P.T., OCS, CSCS

Simple training tools produce the best results. An elegantly simple and extremely versatile training device is a suspension trainer. A suspension trainer is a heavy duty strap with handles and foot holds. Suspension trainer exercises are beneficial for physical therapy patients and fitness clients. I have found some movements work better than others. Over the next four weeks, I will present my six favorite suspension trainer exercises.

If you are not familiar with suspension training, please read the brief introduction on this training modality. It can be a valuable addition to your fitness program.

012Suspension training can be scaled to all fitness levels. The trainer or therapist can utilize leverage and positioning to alter the amount of resistance. A seventy five year old recovering from a knee replacement can be as successful as a professional athlete.
Suspension training develops full body fitness. Every suspension trainer activity demands some degree of core stability, coordination, and balance.

Suspension training permits instant adjustment of resistance. Being able to make your exercise harder or easier in the middle of a training set is invaluable for building strength-endurance and raising your overall fitness levels.

Suspension training is a time saver. The better suspension trainer products adjust quickly and allow you to travel seamlessly through different movement patterns. Quicker transitions from exercise to exercise keep you training more and resting less.

Suspension training is a superior lower body rehab tool. The handles and overhead positioning of a suspension trainer permit unloading of lower extremity movement patterns. Many clients are unable to squat or lunge with their bodyweight. With a suspension trainer, they can perform proper squat, step-up, and lunge patterns with the assistance from the suspension trainer. As strength and stability improve, simply reduce the level of assistance.

Suspension training makes you functionally strong. Many athletes are “Tarzan in the gym and Jane on the field”—their training produces no carry over to real life. The balance, proprioception, and core stability that are always part of suspension training transfer to real world tasks.

Seek out some professional instruction. As suspension trainers become more common in commercial gyms, I have witnessed some cringe worthy performances.   Just like a kettlebell, bosu, slider, or sandbag, most people need some instruction on safe performance and appropriate technique.

Caution: You will be hovering over the ground supported solely by the integrity of a suspension trainer. I would not manufacture a homemade suspension trainer. In my work as a physical therapist, I have treated several do-it-yourselfers that suffered through experimental failures with their suspension inventions. Be smart and use a quality suspension trainer product. The emergency room visit and CT scan of your skull will be far more expensive than the money you saved on equipment. The TRX and Lifeline-USA suspension trainers are well known and time tested products.
-Michael O’Hara, PT, OCS, CSCS

Most fitness folks go to the gym to reduce body fat levels and improve strength. They have busy lives and limited time available to spend on exercise. Many of them have prior orthopedic problems and movement limitations that require modification of training activities. They want the most benefit for the time they invest at the gym. These people do well with regular performance of what I call functional finishers.

A “finisher” is performed at the end of the workout. They deliver the hormonal responses that metabolize fat and improve work capacity. Functional finishers are designed to be joint friendly, scalable to any fitness level, and time efficient. Functional finishers carry over to better performance outside of the gym. You are stronger, more durable, and move better with consistent performance of functional finishers. Unlike the traditional 30 minutes of cardio they replace, functional finishers take less than twelve minutes to perform. They require effort and a willingness to push through a degree of discomfort.


I got this one from strength coach Dan John. I have used this set up successfully with many fitness clients. Pick a sandbag that you can carry on the front of your body, not over your shoulder, for twenty yards. Be reasonable and choose a load that enables you to walk with a steady, upright, and tall gait. Walk twenty yards with the sandbag and then put the sandbag down and immediately crawl forward for ten yards. Rest for thirty seconds and repeat the crawl/carry combo. Perform three to five sets. When five sets starts getting easier increase the carry distance to thirty yards and the crawl to fifteen yards.044


Find a kettlebell you can goblet squat for fifteen repetitions. Load up a sled with 50% to 100% of your body weight. Perform ten goblet squats and then immediately push the sled for twenty yards. Your sled push should be a smooth and steady cadence—not a sprint and not a plow horse pace. Rest for no more than thirty seconds and repeat. I figure the weight of the kettlebell into the load on the sled and place it on the sled so it travels with me and is ready for the next set. Perform three or four sets.


You need some open space, a medicine ball, and a wall. Run down thirty yards and then back thirty yards three times for a total of 180 yards. Immediately afterward perform ten overhead medicine ball throws off the wall—use a four or six pound ball. Keep the feet planted and parallel to the wall. Throw with the entire body and not just the arms. Let the ball bounce of the floor. Rest for forty-five seconds and then repeat. Perform two or three circuits.

If your goal is fat loss, what you eat remains the most important aspect of your fitness program. Functional finishers are an effective method of ramping up your results. Give them a try.

-Michael O’Hara, P.T., OCS, CSCS

Training to develop lower extremity power is important for staying safe on the playing field and functional in everyday life. More important is the ability to efficiently and properly absorb force during a landing. Box jumps are a basic power exercise that will improve these skills. If you are a snow skier, volleyball player, or runner then box jumps should be in your fitness program.

Competition vs. Athletic Enhancement

Box jumps have become popular in fitness competitions. The goal during these games is to get a number of jumps finished in a prescribed period of time. During these events the box jump is the field of play and not a training tool. Athletes who wish to improve performance and reduce the chance of an injury perform box jumps to retrain the neural system and enhance mechanics. Training for a box jump competition and training to improve performance are very different.

Box Jump Prerequisites

You should score a 2 or better on the straight leg raise, squat, and in-line lunge portion of the functional movement screen before you perform box jumps. See one of our trainers if you have not had a movement screen assessment. You should be able to perform a solid stable landing on a “step and catch” off a twelve inch box.

Box Jumps

Box jumps are performed on a plyometric box. At FFAC, we use the Plyosafe boxes made by UCS. These twelve, eighteen, and twenty four inch boxes are made of layered foam padding to absorb much of the force when landing a box jump.

  1. Start in front of a twelve inch box. Your toes should be about six inches from the side of the box with the feet shoulder width.Box_Jumps
  2. Hip hinge–bending a little at the ankle and knees and more at the hips. Do not permit the knees to crash inward. Use the arms to aggressively drive the jump. Throw the arms up as you drive off the floor with the hips.
  3. Do not look down. Keep the eyes up and think about jumping up and extending the legs out long. Do not pull the knees up and turn the jump into a hip flexion exercise. You want to displace the hips vertically and not flex the hips forward in an effort to reach the top of the box. You should never land on the top of the box in the “cannonball dive” position.
  4. Your take off position should be the same as your landing position.   “Stick the landing” by staying stationary for two counts.
  5. Land soft with minimal noise created when you impact on the top. Good plyometrics are seen and not heard.
  6. Use a mirror to assess your landing position. The knees should line up with the feet and never buckle inward. Keep your torso tall and eyes up. Make an effort to get rid of any wobble in your landing.
  7. Step down (do not jump down), reload your stance, and repeat. We want to avoid the eccentric stress and impact of jumping down and remove any influence of the stretch-shortening cycle.

Perform three to five box jumps and then take a short rest to let your neural system recharge. Three sets of three to five repetitions is a good start. Box jumps stress your nervous system so stay with a low volume of high quality box jumps. As you become more proficient, work on using a higher box (most of us will never need a 30 inch box). Avoid the high box jumps you see on the internet that are mostly a measure of hip mobility and sponsored by the local spinal surgery center. Holding a kettlebell, weight plate, or wearing a weight vest and performing a box jump offers little reward and carries lots of unnecessary risk.

We all have limited time to train so choosing the proper training activities is important. The combination of box jumps and some properly performed kettlebell swings will go a long way to prevent injuries, improve strength, and enhance vertical leap.

For video demonstration of the box jump, click on the link below:

-Michael O’Hara, P.T., OCS, CSCS

Every winter, in our physical therapy clinics, we treat numerous snow shoveling related lower back, neck, and hip injuries.  These patients shoveled snow one time and suffered pain so intense that it required medical attention.  All of these problems could have been avoided with some preparation, alteration of technique, and common sense.

snow_shovelingShovel Ready

Athletes prepare for performance with a series of warm up activities specific to their sport.  A baseball player, soccer player, or boxer would never walk into a competition “cold” because they know the risk of injury is much higher if they do not warm up.  Despite this knowledge almost everyone shovels snow without any type of physical preparation.  They pull on their coats, grab the shovel, and without any preparation, charge into an extremely challenging activity.  A snow shoveling warm up of simple stretches and mobility drills takes five minutes and can greatly reduce your chance of injury.

Snowman Mechanics

Poor mechanics when shoveling snow is often the cause of spinal injuries.  Combining spinal flexion (forward bending) with loading (shovel full of snow) and rotation (twisting) is the ergonomic “perfect storm” for lower back pain.  When you lift a big scoop of snow and twist to throw it sideways you create the force combination that can damage the lower lumbar discs and joints.  Push the snow, and if possible, avoid lifting and throwing.  Keep the spine long and straight and bend at the hips and knees so the legs can help perform the work.  Keep your arms wide on the handle and your neck relaxed.  Frequently switching the shovel to the other side spreads the cumulative loads evenly across the body.   The loads on the shovel should be manageable.  You are better off lifting less snow and working longer than lifting more and adding greater compression to the spine.

Shovel 101

Choose the right equipment.  Many snow shovels are just too heavy.  I recommend using a light plastic or aluminum shovel.  Some steel shovels can weigh well over nine pounds and this extra weight can create too much stress on your body.  Wear boots that prevent your feet from slipping.  You must be able to grip the ground to properly transfer force through the legs when shoveling.  Wear good gloves and purchase a shovel with an end handle if you have any problems with grip strength or arthritis in the fingers or wrists.

Live to Shovel Another Day

Finally, if the heaviest object you have lifted in the last six months has been the television remote, you should just hire someone to shovel the snow.  Shoveling snow is a demanding work activity that requires a moderate amount of fitness.  One of the best reasons to exercise on a regular basis is that it enables you to safely perform tasks such as shoveling snow.  The vast majority of snow shoveling injuries happen to people who lead sedentary lifestyles.

-Michael O’Hara, P.T., OCS, CSCS

The holidays can be a very busy and stressful time.  We are consumed by travel, shopping, family, and eating which makes it difficult to maintain our usual exercise routine (if we had one to begin with). The combination of less activity, unlimited supply of high fat, high sugar, calorie dense foods, accompanied by higher stress levels is a recipe for weight gain.  While you can’t out exercise the kids’ Halloween candy or a pumpkin pie, extra energy expenditure in the form of intense exercise will help minimize the damage.  This exercise series will focus on ramping up your metabolism by incorporating time efficient workouts that use multiple muscle groups (the more used, the more calories burned) and keep you moving.

Try this last 20 minute workout on for size to help those pants fit this holiday season:

Butts and Guts

This workout is another simple one requiring only your body and 1 kettlebell (KB). Just like our Push/Pull/Jump workout in this series, we will use a timer. Pick a KB weight that 20 swings with will be very challenging. The two exercises are the KB Swing and  the Plank Jack. These two exercises compliment each other very well. While KB Swings work the grip, hamstrings, glutes, and entire back, Plank Jacks work the anterior core, hip flexors, triceps, and shoulders. This workout will run 15 minutes long. On the minute, for the entire 15 minutes, you will perform the prescribed reps of Plank Jacks and KB Swings. Whatever time is left for that minute will be used for recovery.

Advanced: 15 swings, 20 Plank Jacks on the minute for 15 minutes

Intermediate: 10 swings, 15 Plank Jacks on the minute for 15 minutes.

Novice: 10 swings, 10 Plank Jacks on the minute for 15 minutes

Click on the link below to see video demonstration of the Butts and Guts workout:

-Jeff Tirrell, B.S., CSCS, Pn1