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Learn more about Rehab, Sports Medicine & Performance

Rehabilitation

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Sister Hermeta Saved My Soul and My Spine

Tall Kneeling Core Stabilization Training

During my parochial grade school education,  I was taught how to kneel in church.  Eyes forward, hands together, spine tall, and no leaning on the pew.  You maintained the kneeling posture for extended periods of Father Furlong’s mass.  I believe the good sisters were on to something.  Despite every one of them being well past 100 years of age, they all possessed excellent posture and remarkable mobility.  As a physical therapist, I am convinced that a daily dose of sustained kneeling helped keep the Felician Sisters in fighting form.  I have some tall kneeling training suggestions you can add your fitness routine.

Get to Know Kneeling

Many people will benefit from some sustained tall kneeling.  Protect your knees by placing an Airex pad under your knees.  In and ideal situation, you will have a mirror for feedback on posture and alignment.  Keep some space between your knees and line the feet up with the knees.  Pull the head back, lift the chest, and reach the top of the head to the sky.  Many people have difficulty getting into a fully upright position in kneeling.  The most common problem is a forward lean at the hips accompanied by complaints of tightness in the lower back and front of the thighs.  Holding a pvc pipe or dowel overhead while performing some deep breaths can help reduce muscle tone in the hips and torso.   Perform two or three, thirty second holds at every training session for the next six weeks

Tall Kneeling Pallof Press

The tall kneeling Pallof press is an anti rotation core stability exercise that helps recruit the postural muscles that keep us upright and tall.  Lack of isometric strength-endurance in the spinal muscles is a primary contributor to back injuries.  This exercise will improve that component of spinal function.

Place your knees on an Airex pad and set up in kneeling position.  Use either a cable unit or resistance tubing set at a level even with your sternum while you are in the kneeling position.  The tubing should be directly to your right and slightly behind the body.  Use a double overlap grip on the handle and hold at chest level.  Press the tubing out to arms length and then back to the chest.  Select a resistance level that permits execution of fifteen repetitions without losing the set up posture.  Rest and then repeat on the other side.

Tall Kneeling Anti Extension Holds

The pelvis is a bowl and the torso rests on the top of the bowl.  You need a pelvic position that makes stabilization of the torso over the pelvis effortless and automatic.  The tall kneeling isometric hold aligns your pelvis under the torso.

Kneel on an Airex pad.  Hold a kettlebell, dumbbell or Iron Grip Plate behind your back.  It is difficult to prescribe a load.  Twenty pounds may be too easy and five pounds may be too much.  My suggestion is that you err on the lighter side of the load equation.  Stay in the loaded kneeling position for at least thirty seconds.  Lower the weight, walk around, and take inventory of how you feel.  Repeat for another thirty seconds.

See video demonstration of these exercises: here

Michael S. O’Hara, PT, OCS, CSCS

Will That Machine Help Me?

Home Gym Hints

Television ads, holiday gift giving, and the return of frigid temperatures brings out the “What cardio machine should I purchase for my home?” question.  Is it the bike with an internet trainer, the fat blasting high intensity elliptical trainer, or the Euro designed Nordic ski machine?  Many of these units sell for over $3000 and they wish to choose wisely.  Most of the questioners have no experience with any of these gizmos.  I have some pre-purchase questions they need to answer before buying that expensive cardio machine.

Can you currently walk for thirty minutes without stopping to rest?

If you answer no to that question, do not bother purchasing a treadmill, bike, or elliptical unit.  Focus all of your efforts on developing the strength and skill necessary to walk for thirty minutes without resting.  If pain is a limitation, get to the physical therapy clinic and resolve the problem.  Walking is the essential neuromuscular activity that keeps a body healthy and out of the assisted living center.  Leaning over on a treadmill, elliptical trainer, or recumbent bike is very likely to worsen those walking woes.

Do you have a prior history of consistent exercise?

Just owning a new high-tech training machine will not make you thinner or fitter.  You must use the machine three or four days a week for the next year.  Many people believe that locating the machine in the dwelling will jump-start the exercise habit.  If you answer no to this question, I have concerns that you will not develop a relationship with your internet connected mechanical friend.

Is fat loss the primary reason you are purchasing the home exercise machine?

The fat loss the exercise motto everyone needs to learn is; “familiarity breeds failure”.   The human body is a master at adapting to a physical stress and the forty-five minute spin class that burns 440 calories in February only consumes 180 calories in August.  The sad truth is that the same amount of exercise time and effort produces a weaker fat loss response.   The crucial components for fat loss are long duration meal preparation and high intensity portion awareness.  After you get those under control, progress to activities that you find challenging (difficult, not good at, loath, hate) and change the training modality on a frequent basis.  Using the same exercise device month after month will not produce optimal results.

Michael O’Hara, PT, OCS, CSCS

Save Your Back When Shoveling Snow

Improve Your Snow Shoveling Mechanics to Avoid Injury

‘Tis the season for hot cocoa, warm fires, and lots of snow. With snow comes shoveling, and unfortunately with shoveling comes injury. It is estimated that there are over 11,000 hospital visits each year due to injuries while shoveling snow. This number does not even include the thousands of people that see their primary care doctor with the onset of an injury. Many of these medical visits involve the low back including complaints of pain with movement, leg numbness, and the inability to maintain the proper posture. Lumbar injuries while shoveling are often due to the combination of repeated flexion and rotation of the spine. Adding the load of snow and having poor spine stabilization during the lift results in overload on the structures of the lumbar spine and resultant injury. Here are three exercises you can use to improve your shoveling mechanics in order to spend more time sipping cocoa by the fire, and less time in a physician’s waiting room.

  1. Hip Hinge – a proper movement pattern to bend forward and push snow involves flexion at the hips and knees, while maintaining a more neutral spine.
  • Stand with your feet shoulder width apart. Using a broom stick, golf club, or wooden dowel, place the stock along your lumbar spine.
  • The stick should come in contact with the back of your head, mid-thoracic spine (between your shoulder blades), and at the sacrum/mid-buttock.
  • With a slight bend in your knees, hinge your hips by driving your buttock backwards, while maintaining the three points of contact throughout the movement.
  • Perform ten repetitions

Common mistakes: squatting versus hinging – try and minimize knee bend. Your buttock should move backwards, not down.

Losing contact with the stick – if you notice the stick is leaving the sacrum the spine is flexing. Slow down the movement and move only as far as you can with contact.

  1. Isometric Hip Bridge – once you have properly bent forward to push and load the snow, using the buttock and hamstring muscles to lift the snow will decrease strain of muscles of the lower back.
  • Start lying on your back, knees bent, and hands raised straight in the air.
  • Push through your heels driving your hips upwards, hold for 5-10 seconds, and return. Repeat this movement 10 times.
  • If you find that you feel this more in the low back than the legs or buttocks, try squeezing a pillow at your knees during the lift.
  1. Rotational Step – now that you have properly bent to load the snow, and used the proper muscles to lift it, increasing rotation at the hips to move the snow versus rotating through the lumbar spine will reduce torsional strain on the vertebral discs and spinal stabilizers.
  • Begin by standing in an athletic stance with your feet shoulder width apart and slight bend in your knees.
  • Keeping one foot in place, open up through your hips by stepping to the side and backwards. Your weight should be evenly distributed between the feet.
  • Maintain a neutral spine throughout the movement, being mindful not to bend forward or rotate through the spine.
  • Perform 10 repetitions to each side.

See video demonstration of these exercises: here

Sean Duffey, DPT

Clinic Director, Ivy Rehab, Ortonville

Central Park Fitness Test

This is a picture of my 85 year old Mother and I on a recent family vacation to New York City.

My Mom has kept herself fit and active.  She has traveled with us on many vacations.  I have taken her to the top of mountains in Banf and across rock formations in Moab.  She is an elderly person who is enjoying a long and big life.  On this New York City vacation, we walked from the south end of Central Park, up into Harlem for a well-deserved lunch of beer and Italian cuisine.  She traversed six floors in the Empire State Building stairwell.  Every day required multiple trips up and down subway stairs.

I hope and pray I have inherited every single amino acid of the genes that code for this vitality.

Michael S. O’Hara, PT, OCS, CSCS

Sarcopenia And The Media

Older individuals have the most to gain from strength training. Six weeks of dedicated strength training will normalize balance, rejuvenate posture, revive the metabolism, and eliminate long-standing pain.  I often tell physical therapy patients that strength training is the “fountain of youth”.  Unfortunately, it is difficult to convince older individuals that they need to become dedicated to a routine of consistent resistance training.  I recently got some help from Jane Brody in the New York Times, *Preventing Muscle Loss Among the Elderly.

Drs. Evans and Rosenburg are Tufts University researchers interested in the physical attributes that keep humans healthy and vigorous over an entire life span.  They have determined that the top four biomarkers 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?

They named these top four biomarkers, the decisive tetrad.  They are the prerequisites to maintaining healthy numbers in all of the other essential biomarkers.

  1. Aerobic Capacity
  2. Blood Sugar Tolerance
  3. Cholesterol / HDL ratio
  4. Blood Pressure
  5. Bone Density
  6. Internal Body Temperature Regulation

Drs. Evans and Rosenburg coined the term age related sarcopenia in their 1991 book Biomarkers.  It refers to the gradual loss of muscle mass that occurs as we age.  The keys to aging well; staying durable- no injuries, and maintaining control of all health parameters is maintaining or improving muscle mass / strength and eating properly.  An ongoing program of strength training and nutritional discipline are the foremost components of fitness and health.

I was happy to see that Jane recommended her elderly compatriots consume more protein.  Not enormous amounts of protein- just some protein.  Many fitness clients fail to make optimal gains because they have the protein intake of a bunny rabbit.  Adequate training recovery requires the building blocks of muscle in order to produce results.  A bagel for breakfast, a kale sandwich at lunch, a yogurt snack and a diner of soup, bread and ice cream does not supply the nutrients necessary for recovery.

So, take the time to read the amazing Jane Brody and then get those dumbbells out of the basement.

*Brody, Jane. Preventing Muscle Loss Among the Elderly, September 1, 2018, New York Times.   View article

Michael O’Hara, PT, OCS, CSCS

Location, Location, Location

Overcoming The Diameter Dilemma

The location of bodyfat is far more important than the amount of bodyfat.  Visceral fat, the kind stored in and around the belly, is the hormonal driver of metabolic syndrome; the precursor to diabetes, elevated blood lipids, high blood pressure, and coronary artery disease.  To optimize health, you need to monitor the diameter of your waistline.  The number you need to know is your waist to height ratio.  You want your waist to be less than half your height.  If your waist size is greater than one half your height, then reducing your waist diameter should be the primary goal of your fitness program.  The New York Times has an excellent *article by Jane Brody on the perils of too much belly fat.

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 shed 12-15 pounds of muscle by the time they reach 55 years of age.  This 55 year old will stand on the scale 12 to 18 pounds heavier but the true alteration in body composition is far more dramatic.  The tape measure reveals a much more dramatic transformation.

One of the adverse effects of calorie restriction diets is the loss of muscle that accompanies a reduction of bodyfat.  Muscle is the metabolic engine, injury preventative armor and longevity enhancing elixir of human biology.  The recent research reveals that a program of strength training produces optimal fat loss with significantly less muscle wasting.  Your choice of exercise activity can have a profound impact on your physical performance and health.

Michael S. O’Hara, PT, OCS, CSCS

*The Dangers of Belly Fat, Jane Brody, New York Times, June 11, 2018.  Here’s the link: https://www.nytimes.com/2018/06/11/well/live/belly-fat-health-visceral-fat-waist-cancer.html

Happy Brain Exercises

Daily Neurodevelopmental Brain Boosters

Exercise improves brain neurochemistry, neural connections, and even the number of brain neurons.  I have two suggestions on the best exercise activities to improve brain health.  They both have roots in human neurodevelopment and can be employed by nearly everyone.  Build better brain health with a walk and a crawl.

Walking 101

Morning walks work magic.  Many top leaders talk about how much better they think and analyze when they start the day with exercise.  If you are the decision maker for your family or company, please take a morning walk.

Cadence Counts.  If you are moving at 60 steps a minute, you are not walking, you are strolling.  A compilation of many studies has found that 100 steps per minute as the sweet spot for walkers under the age of sixty.  The data for older walkers has yet to be fully evaluated, but it appears the cadence should not slow much below 100.

Tune in.  Ditch the earbuds.  Tame the dopamine damage of “connectivity” and leave the phone at home.  Be alone with your thoughts for the duration of your walk.  Gandhi, St. Augustine, Thomas Jefferson tell us that difficult problems are resolved with contemplative walks.

Get off the pavement.  The human species evolved walking through undeveloped environments.  Take your walk to a quitter and more tranquil setting.  More trees, less noise, and serene surroundings provide a calmer event.  I personally believe that uneven and inclined pathways do a better job at stimulating neurodevelopmental pathways.

Get comfortable with a long walk.  Thirty minutes a day is great, but once a week go for a sixty-minute walk.  Stretch out the distance you can travel.  Load up a backpack with water and try a two hour ruck walk.  There is no greater brain regenerating activity than a long October nature walk in Michigan.

“Walking is the best possible exercise.  Habituate yourself to walk very far.”

-Thomas Jefferson

All Crawl

It does not matter if you are an Ashtanga Yoga devotee, hard style kettlebell lifter, Crossfit firebreather, PureBarre, or Pilates disciple, there is one exercise that everyone in the fitness world has performed.  For many months we all diligently worked on becoming better at this exercise and it rewarded us with crucial neural connections.  The bad news is that most of us have stopped using this exercise.  The good news is that we can still use the crawl pattern and reboot the brain connections that allowed us to stand and walk.

More of your brain is devoted to movement than any other activity.  Despite what you have read, muscles never work in isolation.  Our muscles are arranged in an interconnected, spiral, and diagonal fashion.  The “core muscles” are neurologically wired to connect your left hip with the right shoulder and the right hip with the left shoulder.  They are designed to stabilize your middle so you can transfer force from the hips to the shoulders.  Crawling is all about that critical, spiral-diagonal connection.

Try adding two crawl training sessions a week to your fitness program.  Crawls are one of those exercises that produce the “What the heck?” effect.  Other activities of daily living suddenly become easier.  Joints move better, posture improves, and long standing soreness resolves.  Just ask any baby.

Michael S. O’Hara, PT, OCS, CSCS

Wonderful Wendy

Please Watch the TED Talk by Dr. Wendy Suzuki

The incredible impact exercise has on your neural and hormonal systems are the biggest reasons to stay consistent with a program of fitness.  More of your brain’s real estate is devoted to movement than math, reading, or texting.  Exercise is unmatched at creating the essential neurochemicals that help us make good decisions and maintain emotional wellness.  For more information on the impact a program of exercise has on brain health watch the *TED talk given by Dr. Wendy Suzuki.

Dr. Suzuki is a neuroscientist researcher at NYU.  In her talk, she discusses how exercise helps build up the areas of our brain responsible for memory and cognition.  She discusses how consistent physical training replenishes brain chemistry, improves mood, and helps us think clearly.  If, after you watch the TED talk you want more information, read her book, Healthy Brain, Happy Life.

We are learning that neurochemicals have a profound impact on family and work place interactions.  Leadership guru Simon Sinek talks about how endorphins, dopamine, serotonin, and oxytocin all play a role in workplace and family happiness.  If you are a decision maker or leader for your family or teammates, you owe them a devotion to the brain enhancing powers of exercise.

Consistent exercise builds more neural connections, immunizes us from depression, and greatly reduces pain.  Physical therapy patients and fitness clients frequently say the most beneficial aspects of a renewed devotion to exercise is the improvement in their mood.  Hundreds of studies have demonstrated the positive effects exercise has on brain chemistry.  All of the happiness promoting and pain suppressing molecules are boosted with exercise.  Levels of endorphins, serotonin and BDNF- Miracle Gro for your neurons, all increase with exercise.  Some of the most revealing research on pain science demonstrates that “pain circuitry” is repaired with exercise.

To build the biggest and baddest hippocampus in the gym, look to the next email.  Take the time and watch the TED talk by Dr. Suzuki.

*TED, The Brain-Changing Benefits of Exercise. Dr. Wendy Suzuki.

Michael S. O’Hara, PT, OCS, CSCS

View the Ted talk: https://www.ted.com/talks/wendy_suzuki_the_brain_changing_benefits_of_exercise

 

Bad Man Break

Men Need To Be More Aware Of Bone Density

Allen was getting out of his fishing boat when he twisted his left leg and fractured two bones in his ankle.  Six weeks after ankle surgery, he landed in our clinic with considerable pain and a very limited lifestyle.  Allen reported lower back pain that he attributed to his limping and use of the boot on his left leg.  On recommendation from his physical therapist, Allen had further medical assessment of his lower back pain.  An x- ray of his lumbar spine revealed two lumbar vertebrae fractures.

On a recent vacation, Mike went on a horseback ride with his grandchildren.  During the ride, he developed pain in his upper back that “took his breath away”.  A visit to the emergency room with what he thought was a cardiac issue revealed a three-level compression fracture in his thoracic spine.  Further assessment showed significant osteoporosis in his hips, pelvis, and lumbar regions.  Allen started on some bone rebuilding medications and physical therapy.  It took over four months to fully recover from this injury.

Randy was working on his garden and fell onto the lawn.  He had right hip pain and was unable to stand.  His wife called the ambulance and he was diagnosed with a hip fracture.  Four days after the surgery to repair his hip, he suffered an embolism and at the age of seventy-one, he passed away.

All three of these older guys had testing that revealed a significant loss of bone density.  Unfortunately, the tests occurred after and not before injury onset.  We are getting better at keeping men alive longer–less smoking and better medications.  As men get older, the need to monitor bone density becomes a crucial aspect of healthy aging.  Men need fewer commercials for the latest in testosterone replacement and ED medication and more awareness of how brittle their bones can become.

The general public views osteoporosis as a “women’s health issue”, but management of osteoporosis is just as important for men.  Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled or die from the fracture.  Since 2008, the rate of osteoporosis related hip fracture in the American male population is going up at an alarming rate.

Osteoporosis is a silent disease.  Most people do not realize they have a problem until something breaks and they are in the middle of a medical crisis.  Even after a fracture, many physical therapy patients are reluctant to follow up with a bone density screening.  Being proactive is the only method of managing osteoporosis.

We know that individuals that participate in consistent resistance training exercises are more likely to have better bone density.  Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it.  The best bone building exercise activities produce a stimulus through your skeleton.  Bone building exercises are easy to understand, but they do require more effort than swallowing a pill or having an injection.  Everyone can perform some form of bone reinforcing exercise.  Proper exercise prescription and consistent progression can work wonders.  See the trainers and physical therapists at Fenton Fitness.

Jane Brody of the New York Times wrote a helpful *article on bone density testing. It covers the latest medical guidelines for testing and the when and why of testing for both men and women.

Michael S. O’Hara, P.T., OCS, CSCS

*New York Times, July 16, 2018, Jane Brody, When to Get Your Bone Density (View Article:here)

Play It All

How To Keep Your Child On The Field And Out Of The PT Clinic

Taylor was recently referred to physical therapy with a painful shoulder and a right hand that frequently went numb. For the last five years, she had been a year round participant in softball. At the age of fifteen, she was missing out on softball and a good night sleep secondary to the pain and limited function in her right arm.

Andy played soccer, and at the age of thirteen, he developed knee pain that prevented him from changing directions and sprinting. Andy practiced or played soccer four days a week for 50 of the 52 weeks in a year. It took four years of year round soccer to create the knee damage that required surgery and an twelve week rehab.

Many of the young athletes we treat in physical therapy are the victims of over exposure to the same training stimulus for far too long a period of time. Gymnastics, dancing, baseball, soccer, and softball are worthwhile endeavors, but a developing body needs a break in order to stay healthy. This becomes even more important as the athlete becomes stronger or more skilled.

Take a moment and read the *article by Jane Brody in the May 7th, 2018 edition of the New York Times. Jane interviews several Orthopedic Surgeons that are treating younger patients with injuries that usually occur ten or fifteen years later in an athlete’s career. The research they present is clear; year round single sports participation is not the best way to excel in athletics or remain healthy.

The recent popularity of the club system has children playing the same sport year round. In the clinic, we are treating more young athletes with old person overuse injuries. Participation in a variety of athletic activities is infinitely more beneficial and safer than single sports specialization. It is no coincidence that most successful collegiate and professional athletes are the product of multi-sport participation.

*New York Times, Jane Brody, May 7, 2018, How to Avoid Burnout in Youth Sports. View article: https://www.nytimes.com/2018/05/07/well/how-to-avoid-burnout-in-youth-sports.html

Michael S. O’Hara, PT, OCS, CSCS

 

 

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