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.
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.”
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
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
100 Steps Per Minute
Step Cadence and Fitness
Exercise researchers have been studying gait cadence for years. A cadence of 80 steps a minute is a stroll. 100 steps a minute is considered a brisk walk. At 130-140 steps a minute, you move into jog or slow run. Recent high tech evaluations of gait cadence has been able to predict the onset of dementia in older people. For many people, walking is their primary form of exercise. Gretchen Reynolds has written an excellent *article on the walking cadence that produces optimal health benefits.
A compilation of many studies has found that 100 steps per minute is the sweet spot for walkers under the age of sixty. The data for older walkers has yet to be fully evaluated, but it appears a slightly slower cadence is a good goal.
I like evaluations of performance. Evaluations tell you if you are getting better or getting worse. The human body is in a constant state of adaptation and never stays the same. Keep track of your cadence by counting your steps for twenty seconds and then multiplying by four. Use that information to track your fitness level. Ideally it should get easier to walk, at faster pace over a greater period of time.
15 x 4 = 60 Pokey Joe.
20 x 4 = 80 Still too slow.
25 x 4 = 100 Good job.
Michael S. O’Hara, PT, OCS, CSCS
*Walk Briskly for Your Health. About 100 Steps a Minute, Gretchen Reynolds, New York Times, June 27, 2018
You Have A Social Media Disease
There Is No App for Thumb Pain
Your thumb is made up of an intricate system of tendons that enable very precise movement. The joints of a thumb are fairly small and yet we are able to produce an amazing amount of force with this single digit. In this age of all things digital, the modern American thumb has been subjected to greater workloads. Problems with thumb pain, numbness, and limited function are becoming more common complaints in physical therapy. I have some suggestions on how to manage pain and limit the damage and embarrassment of excessive social media thumb exposures.
Thumb Tendon Troubles
Dr. De Quervain was the first to clinically described thumb tendonopathy, and we call thumb tedonosis De Quervain Syndrome. The test for De Quervain Syndrome was created by a clinician with an equally odd name and it is called the Finkelstein test. Place your thumb in the palm of your hand. Make a fist with the finger around the thumb. Hold the wrist in neutral and then deviate the wrist toward the pinkie finger. If you feel pain it is a positive Finkelstein test.
Resolution of thumb tendonopathy pain happens quickly when you give in to the symptoms of pain and modify your activities. Rest the thumb tendons by using your fingers instead of your thumb on that smart phone. Avoid fitness activities that put stress on the thumb. Lifting in front of the body with the palms facing inward is often the lift that new mothers perform and develop painful thumb tendons. Early on in the pain onset, icing is often helpful. In physical therapy, we are successful with soft tissue mobilization, ultrasound, and manual therapy. A gauntlet type thumb splint you wear at night is an unattractive but provides aviable position of rest for severely aggravated thumb tendons.
The Numb Thumb
Irritation of the median nerve in the carpal tunnel of the wrist will create thumb, second, and third finger numbness and pain. An injury of the recurrent median nerve in the front of the palm will produce numbness in the thumb and limited strength during thumb opposition–thumb to pinkie finger. Patients with neural irritation often develop numbness, weakness, and then pain. The pain often wakes them from sleep and disrupts hand function.
Once again, you will resolve a numb thumb with rest. Once neural irritation gets fired up, it takes longer to resolve than an aggravated tendon. Giving in to the numbness and resting the hands will produce better results if you start early. Two weeks of avoiding the aggravating hand activity produces good results. Night splints for the wrist and thumb are often helpful. A carpal tunnel release is a common surgical alternative that takes pressure off the median nerve.
Gumbie Thumb Beware
Every joint has a certain degree of stability and certain degree of mobility. Our spine, knees, hips, shoulders, and elbows must move enough to produce motion but not so much that they fall apart. The amount of movement in our joints is largely an inherited characteristic–you can blame Mom and Dad. The person at the extreme end of the scale (“double jointed”) needs to take certain precautions with their thumbs.
The Beighton Score is a popular screening technique for joint hypermobility. It has been around for thirty years and is used in research all around the world. The scoring is based on eight passive range of motion assessments and one active range of motion assessment. One point is assigned for each of the following.
A pinkie finger that can be passively bent backward more than 90 degrees.
A thumb that can be pulled down to the front of the forearm.
Elbows that passively hyperextend to 10 degrees.
Knees that passively hyperextend to 10 degrees.
The subject can place the palms on the floor during a straight leg, forward bend.
Researchers disagree on the score that should be a threshold for concern about systemic joint hypermobility. I have found that fitness clients and physical therapy patients that score a 5/9 or higher require modification of their training programs. It is not uncommon to encounter physical therapy patients that have a Beighton Score of 9/9. Hypermobile individuals need to take more precautions when they perform repetitive tasks such as texting on a smart phone.
Kimberly Salt wrote an excellent article on social media induced thumb pain in the May 19, 2018 issue of the New York Times. Take a minute and read, Me and My Numb Thumb: A Tale of Tech, Texts and Tendons.
Michael S. O’Hara, PT, OCS, CSCS
Lumbar Spine Fitness Guidelines
Janet injured her lower back while exercising in her local gym. She was taking a trip through her favorite “ab ciruit” when she felt a snap in her lumbar spine. The next day she was unable to stand up straight. Two weeks later, we met her in physical therapy for her initial evaluation. She was ready to return to her fitness program three weeks later. Janet was very concerned she may suffer another exercise induced back injury and requested some advice. These are the simple guidelines I give to physical therapy low back patients returning to exercise.
Mobilize the Thoracic Spine and Hips
Movement is supposed to happen at the thoracic spine and hips. Unfortunately, prolonged sitting, deconditioning, and poor training choices tends to restrict mobility in these areas. If you are unable to rotate and extend at the hips and thoracic spine, your brain will use other joints to make up for the deficit. Pushing extra rotation and extension forces into your lumbar spine is never a good thing. Dedicate some training time to improving thoracic spine rotation and hip extension / internal rotation range of motion. If you sit for a living, work on your mobility everyday.
Make the Lumbar Spine Stable
Most fitness clients believe that more lumbar spine movement is a good thing. They perform toe touches, back twists, and the many breeds of up and down dogs. Unfortunately, greater lumbar spine range of motion is positively correlated with a higher incidence of lower back pain. The incidence of low back pain escalates even further when we move those hypermobile lumbar spine segments against a resistance. What does keep lumbar spines healthy is high level of lumbar spine strength endurance. Can you hold the lumbar spine stable and prevent movement from occurring at the pelvis and five lumbar vertebrae. Your lumbar spine stays happy and healthy when you focus training efforts on planks, roll outs, crawls, carries, and Pallof press exercises. Avoid the sit ups, crunches, sidebends, toes to bar, and other assorted “ab” exercises that create lots lumbar spine motion.
Avoid Muscle Isolation Exercise Activities
The muscles that support the lumbar spine work together as part of a neurally connected team. Training activities that support better communication between the team members will create optimal performance. The neuroanatomy saying is “What fires together, wires together”. Ditch the “upper abs”, “lower abs” baloney and sprint away from anyone who trys to strap you into a machine in an effort to “isolate your obliques”.
On her discharge from therapy, Janet was unable to perform a single roll out and fatigue fairly quickly with a twelve pound suitcase carry. For the last three months, she has followed the guidelines and her progress has been excellent. Janet is currently performing a suitcase carry with fifty pounds and has worked up to ten full reps on an ab wheel roll out.
Michael S. O’Hara, PT, OCS, CSCS
The Cumulative Effect of Activity
Many people are put off from starting an exercise routine because they are overwhelmed by the time commitment they feel is necessary. Fitness magazines, exercise experts, and everything on youtube preaches–
–30 minutes of cardio three times a week
–45 minutes of strength training twice a week
–150 minutes of exercise per week
Most of this well-intentioned advice is wrong. Nearly everyone can derive significant benefit from short bouts of fitness activity that are performed on a consistent basis. Walk for five minutes twice a day. A simple routine of two strengthening exercises will take no more than five minutes. Climb the stairs in your home three times once a day. Practice getting up and down of the floor. Stay consistent with a routine of short exercise bouts and you will be healthier and stay independent for a lifetime.
More research has demonstrated the beneficial effect of short exercise sessions interspersed throughout the day. Read the March 28, 2018, New York Times article by Gretchen Reynolds, Those 2-Minute Walk Breaks? They Add Up. View the article: https://www.nytimes.com/2018/03/28/well/move/walking-exercise-minutes-death-longevity.html
Mike O’Hara, PT, OCS, CSCS
Preventing Gardener’s Trauma
After a long, snowy Michigan winter, the first warm and sunny day, we charge outside and clean up the yard. The months snow bound in the house have made the gardeners eager to start the spring clean up and prepare for the summer to come. Most of us will spend the winter in a fairly sedentary physical state and with no physical preparation to launch into hours of challenging outdoor work activity. Every year at our clinics, we treat patients with gardening and yard work induced injuries that could have been prevented with some modifications of activity and preventative exercise. These are my four hints to help safeguard my gardener friends from an unintended trip to the doctor’s office.
#1: Set a Time Limit.
Most of the patients we see with gardener trauma report that they worked “all afternoon” in the yard. It is not uncommon to hear patients report they were bending, pushing, or pulling for five or six hours. Use some caution and limit the duration of your weeding, raking, and shoveling. Set a time limit of two hours and then stop–the garden will be their tomorrow and you will be less likely to have to undergo a springtime MRI.
#2: Use Proper Ergonomics.
Many gardening tasks place your body in challenging positions. Ergonomic experts go to great lengths to eliminate forward trunk flexion and sustained knee flexion from industrial work settings. Pulling weeds and cleaning out flowerbeds combines both of these positions and can create mechanical back and knee pain. Avoid being in the “hands and knees” position for extended periods of time by changing positions frequently. Use knee pads to reduce compressive forces on the knee joints and purchase gardening tools with extended handles so that you need not bend as far or as often.
#3: Avoid Lifting Heavy Objects.
After a sedentary winter spent indoors watching television and knitting, the last thing you should attempt is to hoist the 40 lb. bag of fertilizer into the back of the wheelbarrow. Lifting injuries increase dramatically with loads greater than 25 pounds. Lifting any object from the floor to standing is risky, and carrying unstable loads that can shift around increases stress on the body. Divide heavy loads into smaller portions and avoid lifting directly off the floor. Get a bigger, stronger, and fitter neighbor or family member to help with heavy lifting tasks.
#4: Prepare For Battle.
Gardening and yard work are challenging tasks that should be met with a degree of preparation. If you want to work for five hours in the garden and remain pain free, you must train your body for that level of activity. I have selected three simple exercises you can do to get yourself ready for action in the yard. Simple modification of ergonomics, limitations on work duration, and preparatory exercise can prevent a summer of pain.
Getting Ready To Toil In The Soil.
These three exercises can help you avoid injury and make your spring gardening safer and more productive. Ideally you will perform these drills three times a week for two or three weeks before getting outside and working.
Hip Flexor Stretches
This stretch elongates the large muscle that runs across the front of the hip and attaches to the spine. This region tends to tighten with prolonged sitting and can restrict hip and spinal motion. Place one knee up on a cushioned chair and the other foot slightly forward on the floor. Keep the spine tall and bend the front knee to stretch the hip flexor muscles. Hold for five to ten seconds and repeat five times. Perform the stretch on the other side.
Four Point Fold Ups
If you are going to spend time on all fours, it is a good idea to train your body for this task. Assume a four-point position, knees under the hips and hands under the shoulders. Keep the hands stationary and drop the hips back toward the heels. Go back to the point you feel a stretch and hold–do not stretch into pain. You may feel this in your hips, shoulders, lower back, or upper back. Hold for five to ten seconds and repeat five times.
Gardening and yard work involves a lot of squatting. Being able to safely squat allows you to lift with better body mechanics. Simple bodyweight squats will strengthen the legs and trunk in preparation for these tasks. Place your feet at least shoulder width apart. Check the foot width with a full length mirror– most people squat with the feet too close together. Keep the heels flat on the floor and squat down by pushing the hips back. Work on maintaining balance and control during the motion. Practicing this movement pattern will also improve your flexibility. Perform a series of ten repetitions and then rest and perform another set of ten.
Michael O’Hara, PT, OCS, CSCS