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Rehabilitation

Pushing Through Fitness Barriers

How Sled Pushing Can Produce Big Results

Most of us have busy schedules and limited time to exercise at the gym.  We want the most benefit possible for our time spent working out.  Sled Pushing is a high value activity that can be utilized by almost all fitness clients.

True Core Stability
How our “muscles in the middle” truly work is in a standing position with our legs in contact with the ground.  The legs are usually in an asymmetrical stance, transferring force from the ground through our body into the arms.  Most “core stability” exercise performed in the gym put you in a supine position with no leg to arm connection.  Sled pushing more closely emulates the demands place on our spinal stabilizers during daily activities.

Training Acceleration
In sports performance, the development of acceleration—the first four or five strides– is critical.   Weight room training with box jumps, barbell squatting, and hang cleans has been shown to produce better vertical leap numbers, but not nearly the same gains in 40 yard dash times.  Sled pushing places the body in the forward lean position you need to properly accelerate out of the blocks when sprinting.  It trains the neural pathways that turn on your acceleration muscles.

The Road to Easy Recovery
Sled pushing is all concentric muscle activity and no eccentric.  Eccentric muscle activity, the muscles lengthen against a resistance, creates much of the muscle soreness brought on by exercise.  Your body needs more time to recover from eccentric muscle activity.  You can perform a greater volume of work with a sled, and not be terribly sore the next day.  For older trainees, whose bodies require more recovery time, sled work is a valuable training tool.

The Injured Athletes Rehab Training
If you have a knee, lower back, or hip injury you may not be able to perform squats, lunges, deadlifts, or kettlebell swings.  Sled pushing is an alternative rehabilitation exercise for the lower body.  I have had great success treating runners with knee pain using sled work as a recovery exercise.  The core stability demands of sled pushing are helpful in restoring lumbar function in lower back pain patients.

Scalable to Any Fitness Level
Beginners can start with an empty sled and gradually add weight.  I have been able to progress physical therapy patients from 25 pounds to 125 pounds in as little as four week’s time.  Pushing is a very primal movement pattern, so most people catch on after two or three attempts.

Michael S. O’Hara, P.T., OCS, CSCS

SUSPENSION ROWS

Our shoulders and spine must endure prolonged computer input, extended commuter drives, sustained television staring, and way too much general slumping.  The important postural muscles that keep us tall become weak and the muscles in the front of the shoulders get tight.  The spinal muscles that hold our 24 vertebrae upright and stable functionally fall asleep and forget how to work together as a team.  Prolonged sitting creates all sorts of neuromuscular problems that can be managed with restorative exercise.  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 in 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 strengthen the muscles that retract the shoulder blades.  

Mastery Of Your Bodyweight
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 floor.   

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 weaker than average shoulder muscles.  

Cervical Proprioception
Many people have no idea of how to correct the posture of their head and neck.  Prolonged sitting, driving, and computer work have damaged their positional awareness or proprioception.  The movement of the head and neck during suspension rows produces a neurological training of the cervical proprioceptors that can help fix this problem.

Suspension Rows
Improve the strength and endurance of the team of muscles that keep your posture tall and shoulders strong with suspension trainer rows.  At FFAC, several TRX suspension trainers are located throughout the gym.  For home use, attach the suspension trainer to the top of a doorway.  Adjust the suspension trainer length so the handles are at your waist level or lower.  Stand facing the TRX and grip the handles firmly.  The position of your feet will determine the amount of resistance.  Move the feet forward and the exercise is 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 into your side.  As you perform the rowing motion, focus on moving the shoulder blades down and back.  Return to the starting position and repeat.  Perform two or three sets of six to ten repetitions.  As you get stronger, progress to a full inverted row with the legs on a bench.  

Caution:  Make sure you use a solid suspension trainer product when performing this exercise.  I have treated two patients with injuries that occurred when their homemade units malfunctioned and sent them flying to the floor.  Do not skimp on safety with suspension training exercise.  The emergency room visit and CT scan of your skull will be far more expensive.  The TRX and Lifeline USA suspension trainers are the most well known units on the market.    

Michael S. O’Hara, P.T., OCS, CSCS

ROLLERPALOOZA

Soft tissue mobilGrid rollerization with foam rolls has become popular in physical therapy, sports training, and fitness.  Foam rolling helps decrease pain, improves mobility, and can enhance recovery from exercise.  For an old gym rat like myself, it helps me bounce back from a tough training session, a long golf weekend, or too much computer time.   More varieties of rollers have come on the market, and whenever we are faced with a lot of choices, it becomes more difficult to make a decision.  In this short presentation, I have some suggestions on the proper roller for the job.  

Rollers are available in three foot and one foot lengths.  I find the longer versions easier to use, but I own a short pipe style roller that I take with me when I travel.  Bigger guys generally do not do well with a short roller.  

Standard Foam
foam rollerThe best roller for you will depend on your tissue tolerance and how sensitive are you to the compressive forces of the roller.  If you are new to foam rolling, a low density white Styrofoam roller is softer and will create less discomfort.  As you develop better tolerance to rolling, you can progress to a firmer black foam roll.  It has been my experience that the white rolls break down faster than the firmer black rolls, so be prepared to replace a white roll fairly often.  

Pipe Style
rumble rollerHollow pipe style rollers are newer to the market and I have had good results with two products.  The Grid Trigger Point roller is a cushioned hollow pipe with a grid pattern across the surface or the roller.  Many smaller clients and patients report they like the short version of the Grid roller.  Another hollow pipe version is the Rumble Roller.  This product has a series of projections that extend from the roller surface.  Self-soft tissue mobilization with a Rumble Roller is more uncomfortable than any other roller I have used.   It is a more aggressive treatment but I have found it works well for individuals with thicker and denser muscles.  

Not So Good
The hollow rollers that are covered with Styrofoam tend to break down fairly quickly.  The rollers with fabric covers often create slippage problems with several types of clothing.  The fabric interactions tend to make rolling less than efficient and are more difficult to control.  The fabric covers tend to lose their fit after a few washings.  The air inflated style rollers are a balance training device and are ineffective as a soft tissue mobilization tool.  

Michael S. O’Hara, P.T., OCS, CSCS

PROPER TECHNIQUE–HIP HINGE

With their newest release, BODYPUMP is going back to basic, simple, weight training techniques and principles.   New exercises are part of the lunge track, and greater focus on strengthening the gluteals and hamstrings are in the squat and deadlift tracks.  BODYPUMP 85 will kick off in April at Fenton Fitness.

BODYPUMP TECHNIQUE: PROPER HIP HINGE

The hip hinge is a basic movement pattern we all should master.  It keeps stress off the lumbar spine and improves strength in the hamstrings and gluteal muscles.  The BODYPUMP row, deadlift, and clean all require a proper hip hinge.  Many pump participants perform these lifts with way too much spinal motion.  When you hip hinge the spine stays still and you tilt forward at the pelvis.  The pelvis rolls around the femur to create flexion at the hip.  The gluteal muscles and hamstrings create the motion that moves the bar, and the core stabilizers hold the spine stationary.  The best view of your hip hinge performance is from the side.  Practice the drill below to help improve your hip hinge. 

Hip Hinge Stick Drill

You need a mirror and a pvc pipe, golf club, or yardstick.  Stand sideways to the mirror and place the stick along the length of your spine.  The stick should touch your gluteal muscles, thoracic spine, and head.  A space between the stick and your body should be present at the lumbar spine and neck.  Maintain those spaces as you push your bottom back and tilt forward.  The knees should bend a little (20-30 degrees) and you should feel some tension in the back of the thighs.  The motion happens at your hip and the lumbar and thoracic spine stays still.  Use the mirror side view to assess your performance.  The stick acts as feedback mechanism to help you keep the spine stable and initiate the movement at the hips.  Progress to using your BODYPUMP barbell with a proper hip hinge motion. 

Michael S. O’Hara, P.T., OCS, CSCS

 

TEST FOR SUCCESS

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. 

Y BALANCE TEST
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

 

THE MAGIC

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

GET IN YOUR CAGE

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

MY STANDING DESK EXPERIENCE

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

SLOUCHER SOLUTION SERIES

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

SHAPE SHIFTERS

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

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