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Learn more about Rehab, Sports Medicine & Performance

Rehabilitation

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

MYSTERY MUSCLE–FULL RECOVERY
WITH MULTIFIDUS TRAINING

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

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

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

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

Michael S. O’Hara, P.T., OCS, CSCS

LUMBAGO FIASCO

The Top Three Things You Do In The Gym To Screw Up Your Lower Back

Therapeutic exercise has consistently been proven to be the best way to manage lower back pain.  It has a better long-term outcome than injections, medications, and surgery.  Unfortunately, many people end up injuring their lower backs in a well intentioned, but misguided effort to get fit.  Below are the top three lumbar spine mistakes I see people making in the gym.  

You Exercise Sitting Down
The muscles and joints of the lumbar spine, pelvic girdle, hips, and knees are an interconnected team.  To get the team playing more efficiently, your body needs to be challenged by gravity and trained in an upright position.  A basketball team would never get better if they practiced while sitting at a desk.  You should run away from anyone who straps you into a machine in an effort to help you with a back pain problem.  By the way, you already sit way too much.  You drive, computer, television, and sometimes sleep in a seated position.  Prolonged sitting creates much of the tissue shortening and muscle weakness that makes you more prone to lower back pain.  

No Consideration For Compression
This is an issue that is particularly important for individuals with prior episodes of lower back pain.  Most people are unaware of the many gym activities that create compressive forces on the lumbar spine.  Treadmill running (more if you hold on the handles), leg press, crunches, and leg lifts create a compressive loading of the lumbar joints and discs.  Be aware of the cumulative loading on the lumbar spine, and alter your training schedule so that you perform certain exercise activities on different days.  Do not perform squats on the same day you run on the treadmill.  If you are going to perform 50 incline sit ups, do not do it on the same day you deadlift.  If you are uncertain of what activities place a compressive load on the lumbar spine, you need to work with a physical therapist or certified trainer.  

You Are A Flexibility Freak And A Stability Geek
Creating spinal flexibility without the strength to keep your spine stable sets you up for injury.  Many lumbar pain patients I evaluate are able to flex the spine forward and palm the floor.  They can bend their spine like an overcooked noodle, but they are unable to summon the muscle control to hold the lumbar joints in a stable position.  These patients often report a long history of dedicated stretching, yoga, and Pilates training.  They fail the lumbar stability tests, and are often unable to perform the overhead squat or in line lunge functional mobility tests secondary to a lack of core stability strength.  These same patients are often surprised at their poor performance in the core stability tests because they “strengthen their abdominal muscles” with crunches and leg lifts.  Training to improve spinal stability and exercising your abdominal muscles are completely different things.  Every gym goer needs to learn the difference.

Michael S. O’Hara, P.T., OCS, CSCS

 

KICK THE KICKBACK TO THE CURB

In our physical therapy clinics, we get to treat elbow pain every day.  The pain is usually brought on by some kind of repetitive activity.  Tennis players get pain on the outside of the elbow.  Throwers and golfers get pain on the inside of the elbow.  Fitness clients commonly end up in physical therapy with complaints of elbow pain.  The cause of the pain is usually some sort of triceps isolation training, and the biggest offender is the “triceps kickback” exercise.  The kickback is a Shape magazine standard that appears to be a favorite with female gym goers.  The triceps kickback is more likely to give you elbow pain, than to produce thinner and more shapely arms.  

Three things make this exercise problematic for the elbows.  The kickback exercise creates a bad force curve.  The resistance is the strongest when the triceps muscle is at its least advantageous position, and this places the majority of the load on the elbow joint in a fully extended position.  When I see this exercise performed in the gym, it is usually executed with a swinging of the dumbbell.  The momentum of the weight forces the elbow into excessive end range extension.  Kickbacks are often performed for high repetitions.  It is not uncommon to witness someone perform three or four sets of twenty repetitions.  That is sixty to eighty high speed, end range repetitions under a stressful force curve on each elbow.  

From the elbow pain patient I hear, “But I don’t feel any pain when I perform the kickback exercise.”  Most golfers, tennis players, and throwers don’t feel pain during their participation in sports.  The elbow pain usually sets in later that day or the next morning.  Another common concern is that they will not be able to reduce fat on the back of the arm without direct triceps work.  This is the “spot reduction myth” that just won’t die and keeps many a physical therapists employed.  Avoid the trainer that tells you a specific exercise will take subcutaneous fat off an area of your anatomy.  

Elbow irritation that creates scar tissue and inflammation is often difficult to eliminate.  The pain in the elbow can get so bad that it limits other training activities.  The good news is that elbow pain is often self-inflicted, and with a little education, we can avoid the pain.  Watch the video, dump the kickback exercise, and start training your triceps with some push ups and presses.  Your elbows will thank you.  

Michael S. O’Hara, P.T., OCS, CSCS

HIP LIFTS

The Sure Cure for Gluteal Amnesia

Your hamstrings and gluteal muscles always work together as a team.  Strong, coordinated hamstrings and gluteals are your lower back’s best friend.  They anchor the pelvis and hold a stabilized spine in a tight and tall position.  They work with the other posterior chain muscles to keep stress off of the sensitive structures of the lumbar spine.  Patients with chronic lower back pain often have weak and even atrophied gluteal muscles.  Building strength and coordination in the hamstrings and gluteals is often difficult for patients with lumbar spine pain problems.  Hip lifts are lower back friendly exercises that can restore the function of hamstrings and gluteal muscles.  

Hip Lifts
There are many different types of hip lifts and all are beneficial.  The two basic hip lift drills discussed below work well for most fitness clients and physical therapy patients. 

Feet On Ball Hip Lifts
FOB Hip Lifts photo

This exercise will strengthen your posterior leg muscles and spares your spine any stress.  Lay supine with a physioball under your heels.  Place the arms at the sides and push down into the floor with the arms to stabilize the body.  Keep the feet together and aimed up at the ceiling.  Brace your abdominal muscles and squeeze the legs together.  Use the butt muscles (gluteals) and posterior thigh muscles (hamstrings) to lift you up off the floor.  Hold the suspended position, in one long line from ankle to shoulder, for three counts.  Lower with control and repeat for five to fifteen repetitions.   

Bench Hip Lifts
Bench Hip Lifts photoThis drill coordinates hip extension and lumbar spine stability.  It is very beneficial when progressed to the single leg version.  Lay with your shoulders across a bench with the head supported.  Place your arms out to the sides.  Plant the feet on the ground with the knees bent 90 degrees.  Drop the hips to the floor and then push back up with the gluteals and hamstring muscles.  Hold at the top for three seconds and repeat.  Perform five to ten repetitions.  As you get stronger, progress to performing the exercise one leg at a time.  From the same starting position, lift the left leg up off the ground.  Lower slowly and using just the right leg, lift back to the starting position.  Make sure the right foot stays flat on the floor and you push up through the heel.  Perform five to ten repetitions on each leg.  Switch over to the left and repeat.  If you find one side is more difficult, perform an extra set on that side.  Eliminating performance asymmetries in this exercise often resolves long standing back pain. 

Michael S. O’Hara, P.T., OCS, CSCS

 

 

FRACTIONIZED EXERCISE AND HYPERTENSION

Over 60 million Americans have hypertension and another 65 million have prehypertension.   Prehypertension is a series of risk factors that place the patient on the path to the development of hypertension.  Hypertension is a primary risk factor in stroke and heart disease.  Left untreated, it can cause significant disability and early mortality.   The good news is that hypertension and prehypertension respond very well to exercise.  The bad news is most patients are either are unable or unwilling to exercise for any significant duration of time.  

The commonly prescribed dose of exercise to treat hypertension (high blood pressure) is thirty minutes of uninterrupted activity at 65% to 75% of your age adjusted maximal heart rate.  To produce results, the exercise must be performed every day.  Many hypertensive patients also have physical limitations that limit their activity level.  They are overweight, weak, and often have orthopedic problems that make thirty minutes of continuous exercise impossible.  Many patients despise exercise activity and would rather die than spend thirty consecutive minutes walking or riding a bike.  Researchers at Arizona State University recently tested different exercise prescriptions to see if shorter exercise session performed more frequently would produce positive responses in patients with hypertension.

Study participants wore blood pressure monitoring cuffs that took measurements twenty four hours a day.  They walked three times a day for ten minutes on one training day.  On the next day, they performed one thirty minute walking session.  On the third day, they performed no exercise at all.  While both doses of exercise helped control blood pressure, the brief ten minute sessions performed three times a day was significantly more effective than a single half hour session.  

patient on bikeThe “fractionized” exercise produced lower average blood pressure readings and fewer incidences of blood pressure spikes above 140/90.  It turns out that short, cumulative exercise sessions are remarkably beneficial for vascular health.   Compliance is king when it comes to exercise success.  Compliance with three short bouts of exercise a day is more achievable than one thirty minute session.  A ten minute walk at lunchtime.   Ten minutes on the stationary bike after work and a ten minute evening walk can fit into most peoples lives.

One of my personal training clients has hypertension and he has been much more successful at controlling his blood pressure with abbreviated training sessions.  He was running three times a week and doing yoga on the off days and his blood pressure did not improve.  We changed his program so that he strength trains at the gym two days a week and on his off days, he rides a recumbent bike two times a day for only twelve minutes.  The more frequent training has been more effective at lowering his blood pressure numbers, and he has been able to discontinue medications.  

Michael S. O’Hara, P.T., OCS, CSCS

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