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Learn more about Rehab, Sports Medicine & Performance

Rehabilitation

hippocampusWhile performing Kettlebell swings or some medicine ball throws, I get the question, “What does that exercise work?”  The answer is “My brain.”  I quickly explain how optimal training activates your nervous system and builds the neurons and synapses necessary for brain health.  A research query of great interest is the impact exercise has on the aging brain.  The New York Times, December 31, 2016 article by Dr. Lisa Felman Barrett, *How to Become a ‘Superager’, presents some interesting research.

The article discusses the research results that studied functional MRI scans of the brains of superagers.  Superagers are elderly individuals that score well on tests of memory, task attentiveness, and planning.  These MRI evaluations looked at both the anatomical and activity differences in various locations of the brains of these cognitively adept older adults.  The researchers and Dr. Feldman Barret give us some recommendations on lifestyle challenges that produce a superager brain.   It involves some consistent involvement in strenuous exercise activity and ongoing intellectually challenging tasks.

*New York Times, December 31, 2016, Dr. Lisa Felman Barrett, How to Become a ‘Superager’.  See the article here: http://www.nytimes.com/2016/12/31/opinion/sunday/how-to-become-a-superager.html?_r=0

Michael S. O’Hara, PT, OCS, CSCS

 

 

That Office Chair Can Be Keeping You From Your Fat Loss Goal

the-new-york-timesFor many years, I have been preaching about the negative impact prolonged sitting has on our metabolic health and musculoskeletal system.  All the research has demonstrated that adaptive shortening of connective tissues and weakening of muscles occurs with as little as two days of prolonged sitting.  New studies of daily movement patterns demonstrate that sitting has an even more severe impact on our ability to metabolize body fat.  Take the time to read the article “Keep It Moving” by Gretchen Reynolds in the December 9, 2016 issue of the New York Times.

Once again, the answer is to get up off the Aeron, Barcalounger, La-Z-Boy, or setee and move around.  Every twenty minutes, stand upright and defy gravity with some good old fashioned ambulation.  Do not exercise in a seated position–train in a standing position.  More and more we are learning that consistent daily movement is an essential element of human health.

Read the NY Times article here: http://www.nytimes.com/2016/12/09/well/move/keep-it-moving.html

Michael S. O’Hara, PT, OCS, CSCS

 

Kettlebell Swings and Push Ups

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.   

Swings and Push Ups

Strength coach Dan John got me started on kettlebell swings/push up sessions.   This pairing challenges core stability as the swings create an anti-flexion core stabilization demand and the push ups an anti-extension demand.  If your goal is fat loss, this exercise pairing produces a total body metabolic boost.  A hidden benefit is getting up and down off the floor during the training session.  It is a basic mobility skill we need to practice in order to maintain our independence.

Kettlebell Swings
kb_swingA swing is not a squat and a squat is not a swing.  A kettlebell swing is a hip dominant motion; the hips move a lot and the knees just a little.  The handle of the kettlebell should stay above the knees.  At the bottom of the swing, the forearms should contact the upper thighs.  You swing the kettlebell forward with an explosive contraction of the gluteal and hamstring muscles.  Do not lift the kettlebell with the arms.  Project, or throw, the kettlebell to shoulder level and no higher.  The swing is an exercise that is worthy of some coaching.  Find an instructor that can help you with proper performance.

Push Ups
Keep the shoulder blades down the back and tight against the rib cage.  Hold the head in a retracted position and relax the neck.  The shoulders should not ride up into a shrugged position. Start at the bottom of the push up (flat on the floor).  Place the hands under the shoulders and keep the elbows tucked in to the side of the body.  Grip the floor with the hands and activate the muscles in the back of the shoulder blades.  Brace the abdominal muscles, tighten the glutes, and maintain tension between the legs by drawing them together.  Push up while maintaining spinal and shoulder position.   Hold at the top for two counts and repeat the push up.

Swing/Push Up Sessions
The great thing about these sessions is that you need minimal equipment—just a single kettlebell and a willingness to work hard.

This is a good place to start.  You will need a kettlebell and a stopwatch.
Swings x 20 seconds
Push ups x 6 repetitions
Rest 30 seconds
Repeat for fifteen minutes
As you get stronger, increase the push up repetitions.

This is one of my favorite swing/push up training sessions.
20 swings
20 push ups
20 swings
15 push ups
20 swings
10 push ups
20 swings
5 push ups
20 swings
You will finish with 100 swings and 50 push ups.

Try a push up “countdown” session.  Follow this pattern:
10 swings
10 push ups
10 swings
9 push ups
10 swings
8 push ups
Work your way down to 7-6-5-4-3-2-1 push up.  You will complete 100 swings and 55 push ups and transfer up and down off the floor 10 times.  If that is too much, modify the program and start at five push ups.  You will complete 50 swings and 15 push ups.

View video of Mike performing these exercises here: https://youtu.be/Vq3VYg847Xs

-Michael S. O’Hara, P.T., OCS, CSCS

Turkish Get Ups and Waiters Walks

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.   

Turkish Get Up and Waiter Walk Complex

How you move says more about your fitness than how you look.  The pairing of the Turkish Get Up (TGU) and Waiter Walk is an exercise complex that improves gait mechanics and the survival skill of getting up and down off the ground.  You will be performing a TGU and immediately move into a Waiter Walk so you need twenty yards of open space.  As you get stronger at this complex and use a heavier implement, some interesting things start to happen.  You get better at controlling respiration and have an intense focus on how your body moves during the TGU and Waiter Walk.  My yoga friends tell me this is the focus of their practice sessions: better respiration, improved motor control, and increased strength.

Turkish Get Up

t_get_upsThe Turkish Get Up (TGU) is generally performed with a kettlebell, but you can use a dumbbell.  A medicine ball can help teach body alignment to beginners.

Exercise activities that produce the greatest rewards are the ones that take the most time to master.  You can learn a barbell curl in five seconds but a TGU can take weeks to master.  Developing proficiency with the Turkish Get Up will require some patience and instruction, but for the time spent, the pay off is tremendous.  Complete instruction on the TGU is not possible in this short article.  Watch the accompanying video and work with a qualified trainer on this exercise.  Steve Cotter and Gray Cook both have excellent YouTube tutorials on the TGU.

Waiter Walk

You must have adequate shoulder range of motion and good balance to perform this exercise safely.  Hold the kettlebell overhead like a waiter carrying a tray.  Keep the chest proud and the neck relaxed.  The upper arm should be adjacent to the head and your walk should be smooth and free of any lean or limp.

Complex
I like to train TGU rookies with a soft Dynamax ball.  If they drop the ball it will not damage any aspect of their anatomy.  Balancing the ball on the hand tends to teach proper alignment.  Progress to a kettlebell as you become more proficient.  Start on the floor and perform the TGU ascent.  Once at the top of the TGU, perform a Waiter Walk for twenty yards and then lower back down to the floor with a TGU descent.  Switch the implement to the other side and repeat.  Perform two trips on each side.

When you perform this complex, strive to move more gracefully before adding more resistance.   Get up and down off the floor and walk in a coordinated and efficient manner.  Only then increase the load of the ‘bell.

View video of Mike performing these exercises herehttps://www.youtube.com/watch?v=s0U9GWMI4bU&t=8s

-Michael S. O’Hara, P.T., OCS, CSCS

Renegade Rows and SHELC

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.  

Renegade Row-SHELC Combo

Renegade Rows
The renegade row starts in the top position of a push up.  Rubber hex dumbbells work the best for this exercise since they do not move on the floor.  Place the dumbbells on the floor and position the hands on top of the dumbbells.  Try to align the dumbbells directly under the armpits.  Maintain a strong grip on the dumbbell handle during the exercise.  Spread the feet at least shoulder width.  Tighten the shoulder blades down the back and create total body tension.   Without allowing the torso to turn, row one dumbbell up so the thumb approaches the armpit.  Lower the dumbbell in a controlled manner and repeat with the other arm.  Perform five repetitions on each arm.

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

The anti-flexion and anti-rotation core stabilization demand created by this pair of exercises produces some interesting next day abdominal muscle soreness.  The ability to link the hips to the shoulder and produce movement is what everyone tries to accomplish with functional training.  Move through three sets of the Renegade Row – SHELC combo and let me know how it goes.

View video of Mike performing these exercises here: https://youtu.be/2_fT0zShTSo

-Michael S. O’Hara, P.T., OCS, CSCS

Hip Lifts and Roll Outs

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.  

Hip Lifts and Roll Outs

An intricate system of muscles holds the spine upright over the top of the pelvis.  This pair of exercises coordinates and strengthens this support system.  If you sit all day long, have postural problems, or a history of lower back pain this pair of exercises is worthy of your training time.

Hip Lifts
hip_liftThis 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 and the shins perpendicular to the floor.  Drop the hips to the floor and then push back up with the gluteals and hamstring muscles.  Hold at the top for two counts and repeat.

Roll Outs
The roll out can be scaled to serve any fitness level.  Beginners can start with a large 65 centimeter physioball, and as they become more proficient, progress to a smaller 55 centimeter ball.  The closer the hands get to the floor the more challenging the exercise becomes.  If you get strong enough, you can perform the forward roll out with a Power Wheel or Sorinex roller.

Kneel on a mat to keep the pressure off your knees.  Your femur (thigh bone) is positioned perpendicular to the floor and the hips are hinged at 45 degrees.  Place the hands on the front of the ball and the elbows directly under the chin.  Brace the abdominal muscles and roll out onto the ball until you feel a challenge through your midsection.  Hold in the challenging position for three counts and then return to the starting position.
Perform twelve repetitions of the hip lifts, rest 30 seconds, and then perform ten roll outs.  Rest and repeat the cycle.  Work up to three sets through this exercise combination.

View video of Mike performing these exercises here: https://youtu.be/Xf08rFU7A4w.

-Michael S. O’Hara, P.T., OCS, CSCS

Crawl and Bearhug Sandbag Carry

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.   

Crawl and Bearhug Sandbag Carry

A finisher is a short but intense, high metabolic cost, training event performed at the end of an exercise session.  The best finishers create carry over to real life activities and can be made more challenging as you become more fit.  When linked to proper diet, finishers produce the “metabolic hit” that stimulates fat loss.  As the name implies, you always perform finishers at the end of your workout because, afterwards, you will not want to do anything else.

Crawl
Crawling is all about the spiral, diagonal force connection that happens through the middle of the body.  Crawling is the primal exercise that enabled us to stand and walk.  The “core muscles” neurologically connect the left hip with the right shoulder and the right hip with the left shoulder.  They stabilize the pelvis and spine so you can transfer force from the hips to the shoulders.  Crawling keeps that connection healthy and strong.

Bear Hug Sandbag Carry

sandbagThe bear hug sandbag carry is the cure for the epidemic of device disability syndrome (DDS).  This exercise reverses all of the weakness that is created by endless hours planted in a chair, staring into a screen.  Sandbag carries are functional core stability work.  The abdominal muscles interact with the muscles in the legs and shoulder girdle to hold a stable upright position.  Walking with a sandbag kicks starts your postural reflexes, the neural feedback mechanism that holds us up against gravity.  Do not go too heavy on the sandbag.  You should be able to stay tall and not stagger or lean forward.

The routine is simple:  Crawl for twenty yards—ten yards down and ten yards back.  Try to keep the knees close to the floor and the back flat.  Immediately after finishing the crawl, pick up the sandbag with a bear hug hold- no hands linked- and carry it for twenty yards.  Rest as needed and repeat.  Start out with three circuits and increase to five.  Try to keep the rest periods under thirty seconds.  Once you get up to five circuits, add a weight vest and then a heavier sandbag.  Modify the distance, load, and cycles to suit your needs.  Give the crawl/bear hug carry combo finisher a try and let me know how it goes.

View video of Mike performing sandbag carries here: https://youtu.be/Ygg2vbf-Uoo

-Michael S. O’Hara, P.T., OCS, CSCS

 

Three Gifts I Would Give And Three I Would Take Away

Santa Gives You Gluteal Activation
You need a responsive and strong set of butt muscles to function at optimal levels. Many gym goers have gluteal muscles that are neurologically disconnected.  The term physical therapists and strength coaches use is “gluteal amnesia.”  Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the butt muscles.  We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement.  Most fitness clients are in need of some intensive gluteal training.  The hip lift is a simple exercise activity that produces a superior response.  See the attached video for a demonstration.

Scrooge the Lumbar Spine Flexion
Drop the sit ups, stop doing crunches, ditch the glute ham developer sit ups, and forgo the toes to bar competitions.  Father time, gravity, and the stress of prolonged sitting are already bending our lumbar spines forward all day long.  The last thing you need to do is accelerate degenerative breakdown of the lumbar segments with more repetitions of spine flexion.  Please forget about isolating abdominal muscles.  Instead learn how to control the team of muscles that hold the lumbar spine stable.  It is a neural event that is worthy of all your efforts.

Santa Gives You Medicine Ball Throws
medballLife is an up tempo game.  What you do in the gym is reflected in how well you can move during activities of daily living.  If you continually exercise at slow tempos you will get better at moving slowly.  The capacity to decelerate a fall requires fast reactions.  Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power and speed of movement.  Medicine ball throws are the easiest way to improve power.  Medicine ball throws can be scaled to all fitness levels and are safe as long as you use a properly sized and weighted ball.  The large, soft Dynamax balls are a good choice for beginners.  They rebound well off of the block walls in the gym and are easy to catch.  Do not overload your medicine ball throws, a two to eight pound ball is best for most gym goers.  Get with one of the trainers for instruction on adding medicine ball throws to your training program.

Scrooge Sitting Down in the Gym
Movement happens in an upright, standing position.  “Seated exercise” is an oxymoron.  If you want to improve how your body functions, you must stand up and defy gravity. Every athletic endeavor is performed in a standing position. Seated exercise reinforces poor postural habits and diminishes your capacity to move.  I call it the “illusion of exercise” and it will always be highly visible in commercial gyms because it is easy to sell.

Santa Gives You Four-Point Training
Crawling is the neurological training tool an infant uses to develop the capacity to stand and walk.  It is the pathway to better motor control and less pain.  Nearly every physical therapy patient and most fitness clients benefit from a healthy dose of four-point position exercise.  In your fitness program, reinforce the patterns of spinal stability and reboot the postural reflexes with some horse stance horizontal, crawling, and Jacobs Ladder training.   Four-point training can be scaled to any fitness level.  Watch the attached video for some examples.

Scrooge Elliptical Training
I know you love the elliptical.  It is the no impact, cardio darling of the gym but it should be used as a fitness dessert and not a main course.  Elliptical training has multiple drawbacks.  Ergonomically, it is a one size for everyone apparatus that does not work well for taller or shorter people.  When you walk or run, you improve the important skill of stabilizing your body over one leg.  An elliptical keeps both feet stapled to the machine and deadens any neural enhancement of balance or single leg stability.  Hip extension keeps our back healthy and our body athletic.  Maintaining or improving hip extension should be part of every training session.  There is no hip extension produced when you train on an elliptical.  Many people maintain a flexed spine when they use an elliptical.  Sitting produces the flexed forward spine we all need to work against in our fitness programs.  The repetitive use of the shoulder girdle is a frequent generator of referrals to physical therapy for head and neck pain.  Metabolic adaptation to elliptical training happens fairly quickly.  In January, a 30 minute session burns 330 calories, but by June, your body becomes more efficient and that same routine creates only a 240 calorie deficit.  The low impact, reduced weight bearing nature of an elliptical makes it a poor choice in your fight against osteoporosis.

I am happy when people are more active.  Patients and fitness clients love the elliptical and they believe it helps.  Use that belief to keep you motivated and training.  I just want everyone to manage the drawbacks of this type of training.  Injured people always say “Why didn’t someone tell me?”  Before you jump on the elliptical, take ten minutes and improve your core stability and hip function with some four-point exercises and hip lifts.  Learn how to throw a medicine ball and stay standing through the rest of your training program.  Next Christmas you will thank me.

Merry Christmas and a Humbug to you.

See video of Mike in the gym demonstrating these exercises here: https://youtu.be/H0my94BPHNQ

Michael S. O’Hara, PT, OCS, CSCS

Goblet Squats and Pull Ups

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:

Train efficiently—You get much more work done during your training time. 

Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations. 

Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition. 

Move better—Training neurologically related movement patterns improves motor control.  

Goblet Squats and Pull Ups

The more inefficient you are when performing an exercise activity the greater the metabolic demand.  Inefficient exercise is the key to fat loss.  Most gym goers become efficient in their selected exercise activities and body composition improvement comes to a standstill.  This pair of exercises creates a systemic response that ramps up the metabolism and drives the hormonal response that creates better body composition numbers.

Goblet Squats
toes_to_fingertipsHold a kettlebell by the horns, with the elbows down and the kettlebell held against the sternum.  Keep the chest proud and relax the neck.  Place the feet at shoulder width and initiate the squat by pushing back the hips.  Keep the torso tall and descend to at least a thigh parallel to the floor position.  Let your pelvis fall between the legs. The elbows should drop down between the knees.  As you get stronger, use two kettlebells held in the double rack position.

Pull Ups
If you are unable to perform a pull up with your own bodyweight, use a band for assist or better yet, one of the machines that assists a pull up.  Use a pronated grip (hands facing away) or a neutral grip (hands facing one another).  I like a set of rings as it affords the shoulders more freedom of movement.  Attempt to get your elbows tight to your side at the top of the pull up.

Perform ten goblet squats, then perform six pull ups, rest sixty seconds, and then cycle back through.  Perform four total trips through this pair of exercises and you will have completed 40 goblet squats and 24 pull ups.  There is something about the pull ups that makes my upper back feel more stable and I move through the goblet squats with greater ease.  As your body composition improves, the pull ups get easier.

View video of these exercises here: https://youtu.be/3L13W9VpqXk

-Michael S. O’Hara, P.T., OCS, CSCS

Fitness training for those of us past 40 years of age is more complicated.  Physical performance and recovery capacity are dramatically different.  If you need proof, look for the forty year olds in the NBA or NFL.  The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime.  I have compiled a collection of tips for the forty plus fitness client.

Why Doing Just Enough Is Not Enough–Moving From Maintenance To Improvement

15-hotel-icon-has-gym-800pxWhen I worked in Texas, I had a client named Gail.  When we first met, she had recently turned 50 and was comfortable with her appearance.  She led an active lifestyle and worked out at the gym two days a week.  Overall, she was happy with her fitness level. She just wanted to maintain her routine.  Gail had been coming to the same class at the gym twice a week for 4 years.  The more I got to know Gail, she admitted to wanting to drop the 5-10 lbs which she said had settled solely in her mid-section.  She also mentioned mild knee pain while playing tennis.  In all the years she had been participating in her fitness class, her weight gradually increased and her knee pain only got worse, but these subtle changes hadn’t been enough of a red flag.  Gail needed to change up her routine, which she eventually did with positive results

I hear this word “maintenance” frequently.  Many gym goers are relatively satisfied with their appearance and just want to continue to be active in order to maintain their fitness level.  My experience has shown that maintenance is an illusion.  You either get better at something or you get worse.  Every action and decision you make brings you closer to your goal or takes you further away.  There are no neutral actions.  This is easily measured in the world of fitness and physical performance.  The first time you run a mile or bench press your bodyweight, a relatively high level of energy is used due to the inefficiency of all of the musculature and energy systems being used.  Every time that same mile is run or that same weight is lifted, your muscles fire in a more coordinated manner and your energy systems involved become more efficient, so less energy is used for the same task.  The hour workout that may have required 300 calories worth of energy to complete the first time you performed it may only require 280 calories after a couple of weeks, and perhaps only 200 calories after several months.

When you approach exercise with a “maintenance” mentality you often end up doing the same exercises, at the same speed, with the same loads, and over time this requires less and less work.  If you can no longer do what used to do, this “maintenance” mentality may be the culprit.  The only way to improve is to consistently perform more work or complete the same amount of work in a shorter period of time.  Do this consistently 2-3x per week for months and years on end and you will actually maintain something.  Do it 4-5x per week and you might actually get better.

Jeff Tirrell, CSCS, Pn1

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