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Rehabilitation

Embrace The Hate

Being Comfortable With Being Uncomfortable

“I hate this one.”

“This exercise never gets easier.”

“I do this but I hate this.”

“You like to see me struggle”

These are all common statements from fitness clients and physical therapy patients.  They have complaints about certain exercise activities that are difficult, unsteady, aggravating, and just plain annoying.  The activities that provoke these responses usually involve getting up and down off the ground, single leg biased training, carrying a weight, and / or pushing a sled.

These comments are usually followed by—

“..but I know they are helping.”

“I don’t have that pain anymore.”

“My legs are so much stronger.”

“I hiked in the mountains with my grandchildren.”

To make progress in rehab and fitness, you need to get comfortable with being uncomfortable.  If your fitness regimen involves scented candles, soothing music, and nothing that makes you uneasy, then I doubt it has much value.  Training challenges that restore movement skills, improve strength, and add muscle mass will create some discomfort.  Developing the mindset that embraces the challenge makes all the difference.

Michael S. O’Hara, PT, OCS, CSCS

Muscle Preservation and Fat Loss

NY Times on Fat Loss

One of the adverse effects of diets is the loss of muscle that accompanies a reduction of body fat.  Muscle is the metabolic engine, injury preventative armor, and longevity enhancing elixir of human biology.  Gretchen Reynolds of the New York Times has written an enlightening *article on the best method of losing body fat while holding onto valuable muscle.  The recent research reveals that a program of strength training produces optimal fat loss with significantly less muscle wasting.  Long slow distance exercise combined with caloric restriction accelerates muscle loss.  Your choice of exercise activity can have a profound impact on your physical performance and health.  Read the NY Times article here: https://www.nytimes.com/2017/11/15/well/move/to-maintain-muscle-and-lose-fat-as-you-age-add-weights.html?_r=0.

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.

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 “losing weight” fails to improve health because it accelerates muscle loss.  Middle age muscle loss is the catalyst for many of the illnesses that plague us later in life.

Michael S. O’Hara, PT, OCS, CSCS

*To Maintain Muscle and Lose Fat as Your Age, Add Weights, Gretchen Reynolds, New York Times, November 15, 2017

The Wisdom of Frank–Part IV

“Change It Up”

I met my friend Frank when I was 21 years old and working out at a local gym.  Frank was sixty-eight years old and in great condition.  He had been a professional boxer, army fitness instructor, and then a physical education teacher.  Frank was an incredibly well read student of fitness and human performance.  He was stronger, more agile, and fitter than most people in their twenties.  Success leaves footprints, so I was eager to learn from a master.

Frank was big on developing one set of skills for a defined period of time and then switching to performance parameters.  We would work hard on improving strength with squats, cleans, and pull ups for six weeks and then take a break.  The next six weeks would focus on speed and endurance–lots of jump rope, sprinting, and medicine ball throws.  I never got bored and I never got hurt.

The best injury preventative for athletes and fitness enthusiasts is a consistent change in activity.  Look at your training / competition schedule and alter your activity every six to eight weeks.  Better yet, take a week or two away from running, dance, yoga, lifting, baseball, or Zumba.  If you are older or more injury prone, that rest period might need to be stretched out to three weeks.

The popularity of the club system has young athletes playing the same sport year round.  In the clinic, we are treating young athletes with “old person” overuse injuries.  Playing multiple sports is infinitely more beneficial.  Taking layoffs from overused movement patterns and participating in a variety of athletic endeavors gives the body a chance to rebuild and recover.  It is no coincidence that successful professional athletes are the product of multi-sport participation.

Michael S. O’Hara, PT, OCS, CSCS

The Wisdom of Frank–Part III

“Leave Some In The Tank”

I met my friend Frank when I was 21 years old and working out at a local gym.  Frank was sixty-eight years old and in great condition.  He had been a professional boxer, army fitness instructor, and then a physical education teacher.  Frank was an incredibly well read student of fitness and human performance.  He was stronger, more agile, and fitter than most people in their twenties.  Success leaves footprints, so I was eager to learn from a master.

Frank said that it is always better to do too little than to do too much.  A training session should make you feel alive and awake, not beaten up and broken.  Frank recommended exercise sessions that involved about forty minutes of training and ten minutes of what we now call “recovery work”.  He often told me to take it easy, go home, eat well, sleep soundly, and enjoy being young.  “When you get to my age you will thank me.”

The latest trend in fitness is throwing your body into the propeller.  Lying on the floor gasping for air is a badge of honor and a sought after result.  As a physical therapist that treats the byproduct of this training method, I urge caution.  Most young athletes can only train super hard for eight to ten weeks a year.  Older clients have a much more limited recovery capacity and are unable to sustain that level of activity before an injury occurs.  The winner in the life long quest for health and fitness is the contestant with the fewest surgical scars.

Training related injuries are a tragedy.  It is easy to get swept up by the emotions of competition and the desire to excel.  As we age, maintaining an exercise habit that keeps us strong and injury-free is even more important.  I frequently remind myself to dial it down and then I say a silent “Thank You”.

Michael S. O’Hara, PT, OCS, CSCS

Biomarker Reminder

Drs. Evans and Rosenburg are Tufts University researchers interested in the measurable parameters that keep humans healthy and fit over an entire life span.  They have determined that the top four biomarkers are:

  1. Muscle Mass.  The percentage of your body that 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. Body fat 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 all of the other essential biomarkers.

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

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

Michael S. O’Hara, PT, OCS, CSCS

Ladder Matters

Moving well is a combination of balance, coordination, strength, and power.  During everyday tasks, you must be able to plant, pivot, and shift your bodyweight over one leg to change directions or decelerate an impact.  Movement is a skill that we all take for granted until the day that it fails us.  “I can’t believe I can’t do that,” is commonly heard from people in physical therapy.  They are unaware of the level of motor control they have lost to age, injury, and a sedentary lifestyle.  The good news is that with some consistent training, most motor control skills can be restored.  For gym members, an excellent method of enhancing movement skills is the agility ladder.

Agility ladders help you move better.  How you move says more about your age than how you look.  Responsive legs that can react to a disruption in balance keep you durable and injury free.  Consistent agility ladder training develops the neural coordination that allows more graceful movement.

Rotation is the movement pattern that creates the distance in your golf drive, the pop in your punch, and the acceleration in your sprint.  Rotation is the missing movement pattern in most training programs.  Ladder drills improve cross body, shoulder, and hip rotation.

Ladders are the rehab bridge that allows the injured athlete to move from a controlled series of movement patterns to the chaos of competition.  Ladders are one of the best power production and injury prevention activities older clients can perform.

As a conditioning method, I call ladder drills “three-dimensional jump rope”.   Move through a few sixty second intervals of continuous ladder drills and your body heats up, respiration increases, and your metabolism is disrupted.  Ramp that up to 90 seconds and check your heart rate.  See video of agility ladder drills: https://youtu.be/CmLXGLeyGfE

Michael S. O’Hara, PT, OCS, CSCS

Heat Or Ice For My Shoulder?

Try Standing Upright

In the gym, at the golf course, and during a visit to the hardware store, I am asked my advice on abolishing shoulder pain.  What everyone wants is the magical exercise, miracle ointment, or newest thermal treatment.  What they need–and what they do not want to hear–is that they have to fix their horrible posture.

Sustained poor posture can alter the function of your shoulder complex.  The shoulder girdle has only one, very small, bone to body connection.  The entire system is an interconnected series of muscles and ligaments.  Sustained slouched over postures create a faulty length-tension relationship in these structures that places adverse stress and strain on the four joints of the shoulder and the nerves in the neck and upper back.

OMG I sit lmGm (like my GrandMa).  

Shoulder posture pain problems are happening earlier.  I do not know if it is more tech toys, less physical education in schools, or a change in youth activity levels, but in the physical therapy clinic we are seeing younger people with older people postural shoulder pain.  They sit on the treatment table in extremely slouched over positions and are unable to pull themselves up into a correct position.  Most are unconvinced that how they sit and stand could be the generator of their pain problem.

What exercises can I do?

Stronger muscles will help restore posture.  The shoulder evolved to pull, lift, and carry.  The muscles that keep the shoulder strong and happy are in the back of the shoulder.  They hold the shoulder in a healthy position on the body.  Most of us never perform any pulling or lifting activities other than hoisting our laptop or toting our smart phone.   Making your shoulder girdle muscles stronger will help, but being mindful of your posture during the day is the most important factor.  Physical Therapist and US Soccer Team Trainer Sue Falsone says “You can’t out rep poor posture.”

Start with how you work and live.

Eight hours a day for five days a week equals 2080 hours of computer / desk time a year for the average office worker.  Add in a daily one hour car commute and another two hours of television a day and we push the Monday through Friday slump numbers to 2860 hours a year (120 days).  We have spent millions on state of the art chairs, elevated monitors, slanting keyboards, wrist rests, and lumbar supports.  Office modifications, while well intentioned and generally a good idea, cannot compete with 2860 hours (this number is probably low) of sitting in a year.  In order to fight against the postural stress that creates pain, we need to get up and move.

Recent research on prolonged sitting has demonstrated that the amount of movement we need to stay healthy is greater than we once thought.  To combat the adaptive changes of prolonged sitting, it is suggested you get up and move every twenty minutes.  Set a timer, enlist the help of your coworkers, and work at this every workday for a month.  I believe you will be surprised by the results.

Michael S. O’Hara, PT, OCS, CSCS

A Plea For Your Knee

In our physical therapy clinics, we treat patients with knee pain on a daily basis.  It has become more common to train younger clients with a history of knee injury and ongoing knee pain.  Jane Brody’s recent *article in the New York Times has some excellent advice on the care and management of knee pain problems.  I have some further suggestions and clarifications.

Less Mass

The mass portion of the Force = Mass x Acceleration formula needs to be at an appropriate level for your knees to stay healthy.  Carrying extra body fat creates an environment that invites knee wear and tear.  The common knee pulverizing mistake is to perform high impact exercise activities in an effort to lose fat.  If you are twenty pounds overweight, do not run, stadium step, soccer, tennis, or pickleball.  Start with strength training and low impact cardio.  Lose the fat first, and even then, the lower impact activity will be healthier for your knees.  From the overweight client limping into the clinic I get the “I need to move around to lose weight” protest.  I am sorry, but fat loss is primarily a function of dietary alteration.  Exercise has very little impact on body fat levels if you do not eat properly.

Train the Way You Wish to Play

A properly planned fitness program makes your knees more durable (fewer injuries) when you participate in your favorite recreational activity.  The training must be tailored to your activity goals.  If your goal is to play tennis, then you must perform three dimensional deceleration / acceleration activities as part of your training program.  Yoga will not prepare your knees for tennis.  If you want to water ski, then you must perform strength training for your back, hips, and knees.  Distance running will not prepare your knees for water skiing.  If hockey is your recreational past time, you need to be strong, well conditioned and competent in all planes of motion.  Long duration recliner intervals will not prepare your knees for hockey.

Look Above

If your hips do not move well, your knees will pay the price.  In this age of all day sitting and minimal physical activity, hip function is at an all time low.  Physical therapy patients with knee pain nearly always present with glaring restrictions in hip range of motion and strength.  If your knees hurt, dedicate some training time to restoring hip rotation and hip extension movement.  Learn how to perform some remedial gluteal activation drills.  Learn a proper hip hinge, squat and a pain free lunge pattern.

Think First

Participation in a single inappropriate activity can produce a lifetime of knee trouble.  That box jump workout of the day- maybe not.  The warrior, electric shock, mud hole, death run–bad idea.  Trampoline with the grandchildren–what were you thinking!

Be Proactive and Seek Treatment For Knee Pain

“Training through the pain” can take a graceful athlete and turn them into a lifelong speed limper.  The presence of pain changes the way your brain controls movement.  Left untreated, it can permanently alter neural signals and produce movement patterns that linger long after the pain has resolved.  Live with enough cycles of inefficient movement and you develop early breakdown in the knee.

Michael O’Hara, PT, OCS, CSCS

*What I Wished I’d Known About My Knees, Jane Brody, New York Times. July 3, 2017

Read the NY Times article here: https://www.nytimes.com/2017/07/03/well/live/what-i-wish-id-known-about-my-knees.html?_r=0

Very Short Term Running Preparation

I was recently asked by a fitness client to post exercise recommendations that would prepare her for outdoor distance running.  This person was two weeks away from being out on the road, running two or three miles a day.  She is middle aged, has a prior history of lower back pain, and her goal was to lose fifteen pounds and “tone up”.   Given such short notice, these are my recommendations.

Perform soft tissue work on a daily basis.  Foam roll the legs and use a lacrosse ball on the plantar fascia.  The vast majority of overuse injuries in runners happen in the lower legs and feet.  Attempt to unwind the myofascial distress created by 600-700 foot impacts a mile.

Improve your reciprocal hip pattern–one hip goes back and the other goes forward.  Most general fitness clients have glaring deficits on one side.  Perform some split squats, posterior lunges, step ups, and or walking lunges.  If you struggle with these activities, I would reconsider running as a fitness activity.

Wake up your gluteals.  Every day, perform fifty or sixty bridges, hip lifts, or leg curls.  You need super gluteal strength / endurance to run distances and avoid lower extremity injury.  If your butt gets sore from fifty bridges, you need to do them more often.

Running is a skill and most recreational runners need some practice.  Running hills will improve gait mechanics, enhance hip extension, and decrease deceleration forces.  Find a fifty-yard hill.  Run up the hill and walk back down.  Perform five hill runs.

You are always better to run too little than to run too much.   Start with very short runs– no more than half a mile.  Increase your total weekly mileage by no more than five percent a week.

You can’t do this in two weeks, but this is my big recommendation to all future runners.  Lose the extra weight before running.  As a method of fat loss, distance running has a poor track record.  It tends to elevate the hormones that make you hungry, and physiological adaptation to distance running happens fairly quickly.  Extra adipose makes you far more likely to develop a running related injury.  I know the guys and gals you see running miles and miles every day are lean.  Please remember that lean runners are successful with running because they possess the optimal body mass to run long distances.  They did not start heavy and become lean.  Put a fifteen pound weight vest on that guy or gal and everything will change.  Their gait will lose efficiency and become less graceful.  The extra fifteen pounds of load creates the biomechanical overload that makes them much more likely to suffer an injury.

My final recommendation is that you not become disappointed if you develop pain.  A runnersworld.com poll conducted in 2009 revealed that 66% of respondents reported a running related injury that year.  The statistics indicate that one third of the participants at you local 10k fun run will require medical attention for a running related injury over the next year.  Have the good sense to stop when the pain begins.

Michael S. O’Hara, PT, OCS, CSCS

Are You Ready?

Spring At The Physical Therapy Clinic

The weather is warming up and soon we will leave the heated, insulated, safety of our home gyms and fitness centers.  The spring migration back to tennis, soccer, pickleball, golf, fitness running, ultimate Frisbee, and stadium steps will begin.  My physical therapy question is– Are you ready for these new challenges?  Has your fitness program prepared you to withstand the rigors of these spring endeavors?  This checklist should help you answer the question.

Have you been performing most of your fitness activities in standing?
Nearly every sport and most household chores are performed in a standing position.  During most of my visits to commercial gyms, the majority of the activity I witness is in the supine, seated, or heavily supported positions.  If your goal is to move better and remain free of injury, then 90% of your exercise should be performed in standing.

Do you practice moving in all directions?
Nearly every sport involves moving side to side, forward-backward, and in a rotational pattern.  Basketball, soccer, golf, and tennis all require you to accelerate and decelerate movement in all directions.  Most gym activities are predominantly sagittal plane– forward and backward.  You ride on the elliptical, spin the bike, and run on the treadmill for months, and your spring visit to the tennis court results in a twisted ankle because you are unfamiliar with side to side movement patterns.

Have you been working on better balance?
Balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle.  Many commercial exercise machines take all balance demands away.  The elliptical, spin bike, recumbent bike, rower… all are heavily supported.  Proficiency with single leg stance balance prevents injuries and improves performance.  The older and more deconditioned you have become, the more your fitness program should include single leg stance balance training.

Do you perform any explosive exercises?
We get slower before we get weaker, and life is an up-tempo game.  We need to perform exercise that enhances quickness and improves control of deceleration forces.  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.  If you train explosively, you get better at moving at faster speeds.  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 production and speed of movement.

Michael S. O’Hara, PT, OCS, CSCS

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