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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

Motrin Mayhem

More Research On Effects of Exercise and NSAID Medications

Millions of Americans take a non-steroidal anti-inflammatory drug (NSAID) every day.  Many use these over the counter drugs to reduce the discomfort / pain of fitness activities.  Big Pharma marketing makes the use of these chemicals look harmless.  In the commercial, the lady pops three pills and glides effortlessly through her run.  The basketball player takes his gel capsules and bounds through the game with his buddies.  Most of us view these drugs as harmless and beneficial.  Ongoing studies have shown that the use of NSAIDs as a pre-exercise activity preparation can limit your muscle recovery and damage your internal organs.  A recent New York Times *article by Gretchen Reynolds should scare everyone away from medicating with NSAIDs prior to a training session.

Exercise induced inflammation is a critical biochemical process that helps us recover from a bout of training. You do not get fitter while training, you get fitter during recovery from a bout of exercise.  The inflammatory biochemicals that make you sore and stiff after a vigorous exercise session are called prostaglandins.  NSAIDs work by interrupting the chemical assembly line that makes various prostaglandins.  No prostaglandin production means you have no delayed onset muscle soreness (DOMS), so you feel better.  Prostaglandins are the chemical signal that tells your muscle cells to get busy repairing and reinforcing your skeletal muscle cells.  No prostaglandins, no beneficial adaptation during recovery.  Take a NSAID before training and it’s like you never exercised at all.

Prostaglandin production creates vasodilation– more blood can get where it needs to go during a session of exercise.  The studies cited in the New York Times article have demonstrated that inhibited prostaglandin production creates diminished blood flow to your kidneys.  Limited kidney function dramatically blunts progress toward all fitness goals.   It is very difficult to run further, get stronger, or become leaner while undergoing dialysis.

Take the time to read the article by Gretchen Reynolds and rethink that pre-exercise NSAID protocol. You can view the article here: https://www.nytimes.com/2017/07/05/well/move/bring-on-the-exercise-hold-the-painkillers.html?

*Bring On the Exercise, Hold the Painkillers, Gretchen Reynolds, New York Times, July 5, 2017

Barbara O’Hara, RPh.

Better Tests With More Movement

I attended an overcrowded grade school.  From 1st through 8th grade, we had 40 or more children in a classroom.  One Felician sister kept order by keeping everyone seated and stationary.  During my grade school education, I was stuck in a chair and every day it felt like time had stood still.  When a school day came to an end, the children were so movement deprived they would literally sprint out the doors.  I believe this illustrates the psychological impact of depriving children of movement during the day.

I know we have to be concerned with standardized test scores, and that taking time for physical activity takes away from reading, math, and science.  A long litany of research is revealing that children score better on tests when they are able to move around more.  More movement creates a healthier brain and better test scores.  More of the brain is devoted to movement than language, and if we wish to fully develop intellectual capacity, we need to include movement.  This appears to be even more important for boys.

Everyone involved in improving education needs to read Spark, by Dr John Ratey.  In this book, he discusses how brain function is enhanced by the habit of exercise.  Over the last nine years, more research has documented the positive effects of exercise on brain health.  A teacher friend sent me this *article from the New York Times.  If you have grandchildren or children you need to read this.

Micheal S. O’Hara, PT, OCS, CSCS

* Why Kids Shouldn’t Sit Still in Class, Donna De La Cruz, New York Times, March 21, 2017.  Read the article here: https://www.nytimes.com/2017/03/21/well/family/why-kids-shouldnt-sit-still-in-class.html?_r=0

FAT LOSS NUTRITION QUIZ

FAT LOSS NUTRITION QUIZ

The primary goal of most fitness clients is altering body composition.  They want to lose fat and gain muscle and they know they need to change dietary habits.  Everyone knows the optimal nutritional menu choices.  The stream of weight loss dietary advice has been endless.  Fitness magazines, newspapers, Dr. Oz, Oprah, and hundreds of websites have been serving up dietary fat loss advice for decades.  I like to use my fat loss nutrition quiz to prove my point.  If you can pass this quiz, you know all you need to know in regards to eating for fat loss.  The question that needs to be answered is “What would motivate you to make changes in your eating habits?”

1. Eating a fresh green salad every day.
Very Bad          Bad          Good          Very Good
2. Eating a fresh green salad with half a bottle of Ranch Dressing slathered on top.
Very Bad          Bad          Good          Very Good
3. Eating nothing but salad.
Very Bad          Bad          Good          Very Good
4. Eating a serving of fresh fruit every day.
Very Bad          Bad          Good          Very Good
5. Eating Fruit Loops every day.
Very Bad          Bad          Good          Very Good
6. Having a four ounce glass of wine with dinner.
Very Bad          Bad          Good          Very Good
7. Having a fourteen ounce tumbler of wine with dinner.
Very Bad          Bad          Good          Very Good
8. Eating breakfast every morning.
Very Bad          Bad          Good          Very Good
9. Waking up in the middle of the night and eating.
Very Bad          Bad          Good          Very Good
10. Consuming 120 grams of protein every day.
Very Bad          Bad          Good          Very Good
11. Consuming 12 grams of protein every day.
Very Bad          Bad          Good          Very Good
12. Having an apple as a snack.
Very Bad          Bad          Good          Very Good
13. Having an apple pie as a snack.  
Very Bad          Bad          Good          Very Good
14. Planning and preparing meals ahead of time.  
Very Bad          Bad          Good          Very Good
15. Eating whatever is in the refrigerator.
Very Bad          Bad          Good          Very Good
16. Keeping a daily food log.
Very Bad          Bad          Good          Very Good
17. Keeping Oreos in the house.
Very Bad          Bad          Good          Very Good
18. Consuming 1600 calories a day-women, and 2200 calories a day-men.
Very Bad          Bad          Good          Very Good
19. Having absolutely no idea of how many calories you consume in a day.  
Very Bad          Bad          Good          Very Good
20. Eating foods of as many different colors as possible.
Very Bad          Bad          Good          Very Good
21. Eating only brown, beige, and black colored food.
Very Bad          Bad          Good          Very Good
22. Meals made exclusively from fresh produce.
Very Bad          Bad          Good          Very Good
23. Meals made from the contents of a cardboard box.
Very Bad          Bad          Good          Very Good
24. Post training session rehydration with water.
Very Bad          Bad          Good          Very Good
25. Post training session rehydration with beer.
Very Bad          Bad          Good          Very Good

I have never had anyone fail this test.  The “What do I eat?’ answer is really that simple.  Do not fret over dietary minutia–clean up your big nutritional mistakes.  Do some planning and preparing and exercise consistently.  The results will follow.

Michael S. O’Hara, PT, OCS, CSCS

Slant and Pant

HIIT Methods: Incline Treadmill Walking

Fitness centers present the client with an endless array of cardio training entertainment.  You can spin a bike, wheel around on an elliptical, run on a treadmill, row, ski,…  My recommendation is that we all start performing more incline treadmill walking intervals.  There are three big benefits you get from incline treadmill intervals that you do not get from any of the other cardio contraptions.

Single leg stance stability is a skill we all need to keep in our fitness programs.  Our independence and well-being is based upon being able to repeatedly balance, load, and then drive forward off a single leg.  Since we are all sitting more, we need to make an effort to practice the elaborate leg to leg “game of catch” that happens when we walk.  It is a sad fact that most of the more popular training devices in the gym have made exercise easier by eliminating the single leg stability demand.

Hip extension is the movement of your thigh bone (femur) behind your body.  Hip extension keeps your hamstring and gluteal muscles strong and responsive.  Well functioning hamstrings and gluteals keep your knees and lower back healthy and happy.  In the age of perpetual sitting and very little squatting and sprinting, hip extension has become a lost movement pattern.  Improving hip extension strength should be part of every training session.

Walking on an incline reboots the postural reflexes that hold us tight and tall.   Prolonged sitting, improper training, and weakness shuts down the team of muscles that keep our spine stable and upright.  As fatigue sets in, you can slouch over on a bike, slump onto the elliptical, or fold into a rower and continue to exercise.  If you lose your posture on the incline treadmill walk, you slide down the belt.  Many fitness clients report this is the hardest part of an incline treadmill session–their muscles in the middle fatigue before their legs.

Finding your initial incline and walking pace will be a trial and error endeavor.  My suggestion is that you start easy.  I find most newbies to incline treadmill intervals do well with a 5% incline and a 3.5 mph pace.  Incline treadmill training makes you stronger in all of the most neglected places.  Many people report they are able to significantly advance incline and speed with four months of dedicated training.  For the best results, frequently vary the intervals that you perform.  These are some of the sessions I have found work well for fitness clients.

90 seconds on / 45 seconds off

Walk for ninety seconds.  Step off the treadmill and rest for forty five seconds and repeat for three to six intervals.  The two to one work / rest ratio works well for nearly all fitness clients that are new to incline treadmill walking.

Quarter Mile Repeats

Get a stopwatch and track your performance on this interval session.  Set the treadmill speed and incline.  Walk ¼ of a mile.  Rest as needed and then repeat.  Perform four ¼ mile incline walks.  Record your time to complete all four ¼ mile walks.  I find this to be a good test of cardiorespiratory recovery capacity.  Work toward a faster performance.

10 seconds on / 10 seconds off x 10

This comes directly from Dr. Gibalas research on HIIT.  This protocol has been shown to be as or more effective at improving insulin sensitivity and cardiorespiratory capacity than longer training sessions.  Set the treadmill at a slightly higher incline.  Walk ten seconds and then step off and rest for ten seconds.  Perform ten of these ten second intervals.

2/10th, 3/10th, 5/10th Mile Interval Session

Get a stopwatch and track your performance on this interval session.  Set the treadmill speed and incline.  Walk 2/10th of a mile.  Rest as needed and then perform 3/10th of a mile.  Rest as needed and then perform 5/10th of a mile.  Record your time to complete all three intervals.   As you get stronger your times will improve.

For more information on the many benefits of HIIT read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

The Best Practices for Fat Loss

As the weather warms up, I get more questions from gym goers on the best way to lose body fat.  In the physical therapy clinic, we treat patients who have injured themselves with their exercise efforts to eradicate the extra pounds of adipose they gained over the winter.   For both populations, I direct them to an excellent article written by Alwyn Cosgrove, *The Hierarchy of Fat Loss.  View the article here: https://www.t-nation.com/training/hierarchy-of-fat-loss

Nearly all fitness clients say they have busy schedules and limited time available to spend in the gym.  At best, they can spare two or three hours a week.  In great detail, Alywn explains the optimal fat loss training schedule so that you make the best use of your training time.  For the deconditioned or orthopedically challenged individual, following a plan that focuses foremost on nutrition and strength training will decrease body fat levels and prevent injury.

Michael S. O’Hara, PT, OCS, CSCS

Hills Make It Happen

HIIT Methods: Hill Sprints

Hills sprints are an amazingly effective method of improving fitness and keeping the lower extremities strong.  Sprinting up a hill reduces impact on the joints, improves running mechanics, creates a profound metabolic disruption, and your training session is over in twelve minutes.  Walter Peyton was a huge believer in hill sprints and no one could argue with his results.

Hill sprints are safer than flat surface sprints because the ground rises up to meet the foot.  Maximal lower limb speed and impact is reduced when you sprint up a hill.  Hill sprints make you lean forward into the posture of acceleration.  In order to produce more of the force that lifts the body up the hill, the athlete must pump the arms and drive back through the hips.  Hill sprints are arguably one of the most functional training activities you can perform.

Hill sprints are not for everyone.  They are not appropriate for the physically deconditioned population.  If you have a history of lower extremity orthopedic issues, you want to use another, less aggressive form of HIIT.  Hill sprints take some discipline to complete.  They are not the same as running uphill on an inclined treadmill.  I would argue that hill sprints are the most effective method of disrupting physiological homeostasis–you will get leaner and fitter faster.

The ideal hill is a five to seven percent grade and 100 to 150 yards long.  Most of the hill sprints you will perform are for distances sixty yards or less.  Listed below are some of my favorite hill sprint routines.

20 Yard Hill Sprints

Sprint up the hill for twenty yards.  Walk back down and rest.  Beginners start with three sprints and work your way up to eight sprints.

20 – 40 – 60 – 40 – 20 Yard Hill Sprints

Sprint 20 yards and then rest, 40 yards, rest, 60 yards, rest 40 yards, rest, 20 yards and you are finished.  Recover sufficiently so the next hill sprint does not suffer a breakdown in performance.

40 Yard Hill Sprints

Warm up and perform a 40 yard hill sprint at 80% of full effort.  Walk back down the hill and then perform another 40 yard hill sprint at 85% full effort.  Perform the next three hill sprints at 90-95% full effort.  Five good sprints are all you need.

Watch Mike explain hill sprinting on his favorite hill: https://youtu.be/AHJjmT87g7g

For more information on the many benefits of HIIT read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

Fitness Success Secrets

WSJ and My Fitness Success Suggestions

A member at the gym brought in this *article from the May 20, 2017 issue of the Wall Street Journal.  The article had some good tips on exercise compliance but fell short in other areas.  Take the time to read my suggestions.  These habits have been time tested, proven winners in multiple studies on real world people who were successful in making fitness a lifelong habit.

Get Some Help.

Numerous studies have shown that individuals that seek the assistance of a personal trainer or fitness coach are more successful in long term exercises compliance.  The guidance from a fitness expert improves motivation, goal attainment and is more time efficient.  Scientific understanding of fitness and the best training practices have changed dramatically in the last fifteen years, and your knowledge is probably behind the times.  A good coach will temper your “beginner’s enthusiasm” and make it less likely you will over train and/or injure yourself.  A professional helps you reach goals despite physical limitations or prior fitness challenges.

Personal Performance Evaluations.

In school, you have tests to see if you are gaining knowledge and ready to advance in a specific subject.  The same should be true of your training program.  The minimal requirement is a Functional Movement Screen.  This simple test can prevent 90% of the fitness related injuries we see in the physical therapy clinic.  Keep a record of relevant performance evaluations—a good trainer can help you with this.  Your initial successes with exercise will come in the form of better strength, mobility, and work capacity.  An ongoing record of “fitness victories” strongly reinforces the exercise habit.

Have Reasonable Goals.

The infomercials for fitness products promise big changes in extremely short periods of time.  Television shows document massive fat loss in a single month.   The healthiest changes in body composition occur slowly and steadily.  Make those body composition goals, but also make performance goals such as being able to perform a pullup, twenty lunges, or a full pain free squat.  I can think of no better goals than being able to eliminate blood pressure medication, normalize blood sugar levels, or decrease the use of anti-inflammatory medications.

Place Your Exercise Session At the Beginning Of the Day. 

The University of Michigan department of psychology found that individuals that are successful with long-term exercise compliance train in the morning before other aspects of life have a chance to interfere.  Consistency is King–an exercise plan will never work if you are not able to maintain a schedule.  The most consistent attendance happens when gym members train in the mornings.

Michael S. O’Hara, PT, OCS, CSCS

*Wall Street Journal, May 20, 2017, Rachel Bachman, Five Secrets for Steadier Workouts

Spinning Wheel

HIIT Methods: Air Assault Dual Action Bike

The Air Assault dual action bike is a challenging metabolic disrupting machine.   For older fitness clients, heavier folks, and those of us with legs that are less tolerant of impact, the Air Assault improves cardio-respiratory capacity and minimizes joint stress.  If you are seeking an intense training experience, look no further than the Air Assault bike.

The number two reason people give for not exercising is limited time–lack of results is number one.  The Air Assault solves both of these problems.  Training sessions on the Air Assault are brief and very effective.

Set your seat for height and reach so at the bottom of the pedal stroke, the knee is bent about 20 degrees.  The arms should not fully extend at the elbows.  The bike is simple– increase the pedal speed and you push a greater volume of air.  Go slow—less resistance.  Go fast—more resistance.  Keep a tall posture to effectively drive with the arms and assist the legs.  I have outlined four of my favorite HIIT Air Assault training routines.  As usual, remember to perform a movement preparation warm up before launching into a HIIT session.

30 seconds on / 30 seconds off

Ride at an exertion level of 7/10 (1 is a stroll and 10 is sprinting away from a lion) for 30 seconds and then pedal slowly at a 1/10 exertion level for 30 seconds.  Repeat the cycle for ten intervals.  You are done in ten minutes.

45 seconds on / 15 seconds off

Ride at an exertion level of 7/10 (1 is a stroll and 10 is swimming to escape the alligator) for 45 seconds and then pedal slowly for at a 1/10 exertion level for 30 seconds.  Repeat the cycle for five intervals.  This workout takes five minutes.

Tabata Protocol

Twenty seconds on at an exertion level of 9/10 followed by ten seconds off at 1/10.  Repeat eight times.  This format is built right into the Air Assault bike timer.  Do not get discouraged if you have to stop well before completing eight intervals.  Work your way up to completing all four minutes of the session.

1.5, 1.0, 0.5 Mile Intervals

Ride for one and half miles and then rest 90 seconds.  Ride for one mile and rest for 45 seconds.  Ride for a half mile.  Record you overall time.

View Mike’s video on the assault bike: https://youtu.be/8Y3rmX2cF3s

For more information on the many benefits of HIIT read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

Pushing For Performance

HIIT Methods: Sled Training

A good high intensity interval training (HIIT) session creates a disturbance of metabolic homeostasis while minimizing stress on the joints and / or compression of the spine.  Pushing a sled meets both of those goals.  Sled sessions are time efficient, and they have the added benefits of improving leg strength, core stability, and they make you better at nearly every daily challenge.  A well designed HIIT sled training protocol allows you to assess performance and track progress.  Presented below are four of my most frequently prescribed sled HIIT protocols.   Ditch the elliptical, cancel your Zumba sessions, and for the next month, give these a try.

I cannot tell you how much weight to use on the sled.  In general, men can start with bodyweight and women with half to two thirds bodyweight loads.  You will quickly learn if you have too much or too little on the sled.  Any progressive gym will have several sleds and plenty of open space.  The trainers at Fenton Fitness can get you started.

30 / 30 Protocol: Place a stopwatch so it is visible on the sled.  The load on the sled should create a thirty second interval exertion rating that feels “easy”.  Push the sled for thirty seconds and then rest for 30 seconds.  Perform eight intervals.

10 – 20 – 30 – 10 – 20 – 30 – 10 – 20 – 30 Yard Interval: Load your sled and start the timer.  Push the sled for 10 yards and rest twenty seconds.  Push the sled 20 yards and rest twenty seconds.  Push the sled 30 yards and rest twenty seconds.  Repeat 10, 20, and 30 yards two more times.   Finish all of the intervals and you will have covered 180 yards.  Record your time.

60 – 30 – 15 Yard Interval: Be careful that you do not use too much load for this HIIT sled session.  Push the sled 60 yards.  Rest thirty seconds.  Push the sled 30 yards.  Rest thirty seconds.  Push the sled 15 yards.  Record your time.

15 Yards Times Ten: Use a load on the sled that allows you to move at a fairly steady pace.  Think racehorse, not plow horse.  Place a stopwatch so it is visible on the sled.   Start the timer and push the sled fifteen yards.  Rest ten seconds and then push another fifteen yard push.  Perform ten, fifteen yard intervals.  Record your time.

View Mike’s video on sled training here: https://youtu.be/PfOccHMmzF4

For more information on the many benefits of high intensity interval training, read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

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