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Facing Facts

“Giving up smoking is the easiest thing in the world.  I know because I’ve done it thousands of times.”–Mark Twain

smoking_twin_photoIn 1964, we started adding warning labels to packs of cigarettes.  Over the last fifty years, the cigarette smoking habit in America has gone from 42% of the population to 23%-19%–figures vary as a degree of “shame” now factors into cigarette smoking survey responses.  If we extrapolate the present rate of change out another fifty years, we can expect that at least 11% of the American population will be smokers in 2064.  Based on our knowledge of the massive health care costs related to smoking and our desire to keep all American citizens healthy, this rate of progress is unacceptable.

The tobacco companies spend 8 billion dollars a year marketing (promoting addiction) cigarettes to Americans.  By contrast, anti-smoking efforts spend less than 250 million dollars a year.  Thirty-two dollars is spent encouraging and cajoling Americans to smoke for every dollar spent on prevention.  Anti-smoking groups have attempted to get more graphic warning labels on cigarette packages, but these efforts have been blocked by tobacco company lawyers and judges.  One judge ruled that the new labeling requirement violates the tobacco companies’ “free speech rights”.  Federal District Court Judge Richard Leon blocked more graphic labels.  He feels the labels are “calculated to provoke the viewer to quit”.  Out-spent and out-maneuvered in the court system, I believe the only path to reducing cigarette smoking addiction is the use of ongoing education on the horrors of smoking and higher taxes and fees on cigarettes.

Click here or on the photo above and see how easy it is to identify the “most smokin’ twin”.  Do this test with your kids and make sure they understand that the damage they see on these faces is also happening to the rest of the body.

One of my biggest concerns is that the tobacco companies are going to become involved in the new trend of legalized marijuana distribution.  They have demonstrated the marketing skills to turn us all into stoners in less than ten years.

Michael S. O’Hara, P.T., OCS, CSCS

Super Recovery

Super Bowl Quarterback Peyton Manning

Peyton_ManningPeyton Manning, the Denver Broncos quarterback, will cap off a miraculous recovery from a serious neck injury with his appearance in the Super Bowl this weekend.   Mr. Manning has undergone numerous surgeries and procedures on his cervical spine.  The details of his medical treatment and rehabilitation are the topic of speculation on many sports talk shows.  We do know that he underwent an anterior fusion of his sixth and seventh cervical vertebrae.  An incision is made in the front of the neck and the two bones are fused together using screws and a titanium plate.  The fusion removes compressive forces off the nerve root that exits between the vertebrae and eliminates any movement between these two spinal segments.

Compression on the seventh cervical nerve root creates all kinds of problems for someone who throws a football for a living.  This nerve root carries the signals that fire the triceps muscle (back of the arm) and muscles that help grip the ball.  Trauma to the seventh cervical nerve root can cause loss of sensation in the fourth and fifth fingers of the hand.  Loss of neural control not only has an effect on muscle strength, but also on power production.  You need to be able to create muscle contractions quickly to throw a pass with any velocity.  If the signal that is sent down the seventh cervical nerve root is impeded by compression or inflammation, the pass will be slow.

There are risks associated with playing professional football with a fused cervical spine.  When you fuse the sixth and seventh vertebrae together, you lose about 10% of the range of motion in your neck and you also lose some of the shock absorption capacity in your spine.  The compressive forces and range of motion lost at the fused C6-7 segments are transferred to the vertebrae above and below the fusion.  In the general population, thirty percent of the patients who undergo a cervical fusion require a second fusion in 10 years.  I was unable to find a statistic on pro football players, but I am certain this percentage has to be much higher.

Cervical fusions are not uncommon in professional football, and 70% of the players who have a fusion are able to return to competition.  Mr. Manning plays at the high skill position of quarterback and his passing numbers this year have been amazing.  Win or lose this weekend, Peyton Manning, surgical medicine, and physical rehabilitation deserve applause.

Michael S. O’Hara, P.T., OCS, CSCS

30 Minutes Of Fitness

Remember, You Asked For It

“I don’t have enough time” is the big excuse people give for not exercising.  At Fenton Fitness,  we can get you in and out of the gym in thirty minutes.  Our movement based training sessions produce excellent results with minimal time commitment.  We program in high value exercise activities in a layout that produces optimal gains.  This is the first of six, 30 Minutes of Fitness, sessions.  The best workouts are short, intense, and frequent.  Intensity is usually the missing factor in most gym goers’ training sessions.

Session One
1.    Moving knee to chest mobility drill x 20 yards
2.    World’s Greatest Stretch x 20 yards
3.    Sled Push x 100 yards
4.    A. Push ups 3 x 8-12 repetitions
B. Inverted row or TRX row 3 x 6-10 repetitions.
C. Kettlebell Goblet Squat 3 x 6-10 repetitions.
5.    Medicine Ball Overhead Throws off wall 3 x 5 repetitions.

One and Two:  Perform the two basic movement preparation drills for twenty yards each.
Three:  Load your sled up with +/- 20% of your body weight and give it a push for 100 yards.  You can rest as needed, but try to get the entire 100 yards completed in less than five minutes.
Four:  You should be warmed up, breathing faster, and ready for some strength training.  Perform the next three exercises in a circuit fashion.  A set of push ups followed by a set of rows and then a set of goblet squats.  Between the different exercises, rest as little as possible, and then after you get through an entire circuit, you can take a longer 90 second break.  Repeat the circuit three times.
Five:  Work on power production with three sets of overhead medicine ball throws.  Use a weight that lets you throw a line drive and not a lob.
Choose the appropriate exercise variation and load for your strength exercises.

Session One Synopsis:
Effective mobility training.
Total body conditioning.
Twelve sets of strengthening exercises.
Explosive power training.

See the video for more information.

Michael S. O’Hara, P.T., OCS, CSCS

The Lazy Man’s VO2 Max

You’re In Pretty Good Shape For An Old Guy

VO 2 Max testing is a very useful assessment of fitness.  It is a measure of peak oxygen uptake and has been shown in large-scale studies to closely correlate with longer life spans.  Unfortunately VO 2 Max testing requires a physiology lab and a session on a treadmill that I can only describe as a nausea-inducing, up hill run while wearing a gas mask.  Recently a group of Norwegian researchers created a very accurate on-line calculator of VO 2 Max and fitness age.

The mathematical algorithms the calculator is based upon are from the physiology lab assessments of over 5000 Norwegians of every age from 20 to 90.  You simply plug in your age, sex, exercise frequency and intensity, resting heart rate and waist size in centimeters.  The computer will give you your VO 2 Max number (bigger is better) and fitness age (lower is better).

I have run the Norway VO 2 Max evaluation on several friends, fitness clients, and family members.  The results have been an education for everyone.  The need to exercise at higher intensity levels and reduce waist size was a surprise to many who took the test.  Take the time to plug in your data and get your score.

Evaluate your score here: http://www.ntnu.edu/cerg/vo2max

Michael S. O’Hara, P.T., OCS, CSCS

Huffin’ And Puffin’

Conditioning Sessions: Better Results, Less Time, And Fewer Injuries

sledFor most of the fitness clients I work with, long duration cardio training—thirty minutes on the treadmill, forty minutes on the elliptical, and any time on a recumbent bike is a waste of training time.  It does nothing to move them toward their fitness goals.  A far better choice is to perform strength training followed by a conditioning session.  Conditioning sessions are very different than long duration “cardio”.  Conditioning work is performed for short durations at high intensity.  You link different drills together in a series to produce a metabolism boosting session that lasts ten to twenty minutes.

Conditioning Benefits
Conditioning sessions speed up your metabolism–your body uses more calories just walking around, sitting, sleeping, etc.
It improves your capacity to perform functional tasks such as lifting, carrying, pushing, and pulling.
It is never boring–changing the stimulus changes your body.
Conditioning sessions maintain the physical properties we lose as we age–muscle mass, bone density, and power production.
Conditioning is time efficient–a properly designed session takes ten to twenty minutes and you are done.
You are far less likely to suffer an injury because you are not performing the same movement patterns for multiple hours every week.
Proper programming of a conditioning session will allow you train around an injury.
Conditioning can be scaled to any fitness level.
It is fun.

Conditioning Drawbacks
It will never–and should never–get easy.
You will need a new wardrobe because all of your pants will get looser.
You will not be able to watch TV while you exercise.
It will get you kicked out of Planet Fitness.

Since most gym goers are unfamiliar with conditioning training, we will be posting information on our favorite tools and a monthly conditioning session.  Give these a try and let us know how you do.

Michael S. O’Hara, P.T., OCS, CSCS

Everything Works–For Six Weeks

“The world hates change, but it is the only thing that has brought progress.”–Charles Keating

One of the most frequent complaints from gym members is that they exercise but see no results.  They ride the elliptical, lift weights, and Zumba three days a week, but they make no progress in how they look, move, or feel.  The common feature to almost all of these clients is that they have done the same activity at the same intensity for a prolonged period of time.  The human body is a master at adaptation, and the only way it will change is if you alter your exercise activity on a regular basis.

Novices can stay on the same exercise program for eight to twelve weeks and still see results.  More experienced trainees should alter their routine every three to four weeks.  Increase the weight you lift and lower the number of repetitions–four sets of five repetitions instead of three sets of eight.  Add in some balance challenging single leg training and discontinue the bilateral exercises you have used since high school.  Take a month and work diligently on improving a movement pattern that gives you difficulty.  If your conditioning is below average, program in a series of high intensity sled activities for four weeks.

Most programming changes make training more difficult and produce greater delayed onset muscle soreness.  This is all part of creating a new stimulus that the body finds challenging.  In a few sessions, the soreness will be gone.  In three or four weeks, the sessions will be less demanding and you will be ready for another alteration in the training cycle.

Many athletes and fitness enthusiasts would do well with taking two or three weeks away from training and focus on recovery and regeneration activity.  Elite athletes often schedule two or three periods of recovery into their yearly training plans.  Do not lift any weights, run, jump, or compete for a period of time.  Get plenty of sleep, and spend that time working on your soft tissue restrictions by using a foam roller or massage stick every day.  If you have tight hips, shoulders, or thoracic spine, dedicate this time to restoring motion at the restricted area.  A fourteen day rest period is often enough time to permit full physical recovery, but not so extended that you lose strength or endurance.  With full recovery, all systems will be able to respond much better once you return to training.

Change is good, but frequently neglected.  The best results will be produced with regular alterations of fitness programming.  See our trainers for information on a Functional Movement Screen Assessment and training program design.

Michael S. O’Hara, P.T., OCS, CSCS

What Women Need

Needs Are Different Than Wants

Rosei The RiveterI get to discuss fitness goals with women nearly every day.  They want to lose weight, get rid of musculoskeletal pain problems, have more energy, and “get arms like that girl”.  Many of them have been doing their favorite exercise activity for years and have been unsuccessful at achieving any of their stated fitness goals.  What they tell me they want to do is yoga, elliptical training, and Pilates.   What they need to do is start on a program of strength training.  

Ramping Up Your Metabolism
We all know that a body with more muscle burns more calories all day long.  You can get away with eating more food and not develop greater fat deposits.  Much more significantly, greater muscle mass positively influences fat metabolism, insulin levels, glucose processing, hormone profiles, and disease resilience.  These changes influence the “more energy” feeling you develop with strength training.  

Training To Abolish Pain
Nearly every patient that comes to physical therapy with a chronic pain problem has a glaring strength deficit that is perpetuating the pain.  They have gluteals, scapula retractors, or cervical stabilizers that are not functioning at a level that permit them to perform normal activities of daily living and remain free of pain.  What makes these patients better is a program of targeted strength training.  If you have chronic hip, knee, lower back, or neck pain, your best method of permanently resolving the problem is strength training.  

Bone Health
All of the current research says you need bone jarring, compressive, and aggressive loading of your skeleton to enhance or prevent further loss of bone density.  Over the last year, two government panels of experts have told us that taking more vitamin D and calcium does not appear to make any difference in bone density.  Better bone biology requires that the exercise stimulus be strong and consistent.  Low skeletal stress activities such as yoga, Pilates, and elliptical training do not create the forces needed to have a positive effect on bone density.  Read Bending the Aging Curve by Dr. Joseph Signorile.

Staying Independent
I am sorry Ladies, but muscle mass, strength, and power production all leave you at a far faster rate than your male counterparts.  It is not fair, but it is the truth.  As you age, training to restore these physical capacities becomes much more important if you wish to remain independent for a lifetime.  Ask any physical therapist who works with geriatric clients and they will tell you that weakness is the driver of debility.  The good news is that a properly designed program of strength training can work wonders.  

Motivational Goal Setting
Strength training provides motivation by having clear goals.  “I want to tone up” is not a clear goal.  Any psychology major will tell you that reaching defined goals reinforces positive behavior.  You improve from three to eight solid push ups, carry ten more pounds for fifty yards, press twenty pound dumbbells instead of tens, and it motivates you to stay with the program.  Numerous psychological studies have found that a lack of goal achievement is the number one reason people fail to succeed in staying consistent with an exercise program.  The girl with the arms you like has strength goals.  

Michael S. O’Hara, P.T., OCS, CSCS

The Scoop On Snow Shoveling

Preventing Driveway Disasters

snow shovelingEvery winter, in our physical therapy clinics, we treat numerous snow shoveling related lower back, neck, and hip injuries.  These patients shoveled snow one time and suffered pain so intense that it required medical attention.  All of these problems could have been avoided with some preparation, alteration of technique, and common sense.  

Athletes prepare for performance with a series of warm up activities specific to their sport.  A baseball player, soccer player, or boxer would never walk into a competition “cold” because they know the risk of injury is much higher if they do not warm up.  Despite this knowledge, almost everyone shovels snow without any type of physical preparation.  They pull on their coats, grab their shovels, and charge into an extremely challenging activity for their cardiac and skeletal system.  A snow shoveling warm up takes five minutes and can greatly reduce your chance of injury.  Try some of the exercises in the accompanying video to help you warm up for snow shoveling.  

Poor mechanics when shoveling snow is often the cause of spinal injuries.  Combining spinal flexion (forward bending) with loading (shovel full of snow) and rotation (twisting) is the ergonomic “perfect storm” for lower back pain.  When you lift a big scoop of snow and twist to throw it sideways, you create the force combination that can damage the lower lumbar discs and joints.  Push the snow, and if possible, avoid lifting and throwing.  Keep the spine long and straight and bend at the hips and knees so the legs can help perform the work.  Keep your arms wide on the handle and your neck relaxed.  Frequently switching the shovel to the other side spreads the cumulative loads evenly across the body.   The loads on the shovel should be manageable.  You are better off lifting less snow and working longer than lifting more and adding greater compression to the spine.  

Choose the right equipment.  Many snow shovels are just too heavy.  I recommend using a light plastic or aluminum shovel.  Some steel shovels can weigh well over nine pounds and this extra weight can create too much stress on your body.  Wear boots that prevent your feet from slipping.  You must be able to grip the ground to properly transfer force through the legs when shoveling.  Wear good gloves, and purchase a shovel with an end handle if you have any problems with grip strength or arthritis in the fingers or wrists.   

Finally, if the heaviest object you have lifted in the last six months has been the television remote, you should just hire someone to shovel the snow.  Shoveling snow is a demanding work activity that requires a moderate degree of fitness and good body mechanics to be performed safely.  One of the best reasons to exercise on a regular basis is that it enables you to safely perform tasks such as shoveling snow.  The vast majority of snow shoveling injuries happen to people who lead sedentary lives.  

Michael S. O’Hara, P.T., OCS, CSCS

Chair Check Up

How Functionally Fit Are You?

Image chair testCoaches, trainers, and scouts all want the number of inches in an athlete’s vertical leap test.  The athlete simply jumps up and taps a lever that indicates how many inches he or she can jump straight up off the ground.  This test has proven to be an excellent indicator of how well an athlete will perform in the competitive arena.  NBA players hit impressive vertical leap numbers, so we understand how simple it must be for them to elevate over the rim.  The equivalent test for the 60-year plus population is the Chair Stand Test (CST).  The score you get on the CST is a very reliable indicator of how well you will perform in the game of life.  

Leg power, strength, and lower extremity functional mobility are measured with the CST.  The ability to repeatedly move through the sit to stand transfer without the assist of the arms pushing down on the legs or the armrests of the chair is an important skill everyone needs to maintain an independent lifestyle.  An improved CST score creates carry over to other functional skills. Patients who improve their CST scores develop better gait patterns and standing balance.  

Chair Stand Test: You need a stopwatch, a stable chair with a 17 inch high seat, and an evaluator to monitor your performance and start and stop the timer
1.    Sit in the middle of the chair.
2.    Place your hands on the opposite shoulder with the arms crossed over the chest.
3.    Keep your feet flat on the floor.  
4.    Keep your back straight and your arms against your chest.  
5.    On the order “GO”, rise up to full standing and then sit back down.  
6.    Repeat for as many repetitions as you can in thirty seconds.  
7.    If you are halfway to a standing position when time expires, count that as a repetition.  
8.    Record your results and be concerned if you score below average.

The age adjusted scores for the CST listed below are a composite of the data gathered from several research studies since 2001.  The CST has proven to be a reliable assess-ment of fitness in older adults for over a decade.  Individuals who score below average on this test are more likely to suffer falls and require assisted care in their advancing years.  For the older fitness participant, knowing your Chair Stand Test score is just as important as knowing your blood pressure numbers. 

Men’s Results
Age                    Below Average       Average       Above Average
60-64                       < 14                   14 – 19                > 19
65-69                       < 12                   12 – 18                > 18
70-74                       < 12                   12 – 17                 > 17
75-79                       < 11                    11 –17                  > 17
80-84                       < 10                  10 – 15                 > 15
85-89                       < 8                     8 – 14                  > 14
90-94                       < 7                     7 – 12                  > 12

Women’s Results
Age                    Below Average       Average       Above Average
60-64                       < 12                   12 – 17                > 17
65-69                       < 11                   11 – 16                 > 16
70-74                       < 10                   10 – 15                > 15
75-79                       < 10                   10 –15                 > 15
80-84                       < 9                      9 – 14                > 14
85-89                       < 8                      8 – 13                 > 13
90-94                       < 4                      4 – 11                 > 11

Michael S. O’Hara, P.T., OCS, CSCS

Stand Up, Walk Around, And Read This Article

I have been ranting about how damaging hours and hours of sitting is for our fitness and overall health.  More research is validating my belief that all the driving, computer time, and television watching is going to keep physical therapists, cardiologists, and surgeons working overtime for the next twenty years.  It appears that going to the gym three times a week is not enough of a stimulus to counteract the bad that happens when you sit for eight hours a day.  What we need is more general physical activity interspersed throughout our day and less sitting.  Take the time to read this article, The Marathon Runner as Couch Potato written by Gretchen Reynolds from the New York Times, October 30, 2013.

Link to article: http://well.blogs.nytimes.com/2013/10/30/the-marathon-runner-as-couch-potato/?_r=0

Michael S. O’Hara, P.T., OCS, CSCS

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