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Modern medicine has lengthened our lives, but unfortunately, many older people physically deteriorate to a level that makes them vulnerable to minor health setbacks.  Frailty is a syndrome marked by weakness, poor mobility, a slow gait, and excessive fatigue.  Frail individuals are unable to adequately recover from physical activity or a challenge to their health.  Minor illnesses send them to the hospital, nursing home, or assisted living center.  Frail individuals are often unable to tolerate beneficial medical procedures and must live with pain and physical restrictions.  Frailty is a problem that responds very well to treatment.

In the 65 year old plus population, frailty syndrome is common.  Fifteen percent of the non-nursing home population is frail and forty five percent is pre-frail.  Frail individuals are far more likely to fall.  Forty percent of the frail and twenty two percent of the pre-frail individuals are hospitalized every year.  Frailty is a marker for adverse health outcomes and a means of identifying opportunities for intervention in patient care.

Physical activity has been shown to be the best preventative and treatment for frailty.  Patients bounce back from surgery much better if they under take a program of prehabilitation exercise prior to surgery.  Research on rehabilitation has demonstrated the benefits of exercise to restore strength and mobility in the frail population.  Take the time to read, One Last Question Before the Operation: Just How Frail Are You? by Paula Span in the October 27, 2017 issue of the New York Times.  Read the article here: https://www.nytimes.com/2017/10/27/health/elderly-surgery-frailty.html

In the senior population, fitness activities must focus on training that maintains functional mobility and an independent lifestyle.  You need to stand up and train to be a more graceful and competent walker.  Practice drills that improve your capacity to transfer from the floor to standing.  Always include balance and reaction exercises that keep you free from falls.  Foremost are strengthening activities that maintain bone density and restore capacity to lift, carry, push, and pull.

Michael S. O’Hara, PT, OCS, CSCS

* New York Times, One Last Question Before the Operation: Just How Frail Are You? Paula Span, October 27, 2017

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Horizontal Presses

The Horizontal Pressing variations primarily work the pectoral musculature, anterior deltoid, and triceps.  The rotator cuff musculature plays a stabilizing role.  As we progress through this series, the core musculature, particularly the anterior core and glutes play even more of a stabilizing role.  The strength of the stabilizers will be your limiting factor on these movements, not the prime movers.  These movements can be performed on the floor, bench, or incline bench.

DB Bench Press: Set up with both feet planted firmly on the floor, slightly wider than shoulder width apart.  Lie down on the bench bringing the dumbbells to your shoulders as you do.  As soon as you are lying down, press the dumbbells straight up.  Try to keep your elbows at roughly 45 degrees from the side of your body.

Alternating DB Bench Press: With the same setup as the DB Bench Press, start with both arms extended straight and dumbbells touching. Lower one arm at a time keeping the other arm fully extended. This variation builds endurance and promotes stability in the chest, triceps, and shoulder muscles.

One Arm DB Bench Press: Performing a DB Bench Press with one arm really engages the core and stabilizer muscles in the chest. This is a great exercise for athletes as they are often required to throw, shoot, or hit a ball with one arm and this variation mimics that motion. Set up in the same position as the previous variations except only use one dumbbell. The other arm can extend out to the side or rest on the stomach. Lower the one arm down slowly and make sure to extend fully at the top, avoiding the tendency to lean to the opposite side.

Contralateral DB Bench Press: This variation of the dumbbell bench press requires the core to brace and stabilize while having one hip flexed and the other extended (just like it would be when throwing a ball). With one dumbbell that is lighter than one you would usually use for pressing, lay flat on the bench and bring the leg up on the same side as the dumbbell. Bend the knee at a 90 degree angle, flex the hip, and dorsiflex the ankle. The other foot is firmly planted on the floor. Place the free hand on the stomach or straight out to the side for balance. The core should be braced and the low back should be pressing into the bench as you press the dumbbell straight up just as in the other variations.

Watch video of press progressions here: https://youtu.be/4ihkyIOXi4g

With the start of a new year, many of us will be making the resolution to return to the beneficial habit of exercise.  We will purchase treadmills, rowing machines, recumbent bikes, Yoga DVDs, running shoes, or perhaps join a gym.  We set off with an iron will and a fierce determination to reach our fitness goals.  Sadly the statistics are against us.  Most of us will not stay compliant with the exercise habit past mid February.  Dr.Jordan Metzl wrote an excellent *article in the New York Times on how you can improve your chances of making the exercise habit “stick”.  Give it a read and send the article to your friends.  View the article here: https://www.nytimes.com/2017/12/19/well/move/this-year-make-your-fitness-resolution-stick.html?_r=0

Michael S. O’Hara, PT, OCS, CSCS

*This Year, Make Your Fitness Resolution Stick, Dr. Jordan Metzl, New York Times. 

Remember What You Wrote

Things I’ll Do Differently When I’m Old

Steven Petrow of the New York Times wrote a great article, Things I’ll Do Differently When I’m Old.  As a physical therapist that has guided thousands of 60 year plus individuals through the rehabilitation process, I have some suggestions.

I will work with a professional on developing a sustainable fitness program.  The preventative against age related physical decline is a program of exercise.  Consistent exercise reduces fall risk and maintains independence.  No other modality has a greater impact on health.  Blood sugar levels, respiratory capacity, mental health, and cardiac fitness all respond favorably to exercise.  Do not be a fitness “do it yourselfer”.  Older, deconditioned, and previously injured individuals get much better results when under the direction of a qualified professional.   One way or the other, you are going to spend time and money on your health.  Spend it up front–you will be much happier.

I will not let pain linger. Pain is not a “normal part of aging”.  Chronic pain alters brain chemistry and destroys healthy movement patterns.  Left untreated, pain has the capacity to weaken and spread damage to joints not involved with the initial pain provocation. See a physical therapist and find out what you can do to resolve pain issues before they become chronic.

I will exercise caution with medications that have an effect on the central nervous system.  Many older people take multiple medications that impact brain neurochemistry.  More brain real estate is devoted to movement than reading, writing, and arithmetic.  A steady diet of pain medications, sleeping pills, and anti-depressants takes a toll on coordination, balance, and the ability to safely get around town.  Add in a cocktail or three and you have a dangerous combination.

I will make a sustained effort to recover from any and all physical challenges.   As we travel through our senior years, most of us will experience a health setback that requires rehabilitation.  Full recovery of strength, mobility, and function takes eight to twelve months.  Many physical therapy patients stop all rehab efforts way too soon.  More of the rehabilitation battle is being fought in isolation as reimbursement for physical therapy care is shrinking.  You may be done with formal physical therapy in four weeks, but you need to continue with a restorative exercise program for much longer.

I will not get fat.  Physical therapy patients that are overweight have much more difficulty recovering from an injury or a challenge to their health.  Sarcopenia is the medical name given to age related loss of muscle mass.  Adding extra fat onto a body that is losing muscle creates an environment that makes movement more difficult and pain more prevalent.

I will listen and answer all questions from my health care provider to the best of my ability.  The answers we get from the patient are the clues that lead us to the proper care.  We need to know how your pain / symptom behaves and the effect it has on your life.  Please do not omit any information that you feel is not important or unrelated to your condition.  Do not lie about any aspect of your functional status, medications, mental health, etc…  Your therapist, doctor, or physician assistant cannot help if we do not have all of the information.

I will plan ahead.  In my dealings with older physical therapy patients, these are the three things that make life easier for both the patient and their families.  Do what you can to manage these issues while you are healthy and clear headed.

  1. Have a Will with end of life directives.
  2. Insurance coverage that reduces the expense of long-term care.
  3. Pre-planned funeral services and insurance

Michael S. O’Hara, PT, OCS, CSCS

Read the NY Times article here: https://www.nytimes.com/2017/12/05/well/family/thing-ill-do-differently-when-im-old.html?_r=0

 

Olympic Lifts–Do We Really Need Them?

Hang Snatch

 

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise is the Hang Snatch.  Watch the video, give it a try, and let us know how you do. View the video here: https://youtu.be/TrOhhKLIpqA.

The Hang Snatch, like the Hang Clean, is a better, easier option to learn than the full Snatch or Power Snatch.  Again, you start from the standing position.  We teach the Hang Snatch with a Hang Clean grip.  The traditional grip of the Snatch is much wider and places much more stress on the shoulders.  It is done to reduce the distance the bar must travel so you can increase the load you are able to use.  If you are not competing in Weightlifting, however, this doesn’t matter.  Once you are ready for the Hang Snatch and have the required shoulder mobility (can you touch your fingers behind your back?), it is the best power movement out there. The lighter loads used on this exercise compared to the Hang Clean make it an even friendlier exercise on your spine and the longer bar path requires more power output.

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Hang Clean

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise is the Hang Clean.  Watch the video, give it a try, and let us know how you do.  See the video here: https://youtu.be/KupitKep6Lk

The problem with the traditional Clean and Power Clean is that many people have trouble getting into a good position to start the movement.  The Hang Clean eliminates this problem by starting from the standing position.  It only requires a small amount of hip movement, yet still produces a great deal of power.  A good goal for your hang clean is to do the same amount of weight as your 1 rep max bench press.  If you can’t get there, you need more cleans and less bench work.

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Push Press

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise is the Push Press.  Watch the video, give it a try, and let us know how you do.  See the video here: https://youtu.be/1pI4eb6lMYQ

The Push Press is a limited, less technical, portion of the Clean and Jerk weightlifting movement.  It’s a great alternative as it has been shown to increase power but is much simpler to teach.  As long as you possess adequate shoulder mobility, there is much less risk with this exercise.  If done properly, both the hips and shoulders produce a large amount of vertical force which has strong carryover to sports that require jumping and overhead activities (throwers, volleyball, etc.).

-Jeff Tirrell, CSCS, CFSC, Pn1

 

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

Olympic Lifts–Do We Really Need Them?

Plyo Push Ups

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise: Plyo Push Ups.  Watch the video, give it a try, and let us know how you do. View the video here: https://youtu.be/C0A0dibCmqE

Plyo Push Ups are a great horizontal power exercise for the upper body that simultaneously improves core stability. Pushing has obvious carryover for most sports and tends to be more on the speed side of the power spectrum. It can be easily progressed by adding a weight vest (use caution while performing this exercise due to force on the wrists).

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Split Jumps

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise: Split Jumps.  Watch the video, give it a try, and let us know how you do. See video here: https://youtu.be/yahWPNE0C-k

Those who have worked up to Split Jumps know it is a tremendous power exercise.  It challenges balance and puts the individual in a split stance which has much more carryover to running and cutting on the athletic field.  Split Jumps can be increased in difficulty by adding load (DBs or KBs in the hands or a weight vest) or by elevating the back foot.

-Jeff Tirrell, CSCS, CFSC, Pn1

 

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