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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

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

Eat More Protein

rg1024-eggsSince the onset of Nutrition Coaching here at Fenton Fitness, a very common problem has surfaced.  People are not eating enough protein.  Most people think they are getting enough, but in most cases, they are wrong.  The current recommendations for optimal body composition, recovery, health, and performance are anywhere from 0.5g/lb of bodyweight up to 0.8g/lb of bodyweight. The biggest issue?  People aren’t sure how to get more protein or what foods have the most bang for their buck.  As a general tip, try to include some sort of dense protein food at each meal (at least 20g and up to 60g).

Listed below are my top picks for protein dense foods and how much you need to get the recommended 20g-30g in a sitting:
-Eggs (4 whole eggs=24g protein)
-Lean beef (4 oz.-under 10% fat)
-Poultry (4 oz. chicken, turkey, duck, goose, etc.)
-Lean Pork (4 oz. lean ground, pork chops)
-Fish (4 oz. salmon, tuna, tilapia, etc.)
-Greek Yogurt (1 cup= about 20g)
-Cottage Cheese (1 cup=26g)
-High quality protein supplement (Whey preferred, with minimal fat and carbs)
-Beef or Turkey Jerky (convenient, but limit as sodium is high)
-Tofu (men may want to avoid this as it contains soy which can elevate estrogen levels)
-Beans (1 cup black, garbanzo, kidney, black-eyed peas, etc.)
-Milk (1 cup cow or goat- plant based milks are lower in protein)

Jeff Tirrell, B.S., CSCS, Pn1

Mr. V had pain inman_falling his lower back and right hip. The problem had been present for over a year and he had been diagnosed with spinal stenosis. He was sent for physical therapy by his family physician because he was having difficulty climbing the stairs and walking in his home. Mr. V was 78 years old and lived with his wife Miriam. Miriam reported that her husband had mild dementia and had fallen three times over the last month. Mr. V stated that he often felt dizzy when he got out of bed, but he was not sure why the falls happened. Miriam stated that they did not bother to tell the doctors about these falls.

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pain_meds
One of the best reasons to develop the habit of fitness is that it can reduce your reliance on medications. It makes my day when fitness clients inform me that they have been able to discontinue a medication because of the improvement in their blood pressure, lipid, or sugar levels. Pain relief medications are no longer necessary when joints and muscles work more efficiently. Exercise has been shown to work as well or better for the treatment of depression. The quality of sleep is enhanced and brain neurochemistry improves when you exercise on a consistent basis. The habitual performance of exercise is the most effective method of reducing medications.

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A Landmine is a simple modification of the use of an Olympic bar. The bar is anchored onto the floor at one end and you lift the free end of the bar with the load of your choosing. At FFAC, we have five landmine set ups that can be used with either a standard 45 pound Olympic bar or a 15 pound half_kneeling_landmine_presstraining bar. One of the best push pattern strengthening activities is the Half Kneel Landmine Press. Take a minute to read this article and then give this exercise a place in your training program.

Hip to Opposite Shoulder Core Connection
Your shoulder girdle works together with your opposite side hip through an interwoven series of muscle and fascia known as your core. The power in a punch and the speed in a fastball are generated from the hip and travels through your torso to your shoulder girdle. Training activities that enhance this hip-torso-opposite shoulder connection will help you function better during daily activities and athletics. Pressing in a half kneeling position creates that hip to shoulder connection.

Trigonometry Training
The force created by the load on the landmine decreases as you raise the bar off the floor. At a forty-five degree angle, the force drops by 15% and as you push the bar upward to a sixty degree angle it falls to 30%. One hundred pounds becomes 85 pounds at 45 degrees and then 70 pounds at 60 degrees. This gradual reduction in force is helpful in clients who have limited overhead shoulder girdle stability and less than optimal core strength. They are able to be successful in training a single arm push movement pattern and use the half kneeling landmine single arm press as a bridge to more challenging drills.

Shoulder Saver
Pressing directly overhead is a beneficial exercise but a vast number of fitness clients and athletes do not possess the shoulder anatomy or mobility to press overhead and maintain a healthy and pain free shoulder. The athlete involved in high repetition overhead sports such as pitching in baseball, serving in tennis, and or swimming should be wary of loading an overused movement pattern. If you have a prior history of shoulder rotator cuff problems or impingement issues, you may want to rethink pressing directly overhead. The landmine press is a hybrid exercise that requires the gluteal and core stabilization of an overhead press but reduces shoulder stress by changing the angle of the pressing movement.

Injury Prevention
Performance asymmetries make us more susceptible to injury. The half kneeling landmine single arm press will quickly reveal right versus left performance deficits. If you notice six repetitions are easy with the right arm but you are barely able to perform four with the left, you need to work on resolving that asymmetry.

Half Kneeling Landmine Press
You need a landmine attachment for an Olympic bar and an Airex pad to cushion your knee. Load the Olympic bar on one end and set up with the bar directly in front of the right side of your body. Assume a half kneeling position facing the end of the Olympic bar. Place the right knee down on the Airex pad and the left foot directly in front of the left hip. Both knees should be bent to 90 degrees flexion. Place the end of the Olympic bar in the right hand and grip the bar tightly. Grip the floor with the toes of the right foot and the entire left foot. Contract the gluteal muscles and brace the abdominal muscles. Make a strong fist with the left hand and tighten the left shoulder. Keep a tall and tight torso as you push the bar up with the right arm. Keep the elbow underneath the end of the bar during the press. Hold for two counts at the top of the press and then lower with control. Repeat for five to ten repetitions. Switch leg positions and perform the exercise on the left side.

 -Michael S. O’Hara, PT, OCS, CSCS

To view a demonstration of the half kneeling landmine press, click on the link below:

Half_Kneeling_Landmine_Press

For the last three months, I have been performing a workout finisher recommended by Strengthbear Coach Dan John. This event consists of only two activities: a bear hug carry with a sandbag and a crawl. I worked this routine into my training once a week and the results have been great. My recovery capacity has improved, and I have been able to progress to wearing a weight vest during this finisher. Every spring, I return to sprint intervals and this year I had none of the hamstring and old man hip soreness that bothered me in the past. My kettlebell swings have improved and I travel through a series of snatches with less fatigue. I attribute this to my ongoing performance of the crawl-carry finisher.

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PITCHER ISSUES
A True Baseball Insiders Safety Suggestions.Eric_Cressey

Mr. Eric Cressey is a strength coach who specializes in making baseball players better athletes. He rehabs and develops multiple millions of dollars worth of throwing arms. Eric has worked with baseball players at all competitive levels and is the ultimate insider. Mr. Cressey is an “in the trenches” coach that has witnessed how the present system is operating. I have heard him speak on four different occasions. He is articulate and always informative. If you are a baseball player, or the parent of a baseball player, Mr. Cressey has some suggestions on how to stay healthy.

Take the time to read his January 3, 2016 blog, Preventing Shoulder Injuries: Actions Speak Louder Than Words. I often send parents of injured baseball players to Mr. Cressey’s site for the valuable information they have not been hearing.

-Michael S. O’Hara, PT, OCS, CSCS

View Cressey Article

A Landmine is a modification on the use of an Olympic bar. The bar is anchored onto the floor at one end with a Landmine device and you lift the free end of the bar with a load of your Landmine_Ichoosing. At FFAC, we have five landmine set ups that can be used with either a standard 45 pound Olympic bar or a 15 pound training bar. These are the reasons to use a Landmine.

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Babe_Ruth

Daniel Norris, a pitcher for the Detroit Tigers recently suffered multiple spinal fractures during an attempt at the clubhouse “box jump record” (See the Detroit Free Press article link below). He will be out of the line up recovering from his 57 inch leap for glory. The popularity of the YouTube, uber high, box jump has been great for the physical therapy business and terrible for athletic performance. Please take the time to read my article on appropriate box jump training. (See link below).

Professional athletes are no different than the general population in the mistakes they make in training. Pro basketball players have fractured arm bones falling off a physioball while bench pressing. A professional tennis player recently created an ankle avulsion fracture jumping onto a bosu. I witnessed a high level fitness trainer tear his Continue reading

I recently had the opportunity to hear a presentation on the latest and greatest in running research. The presenters used sophisticated computer software to measure the forces runners created with every foot contact. The variance between runners was dramatic. Some glided along with minimal evidence of foot to ground interaction and others shook the earth. The numbers did not coincide with greater bodyweights or sex. Some of the heaviest individuals ran with minimal impact and some of the more svelte runners were thunderfoots. Men did not necessarily land harder than women. What researchers did find is that high impact runners are far more likely to suffer an overuse injury.

Not everyone has access to force plates to measure ground force reactions, so how do you know if you are a high impact runner? The advice the researchers gave was to listen. The individuals with the hshutterstock_109581608ighest force plate impact numbers were the ones who produced the most noise when they ran on a treadmill. After analyzing over 200 runners, the students and researchers were able to easily predict force plate results based on the noise they heard during the treadmill warm up.

Distance running is a very high-level fitness activity, and you must have all performance parameters functioning at optimal levels to avoid injury. If you fail the treadmill listen test, then work on developing a smoother and less stressful gait pattern. Landing lightly has a big impact on staying healthy and pain-free while running. Take the time to read the February 10, 2016, New York Times article by Gretchen Reynolds, “Why We Get Running Injuries (and How to Prevent Them).”

Click on the link below to read the article:

http://well.blogs.nytimes.com/2016/02/10/why-we-get-running-injuries-and-how-to-prevent-them/?_r=0

-Michael S. O’Hara, P.T., OCS, CSCS

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