Learn how to keep your spinal stabilizers strong by performing side planks. Mike O’Hara explains this in his article, “Learning to Lean”, and includes video demonstration and explanation of the importance keeping your stabilizers strong to stand up to the demands of daily life. It’s time for another Fenton Fitness Love Your Jeans Challenge–see page 3 for more information. In his article, “The Periodization of Nutrition”, Jeff Tirrell gives tips on optimizing dietary intake.
Movement You Should Master
Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer. Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body. An exercise that requires no equipment and has bountiful benefits is the Push Up.
Push ups strengthen the pecs, deltoids, triceps. They also allow free movement of the shoulder blades (unlike the bench press) and build stability in the core if done properly. There is no need to get overly fancy with these. If you can’t do a true push up with your chest touching the ground and your core locked in, start by elevating your hands instead of resorting to “girl” push ups on your knees. Guys should try to work up to 3 sets of 20 reps at least a couple of times/week. Women should strive for at least 10 reps but by no means need to stop there. Watch the video and give it a try: https://youtu.be/7oQ-_J8FjEU
-Jeff Tirrell, CSCS, Pn1
Movement You Should Master
Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer. Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body. An exercise that I have found to be essential for overall strength is the Deadlift.
At some point in your week, you will need to pick something up off the ground. If you have ever moved furniture or loaded your push mower into the back of your car for repairs, you have seen the value in this task.
Deadlifts are an amazing exercise to work the quads, calves, hamstrings, glutes, core, and entire back all the way up to the traps and forearms. As useful as deadlifts are, they are also one of the most butchered exercises in the gym. I would highly recommend the help of a skilled professional and/or a mirror before implementing this movement into your routine. I find that for the general fitness population, 2-3 deadlift variations are all you need for the bulk of your training. Watch the video and give them a try:
1) One Leg Romanian Deadlift (mimics picking up smaller items around the house or yard; minimizes shear forces on the spine)
2) Hex Bar Deadlifts (great for maximal strength and the occasion when you have to pick up something really heavy) Note: This version offers virtually all of the benefits of a barbell deadlift with slightly more freedom for individual anatomical differences and slightly lower shear forces on your spine.
View video of deadlifts: https://youtu.be/CRbbXOMSeww
-Jeff Tirrell, CSCS, Pn1
How Do They Know What Is Wrong Without An MRI?
This is a fairly common question in physical therapy. Patients with lower back, leg, neck, and arm pain know the test they need is an MRI. They have friends and relatives that tell them they should have an MRI. They are concerned that something is being overlooked and that the pictures from the MRI will make treatment more beneficial. I have some research information on the limitations of a spinal MRI.
In 1994, the *New England Journal of Medicine published a study on physician evaluation of lumbar spine MRIs. The MRIs of 98 asymptomatic individuals –-no pain, feelin’ good people, were found to have disc abnormalities (82% of the MRIs).
-52% had a bulged disc at one level
-27% had a disc protrusion
-1% had a disc extrusion
-38% had an abnormality at more than one disc
Since that publication, several other studies have backed up these results. Bulged, protruding, and extruded lumbar discs are a fairly common finding on a lumbar MRI. Changes in our lumbar discs are probably no different than the wrinkles on your face or the gray in your hair. Changes in a disc’s shape is not a indicator of pain problems
Another **MRI study of athletes revealed spondylolysis (vertebral fractures) are fairly common, yet less than 50% of the athletes with these fractures ever report any episode of lower back pain. It appears that lumbar spine fractures do not always produce pain.
In my years in the physical therapy clinic, I have received the MRI reports of many neck and lower back pain patient’s spines that show disc protrusions and foraminal stenosis on one side of the spine but the patient has all of his or her symptoms on the opposite side. I have treated patients with severe lower back pain and completely normal spinal MRIs.
MRI research has demonstrated that “abnormalities” in our spines are fairly common and difficult to accurately link to any specific pain problem. We do know that once a patient has an MRI, they are far more likely to progress to ***surgery. Please read, The Myth of Accuracy in Diagnosis, by Dr. Ron Fudala. In physical therapy, the resolution of a spinal pain problem starts with a history and thorough physical evaluation. Imaging tests are a small part of the “big picture” and often provide nothing but confusion.
*Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people with and without back pain, New Engl J Med. Jul 14
**Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med, 2000 Jan – Feb.
***Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003;28:616 –20.
Michael S. O’Hara, PT, OCS, CSCS
Standing desks are great for posture and health, but many people have difficulty when they first start using them. In this issue, Mike O’Hara, PT gives exercises that can help you stand for longer periods of time. Watch the video for instruction on these exercises. In his article, “The Biomechanics We All Need To Know, Mike agrees with the advice given by Stuart McGill. Be sure to read about Fenton Fitness Member Jan Pilar and her success with her program.
The New York Times recently reprinted an article by Jane Brody entitled “Posture Affects Standing, and Not Just the Physical Kind.” In the article, Ms. Brody talks about how poor posture creates problems across multiple areas of physical function. The respiratory, digestive, emotional, and neurological systems are all impacted by postural restrictions. You are even more likely to be a victim of crime if you have a slumped over posture. So how do you develop better posture?
Get Up Out of the Chair
Ergonomic chairs, elevated monitors, slanting keyboards, and lumbar supports are fine, but nothing works as well as standing up and walking around every fifteen minutes. Office modifications, while well-intentioned and generally a good idea, cannot compete with endless hours of desk sitting. In order to fight against the postural stress that creates pain, we need to get up and move. Everyone wants an exact number, so I suggest that after fifteen minutes of sitting, you stand up and walk/stretch for three minutes. The best advice is to get a standing desk and completely eliminate working in a seated position.
Perform Posture Correction Exercises Every Day
If you want to abolish the neural and connective tissue restrictions created by postural flaws, you need to work on it every day of the week. Two or three visits to the gym will not be enough. You need lots of repetitions over a long period of time to reverse the changes created by hours slumped over the desk or strapped in a seatbelt. Specific exercises that wake up your nervous system, strengthen your postural muscles, and reverse tissue shortening are required. It should take you no more than 90 seconds to complete one or two of the exercises listed below. Set a timer, enlist the help of your coworkers, and work at these exercises every day. See the exercise suggestions and video presented at the end of this article.
“This Feels Weird”
For most Postural Stress Disorder (PSD) patients, standing upright and sitting tall will feel abnormal. Their body positioning neural feedback mechanisms have been damaged by years of improper loading. Feeling better with a more upright and stable posture will take between six weeks and six months to achieve. Very often, “other sensations” go away fairly quickly– Migraine and sinus headache episodes are less frequent. That torn rotator cuff no longer creates shoulder pain. The arthritis in your hip is less problematic. The plantar fasciitis pain in your foot resolves. The pain symptoms caused by poor posture are far more widespread than most people realize.
You May Have To Avoid Certain Activities
Your gym program and recreational activities can make your posture worse. When you exercise, avoid movements or activities that pull your head and spine further into a forward bent position. The rowing machine and the exercise bike are often poor choices. If you have postural problems, do not perform sit ups, crunches, or any other repeated or sustained spinal flexion. Avoid exercises that shorten the muscles in the front of the shoulders such as bench pressing and flys. Most PSD sufferers sit too much, so refrain from any fitness activity performed in a seated position. The most important thing a good fitness coach can do for clients is put them on the path to postural integrity.
How Long Will it Take to See Changes?
Most physical therapy patients report that the exercises get easier and they feel better after three weeks. Postural correction is a long-term project and clients continue to see results twelve months after starting on a consistent program of postural retraining.
So What Do I Do?
The forward head posture of the average computer operator creates all kinds of adaptive tissue changes in front and in back of the neck. Some daily chin tucks can mitigate the damage. Stand at attention, pull your shoulder blades back, and push your chest forward. For many of you, this is going to be challenging. Place you finger tips on your chin and gently push your head straight back. Visualize your head being pulled upward by an imaginary string attached to the crown of your head. Hold for two counts and then release. Perform ten repetitions.
Office workers perform so many tasks with the arms forward and head down that they develop restrictions in the muscles in the front part of the shoulders and chest. Use a doorway stretch to reverse this adaptive shortening. Stand up with the elbows placed at shoulder level against the doorjamb. Step one foot forward through a doorway. Hold a gentle stretch for ten seconds and then lower the arms and rest. Perform two or three ten second stretches.
Overhead Back Bend
The sustained forward bent sitting posture tightens the front of the shoulders, inhibits thoracic spine extension, and can mess up your respiration. You can reverse all of these with some overhead back bends. Stand with the feet shoulder width apart. Reach the arms over your head and bend backward. Allow your hips to come forward and lean back into your heels. Breathe in through your nose and let your stomach rise. Breathe out through your mouth and let the abdomen fall. Perform three or four deep abdominal breaths while holding the arms overhead.
Standing Tubing Rows
Prolonged sitting weakens the upper back and shoulder retractor muscles. Standing tubing rows strengthens these muscles. Purchase an all-purpose band ($25.00) from performbetter.com and set it up in a door at work. Grasp the handles and stand tall with the arms extended and tension on the bands. Contract the muscles between the shoulder blades and pull the handles toward your body in a rowing motion. Hold the elbows back for two counts and then return to the starting position. Keep your neck relaxed during the exercise. Perform eight to fifteen repetitions.
View video of these exercises: https://youtu.be/KktwMew5Wks
Read the NY Times article here: http://well.blogs.nytimes.com/2015/12/28/posture-affects-standing-and-not-just-the-physical-kind/
-Michael S. O’Hara, P.T., OCS, CSCS
One of the best training tools is a set of all purpose bands ($25.00 from performbetter.com). These bands are a sturdy, dipped latex product made by Lifeline. They have two handles on one end and a loop system that makes them easy to anchor in either a closed door or around something stable and upright. The bands come in progressive resistance levels and can be integrated into many beneficial exercises. One of my favorite resistance band exercises is the posterior lunge and row.
I like exercise activities that produce a lot of benefit for the time invested in training. These are the big benefits of the posterior lunge and row:
In this month’s issue, Mike O’Hara discusses hypermobile joints and exercise, 4 steps to fitness success are given, and information on how to stop back pain from disturbing sleep is presented. Check out page three for a description of the latest class offered at Fenton Fitness– Suspension Shred.
In this issue, Mike O’Hara, PT discusses the importance of strong, well-functioning upper back muscles. Exercises, including video, are presented. Jeff Tirrell gives us ways to keep all those New Year’s fitness resolutions, and Mike gives fitness tips to make your program more successful.
For the last two years, Janet had been “bothered” by lower back and hip pain. When the symptoms made walking and getting out of bed difficult, she sought medical attention. Janet had X-rays and Magnetic Resonance Imaging of her lumbar spine that showed she had some arthritis and stenosis in her lower back. She, then, underwent ablation of nerves in her lumbar spine and injections into her sacroiliac joints. These treatments decreased the pain in the lower back, but pain in the left hip and sacral region persisted. Three months after her last injections, Janet was referred for physical therapy.
On her initial physical therapy evaluation, Janet had none of the pain that caused her to seek medical attention. She stated the pain was present in the morning and with prolonged standing. She could stand for no more than ten minutes when the pain would become so intense she had to sit down. Sitting for fifteen to twenty minutes would resolve her pain. Janet had good spinal mobility, excellent hip range of motion, and normal strength in both legs. Her core stability was limited to a poor grade, but otherwise, she passed all functional tests. On further questioning about her lifestyle and activities, Janet failed a big test.
Janet: I walk on a treadmill every day.
Physical Therapist: How long do you walk?
Janet: One or two miles.
Physical Therapist: I thought standing caused you to have pain?
Janet: I do not have pain if I hold onto the rails.
Treatment: Stop walking on the treadmill.
Janet was skeptical. After all, walking was good exercise, and she wasn’t in pain if she held the rails. How could something good for you perpetuate the pain? Janet, however, was willing to try anything to get rid of her pain, so she agreed to a one week break from the treadmill. Ten days later Janet was pain- free.
When you walk on a treadmill you perform 2,000-2,500 step repetitions per mile. With every step taken, you must decelerate and then accelerate one and a half to two times your body weight. Holding onto the rails or the console of the treadmill can easily add 10-15% more load through your spine and pelvis. A woman who weighs 135 pounds walks with a fifteen pound weight vest on her back when she holds onto the treadmill. Torso and pelvic girdle rotation is a key component of normal locomotion–watch any speed walker. Holding onto the rails restricts the free flowing, rotational component of gait. Thousands of repetitions of a restricted gait pattern, with extra load, performed on a daily basis, can create lots of pain problems.
Treadmill gripping is a common driver of pain problems. As is often the case, the pain is not experienced during the treadmill exercise session, so the patient does not connect the activity with the symptoms. Patients with head, neck, lower back, and leg pain symptoms often have this same well-intentioned exercise habit.
-Michael O’Hara, P.T., OCS, CSCS