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Learn more about Rehab, Sports Medicine & Performance


In the April 2018 issue, Mike O’Hara discusses the benefits of the farmer’s walk exercise. Jeff Tirrell tells you how to reduce injury to your ligaments and tendons, and tips are given for getting back out into the garden.

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Discover the difference between muscle soreness following exercise activity and pain you should be concerned about in “Do I Have A Problem?”.  Jeff Tirrell gives advice for women on optimizing performance  and Mike O’Hara discusses training priorities for those over forty.

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Renegade Rows and SHELC

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.  

Renegade Row-SHELC Combo

Renegade Rows
The renegade row starts in the top position of a push up.  Rubber hex dumbbells work the best for this exercise since they do not move on the floor.  Place the dumbbells on the floor and position the hands on top of the dumbbells.  Try to align the dumbbells directly under the armpits.  Maintain a strong grip on the dumbbell handle during the exercise.  Spread the feet at least shoulder width.  Tighten the shoulder blades down the back and create total body tension.   Without allowing the torso to turn, row one dumbbell up so the thumb approaches the armpit.  Lower the dumbbell in a controlled manner and repeat with the other arm.  Perform five repetitions on each arm.

Supine Hip Extension Leg Curls
shelcSet the TRX straps so the bottom of the strap is at the mid-calf level of your leg.  Lay supine and place the heels in the foot straps of the TRX.  The feet should be directly under the overhead attachment point of the TRX.  Place the arms on the floor at a 45 degree angle.  Brace the abdominal muscles and keep the head down.  Push the arms against the floor for stability.  Lift the hips off the floor and keep them up for the duration of the set.  Bend the knees so that the feet travel toward the body.  Keep the hips up and extend the knees in a controlled manner.  Perform ten to fifteen repetitions.  Common mistakes are turning the feet outward and allowing the hips to fall toward the floor as the knees flex and extend.

The anti-flexion and anti-rotation core stabilization demand created by this pair of exercises produces some interesting next day abdominal muscle soreness.  The ability to link the hips to the shoulder and produce movement is what everyone tries to accomplish with functional training.  Move through three sets of the Renegade Row – SHELC combo and let me know how it goes.

View video of Mike performing these exercises here: https://youtu.be/2_fT0zShTSo

-Michael S. O’Hara, P.T., OCS, CSCS

WORKOUTFitness 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.

Punch the Clock
I am a big fan of what strength coach Dan John calls “punch the clock workouts.” Go to the gym with a plan and complete a quality training session that leaves you feeling good and not gassed. Eat well, sleep soundly, and repeat.

Keep it simple and well within your capacity to recover.
High intensity training routines are currently all the rage. The Tap Out, Insanity, Ripped in 30, P90x home fitness videos all operate at fairly high levels of exertion. It is difficult for anyone of average capacities to sustain that level of training on a consistent basis.

Competitive exercise protocols that involve performing “as many reps as possible” in a defined period of time are omnipresent on the internet. Competition creates a training environment that impedes good judgment. “Men will die for points” is a common quote that I hear in certain training circles.
As a physical therapist who treats exercise related injuries, I can state that pushing the exercise envelope and forty years plus is a dangerous combination. You may have another injury in you, but you may no longer have the capacity to fully recover from that injury.

In the long run, the guy or gal with the fewest “dings and dents” is the one who is able to remain in the fitness race. I like the idea of “user friendly” fitness activities. Training does not have to be complicated or overly intense. Get better at moving a weight or your body through three sets of eight, four sets of six, or two sets of twelve. Perform five or six exercises with your chosen set/repetition range. Take a long walk every day of the week. Consistency is King– eat, sleep, rest, and then repeat.

-Michael S. O’Hara, P.T., OCS, CSCS

treadmillFitness 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.

Manage Spinal Compression

As we age, changes occur in the joints, discs, and muscles that make up our spine. A lifetime of driving and sitting at a desk can create soft tissue restrictions and postural flaws. Statistically, the primary predictor for a future injury is a prior injury. By the age of 45, over 80% of the population will have lived through either a lower back or neck pain problem that was so severe it required medical attention. If you are older and have a history of lower back or neck pain, you should manage the level of spinal compression during your fitness program.

Compressive forces are at work on our spine from the moment we stand upright in the morning until we retire to our bed for a night of sleep. In the world of industrial ergonomics, we work to limit compressive forces that workers experience at the job site because we know increased compression produces more injuries. Recent dynamic imaging tests of lower lumbar and cervical spines placed under compressive loads have revealed surprising changes in disc dimension and spinal position. Rehabilitation and fitness professionals are now more aware than ever that the daily compressive forces our spines encounter is a major driver of pain and disability.

One third of our spinal length is made up of intervertebral discs—that is why we get shorter as we get older. Intervertebral discs are made up of compressible tissue. Under normal loads the discs can deform and then bounce back to their normal height, but inappropriate loading can damage the discs and alter their ability to absorb forces and create motion. Thinner discs create greater intervertebral joint stress and the environment for “wear and tear” breakdown of the spinal joints. Smoking, diabetes, and occupational sitting are some of the health and environmental factors that make you more susceptible to the damaging effects of excessive spinal compression.

Most people are unaware of the many fitness activities that create compressive forces on the lumbar spine. Treadmill running (greater if you hold on the treadmill handles), leg press, rowing machine, crunches, and leg lifts all create a compressive loading of the lumbar joints and discs. Be aware of the accumulated level of compression you place on your spine during a week of exercise. If you are uncertain which activities place a compressive load on the lumbar spine, you need to work with a physical therapist or an educated trainer.

-Michael S. O’Hara, P.T., OCS, CSCS

I am often asked about my fstir_the_potavorite “core exercise.” My response is Stir the Pot, an exercise I learned at a lecture given by spine biomechanics expert, Dr. Stuart McGill. Most people have never heard of this exercise, and I have never witnessed it performed in a commercial gym. It is a challenging drill that is worthy of your training time.
But first I need to make a disclaimer: If your training goal is to reduce the layer of fat across your abdomen and develop a six pack, the Stir the Pot exercise is far from the most beneficial exercise. The best exercise for that is the table push away. One strict repetition of the table push away, performed midway through each meal, is the only exercise that will make the six pack visible. If your training goals are to improve your posture, reduce back pain, and function more efficiently, try adding Stir the Pot to your training program.
The abdominal muscles operate as a team to reduce, not produce, spinal motion. They hold the torso upright and transmit forces from the lower to the upper extremities. You need to develop the isometric strength/endurance that enables the team of abdominal muscles to turn on, and stay on, for an extended period of time.

Stir the Pot Performance

You need a properly inflated physioball for this exercise. Place your elbows on the physioball with the shoulders directly over the elbows. Dig your toes into the floor and set the feet at least shoulder width apart. Lift up into a solid plank position—one long line from the ear to the ankles. Tighten up the gluteal muscles and the pull the shoulder blades down the back. The pelvis should not drop or rise up during the exercise—a mirror and some instruction can help with this common problem. Rotate the ball with the arms clockwise and then counter clockwise for five repetitions, each direction. Try to perform this exercise for time. Work up to sixty seconds of Stir the Pot, and as you get stronger, try elevating the feet on a bench.

-Michael O’Hara, P.T., O.C.S., C.S.C.S.

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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.



Do the Most Important Thing First and Do It More Often

Older gym goers have a work capacity “gas tank” that is smaller than their younger friends. Their neural and energy pathways give out sooner and take longer to recover. Older fitness clients need to place the most important training activities early in an exercise session before fatigue degrades performance. Make your weakest movement pattern the first one you train. If you lack mobility in a specific movement such as a squat, hip hinge, or lunge, train that first. Activities that demand more neural control, such as balance and power drills, should be placed early in the training session.

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In a recent article on interval training, I mentioned my preference for “Crash Free” training modalities. Since that article, I have gotten several requests for more information on training methods that produce an optimal metabolic response with limited biomechanical wear and tear. The long-term goal of any fitness program should be to enhance movement and keep you in the fitness game for a lifetime. Training should never accelerate joint breakdown or destroy your ability to move. Take the time to read the May 16, 2016 Wall Street Journal article by Allan Ripp, “The Accidental Running Guru.” These are my top five Crash Free Cardio choices.

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For injury prevention, athletic perforpower_productionmance, and general health, a regular program of lower extremity power training is beneficial. Traditional exercises that improve explosive leg power—jumps, hops, bounds, and skips—are too challenging for many fitness clients. Limited leg strength, poor balance, joint problems, and a high body mass index all make traditional plyometric training problematic. The assistance of a suspension trainer creates an environment that permits everyone to succeed in exercises that improve leg power.

Older fitness clients may not possess the balance to perform traditional plyometric power production exercises. The stability assist from the TRX is the balance “training wheels” necessary for beneficial jump, split jump, jump squat, and lunge exercises. The suspension trainer unloads an exercise and allows the client the opportunity to practice explosive movements with less joint stress. TRX power exercises require no set up time, and a full complement of explosive enhancing drills can be completed in five minutes.

Older fitness clients are in special need of training to improve leg power. Between the ages of 65 and 89 lower limb power (the ability to move the legs explosively) declines at a rate of 3.5% per year. Strength declines at a slower 1-2% per year rate in this same group. Power is the ability to create force in a short period of time and is different than raw strength. Lower extremity power capacity keeps us safe. It is the component of fitness that enables you to react and save yourself from a fall or sudden disturbance in balance. As leg power falters, injuries increase. As injuries increase, pain, mobility and independent living decreases.

Exercise is like medicine, administer the correct prescription at the proper dose and the patient thrives. The “exercise medicine” that is missing in many training programs is a consistent dose of power training. Watch the video for some examples of simple power production exercises you can add to your program.

-Michael S. O’Hara, PT, OCS, CSCS

To view a video demonstration of multiple exercises completed with TRX, click on the link below:


The holidays can be a very busy and stressful time.  We are consumed by travel, shopping, family, and eating which makes it difficult to maintain our usual exercise routine (if we had one to begin with). The combination of less activity, unlimited supply of high fat, high sugar, calorie dense foods, accompanied by higher stress levels is a recipe for weight gain.  While you can’t out exercise the kids’ Halloween candy or a pumpkin pie, extra energy expenditure in the form of intense exercise will help minimize the damage.  This exercise series will focus on ramping up your metabolism by incorporating time efficient workouts that use multiple muscle groups (the more used, the more calories burned) and keep you moving.

Try this last 20 minute workout on for size to help those pants fit this holiday season:

Butts and Guts

This workout is another simple one requiring only your body and 1 kettlebell (KB). Just like our Push/Pull/Jump workout in this series, we will use a timer. Pick a KB weight that 20 swings with will be very challenging. The two exercises are the KB Swing and  the Plank Jack. These two exercises compliment each other very well. While KB Swings work the grip, hamstrings, glutes, and entire back, Plank Jacks work the anterior core, hip flexors, triceps, and shoulders. This workout will run 15 minutes long. On the minute, for the entire 15 minutes, you will perform the prescribed reps of Plank Jacks and KB Swings. Whatever time is left for that minute will be used for recovery.

Advanced: 15 swings, 20 Plank Jacks on the minute for 15 minutes

Intermediate: 10 swings, 15 Plank Jacks on the minute for 15 minutes.

Novice: 10 swings, 10 Plank Jacks on the minute for 15 minutes

Click on the link below to see video demonstration of the Butts and Guts workout:

-Jeff Tirrell, B.S., CSCS, Pn1