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gait

Movement You Should Master

Step Ups

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 very helpful in restoring the capacity to get up and down off the floor is the Step Up.

Step Ups

The ability to go up and down steps will almost always be needed.  Losing this ability is a sure sign that one’s quality of life and independence are quickly fading.  Step Ups can be done in a variety of different directions and loaded a number of ways making them easily progressed or regressed based on goals and fitness level.  Step Ups improve balance and strength in the glutes, quads, and hamstrings.  Depending how you load, they can also challenge the core and shoulders.  The average step in the United States is 7 inches tall.  Strive to work up to a 14 inch box so that no flight of stairs will ever intimidate you.

Here Coach Katie demonstrates two different versions we like to use and the benefits of each along with some progressions.  Watch the video and give it a try: https://youtu.be/iGXtKyGlKMg.

1) Anterior Step up (Progression: Anterior Step Up with Racked Kettlebell hold)

2) Lateral Step Up (Progression: Lateral Step Up with one side loaded)

-Jeff Tirrell, CSCS, Pn1

 

Movement You Should Master

Weighted Carries

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 efficient and effective is a Weighted Carry.

Weighted Carries

Very few things are more functional than a carry.  You’d be hard pressed to get through daily life without having to carry something at least a few times per week.  While basic, a carry is an efficient and effective full body exercise.  Depending on the carry you choose, the load is virtually limitless.  Performed for time or distance, carries will always improve gait and core stability.  Depending on which version you use, they can also be an effective tool for improving shoulder mobility/stability, grip strength, balance, and overall awesomeness.  Watch the video and give it try: https://youtu.be/PaP4-IlVAOA

Coach Chad demonstrates my top four carry picks:

1) Farmers Walk (gait, core stability, grip strength, upper back, legs)

2) Suitcase Carry (gait, core anti-lateral flexion, grip, upper back, balance)

3) Waiters Carry (gait, core stability, shoulder stability, balance)

4) Double Waiters Carry (gait, core stability, shoulder mobility, shoulder stability, balance)

-Jeff Tirrell, CSCS, Pn1

 

Turkish Get Ups and Waiters Walks

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.   

Turkish Get Up and Waiter Walk Complex

How you move says more about your fitness than how you look.  The pairing of the Turkish Get Up (TGU) and Waiter Walk is an exercise complex that improves gait mechanics and the survival skill of getting up and down off the ground.  You will be performing a TGU and immediately move into a Waiter Walk so you need twenty yards of open space.  As you get stronger at this complex and use a heavier implement, some interesting things start to happen.  You get better at controlling respiration and have an intense focus on how your body moves during the TGU and Waiter Walk.  My yoga friends tell me this is the focus of their practice sessions: better respiration, improved motor control, and increased strength.

Turkish Get Up

t_get_upsThe Turkish Get Up (TGU) is generally performed with a kettlebell, but you can use a dumbbell.  A medicine ball can help teach body alignment to beginners.

Exercise activities that produce the greatest rewards are the ones that take the most time to master.  You can learn a barbell curl in five seconds but a TGU can take weeks to master.  Developing proficiency with the Turkish Get Up will require some patience and instruction, but for the time spent, the pay off is tremendous.  Complete instruction on the TGU is not possible in this short article.  Watch the accompanying video and work with a qualified trainer on this exercise.  Steve Cotter and Gray Cook both have excellent YouTube tutorials on the TGU.

Waiter Walk

You must have adequate shoulder range of motion and good balance to perform this exercise safely.  Hold the kettlebell overhead like a waiter carrying a tray.  Keep the chest proud and the neck relaxed.  The upper arm should be adjacent to the head and your walk should be smooth and free of any lean or limp.

Complex
I like to train TGU rookies with a soft Dynamax ball.  If they drop the ball it will not damage any aspect of their anatomy.  Balancing the ball on the hand tends to teach proper alignment.  Progress to a kettlebell as you become more proficient.  Start on the floor and perform the TGU ascent.  Once at the top of the TGU, perform a Waiter Walk for twenty yards and then lower back down to the floor with a TGU descent.  Switch the implement to the other side and repeat.  Perform two trips on each side.

When you perform this complex, strive to move more gracefully before adding more resistance.   Get up and down off the floor and walk in a coordinated and efficient manner.  Only then increase the load of the ‘bell.

View video of Mike performing these exercises herehttps://www.youtube.com/watch?v=s0U9GWMI4bU&t=8s

-Michael S. O’Hara, P.T., OCS, CSCS

Fitness training for those of us past 40 years of age is more complicated.  Physical performance and recovery capacity is dramatically different.  If you need proof, look around 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. 

Walk Your Way into a Better Gait Pattern

How well you move says more about your age and fitness level than any aspect of appearance. Walking is the fundamental functional activity we need to maintain in order to stay healthy and independent for a lifetime.  Your fitness program should make your gait more symmetrical, efficient, and graceful.

shutterstock_298057595Simple observation of gait patterns (how you walk) is one of the best evaluation tools a physical therapist has to lead him to the cause of your pain problems.  Restrictions in stance time, stride length, and propulsion with one side of the body create the stress that drives pain in the upper back and shoulder.  Limited torso rotation causes greater stress in the lower leg and early onset degenerative breakdown in the knee.  The tight hip that does not fully extend is the culprit behind your plantar fascitis.

Thirty years ago, a wise physical therapy instructor of mine told me my treatment program was only successful if it “enhances the patients’ ability to walk.”  Most fitness training is devoid of any activity that improves the gait pattern.  Despite more talk about “functional fitness,” the majority of training programs address the body as individual parts instead of an integrated whole.  Split (upper body on one day and lower on another) and body part training (arm day) artificially divides training stimulus and blunts the neural benefits exercise has on our movement skills.

Training that improves your gait pattern requires some open space and enlightened coaching.  Activities that improve your walk are taxing on the neural system, so they should be performed early in the training session.  The best results are achieved with consistent feedback and ongoing activity progressions.

-Michael S. O’Hara, P.T., OCS, CSCS

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

“You can observe a lot by watching.” 

-Yogi Berra

Chris logged 25 to 30 miles a week running on the roads.  He had completed well over forty marathon races and could be found nearly every weekend at a 10 kilometer run.  In March, he started having lower back and then right knee pain during his runs.  He moved off the road and started using a treadmill, but the pain persisted.  He tried switching between biking and running, but the pain did not go away.  After three months of self-treatment, he was referred for physical therapy by his family physician.shutterstock_109581608

The only time Chris had the pain was when he was running.  Symptoms began after approximately ten minutes of running and were particularly painful whenever he had to run downhill.  During his musculoskeletal evaluation, we could not recreate Chris’s pain.   He demonstrated good range of motion, normal strength levels, and he had no neural tension problems.  We put Chris of the treadmill, and after five minutes of running, his problem became obvious.  With every right foot strike the knee collapsed inward, the hip joint fell into extreme internal rotation, and the pelvis dropped.  Chris could not feel his running gait deteriorate, but the changes were glaring.  Ten minutes of running on the treadmill in front of the mirror, and he was convinced.  We both knew what had to be fixed.

All parameters of fitness must be at optimal levels to run distances and stay injury free.  Managing tens of thousands of repetitions of joint loading on a daily basis can easily create tissue overload and pain symptoms.  The first sign that a runner is heading toward a pain problem is when his or her running gait starts to deteriorate.  Forty thousand strides a week with excessive internal rotation and not enough hip extension will eventually take a toll.  The good news is that nearly all gait changes are detectable by simply watching how you run on the treadmill.

You do not need a computer with infrared sensors or force plates in your shoes.  You just need a big mirror.  Position the treadmill facing a mirror.  You need to be able to see your feet hit the treadmill when you run.  Start up the treadmill and work up to your training tempo. Keep your eyes open and look for these problems.  Be patient as many of the worst problems only show up after muscles start to fatigue.

Valgus Knee

If after foot strike the knee rolls inward during the stance phase, you have a problem.  For many runners this deficit can be extreme.  Distance running with valgus knees earns you the early knee replacement medal.

Vertical Displacement

Efficient runners are smooth runners.  The more you move up and down the more shock you must attenuate when you land.  Runners with poor strength and endurance often start out smooth and finish bouncy.

Unequal Stride Length

As fatigue sets in, one leg moves well and the other starts to exhibit a stride restriction.  It is not uncommon to witness a 20% decrease in stride length.  Stride asymmetry causes all sorts of tissue tension problems in the lumbar spine and pelvic girdle.

Tilt

This covers all of the head and torso positional changes:  The head leans to one side, shoulder rotation is full on one side and absent on the other, one side of the pelvis is up and the other down.  Watch the finish of any 10 kilometer run.  Nearly everyone has some tilt.

Most recreational runners do not like to pay attention to any aspect of their training.  Their time on the road is a form of mental relaxation or mediation.  Many people who run for exercise actually hate running, and they watch television while on the treadmill to counteract the boredom.  My suggestion is to spend some portion of your training evaluating how well you are moving.  Stop swearing at Chris Matthews and Bill O’Riley while you run and do something that will actually help improve your performance.  Be more mindful of your gait and make corrections before the pain starts.

Chris was able to return to running after three weeks of manual therapy and corrective exercise.  He has set up a mirror in front of his home treadmill and reports the results have been revealing.

-Michael O’Hara, P.T., OCS, CSCS

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