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Learn more about Rehab, Sports Medicine & Performance

health

Biomarker Reminder

Drs. Evans and Rosenburg are Tufts University researchers interested in the measurable parameters that keep humans healthy and fit over an entire life span.  They have determined that the top four biomarkers are:

  1. Muscle Mass.  The percentage of your body that is made of muscle.
  2. Strength.  Can you use that muscle to push, pull, lift and carry.
  3. Basal Metabolic Rate.  The number of calories your body expends at rest.
  4. Body fat Percentage.  What percentage of your body is composed of fat.

The authors named these top four biomarkers, the decisive tetrad.  They are the prerequisites to maintaining healthy numbers in all of the other essential biomarkers.

  1. Aerobic Capacity
  2. Blood Sugar Tolerance
  3. Cholesterol / HDL ratio
  4. Blood Pressure
  5. Bone Density
  6. Internal Body Temperature Regulation

Drs. Evans and Rosenburg coined the term age related sarcopenia in their 1991 book Biomarkers.  It refers to the gradual loss of muscle mass that occurs as we age.  The keys to aging well, staying durable–no injuries, and maintaining control of all health parameters is maintaining or improving muscle mass / strength and eating properly.  An ongoing program of strength training and nutritional discipline are the foremost components of fitness and health.

Michael S. O’Hara, PT, OCS, CSCS

Ladder Matters

Moving well is a combination of balance, coordination, strength, and power.  During everyday tasks, you must be able to plant, pivot, and shift your bodyweight over one leg to change directions or decelerate an impact.  Movement is a skill that we all take for granted until the day that it fails us.  “I can’t believe I can’t do that,” is commonly heard from people in physical therapy.  They are unaware of the level of motor control they have lost to age, injury, and a sedentary lifestyle.  The good news is that with some consistent training, most motor control skills can be restored.  For gym members, an excellent method of enhancing movement skills is the agility ladder.

Agility ladders help you move better.  How you move says more about your age than how you look.  Responsive legs that can react to a disruption in balance keep you durable and injury free.  Consistent agility ladder training develops the neural coordination that allows more graceful movement.

Rotation is the movement pattern that creates the distance in your golf drive, the pop in your punch, and the acceleration in your sprint.  Rotation is the missing movement pattern in most training programs.  Ladder drills improve cross body, shoulder, and hip rotation.

Ladders are the rehab bridge that allows the injured athlete to move from a controlled series of movement patterns to the chaos of competition.  Ladders are one of the best power production and injury prevention activities older clients can perform.

As a conditioning method, I call ladder drills “three-dimensional jump rope”.   Move through a few sixty second intervals of continuous ladder drills and your body heats up, respiration increases, and your metabolism is disrupted.  Ramp that up to 90 seconds and check your heart rate.  See video of agility ladder drills: https://youtu.be/CmLXGLeyGfE

Michael S. O’Hara, PT, OCS, CSCS

Heat Or Ice For My Shoulder?

Try Standing Upright

In the gym, at the golf course, and during a visit to the hardware store, I am asked my advice on abolishing shoulder pain.  What everyone wants is the magical exercise, miracle ointment, or newest thermal treatment.  What they need–and what they do not want to hear–is that they have to fix their horrible posture.

Sustained poor posture can alter the function of your shoulder complex.  The shoulder girdle has only one, very small, bone to body connection.  The entire system is an interconnected series of muscles and ligaments.  Sustained slouched over postures create a faulty length-tension relationship in these structures that places adverse stress and strain on the four joints of the shoulder and the nerves in the neck and upper back.

OMG I sit lmGm (like my GrandMa).  

Shoulder posture pain problems are happening earlier.  I do not know if it is more tech toys, less physical education in schools, or a change in youth activity levels, but in the physical therapy clinic we are seeing younger people with older people postural shoulder pain.  They sit on the treatment table in extremely slouched over positions and are unable to pull themselves up into a correct position.  Most are unconvinced that how they sit and stand could be the generator of their pain problem.

What exercises can I do?

Stronger muscles will help restore posture.  The shoulder evolved to pull, lift, and carry.  The muscles that keep the shoulder strong and happy are in the back of the shoulder.  They hold the shoulder in a healthy position on the body.  Most of us never perform any pulling or lifting activities other than hoisting our laptop or toting our smart phone.   Making your shoulder girdle muscles stronger will help, but being mindful of your posture during the day is the most important factor.  Physical Therapist and US Soccer Team Trainer Sue Falsone says “You can’t out rep poor posture.”

Start with how you work and live.

Eight hours a day for five days a week equals 2080 hours of computer / desk time a year for the average office worker.  Add in a daily one hour car commute and another two hours of television a day and we push the Monday through Friday slump numbers to 2860 hours a year (120 days).  We have spent millions on state of the art chairs, elevated monitors, slanting keyboards, wrist rests, and lumbar supports.  Office modifications, while well intentioned and generally a good idea, cannot compete with 2860 hours (this number is probably low) of sitting in a year.  In order to fight against the postural stress that creates pain, we need to get up and move.

Recent research on prolonged sitting has demonstrated that the amount of movement we need to stay healthy is greater than we once thought.  To combat the adaptive changes of prolonged sitting, it is suggested you get up and move every twenty minutes.  Set a timer, enlist the help of your coworkers, and work at this every workday for a month.  I believe you will be surprised by the results.

Michael S. O’Hara, PT, OCS, CSCS

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

FAT LOSS NUTRITION QUIZ

FAT LOSS NUTRITION QUIZ

The primary goal of most fitness clients is altering body composition.  They want to lose fat and gain muscle and they know they need to change dietary habits.  Everyone knows the optimal nutritional menu choices.  The stream of weight loss dietary advice has been endless.  Fitness magazines, newspapers, Dr. Oz, Oprah, and hundreds of websites have been serving up dietary fat loss advice for decades.  I like to use my fat loss nutrition quiz to prove my point.  If you can pass this quiz, you know all you need to know in regards to eating for fat loss.  The question that needs to be answered is “What would motivate you to make changes in your eating habits?”

1. Eating a fresh green salad every day.
Very Bad          Bad          Good          Very Good
2. Eating a fresh green salad with half a bottle of Ranch Dressing slathered on top.
Very Bad          Bad          Good          Very Good
3. Eating nothing but salad.
Very Bad          Bad          Good          Very Good
4. Eating a serving of fresh fruit every day.
Very Bad          Bad          Good          Very Good
5. Eating Fruit Loops every day.
Very Bad          Bad          Good          Very Good
6. Having a four ounce glass of wine with dinner.
Very Bad          Bad          Good          Very Good
7. Having a fourteen ounce tumbler of wine with dinner.
Very Bad          Bad          Good          Very Good
8. Eating breakfast every morning.
Very Bad          Bad          Good          Very Good
9. Waking up in the middle of the night and eating.
Very Bad          Bad          Good          Very Good
10. Consuming 120 grams of protein every day.
Very Bad          Bad          Good          Very Good
11. Consuming 12 grams of protein every day.
Very Bad          Bad          Good          Very Good
12. Having an apple as a snack.
Very Bad          Bad          Good          Very Good
13. Having an apple pie as a snack.  
Very Bad          Bad          Good          Very Good
14. Planning and preparing meals ahead of time.  
Very Bad          Bad          Good          Very Good
15. Eating whatever is in the refrigerator.
Very Bad          Bad          Good          Very Good
16. Keeping a daily food log.
Very Bad          Bad          Good          Very Good
17. Keeping Oreos in the house.
Very Bad          Bad          Good          Very Good
18. Consuming 1600 calories a day-women, and 2200 calories a day-men.
Very Bad          Bad          Good          Very Good
19. Having absolutely no idea of how many calories you consume in a day.  
Very Bad          Bad          Good          Very Good
20. Eating foods of as many different colors as possible.
Very Bad          Bad          Good          Very Good
21. Eating only brown, beige, and black colored food.
Very Bad          Bad          Good          Very Good
22. Meals made exclusively from fresh produce.
Very Bad          Bad          Good          Very Good
23. Meals made from the contents of a cardboard box.
Very Bad          Bad          Good          Very Good
24. Post training session rehydration with water.
Very Bad          Bad          Good          Very Good
25. Post training session rehydration with beer.
Very Bad          Bad          Good          Very Good

I have never had anyone fail this test.  The “What do I eat?’ answer is really that simple.  Do not fret over dietary minutia–clean up your big nutritional mistakes.  Do some planning and preparing and exercise consistently.  The results will follow.

Michael S. O’Hara, PT, OCS, CSCS

Aging Muscles and Exercise

Fast Reaction and Helpful Hormones

New technology has produced some surprising information on the cellular response of muscle to various types of exercise.  Super blood analyzers and computers have enabled scientists to monitor gene expression and hormonal release in muscle cells during and after sessions of exercise.  The information from this research is revolutionizing our understanding of optimal exercise prescription for health and longevity.  It appears that older individuals derive the most beneficial muscle cell response with fairly intense interval training sessions.  Please take the time to read Gretchen Reynolds article in the New York Times, The Best Exercise for Aging Muscles.

Dr. Martin Gibala, a professor at the kinesiology department at McMaster University in Hamilton, Ontario recently released an outstanding book, The One Minute Workout.  Dr. Gibala explains the science behind high intensity interval training (HIIT) and why it is safe and effective for older fitness participants.

Skeletal muscles produce beneficial biochemicals called myokines that stimulate a response in cells throughout the body.  Myokines are a fairly new scientific discovery and we have only recently begun to understand their remarkable effect on human physiology.  Myokines enhance blood vessel development, promote beneficial hormone levels, stimulate greater mitochondria production, and improve the metabolism of fat.  In the older individual, myokine levels are enhanced with strength training and high intensity interval training.

The best method of creating more of the beneficial myokine biochemistry is to consistently perform some progressive resistance training followed by a brief but intense interval training session.  This regimen of training is similar to that of track athletes involved in sprinting.  These athletes have high levels of muscle mass and very low body fat levels.

Michael S. O’Hara, PT, OCS, CSCS

Read the NY Times article here: https://www.nytimes.com/2017/03/23/well/move/the-best-exercise-for-aging-muscles.html

I hate cigarette smoking.   I find most smokers also hate cigarette smoking but they are unable to quit the habit.  Smoking is a menace as dangerous and deadly as cell phones and driving.  Every now and then, we need to be reminded of the enormous burden cigarette smoking creates on our country’s health system.   Take the time to read The New York Times article by Nicholas Bakalar entitled “A New Death Toll for Smoking.”  I have some suggestions on how we can eradicate the cigarette problem in America.

Triple the tax on all tobacco products and use the revenue to pay for medical care and research.  Currently, 19% of the USA population admits to smoking (the true number is probably closer to 25%) and conservative estimates are that tobacco users add another 210 billion dollars a year to our health care costs.

Toughen the penalties for selling tobacco to minors.  Most people develop the smoking habit before adulthood.  Young, and not always forward thinking, minds are more susceptible to the allure of smoking and the advertisements from the tobacco industry.  Gram for gram, nicotine is the most addictive chemical on the planet and it produces a physical withdrawal that most people are unable to overcome.  The tobacco companies know this and they need Americans to start smoking early and often.  After all, their product kills most of their best customers.  Let us make a greater effort to stop this habit before it starts.

Outlaw every aspect of tobacco advertising—no exceptions.  No signs in stores, no displays, no magazine ads, no anything.  Shame any actor that smokes in a film, television show, or performance.  Young people emulate their heroes and those actors have a responsibility.   Tobacco is a horror that should have been dealt with years ago.  Spend some time with a patient afflicted with esophageal, tonsil, tongue, or oral cancer and you will understand.

Read the NY Times article here: https://www.nytimes.com/2016/11/01/health/smoking-deaths-cancer.html?_r=0

-Michael S. O’Hara, P.T., OCS, CSCS

PDFStanding 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.

Download Here

Advice from the Experts at Fenton Fitness

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#2—Throw out your bathroom scale.

shutterstock_214236508Weighing yourself on a daily basis is a counter-productive, and possibly unhealthy, activity.  It does nothing to enhance health and tracking the number on the scale tells you very little about your ability to move, your overall health, or your level of fitness.  Body dysmorphia issues start early and can generate habits that are harmful to your health.

The numbers from the bathroom scale are often misleading.  A great program of exercise will add a few pounds of muscle and subtract a few pounds of fat, so the number on the scale will not move.  The client will be stronger, fitter, have a faster metabolism but still becomes discouraged because the scale numbers have not gone down.  A horrible program of exercise removes equal amounts of muscle and fat.  It produces a weaker body with a suppressed metabolism, but the client is pleased with lower scale numbers.  In many ways, the perseveration on bodyweight numbers sets you up for failure.

-Mike O’Hara, Physical Therapist for the last 32 years.  Fitness coach and board certified orthopedic specialist 

See what advice Fenton Fitness member Bruce Walker has to give here: https://youtu.be/pOH6XQva2wE

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?_r=0

Health and Ergonomic Assist Gift That Get Used

I have some fitness and health promoting ergonomic gift recommendations for the 2016 holiday season.  I have used all of these products and have been happy with the results.  Most can be purchased on line and this allows you to devote more time to a fitness program.  In the tradition of all great holiday shoppers, I like to get one for me and another to give.

Personal Training
Giving a healthy holiday gift is easy at Fenton Fitness and Athletic Center.  Our Christmas gift certificates can be used for any of the training programs at the club.  Team training classes and personal training packages make great gifts.  Numerous studies have shown that individuals who utilize professional guidance are more successful in reaching fitness goals.  No one performs exercises correctly after only one training session.  You need ongoing evaluation and progression on proper exercise performance.  Older and physically limited individuals need the assistance of a trainer more than any other group.  Our team of trainers and physical therapists can help everyone reach their fitness goals.

Jungle Gym XT Suspension Trainer
The creation of user-friendly suspension trainers set off a mini revolution in fitness.  If you go into a fitness center and they do not have multiple suspension trainers readily available, you need to find a new gym.  The Lifeline Jungle Gym XT is an elegantly simple and extremely versatile device that should be a part of every home gym.  Suspension trainer exercises can be scaled to any level of fitness and are a valuable weapon in our fight against age, injury, and occupational stress.  At $90.00, the Jungle Gym XT wins the price war and, in my experience, it has worked well in both commercial and clinical conditions.

Aerocart by Worx
worx-toolsGardening and landscaping activities are responsible for many of the referrals to physical therapy.  The afflicted gardener has tweaked a lower back or strained a knee after hoisting a heavy object or spending too much time slumped over the flowerbeds.  A single ergonomic tool can help remedy both of those problems.  The Aerocart from Worx is a gardener’s Swiss Army Knife.  It functions as a lightweight wheelbarrow, handcart, rock lifter, snow plow, pull wagon, and gardening stool.   The Aerocart costs $140 and you can get a snow plow- my favorite- and the wagon attachments for another $100.  I have used this tool to push snow, haul firewood, rearrange rocks, and move soil.  The fact that the bucket does not hold mega volume prevents a user from overloading his spine.  This device will extend the gardening career of the avid weed puller on your Christmas list.

All Purpose Bands From Perform Better
One of the best strength training devices is a set of the All Purpose Bands.  These bands are sturdy dipped latex products 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 a stable upright device.  All Purpose Bands can be used in a home gym set up, but my suggestion is that you anchor a set in a door at work and fight off the debilitating stress of all day sitting with some daily rowing, hip hinging, and scapula retraction exercises.  A set of All Purpose Bands costs $25.00, and as your strength improves, you can purchase the next level of resistance in the series (light—purple, pink, orange, yellow, blue, black—strong) from performbetter.com.

Varidesk Conversion Desk
standing-desk-pro-plus-36_main-10a88d7d8eef66cbc9309ff1100d93b41Human physiology was designed to function under the physical demands of standing and walking.  Much of the now rampant obesity, heart disease, diabetes, and metabolic syndrome can be linked to our species’ sudden fall into sustained sitting.  The health statistics on the damaging effects of sustained sitting are distressing.

I can think of no better health-promoting gift for a loved one than a sit to stand conversion desk.  The product I have the most experience with is the Varidesk.  It comes pre-assembled and has functioned flawlessly.  It allows the user to sit for some portion of the day and gradually transition to greater time in the standing position.  The Varidesk comes in a variety of sizes / set ups and costs $375 to $550.

My First Stand Up from Jaswig
The New York Times recently reprinted an article by Jane Brody, “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 and mental well-being.  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?

My suggestion is to start with early intervention in the form of a standing workstation.  The Belgian company Jaswig, has produced a standing desk for children.  As the child grows, this adjustable wood desk travels with him.  In our physical therapy clinics, we are seeing younger people with head, neck, and upper back pain problems related to poor posture.  Mobile phones, laptops, tablets, and all the other “devices” are being used at earlier ages leading to the postural breakdown that usually occurs in later years of life.   The My First Stand Up workstation from Jaswig (cost $379) is the early intervention answer.

PowerBlock Adjustable Dumbbell Set
Dumbbell training is one of the most effective forms of exercise.  The big limitation of dumbbell training is the cost of buying a series of varying dumbbell weights and the space required to store 10 – 15 sets.  The PowerBlock company has solved this problem.  A set of PowerBlocks occupies less than three square feet of your home and, depending on the size you purchase, replaces 10 – 25 pairs of traditional dumbbells.  I have put some heavy use on a set of PowerBlocks that I purchased in 1992.  They have functioned flawlessly and show minimal wear.  A beginner set of PowerBlocks (5-40 pounds) costs from $300 – $330 and you can add expansion sets as you get stronger.  My thirteen-year old self would have loved to get a set of PowerBlocks for Christmas.

Hyper Vest
Most people have busy lives and limited time to devote to fitness.  They want to get stronger, improve mobility, and maintain some degree of conditioning with minimal time commitment.  For those people, I have a suggestion: Buy a Hyper Vest Pro and get to work.

I have used the Hyper Vest Pro for many years and can vouch for its durability.  The comfort and overall function of the Hyper Vest Pro is impressive.  The side lacing system makes the fit superior to other weight vest products.  The individual weights are small and spread evenly over the front and back of the vest.  Ten pounds of small steel plates are standard with the Hyper Vest Pro.  I have found fitness clients do well with vest loads between five and twelve pounds.  At $160, the Hyper Vest Pro is more expensive than other products, but the first rate fit and comfort make it worth the money.  It is a great holiday present for the fitness fanatic on your shopping list.

Roller
gridx_matrix1If you consistently exercise, one of the best things you can do to enhance recovery between sessions is perform foam rolling soft tissue work.  Combining foam roll work with mobility drills is the secret fitness ingredient that makes chronically tight individuals more flexible.  The older you are, the harder you work, and the more frequently you train, the more you will benefit from the foam roll.  I like the roller made by Trigger-Point (tptherapy.com).  They come as a short, 13 inch version for $40.00 or the longer, 26 inch roller for $65.00.

-Michael S. O’Hara, P.T., OCS, CSCS

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