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In our May issue, Mike O’Hara discusses the importance of walking.  If you have pain or difficulty with walking, there are things that help.  Mike demonstrates some exercises to get you ready.  Be sure to read Jeff Tirrell’s article on squatting, and read about Afterburn–a new class at Fenton Fitness that uses heart rate monitors while training.

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Triathlon Success: Hamstring And Glute Togetherness

To keep a triathlete healthy and resilient, the hamstrings and gluteal muscles must work together as a team.   The athlete fires the gluteals and hamstrings simultaneously to stabilize the pelvis and produce force through the lower leg.  When you run, bicycle, or swim, these muscles work at a team to produce efficient propulsion and reduce stress on the lumbar spine and knee.  A triathalon is the ultimate long duration physical endeavor.  Triathletes need hamstrings and gluteal muscles that can stay on and strong for a long time.

Most fitness programs do not properly train the muscle of the posterior chain.  Fitness center exercise generally involves training the hamstrings as knee flexors on some type of “leg curl” machine.  Gluteal training rarely occurs past neutral hip extension, with little effort on improving overall hip range of motion.  Any type of seated gluteal training is inappropriate for an athlete.

The term physical therapists and strength coaches use for butt muscles that are non- responsive is “gluteal amnesia”.  Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the gluteal muscles.  We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement.  Many fitness clients and most physical therapy patients need some remedial gluteal training.  Give these three drills a place in your triathalon training program.

Single Leg Bridges

Lay supine with the arms braced against the floor to stabilize the upper body.   Bend the knees and place the feet flat on the ground.  Lift the right leg up off the ground.  Using the muscles in the back of the left leg, lift the hips up off the ground.  Push up through the heel of the left foot and drive the left hip into full extension.  Hold at the top for three seconds and then lower in a controlled manner.  Perform ten repetitions on each leg.  Common mistakes are allowing the pelvis to tilt and not fully extending the hip.  Hamstring cramping is an indication that you are not using the glutes enough and need to focus on creating a better mind to butt connection.

Goblet Squat

The squat movement pattern is a skill that is easier to teach if you add some load.  You can use either a dumbbell or a kettlebell for this exercise.  It has been my experience that the exercise is easier to learn with a kettlebell.  Hold a kettlebell by the horns, with the elbows down, and the kettlebell close to the chest.  Keep the chest proud and pull the abdominal muscles tight.  You may have to experiment with foot placement as everyone has different hips.  The position you would place the feet if you were going to jump is a good starting point.  Initiate the squat by pushing back the hips.  Keep the torso tall and descend.  Let your pelvis fall between the hips. The elbow should drop down between the knees.  Nothing will inhibit your progress more than thinking about how you are moving during goblet squats.  Keep your brain quiet and get in some repetitions.  Effort has amazing capacity to improve motor control.   Perform ten repetitions.

Mini Band Monster Walk

Your will need a mini resistance band–a nine inch loop of resistance band, (two dollars from performbetter.com).  Most fitness clients will do well with a green or yellow mini band.  Place the mini band loop around both legs just above the ankles.  Assume an athletic stance with the feet straight ahead, knees bent, and hips flexed.  The band should be held taught throughout the exercise.  Imagine your feet are standing on railroad tracks.  Walk forward for ten steps on each side, keeping the feet over the railroad tracks.  Walk backward for five repetitions on each leg.  Try to keep the hips and shoulders level throughout the exercise.

Once you have mastered all three exercises, build your gluteal and hamstring performance by traveling through the program for two or three trips.

  1. single leg bridges  R and L x 10
  2. goblet squats x 10
  3. mini band monster walk x 10 each leg

View video of the exercises here: https://youtu.be/QeteeLPF4AU

Kat Wood, DPT, ATC

Triathlon Success: Core Connection

In the fitness world core stability training has gained a solid foothold and more people are getting away from spinal damaging resisted twisting machines and the ever present sit up gizmo.  Most people know how to perform a “plank” exercise and have added this drill to their fitness routines.  Learning how to properly brace the core stabilizers and perform a sustained plank type isometric exercise will resolve back pain, improve the hip to shoulder girdle connection, and make you a better movement machine.  The problem is most people never advance beyond the basic plank exercise.  Triathletes need significant anti-rotation and anti-extension core strength and endurance.  I have three drills that will help keep you strong and resilient in your quest to complete you first tri.    Read the directions and give these activities a place in your fitness program.

Alternate Single Arm Planks

Position the body in a toes and elbows plank, but separate the legs so the feet are wider than the shoulders.  Lift one arm up at a 45 degree angle in relation to your body and hold for five seconds.  Lower the arm back down and try the other arm.

If you are unable to perform the alternate arm plank on the floor, regress the exercise by placing the hands on a bench in a push ups position.  Lift one arm up at a 45 degree angle in relation to your body and hold for five seconds.  Lower the arm back down and try the other arm.  How many and much?  Perform three to five repetitions on each arm.  Work up to longer hold times instead of more repetitions.  Five repetitions on each arm with a ten second hold is a good goal.

Pallof Press

You need a cable machine or resistance tubing set at mid torso level.   Position your body at a 90 degree angle in relation to the pull of the cable.  Assume an athletic posture with the feet at least shoulder width apart and the spine neutral.  Push the hips back a little and keep a slight bend in the ankles and knees.  You should look like a tennis player preparing to return an opponent’s serve.  Use a strong overlap grip on the handle and set the hands in the middle of the chest.  Brace the midsection and hips and move the handle out in front of the body and then back to the chest.  Select a resistance level that permits execution of all repetitions without losing the set up posture.  If one side is more difficult, start the exercise on that side.  Perform fifteen repetitions on each side.

Many of us have terrible respiratory patterns.  We are unable to fully inhale and exhale when under any physical stress.  The Pallof Press can be used to improve respiratory control.  Use the same set up and press the cable out.  Hold the cable with the arm fully extended while inhaling for four seconds and exhaling for six seconds.  Bring the arms back in and then repeat.  Perform four of five inhale / exhale respiration repetitions on each side.

View the video here: View Video

 Michael S. O’Hara, PT, OCS, CSCS

Triathlon Success: Hip Flexor Function

Two of the most important muscles for efficient running and a pain free set of knees are not visible in the mirror.  Most people have never heard the names of these muscles.  Located deep inside the body, covered by innards and all too often, layers of mesenteric fat, these muscles labor unloved and forgotten.  Triathletes interested in optimal performance and a body that remains injury free should give some attention to the iliacus and psoas muscles.

Anatomy

Five muscles flex the hip–bring your femur forward.  Three of the hip flexors attach to the front of your pelvis and run down the front and sides of your thigh.  They are the sartorius, tensor fascia latae, and the rectus femoris.  Two of the muscles attach to your spine and posterior pelvis and travel across all of the lumbar vertebrae, the sacroiliac joint, and the front of the hip joint.  They are the iliacus and psoas muscles.  The sartorius, tensor fascia latae, and the rectus femoris can lift your femur to parallel, 90 degrees hip flexion, and no further.  The iliacus and psoas are responsible for lifting the hip above parallel.  Many people have very weak iliacus and psoas muscles and are unable to flex the hip above 90 degrees.

Multi Joint Control

“Hip flexor” is a very simplistic description of the function of the iliacus and psoas muscles.  The iliacus and psoas flex the hip, but they also rotate the hip, stabilize the pelvic girdle / lumbar spine, decelerate hip extension and co-contract with a team of muscles to hold us upright.  Properly functioning iliacus and psoas muscles keep the pelvis stable when you walk or run and this mitigates stress on the knees and lower back.  When the iliacus and psoas muscles are weak, the pelvis tilts forward and backward.  This rotates the femur in and out and twists the knee.  Your knee joint likes to bend back and forth and dislikes any extra rotation.  Extra knee rotation wears out the back of the kneecap (patella) and places stress on the supportive cartilage (medial and lateral meniscus) of the knee.  A triathlete with a wobbly pelvis places significantly more stress on their lumbar spine.

Triathalon Considerations

Riding a bike shortens and neurologically anesthetizes the iliacus and psoas muscles.  A tight psoas muscle compresses the lumbar vertebrae together and increases pressure in the lumbar discs.  Athletes with “quad strains” often have pain in the sartorius and rectus femoris muscles that has been brought on by overuse of these muscle as they compensate for a weak iliacus and psoas muscles.  Tight and inhibited iliacus and psoas muscles are responsible for the wobbly gait pattern you frequently see as the triathlete transitions from the bike to the run.  Two drills that will improve the function of the iliacus and psoas muscles are listed below.  Read the directions and watch the video.

Standing Hip Flexor Isometric

The Standing Hip Flexor Isometric drill functions as both an evaluation and a method of restoring iliacus and psoas function.  If you struggle with this exercise, you need to spend some time and effort on improving the performance of your iliacus and psoas.  Listed below is a description of the exercise and several activity regressions and progressions.

You need a box or exercise bench.  The taller you are, the higher the bench.  Six feet tall, try a bench that is 24 inches high.  Five foot, four inches, try a twelve inch box.  A mirror for visual feedback is helpful.  Stand with the right foot on the bench and the left foot on the floor.  Hold a pvc pipe, broomstick, or golf club overhead.  Brace the abdominal muscles to keep a tall spinal position and tight lordosis (inward curve) in your lower back.  Lift the right foot off the bench by pulling the thigh up with the muscles in front of the hip.  Hold the foot off the bench in a solid and stable position for five seconds and then lower.  Do not let the position of the spine change.  Do not bend the left knee or tilt the pelvis.  The only joint that moves is the right hip.  Athletes should be able to lift and hold the right knee 30 degrees above waist level.  Start with sets of three repetitions and alternate sides.  As you get stronger, increase the duration that you hold the foot up to ten  seconds.  If one side is weaker than the other, perform more repetitions or an extra set on that side.

Bench Assisted Hip Flexor Stretch

This drill will improve hip extension range of motion and enhance mobility in all of the hip flexor muscles.  Bicyclists often have very flexed lumbar spines and limited lumbar and/or hip extension.  This mobility exercise is the antidote for the physical restrictions created by too much time in the saddle.

You will need an exercise bench or a padded chair that is 12 to 16 inches tall.  Place a cushion or Airex pad directly in front of the bench.  Set up with the left foot on the floor in front of the Airex pad and aligned with the left hip.  Place the right knee on the Airex pad and the front of the right foot up on the bench.  Stay tall through the spine and hold the position for twenty to thirty seconds.  For many people this will be enough stretch.  If you are able take the arms overhead.  Work further into the movement by bending the front knee and moving forward.  Repeat on the other side.

Video of these exercises can be found here: View Video

 Michael S. O’Hara, PT, OCS, CSCS

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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In the February issue of our newsletter, Mike O’Hara discusses ways to improve hip mobility and strength.  Read Jeff Tirrell’s article on why dairy products may actually be good for you.  Having back pain doesn’t mean you can’t have a fitness program.

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Finding Fitness With Lower Back Pain

The number of USA emergency room visits, pain medication orders, injections, imaging studies, and surgical interventions directed at lower back pain continue to rise.  I frequently meet people who report their fitness efforts have been hampered by low back pain.  I have five recommendations that can help fitness clients with lower back pain have more success in the gym.

#1 Do not exercise first thing in the morning:  Ergonomic experts have found that many more industrial lower back injuries happen in the morning.  The theory is that the discs in the lower back imbibe or gain fluid overnight and are more likely to deform with a physical challenge.  Give your lower back one or two hours of walking around time before starting an exercise session.

#2 Isometric strengthening of the spinal stabilizers:  The function of your “core” muscles is to limit movement of the lumbar spine and pelvis.  Stop all crunches, toes to bar, sidebends, sit ups, seated twisting, and learn how to perform bird dogs, side hovers, Pallof press, planks, and carries.  Compliance with this single hint would reduce USA expenditures on lower back pain dramatically.

#3 Enhance the function of your hip flexors and gluteal muscles: Please cease all the forward spine flexion, toe touching, spine twisting activities.  Greater lumbar spine range of motion is associated with more–not less, lower back pain problems.  Learn how to foam roll and mobilize the hip flexors and gluteal muscles.  Prolonged sitting and most popular “cardio training” deadens these muscles.  Properly functioning hip flexors and gluteal muscles keep the pelvis stable and take stress off the lower back.  Reawakening dormant gluteals and hip flexors is the magic that resolves long term lower back pain.

#4 Focus on single leg strength training:  Ditch the front loaded hip hinges–deadlifts, cleans, snatch, and drop the loaded squats.  Swear off the lower lumbar deranging leg press.  Reduce spinal compression and train the legs, one at a time.  Single leg training reveals the right / left side movement asymmetries that drive lower back pain.  Resolving these asymmetries and sparing the spine goes a long way to abolishing back pain.  You will need some guidance on exercise selection and execution- this brings me to #5.

#5 Get some help:  Exercise is the most powerful medication on the planet.  Nothing else comes close.  Take the proper dose of appropriate training and the results will be amazing.  Take the wrong dose of an inappropriate activity and the results can be devastating.  This is especially true for people with a history of lower back pain.  Find a qualified physical therapist to guide you through your fitness journey.  One way or the other, you are going to spend time and money on your health.  Proactive spending is always cheaper and more beneficial than reactive spending.

Michael S. O’Hara, PT, OCS, CSCS

 

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Lower Body

Split Squat

To set up for the split squat, put one foot in front of the other with the heel of the back foot off the ground. 85% of the weight should be on the front foot. An airex pad can be placed under the body for the knee to come down on when lowering to the floor. When in the bottom position of the exercise, the front knee should be in line with the toe creating a slight shin angle. Make sure to push through the front heel on the way up instead of the toe. This exercise can be made easier by holding onto a railing, or can be made harder by adding weight such as a kettlebell in a goblet hold. The split squat displays greater hamstring, external oblique, and gluteus medius muscle activity than the back squat, but less quadriceps muscle activity.

RFE Split Squat: RFE stands for “rear foot elevated”. With this variation of the split squat, set up with the back foot elevated on a bench or a padded stand created for this exercise. An airex pad can be used under the knee if necessary. Squat down, touching the knee to the floor or airex pad.  When in this bottom position, the shin angle should be angled forward just as before, not straight up and down. Common errors include sitting too far back on the rear foot, touching the glute to the heel, or the back foot can tend to roll off the padded stand on the way up and move more onto the shin. Avoid this by putting more weight into the front leg and dropping the knee straight down instead of back. This exercise can be made more difficult by adding dumbbells in each hand, a kettlebell in the goblet, racked, or double racked position, or a barbell in the front or back position. Make sure to descend slowly, creating an eccentric load instead of dropping down fast.

FOB Hip Lift: FOB stands for “feet on ball”. Lay on the floor or table on your back and place the arms out to the side. Push down into the floor with the arms to stabilize the body. Keep the feet together and brace your abdominal muscles. Use the glutes and hamstrings to lift yourself up off the floor, making sure to keep everything tight at the top of the movement. Hold 3-10 seconds at the top and lower slowly and controlled. You can remove the arms from the floor and rest them on your stomach or behind your head to create more of a challenge.

One Leg FOB Hip Lift: Same setup as before except one leg will be used. The other leg will be pointed up to the ceiling as the other presses into the ball to lift the body. This creates more of a stability challenge.

FOB Leg Curl: This variation starts out just like the FOB hip lift, except at the top of the movement when the body is raised, the knees are bent and the ball is pulled in towards the body creating more work for the hamstrings. Keep the hips extended by activating the glutes and moving the hips upward, avoiding the tendency to bend at the hips. It should look like your hips move up and then return to a straight body position.

One Leg FOB Leg Curl: The hardest variation for the FOB series is the one leg curl. Use one leg instead of two, extending the other leg up to the ceiling. Make sure to still avoid bending at the hips in this variation as well.

One Leg Deadlift: When starting out with this exercise, it is best to just use bodyweight. Stand with 95% of your weight on one leg. Extend the arms and free leg out to a “T” position, bending the standing leg slightly. The extended leg should be reaching backwards as far as it can go.  Think about sitting into that hip just as you would during deadlifts. As this exercise becomes easier and balance is not an issue, it can be progressed by holding a kettlebell. The kettlebell should be held in the same side as the leg extending back. Reach the kettlebell straight down by the big toe; the weight should not go in front of the toe but rather by the instep of the foot. If you have progressed pass the kettlebell, two kettlebells can be used or a barbell with weight. The primary muscles being used in this exercise are the posterior leg muscles including the glutes and hamstrings.

One Leg Squat: Stand in front of a 12-18” box (start higher, and work your way to a lower box).  You will want to have 5-10# of weight to use as a counter balance (dumbbell, plate, or med ball).  Standing on only one leg, slowly lower yourself to the box.  As you descend, reach forward with the weight to help with balance.  Control the descent until your butt taps the box and then stand back up.  Work for 3-12 reps before switching legs.  Over time, try to get to a lower box so that your hip is slightly below your knee at the bottom position.

Watch video of these exercises: https://youtu.be/SqFqf81UnIk

 

 

 

 

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

Keep your shoulders and spine happy and strong by following Mike O’Hara’s advice in “Pushing Up Performance”.  Video explanation and performance of pushups and their variations included.  Jeff Tirrell discusses the proper performance of pull ups in his article. “Movement You Should Master”. Is your mobility limited?  Try massage sticks or foam rollers with the information provided in “Pain, Pressure, and Pliability”.

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