Stay independent longer by increasing your stair climbing capacity. Mike O’Hara shows you how in his article, “Keep Climbing”. Mike also discusses standing desks and the many benefits of standing while working. Jeff Tirrell explains the effect of exercise on appetite.
Our June issue brings information on preventing neck pain by strengthening your neck. Mike O’Hara describes and demonstrates in a video exercises that will help strengthen the muscles of your neck. In another article, Mike tells how grip strength can be a predictor of early death in some patients. Be sure to read Jeff Tirrell’s article on performance based training.
You Have A Social Media Disease
There Is No App for Thumb Pain
Your thumb is made up of an intricate system of tendons that enable very precise movement. The joints of a thumb are fairly small and yet we are able to produce an amazing amount of force with this single digit. In this age of all things digital, the modern American thumb has been subjected to greater workloads. Problems with thumb pain, numbness, and limited function are becoming more common complaints in physical therapy. I have some suggestions on how to manage pain and limit the damage and embarrassment of excessive social media thumb exposures.
Thumb Tendon Troubles
Dr. De Quervain was the first to clinically described thumb tendonopathy, and we call thumb tedonosis De Quervain Syndrome. The test for De Quervain Syndrome was created by a clinician with an equally odd name and it is called the Finkelstein test. Place your thumb in the palm of your hand. Make a fist with the finger around the thumb. Hold the wrist in neutral and then deviate the wrist toward the pinkie finger. If you feel pain it is a positive Finkelstein test.
Resolution of thumb tendonopathy pain happens quickly when you give in to the symptoms of pain and modify your activities. Rest the thumb tendons by using your fingers instead of your thumb on that smart phone. Avoid fitness activities that put stress on the thumb. Lifting in front of the body with the palms facing inward is often the lift that new mothers perform and develop painful thumb tendons. Early on in the pain onset, icing is often helpful. In physical therapy, we are successful with soft tissue mobilization, ultrasound, and manual therapy. A gauntlet type thumb splint you wear at night is an unattractive but provides aviable position of rest for severely aggravated thumb tendons.
The Numb Thumb
Irritation of the median nerve in the carpal tunnel of the wrist will create thumb, second, and third finger numbness and pain. An injury of the recurrent median nerve in the front of the palm will produce numbness in the thumb and limited strength during thumb opposition–thumb to pinkie finger. Patients with neural irritation often develop numbness, weakness, and then pain. The pain often wakes them from sleep and disrupts hand function.
Once again, you will resolve a numb thumb with rest. Once neural irritation gets fired up, it takes longer to resolve than an aggravated tendon. Giving in to the numbness and resting the hands will produce better results if you start early. Two weeks of avoiding the aggravating hand activity produces good results. Night splints for the wrist and thumb are often helpful. A carpal tunnel release is a common surgical alternative that takes pressure off the median nerve.
Gumbie Thumb Beware
Every joint has a certain degree of stability and certain degree of mobility. Our spine, knees, hips, shoulders, and elbows must move enough to produce motion but not so much that they fall apart. The amount of movement in our joints is largely an inherited characteristic–you can blame Mom and Dad. The person at the extreme end of the scale (“double jointed”) needs to take certain precautions with their thumbs.
The Beighton Score is a popular screening technique for joint hypermobility. It has been around for thirty years and is used in research all around the world. The scoring is based on eight passive range of motion assessments and one active range of motion assessment. One point is assigned for each of the following.
A pinkie finger that can be passively bent backward more than 90 degrees.
A thumb that can be pulled down to the front of the forearm.
Elbows that passively hyperextend to 10 degrees.
Knees that passively hyperextend to 10 degrees.
The subject can place the palms on the floor during a straight leg, forward bend.
Researchers disagree on the score that should be a threshold for concern about systemic joint hypermobility. I have found that fitness clients and physical therapy patients that score a 5/9 or higher require modification of their training programs. It is not uncommon to encounter physical therapy patients that have a Beighton Score of 9/9. Hypermobile individuals need to take more precautions when they perform repetitive tasks such as texting on a smart phone.
Kimberly Salt wrote an excellent article on social media induced thumb pain in the May 19, 2018 issue of the New York Times. Take a minute and read, Me and My Numb Thumb: A Tale of Tech, Texts and Tendons.
Michael S. O’Hara, PT, OCS, CSCS
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.
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.
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.
- single leg bridges R and L x 10
- goblet squats x 10
- 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.
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.
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.
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.
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.
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