Learn how to keep your shoulders healthy in Mike’s article, “Graceful Shoulder Aging”. Jeff Tirrell gives some practical advice on how to train, and Mike explains the importance of changing your fitness routine.
NY Times Article on Fall Prevention
When discussing fitness goals, most people never mention fall prevention, but I suggest that it is more important than fat loss or improving your cardiovascular capacity. Please take the time to read Gretchen Reynolds excellent article; Falls Can Kill You. Here’s How to Minimize the Risk. In the article, Ms. Reynolds presents several good lifestyle modifications and medication precautions that will help prevent a fall. Try adding some of my long standing fall prevention training tips.
Exercise in a standing position.
If your goal is to move better and remain free of injury, then 90% of your exercise activity should be performed in standing. Developing better kinesthetic awareness, strength, and coordination in a standing posture is the crucial component of training that prevents a fall. During my visits to commercial gyms, most of the exercise activity I witness is performed in a supine, seated, or supported position.
Practice moving in all directions.
Fall prevention training involves improving multi-directional movement skills. Most falls happen from an unexpected disruption of your equilibrium. You get pushed to one side, twisted off center, or a foot slides from under the body. Most gym activities are predominantly sagittal plane- forward and backward. We need to be able to move well in all directions.
Practice moving faster.
Fall reaction training should focus on exercise activities that make you quicker. Research on falls has shown that a gait pattern (how you walk) that starts to slow down is the best predictor for a future fall. Agility ladder footwork, medicine ball throws, and hurdle drills are examples of faster paced training activities. Yoga, Pilates, recumbent bicycle riding, and muscle isolation exercises will not make you better at moving faster.
Stand on one leg.
A simple and proven fall prevention activity is single leg stance balance training. Single leg balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle. Stand on one leg for twenty seconds. Stand on one leg and turn your head side to side. Stand on one leg and then close your eyes.
Practice getting up and down off the floor.
One of the best anti fall training activities is consistent practice of getting up and down off the floor. Moving gracefully from standing to the floor and back up again is a life skill that keeps you independent and safe. As a Physical Therapist, I frequently find people who are very impaired in this basic task of mobility. They crawl to a piece of furniture for an assist and transition from the floor in an unsteady and unsafe manner. Most of these patients are not elderly, they are tight, weak, and deconditioned.
Perform single leg strength training.
We are monopods. We absorb and then create force one leg at a time. During activities of daily living, one leg is loaded more than the other. It only makes sense that we train our legs the same way we use them. Work with a trainer and learn how to perform step ups, single leg squats, rear foot elevated split squats, single leg deadlifts…
Become a better shock absorber.
Fall events often occur because of an impact. The force of the impact causes our body to give in to gravity and down we go. Just like any other physical attribute, impact resilience can be trained. Mat work, medicine ball throws, and rope drills are some of the activities that can be used to improve impact resilience.
Make balance practice a daily event.
Integrate anti-fall training into your lifestyle. Stand on one leg while you brush your teeth–right leg thirty seconds then left leg thirty seconds. Perform multi directional exercise as movement preparation before a bike ride or run. Get some instruction on a program of exercise that improves agility, single leg strength, and power production.
Someday, somehow, and when you least expect it, you are going to have an unplanned interaction with gravity. Your fitness program should make you more responsive to a fall event and less likely to be injured.
Link to article: here
Michael S. O’Hara, PT, OCS, CSCS
Pressurize Your Anatomical Inner Tube
Push Up Position Planks
The center of the body is a cylindrical tube of interwoven muscle and fascia. On the top and bottom, you have the diaphragm and pelvic floor. The sides are reinforced by the oblique muscles and across the front by the rectus and tranverse abdominus muscles. These muscles work together to create pressure inside the cylinder. The tension capacity of our “anatomical inner tube” allows us to lift, carry, push, and pull loads that would overwhelm any single joint in the spine. Developing better tension strength will improve athleticism and reduce injuries. One of the best exercises to improve tension strength is the Push Up Position Plank.
Push Up Position Planks – PUPP
Place the hands under the shoulders with the elbows extended. Pull your shoulder blades down your back and keep your neck long. Lift your pelvis so that your body is supported on the feet and hands. Pull the legs together and lift up onto the balls of the feet. Your body is held in one long line from the ears to the ankles. Do not let your hips sink or rise up—check your position in a mirror. Create an isometric external rotation force in the shoulders by screwing the hands into the floor. Imagine you are crushing oranges in your armpits. Now squeeze the legs together and pull the hands toward the toes. Hold that position for twenty seconds and work up to longer durations. A good goal is a thirty-second high tension PUPP.
Elevated Feet-Push Up Position Plank
Once you can hold a solid thirty second push up position plank with the feet on the floor, progress to elevating the feet on a step or exercise bench for more resistance. Work up to a thirty-second hold.
In rehab, we use push up position planks to help patients recover function in their neck, shoulders, lumbar spine, and pelvis. For the fitness client, try putting two or three sets of PUPPs between pulling exercises. Watch the demonstrations and give the push up position plank a try.
View video here
Michael S. O’Hara, PT, OCS, CSCS
Push Ups and Longevity
Recent Study is a Biomarker Reminder
Take a moment and read the recent New York Times article, How Many Push-Ups Can You Do? It May Be a Good Predictor of Heart Health. It appears that being able to perform well on a push up test is a better predictor of heart health than the traditional treadmill test. The article postulates several reasons for the research results. We only need to read the book Biomarkers for a thorough explanation.
In the book Drs. Evans and Rosenburg looked at the measurable “biomarkers” that keep humans healthy, independent, and fit over an entire life span. They have determined the top four biomarkers are:
- Muscle Mass. What percentage of your body is made of muscle.
- Strength. Can you use that muscle to push, pull, lift and carry.
- Basal Metabolic Rate. The number of calories your body expends at rest.
- Bodyfat 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.
- Aerobic Capacity
- Blood Sugar Tolerance
- Cholesterol / HDL ratio
- Blood Pressure
- Bone Density
- Internal Body Temperature Regulation
Push up proficiency requires muscle mass, strength, and a minimal amount of extra load to lift in the form of bodyfat. Those three traits are all a part of the decisive tetrad. To age well, stay durable–no injuries, and maintain control of all health parameters–we need to maintain or improve muscle mass / strength and not avoid extra bodyfat. An ongoing program of strength training and nutritional discipline are the foremost components of fitness and health.
Now get on the floor and give me twenty.
View the article here.
Michael O’Hara PT, OCS, CSCS
Learn how some simple exercises can reduce or prevent lower back pain in Mike O’Hara’s article “Daily Lower Back Pain Meditation”. Jeff Tirrell explains the importance of working with a qualified trainer in a small group. Do you know the five fitness numbers everyone should know?
Anti Extension Progression
An interconnected team of muscles holds our spinal column stable. If you wish to be strong in all endeavors, you need to develop isometric (no movement) torso strength that resists flexion, resists extension, and resists rotational forces. Most people have poor anti extension torso strength, and many of them show up in the physical therapy clinic with lower back, hip, and neck pain. Presented below is a time-tested progression of training activities that will improve anti extension torso strength. Watch the video and make these exercises a part of your training program.
Anti Extension Torso Strength Program
- Wall Planks
- Bench Planks
- Push up Position Planks
- Push up Position Planks feet elevated
- Ball Roll Outs
- Ab Wheel Roll Outs
Initial anti extension exercises are all a version of planks that are scaled from easiest to hardest–wall, bench, push up position, and then push up position feet elevated.
Weaker people require more practice to develop the neural connections that improve strength. They need two sessions a day to drive a reboot of their neural system. Start with the wall planks for two holds of twenty seconds. Gradually increase the time you hold the wall planks from twenty seconds to forty seconds. When forty seconds gets easy, move to the next progression–bench planks. Return to twenty second holds for two planks after each progression.
Once you can perform forty seconds of the push up position plank with feet elevated, move to the ball roll out exercise for five repetitions. As your strength improves, gradually increase the repetitions until you can complete fifteen repetitions of the ball roll out. The final progression is the ab wheel roll out–start with five and work up to fifteen repetitions.
View video of these exercises: here
Michael S. O’Hara, PT, OCS, CSCS
Sister Hermeta Saved My Soul and My Spine
Tall Kneeling Core Stabilization Training
During my parochial grade school education, I was taught how to kneel in church. Eyes forward, hands together, spine tall, and no leaning on the pew. You maintained the kneeling posture for extended periods of Father Furlong’s mass. I believe the good sisters were on to something. Despite every one of them being well past 100 years of age, they all possessed excellent posture and remarkable mobility. As a physical therapist, I am convinced that a daily dose of sustained kneeling helped keep the Felician Sisters in fighting form. I have some tall kneeling training suggestions you can add your fitness routine.
Get to Know Kneeling
Many people will benefit from some sustained tall kneeling. Protect your knees by placing an Airex pad under your knees. In and ideal situation, you will have a mirror for feedback on posture and alignment. Keep some space between your knees and line the feet up with the knees. Pull the head back, lift the chest, and reach the top of the head to the sky. Many people have difficulty getting into a fully upright position in kneeling. The most common problem is a forward lean at the hips accompanied by complaints of tightness in the lower back and front of the thighs. Holding a pvc pipe or dowel overhead while performing some deep breaths can help reduce muscle tone in the hips and torso. Perform two or three, thirty second holds at every training session for the next six weeks
Tall Kneeling Pallof Press
The tall kneeling Pallof press is an anti rotation core stability exercise that helps recruit the postural muscles that keep us upright and tall. Lack of isometric strength-endurance in the spinal muscles is a primary contributor to back injuries. This exercise will improve that component of spinal function.
Place your knees on an Airex pad and set up in kneeling position. Use either a cable unit or resistance tubing set at a level even with your sternum while you are in the kneeling position. The tubing should be directly to your right and slightly behind the body. Use a double overlap grip on the handle and hold at chest level. Press the tubing out to arms length and then back to the chest. Select a resistance level that permits execution of fifteen repetitions without losing the set up posture. Rest and then repeat on the other side.
Tall Kneeling Anti Extension Holds
The pelvis is a bowl and the torso rests on the top of the bowl. You need a pelvic position that makes stabilization of the torso over the pelvis effortless and automatic. The tall kneeling isometric hold aligns your pelvis under the torso.
Kneel on an Airex pad. Hold a kettlebell, dumbbell or Iron Grip Plate behind your back. It is difficult to prescribe a load. Twenty pounds may be too easy and five pounds may be too much. My suggestion is that you err on the lighter side of the load equation. Stay in the loaded kneeling position for at least thirty seconds. Lower the weight, walk around, and take inventory of how you feel. Repeat for another thirty seconds.
See video demonstration of these exercises: here
Michael S. O’Hara, PT, OCS, CSCS
Mike O’Hara gives tips for aging gracefully and staying fit in his article, The Five Don’ts of Sustainable Fitness. Learn the importance of increasing mobility and stability in order to get stronger, and discover how a simple test that measures how well you get up from the floor can tell a lot about whether or not your fitness program is working.
Will That Machine Help Me?
Home Gym Hints
Television ads, holiday gift giving, and the return of frigid temperatures brings out the “What cardio machine should I purchase for my home?” question. Is it the bike with an internet trainer, the fat blasting high intensity elliptical trainer, or the Euro designed Nordic ski machine? Many of these units sell for over $3000 and they wish to choose wisely. Most of the questioners have no experience with any of these gizmos. I have some pre-purchase questions they need to answer before buying that expensive cardio machine.
Can you currently walk for thirty minutes without stopping to rest?
If you answer no to that question, do not bother purchasing a treadmill, bike, or elliptical unit. Focus all of your efforts on developing the strength and skill necessary to walk for thirty minutes without resting. If pain is a limitation, get to the physical therapy clinic and resolve the problem. Walking is the essential neuromuscular activity that keeps a body healthy and out of the assisted living center. Leaning over on a treadmill, elliptical trainer, or recumbent bike is very likely to worsen those walking woes.
Do you have a prior history of consistent exercise?
Just owning a new high-tech training machine will not make you thinner or fitter. You must use the machine three or four days a week for the next year. Many people believe that locating the machine in the dwelling will jump-start the exercise habit. If you answer no to this question, I have concerns that you will not develop a relationship with your internet connected mechanical friend.
Is fat loss the primary reason you are purchasing the home exercise machine?
The fat loss the exercise motto everyone needs to learn is; “familiarity breeds failure”. The human body is a master at adapting to a physical stress and the forty-five minute spin class that burns 440 calories in February only consumes 180 calories in August. The sad truth is that the same amount of exercise time and effort produces a weaker fat loss response. The crucial components for fat loss are long duration meal preparation and high intensity portion awareness. After you get those under control, progress to activities that you find challenging (difficult, not good at, loath, hate) and change the training modality on a frequent basis. Using the same exercise device month after month will not produce optimal results.
Michael O’Hara, PT, OCS, CSCS
Save Your Back When Shoveling Snow
Improve Your Snow Shoveling Mechanics to Avoid Injury
‘Tis the season for hot cocoa, warm fires, and lots of snow. With snow comes shoveling, and unfortunately with shoveling comes injury. It is estimated that there are over 11,000 hospital visits each year due to injuries while shoveling snow. This number does not even include the thousands of people that see their primary care doctor with the onset of an injury. Many of these medical visits involve the low back including complaints of pain with movement, leg numbness, and the inability to maintain the proper posture. Lumbar injuries while shoveling are often due to the combination of repeated flexion and rotation of the spine. Adding the load of snow and having poor spine stabilization during the lift results in overload on the structures of the lumbar spine and resultant injury. Here are three exercises you can use to improve your shoveling mechanics in order to spend more time sipping cocoa by the fire, and less time in a physician’s waiting room.
- Hip Hinge – a proper movement pattern to bend forward and push snow involves flexion at the hips and knees, while maintaining a more neutral spine.
- Stand with your feet shoulder width apart. Using a broom stick, golf club, or wooden dowel, place the stock along your lumbar spine.
- The stick should come in contact with the back of your head, mid-thoracic spine (between your shoulder blades), and at the sacrum/mid-buttock.
- With a slight bend in your knees, hinge your hips by driving your buttock backwards, while maintaining the three points of contact throughout the movement.
- Perform ten repetitions
Common mistakes: squatting versus hinging – try and minimize knee bend. Your buttock should move backwards, not down.
Losing contact with the stick – if you notice the stick is leaving the sacrum the spine is flexing. Slow down the movement and move only as far as you can with contact.
- Isometric Hip Bridge – once you have properly bent forward to push and load the snow, using the buttock and hamstring muscles to lift the snow will decrease strain of muscles of the lower back.
- Start lying on your back, knees bent, and hands raised straight in the air.
- Push through your heels driving your hips upwards, hold for 5-10 seconds, and return. Repeat this movement 10 times.
- If you find that you feel this more in the low back than the legs or buttocks, try squeezing a pillow at your knees during the lift.
- Rotational Step – now that you have properly bent to load the snow, and used the proper muscles to lift it, increasing rotation at the hips to move the snow versus rotating through the lumbar spine will reduce torsional strain on the vertebral discs and spinal stabilizers.
- Begin by standing in an athletic stance with your feet shoulder width apart and slight bend in your knees.
- Keeping one foot in place, open up through your hips by stepping to the side and backwards. Your weight should be evenly distributed between the feet.
- Maintain a neutral spine throughout the movement, being mindful not to bend forward or rotate through the spine.
- Perform 10 repetitions to each side.
See video demonstration of these exercises: here
Sean Duffey, DPT
Clinic Director, Ivy Rehab, Ortonville