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Learn more about Rehab, Sports Medicine & Performance

pain

Embrace The Hate

Being Comfortable With Being Uncomfortable

“I hate this one.”

“This exercise never gets easier.”

“I do this but I hate this.”

“You like to see me struggle”

These are all common statements from fitness clients and physical therapy patients.  They have complaints about certain exercise activities that are difficult, unsteady, aggravating, and just plain annoying.  The activities that provoke these responses usually involve getting up and down off the ground, single leg biased training, carrying a weight, and / or pushing a sled.

These comments are usually followed by—

“..but I know they are helping.”

“I don’t have that pain anymore.”

“My legs are so much stronger.”

“I hiked in the mountains with my grandchildren.”

To make progress in rehab and fitness, you need to get comfortable with being uncomfortable.  If your fitness regimen involves scented candles, soothing music, and nothing that makes you uneasy, then I doubt it has much value.  Training challenges that restore movement skills, improve strength, and add muscle mass will create some discomfort.  Developing the mindset that embraces the challenge makes all the difference.

Michael S. O’Hara, PT, OCS, CSCS

Learn how to keep your spinal stabilizers strong by performing side planks.  Mike O’Hara explains this in his article, “Learning to Lean”, and includes video demonstration and explanation of the importance keeping your stabilizers strong to stand up to the demands of daily life. It’s time for another Fenton Fitness Love Your Jeans Challenge–see page 3 for more information. In his article, “The Periodization of Nutrition”, Jeff Tirrell gives tips on optimizing dietary intake.

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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

Discover the difference between muscle soreness following exercise activity and pain you should be concerned about in “Do I Have A Problem?”.  Jeff Tirrell gives advice for women on optimizing performance  and Mike O’Hara discusses training priorities for those over forty.

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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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How Do They Know What Is Wrong Without An MRI?

This is a fairly common question in physical therapy.  Patients with lower back, leg, neck, and arm pain know the test they need is an MRI.  They have friends and relatives that tell them they should have an MRI.  They are concerned that something is being overlooked and that the pictures from the MRI will make treatment more beneficial.  I have some research information on the limitations of a spinal MRI.

In 1994, the *New England Journal of Medicine published a study on physician evaluation of lumbar spine MRIs.  The MRIs of 98 asymptomatic individuals –-no pain, feelin’ good people, were found to have disc abnormalities (82% of the MRIs).
-52% had a bulged disc at one level
-27% had a disc protrusion
-1% had a disc extrusion
-38% had an abnormality at more than one disc

Since that publication, several other studies have backed up these results.  Bulged, protruding, and extruded lumbar discs are a fairly common finding on a lumbar MRI.  Changes in our lumbar discs are probably no different than the wrinkles on your face or the gray in your hair.  Changes in a disc’s shape is not a indicator of pain problems

Another **MRI study of athletes revealed spondylolysis (vertebral fractures) are fairly common, yet less than 50% of the athletes with these fractures ever report any episode of lower back pain.  It appears that lumbar spine fractures do not always produce pain.

In my years in the physical therapy clinic, I have received the MRI reports of many neck and lower back pain patient’s spines that show disc protrusions and foraminal stenosis on one side of the spine but the patient has all of his or her symptoms on the opposite side.  I have treated patients with severe lower back pain and completely normal spinal MRIs.

MRI research has demonstrated that “abnormalities” in our spines are fairly common and difficult to accurately link to any specific pain problem.  We do know that once a patient has an MRI, they are far more likely to progress to ***surgery.  Please read, The Myth of Accuracy in Diagnosis, by Dr. Ron Fudala.  In physical therapy, the resolution of a spinal pain problem starts with a history and thorough physical evaluation.  Imaging tests are a small part of the “big picture” and often provide nothing but confusion.

*Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people with and without back pain, New Engl J Med. Jul 14

**Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete.  Am J Sports Med, 2000 Jan – Feb.
***Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003;28:616 –20.

Read more here: http://spineline.net/spine-pain-the-myth-of-accuracy-in-diagnosis/

Michael S. O’Hara, PT, OCS, CSCS

Very Short Term Running Preparation

I was recently asked by a fitness client to post exercise recommendations that would prepare her for outdoor distance running.  This person was two weeks away from being out on the road, running two or three miles a day.  She is middle aged, has a prior history of lower back pain, and her goal was to lose fifteen pounds and “tone up”.   Given such short notice, these are my recommendations.

Perform soft tissue work on a daily basis.  Foam roll the legs and use a lacrosse ball on the plantar fascia.  The vast majority of overuse injuries in runners happen in the lower legs and feet.  Attempt to unwind the myofascial distress created by 600-700 foot impacts a mile.

Improve your reciprocal hip pattern–one hip goes back and the other goes forward.  Most general fitness clients have glaring deficits on one side.  Perform some split squats, posterior lunges, step ups, and or walking lunges.  If you struggle with these activities, I would reconsider running as a fitness activity.

Wake up your gluteals.  Every day, perform fifty or sixty bridges, hip lifts, or leg curls.  You need super gluteal strength / endurance to run distances and avoid lower extremity injury.  If your butt gets sore from fifty bridges, you need to do them more often.

Running is a skill and most recreational runners need some practice.  Running hills will improve gait mechanics, enhance hip extension, and decrease deceleration forces.  Find a fifty-yard hill.  Run up the hill and walk back down.  Perform five hill runs.

You are always better to run too little than to run too much.   Start with very short runs– no more than half a mile.  Increase your total weekly mileage by no more than five percent a week.

You can’t do this in two weeks, but this is my big recommendation to all future runners.  Lose the extra weight before running.  As a method of fat loss, distance running has a poor track record.  It tends to elevate the hormones that make you hungry, and physiological adaptation to distance running happens fairly quickly.  Extra adipose makes you far more likely to develop a running related injury.  I know the guys and gals you see running miles and miles every day are lean.  Please remember that lean runners are successful with running because they possess the optimal body mass to run long distances.  They did not start heavy and become lean.  Put a fifteen pound weight vest on that guy or gal and everything will change.  Their gait will lose efficiency and become less graceful.  The extra fifteen pounds of load creates the biomechanical overload that makes them much more likely to suffer an injury.

My final recommendation is that you not become disappointed if you develop pain.  A runnersworld.com poll conducted in 2009 revealed that 66% of respondents reported a running related injury that year.  The statistics indicate that one third of the participants at you local 10k fun run will require medical attention for a running related injury over the next year.  Have the good sense to stop when the pain begins.

Michael S. O’Hara, PT, OCS, CSCS

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.

#10–Establish A Veggie And Protein Habit

One of the biggest deficits I see in many food logs is the lack of protein consumed.  We have been conditioned to snack on high carb/highly processed food, so eating more protein can be a difficult shift.  When I do see protein, it’s in the higher fat varieties of sausage, bacon, burgers, etc.  It would benefit younger individuals to start adding healthy doses of protein to their diets as soon as they are responsible for their own food preparation.  Shoot to have some form of lean protein as the base of your meal along with a couple of servings of vegetables. Once you have that base (taking up ½ to ⅔ of your plate), then you can add in whole grains, starchy carbs, fruits, dairy, healthy fats, etc.  Protein increases your metabolic rate more than any other nutrient, aids in recovery, helps build and maintain muscle mass, and much more.  We recommend 25-35% of total calories to come from protein, or 0.8-1gram/pound of body weight.  Most individuals should shoot for 4-8 servings of vegetables per day as well.

-Jeff Tirrell, CSCS, Pn1

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

 

 

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.

#9–Build Muscle

Much like strength, muscle mass is often not prioritized until it is largely too late.  Though you can still build muscle at an older age, it is much more difficult.  Muscle mass is highly correlated with strength which is correlated with power.  All of these tend to decline substantially at around age 30.  If you take advantage of your hormonal environment and your recovery abilities in your 20’s, you can stockpile a good amount of muscle for the rest of your life so that you can keep doing everything you want as you age.  More muscle also means a better and healthier metabolism which means less accumulation of unwanted body fat and overall better health. The best way to build muscle mass is through resistance training with gradual increases to volume (weight x reps x sets) over time along with a moderate to high protein intake.

-Jeff Tirrell, CSCS, Pn1

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

 

 

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