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Learn more about Rehab, Sports Medicine & Performance


That pain in your arm or hand could be coming from somewhere else.  Read Mike O’Hara’s article, Changing Locations to find out more.  Jeff Tirrell gives nutrition tips and Mike discusses the benefits of using an agility ladder.

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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.

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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.

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If a fitness magazine puts the word ‘abs’ on the front of an issue, it is guaranteed to sell more copies.  The fitness world is infatuated with whatever ‘abs’ means, yet most gym junkies get abdominal muscle training wrong.

The segmented “six pack” muscle that covers the front of the torso is the rectus abdominus.  The function of the indentations in this muscle is to create hoop stress that holds your body tight and tall, much like the support bars on a cellular tower.  The internal and external oblique muscles are the angled wires of the tower that create intersecting diagonal forces that keep the torso upright and stable.

In fitness centers, you see whole sets of circuit machines that flex, rotate, and extend the torso.  People perform endless repetitions of forward bending, side bending, leg lifting, and haphazardly crunch away.  These activities are well-intentioned, but are unfortunately far from optimal training.  Most of these people already spend too much time, working and driving, in a slumped forward spine position.  Their vertebral columns need less, not more, movement into flexion and rotation.

True core stability involves using your abdominal muscles to hold the pelvis, spine, and rib cage in a solid, stationary position while you move the arms and the legs.  When you run, jump, lift, or carry, the muscles in the middle must efficiently transfer force from the lower extremities through your pelvis and spine to the arms.  Any weakness in the “core stabilizers” creates a power leak that reduces performance and makes you more susceptible to injury.


One of the best training exercises for developing better core stability is the Roll Out.  The Roll Out can be progressed or regressed to fit all strength levels.  It requires minimal equipment and produces carry over to other fitness activities.  Getting stronger at the Roll Out exercise will enable you to lift, carry, push, pull, squat, hip hinge, and lunge more efficiently.


Kneel on a padded surface.  The hips are bent to 45 degrees and the spine is held in a neutral position.  Place the wrist on the front part of the ball.  Take a deep breath and brace the abdominal muscles.  Initiate a forward roll of the ball by extending at the hips and shoulders simultaneously.  Stop just short of the point where you begin to have difficulty holding good spinal alignment.  Hold this position for 3 seconds before returning to the start position.  Rest for three seconds between repetitions.  Perform two sets of ten repetitions.

There are several ways to make the physioball roll out more challenging:

1.         Roll farther forward so long as you maintain perfect form.

2.         Extend the hold time from three to five seconds.

3.         Use a smaller ball

4.         Use a Power Wheel instead of a ball.


Roll Outs with a Power Wheel are a challenging step up from Roll Outs with a Physioball.  It will take some time to master this exercise, but the reward of better functional strength is big.  Power Wheel Roll Outs develop the total body tension you need to successfully lift and carry greater loads.  They will increase your pull up power and enhance squat mechanics.  The Power Wheel Roll Out serves to counteract the stress of repeated hip hinging activities such as Olympic lifting, kettlebell training, or a challenging Zumba step class.

Kneel on a mat to keep the pressure off your knees.  Your femur (thigh bone) is positioned straight up and down from the floor and the hips are hinged at 45 degrees.  Place the hands on the padded handles of the Power Wheel and the elbows directly under the chin.  Brace the abdominal muscles and roll out until you feel a challenge through your midsection.  Hold the challenging position for three counts and then return to the starting position.  Perform five to ten repetitions.


Progress the Roll Out by adding a sandbag across your back or by wearing a weight vest.  Challenge yourself even more by attaching resistance tubing to the Power Wheel.  The forward pull of the tubing will make it more difficult to pull back up to the starting position.

Take six weeks off the crunches, sit ups, side bends, and leg lifts and get better at Roll Outs.  Your body will thank you.

-Mike O’Hara, P.T., OCS, CSCS

I get flak from some of my fellow gym rats because I do not believe in muscle isolation exercises.  While I do not think it will harm most young and recovery-resilient trainees to perform fifteen sets of shoulder lateral raises or five different styles of bicep curls, I do find that format of training less than optimal.  Older gym goers (30+ years) will see better results and fewer injuries if they stay far away from incline curls and the seated knee extension machine.  Father time and experience has taught me that, excluding the bodybuilder who trains solely for hypertrophy, most of us will be more successful by becoming proficient in multi-joint exercises.

That being said, there are a few isolation-type exercises that I regularly use with fitness and rehabilitation clients.  These isolation exercises are designed to improve posture, restore proper joint mechanics, enhance neural response, and reduce the risk of injury.  These activities will not put a “peak on your bicep” or give you “massive quads,” but they will make you less likely to develop shoulder and lower back pain.

Band No Money Drill

Most people have weak shoulder external rotator muscles and a rounded over shoulder girdle posture.  This is never a good combination if you are going to perform any type of upper extremity strength training.  The band no money drill helps remedy both of these problems.

Stand tall with the chest proud and the head pulled back.  Hold the band with the palms to the sky, elbows bent at 90 degrees held at the side-the palm up and no money in your hand position.  Concentrate your efforts on the muscles between your shoulder blades as you pull the band apart and bring the hands out to the side.  The tempo of the exercise should be controlled– two counts to pull the band apart and two counts to return to the starting position.  Choose a resistance band that is fairly easy and focus on making the motion smooth.  Perform two or three sets of ten repetitions.

Four Point Band Gluteal Activation

The gluteus medius is the muscle responsible for preventing unwanted rotation and inward collapse at the knee.  It also helps stabilize the pelvis and keeps damaging stress off the lumbar spine.  The four point gluteal activation drill activates the gluteus medius.

Place a mini band around both legs just above the knees.  Position on all fours–hands directly under the shoulders and knees under the hips.  Keep the spine stationary and lift the right leg up and out to the side so that the hip abducts approximately 30 degrees.  Hold for twenty to thirty seconds and then repeat on the other side.  Perform two times on each side.

Belly On Ball “Ys”

Postural Stress Disorder (PSD) is the new name given to the multiple pain problems associated with a flexed-over thoracic spine, forward head, and rounded shoulder posture.  Your fitness program should help you combat the damaging forces created by prolonged sitting.  The belly on ball Y exercise helps train away the postural flaws that create the symptoms of PSD.

Position yourself facedown over the top of a physioball.  You need a fairly firm ball that does not flatten out when placed under load.  Keep your spine stable and the chest off the ball.  Lengthen the neck and thoracic spine-they should not move at all during the exercise.  Keep the gluteal muscles tight and legs extended.  Start with the arm in front of the shoulders on either side of the ball.  The shoulders should be externally rotated in a thumbs up position.  Raise the arms overhead like a football official signaling touchdown.  This will create a Y shape with your torso and arms.  Hold the arms overhead for three counts and then lower back down in a controlled fashion.  Perform two sets of ten repetitions.  As you get stronger try adding resistance with some dumbbells.

Single Leg Hip Lifts

Gluteal amnesia is at epidemic levels in gyms and fitness centers across America.  A loss of gluteal muscle activity is the primary driver of lower back, knee, and hip pain.  Prolonged sitting, elliptical training, and a general lack of any type of sprinting has created a large group of people who are unable to efficiently fire their gluteal muscles.

The single leg hip lift facilitates a better neural connection to the gluteals and can help reduce the occurrence of anterior hip pain.  Lay supine with the knees bent and feet flat on the floor.  Lift the right leg off the floor and hold onto the front of the right lower leg with both hands.  Use the left leg to perform a single leg bridge.  Focus on contracting the left gluteal muscles in an attempt to reach full left hip extension.  Hold at the top of the bridge for three seconds.  Perform two or three sets of five to ten lifts on each leg.

To view video demonstration of Mike’s choice isolation exercises, click on the link below:


-Mike O’Hara, PT, OCS, CSCS



I have received several requests for more recommendations on postural restoration exercises.  This is the second of three articles.  This pair of exercises is a good choice for overhead athletes such as tennis and volleyball players.  Watch for number three next week.

Most of us drive, commute, do computer work, watch television, and often sleep in the same position.  We become stuck in a forward flexed thoracic spine posture that rotates the shoulder blades downward and pushes the head forward.  Long-term postural flaws will limit your strength, functional mobility, and are the precursor to many of the pain problems we treat in physical therapy.  Your fitness program should eliminate, not feed, these postural problems.  I have some postural restoration training suggestions that nearly anyone can implement into his/her fitness program.

Many strength coaches and physical therapists have found that performing a mobility exercise followed by an activation (strengthening) exercise produces more expedient changes in postural flaws.  Your goal is to increase the restricted movement pattern and then strengthen through the newly acquired range of motion.

TRX “Stoney Stretch” and Belly On Ball “Y”s

Stand facing away from the TRX strap.  Place the handles at eye level on either side of your head.  Step forward with the right leg and simultaneously reach the hands up in a letter Y shape.  The TRX will provide an effective mobilizing stretch to the shoulders and upper thoracic spine.  Do not hold the stretch for more than three seconds.  Step back and then repeat with the left leg.  How far forward you step depends on your shoulder and upper thoracic spine mobility.  As your ability to move improves,  the step can be progressed to a full forward lunge.  Perform five repetitions with each leg and then move to the Belly on Ball Y exercise.

Position yourself face down over the top of a physioball.  You need a fairly firm ball that does not flatten out when placed under load.  Keep your spine stable and the chest off the ball.  Lengthen the neck and thoracic spine.  They should not move at all during the exercise.  Keep the gluteal muscles tight and legs extended.  Start with the arms in front of the shoulders on either side of the ball.  The shoulders should be externally rotated (keep a thumbs-up position of the hands).  Raise the arms overhead like a football official signaling touchdown.  This will create a letter “Y” shape with your torso and arms.  Hold the arms overhead for three counts and then lower back down in a controlled fashion.  Repeat for 10-12 repetitions.

Common mistakes include using a ball that is too small or too soft, swinging the arms up and down instead of in a controlled fashion, failing to hold the arms overhead for three counts, and/or extending the cervical spine (looking up) instead of maintaining a lengthened position through the spine.  You can make the exercise more challenging by adding dumbbells.

Click on the link below for a video demonstration of the above exercises:


-Michael O’Hara, P.T., OCS, CSCS