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Learn more about Rehab, Sports Medicine & Performance

plank

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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Hamstring injuries are on the rise.  In this month’s newsletter, Mike O’Hara, PT provides information on preventing hamstring injuries and includes videos of the recommended exercises.  Learn what it is to be “farm boy strong” and what you can do to become a “functional farmer”.

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Are you getting better or are you getting worse? No one stays the same. Our children get standardized reading tests, math exams, and comprehension assessments to measure learning. Your doctor continually assesses your blood pressure, lipid profile, and indicators of inflammation to determine if prescribed medication and lifestyle changes produce a beneficial response. In physical therapy, we look at range of motion, strength, mobility, balance, and movement patterns to make judgments on our treatment programs. In the fitness world, assessment is generally absent. This wastes valuable training time and can lead to injuries. I have some suggestions on basic fitness tests we can all use to determine if our exercise program is helping or hindering our physical performance.

The best performance tests require minimal testing equipment and can be performed safely by most individuals. They produce a time, a distance, or a measurement that can be recorded and compared to future and past results. The results are used to guide the choices you make in your exercise program. If performance tests worsen, then what you are doing is not working and you need to make some changes. If performance tests get better, be happy and keep on with your present training.

In the physical therapy clinic, we frequently see patients who pass some performance tests with an A+ grade and get a D- in other tests. They are the equivalent of the sixth grader who reads at a college level but is unable to perform simple addition and subtraction. The deficit in performance is what created the pain that brought them to the physical therapy clinic. The long term solution for these patients is to create a program of training that brings the D- up to a B grade. More reading will not improve the student’s dismal math grade.

Performance tests are the cure for the “I am not seeing any results” issue. Many well-intentioned exercise programs destroy performance, inhibit fat loss, and reduce functional capacity. Consistent assessments alert us to problems before pain is created and too much time is wasted.

Plank Test

I like this test for nearly everyone. It will quickly tell you if you need to work on improving the strength and endurance in your core stabilizers. Patients with lower back pain frequently fail this test. Many young physical therapy patients crash and burn on this test.

Dr. Stuart McGill’s research on spinal injuries and rehabilitation helped popularize this test. Dr. McGill proposes that we only have so many cycles of flexion in our lumbar spine, and if we use them up with sit ups and crunches, we pave the way to lumbar disc derangements. Occupationally, we are all sitting, driving, and computing more than ever and this weakens our core stabilizers and exposes the spine to greater flexion stress. I believe Dr. McGill is onto something, and I have all my sit up and crunch clients review his research.

PLANK

 

 

 

 

Performance

You need a stopwatch, some open space, and an assistant. Lay face down with your forearms resting on the floor. Your elbows are under your shoulders and bent 90 degrees. Place your feet hip distance apart. Dig your toes in and lift your body up off the floor supporting an elongated spine on the elbows and toes. Tuck in your chin so the head is in line with the body. Pull the bottom of the rib cage in and tighten the shoulder blades down onto the body. Your body should form a straight line from ear to the ankle. Have someone place a pvc pipe on your back so that it makes contact with the butt, thoracic spine, and the head. Maintain the position for as long as you are able. If the pvc pipe moves off any of the contact points, the test is over.

Scoring

Very Strong   240 – 390 seconds

Strong             120 – 240 seconds.

Acceptable     60 – 120 seconds

Average           30 – 60 seconds

Weak               15 – 29 seconds

Very Weak     less than 15 seconds.

I see long standing lower back pain resolve when my physical therapy patients and fitness clients crack the sixty seconds barrier on this test. The “Pillar Strength” developed with plank- type training is an injury-reducing activity that produces carry over to real life activities. A beneficial fitness program should make your Plank Test time better. A bad training program makes the score worse. Take this assessment every four weeks and make sure your exercise program is taking you in the right direction.

-Michael O’Hara, P.T., OCS, CSCS

To view video demonstration of the Plank Test, click on the link below:

 

We all want fitness results, and we want them now.  We want to look, move, and feel better in two weeks.  We know it took us years to get into this overweight, weak, and de-conditioned state, but we have a wedding in three months, a reunion in six weeks, and a date next Friday.

Unfortunately, many of the physical problems that slow our progress toward specific fitness goals will not resolve with two or three exercise sessions a week.  Postural deficits, faulty motor control, mobility limitations, and joint restrictions require daily attention to elicit any meaningful change.  Short bouts of focused training, interspersed throughout the day, will produce the best results.  In physical therapy rehabilitation, we prescribe home exercise programs that are performed up to every two hours to reduce pain and restore function.  Fitness clients will more rapidly reach their goals with some daily Nano Sessions of exercise.

shakey_shoulder

Shakey Shoulder Nano Session

Your shoulder is held onto your body with a basket weave of muscles that connect the shoulder blade to the rib cage.  They function in a highly coordinated fashion to isometrically fix the upper arm to the body.  As infants, this scapula on thorax muscle control develops as we master crawling.  It reaches higher levels of integration with pulling and pushing activities found on the long forgotten monkey bars and the litigated away ropes of gym class.   A sedentary lifestyle and postural breakdown erode away the strength and coordination of our scapula stabilizers.  Poor scapula on thorax stability reduces performance and leads to shoulder and neck problems.

When the inside border of the shoulder blades projects up off the body, we call it “winging.”  Scapula winging is a hallmark sign of poor shoulder girdle stability and the first thing you need to remedy in your training program.  Upper extremity strength needs to be developed from the center out.  If you are unable to hold a solid push up position plank then performing Olympic lifts and bench pressing is getting the cart before the horse.

Push Up Position Plank 101

Basic Push Up Position Plank

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.  The feet should be at least shoulder width apart.  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.  The critical part of the exercise is creating tension in the core stabilizers by tightening the gluteal muscles and keeping the shoulder blades tight to the rib cage.  Hold for at least twenty seconds and work up to longer hold durations.  A good goal is a sixty-second plank.

Elevated Feet-Push Up Position Plank

Once you can hold a sixty 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 solid sixty second hold.

Alternate Arm Lift-Push Up Position Plank

This variation adds an anti-rotation stability component to the exercise.  Get into the push up plank position with the feet up on a bench.  Shift slightly over the left arm and then lift the right hand up off the floor.  Reach the right arm out at a 45 degree angle and hold for five seconds.  Lower the right hand back down and repeat with the left arm.  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.

Shoulder Carry

If you are new to this exercise, use a dumbbell, and as you get stronger, you can progress to a kettlebell held in a bottoms-up position.  Using a strong grip, position the implement with the shoulder flexed approximately 85 degrees.  This should place the upper arm in front of the body and the elbow just below the shoulder.  Maintain a strong hold and pull the shoulder blades down the back.  Try to keep the biceps muscle from working too hard.  Keep a tight and tall cervical posture and perform a steady walk.  Do not allow the lower back to arch and keep the front of the rib cage flat.  Switch the implement to the other hand and walk back.

Shoulder Carry Regressions and Progressions

Many people can only travel fifteen feet before they must rest.  Start slow and build up to a thirty yard carry with each arm.

Keep the weight you use light and work on maintaining a stable shoulder posture with a steady gait.

Start with a dumbbell and progress to an inverted kettlebell.

Walk greater distances to build up more isometric strength endurance in the shoulder.

The task of balancing an unstable upside down kettlebell while you walk creates a reflex activation of the rotator cuff and scapula stabilizer muscles.  This exercise teaches your shoulder girdle muscles how to work as a team.

The repetitive shoulder stress of throwing, swimming, and overhead racquet sports often leads to the development of muscle imbalances in the shoulders.  The bottoms-up kettlebell carry will train away those imbalances.

Many athletes and fitness clients have difficulty keeping the neck relaxed when they use the shoulder muscles.  This exercise will help resolve this abnormal movement habit.

If you have a shoulder winging problem you need to retrain your motor control with frequent sessions of exercise.  Perform the push up position plank (PUPP) and the shoulder carry twice a day for the next six weeks.  Work on greater duration of the hold on the PUPP and start with a light weight on the carry,  gradually adding distance.  Thirty yards on each hand is your goal.

To view video demonstration of the above exercises, click on the link below:

https://www.youtube.com/watch?v=kJ9shseIyTM&feature=youtu.be 

-Michael O’Hara, P.T., OCS, CSCS

How To Score Your First Push Up

Improving Performance Of A Fundamental Fitness Activity

Improving push up performance enhances spinal stability from the base of the skull to the pelvis, as well as strength in the shoulder girdle.  Push ups are a valuable exercise that improves multiple aspects of fitness in a short amount of time.  Various types of push ups can be used to achieve different goals such as better rotator cuff coordination, power production, or muscular endurance.  Many people have never been able to perform a single solid push up.  Getting better at performing push ups is easy.  The trick is breaking the push up into pieces.

Push Up Planks
The biggest limitation for beginners is limited core and shoulder girdle stability.  The torso and hips sag and the shoulder blades wing off the rib cage.  To remedy these problems, work on improving isometric stability with push up planks.  Set up in the top position of the push up and hold for thirty to sixty seconds.  Get a mirror or have a training partner check your position.  Keep the gluteal muscles tight and pull the shoulder blades down the back.  Elevate the feet on a bench or box to increase the challenge.

Eccentric Push Ups
The most difficult portion of a push up is the eccentric or the lowering phase.  You often see “half push ups” performed in the gym because the trainee is unable to maintain control if they drop any further.  Start from the top of the push up and lower in a controlled fashion all the way to the floor.  You will probably find that the bottom half is difficult to control–keep trying, it will get better.  Perform two or three sets of three eccentric push ups.

Dead Stop Push Ups  
The neural link up between varying muscle groups needs to be turned on to make a push up happen.  Starting your push up from a dead stop off the floor improves these connections.  Lay prone and place the hands on the floor directly adjacent to the armpits with the elbows back.  Your upper arm should be no higher than 60 degrees from your side.  Set your body by tightening up the shoulders, pulling in the chin, and bracing the abdominals and gluteal muscles.  Think about moving quickly off the floor.  Return to the floor, recharge your neural system with a ten second rest, reset, and perform another repetition.  Once you get up to five good dead stop push up repetitions, move on to a full push up from the top position.

BOSU Leverage Push Ups
If you are not able to perform a push up from your toes instead of dropping onto the knees, I recommend using a BOSU under the thighs.  It will produce a higher core stability demand, and I have found it has far more carry over to a true, full push up than the kneeling “girls push up’.

Avoid Training To Failure
Getting better at push ups is more neural than it is muscular.  You make better progress if performing fewer repetitions with good technique rather than dozens of bad push ups.  If you want to improve your push up performance, do not train your push ups to the point of failure.  Stop the set with one or two repetitions “still in the tank”.  If six repetitions is your maximum, stop at four, rest, and then repeat for another sub maximal set.  Try laddering your sets of push ups; perform a five repetition set, and then a four repetition set, and then a three until you reach one repetition.  You will increase the total work volume–more practice, without exhausting the nervous system.

Michael S. O’Hara, P.T., OCS, CSCS

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