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Learn more about Rehab, Sports Medicine & Performance

plank

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.

Download Here

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

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?

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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

  1. Wall Planks
  2. Bench Planks
  3. Push up Position Planks
  4. Push up Position Planks feet elevated
  5. Ball Roll Outs
  6. 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

Real Core Training Part Four

Anti-Rotation

Like everything in the fitness world, core training has evolved.  When I bought my first bodybuilding magazine in the late 90s, the word “core” wasn’t even used.  Instead, you would find ab workouts, oblique workouts, and sometime, low back workouts.  Like pretty much everything in the 90s, muscles were trained in isolation with little concern for how the musculoskeletal system was designed to function as a unit.  We have come a long way in our understanding of physiology, biomechanics, and injury prevention/reduction.

The core used to be trained and often still is through movement: flexion (anterior), lateral flexion, extension, and rotation.  Sit ups, crunches, side bends, and Russian twists aim to strengthen the muscles concentrically and eccentrically.  These build mass and thickness to the core musculature.  The second way we train the core is to recognize it as a stabilizer of the low back and hips.  This involves training this musculature to resist movement.  When it comes to increasing strength, power, speed, and reducing injury, this training is more important than dynamically training the core.  This style of training is referred to as “anti-core training” because we are resisting flexion, extension, lateral flexion, and rotation.  The other benefit of anti-core training is that it involves isometric contractions which are much less likely to create muscle hypertrophy, which individuals typically don’t want in their waist.  I typically recommend that 70-90% of your core training consist of anti-core work depending on your health/injury history and goals.

The key to good core training is understanding what you are trying to accomplish, as well as how to progress or regress the movement.  Here are the some of our favorites that we use at Fenton Fitness for each of the four anti-core categories.

Jeff Tirrell, CSCS, CSFC, Pn1

Anti-Rotation

Tall Kneeling Pallof Press: Grab some elastic tubing or a cable (anchored to something sturdy) and assume a tall kneeling position.  Hold with both hands and press outward away from body.  Do not allow your body to twist or rotate.  Increase load or stretch on tubing to increase difficulty.  Work up to 12 reps per side.

Half Kneeling Pallof Press: Set up in a half kneeling position.  Use the same execution as the tall kneeling version.  Make sure that you don’t allow your legs/hips to lean or twist.  Work up to 12 reps per side.

Standing Pallof Press: Assume an athletic stance with your feet just outside of shoulder width, slight bend in the knees, and slightly flexed at the hips.  Execute the same movement as you would for the tall or half kneeling Pallof press. Work up to 12 reps per side.

One Leg Pallof Press: Stand on one leg with the other leg flexed at 90 degrees at the foot, knee, and hip.  Execute the Pallof press the same way as the standing Pallof press. This is a much more a balance and overall body stability drill.  Tension/resistance will need to be reduced.  Be slow and gradual with your increases in load, volume, or frequency to allow your knee time to adapt.  Work up to 12 reps per side.

PUPP with alternating arm raise:  Assume a push up position with your feet slightly wider than shoulder width.  Raise one arm out in front of your body while maintaining spine and pelvic positions.  A wider feet position makes the movement more stable and easier, while a narrower foot position increases difficulty.  You can also slow the movement to increase difficulty.  Remember, top priority is no hip/spine movement before trying to increase difficulty.  Work up to 10 per side.

Landmine Anti-Rotations:  Place a barbell in a landmine and assume an athletic position.  Press the landmine away from your body and slowly make a rainbow arching pattern moving the barbell from one hip to the other.  Make sure that only your shoulder/elbow joints move, everything else stays stiff.  Work up to 10 reps per side.

Crawl: Get on your hands and knees with your toes dug into the ground.  Lift your knees slightly off the ground.  Keeping your back flat and stable, move your opposite hand and foot to crawl forward or backward.  Work up to 50 yards.

For video demonstration of these exercises, click here

Real Core Training Part Three

Anti-Extension

Like everything in the fitness world, core training has evolved.  When I bought my first bodybuilding magazine in the late 90s, the word “core” wasn’t even used.  Instead, you would find ab workouts, oblique workouts, and sometime, low back workouts.  Like pretty much everything in the 90s, muscles were trained in isolation with little concern for how the musculoskeletal system was designed to function as a unit.  We have come a long way in our understanding of physiology, biomechanics, and injury prevention/reduction.

The core used to be trained and often still is through movement: flexion (anterior), lateral flexion, extension, and rotation.  Sit ups, crunches, side bends, and Russian twists aim to strengthen the muscles concentrically and eccentrically.  These build mass and thickness to the core musculature.  The second way we train the core is to recognize it as a stabilizer of the low back and hips.  This involves training this musculature to resist movement.  When it comes to increasing strength, power, speed, and reducing injury, this training is more important than dynamically training the core.  This style of training is referred to as “anti-core training” because we are resisting flexion, extension, lateral flexion, and rotation.  The other benefit of anti-core training is that it involves isometric contractions which are much less likely to create muscle hypertrophy, which individuals typically don’t want in their waist.  I typically recommend that 70-90% of your core training consist of anti-core work depending on your health/injury history and goals.

The key to good core training is understanding what you are trying to accomplish, as well as how to progress or regress the movement.  Here are the some of our favorites that we use at Fenton Fitness for each of the four anti-core categories.

Jeff Tirrell, CSCS, CSFC, Pn1

Anti-Exension

Supine Bent Knee March

Lay on your back and lift your legs off the ground with your knees and hips at 90 degree angles.  Posteriorly tilt your hips so that your low back is pressed firmly into the ground.  Slowly lower one heel to the ground keeping your knee at 90 degrees and not allowing your low back to lift off the floor.  Bring this leg back up and repeat on the other side.  Work up to 10 reps per side.

Bent Leg Dead Bug

Assume the same position as the previous exercise.  Reach your arms straight up to the ceiling.  Keep your low back pressed into the floor and straighten one leg, getting the heel as close to the ground as possible without touching.  Simultaneously reach the opposite arm overhead without quite touching the ground.

Straight Leg Dead Bug

Lay on your back with your legs and arms all reaching up toward the ceiling.  Keep your leg straight. and slowly lower it toward the ground while simultaneously reaching overhead with the opposite arm.  Don’t allow your foot or arm to rest on the ground, and keep your low back pressed into the floor.

Hollow Body Hold

Lay on your back and press your low back into the floor.  Lift your feet, shoulders, and arms off the floor, keeping your low back pressed into the floor.  Keep your feet and arms as close to the ground as possible while also keeping your low back on the ground.  Hold for up to 60 seconds.

Plank

Lay on your stomach and place your elbows under your shoulders.  Put your feet together and lift your hips off the ground.  Maintain neutral lumbar, thoracic, and cervical spine positions. Contract your glutes, pull your ribs down with a forceful exhalation, and try to pull your elbows toward your toes (they won’t actually move) to engage your lats.  Try to create maximum full body tension.  Hold for up to 30 seconds.

Long Lever Plank

Use the same set up and execution as the plank, except that the elbows will be farther out in front of the shoulders.  The farther forward the elbows, the harder this will be.  Work up to 30 seconds.

Body Saw

Use the set up the same as the plank only with carpet sliders under your toes.  Use your shoulders to slide yourself into the long lever position and then slide back.  Make sure you maintain spinal and pelvis positioning during the whole movement.  Work up to 12 reps.

Physioball Rollouts

Start in a tall kneeling position with a Physioball at arm’s length in front of you.  Pull your ribs down and engage your glutes.  Allow your body to fall forward by letting your hands and forearms roll up onto the ball.  Once you feel you are going to break lumbopelvic positioning, reverse the movement to get you back to your starting position.  Work up to 10 reps.

TRX Fallouts

Use the same set up as with the physioball, but use a suspension trainer instead.  Set up with straps at mid-thigh height.  Execute in the same manner.  Lower the strap starting position to increase difficulty.  Work up to 10 reps.

Ab Wheel/Dolly Rollouts

Set up on your knees with your hands on an ab wheel or dolly and place your hands directly under your shoulders.  Begin to fall forward by flexing the shoulder (overhead) and extending the hips.  Go forward as far as possible without losing spinal positioning and then reverse movement back to the start.  Make sure shoulder and hip joints extend/flex at the same speed.

For video demonstration of these exercises, click here

Real Core Training Part Two

Anti-Lateral Flexion

Like everything in the fitness world, core training has evolved.  When I bought my first bodybuilding magazine in the late 90s, the word “core” wasn’t even used.  Instead, you would find ab workouts, oblique workouts, and sometime, low back workouts.  Like pretty much everything in the 90s, muscles were trained in isolation with little concern for how the musculoskeletal system was designed to function as a unit.  We have come a long way in our understanding of physiology, biomechanics, and injury prevention/reduction.

The core used to be trained and often still is through movement: flexion (anterior), lateral flexion, extension, and rotation.  Sit ups, crunches, side bends, and Russian twists aim to strengthen the muscles concentrically and eccentrically.  These build mass and thickness to the core musculature.  The second way we train the core is to recognize it as a stabilizer of the low back and hips.  This involves training this musculature to resist movement.  When it comes to increasing strength, power, speed, and reducing injury, this training is more important than dynamically training the core.  This style of training is referred to as “anti-core training” because we are resisting flexion, extension, lateral flexion, and rotation.  The other benefit of anti-core training is that it involves isometric contractions which are much less likely to create muscle hypertrophy, which individuals typically don’t want in their waist.  I typically recommend that 70-90% of your core training consist of anti-core work depending on your health/injury history and goals.

The key to good core training is understanding what you are trying to accomplish, as well as how to progress or regress the movement.  Here are the some of our favorites that we use at Fenton Fitness for each of the four anti-core categories.

Jeff Tirrell, CSCS, CSFC, Pn1

Anti-Lateral Flexion

Bent Knee Side Plank

Lay on your side and place your elbow under your shoulder and line your knees up below your hips.  Lift your hips off the ground and hold.  Work up to 45 seconds.

Side Plank

Lay on your side and place your elbow under your shoulder and straighten your legs out.  Stack your legs on top of each other and lift your hips off the ground.  Hold for up to 60 seconds.

Side Plank with Top Leg Elevated

Position yourself in the same set up as the side plank.  Once your hips are lifted off the ground, you will move your top leg away from the bottom leg.  Make sure that you don’t flex either hip when raising the top leg.  Work up to 30 seconds.

Side Plank with Top Leg on Bench

Lay on your side and place your elbow under your shoulder.  Place your top leg on top of a bench.  Lift your hips off the ground.  The bottom leg can squeeze the bottom of the bench or dangle in the air.

Suitcase Hold

Grab a KB/DB in one hand, stand tall, and maintain a neutral lumbar, thoracic, and cervical spine position. Make sure your shoulder blades stay down and back.  If possible, watch yourself in the mirror to ensure you aren’t leaning.  Hold for up to 60 seconds.

Suitcase Carry

Assume the same set up as the suitcase hold.  Start walking with a normal gait.  Make sure to not lean excessively.  Start with 20 yards per side and work up to 100 yards.

For video demonstration of these exercises, click here

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.

Goblet Squat

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.

  1. single leg bridges  R and L x 10
  2. goblet squats x 10
  3. 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.

Pallof Press

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

Progression Know How

Carries, Crawls, and Core

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Carries, Crawls, and Core

Push Up Position Plank: Goal of 1 minute

Plank: Goal of 30 seconds

Side Plank: Goal of 30 seconds/side

Side Plank w/ outside foot elevated: Goal of 30 seconds/side

Side Plank w/ inside leg elevated: Goal of 30 seconds/side

Anterior Baby Crawl: goal of 15 yards with stable torso

Anterior Crawl: Goal of 30 yards with stable torso

Farmers Walk: Goal of 60 yards with body weight

Turkish Get Up (¼): Goal of 8/6kg (men/women) for 10 reps/side

Turkish Get Up (½): Goal of 10/12kg (men/women) for 6 reps/side

Turkish Get Up (full): Goal of 25% body weight for 4 reps/side.

See video demonstration of these exercises here: https://youtu.be/5OkXbOWx4mw

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