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posture

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

Movement You Should Master

Weighted Carries

Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer.  Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body.  An exercise that I have found to be efficient and effective is a Weighted Carry.

Weighted Carries

Very few things are more functional than a carry.  You’d be hard pressed to get through daily life without having to carry something at least a few times per week.  While basic, a carry is an efficient and effective full body exercise.  Depending on the carry you choose, the load is virtually limitless.  Performed for time or distance, carries will always improve gait and core stability.  Depending on which version you use, they can also be an effective tool for improving shoulder mobility/stability, grip strength, balance, and overall awesomeness.  Watch the video and give it try: https://youtu.be/PaP4-IlVAOA

Coach Chad demonstrates my top four carry picks:

1) Farmers Walk (gait, core stability, grip strength, upper back, legs)

2) Suitcase Carry (gait, core anti-lateral flexion, grip, upper back, balance)

3) Waiters Carry (gait, core stability, shoulder stability, balance)

4) Double Waiters Carry (gait, core stability, shoulder mobility, shoulder stability, balance)

-Jeff Tirrell, CSCS, Pn1

 

PDFStanding desks are great for posture and health, but many people have difficulty when they first start using them.  In this issue, Mike O’Hara, PT gives exercises that can help you stand for longer periods of time.  Watch the video for instruction on these exercises.  In his article, “The Biomechanics We All Need To Know, Mike agrees with the advice given by Stuart McGill.  Be sure to read about Fenton Fitness Member Jan Pilar and her success with her program.

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That Office Chair Can Be Keeping You From Your Fat Loss Goal

the-new-york-timesFor many years, I have been preaching about the negative impact prolonged sitting has on our metabolic health and musculoskeletal system.  All the research has demonstrated that adaptive shortening of connective tissues and weakening of muscles occurs with as little as two days of prolonged sitting.  New studies of daily movement patterns demonstrate that sitting has an even more severe impact on our ability to metabolize body fat.  Take the time to read the article “Keep It Moving” by Gretchen Reynolds in the December 9, 2016 issue of the New York Times.

Once again, the answer is to get up off the Aeron, Barcalounger, La-Z-Boy, or setee and move around.  Every twenty minutes, stand upright and defy gravity with some good old fashioned ambulation.  Do not exercise in a seated position–train in a standing position.  More and more we are learning that consistent daily movement is an essential element of human health.

Read the NY Times article here: http://www.nytimes.com/2016/12/09/well/move/keep-it-moving.html

Michael S. O’Hara, PT, OCS, CSCS

 

Crawl and Bearhug Sandbag Carry

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.   

Crawl and Bearhug Sandbag Carry

A finisher is a short but intense, high metabolic cost, training event performed at the end of an exercise session.  The best finishers create carry over to real life activities and can be made more challenging as you become more fit.  When linked to proper diet, finishers produce the “metabolic hit” that stimulates fat loss.  As the name implies, you always perform finishers at the end of your workout because, afterwards, you will not want to do anything else.

Crawl
Crawling is all about the spiral, diagonal force connection that happens through the middle of the body.  Crawling is the primal exercise that enabled us to stand and walk.  The “core muscles” neurologically connect the left hip with the right shoulder and the right hip with the left shoulder.  They stabilize the pelvis and spine so you can transfer force from the hips to the shoulders.  Crawling keeps that connection healthy and strong.

Bear Hug Sandbag Carry

sandbagThe bear hug sandbag carry is the cure for the epidemic of device disability syndrome (DDS).  This exercise reverses all of the weakness that is created by endless hours planted in a chair, staring into a screen.  Sandbag carries are functional core stability work.  The abdominal muscles interact with the muscles in the legs and shoulder girdle to hold a stable upright position.  Walking with a sandbag kicks starts your postural reflexes, the neural feedback mechanism that holds us up against gravity.  Do not go too heavy on the sandbag.  You should be able to stay tall and not stagger or lean forward.

The routine is simple:  Crawl for twenty yards—ten yards down and ten yards back.  Try to keep the knees close to the floor and the back flat.  Immediately after finishing the crawl, pick up the sandbag with a bear hug hold- no hands linked- and carry it for twenty yards.  Rest as needed and repeat.  Start out with three circuits and increase to five.  Try to keep the rest periods under thirty seconds.  Once you get up to five circuits, add a weight vest and then a heavier sandbag.  Modify the distance, load, and cycles to suit your needs.  Give the crawl/bear hug carry combo finisher a try and let me know how it goes.

View video of Mike performing sandbag carries here: https://youtu.be/Ygg2vbf-Uoo

-Michael S. O’Hara, P.T., OCS, CSCS

 

Goblet Squats and Pull Ups

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:

Train efficiently—You get much more work done during your training time. 

Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations. 

Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition. 

Move better—Training neurologically related movement patterns improves motor control.  

Goblet Squats and Pull Ups

The more inefficient you are when performing an exercise activity the greater the metabolic demand.  Inefficient exercise is the key to fat loss.  Most gym goers become efficient in their selected exercise activities and body composition improvement comes to a standstill.  This pair of exercises creates a systemic response that ramps up the metabolism and drives the hormonal response that creates better body composition numbers.

Goblet Squats
toes_to_fingertipsHold a kettlebell by the horns, with the elbows down and the kettlebell held against the sternum.  Keep the chest proud and relax the neck.  Place the feet at shoulder width and initiate the squat by pushing back the hips.  Keep the torso tall and descend to at least a thigh parallel to the floor position.  Let your pelvis fall between the legs. The elbows should drop down between the knees.  As you get stronger, use two kettlebells held in the double rack position.

Pull Ups
If you are unable to perform a pull up with your own bodyweight, use a band for assist or better yet, one of the machines that assists a pull up.  Use a pronated grip (hands facing away) or a neutral grip (hands facing one another).  I like a set of rings as it affords the shoulders more freedom of movement.  Attempt to get your elbows tight to your side at the top of the pull up.

Perform ten goblet squats, then perform six pull ups, rest sixty seconds, and then cycle back through.  Perform four total trips through this pair of exercises and you will have completed 40 goblet squats and 24 pull ups.  There is something about the pull ups that makes my upper back feel more stable and I move through the goblet squats with greater ease.  As your body composition improves, the pull ups get easier.

View video of these exercises here: https://youtu.be/3L13W9VpqXk

-Michael S. O’Hara, P.T., OCS, CSCS

snapshot-1-11-9-2016-12-58-pmThe New York Times recently reprinted an article by Jane Brody entitled “Posture Affects Standing, and Not Just the Physical Kind.” In the article, Ms. Brody talks about how poor posture creates problems across multiple areas of physical function. The respiratory, digestive, emotional, and neurological systems are all impacted by postural restrictions. You are even more likely to be a victim of crime if you have a slumped over posture. So how do you develop better posture?

Get Up Out of the Chair
Ergonomic chairs, elevated monitors, slanting keyboards, and lumbar supports are fine, but nothing works as well as standing up and walking around every fifteen minutes. Office modifications, while well-intentioned and generally a good idea, cannot compete with endless hours of desk sitting. In order to fight against the postural stress that creates pain, we need to get up and move. Everyone wants an exact number, so I suggest that after fifteen minutes of sitting, you stand up and walk/stretch for three minutes. The best advice is to get a standing desk and completely eliminate working in a seated position.

Perform Posture Correction Exercises Every Day
If you want to abolish the neural and connective tissue restrictions created by postural flaws, you need to work on it every day of the week. Two or three visits to the gym will not be enough. You need lots of repetitions over a long period of time to reverse the changes created by hours slumped over the desk or strapped in a seatbelt. Specific exercises that wake up your nervous system, strengthen your postural muscles, and reverse tissue shortening are required. It should take you no more than 90 seconds to complete one or two of the exercises listed below. Set a timer, enlist the help of your coworkers, and work at these exercises every day. See the exercise suggestions and video presented at the end of this article.

“This Feels Weird”
For most Postural Stress Disorder (PSD) patients, standing upright and sitting tall will feel abnormal. Their body positioning neural feedback mechanisms have been damaged by years of improper loading. Feeling better with a more upright and stable posture will take between six weeks and six months to achieve. Very often, “other sensations” go away fairly quickly– Migraine and sinus headache episodes are less frequent. That torn rotator cuff no longer creates shoulder pain. The arthritis in your hip is less problematic. The plantar fasciitis pain in your foot resolves. The pain symptoms caused by poor posture are far more widespread than most people realize.

You May Have To Avoid Certain Activities
Your gym program and recreational activities can make your posture worse. When you exercise, avoid movements or activities that pull your head and spine further into a forward bent position. The rowing machine and the exercise bike are often poor choices. If you have postural problems, do not perform sit ups, crunches, or any other repeated or sustained spinal flexion. Avoid exercises that shorten the muscles in the front of the shoulders such as bench pressing and flys. Most PSD sufferers sit too much, so refrain from any fitness activity performed in a seated position. The most important thing a good fitness coach can do for clients is put them on the path to postural integrity.

How Long Will it Take to See Changes?
Most physical therapy patients report that the exercises get easier and they feel better after three weeks. Postural correction is a long-term project and clients continue to see results twelve months after starting on a consistent program of postural retraining.

So What Do I Do?

Chin Tucks
The forward head posture of the average computer operator creates all kinds of adaptive tissue changes in front and in back of the neck. Some daily chin tucks can mitigate the damage. Stand at attention, pull your shoulder blades back, and push your chest forward. For many of you, this is going to be challenging. Place you finger tips on your chin and gently push your head straight back. Visualize your head being pulled upward by an imaginary string attached to the crown of your head. Hold for two counts and then release. Perform ten repetitions.

Doorway Stretch
Office workers perform so many tasks with the arms forward and head down that they develop restrictions in the muscles in the front part of the shoulders and chest. Use a doorway stretch to reverse this adaptive shortening. Stand up with the elbows placed at shoulder level against the doorjamb. Step one foot forward through a doorway. Hold a gentle stretch for ten seconds and then lower the arms and rest. Perform two or three ten second stretches.

Overhead Back Bend
The sustained forward bent sitting posture tightens the front of the shoulders, inhibits thoracic spine extension, and can mess up your respiration. You can reverse all of these with some overhead back bends. Stand with the feet shoulder width apart. Reach the arms over your head and bend backward. Allow your hips to come forward and lean back into your heels. Breathe in through your nose and let your stomach rise. Breathe out through your mouth and let the abdomen fall. Perform three or four deep abdominal breaths while holding the arms overhead.

Standing Tubing Rows
Prolonged sitting weakens the upper back and shoulder retractor muscles. Standing tubing rows strengthens these muscles. Purchase an all-purpose band ($25.00) from performbetter.com and set it up in a door at work. Grasp the handles and stand tall with the arms extended and tension on the bands. Contract the muscles between the shoulder blades and pull the handles toward your body in a rowing motion. Hold the elbows back for two counts and then return to the starting position. Keep your neck relaxed during the exercise. Perform eight to fifteen repetitions.

View video of these exercises: https://youtu.be/KktwMew5Wks

Read the NY Times article here: http://well.blogs.nytimes.com/2015/12/28/posture-affects-standing-and-not-just-the-physical-kind/

-Michael S. O’Hara, P.T., OCS, CSCS

Fitness training for those of us past 40 years of age is more complicated. Physical performance and recovery capacity are dramatically different. If you need proof, look for the forty year olds in the NBA or NFL. The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime. I have compiled a collection of tips for the forty plus fitness client.

Recover Bettersleep
Many older fitness clients are able to train at intensity levels that are equal to their younger counterparts. What they are unable to do is fully recover between bouts of training. Insufficient recovery makes progress toward higher levels of fitness nearly impossible and creates an environment that invites injury. Activities that promote recovery between training sessions have great value for older training clients.
Quality sleep is essential for recovery. Unfortunately, many age-related changes can interfere with sleep. Menopause for women, prostate issues for men, arthritic joints, and acid reflux are just of few of the more common problems. If you have problems getting seven to eight hours of quality sleep, talk to your doctor about possible medical assistance to improve your sleep. Invest in better pillows and a quality mattress. If your schedule permits, take a nap during the day to boost your total sleep time.
Active Recovery is the term used by strength coaches and trainers for short and easy exercise sessions that speed up recovery. On your days out of the gym, take ten to fifteen minutes and work on these areas:

Resolve movement pattern restrictions
Develop a more efficient and pain-free squat, lunge, hip hinge, or toe touch pattern and it will reduce tissue overload during training sessions.

Eliminate postural flaws
Occupational responsibilities and daily activities place us in the positions that feed into poor postural habits. Nothing stalls progress more than posture restrictions. These deficits will only resolve with daily training.

Soft tissue work
Soft tissue work with a foam roller, massage stick, or any of the other myofacial tools can work wonders. Find a physical therapist or trainer who can teach you how to use these tools to assist in recovery.
Have a recovery day. Many older fitness clients are unaware of how much they are taxing their bodies until they end up with an overuse pain problem. If you are going to perform high level fitness activities such as distance running, resistance training, or an hour of yoga, you are going to need some days in between that involve solid sleep, minimal activity, and maybe an easy walk.

-Michael S. O’Hara, P.T., OCS, CSCS

A Demanding Drill for Core Stability

The addition of handles to the simple weight plate was a brilliant idea that made maneuvering plates on and off bars and weight machines much safer.  I am certain thousands of toes and fingers have been spared since these new plates became standard equipment in most gyms.  Plates made by Iron Grip are encased in urethane and have large diameter handles that make them more user friendly than traditional plates.  The grips on the Iron Grip plates are parallel to one another and the handles are rounded and ergonomically correct.  One of my favorite Iron Grip plate exercises is the Overhead Plate Carry.

Overhead Plate Carry

overhead_plate_carryThis is a challenging drill that builds hip strength, core stability and scapulothoracic control.  Start with no more than a twenty-five pound plate and hold it directly overhead.  You must have sufficient shoulder girdle mobility to get the arms next to the head and keep the elbows straight.  Maintain a tall torso and walk forward 30 yards while keeping the plate overhead and torso tall.  Lower the plate, take inventory, and if able, attempt a second trip of thirty yards.  Gradually work up to a heavier plate and greater distances.  A mirror is helpful to monitor your posture.
Try greater distances before adding greater load to this exercise.  A five pound plate joiner can be used to increase a forty five pound plate up to ninety pounds.
-Michael O’Hara, P.T., O.C.S., C.S.C.S.

Watch video

Mr. V had pain inman_falling his lower back and right hip. The problem had been present for over a year and he had been diagnosed with spinal stenosis. He was sent for physical therapy by his family physician because he was having difficulty climbing the stairs and walking in his home. Mr. V was 78 years old and lived with his wife Miriam. Miriam reported that her husband had mild dementia and had fallen three times over the last month. Mr. V stated that he often felt dizzy when he got out of bed, but he was not sure why the falls happened. Miriam stated that they did not bother to tell the doctors about these falls.

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