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Learn more about Rehab, Sports Medicine & Performance

posture

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.

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Standing Desk Exercise Rx

Work Station Transition Training

As a physical therapist making his living taking care of people with pain problems and physical limitations caused by prolonged sitting, I am an avid promoter of standing desks.  Over the last five years, the prices of standing desk products have come down and the variety has increased.  Manufacturers now permit a 30 day “no risk” trial.  Try a standing desk for thirty days and then ship it back if it does not meet your needs.  I encourage anyone who must sit for more than five hours a day to convert some of those sitting hours to a stand up desk.  Employers are now aware of the benefit of standing desks and actively encouraging their use.  It can take some time to become accustomed to working at a standing desk.  I have three training tools that can help make working at a standing desk easier.  Read this article and watch the video for a demonstration of how to use each product.

Foot Care With a Spiky Ball

The bottom of the foot is a busy intersection of muscles, tendons, ligaments, fascia, and nerves.  Heel and plantar pain are common reasons we see patients in the physical therapy clinic.  Foot pain problems can take months to fully recover.  A little proactive soft tissue treatment will bulletproof the feet from overuse injury and pain.   A spiky ball is a small sphere with fairly aggressive projections.  Take off your shoes and give your peds a little love by rolling the bottom of your foot over a spiky ball.  Spiky balls come in various sizes and resistances.  I have found the smaller (2 ½ – 3 inch) and firmer models work the best for my foot.  Most people report that it “hurts good” and often get one for work and one for the home office.  Most spiky balls cost around seven dollars.

Posture Correction With Resistance Bands

If you have been a long-term seated data input warrior, you have probably been infected with the i-hunch virus.  As we get older, the muscles that hold the thoracic region tall and pull the shoulder blades back tend to get weaker at a faster rate than other muscles.  Prolonged standing is going to be challenging without some remedial rebooting of the software that holds you tight and tall.  I keep a ¼ inch superband (nine dollars from performbetter.com) at my desk and perform two upper body postural strengthening exercises.  Posture restoration takes some time so work on these drills every day for at least three months.

Band Pull Aparts

Choose a resistance band that allows you to perform a complete set without reaching failure.  The force produced by the band becomes greater as you travel through the movement so avoid a band with a strong resistance.   The tempo of the movement should stay smooth and steady.

Stand tall with the chest proud and the head pulled back.  Do not arch the upper back.  Tighten the abdominal muscle and keep the front of the rib cage down.  Hold the elbows fully extended and the wrist in neutral.  You can use either a palms up or a palms down arm position.  Individuals with some shoulder wear and tear may feel better with a palms up position.  Hold the arms up to 85 degree shoulder flexion and start with a low level of tension on the band.  Concentrate your efforts on the muscles between your shoulder blades as you pull the band apart and bring the hands out to the side.  Let the band stretch across the chest and pull the hands behind the body.  Tempo: Two counts- pull the band apart. Two counts- hold at end range. Two counts- return to the starting position.   Repetitions:  10 – 20 repetitions.

Postural Band Aid

One of the most convenient and easy to perform postural correction activities is an exercise I call the postural band aid.  Take a short length of therapy resistance band and stand up.  Assume a tall posture with a proud chest and the head pulled back.  Hold one side of the band in each hand with the palms up.  Keep the elbows by the side and bent to 90 degrees.  Pull the band apart so that your arms form a letter W with your arms and body.  You should feel a tightening of the muscle between your shoulder blades.  Hold the band apart for three counts and then slowly release back to the starting position.  Perform ten repetitions.

Dynamic Core Stability With Dynamax Medicine Ball

Physical therapy patients and fitness clients often complain of lower back fatigue when using a standing desk.  Solve this problem with some dynamic stabilization training.  Place a Dynamax medicine ball or an under inflated basketball under the desk and take turns elevating one leg up onto the ball.  The round ball creates a degree of instability that kicks in the stabilizers of the pelvic girdle and lower back.  Changing position and relieving stress on the joints in the pelvic girdle and lumbar spine can help abolish symptoms of fatigue.  It is one of the reasons your local saloon has a place to rest your foot when you belly up to the bar.  The majority of standing desk users report an improvement in symptoms using this simple alteration in stance.

Watch the 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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Mike O’Hara gives tips for aging gracefully and staying fit in his article, The Five Don’ts of Sustainable Fitness. Learn the importance of increasing mobility and stability in order to get stronger, and discover how a simple test that measures how well you get up from the floor can tell a lot about whether or not your fitness program is working.

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To combat the effects of aging, consistent exercise is key.  Mike O’Hara discusses the benefits of fitness and gives tips on starting and continuing a program of exercise for life in his article, The Three Do’s of Sustainable Fitness.  Jeff Tirrell of Fenton Fitness gives nutrition tips for athletes and Mike’s exercise for better posture and more efficient movement is the bird dog.

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How To Start Working Out

*How to Start Working Out, is a great article by Anahad O’Connor.  Most media articles on developing the fitness habit are fairly flawed, but Mr. O’Connor has done well.  I am encouraged because he discusses two of the more important aspects of fitness success: process goals and strength training.

Process Goals

Developing and maintaining the fitness habit is a motivational mind game.  Having a goal provides the emotional reinforcement necessary to be successful.  Most fitness clients set outcome goals—they want to lose twenty pounds, get stronger, or run a 5 kilometer race in record time.  Outcome goals are achieved through proper nutrition and consistent training.  Outcome goals are achieved through the development of a better life process.  I try to steer clients toward process goals—eat more protein, sleep better, daily mobility sessions, etc…  Process goals are the building blocks of fitness success and focus on your life outside of the gym.  Setting and achieving process goals creates the environment for achieving nearly everyone’s outcome goals.  Stronger, leaner, pain free, and faster will all follow when you have better life processes working in your favor.

Every expert on habit development recommends a paper and pen.  Writing it down is part of the commitment to fitness.  Record your process goals in an exercise log book or a nutrition diary.  Process goals that have worked well for fitness clients are listed below.

-Perform a daily five minute foam roll / mobility session for the next forty days.

-Weigh every serving of food you consume for the next two weeks.

-Take a thirty-minute walk for forty consecutive days.

-Get an extra hour of sleep every night for the next two months.

-Drop all sweetened drinks (juice, soda, sports drinks) for three months.

-Learn how to prepare a new healthy meal every week for six months.

Older, deconditioned, and metabolically challenged fitness clients will develop the fitness habit more readily with a dedication to process goals.  Build on the habits created by achieving ever more challenging process goals and you will reach all of your outcome goals.

Strength Training

When you get stronger, the magic happens.  It is really that simple.  If you want to be leaner—get stronger.  If you want to chase away the pain—get stronger.  If you want to improve your performance—get stronger.  If you want to prevent injuries—get stronger.  If you want to be active and vital into old age—get stronger.  The problem is that many barriers exist to the strength solution.

For best results, we need to start early.  An adequate strength level keeps you functioning well for a lifetime.  If in your early years, you were fairly sedentary, you need to get busy and strength train.  As we age, we lose a portion of our lean tissue, and if you have less muscle and bone “in the bank” you will reach your fifties and sixties in a weak and frail body.  Age related sarcopenia (loss of muscle mass) is one of the primary drivers of metabolic problems such as diabetese, hyperlipidemia, and chronic inflammation.  Today’s children are growing up with fewer episodes of bone and muscle building lifting and carrying activities.  I see teens nearly every day with lower back, knee, and hip pain all related to glaring strength deficits.

A lack of proper coaching and progressive programming are barriers to your strength training success.  Strength training is like medicine; given the proper prescription and dose, the results are consistently good.  Many of the people that have tried strength training and had bad results have taken the wrong medicine at the wrong dose.  They utilize advice from magazines, celebrity trainers, and the internet.  They confuse pharmaceutically assisted bodybuilding programs as appropriate strength training for a forty year old.  The best results are achieved when you work closely with a qualified coach who can monitor your results and teach you how to get stronger.

Michael S. O’Hara, PT, OCS< CSCS

*New York Times, Health Section, Anahad O’Connor, How to Start Working Out. View here.

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Lower Body

Split Squat

To set up for the split squat, put one foot in front of the other with the heel of the back foot off the ground. 85% of the weight should be on the front foot. An airex pad can be placed under the body for the knee to come down on when lowering to the floor. When in the bottom position of the exercise, the front knee should be in line with the toe creating a slight shin angle. Make sure to push through the front heel on the way up instead of the toe. This exercise can be made easier by holding onto a railing, or can be made harder by adding weight such as a kettlebell in a goblet hold. The split squat displays greater hamstring, external oblique, and gluteus medius muscle activity than the back squat, but less quadriceps muscle activity.

RFE Split Squat: RFE stands for “rear foot elevated”. With this variation of the split squat, set up with the back foot elevated on a bench or a padded stand created for this exercise. An airex pad can be used under the knee if necessary. Squat down, touching the knee to the floor or airex pad.  When in this bottom position, the shin angle should be angled forward just as before, not straight up and down. Common errors include sitting too far back on the rear foot, touching the glute to the heel, or the back foot can tend to roll off the padded stand on the way up and move more onto the shin. Avoid this by putting more weight into the front leg and dropping the knee straight down instead of back. This exercise can be made more difficult by adding dumbbells in each hand, a kettlebell in the goblet, racked, or double racked position, or a barbell in the front or back position. Make sure to descend slowly, creating an eccentric load instead of dropping down fast.

FOB Hip Lift: FOB stands for “feet on ball”. Lay on the floor or table on your back and place the arms out to the side. Push down into the floor with the arms to stabilize the body. Keep the feet together and brace your abdominal muscles. Use the glutes and hamstrings to lift yourself up off the floor, making sure to keep everything tight at the top of the movement. Hold 3-10 seconds at the top and lower slowly and controlled. You can remove the arms from the floor and rest them on your stomach or behind your head to create more of a challenge.

One Leg FOB Hip Lift: Same setup as before except one leg will be used. The other leg will be pointed up to the ceiling as the other presses into the ball to lift the body. This creates more of a stability challenge.

FOB Leg Curl: This variation starts out just like the FOB hip lift, except at the top of the movement when the body is raised, the knees are bent and the ball is pulled in towards the body creating more work for the hamstrings. Keep the hips extended by activating the glutes and moving the hips upward, avoiding the tendency to bend at the hips. It should look like your hips move up and then return to a straight body position.

One Leg FOB Leg Curl: The hardest variation for the FOB series is the one leg curl. Use one leg instead of two, extending the other leg up to the ceiling. Make sure to still avoid bending at the hips in this variation as well.

One Leg Deadlift: When starting out with this exercise, it is best to just use bodyweight. Stand with 95% of your weight on one leg. Extend the arms and free leg out to a “T” position, bending the standing leg slightly. The extended leg should be reaching backwards as far as it can go.  Think about sitting into that hip just as you would during deadlifts. As this exercise becomes easier and balance is not an issue, it can be progressed by holding a kettlebell. The kettlebell should be held in the same side as the leg extending back. Reach the kettlebell straight down by the big toe; the weight should not go in front of the toe but rather by the instep of the foot. If you have progressed pass the kettlebell, two kettlebells can be used or a barbell with weight. The primary muscles being used in this exercise are the posterior leg muscles including the glutes and hamstrings.

One Leg Squat: Stand in front of a 12-18” box (start higher, and work your way to a lower box).  You will want to have 5-10# of weight to use as a counter balance (dumbbell, plate, or med ball).  Standing on only one leg, slowly lower yourself to the box.  As you descend, reach forward with the weight to help with balance.  Control the descent until your butt taps the box and then stand back up.  Work for 3-12 reps before switching legs.  Over time, try to get to a lower box so that your hip is slightly below your knee at the bottom position.

Watch video of these exercises: https://youtu.be/SqFqf81UnIk

 

 

 

 

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Pulls

Just like the vertical press exercises, vertical pulls can be hard to execute due to their mobility requirements, but are the most effective and efficient movements when trying to build a strong and healthy upper body. The broadest posterior chain muscle in the body, the latissimus dorsi, has the primary actions of humeral adduction, extension and internal rotation, but also contributes to posture due to its attachment points. Vertical pulls also work the arms (brachioradialis, biceps brachii, triceps long head), shoulders/back (trapezius, posterior deltoid, teres major, rhomboids), and pelvic floor (rectus abdominis, internal and external obliques).

Pull Up/Chin Up: Pull ups/chin ups work the majority of the muscles in the mid/upper back and flexors of the arm. The rotator cuff muscles and core musculature play a more stabilizing role.  In both variations, think about keeping the core engaged.  There should not be extension in the lower back and if there is, you will notice yourself swinging back and forth during reps. When pulling up, think about leading with your collarbone and actually touching it to the bar. Another useful cue is to think about pulling the elbows to your pockets. Avoid rounding the upper back over the bar when reaching the top of the movement.  If you are having trouble touching your chest to the bar, it is either a strength or mobility issue.

½ Kneeling One Arm Pull Down
Set up at the Cybex machine or any cable hook up. Grab just one handle and put that same side knee down on the ground with the toe dug in.  Make sure the arm is angled in such a way that you have to reach across your body when the arm is flexed overhead. Your palm should be facing forward, and as you pull down, turn the hand towards the body and keep the elbow close to your side. Concentrate on squeezing the muscles in the back and keeping the rest of the body still with the core braced. Switch legs when you switch arms.

View video of vertical pulls here: https://youtu.be/knAFry9p-LM.

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

 

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