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Learn more about Rehab, Sports Medicine & Performance

prevention

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Ladder Matters

Moving well is a combination of balance, coordination, strength, and power.  During everyday tasks, you must be able to plant, pivot, and shift your bodyweight over one leg to change directions or decelerate an impact.  Movement is a skill that we all take for granted until the day that it fails us.  “I can’t believe I can’t do that,” is commonly heard from people in physical therapy.  They are unaware of the level of motor control they have lost to age, injury, and a sedentary lifestyle.  The good news is that with some consistent training, most motor control skills can be restored.  For gym members, an excellent method of enhancing movement skills is the agility ladder.

Agility ladders help you move better.  How you move says more about your age than how you look.  Responsive legs that can react to a disruption in balance keep you durable and injury free.  Consistent agility ladder training develops the neural coordination that allows more graceful movement.

Rotation is the movement pattern that creates the distance in your golf drive, the pop in your punch, and the acceleration in your sprint.  Rotation is the missing movement pattern in most training programs.  Ladder drills improve cross body, shoulder, and hip rotation.

Ladders are the rehab bridge that allows the injured athlete to move from a controlled series of movement patterns to the chaos of competition.  Ladders are one of the best power production and injury prevention activities older clients can perform.

As a conditioning method, I call ladder drills “three-dimensional jump rope”.   Move through a few sixty second intervals of continuous ladder drills and your body heats up, respiration increases, and your metabolism is disrupted.  Ramp that up to 90 seconds and check your heart rate.  See video of agility ladder drills: https://youtu.be/CmLXGLeyGfE

Michael S. O’Hara, PT, OCS, CSCS

Discover the difference between muscle soreness following exercise activity and pain you should be concerned about in “Do I Have A Problem?”.  Jeff Tirrell gives advice for women on optimizing performance  and Mike O’Hara discusses training priorities for those over forty.

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Movement You Should Master

Step Ups

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 very helpful in restoring the capacity to get up and down off the floor is the Step Up.

Step Ups

The ability to go up and down steps will almost always be needed.  Losing this ability is a sure sign that one’s quality of life and independence are quickly fading.  Step Ups can be done in a variety of different directions and loaded a number of ways making them easily progressed or regressed based on goals and fitness level.  Step Ups improve balance and strength in the glutes, quads, and hamstrings.  Depending how you load, they can also challenge the core and shoulders.  The average step in the United States is 7 inches tall.  Strive to work up to a 14 inch box so that no flight of stairs will ever intimidate you.

Here Coach Katie demonstrates two different versions we like to use and the benefits of each along with some progressions.  Watch the video and give it a try: https://youtu.be/iGXtKyGlKMg.

1) Anterior Step up (Progression: Anterior Step Up with Racked Kettlebell hold)

2) Lateral Step Up (Progression: Lateral Step Up with one side loaded)

-Jeff Tirrell, CSCS, Pn1

 

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

 

Movement You Should Master

Pull Ups

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 helps build upper body strength and maintain shoulder mobility is the Pull Up.

Pull Ups

If you are a superhero and find yourself hanging off the edge of a cliff or a building, you’ll need to pull yourself up.  All kidding aside, the pull up is a fantastic exercise to build strength in the lats, biceps, rhomboids, and rear delts, while helping to maintain shoulder mobility.  Pull ups can be done with a variety of grips.  The most important thing is to use a full range of motion and maintain control (avoiding excessive movement to reduce injury risk).  I utilize one of three pull up versions with most clients depending on their fitness level.  Watch the video and give it a try.

1) Eccentric Pull ups: Use a box to start in the top position, and slowly lower yourself with complete control down to the bottom position.  Once you can complete 10 of these with a good 4-6 second descent, then it’s time to move on to a standard pull up.

2) Standard Pull up:  Start hanging from a bar (or rings) with your arms completely straight.  Pull yourself up until your clavicle touches the bar.  Slowly lower yourself back down until your arms are completely straight and your body is motionless.

3) Xiphoid Pull ups: Start as you would for a standard pull up, but rather than pulling to your clavicle, you want to lean back and pull yourself up until your xiphoid process (bony part at the bottom of your sternum) touches the bar.  Then, lower yourself in a controlled manner back to the start.

See video of pull ups here: https://youtu.be/Cyvp4X2MRC0

-Jeff Tirrell, CSCS, Pn1

Think About This

The Latest Science on the Prevention of Alzheimer’s

Over the last 30 years, more than two hundred experimental drugs have failed to produce any success in the fight against Alzheimer’s.  It does not appear we are going to have a pharmaceutical for the treatment of Alzheimer’s any time in the near future.  A recent *article in the April issue of Scientific American discusses a treatment option that does appear to work.  This is currently our only hope in the fight against this terrible disease.  The good news is the treatment that prevents cognitive decline helps with so many other problems.

The study’s researchers demonstrated that an interventional program of exercise, proper nutrition, and cognitive training produced significant improvements in brain function.  The **Finnish Intervention Study to Prevent Cognitive Impairment and Disability (FINGER study) enrolled 1260 men and women between ages 60 and 77.  Over the course of two years, participants demonstrated improved cognitive test scores in processing speed (up 150%), executive function (up 83%), and complex memory (up 40%).

The exercise program in this study was not complex or time consuming.  The routines were developed by physical therapists and performed four or five days a week.  The exercise sessions involved strength training, balance skills, and aerobic activities.  As the participants became fitter, their training regimens were progressed–more challenging activities, more resistance, and/or more volume.  The time spent in training was four to five hours a week.

If your goal is to maintain or improve cognitive capacity and remain independent, then the prescription is a consistent routine of exercise.  Take the time to read the article, lace up your sneakers, and make a progressive program of fitness a lifelong habit.

* A Rare Success Against Alzheimer’s, Scientific American, April 2017

** The FINGER study, Alzheimer Prevention. Download the article here: http://r.search.yahoo.com/_ylt=A0LEViMTIfZYurkAQNsnnIlQ;_ylu=X3oDMTBybGY3bmpvBGNvbG8DYmYxBHBvcwMyBHZ0aWQDBHNlYwNzcg–/RV=2/RE=1492554131/RO=10/RU=http%3a%2f%2fwww.alzheimersprevention.org%2fdownloadables%2fFINGER-study-report-by-ARPF.pdf/RK=0/RS=fHWCrTAi9LEEDrH5jWfmRvAI7LU-

Michael S. O’Hara, PT, OCS, CSCS

Very Short Term Running Preparation

I was recently asked by a fitness client to post exercise recommendations that would prepare her for outdoor distance running.  This person was two weeks away from being out on the road, running two or three miles a day.  She is middle aged, has a prior history of lower back pain, and her goal was to lose fifteen pounds and “tone up”.   Given such short notice, these are my recommendations.

Perform soft tissue work on a daily basis.  Foam roll the legs and use a lacrosse ball on the plantar fascia.  The vast majority of overuse injuries in runners happen in the lower legs and feet.  Attempt to unwind the myofascial distress created by 600-700 foot impacts a mile.

Improve your reciprocal hip pattern–one hip goes back and the other goes forward.  Most general fitness clients have glaring deficits on one side.  Perform some split squats, posterior lunges, step ups, and or walking lunges.  If you struggle with these activities, I would reconsider running as a fitness activity.

Wake up your gluteals.  Every day, perform fifty or sixty bridges, hip lifts, or leg curls.  You need super gluteal strength / endurance to run distances and avoid lower extremity injury.  If your butt gets sore from fifty bridges, you need to do them more often.

Running is a skill and most recreational runners need some practice.  Running hills will improve gait mechanics, enhance hip extension, and decrease deceleration forces.  Find a fifty-yard hill.  Run up the hill and walk back down.  Perform five hill runs.

You are always better to run too little than to run too much.   Start with very short runs– no more than half a mile.  Increase your total weekly mileage by no more than five percent a week.

You can’t do this in two weeks, but this is my big recommendation to all future runners.  Lose the extra weight before running.  As a method of fat loss, distance running has a poor track record.  It tends to elevate the hormones that make you hungry, and physiological adaptation to distance running happens fairly quickly.  Extra adipose makes you far more likely to develop a running related injury.  I know the guys and gals you see running miles and miles every day are lean.  Please remember that lean runners are successful with running because they possess the optimal body mass to run long distances.  They did not start heavy and become lean.  Put a fifteen pound weight vest on that guy or gal and everything will change.  Their gait will lose efficiency and become less graceful.  The extra fifteen pounds of load creates the biomechanical overload that makes them much more likely to suffer an injury.

My final recommendation is that you not become disappointed if you develop pain.  A runnersworld.com poll conducted in 2009 revealed that 66% of respondents reported a running related injury that year.  The statistics indicate that one third of the participants at you local 10k fun run will require medical attention for a running related injury over the next year.  Have the good sense to stop when the pain begins.

Michael S. O’Hara, PT, OCS, CSCS

Aging Muscles and Exercise

Fast Reaction and Helpful Hormones

New technology has produced some surprising information on the cellular response of muscle to various types of exercise.  Super blood analyzers and computers have enabled scientists to monitor gene expression and hormonal release in muscle cells during and after sessions of exercise.  The information from this research is revolutionizing our understanding of optimal exercise prescription for health and longevity.  It appears that older individuals derive the most beneficial muscle cell response with fairly intense interval training sessions.  Please take the time to read Gretchen Reynolds article in the New York Times, The Best Exercise for Aging Muscles.

Dr. Martin Gibala, a professor at the kinesiology department at McMaster University in Hamilton, Ontario recently released an outstanding book, The One Minute Workout.  Dr. Gibala explains the science behind high intensity interval training (HIIT) and why it is safe and effective for older fitness participants.

Skeletal muscles produce beneficial biochemicals called myokines that stimulate a response in cells throughout the body.  Myokines are a fairly new scientific discovery and we have only recently begun to understand their remarkable effect on human physiology.  Myokines enhance blood vessel development, promote beneficial hormone levels, stimulate greater mitochondria production, and improve the metabolism of fat.  In the older individual, myokine levels are enhanced with strength training and high intensity interval training.

The best method of creating more of the beneficial myokine biochemistry is to consistently perform some progressive resistance training followed by a brief but intense interval training session.  This regimen of training is similar to that of track athletes involved in sprinting.  These athletes have high levels of muscle mass and very low body fat levels.

Michael S. O’Hara, PT, OCS, CSCS

Read the NY Times article here: https://www.nytimes.com/2017/03/23/well/move/the-best-exercise-for-aging-muscles.html

PDFTreadmills are found in virtually every gym.  Read the six treadmill facts you need to know.  Meet a Fenton Fitness member who learned how to manage her back pain, and read about the seven best TRX exercises.  Do you have limited time to exercise?  Be more efficient with HIIT.

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Are You Ready?

Spring At The Physical Therapy Clinic

The weather is warming up and soon we will leave the heated, insulated, safety of our home gyms and fitness centers.  The spring migration back to tennis, soccer, pickleball, golf, fitness running, ultimate Frisbee, and stadium steps will begin.  My physical therapy question is– Are you ready for these new challenges?  Has your fitness program prepared you to withstand the rigors of these spring endeavors?  This checklist should help you answer the question.

Have you been performing most of your fitness activities in standing?
Nearly every sport and most household chores are performed in a standing position.  During most of my visits to commercial gyms, the majority of the activity I witness is in the supine, seated, or heavily supported positions.  If your goal is to move better and remain free of injury, then 90% of your exercise should be performed in standing.

Do you practice moving in all directions?
Nearly every sport involves moving side to side, forward-backward, and in a rotational pattern.  Basketball, soccer, golf, and tennis all require you to accelerate and decelerate movement in all directions.  Most gym activities are predominantly sagittal plane– forward and backward.  You ride on the elliptical, spin the bike, and run on the treadmill for months, and your spring visit to the tennis court results in a twisted ankle because you are unfamiliar with side to side movement patterns.

Have you been working on better balance?
Balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle.  Many commercial exercise machines take all balance demands away.  The elliptical, spin bike, recumbent bike, rower… all are heavily supported.  Proficiency with single leg stance balance prevents injuries and improves performance.  The older and more deconditioned you have become, the more your fitness program should include single leg stance balance training.

Do you perform any explosive exercises?
We get slower before we get weaker, and life is an up-tempo game.  We need to perform exercise that enhances quickness and improves control of deceleration forces.  What you do in the gym is reflected in how well you can move during activities of daily living.  If you continually exercise at slow tempos, you will get better at moving slowly.  If you train explosively, you get better at moving at faster speeds.  The capacity to decelerate a fall requires fast reactions.  Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power production and speed of movement.

Michael S. O’Hara, PT, OCS, CSCS

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