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Learn more about Rehab, Sports Medicine & Performance


Less Is More

Understanding The Requirements Of Rest

The weight room at my high school was small and had only basic equipment.  It consisted of two Olympic weight sets, some mismatched dumbbells, a squat rack, and a chin up bar.  In the gym, we had a pegboard and a rope for climbing.  No bench press, curl bar, or pulldown machine.  It was the ultimate blessing in disguise.  We did not have the temptation of exercise variety for variety’s sake.  What we did have was solid instruction on basic lifts.  We performed the same exercises repeatedly and became more proficient at squats, hang cleans, overhead presses, and pull ups.  Four simple activities performed consistently with an effort to add weight to the bar on a regular basis.  The results were magic.

The television fitness gurus have brought forth the latest craze of “muscle confusion”.  You change your exercise activity often in an attempt to stimulate a greater adaptation response.  The problem is that you never get the chance to practice the exercise long enough or with enough resistance to get stronger.  Getting stronger is the performance parameter that preserves muscle mass, speeds up your metabolism, and makes you more durable–less likely to get hurt.

I never want any of my muscles, nerves, joints, or any other part of my body to be “confused” when training.  I want the bodies of the athletes I train to perform better at every session.  My suggestion is that you pick five or six exercises and set a goal of getting better at each of them over the next six months.  The exercises you chose do not have to be a barbell or dumbbell exercise.  Bodyweight exercises will work just as well and are a better choice for most fitness clients.  Keep a record of your performance and work on improving the number of inverted rows, pull ups, or push ups you can perform.  Single leg strength training is a good choice for nearly everyone and works wonders for athletes. Athletes should choose exercises that not only improve strength, but also mobility—front squats.  Long term dedication to the mastery of an exercise will reward you with better body composition, enhanced mobility, less pain, and the strength you need to perform in athletics and daily activities.

This training approach requires mental toughness and a willingness to at times be bored.  Toughen up and get after the challenge.  Read this recent article in the Wall Street Journal, “We Need To Relax Like Roger Federer”.   Better yet, go out and buy the book Starting Strength.

Michael S. O’Hara, PT, OCS, CSCS

Keep your shoulders and spine happy and strong by following Mike O’Hara’s advice in “Pushing Up Performance”.  Video explanation and performance of pushups and their variations included.  Jeff Tirrell discusses the proper performance of pull ups in his article. “Movement You Should Master”. Is your mobility limited?  Try massage sticks or foam rollers with the information provided in “Pain, Pressure, and Pliability”.

Download Here

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

Spinning Wheel

HIIT Methods: Air Assault Dual Action Bike

The Air Assault dual action bike is a challenging metabolic disrupting machine.   For older fitness clients, heavier folks, and those of us with legs that are less tolerant of impact, the Air Assault improves cardio-respiratory capacity and minimizes joint stress.  If you are seeking an intense training experience, look no further than the Air Assault bike.

The number two reason people give for not exercising is limited time–lack of results is number one.  The Air Assault solves both of these problems.  Training sessions on the Air Assault are brief and very effective.

Set your seat for height and reach so at the bottom of the pedal stroke, the knee is bent about 20 degrees.  The arms should not fully extend at the elbows.  The bike is simple– increase the pedal speed and you push a greater volume of air.  Go slow—less resistance.  Go fast—more resistance.  Keep a tall posture to effectively drive with the arms and assist the legs.  I have outlined four of my favorite HIIT Air Assault training routines.  As usual, remember to perform a movement preparation warm up before launching into a HIIT session.

30 seconds on / 30 seconds off

Ride at an exertion level of 7/10 (1 is a stroll and 10 is sprinting away from a lion) for 30 seconds and then pedal slowly at a 1/10 exertion level for 30 seconds.  Repeat the cycle for ten intervals.  You are done in ten minutes.

45 seconds on / 15 seconds off

Ride at an exertion level of 7/10 (1 is a stroll and 10 is swimming to escape the alligator) for 45 seconds and then pedal slowly for at a 1/10 exertion level for 30 seconds.  Repeat the cycle for five intervals.  This workout takes five minutes.

Tabata Protocol

Twenty seconds on at an exertion level of 9/10 followed by ten seconds off at 1/10.  Repeat eight times.  This format is built right into the Air Assault bike timer.  Do not get discouraged if you have to stop well before completing eight intervals.  Work your way up to completing all four minutes of the session.

1.5, 1.0, 0.5 Mile Intervals

Ride for one and half miles and then rest 90 seconds.  Ride for one mile and rest for 45 seconds.  Ride for a half mile.  Record you overall time.

View Mike’s video on the assault bike: https://youtu.be/8Y3rmX2cF3s

For more information on the many benefits of HIIT read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, OCS, CSCS

Pushing For Performance

HIIT Methods: Sled Training

A good high intensity interval training (HIIT) session creates a disturbance of metabolic homeostasis while minimizing stress on the joints and / or compression of the spine.  Pushing a sled meets both of those goals.  Sled sessions are time efficient, and they have the added benefits of improving leg strength, core stability, and they make you better at nearly every daily challenge.  A well designed HIIT sled training protocol allows you to assess performance and track progress.  Presented below are four of my most frequently prescribed sled HIIT protocols.   Ditch the elliptical, cancel your Zumba sessions, and for the next month, give these a try.

I cannot tell you how much weight to use on the sled.  In general, men can start with bodyweight and women with half to two thirds bodyweight loads.  You will quickly learn if you have too much or too little on the sled.  Any progressive gym will have several sleds and plenty of open space.  The trainers at Fenton Fitness can get you started.

30 / 30 Protocol: Place a stopwatch so it is visible on the sled.  The load on the sled should create a thirty second interval exertion rating that feels “easy”.  Push the sled for thirty seconds and then rest for 30 seconds.  Perform eight intervals.

10 – 20 – 30 – 10 – 20 – 30 – 10 – 20 – 30 Yard Interval: Load your sled and start the timer.  Push the sled for 10 yards and rest twenty seconds.  Push the sled 20 yards and rest twenty seconds.  Push the sled 30 yards and rest twenty seconds.  Repeat 10, 20, and 30 yards two more times.   Finish all of the intervals and you will have covered 180 yards.  Record your time.

60 – 30 – 15 Yard Interval: Be careful that you do not use too much load for this HIIT sled session.  Push the sled 60 yards.  Rest thirty seconds.  Push the sled 30 yards.  Rest thirty seconds.  Push the sled 15 yards.  Record your time.

15 Yards Times Ten: Use a load on the sled that allows you to move at a fairly steady pace.  Think racehorse, not plow horse.  Place a stopwatch so it is visible on the sled.   Start the timer and push the sled fifteen yards.  Rest ten seconds and then push another fifteen yard push.  Perform ten, fifteen yard intervals.  Record your time.

View Mike’s video on sled training here: https://youtu.be/PfOccHMmzF4

For more information on the many benefits of high intensity interval training, read the The One Minute Workout by Dr. Martin Gibala.

Michael S. O’Hara, PT, 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

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.  

Carry, Squat, Lunge, Hinge, Pull, Push– Every Week

005Most strength coaches divide human movement into 5-6 fundamental movement patterns.  These movements are what we are talking about when we call our training “functional.” Personally, I like to go with 6 patterns in the following order of importance: Carry, Squat, Lunge, Hinge, Pull, and Push.  These functional patterns include virtually all aspects of human movement.

The first two, carry and squat, are performed daily in real life while the other movement patterns are used less frequently.  Incorporating these movement patterns into your training program at least once per week will ensure that you develop a well-rounded physique, but more importantly, that your musculoskeletal system functions like the awesome machine it was made to be. Practicing these movement patterns should keep you free from asymmetry and injuries.  You will also become stronger and well balanced giving you the confidence to take on whatever life throws at you.  Just how frequently you train each pattern will depend on your current training status, movement quality, experience, and goals.  Following is a loose guide:
Carry: 3-5x/wk  (this can include traditional carries, crawls, Turkish Get Ups, or sleds)
Squat: 2-3x/wk
Lunge: 2-4x/wk
Hinge: 1-2x/wk, (Deadlifts, KB swings, or Good Mornings all fall into this category)
Pull: 3-5x/wk
Push: 2-4x/wk

-Jeff Tirrell, B.S., CSCS, Pn1

Activity GoalTRXfacepull1

Improve horizontal pulling strength. Enhance stability in the shoulders.


Strengthen the Deltoids, Traps, Rhomboids, Teres, Minor, and Bicep muscles. Improve neurological control that stabilizes the shoulder joint.

Starting Position

Grab a pair of TRX handles. Firmly grip the handles and lean back. Keep a straight line from your ear, shoulder, hips, knee and ankle.


Pull your hands toward your ears/face. As you pull, turn your wrist so that you finish with the back of your knuckles to your ears. You should finish with your elbows high, squeezing your shoulders together at the top.

Common Mistakes

Taking too steep of an angle; not rotating the wrist; lacking control; allowing hips to drop.

-Jeff Tirrell, B.S., CSCS

Semper Pullus

Strength Is A Skill–You Just Need To Practice

The Marine Corp just decided to delay implementation of the 3 pull up proficiency mandate for female recruits as only 45% of the female soldiers could achieve this level of proficiency.  They plan on revising their training protocol and assessing the results later in the year.

Bad news sells.  The stories that broke in the newspapers and on TV all mentioned that 55% of the female recruits could not achieve three pull ups, but what they did not tell you was that the duration of the training was only sixteen weeks and that the initial level of fitness for many of the female recruits was poor.  Ask any strength coach that has trained female clients and they will tell you that the Marine Corp pass rate of 45% on the 3 pull up test is above average.

The October 28, 2013 issue of the New York Times ran an article detailing all of the reasons women are unable to perform pull ups.  Research done at the University of Dayton on a pull up training program was the basis of the New York Times article.  The program consisted of only seventeen participants, so the training protocol was far from optimal.  The fact that they were able to progress four of the seventeen participants to one pull up with this flawed three month regimen shows that nearly every female can achieve pull up prowess.

For the military, the three pull up test demonstrates that the soldier can manipulate her body weight over an obstacle.  If you can perform three pull ups, you will be able to get out of a ditch, climb a fence, and haul your body out of the water and onto a raft.  For fitness clients, the ability to perform pull ups improves posture, bulletproofs the shoulders and makes you less likely to develop head, neck, and upper back pain problems.  Pull up proficiency makes you stronger at other skills, such as push-ups, sprinting, and throwing.  I have some suggestions on how female trainees can get better at pull ups.

Do Not Train With Other Machines
Strength is a skill and just like any other skill it is neurologically very specific.  You will not get better at hitting golf balls by hitting a tennis ball–it is too different.  Lat pull down machines, incline total gym trainers, and all other devices are too different from a fixed bar pull up.  If your goal is to get better at pull ups, you have to stay away from these devices.

Perform Inverted Rows
Watch the video and add this exercise to your training program.  Inverted rows require proper positioning of the spine and shoulders.  Inverted rows will make you better at initiating the movement with the back muscles and not the arms.  The horizontal pull strength you develop with an inverted row compliments the vertical pulling skill you need to perform a bar pull up.

Do Not Train To Failure
Pull up prowess requires you to make a connection between multiple muscles in a manner that will be very new to most fitness clients.  You need to keep the neural lines of communication fresh and free from fatigue.  You will start your training with one solid repetition followed by an extended recovery.

Do Not Train Your Biceps
You need to learn to pull with your back muscles and not your arms.  Stay away from any kind of direct biceps training while you are working on your pull up program.  Your biceps will get stronger from the pull up training.  Gymnasts are the “pull up kings” of the athletic world and they perform no direct biceps exercise activity.  This was a big mistake in the University of Dayton research program.

Do Not Do A Lot Of Cardio
The University of Dayton program had their female clients do cardio activity in an effort to lower their body fat levels so they would have less to lift during a pull up.   Lots of cardio blunts your acquisition of greater strength.  It is difficult to get stronger if you are sapping your recovery capacity with lots of miles on the treadmill or bike.  Use intervals of intense work with short rest periods as a substitute.  Increasing the strength and control of your muscles keeps you lean, pain free, and healthy for a lifetime.

Improve Your Thoracic Spine Mobility
Many fitness clients have a thoracic spine- mid and upper back- that is stuck in flexion.  Hours in the car, computer work, iphone, and some poor training practices have locked them in a bent over position.  You need to be able to extend the thoracic spine in order to set the pulling muscles of the back in a proper position for a successful pull up.  A simple foam roll can help improve extension in the thoracic spine.

Train With A Band Assist
The pull up novice needs to use the assist of an elastic band.  The band gives you assist at the bottom of the pull up, and then has you working harder as you get closer to the bar.  Make sure you keep your knee down so the band does not snap off the leg.

Do Not Kip a Pull Up
“Kipping” a pull up is when you use motion of the lower body and torso to help propel your body up toward the bar.  As a physical therapist who treats people with shoulder pain problems, I love the kipping pull—especially for high repetitions.  As a strength coach interested in improving function and not injuring clients, kipping a pull up places far too much stress on the shoulders of clients who are new to overhead training.  When you have trained on improving your pull up performance for six months and can execute six solid smooth pull ups, you may be ready for some kipping pull ups.

Train Pull Ups More Often
The beginner golfer who practices five days a week is going to have an advantage over the golfer who practices twice a week.  Pull ups are a skill and newbies need to practice more often.  Get a bar set up in a doorway at home–one you must walk under frequently.  Get your kids to practice pull ups and work on this skill as a team.

Improve Rib Cage Stability
The pulling muscles of the upper back attach to your rib cage.  You need to be able to hold the front of your rib cage down with your abdominal muscles to become proficient at pull ups.  Get better at planks, ball roll outs, and the power wheel, and you will get better at pull ups.

Be Patient And Stay Consistent
It is going to take longer than three or four months to become proficient at pull ups.  You need to give this training nine months.  If you have long arms it is going to take more time to get better at pull ups.  Female Olympic level gymnasts are four feet, nine inches tall, so they make it look easy.

The Formula
Three days a week in the gym you do this:  Set up a bar with a band if you need an assist.  Perform one smooth repetition and then stop.  Go do something else as long as it is not biceps exercises or long slow duration cardio, and then come back to the bar in seven to ten minutes and do another single repetition.  Repeat this process three or four times every time you go to the gym.  As you get stronger, use a lighter assist band or perform two repetitions as long as each repetition is smooth and struggle free.  On two of your off days, perform three or four single pull ups.  Space them out throughout the day.  One pull up in the morning, one in the afternoon, and one at night.  The emphasis should be on performing every repetition in a smooth and struggle free fashion and keeping your neural system free of fatigue.  Perform inverted rows for three sets at least twice a week.  Work on your thoracic spine mobility with a foam roll, and improve the strength of the rib cage stabilizers with some planks and roll outs.

Test Progress
Every six weeks, test your maximal pull up capacity.  How many pull ups can you perform in a row with no assist.  Do not get discouraged if after six weeks you cannot perform a single.  Only 20% of the female trainees will get a single with just six weeks of training, but after twelve weeks, 40% of them will get one pull up.  Most will require five months of training to get a single pull up.  The good news is that once you achieve a level of success with pull ups, your body holds on to the neural connections that make them easy to perform.  As your skill level increases, it takes less effort to get even better at pull ups.

Michael S. O’Hara, P.T., OCS, CSCS