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Learn more about Rehab, Sports Medicine & Performance


Movement You Should Master

Push 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 requires no equipment and has bountiful benefits is the Push Up.

Push Ups

Push ups strengthen the pecs, deltoids, triceps.  They also allow free movement of the shoulder blades (unlike the bench press) and build stability in the core if done properly.  There is no need to get overly fancy with these.  If you can’t do a true push up with your chest touching the ground and your core locked in, start by elevating your hands instead of resorting to “girl” push ups on your knees.  Guys should try to work up to 3 sets of 20 reps at least a couple of times/week.  Women should strive for at least 10 reps but by no means need to stop there.  Watch the video and give it a try: https://youtu.be/7oQ-_J8FjEU

-Jeff Tirrell, CSCS, Pn1

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”.

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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

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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Kettlebell Swings and Push 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.   

Swings and Push Ups

Strength coach Dan John got me started on kettlebell swings/push up sessions.   This pairing challenges core stability as the swings create an anti-flexion core stabilization demand and the push ups an anti-extension demand.  If your goal is fat loss, this exercise pairing produces a total body metabolic boost.  A hidden benefit is getting up and down off the floor during the training session.  It is a basic mobility skill we need to practice in order to maintain our independence.

Kettlebell Swings
kb_swingA swing is not a squat and a squat is not a swing.  A kettlebell swing is a hip dominant motion; the hips move a lot and the knees just a little.  The handle of the kettlebell should stay above the knees.  At the bottom of the swing, the forearms should contact the upper thighs.  You swing the kettlebell forward with an explosive contraction of the gluteal and hamstring muscles.  Do not lift the kettlebell with the arms.  Project, or throw, the kettlebell to shoulder level and no higher.  The swing is an exercise that is worthy of some coaching.  Find an instructor that can help you with proper performance.

Push Ups
Keep the shoulder blades down the back and tight against the rib cage.  Hold the head in a retracted position and relax the neck.  The shoulders should not ride up into a shrugged position. Start at the bottom of the push up (flat on the floor).  Place the hands under the shoulders and keep the elbows tucked in to the side of the body.  Grip the floor with the hands and activate the muscles in the back of the shoulder blades.  Brace the abdominal muscles, tighten the glutes, and maintain tension between the legs by drawing them together.  Push up while maintaining spinal and shoulder position.   Hold at the top for two counts and repeat the push up.

Swing/Push Up Sessions
The great thing about these sessions is that you need minimal equipment—just a single kettlebell and a willingness to work hard.

This is a good place to start.  You will need a kettlebell and a stopwatch.
Swings x 20 seconds
Push ups x 6 repetitions
Rest 30 seconds
Repeat for fifteen minutes
As you get stronger, increase the push up repetitions.

This is one of my favorite swing/push up training sessions.
20 swings
20 push ups
20 swings
15 push ups
20 swings
10 push ups
20 swings
5 push ups
20 swings
You will finish with 100 swings and 50 push ups.

Try a push up “countdown” session.  Follow this pattern:
10 swings
10 push ups
10 swings
9 push ups
10 swings
8 push ups
Work your way down to 7-6-5-4-3-2-1 push up.  You will complete 100 swings and 55 push ups and transfer up and down off the floor 10 times.  If that is too much, modify the program and start at five push ups.  You will complete 50 swings and 15 push ups.

View video of Mike performing these exercises here: https://youtu.be/Vq3VYg847Xs

-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

The exercises that produce the greatest long term pay off are the activities that slow the aging process and prevent injury.  I believe these activities should be part of all training programs.  One of my favorite exercises is the Suspension Push Up. 

Dr. Janda has told us that certain muscles tend to become weaker earlier in the aging process.  They are the deltoids, triceps, rhomboids, abdominal, and gluteal muscles.  The suspension push up activates all of these muscles.  If you are looking to stay strong and fight off the effects of aging, you cannot get much better than a suspension push up.  Paired up with a suspension row, you have a superior push-pull upper body strengthening and core stability program that is hard to beat.

A common cause of chronic shoulder pain is poor glenohumeral joint stability.  The humeral head (golf ball) does not stay properly centered against the glenoid (golf tee).  Muscle imbalances, prior injuries, and inappropriate training can all create an environment where the humeral head moves too far upward and forward.  Excessive humeral head movement is the cause of acromioclavicular joint degeneration, or tears in the rotator cuff tendons and damage to the articular surfaces and support cartilage of the shoulder.   Suspension Push Ups can retrain glenohumeral joint stability.

Most pressing-type strengthening exercises do little to enhance glenohumeral stability and many exercises such as wide grip bench pressing and dumbbell flys enhance instability.  Performing the push up with rings or suspension loops produces an outward pull on the shoulders as the arms move through a horizontal push.  The pectoral muscles, internal rotators, latissimus dorsi, serratus anterior, and deltoids must work as a team to prevent the rings from moving apart.   The unstable nature of the rings or loops helps to restore the dynamic isometric control of the humeral head on the glenoid.  An added bonus is the anti-extension, core stability demand.  Your arms can only push what your spine can hold up.

The position of the suspension rings or loops is important.  They must hang at least four feet apart.  This assures you will be working against a horizontal abduction force (outward pull) during the exercise.  A single strap TRX is not appropriate for this exercise.  The rings or loops should hang about eight inches from the floor.  Get into a push up position and set your feet at hip width.  Maintain a good strong grip on the rings or loops –this helps recruit better glenohumeral stability.  Keep the body straight in one long line from the ears to the ankles.  Tighten the gluteal muscles and pull the shoulder blades down the back.  Lower slowly by pulling the elbows in toward the sides of the body.  Hold briefly at the bottom of the push up, and then push back up to the starting position.  Maintain a steady inward pressure on the rings or loops at all times.  Perform two or three sets of six to ten repetitions.

Common mistakes during suspension push ups are flaring the elbows, holding the hips too high or losing core stability, and performing a circus seal push up.  Make sure you move through a full range of motion.

You can make this exercise more challenging by elevating your feet on a box, adding resistance from a weight vest, or by slowing the tempo of performance.

To view video demonstration of the Suspension Push Up, click on the link below:


-Michael O’Hara, P.T., OCS, CSCS

How To Score Your First Push Up

Improving Performance Of A Fundamental Fitness Activity

Improving push up performance enhances spinal stability from the base of the skull to the pelvis, as well as strength in the shoulder girdle.  Push ups are a valuable exercise that improves multiple aspects of fitness in a short amount of time.  Various types of push ups can be used to achieve different goals such as better rotator cuff coordination, power production, or muscular endurance.  Many people have never been able to perform a single solid push up.  Getting better at performing push ups is easy.  The trick is breaking the push up into pieces.

Push Up Planks
The biggest limitation for beginners is limited core and shoulder girdle stability.  The torso and hips sag and the shoulder blades wing off the rib cage.  To remedy these problems, work on improving isometric stability with push up planks.  Set up in the top position of the push up and hold for thirty to sixty seconds.  Get a mirror or have a training partner check your position.  Keep the gluteal muscles tight and pull the shoulder blades down the back.  Elevate the feet on a bench or box to increase the challenge.

Eccentric Push Ups
The most difficult portion of a push up is the eccentric or the lowering phase.  You often see “half push ups” performed in the gym because the trainee is unable to maintain control if they drop any further.  Start from the top of the push up and lower in a controlled fashion all the way to the floor.  You will probably find that the bottom half is difficult to control–keep trying, it will get better.  Perform two or three sets of three eccentric push ups.

Dead Stop Push Ups  
The neural link up between varying muscle groups needs to be turned on to make a push up happen.  Starting your push up from a dead stop off the floor improves these connections.  Lay prone and place the hands on the floor directly adjacent to the armpits with the elbows back.  Your upper arm should be no higher than 60 degrees from your side.  Set your body by tightening up the shoulders, pulling in the chin, and bracing the abdominals and gluteal muscles.  Think about moving quickly off the floor.  Return to the floor, recharge your neural system with a ten second rest, reset, and perform another repetition.  Once you get up to five good dead stop push up repetitions, move on to a full push up from the top position.

BOSU Leverage Push Ups
If you are not able to perform a push up from your toes instead of dropping onto the knees, I recommend using a BOSU under the thighs.  It will produce a higher core stability demand, and I have found it has far more carry over to a true, full push up than the kneeling “girls push up’.

Avoid Training To Failure
Getting better at push ups is more neural than it is muscular.  You make better progress if performing fewer repetitions with good technique rather than dozens of bad push ups.  If you want to improve your push up performance, do not train your push ups to the point of failure.  Stop the set with one or two repetitions “still in the tank”.  If six repetitions is your maximum, stop at four, rest, and then repeat for another sub maximal set.  Try laddering your sets of push ups; perform a five repetition set, and then a four repetition set, and then a three until you reach one repetition.  You will increase the total work volume–more practice, without exhausting the nervous system.

Michael S. O’Hara, P.T., OCS, CSCS