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The Wisdom of Frank–Part IV

“Change It Up”

I met my friend Frank when I was 21 years old and working out at a local gym.  Frank was sixty-eight years old and in great condition.  He had been a professional boxer, army fitness instructor, and then a physical education teacher.  Frank was an incredibly well read student of fitness and human performance.  He was stronger, more agile, and fitter than most people in their twenties.  Success leaves footprints, so I was eager to learn from a master.

Frank was big on developing one set of skills for a defined period of time and then switching to performance parameters.  We would work hard on improving strength with squats, cleans, and pull ups for six weeks and then take a break.  The next six weeks would focus on speed and endurance–lots of jump rope, sprinting, and medicine ball throws.  I never got bored and I never got hurt.

The best injury preventative for athletes and fitness enthusiasts is a consistent change in activity.  Look at your training / competition schedule and alter your activity every six to eight weeks.  Better yet, take a week or two away from running, dance, yoga, lifting, baseball, or Zumba.  If you are older or more injury prone, that rest period might need to be stretched out to three weeks.

The popularity of the club system has young athletes playing the same sport year round.  In the clinic, we are treating young athletes with “old person” overuse injuries.  Playing multiple sports is infinitely more beneficial.  Taking layoffs from overused movement patterns and participating in a variety of athletic endeavors gives the body a chance to rebuild and recover.  It is no coincidence that successful professional athletes are the product of multi-sport participation.

Michael S. O’Hara, PT, OCS, CSCS

The Wisdom of Frank–Part III

“Leave Some In The Tank”

I met my friend Frank when I was 21 years old and working out at a local gym.  Frank was sixty-eight years old and in great condition.  He had been a professional boxer, army fitness instructor, and then a physical education teacher.  Frank was an incredibly well read student of fitness and human performance.  He was stronger, more agile, and fitter than most people in their twenties.  Success leaves footprints, so I was eager to learn from a master.

Frank said that it is always better to do too little than to do too much.  A training session should make you feel alive and awake, not beaten up and broken.  Frank recommended exercise sessions that involved about forty minutes of training and ten minutes of what we now call “recovery work”.  He often told me to take it easy, go home, eat well, sleep soundly, and enjoy being young.  “When you get to my age you will thank me.”

The latest trend in fitness is throwing your body into the propeller.  Lying on the floor gasping for air is a badge of honor and a sought after result.  As a physical therapist that treats the byproduct of this training method, I urge caution.  Most young athletes can only train super hard for eight to ten weeks a year.  Older clients have a much more limited recovery capacity and are unable to sustain that level of activity before an injury occurs.  The winner in the life long quest for health and fitness is the contestant with the fewest surgical scars.

Training related injuries are a tragedy.  It is easy to get swept up by the emotions of competition and the desire to excel.  As we age, maintaining an exercise habit that keeps us strong and injury-free is even more important.  I frequently remind myself to dial it down and then I say a silent “Thank You”.

Michael S. O’Hara, PT, OCS, CSCS

Motrin Mayhem

More Research On Effects of Exercise and NSAID Medications

Millions of Americans take a non-steroidal anti-inflammatory drug (NSAID) every day.  Many use these over the counter drugs to reduce the discomfort / pain of fitness activities.  Big Pharma marketing makes the use of these chemicals look harmless.  In the commercial, the lady pops three pills and glides effortlessly through her run.  The basketball player takes his gel capsules and bounds through the game with his buddies.  Most of us view these drugs as harmless and beneficial.  Ongoing studies have shown that the use of NSAIDs as a pre-exercise activity preparation can limit your muscle recovery and damage your internal organs.  A recent New York Times *article by Gretchen Reynolds should scare everyone away from medicating with NSAIDs prior to a training session.

Exercise induced inflammation is a critical biochemical process that helps us recover from a bout of training. You do not get fitter while training, you get fitter during recovery from a bout of exercise.  The inflammatory biochemicals that make you sore and stiff after a vigorous exercise session are called prostaglandins.  NSAIDs work by interrupting the chemical assembly line that makes various prostaglandins.  No prostaglandin production means you have no delayed onset muscle soreness (DOMS), so you feel better.  Prostaglandins are the chemical signal that tells your muscle cells to get busy repairing and reinforcing your skeletal muscle cells.  No prostaglandins, no beneficial adaptation during recovery.  Take a NSAID before training and it’s like you never exercised at all.

Prostaglandin production creates vasodilation– more blood can get where it needs to go during a session of exercise.  The studies cited in the New York Times article have demonstrated that inhibited prostaglandin production creates diminished blood flow to your kidneys.  Limited kidney function dramatically blunts progress toward all fitness goals.   It is very difficult to run further, get stronger, or become leaner while undergoing dialysis.

Take the time to read the article by Gretchen Reynolds and rethink that pre-exercise NSAID protocol. You can view the article here: https://www.nytimes.com/2017/07/05/well/move/bring-on-the-exercise-hold-the-painkillers.html?

*Bring On the Exercise, Hold the Painkillers, Gretchen Reynolds, New York Times, July 5, 2017

Barbara O’Hara, RPh.

Advice From The Experts At Fenton Fitness/Fenton Physical Therapy

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#1—Don’t do dumb stuff

snapshot-1-1-11-2017-10-09-amThe cumulative injuries you suffer in your twenties echo through a lifetime.  My long and busy career as a physical therapist has taught me that this is true.  The 20 year old with a knee arthroscopy returns as a 32 year old with a ligament reconstruction and then again as a 50 year old knee replacement patient.  Surgery and rehab can only do so much.  Resist participation in the “hold my beer” events that inevitably present themselves in the social lives of 20 year olds.  Think twice before you enter that Gladiator Challenge Race, swing from that rope suspended over a river, or text and drive.  Your sixty-year old self will thank you.

-Mike O’Hara, Physical Therapist for the last 32 years.  Fitness coach and board certified orthopedic specialist 

To read the article, click on the link below:

http://www.nytimes.com/interactive/2016/10/16/well/live/health-tips-for-your-20s.html?

Listen to Mike’s advice: https://youtu.be/8JCtFzj539M

PDFIn this month’s issue, Mike O’Hara, PT provides information on Achilles tendinopathy with exercises that will help prevent this painful condition. Watch the video for the exercises by following the link in the article “Achilles Recovery”. Mike also demonstrates and describes the combination of turkish get ups and waiters walks–paired exercises that can help you train efficiently. Video for this article can also be seen on our youtube channel; just follow the links in the article.

Download Here

 

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

recovery_road

REAL WORLD RECOVERY

Many times patients, employers, rehab nurses, athletes, coaches, and insurance companies have unrealistic expectations in regards to rehabilitation recovery times. It falls to the physical therapist to explain the healing and recovery “time line.” These guidelines are applicable to the patient who undergoes a rotator cuff repair, lumbar fusion, tibia plateau fracture, humeral head fracture, etc… Understanding the duration and the level of effort required to fully regain function can keep a patient focused and eliminate disappointment.

Recovery Reality
If you have systemic health issues such as rheumatoid arthritis, diabetes, etc…. your recovery will take longer. The older you are, the longer your recovery will take. That professional athlete who went back to basketball, three weeks after a knee arthroscopy—he is 24 years old and you are 48 years old. It is going to take you much longer. The weaker you are at injury onset, the longer your recovery will take. If this is a second, third, or fourth injury of the same joint—the recovery will take longer.

Consistency is king in recovery. The individual who follows the program and performs the work will recover sooner. Many patients want to order off the rehab menu—I will have this and this but none of that. In these cases, recovery will take longer and be less effective.

You will probably have to work on more than your injured / post surgical joint during your recovery. The body is an interconnected machine and weakness / limited movement in one area can create the tissue breakdown in other areas. The post ACL repair patient often needs extensive strengthening of the hip. The shoulder pain patient will have to address postural issues in the neck.

Very often you have to change your lifestyle during the recovery period. Yoga after a back surgery may be on hold for nine months. Road running after a surgical repair of your ankle can be off the program for up to a year. After a reverse total shoulder replacement, you may not be able to chop firewood for twelve months.

Progress is never linear. You have good days and bad days—this is normal. You feel and move better for three or four therapy sessions and then you have a few sessions of greater symptoms and more limited function. Do not collapse, despair, call the president–stay with the program and realize that time is on your side.

TIME LINES

Onset – Three Months
This is the in the physical therapy clinic rehabilitation phase.

The inflammatory phase of the injury / surgery resolves.

Active and passive movement of the joint improves.

Depending on the injury / surgery, pain resolution occurs later in this phase.

A protocol of rehabilitation activity may be in effect for certain surgical procedures.

Most patients have regained 60-70% of the function at the end of three months.

People with sedentary work can return to their occupations. More strenuous occupations will require further conditioning.

Three – Six Months
You exercise three or four times a week. Ideally, you visit the physical therapist for progressions of the training program.

You can expect some level of discomfort. The post surgical shoulder will still not feel like the non surgical shoulder. The lower back will have days of stiffness. These episodes are normal and part of the recovery process.

Strength is still limited and you will have to work on corrective exercises for the next three months. Resist the temptation of an early return to your Olympic lifting, Warrior Run, or Zumba class.

Individuals with strenuous occupations undergo a work conditioning program.

Most patients have regained 85-90% of their function at the end of six months.

Six – Nine / Twelve Months
This is the point that most people stop all formal rehab exercise activity.

The more active you are and the more demanding your lifestyle the more you need to continue to train through this phase.

I personally believe this is the most important recovery phase for spinal patients. You never completely recover from a spinal injury—you actively manage the problem.

I encourage everyone to work with a trainer on your fitness program. Exercise is like medicine. Take the proper dose for your specific problem and the results are magic.

The focus of your training should be to get stronger.

Nine / Twelve Months – Death
Consistent maintenance of the machine that carries you through life can dramatically improve the quality of that existence.

The biggest predictor for a future injury is a prior injury. Stronger individuals are less likely to get injured and have to travel back through the nine month rehab process.

Michael S. O’Hara, PT, OCS, CSCS

Sleep is involved in multiple aspects of fitness and health. In physical therapy, we know that the better you sleep the more likely your pain will resolve and the faster you will recover. Reduce sleep time and neurotransmitter production slumps, pain intensifies, and rehab recovery slows. You do not get stronger or more effic476804941ient while exercising. You get better with sufficient recovery. Proper sleep is the number one component of recovery. So, how do you know if you have a sleep impairment problem?

The Epworth Sleepiness Scale

The Epworth Sleepiness Scale* is a good place to start. It is widely used in the field of sleep medicine as a subjective measure of a patient’s sleepiness. The test is a list of eight situations in which you rate your tendency to become sleepy on a scale of 0 (no chance of dozing) to 3 (high chance of dozing). When you finish the test, add up the values of your responses. If you score a 10 or better, see your medical professional for a consultation. Many things have an impact on the quality and quantity of our sleep. Stay tuned for further sleep related articles.

To take the test, click on the link below:

http://epworthsleepinessscale.com/epworth-sleepiness-scale.pdf

*Reference: Johns MW. A new method for measuring daytime sleepiness:  The Epworth Sleepiness Scale. Sleep 1991; 14(6):540-5

-Michael O’Hara, P.T., OCS, CSCS

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