That pain in your arm or hand could be coming from somewhere else. Read Mike O’Hara’s article, Changing Locations to find out more. Jeff Tirrell gives nutrition tips and Mike discusses the benefits of using an agility ladder.
Stay independent longer by increasing your stair climbing capacity. Mike O’Hara shows you how in his article, “Keep Climbing”. Mike also discusses standing desks and the many benefits of standing while working. Jeff Tirrell explains the effect of exercise on appetite.
Bad Man Break
Men Need To Be More Aware Of Bone Density
Allen was getting out of his fishing boat when he twisted his left leg and fractured two bones in his ankle. Six weeks after ankle surgery, he landed in our clinic with considerable pain and a very limited lifestyle. Allen reported lower back pain that he attributed to his limping and use of the boot on his left leg. On recommendation from his physical therapist, Allen had further medical assessment of his lower back pain. An x- ray of his lumbar spine revealed two lumbar vertebrae fractures.
On a recent vacation, Mike went on a horseback ride with his grandchildren. During the ride, he developed pain in his upper back that “took his breath away”. A visit to the emergency room with what he thought was a cardiac issue revealed a three-level compression fracture in his thoracic spine. Further assessment showed significant osteoporosis in his hips, pelvis, and lumbar regions. Allen started on some bone rebuilding medications and physical therapy. It took over four months to fully recover from this injury.
Randy was working on his garden and fell onto the lawn. He had right hip pain and was unable to stand. His wife called the ambulance and he was diagnosed with a hip fracture. Four days after the surgery to repair his hip, he suffered an embolism and at the age of seventy-one, he passed away.
All three of these older guys had testing that revealed a significant loss of bone density. Unfortunately, the tests occurred after and not before injury onset. We are getting better at keeping men alive longer–less smoking and better medications. As men get older, the need to monitor bone density becomes a crucial aspect of healthy aging. Men need fewer commercials for the latest in testosterone replacement and ED medication and more awareness of how brittle their bones can become.
The general public views osteoporosis as a “women’s health issue”, but management of osteoporosis is just as important for men. Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled or die from the fracture. Since 2008, the rate of osteoporosis related hip fracture in the American male population is going up at an alarming rate.
Osteoporosis is a silent disease. Most people do not realize they have a problem until something breaks and they are in the middle of a medical crisis. Even after a fracture, many physical therapy patients are reluctant to follow up with a bone density screening. Being proactive is the only method of managing osteoporosis.
We know that individuals that participate in consistent resistance training exercises are more likely to have better bone density. Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it. The best bone building exercise activities produce a stimulus through your skeleton. Bone building exercises are easy to understand, but they do require more effort than swallowing a pill or having an injection. Everyone can perform some form of bone reinforcing exercise. Proper exercise prescription and consistent progression can work wonders. See the trainers and physical therapists at Fenton Fitness.
Jane Brody of the New York Times wrote a helpful *article on bone density testing. It covers the latest medical guidelines for testing and the when and why of testing for both men and women.
Michael S. O’Hara, P.T., OCS, CSCS
*New York Times, July 16, 2018, Jane Brody, When to Get Your Bone Density (View Article:here)
Play It All
How To Keep Your Child On The Field And Out Of The PT Clinic
Taylor was recently referred to physical therapy with a painful shoulder and a right hand that frequently went numb. For the last five years, she had been a year round participant in softball. At the age of fifteen, she was missing out on softball and a good night sleep secondary to the pain and limited function in her right arm.
Andy played soccer, and at the age of thirteen, he developed knee pain that prevented him from changing directions and sprinting. Andy practiced or played soccer four days a week for 50 of the 52 weeks in a year. It took four years of year round soccer to create the knee damage that required surgery and an twelve week rehab.
Many of the young athletes we treat in physical therapy are the victims of over exposure to the same training stimulus for far too long a period of time. Gymnastics, dancing, baseball, soccer, and softball are worthwhile endeavors, but a developing body needs a break in order to stay healthy. This becomes even more important as the athlete becomes stronger or more skilled.
Take a moment and read the *article by Jane Brody in the May 7th, 2018 edition of the New York Times. Jane interviews several Orthopedic Surgeons that are treating younger patients with injuries that usually occur ten or fifteen years later in an athlete’s career. The research they present is clear; year round single sports participation is not the best way to excel in athletics or remain healthy.
The recent popularity of the club system has children playing the same sport year round. In the clinic, we are treating more young athletes with old person overuse injuries. Participation in a variety of athletic activities is infinitely more beneficial and safer than single sports specialization. It is no coincidence that most successful collegiate and professional athletes are the product of multi-sport participation.
*New York Times, Jane Brody, May 7, 2018, How to Avoid Burnout in Youth Sports. View article: https://www.nytimes.com/2018/05/07/well/how-to-avoid-burnout-in-youth-sports.html
Michael S. O’Hara, PT, OCS, CSCS
Our June issue brings information on preventing neck pain by strengthening your neck. Mike O’Hara describes and demonstrates in a video exercises that will help strengthen the muscles of your neck. In another article, Mike tells how grip strength can be a predictor of early death in some patients. Be sure to read Jeff Tirrell’s article on performance based training.
You Have A Social Media Disease
There Is No App for Thumb Pain
Your thumb is made up of an intricate system of tendons that enable very precise movement. The joints of a thumb are fairly small and yet we are able to produce an amazing amount of force with this single digit. In this age of all things digital, the modern American thumb has been subjected to greater workloads. Problems with thumb pain, numbness, and limited function are becoming more common complaints in physical therapy. I have some suggestions on how to manage pain and limit the damage and embarrassment of excessive social media thumb exposures.
Thumb Tendon Troubles
Dr. De Quervain was the first to clinically described thumb tendonopathy, and we call thumb tedonosis De Quervain Syndrome. The test for De Quervain Syndrome was created by a clinician with an equally odd name and it is called the Finkelstein test. Place your thumb in the palm of your hand. Make a fist with the finger around the thumb. Hold the wrist in neutral and then deviate the wrist toward the pinkie finger. If you feel pain it is a positive Finkelstein test.
Resolution of thumb tendonopathy pain happens quickly when you give in to the symptoms of pain and modify your activities. Rest the thumb tendons by using your fingers instead of your thumb on that smart phone. Avoid fitness activities that put stress on the thumb. Lifting in front of the body with the palms facing inward is often the lift that new mothers perform and develop painful thumb tendons. Early on in the pain onset, icing is often helpful. In physical therapy, we are successful with soft tissue mobilization, ultrasound, and manual therapy. A gauntlet type thumb splint you wear at night is an unattractive but provides aviable position of rest for severely aggravated thumb tendons.
The Numb Thumb
Irritation of the median nerve in the carpal tunnel of the wrist will create thumb, second, and third finger numbness and pain. An injury of the recurrent median nerve in the front of the palm will produce numbness in the thumb and limited strength during thumb opposition–thumb to pinkie finger. Patients with neural irritation often develop numbness, weakness, and then pain. The pain often wakes them from sleep and disrupts hand function.
Once again, you will resolve a numb thumb with rest. Once neural irritation gets fired up, it takes longer to resolve than an aggravated tendon. Giving in to the numbness and resting the hands will produce better results if you start early. Two weeks of avoiding the aggravating hand activity produces good results. Night splints for the wrist and thumb are often helpful. A carpal tunnel release is a common surgical alternative that takes pressure off the median nerve.
Gumbie Thumb Beware
Every joint has a certain degree of stability and certain degree of mobility. Our spine, knees, hips, shoulders, and elbows must move enough to produce motion but not so much that they fall apart. The amount of movement in our joints is largely an inherited characteristic–you can blame Mom and Dad. The person at the extreme end of the scale (“double jointed”) needs to take certain precautions with their thumbs.
The Beighton Score is a popular screening technique for joint hypermobility. It has been around for thirty years and is used in research all around the world. The scoring is based on eight passive range of motion assessments and one active range of motion assessment. One point is assigned for each of the following.
A pinkie finger that can be passively bent backward more than 90 degrees.
A thumb that can be pulled down to the front of the forearm.
Elbows that passively hyperextend to 10 degrees.
Knees that passively hyperextend to 10 degrees.
The subject can place the palms on the floor during a straight leg, forward bend.
Researchers disagree on the score that should be a threshold for concern about systemic joint hypermobility. I have found that fitness clients and physical therapy patients that score a 5/9 or higher require modification of their training programs. It is not uncommon to encounter physical therapy patients that have a Beighton Score of 9/9. Hypermobile individuals need to take more precautions when they perform repetitive tasks such as texting on a smart phone.
Kimberly Salt wrote an excellent article on social media induced thumb pain in the May 19, 2018 issue of the New York Times. Take a minute and read, Me and My Numb Thumb: A Tale of Tech, Texts and Tendons.
Michael S. O’Hara, PT, OCS, CSCS
The Cumulative Effect of Activity
Many people are put off from starting an exercise routine because they are overwhelmed by the time commitment they feel is necessary. Fitness magazines, exercise experts, and everything on youtube preaches–
–30 minutes of cardio three times a week
–45 minutes of strength training twice a week
–150 minutes of exercise per week
Most of this well-intentioned advice is wrong. Nearly everyone can derive significant benefit from short bouts of fitness activity that are performed on a consistent basis. Walk for five minutes twice a day. A simple routine of two strengthening exercises will take no more than five minutes. Climb the stairs in your home three times once a day. Practice getting up and down of the floor. Stay consistent with a routine of short exercise bouts and you will be healthier and stay independent for a lifetime.
More research has demonstrated the beneficial effect of short exercise sessions interspersed throughout the day. Read the March 28, 2018, New York Times article by Gretchen Reynolds, Those 2-Minute Walk Breaks? They Add Up. View the article: https://www.nytimes.com/2018/03/28/well/move/walking-exercise-minutes-death-longevity.html
Mike O’Hara, PT, OCS, CSCS
In our May issue, Mike O’Hara discusses the importance of walking. If you have pain or difficulty with walking, there are things that help. Mike demonstrates some exercises to get you ready. Be sure to read Jeff Tirrell’s article on squatting, and read about Afterburn–a new class at Fenton Fitness that uses heart rate monitors while training.
Triathlon Success: Hamstring And Glute Togetherness
To keep a triathlete healthy and resilient, the hamstrings and gluteal muscles must work together as a team. The athlete fires the gluteals and hamstrings simultaneously to stabilize the pelvis and produce force through the lower leg. When you run, bicycle, or swim, these muscles work at a team to produce efficient propulsion and reduce stress on the lumbar spine and knee. A triathalon is the ultimate long duration physical endeavor. Triathletes need hamstrings and gluteal muscles that can stay on and strong for a long time.
Most fitness programs do not properly train the muscle of the posterior chain. Fitness center exercise generally involves training the hamstrings as knee flexors on some type of “leg curl” machine. Gluteal training rarely occurs past neutral hip extension, with little effort on improving overall hip range of motion. Any type of seated gluteal training is inappropriate for an athlete.
The term physical therapists and strength coaches use for butt muscles that are non- responsive is “gluteal amnesia”. Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the gluteal muscles. We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement. Many fitness clients and most physical therapy patients need some remedial gluteal training. Give these three drills a place in your triathalon training program.
Single Leg Bridges
Lay supine with the arms braced against the floor to stabilize the upper body. Bend the knees and place the feet flat on the ground. Lift the right leg up off the ground. Using the muscles in the back of the left leg, lift the hips up off the ground. Push up through the heel of the left foot and drive the left hip into full extension. Hold at the top for three seconds and then lower in a controlled manner. Perform ten repetitions on each leg. Common mistakes are allowing the pelvis to tilt and not fully extending the hip. Hamstring cramping is an indication that you are not using the glutes enough and need to focus on creating a better mind to butt connection.
The squat movement pattern is a skill that is easier to teach if you add some load. You can use either a dumbbell or a kettlebell for this exercise. It has been my experience that the exercise is easier to learn with a kettlebell. Hold a kettlebell by the horns, with the elbows down, and the kettlebell close to the chest. Keep the chest proud and pull the abdominal muscles tight. You may have to experiment with foot placement as everyone has different hips. The position you would place the feet if you were going to jump is a good starting point. Initiate the squat by pushing back the hips. Keep the torso tall and descend. Let your pelvis fall between the hips. The elbow should drop down between the knees. Nothing will inhibit your progress more than thinking about how you are moving during goblet squats. Keep your brain quiet and get in some repetitions. Effort has amazing capacity to improve motor control. Perform ten repetitions.
Mini Band Monster Walk
Your will need a mini resistance band–a nine inch loop of resistance band, (two dollars from performbetter.com). Most fitness clients will do well with a green or yellow mini band. Place the mini band loop around both legs just above the ankles. Assume an athletic stance with the feet straight ahead, knees bent, and hips flexed. The band should be held taught throughout the exercise. Imagine your feet are standing on railroad tracks. Walk forward for ten steps on each side, keeping the feet over the railroad tracks. Walk backward for five repetitions on each leg. Try to keep the hips and shoulders level throughout the exercise.
Once you have mastered all three exercises, build your gluteal and hamstring performance by traveling through the program for two or three trips.
- single leg bridges R and L x 10
- goblet squats x 10
- mini band monster walk x 10 each leg
View video of the exercises here: https://youtu.be/QeteeLPF4AU
Kat Wood, DPT, ATC
Triathlon Success: Core Connection
In the fitness world core stability training has gained a solid foothold and more people are getting away from spinal damaging resisted twisting machines and the ever present sit up gizmo. Most people know how to perform a “plank” exercise and have added this drill to their fitness routines. Learning how to properly brace the core stabilizers and perform a sustained plank type isometric exercise will resolve back pain, improve the hip to shoulder girdle connection, and make you a better movement machine. The problem is most people never advance beyond the basic plank exercise. Triathletes need significant anti-rotation and anti-extension core strength and endurance. I have three drills that will help keep you strong and resilient in your quest to complete you first tri. Read the directions and give these activities a place in your fitness program.
Alternate Single Arm Planks
Position the body in a toes and elbows plank, but separate the legs so the feet are wider than the shoulders. Lift one arm up at a 45 degree angle in relation to your body and hold for five seconds. Lower the arm back down and try the other arm.
If you are unable to perform the alternate arm plank on the floor, regress the exercise by placing the hands on a bench in a push ups position. Lift one arm up at a 45 degree angle in relation to your body and hold for five seconds. Lower the arm back down and try the other arm. How many and much? Perform three to five repetitions on each arm. Work up to longer hold times instead of more repetitions. Five repetitions on each arm with a ten second hold is a good goal.
You need a cable machine or resistance tubing set at mid torso level. Position your body at a 90 degree angle in relation to the pull of the cable. Assume an athletic posture with the feet at least shoulder width apart and the spine neutral. Push the hips back a little and keep a slight bend in the ankles and knees. You should look like a tennis player preparing to return an opponent’s serve. Use a strong overlap grip on the handle and set the hands in the middle of the chest. Brace the midsection and hips and move the handle out in front of the body and then back to the chest. Select a resistance level that permits execution of all repetitions without losing the set up posture. If one side is more difficult, start the exercise on that side. Perform fifteen repetitions on each side.
Many of us have terrible respiratory patterns. We are unable to fully inhale and exhale when under any physical stress. The Pallof Press can be used to improve respiratory control. Use the same set up and press the cable out. Hold the cable with the arm fully extended while inhaling for four seconds and exhaling for six seconds. Bring the arms back in and then repeat. Perform four of five inhale / exhale respiration repetitions on each side.
View the video here: View Video
Michael S. O’Hara, PT, OCS, CSCS