(810) 750-1996 PH
Fenton Fitness (810) 750-0351 PH
Fenton Physical Therapy (810) 750-1996 PH
Linden Physical Therapy (810) 735-0010 PH
Milford Physical Therapy (248) 685-7272 PH

Learn more about Rehab, Sports Medicine & Performance

shoulder

The Coldest of Shoulders

Understanding and Not Understanding Adhesive Capsulitis

Marilyn first noticed the right shoulder pain when she was sleeping on her right side.  Over the next month, the pain became more frequent and more intense.  Her shoulder ached in the morning and after any repetitive activity.  Marilyn tried medications and ice, but the pain persisted.  After eight weeks, the pain decreased, but her shoulder movement had become restricted.  Her shoulder became so tight that she developed difficulty with activities of daily living such as fixing her hair, dressing, and bathing.  Marilyn had developed a “frozen shoulder” and the frustrating thing was that she had no idea why it had happened.

No one fully understands why a frozen shoulder develops.  For some reason, the envelope of tissue that surrounds the glenohumeral joint–the joint capsule, shortens and develops thickened adhesions or scar tissue.  The medical term is “Adhesive Capsulitis”.  This tissue restriction limits the ability of the humeral head (upper arm bone) to rotate and glide properly so your shoulder becomes tight and painful.

Most of the time, a frozen shoulder occurs with no associated injury or activity.  Frozen shoulder most commonly affects patients between the ages of 40 and 60 years old.  It is far more common in women than men.  Individuals with diabetes are at far greater risk.  If you have undergone a surgery or sustained a trauma to the shoulder, you can develop a frozen shoulder.  This is especially true if you have held the joint immobile for a period of time.  Several studies have linked Parkinson’s disease, thyroid problems, and heart disease to a greater incidence of frozen shoulder.  Patients that develop a frozen shoulder are more prone to getting it in the opposite shoulder.  Despite all of this knowledge, we continue to see many frozen shoulder patients that have none of these predisposing factors.

I would add another condition to the commonly mentioned predisposing risk factors for frozen shoulder.  In my career as a physical therapist, it has been a rarity to find a frozen shoulder patient who was strong.  From grip strength in the hand to the muscles that hold the shoulder blade on the rib cage, these patients are usually weaker than their same age and sex peers.  The strength in the unaffected arm is often as limited as the arm with the frozen shoulder.  My belief is that the most common risk factor for developing a frozen shoulder is upper body weakness.  The glenohumeral joint is a fairly unstable joint that relies on the integrity of the muscles to kept it free from trauma.  If the shoulder muscles are unable to properly control the joint, then excessive stress is transmitted to the joint capsule and an inflammatory response ensues that scars and tightens the capsule.

Physical therapy for a frozen shoulder consists of manual therapy to stretch out the shortened joint capsule and a program of exercise to restores shoulder range of motion, coordination, and strength.  Most of the time, we get the patient when the shoulder is at its tightest point and recovery takes six to ten weeks.  As with so many conditions, the patients that get to therapy earlier or before the shoulder is fully frozen do better with therapy.

In many ways, Marilyn is the typical frozen shoulder patient.  She is the correct, age, sex, and fitness level.  Further medical work up revealed that she was prediabetic and in need of some ongoing medical attention.  Marilyn was a model physical therapy patient and her shoulder function was restored with six weeks of physical therapy.

Michael S. O’Hara, PT, OCS, CSCS

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Lower Body

Split Squat

To set up for the split squat, put one foot in front of the other with the heel of the back foot off the ground. 85% of the weight should be on the front foot. An airex pad can be placed under the body for the knee to come down on when lowering to the floor. When in the bottom position of the exercise, the front knee should be in line with the toe creating a slight shin angle. Make sure to push through the front heel on the way up instead of the toe. This exercise can be made easier by holding onto a railing, or can be made harder by adding weight such as a kettlebell in a goblet hold. The split squat displays greater hamstring, external oblique, and gluteus medius muscle activity than the back squat, but less quadriceps muscle activity.

RFE Split Squat: RFE stands for “rear foot elevated”. With this variation of the split squat, set up with the back foot elevated on a bench or a padded stand created for this exercise. An airex pad can be used under the knee if necessary. Squat down, touching the knee to the floor or airex pad.  When in this bottom position, the shin angle should be angled forward just as before, not straight up and down. Common errors include sitting too far back on the rear foot, touching the glute to the heel, or the back foot can tend to roll off the padded stand on the way up and move more onto the shin. Avoid this by putting more weight into the front leg and dropping the knee straight down instead of back. This exercise can be made more difficult by adding dumbbells in each hand, a kettlebell in the goblet, racked, or double racked position, or a barbell in the front or back position. Make sure to descend slowly, creating an eccentric load instead of dropping down fast.

FOB Hip Lift: FOB stands for “feet on ball”. Lay on the floor or table on your back and place the arms out to the side. Push down into the floor with the arms to stabilize the body. Keep the feet together and brace your abdominal muscles. Use the glutes and hamstrings to lift yourself up off the floor, making sure to keep everything tight at the top of the movement. Hold 3-10 seconds at the top and lower slowly and controlled. You can remove the arms from the floor and rest them on your stomach or behind your head to create more of a challenge.

One Leg FOB Hip Lift: Same setup as before except one leg will be used. The other leg will be pointed up to the ceiling as the other presses into the ball to lift the body. This creates more of a stability challenge.

FOB Leg Curl: This variation starts out just like the FOB hip lift, except at the top of the movement when the body is raised, the knees are bent and the ball is pulled in towards the body creating more work for the hamstrings. Keep the hips extended by activating the glutes and moving the hips upward, avoiding the tendency to bend at the hips. It should look like your hips move up and then return to a straight body position.

One Leg FOB Leg Curl: The hardest variation for the FOB series is the one leg curl. Use one leg instead of two, extending the other leg up to the ceiling. Make sure to still avoid bending at the hips in this variation as well.

One Leg Deadlift: When starting out with this exercise, it is best to just use bodyweight. Stand with 95% of your weight on one leg. Extend the arms and free leg out to a “T” position, bending the standing leg slightly. The extended leg should be reaching backwards as far as it can go.  Think about sitting into that hip just as you would during deadlifts. As this exercise becomes easier and balance is not an issue, it can be progressed by holding a kettlebell. The kettlebell should be held in the same side as the leg extending back. Reach the kettlebell straight down by the big toe; the weight should not go in front of the toe but rather by the instep of the foot. If you have progressed pass the kettlebell, two kettlebells can be used or a barbell with weight. The primary muscles being used in this exercise are the posterior leg muscles including the glutes and hamstrings.

One Leg Squat: Stand in front of a 12-18” box (start higher, and work your way to a lower box).  You will want to have 5-10# of weight to use as a counter balance (dumbbell, plate, or med ball).  Standing on only one leg, slowly lower yourself to the box.  As you descend, reach forward with the weight to help with balance.  Control the descent until your butt taps the box and then stand back up.  Work for 3-12 reps before switching legs.  Over time, try to get to a lower box so that your hip is slightly below your knee at the bottom position.

Watch video of these exercises: https://youtu.be/SqFqf81UnIk

 

 

 

 

Functional Stability

The last twenty years have brought about many changes in the fitness industry as our understanding of functional anatomy and evidence based training grows.  Some of these changes have been taken too far, misunderstood, or poorly applied such as stability training. When I was introduced to weights in 1998, exercise programs were built around machines which offer very little carry over to stability, core strength, and function.  Machine based training fails to maximally improve balance/stability, prevent injury, or maximize performance.  Enter functional fitness.  This concept has been popularized by strength coaches and physical therapists such as Eric Cressey, Dan John, Mike Boyle, Grey Cook, and Fenton Fitness owner, Mike O’Hara who saw a gap in training methods and optimal coaching.  Functional training includes better core stability/lumbopelvic control and more unilateral (single limb) exercises that closely mimic human movement. Unfortunately, as with many concepts in the fitness industry, this trend has been taken too far.

Many have latched onto “functional” fitness and incorporated unstable surfaces to challenge the small stabilizing musculature. This gives the illusion of strength and function, but as world renowned strength coach Mark RIppetoe says, these are simply “balance tricks”.  Real life doesn’t involve unstable surfaces like wobble boards, bosu balls, physioballs, etc.  This type of training highly restricts the amount of work the primary movers of the body can do, and doesn’t allow for strength adaptation to occur which should be a primary focus of any solid fitness program.

This Functional Stability series will address the best ways to improve real world function and strength while reducing injury.

Jeff Tirrell, CSCS, CSFC, Pn1

Vertical Pulls

Just like the vertical press exercises, vertical pulls can be hard to execute due to their mobility requirements, but are the most effective and efficient movements when trying to build a strong and healthy upper body. The broadest posterior chain muscle in the body, the latissimus dorsi, has the primary actions of humeral adduction, extension and internal rotation, but also contributes to posture due to its attachment points. Vertical pulls also work the arms (brachioradialis, biceps brachii, triceps long head), shoulders/back (trapezius, posterior deltoid, teres major, rhomboids), and pelvic floor (rectus abdominis, internal and external obliques).

Pull Up/Chin Up: Pull ups/chin ups work the majority of the muscles in the mid/upper back and flexors of the arm. The rotator cuff muscles and core musculature play a more stabilizing role.  In both variations, think about keeping the core engaged.  There should not be extension in the lower back and if there is, you will notice yourself swinging back and forth during reps. When pulling up, think about leading with your collarbone and actually touching it to the bar. Another useful cue is to think about pulling the elbows to your pockets. Avoid rounding the upper back over the bar when reaching the top of the movement.  If you are having trouble touching your chest to the bar, it is either a strength or mobility issue.

½ Kneeling One Arm Pull Down
Set up at the Cybex machine or any cable hook up. Grab just one handle and put that same side knee down on the ground with the toe dug in.  Make sure the arm is angled in such a way that you have to reach across your body when the arm is flexed overhead. Your palm should be facing forward, and as you pull down, turn the hand towards the body and keep the elbow close to your side. Concentrate on squeezing the muscles in the back and keeping the rest of the body still with the core braced. Switch legs when you switch arms.

View video of vertical pulls here: https://youtu.be/knAFry9p-LM.

PDFFind out if you scalenes are causing problems in Mike’s article, Scalene Salvation.  Read the inspirational stories of some Fenton Fitness members who conquered osteoporosis.

Download Here

Olympic Lifts–Do We Really Need Them?

Hang Snatch

 

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise is the Hang Snatch.  Watch the video, give it a try, and let us know how you do. View the video here: https://youtu.be/TrOhhKLIpqA.

The Hang Snatch, like the Hang Clean, is a better, easier option to learn than the full Snatch or Power Snatch.  Again, you start from the standing position.  We teach the Hang Snatch with a Hang Clean grip.  The traditional grip of the Snatch is much wider and places much more stress on the shoulders.  It is done to reduce the distance the bar must travel so you can increase the load you are able to use.  If you are not competing in Weightlifting, however, this doesn’t matter.  Once you are ready for the Hang Snatch and have the required shoulder mobility (can you touch your fingers behind your back?), it is the best power movement out there. The lighter loads used on this exercise compared to the Hang Clean make it an even friendlier exercise on your spine and the longer bar path requires more power output.

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Hang Clean

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise is the Hang Clean.  Watch the video, give it a try, and let us know how you do.  See the video here: https://youtu.be/KupitKep6Lk

The problem with the traditional Clean and Power Clean is that many people have trouble getting into a good position to start the movement.  The Hang Clean eliminates this problem by starting from the standing position.  It only requires a small amount of hip movement, yet still produces a great deal of power.  A good goal for your hang clean is to do the same amount of weight as your 1 rep max bench press.  If you can’t get there, you need more cleans and less bench work.

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Push Press

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise is the Push Press.  Watch the video, give it a try, and let us know how you do.  See the video here: https://youtu.be/1pI4eb6lMYQ

The Push Press is a limited, less technical, portion of the Clean and Jerk weightlifting movement.  It’s a great alternative as it has been shown to increase power but is much simpler to teach.  As long as you possess adequate shoulder mobility, there is much less risk with this exercise.  If done properly, both the hips and shoulders produce a large amount of vertical force which has strong carryover to sports that require jumping and overhead activities (throwers, volleyball, etc.).

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Plyo Push Ups

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise: Plyo Push Ups.  Watch the video, give it a try, and let us know how you do. View the video here: https://youtu.be/C0A0dibCmqE

Plyo Push Ups are a great horizontal power exercise for the upper body that simultaneously improves core stability. Pushing has obvious carryover for most sports and tends to be more on the speed side of the power spectrum. It can be easily progressed by adding a weight vest (use caution while performing this exercise due to force on the wrists).

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Split Jumps

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise: Split Jumps.  Watch the video, give it a try, and let us know how you do. See video here: https://youtu.be/yahWPNE0C-k

Those who have worked up to Split Jumps know it is a tremendous power exercise.  It challenges balance and puts the individual in a split stance which has much more carryover to running and cutting on the athletic field.  Split Jumps can be increased in difficulty by adding load (DBs or KBs in the hands or a weight vest) or by elevating the back foot.

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Olympic Lifts–Do We Really Need Them?

Broad Jumps

Over the last several years, Olympic lifting movements have made a comeback into many gyms.  The primary reason to use Olympic lifts is to improve/maximize power output, or Rate of Force Development (RFD); however, the general fitness population lacks the requisite mobility and stability to safely get into the required positions to perform these exercises.  Over the next several weeks, I will introduce thirteen exercises that you can use instead to maximize speed, power, and RFD with less risk of injury, less technical skill required, and more efficiency.  Today’s exercise: Broad Jumps.  Watch the video, give it a try, and let us know how you do. Watch the video here: https://youtu.be/iAmz2kyOx-0.

Broad jumps are a great movement for developing horizontal power/force production. Traditional Olympic Lifts emphasize vertical force with little carryover to sprinting/jumping.  Broad jumps emphasize speed though loading them can be difficult.  However, if you wish to progress the exercise and you have good mechanics, add a weight vest with a load of 10-20% of your body weight.

-Jeff Tirrell, CSCS, CFSC, Pn1

 

Categories