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sitting

Heat Or Ice For My Shoulder?

Try Standing Upright

In the gym, at the golf course, and during a visit to the hardware store, I am asked my advice on abolishing shoulder pain.  What everyone wants is the magical exercise, miracle ointment, or newest thermal treatment.  What they need–and what they do not want to hear–is that they have to fix their horrible posture.

Sustained poor posture can alter the function of your shoulder complex.  The shoulder girdle has only one, very small, bone to body connection.  The entire system is an interconnected series of muscles and ligaments.  Sustained slouched over postures create a faulty length-tension relationship in these structures that places adverse stress and strain on the four joints of the shoulder and the nerves in the neck and upper back.

OMG I sit lmGm (like my GrandMa).  

Shoulder posture pain problems are happening earlier.  I do not know if it is more tech toys, less physical education in schools, or a change in youth activity levels, but in the physical therapy clinic we are seeing younger people with older people postural shoulder pain.  They sit on the treatment table in extremely slouched over positions and are unable to pull themselves up into a correct position.  Most are unconvinced that how they sit and stand could be the generator of their pain problem.

What exercises can I do?

Stronger muscles will help restore posture.  The shoulder evolved to pull, lift, and carry.  The muscles that keep the shoulder strong and happy are in the back of the shoulder.  They hold the shoulder in a healthy position on the body.  Most of us never perform any pulling or lifting activities other than hoisting our laptop or toting our smart phone.   Making your shoulder girdle muscles stronger will help, but being mindful of your posture during the day is the most important factor.  Physical Therapist and US Soccer Team Trainer Sue Falsone says “You can’t out rep poor posture.”

Start with how you work and live.

Eight hours a day for five days a week equals 2080 hours of computer / desk time a year for the average office worker.  Add in a daily one hour car commute and another two hours of television a day and we push the Monday through Friday slump numbers to 2860 hours a year (120 days).  We have spent millions on state of the art chairs, elevated monitors, slanting keyboards, wrist rests, and lumbar supports.  Office modifications, while well intentioned and generally a good idea, cannot compete with 2860 hours (this number is probably low) of sitting in a year.  In order to fight against the postural stress that creates pain, we need to get up and move.

Recent research on prolonged sitting has demonstrated that the amount of movement we need to stay healthy is greater than we once thought.  To combat the adaptive changes of prolonged sitting, it is suggested you get up and move every twenty minutes.  Set a timer, enlist the help of your coworkers, and work at this every workday for a month.  I believe you will be surprised by the results.

Michael S. O’Hara, PT, OCS, CSCS

Americans are far behind the rest of the world when it comes to the number of steps we take in a day.  The body mass index numbers and mortality rates of our fellow citizens are rising in direct proportion to time spent seated.  Human physiology operates optimally under the physical demands of a significant amount of standing and walking.  Much of the now rampant obesity, heart disease, diabetes, and metabolic syndrome can be linked to our species sudden fall into sustained sitting.  Standing for most of your workday and a daily habit of walking pays huge health and fitness benefits.

We are de-evolving into a nation of sitters.  Between internet, television, driving, and computer work, it is not uncommon for many of my physical therapy patients and fitness clients to sit for ten hours a day.  Unfortunately, you cannot train away the metabolic and physical damage created by prolonged sitting with a few 45 minute exercise sessions every week.

Seventy years ago, the London Transit Workers Study provided the initial scientific insights into the powerful health benefits of sitting less and standing more.  Take the time to read the recent *article by Gretchen Reynolds in the March 23, 2017 edition of the New York Times.  Ms. Reynolds’ provides some valuable information on the benefits of standing up and moving as much as possible.  Now go for a walk and then Google Varidesk.

–Michael S. O’Hara, PT, OCS, CSCS

*Should 15,000 Steps a Day Be Our New Exercise Target?, Gretchen Reynolds, New York Times, March 23, 2017

Read the article here: https://www.nytimes.com/2017/03/22/well/move/should-15000-steps-a-day-be-our-new-exercise-target.html

 

Are You Ready?

Spring At The Physical Therapy Clinic

The weather is warming up and soon we will leave the heated, insulated, safety of our home gyms and fitness centers.  The spring migration back to tennis, soccer, pickleball, golf, fitness running, ultimate Frisbee, and stadium steps will begin.  My physical therapy question is– Are you ready for these new challenges?  Has your fitness program prepared you to withstand the rigors of these spring endeavors?  This checklist should help you answer the question.

Have you been performing most of your fitness activities in standing?
Nearly every sport and most household chores are performed in a standing position.  During most of my visits to commercial gyms, the majority of the activity I witness is in the supine, seated, or heavily supported positions.  If your goal is to move better and remain free of injury, then 90% of your exercise should be performed in standing.

Do you practice moving in all directions?
Nearly every sport involves moving side to side, forward-backward, and in a rotational pattern.  Basketball, soccer, golf, and tennis all require you to accelerate and decelerate movement in all directions.  Most gym activities are predominantly sagittal plane– forward and backward.  You ride on the elliptical, spin the bike, and run on the treadmill for months, and your spring visit to the tennis court results in a twisted ankle because you are unfamiliar with side to side movement patterns.

Have you been working on better balance?
Balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle.  Many commercial exercise machines take all balance demands away.  The elliptical, spin bike, recumbent bike, rower… all are heavily supported.  Proficiency with single leg stance balance prevents injuries and improves performance.  The older and more deconditioned you have become, the more your fitness program should include single leg stance balance training.

Do you perform any explosive exercises?
We get slower before we get weaker, and life is an up-tempo game.  We need to perform exercise that enhances quickness and improves control of deceleration forces.  What you do in the gym is reflected in how well you can move during activities of daily living.  If you continually exercise at slow tempos, you will get better at moving slowly.  If you train explosively, you get better at moving at faster speeds.  The capacity to decelerate a fall requires fast reactions.  Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power production and speed of movement.

Michael S. O’Hara, PT, OCS, CSCS

That Office Chair Can Be Keeping You From Your Fat Loss Goal

the-new-york-timesFor many years, I have been preaching about the negative impact prolonged sitting has on our metabolic health and musculoskeletal system.  All the research has demonstrated that adaptive shortening of connective tissues and weakening of muscles occurs with as little as two days of prolonged sitting.  New studies of daily movement patterns demonstrate that sitting has an even more severe impact on our ability to metabolize body fat.  Take the time to read the article “Keep It Moving” by Gretchen Reynolds in the December 9, 2016 issue of the New York Times.

Once again, the answer is to get up off the Aeron, Barcalounger, La-Z-Boy, or setee and move around.  Every twenty minutes, stand upright and defy gravity with some good old fashioned ambulation.  Do not exercise in a seated position–train in a standing position.  More and more we are learning that consistent daily movement is an essential element of human health.

Read the NY Times article here: http://www.nytimes.com/2016/12/09/well/move/keep-it-moving.html

Michael S. O’Hara, PT, OCS, CSCS

 

standing-desk-pro-plus-36_main-1I have known Tracy for at least seven years.  She is an active mother of three children and works full time as an accountant.  Over a four-year span, Tracy was a patient in our physical therapy clinic three times for the same problem of leg and lower back pain.  Tracy always recovered and was able to return to work but her last bout of pain lasted three months.  I ran into Tracy at a restaurant recently.  She stated that she was ashamed to admit it, but after four years of listening to me preach about the benefits of a standing work station, she finally got out of the chair and started working at a stand up desk.  This is her standing desk story.

Her legs “felt tired” for the initial eight weeks and she went back and forth between standing and an office chair.  Tracy kept performing her hip mobility exercises and lumbar stability drills and gradually became more accustom to her new workstation.  She has been using the standing desk for three years, and in that time, she has not been bothered by any back or leg pain.  An additional benefit has been an eight-pound weight loss and “surprisingly” her “sinus headaches” have resolved.  Tracy told me she sits for at most three hours of a workday and could not imagine going back to a seated workstation. Tracy stated that three of her coworkers have made the standing desk transition and all report similar results.

Prolonged sitting creates multiple postural pain problems.  Postural Stress Disorder (PSD) is the new term given to the pain created by seated office work.  In our physical therapy clinics, we are seeing more and more patients with face, head, neck, shoulder, back, and hip pain associated with prolonged sitting.

We are de-evolving into a nation of sitters.  Between internet, television, driving, and computer work, it is not uncommon for many of my physical therapy patients and fitness clients to sit for ten hours a day.  Unfortunately, you cannot train away the bad effects of prolonged sitting with a 45 minute session of exercise.

While it takes some effort, and a little office remodeling, the benefits of using a standing workstation cannot be ignored.  I was happy to hear Tracy’s story and recognize her as one of my reluctant, but now pain-free converts.  If you have an occupation that places you in front of a computer, you should invest in a stand up style workstation that allows you to be upright for most of the day.  Many large corporations have recognized the benefit and have made the switch to standing workstations.  Standing desks are now more affordable and several of my converts have one at work and one at home.
-Michael O’Hara, P.T., OCS, CSCS

I have been a standing desk evangelist for the last six years.I have converted hundreds of seated apostates to the virtues of the standing workstation. Physical therapy patients and fitness cliestanding_desknts testify to the resolution of pain, restoration of function and a new belief in all things movement. Indeed my time on this earth will have been well spent if I can just get more people standing during their workday.

If you have a boss that controls expenditures for office equipment, he or she should read Daniel Akst June 2, 2016 article in the Wall Street Journal, “Want To Get More Done at the Office? Just Stand Up.” The author discusses recent research from Texas A & M on the use of standing desks in the work place. The big take away is that the subjects in this fairly large and long-term study were 46% more productive than their seated workmates.

Continue reading

More data on the impact prolonged sitting has on our health has been published. A recent Wall Street Journal article by Sumathi Reddy summarizes the findings.

Physical therapy patients and fitness clients often ask for guidelines on how often they should stand and move around during the day. My suggestion has been five minutes every half hour but the ergonomics expert in this article recommends to sit twenty minutes, stand for eight, and stretch for two minutes. I think he is correct.

Feedback from folks who attempt to stand more during the day is that their feet get sore, their ankles swell, and their lower back gets tight. Changing your activity levels will always create some unwanted discomfort but know that it will resolve with time. Sore feet will not kill you but a fatty liver and heart disease will.

To read the article, click on the link below:

http://www.wsj.com/articles/the-price-we-pay-for-sitting-too-much-1443462015

-Michael O’Hara, P.T., OCS, CSCS

Are you getting better or are you getting worse? No one stays the same. Our children get standardized reading tests, math exams, and comprehension assessments to measure learning. Your doctor continually assesses your blood pressure, lipid profile, and indicators of inflammation to determine if prescribed medication and lifestyle changes produce a beneficial response. In physical therapy, we look at range of motion, strength, mobility, balance, and movement patterns to make judgments on our treatment programs. In the fitness world, assessment is generally absent. This wastes valuable training time and can lead to injuries. I have some suggestions on basic fitness tests we can all use to determine if our exercise program is helping or hindering our physical performance.

The best performance tests require minimal testing equipment and can be performed safely by most individuals. They produce a time, a distance, or a measurement that can be recorded and compared to future and past results. The results are used to guide the choices you make in your exercise program. If performance tests worsen, then what you are doing is not working and you need to make some changes. If performance tests get better, be happy and keep on with your present training.

In the physical therapy clinic, we frequently see patients who pass some performance tests with an A+ grade and get a D- in other tests. They are the equivalent of the sixth grader who reads at a college level but is unable to perform simple addition and subtraction. The deficit in performance is what created the pain that brought them to the physical therapy clinic. The long term solution for these patients is to create a program of training that brings the D- up to a B grade. More reading will not improve the student’s dismal math grade.

Performance tests are the cure for the “I am not seeing any results” issue. Many well-intentioned exercise programs destroy performance, inhibit fat loss, and reduce functional capacity. Consistent assessments alert us to problems before pain is created and too much time is wasted.

Sitting Rising Test (SRT)

I like this test for nearly everyone. If you have knee stability issues, you may want to avoid this test. The SRT is very revealing, and it is often a wake up call for the “I ride the elliptical and watch TV” gym member. It takes less than five minutes to perform and nearly everyone can understand the scoring. It is a motivator that sends gym members and physical therapy patients in search of some balance, strength, and mobility.

The SRT was developed by Dr. Claudio Gil Araujo at the Clinimex Exercise Medicine Clinic in Brazil. He found that many of his cardiac patients could pass a treadmill stress test but had very limited strength and mobility. He devised a simple functional test that anyone can perform to assess balance, mobility, and strength.

Sitting_Rising

 

 

 

Performance

  1. Stand in comfortable clothes, in your bare feet, with a clear space around you.
  2. Lower yourself to a sitting position on the floor without leaning on anything.
  3. Stand back up, trying not to use your hands, knees, forearms, or the sides of your legs.

Scoring

For the lowering portion you have five points. For the rising portion you have five points. A perfect score is a ten. Subtract one point every time a hand, knee, thigh, forearm, or side of leg is used to assist sitting down or rising back up. Subtract one half point for a loss of balance.

Example: Touch the hand and the side of the leg on the way down the score is 3. Touch the forearm and then wobble on the way up and score a 3 ½. Total score 6 ½.

Research results

After following over 2000 patients in the 51 to 80 year age range, the data revealed some interesting findings. Patients who scored lower than eight points were twice as likely to die within the next six years compared to those with scores greater than eight. The patients who scored three points or fewer were five times more likely to die compared to those who scored more than eight points.

A beneficial fitness program should make the Sitting Rising Test score better. A bad training program makes the score worse. Take this assessment every four weeks and make sure your exercise program is taking you in the right direction.

-Michael O’Hara, P.T., OCS, CSCS

To view video demonstration of the Sitting Rising Test, click on the link below:

 

At the clinic, I have always had a standard seated workstation.  For the last three years, I have been using a standing desk in my home office.  I feel much better, and I am far more productive when I work at the standing desk.  It took four weeks to get used to the position of the mouse, keyboard, and monitor at the standing desk but all of the initial difficulties have passed, and I am now a standing desk convert.

Human physiology was designed to function under the physical demands of standing and walking.  Much of the now rampant obesity, heart disease, diabetes, and metabolic syndrome can be linked to our species’ sudden fall into sustained sitting.  Some of the statistics on the damaging effects of sustained sitting are distressing.sittring

If you have a desk job you are twice as likely to develop cardiovascular diseases as those who stand.

People who sit all day have high density lipoprotein (good cholesterol) levels that are 22% lower than people who stand.

The enzyme lipase breaks down the fat circulating in your bloodstream.  Researchers at the University of Missouri found lipase activity drops by 90% with as little as 20 minutes of sitting.  The circulating fat that is not acted on by lipase is stored as fat or deposited on the arterial walls.

Circulatory problems in the lower extremities, such as deep vein thrombosis, are 3 times more prevalent in people who sit for more than eight hours a day.

A Harvard research study found that men who spend more than forty hours a week sitting are three times more likely to develop Type II diabetes.  The numbers were not better if the subjects exercised three times a week indicating that we are unable to counteract the negative metabolic effects of prolonged sitting with exercise.

Prolonged sitting creates multiple postural pain problems.  Postural Stress Disorder (PSD) is the new term given to the pain created by seated office work.  In our physical therapy clinics, we are seeing more and more patients with face, head, neck, shoulder, back, and hip pain associated with prolonged sitting.

We are de-evolving into a nation of sitters.  Between internet, television, driving, and computer work, it is not uncommon for many of my physical therapy patients and fitness clients to sit for ten hours a day.  Unfortunately, you cannot train away the bad effects of prolonged sitting with a 45 minute session of exercise.

My suggestion is to invest in a workstation that allows you to stand for most of the day.  If you must sit get up and move often—every fifteen minutes is the suggested duration from the researchers.

-Michael O’Hara, P.T., OCS, CSCS

Stand Up, Walk Around, And Read This Article

I have been ranting about how damaging hours and hours of sitting is for our fitness and overall health.  More research is validating my belief that all the driving, computer time, and television watching is going to keep physical therapists, cardiologists, and surgeons working overtime for the next twenty years.  It appears that going to the gym three times a week is not enough of a stimulus to counteract the bad that happens when you sit for eight hours a day.  What we need is more general physical activity interspersed throughout our day and less sitting.  Take the time to read this article, The Marathon Runner as Couch Potato written by Gretchen Reynolds from the New York Times, October 30, 2013.

Link to article: http://well.blogs.nytimes.com/2013/10/30/the-marathon-runner-as-couch-potato/?_r=0

Michael S. O’Hara, P.T., OCS, CSCS

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