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spine

Pressurize Your Anatomical Inner Tube

Push Up Position Planks

The center of the body is a cylindrical tube of interwoven muscle and fascia.  On the top and bottom, you have the diaphragm and pelvic floor.  The sides are reinforced by the oblique muscles and across the front by the rectus and tranverse abdominus muscles.  These muscles work together to create pressure inside the cylinder.  The tension capacity of our “anatomical inner tube” allows us to lift, carry, push, and pull loads that would overwhelm any single joint in the spine.  Developing better tension strength will improve athleticism and reduce injuries.  One of the best exercises to improve tension strength is the Push Up Position Plank.

Push Up Position Planks – PUPP

Place the hands under the shoulders with the elbows extended.  Pull your shoulder blades down your back and keep your neck long.  Lift your pelvis so that your body is supported on the feet and hands.  Pull the legs together and lift up onto the balls of the feet.  Your body is held in one long line from the ears to the ankles.  Do not let your hips sink or rise up—check your position in a mirror.  Create an isometric external rotation force in the shoulders by screwing the hands into the floor.  Imagine you are crushing oranges in your armpits.  Now squeeze the legs together and pull the hands toward the toes.  Hold that position for twenty seconds and work up to longer durations.  A good goal is a thirty-second high tension PUPP.

Elevated Feet-Push Up Position Plank

Once you can hold a solid thirty second push up position plank with the feet on the floor, progress to elevating the feet on a step or exercise bench for more resistance.  Work up to a thirty-second hold.

In rehab, we use push up position planks to help patients recover function in their neck, shoulders, lumbar spine, and pelvis.  For the fitness client, try putting two or three sets of  PUPPs between pulling exercises.  Watch the demonstrations and give the push up position plank a try.

View video here

Michael S. O’Hara, PT, OCS, CSCS

Real Core Training Part Four

Anti-Rotation

Like everything in the fitness world, core training has evolved.  When I bought my first bodybuilding magazine in the late 90s, the word “core” wasn’t even used.  Instead, you would find ab workouts, oblique workouts, and sometime, low back workouts.  Like pretty much everything in the 90s, muscles were trained in isolation with little concern for how the musculoskeletal system was designed to function as a unit.  We have come a long way in our understanding of physiology, biomechanics, and injury prevention/reduction.

The core used to be trained and often still is through movement: flexion (anterior), lateral flexion, extension, and rotation.  Sit ups, crunches, side bends, and Russian twists aim to strengthen the muscles concentrically and eccentrically.  These build mass and thickness to the core musculature.  The second way we train the core is to recognize it as a stabilizer of the low back and hips.  This involves training this musculature to resist movement.  When it comes to increasing strength, power, speed, and reducing injury, this training is more important than dynamically training the core.  This style of training is referred to as “anti-core training” because we are resisting flexion, extension, lateral flexion, and rotation.  The other benefit of anti-core training is that it involves isometric contractions which are much less likely to create muscle hypertrophy, which individuals typically don’t want in their waist.  I typically recommend that 70-90% of your core training consist of anti-core work depending on your health/injury history and goals.

The key to good core training is understanding what you are trying to accomplish, as well as how to progress or regress the movement.  Here are the some of our favorites that we use at Fenton Fitness for each of the four anti-core categories.

Jeff Tirrell, CSCS, CSFC, Pn1

Anti-Rotation

Tall Kneeling Pallof Press: Grab some elastic tubing or a cable (anchored to something sturdy) and assume a tall kneeling position.  Hold with both hands and press outward away from body.  Do not allow your body to twist or rotate.  Increase load or stretch on tubing to increase difficulty.  Work up to 12 reps per side.

Half Kneeling Pallof Press: Set up in a half kneeling position.  Use the same execution as the tall kneeling version.  Make sure that you don’t allow your legs/hips to lean or twist.  Work up to 12 reps per side.

Standing Pallof Press: Assume an athletic stance with your feet just outside of shoulder width, slight bend in the knees, and slightly flexed at the hips.  Execute the same movement as you would for the tall or half kneeling Pallof press. Work up to 12 reps per side.

One Leg Pallof Press: Stand on one leg with the other leg flexed at 90 degrees at the foot, knee, and hip.  Execute the Pallof press the same way as the standing Pallof press. This is a much more a balance and overall body stability drill.  Tension/resistance will need to be reduced.  Be slow and gradual with your increases in load, volume, or frequency to allow your knee time to adapt.  Work up to 12 reps per side.

PUPP with alternating arm raise:  Assume a push up position with your feet slightly wider than shoulder width.  Raise one arm out in front of your body while maintaining spine and pelvic positions.  A wider feet position makes the movement more stable and easier, while a narrower foot position increases difficulty.  You can also slow the movement to increase difficulty.  Remember, top priority is no hip/spine movement before trying to increase difficulty.  Work up to 10 per side.

Landmine Anti-Rotations:  Place a barbell in a landmine and assume an athletic position.  Press the landmine away from your body and slowly make a rainbow arching pattern moving the barbell from one hip to the other.  Make sure that only your shoulder/elbow joints move, everything else stays stiff.  Work up to 10 reps per side.

Crawl: Get on your hands and knees with your toes dug into the ground.  Lift your knees slightly off the ground.  Keeping your back flat and stable, move your opposite hand and foot to crawl forward or backward.  Work up to 50 yards.

For video demonstration of these exercises, click here

Real Core Training Part Three

Anti-Extension

Like everything in the fitness world, core training has evolved.  When I bought my first bodybuilding magazine in the late 90s, the word “core” wasn’t even used.  Instead, you would find ab workouts, oblique workouts, and sometime, low back workouts.  Like pretty much everything in the 90s, muscles were trained in isolation with little concern for how the musculoskeletal system was designed to function as a unit.  We have come a long way in our understanding of physiology, biomechanics, and injury prevention/reduction.

The core used to be trained and often still is through movement: flexion (anterior), lateral flexion, extension, and rotation.  Sit ups, crunches, side bends, and Russian twists aim to strengthen the muscles concentrically and eccentrically.  These build mass and thickness to the core musculature.  The second way we train the core is to recognize it as a stabilizer of the low back and hips.  This involves training this musculature to resist movement.  When it comes to increasing strength, power, speed, and reducing injury, this training is more important than dynamically training the core.  This style of training is referred to as “anti-core training” because we are resisting flexion, extension, lateral flexion, and rotation.  The other benefit of anti-core training is that it involves isometric contractions which are much less likely to create muscle hypertrophy, which individuals typically don’t want in their waist.  I typically recommend that 70-90% of your core training consist of anti-core work depending on your health/injury history and goals.

The key to good core training is understanding what you are trying to accomplish, as well as how to progress or regress the movement.  Here are the some of our favorites that we use at Fenton Fitness for each of the four anti-core categories.

Jeff Tirrell, CSCS, CSFC, Pn1

Anti-Exension

Supine Bent Knee March

Lay on your back and lift your legs off the ground with your knees and hips at 90 degree angles.  Posteriorly tilt your hips so that your low back is pressed firmly into the ground.  Slowly lower one heel to the ground keeping your knee at 90 degrees and not allowing your low back to lift off the floor.  Bring this leg back up and repeat on the other side.  Work up to 10 reps per side.

Bent Leg Dead Bug

Assume the same position as the previous exercise.  Reach your arms straight up to the ceiling.  Keep your low back pressed into the floor and straighten one leg, getting the heel as close to the ground as possible without touching.  Simultaneously reach the opposite arm overhead without quite touching the ground.

Straight Leg Dead Bug

Lay on your back with your legs and arms all reaching up toward the ceiling.  Keep your leg straight. and slowly lower it toward the ground while simultaneously reaching overhead with the opposite arm.  Don’t allow your foot or arm to rest on the ground, and keep your low back pressed into the floor.

Hollow Body Hold

Lay on your back and press your low back into the floor.  Lift your feet, shoulders, and arms off the floor, keeping your low back pressed into the floor.  Keep your feet and arms as close to the ground as possible while also keeping your low back on the ground.  Hold for up to 60 seconds.

Plank

Lay on your stomach and place your elbows under your shoulders.  Put your feet together and lift your hips off the ground.  Maintain neutral lumbar, thoracic, and cervical spine positions. Contract your glutes, pull your ribs down with a forceful exhalation, and try to pull your elbows toward your toes (they won’t actually move) to engage your lats.  Try to create maximum full body tension.  Hold for up to 30 seconds.

Long Lever Plank

Use the same set up and execution as the plank, except that the elbows will be farther out in front of the shoulders.  The farther forward the elbows, the harder this will be.  Work up to 30 seconds.

Body Saw

Use the set up the same as the plank only with carpet sliders under your toes.  Use your shoulders to slide yourself into the long lever position and then slide back.  Make sure you maintain spinal and pelvis positioning during the whole movement.  Work up to 12 reps.

Physioball Rollouts

Start in a tall kneeling position with a Physioball at arm’s length in front of you.  Pull your ribs down and engage your glutes.  Allow your body to fall forward by letting your hands and forearms roll up onto the ball.  Once you feel you are going to break lumbopelvic positioning, reverse the movement to get you back to your starting position.  Work up to 10 reps.

TRX Fallouts

Use the same set up as with the physioball, but use a suspension trainer instead.  Set up with straps at mid-thigh height.  Execute in the same manner.  Lower the strap starting position to increase difficulty.  Work up to 10 reps.

Ab Wheel/Dolly Rollouts

Set up on your knees with your hands on an ab wheel or dolly and place your hands directly under your shoulders.  Begin to fall forward by flexing the shoulder (overhead) and extending the hips.  Go forward as far as possible without losing spinal positioning and then reverse movement back to the start.  Make sure shoulder and hip joints extend/flex at the same speed.

For video demonstration of these exercises, click here

Real Core Training Part Two

Anti-Lateral Flexion

Like everything in the fitness world, core training has evolved.  When I bought my first bodybuilding magazine in the late 90s, the word “core” wasn’t even used.  Instead, you would find ab workouts, oblique workouts, and sometime, low back workouts.  Like pretty much everything in the 90s, muscles were trained in isolation with little concern for how the musculoskeletal system was designed to function as a unit.  We have come a long way in our understanding of physiology, biomechanics, and injury prevention/reduction.

The core used to be trained and often still is through movement: flexion (anterior), lateral flexion, extension, and rotation.  Sit ups, crunches, side bends, and Russian twists aim to strengthen the muscles concentrically and eccentrically.  These build mass and thickness to the core musculature.  The second way we train the core is to recognize it as a stabilizer of the low back and hips.  This involves training this musculature to resist movement.  When it comes to increasing strength, power, speed, and reducing injury, this training is more important than dynamically training the core.  This style of training is referred to as “anti-core training” because we are resisting flexion, extension, lateral flexion, and rotation.  The other benefit of anti-core training is that it involves isometric contractions which are much less likely to create muscle hypertrophy, which individuals typically don’t want in their waist.  I typically recommend that 70-90% of your core training consist of anti-core work depending on your health/injury history and goals.

The key to good core training is understanding what you are trying to accomplish, as well as how to progress or regress the movement.  Here are the some of our favorites that we use at Fenton Fitness for each of the four anti-core categories.

Jeff Tirrell, CSCS, CSFC, Pn1

Anti-Lateral Flexion

Bent Knee Side Plank

Lay on your side and place your elbow under your shoulder and line your knees up below your hips.  Lift your hips off the ground and hold.  Work up to 45 seconds.

Side Plank

Lay on your side and place your elbow under your shoulder and straighten your legs out.  Stack your legs on top of each other and lift your hips off the ground.  Hold for up to 60 seconds.

Side Plank with Top Leg Elevated

Position yourself in the same set up as the side plank.  Once your hips are lifted off the ground, you will move your top leg away from the bottom leg.  Make sure that you don’t flex either hip when raising the top leg.  Work up to 30 seconds.

Side Plank with Top Leg on Bench

Lay on your side and place your elbow under your shoulder.  Place your top leg on top of a bench.  Lift your hips off the ground.  The bottom leg can squeeze the bottom of the bench or dangle in the air.

Suitcase Hold

Grab a KB/DB in one hand, stand tall, and maintain a neutral lumbar, thoracic, and cervical spine position. Make sure your shoulder blades stay down and back.  If possible, watch yourself in the mirror to ensure you aren’t leaning.  Hold for up to 60 seconds.

Suitcase Carry

Assume the same set up as the suitcase hold.  Start walking with a normal gait.  Make sure to not lean excessively.  Start with 20 yards per side and work up to 100 yards.

For video demonstration of these exercises, click here

Lumbar Spine Fitness Guidelines

Janet injured her lower back while exercising in her local gym.  She was taking a trip through her favorite “ab ciruit” when she felt a snap in her lumbar spine.  The next day she was unable to stand up straight.  Two weeks later, we met her in physical therapy for her initial evaluation.  She was ready to return to her fitness program three weeks later.  Janet was very concerned she may suffer another exercise induced back injury and requested some advice.  These are the simple guidelines I give to physical therapy low back patients returning to exercise.

Mobilize the Thoracic Spine and Hips

Movement is supposed to happen at the thoracic spine and hips.  Unfortunately, prolonged sitting, deconditioning, and poor training choices tends to restrict mobility in these areas.  If you are unable to rotate and extend at the hips and thoracic spine, your brain will use other joints to make up for the deficit.  Pushing extra rotation and extension forces into your lumbar spine is never a good thing.  Dedicate some training time to improving thoracic spine rotation and hip extension / internal rotation range of motion.  If you sit for a living, work on your mobility everyday.

Make the Lumbar Spine Stable

Most fitness clients believe that more lumbar spine movement is a good thing.  They perform toe touches, back twists, and the many breeds of up and down dogs.  Unfortunately, greater lumbar spine range of motion is positively correlated with a higher incidence of lower back pain.  The incidence of low back pain escalates even further when we move those hypermobile lumbar spine segments against a resistance.  What does keep lumbar spines healthy is high level of lumbar spine strength endurance.  Can you hold the lumbar spine stable and prevent movement from occurring at the pelvis and five lumbar vertebrae.  Your lumbar spine stays happy and healthy when you focus training efforts on planks, roll outs, crawls, carries, and Pallof press exercises.  Avoid the sit ups, crunches, sidebends, toes to bar, and other assorted “ab” exercises that create lots lumbar spine motion.

Avoid Muscle Isolation Exercise Activities

The muscles that support the lumbar spine work together as part of a neurally connected team.  Training activities that support better communication between the team members will create optimal performance.  The neuroanatomy saying is “What fires together, wires together”.  Ditch the “upper abs”, “lower abs” baloney and sprint away from anyone who trys to strap you into a machine in an effort to “isolate your obliques”.

On her discharge from therapy, Janet was unable to perform a single roll out and fatigue fairly quickly with a twelve pound suitcase carry.  For the last three months, she has followed the guidelines and her progress has been excellent.   Janet is currently performing a suitcase carry with fifty pounds and has worked up to ten full reps on an ab wheel roll out.

Michael S. O’Hara, PT, OCS, CSCS

Finding Fitness With Lower Back Pain

The number of USA emergency room visits, pain medication orders, injections, imaging studies, and surgical interventions directed at lower back pain continue to rise.  I frequently meet people who report their fitness efforts have been hampered by low back pain.  I have five recommendations that can help fitness clients with lower back pain have more success in the gym.

#1 Do not exercise first thing in the morning:  Ergonomic experts have found that many more industrial lower back injuries happen in the morning.  The theory is that the discs in the lower back imbibe or gain fluid overnight and are more likely to deform with a physical challenge.  Give your lower back one or two hours of walking around time before starting an exercise session.

#2 Isometric strengthening of the spinal stabilizers:  The function of your “core” muscles is to limit movement of the lumbar spine and pelvis.  Stop all crunches, toes to bar, sidebends, sit ups, seated twisting, and learn how to perform bird dogs, side hovers, Pallof press, planks, and carries.  Compliance with this single hint would reduce USA expenditures on lower back pain dramatically.

#3 Enhance the function of your hip flexors and gluteal muscles: Please cease all the forward spine flexion, toe touching, spine twisting activities.  Greater lumbar spine range of motion is associated with more–not less, lower back pain problems.  Learn how to foam roll and mobilize the hip flexors and gluteal muscles.  Prolonged sitting and most popular “cardio training” deadens these muscles.  Properly functioning hip flexors and gluteal muscles keep the pelvis stable and take stress off the lower back.  Reawakening dormant gluteals and hip flexors is the magic that resolves long term lower back pain.

#4 Focus on single leg strength training:  Ditch the front loaded hip hinges–deadlifts, cleans, snatch, and drop the loaded squats.  Swear off the lower lumbar deranging leg press.  Reduce spinal compression and train the legs, one at a time.  Single leg training reveals the right / left side movement asymmetries that drive lower back pain.  Resolving these asymmetries and sparing the spine goes a long way to abolishing back pain.  You will need some guidance on exercise selection and execution- this brings me to #5.

#5 Get some help:  Exercise is the most powerful medication on the planet.  Nothing else comes close.  Take the proper dose of appropriate training and the results will be amazing.  Take the wrong dose of an inappropriate activity and the results can be devastating.  This is especially true for people with a history of lower back pain.  Find a qualified physical therapist to guide you through your fitness journey.  One way or the other, you are going to spend time and money on your health.  Proactive spending is always cheaper and more beneficial than reactive spending.

Michael S. O’Hara, PT, OCS, CSCS

 

PDFRead about keeping your hip flexors healthy and working well in Mike’s article, Nobody Names Their Child Iliacus.  Video instruction of the exercises in the article is available.  Jeff Tirrell gives five nutrition rules than can be broke.  Find out the correct way to set up your dual action air assault bike.

Download Here

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

Learn how to keep your spinal stabilizers strong by performing side planks.  Mike O’Hara explains this in his article, “Learning to Lean”, and includes video demonstration and explanation of the importance keeping your stabilizers strong to stand up to the demands of daily life. It’s time for another Fenton Fitness Love Your Jeans Challenge–see page 3 for more information. In his article, “The Periodization of Nutrition”, Jeff Tirrell gives tips on optimizing dietary intake.

Download Here

Hip Lifts and Roll Outs

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.  

Hip Lifts and Roll Outs

An intricate system of muscles holds the spine upright over the top of the pelvis.  This pair of exercises coordinates and strengthens this support system.  If you sit all day long, have postural problems, or a history of lower back pain this pair of exercises is worthy of your training time.

Hip Lifts
hip_liftThis drill coordinates hip extension and lumbar spine stability.  It is very beneficial when progressed to the single leg version.  Lay with your shoulders across a bench with the head supported.  Place your arms out to the sides.  Plant the feet on the ground with the knees bent 90 degrees and the shins perpendicular to the floor.  Drop the hips to the floor and then push back up with the gluteals and hamstring muscles.  Hold at the top for two counts and repeat.

Roll Outs
The roll out can be scaled to serve any fitness level.  Beginners can start with a large 65 centimeter physioball, and as they become more proficient, progress to a smaller 55 centimeter ball.  The closer the hands get to the floor the more challenging the exercise becomes.  If you get strong enough, you can perform the forward roll out with a Power Wheel or Sorinex roller.

Kneel on a mat to keep the pressure off your knees.  Your femur (thigh bone) is positioned perpendicular to the floor and the hips are hinged at 45 degrees.  Place the hands on the front of the ball and the elbows directly under the chin.  Brace the abdominal muscles and roll out onto the ball until you feel a challenge through your midsection.  Hold in the challenging position for three counts and then return to the starting position.
Perform twelve repetitions of the hip lifts, rest 30 seconds, and then perform ten roll outs.  Rest and repeat the cycle.  Work up to three sets through this exercise combination.

View video of Mike performing these exercises here: https://youtu.be/Xf08rFU7A4w.

-Michael S. O’Hara, P.T., OCS, CSCS

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