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
Standing desks are great for posture and health, but many people have difficulty when they first start using them. In this issue, Mike O’Hara, PT gives exercises that can help you stand for longer periods of time. Watch the video for instruction on these exercises. In his article, “The Biomechanics We All Need To Know, Mike agrees with the advice given by Stuart McGill. Be sure to read about Fenton Fitness Member Jan Pilar and her success with her program.
Health and Ergonomic Assist Gift That Get Used
I have some fitness and health promoting ergonomic gift recommendations for the 2016 holiday season. I have used all of these products and have been happy with the results. Most can be purchased on line and this allows you to devote more time to a fitness program. In the tradition of all great holiday shoppers, I like to get one for me and another to give.
Giving a healthy holiday gift is easy at Fenton Fitness and Athletic Center. Our Christmas gift certificates can be used for any of the training programs at the club. Team training classes and personal training packages make great gifts. Numerous studies have shown that individuals who utilize professional guidance are more successful in reaching fitness goals. No one performs exercises correctly after only one training session. You need ongoing evaluation and progression on proper exercise performance. Older and physically limited individuals need the assistance of a trainer more than any other group. Our team of trainers and physical therapists can help everyone reach their fitness goals.
Jungle Gym XT Suspension Trainer
The creation of user-friendly suspension trainers set off a mini revolution in fitness. If you go into a fitness center and they do not have multiple suspension trainers readily available, you need to find a new gym. The Lifeline Jungle Gym XT is an elegantly simple and extremely versatile device that should be a part of every home gym. Suspension trainer exercises can be scaled to any level of fitness and are a valuable weapon in our fight against age, injury, and occupational stress. At $90.00, the Jungle Gym XT wins the price war and, in my experience, it has worked well in both commercial and clinical conditions.
Aerocart by Worx
Gardening and landscaping activities are responsible for many of the referrals to physical therapy. The afflicted gardener has tweaked a lower back or strained a knee after hoisting a heavy object or spending too much time slumped over the flowerbeds. A single ergonomic tool can help remedy both of those problems. The Aerocart from Worx is a gardener’s Swiss Army Knife. It functions as a lightweight wheelbarrow, handcart, rock lifter, snow plow, pull wagon, and gardening stool. The Aerocart costs $140 and you can get a snow plow- my favorite- and the wagon attachments for another $100. I have used this tool to push snow, haul firewood, rearrange rocks, and move soil. The fact that the bucket does not hold mega volume prevents a user from overloading his spine. This device will extend the gardening career of the avid weed puller on your Christmas list.
All Purpose Bands From Perform Better
One of the best strength training devices is a set of the All Purpose Bands. These bands are sturdy dipped latex products made by Lifeline. They have two handles on one end and a loop system that makes them easy to anchor in either a closed door or around a stable upright device. All Purpose Bands can be used in a home gym set up, but my suggestion is that you anchor a set in a door at work and fight off the debilitating stress of all day sitting with some daily rowing, hip hinging, and scapula retraction exercises. A set of All Purpose Bands costs $25.00, and as your strength improves, you can purchase the next level of resistance in the series (light—purple, pink, orange, yellow, blue, black—strong) from performbetter.com.
Varidesk Conversion Desk
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. The health statistics on the damaging effects of sustained sitting are distressing.
I can think of no better health-promoting gift for a loved one than a sit to stand conversion desk. The product I have the most experience with is the Varidesk. It comes pre-assembled and has functioned flawlessly. It allows the user to sit for some portion of the day and gradually transition to greater time in the standing position. The Varidesk comes in a variety of sizes / set ups and costs $375 to $550.
My First Stand Up from Jaswig
The New York Times recently reprinted an article by Jane Brody, “Posture Affects Standing, and Not Just the Physical Kind.” In the article, Ms. Brody talks about how poor posture creates problems across multiple areas of physical and mental well-being. The respiratory, digestive, emotional, and neurological systems are all impacted by postural restrictions. You are even more likely to be a victim of crime if you have a slumped over posture. So how do you develop better posture?
My suggestion is to start with early intervention in the form of a standing workstation. The Belgian company Jaswig, has produced a standing desk for children. As the child grows, this adjustable wood desk travels with him. In our physical therapy clinics, we are seeing younger people with head, neck, and upper back pain problems related to poor posture. Mobile phones, laptops, tablets, and all the other “devices” are being used at earlier ages leading to the postural breakdown that usually occurs in later years of life. The My First Stand Up workstation from Jaswig (cost $379) is the early intervention answer.
PowerBlock Adjustable Dumbbell Set
Dumbbell training is one of the most effective forms of exercise. The big limitation of dumbbell training is the cost of buying a series of varying dumbbell weights and the space required to store 10 – 15 sets. The PowerBlock company has solved this problem. A set of PowerBlocks occupies less than three square feet of your home and, depending on the size you purchase, replaces 10 – 25 pairs of traditional dumbbells. I have put some heavy use on a set of PowerBlocks that I purchased in 1992. They have functioned flawlessly and show minimal wear. A beginner set of PowerBlocks (5-40 pounds) costs from $300 – $330 and you can add expansion sets as you get stronger. My thirteen-year old self would have loved to get a set of PowerBlocks for Christmas.
Most people have busy lives and limited time to devote to fitness. They want to get stronger, improve mobility, and maintain some degree of conditioning with minimal time commitment. For those people, I have a suggestion: Buy a Hyper Vest Pro and get to work.
I have used the Hyper Vest Pro for many years and can vouch for its durability. The comfort and overall function of the Hyper Vest Pro is impressive. The side lacing system makes the fit superior to other weight vest products. The individual weights are small and spread evenly over the front and back of the vest. Ten pounds of small steel plates are standard with the Hyper Vest Pro. I have found fitness clients do well with vest loads between five and twelve pounds. At $160, the Hyper Vest Pro is more expensive than other products, but the first rate fit and comfort make it worth the money. It is a great holiday present for the fitness fanatic on your shopping list.
If you consistently exercise, one of the best things you can do to enhance recovery between sessions is perform foam rolling soft tissue work. Combining foam roll work with mobility drills is the secret fitness ingredient that makes chronically tight individuals more flexible. The older you are, the harder you work, and the more frequently you train, the more you will benefit from the foam roll. I like the roller made by Trigger-Point (tptherapy.com). They come as a short, 13 inch version for $40.00 or the longer, 26 inch roller for $65.00.
-Michael S. O’Hara, P.T., OCS, CSCS
We all want fitness results, and we want them now. We want to look, move, and feel better in two weeks. We know it took us years to get into this overweight, weak, and deconditioned state, but we have a wedding in three months, a reunion in six weeks, and a date next Friday.
Unfortunately, many of the physical problems that slow our progress toward specific fitness goals will not resolve with two or three exercise sessions a week. Postural deficits, faulty motor control, mobility limitations, and joint restrictions require daily attention to elicit any meaningful change. Short bouts of focused training, interspersed throughout the day, will produce the best results. In physical therapy rehabilitation, we prescribe home exercise programs that are performed up to every two hours to reduce pain and restore function. Fitness clients will more rapidly reach their goals with some daily Nano Sessions of exercise.
Nano Office Session
A rounded shoulder, forward bending thoracic spine posture is delivered free of charge with your new smart phone. This posture has become nearly universal, and it brings with it a gigabyte of shoulder, neck, and head pain problems. Fitness training at the gym often feeds into this postural problem- sit ups, crunches, spin bike, heavy bench texting, etc… Combine this with an eight hour office day of computer entry and number crunching and you create a postural deterioration feedback loop that needs a killer app. This Nano Training session can help.
You will need a resistance band or tubing and a doorway. It takes daily training to eliminate postural deficits. Perform this program twice a day. Two or three gym workouts a week are not enough. I understand you can set an alarm on your smart phone as a reminder that it is time to stand up and move through your Nano Session.
Office workers perform so many tasks with the arms forward and head down that they develop restrictions in the muscles in the front part of the shoulders and chest. Use a doorway stretch to reverse this adaptive shortening. Stand up with the elbows placed just below shoulder level against the doorjamb. Step one foot forward through a doorway. Hold a gentle stretch for ten seconds and then lower the arms and rest. Perform two or three ten second stretches.
The stretch should be felt across the front of the shoulders and chest. Go easy. Stop at the first point you feel a stretch. If you are grimacing in agony, then you either have a shoulder problem or you are being too aggressive with the stretch. As the stretch gets easier, try working the elbows higher up the doorjamb.
Postural Band Aid
One of the most convenient and easy to perform postural correction activities is an exercise I call the postural band aid. This exercise takes less than thirty seconds to complete and can be performed at any work sight. Take a short length of tubing or resistance band and stand up. Assume a tall posture with a proud chest and the head pulled back. Hold one side of the band in each hand and keep the elbows by the sides. Pull the band apart so that your arms form a letter W with your body. You should feel a tightening of the muscle between your shoulder blades. Hold the band apart for three counts and then slowly release back to the starting position. Repeat for eight to ten repetitions.
To view video demonstration of the above exercises, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS
Chair Check Up
How Functionally Fit Are You?
Coaches, trainers, and scouts all want the number of inches in an athlete’s vertical leap test. The athlete simply jumps up and taps a lever that indicates how many inches he or she can jump straight up off the ground. This test has proven to be an excellent indicator of how well an athlete will perform in the competitive arena. NBA players hit impressive vertical leap numbers, so we understand how simple it must be for them to elevate over the rim. The equivalent test for the 60-year plus population is the Chair Stand Test (CST). The score you get on the CST is a very reliable indicator of how well you will perform in the game of life.
Leg power, strength, and lower extremity functional mobility are measured with the CST. The ability to repeatedly move through the sit to stand transfer without the assist of the arms pushing down on the legs or the armrests of the chair is an important skill everyone needs to maintain an independent lifestyle. An improved CST score creates carry over to other functional skills. Patients who improve their CST scores develop better gait patterns and standing balance.
Chair Stand Test: You need a stopwatch, a stable chair with a 17 inch high seat, and an evaluator to monitor your performance and start and stop the timer
1. Sit in the middle of the chair.
2. Place your hands on the opposite shoulder with the arms crossed over the chest.
3. Keep your feet flat on the floor.
4. Keep your back straight and your arms against your chest.
5. On the order “GO”, rise up to full standing and then sit back down.
6. Repeat for as many repetitions as you can in thirty seconds.
7. If you are halfway to a standing position when time expires, count that as a repetition.
8. Record your results and be concerned if you score below average.
The age adjusted scores for the CST listed below are a composite of the data gathered from several research studies since 2001. The CST has proven to be a reliable assess-ment of fitness in older adults for over a decade. Individuals who score below average on this test are more likely to suffer falls and require assisted care in their advancing years. For the older fitness participant, knowing your Chair Stand Test score is just as important as knowing your blood pressure numbers.
Age Below Average Average Above Average
60-64 < 14 14 – 19 > 19
65-69 < 12 12 – 18 > 18
70-74 < 12 12 – 17 > 17
75-79 < 11 11 –17 > 17
80-84 < 10 10 – 15 > 15
85-89 < 8 8 – 14 > 14
90-94 < 7 7 – 12 > 12
Age Below Average Average Above Average
60-64 < 12 12 – 17 > 17
65-69 < 11 11 – 16 > 16
70-74 < 10 10 – 15 > 15
75-79 < 10 10 –15 > 15
80-84 < 9 9 – 14 > 14
85-89 < 8 8 – 13 > 13
90-94 < 4 4 – 11 > 11
Michael S. O’Hara, P.T., OCS, CSCS