Standing Desk Exercise Rx
Work Station Transition Training
As a physical therapist making his living taking care of people with pain problems and physical limitations caused by prolonged sitting, I am an avid promoter of standing desks. Over the last five years, the prices of standing desk products have come down and the variety has increased. Manufacturers now permit a 30 day “no risk” trial. Try a standing desk for thirty days and then ship it back if it does not meet your needs. I encourage anyone who must sit for more than five hours a day to convert some of those sitting hours to a stand up desk. Employers are now aware of the benefit of standing desks and actively encouraging their use. It can take some time to become accustomed to working at a standing desk. I have three training tools that can help make working at a standing desk easier. Read this article and watch the video for a demonstration of how to use each product.
Foot Care With a Spiky Ball
The bottom of the foot is a busy intersection of muscles, tendons, ligaments, fascia, and nerves. Heel and plantar pain are common reasons we see patients in the physical therapy clinic. Foot pain problems can take months to fully recover. A little proactive soft tissue treatment will bulletproof the feet from overuse injury and pain. A spiky ball is a small sphere with fairly aggressive projections. Take off your shoes and give your peds a little love by rolling the bottom of your foot over a spiky ball. Spiky balls come in various sizes and resistances. I have found the smaller (2 ½ – 3 inch) and firmer models work the best for my foot. Most people report that it “hurts good” and often get one for work and one for the home office. Most spiky balls cost around seven dollars.
Posture Correction With Resistance Bands
If you have been a long-term seated data input warrior, you have probably been infected with the i-hunch virus. As we get older, the muscles that hold the thoracic region tall and pull the shoulder blades back tend to get weaker at a faster rate than other muscles. Prolonged standing is going to be challenging without some remedial rebooting of the software that holds you tight and tall. I keep a ¼ inch superband (nine dollars from performbetter.com) at my desk and perform two upper body postural strengthening exercises. Posture restoration takes some time so work on these drills every day for at least three months.
Band Pull Aparts
Choose a resistance band that allows you to perform a complete set without reaching failure. The force produced by the band becomes greater as you travel through the movement so avoid a band with a strong resistance. The tempo of the movement should stay smooth and steady.
Stand tall with the chest proud and the head pulled back. Do not arch the upper back. Tighten the abdominal muscle and keep the front of the rib cage down. Hold the elbows fully extended and the wrist in neutral. You can use either a palms up or a palms down arm position. Individuals with some shoulder wear and tear may feel better with a palms up position. Hold the arms up to 85 degree shoulder flexion and start with a low level of tension on the band. Concentrate your efforts on the muscles between your shoulder blades as you pull the band apart and bring the hands out to the side. Let the band stretch across the chest and pull the hands behind the body. Tempo: Two counts- pull the band apart. Two counts- hold at end range. Two counts- return to the starting position. Repetitions: 10 – 20 repetitions.
Postural Band Aid
One of the most convenient and easy to perform postural correction activities is an exercise I call the postural band aid. Take a short length of therapy 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 with the palms up. Keep the elbows by the side and bent to 90 degrees. Pull the band apart so that your arms form a letter W with your arms and 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. Perform ten repetitions.
Dynamic Core Stability With Dynamax Medicine Ball
Physical therapy patients and fitness clients often complain of lower back fatigue when using a standing desk. Solve this problem with some dynamic stabilization training. Place a Dynamax medicine ball or an under inflated basketball under the desk and take turns elevating one leg up onto the ball. The round ball creates a degree of instability that kicks in the stabilizers of the pelvic girdle and lower back. Changing position and relieving stress on the joints in the pelvic girdle and lumbar spine can help abolish symptoms of fatigue. It is one of the reasons your local saloon has a place to rest your foot when you belly up to the bar. The majority of standing desk users report an improvement in symptoms using this simple alteration in stance.
Watch the video here
Michael S. O’Hara, PT, OCS, CSCS
NY Times Article on Fall Prevention
When discussing fitness goals, most people never mention fall prevention, but I suggest that it is more important than fat loss or improving your cardiovascular capacity. Please take the time to read Gretchen Reynolds excellent article; Falls Can Kill You. Here’s How to Minimize the Risk. In the article, Ms. Reynolds presents several good lifestyle modifications and medication precautions that will help prevent a fall. Try adding some of my long standing fall prevention training tips.
Exercise in a standing position.
If your goal is to move better and remain free of injury, then 90% of your exercise activity should be performed in standing. Developing better kinesthetic awareness, strength, and coordination in a standing posture is the crucial component of training that prevents a fall. During my visits to commercial gyms, most of the exercise activity I witness is performed in a supine, seated, or supported position.
Practice moving in all directions.
Fall prevention training involves improving multi-directional movement skills. Most falls happen from an unexpected disruption of your equilibrium. You get pushed to one side, twisted off center, or a foot slides from under the body. Most gym activities are predominantly sagittal plane- forward and backward. We need to be able to move well in all directions.
Practice moving faster.
Fall reaction training should focus on exercise activities that make you quicker. Research on falls has shown that a gait pattern (how you walk) that starts to slow down is the best predictor for a future fall. Agility ladder footwork, medicine ball throws, and hurdle drills are examples of faster paced training activities. Yoga, Pilates, recumbent bicycle riding, and muscle isolation exercises will not make you better at moving faster.
Stand on one leg.
A simple and proven fall prevention activity is single leg stance balance training. Single leg balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle. Stand on one leg for twenty seconds. Stand on one leg and turn your head side to side. Stand on one leg and then close your eyes.
Practice getting up and down off the floor.
One of the best anti fall training activities is consistent practice of getting up and down off the floor. Moving gracefully from standing to the floor and back up again is a life skill that keeps you independent and safe. As a Physical Therapist, I frequently find people who are very impaired in this basic task of mobility. They crawl to a piece of furniture for an assist and transition from the floor in an unsteady and unsafe manner. Most of these patients are not elderly, they are tight, weak, and deconditioned.
Perform single leg strength training.
We are monopods. We absorb and then create force one leg at a time. During activities of daily living, one leg is loaded more than the other. It only makes sense that we train our legs the same way we use them. Work with a trainer and learn how to perform step ups, single leg squats, rear foot elevated split squats, single leg deadlifts…
Become a better shock absorber.
Fall events often occur because of an impact. The force of the impact causes our body to give in to gravity and down we go. Just like any other physical attribute, impact resilience can be trained. Mat work, medicine ball throws, and rope drills are some of the activities that can be used to improve impact resilience.
Make balance practice a daily event.
Integrate anti-fall training into your lifestyle. Stand on one leg while you brush your teeth–right leg thirty seconds then left leg thirty seconds. Perform multi directional exercise as movement preparation before a bike ride or run. Get some instruction on a program of exercise that improves agility, single leg strength, and power production.
Someday, somehow, and when you least expect it, you are going to have an unplanned interaction with gravity. Your fitness program should make you more responsive to a fall event and less likely to be injured.
Link to article: here
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
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
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.
That Office Chair Can Be Keeping You From Your Fat Loss Goal
For 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
Three Gifts I Would Give And Three I Would Take Away
Santa Gives You Gluteal Activation
You need a responsive and strong set of butt muscles to function at optimal levels. Many gym goers have gluteal muscles that are neurologically disconnected. The term physical therapists and strength coaches use is “gluteal amnesia.” Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the butt muscles. We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement. Most fitness clients are in need of some intensive gluteal training. The hip lift is a simple exercise activity that produces a superior response. See the attached video for a demonstration.
Scrooge the Lumbar Spine Flexion
Drop the sit ups, stop doing crunches, ditch the glute ham developer sit ups, and forgo the toes to bar competitions. Father time, gravity, and the stress of prolonged sitting are already bending our lumbar spines forward all day long. The last thing you need to do is accelerate degenerative breakdown of the lumbar segments with more repetitions of spine flexion. Please forget about isolating abdominal muscles. Instead learn how to control the team of muscles that hold the lumbar spine stable. It is a neural event that is worthy of all your efforts.
Santa Gives You Medicine Ball Throws
Life is an up tempo game. 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. 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 and speed of movement. Medicine ball throws are the easiest way to improve power. Medicine ball throws can be scaled to all fitness levels and are safe as long as you use a properly sized and weighted ball. The large, soft Dynamax balls are a good choice for beginners. They rebound well off of the block walls in the gym and are easy to catch. Do not overload your medicine ball throws, a two to eight pound ball is best for most gym goers. Get with one of the trainers for instruction on adding medicine ball throws to your training program.
Scrooge Sitting Down in the Gym
Movement happens in an upright, standing position. “Seated exercise” is an oxymoron. If you want to improve how your body functions, you must stand up and defy gravity. Every athletic endeavor is performed in a standing position. Seated exercise reinforces poor postural habits and diminishes your capacity to move. I call it the “illusion of exercise” and it will always be highly visible in commercial gyms because it is easy to sell.
Santa Gives You Four-Point Training
Crawling is the neurological training tool an infant uses to develop the capacity to stand and walk. It is the pathway to better motor control and less pain. Nearly every physical therapy patient and most fitness clients benefit from a healthy dose of four-point position exercise. In your fitness program, reinforce the patterns of spinal stability and reboot the postural reflexes with some horse stance horizontal, crawling, and Jacobs Ladder training. Four-point training can be scaled to any fitness level. Watch the attached video for some examples.
Scrooge Elliptical Training
I know you love the elliptical. It is the no impact, cardio darling of the gym but it should be used as a fitness dessert and not a main course. Elliptical training has multiple drawbacks. Ergonomically, it is a one size for everyone apparatus that does not work well for taller or shorter people. When you walk or run, you improve the important skill of stabilizing your body over one leg. An elliptical keeps both feet stapled to the machine and deadens any neural enhancement of balance or single leg stability. Hip extension keeps our back healthy and our body athletic. Maintaining or improving hip extension should be part of every training session. There is no hip extension produced when you train on an elliptical. Many people maintain a flexed spine when they use an elliptical. Sitting produces the flexed forward spine we all need to work against in our fitness programs. The repetitive use of the shoulder girdle is a frequent generator of referrals to physical therapy for head and neck pain. Metabolic adaptation to elliptical training happens fairly quickly. In January, a 30 minute session burns 330 calories, but by June, your body becomes more efficient and that same routine creates only a 240 calorie deficit. The low impact, reduced weight bearing nature of an elliptical makes it a poor choice in your fight against osteoporosis.
I am happy when people are more active. Patients and fitness clients love the elliptical and they believe it helps. Use that belief to keep you motivated and training. I just want everyone to manage the drawbacks of this type of training. Injured people always say “Why didn’t someone tell me?” Before you jump on the elliptical, take ten minutes and improve your core stability and hip function with some four-point exercises and hip lifts. Learn how to throw a medicine ball and stay standing through the rest of your training program. Next Christmas you will thank me.
Merry Christmas and a Humbug to you.
See video of Mike in the gym demonstrating these exercises here: https://youtu.be/H0my94BPHNQ
Michael S. O’Hara, PT, OCS, CSCS
The New York Times recently reprinted an article by Jane Brody entitled “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 function. 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?
Get Up Out of the Chair
Ergonomic chairs, elevated monitors, slanting keyboards, and lumbar supports are fine, but nothing works as well as standing up and walking around every fifteen minutes. Office modifications, while well-intentioned and generally a good idea, cannot compete with endless hours of desk sitting. In order to fight against the postural stress that creates pain, we need to get up and move. Everyone wants an exact number, so I suggest that after fifteen minutes of sitting, you stand up and walk/stretch for three minutes. The best advice is to get a standing desk and completely eliminate working in a seated position.
Perform Posture Correction Exercises Every Day
If you want to abolish the neural and connective tissue restrictions created by postural flaws, you need to work on it every day of the week. Two or three visits to the gym will not be enough. You need lots of repetitions over a long period of time to reverse the changes created by hours slumped over the desk or strapped in a seatbelt. Specific exercises that wake up your nervous system, strengthen your postural muscles, and reverse tissue shortening are required. It should take you no more than 90 seconds to complete one or two of the exercises listed below. Set a timer, enlist the help of your coworkers, and work at these exercises every day. See the exercise suggestions and video presented at the end of this article.
“This Feels Weird”
For most Postural Stress Disorder (PSD) patients, standing upright and sitting tall will feel abnormal. Their body positioning neural feedback mechanisms have been damaged by years of improper loading. Feeling better with a more upright and stable posture will take between six weeks and six months to achieve. Very often, “other sensations” go away fairly quickly– Migraine and sinus headache episodes are less frequent. That torn rotator cuff no longer creates shoulder pain. The arthritis in your hip is less problematic. The plantar fasciitis pain in your foot resolves. The pain symptoms caused by poor posture are far more widespread than most people realize.
You May Have To Avoid Certain Activities
Your gym program and recreational activities can make your posture worse. When you exercise, avoid movements or activities that pull your head and spine further into a forward bent position. The rowing machine and the exercise bike are often poor choices. If you have postural problems, do not perform sit ups, crunches, or any other repeated or sustained spinal flexion. Avoid exercises that shorten the muscles in the front of the shoulders such as bench pressing and flys. Most PSD sufferers sit too much, so refrain from any fitness activity performed in a seated position. The most important thing a good fitness coach can do for clients is put them on the path to postural integrity.
How Long Will it Take to See Changes?
Most physical therapy patients report that the exercises get easier and they feel better after three weeks. Postural correction is a long-term project and clients continue to see results twelve months after starting on a consistent program of postural retraining.
So What Do I Do?
The forward head posture of the average computer operator creates all kinds of adaptive tissue changes in front and in back of the neck. Some daily chin tucks can mitigate the damage. Stand at attention, pull your shoulder blades back, and push your chest forward. For many of you, this is going to be challenging. Place you finger tips on your chin and gently push your head straight back. Visualize your head being pulled upward by an imaginary string attached to the crown of your head. Hold for two counts and then release. Perform ten repetitions.
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 at 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.
Overhead Back Bend
The sustained forward bent sitting posture tightens the front of the shoulders, inhibits thoracic spine extension, and can mess up your respiration. You can reverse all of these with some overhead back bends. Stand with the feet shoulder width apart. Reach the arms over your head and bend backward. Allow your hips to come forward and lean back into your heels. Breathe in through your nose and let your stomach rise. Breathe out through your mouth and let the abdomen fall. Perform three or four deep abdominal breaths while holding the arms overhead.
Standing Tubing Rows
Prolonged sitting weakens the upper back and shoulder retractor muscles. Standing tubing rows strengthens these muscles. Purchase an all-purpose band ($25.00) from performbetter.com and set it up in a door at work. Grasp the handles and stand tall with the arms extended and tension on the bands. Contract the muscles between the shoulder blades and pull the handles toward your body in a rowing motion. Hold the elbows back for two counts and then return to the starting position. Keep your neck relaxed during the exercise. Perform eight to fifteen repetitions.
View video of these exercises: https://youtu.be/KktwMew5Wks
Read the NY Times article here: http://well.blogs.nytimes.com/2015/12/28/posture-affects-standing-and-not-just-the-physical-kind/
-Michael S. O’Hara, P.T., OCS, CSCS
I 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
Fitness training for those of us past 40 years of age is more complicated. Physical performance and recovery capacity are dramatically different. If you need proof, look for the forty year olds in the NBA or NFL. The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime. I have compiled a collection of tips for the forty plus fitness client.
Reduce Sitting in Your Life and Never Sit Down and Exercise
Most of us already spend too much time in a seated position. The last thing you need in your fitness program is more sitting. Movement happens in an upright, standing position. “Seated exercise” is an oxymoron. If you want to improve how your body functions, you must stand up and defy gravity.
Injuries happen in an upright position. I have never treated someone with a recliner related anterior cruciate tear or an office chair induced ankle sprain. Nearly every sport is performed in a standing position. If the goal of your exercise program is to improve how your body functions and reduce the risk of an injury, then your exercise activity should be performed in a standing position.
“But Mike, what about all those fancy machines?” Seated, prone, and supine exercises are devoid of core stabilization and balance demands. Isolated muscles are trained and the remainder of the body is neurologically asleep. Seated exercises also reinforce poor postural habits and diminish your capacity to move. I call it the “illusion of exercise,” and it will always be highly visible in commercial gyms because it is easy to sell.
Researchers on health and longevity have labeled prolonged sitting “the cigarette smoking of fitness.” Prolonged sitting produces all sorts of spinal and joint restrictions that contribute to the postural flaws that are rampant in offices across America. The more worrisome issue is that those of us who spend more time sitting are statistically more likely to die earlier. All things equal, the people who stand more are healthier. They have better blood lipids, less hypertension, and fewer vascular problems. Unfortunately, you cannot undo the ill effects of eight hours of daily sitting with two or three visits to the gym a week.
Make an effort to stand more during your day. Ditch the ergonomic wonder chair in your office and throw out that recliner. Try using a chair that physically reminds you it is time to stand up and move around every twenty minutes. I am a big believer in stand up desks and have created many happy converts.
-Michael S. O’Hara, P.T., OCS, CSCS