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steps

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

 

In an effort to get back into shape, Monica added some stadium step running to her fitness program.  She went to the high school stadium and made twenty trips up and down the bleachers.  The initial sessions went well but after the first few weeks her knees started aching and the pain began to interfere with activities of daily living.  Monica tried some anti- inflammatory medications and ice but neither produced any relief.  She recently arrived at our physical therapy clinic for some help with her knee pain.

Running stadium steps is a demanding exercise activity that will produce a strong metabolic response.  Unfortunately, stadium steps are too stressful for most people.

Risk/Reward Ratio of the Stadium Steps
shutterstock_385922764For deconditioned individuals, stadium steps fall on the risk side of the risk reward ratio.  Most overweight and “out of shape” fitness clients have tight and weak hips.  They are inefficient in the skill of decelerating their body down the stairs and that skill deteriorates as they fatigue.  They need to use training methods that reduce orthopedic stress and limit biomechanical overload.

Stadium steps are a high level fitness activity.  It is the calculus of mathematical learning.   Deconditioned and overweight individuals need to start with basic algebra before venturing into quantum physics.  The better approach is to get fit first and then add stadium steps to your workout after you have improved strength, body composition, and mobility.

Run hills instead.  I have switched many stadium stepping physical therapy patients to running up and walking down hills.  It is a more forgiving form of fitness training than stadium steps and the benefits are superior.

Your Inner Gladiator
If you insist on stadium step training, I have some suggestions.  Spend six weeks strengthening your hips.  Most deconditioned folks, sit all day and have poor strength/strength endurance in the hips.  Weakness in the hips permits the knees to collapse inward on your downward bound through the steps.  I like bridges, hip lifts, mini band squats, and walking lunges.  See my recent article and video on my favorite gluteal strengthening exercises.

Foam roll the outside, inside, back, and front of your hips, thighs, and hip rotators.  Most stadium stepping pain patients are a big basket of myofacial restrictions.  They writhe around on a soft roller and look at me like I am crazy.  Restoring the mobility of the fascia that encapsulates the deceleration muscles of the hip will help improve performance.

Run up and walk down, softly.  It is the step descent that causes the biomechanical stress on the muscles and joints.  As you travel down the steps, think about actively engaging the gluteal muscles and decelerating with the hips and not the knee.  The louder the impact on the descent the more likely you are an inefficient decelerator.  Have someone watch you as you travel down the steps.  If your knee collapses inward, you need to get off the steps.
Build up slowly.  Do not start with twenty flights.  Start with three trips and gradually build up your work capacity–once a week is more than enough for most folks.  Find other training modalities that are less stressful.  Being too aggressive with a training program is one of the big reasons people fail with fitness, and it keeps me busy in the clinic.

Monica was, by her own account, twenty pounds overweight.  Her hip mobility was less than ideal and she had prior history of hip pain problems.  She had diminished hip range of motion and limited strength in her hamstrings and glutes.  During assessment of her deceleration skills, Monica tended to land in a collapsed inward knee position.  We had Monica perform a program of mobility and strengthening exercises for both hips and rest from all “cardio” activities.  Her knee pain resolved and she was able to return to a program of fitness training.
-Michael O’Hara, P.T., OCS, CSCS

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