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
Embrace The Hate
Being Comfortable With Being Uncomfortable
“I hate this one.”
“This exercise never gets easier.”
“I do this but I hate this.”
“You like to see me struggle”
These are all common statements from fitness clients and physical therapy patients. They have complaints about certain exercise activities that are difficult, unsteady, aggravating, and just plain annoying. The activities that provoke these responses usually involve getting up and down off the ground, single leg biased training, carrying a weight, and / or pushing a sled.
These comments are usually followed by—
“..but I know they are helping.”
“I don’t have that pain anymore.”
“My legs are so much stronger.”
“I hiked in the mountains with my grandchildren.”
To make progress in rehab and fitness, you need to get comfortable with being uncomfortable. If your fitness regimen involves scented candles, soothing music, and nothing that makes you uneasy, then I doubt it has much value. Training challenges that restore movement skills, improve strength, and add muscle mass will create some discomfort. Developing the mindset that embraces the challenge makes all the difference.
Michael S. O’Hara, PT, OCS, CSCS
A Plea For Your Knee
In our physical therapy clinics, we treat patients with knee pain on a daily basis. It has become more common to train younger clients with a history of knee injury and ongoing knee pain. Jane Brody’s recent *article in the New York Times has some excellent advice on the care and management of knee pain problems. I have some further suggestions and clarifications.
The mass portion of the Force = Mass x Acceleration formula needs to be at an appropriate level for your knees to stay healthy. Carrying extra body fat creates an environment that invites knee wear and tear. The common knee pulverizing mistake is to perform high impact exercise activities in an effort to lose fat. If you are twenty pounds overweight, do not run, stadium step, soccer, tennis, or pickleball. Start with strength training and low impact cardio. Lose the fat first, and even then, the lower impact activity will be healthier for your knees. From the overweight client limping into the clinic I get the “I need to move around to lose weight” protest. I am sorry, but fat loss is primarily a function of dietary alteration. Exercise has very little impact on body fat levels if you do not eat properly.
Train the Way You Wish to Play
A properly planned fitness program makes your knees more durable (fewer injuries) when you participate in your favorite recreational activity. The training must be tailored to your activity goals. If your goal is to play tennis, then you must perform three dimensional deceleration / acceleration activities as part of your training program. Yoga will not prepare your knees for tennis. If you want to water ski, then you must perform strength training for your back, hips, and knees. Distance running will not prepare your knees for water skiing. If hockey is your recreational past time, you need to be strong, well conditioned and competent in all planes of motion. Long duration recliner intervals will not prepare your knees for hockey.
If your hips do not move well, your knees will pay the price. In this age of all day sitting and minimal physical activity, hip function is at an all time low. Physical therapy patients with knee pain nearly always present with glaring restrictions in hip range of motion and strength. If your knees hurt, dedicate some training time to restoring hip rotation and hip extension movement. Learn how to perform some remedial gluteal activation drills. Learn a proper hip hinge, squat and a pain free lunge pattern.
Participation in a single inappropriate activity can produce a lifetime of knee trouble. That box jump workout of the day- maybe not. The warrior, electric shock, mud hole, death run–bad idea. Trampoline with the grandchildren–what were you thinking!
Be Proactive and Seek Treatment For Knee Pain
“Training through the pain” can take a graceful athlete and turn them into a lifelong speed limper. The presence of pain changes the way your brain controls movement. Left untreated, it can permanently alter neural signals and produce movement patterns that linger long after the pain has resolved. Live with enough cycles of inefficient movement and you develop early breakdown in the knee.
Michael O’Hara, PT, OCS, CSCS
*What I Wished I’d Known About My Knees, Jane Brody, New York Times. July 3, 2017
Read the NY Times article here: https://www.nytimes.com/2017/07/03/well/live/what-i-wish-id-known-about-my-knees.html?_r=0
In this issue, Mike O’Hara, PT gives ten reasons to love lunges. Video of lunge exercises/progressions are included. In Going Grizzly, Mike presents the exercise combination of Crawls and Sandbag Carries; a combination that helps you train more efficiently and move better. Watch the video for instruction on these exercises.
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
In this month’s issue, Mike O’Hara, PT provides information on Achilles tendinopathy with exercises that will help prevent this painful condition. Watch the video for the exercises by following the link in the article “Achilles Recovery”. Mike also demonstrates and describes the combination of turkish get ups and waiters walks–paired exercises that can help you train efficiently. Video for this article can also be seen on our youtube channel; just follow the links in the article.
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.
Punch the Clock
I am a big fan of what strength coach Dan John calls “punch the clock workouts.” Go to the gym with a plan and complete a quality training session that leaves you feeling good and not gassed. Eat well, sleep soundly, and repeat.
Keep it simple and well within your capacity to recover.
High intensity training routines are currently all the rage. The Tap Out, Insanity, Ripped in 30, P90x home fitness videos all operate at fairly high levels of exertion. It is difficult for anyone of average capacities to sustain that level of training on a consistent basis.
Competitive exercise protocols that involve performing “as many reps as possible” in a defined period of time are omnipresent on the internet. Competition creates a training environment that impedes good judgment. “Men will die for points” is a common quote that I hear in certain training circles.
As a physical therapist who treats exercise related injuries, I can state that pushing the exercise envelope and forty years plus is a dangerous combination. You may have another injury in you, but you may no longer have the capacity to fully recover from that injury.
In the long run, the guy or gal with the fewest “dings and dents” is the one who is able to remain in the fitness race. I like the idea of “user friendly” fitness activities. Training does not have to be complicated or overly intense. Get better at moving a weight or your body through three sets of eight, four sets of six, or two sets of twelve. Perform five or six exercises with your chosen set/repetition range. Take a long walk every day of the week. Consistency is King– eat, sleep, rest, and then repeat.
-Michael S. O’Hara, P.T., OCS, CSCS