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Learn more about Rehab, Sports Medicine & Performance


Falling Facts

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

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

Push Ups and Longevity

Recent Study is a Biomarker Reminder

Take a moment and read the recent New York Times article, How Many Push-Ups Can You Do? It May Be a Good Predictor of Heart Health. It appears that being able to perform well on a push up test is a better predictor of heart health than the traditional treadmill test.  The article postulates several reasons for the research results.  We only need to read the book Biomarkers for a thorough explanation.

In the book Drs. Evans and Rosenburg looked at the measurable “biomarkers” that keep humans healthy, independent, and fit over an entire life span.  They have determined the top four biomarkers are:

  1. Muscle Mass.  What percentage of your body is made of muscle.
  2. Strength.  Can you use that muscle to push, pull, lift and carry.
  3. Basal Metabolic Rate.  The number of calories your body expends at rest.
  4. Bodyfat Percentage.  What percentage of your body is composed of fat.

The authors named these top four biomarkers, the decisive tetrad.  They are the prerequisites to maintaining healthy numbers in all of the other essential biomarkers.

  1. Aerobic Capacity
  2. Blood Sugar Tolerance
  3. Cholesterol / HDL ratio
  4. Blood Pressure
  5. Bone Density
  6. Internal Body Temperature Regulation

Push up proficiency requires muscle mass, strength, and a minimal amount of extra load to lift in the form of bodyfat.  Those three traits are all a part of the decisive tetrad. To age well, stay durable–no injuries, and maintain control of all health parameters–we need to maintain or improve muscle mass / strength and not avoid extra bodyfat.  An ongoing program of strength training and nutritional discipline are the foremost components of fitness and health.

Now get on the floor and give me twenty.

View the article here.

Michael O’Hara PT, OCS, CSCS

That pain in your arm or hand could be coming from somewhere else.  Read Mike O’Hara’s article, Changing Locations to find out more.  Jeff Tirrell gives nutrition tips and Mike discusses the benefits of using an agility ladder.

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Stay independent longer by increasing your stair climbing capacity.  Mike O’Hara shows you how in his article, “Keep Climbing”.  Mike also discusses standing desks and the many benefits of standing while working.  Jeff Tirrell explains the effect of exercise on appetite.

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Our June issue brings information on preventing neck pain by strengthening your neck.  Mike O’Hara describes and demonstrates in a video exercises that will help strengthen the muscles of your neck.  In another article, Mike tells how grip strength can be a predictor of early death in some patients.  Be sure to read Jeff Tirrell’s article on performance based training.

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In our May issue, Mike O’Hara discusses the importance of walking.  If you have pain or difficulty with walking, there are things that help.  Mike demonstrates some exercises to get you ready.  Be sure to read Jeff Tirrell’s article on squatting, and read about Afterburn–a new class at Fenton Fitness that uses heart rate monitors while training.

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Progression Know How

Carries, Crawls, and Core

If I could kill a word it would be “workout”.  People who are into fitness love to talk about working out, but seldom do you hear people talk about training or practicing movements.  “Workout” tends to infer any form of structured exercise with the sole purpose of expending energy or making you tired.  It focuses on today and perhaps a feeling (tired, sore, or getting a pump, etc.), but has no thought of tomorrow.   Our focus at Fenton Fitness is always on training or practicing movements.  The focus is always on the future–reducing injury risk, becoming more durable, performing better at sports or life, or just feeling better.  Our focus is on skill acquisition, not feeling tired.  Just imagine if we treated education the way we treat exercise.  Think of the difficulty of  learning a new subject every day, rarely repeating something, with the sole purpose of making it difficult.  That would be crazy, yet that is more and more of what we see in the fitness industry.  In workouts, exercises tend to change just for the sake of changing.  In training, the movements are not random and serve a direct purpose, and are therefore performed for a minimum of 3-4 weeks.  We progress these movements by performing them with more control, increasing the number of sets or reps, increasing load, or reducing rest intervals.  Here are some benchmarks that we like to use with some basic exercises to do before progressing on to the next movement.

Jeff Tirrell, CSCS, CSFC, Pn1

Carries, Crawls, and Core

Push Up Position Plank: Goal of 1 minute

Plank: Goal of 30 seconds

Side Plank: Goal of 30 seconds/side

Side Plank w/ outside foot elevated: Goal of 30 seconds/side

Side Plank w/ inside leg elevated: Goal of 30 seconds/side

Anterior Baby Crawl: goal of 15 yards with stable torso

Anterior Crawl: Goal of 30 yards with stable torso

Farmers Walk: Goal of 60 yards with body weight

Turkish Get Up (¼): Goal of 8/6kg (men/women) for 10 reps/side

Turkish Get Up (½): Goal of 10/12kg (men/women) for 6 reps/side

Turkish Get Up (full): Goal of 25% body weight for 4 reps/side.

See video demonstration of these exercises here: https://youtu.be/5OkXbOWx4mw

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

Advice From The Experts At Fenton Fitness

Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.”  While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.

#7—Go Easy On Caffeine And Sleep More.

Caffeine is one of the most widely used drugs in the United States.  We consume it in coffee, tea, pop, energy drinks, and sometimes even in pill form.  We often consume caffeine to help us feel more awake and alert or to elevate our performance.  Often times, this is done in an effort to undo the lethargic effects of inadequate sleep.  Unfortunately, many people are sensitive to caffeine.  These individuals can experience increased heart rate and/or blood pressure which puts extra strain on the cardiovascular system.  All the caffeine in the world will not make up for the poor hormonal profile which results from low levels of sleep and eventually leads to decreased muscle mass and increased fat mass.  In addition, the stimulating effects of caffeine wear off over time and your body requires more and more to create the same effect.  It is far better in your 20’s to establish a sleep and waking routine that allows you to consistently get 7-9 hours of sleep each night.  The well-formed habit will then be easier to maintain as you age and adopt a more complicated schedule with work, kids, a spouse, etc.

-Jeff Tirrell, CSCS, Pn1

To read the article, click on the link below: