August 2009
Fenton
Physical
Therapy
400 Rounds Drive
Fenton, MI 48430
(810) 750-1996
Linden
Physical
Therapy
319 S. Bridge Street
Linden, MI 48451
(810) 735-0010
Milford
Physical
Therapy
135 S. Milford Rd
Milford, MI 48381
(248) 685-7272
How Do I Get Rid Of This?
One of the
most common
questions
I
get from gym
members is
“How to get
rid of this?”—
accompanied
by a finger
pointing to the
offending
body
area.
The men consistently point to their chest and/or abdomen, and the women point to the back of the
arms and the hips. They are expecting a magical
exercise that will regionally remove the subcutaneous fat and selectively slenderize their arms, chest,
or abdomen. You see the disappointment in their
eyes when they are told that high repetition leg lifts
will not take fat off their hips, and that tricep kickbacks will do more to irritate their elbows than
shape their arms. Selective use of isolation exercise to “spot reduce” is at best futile, and at worst,
dangerous. The key to controlling body fat levels is
to control your diet and maintain muscle mass.
Gym members frequently perform muscle isolation
exercises in an effort to eradicate fat from a single
area. Many of these isolation exercises are performed for high repetitions, and place excessive
stress on a single joint of the body. The Jane
Fonda exercise tapes of the 1980s were great for
the physical therapy business. Ladies with hip bursitis and tendonitis arrived in the clinic after one or
two weeks of leg lifts. I frequently treat patients with
lower back pain that occurred after a session of high
repetition “abdominal exercises”. Lots of triceps exercises to eradicate arm fat lands the patient in the
doctor’s office with howling elbow pain.
Changing body fat levels is achieved with a proper
diet. My favorite “fat blasting” exercise is the Table
Push Away. The best exercise program in the world
will not result in a change in body fat levels if you
are eating improperly. Even a lousy exercise regimen has a good chance of working if you eat properly. Proper diet combined with an appropriate exercise prescription is the key to long term fat reduction.
Controlling body fat throughout your entire life is accomplished by staying strong. The inconvenient
truth is that we lose muscle mass as we age, and
this tends to make us more susceptible to the accumulation of body fat. The latest research in the journal Cell Metabolism places the rate of muscle loss
at six pounds per decade after the age of thirty.
Specifically, we lose fast twitch muscle fibers; the
fibers that keep us fast, strong, and slender at a far
greater rate. Progressive resistance training is the
only exercise activity that has been proven to increase muscle mass and preserve fast twitch muscle fibers. Long duration, low intensity exercise has
no capacity to increase muscle mass.
So the answer to the spot reduction question is to
get your diet in order, and then work on getting
stronger. Use compound exercises that utilize multiple joints, and stay away from isolation exercises.
Squats, lunges, rows, push ups, and pull ups are
good examples of compound exercises. Remember
that fat is lost from the body in a fashion that you
may not like. The area reduction rule is that the first
place you gained the fat is the last place you will
lose the fat.
Michael S. O’Hara, P.T.,O.C.S.,C.S.C.S.
Hours
Mon-Thur: 5:30am-10pm
Friday: 5:30am-9:00pm
Saturday 8am-5pm
Sunday 8am-2pm
404 Rounds Drive
Fenton, MI 48430
810-750-0351
Diagnosis: Ellitihip
You May Have It And Not Know It
The first elliptical training unit was developed and introduced by Precor in 1995.
The units became an instant success, and over the years, many elliptical variants
have been developed and sold by different companies. The Elliptical Trainer machine has become a mainstay in the fitness industry, and most gyms have an entire row devoted to the elliptical. Every day, thousands of people use these units
in homes and gyms across the country. Many gym members can list their favorite elliptical models, and report that it is their favorite piece of “cardio equipment”.
If you are looking for a low impact training method that produces a good cardiovascular response, Elliptical Trainers are great. However, long term use of these
units can create substantial lower extremity muscle imbalances that need to be
addressed with proper flexibility and strength training.
The elliptical trainer never carries the hip joint into full flexion (the thigh moves forward). On most units, the hip
never flexes more than 60 of the available 120 degrees of flexion. Several important muscles flex the hip. The
rectus femoris muscle and the tensor fascia latae (TFL) are smaller muscles that are responsible for the first sixty
degrees of flexion. The larger psoas muscle does not begin to work until the hip flexes well past sixty degrees. In
the absence of any other type of training stimulus, the rectus femoris and TFL become overworked. This frequently
leads to the development of shortening and painful trigger points. The psoas muscle is not trained, and you lose
the ability to efficiently flex the hip if it weakens. The psoas is also a major contributor to lumbar and pelvic stability, and if it weakens, you are susceptible to lower back pain. Test your hip flexor function with the foot on box hip
lift test on the next page.
The elliptical unit keeps the feet at a fixed distance from each other. The distance varies from model to model, with
the biggest gap at 22 inches, and the smallest at 14 inches. An efficient and healthy gait pattern places the feet in
line with one another. Basically, you run on a straight line. Training with the feet apart all of the time allows the
muscles and connective tissue structures on the outside of the hips to adaptively shorten. This can lead to pain,
alterations in hip mobility, and strength deficits. You can self-assess lateral hip flexibility with the Ober’s test on the
next page.
So how do you know if you have a problem related to elliptical training?
Does the outside of your hip or knee hurt after training or during normal activities?
Do you fail the Hip Lift or Ober’s test on the next page?
Does your pelvis rock side to side while using the elliptical machine?
If you answer yes to the pain question, stop using the elliptical machine and perform corrective exercises until the
pain goes away. If you answer yes to any of the other tests, then simply add some training to improve the flexibility
and/or strength in those muscles. If you answer yes to all of the questions, then get with a trainer and work on
these deficits before you get into real trouble. On the next page are the flexibility and strength tests that should
help tell you if you have a problem that needs to be addressed.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
08/09
Your Elliptical Drivers Tests
Try these two tests and see how well you do. If you fail the tests and do not have pain, you can keep training
on an elliptical. Just work on improving hip flexor strength and hip mobility.
Ober’s Test
You need proper length in the muscles and connective tissues on the outside of the hip and leg. You can assess this by performing the Ober’s Test. Lay on your right side and lift the left leg up toward the ceiling with
the knee bent. Keep your pelvis level and lower the left leg until it reaches the floor or mattress behind the
right leg. Your left leg should easily move all the way down to the floor. The knee should reach the floor, and
no pain should be present in the lower back, hip, or leg. Repeat on both sides. If the leg cannot move freely,
or pain is present, then a problem with shortening or trigger points in the iliotibial band, tensor fascia latae, or
gluteus medius is present.
Hip Flexor Function Test
To assess the function of hip flexion above 70 degrees of flexion, perform this test. Many people are
unable to hold this position because of a weak or inhibited psoas muscle. The psoas is a very important
muscle for maintaining a strong spine and a stable
pelvis. You cannot see your psoas so it gets very little attention in most fitness programs.
Place the left foot on a step box between 12 and 16
inches high. Shorter people use a 12 inch box and
taller people use a 16 inch box. Place the hands behind the head and tighten up the torso into a tall position. Keep the right knee straight and lift the left foot
three inches off the box. Hold the single leg stance
with the left hip flexed for five seconds. Try to keep
the torso solid and the right knee straight. If you are
unable to hold yourself up, you fail the test.
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Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
Stolen Season
Marcy was a regular at the
gym. She trained three or
four times a week, and always spent at least 30 minutes on the elliptical machine.
She had been an athlete in
high school and she was an
avid softball player in the
summer. Marcy was looking
forward to a great summer
season of softball, but after
her first game, she developed
a strong pain across the outside of her left hip. Initially,
the pain was only present in
the morning, but gradually it
worsened. The pain eventually stopped her from exercising and began to wake
her from sleep. Marcy was referred for physical therapy by her physician.
On initial evaluation, Marcy had pain and sensitivity
to palpation across the outside of the left hip. She
had a normal Ober’s test on the right, and a very limited and painful test on the left. She was unable to
bring the left hip above 90 degrees flexion secondary
to weakness. Strength in the psoas muscles on both
sides scored at much lower levels than you would expect for someone her age and activity level.
Marcy’s pain resolved with three sessions of manual
therapy to the left hip and a home stretching program. Restoring the strength and full active motion in
her left hip took much longer. Her left hip had full
motion after four weeks, but normal grade strength in
the hip flexors took over two months of consistent exercise. Marcy was then progressed to a program of
exercises to restore sprint and acceleration mechanics. Marcy still uses the elliptical machine, but she
makes sure that she also performs her flexibility and
strengthening exercises.
Gymboss Interval Timer
The best exercise devices are always simple and
easy to use. They make your training sessions more
productive and permit instant feedback on your performance. The Gymboss interval timer is a great
product that I have been using for the last two years.
This digital countdown timer
can be set for both a work
and a rest interval. It is the
size of a small pager and
runs on a single AAA battery. The beep signal is
clear and can be heard over
the music in the gym. It
even keeps track of the
number of intervals you perform, so you never lose
track.
Most of us count the number of sets, reps, and the
amount of weight we lift, but rarely do we measure
the time component of our training. We perform progressively longer workouts that consume more of our
waking hours, when we would be better served by
shorter sessions performed at higher intensity levels.
Doing more work in the same amount of time is the
quickest way to improve overall fitness.
The Gymboss allows you to keep your mind on the
exercise and off the clock. You switch from work to
rest, or from exercise A to exercise B on the signal
from the Gymboss. As you get fitter, the rest intervals
can be shortened. It sells for $20.00 and is available
at Gymboss.com.
Dear Doctor:
At our facilities, the initial evaluation, consistent reevaluations, exercise instruction and manual therapy are
always and only performed by a Physical Therapist on each and every visit. Excellent service and treatment
standards can only be maintained when the highest level of professional care is provided. We are also able
to treat your patients within a day or two of referral. Our extended evening hours allow convenient scheduling times for your patients. They are seen when they need it most, without an extensive waiting period.