Posts in strengthening
Should Women with Osteoporosis Engage in High Intensity Resistance and Impact Training?

Despite the fact that bones respond favorably to high impact exercise and high-intensity resistance training these types of exercise are typically avoided in women with osteoporosis due to concerns that heavy loading of ‘fragile’ bone may result in increased risk of fracture. The LIFTMOR trial (Watson et al 2017, J Bone Mineral Research) calls into question this traditional belief that osteoporotic females should not lift heavy weights.

 This high-quality trial investigated the effects of an 8-month, 2x/week high intensity, progressive resistance and impact weight-bearing training (>80-85% of 1 rep max) in women with osteoporosis compared to women participating in low-resistance (<60% 1 rep max) exercise targeting mobility and balance. The high-intensity exercisers gained bone mass where their low-intensity counterparts lost bone mass. The high intensity group also had significant improvements in measures linked to fall risk as well as height.

 Importantly, in the over 2600 high-intensity training sessions, only 1 mild adverse event was noted and that participant returned to high intensity training to complete the study without concerns.

 High-intensity exercises included (*all exercise sessions supervised by a physical therapist):

Dead lift

Overhead press

Back squat

Jumping chin-ups with drop landings


Contact your exercise experts at Mend to get started on improving your bone health now.

Influence of Leg Strength on Golf Club Speed
golf-driving distance-club speed-strengthening-exercises

The golf swing involves movement from our feet through our hands as we accelerate the club head through the ball.  In our Boulder Physical Therapy practice we often see golfers with low back pain aggravated by their golf swing.  Often these athletes have a loss of either hip rotation or hip strength which places unnecessary stresses across the low back.  Treatment to restore motion and especially strength has been shown to improve driving distance through increases in club head speed.  Club head speed is one of the key determinants of golf performance among amateurs do to its' impact on driving distance.

Recently authors examined the correlation of driving distance and club speed with professional golfers' strength.  The authors studied 20 professional golfers and put them through strength and power testing then correlated these findings to the golfer's on course performance measures including club speed.  Younger golfers (<30 years old) utilized more leg strength on the course where as older golfers (>30 years old) used more upper body strength.  Among the younger golfers a significant correlation was found between club speed and leg strength and power.  Golfers looking to improve their performance on the course are advised to work with a Physical Therapist to improve their leg strength and power.  

Muscle Activation During an Inverted Row

The standing row is an excellent exercise to develop strength and stability in the upper back, shoulder, and arms.  In addition to the standard standing position, individuals may choose other positions including using TRX straps or a bar to increase the demands on the upper body and core musculature.  A recent article examined the recruitment of these muscles during various positions of the row exercise (Youdas et al. J Strength Cond Res. 2016).

Authors placed 26 patients through 4 different versions of the inverted row to determine their relative muscle recruitment patterns.  The authors noted all positions of the inverted row were excellent for targeting the biceps, deltoids, latissimus dorsi, and trapezius muscles.  Surprisingly no significant differences were noted performing the exercise in either a single or double leg supported position.   This article adds to the existing strengthening literature indicating the inverted row with straps or a bar is an excellent option to strengthen the upper back musculature. 

Altered Muscle Recruitment in Patients with Shoulder Pain

Shoulder pain is a common musculoskeletal problem and one of the top reasons patients seek care from their primary care physician.   There are many sources of shoulder pain including impingement and rotator cuff tendonitis or tears, but they all have one impairment in common altered muscle recruitment.  When pain is introduced into the body the nervous system's ability to contract and coordinate the activity of the surrounding muscles is altered.  These changes lead to compensatory movements, more pain, and loss of function.   In addition to treating a patient's pain Physical Therapists utilize exercises to restore normal muscle function to the affected areas.

A recent article in the Journal of Shoulder and Elbow Surgery compared the muscle activation levels between patients with impingement and their pain free peers (Michener et al. 2016).  All participants were asked to perform a weighted arm lifting task as the researchers collected muscle activation data.  The patients with impingement demonstrated an altered movement pattern while performing the task overworking their neck muscles in the process.  In comparison, the healthy controls were able to perform the task using the correct shoulder blade muscles without overcompensation from their necks.

This study highlights the importance of correcting these muscle imbalances and coordination deficits to reduce the risk of a patient's pain returning.  To learn more about how to reduce your pain and improve your shoulder function contact your local Physical Therapist.  

Weakened Foot Strength and Orthotic Use in Patients with Heel Pain

In our previous posts we have documented the weakness and atrophy of the foot's "core" muscles among patients with heel pain.   Heel pain is one of the most common foot and ankle diagnoses we see in our Boulder Physical Therapy Practice.  This condition is commonly treated with manual therapy and exercises targeting the lower quarter.  A targeted area for exercise involves the foot's core muscles which contribute to stability and function of our arch.  Without adequate strength and control of the arch we are more at risk for conditions such as heel pain and plantar fasciitis.  Recent research highlights the importance of these muscles and the negative impact foot orthoses may have on their function. 

McClinton and colleagues studies 27 patients with heel pain compared to matched peers who ddi not have any heel pain (JOSPT 2016).  Participants' foot strength was tested using two clinical tests for foot "core" strength.  Not surprisingly, the patients with heel pain had significantly less foot strength than their asymptomatic peers.  Interestingly, longer use of foot orthoses was associated with lower performance on these strength measurements.   Stabilization of the arch with foot orthotics may weaken the foot's core muscles because they prevent these muscles from performing their natural function.  

Patient's are encouraged to contact their local PT on the most appropriate treatments for their heel and foot pain.  

Ibuprofen's Impact on Muscle Growth and Development

Non Steroid Anti Inflammatory Drugs (NSAIDS) such as ibuprofen are the most common drugs listed on our patients intake paperwork.  Patients are often using these drugs due to their beneficial effects on pain and inflammation.  Due to being sold over the counter these drugs are often thought to be free of side effects, but they lead to close to 80,000 hospitalizations and 8,000 deaths due to gastrointestinal bleeding.  In addition to these serious consequences, NSAIDs are also thought to delay or prevent healing after acute ligamentous and bone injury as well as reduce the beneficial adaptations to exercise.

A recent article in the American Journal of Sports Medicine studied the impact of NSAID use on the effects of an exercise program (Rooney et al. 2016).  The authors conducted an animal study placing animals in either an exercise or sedentary group.  Within each group half of the animals were placed on NSAIDs and were followed over the 8 week course of exercise.  The authors found the NSAIDs did not impair the beneficial mechanical adaptations to exercise such as stiffness or tissue quality, but did decrease the cross sectional size of the muscle.  The results of the study suggest the animal's medication use attenuated the normal growth of the muscles in response to the exercise.    

This study adds to the existing literature on the impact of NSAIDs on healing and adaptations to exercise.  Patients are advised to speak with their primary care doctor regarding these medications, their effects and side effects.