3 Tools to Get More Out of Your Programs

Ah, it’s that time of the year again, time for New Year’s resolutions!  While many people will be taking the plunge and dedicating some time and energy to fitness goals, the real challenge is sticking to these New Year’s resolutions for more than a month!  There are many reasons why people don’t stick to their workouts and fitness New Year’s Resolutions.  Some of them are just facts of life, such as time commitments, financial concerns, and lofty expectations.

Two common reasons for not sticking to your fitness resolutions that I have observed are soreness from the initiation of a new program and plateaus in your progress.  These are much more manageable and something that I think are sometimes related to mobility issues that can be addressed.

For the person just beginning a fitness program, muscle soreness and tightness after performing new exercises is essentially expected.  But there are some ways to reduce this soreness and get over the initial hump a little easier.  Movement and massage are two prime examples.  For the person that has some workout experience but aren’t working with a qualified professional, they often have some muscle imbalances and movement restrictions because someone isn’t helping them address their weaknesses.  Everyone wants to work on their strengths, right?

These are both obvious reasons as to why you want to work with a qualified strength and conditioning coach or personal trainer that can help identify and address your mobility concerns.  But what if you don’t have the access to a great coach and just want to start a home workout program or buy a generic gym membership?

Here are 3 tools that I recommend for you to get more out of your programs.  For a small amount of money, you can start your own package of tools that you can use at home between workouts.  Use these tools daily for 10 minutes and you’ll move and feel better between workouts, which will allow you to get more from your programs.


Foam Roller

GRID foam roller Foam rollers are a staple for many people and certainly not anything new.  While foam rollers are popular at the gym before a workout, having one at home to use between workouts is a must as well.  Many people consider a foam roller a “self-myofascial release” tool.  I’m not sure if we are making any significant fascial changes when we foam roll, but the combination of the compression on the tissue and movement associated with foam rolling likely has a positive effect on neuromodulating tissue soreness and tightness.  What does this mean for you?  You’ll feel better and move better when you are done!

How to Use a Foam Roller

I recommend two uses for foam rollers – 1) as a generalized full body program, and 2) on specific sore muscles.  I would recommend rolling out the major hot sports of the body, such as:

  • Low back
  • Mid back
  • Posterior shoulder
  • Lats
  • Glutes
  • Hips
  • Quads
  • Hamstrings
  • Groins

I essentially recommend 5-10 full length rolls of each area, performed in a slow and controlled pace each day.  If specific muscles are sore after a workout, I would emphasize these and perform another 5-10 reps, however, if you find a specific point of discomfort, you can pause at that spot for 10 seconds.  Take a few deep breaths and try to relax.  I would also recommend performing a few thoracic spine extensions while rolling the mid back.  Here is a great video demonstration from Eric Cressey.  He hits a few different areas, however, the general concepts are the same and these are great examples.  There are also a few trigger point ball examples towards the end, but more on that later:

What Foam Roller to Buy?

I currently recommend two foam rollers, one for beginners that are just looking to incorporate foam rolling and another for more advanced uses that don’t mid spending a little more.

  • For Beginners: Perform Better Elite Molded Foam Rollers.  Pretty much a great basic foam roller that you can get for around $25
  • For Advanced Users: The Grid Foam Roller.  When you are ready to step up to a more firm roller, the Grid is by far the best on the market.  I don’t really think all those ridges and nubs do anything, but this is a great firm and durable roller that will last you a lifetime.  It’s a bit pricier between $30 and $40, but worth it.


Massage Stick

theraband massage rollerWhile foam rollers are great, they aren’t perfect for every body part.  Essentially, if you can’t put a lot of weight through the foam roller, it doesn’t feel like you are doing much.  If you notice the above list of muscle areas does not include the entire body.  To hit more specific areas, a massage stick is a great tool and essentially a foam roller with handles!  You can use your hands to put more pressure into the movement when body weight isn’t available.  I see a foam roller and massage stick as complementary, and a massage stick is great for:

  • Calfs
  • Outer side of lower leg
  • Upper traps
  • Forearms

As you can see, pretty important areas, and spots that foam rollers really don’t hit well.  Not only do these areas get sore, but limitations often result in poor performance when training.

How to Use a Massage Stick

I use a massage stick just like a foam roller, with about 5 full length rolls on each area.  If sports are sore, which is pretty common in the calf and upper trap, I will pause there for about 10 seconds.  Here is a demonstration I have used in the past on how I use massage sticks for the forearm:

What Massage Stick to Buy?

I have used several massage sticks in the past and must say that there is only one I would currently recommend as it is by far superior to the others:

  • TheraBand Roller Massager+.  I was skeptical when I first used this massage stick, assuming that the ridges were just a way of separating themselves from the rest of the market.  However, the combination of the ridges and the material of the roller makes for a great combo and the best roller on the market!  The material grabs the skin well and the ridges create a drag sensation in addition to the compression.


Trigger Point Ball

sklz reaction ballWe have progressed from a foam roller, to a massage stick, and now to a trigger point ball, the third component of a great self-help tool package!  Even with a roller and a stick, there are still some areas that are just too hard to get to.  As you can see, we are getting more specific with each tool.  Here is what I use trigger point balls for:

  • Specific trigger points in the glutes and hips
  • The QLs
  • Upper and middle trap areas
  • Posterior rotator cuff
  • Plantar fascia

If these are areas of concern for you, you’ll want to get some sort of trigger point ball to hit these spots with ease.

How to Use a Trigger Point Ball

Using a trigger point ball is a little different from a roller or a stick, I usually don’t recommend rolling the body on the ball, but rather just stick to a trigger point release.  These balls can get to a small specific spot, so you can hit multiple points in each area, holding each for about 10 seconds.  Here is an example of using a trigger point ball on the posterior shoulder:

What Trigger Point Ball to Buy?

I typically use a couple of different trigger point balls, depending on how firm I want the ball to be.  I would recommend the softer balls for beginners and firmer for advanced users.  I think lacrosse balls are great, but they are pretty firm and don’t have a small nub to use, making them less than ideal for some areas.  Here is what I recommend:

  • For Beginners: Trigger Point Therapy Massage Ball.  These are a little more expensive than lacrosse balls at about $15, but they are softer and have a little nub than you can wedge into different areas, which I like.  This is a good starting point, but if you weigh a lot or plan on using it exclusively for the glutes, the brand new Trigger Point Therapy X-Factor Ball is a little larger and more firm.  I use these a lot.
  • For Advanced Users: SKLZ Reaction Ball.  You know those little yellow reaction balls that you drop and bounce all over the place?  A friend just recently turned me on to these as trigger point tools!  They work great!  They are firm and have great little nubs to really get in to the tissue.  Plus you can usually find them for under $10.


By combining these 3 tools, you’ll have a perfect home kit to help you move better and feel better between workouts, which means you’ll get more out of your programs and hopefully stick to those New Year’s resolutions!



Assessing and Treating Loss of Knee Extension Range of Motion

Assessing and treating loss of knee extension range of motion is an important component of rehabilitation following any knee surgery.  We recently discussed how loss of knee extension range of motion may be one of the biggest factors associated with the development of osteoarthritis following ACL reconstruction.

The purpose of this article is to review some of the many methods of assessing and treating loss of knee extension range of motion to help maximize outcomes following knee surgery or injury while minimizing long term complications.


Assessing Loss of Knee Extension Range of Motion

There are many ways to treat loss of range of motion in the knee, however, proper assessment of range of motion is even more important.  A certain degree of hyperextension is normal, with studies citing a mean of 5 degrees of hyperextension in males and 6 degrees in females.  Simply restoring knee range of motion to an arbitrary 0 degrees is not advantageous.

The most important factor in assessing loss of knee extension range of motion is looking at the noninvolved knee.  As simple as this sounds, this can not be overlooked as you need to establish a baseline for what is “normal” in each patient or client.

The first thing I look at is simply grasping the 1st toe with one hand to lift the foot off the table.  My proximal hand can stabilize the distal femur.  This is a quick and dirty assessment but I always recommend quantifying the available range of motion.

To accurately measure knee extension range of motion, you will need to use a towel roll of various height to assure the knee is fully hyperextended before taking a goniometric measurement.

Knee Hyperextension

Other aspects of assessment that should be performed when dealing with loss of knee extension range of motion should include patellar mobility, tibiofemoral arthrokinematics, and soft tissue restrictions.  Patellar mobility is especially important after ACL reconstruction using a patellar tendon autograft.  Any restrictions in patellar mobility can have an obvious correlation with restricted knee extension.  Scarring of the patellar tendon can restrict superior glide of the patella and full knee extension.

These assessments will help guide our manual therapy approach to restoring normal arthrokinematics and range of motion of the knee.

Documenting Knee Range of Motion

I took a poll of a large group of students coming through my clinic in the past and found that there was great confusion regarding how we document hyperextension of the knee.   Is + or – when defining a numerical value?

Let’s say that someone has a contracture and is sitting in 10 degrees of flexion and is unable to straighten their knee.  That would be +10 degrees of flexion, thus has to be -10 degrees of extension.  They are on two ends of the spectrum.

Still, using a + or – can be potentially confusing, so I have long taught my students that we should document range of motion using the A-B-C method.  Other authors, such as Dr. Shelbourne, recommend this method as well.

  • If a person has 10 degrees of knee hyperextension and 130 degrees of knee flexion, it would be documented as 10-0-130.
  • If a person has a 10 degree contracture and loss of full knee extension with 130 degrees of knee flexion, it would be documented as 0-10-130.
Using the A-B-C method eliminates the potential for confusion while documenting.

Treating Loss of Knee Extension Range of Motion

There are several ways to improve knee extension range of motion, however, if a person is struggling with this motion I have found that self-stretches, low load long duration (LLLD) stretching, and range of motion devices can be superior to us cranking of a already cranky knee!  Allowing gentle, frequent, and progressive load to the knee is usually more tolerable for the person, especially those that are sore or guarded in their movements.

The intent of this article is to discuss some specific independent strategies to enhance knee extension range of motion.  Other skilled treatments should focus on patellar mobility, soft tissue mobility, and other aspects of manual therapy for the knee as needed.   However, patients will need to perform stretches at home to assure good outcomes.


Self Stretches for Knee Extension Range of Motion

Two of the first stretches that I give patients following surgery are simple self stretches for knee extension.  The basic version simple has the patient applying a stretch into extension by pushing their distal thigh.  The second and slightly more advanced version, has the patient press down on their distal thigh while using a towel around the foot to pull up and simultaneously stretch the hamstrings.

Knee Extension Stretch

Towel Knee Extension Stretch

Similar to how we assess knee extension range of motion, you will want to use some sort of wedge under the heel to assure that you are restoring full motion.


Low Load Long Duration Stretching for Knee Extension Range of Motion

For the person that is having a hard time achieving knee extension, my next line of defense is usually LLLD stretching.  Several research articles have been published showing the benefit of LLLD stretching in achieving range of motion gains.

I prefer performing LLLD stretching for knee extension in the supine position rather than prone knee hangs (follow the link to learn why).  This has always been a more comfortable and thus more beneficial position for me.  To perform this exercise, place a towel roll or similar item under the heel to allow full knee extension and then a comfortable weight over the distal thigh.

Low Load Long Duration Stretch Knee

The purpose of this exercise is to be gentle and to hold the stretch for several minutes.  I typically use anywhere from 6 to 12 pounds and hold the position for at least 10 minutes.  If the person is fighting against the weight, then it is too aggressive.  Lower the weight and you’ll see better results.

Don’t forget that you can apply moist heat to the knee simultaneously for even more benefit.

LLLD Knee Stretch with Heat

Devices for Knee Extension Range of Motion

I am also quick to prescribe a range of motion restoration device for people that may be struggling with range of motion or are not moving their knee enough throughout the day.  I have tried some of the dynamic splinting in the past but found that many people would rather control and hold a sustained stretch rather than have the brace apply a dynamic stretch.

The two devices I have used and enjoyed are from Joint Active System (JAS) and End Range of Motion Improvement (ERMI).

JAS Knee Brace        ERMI Knee Brace

Both devices allow the patient to apply their own tolerable LLLD stretch at home.  This is helpful as frequent movement throughout the day is always beneficial.

Personally my criteria to use these devices is usually when I perceive the person will self-limit themselves and avoid motion.  I will get a device in their hands early so that they can move their knee more at home and have a feeling that they are controlling the restoration of range of motion.  We probably resort to using these devices when it is too late and the patient is already too stiff.



These are just some of the many ways to assess and treat loss of knee extension range of motion.  Considering how important it is to restore full knee extension after knee surgery, properly assessing early signs of loss of motion and effectively treating the knee to avoid long term loss of motion is critical.

Get in Shape in 2012

Each year around this time I offer an article about fitness to help those with New Year Resolutions and those that want to get in shape in 2012.  I like to update this every year as trends in fitness are constantly changing.

Why You Need to Get in Shape in 2012

I discussed this in last year’s article on How to Become Healthier, Richer, and More Attractive, but the numbers are real and worth reiterating.  Recent reports are stating that close to 75% of Americans will be overweight by 2015.  That is completely insane.  I’m going to take this directly from Men’s Health editor David Zinczenko in his new book The New Abs Diet (which I still love and you should read more about here), but here are some startling facts if you are overweight:

  • 50% more likely to develop heart disease
  • 360% more likely to develop diabetes
  • 31% more likely to die of any cause
  • 120% more likely to develop stomach cancer
  • 590% more likely to develop esophageal cancer
  • 35% more likely to develop kidney cancer

But for some reason, these numbers don’t scare us enough, maybe these next two will since no one seems to care about their health, lets focus on what really motivates us – money and…  well, you know:

  • 14% less attractive to the opposite sex
  • 37% more in expenses for prescription drugs
But there is hope.  Exercising a small amount each day has been shown to:
  • Reduce mortality by 14%
  • Reduce chance of cancer by 10%
  • Reduce chance of cardiovascular disease by 20%

So in a nutshell, getting in shape in 2012 will allow you be healthier, richer, and more attractive.  Where do we start???

Home Workouts

Like I do each year, I will start this section off by saying that I fully encourage people to go to a gym and work with a qualified personal trainer or strength and conditioning specialist.  There is NO DOUBT in my mind that this is ideal and will provide much better benefits than any home workout.  That being said, this section isn’t geared towards people that want to do that, it is geared towards everyone else.  Realistically, I know that there is a large percentage of our population that simply can’t or will not do this, so encouraging home workouts is an option for them.

In the past, I have discussed the best home workout programs and included such staples as P90X, Mark Verstegan’s Core Performance series, and Yoga (click the link earlier to read more).  I still like all of these programs but there are three programs that have been on the market since I originally published this article in 2008 that are worth mentioning.

Eric Cressey’s Show and Go Training

Show and Go TrainingI have always kept the target of these articles to programs that can be conducted at home, however Eric Cressey has released his Show and Go Training program that anyone can use on their own.  Unless you have a sweet gym in your basement or garage, you will need to get to a gym to perform these workouts.  However, this is the next best thing to working one on one with a fitness specialist.  Eric shares his acclaimed training programs and provides a comprehensive program that any can follow and any can benefit from.  This is the next step program that many of us are probably looking for to narrow the gap between a home workout like P90X and a real strength and conditioning program.

Click here for more information on Eric Cressey’s Show and Go Training.


P90X2The sequel to the original and has 12 new workouts.  I really enjoyed the original P90X programming and thought they did a good job with the production of the DVDs.  P90X2 is even better.  This time around, they took feedback from the millions of P90X users and combined it with more modern science and fitness research.  I like the added focus on recovery and mobility in this new series.  Like the original P90X, P90X2 is a very thorough program.  You won’t get bored quickly and you will be challenged.  You may still probably mute the DVDs and play your own music once you are familiar with the programs!

Click here for more information about P90X2.


I have to mention it, but P90X has had a competitor the last few years called Insanity.  I’ve taken a look at the program and it is pretty intense.  I love the marketing as well and have to admit, we tried throwing the words “insanity” and “extreme” around in rehab but it just doesn’t work as well when I tell someone to perform their “Extreme Shoulder Program” or “Range of Motion Insanity” program.  If you truly do not want to go to the gym, then P90X and Insanity may be options for you, but the programs are not quick and easy, the both have nearly daily workouts between 60-90 minutes.

Click here for more information about the Insanity workout.


Jillian Michaels

Jillian Michaels

I have to mention that Jillian Michaels can basically sneeze on a napkin and turn it into a well selling workout at this point.  One of the fitness specialists from the Biggest Loser TV show, Michaels has turned herself into a huge fitness business.  She has more DVDs out right now than I can even count, but what may be even more impressive is how many different sports bras she owns.  She is hot right now and has such a variety of home base workout programs that you should be able to find one that fits your goals.  I must admit that I cringe every time I watch the biggest loser and see the workouts they perform, so take popularity with a grain of salt.

Click here for more information on all of Jillian Michaels’ DVDs.



Home Workout Equipment

My original article on the best home workout equipment include items like the Perfect Push Up, Yoga Equipment, and the Bowflex SelectTech Weight System.  Still great products and worth pursuing.  Last year I discussed the TRX Suspension Training system.


TRX Suspension Training and the TRX Rip Trainer

TRX Rip Trainer

I really love the TRX Suspension Trainer.  Over the summer, I published a video of a new exercise I called TRX Serratus Slides to strengthen the serratus anterior.  This is just a small example of how I use the TRX Suspension System in rehab, but the programs that come with the TRX products can form a very good home workout program with minimal equipment.  Eric Cressey and I show a few techniques with the TRX products during our Functional Stability Training of the Core program as well.

TRX now has a new product called the TRX Rip Trainer, which is essentially a bungie cord at the end of a long dowel.  Like all of the TRX products, the Rip Trainer’s production quality is top notch.  TRX really does a great job putting together a great product with a great workout program included.  The Rip Trainer can be used to perform many home exercises including chops and lifts that traditionally require a Keiser or Pulley machine.  There are bunch of new uses that I come up with everyday as well.

I recommend both the TRX Suspension Training System and TRX Rip Trainer, click here for more information on both.

Xbox Kinect Workouts

ZumbaWow, I never thought I would include a video game in this type of article, sounds counterproductive doesn’t it?  The Wii was close, but the Xbox 360 with the Kinect motion sensor really does open up the possibility to offer home workout “virtual coaching” better than a pure DVD video.  The Xbox Kinect system can see you and assess the quality of your movement as you go along with the workout programs.  Games include several dance based titles that can serve as a cardio workout, but also many workout programs including:

I wouldn’t underestimate these options for home workout programs as they can be fun and motivation is the key.

Click here for more information on the Xbox Kinect Motion Sensor.


Self Myofascial Release

I really think that we are going to start seeing more of the trend towards “feeling better” in our home workout programs.  As we mentioned above, P90X2 has a new section of the program designed for recovery and mobility, and Mark Verstegan’s Core Performance programs have always featured this concept.

One simple way to start feeling better in addition to getting in shape for 2012 is self myofascial release and trigger point releases.

UPDATE:  This article has been revised and updated with newer products!  Click here to see my current list of best self myofascial release tools.


Foam Rollers

Thoracic Spine Mobility ExercisesI have reviewed many of the best foam rollers on the market right now.  I still like all my original recommendations, though one new product is also worth checking out.  I have actually gravitated to using the Grid roller myself, and I think it is great, but for those on a tight budget it is hard to justify the extra cost from the simple foam roller.

In addition to self myofascial release, foam rollers are also excellent at working on thoracic mobility, which we all really need in our society.  I showed a video of how I perform simple thoracic mobility exercises on a foam roller than anyone can perform.  Start enhancing your posture now!

Click here to check out the best foam rollers.

Trigger Point Massage Balls

Trigger Point Massage BallThe same company as the Grid roller, Trigger Point Performance Therapy, has released a trigger point massage ball that I really like.  Softer than a lacrosse ball and firmer than a tennis or racquetball with a little nub to really get into a trigger point.  This has been my go to tool for self trigger point releases over the last year or so.  I showed a technique I use for the self trigger point release of the shoulder and rotator cuff.  This is a great compliment to any foam roller you have.

Click here for more information on the Trigger Point Massage Balls.


I hope this information helps.  I am always looking for good products so feel free to comment and share your experiences too!  Good luck with your New Year Resolution to get in shape in 2012!

How to Become Healthier, Richer, and More Attractive


[box type=”note”]UPDATE:  See my latest article Get in Shape in 2012 for an update to this article![/box]

HAPPY NEW YEAR!  Welcome to 2011!  How about that for a title of an article on this site!  Can’t wait to see how many people do (or do not!) read this!  To celebrate the new year, I have published some recommendations for those just starting some new year’s resolutions to get back into shape and to workout.  Everyone knows that I am a therapist, athletic trainer, and strength coach and actively work in all 3 domains – I am very much in favor of getting personal attention from a strength specialist when it comes to workouts.

But I am also a busy professional myself that travels frequently – I know the demands many of us face and understand that “not enough time” is going to always be everyone’s number reason for not working out.  This article is for you.  Yes, I realize that a program entitle the “10 Minute Trainer” is probably not the best program in the world, but it may be a place to start for some people.  Again, this article is for you.  But more importantly, we have a huge problem with obesity in our society.  Again, this article is for you.


We have a Problem in Our Society

One thing is for certain, our culture is slowly getting more and more out of shape and in effect, less healthy.  Recent reports are stating that close to 75% of Americans will be overweight by 2015, which is completely insane.  I’m going to take this directly from Men’s Health editor David Zinczenko in his new book The New Abs Diet (more on this later), but here are some startling facts if you are overweight:

  • 50% more likely to develop heart disease
  • 360% more likely to develop diabetes
  • 31% more likely to die of any cause
  • 120% more likely to develop stomach cancer
  • 590% more likely to develop esophageal cancer
  • 35% more likely to develop kidney cancer

But for some reason, these numbers don’t scare us enough, maybe these next two will since no one seems to care about their health, lets focus on what really motivates us – money and…  well, you know:

  • 14% less attractive to the opposite sex
  • 37% more in expenses for prescription drugs


Lose Weight, Get in Shape, Become Healthier

Again, take a peek at my past articles on the best home exercise programs, best home workout equipment, and my updates from 2011 as a reference.  Not much has changed.  I still like P90X for many people (not for the really serious or athletes – you guys see below for Eric Cressey’s new program), encourage people to perform Yoga (probably because I am so tight!), and I still am a follower of the Abs Diet (not really a diet, but a better way to choose foods).  A new edition of the Abs Diet book and accompanying cookbook just came out two weeks ago, looking forward to reading them as I know the author, Men’s Health magazine Editor-in-Chief David Zinczenko, has added a ton of new research and materials to back up his recommendations, probably the main reason why I like his book so much.

This year I want to highlight two new products that I think would be a perfect addition to any home gym or independent workout program – the TRX Suspension Training bands and Eric Cressey’s new training program, Show and Go Trainer.


TRX Suspension Training Bands

imageI’ve been using TRX Suspension System for the last couple of years.  I could probably use them more, but to be honest I have access to so much equipment that I don’t always need them.  You, however, probably aren’t in the same situation.  That being said I have been playing around with some new techniques and plan on integrating them even more this upcoming year.

These bands are a great way to get a workout in at home without needing a ton of weights or equipment.  Really a great idea, one of those moments when you’ll probably say “why didn’t I think of that…”  I’ll be traveling with these this year to get some workouts in on the road in the hotel!  Well worth the small price and great quality of material and packaging, even comes with a cool DVD.  Get the door handle to you can use these anywhere.  Put this together with an Iron Gym and your upper body is and core are covered.

I’m also going to try to work on some rehab applications and post on them here in he future.


Eric Cressey’s Show and Go Training

imageFor the more serious people out there, I am actually really excited to have a “real” program to talk about this year.  The infomercial garbage that is out there has its pros and cons, no doubt, but finally there is a program out there that isn’t built for a generic workout DVD.  Eric Cressey’s Show and Go Training is a real strength training program built by a real strength coach.

The program is packed with everything  – foam rolling, mobility training, active warm-up, strength training, cardio/energy system training, even nutrition.  Plus, there are over 170 video demos of all the exercises in the program.

If you are serious about your workouts, this amount of info at this price is really hard to come by, it’s like having Eric write you a personal program!


Good luck with your goals for 2011!