Brett Birnbaum 12/1/24 Brett Birnbaum 12/1/24

How to Stay Consistent During the Holidays

Welcome back to the Total Performance Newsletter! If you are a new subscriber and did not receive previous editions, check out the "Newsletter" tab on my website (www.totalperformance-pt.com) and they are all posted there. This month, we will continue to take a look at some specific movement and injury-related issues that commonly arise and how to deal with them.

Before we dive into today's topic, I wanted to give a quick social media plug. Follow us on Instagram (@total_performance_pt) and Facebook (@Total Peformance Physical Therapy). I have been more active in those places and will be making regular posts on ways to further help you move better, feel better, and perform better!

Getting back to today's newsletter, we're going to focus on some tips to help you stay on track with your health, fitness, and rehab goals during the holiday season. These types of lists are everywhere and there are countless strategies and pieces of advice on this topic, but this newsletter is going to focus on just 4 that I find to be useful and practical.

The basis behind each of these tips is to allow you to ENJOY the holidays WITHOUT RESTRICTION. Yes, you read that correctly, we can still stay on track with our goals without having to restrict ourselves or miss out on anything. I will explain how below.

Progress is not made nor ruined in 1 day (or even 1 week)
- This is more of a mindset shift than it is an actionable tip, but it's an important one to start off with. An extra slice of pie will not cause you to gain weight in a day (any fluctuation in the scale is just your body holding onto water-we do not gain or lose fat/muscle that quickly). Missing a workout or skipping your home exercises for a day or two won't derail your fitness or rehab progress. Just like positive, long-lasting results are due to consistent action over a long period of time, negative, long-lasting results are also due to consistent action over a long period of time. Driving yourself crazy over fluctuations on a shorter timeline is likely more detrimental than the extra dessert or missed workout actually is. The key here though, is to make sure you get back on track as soon as possible-do not let a day or a week turn into a month.
Plan ahead
- If you know you have a holiday dinner party and the desserts are going to be irresistible, be sure to make healthy choices for breakfast and lunch. If you are going to be away for a few days with limited time for exercise, be sure to get in some good training sessions before you head out of town. If you are going to have limited access to equipment, find alternative exercises that target the same goals-a qualified coach/physical therapist can help you with this. Whatever your situation may be, a little planning will go a long way in making sure you stay on track with your goals without having to miss out on any quality time with family and friends.
A little goes a long way
- This one is more exercise-related. Holiday season is a busy time-shopping, traveling, work parties, family and friend get-togethers, it can be challenging to find time for your normal workout/rehab exercise routine. That's totally fine. Here is where a little goes a long way. Maybe your usual 60 minutes in the gym isn't feasible-set the clock for 20 minutes (or whatever you have time for), pick a few exercises, run them as a circuit, and get out of the gym (my newsletter from September discusses this topic in more detail-there is a link above in the first paragraph where you can find that newsletter). Maybe you have a list of 10 home exercises you do for your shoulder rehab-pick 3-4 of the most important ones and stick with those. Don't even have time for a quick gym session or some home exercises? No worries, grab some friends and family and go for a walk in the neighborhood. Again, every situation is unique, but do not worry about being perfect with your normal routine-any bit that you can manage will help move the needle in the right direction.
Keep it simple
- This one piggybacks off the previous tip. When you're busy and have other priorities, it is not the time to try a bunch of new exercises or introduce new things into your routine. Keep it simple, stick to things you are familiar with and that work for you, get it done, and go have fun with your family and friends. In reality, the holiday season is just a few weeks-once it's over, you can refocus your efforts. For now, leave the creativity for party planning, holiday decorations, and new recipes.

I hope you find these tips useful and if you need any guidance, do not hesitate to reach out. But more importantly, I hope you all have a wonderful holiday season!

Stay tuned for next month’s newsletter, where will we continue to look into some common issues that arise and practical solutions to deal with them! Also, if you have any topics that you want to see covered in a future newsletter, please let me know!

Brett Birnbaum 11/1/24 Brett Birnbaum 11/1/24

How to Actually Make a Nutrition Change

Getting back to today's newsletter, we will go through the step by step process of how to make nutritional changes in your everyday life. In last month's newsletter, we talked about some foundational principles that anyone can use to improve their nutritional habits. This month, we are going to go through the exact process I use to help people make these changes and have them become a regular part of their daily life.

Step 1: Write down everything you eat

The most important part of making sustainable nutritional changes is making sure that it actually fits your lifestyle. The best meal plan in the world is useless if you aren't able to follow through on it. So, the best way to start is to take 5-7 days and write down everything that you eat and drink. It does not have to be precise and you do not have to weigh and measure anything, but make sure you are honest. This is not something you have to do forever, but the goal is to get a realistic picture of what a normal week of eating/drinking looks like for you. This way, we can begin to make changes that actually make sense for you and that you can follow through on.

Step 2: Review and make a list of all changes that need to be made

Once you've got that week of food/drink written down, now it's time to look it over. This can be hard to do objectively on your own, so a qualified coach can be a big help here. As you are looking over your food log, write down any changes you think you need to make. You will not be doing all of these at once, but it is important to make a list of all the potential areas of improvement. Some examples may include, "drink more water," "eat breakfast more consistently", or "trade out chips for carrots as a snack."

Step 3: Pick one thing at a time to change

Even if you think you can work on multiple things at once, stick with one change at a time. This is the most sustainable way to actually engrain a habit so solidly into your lifestyle that you do not even have to think about anymore. Start with the easiest, most simple change you can make. Stick with this for at least 2 weeks before you consider making the next change. If you are looking for true, sustainable, life-long habit changes, then slow and steady is the name of the game.

Step 4: Go back to your list and repeat Step 3

Continue to implement just one change at a time, making sure it is a rock-solid habit before moving on to the next. Continue with this process until you feel you've made all the changes you need and you're moving in the right direction towards your goals. If you ever feel like progress has stalled, log your food again for another 5-7 days and re-evaluate if other changes need to be made.

If you're interested, click here for a sample food log, a list of changes that need to be made, and then the order in which I would suggest making those changes based on this log. It is important to note that this just an example, and the specifics will vary for each person.

I hope you found this useful and that it simplified a process that is often too complicated. If you need help or some specific guidance, do not hesitate to reach out!

Brett Birnbaum 10/1/24 Brett Birnbaum 10/1/24

Nutrition Tips for Health and Rehab

Getting back to today's newsletter, we will discuss the role that nutrition plays in injury rehab and go over 5 essential tips that will be helpful for general health, performance, and recovery.

We have all heard the old saying that goes, "You are what you eat." This could not be more true when talking about rehabbing from an injury. When our body experiences a trauma such as a break, tear, sprain, strain, or even a cut, it literally needs new materials to heal the damaged tissue. The only way our body can produce the materials to do this is from the food we put into our body. The better food we put in, the better materials our body can make, the better the healing process goes.

Even in situations in which we have pain without actual tissue damage, our body still needs proper fuel. Whether it is your home exercise program or during a session, anytime you are moving your body in an effort to recover from an injury, your body is going to consider that a workout. How do we recover from workouts? Proper nutrition in order to provide our body with the materials in needs to remodel and build new tissue.

With that being said, let's dive into 5 essential tips that can be applied to just about any case. Yes, more individual changes may be necessary for each person, but these 5 tips serve as the foundation for any specific changes that need to be made.

3 Meals/day
1. It may sound cliche, but I am a big proponent of 3 square meals per day. There are two main reasons. First, it ensures you are getting a consistent flow of fuel throughout the day. Our bodies work best when they receive consistent, steady, and healthy inputs. It's an added stress to go through waves of feeling hungry and have energy levels crashing and then stuffing ourselves and feeling overly full and lethargic. Second, and related to the first, is that it helps reduce cravings and helps you to make better food-related decisions. We all know what happens if you go grocery shopping on an empty stomach-it is too easy to grab things that catch your eye but are not the best heath-related choices. If you know you ate a full, nutritious breakfast and aren't going into lunch starving, it will be much easier to pick a healthy lunch instead of reaching for chips and cookies. The examples are endless, but stick with consistent meals and watch your decision making become infinitely easier.
Protein-Centered Meals
1. It is basically impossible to overeat protein. We've all had the experience of finishing a giant bag of chips or shoveling 3 bowls of pasta into our mouths (maybe the pasta is just me being from New Jersey???). But, have you ever had that with steak or grilled chicken? Probably not, no matter how good you are on the grill. When you eat protein, your body knows when it's had enough, and it tells you by signaling that satisfied but not overly full feeling. Why is that? Think of protein as your building blocks, while carbs and fat are your energy sources. The primal part of our brain still thinks it has to store all of the energy it possibly can, so it allows you to continue to eat carbs/fat well beyond the "I'm full" sensation. In today's world with food readily available, doing so is completely unecessary, so it takes some conscious thought to not give in to that part of the brain. However, the building block requirements of our bodies has not really changed, so the signaling for protein is far more easy to regulate without conscious thought. The actionable item here is to make each of your meals protein-centered, and then fill in the gaps with veggies and healthy carbs and fats. The protein serves two major benefits-it will regulate your hunger signaling to prevent you from overeating, and it will ensure you're getting the building blocks you need for building and remodeling tissue.
Don't Drink Your Calories
1. This one is pretty simple. Drink water. If you're fueling yourself with food, there is no need for extra calories from drinks. Soda and sugary drinks provide no nutritional value. You can decide how often you want to indulge, but if we are staying objective, there are no drinks on the market that are superior to the nutritional value of food. Healthy smoothies do not count here-they will be discussed below in the "Snacks and Supplements" section.
Whole, Real Foods
1. "If it doesn't walk the land, swim in the sea, or grow on a tree, don't eat it." This summarizes this one. Whole, real foods in their natural form are going to be the most nutritious and bio-available forms of food. Anything that has been messed with or altered or had chemicals added to it is going to take away from its nutritional value and impede our body's ability to properly utilize the nutrients. If you are recovering from an injury and need to provide fuel and building blocks to your body, you're going to want to do so in the most efficient and abundant way possible. Eat the real stuff.
Snacks and Supplements
1. Snacks and supplements are meant to supplement your diet and bridge the gap between meals. They are not meant to replace meals. Fruits, veggies, nuts, and protein are going to be your primary choices here. Fruits, veggies, and nuts are going to provide your carbs and fats if you need a clean boost in energy. If you are eating this stuff in its natural form, you're not going to over eat it, so don't worry about extra calories from these sources. The only exception here is with nuts, which can be high in fat-the best thing to do there is take a handful or two and walk away from the bag-if you eat from the bag, it will be half gone before you know it. Great protein snacks include things like beef jerky (the plain flavors are best-ingredients should be the protein source and some seasoning-nothing else), yogurt (if you can tolerate dairy),and protein (preferably whey) and fruit smoothies. If you need something to help you get to the next meal, keep these things around and it will prevent you from reaching for chips and candy while providing you with consistent and useful fuel throughout the day.

One more important note before we wrap up. Nutritional changes are difficult to make-it can involve some pretty radical lifestyle changes. The best way to make these positive changes sustainable and avoid being overwhelmed is to do one thing at a time. Pick one of these habits listed above and solely focus on making that one change for 2-3 weeks, or however long it takes for it to become a natural part of your life. When you're ready, pick the next change and roll with that until it is solidified. In no time, you'll have all of these habits, and any others that you choose to follow, engrained into your everyday life. If you need help or some specific guidance, do not hesitate to reach out!

Brett Birnbaum 9/1/24 Brett Birnbaum 9/1/24

Quick Workout Template

Getting back to today's newsletter, we will go over a quick and easy template to get in a productive workout when you are short on time.

This template is very simple. Pick 5 exercises, set the clock for 20-30 min, and complete the exercises as a circuit for the allotted time. Minimal rest between exercises, ~60 seconds rest between rounds. You should be able to complete 4-6 rounds; if you can't do 4 rounds, it is probably too difficult. If you do more than 6, it is probably too easy. There are countless ways you can lay this out, but here's how I typically do it.

Exercise #1: Pick a cardio exercise and perform at a moderate pace for 1 min. You can choose a bike, rowing machine, ski erg, jump rope, or push a sled. Anything that gets the heart rate going.

Exercise #2: Abs. I typically like to choose something that gets the spine moving or works on a specific quality I am trying to improve. Here are some examples (click on the exercises for video demonstrations): Hanging Leg Raises, Feet Anchored Sit Ups, Deadbug, Modified Side Plank w/Rotation, Wide Stance Cable Rotations, Cable Chop, Ab Wheel. 10-15 reps per set

Exercise #3: Lower Body Mobility. This can be a strength-based exercise or a true mobility-type exercise. If you go the strength route, keep the weight light and make sure it targets a specific mobility quality that you are trying to improve. Here are some examples (click on the exercises for video demonstrations): Lateral Squat KB Catch, Alternating Reverse Lunge w/KB Catch, Hands Supported Hip Airplane, Retro Walk RDL, Airplane Windmill. 8-10 reps per set

Exercise #4: Upper Body Mobility. Same rules as exercise #3, but it will be harder to make this a strength-based exercise. 5 or 6 sets of any strength-based upper body exercise is a ton of volume and probably will require using a weight that is not going to get you strength adaptations. So, it is better to stick with mobility-based exercises here. Here are some examples (click on the exercises for video demonstrations): Crab Hip Lift, Bear Swing Through, Hands Supported Pushup ISO Rotation, Armbar w/Shoulder Rotation. 8-10 reps per set

Exercise #5: Medicine Ball Work or Other Cardio. I really like medicine ball work here. Using low intensity, high rep throws/slams is a great way to work on mobility and get your heart rate going at the same time. Here are some examples (click on the exercises for video demonstrations): Squared Up Rotational Scoop Toss, Extensive Rotational Scoop Toss, Rotational MB Slams, Step Back Offset MB Slams. If you can't throw/slam a medicine ball, choose another cardio exercise that is different from the first one. Sled work or basic foundational movement exercises are great here. Here are some examples (click on the exercises for video demonstrations): Sled Push, Sled Pull, Skips, Carioca, Lateral Shuffles. 15-20 reps for medicine ball work, 20-30 yards for sled/movement exercises.

This workout template is great because it allows you to get in a ton of quality work in a short amount of time. You can get really specific with including movements that you need to work on to overcome/prevent an injury, or you can keep it general and just get a good sweat in. You can do it in a highly equipped gym or even a hotel room. Next time you are crunched for time but want to get your work in, give this a shot!

Brett Birnbaum 8/1/24 Brett Birnbaum 8/1/24

Habits and Mindset for Successful Physical Therapy

Getting back to today's newsletter, we will focus on some habits and mindset tips that make for successful physical therapy.

When people think of physical therapy, they often think of stretches, exercises, and some manual therapy. Of course, this constitutes most of what PT is. However, if we are taking a comprehensive view of health, whether that includes recovering from an injury or just living an active lifestyle, there are other factors that are important to consider that are necessary for success. In this newsletter, we will focus on what I consider to be the 5 of the most important contributing factors to injury rehab and general health and wellness.

Consistency is Key

Long lasting change occurs when proper inputs are given repeatedly over a period of time. This goes for completing a home exercise program, eating a healthy diet, or maintaining a regular exercise program. The more positive inputs we give the body, the more positive results we get. The more positive results our body experiences, the more this will become the body's "default" state.

For example, lets say we do some squats and it improves hip mobility and helps our back feel better. Great! Now, the next day our back starts to stiffen up again. We do some more squats and things feel better again. This time, we get two days of relief from it. Even better! As we continue to do our squats, we get relief for longer and longer periods of time, and tasks that were once painful become less painful. Eventually, maybe we don't have to do squats every day to keep our hips mobile, but just 1-2x/week. This is a sign that our "default" is changing for the better. This is a simplified example, but the point is that doing the right things repeatedly over a long period of time is how are body makes true, long lasting changes.

No Magic Fixes

This one relates to the point above. There is never a magic exercise or some perfect manual therapy technique that instantly solves your problems forever. Trust me, I wish there was, and if you find it, please let me know-I will make sure you get the credit!

Now, don't get me wrong. Sometimes we do just one exercise, retest the painful motion, and all of a sudden the pain is gone. It seems like magic, but it's not. What that situation is telling is that that particular input is exactly what the body needed, and there are two ways we can use it.

The first way is that we know we have a tool to use if we have a flare up of similar symptoms. Maybe stretching your quad relieves your knee pain. Anytime that knee starts to bother you, do some quad stretching and get back to what you were doing. Even better, keep some quad stretching in your regular routine so that it limits the chances of a future flare up. Again-consistency is key to changing our body's "default."

The second way is that our body needs more of that stimulus. For instance, maybe we did a positional breathing exercise to relieve shoulder pain when you raise your arm overhead. Now, we know that the breathing exercise created space in a particular part of your body that improved your range of motion. So, the next thing we would do is a more active exercise that utilizes that newly found range of motion so that your body learns to use it properly with more functional tasks that are related to your particular goals. Again, consistency is key-giving your body positive inputs on a regular basis over a period of time leads to long lasting results.

Pain Is Information

Now this one might be the most interesting of the five factors discussed here. If you have worked with me before, you probably have heard me say "pain is not good or bad, it's just information." Here's what I mean.

If you do a movement and it hurts, that is our body telling us something. Maybe we don't have the range of motion to perform that movement. Maybe our body is compensating and that places more force on a joint or muscle. Maybe we lack strength and stability. Maybe our technique is wrong. Maybe we did too much, and our body can handle 5 reps but our body gets tired and cannot maintain technique once we do more reps. This is not an exhaustive list of what information we can gather, but you get the point. Now, what do we do with this information?

The key here is to take this information and find a solution. Technique or positioning might need some adjustments. Maybe we need an exercise to improve a range of motion so that the next movement/exercise feels better. Maybe instead of 2 sets of 10 reps, we do 3-4 sets of 5 reps, making sure all 5 reps are performed properly. In some cases, we need to pick a new exercise entirely. The specific solutions will be different for each scenario, and a qualified clinician will be able to help you with that.

Equally as important as knowing what to do is knowing what NOT to do. It's easier said than done, but if we experience pain, it is important to NOT panic, get frustrated, give up, and avoid a specific movement or activity all together. In the moment this can be difficult, but reminding yourself that pain is not good or bad, it's just information, and we can use this information to find a solution, will keep you on the right track.

Every Journey is Different

You have probably heard this one in several aspects of life, but it is equally as important when talking about injury rehab and general health/wellness. Regardless of where you are on your rehab/training continuum, it is important to not compare yourself to others. Not only is every person different, but every injury is different. Sometimes, even the same injury on the other side of the body can be different. I hope you never have to go through 2 ACL surgeries and rehabs, but sometimes these are even different from each other.

Of course, there are overlaps and similarities among rehabs. And yes, there is plenty to learn from others who have undergone a similar experience to yours. While I certainly encourage you to take in all the tips and lessons that you can, just remember that each journey may look a little different-as long as we get to the end goal successfully, that's all that matters.

Sleep, Stress, Nutrition

As stated above, exercises, stretches, and manual therapy constitute the bulk of physical therapy. But there is more to what helps the body heal and stay healthy-this is where sleep, stress, and nutrition come into play. Each of these deserves their own newsletter, so I will keep it brief here regarding the importance of each.

Sleep is the ultimate "recovery tool." Cold plunges, saunas, meditation, foam rollers, and all similar modalities have their place, but none are even in the same universe as sleep. I do not believe in magic pills to solve problems-the only thing that could change my mind would be if the benefits of sleep were put into a pill. We've all heard this before, but it's worth mentioning again-get your 7-9 hours on a consistent basis. This is especially important if you are recovering from an injury-your body needs the time and resources to repair damaged tissue, and sleep is when this happens best.

Our body doesn't know the difference between physical, emotional, mental, or psychological stress. It just knows that stress is stress. And it deals with stress by creating protective tension throughout our system, including our musculoskeletal system. We can get away with this (especially non-physical stress) for a while, but eventually, we're going to start to feel it. A big part of most rehab is regaining ranges of motion that were lost. To regain range of motion, we need to decrease tension in our system. If stress is high and unchecked, and our body is holding that protective tension, it will be that much more difficult to regain the ranges of motion that are essential to a particular rehab process. The countless ways to deal with stress are beyond the scope of this newsletter, but finding something that works is vital.

Whether we are rehabbing from an injury or recovering from a workout, our body needs fuel to recover and rebuild itself. Proper nutrition provides this fuel. There are plenty of nuances to nutrition, but here are the basics. Eat plenty of protein, ideally from animal sources and eggs. Include good fat sources from things like nuts, avocados, and real butter. Eat clean carbs like potatoes and rice. Unlimited fruits and vegetables. Plenty of water and salt for hydration. Stick with these basics and you'll give your body the fuel it needs.

Now, here is a caveat to these lifestyle factors. There are times in life when doing these things is just not in the cards. Maybe there is a work deadline coming up and getting enough sleep is just not going to happen. Maybe there are life events that are just going to be stressful and there is no way around it. Maybe you are traveling a lot and finding healthy food is too difficult. This is perfectly fine and a normal part of life-not everything is going to be ideal all time. But, having awareness of what you should be doing can help you make the best decisions possible in a less than ideal situation, and also helps you get back on track once things settle down. It's okay to stray away at times, just make sure you find your way back.

Wrap Up

To wrap up, I hope you found this information helpful, as these factors are just as important for successful rehab and general health/wellness as are the specific exercises and manual therapy techniques you utilize. Wherever you are on the rehab/training continuum, give some of these a thought and see where you can make some improvements. If you have questions or need some guidance, do not hesitate to reach out!

Brett

Brett Birnbaum 7/1/24 Brett Birnbaum 7/1/24

How to Structure A Workout

Getting back to today's newsletter, we will focus on a simple way to structure a workout.

Before we dive into the details, it is important to note that there are countless ways to structure a workout, but the method we are going to focus on in this newsletter is a simple, effective, efficient, and adaptable way to get in a well-rounded training session.

Let's dive in.

The Warmup:

Every workout should start with a warmup. The newsletter from May, entitled "The Ins and Outs of a Warmup" explained the why, the how, and the what of how to structure a warmup-check it out or let me know if you want me to resend it if you are interested in a more in-depth explanation. For this newsletter, we'll keep it brief. Pick 2-3 exercises that address specific mobility limitations you may have and prepare you for the work you are going to do later in the workout. Most common areas to address are hip mobility, thoracic mobility, and core strength. Perform these exercises as a circuit for 2-3 rounds. After this circuit, your body should feel loose and you should have a light sweat going. Look below under "Sample Workout" for some examples of exercises to choose from.

Power:

Everyone, regardless of age, ability, or goals, should be training power to some extent. The only exception to this is during the early to middle phase of rehab, in which we are still monitoring tissue healing parameters. You do not need to jump or sprint like a world-class athlete, but your training should always include some element of making your body produce and/or accept for quickly. This is the first quality that degrades as we get older, so it is imperative that we train it consistently and build a large foundation.

This part of a workout will vary the most amongst individuals based on abilities, limitations, and goals. It can include things like jumps, hops, medicine ball throws, running drills, and other agility-based exercises. The list under the "Sample Workout" below is far from exhaustive, but the main idea is find things that fit your abilities and goals and force you to move your body quickly. Pick 2-3 exercises and perform 2-3 rounds. Keep the reps low so that you can focus on producing high amounts of force with minimal fatigue.

Strength Circuit 1:

Here is where we get into the meat and potatoes of the workout. This circuit will contain your main lifts of the day-one for the upper body and one for the lower body. Reps will stay on the lower end, between 5-8, so the weight you use for each lift can be heavier. Most frequently, I like to pair exercises that emphasize opposing sides of the body. So, if you choose quad-dominant (front of the body) exercise for the lower body, I would pair that with a back exercise for the upper body. If you choose a glute/hamstring (back of the body) exercise for the lower body, I would pair that with a pressing exercise for the upper body. This helps to limit any "interference" each exercise has on the other and allows you to get the most out of each exercise. Check out the "Sample Workout" below from some examples.

Strength Circuit 2:

This part of the workout is where we get our accessory work in, which helps to supplement the main exercises in the previous circuit and distribute force across the entire body. Here, we are going to pick three exercises; one upper body, one lower body, and one core exercise. The upper and lower body exercise will emphasize the opposite muscles that we worked during the main work. For example, if you choose a squat (quad focused exercise) for your main lower body lift, then you will choose an exercise that works the glutes/hamstrings in this section, and vice versa. If you chose a 1 Point DB Row (back exercise) for the main upper body lift, then you will choose a pressing exercise in this section, and vice versa. The core exercise can be something stationary, like a plank, or more dynamic, like a cable chop. In this section, reps will be higher, more in the 8-12 rep range, and weights will be a bit lighter. Check out the "Sample Workout" below from some examples.

Finisher:

This part of the workout is where we can have some fun. You can get a pump and do some arms/shoulder work, you can do extra abs and mobility work, or you can do some conditioning. Whatever you choose here should leave you feeling like you had a great workout. Check out the "Sample Workout" below from some examples.

Sample Workout:

Here is the sample workout. Click on the names of the exercises for video links. The exercises listed are far from an exhaustive list-they are meant to show you the types of exercises that fit into each category.

Warmup: 2-3 rounds

*pick 2-3 exercises

-Airplane Windmill (8-10 reps per side), Hands Supported Toe Taps (6-8 reps per side), Hands Supported Pushup ISO Rotation (6-8 reps per side), Modified Side Plank (15-20 sec per side), Pushup ISO Knee Drive (6-8 reps per side), Hands Supported Reverse Lunge (6-8 reps per side), Lateral Squat (6-8 reps per side)

Power Circuit: 2-3 rounds

*pick 2-3 exercises

-Box Jump (4-5 reps), Pogo Hops (10-15 yards), Snapdowns (5-6 reps), Skips (20-30 yards), Shuffles (15-20 yards), Carioca (15-20 yards), MB Drop Squat Catch (5-6 reps), MB Slam (6-8 reps), Offset MB Slam (6-8 reps), Rotational MB Slam (6-8 reps), MB Shotput (5-6 reps), MB Rotational Scoop Toss (5-6 reps)

Strength Circuit 1: 2-4 rounds

Quad and Back exercises to pair together (pick one of each)

-Quad: Goblet Squat (5-8 reps), Split Squat (5-8 reps), RFE Split Squat (5-8 reps)

-Back: 1 Point DB Row (5-8 reps), 2 Point DB Row (5-8 reps), Chest Supported Rows (5-8 reps)

Glute/Hamstring and Pressing exercises to pair together (pick one of each)

-Glute/Hamstring: KB Deadlift (5-8 reps), 2 DB RDL (5-8 reps), Reverse Lunge (5-8 reps)

-Pressing: DB Bench Press (5-8 reps), Incline DB Bench Press (5-8 reps), DB Floor Press (5-8 reps)

Strength Circut 2: 2-4 rounds

*if you picked quad and back above, pick 2 exercises from this grouping here:

-Hands Supported SL RDL (8-12 reps), Shoulders Elevated Glute Bridge (8-12 reps), Eccentric Hamstring Curls (8-12 reps), Kickstand RDL (8-12 reps), Lateral Squat (8-12 reps), Alternating DB Bench Press (8-12 reps), SA DB Bench Press (8-12 reps), Pushups (8-12 reps)

*if you picked glute/hamstring and pressing above, pick 2 exercises from this grouping here:

-Step Up (8-12 reps), Walking Lunge (8-12 reps), Lateral Step Down (8-12 reps), Split Stance Single Arm Cable Row (8-12 reps), 1/2 Kneeling Single Arm Pulldown (8-12 reps), TRX Rows (8-12 reps)

*add a core exercise to complete this circuit

-Bear ISO Hold (20-30 sec), Mini Squat Stance Palloff Press (6-8 reps), Split Stance Cable Chop (6-8 reps), Split Stance Lift and Press (8-12 reps)

Finisher:

*Arms/shoulders idea

-2-4 rounds of Bicep Curls (10-12 reps), Tricep Pushdowns (10-12 reps), Lateral Raises (10-12 reps)

*abs/mobility idea

-2-3 rounds of Hollow Hold KB Crunch (12-15 reps), 1/2 Kneeling Adductor Rockback (8-10 reps)

*conditioning idea

-10 rounds of 30 sec work, 30 sec rest stationary bike

Hopefully this information provides some insight into how to develop a well-structured workout that will keep you moving better, feeling better, and performing better!

Brett

Brett Birnbaum 6/1/24 Brett Birnbaum 6/1/24

SI Joint Pain

Getting back to today's newsletter, I have recently received a lot of questions about SI joint pain, so I figured it would be worthwhile to give some detailed info on it. Let's dive in.

What is the SI joint?

The SI (sacroiliac) joint is where your sacrum and pelvis (ilium) meet. Its main function is shock absorption and helping to transmit forces between the upper and lower body. Here is a picture:

There are 5 very strong ligaments that hold these bones together. Interestingly, there are no muscles that attach directly to the SI joint, and there aren't any muscles whose job it is specifically move the SI joint. However, there are 40 muscles that surround it and attach nearby and move all of the other joints in the area. In fact, it is widely agreed upon that the SI joint only moves between 0.8 and 3 degrees, depending on which movement is measured-this amount of movement is barely even noticeable. So, if it barely moves, no muscles attach there, and has very strong ligaments, why is SI pain so common and debilitating?

Why does it hurt?

For the sake of this newsletter, we're going to focus on why SI pain occurs in the absence of an obvious or traumatic injury. The overarching reason for this type of pain is what I call a "force distribution" issue. I wrote a previous newsletter on this, but a general summary is this:

Every time we move, our body absorbs and produces force. In a perfect world, we distribute this force evenly throughout our body and all of our muscles, bones, ligaments, tendons, joints, and other structures do their fair share. However, often times, different areas of our body lose range of motion. When we lose range of motion in one area, our body will compensate to perform the tasks/movements we want to do. When we compensate, this places extra force on certain areas of the body, and over time, this extra force can cause pain.

Since the SI joint does not move all that much, it is not one of the areas that loses range of motion. Instead, since its function is primarily to absorb and transmit force throughout the body, it is commonly one of the areas that takes the extra force if range of motion is missing somewhere else. In other words, the SI joint "picks up the slack", and it picks up too much slack for too long a period of time, it will start to tell you so with pain.

What do to about it?

The first step in dealing with SI joint pain is figuring out what ranges of motion are missing. There are several possibilities here, and it is always best to get a thorough evaluation from a qualified professional, but the most common motion that is missing with SI joint pain is hip internal rotation. If we are missing hip internal rotation, it usually indicates that our glutes and low back are tight and compressed. If you look at the picture of the SI joint above, the glute and low back muscles are the main muscles covering the bones in the picture. So, you can imagine that if these muscles are tight/compressed, it would place extra pressure on the SI joint. Click here for a video that may help visualize this.

Assuming that missing hip internal is the culprit, we need to find ways to gain back that motion and decrease the compression in the glutes/low back. We do this by doing things that stretch/lengthen/create expansion through the glute and low back area. Here's a sequence I frequently use:

Foam Roller Walkover; 1-2 sets of 10 reps per side
1. put roller in the middle of your hip-above the "ball" of your hip but below the top part; keep the bottom foot parallel to the ground as your walkover-do not let the heel roll up towards the ceiling
Hands Supported Offset Posterior Hip Capsule Stretch; 2-3 sets of 5 breaths per side
1. more weight on back foot compared to front foot (we are stretching glute on the leg that is back); soft knees, push hips back until you feel a stretch in the glutes; keep weight on back heel will help; slow inhales through the nose, slow exhales through the mouth
Feet on Wall/Box Hip Bridge; 2-3 sets of 8-10 reps per set
1. drag heels down the wall to lift hips, brief pause, return back to bottom slowly; only go as high as you feel hamstrings but NOT low back; key is to feel hamstrings working, NOT your glutes or low back
Reverse Kickstand RDL; 2-3 sets 8-10 reps per side, per set
1. same concept as Posterior Hip Capsule Stretch above, but now we are moving through a range of motion; should feel glute on same side as back leg working
Lateral Squat; 2-3 sets of 6-8 reps per side, per set
1. wide but comfortable stance, keep toes pointed straight; let hips/knees help out as you sit and keep opposite leg straight; should feel glute/quad on side you are sitting towards and inner thigh stretch on side you are sitting away from

As I said above, there can be several reasons for SI joint pain and different exercises work for different people, but this list is usually a good place to start and covers a lot of bases.

Brett

Brett Birnbaum 5/1/24 Brett Birnbaum 5/1/24

The Ins and Outs of a Warmup

Getting back to today's newsletter, we will focus on the why, the how, and the what of warming up for a rehab/training session.

Why Warmup

Let's start with the why. The main point of warming up is to prepare the body for what you are about to do. Just like you wouldn't (or at least shouldn't) go into a test without studying, you shouldn't jump right into exercise without making sure you are physically prepared. Now, this can look vastly different based on what the rest of the session will look like. Sometimes a warmup can just be manual therapy, sometimes it can be 1-2 exercise circuits, or even a combination of both. Regardless, there should always be some type of prep work done before diving into the main work of the session.

How to Warmup

There are countless stretches, exercises, and manual therapy techniques to use as a warmup, but no matter which you choose, the warmup should do 3 things.

First, it should quite literally warm you up. If you are using exercise as a warmup, your heart rate should be at least slightly elevated and maybe even break a light sweat. If you are using only manual therapy, you will not get the same systemic effect but the area you worked on should at least feel looser and more mobile.

Second, it should improve ranges of motion that are lacking and that are relevant to the rest of the session. For example, if you lack some hip motion and you plan on squatting, your warmup should address the specific motions you lack that could impact your squat.

Finally, it should allow you to practice the movements you will need for the main focus of the session, or at least use the same muscles in similar ranges of motion and positions as you will need later on. For example, if you are going to deadlift later in the session, your warmup should have some type of hinge motion that utilizes the glutes, hamstrings, and quads. If you are going to bench press, your warmup should have pushups, lighter pressing movements, or at least something that uses the arms, shoulders, and chest muscles.

Warmup Examples

As stated above, there are countless ways to structure a warmup and a never-ending list of methodologies, but here is the general outline I most often use. The basic idea is to first open up ranges of motion, and then train the body to use those ranges of motion in a more active way.

Manual therapy or SMR with foam rolling or lacrosse ball
- If necessary, this is where I will utilize manual therapy techniques to improve ranges of motion that we will need for the session; if you are not working with a qualified practitioner, using a foam roller, lacrosse ball, or massage gun is a good substitute. Ideally, I try to skip this portion and go right to positional breathing exercises. Here are some examples: Glutes, Quads, Chest, Upper Back
Stretching
- Stretching serves a similar function to manual therapy, and again is only used if necessary to decrease tension on specific muscles. Ideally, I also try to skip this portion and go right to positional breathing exercises. Here are some common stretches I utilize: Hip, Quad, Inner Thigh, Lat/Obliques
Positional Breathing Exercises
- There is lots of nuance to how these are performed, but they can be really powerful in opening up ranges of motion. I've provided a few basic cues below. Essentially, we are utilizing our position and our breath to create space for body to move better. I usually use just one of these in each session, but here are a few examples to choose from:
  - Quadruped Breathing; gently push upper back away from hands; long, slow, relaxed breaths-inhale through your nose, exhale through your mouth while maintaining position; goal is to feel a gentle stretch in upper back; this will improve shoulder motion
  - Hooklying Pullover Breathing; keep back of hip bones in contact with the ground; inhale as your arms go overhead, exhale as they return to starting position; only raise arms overhead as far as you can maintain position; should feel gentle stretch in upper chest when you raise arms overhead/inhale; this will improve shoulder motion
  - Offset Glute Stretch Breathing; have more weight on leg that is slightly back; push hips back while maintaining "soft" knees; should feel gentle stretch in glute of back leg; long, slow, relaxed breaths-inhale through your nose, exhale through your mouth while maintaining position; this will improve hip motion
  - Mini Wall Squat Breathing; start your foot's length away from the wall; do a mini squat while maintaining contact with your back/top of back hip bones against the wall; long, slow, relaxed breaths-inhale through your nose, exhale through your mouth while maintaining position; this will improve hip and shoulder motion
Dynamic Exercises
- This is really the main part of the warmup. After we have opened up ranges of motion using one or a few of the techniques above, this is where we train our body to use those motions and really get ready for the rest of the session. Here, I typically use 2-3 exercises in a circuit with minimal rest in between. When choosing which exercises to use for each person, I make sure to address a specific need related to the rest of the session. Here are some examples of warmup exercises I frequently use:
- Lower Body: Airplane Windmill; Toe Taps; Inchworm; Reverse Kickstand RDL; Cable Box Squat; Lateral Squat, Reverse Lunges
- Upper Body: Pushup ISO Rotation, Armbar, Shoulder Rotation, Crab Hip Lift, Yoga Pushup
- Core: Bear ISO Hold, Modified Side Plank, Deadbug, Suitcase March

Again, these exercises are by no means an exhaustive list of all the ways to warmup. The best way to make sure you have the proper warmup for you is to work with a skilled clinician or coach, but if you don't, try out some of these examples and see what works best for you!

Hopefully this information provides some insight into an important but often overlooked part of a rehab/training program that can be a real difference maker in helping you get the most out of your time in the gym!

Brett

Brett Birnbaum 4/1/24 Brett Birnbaum 4/1/24

Why Things Hurt Without an Injury

Getting back to today's newsletter, we will focus on why things start to hurt without an obvious injury.

We've all been there before-you go to open a jar and your elbow starts to bother you, or you notice your hip pinches while getting out of car, or you bend to pick something up from the ground and your low back aches. You think nothing of it, but these things continue to nag you and then before you know it 3 weeks go by and these aches and pains are spilling over into your every day life. Without an obvious reason for why these aches and pains occur, this can be a very frustrating experience, but there is a reasonable explanation and solution. Let me explain.

The onset and recurrence of these types of aches/pains are often the result of what I call a "force distribution issue." Whenever our body moves, it produces and absorbs force. In a perfect world, each part of our body does its fair share to evenly distribute this force across all the relevant structures. However, this perfect world is seldom reality, and we often develop range of motion limitations in one or multiple joints throughout our body. These range of motion limitations lead to movement compensations, which places extra stress on certain areas of the body. Over time, this extra stress can lead to aches/pains that seem to pop out of nowhere.

For example, lets say your back hurts when you sit down/stand up from a chair. During an evaluation, we find there is limited hip range of motion. We need a certain amount of hip range of motion to sit down and stand up. Even if we are missing one or more of these motions, our body will find a way to compensate to complete the task. Since the hip cannot do the work it is supposed to, another part of the body, such as the back, will take up the slack. Eventually, the back will be tired of taking up the extra slack from the hip, and it will tell you so by beginning to hurt, and continuing to hurt until it no longer has to do the extra work that is supposed to be done by the hip. Here is a video explanation of this concept: https://youtu.be/JC2sPAtRazQ

So, the solution? Find the relevant missing ranges of motion, restore them, and then teach your body to use them properly during tasks that are meaningful to you. The specifics of this process is going to vary for each individual person based on their needs, goals, and abilities, so while I usually try to provide an example sequence of exercises to address a common issue, it would not be helpful for this particular topic.

However, here are some strategies to address this type of issue and prevent it from happening in the first place:

1) take an extra second and pay attention to how you perform tasks that are causing you problems; adjust your position/movement in different ways and see if there is a method that feels better; these adjustments are equivalent to making technique changes in the gym; "force distribution" and compensations are all about where our body is positioned and how it is being used

2) if you exercise regularly, film yourself during your workouts or ask a qualified trainer/coach/PT to check your technique-you may not always feel yourself doing something wrong, but it will usually be easy to pick up visually

3) find a qualified movement professional who can perform a comprehensive evaluation, find the relevant areas that need improvement, put the information together in an easily understandable way, and help you create a plan that fits your needs and goals

Hopefully this information provides some insight into a frustrating situation and provides some clarity on how to get things moving in the right direction!

Brett

Brett Birnbaum 3/1/24 Brett Birnbaum 3/1/24

Healthy Shoulders

Before we dive into today's topic, I wanted to give a quick social media plug-follow us on Instagram (@total_performance_pt) and Facebook (@Total Peformance Physical Therapy). I am going to be more active in those places and will be making regular posts on ways to further help you move better, feel better, and perform better!

Getting back to today's newsletter, we will focus on the common approach we take at Total Performance keep your shoulders healthy, strong, and mobile.

First, a brief background on the methodology behind our approach. The shoulder is a ball and socket joint, where the ball sits in the socket. The arm bone (humerus) is the ball, and the shoulder blade (scapula) is the socket. Though not directly part of the shoulder, it is important to note that the shoulder blade rests on the ribcage, and the ribcage acts as a "track" for the shoulder blade to move on. Anytime you move your shoulder, the shoulder blade has to "travel" on the ribcage in order for the shoulder joint to move properly and keep the ball in the socket. The part of the ribcage in which the shoulder blade sits has a natural curvature to it, which provides an optimal track for all this motion to occur.

So, our approach to maintaining healthy shoulders is to optimize this shoulder blade/ribcage position, and then train the shoulder to move properly within this positioning. If you'd prefer a visual, here is a video link: https://youtu.be/BrJucdBzC6Q

Here is a sequence of exercises we frequently use to accomplish this. Click on the name of the exercise for video demonstrations.

Quadruped Breathing; 3-4 sets of 5-6 breaths per set
1. set up with hands under shoulders, knees under hips, eyes looking just in front of finger tips; gently push upper back away from your hands without rounding over too much; take slow, silent inhales through your nose, with slow, relaxed exhales through your mouth without losing the upper back position; should feel a gentle stretch in upper back/between shoulder blades with each inhale; the goal here is to use our air and position to stretch the upper/back part of the ribcage to restore the proper relationship of the ribcage and shoulder blade
Circuit; 2-3 rounds
1. Hands Supported Downward Dog; 8-10 reps
  1. use a support surface as high or as low as needed-if able, you can do this from the floor as well; start with upper back gently pushed away from hands without rounding over, keep hips relaxed/in straight line with the body; from here, push hips up into air and let heels fall naturally towards the ground; only go as far as you comfortably can without pain; pause briefly, then return to starting position; reset upper back position if needed before each rep; goal is to utilize the ribcage/shoulder blade position from the previous exercise and train the shoulders in an unweighted overhead motion (they shoulders unweight as your hips go up in the air); an extra bonus is the nice hamstring/calf stretch you will feel
2. Hooklying DB Shoulder Rotation; 8-10 reps per direction, per arm
  1. gently reach towards ceiling and rotate the shoulder as far as you comfortably can in each direction without pain; make sure you are rotating from the shoulder and not just the wrist/elbow; goal is to train the rotational motions of the shoulder while taking advantage of positioning we gained from the first exercise
Circuit; 2-3 rounds
1. 1/2 Kneeling Single Arm Cable Row; 10-12 reps
  1. as you perform the rows, let the arms do the work (do not actively twist the trunk); when each arm is long, be sure to let it reach long-should feel a gentle stretch in the upper back when you do this; the goal here is to train the shoulder blade to move around the ribcage in a more active manner; if this is easy and you need more overhead mobility, progress to a High to Low Row (https://youtube.com/shorts/0UweFD-j7L4?feature=share)
2. Bear ISO Hold; 15-30 seconds
  1. set up with hands under shoulders, knees under hips, eyes looking just in front of finger tips; gently push upper back away from your hands without rounding over too much; lift knees 2-3 inches off the ground and hold this position for 15-30 seconds (break into multiple sets if needed); should feel abs/shoulders working-if you feel your legs working, gently shift weight forward just a bit while maintaining upper back position; goal is to build strength/stability with proper ribcage/shoulder blade positioning
Single Arm Bottoms Up KB Waiter's Carry; 2-3 sets of 20-30 yards per arm
1. if you do not have a kettlebell, use a dumbbell as shown in this video; arm should be at about 45 degree angle from the body (can adjust for comfort) with elbow at 90 degree angle in relation to the shoulder; gently reach the arm forward and feel a gentle stretch in the upper/mid back; maintain this position as you walk the given distance; goal here is to challenge the strength/stability of the shoulder to maintain proper positioning under load

You can use this sequence as a shoulder-mobility focused workout, or you can take pieces of it and incorporate it into your regular training routine.

As always, there are several progressions and variations for each of these exercises based on each person's individual capabilities, limitations, and needs, but this general outline is a good place to start. Give this a shot and if you have any questions, need some different variations, or are ready to progress beyond this starting point, feel free to reach out!

Brett

Brett Birnbaum 2/1/24 Brett Birnbaum 2/1/24

Plantar Fasciitis Solutions

Brett Birnbaum 1/2/24 Brett Birnbaum 1/2/24

Fixing those achy knees

Fixing Those Achy Knees

Are you someone who has "bad knees?" Maybe you have to wear a brace when playing tennis on the weekends or even to just go for a walk. Or maybe they ache, click and crack whenever you go up and down the stairs. Or maybe you've had someone tell you to avoid squatting because it "puts too much pressure" on your knees. If so, this newsletter is for you.

Knee problems can develop for several reasons, but this newsletter is going to focus on the most common cause for pain that develops over time for no obvious reason. With that being said, it is important to rule out any significant structural damage, such as a torn ligament. A qualified professional can do this.

When knee problems develop over time without an obvious cause, it is often the result of a lack of mobility at the hips and/or at the tibia (shin bone). More specifically, if these two areas lack what is called "internal rotation," the knee is often affected. To summarize briefly, internal rotation is needed at the hip every time you bend down or squat. If the hip lacks this motion, the knee will pick up the extra range of motion in order to help your body compensate. Regarding the tibia, every time the knee bends, the shin bone twists inwards slightly-you can barely see this and we cannot actively control this motion, but it is needed for proper movement to occur. If either or both of these motions are limited, this will place extra stress on the knee joint, and over time, can contribute to achy and painful knees.

In turn, the best way to begin to help achy knees is to improve these ranges of motion and build strength with proper movement mechanics. In turn, this will decrease any compensations your body has to do and therefore, take pressure off the knees. This exercise sequence is a great place to begin this process.

Hinge Squat Breathing; 4-5 sets of 5 breaths per set (video link: https://youtube.com/shorts/AT6ZQTp7PDs)
1. Cues to remember: goal is to stretch out the glute muscles, which will improve hip internal rotation; hinge back with knees slightly bent until you feel a gentle stretch in your glutes; then, reach your arms out in front of you and squat down just a little to increase the stretch in the glutes; take slow inhales through your nose and slow exhales through your mouth; maintain full foot pressure, with slight emphasis on inner part of foot (base of big toe and inner heel); after 5 breaths, stand up, rest briefly, and repeat for 4-5 sets
Foot on Box Knee Flexion; 3-4 sets of 10-12 reps per set (video link: https://youtube.com/shorts/B27mXMPO5C0)
1. Cues to remember: goal is to restore tibia (shin bone) internal rotation; knee should travel straight over the front foot-knee cap should travel between big toe and 2nd toe; as you rock forward, use your hands to twist your shin inward while keeping kneecap in alignment-also be sure to maintain full foot pressure, with slight emphasis on inner part of foot (base of big toe and inner heel); as you rock backward, let shin twist back outwards to "neutral"
2 Band TKE; 3-4 sets of 12-15 reps per set (video link: https://youtu.be/I6Hy2poZcjg)
1. Cues to remember: goal is to work the knee through it's range of motion and utilize the tibia internal rotation that you gained from the previous exercise; put top band just above knee and lower band just below knee; rock as far forward as you can while keeping heel down-kneecap should travel between big toe and 2nd toe; as you rock forward, maintain full foot pressure, with slight emphasis on inner part of foot (base of big toe and inner heel); to straight your knee, push into the ground through these foot contacts; should feel your quad muscle working
Hands Supported Split Squat; 2-3 sets of 8-10 reps per set (video link: https://youtube.com/shorts/ORMApgUHDDE?si=6FGlU3IW8edpIKQl)
1. Cues to remember: goal is to train your body to utilize the hip and tibia range of motion that you gained from previous exercises and start to build strength so that those ranges of motion can become more permanent; at the bottom, hips and knees should be at about 90 degree angles with a little more weight on the front leg compared to the back leg; on the front foot, maintain full foot pressure, with slight emphasis on inner part of foot (base of big toe and inner heel); to stand up, push into the ground through these foot contacts; as you move up/down, think about moving as vertical as possible (think "move like an elevator, not an escalator); should feel your front leg working

There are several progressions and variations for each of these exercises based on each person's individual capabilities, limitations, and needs, but this general outline is a good place to start. Give this a shot and if you have any questions, need some different variations, or are ready to progress beyond this starting point, feel free to reach out!

Brett

Brett Birnbaum 12/1/23 Brett Birnbaum 12/1/23

Quick Fix for a Stiff Neck

Brett Birnbaum 11/1/23 Brett Birnbaum 11/1/23

All About Posture

Welcome back to the Total Performance Newsletter! If you are a new subscriber and did not receive previous editions, let me know and I will send them over right away! This month, we will be continuing with our "Daily Habits" series, and will be taking a look at posture. First, I will start with some basics about posture. Then, I will get into some common posture "issues" that I come across, and finally I will go through a sequence of exercises that can be used to "improve" your posture. Yes, "issues" and "improve" are in quotes for a reason, which will be explained below.

Posture Basics

To start, lets define posture as the natural resting position that someone assumes. This can be in sitting, standing, or laying down-the key is that it is not a position someone actively tries to hold (like "sitting up straight"), but rather the position that the body just goes to.

As I have mentioned in previous newsletters, there is no such thing as "perfect posture." In fact, I would venture to say there is not even good or bad posture. Instead, posture just gives us information. Our bodies are naturally lazy, and it will always default to the path of least resistance in order to preserve energy. So, when we observe someone in their natural, resting posture, this provides us information as to what movement strategies someone has available to them, and which ones are most efficient to that person at that particular point in time. This also gives us information as to what movement strategies may not be available, and as a result, which specific motions may be limited. In terms of pain or injury, these potential limitations may be contributing factors. More specifics on this below.

With efficiency and minimizing energy expenditure in mind, it is important to note that when we are trying to change posture, these changes should not be something that needs to be actively held or forced, but rather just the resting state that your body defaults to. More on the specifics of how we do this are below under "Improving Posture."

Common Posture "Issues"

Let's start this section by addressing why "issues" is in quotes. As made obvious above, there is no real issue with a specific posture and there is no posture that is better or worse than another. Instead, the value in looking at someone's posture is that it gives information into how that person may move, which can then potentially correlate with pain or injury they may be experiencing. So, we can use resting posture as just one indicator of how our treatment is changing the movement options someone has available to them. Typically, more movement options = better movement mechanics = less pain. Now, let's dive into 2 of the most common "issues" that I come across.

The most common posture "issue" that I typically see is being stuck in one position for a prolonged period of time. While no specific posture is inherently bad, being stuck in any one posture or position for a prolonged period time is where problems occur. This goes for slouching, standing up tall, or any other postural positions we tend to utilize. If we are stuck in one position or just use one movement strategy over and over again, we place repetitive stress on specific areas. Over time, this repetitive stress can lead to motion limitations and therefore, contribute to various aches, pain, and injury. Put simply, "the best posture is the next posture" or "static is the enemy." Here is a video link to provide a visual of this: https://youtu.be/Gl2J_kEIYZ8

Another common posture "issue" that people worry about is slouching, and then over-correcting for it by "standing up tall." It is fair to say that if you are slouched all day long, you are creating compression and tension throughout various parts of your chest, shoulders, trunk, neck, and upper back. However, if you over-correct by standing up tall and following the common advice of "pulling your shoulders back", now you are just creating compression and tension in different parts of the upper back, shoulders, trunk, low back, and neck. It is a "robbing Peter to pay Paul" situation. While the intention of not slouching may have value, the common over-correction just moves the problem somewhere else. Here is a video link to provide a visual of this: https://youtu.be/iWcKVv4rZZM

"Improving" Posture

Let's start this section off with why "improving" is in quotes. When we talk about improving posture, we are not trying to improve a posture by itself. Instead, we are looking to see if our treatment approach is changing posture in a way that would indicate we have increased or improved the range of motion/movement strategies that our body has available. Now, let's dive into some specific ways to make these changes.

The first step of "improving" posture is simply having an awareness of your body and being sure to shift positions on a regular basis. This is especially helpful for people who find themselves stuck in one position for prolonged periods of time. For these people, I suggest doing what I call check-ins. It is very simple-just take a pause in whatever you are doing and figuring out where your body is in space. Have you been slouching for a while? Or trying to sit up tall? Have you been standing on your right leg for too long? Have you been leaning more on your left side versus your right while driving? Whatever you find, the goal is just to move into a new position. This can include anything from getting up and going for a walk or just shifting your weight to the other side. At first, these check-ins usually have to be frequent and require some cognitive effort, but they become more natural and require less attention the more you do them.

A more specific version of this check-in strategy is something I call the "chin tuck/breathing check-in." This is specifically for people who find themselves in the typical slouch/forward head posture. To do this, you want to start by putting your finger on your chin-you will probably notice it juts forward. From here, you want to perform a chin tuck-gently push your chin backwards towards your neck and move the top of your head upwards. Move back and forth between the extreme ranges of motion (chin jutted forward, chin tucked) a few times, and then rest somewhere in the middle between those two positions. The point of this is to bring awareness to where you head/neck is in space, and then find a neutral, relaxed position-it is important to remember we are not stretching or strengthening any muscles-we are just bringing awareness to a position. Once you find a neutral neck position, we are going to move on to the breathing portion. Put one hand on your chest and one on your lower back. Take long, slow, deep, relaxed, inhales through your nose, with long, slow, relaxed exhales through your mouth. As you breath in, you should feel a gentle expansion in your chest and your low back-if you get these spots, you know that breathing in a nice, 360 degree manner. As you exhale, you should feel these areas "deflate" and relax. After a few breaths, let your arms hang and feel where you body is-everything should feel relaxed and neutral and you should feel like you are less slouched without putting in any effort. You can do this a few times throughout the day as you build awareness. Here is a video link to demonstrate: https://youtu.be/bqXG64FskTI

Finally, here is an exercise sequence that can improve your natural resting posture. Each person can utilize different combinations of these exercises depending on what specific limitations they may have, but going through this sequence will cover all your bases. Basic idea behind this sequence is to open up all areas of the ribcage/trunk, and then utilize this increased range of motion to help make it stick. Sets, reps, and cues to remember are listed below, and the names of the exercises are links to demonstration videos:

Sidelying Rib Smash Breathing; 2-3 sets of 6-8 breaths per side, per set
1. use a yoga block or foam roller; inhale through your nose, exhale through your mouth with slow, controlled, relaxed breathing; slowly melt into the yoga block/foam roller with each breath; purpose here is to expand the ribcage front to back, which allows for better motion
Quadruped Breathing; 2-3 sets of 6-8 breaths per set
1. hips gently tucked, upper back gently pushed away from hands, eyes just in front of hands; inhale through your nose, exhale through your mouth with slow, controlled, relaxed breathing; as you inhale, should feel gentle stretch in upper back-do not lose position as you exhale; purpose is to open up back of ribcage/trunk, decreasing the tension caused by slouching or pulling shoulder blades back
Hooklying Pullover w/Breathing; 2-3 sets of 8-10 reps per set
1. as you reach overhead, inhale through your nose; exhale through your mouth as you return to starting position; only reach as far as you can without ribs flaring or lower back arching; should feel gentle stretch in chest as you reach overhead/inhale; purpose is to open up front of ribcage and decrease compression caused by prolonged slouching
Seated Alternating Rows; 2-3 sets of 8-10 reps per side, per set
1. start with long arms, feeling a gentle stretch in the upper/mid back; perform rows in alternating fashion while eyes/chest stay pointed forward; when each arm is long, allow it to reach long and feel gentle stretch in upper/mid back; purpose is to use the range of motion gained from previous exercises to help it stick better
Alternating DB Floor Press; 2-3 sets of 8-10 reps per side, per set
1. inhale through your nose as you lower each arm, exhale through your mouth as you press up; should feel gentle stretch in chest as you lower each arm; purpose is to use the range of motion gained (especially in chest) from previous exercises to help it stick better

Usually we can see pretty quick changes with this sequence of exercises, and as long as we continue to follow a well rounded, individualized training program then we should see them stick long-term!

Hopefully this provided a comprehensive overview to the ins and outs of posture and maybe cleared up some common misconceptions!

Stay tuned for next month’s newsletter, where will we move on from the "Daily Habits" series and start to talk about more specific rehab/training topics. Also, if you have any topics that you want to see covered in a future newsletter, please let me know!

Brett

Brett Birnbaum 10/1/23 Brett Birnbaum 10/1/23

How to Improve Your Walking

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

Don’t worry about sounding professional. Sound like you. There are over 1.5 billion websites out there, but your story is what’s going to separate this one from the rest. If you read the words back and don’t hear your own voice in your head, that’s a good sign you still have more work to do.

Be clear, be confident and don’t overthink it. The beauty of your story is that it’s going to continue to evolve and your site can evolve with it. Your goal should be to make it feel right for right now. Later will take care of itself. It always does.

Brett Birnbaum 9/1/23 Brett Birnbaum 9/1/23

A Deep Dive on Sitting

Welcome back to the Total Performance Newsletter! If you are a new subscriber and did not receive last month's edition, let me know and I will send it over right away! This month, we will be continuing with our "Daily Habits" series, and will be taking a look at sitting. Yes, you read that correctly-we are going to take a deep dive into all things sitting; what "proper" sitting posture should look like, how to make prolonged sitting more comfortable, and even how to "staying moving" while sitting.

Before we get into details, lets talk about sitting in general. Sitting often gets a bad reputation, with some even going as far as saying "sitting is the new smoking." Of course, sitting around all day is not ideal for optimal health, but it is a normal part of human life and we should have strategies available to us to ensure it does not hinder our health, fitness, or performance goals.

Sitting Posture

With that being said, lets take a look at what "proper" sitting posture looks like. Proper is in quotes because in reality, there is no such thing as good or bad posture. Sitting up tall is not inherently good or bad. Slouching is not inherently good or bad. Problems begin to arise when we are stuck in any one position for a prolonged period of time. When are static for extended periods of time, muscles tighten up, joints stiffen, and our body gets used to this position. So when we go to move, our body says "not so fast," and this is when we often experience those aches and pains.

The solution? Change up your sitting position on a regular basis. If you've been slouching for a while, sit up straight for a bit. If you've been trying to sit up straight for a while, let yourself slouch. Check in with where your weight is distributed. If you feel that you are more on your right side, shift to your left, and vice versa. Put your feet out in front of you for a bit. Tuck them under the chair after a while. These are just some suggestions, but the idea here is that you should regularly change up how you are sitting. That does not mean you need to constantly fidget around, but rather just check in once in a while and make some subtle shifts and adjustments. To summarize, there is a saying that puts it simply-"the best posture is the next posture."

Making Sitting More Comfortable

Next, lets take a look at ways to make sitting more comfortable. Besides for being static and the resulting stiffening of muscles/joints, one of the reasons sitting can cause problems is because of the constant pressure it puts on the part of our hips/glutes/legs that we are sitting on. So, in addition to changing postures, another strategy we can use is to change where that pressure is distributed. These are some very simple strategies that can be used almost anywhere.

1) Sit on a thin book, magazine, folded up towel, or some similar object. You can sit on it with both hips, or put it under one hip at a time. Play around with all options and see what works best. You usually do not need much elevation at all to make a difference in pressure distribution, especially when putting it under one hip at a time.

2) Elevate your feet on a book, pillow, folded towel, or small stool. Try elevating both feet at the same time or alternate between elevating each foot separately. Similar to above, it does not take much elevation to change the part of our pelvis where pressure is distributed.

3) Alter your foot pressure. This one may seem minuscule, but it can be a game changer. Often times, we find ourselves on the outside of our feet, especially when sitting. This position puts some slight tension on the outside of our legs all the way up into the hips and low back. If held over a longer period of time, this tension can really start to irritate the hips and low back. If you notice you're in this position, spend some time with your feet deliberately flat on the ground, with a slight emphasis on the inner part of your feet. This can relieve that outer hip/low back tension and make both sitting and standing up afterwards much more comfortable.

Next time your stuck at your desk or on a long drive, give these a shot and see how they feel.

Moving While Sitting

Finally, lets talk about moving while sitting. The best option here is to actually get up and go for walks periodically. But, sometimes this isn't feasible, so we will go over some ways to get some movement in while you are sitting. Here are some exercises you can do while seated in pretty much any chair or car.

1) Seated Adductor Squeezes; put something between your legs-a foam roller, folded up pillow, or a small ball will work well, but you can even put your fist between your knees if nothing else is available. Make sure feet are flat and pointing forward. From here, simply squeeze the object between your knees, hold for 2-3 seconds, relax, and repeat for 10-12 reps at a time. As you squeeze, you should feel your inner thighs working a bit. This inner thigh (adductor muscles) contraction will take some pressure off the low back and glutes. Here is a demonstration video: https://youtube.com/shorts/0Fvkp--Ditc

2) Seated Hip Shifts; you can put something between your knees, same as above, or just do it without as shown in the video below. Make sure feet are flat and pointing forward. From here, shift one knee back and one knee forward, pause briefly, then repeat on the other side and continue to alternate for 8-10 reps per side. Though you are focusing on shifting your knees forward/back, the movement is really happening from the hips-with the leg that is pulled back, you may feel some gentle stretching/work in the glutes and/or inner thigh-if you don't, that is okay, as long as the movement is happening through the hips. Getting reciprocal movement through the hips will help keep the hips and low back loose. Here is a demonstration video: https://youtube.com/shorts/6sCpTa7WCP0?feature=share

3) Desk Breathing; you will need a desk for this one, but it will be great for keep the upper back/neck loose while sitting for prolonged periods. Get set up sitting close to the desk, feet flat, elbows on the desk. Sit straight with chest/eyes pointing forward without arching through the back. Elbows should be bent with palms facing you. From here, gently push the upper back away from your hands without slouching-you will feel a gentle stretch in your upper back between your shoulder blades; then, take long, slow, relaxed, deep inhales through your nose, and long, slow, relaxed, full exhales through your mouth without losing position. As you inhale, you should feel a gentle stretch through your upper back; repeat for 6-8 breaths at a time. Here is a demonstration video: https://youtube.com/shorts/TeNr7umOk0U

Try these exercises out and see how they feel.

To wrap this up, sitting for prolonged periods of time is not ideal, but it is part of our lives, so it is best to have some options to minimize potential issues and keep us feeling good. Next time your stuck at your desk, on a long flight, or sitting in traffic, try some of these strategies and see which ones work best for you!

Stay tuned for next month’s newsletter, where will we continue to break down some common daily activities and provide some strategies to make them more tolerable if you are dealing with pain or injury. Also, if you have any topics that you want to see covered in a future newsletter, please let me know!

Brett

Brett Birnbaum 8/1/23 Brett Birnbaum 8/1/23

Daily Mobility Routine

Welcome to first official edition of the Total Performance Newsletter! For the first few editions, we will be doing a “Daily Habits” series. We will look at quick and easy routines that will keep you feeling good and moving well, as well as breaking down common daily activities and providing strategies to perform these activities if you are dealing with pain or injury.

For the for first installment of the “Daily Habits” series, we’ll take a look at a quick and effective daily mobility routine that can be performed with no equipment and minimal space. The goal here is to loosen up the hips, shoulders, and trunk. It is most effective to use this first thing in the morning to get you moving, during a break at work after sitting for prolonged periods of time, after a long day of traveling, or even if you need a quick warmup before a workout. Check it out below!

Perform these exercises as a circuit for 2-4 rounds. The names of the exercises are hyperlinks to video demonstrations.

1. Pushup ISO Toe Tap; 6-8 reps per side

a. Cues to remember: in the starting position, make sure hips are gently tucked and upper back is pushed away from your hands-be sure to return to this position after each rep and reset as needed; if you need to make it easier, put your hands on an elevated surface

2. Airplane Windmill; 8-10 reps per side

a. Cues to remember: hips/knees should be at 90 degree angles, but feel free to move the front leg outwards if needed; as you rotate, keep you eyes on the hand that you are rotating towards; allow the front knee to travel backwards, but do not let it roll outwards once you have found your starting position

3. Modified Side Plank w/Rotation; 6-8 reps per side

a. Cues to remember: make sure the supporting elbow is lined up right under the shoulder, with the crease of the elbow just in front of the shoulder; as you rotate, be sure to follow the rotating arm with your eyes

4. Lateral Squat w/Reach to Instep; 6-8 reps per side

a. Cues to remember: as you sit to once side, pretend you are sitting in a chair that is diagonally behind you; as you sit-let the hips and knees help you get there; keep the opposite leg straight; reach the opposite arm towards the foot you are sitting towards and let the torso move down naturally

The key with these exercises is to stay within ranges of motion you can control and that feel good-you will notice you can increase range of motion over time. Each of these exercises can be modified if you are dealing with pain or injury-if you need some help with this, feel free to reach out and I’d be more than happy to help.

Give this routine a shot and let me know what you think! And if you have family or friends that may benefit, share it with them as well!

Stay tuned for next month’s newsletter, where will we begin to break down some common daily activities and provide some strategies to make them more tolerable if you are dealing with pain or injury. Also, if you have any topics that you want to see covered in a future newsletter, please let me know!

Brett

Brett Birnbaum 7/12/23 Brett Birnbaum 7/12/23

Total Performance Physical Therapy Newsletter

Welcome to the Total Performance Newsletter! If you are receiving this email, it is because you are currently working with Total Performance Physical Therapy, or have worked with me in the past. This is the introduction of my new monthly newsletter, which will officially begin August 1st. The newsletter will vary each month, but will contain useful tips to improve your health, fitness, and performance, and provide insight into how I help my patients and clients each day. If you wish to unsubscribe, feel free to do so anytime by clicking on the "Unsubscribe" link at the bottom of the email. However, I do encourage you to stick around for at least a few emails and see if the information I provide is valuable to you!

For this introductory edition, I want to officially announce the opening of my new facility! I have moved to my own stand-alone space, located at 2474 Orchard Lake Road, Sylvan Lake, MI 48320. This move was in the works for a long time, and I could not be more excited for this next chapter for Total Performance Physical Therapy. I also want to give an enormous and heartfelt thank you to all of my patients and clients, who have supported me since I first opened my practice and have entrusted me with their care. I look forward to continuing our work in pursuit of your health, fitness, and performance goals in our brand new space. Check out some pictures below!

Be on the lookout for the first edition of the newsletter in a few weeks, and if you think any of your family and friends may benefit, feel free to share it with them with this link!

https://total-performance-physical-therapy.ck.page/e98ccf1b07

All the Best,

Brett