Part 4: Wrapping Up & More Power Examples

Welcome back for our last post in our Power Training Series. In part 3, we left off with using the chop and lift to initiate training the core and rotational stability in our patients.

After our patients demonstrate “ownership” of the chop and lift, it’s time to transition them out of half kneeling positions and into upright and functional postures.  We often find deadlifts to be a great pattern for this.

Power Exercise 2: The Deadlift

Reinforcement of hip hinge, cervical retraction, reflexive lumbar stability, scapular stability, and shoulder packing all come into play when educating a good deadlift.  The deadlift can also be used as an alternative for patients who cannot squat as a way to generate power through the hips.

Here’s how to perform the deadlift:

1. Have the patient stand w/ feet shoulder-width apart
2. Build position from “bottom up”.  Have patient grasp weight with both hands while maintaining proper alignment.  If patient cannot assume good position with weight on floor simply raise surface with boxes/steps/etc.  A common cue for patients to maintain posterior weight shift is to pull their toes up and keep them off the floor throughout movement
3. Cue for 20-30 degrees of knee flexion and inform patient they should feel tension through their hamstrings.  
4. When proper form is established instruct patient to breathe out while squeezing gluts and push hips forward to lift weight.  Reverse pattern to lower weight to floor/step.  Cue for “quiet landing” to ensure that patient has control over weight.   

We learned the true fundamentals of the kettlebell deadlift at Mark Cheng’s Functional Rehab Medicine seminar, an event we were proud to host at Perfect Stride’s NYC office this summer. One of my favorite takeaways from the course was a tactile cue to keep a neutral spine in a hip hinge: Grab your skin at the belt line on your back and hip hinge down. If you lose that skin, you’ve rounded your back.  This can be visualized in the picture below:

If your patient is having trouble with the technique, look for impaired ankle mobility or tight quads. Mark had us perform an ankle mobility complex and foam roll the vastus lateralis, both of which helped improve our kettlebell deadlift pattern.  We will visit these topics in future blogs so stay tuned!

But What About Back Pain?

We use the deadlift for everyone who needs to learn how to control static loads.  Yes, even for people who have back pain.  The back is not “fragile;” rather, it is one of the strongest areas of our bodies.  This can be a tough sell to patients who thinks deadlifts and power training is “bad” for them.  Some interesting information is how much disk pressure is placed through the spine with a simple maneuver of trying to place a bed pan under you…try 5-6 times bodyweight!  Yet somehow certain exercises have been given a bad rep.  Connecting the mind-body or mind-back gap is crucial for patients before progressing beyond this exercise.

When our patient has demonstrated proper skill and technique in deadlifting, we need something to bring it all together. A great option for this is the kettlebell swing.

Power Exercise 3: The Power Hinge & Kettlebell Swing

The kettlebell swing provides great recruitment of the gluteal muscles and the multifidus. We also find it gives patients a chance to have a little more fun with their therapy and even improve their confidence.  By varying two and one handed swings we can add an element of rotational stability to the exercise.  Again we do not need to re-invent the wheel when it comes to exercise progression, simple changes in body positions or performing an exercise unilaterally may be all the progression we need.  However REGRESSIONS might also be the best exercises for most patients.  But how can we still incorporate power?  The answer may be in the “Power Hinge”.  Below we show two videos of a Kettlebell Regression (Power Hinge) and proper performance of the Kettlebell Swing.  

Here’s how to perform the kettlebell swing:

1. Patient begins with feet shoulder-width apart and performs hip hinge 
2. Kettlebell should be ~arm length away from feet so patient can assume “football hike” position. 
3. With a firm grasp on the kettlebell, swing it back towards the legs/thigh
4. As weight passes between legs, keep neutral spine – including cervical/neck position.  Squeeze your gluts/snap hips forward as you breathe out and let the weight carry arms and body upright (arms should not go higher than shoulders and should not provide “lift”.  Patient should note feeling of weightlessness at top of swing)

Be sure to look out for rounded backs, holding of breathe, swings to low to the ground, “powering” through motion with shoulder shrugging and hyperextension/anterior pelvic tilting of the lumbar spine at the end of the swing phase.  

Wrapping Up

We are of the opinion that PTs need something better to give their patients than the phrase “Let pain be your guide” at the end of their rehab program.  Often times if you have pain with doing an activity it is probably already too late.  

Focus less on quantity and more on quality,  each rep should be perfect.  It is more important to have a patient perform 10 sets of 1 perfect rep than 3 sets of 10 “pretty good” reps that contribute to their faulty movement pattern.  Be confident, empower your patients, and reduce injury risk by taking patients through the entire continuum of care – that includes power training!  Let us know how you liked the series on our Facebook page, and what other topics you’d like to see us address. 

Until then, Happy Rehabbing!

References

1. Cheng, Mark. “Functional Rehab Medicine.” Functional Rehab Medicine. Perfect Stride Physical Therapy, New York. 3 Aug. 2014. Lecture.
2. Roth, Patrick. “Kettlebells Have Your Back: A Neurosurgeon’s Personal and Professional Perspective.” Kettlebells Have Your Back: A Neurosurgeon’s Personal and Professional Perspective. Dragon Door, 1 Mar. 2014. Web. Accessed 28 Oct. 2014.