Clinical Strength

February 15, 2018

 

 

This is the first post on the new site. I am going to discuss the hinge and the act of picking something up from the floor and how it relates to the people you work with. You will pick things up the rest of your life. This is almost a certainty. The scale will vary and as you age you will be more likely to ask someone else to help you lift something, but you should have a strategy to grab anything off the ground. I want you to look through the five pictures below and notice something. They are all with different implements and each will require a slightly different strategy. The first two lifts are the ones I will typically start with when I am working with a patient and applying concepts of strength and conditioning to their recovery. I could spend all day giving them ten different exercises to work on ten different "core muscles," or I can spend a few minutes with them discussing a well executed hinge and deadlift. I can reduce the fear associated with certain movements and loads and help the person begin the process of recovery. There is nothing quite like showing a person in acute or chronic pain that they can easily pick 20-50 pounds up from the floor with no pain. In reality, the average person you work with in the world of medicine is not going to need to pick up much more than 100 pounds from the floor by themselves; ever. Getting a person to understand they can do this and it won't make their back explode is an enormous win.

I always start with the kettlebell and the medicine ball because it allows me to mimic things they may encounter in the real world. The barbell will be discussed at the end and it is actually the last thing I am interested in when working with a patient. These two, and the next picture, the sandbag, are implements that demand you be put in the actual position your body was designed to be put into to pick up something. The vast majority of the lifting you encounter in the real world will not be attached neatly to a barbell. What you typically pick up outside of the gym will be between your legs. This way you can grab it with your hands between your legs, get it as close to your center of mass as possible, hinge and pull it up. Your system is best suited for this kind of lifting. You are not going to be picking up anything that is 1000 pounds in this manner, but that is why they invented friends.

The next two lifts will be done with the weight to the outside of your body but one of them is a much more likely scenario in the real world. If you are going to pick something up, and the weight is going to be distributed to the outside of your body, you are likely going to stand next to it or stand between the two things (if there are two things). Enter the suitcase deadlift or farmers deadlift. 

 You can just do deadlifts in this manner but the idea is to be able to pick one or two things up in this manner and then carry them for a distance. You could actually do all of your deadlifts in this manner (or with a trap bar) forever as long as you are not interested in entering a competition that demands you deadlift with a barbell (to tell you the truth, the majority of patients you work with are not going to be competing in a barbell sport). The med ball and sandbag deadlifts are also great to turn into a carry for distance but for different reasons. 

 

You are designed to pick things up and carry them for some kind of distance. You rarely, if ever, pick something up to just pick something up. If you leave this critical piece out of your training or the training of other people, you will develop certain issues revolving around only lifting in a sagittal plane. This typically presents as back pain and many times elbow pain as people are only training in one plane and with one grip. When you can load people in single leg stance and tax their grip and their trunk stiffness, you can replace a lot of different exercises. 

 

 

This brings me to the last thing on my mind when I am working with a patient, the barbell deadlift. Don't get wrong, I love to deadlift with a barbell. I love helping people learn to deadlift with a barbell. I travel the country teaching people about pulling big weights with a barbell and correcting the nuances of technique. If you want to learn the finer points of deadlifting with a barbell, I can help you with that. With that said, most people don't need to know how to deadlift with a barbell or care to learn how to deadlift with a barbell. Many of them have preconceived notions about the deadlift and a barbell and it becomes a barrier as they have a certain fear associated with the movement. This can be because they have been injured doing the movement or they have heard from other people (likely a physician they hold in high regard) that deadlifts are bad for their back. 

 

A person may never need to use a barbell. I have all sorts of patients that use hex bars (sometimes called trap bars) or all the above implements and never even ask about using a regular barbell. The barbell doesn’t really mimic any situation they will encounter in real life and unless they plan on competing in a competition that requires the use of a barbell, it is really unnecessary to teach the average patient to use one. If they find an interest in learning, then by all means. 

 

This comes down to your ability to communicate with the patient why you are doing certain things and how it will align with their goals. Many of you are well aware that a lot of patients see the rehab professional as someone who will fix them with the fancy new passive modality they saw their favorite athlete receiving (taping, scraping, needling, cupping, etc…). The average person has been conditioned to believe they do not need to do much or change anything about their life and you will fix them. They don’t understand their are some habits and behaviors that will have to change for them to truly improve. There are barriers to adherence you will have to remove and fears you will have to help them overcome. I have all sorts of people carrying dumbbells around the track at the wellness center and lifting old boat batteries in their garages. This is because I had short and meaningful conversations with people about how my principles and methods can align with their goals and we can work together to help move you in the right direction along the path. You will not mesh with everyone and everyone cannot be helped and that is perfectly fine. You do not want to get sucked into the world of the patient that truly doesn’t want your help anyway. 

 

Why do I call this Clinical Strongman? It is because I feel the typical events you see in strongman are the most relevant, useful, scalable, and teachable exercises you can use with people. The trick is to not say you are using strongman to help them. When the average person hears the word “strongman” they automatically think about what they see on TV. That world is full of impossibly large men and women doing unbelievable feats of strength the average person cannot even imagine to be possible. If you look at the underlying principles, you will see infinitely scalable exercises that are easy to learn (of course there are nuances you can master forever but the average person is not going to compete in these things, they just need to understand the most basic principles), easy to replicate at home to some degree, and look like things that the average person will encounter in daily life. You better believe someone will pick something up, push, pull or drag something, carry something, squat down with something, and put something over their head during the course of a day. After a while they start to say things like, “this is just like those big guys on TV do!”

 

This comes with building trust and helping patients overcome their fears of certain movements and exercises. You need to have a variety of implements available in your clinic but show the person what you are teaching them can be done at home with something they likely have available. You can show them all the transverse abdominus and glute activation drills you want but it is hard to beat a well executed and coached deadlift done with and appropriate load and intention. This way we are doing something that is meaningful to the patient and they can see will benefit them in their real life. The body also likes to be used in one piece and in movement patterns so they will get the added benefit of feeling better while they move and fear reduction around grabbing stuff off the floor and carrying it around. I have yet to find anyone, no matter how feeble and de-conditioned they are, who couldn’t lift up my lightest kettlebell and take it for a walk. The simpler you can make it for the patient, the more likely they are to follow through with your advice. Every thing you tell them to go home and do is another barrier to them adhering to the plan. You can give them ten things to do that do ten different things of you can give the one or two things to do that tackle ten things at once. 

 

 

 

 

 

 

 

 

 

 

 

 

 

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