The Principles of Functional Movement: Applying Barbell training to the Physical Therapy & Rehabilitation Populations
In clinical injury rehabilitation there is often a separation between therapeutic exercises and strength training. Clinicians take a “bottom-up” approach to treatment, starting as simple and gentle as possible, often prolonging the rehab experience or even leaving it incomplete.
Our philosophy at PRS is that strength training should be the foundation of physical therapy utilizing a “top-down” approach, starting at the highest functional strength training level a patient can tolerate. In order to do so, physical therapists and chiropractors need to be coaches in addition to just therapists.
There 3 major problems physical therapists and chiropractors face are:
Most clinical settings do not have the appropriate equipment for strength training with barbells (even at low levels)
Strength training prescription and coaching of any kind is not taught in our education process
They treat patients as fragile
Through mentoring clinicians in our Clinical Barbell Coaching Institute since 2019 we’ve found that an overwhelming majority of them struggle to create an integrated approach to rehab and exercise prescription to effectively rehabilitate clients using a “top-down” approach.
In this episode, we discussed the importance of having a background in barbell training, exercise prescription, and movement coaching of people without injuries or medical concerns. Because from there, you can then easily modify the movements based on the very unique circumstances of the person presenting to you for rehab.
In this episode of the PRS Podcast we deep dive into:
The problem with viewing the barbell movements as JUST barbell movements applicable to ONLY well-individuals and barbell athletes
How you can modify the lifts based on the very unique circumstances of each individual
Building confidence with complex or post-operative cases
The importance of acquiring the skills of coaching and programming beyond the clinic
How you can integrate the principles of barbell strength training from a “top-down” approach and in a clinical setting with limited equipment
At the end of this episode you will be equipped with insight and resources so that your critical thinking and clinical outcomes go beyond TherEx and modalities. We want to ensure that your clients get results they deserve and you become the clinician you’ve always wanted to be.
Resources:
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Dr. Rori Alter, PT, PRSCC, SSC: [00:00:38] Today, we are talking about something we are both extremely passionate about (shocker!) because that's what we do on this podcast is talk about things that we're passionate about. So Alyssa, what are we talking about today?
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:01:14] So Rori, we've been mentoring rehab clinicians since 2019 who are taking our courses, and there is something that we run into pretty frequently. It's the issue that the clinician faces where there's this difference or mindset difference between TherEx and exercise. And frequently struggle to integrate resistance exercise or barbell movements into rehab when they're looking at somebody who needs something different than the typical barbell movements, not necessarily going right to modifying them but going directly to TherEx or a lower level gentle exercise that doesn't necessarily translate to more functional movement. And, you know, like, why is that? Why why are we running into that problem in the rehab field?
Dr. Rori Alter, PT, PRSCC, SSC: [00:02:11] Yeah, I think it's because many clinicians don't look at physical therapy or rehabilitative chiropractic work as training. And when we're looking at someone from a rehab perspective, and it's not just about the range of motion, it's not just about being able to climb stairs and whatnot. The foundation of rehabilitation is strength training because it uses that range of motion. You have to climb those stairs. To do those functional things, you have to have strength. And when we're in the clinical setting, most clinical settings don't have a couple of things. They don't have the equipment we might consider for barbell resistance training. The other thing is that we're not taught how to prescribe exercise in school. We're not taught how to coach exercises. We're not even taught what exercises are good for different types of injuries, surgeries, or whatnot. Right. Because we don't know how to choose exercises and coach exercises, we're not going to utilize the most functional exercises. Which are the squat bench press, deadlift, overhead press, and some form of an upper body pull like a pull-down or pull-up or chin up or whatnot. So then, we are sent out to our clinical rotations to learn what to do in the clinic. And if we don't have an exercise background, we're expected to take what we learn in the clinic and apply it to our practice when we graduate and become licensed.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:04:12] So I'm going to interrupt you because I think there is one other aspect to this: a bigger conversation than we're going to have right now. But I think most people in rehab for an injury or symptoms are focused on pain, and we want to get them out of pain. And I think that there is a mindset that we don't want to do anything that will cause further pain. And we see that clinicians are often relatively gentle with their patients or clients. And again, the pain conversation is another conversation. But going back into, you know, barbell movements or resistance training in general, I think that there is this thought that it's either dangerous or there's a fear of it, especially if a clinician doesn't know how to do those movements themselves or teach those movements. And I think there's a roadblock where they don't know how to modify them to make them more gentle.
Dr. Rori Alter, PT, PRSCC, SSC: [00:05:19] Yeah. And I think that, and that's when we kind of run into the doctors who say, "Oh, no, after surgery, you'll never be able to bench press again, or you had a back injury, and you shouldn't squat or deadlift again." And I think it comes down to exactly what you said about modifying the movement. So in a typical traditional rehabilitation setting, we look at it as a bottom-up approach. For exercise, we do the simplest, most gentle. I love that you're using the word gentle, isolated exercise. And we had a whole conversation. I forget what episode this was, but it was with Dr. John Petrizzo, another clinical coach here at Progressive Rehab & Strength. We're looking at it from a basic isolated perspective and this bottom-up approach where we should take a top-down approach with the movement. Hence, if we understand that the most functional exercises are the squat bench press, deadlift, and overhead press. Even if you aren't a barbell athlete, these exercises are just for really anyone. These will be the main movements that are the largest drivers of strength, strength, and development, and we have to understand those movements. Learn how they're performed, why they're performed a certain way, and understand the biomechanics and the physics that go into those movements at the highest level to use our clinical knowledge and brain to break those movements down, to meet the client where they're at. And that's that it becomes easier to do this for the rehab client when you know how to do it for someone who isn't injured or dealing with a post-op situation or pain. And this is where you and I believe that physical therapists and chiropractors need to be movement coaches and barbell coaches. In addition to physical therapists, it's about understanding the movement, translating it to the other person, and then modifying it based on their needs and current situation. Pain, range of motion, tissue ability, the ability of the tissue to handle the load, and all those things. I see you nodding.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:07:48] Yeah. And I think, you know, even if the goal is to get somebody to do a barbell back squat while they are still in physical therapy, that doesn't mean they have to start on it on day one. And depending on where they're starting, that doesn't mean they even have to start with a goblet squat or any type of weighted squat. That could be the goal, assuming that's a realistic and reasonable goal for them and getting them there, but we're not going to get them there by having them do the same reps and with the same TherEx band for six weeks. There has to be a progression to get there. And so knowing where to start and how to get them there and not being fearful of that and as a clinician, you not being fearful of that and instilling some confidence in your patients that they can believe in you, that it's not going to hurt them and it's not scary. It's also really important.
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