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I am a current doctorate of physical therapy student. Over the last year, I have become interested in barbell training for both myself and my patients. To learn more, I have investigated Starting Strength and these forums. I was surprised to see how displeased the strength community was with physical therapy. As far as I can tell, it seems that people have experienced physical therapy that fails to sufficiently challenge them and/or improve their physical problems.
My school's program has always emphasized the need for functional training to create change on a neurological level. That is, repeated functional exercises like squats and lunges help people learn how to perform a movement efficiently and thus allows them to perform the same movements well at work and in their home life. From what I can tell, this is something Starting Strength also emphasizes. Modalities like ultrasound are considered laughable by my professors, as are light resistance band exercises for all but the profoundly immobile and disabled.
As someone who wants to be good at their job and help affect their profession in a positive way, I am curious as to what you perceive as the main issues in physical therapy and what changes you wish PT would make. What suggestions do you have for a new grad hoping to avoid those issues?
Physical Therapy is insufficiently stressful to provoke an adaptive response. The stress/recovery/adaptation cycle is not taught as the foundational concept in PT, and our approach to rehab actually works while PT -- as practiced in the US by <99% of clinics -- is so bad that I consider it to be a form of medical fraud. IOW, if you get better while in PT, you just healed up. So, my suggestion is that Physical Therapy be approached from the same perspective as training, i.e. a program of progressively increasing resistance be actually applied to PT patients, as opposed to mere lip-service in this direction. Further, PT needs to revisit the concept of Specificity, and evaluate its role in the design of rehab protocols.
I think part of the problem is that many PTs, especially outside of the sports area of practice, lack the confidence or training to instruct patients in the basic lifts that are so functionally relevant. This is part of the reason I'm trying to get a good foundation now so I can progress patients to a meaningful level of strength. Thanks for your insight.
I got "serious" about "fitness" with crossfit about 4 years ago, stopped it two years ago. Thereafter, I rehabbed an injury (one that pre-dated crossfit), and continued with basic strength work with some conditioning thrown in after discovering your book and this website about two years ago.
On the subject of sleep, I've suffered severe insomnia for at least 10 years, maybe more. I'd really plateaued on my strength work over the past 9 months or year. Finally, my insomnia just became unbearable and I saw my MD about it. Long story short, I'm a month into treatment, and my sleep is improving. Lo and behold, in that same month, all my lifts have improved. Coincidence? Possibly. But I doubt it. I've made no radical changes elsewhere in my life, haven't gained any weight, and haven't changed my diet. Obviously, I'll know more with the benefit of more time, but I wanted to just reinforce for others the importance of sleep.
On the subject of back pain. I was on the crew team in college and herniated two discs (L4-L5, L5-S1). I used to tell people, truthfully, that I had not had a pain free day since I was 18 years old. Used to. I can now tell you that my back has never felt better (knock on wood).
How bad did my back used to be? The worst flare-up occurred in 2002 or 2003. Over the course of a week it deteriorated to where, one night, I was forced to crawl from bed to the bathroom to pee, did so, fainted from the pain and could not crawl out of the bathroom -- much less back to bed. Unable to move further without fainting, sweats and nausea, I spent the night on the bathroom floor. I called the MD in the morning seeking a Rx, and he said I had to call the ambulance. When the paramedics arrived, they could not roll me onto the back board until they gave me not 1, but 2 morphine injections. I spent a couple of days thereafter in the hospital on a dilaudid drip. I remember the doctor telling me I had to get up and walk to the end of the hall and back and I almost cried.
As I said above, I discovered the book and your website two years ago. My back had already improved a lot from crossfit, but I still had chronic pain -- more like chronic stiffness/minor soreness with occasional minor pain. The past two years of sucking it up and squatting and deadlifting -- even when I had another minor flare up -- seem to have changed my life. I am completely pain/soreness/stiffness free for the first time since before rowing in college. It has taken a lot of time, effort and dedication to get there, but I love how I feel, and I guess I'm middle aged.
My only frustration is my inability to convince my friends, family and peers, who have seen me suffer through my entire adult life, that squatting and deadlifting have been my salvation.
Thomas, I'll second your claim that SS is a godsend. Oddly, I have similar problems with my back - L4-L5 and L5-S1 herniations that impinge on my nerves and for a couple months caused unbearable sciatic pain. Though I never had to call an ambulance or was hospitalized, it was rather terrifying as a 23 year old who completed 3 triathlons (1 sprint, 2 olympic distance) the previous year that I could hardly walk around the block without tearing up in pain.
Lucky for me, the doc cleared me to "let the pain be my guide" at the end of November, though he told me to avoid squats and deadlifts or other things that might increase my intraabdominal pressure (for reasons I can understand, as it did, previously increase my pain level). I ignored the second part, embraced the first part of his plan and met with Jordan, who set me up on LP, which I'm still running. My back has never felt better (the spasms that plagued me for years and impeded my ability to kick my legs up on a chair or sit up straight on the floor with my legs out are gone) and the sciatica still bothers me, but nowhere near the same level it did 2 months ago. I'm actually starting to notice it more now simply because of its infrequency.
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