Factors Discouraging Physical Therapists from Utilizing Basic Barbell Movements

[stef]

Factors Discouraging Physical Therapists from Utilizing Basic Barbell Movements for Strength Development in Outpatient Orthopedic Rehabilitation

by Jack Patterson

"The purpose of this research is to determine why a vast majority of physical therapists are still practicing methods of strength development with their patients that research and reasoning have suggested are sub-optimal when compared to alternatives."

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[Jdcuth]

It seems an unusual situation where the success of an intervention (barbell training) is limited by the fact that it is so effective- it has made generations of young men unbelievably strong, so people assume it should be reserved for those types of individuals. More videos and case studies of women in there seventies reversing osteoporosis and sarcopenia using this method would be helpful

[Mainstream]

Because they are intelligent people...you do not want to introduce something NEW to someone who is hurt..and lighter resistance WITH more reps is effective in increasing strength and decreases the chance of injury...they do rely to much on isolation type exercises..but thats to maximize the effectivenessness of reps with light weight

[Robert Santana]

Except it should not be new. It is only "new" because most people have poor baseline movements. The suggestion that you should not rehab someone who is hurt to the correct motor pattern that they should have possessed prior to the injury is malpractice.

[Ben Lacasse]

is this study published anywhere else other than Starting Strength? like for example on PubMed or similar?

[Mark Rippetoe]

No. Why?

[Vick Volkov]

Except it should not be new. It is only "new" because most people have poor baseline movements. The suggestion that you should not rehab someone who is hurt to the correct motor pattern that they should have possessed prior to the injury is malpractice.

That's exactly the case. PT rehab goals attribute to patient's return to his normal functional ability. Seemingly, most patients (professional athletes included) do not have quality baseline movement patterns, such as a correctly performed squat and deadlift, in the first place.

I'm working at a PT outpatient clinic with diverse patient profiles - recreational and professional athletes, pre and post-opp patients and patients with all-causes injuries. Our multi-disciplinary staff (about 25 members) includes PTs, PEs and athletic trainers. Most are ~35yo and younger. Our new clinic contains two large training halls, the largest one is equipped with multiple Pilates tables and TRXs, and the other hall equipped with all equipment you would have expect to see in a PT clinic, as well some of the newest technologies. The third rather small training hall contains a Technogym half power rack, a barbell and plates, and it's clearly underused. The only PTs using this equipment are the ones exposed to barbell training via crossfit, and I cannot say that there appears to be a clear, qualitative understanding of barbell movements there. The rest of the staff members seem to be deterrent by barbell training or indifferent of it. Moreover, one staff member is a DPT who is a spine rehab researcher and he fiercely opposes loaded human movement.
I have been using this barbell equipment with patients ever since my first month there, inspired by the work of Petrizzo, Morris and Deaton, patiently hoping to spread the word among the staff and the other patients. In a three years' time since I've started working there, only two staff members have shown some interest in what I do and discussed me about it. I once planned a BT workshop for the staff with the PT team leader, but it never came to fruition. And frankly, I don't think there's enough interest in implementing it in the clinic. It has been a great dissonance for me ever since, but I strongly believe in individually implementing the therapeutic impact of barbells and leading by example. The most significant changes start from inside, at the surface level.

Thank you for the article, Jack!

[LimieJosh]

I was actually surprised that the availability of barbells was as high as was reported here. I wonder if some of the people who responded yes that they have barbells really have the capability to do what we as a group interpret that to mean, or whether it means they have a 10lbs fixed load bar somewhere in the corner.

[JackPat]

I was actually surprised that the availability of barbells was as high as was reported here. I wonder if some of the people who responded yes that they have barbells really have the capability to do what we as a group interpret that to mean, or whether it means they have a 10lbs fixed load bar somewhere in the corner.

I think both of those are probably the case. I believe I mentioned that in the limitations, and it's almost hard to believe that a likely majority of professionals could actually not know the difference given its simplicity and effectiveness.

I'm working at a PT outpatient clinic with diverse In a three years' time since I've started working there, only two staff members have shown some interest in what I do and discussed me about it. I once planned a BT workshop for the staff with the PT team leader, but it never came to fruition. And frankly, I don't think there's enough interest in implementing it in the clinic. It has been a great dissonance for me ever since, but I strongly believe in individually implementing the therapeutic impact of barbells and leading by example.

I think that's the most dissuading factor to me as well; even if you could explain to people that there's a better way of doing things, their own biases (ego, contradicting education, and general lack of interest) seem like they'll keep them from coming around to something better. A big problem with the situation is that the whole "low weight high reps" does has a small degree of success with patients. It still drives a beneficial adaptation in the patient, but the tricky part comes in convincing people that better strength training in rehab will provide a BETTER, stronger adaptation that will be better for the patient's health and quality of life. I think it's probably easier for a PT to not care so much about the long-term strength of their patients (out of sight out of mind), but it's a much bigger deal to the person living with the recovered injury. Oftentimes to clear patients, PTs just need to check some boxes or have them pass certain basic tests. Patients make it harder by being anxious to be done with rehab in order to return to sports, work, or because of their insurance coverage, etc. All of these factors go further to prevent therapists from spending quality training time with their patients to actually get them in better form. It ultimately boils down to what it takes to to get people to do more than the bare minimum, which is a question with a much bigger scope than outpatieng PT. Glad you enjoyed reading.

Because they are intelligent people...you do not want to introduce something NEW to someone who is hurt..and lighter resistance WITH more reps is effective in increasing strength and decreases the chance of injury...they do rely to much on isolation type exercises..but thats to maximize the effectivenessness of reps with light weight

The first assumption here is wrong in that not everyone in PT is hurt. Reasons for visiting include, but aren't limited to, chronic or acute pain, weakness and tissue damage, and post-surgical rehabilitation. Generally there is pain involved with the initial condition, but being in pain and being hurt are two separate things. The purpose of orthopedic physical therapy is to improve physical fitness and ability which is a direct derivative of physical strength. If you'd been paying attention to the content being put out on this site, you'd understand that while light weight and high reps CAN work, heavier weights and better movements work BETTER (which is the whole point of the research). A main tenet of the Starting Strength argument is that better, basic movement patterns with higher weights and more muscle mass is more effective in developing strength, and the extension is that weakened/injured patients are the ultimate novice who can benefit from this. And to emphasize what Santana said, these are basic human movement pattern; a squat should not be something new to a patient, and if it is for some reason then that person has the most to gain from adding resistance to that exercise.