From Physical Therapy to Training Here's 5 Reasons Why I love Those Kettlebells

 By Kirsten Carmichael PT, DPT, SFG I, CSCS

I commonly get asked what’s the deal with the kettlebells.  My answer is they are an amazing all in one tool. You can rehab injuries, build strength, endurance, and power all at once.  Kettlebells have in fact been around for ages but their popularity seems to come and go in phases like so many things in the fitness world.  There is always something new and flashy but the kettlebell will forever be a staple you can use anytime, anywhere for a full body workout. Here are some cool benefits of training with kettlebells (and why I use them as both a physical therapist and strength coach).

11)    They are fantastic for your shoulders.  As a physical therapist improving the strength and dynamic stability (ability of the deep shoulder muscles to really lock the ball in the socket) are key.  Since my patients can’t take me home with them for manual exercises, I use kettlebells and their unique weight distribution to train this.  Kettlebell arm bars, get ups, bottoms up work, windmills...they all improve stability and mobility of the shoulder girdle. Also, when pressing the kettlebell allows the shoulder to move in more planes of motion than a conventional barbell.  The ability to rotate is huge for your cuff muscles as well as preventing injury (because you don’t jam your tendons).

22)    Kettlebells build incredible grip strength.  This is so important for everything from sports to performing daily activities.

33.)    You can train power, strength, and endurance all at one time.  Again, your more dynamic movements like swings, cleans, and snatches with the kettlebell train power while also sparing wrists/arms that receive a great deal more stress with the barbell versions. 

44.)    You can train stability and mobility at the same time.  Just take a look at the get up…that requires all kinds of shoulder and hip mobility but trains strength and stability at the same.  And it doesn’t get any more functional than getting up from the floor and back down again.

55.)    You can train literally anywhere.  You don’t need to spend a lot of money, and you don’t need a ton of equipment or space. 

Interested in our approach to injury rehabilitation or looking to improve your fitness?  Contact us today to learn more about our Physical Therapy and Strength and Conditioning services and community!

Arm Care Part 2-Dynamic Stabilization

In the last blog we talked about some of the most important arm care exercises for strength.  This time we will add on and go over some nice options for building dynamic stability.

The shoulder is the most mobile joint in the body.  Often times when we see shoulder trouble it is not an issue of mobility but rather a lack of stability. If we think about the function of the "core" muscles of the shoulder (the rotator cuff) they are not designed to be prime movers of the shoulder but rather help hold (stabilize) the ball in the socket. In baseball during pitching these muscles help control the deceleration phase.  If stability is lacking it often leads to shoulder pain and can trickle down the chain where the forces impact the elbow and cause problems there.

In Physical Therapy we utilize a lot of manually resisted exercises to help improve dynamic shoulder stability where the therapist applies forces with their hands in different directions in certain positions or exercises.  However, there are some great exercises that can get those dynamic stabilizers firing and can be done at home or the gym.  Here are a few examples to get started with! (Shout out to my model Craig Valentine, owner of my home Loomis Kettlebell Gym and Del Oro baseball alum).

Kettlebell Arm Bar: This is a great exercise for getting the stabilizers going in the shoulder.  The offset weight of the bell cues those muscles to fire to keep the arm from moving.  The goal here is to really engage the lat muscles and "pack your shoulder" holding the arm strong.  Start light with this exercise as these muscles aren't the big movers.

Sidelying External Rotation Catches:  We talked in the last blog about sidelying external rotation with the weight being one of the very best exercises for strengthening the cuff.  Here we put a little spin on the same exercise making it more dynamic by doing a drop/catch with a small medicine ball (two pound weighted ball shown here).  You can start slow as you learn to control the movement and then increase your tempo from there.

90/90 Wall Dribbles: With overhead athletes we want to make sure we train these muscles in the functional positions of your sport.  So getting the arm up into an overhead range is important.  These are surprisingly fatiguing but train great stability!

 Wall Clock Dribbles: Again this is another exercise that allows you to move and work the stabilizers through a greater range of motion also making sure we engage those muscles overhead.

Prone Ball Drops: Here we get some more scapular stabilizers involved and change up the position by lying prone over a ball.  These are also very fatiguing so start with short bouts and work your way up from there.

Now we have both strength and stability arm care covered!  Hope everyone's spring seasons are getting off to a pain-free start.  And as always keep those arms strong and healthy!!! Follow us for more tips on Instagram and Facebook @gonextlevelpt

Aerobic Exercise Speeds Concussion Recovery

The recommendations for activity following concussion have been changing with the current guidelines being a shorter period (24-48 hours) of rest following injury.  We are now finding that this shorter period of rest and early subthreshold aerobic activity are beneficial in speeding recovery after concussion.

A recent study by Leddy et al looked at adolescent males who came to a concussion clinic less than 10 days from injury.  They were grouped into an exercise and rest group.  The exercise group completed the Buffalo Concussion Treadmill Test (used to determine an appropriate submaximal heart rate) and performed 20 minutes of exercise daily on the bike or treadmill.  This was compared to the group that was advised to completely rest from physical activity.  The exercise group recovered in mean of 8.29 days from initial visit and 13.04 days from day of injury.  The rest group recovered in 23.93 days from initial visit and 28.43 days from day of injury.  These findings indicate recovery time from initial visit was significantly faster for the exercise group.  Also, none of the exercise group participants had delayed recovery (>30 days of symptoms) while four participants in the rest group had delayed recovery. From day 4 forward the exercise group had a significantly lower total symptom score compared with the rest group. 

This study is an excellent start in support of early subthreshold aerobic exercise following concussion injury.  The study also had some interesting discussion about the benefits of aerobic exercise including:

·         Enhances neuroplasticity acutely to promote neuron growth and repair

·         Reduces heart rate at rest and reduces submaximal exercise heart rate by reducing sympathetic activity

·        By improving Autonomic Nervous System balance aerobic exercise may also improve sleep (a big deal in many patients after a concussion injury)

The recommendations continue to move towards a more active approach to concussion management.  A Physical Therapist can assess you and help determine the appropriate prescription for aerobic exercise since too much can exacerbate symptoms and delay recovery. We say this for so many other types of injuries in Physical Therapy and now we can also apply it to concussions…Exercise is Medicine!!!

Leddy JJ, Haider MN, Hinds AL, Darling S, Willer BS. A Preliminary study of the effect of early aerobic exercise treatment for sport-related concussion in males. Clin J Spsort Med. 2018;1-8.

Running Injuries: Prevention From The Ground Up Part 1

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

I frequently get to work with runners and one common complaint is with foot/ankle discomfort or pain.  I decided it would be great to provide some preventive tips and tricks starting at the feet and working my way from the ground up.  These are also great tips for other athletes who may be experiencing similar problems.  Give them a try! 

First, many problems up and down the leg can occur from a limitation in ankle mobility.  To test this you can stand with your toes about 5 inches away from the wall in a lunge position.  Keeping your heel on the ground, bend your knee and reach it as close to the wall as possible.  If your knee easily touches the wall your mobility is looking good.  If you can't reach the wall without your heel lifting or feel stiffness in your ankle then this is an area to work on.  In the same position as the test (see video below) you can perform some active glides.  We recommend performing 10 repetitions on each side. 

Next, there are some great tools to keep your soft tissue mobility looking good.  One awesome tool for plantar fascia health is rolling on a lacrosse ball.  Simply place your foot on top of the ball and roll along the ball of your foot, the inner arch, and along your heel.  If you feel any tight or "crunchy" areas then give these spots a little extra love.  

You also want to make sure the soft tissues in your calves stay loosened up.  Sometimes using a foam roller for this area can be a bit awkward so I prefer to use a stick.  If you get in a half kneeling position as shown you can also get a little extra stretch on the calf as you roll.  If you find any "bumps" in the road you can move the stick (as shown) side to side to create a cross sectional release.  I usually recommend 10 rolls up and down on each side again spending a little extra time on any trouble spots. 

Now that you've mobilized your ankle joint and soft tissues you want to stretch in that newly found range of motion.  A good gastroc stretch is first on the list as shown.  Make sure you keep that toe pointed straight ahead and your heel on the ground. 

Deep to that gastroc muscle is the often neglected soleus muscle.  As shown below move the back foot in just a bit and give the knee a bend to stretch this guy as well. 

Finally, after all of this mobilization and stretching it is great to reinforce those deep muscles that support your arches.  A great way to get this started is called "arch doming". In standing you will focus on grounding your big toe and making an arch along the inside of your foot (see video below).  I usually recommend 20 repetitions. 

Definitely give all of these a try pre-run or work out to make sure your mobility and stability are in check before you load the system.  Performing some of the soft tissue release and stretching after can also be beneficial if anything has tightened up along the way.  Over time you will develop a beautifully balanced foot and ankle and prevent any future issues! 

Hope you found these tips useful!  If you are still experiencing any pain or discomfort contact us!  We love nothing more than to help athletes perform pain-free and at their best! 

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