Gimme Some... PTs

Greetings! I am currently a second year DPT student and am currently on my first round of clinical rotations. Within this intensive course load over the past couple months, I have become quite ensconced in the nuance (see what I did there) of bbmed and all of the exciting information regarding strength training (and other topics) and its impact on overall quality of life. As noted previously, I am relatively new to both bbmed and this forum. First and foremost, I am wondering if there are any other DPT student members on this forum? (that is not meant to exclude practicing PTs, or anyone else for that matter) Additionally, would such individuals be interested in sharing and discussing relevant topics within the field of PT (sports medicine, pain management, rehabilitation protocol, etc) and how they may be integrated, or even improved, with the valuable insights and knowledge we are able to gain from the bbmed staff and organization?

First and foremost i will admit that i am not in PT school(yet) but i will gladly have a discussion about pretty much anything in relation to rehabilitation. If you want more specific people, Alex, Micheal Ray and Derek Miles and obviously Jordan & Austin are great resources for this stuff and would gladly offer you any advice.

Happy to have a discussion…so long as it follows this flowchart

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Cal,

Any form of progressive loading will suffice so long as it meets the patients desired goal and limitation.

A barbell is one method to load the shoulder with pushing, pulling, overhead lifting and lowering. Isometrics, therabands, dumbbells, kettlebells, a box, crate or crock pot for the home health providers will all do. Even with the high functioning person, low load isometrics and therabands may have a place early post-op or if the individual is showing high levels of fear, anxiety, etc. A light load moved in a confident manner can pave the way for a linear progression toward heavy barbell pressing, etc.

I recently had an individual concerned about the “popping” in their shoulder. As a result they discontinued strength training. Did I use isometrics to show them it was safe to load? Yup. Did I add a pink dumbbell after that while pointing out the “pinkness” to suggest safety? Yup. Did 1lb become 3lb become 5lb? Yup. the individual was provided sensible loading progression advice and returned to the gym with the confidence they lost.

No non-sense scapular gobbily-gook. No talk of injury, damage, “unsafe” exercises. Loads of re-assurance, sensible advice, confidence building (see “EXPECTATION VIOLATION”) and loading.

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In my opinion it’s because clinicians fear for their patients and themselves what they don’t understand. Example being if I was a clinician that didn’t resistance train with barbells I would have a hard time prescribing that movement to a patient when I myself couldn’t properly execute it. Then there’s always the clinicians that make their patients do ridiculous movements like bosuball balance, and half squats and stupid band pull aparts for 12 weeks with no progression.

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Howdy! I am currently a 3rd year PT student. I realize I’m a little late on this thread but I would definitely be interested in discussing this stuff! I just recently finished my 3rd clinical rotation and I learned a ton but I also still have a long way to go. BBM has been a pretty awesome resource for me. You guys who haven’t started school yet are pretty fortunate to gain exposure to the nuance early on as it will help you sift through(or at least be able to acknowledge) the BS when you get into the field!

While on my rotations I started PRE with a lot of patients in a lot of different ways. I feel like people try to overcomplicate rehab and find the “perfect exercise” when in reality you can just start with tolerable weight/resistance and build up over time, monitoring how it affects them, all the while educating them on pain and the resiliency of the human body. I agree with Matthew. I think there is definitely merit in the little things, especially with someone who is very fearful of movement/in a lot of pain. The hard part comes when you work with others who don’t understand the plan and spend 3 straight sessions stretching or something like that. You obviously can’t make everyone treat in the same way you do, but it helps to be on the same page.

Dhruv, you are definitely right about clinicians fearing the things they don’t know. I’ve seen this quite a bit in the short amount of time I’ve been working. Especially surrounding deadlifts for some reason. I swear people think it’s going to break someone in half.

I would love to be a part of future discussions!

The funny and frustrating part when I asked the clinic coordinator why their patients deadlift or squat and the answer I got was that “the patients wouldn’t be interested in it”. What I should’ve replied with should’ve been “the patients don’t wanna do these stupid band pull apart sandman internat/external rotation with bands for 12 weeks with no progression.”

My_pal,

Here is something I post at my desk. Simple and succinct:
“A physical therapist is a licensed healthcare professional trained in rehabilitation and the optimization of function after injury or disease.” Push, pull, lift, carry, bend, walk, run, get down, get up. Sometimes heavy, sometimes light, sometimes short, sometimes long. Doesn’t need to be more complicated than that.

Dhruv4,

My response to your coordinator: They may not be interested in doing DL and squats…but they are interested in picking up their kids, salt bags, garbage cans, manual labor, etc. For those things you’d be hard pressed to find a better prescription than the DL and squats. Keep fighting the good fight.

Keep in mind, many PT’s are still afraid to lift stuff
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