Strength Matters

Hi everyone
When I was working as a physiotherapist in India, the bulk of my interventions were primarily electrotherapy based modalities in rehabbing people with disability. As I look back now, while there is a place for electrotherapy (but very little, in my opinion), overly relying on these modalities had a negative impact on my learning curve and overall development as a therapist. It steered me away from interventions like manual therapy, corrective and functional exercises strength training, injury prevention and improving quality of life. Anytime I was uncomfortable and didn’t know what was going on with my patients, electro therapy seemed like a ‘safe space’ to fall back on where I could tell my patients that the ‘machine would reduce the inflammation’ and to ‘give it some time’ to avoid questions I couldn’t answer or problems I couldn’t treat.
I started learning and utilizing the aspects of strength training, functional exercises and injury prevention when I volunteered with the strength and conditioning coach of Long island university’s athletic teams, learning from coaches training high level UFC fighters and boxers etc. Today’s blog post is dedicated to one such neglected aspect of overall rehabilitation which is  strength training. Not just pursuing the goal of getting our patients stronger but working on this attribute ourselves.
To build on this case further, before anything else, I would like to ask you all a question, who in your opinion will not benefit from getting stronger?

• Some would say children (not you though, you know better than that). While there is scientific evidence to prove that loading a child with weights could be detrimental to the growing epipheseal plates, there are a lot of ways to incorporate strength training in children. Body weight exercises is a good example. Not only is it a good exercise to build strength but it also helps with learning skills. Learning requires repetition and this helps create new neuro muscular pathways. These pathways help ingrain movement patterns in them. After all, why are we able to brush our teeth so well with our dominant hand and struggle when we tend to do the same activity with the other hand. Do you think that the toothbrush is heavy that makes it so difficult? Of course not, it is because we have used our dominant hand a gazillion  times and that motor patter has now been mastered by our brain which makes the task smooth and effortless. By keeping them away from some sort of a ‘reasonable’ training program because  we fear it will ‘impede their height’, we delay the foundation on which we would like to build upon. We should look at China as an example, they start training their athletes at a very young age. The early years are spent perfecting skills without putting too much stress on the body and when the time comes these children are better prepared to handle exercises and out perform their peers. No wonder they win the number of gold medals they do at the Olympics.

• Some might say older people (though I cannot imagine who). Lifting weights could be one of the best things that could positively affect grandma and grandpa’s health. We know some of the major effects of aging are sarcopenia (losing muscle mass) or weaker bones with older adults and what better way to slow down these processes than lifting weights? (No, not going on leisurely walks). While aerobic exercise has its benefits, its not the preferred form of exercise to mitigate the negative effects of age related sarcopenia or osteoperosis.

• People trying to lose weight? I think they are excellent candidates for lifting heavy weights. When trying to lose weight, what we are truly trying to achieve is losing body fat. Instead of  slow paced jogging on a treadmill for 1 hour, how about doing high intensity sprints for 1 minute and then walking for 1 minute to recover and repeating it for maybe 15-20 minutes ( of course, rule out any pre-existing heart conditions). High intensity training seems to have a better outcome in burning fat as it puts a higher demand on the metabolic system and the intermittent slow and fast running causes heart rate variability which is  good training for one’s cardiovascular system. But we are missing the icing on the cake (sorry, bad example when we are talking about losing weight but I love chocolate cakes). Lifting heavy weights increases muscle mass and size. Now when someone asks you what that has to do with losing weight you are in a position to educate them that bigger muscles needs more blood and nutrients (energy) and this increases their overall metabolic rate. So people with more muscle mass tend to have higher basal metabolic rate even at rest. This means even when they are not working out, their bodies our burning more energy than a person who has less muscular mass.

• How about athletes? No debate here. A good strength training program can help a football players outrun his opponent, gives the cricket fielder that explosive power to dive  higher for that ‘highlight match turning catch’, a batsman the rotatory power to smash that ball outta the stadium (and win that price money cheque $$$) etc, the list is endless.

•  Even us physios.  Keeping aside the obvious benefits of strength training to meet the rigors of our job, we are more likely to be consulted  by fitness and gym enthusiasts if they know that their therapist shares their passion for working out. If the last time we entered a gym was in our second year of BPT education, it would be hard to convincing our patient who blew out his back squatting 80 Kilos that we are the right therapist for him; and rightly so, if we have never felt that load ourselves, how could we be in the best position to help others? After all, don’t we learn from experience? Here in the US/ Canada, I have seen this all to often. Runners will seek out therapist who were former runners, athletes injured playing a specific sport will look for therapists who were athletes themselves, people hurt in the gym lifting weights will try to look for a therapist who has some experience in bodybuilding type of exercises etc etc.

•  How about that skinny guy trying to impress the girl in his class? Gaining a few extra pounds of muscle mass won’t hurt at all.

To know the nuances of strength training and to be creative in program design is paramount for a sports physiotherapist in India, because unlike north america and many other parts of the world, where athletes have a entire team of professionals like athletic trainers and certified strength coaches (I have written briefly about these professionals Here), we don’t have such luxury. We must be a one man sports medicine team. We must be the the guy who prescribes an off season strength and conditioning program to make our athletes run faster, jump higher, lift heavier etc and educate about injury prevention, and despite all this if the athlete does get injured (which most likely they will) we must now put on our therapist hats and get to our treatments. Hence, the importance of the  knowledge about good exercise selection and prescription cannot be overstated.
To cut a already long story short, almost everyone could benefit from lifting heavy weights. However, what are these exercises that make our patients functionally stronger, faster and can also be incorporated by athletes for their individual sports specificity. It cannot be bicep curls, triceps extensions, abdominal curl exercises, lat pull downs etc (these are more of body building exercises) that might help somewhat, but there are better ways. My intention with this blog is to take it in a new direction where I cover both aspects of what a physiotherapist might encounter,

1. Topics which are purely based on physical therapy rehab, like new assessments and techniques that I find beneficial.
2.  Topics on S&C (strength and conditioning) and exercise prescription for health and performance in otherwise healthy individuals.

In my following blog post, I will discuss about certain exercises, training principles  for building strength and basic terminologies that are often incorrectly used like hypertrophy, strength and power. Until then.
Pursue excellence
Abhijit Minhas PT
(BPT, MS, CMP, FMT)