As my callouses have healed and my body has recovered, I've had some time to reflect on my recent Russian Kettlebell Certification (RKC) experience. This is not a traditional certification sought after by a physical therapist that mainly works with the homebound elderly. Yet, the more I straddle the line of fitness and rehab, I am seeing how complimentary both fields are to each other. In particular, I am seeing great value in the RKC for PT's who work with the elderly. I think my patients would agree with me as well.
"PT's are exercise experts across the lifespan." Really?
The World Confederation for Physical Therapy states that physical therapists are "exercise experts across the lifespan". Yet, when you witness some (not all) elderly rehab, you're likely going to see patients doing some variation of the following: isolated theraband movements, light resistance, light cardio work, standing on a foam cushion, and lots of sitting. I'm not bashing these interventions as they DO work for some. Yet, for these interventions to be effective, they must be treating the patient's specific deficit.
It's common to see quad weakness in patients and assume some long arc quads will solve the problem. What if that quad "weakness" is a result of a mobility/stability issue up the chain? Will isolated long arc quads really get to the underlying issue if we're focusing on flexing/extending the knee? Beyond that, when we are address the underlying issue, we often don't provide enough of a challenge to stimulate adaptation.
This begs me to ask the question...Are physical therapists really exercise experts across the lifespan?
The APTA (American Physical Therapy Association) even admits to PT's under-prescribing of strength training for older adults. PT's can do better...myself included. We can provide effective interventions that address the root of our client's problems and develop real world, practical strength. The RKC can help.
The RKC is a SYSTEM of STRENGTH
The benefits of strength training for older adults is becoming more and more prevalent. We need to get our patients stronger to improve their abilities. Yet, strength training doesn't necessarily mean going from green to gray theraband with ankle pumps. Isolated movements with light resistance do have their place in the treatment of patients if their evaluation calls for such interventions. However, isolated exercises may not be as effective in terms of developing practical strength, especially if those isolated exercises are used far too long in the rehab process. In patients that are generally deconditioned with no major asymmetries (many of the elderly we serve), major gains can be made with appropriately loaded, compound movements.
The RKC provides a framework and logical progression to help develop practical strength through hip hinging, deadlifts, swings, squats, getting up from the ground, pressing things overhead, etc. PT's, with their extensive knowledge of the body across the lifespan, can take the principles learned and utilize them with the elderly client using a walker or the collegiate athlete that's preparing for their season.
The RKC teaches principles of strength that are applicable with nearly anyone you come across...not just a select subset of people.
The RKC demands MASTERY
Many certifications require you take a test to demonstrate that you have gained the appropriate knowledge. The RKC requires you to demonstrate MASTERY of the tested techniques as well as competency to TEACH the progressions/regressions of the movements. This is vital to us as clinicians because (as Dr. Scott Butcher has pointed out), many PT's fail to spend much time strength training to better understand proper technique, how to coach, and how to program.
How can we as PT's help others develop strength if we are not strong ourselves?
This has been powerful for me as I'm prone to read and study more more than I execute. I fail to "practice what I preach". Yet, I can honestly say I've learned as much about movement through my own strength and conditioning as I have in 7 years of formal movement education...and I'm still an absolute novice!
The demands and standards of the RKC will challenge you to be a better athlete which will translate into you being a better clinician.
The RKC utilizes Kettlebells - The Handheld Gym
I'm not here to say the kettlebell is the end all be all to develop practical strength. There's much debate on this topic. However, if I could think of a tool to have in my clinic (or car for us home PT's), I would want it to be:
With all that said, kettlebells are not the magic bullet for everything nor everyone receiving physical therapy. But for the vast majority of the population, kettlebells can serve them well if used wisely. I urge my fellow physical therapists to become familiar with hardstyle kettlebell training and consider pursuing their RKC. Seek out a skilled coach and soak up as much as you can. You will gain valuable skills and knowledge that will serve you and your patients for the rest of your life and career.
For more tips on rehab/fitness with the elderly population: