strength and conditioning

11 Strength and Conditioning Practices that Every PT Needs to Use

As a profession, physical therapy has come a long way from falling into the 3 x 10 and e-stim mindset for every visit for every patient. Recently, the spotlight has become a bit brighter regarding a new model of a strength and conditioning professional crossed with a physical therapist.

The coined new term “Hybrid PT” has surfaced and is popping up across all forms of social media…be it blog posts, Instagram, and job postings preferring applicants with CSCS certification. The greats like Gray Cook, Mike Reinold, and Tony Gentilcore set the precedent for this movement currently sweeping through the field.

The good news is, as physical therapists, our educational background has prepared us immensely for success in implementing the practices of the most successful strength and conditioning professionals into our own treatment plans. The principles can be beneficial in every setting of physical therapy.

Remember those exercise physiology and orthopedic principles? I’m talking about periodization, rep schemes, and proper stimulus for your desired effect on tissue. Strength professionals and PTs have the same goals in mind, whether it be geared toward a client or patient. As someone who has held positions in strength and conditioning, exercise physiology, and rehabilitation, I have compiled what I believe to be a handful of the key points to “bridge the gap” (buzzword!) between strength and conditioning.

This list is in no way an end-all-be-all, but just my take on what is important to bring into your practice. Without further ado, I present to you 11 strength and conditioning practices that you can implement in ANY setting of physical therapy.

1. Basics

The first recommendation I would suggest is do not forget the basic principles you learned. Strength and conditioning personnel use the term “program” to describe their plan. It often covers meso-, micro-, and macrocycles that span days, weeks, months, and even years.

While it may not be feasible or realistic for us to plan out months or years for our patients, PTs are well equipped to be able to provide an effective treatment program for days and weeks, and we should!

Remember strength, power, endurance, and hypertrophy? These are the Holy Grail principles of strength and conditioning. Your patients require power to rise up from a chair, endurance to walk around the grocery store, strength to carry a grandchild or sit up in bed, and have a hypertrophic need after major trauma or surgery. Plan a treatment program without forgetting these basics and you’re set up for nothing but success.

2. Stimulus

It is assumed that as physical therapists we are applying the proper stimulus for the desired effect, but are we really? What strength professionals do well is know how to properly load the body. Therapists live where load must equal capacity and also where load must be less than capacity for prevention.

I will never forget what one of my professors said regarding stimulus. To loosely quote Dr. Kevin Lulofs-Macpherson, “How can we expect to evoke proper stimulus when we are not even close to the load they carry on a regular basis? We become afraid to load more than a 2lb dumbbell for some patients when they carry around purses and bags regularly weighing upwards of 8-10lbs or more.”

3. Purpose

Piggy-backing off the last tip, load with a purpose. This is the buy-in for your patient. Strength professionals do this very well by designing their programs with movements designed for the intended purpose of the professional, but also are purposeful for the patient.

The most simplistic example I can think of is, if the patient desires to walk more, you get better by walking more. A mother may need to carry groceries, children, and pick up toys regularly. Make your treatment programs purposeful to her activities, not just performing an exercise to exercise. Not everyone is going to benefit from a cookie cutter 3×10 of yellow Theraband exercises.

Warm-up with a purpose, too. Remember, not everyone needs to ride the recumbent bike for 10 minutes before a treatment session. There may be something more beneficial to them.

4. Needs analysis

Every patient is unique and they have unique needs. This practice principle is necessary for both physical therapy and strength and conditioning, and I believe we all know it is a cornerstone of treatment. However, it needs to be restated for emphasis.

Look at your patient as a whole, listen to your patient fully, and develop a treatment for their needs. As physical therapists, we can elevate ourselves by adding what we know to make patients achieve their needs to the highest level possible.

5. Maximize time

Strength professionals are great at maximizing their time. True, they often do not have the burden of documentation that physical therapists have, but we can take a few pointers from them. Start by eliminating exercises prescribed out of habit and how recent they are in your memory recall.

Our patients and profession will benefit most when a treatment session is maximized by quality over quantity, ensuring patients return to their lives as soon as possible.

6. Mastery before moving on

A strength professional is great at knowing a client’s limits and when to progress and when to pull back. Ensure that your patient is proficient in the exercise you are prescribing before moving on.

This ties back into stimulus as well. Demonstrating mastery is a good indicator of when an increase in the stimulus is needed or when a patient has reached a level of independence and could be considered for possible discharge recommendations.

7. Compound movements

All of the above points I have mentioned are intertwined with each other, this point being no exception. Ensure that your exercise repertoire includes several compound movements. It will help to both maximize time and provide the most functional benefit.

I’m talking about squats, deadlifts, powerlifts, and every variation in between. Break out of the stereotypical thinking of a squat as heavily loading a bar, lowering the weight, and standing it back up. What does a sit to stand look like? A squat. When your patient needs to lift dishes from the dishwasher to the cabinet, does that not mimic the mechanics of a squat with a shoulder press?

Use your movement analysis skills to see how you can manipulate basic exercises to encompass your patient’s needs in order provide purposeful and functional benefit.

8. Body weight

Again, related to stimulus, mastery, and needs analysis, body weight can be a beneficial tool to elicit the desired response from your treatment program. The great strength professionals know that manipulating the rep schemes, rest time, and movements with body weight can be quick, effective, and relevant to the client.

You can challenge your patient effectively when you have a knowledge base of a variety of body weight exercises. This allows you to the perform effectively and efficiently without having to jump right to machines and physioballs. Again, this is all based on the needs of the individual patient. It may not always be indicated or necessary.

9. Patient-driven performance

It has been a goal of the profession to move past the massage and TA contraction stigma of the past. Strength professionals allow their clients to do the work. It is how they progress and achieve better performance.

Making sure your patient can perform a treatment program independently is a strong indicator that they will be successful both in the clinic and in their regular environment. We elevate ourselves as clinicians when we are able to teach independence to our patients.

10. Experience

Experience is something that we all gain by treating patients, past clinical rotations, continuing education, and the knowledge you had prior to gaining the title of physical therapist. How I feel strength professionals differ from physical therapists is that they are not afraid of learning via trial and error.

Your patients will respect that you are trying different things to see what works best and not just trying to fit them into a standard that may not work for them. Do not underestimate the value of an opportunity to learn. Experience trumps all when it comes to how varied exercise can be. The only way to make it less overwhelming is to dedicate yourself to learning a little more every day.

11. Be coachable

The last tip that I have is to be coachable. There is always something to learn and someone to learn from. Whether it be your patient, a colleague, or another professional. Become better at listening and assessing and you will become a better therapist and coach yourself.

Again, this list is not all encompassing. It was compiled to provide physical therapists a stepping stone to starting to become more comfortable with implementing strength and performance into their practice. Now, get out there and get strong!

Looking for more reasons to incorporate strength and conditioning into your physical therapy practice? Check out Why PTs Need to Embrace Strength Training.

About Brittny Silke

Brittny Silke
Brittny is a 3rd year SPT at the University of Florida graduating in May 2018. She received her Bachelor's Degree from the University of Central Florida in Sport and Exercise Science with a concentration in Human Performance. She is CSCS and PWR! certified. Brittny comes from the Pine Tree State (Maine) and enjoys any outdoor activity, warm or cold. Personal hobbies include fitness, reading, traveling, and experimental cooking and is looking to pursue physical therapy in adaptive sports.

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