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Strength Training for Rehab


By Evan Loomis, PT, DPT

Take a moment to picture a woodworking shop in your head. What do you see? Even if you have never seen a woodworking shop before in your life, you would probably picture a few abstract items: a workbench, tools, maybe a big saw. The demands of producing finely crafted furniture tell you all about the tools needed for the task. When people picture a physical therapy clinic, they usually imagine patient tables, elastic bands, and small brightly-colored dumbbells. To be fair, those tools have important uses, especially for the early stages of many rehabilitation cases, and we use them at our clinic all the time. Most people would not picutre barbells, squat racks, and heavy weights in a physical therapy clinic. Most would feel this belongs only in a gym!  This clinical mental picture belies an oversight in the physical therapy industry: we sometimes neglect the opportunity to get people stronger.

To be fair, I think that the common fallacy of neglecting efficient strength training in physical therapy rehab is not a willfully ignorant one. I can attest that my education in earning my doctoral degree in physical therapy did not include a comprehensive strategy in training for strength. Physical therapy school does produce clinicians who excel at managing common conditions affecting the musculoskeletal system at acute, subacute, and chronic levels. However, physical therapists are meant to help with treatment and prevention of reinjury, I would argue that physical therapists who aren’t able to effectively transition an injured person into meaningful strength training as part of their rehabilitation are leaving crucial elements of recovery on the table.

Stronger is Better

Strength is defined in Starting Strength, 3rd edition (Rippetoe, 2011) as the “production of force against an external resistance.” In other words, we can think about strength as the way we physically interact with our surroundings. It stands to reason that if your strength improves, your interaction with your physical environment will improve. When you participate in physical therapy, your therapist is responsible for helping manage recovery from injury and to improve your ability to function within your daily activities. This task is best managed when your therapist pays attention to improving your strength as it relates to those daily activities.

The process of improving physical strength is a relatively simple one; a stress must be applied, then the body is allowed to recover from that new stress and adapt to it. This cycle is repeated with gradually increased stress (weight) applied over time.  The causes the body to adapt to this stress over time to that stress and as a result strength is increased. For individuals of most levels of training or rehabilitation, this process of stress, recovery, and adaptation occurs between each physical therapy session in small increments, until the patient has successfully achieved their rehab goals.

The barbell has received an increased amount of attention culturally over the last decade, largely because of the influence of CrossFit and similar organizations. Barbell training can be understood simply as applying an increased load to the functional movement patterns we already use in daily life; the squat is analogous to sitting and standing, just as the deadlift is nothing more than picking up something heavy. Pressing overhead and the bench press represent interacting with your environment by either lifting objects over your head or pushing them away from you, and the list goes on. Performing these basic patterns of movement with a load that increases over time allows you to challenge your strength within those capacities, and utilizing the right dose and frequency of exposure to increasing resistance harnesses your body’s ability to adapt to increased stress and to improve your physical strength.

We often use barbells to train strength in our clinic because for most people, it’s the ideal tool for the job. We still use those traditional physical therapy implements I referred to earlier, as well as dumbbells, kettlebells, cable machines, and any number of other tools. But those tools should only be used in situations where barbell training is not the most efficient method of training that specific individual in their current state of injury or rehabilitation. The rationale for selecting the best training tool is based on which tool helps achieve the goal of improving strength most efficiently. Personal preference and aesthetics (i.e. a perception of which exercises “look cool”) vary from person to person and should take a backseat to the primary objective of improving each patient’s physical existence in relation to their specific goals. 

Treatment versus prevention

A significant amount of energy has been expended in the healthcare industry considering how to best incorporate prevention into treatment of adverse health events. The adage “an ounce of prevention is worth a pound of cure” summarizes this thinking nicely. Physical therapy is a field which especially trafficks in both treatment and prevention. I would suggest that an intelligent strength training program included as part of routine physical therapy intervention serves the aims of both treatment and prevention simultaneously, because the process of training through injury does produce the strength that safeguards one from future injury. In the process of treating chronic back pain, we often use the squat and deadlift as training tools which, when dosed correctly, achieve dual goals of recovering from the injury at hand while also providing the strength to reduce the likelihood of that patient reinjuring their back next time they move something heavy.

If you’ve taken the time to read this blog post, it’s probably safe to assume that you have participated in physical therapy at some point. Should you find the need for physical therapy to help recover from injury in the future, I would recommend you apply a critical lens to the rationale for which tools are selected in helping you achieve your goals. Furthermore, I recommend you seek out a physical therapist who can effectively and efficiently help you achieve those goals with the development of physical strength in mind. If you have questions how our clinic can utilize barbell strength training to help you, then call us at 479-202-0337.  Myself or any of our therapists would be happy to share our insight with you.