WEBVTT
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What's up, everybody. You are listening to the Strength and
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00:00:03.640 --> 00:00:06.879
Knowledge podcast. I'm doctor Zach Baker, and I have with
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00:00:06.919 --> 00:00:09.519
me today doctor Corey Jones, and we're going to talk
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a little bit about lifting weights and exercising and answering
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a question that always comes up in the clinic, especially
6
00:00:18.199 --> 00:00:21.760
with students and new grads, and it is always what
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00:00:21.920 --> 00:00:25.399
is the best exercise to do with my patient? And
8
00:00:25.480 --> 00:00:28.440
as with almost every question you'll get, the answer is
9
00:00:28.480 --> 00:00:32.320
it depends and it's probably context dependent. But in the
10
00:00:32.359 --> 00:00:36.200
world of exercise and fitness and strength and conditioning, there's
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a variety of different things that we can do with
12
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our patients, and it can be overwhelming trying to figure
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out where do I start with this person, what do
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they need, what do they want, and what is going
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to give them the most bank for their buck. So
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if we have some sort of strategic way to go
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about answering this question and thinking through this question, I
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think as clinicians, it'll make your day a lot more
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or streamlined, a lot less cognitively demanding, and you're just
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less mentally fatigued at the end of the day because
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you have some kind of automated responses. So Corey. I
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know a lot of people always ask like what should
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I start with with my patient, or what should I
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do with my patient? Should I do isolated exercises, should
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I do compound movement, should I do single or multi
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joint How would you go about even answering that?
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Yeah, so I would say isolated exercise or like single
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joint exercise are really useful whenever you are trying to
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restore range of motion. So if you have mobility limitations,
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some of the things that we think about there are
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using either light eccentrics or reciprocal or autogenic inhibition. So
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if you're using those things to restore range, sometimes it's
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super helpful to do really particular things and very specific
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things for that joint. Or if you've gained some of
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that motion back recently and you're like wanting to really
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rebuild that map in the brain that munculus, you want
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to really restore that to where the body recognizes that
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this joint has more range of motion. I think it's
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helpful to do some of these isolated activities where you're
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really zeroing in on one particular joint. Another thing that
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comes to mind is if you're really working on particular
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tendons or tenanitises right, So we want to be direct
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in our application of some of these forces that we
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can desensitize tissue. So sometimes that's another time we are
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getting really isolated and you're zeroing in on one particular aspect. However,
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the body works together, right, so it's always going to
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be something that we have to coordinate joints and coordinate movement.
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There's a regional interdependence no matter what movement that you're doing.
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So the big thing there is not staying in isolated
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movement patterns. So yes, we can train them and use
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them right after getting a range of motion back, but
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then we also want to dive into how does this
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fit into the whole system, How does it fit into
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a movement pattern, how does it fit into a squat,
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A hinge a a push, a pull, some of those
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basic weightlifting words that you hear when you're training specifics
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in the gym. So always important to eventually get back
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to that global because we also need to figure out
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nurow motor control when we're using that force. So you
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can train all you want, but if you don't know
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how to apply that force and apply that throughout an
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entire skeleton, then it's going to be really hard to
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actually have some of these functional movement patterns nailed down.
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So restoring that stability, restoring that strength super important joint
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to joint, but then we got to throw it into
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a more global movement pattern to really translate into real life.
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So sometimes I feel like people often do that in
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the gym. What would you say, Zach, to somebody who's
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trying to dive into whether or not to use free
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weights versus maybe some of the machines of the gym,
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how would you talk about some of the similar things
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in relation to what to get after at the gym.
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So I think there are instances where both can be
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highly beneficial. And whether it's in early phase rehab or
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later phase reha, or whether you're trying to make things
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more simple or more difficult for them. The beauty of
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machines is that they reduce the degrees of freedom. They
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constrain movement, which sometimes you don't like that because you
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want them to be able to express move them a
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little bit freely. But if you have somebody that maybe
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coordination is an issue, or maybe stability is an issue,
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or maybe you don't want them having to worry about technique,
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and you just want them to be able to put
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forth a lot of effort. Machines are great for that.
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It constrains the movement, It puts them in a very
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predictable environment, and all they have to worry about is
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how hard they're pushing and how many times they need
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to push that weight. So it can be a very
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good way to simplify something so that they can just
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focus on the effort at hand. The other thing that
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machines do really well is they isolate. So if I
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have somebody who is a post operative knee patient and
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I know that I need to get their knee extension
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strength better and their quads developed well, squads are a
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good exercise for that. Lunges are a good exercise for that.
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Step ups are a good exercise for that. But unfortunately,
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there's no way to definitively quantify how much the quads
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are actually contributing to that. And we know if we're
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doing more reps, we're doing more weight, then indefinitely they
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are getting stronger, but we can never truly put a
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number on it. But if I put them on a
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leg extension machine, I know the only muscle group that's
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going to be contributing to that movement is the quads.
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There's no way to cheat the system. There's no way
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to compensate or I mean, if you find a way,
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you're going to look pretty goofy trying to do that.
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But it's a way to really isolate the quad and
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you can definitively quantify and know, am I getting stronger?
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Am I moving more weight? With this? Now, maybe we
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want to focus on something that is a little bit
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more appropriateuceptively challenging. Maybe we do want to give them
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a little bit more technical demands with the activity. Maybe
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we want them operating in space and having to show
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competency with high levels of intention and high levels of
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force when they don't have that inherent stability or kind
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of guided pathway that the machine provides. And this is
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where free weights really really come in handy. Now, the
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one downside to that, the more movement that is allowed,
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there's more to coordinate, there's more to stabilize, there's more
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pieces to put together, so that could potentially limit the
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amount of force and intensity that they're able to operate at.
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If they have so much of their their bandwidth and
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their energy going towards proper reception and stability. There's only
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so much left in regards to force production or force dissipation.
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But I think a lot of this comes down to
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what do we think is the weakest link. And when
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we're looking at movements and maybe somebody has a an
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altered movement strategy and we're trying to figure out, you know,
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why is this person not descending steps? Well, you know
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they have a very stiff kneed pattern, they're not flexing
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the knee. What do we think is contributing to that?
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Is it coordination, is it strength? Is it apprehension? And
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that is huge when considering that. I don't know if
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you have any thoughts there, Corey.
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Yeah, so that makes me think too. Like when we're
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talking diagnostically, like trying to determine what muscles we need
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to might work into more, or what movement patterns we
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need to move into more, one of the diagnostic things
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that we're doing is eliminating body parts. So exactly what
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you're saying, So if we need if we are doing
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a squat that's involving almost everything, right, that's triple flexion.
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Everybody's moving. If we want to see how the hip
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is particularly operating that let's eliminate some joints. So let's
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have them go to half kneeling, and now let's have
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them do a half kneeling sit back. It's still a
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squat pattern, but we've eliminated foot and ankles, So now
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we can see what is the hip doing in this movement.
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Is it moving extra in the frontal plane? Is it
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moving very well in the sagital plane. Do they have
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full into motion and full capacity to load this joint.
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So it's interesting because it kind of comes back to
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that too. When you're in that free weight stance, you
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can just do a whole movement pattern to be functional,
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or you can diagnostically say, I need to zero in
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on who's really not paying it, you know, paying their
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dues as far as this movement goes, who's not contributing?
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And so we can eliminate body parts by changing through
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those NeuroD developmental stages. So I need to go to
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either half kneeling, tall an aniling, I need to go
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way down to quadruped or spine supported and figure out
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who's not contributing. Then maybe where we work directly into
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that joint again, boost some of that strength and see
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if we can put the puzzle piece back into the puzzle,
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or we're looking at functional strength again. So it's just
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I think really important based on what you said, just
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to make sure that we're using both in ways that
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we can rationalize. Right, So it's not like there's one
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better than the other, but it's almost context dependent and
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situational to say this one's going to help me at
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this time because I'm after this particular muscle or at
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this moment, I'm more interested in what's happening. Yeah, neurologically
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properceptive in a full movement pattern to see if we
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can coordinate and really load tissues adequately in order to
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generate more force. So yeah, interesting to kind of chat
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back and forth where each has their place.
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Yeah, And I think that's important to note is that
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each does have their place. And I think we have
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a lot of purists or absolutists that think one is
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superior to the other or one is necessary. And I
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think this highlights that there's a lot of different ways
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that you can accomplish the same goal, and there may
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be some where it's a little bit more advantageous to
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go at it with one approach, whereas another way you
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may want the opposite approach. So I think the take
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home message is be intentional, be strategic, and make sure
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you have a rhyme or reason as to why you're
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doing what you're doing. And if you do that and
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you're tracking progress, you're probably going to get pretty good results. We,
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as always Corey, appreciate having you on here sharing your
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words of wisdom with us. If you enjoyed this episode,
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please share, like, and subscribe. You are listening to the
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Strength and Knowledge podcast. Have a great day.
1
00:00:01.280 --> 00:00:03.600
What's up, everybody. You are listening to the Strength and
2
00:00:03.640 --> 00:00:06.879
Knowledge podcast. I'm doctor Zach Baker, and I have with
3
00:00:06.919 --> 00:00:09.519
me today doctor Corey Jones, and we're going to talk
4
00:00:09.560 --> 00:00:13.599
a little bit about lifting weights and exercising and answering
5
00:00:13.640 --> 00:00:17.920
a question that always comes up in the clinic, especially
6
00:00:18.199 --> 00:00:21.760
with students and new grads, and it is always what
7
00:00:21.920 --> 00:00:25.399
is the best exercise to do with my patient? And
8
00:00:25.480 --> 00:00:28.440
as with almost every question you'll get, the answer is
9
00:00:28.480 --> 00:00:32.320
it depends and it's probably context dependent. But in the
10
00:00:32.359 --> 00:00:36.200
world of exercise and fitness and strength and conditioning, there's
11
00:00:36.240 --> 00:00:38.880
a variety of different things that we can do with
12
00:00:38.920 --> 00:00:42.159
our patients, and it can be overwhelming trying to figure
13
00:00:42.159 --> 00:00:44.359
out where do I start with this person, what do
14
00:00:44.399 --> 00:00:47.159
they need, what do they want, and what is going
15
00:00:47.200 --> 00:00:49.960
to give them the most bank for their buck. So
16
00:00:50.039 --> 00:00:53.240
if we have some sort of strategic way to go
17
00:00:53.320 --> 00:00:57.079
about answering this question and thinking through this question, I
18
00:00:57.079 --> 00:01:00.000
think as clinicians, it'll make your day a lot more
19
00:01:00.119 --> 00:01:04.959
or streamlined, a lot less cognitively demanding, and you're just
20
00:01:05.159 --> 00:01:07.400
less mentally fatigued at the end of the day because
21
00:01:07.439 --> 00:01:11.760
you have some kind of automated responses. So Corey. I
22
00:01:11.799 --> 00:01:13.560
know a lot of people always ask like what should
23
00:01:13.599 --> 00:01:15.840
I start with with my patient, or what should I
24
00:01:15.879 --> 00:01:20.079
do with my patient? Should I do isolated exercises, should
25
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I do compound movement, should I do single or multi
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joint How would you go about even answering that?
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Yeah, so I would say isolated exercise or like single
28
00:01:32.000 --> 00:01:34.959
joint exercise are really useful whenever you are trying to
29
00:01:35.000 --> 00:01:39.640
restore range of motion. So if you have mobility limitations,
30
00:01:39.680 --> 00:01:41.280
some of the things that we think about there are
31
00:01:41.359 --> 00:01:46.040
using either light eccentrics or reciprocal or autogenic inhibition. So
32
00:01:46.079 --> 00:01:48.680
if you're using those things to restore range, sometimes it's
33
00:01:48.719 --> 00:01:52.200
super helpful to do really particular things and very specific
34
00:01:52.239 --> 00:01:55.040
things for that joint. Or if you've gained some of
35
00:01:55.079 --> 00:01:58.319
that motion back recently and you're like wanting to really
36
00:01:58.359 --> 00:02:01.920
rebuild that map in the brain that munculus, you want
37
00:02:01.920 --> 00:02:04.879
to really restore that to where the body recognizes that
38
00:02:04.920 --> 00:02:07.640
this joint has more range of motion. I think it's
39
00:02:07.640 --> 00:02:10.319
helpful to do some of these isolated activities where you're
40
00:02:10.360 --> 00:02:13.840
really zeroing in on one particular joint. Another thing that
41
00:02:13.879 --> 00:02:16.599
comes to mind is if you're really working on particular
42
00:02:16.800 --> 00:02:19.560
tendons or tenanitises right, So we want to be direct
43
00:02:19.840 --> 00:02:21.879
in our application of some of these forces that we
44
00:02:21.919 --> 00:02:25.039
can desensitize tissue. So sometimes that's another time we are
45
00:02:25.039 --> 00:02:29.120
getting really isolated and you're zeroing in on one particular aspect. However,
46
00:02:29.639 --> 00:02:32.560
the body works together, right, so it's always going to
47
00:02:32.599 --> 00:02:35.879
be something that we have to coordinate joints and coordinate movement.
48
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There's a regional interdependence no matter what movement that you're doing.
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So the big thing there is not staying in isolated
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movement patterns. So yes, we can train them and use
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them right after getting a range of motion back, but
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then we also want to dive into how does this
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fit into the whole system, How does it fit into
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a movement pattern, how does it fit into a squat,
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A hinge a a push, a pull, some of those
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basic weightlifting words that you hear when you're training specifics
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in the gym. So always important to eventually get back
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to that global because we also need to figure out
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nurow motor control when we're using that force. So you
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can train all you want, but if you don't know
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how to apply that force and apply that throughout an
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entire skeleton, then it's going to be really hard to
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actually have some of these functional movement patterns nailed down.
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So restoring that stability, restoring that strength super important joint
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to joint, but then we got to throw it into
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a more global movement pattern to really translate into real life.
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So sometimes I feel like people often do that in
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the gym. What would you say, Zach, to somebody who's
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trying to dive into whether or not to use free
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weights versus maybe some of the machines of the gym,
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how would you talk about some of the similar things
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in relation to what to get after at the gym.
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So I think there are instances where both can be
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highly beneficial. And whether it's in early phase rehab or
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later phase reha, or whether you're trying to make things
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more simple or more difficult for them. The beauty of
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machines is that they reduce the degrees of freedom. They
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constrain movement, which sometimes you don't like that because you
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want them to be able to express move them a
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little bit freely. But if you have somebody that maybe
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coordination is an issue, or maybe stability is an issue,
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or maybe you don't want them having to worry about technique,
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and you just want them to be able to put
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forth a lot of effort. Machines are great for that.
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It constrains the movement, It puts them in a very
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predictable environment, and all they have to worry about is
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how hard they're pushing and how many times they need
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to push that weight. So it can be a very
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good way to simplify something so that they can just
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focus on the effort at hand. The other thing that
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machines do really well is they isolate. So if I
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have somebody who is a post operative knee patient and
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I know that I need to get their knee extension
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strength better and their quads developed well, squads are a
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good exercise for that. Lunges are a good exercise for that.
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Step ups are a good exercise for that. But unfortunately,
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there's no way to definitively quantify how much the quads
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are actually contributing to that. And we know if we're
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doing more reps, we're doing more weight, then indefinitely they
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are getting stronger, but we can never truly put a
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number on it. But if I put them on a
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leg extension machine, I know the only muscle group that's
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going to be contributing to that movement is the quads.
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There's no way to cheat the system. There's no way
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to compensate or I mean, if you find a way,
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you're going to look pretty goofy trying to do that.
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But it's a way to really isolate the quad and
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you can definitively quantify and know, am I getting stronger?
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Am I moving more weight? With this? Now, maybe we
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want to focus on something that is a little bit
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more appropriateuceptively challenging. Maybe we do want to give them
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a little bit more technical demands with the activity. Maybe
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we want them operating in space and having to show
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competency with high levels of intention and high levels of
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force when they don't have that inherent stability or kind
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of guided pathway that the machine provides. And this is
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where free weights really really come in handy. Now, the
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one downside to that, the more movement that is allowed,
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there's more to coordinate, there's more to stabilize, there's more
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pieces to put together, so that could potentially limit the
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amount of force and intensity that they're able to operate at.
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If they have so much of their their bandwidth and
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their energy going towards proper reception and stability. There's only
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so much left in regards to force production or force dissipation.
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But I think a lot of this comes down to
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what do we think is the weakest link. And when
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we're looking at movements and maybe somebody has a an
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altered movement strategy and we're trying to figure out, you know,
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why is this person not descending steps? Well, you know
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they have a very stiff kneed pattern, they're not flexing
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the knee. What do we think is contributing to that?
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Is it coordination, is it strength? Is it apprehension? And
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that is huge when considering that. I don't know if
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you have any thoughts there, Corey.
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Yeah, so that makes me think too. Like when we're
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talking diagnostically, like trying to determine what muscles we need
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to might work into more, or what movement patterns we
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need to move into more, one of the diagnostic things
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that we're doing is eliminating body parts. So exactly what
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you're saying, So if we need if we are doing
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a squat that's involving almost everything, right, that's triple flexion.
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Everybody's moving. If we want to see how the hip
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is particularly operating that let's eliminate some joints. So let's
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have them go to half kneeling, and now let's have
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them do a half kneeling sit back. It's still a
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squat pattern, but we've eliminated foot and ankles, So now
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we can see what is the hip doing in this movement.
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Is it moving extra in the frontal plane? Is it
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moving very well in the sagital plane. Do they have
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full into motion and full capacity to load this joint.
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So it's interesting because it kind of comes back to
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that too. When you're in that free weight stance, you
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can just do a whole movement pattern to be functional,
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or you can diagnostically say, I need to zero in
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on who's really not paying it, you know, paying their
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dues as far as this movement goes, who's not contributing?
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And so we can eliminate body parts by changing through
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those NeuroD developmental stages. So I need to go to
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either half kneeling, tall an aniling, I need to go
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way down to quadruped or spine supported and figure out
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who's not contributing. Then maybe where we work directly into
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that joint again, boost some of that strength and see
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if we can put the puzzle piece back into the puzzle,
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or we're looking at functional strength again. So it's just
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I think really important based on what you said, just
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to make sure that we're using both in ways that
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we can rationalize. Right, So it's not like there's one
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better than the other, but it's almost context dependent and
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situational to say this one's going to help me at
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this time because I'm after this particular muscle or at
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this moment, I'm more interested in what's happening. Yeah, neurologically
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properceptive in a full movement pattern to see if we
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can coordinate and really load tissues adequately in order to
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generate more force. So yeah, interesting to kind of chat
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back and forth where each has their place.
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Yeah, And I think that's important to note is that
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each does have their place. And I think we have
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a lot of purists or absolutists that think one is
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superior to the other or one is necessary. And I
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think this highlights that there's a lot of different ways
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that you can accomplish the same goal, and there may
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be some where it's a little bit more advantageous to
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go at it with one approach, whereas another way you
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may want the opposite approach. So I think the take
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home message is be intentional, be strategic, and make sure
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you have a rhyme or reason as to why you're
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doing what you're doing. And if you do that and
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you're tracking progress, you're probably going to get pretty good results. We,
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as always Corey, appreciate having you on here sharing your
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words of wisdom with us. If you enjoyed this episode,
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please share, like, and subscribe. You are listening to the
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Strength and Knowledge podcast. Have a great day.
