Kettlebells Enter Rehab

It is time for kettlebells to enter the rehabilitation and reconditioning setting.

 I have been using them with painful and dysfunctional clientele with a plethora of various pathologies. I do not contraindicate movements, but rather I contraindicate individuals for particular movements.  This is an important delineation that must be made, and biases must be avoided based upon assumptions.  The clinical reasoning process is critical, and must be well understood before prescribing dynamic activities such as kettlebell lifting.  Obviously the rehabilitation professional must respect the irritability of the client along with the level of tissue healing. However, when deemed appropriate the kettlebell is a useful tool that is unique from any other piece of equipment.

My argument for the use of kettlebells in rehabilitation is multi-factorial, but it mirrors the same reasons that they are used for Girevoy sport, tactical conditioning, collegiate sports, professional sports, Crossfit, and with the general healthy population in the fitness industry.  Pragmatically, the kettlebell is the most logistically sensible tool available for all that it offers an adept professional.  It requires very little space, they are a relatively small investment, they provide various exercise permutations, and they are completely different from other strengthtraining modalities.  Furthermore their use promotes total body integrated function in a 3D way, they are always improving grip strength, power development is readily made available with them, trunk stability is easily assessed, and they lend themselves to simple program design.  I attempt to follow the Daily adjustable progressive resistive exercise (DAPRE) system which is as follows:

1st set requires 10 repetitions of 50% of the estimated 1RM.
2nd set requires six repetitions of 75% of the estimated 1RM.
3rd set requires the maximum number of repetitions of 100% of the estimated 1RM.
4th set = the number of repetitions performed during the third set determines the adjustment to be made in resistance for the fourth set. 

3rd Set                  4th Set                 Next Session

0-2                        -5-10lbs                    -5-10lbs 
3-4                        -0-5lbs                         Same
5-6                         Same                       +5-10lbs
7-10                      +5-10lbs                   +5-15lbs
11 or more            +10-15lbs                 +10-20lbs
*NSCA: The Essentials of S&C Ch. 20

In the rehabilitative setting I have used the reverse dead lift with the kettlebell behind the client with both hands on the handle all the way across the continuum to the snatch with numerous pathologies including but not limited to:

Lower Back Pain, Degenerative Disc Disease, Sciatica, Piriformis Syndrome, Lumbar Strain, Hamstring Strain, Calf Strain, Adductor Strain, ACL reconstruction, Meniscus Repair, etc.

The Swing is extremely valuable to have in your exercise collection because it directly attacks the lower crossed syndrome and can be applied for Adhesive Capsulitis due to the traction on the gleno-humeral joint to teaching trunk stability to your young female Patello-Femoral Pain Syndrome clients.  If you want to go overhead learn the snatch or overhead press.  Another universally valuable exercise is the Turkish Get Up that is valuable for approximation of the gleno-humeral joint for Shoulder Instability and Rotator Cuff Dysfunction.  I also prescribe the arm bar manuever for local spinal muscle recruitment during the rolling pattern and overall spinal mobility with integration of the entire body.

The kettlebell is an often times ignored and under utilized tool in the clinical setting and this must be changed in order to provide the best services possible for our clientele.  The evolution of rehabilitation and reconditioning must continue based on appropriate clinical reasoning and rationale.  It is time for the kettlebell to enter the rehabilitation and reconditioning setting and I hope that you will invite it in with open minds!

Posted by Dr. Don Reagan, DPT


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