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.
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.
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.
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.
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 the load must equal capacity and also where the load must be less than capacity for prevention.
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 3x10 of yellow Theraband exercises.
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.
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 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?
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 manipulating the rep schemes, rest time, and movements with bodyweight 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 bodyweight exercises. This allows you to 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.
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 a 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!