We all know that working on load progressions is an important part of therapy and training, but not everyone has access to equipment to properly load people.
Luckily, there are things you can do to progressively load people with minimal equipment.
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#AskMikeReinold Episode 289: Progressive Loading with Minimal Equipment
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Show Notes
Transcript
Student:
Ursula from Europe. Did you hear me? Ursula from Europe?
Mike Reinold:
Yes.
Student:
Could you give us some more suggestions on how to progress rehab program when working in a setting with very limited equipment access? I’ve read so much about loading for strength gain recently and I feel like I just can’t do that at my work current workplace. So I’m struggling with how to make the program challenging enough.
Mike Reinold:
Awesome. Great question, Ursula. I like that. And I bet you Ursula, I bet you’re not the only one that has these problems, right? So I think what’s great about this question is that Ursula’s identified that she’s been learning a lot and she sees the need to add more loading to her. And I would say in the rehab environment, in the physical therapy world, we probably load people poorly, right? In general, as a profession, I would say, not everybody of course. But I’d say that’s an area that we probably are lacking on sometimes. So I think it’s awesome that Ursula sees the need, but she’s in a clinic that doesn’t have a lot of equipment, right? So, common dilemma. I bet a lot of people are doing this. I’m hearing from a lot of clinic owners that are actually now starting to get out there and try to buy equipment for this exact need. But what do you do in the meantime, who wants to take the lead on this one? Who wants to start off?
Dave Tilley:
I think the guy with two strong man trophies in his background should do it.
Dan Pope:
Check it out.
Mike Reinold:
Yeah. What’s up Dan? What do you think? So like you’ve been in clinics before, right? And not every clinic has squat racks and barbells and bumper plates. What have you done in the past? How do you load people if maybe you don’t have access to some of that fancy strength and conditioning equipment?
Dan Pope:
Yeah it is kind of funny, right? If you’re like an outpatient gym with kettle bells up to like 16 pounds, that’s like hardcore, right?
Mike Reinold:
(Laughs) Right.
Dan Pope:
But yeah, usually it’s like 12 pounds is like the top for dumbbells and then maybe some Pilates equipment or maybe some machines, if you’re lucky and that’s tough. And I’ve been in clinics like this in the past, and it’s challenging because not a lot of folks have the money or they have the space to put in like a squat rack with bumper plates and all the crazy stuff that maybe we have. But I do think there’s a few pieces of equipment that go a long way. When I was in a smaller outpatient facility, I ended up bringing my own equipment in, you know?
Mike Reinold:
Wow.
Dan Pope:
And I brought in… Yeah, just because I’ve seen a lot of patients that really needed a bit more load for their goals. And I think if you could, if you were able to get some adjustable dumbbells, maybe something like zero to 50 pounds. It’s something that takes up very little space. Nowadays it’s a bit more expensive, but it’s going to be something that goes a long way. If you just have some dumbbells up to, let’s say 50 pounds, you can do so much with the average person.
Dan Pope:
Maybe for when he’s a higher level athlete, you’d be a little bit struggling in terms of trying to find enough load for them. But that’s a great place to start. The other thing I think is super duper versatile and doesn’t take up a lot of space is trying to use a landmine. So if you guys haven’t heard of a landmine before, you just take a barbell, you put it on one end and you put plates on the end of it. And it can kind of as a dumbbell or a barbell. You can squat, lunge, press. You can do so much with it. It’s kind of crazy if you’re just a little bit more creative.
Dan Pope:
And the other idea that I had for folks is to try to dabble a little bit more with blood flow restriction training. Now BFR is, I would say it’s more of an introductory type of treatment just because you’re using lower loads. And often times the patient over the course of time is going to have to tolerate higher loads at higher speeds. And that’s not what BFR is all about, but you can use around 20% of the patient’s max and do higher reps. So 30, 15, 15, 15 is a common set and rep scheme. And you can get people quite a bit stronger, build muscle mass. It’s phenomenal for rehab in general, because most folks can’t tolerate much load initially. And those can kind of get you by. And I think if you’re doing those three things, you’re probably doing more than 80% of clinics that I’ve seen in a standard outpatient place.
Mike Reinold:
Yeah and you can probably get pretty creative with just that. I mean, what you just listed there was just hundreds of dollars and on the low end of hundreds of dollars too, to be honest with you. So upgrading some of your equipment Ursula I think is probably a reality that’s probably going to have to happen and there’s some creative ways to do that without spending $10-20,000. But I feel like as a general rule of thumb, please nobody tweet this, but if your PT clinic looks worse than like a Holiday Inn fitness center, that’s probably a bad sign, right? Like you probably need to have a little bit more equipment than just what you’d find at a very low end hotel.
Mike Reinold:
So for me, I think if you only have 12 pounds, you don’t have enough weight. Your patient demographic is either not somebody that you care about loading or you just have a completely different treatment model. So I like the suggestions there from Dan. I like the BFR suggestion too, because if you don’t have access too, is what BFR allows you to do is get some significant strength gains with lesser load. Which is something you’re dealing with in your setting, which is fantastic. Now that doesn’t replace loading in the future, but it is an adjunct towards that. And it sounds like Ursula, that would be a good step. But Dave, what do you think you want to add anything to that?
Dave Tilley:
Yeah, I was just talking to, I think maybe Ali about this the other day. But I mean, obviously the getting equipment is what I think we all would suggest, but I think sometimes you’re dealing with maybe managers or people who are not as receptive to doing that really fast. So you’re still stuck for a couple months without that. So I think it’s important to remember, although not ideal, there’s a lot of different ways to make exercise harder without it just being load dependent, right? So you could, in the short term, maybe find some patterns that are maybe more challenging, just going from a double leg squat or a double leg hinge to a single leg exercise is going to be a little bit more challenging. So doing a step up or some sort of split pelvis might be more challenging, but also you can play around with some of the other variables like tempo, pause, density and back to back sets or volume and stuff like that to maybe make things harder in the short term.
Dave Tilley:
So instead of getting a 50 pound goblet squat, you could probably easily do a 12 pound dumbbell split squat, and maybe elevate the front leg or the back leg if it’s appropriate for the person. And that’s pretty terrible. Like it’s really hard to do like a good three second, one second, pause and a one second on the way back up for like seven reps of that. And if you pair that with something else, that’s maybe got some density for isolation. So some knee extensions, if you have ankle weights or some other sort of planking exercises, you can probably build a pretty decent program that can maybe make the ends meet for maybe a month or two before you can pick the battle of getting some more equipment that you need.
Dave Tilley:
So I find it many times… Particularly people have like back or hip issues or stuff like that or lower body. And I mean, the upper body is very similar with single arm movements. Sometimes people don’t tolerate load really well early in the rehab setting, which is why we use BFR. But like things like single leg exercises, split pelvis or other options are usually more friendly anyways. So you might be able to kind of cheat the corners that way with it.
Mike Reinold:
Right. Great suggestions. I like it. Kevin, did I, you want to add to that?
Kevin Coughlin:
Yeah, I just want to say I’ve I found myself in this situation being in a clinic without a ton of equipment. And I kind of did a combination of what Dave and Dan both alluded to. So I used some money early on, just because I have a long your goal of kind of having my own home gym. So I think if you’re going to, if you’re going to invest in equipment for yourself, you can bring it into the clinic. So that was something I did that was helpful. And then even getting creative, just like most of these types of facilities have either like hand weights that go up to 10 pounds or something or ankle weights.
Kevin Coughlin:
So if you even get like a backpack and throw some of the weight in there, it’s at least a way to do a little bit of loaded. That’s something I did a lot with like Achilles tendinopathy patients or plantar fasciitis, so maybe start with like double leg stuff like Dave was saying with just some tempo progressing into like single leg. And then if you get one of these backpacks, just normal backpack and throw some weight in there, at least you’re able to get the most out of what you have. And then if it’s a clinic you see yourself at long term, if your clinic isn’t worth, if they’re not going to invest in it’s an investment you can make on your own. And I think the patients would definitely greatly appreciate it.
Mike Reinold:
Yeah and you should probably over time probably consider maybe getting in a work environment that thinks that loading is beneficial for people too. And that’s kind of one of the things that jumps out in my mind kind of listening to some of these answers here is we’re talking about hundreds of dollars. At Champion, we always talk about our treatment paradigm, it’s mobility control, load. That’s kind of how we deal with most things. Mobility control, load. If you’re building your practice and you don’t have the ability to load, you’re missing out on a good chunk of the treatment, right?
Mike Reinold:
Lisa, what do you think?
Lisa Lowe:
Excuse me. I was just thinking even within the clients that we see at Champion, a lot of times I have people who aren’t able to come in as frequently as they would need to use our equipment to be loaded often. So what I’ve had a lot of people do, and I know pretty much everybody else does this too, I will have them if they’re like a YMCA member, or a Planet Fitness person or a whatever their other gym is… I’ll have them let me know what equipment they have and then send me videos of them moving during their workout so that at least they make sure they know I don’t want them to waste their time just because they can’t come in. It doesn’t mean they can’t make progress.
Lisa Lowe:
And, so even though we have the load like not everybody can always come utilize the load. So being able to let them use what they have at home or encourage them to just like get a gym membership so that they can do what they need to. Getting a YMCA membership is not that expensive. So people being able to do that and then have access to load it seems to work pretty well when people can’t necessarily make it in, or then also if you just don’t have access to load in your clinic.
Mike Reinold:
Yeah, and it also made me think too, like if your clinic doesn’t value loading and it doesn’t have enough equipment for loading, you probably need to have relationships with some local gyms too. Anyway, that probably needs to be part of what you’re helping your patients with is, alright, I’ve gotten you past these beginning steps. Now it’s time to progress over there. Maybe you collaborate with some strength coaches too, or help them with their own home program at a gym. I think that’s great. Diwesh, as our strength coach on the call for now, right? I don’t want to lead your answer here, but I was thinking we just went through COVID, right? Where the gym was completely shut down and we were helping tons of people exercise and still meet their fitness and sports performance goals at home. So you could argue, we kind of face that to an extent. But that, including your other thoughts, but I’d love to hear from a strength coach’s perspective, ways that you can help people build some loading capacity when maybe you don’t have access to all this equipment.
Diwesh Poudyal:
Yeah, for sure. I think Dave definitely covered a lot of it. And I think it does come down to utilizing your variables, to increase a little bit more of the total amount of stress on the body, right? Whether that’s the number of sets and the number of reps increasing the time under tension. But other creative ways that we can kind of go about it is kind of doubling down on different types of equipment. So what I’m talking about is, imagine you’re doing a dumbbell RDL, right? But let’s say we only have those 12 pound dumbbells, where while you can stand on a pair of bands and you can hold the band tension in the hand on top of the weights, now you have your 12 pound dumbbells plus an extra band tension, right.? So that’s kind of some of the stuff that we ended up doing as we were going through COVID we just kind of found creative ways to start adding on different levels or different types of tension on top of the conventional weights that they had.
Diwesh Poudyal:
And then the other thing that I think is very underutilized, is really using gravity to our advantage, right? So if you put someone on prone or quadruped for upper body exercise, that becomes way harder. Right? So stuff like that, I think can definitely go quite a long ways. And believe it or not, people that are willing to get creative, and maybe you as a clinic, have to be a little bit more creative. But I remember I had a couple kids throughout COVID like literally started filling up jugs of water bottles with sand and crazy stuff like that. I had a kid actually make his own squat rack. He didn’t have the money to buy a dumbbell, barbell and stuff. But he went out to Home Depot, bought some wood and filled up some water jugs with sand and stuff, and he got a barbell. So there’s…
Mike Reinold:
That’s crazy.
Lenny Macrina:
This sounds like a young Dan Pope.
Diwesh Poudyal:
Yeah…
Mike Reinold:
Yeah, exactly.
Diwesh Poudyal:
Yeah, Dan was mentoring this kid along the way.
Mike Reinold:
What do you fill it with? Because you could argue like a pound of water might weigh different than a pound of feathers, for example.
Dan Pope:
Who would make that argument?
Mike Reinold:
(Laughs) Just seeing who’s still awake. I like that. That’s great. (laughs)
Mike Reinold:
Awesome. Well Ursula, I think the main point is there’s ways to get creative, right? I like what Dewey added right there. I’ve seen people use like gallons of milk that are filled up with various amounts of water for different exercises. There’s definitely ways to do it. There are some low cost ways to also get some equipment in your facility that allows you to do a little bit more. You don’t have to break the bank and spend $10,000. You can do this in a, probably a budget friendly way. So that’s probably a conversation worth having with your facility because I think that is an important one, right? There’s definitely some different things that are out there. So for example, Mike Scaduto just brought up a good example. There’s a new company called Ancore, A-N-C-O-R-E, that’s just outside Boston. We met with the owner the other day and they have a great device for $500 that essentially is the size of it’s…I don’t even know what’s the size of like a sneaker.
Mike Scaduto:
Like a TV remote. Yeah.
Mike Reinold:
Yeah, yeah. It’s like the size of, yeah… It replaces essentially like a 60 pound cable pulley. So I think that, you get some power blocks, you get a barbell, like Dan said. I still think we’re looking at pretty much underneath $1,000 that you can amortize over the cost of every patient that should be coming in your clinic. So I think there’s ways to do it, but I also think as others suggest that there’s ways to manipulate variables and just set rep schemes and tempo and loading and stability.
Mike Reinold:
So hopefully those tips helped Ursula. I don’t think this is a rare predicament. So if you have other suggestions or things you’ve done in your clinic, throw it out there on social media for us. We’d love to see it because I think this is a pretty common thing so I like this question. So, thanks again. If you have a question like that, head to mikereinold.com, click on that podcast link, and you could fill out the form to ask us a question just like that. And be sure to head to iTunes, Spotify… Rate, review, and subscribe, and we will see you on the next episode.
