On this episode of The Ask Mike Reinold Show, we talk about if physical therapists should be loading up big movements like the squat and the deadlift with their patients. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 189: Should Physical Therapists Squat and Deadlift with Their Patients?
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Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about wether or not you should be loading some of the big lifts, like squatting and deadlifting, in physical therapy.
Mike Reinold: All right so Ricky Bobby from Talladega.
Student: My boss said to me that PT is not personal training. You need to stop overloading these patients with squats and dead lifts. These patients are injured. You need to take it easy on them. I thought the evidence of large muscle group training in addition to PT exercises is pretty clear. It was tough to hear, especially when I have older patients that lifting 80 plus pounds from the floor with amazing technique and a boost in confidence. My patients love coming to PT because they actually feel like exercise translates to life. What do you think about this?
Mike Reinold: Great question. You know what? I actually think the second half of your question, Ricky, you did a really good job with this because if you just said the beginning, who knows, maybe you’re squatting and dead lifting people inappropriately all the time. But you said you have older patients that are doing it with a moderate amount of weight with great technique, right? I think you gave us all the info you need, and they feel good about themselves afterwards. It applies to life. You biased the question in a great way. That was awesome. But that is disappointing that your boss says you shouldn’t be doing lifting with people. Mike, you want to start?
Mike Scaduto: I think I understand where we’re all coming from in terms of what we actually do with our patients. We do all these exercises with them. Could it be that the boss was saying that in insurance based model you can justify your treatment and was possibly not getting reimbursed for these treatments? Could that be? I don’t know. I’ve never worked in insurance pay.
Dave Tilley: Plot thickens.
Mike Reinold: Yeah. That could be really interesting that insurance is trying to get you back to baseline. Right? And maybe these things are advanced. I think you could document that well though that these are functional tasks. Squatting and hinging, right? I know that there’s ways to do it, but I don’t know. I feel like it’s deeper than that. I feel like his boss or, I guess it is a he. It’s Ricky. I feel like his boss is saying that he should stick to just generic PT treatments and not exercise and load people with the bigger lifts.
Dan Pope: Wow. Well obviously I love this stuff, right? I love doing this and you’re not going to hear me say, bad job.
Mike Reinold: Just the fact that you have your shirt on right now.
Dan Pope: I know.
Mike Reinold: It’s amazing.
Dan Pope: It’s tough. It’s 60 minutes worth recording is hard. I kind of came out of school with the same philosophy. I want to load everyone and have them all train hard. I would say that most people think they’re doing a good job generally. It’s kind of hard to really look at your treatments and figure out if that’s really the best thing for every single person or just your strong bias you really want to push towards people.
Mike Reinold: Right.
Dan Pope: There’s a chance you’re doing phenomenal. And I’d say keep it up and have a talk with your manager or your boss. Just let him know my patient’s doing phenomenally well, right?
Dan Pope: All the outcomes are great. This is what we want. What’s the problem? And then try to figure it out from there. The other thing is to think about is this really the best thing for all your patients? A lot of people right now are pushing a deadlift is the best thing for low back rehab. And it may be a phenomenal tool, but I’ve got to tell you, most of my older people I worked with, they didn’t want to deadlift. They didn’t want to squat heavy weights. They didn’t want to do that stuff. When I hear people telling me all my patients love squatting and they love deadlifting. Some do. A lot of them hate it. I think a big thing is that make sure you actually are giving the right thing for the person that’s in front of you.
Dan Pope: Look at your treatments and figure out if that’s really the best thing. I think a lot of times from outcome perspective, giving the exercise to the person who wants to do is probably better than just blanketly, you’re going to deadlift because it’s going to make you stronger and better life. Long story short, good job. I think it’s good that you’re squatting, deadlifting with your patients. Maybe take a hard look at what you’re doing and see if that’s truly the right thing for your patient. And then maybe talk to your boss and let them know, I’m doing a good job or maybe I’m not. And try to figure out what that problem is.
Lenny Macrina: I would say if you’re not, you have to communicate that with your boss and if there’s a fundamental difference in how you want to treat on how far out you are from school or how advanced you are as a PT itself, but sounds like there’s a fundamental difference. And if the communication isn’t working, then it might be time to update your resume and move from Talladega to Birmingham.
Mike Reinold: If you articulate it to your boss the way you just did it to us. It’s going to be really hard to kind of refute that. I wonder if there’s a little bit of a middle ground here. I think the trend on social media right now is just load, load, load. That’s all you need. That cures everything. You don’t need to really do physical therapy anymore. I wonder if that’s a bit of what’s happening here. I will say the first half of your question, that’s the first thing that jumped in my mind. You were one of those people that were ignoring the obvious stuff, like some isolated weakness, or some treatments, or some potential manual therapy. Things that you could do and just saying load, load, load. That’s all they need is progressive load.
Mike Reinold: And we all load our patients here, right? That is a fundamental thing that we do with everybody. We load that here, but we also don’t just load that. We think it’s pretty shortsighted to just think that the squats, the deadlift is going to fix everything. That being said though, it sure sounds like you’re doing it for a functional training technique later along in their program. Sure sounds like you’re doing it really well for me. I think you’re doing everything really well. I wonder if maybe perhaps, though, you just sugarcoated the question a little bit. Maybe you are doing it in too many people. What I would say is take a step back. Dan brought up some good points. There are some people that maybe don’t need that, or maybe they could do similar type things, or they don’t need to load it quite as much. Or they don’t want to, but then most people should have a progressive loading pattern. I think you got to put that together.
Lenny Macrina: I’m going to assume that you’ve spoken to your boss about this. But if you haven’t, maybe people have complained to your boss that they are lifting too much, and afraid that they’re going to hurt themselves by deadlifting because there is a perception in the lay world of bending over and lifting stuff up off the ground could hurt people’s backs. I don’t agree with it necessarily, but some people are probably afraid to do it. If you’re having people do it, maybe they do it for you and they say they like it, but maybe they’re going higher up and saying “I don’t know if I should be doing this.” Again, the conversation has to happen, if it hasn’t happened already.
Mike Reinold: Great. Maybe they’re saying, I want to work with another therapist because I don’t feel comfortable dead lifting with my low back pain or something. There’s probably more to this story, but I think there’s a general summary. I think everybody agrees, right? Do we progressively load? Do we use the main, big lifts with most of our patients? Yeah. We’re on board with your thought process in there, but I will say, though, that we do that in combination with the rest of our strategies. We’re doing things like we’re working on their mobility, their isolated strength, their neuromuscular control, and then they’re progressive loading. If you only focus on progressive loading, I think you may be missing the boat as well. That might be a little bit of what’s going on there too.
Mike Reinold: We load everybody, but that’s not all we do. Anything else? Any other tidbits or advice? I think Lenny’s right. You got to talk to your boss about that and clear up some of the confusion. But I don’t think any of us would do it different, right?
Dave Tilley: Nope.
Mike Reinold: Nice.
Dan Pope: I don’t like dead lifting.
Mike Reinold: Yeah. Dan doesn’t like to deadlift. Well Ricky, keep going with what you’re doing because we’re on board with what you’re doing.
Mike Reinold: Shake and bake, baby. But…
Dave Tilley: I want to go faaast.
Mike Reinold: Keep going with what you’re doing because I think your head’s right, but take a step back. Maybe he’s telling you something that may be going on there. Maybe you have to think about it as different strategies for different types of people. Great question. If you have more questions like that, head to Mikereinold.com. Click on that podcast link and ask away. We’ll do our best to get to each and every question that comes across. Awesome. See you on the next episode.