Wednesday 7 November 2018

Do I Need A Strength & Conditioning Certification As A Physiotherapist And If So Which One Should I Take?

                Over the last couple weeks I’ve gotten several messages in my Messenger inbox and I’ve also seen several social media posts discussing whether or not physiotherapists should get involved in strength training clients and discussing which certifications to get. The past decade has seen a huge increase in “hybrid” physiotherapists & strength coaches and while it’s great to see people that can take clients from in pain to high performance it begs the question – do all physiotherapists need S&C certifications and if so what route to take?
                The answer is, to quote my friend and mentor Stuart McGill, “it depends.” It depends on…

1) The demographic you want to work with

This is the biggest decision-maker. If you work in pediatrics – good luck getting them into strength training. If you work in ICU, or acute care in general, spending a lot of money on a strength & conditioning certification probably won’t offer the same return on investment as courses & education more tailored to that setting. Same goes for pelvic health physiotherapy.

When it comes to neuro rehab it’s a grayer area as it depends on how well functioning your clients are. If many of your clients have at least Grade 3/5 muscle strength than hell yes it’s worthwhile to know this stuff. If many of your clients tend to be more flaccid and lack that strength than learning more neuro-rehab specific techniques is likely a better use of your time & effort. As Stan Efferding said “you can be good at anything but you can’t be good at everything.”

If you work in orthopedics in a more general population setting I don’t believe a S&C certification is essential although it can be helpful if you have athletes and/or lifting junkies come through the door on occasion. That said I do believe a basic knowledge of exercise prescription is essential for all physios in any setting.

The biggest populations where having a personal training or strength coaching certification can be helpful are

- When working with chronic disease populations such as osteoarthritis, osteoporosis, cancer, diabetes, heart disease and/or lung disease due to the number of safety precautions and rules that you have to be aware of.

At UW KINNection 2018 where many Kinesiology students get their first experience making exercise programs for people with chronic diseases.

- The big one … if you work in a clinic with athletes and/or people who love weight training. This is self-explanatory as you need to, to do your job effectively, have the knowledge to transition those clients from pain & potentially very remedial levels of exercise to being able to do high performance movements such as lifting, sprinting, jumping, and potentially throwing based on their activities.

This may seem like common sense but, as strength coach Trevor Cottrell said, a lot of physios don’t know strength training and athletics & spend more time strengthening their clients’ glute med than they do physically preparing them to withstand the demands of athletic + strength training endeavours. It’s as big of an injustice to underload and underprepare someone and put them through “rehab purgatory” just prior to returning them to sport as it is to overload them.

Under Trevor Cottrell's coaching earlier this year at the Intro To Olympic Lifting course at The Vault Barbell Club

2) If you need it for a job

Some clinics, particularly sport rehab clinics or clinics in a gym, will require you or recommend you have a strength coaching or personal training certification.

So now to the second part of the article … which certification should I take?

Option #1: I work with elderly and/or diseased populations

In that case the best certifications are the CSEP (in Canada) or ACSM (in the US) Exercise Physiologist certifications. I do believe you should spend a fair amount of time working with those populations, under the direction of someone highly qualified, before working with that population on your own as there is great potential to help people but also great potential for harm if things are done incorrectly.

The GLAD (GoodLife with osteoArthritis in Denmark) courses done worldwide are fantastic for understanding lower body exercise prescription, not just for osteoarthritis, but in general.

BoneFit, done by Osteoporosis Canada in Canada, is quite useful as well.

Option #2: I work with athletes and/or weight training clients

CSCS is the most popular one that people go with. That said there are a couple holes that CSCS, in my opinion, leaves uncovered which are
-          Understanding how to coach, program and progress speed movements (I.e. sprinting & jumping): I recommend Joe DeFranco, Lee Taft, and Nick Winkelman’s work as resources for speed training as this is essential for returning team sport athletes to sport after certain injuries (i.e. ACL tear, hamstring strain)
-          Understanding how to coach and modify the powerlifts for clients: I did the Canadian Powerlifting Union Coaching Certification this year and found it insanely valuable. It was probably the best training related certification I’ve done specifically on the powerlifts.

At the CPU Coaching Certification earlier this year at The Vault Barbell Club

As with Option 2 – you still need to, in my opinion, spend time working with these populations under the supervision of a qualified coach before working with these populations on your own. That’s why, despite my certification, I don’t call myself a powerlifting coach.

Bonus: Who are good people to learn from?

People that I recommend other physios learn from in regards to strength training are

Physiotherapists: Scotty Butcher, Charlie Weingroff, Stefi Cohen, John Rusin, Dani LaMartina (Overcash), Christina Prevett (Nowak), Michael Mash, Zach Long … and myself.

Strength Coaches: Nick Winkelman, Brian Carroll, Chris Duffin, Travis Mash, Meghan Callaway, Mike Boyle, Eric Cressey, Mike Robertson.

I hope this article provided some useful advice and guidance and I hope you will share it with other physiotherapists & physiotherapy students who may have the same question. As always – thanks for reading.

Monday 5 November 2018

My Experience At SWIS 2018 And The Top Things I Learned

On October 26th I travelled down the 401 to Mississauga for SWIS (Society of Weight-Training Injury Specialists) 2018. The weekend was the highlight of my year and exceeded all expectations. Hell – I’m still coming down from the energy high of the symposium a week later. So bear with me while I try to explain my experiences from the weekend.
                In a previous Facebook post SWIS organizer Ken Kinakin encouraged people to come to SWIS in person rather than just buy the video package. Don’t get me wrong, the presentations were great, but the interpersonal interaction with many great rehab & fitness professionals from around the world was even greater.
                I came to SWIS with a list of people in my head that I wanted to meet (and get my picture taken with). I thought to myself “I’ll probably be lucky to get a few seconds here & there with them” but I ended up running into all of them fairly frequently in the hallway, restaurant, bar and lobby. I met Ken & Sheri Whetham, caught up with Stan Efferding, met Dani LaMartina (Overcash) and met Scotty Butcher within the span of just over an hour.
                Some of the highlights (god there were so many) from these interactions included

1)      Hanging out with fellow PTs, lifters, and strength training junkies – EliteFTS writer & 2nd ranked powerlifter in the world in her weight class Dani LaMartina and University of Saskatchewan professor & Strength Rebels founder Scotty Butcher.

2)      Getting into a conversation (and picture) with Stan Efferding, Brian Carroll, and Stu McGill – easily 3 of the biggest influences on my training.

3)      Ducking out after the Rehab Panel’s presentation on Saturday afternoon & being invited for a whiskey by Jim Wendler. If you’d have told me I’d have spent the evening of my 28th birthday talking about everything under the sun with Wendler I wouldn’t have believed you.

4)      A good hour or so of chit chat with Dani and John Rusin – two of the most influential PTs in the world of strength training today.

5)      Spending a good chunk of Sunday afternoon with my good friend & mentor Stuart McGill, Brian & Ria Carroll, Dani LaMartina, and Paul Oneid.

6)      And meeting Bill Kazmaier (whom I’ve watched on TV since being a little kid) and Eddy Coan – that’s pretty self-explanatory

The presentations that I went to (and the top point I learned from each) were…

Stan Efferding - The Vertical Diet: Meal prepping and organized diets like Weight Watchers & Jenny Craig are actually more effective for weight loss than advice provided by a dietician or doctor.

Bill Kazmaier & Ed Coan - Powerlifting Workshop: Both lifters emphasized how they trained in a “powerbuilding” style in the off-season further away from meets using more general movements and a focus on volume. This is a contrast to the popular high-volume, high specificity, and high-frequency style of training used by many drugfree lifters yet it seems (so far, anecdotally) that the former style of  training is more conducive to longevity.

Chris Duffin & Brandon Senn – Back Training For The Strength Athlete: Their presentation was not so much on stereotypical back muscle training (i.e. chins, rows, face pulls, shrugs) as it was on training the back to withstand high training volumes of axially loading exercises. Brandon emphasized that you can progress training volume very slowly – a couple reps or a set at a time over a period of weeks to months to allow for progress while minimizing injury risk. This is in line with Tim Gabbett’s work on acute/chronic workload ratios & injury risk in athletes.

Bill Kazmaier, Ed Coan, Jim Wendler, Matt Wenning, Ken Whetham, Brian Carroll, J.L. Holdsworth – Powerlifting Panel: The biggest point they emphasized to me was putting the ego in park, not rushing things, and progressing slowly. This is a tough thing to do as we are a delayed gratification society … and admittedly it was a tough thing to do for me as I had i) achieved a lot of professional success at a young age and ii) always felt like I needed to be a better lifter for fear that I would be seen as a “fraud” by the strength training community.

Brian Carroll & Stu McGill – Gift Of Injury: Now being a student of Stu’s and having worked off of Brian’s training philosophy for 3 years I am quite familiar with their work already. The biggest thing I’ve learned from them over the years, and told them, was their focus on purposeful repetitions and maximal full body tightness & intensity. This is the kind of technique that you can only execute for a rep or 2 ‘cause it’s so exhausting.

J.L. Holdsworth – Grip Strength Training: J.L. broke down grip strength training to a level that I had never thought of before. To me grip training was always doing lots of deadlifts, carries, shrugs, chins and rows with challenging weights. J.L. described 7 different types of grip strength and the ways to train each of them. He also discussed how, contrary to popular belief, long duration holds (i.e. farmer’s walks) may be counterproductive for grip strength training and would build more endurance than strength.  

Rehab Panel: How funny and outrageous Dr. Eric Serrano is. No but seriously the top thing I learned from this presentation was the value of scapular upward rotation & protraction work for athletes who train the bench press in a competitive manner (i.e. lats tight, scapulae retracted & depressed). The problem is – people think that chins or rows are antagonistic to bench press but they really (assuming you bench for strength) involve the same scapular movements. The presenters described a neat variation of the scap pushup that involved more scapular upward rotation and t-spine movement to, in theory, involve the serratus anterior more and train those movement qualities that get neglected in bench pressing powerlifters.

Jim Wendler – High School Strength Training: Wendler’s known worldwide for his ability to simplify strength training through his 5/3/1 books and this was no different. The two top things that Wendler discussed were the concepts of letting young athletes become leaders and the idea of giving them a high GPP base through running, jumping jacks, bodyweight movements and the like. I wish I would have done this kind of training earlier in my lifting career.

John Rusin - Performance Recovery Systems: In Rusin’s recovery system he discussed a difference between foam rolling for warming up to work out (i.e. hard, short, fast) and the idea of foam rolling for recovery (i.e. slow paced, over broad muscle groups, relaxed). Admittedly I did treat foam rolling as a “fuck it – let’s get this over with” kind of project but now I will focus more on foam rolling in the latter manner to get the maximum benefit.

 I ended up helping Stu & Brian with some stuff Sunday afternoon and as such didn’t get to the last couple presentations. I have a good 15 hours (or more) of video to watch from presentations I didn’t even attend.

My only regret from the weekend was not getting to know more about the less “famous” (if that’s the right word) presenters. I wanted to meet the heavy hitters like Kaz, Coan, Carroll, Wenning, Rusin, Wendler etc. and as such didn’t investigate the backgrounds of many of the other presenters.

As an example - at the dinner table on Saturday I was surrounded by Wendler on one side and by medical doctor & 2 time European Union powerlifting champ Dr. Fionnula McHale on the other side. Fionnula was visited by many people, almost to the point where we couldn’t talk much. She struck me as a very beautiful, outgoing, physically fit woman who I had; to my own chagrin; assumed was a bodybuilder or figure competitor. I had no idea; until Kaz told me the next morning; that she had overcame a lot of mental demons to present here and that she was such a successful athlete, doctor & person. I had no idea how amazing of a person I had sitting behind me. I use this as an example, and as advice to future attendees to do your homework and read more into the stories & credentials of all the presenters … not just the #1 attractions.

Another piece of advice I have from SWIS, and in contrast to above was something I did right, is to take the time to meet local fitness & rehab professionals closer to your area. When you have people coming from as far as Singapore & Hong Kong it’s easy to neglect connections with the people near you. Take the time to do so.

With the man behind the magic - Ken Kinakin

Well – this article is nearing 1500 words and as such it’s time to wrap it up. Thank you Ken Kinakin, and all the amazing people mentioned above, for an amazing weekend. I look forward to the next SWIS symposium. As always – thanks for reading.

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