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Using Kettlebells in the Rehabilitation of the Core

Using Kettlebells in the Rehabilitation of the Core. Philip Johnson, MS, ATC University of Michigan. Purpose of the Presentation. Understand the history of the Kettlebell Basic knowledge of the fundamental exercises Uses in rehabilitation of low back injury Case reviews

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Using Kettlebells in the Rehabilitation of the Core

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  1. Using Kettlebells in the Rehabilitation of the Core Philip Johnson, MS, ATC University of Michigan

  2. Purpose of the Presentation • Understand the history of the Kettlebell • Basic knowledge of the fundamental exercises • Uses in rehabilitation of low back injury • Case reviews • “Core” definition

  3. What is a Kettlebell? • Best described as a “cannonball with a handle” • Styles • Fitness tool • Rehabilitative tool

  4. History of the Kettlebell • Russian background • 18th Century Russia • Appeared in the Russian dictionary in 1704 • (Cherkikh, 1994) • Red Army • 1900’s Strongman • 1985 Soviet Union Sport

  5. History- continued • Fitness Certifications: • Russian Kettlebell Certification (RKC) • International Kettlebell and Fitness Federation (IKFF) • Art Of Strength (AOS) • Military Training/ Fitness- SS Snatch test • 10min: snatch 24kg, 200reps • MMA/ UFC • Crazy “fitness trend”?? • Rehabilitation • Research???

  6. Kettlebell Vs. Dumbell • Different weighted tools/ different load • KB 6-8 inches out of center of hand • Positions load anterior, posterior, moving • KB: “offset” load • Primary use to reinforce movement patterns • Focus on muscle group function in unison • Less use in isolated strengthening • Momentum driven • Convenient for explosive patterns • Grip strength

  7. KB vs. DB • Cost $$: KB (PB/PS) DB • 8kg/ 18lb $35/36 $30/26 • 12kg/ 26lb 45/41 37/33 • 16kg/ 35lb 60/55 52/46 • 20kg/ 44lb 70/65 67/60 • 24kg/ 53lb 80/75 82/72 • 32kg/ 70lb 100/95 104/92 *reference: Perform Better(PB) and Power Systems (PS)

  8. Kettlebell Manufacturers • Art of Strength • Dragon Door • K2 • Kettlebell Concepts • Gill • Perform Better • Ader • Lifeline • Power Systems • Troy • York • Wright • Apollo • Muscle Driver • RETAIL

  9. My Experience • **I am NOT a certified instructor** • Not well educated/ experienced in Weight Room • June 2008: Perform Better Seminar • Anthony DiLuglio • www.artofstrength.com • Enter The Kettlebell –PavelTsatsouline • Published 2006 • www.dragondoor.com

  10. Additional Resources • Blogs/ Websites • www.begin2dig.com • www.chasingstrength.com Geoff Neupert • www.liftkettlebells.com • www.mikemahler.com • YouTube: “kettlebells” • about 22,000 videos • Google • DVD’s

  11. Getting Started • Don’t be Intimidated! • “Average” Male 16kg, “Strong” Male 20kg • “Average” Female 8kg, “Strong” Female 12kg • “Heavy” >32 kg; traditionally 48kg is heaviest • (Tsatsouline, dragondoor.com) • Can Find: • 92kg

  12. Benefits of Kettlebell Use • Strengthening- Muscle integration rather than Isolation • Endurance/ Cardiovascular • Power output • Grip • Efficiency of training/rehab • Reduces space needs/ Cost • Utilize a Balance of Tension and Relaxation • Hip Extension and Deceleration • Variety and Versatility

  13. Safety Issues • Surroundings- keep clear space • Start slow- practice • Focus on movements- setting down KB • Low Back- flat back “anti-slouch” • Use Safety “Sense”

  14. Benefits of Kettlebell Use in Rehabilitation • Postural Correction/Improvement • Reinforce Movement Patterns • Strengthen Gross Movements • CORE/HIPS! • Improve Return to Olympic Lifts • Cardiovascular Stress • (Schnettler, et al., 2010)

  15. “Core” Specific Rehabilitation • Abdominal • Unilateral loads; Single leg stance • Functional abdominal activation • Hip • Anterior (hip flexor)- Reciprocal inhibition • Posterior (Glut/ Prox Ham)- Activation • Restore normal Lumbo-pelvic-hip function • LatissimusDorsi • Eccentric arm control • Spine stabilization • Upper/Lower Back • Segmental stabilization

  16. The SWING • THE fundamental kettlebell exercise • Base movement for other exercises • Great posterior chain work • “dynamic” Deadlift • HIP HINGE!!!

  17. The SWING

  18. The SWING

  19. SWING- Breakdown • Hip Hinge • Push butt back • Keep back flat • Weight on Heels • Wiggle toes • Shins vertical • Eyes ahead • Focus on spot in front • “Hike” hands • Hike football • Thumbs tight • Reach through legs with straight arms

  20. SWING- Breakdown • Hip Drive • Extend Hips • Chest out/ back flat • Shoulder blades together • KB weightless • Be able to let go- light grip • Pendulum arms • Move passively- rope like • Momentum dependent

  21. SWING- breakdown • Pull patella superior • Pull knee cap to ceiling • Glut tight/ squeeze • Hold a quarter in cheeks • ER hip joint • Scapula retracted • Chest out • KB to shoulder height • Not crossfit- “American” Swing • Control with latissimusdorsi

  22. SWING- video

  23. Swing- problems • Not enough weight

  24. SWING- Problems • “Squatting the Swing”

  25. Swing- problems • Weight Forward

  26. Swing- problems • Hands too Low/ Rounded T-spine

  27. Swing- problems • Low Back Hyperextension

  28. The SWING • Quick Learning Curve • Active Core: • Gluteals • Hamstring- proximal • Upper Back • Low Back- no axial load, single plane, no rotation • Stabilization • Load away from body but controlled by hips • Latissimusdorsi • Cardio • 30s on/30s off

  29. Rehabilitative Goals of the Swing • Back stabilization, muscular control • Posterior hip activation: • concentric glut to extend hip • eccentric to decelerate • Anterior hip- reciprocal inhibition in erect posture • Improved hip musculature coordination • “functional” abdominal contraction  lower back reciprocal inhibition

  30. Static Carry-McGill Bottoms Up-Overhead Carry-Sidebend

  31. Deadlift Variations

  32. Deadlift- SUITCASE

  33. Deadlift- Single leg w/ hand variation

  34. Squat- Sumo

  35. Squat- rack

  36. Squat- Goblet

  37. Squat- Swing flip to a Squat

  38. Turkish Get Up

  39. Turkish Get Up- continued

  40. Figure 8 to a Hold

  41. Clean (and Press)

  42. Hi-Pull to a Snatch

  43. Case #1- L4-L5,L5-S1 Disc • Symptoms: • Pain- limiting hip flex, knee ext • Radicular symptoms • Started KB • Decreased acute pain/ inflam • ~1week post injection • Tolerate ROM, • table (open chain) exercises • Bridge DL ROM DL wt Static carryswing • Supplement to return to weightroom

  44. L4-L5, L5-S1 Disc Bulge • *Caution: Anterior load and Opp side load* • Farmer walk • Abdominal bracing • Overhead carry • Abdominal bracing • Sumo Squat • Core control, lumbar stability • Deadlift • Lumbar stability, hamstring flx, gluteal control • Swing • Lumbar stability, dynamic hip • Cardio?

  45. SI Joint Dysfunction • Anterior Hip/Groin pain • Lateral Hip pain • Proximal Hamstring pain • No signs of muscle tissue damage • May have SI joint pain • Usually functional but not comfortable • Innominate rotation on exam

  46. Case #2- SI Joint Dysfunction • Anterior Rotation of the Innominate • Sumo Squat- modify • Glut/Groin loaded- activate • Single Leg Deadlift- modify • Unilateral activation • Reinforce manual therapy correction • Goblet Squat- if ROM tolerated • Posterior rotation of pelvis • Swing • Restore normal coordination of hips

  47. Spndylolysis • Typically pre-existing • Overweight • Lordosis • Posterior butt • Aggravated in extension • Spasm • Function but pain

  48. Case #3- Spondylolysis- RT L3 • *Caution: Posterior and same side load* • McGill Bottom Up • Abdominal bracing • Rack Squat • Unilateral load, core control • DL- modified ROM • Lumbar stability, glut control • Swing • Lumbar stability, dynamic hips

  49. Other Times of Use • Pre-Lift • Warm Up: 30 swings >150bpm • Poor Squat or Deadlift motion • Chronic Problems: groin/sports hernia • Off Days (10-20min) • Corrective: STM MT/Mob KB exer • Rehab (Fine Tune): ex: chronic hamstring • Cardio: 5 min tabata; circuit

  50. Kettlebell Limitations • Always SAFETY 1st • Common sense dictates • Take time to teach movements • Learning Curve/ Progressions • Hand/Grip/Forearm injury • Hip joint pathology?

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