At Progressive Rehab & Strength we not only aim to help athletes recover from injury and return to training and competing using the most up-to-date evidence-based strategies for long-term injury risk reduction, but we also aim to help clinical rehab students and professionals integrate this into their practice.
As more and more research is put out about the benefits of active treatment approaches and progressive overload versus the traditional pain management techniques taught in our education systems, we’re seeing the younger generations of clinicians integrate resistance/strength training, barbell lifts, and progressive overload into treatments across the entire lifespan and with almost every diagnosis.
In 2019 we began our online education system to help emerging clinicians enter the physical therapy workforce with tools they weren’t taught in school. Our goal is to help the growth of a new generation of forward thinking clinicians and change the traditional image of physical therapy.
Little did we know that veteran physical therapist, Dr. Al Lin, PT, would be joining our first class of PRS Blackboard students. After 15 years of practicing physical therapy, Dr. Lin is an example of how all clinicians should practice: develop with the changing evidence instead of sticking to “what they know,” or what they were taught in school.
We’d love to share his evolution of growth. Enjoy his story below!
Al's Story
Hi, my name is Al Lin and I’ve been a Doctor of Physical Therapy for over 15 years. I started barbell training in 2018 and it changed my life and clinical practice. I’ve seen all types of fads and trends come and go in rehab, but it wasn’t until I started to incorporate barbell and strength training principles into clinical physical therapy practice that I saw longer lasting relief compared to short-term fixes.
I had always been active growing up. I played sports like basketball and tennis and would go to the gym almost daily, but I had no real set plan or program. I had been doing that for close to two decades and realized I had made no gains in strength and didn’t know why. I realize now that I was “exercising,” and not “training.”
In 2017, one of my good friends, who also happens to be a physical therapist, started competing in powerlifting. At first I was resistant when he suggested I start training for a competition; my hesitation came from the fact that I had been taught in physical therapy school that some of the lifts were not “safe” and consequently I had been discouraging patients (and myself) from doing them the last 10 years!
Myths we’ve all heard about in PT school, and from orthopedic authorities, include:
Never do a full squat
Bench pressing is bad for your shoulders
Deadlifting will break your back
Luckily, over the last 5 years, the mindset has shifted in the field of rehab (general and sport-specific) and we now know that these movements are perfectly safe as long as the body is adequately prepared to handle them. This has shifted my clinical treatment style significantly as I’ve started incorporating more strength-based training, barbell movements such as the squat, press and deadlift, and progressive overload with my patients.
Incorporating Strength Training into Practice
When I tell patients we need to start strength training, most of them are hesitant. They’ve been told lifting “heavy” weight will damage their body, they’ll become bulky and slow, or they’re just unfamiliar with weights entirely. That’s ok. We find an appropriate starting point for them; whether it be a sit-to-stand with a 2-pound dumbbell, an incline push-up, or a kettlebell deadlift from a high box, we start where they are capable and progress incrementally from there. Once they start to see the carryover effect it has on their everyday activities, it really empowers them. They begin to see that they can actively and independently manage their rehab and health long term versus seeking a clinician who provides short term fixes.
Some of my older colleagues smirk when they see me giving geriatric or neuro patients kettlebells and instruct them in sit-to-stands (hello squats!), but I’ve seen cases where stroke survivors with long term deficits, or patients with poor balance, have been able to decrease dependence on, or get rid of, their assistive devices altogether. I’ve seen how patients report they can get up and down stairs much easier and faster with less reliance on handrails than before. Where previously they may have avoided going up stairs or limited the number of times they go up the stairs in their house, they don’t feel that same reservation anymore. This is because of progressive overload with truly functional movements: The squat, bench press, deadlift, and overhead press, or regression variations that are most appropriate.
With the old school model of strength training we are taught in PT school, many of our patients are underloaded with the typical rehab exercises. A perfect example of this is a person who had a rotator cuff repair, regained their full range of motion passively, yet years later still has trouble putting things into their top kitchen cabinets. And forget about putting their 20-pound carry-on into the overhead compartment of an airplane! Bands or tubing may be enough stimulus initially after surgery but if they want to regain full function they will need to add stress through weight into their exercise routine and continue increasing the weight gradually to progressively overload and reach at a minimum their baseline level if not surpass that.
In the medical and exercise fields, the full-depth Squat has been demonized. Medical authorities (Doctors and Physical Therapists alike) have preached that squatting past 90 degrees of knee flexion puts excessive compressive force on the kneecap. And it will explode! Tell me the last time you got up from the floor after playing with your kids...did you stand up and walk around to tell the tale that you survived squatting below 90 degrees? That’s right. I thought so. It’s safe, normal, and functional so you need to be strong with this movement.
We wonder why our grandparents, or patients who undergo joint replacement surgery, or other common surgeries and disorders, struggle to get off the toilet, go up and down stairs, and get off soft sofas without struggling or relying on assistance from an arm or a handrail. The typical explanation is: they’re old or they have something “wrong” with them like “arthritis.” But the truth of the matter is, 90% of the time people are just weak. It’s really an unfortunate truth.
No amount of balance training, range of motion exercises, passive modalities, or resistance bands can adequately rehabilitate functional strength. And it certainly doesn’t happen in the 6-12 weeks of band-pulling-massage physical therapy that most insurance companies will authorize and pay for. Strength training takes time to see the results and it’s not something you can stop doing and expect to maintain or improve long term.
A popular phrase in the Instagram rehab world is “you can’t go wrong getting strong.” I’ve found that these principles can be applied to every age group and diagnosis that comes into the clinic. It helps make our patients stronger, more resilient, and less reliant on us as clinicians to 'fix'' them. Barbell strength training has helped me transform my old-school treatment methods and take a progressive, more evidence-based approach to truly helping every person who walks through the door. The positive functional changes that they realize from resistance training shows them a path they can continue on independently to keep them from coming back to see us for the same issue over and over again.
If you're interested in learning how to optimize barbell technique, maximize strength and muscular development, and reduce injury risk (and peeing) for you, your clients or patients, then join the waitlist to get insider information on all the PRS online courses when they're ready for enrollment!