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Strength coaches are not physical therapists and that is a good thing
Unpopular Opinion – Sometimes lighthearted and sometimes serious commentary on issues surrounding strength training, physical fitness, and culture.
Strength coaches are not physical therapists, which can be to the benefit of the client. Of similar vein, many strength coaches have begun to blur the lines and practice as poorly educated physical therapists, much to the harm of the client. This article will explore my issues with the practice of physical therapy and conversely my issues with strength coaches acting as pseudo physical therapists.
The profession of physical therapy traditionally works with injured and ill persons for the purposes of restoring baseline function and reducing pain. While there are individuals out there that are highly educated and incredibly effective, the majority of physical therapists are woefully inadequate at performing the task. There ineffectiveness is multi-factorial.
My primary concern is the complete disregard for the importance of strength and strength endurance in a rehabilitation setting. One of the main issues with injury is a loss of functionality of the given tissue that is injured. In a sense the tissue is weak, creating disability. The logical modality of treatment would be to give the tissue an appropriate challenge in a manner consistent with its function. Upon successful completion and recovery from the stress, a slightly greater challenge must be applied to cause further adaptation. Instead what I typically witness is the application of a variety of novel exercises with isolated load to the injured tissue. Once the client has achieved a satisfactory movement pattern a different stimulus is added. Once the client can perform a checklist of movements they are “cured.”
In this manner physical therapy is crossfit ultra-light. Since motor learning is a quick process, constantly varying movements makes clients feel like they are making rapid progress. However, any real progress made is mostly by chance or simply a factor of time. Instead focus on a small subset of movements pertinent to the function of the tissue and apply progressive overload.
What is the physical therapist to do once the client is moving without pain or disability? Typically discharge. Essentially the client is being discharged in a state of health similar or worse than before the injury occurred. The client may very well have some additional knowledge of movement prevention strategies but without an additional resilience. This is where the strength coach shines. Once the tissue can manage load, a strength coach can guide the client in gaining strength and strength endurance. With increased strength comes injury resilience and greater function then before the injury.
Rick the Diesel Truck
Client in the spotlight – Where Stanton Strength athletes are featured that have accomplished amazing feats of strength or physical transformation.
Rick is one of the very first clients involved with Stanton Strength and has been a huge influence in its development. Rick sought out Stanton Strength after a vacation in which his son took a photo of him that he was not proud of. Rick having served in the military and being an active person wasn’t used to the person now staring back at himself. Rick took it upon himself to do something about it. I am not sure either of us knew exactly how dedicated and hard working he really could be.
Rick’s goal was and still is a healthier body with a lower body fat percentage while being strong and capable. Rick began over 260 pounds with a hydrostatic bodyfat measured at 31%. Rick had considerable left shoulder discomfort and a history of two severe disc herniations. Ricks started with a squat of 125lbs, bench press 145 lbs, overhead press 95 lbs, and a deadlift of 155lbs.
Ricks journey began with a linear novice progression, adding weight to the bar every time. Initially Rick was encouraged to eat and maintain his bodyweight. Strength was the most important attribute holding Rick back from achieving his goals. Given Rick’s age of 54 at the time the power clean was left out. With just the squat, bench, overhead press, deadlift, and highly assisted chin ups Rick made incredible progress.
The first diet phase was very successful. Cleaning up his diet and creating a caloric deficit Rick dropped from 258 to 237 pounds. 31% bodyfat to 27%. The second round from 27% to 22%. The third round estimates Rick at 20%, but the mirror is beginning to tell a much more important story. Veins are appearing all over his arms and legs. Physically his chest is larger, belly is slimmer, and legs have grown considerably. Rick looks nothing like his past self.
Rick’s training has always been simple and to the point. Lots of barbell movements with a healthy dose of sled work. Considering his age Rick can tolerate a great deal of volume. Only minor modifications in the form of slight volume reductions has been required to his programming. Rick can do what kids half his age can sometimes not manage to recover from. The shoulder ache is just a dull memory, and back pain is nonexistent.
In spite of time spent away for personal time and family tragedy, Rick has made most impressive gains. Rick’s all time best lifts are squat 390lbs, bench 280lbs, overhead press 180lbs, and deadlift 355lbs. Rick has even competed in the sport of powerlifting, easily crushing the competition in his division at the local level. Rick can now do several unassisted pull-ups and dips as well.
Rick always sneaks in his “silly exercises” and loves when I give him “pump” work. I think it’s secretly because he loves pain but also excels at that type of work. He will never surrender until the barbell staples him to the floor. He always has another rep, even when he doesn’t. I wish I could push as hard as this guy does. The intestinal fortitude is unreal. For heaven’s sake watch the deadlift video at the end. What sane person would not have stopped pulling? His grind gear is legendary!
I enjoy every session with this guy and hope to someday be that tough. Rick has goals of hitting a bodyweight overhead press, body fat under 15%, and slamming out 20 unassisted pull ups. We appreciate you more then you know Rick and look forward seeing you achieve every goal that you set for yourself.
Creating a meal plan for a hypothetical athlete
Nutrition is relatively simple when distilled into the basic components of caloric balance, macronutrients, meal frequency, food composition, and supplementation. Protein synthesis, although a complicated process, can be maximized using relatively simple principles as discussed in part two. In part three we shall discuss how to pull all of the principles together to create a full meal plan for a hypothetical athlete.
Our athlete for this example is 5’9” 200 lb female recreational ball sport athlete. She is 35 years old and would ideally be 15 pounds lighter for her position. She trains hard 4 days per week, including resistance exercise. During her days off she takes a 30-60 minute brisk walk for active recovery.
The initial step is estimating her daily caloric expenditure for days of activity and relative inactivity. The number simply needs to create a ballpark, absolute accuracy is impossible. For this purpose my preferred equation is Harris-Benedict.
Male: (66+(6.23 x weight in pounds)+(12.7 x height in inches)-(6.8 x age in years)) x *Activity Level Coefficient
Female: (655+(4.35 x weight in pounds)+(4.7 x height in inches)-(4.7 x age in years)) x *Activity Level Coefficient
*Activity Level Coefficient
Sedentary : 1.2
Lightly active : 1.375
Moderately active : 1.55
Very Active : 1.725
Strenuous activity : 1.9