CEU: Rehab Concepts: Kettlebell Training - 195

Hey, this is Sandy. And Randy? And we're here on AT Corner. Being an Athai trainer comes with ups and downs, and we're here to showcase it all. Join us as we share our world in sports medicine. Welcome back to another episode of AT Corner. For this week's episode, we have ACU episode that I hope is going to be like a new kind of style of CEU episodes and it's going to be kind of focused on like rehab concepts. Oh, I like that. Idea, yes.

In particular, this one's going to be focusing on kind of like kettle bells and like kettlebell training. All right, So what are we going to talk about? Yeah. So we're going to discuss the history of kettlebell training within athletics and then we're going to discuss the biomechanical principles of just some various kettlebell exercises, and then we're going to examine the evidence of kettlebell training within rehab and athletic performance. Awesome.

So if you guys are interested in the CU, it is available for free. If you're listening to this as it comes out through clinically pressed and athletic training chat, big thank you to them. Make sure you Scroll down to the show notes to find the quiz and course evaluation. Enroll, enroll in the course and get your certificate. So if you're interested in that, it is available to you. Why don't we get started with the anatomy of a kettlebell?

Yeah, so we're going to talk about the history of kettlebell training. 1st. What exactly is a kettlebell? I feel like kind of like it's kind of become pretty mainstream now. The Anatomy of A. Kettlebell. Yeah, yeah, literally it's a round shaped cast iron or steel weight, which nowadays I it can almost be made of it. Anything could kind of be kind of like a a kettlebell. I don't think it has to be steel or cast iron, but that's kind of traditionally what they've been.

And it kind of has a handle on top. So it almost resembles like a cannonball with a handle, right. That's exactly what a kettlebell is. It originated from the Soviet Union. So it's kind of like a kind of a Russian style of exercise, which I mean, Soviet Union lifters, they were jacked, maybe taking steroids, but just saying they were jacked. They know something or two about lifting. But there are many different styles of kind of kettlebell training, right? There's what's termed kind of

sport. There's kind of like the stuff you kind of see in CrossFit. Like CrossFit does kind of implement some kettlebell exercises. But I think the important thing is that's not necessarily true kettlebell training. It's kind of just using exercises with kettle bells. With, that's a good way to put it. Yeah, and that's the one thing too, like this episode's more kind of like actual styles of kettlebell training. Any exercise can incorporate a

kettlebell. We're actually going to be talking about the exercises that are specific to the the philosophy of kettlebell training. I think what most people are familiar with without them knowing they're familiar with it is what's termed kind of hard style. This is like your kettlebell swing, your kettlebell snatch, kettlebell clean, kettlebell press squat, and then everyone's favorite, the Turkish get up.

That is my favorite. Yeah, if you're a corrective exercise person, Turkish get up is your go to. Feel like Turkish get up is just so beneficial. For everything. Yeah, shoulder stability, yeah. You can. You can incorporate in so many different ways. You can even just do like a partial Turkish get up. Yeah. Also, yeah, you could break down each movement into different segments by what you're trying to work on. Also, it's great for the lifespan.

All right? It's great for athletes, but it's also great for teaching people, hey, if you fall and you got to be able to get up or catch yourself, Yeah, it's great for the lifespan. I've never heard of hard style before, so that's pretty interesting. Yeah, yeah. That's just kind of like the school thought behind it. And that's just what those exercises are termed within the actual kettlebell training.

And I think most people are kind of familiar with the swing and the get up. And there's actually a lot of, a lot of the literature is mostly focused on the swing and mostly just the kettlebell swing. There's some stuff on the snatch and the clean, but it's all kind of like the motions are the same to your kind of normal snatch, except for this was just a single arm. You're not really necessarily doing both. Right, that's how I I broke my Apple Watch screen. Oh yeah, that's right.

Oops. Yeah, that's your oops. So as we just start talking about like kettlebell training, the reason that there's kind of like a technicality is because it's not just like you're just normal, like OK, do your classic three sets of 10. They do have kind of set

parameters. Everything I've kind of seen in the literature does say there's about three to five sets of like 20 swings or 20 reps of the actual exercise with 20 seconds rest in between over a 2 minute kind of two-minute ish interval, right? So it's a very kind of fast-paced workout that's still also emphasizing not Max strength, but kind of like that strength endurance kind of well. I was going to say sets a 20. That's like. You're moving, right? And that's no like that's a lot.

That is, that is a lot. Like more than your typical strength? What is it strength like 8:00 to 12:00? Parameter, yeah. Well that that could be hypertrophy. If you're going Max strength, you would go less because your load is so much higher. So it could be one to five. So, yeah, yeah. So this is more going towards that kind of endurance side. Especially the swing is actually really interesting that they did a lot of research on that because I feel like I'm trying to picture.

I cannot picture when I would use a swing in my rehab. Oh, we'll talk about it. I'm intrigued. I'm intrigued. As far as the weight goes, you want a weight that is going to be challenging and this is going to be kind of different per obviously individualized per patient athlete. But in general, it seemed like most articles that kind of looked at male, female, females kind of started with eight kilograms, which is about 17

lbs. Obviously you can go higher, right, depending on the athlete and what they can tolerate. And males tended to start around like 12 kilograms, which is about 26 1/2 lbs. Those are just kind of starting points again, right? That's kind of a good place to start. Obviously, you can go like if I have a male athlete like who can't tolerate swinging 26 1/2 lbs with good form, then right, back them down a little bit, right? And vice versa, right?

If it's too easy, you can go up. You don't have to necessarily start there. I think the important thing to to note with this episode is there are certifications in kettlebell training, right? So there are actual courses to learn the full kind of philosophy of the style. This is more to give you that introduction to start thinking about it into your rehab and how you can incorporate some of these exercises into kind of what you do with your rehab.

Or even kind of like that late stage rehab, like return to sports stuff 'cause this is pretty dynamic stuff. So it it's definitely kind of something that is very beneficial later. So as you know, as we start talking about that kind of rehab aspect of it is we need to understand what does it do right? Why? What groups is this working on? Why? Why do I even want to do it in my rehab? And for the kettlebell swing, this is definitely what you probably picture.

So the kettlebell swing is basically you kind of hinge with the kettlebell in between your legs and you swing up to about shoulder height. You can also go overhead too

with the kettlebell swing and then you let the weight kind of come back down in between your legs, right? So if you look at the kind of the motion of it, it's a very hip hinge dominant exercise. That's the whole point. It kind of looks like a deadlift, but more dynamic, right? So just based on that, you already can tell it's going to activate the posterior chain

very effectively. And it does have high activation levels of the posterior chain muscles like glute Max has a 75% MVIC, which is Max monetary isometric contraction. Biceps femoris has 78 and glutenid has 55%. Kind of a, to give meaning to these percentages, anything over about 50% kind of Max MVIC is thought to be enough activation to promote strength gains. So anything you see over 50, you're like, oh, we're strengthening things, right?

So that's kind of what your target is when you're choosing exercises for certain muscle groups. It didn't talk about the the abdominals now. There are some and the ones that really talked about the abdominals were really geared towards the variation of instead of doing 2 handed or two armed kettlebell swing, doing just one arm. And that's really where you'll start to see the more core activation with it I assume.

More like oblique. Yeah, you'll see like kind of contralateral oblique, you'll get some ipsilateral rectus abdominis if you're really kind of splitting hairs between the two. So really how I kind of just simplify it is if you're looking to really kind of challenge that kind of Rotary stability of the core, the single arm is going to be kind of your best bet because you will start to challenge that core in a different fashion. I feel like that.

When I picture that, I think you'd be really good for baseball or softball, yes. A. 100% any really, yeah, any of your overhead sports because of the shoulder aspect too, because even though like the shoulder studies that I looked at kind of looked at like the Turkish get up, of course, and then they kind of did the snatch and like stuff like that. Not a ton went into like the arms, the kettlebell swing

itself. But for sure, anytime you're getting weight and you're throwing overhead, right, there is going to be a stability component, all right, for sure. As far as the other our posterior core muscle, right, the erector spinae, right, the effects, it kind of depends. It in essence, it might be fairly minimal. Some studies I've seen shows it could activate the erector spinae up to 60%. But really, it's not that much better than just doing erector focused exercises.

I guess it also depends on if you're queuing correctly for sure, or if they're executing it correctly. For sure. It's like the deadlift, right? There's some people who just feel it in their back more. Right. Yeah, that could be their just motor pattern for sure. Yeah. So that's kind of the kettlebell swing. Like I said, it's a really classic example of kind of what most people think of like using a kettlebell and like kettlebell

specific exercises. And it's really good for the posterior chain, especially like that late stage rehab. And we'll kind of talk about the effects of it clinically a little bit later. OK. As far as the Turkish get up, of course, this is a, as with kettlebell training itself, it's a full body exercise, which again is the nice thing about the idea behind kettlebell

exercises. It's not just one thing, it's a full body exercise which is going to promote a lot more adaptation than just kind of focusing on one muscle group, right? So in phases where the arm is supporting the body, the shoulder like the demands on the shoulder are higher right? A lot. The demands on the kettlebell holding shoulder. The shoulder that's supporting the body, okay, right.

So when you're on that phase of elbow on the ground and even transitioning up to hand on the ground, there's a lot larger demand on the shoulder there compared to the one that's holding the weight. Interesting. And a lot of it is the larger muscles like the lats kick in a little bit more, upper trapezius kicks in more. I would argue the rotator cuff probably still has a large role in that. The study that I was looking at, the infraspinatus didn't have a lot of EMG activity, but I

believe posterior delt did. And anytime you talk about like EMG measurements, you always have to worry about crosstalk between other muscles because all it is is a sensor on the skin, right? It could be picking up a signal from anywhere. So I still think. Surface EMG they're not doing. No, it was surface EMG. So I think that's a limitation. And I do think like there's a ton of previous other studies that show weight bearing is really good for the rotator cuff.

So I would still assume the overall rotator cuff is firing even though infraspinatus maybe not. And guess what? It's not going to be the only exercise that you're doing. So if you're really worried about that, you can stick another shoulder stability exercise in there, or another rotator cuff. For sure. And on the flip side, when you take out the weight bearing support of the upper extremity, the the extremity with the weight does see a higher rotator

cuff activation. So infraspinatus is higher on the one that's holding the weight, which is what we would expect and why we would probably want to do this exercise in the first place. So again, really good exercise for really just we haven't even talked about how it's good for the lower extremity, right, because there is a hip extension aspect to it. There's a press, right leg press to actually stand up right and the squat to lower yourself back down right. Overall great exercise.

So those are the bio mechanics behind it. What does that mean for actual clinical practice? I was thinking about this while you were talking about it and I feel like you're saying also like late phase rehab, right? And I feel like this is also where it comes into play, like the difference between rehab and training. And this is kind of like in that cross, you know, like building strength kind of more training than it is traditional rehab.

Yes. And also too, I'm glad you brought that up. The advantage to the kettlebell and why it became really popular over the past decade and a little bit longer than that is because of the aspect of it doesn't require as much equipment or space, right traditional. Cannonball on a stick? Yeah, on. A on a handle. Right. And you just need enough space to be able to swing right and get up and down from the ground

and stuff like that, right? So it doesn't take a lot of space like traditional weights would, right? Like I. Don't know, I'd be kind of scared to do have my athletes do a swing in the ATM. Yeah, I don't know if I'd do it in the in the room, maybe we're going outside. But like when you think about like we have like weight rooms have these squat racks and you have the the barbell and then you have the the racks for the weights, right. It it's very equipment

intensive. It could be costly space, very filling, right? You, you, you're going to need a big space for all that stuff, whereas this you really just need just progressing weights of kettle bells and you can get a full body exercise out of it, so. They don't take up that much space except in our ATR they sit on the floor and we trip on them all. The time that's the problem. They sit on the floor, right?

Which mine did for a long time, but I found myself a shelf and I now have my kettle bells in a shelf. That's nice. It's nice. I'm we need to do another video of my athletic training room to show the growth and the more duckies or as Instagram like to say duckies. I got more duckies. But yeah, that was actually a big advantage to the kettle

bells. And when you, when you brought that up, it made me think about, well, that's kind of perfect for us because we run into this problem a lot where I can only stress them so much in the athletic training room. At a certain point, all the things that I have can't stress them anymore. And that's. When I set them to our strength. Exactly. That's when like, oh, you need the strength coach, right?

Or the weight room, right? And if you have one, that's great, that's a great tool to utilize and you know, that's super beneficial, right? But in those places where, hey, maybe you don't have one or you don't have one consistently, right, or just something to kind of work into whatever their programming is, this could be a great way to still further challenge without having a giant weight room and all these weights and maxing out, right. Yeah.

So clinically, there's not a ton of like if it feels like like

this was really popular in like 2014, 2015 and then like now it's like I could barely find anything on like the actual application of kettlebell training. Interesting, very interesting. But there are a few interesting aspects to it that do show some benefit, right? 1 is a case study. And again, I know it's just a case study of. Studies are important too. Yes, they drive larger rehab research, I mean.

Exactly, on an elite women's soccer athlete that was post op ACL, she had some neuromuscular dysfunction to where she had higher activation of like her vasus lateralus compared to her medial hamstring group. Right, which this group has kind of identified as that's a big risk factor for injury cause the medial hamstring group can play a large role in supporting the Rotary stability of the knee, especially the job of the ACL. Sorry, can. You say that again.

She had. She had higher activation of the vastus lateralus compared to her medial hamstring group. Interesting. Yeah. Now again, not many of us have the capabilities of testing that, but good to know. Surface EMG. Surface EMG. That's why they grouped it into medial hamstrings. But they but they could take out the vastus lateralus. That one's a little bit easier because like, it is pretty. Like quads are pretty like noticeably split like. You can identify that easier

than. But not semi member, no systems exactly. You'll get a lot, you're getting a lot of crosstalk. So it's just easier to just scoop. Yep. And what they did is they basically took this athlete who is post op through six weeks of just straight kettlebell training. And really it was mostly focused. It wasn't even like transitioning the exercises like oh, we're doing snatch today, we're doing clean. It was literally kettlebell swing and they just changed the parameters from there.

And it actually improved the activation of the medial hamstring group compared to the vastus lateralus. So it actually helped correct the neuromuscular dysfunction. That's really cool. Which does make some sense because you do see the higher posterior chain activation with the swing and not saying that the quads aren't involved, right? But if you're truly doing it well with the actual hip hinge, the quad activation should be pretty minimal. Yeah, right.

It's more, it's more stability at that point, Yes, it's not really a mover. I shouldn't be and if anything it's minimal cause again, you should be mostly hip hinging, not necessarily bending the knees too much. You can also see improved postural control and this is especially as we talk about the like single arm swings, right, 'cause you're challenging the Rotary stability of the core a

lot more, right? So it's actually been shown to help with that kind of postural control and actually have the fine motor skills to like if you're being perturbed, right? If you're being, if your torso is being pushed right, you have the proper activation to turn off certain muscles and turn on the right ones a lot quicker after doing kettlebell exercises compared to not, which is very important to postural control.

One thing that I did find that was interesting was the kettlebell swing actually creates a posterior shear force against the lumbar discs instead of an anterior shear force. So if you're thinking about disc herniation, right, anterior shear force is a big problem. That's not good because that's what kind of helps create that nucleus pulsis pushing posterior. So this is actually going on the flip side and creating that posterior shear force. Now if you have a spondee, that's bad.

Post your shears bad, but for our disc, which is very common, this could be a beneficial late stage exercise. I'd say I probably wouldn't do this early on with someone who has especially a fairly symptomatic disc, but you could feel confident to do this exercise later.

The next is that I think what most people kind of think of this exercise as is kind of being like a, a power exercise because it's very the weight's not super heavy and you do have to kind of move fast with it and produce a lot of force to get the weight up and catch it and bring it back up. And honestly, the power aspect is it might help a little bit, but it seems to be pretty minimal, right?

Some studies show that, hey, maybe it does improve jump performance, but the, the stats that were run showed that it really wasn't significant. So you can't necessarily say like, oh, did it truly help? Maybe not, but again, for an individual athlete that might see an improved gym performance, that may be beneficial, even though statistically it shouldn't have been. I'm amazed that you were able to read all these things and remember all of this.

Heck, yeah, I was. I was fascinated by this. All right, so it might have a power component. Now, if your goal is, hey, I'm training power, there's probably better exercises, but this could have an effect on power if that's kind of like a secondary goal or something you're not necessarily focusing with or wanting to change up the late

stage rehab, I feel like. It seems from an outside perspective like a power exercise, but like when you actually do it, I feel like it doesn't feel like power, like it feels. It feels more like strength. And also this is also just reminding me like, and this could be for your industrial athletes, I guess, very, very sports specific activity specific for them, I guess, because all of this is just reminding me of when in our backyard we had this brick wall that was just kind of random and

just in the middle of our yard. So we sledge hammered it down and this is literally like it was like A1 handed kettlebell swing over and over and over to get these bricks like down 1 by 1. And that was so much posterior chain and repetition and and it was a lot of hip hinge and it like exactly what we're talking about here. So like I'm just picturing like industrial athlete construction

like very activity specific. You know, and it's funny that you brought up industrial athlete, like they some of the studies referenced work that looked at like a non athletic population, so like just workers and it improved like those ergonomics and the worker satisfaction and like cardiovascular stuff. So yeah, definitely. And again, and like you said, I, I feel this is really geared towards like strength endurance, right?

Like you're getting the aspect of strength, but you're also getting like high reps very quickly. Could be very fatiguing, like really trying to maintain that as opposed to really leaning towards one or the other, like a power or just a strength or just an endurance. I think it really kind of blends that strength endurance aspect together as far as the strength goes.

Again, you see small strength gains, which again, which is what you would see with most strength endurance kind of stuff, you're not going to see huge strength gains, but you do see small strength gains now compared to other lifting techniques, right? This is going to be probably be pretty minimal, right? So if your true goal is like, hey, I just want to build strength, right? There going to be better programming aspects than this.

But this could be, again, a nice change of pace or a different phase of that kind of goal that you're working out out of, right? Like stability with movement? Yes, which is also what so much of Pilates is. Yeah, for sure. With, but this is actually like a lot more resistance training than like Pilates would be. Yes. So that's a. Oh yeah, and plus has a weight, you know, you got to have a weight. You don't always have to have a

weight. What you say when you think of strength, right They, the meatheads, the gym rats, think of weights. They've never tried Pilates. No, it's hard. They don't know because it doesn't involve weight, so they're like no. So non hard style type kettlebell fun extra bonus content. Yes, I like to use kettle bells for like any time that I'm trying to use like stability, like what are they called kettlebell suitcases?

No, I'm gonna. Be. Make up all names of this so not this is practice based evidence over here. Yeah, the suitcase carry where you can put the kettlebell upside down and hold. Just that one. That one's the a bottoms up carry. What do you mean it's a bottoms up? Because suitcase carrier would be more like holding a suitcase down. Oh wow, I've been calling them the wrong thing the entire time I've been. Calling that one is a bottoms up because the bottom should be facing up.

See This is why it's practice based evidence. Which is another challenge because the bottom facing up, it wants to fall a certain way, so you have to. That's exactly why I like it so much. Yeah, it's a really good one, that one. Anything Turkish get up even like laying on your side and doing external rotation with your top shoulder with the kettlebell 'cause I'll do that with the dumbbell as well because you're using gravity instead of like double external

rotation. Holding a theraband. You're I mean, yes, you're pulling resistance like with the band, but like really you're you're not really utilizing gravity to your advantage. So really getting them side lying with that affected shoulder towards the ceiling and then holding either a theraband. You could start with a theraband or you could do it with a dumbbell or you could do with a

kettlebell. I like adding that kettlebell in just to get a little bit more of that stability aspect where you're getting a little bit more of that movement. Where's some other kettlebell ones? I like, oh, anything that you're passing the kettlebell back and forth between hands like like a squat or like we do one where you have your one leg forward like a split squat or like a

lunge. You could do it just like that, or you could do like toe on the air X pad in that split squat and you're just passing the the kettlebell back and forth underneath your front leg. Oh. That's a good one yeah, I do a lot of kettlebell stuff. I use the kettle bells a lot because those are my heavier weights cause like the dumbbells in the clinic go up to 10 right? So my my kettle bells, I have 15 to 20.

So once I'm ready to start adding more weight to whatever exercise, a lot of times I have to use kettlebell for that. I like goblet squats with the kettlebell. That's a good one. Do that one a lot. I want to start incorporating the swings and stuff but again I need more late stage reactive. Glass door. We do it in the hallway. If you still have a glass door in the hallway. Yeah, but further, it's a little bit harder to damage that. I do have a glass door.

Oh, also too, sorry, I don't want to sound like too crossfitty here, but one of the studies talked about these things called like, Indian clubs. Like it. It almost looks like a bowling pin, but a lot thinner and the weight's pretty minimal. I can't remember how much it was. And like, you could use that for like, shoulder and like the way they were describing the exercises, I was like, well, that's like really functional. Like that would actually be kind of cool. I have to look that.

Up. Yeah, look it up. It's pretty dope. So now I'm like I want some. That's not kettlebell. I know, but they compared it to a kettlebell, so it was what I was reading. Got it. Yeah. I can't remember the results between the two. I mean, the kettlebell was more because of the weight was a little bit more but. Still. So wait, tell me what a suitcase carry is because. Because apparently I've been getting. Them confused just holding the weight down like if you were to

hold a suitcase and just. Walk. And just walk. You know what I do use the kettlebell like that, but instead of walking I do, I do it for upper trap. So I'll have them like lateral flexion of the neck away from the side and then I'll do like shoulder to ear towards the same side. That's cool. With the kettlebell or even just shoulder shrugs. 1 sided shoulder shrugs. I feel like we're going to stop recording and then I'm going to think of a million other kettlebell exercises.

Yeah, Yeah, it does give a lot of versatility and it is pretty functional than just kind of like dumbbells or like a barbell, something different, yeah. Definitely something different. What is your action item? I think kettle bells are a nice change of pace if you're trying to challenge your student athletes a little bit different.

Again, if your goal is really focused towards strength endurance, I think this is a great set of exercises to to do same thing with like the snatch and the actual clean the kettlebell clean kettlebell snatch, right?

That's a great shoulder stability and especially for someone that like you probably don't really trust doing a snatch right, this may be a good way to actually learn how to do the snatch right, actually learn the mechanics of it in a less dangerous environment compared to a heavy barbell over your head. And I said this could be a good start, right. So kind of like. Really. Even return back to that.

Yeah, right. So really kind of define your goal and you could tailor these exercises to what you want your goal. Learn to what your goal is. Sweet, Yeah. How many references did you use for this? We used about 12, yeah, about 12:12 to 14. Those will be on our website. If you're interested again in the show notes where you will also find the course evaluation course quiz, all of that listed down below in the link to the course that you can register

for. Thank you so much to Clinically Pressed. Please let us know your favorite kettlebell exercises in our Facebook group, facebook.com/group/AT Corner podcast. There's only one question to get in. Where did you hear about our podcast? It will automatically let you in and it will be the question of the week this week. So if you're interested in some other kettlebell exercises, hop on that link and I'm sure some other people will comment. You can see what other people

are doing in their practice. So, so I think that's it for the main episode. If you guys are new, we do every episode as either education stories or interviews. Education episodes are just like this one where Randy does a deep dive into our literature and we kind of compare it and just have a nice conversation and they're eligible for Cus. Our story episodes are from real life athletic trainers all around the world, which is super exciting to say.

And we bring stories on different topics and chat about those and how to handle things and what we've seen and what we haven't seen. And then we bring on people for spotlight interviews about so many different things. So make sure you tune in. And if you ever want to hear anything on the podcast, let us know on Instagram at AT Corner podcast. And I think that's it. Thank you for helping us showcase athlete training behind the tape. Bye.