Why I Never Prescribe Bridges & Always Prescribe Deadlifts

: On today's episode, why I never prescribe bridges and always prescribe deadlifts. Welcome to the podcast that gives you the most up to date, evidence-based information on PHT rehab. My name is Brodie. I am an online physio, but I've also managed to overcome my own battle with PHT in the past. And now I've made it my mission to give you all the resources you need to overcome this condition yourself. So with that, let's dive into today's episode. Welcome back everyone. Hopefully your rehab is going well. Today is going to be, I'm assuming it, well, you know, anticipating a bit of a shorter one because I just wanted to get my thoughts on a particular topic. Being around my exercise prescription when talking with you about your PhD rehab and a current theme that keeps popping up because you may have heard me talk about little bits and pieces of what I'm about to talk about in other various episodes, but just thought I would share my thoughts and house it on one particular episode so I can share it to certain people and you know, people can find it useful because I know there are a lot of episodes on this podcast. And I know not everyone has the capacity and time and patience to listen to every single one, but I think this is an important topic, particularly because I'm jumping on a lot of injury chats with you and I'm seeing a very, very similar pattern every time. And typically it is people, you know, having PhD for six, 12, 24 plus months. And I ask about their exercises, what they've decided to gravitate towards or what their health professional, what exercise they're given and it's bridges and a lot of bridges, a lot of variations of bridges, maybe some other TheraBand type exercises and... When I ask about heavier exercises like deadlifts, it's either, no, we haven't progressed to that stage yet, or it's, I've tried those in the past and they flared me up so I never went back to them. And, or like, yes, I'm slowly working on my deadlifts and we look at the progressions and they haven't progressed, you know, anywhere near as quickly or as sensibly as what I might've done so. So like, it's a very common theme. And unfortunately it's... like the health professionals guiding that and nothing to do with you. But it's also maybe what you have found in terms of advice, looking online and all those sorts of things. So, um, or it's like based on research because we had even I've done episodes in the past, very in the early days, looking at research released by Tom Goom, who's talking about the three stages of PhD rehab, and I've done an episode that covers that and stage one. is all the bridges type of variations and then stages two and three are introducing more explosive sort of stuff or heavier stuff single leg deadlifts and those type of things but people just get stuck on phase one because they feel like they're not equipped to progress to the next phase and so yep this topic this episode is going to cover two specific Parts, one's gonna be why I never prescribe bridges and then the other is gonna be why I always prescribe deadlifts. And so let's start with the first part, why I never prescribe bridges. First and foremost, doesn't load the tendon enough. Despite like you might get a good burn in the hamstring belly, you might actually feel symptoms that are quite high. You might notice that symptoms, it actually helps symptoms, but it's just not loading the tendon enough based on. the orientation of the exercise based on where that load is going. It's, it's a low, very low level exercise. And said before, I'll say it again, tendons love slow, heavy, progressive load. And the, the heavy and progressive is where the, the bridges really like, they just don't tick those boxes. Yes, you can do it to create this analgesic effect because it is a low load that goes through the tendon and sometimes that load provides a temporary short term reduction in pain and symptoms. And so that's why people find it quite nice. That's why people gravitate towards it. And, you know, they end up doing more of it. Because it's like, Oh, I finally found the answer of the type of exercise that provides relief and getting me moving in the direction of recovery. But It's just transient. It's a short term. It's a, um, it will provide temporary relief, but won't provide long term rehab because we're not building strength, capacity function to that tendon. Because like I say, the, the load isn't high enough. So that's the number one reason. Number two is just, it's just not functional enough. Like we, if we want to return to sport, if we want to return to sitting for longer periods of time or driving for longer periods of time, or you know, cycling, swimming, all those sorts of things. It doesn't engage the hamstring in a way that can then be transferable into daily function. And yes, phase one exercises, yeah, they don't really look that functional, that's fine. But when it comes to hamstring stuff, we want the hamstrings to tolerate eccentric load, which is load while lengthening, especially you runners that are listening to this. very important because it's the eccentric phase during the running cycle that the hamstring loads really spike and if you are If you have a very high capacity to eccentric strength, then that's going to carry over and translate very well into your running capacity It doesn't have a concentric phase, which is the shortening part like a typical hamstring curl will Contract the hamstring and build up the hamstring muscle capacity which then box up the muscle and therefore like it's the same unit, the muscle is the same unit as the tendon. So bulking up the muscle with concentric contractions and getting stronger and stronger and stronger is going to help the tendon as well. But also the bridges don't build up the tolerance for the tendon to tolerate compression, which compression is like the squashing or the pushing of the tendon into the sit bone. as you sit, as you bend over, as you hinge, as you put on your socks, all that sort of stuff, to which the bridges don't do, yeah, will load, low load the tendon outside of compression. So that's when it becomes particularly tricky. Another reason, it's hard to progress. And I've seen a ton of variations with the bridges, but it's just not, you could put like a whole bunch of load a lot of weight on the hips and go up into a bridge but I don't really see many people doing that. I know a lot of people waste a lot of time doing variations they're like yeah I do my double leg bridges my single leg bridges my long lever bridges which is like moving the heels further away from your body which recruits more and more of the hamstring muscle. Yeah and I do my bridges with my feet elevated on a chair or a step. So I do that double leg and I do that single leg. And there's just better time spent doing better quality exercises. And so it could be a bit of a time waster, like doing all those variations does take time. And as if people have worked with me before, they know I just like to strip it all back and just give like four exercises, just do the best four exercises for PhD recovery. And Bridges is not on that list. because like I said, there's better quality exercises out there. However, I wanted to just have you keep in mind that if someone is doing bridges and finds benefit from it, I don't take it away from their program. I have a conversation to see if they want to keep it in or not. If they're only doing bridges and doing all these other things, if they're only doing bridges and not doing any of the other... what I would deem more beneficial exercises, we might remove it if they don't have the time to do it. But if someone is already doing their deadlifts, their curls, their step-ups or their lunges or something that's moving the needle for the longterm, but they also find doing some bridges for like a warmup or on their non-strength days and still finding benefit with that, then I'd say, you know what, you can still do that. It's totally fine to do it if you enjoy it or if you're finding... like a short term benefit, but we also need to do the long term stuff. And if we can find the balance between the two, then I keep it in, but very, very rarely would I have someone who isn't doing bridges and I'll actually prescribe it for them. So many reasons why I don't feel like the bridges are that particular effective and that's why I don't assign them to people. But then there's this other side of things of why I give deadlifts to almost everyone. And I say this because some, for one reason, some people never make it to the deadlift phase of their rehab. They're like, okay, I'm working on phase one of my rehab right now. And I've been on phase one for three months, but there's too much pain, in too much discomfort with my low level exercises to then progress to the next phase. And they're just stuck there for a very long time. So that's like a typical story that I'll hear. But deadlifts, they tick the boxes. It's slow, it's heavy, and it's progressive. Slow in the way of, usually we say about three seconds down, two seconds up. So five seconds time under tension per rep. And then if we're doing three sets of eight, you can tell that's like a long time under tension. I'm not talking about 10 seconds down. hold it for five seconds and come up for 10 seconds. I've seen that a couple of times, but I think that's a little bit too long, particularly because you'll never be able to get heavy when holding it for that long period of time. Yes, we can make it heavy. If it's three seconds down, two seconds up, and that feels okay for three sets of eight, we can then move, we can add on 10 pounds, 10 pounds, 10 pounds, as your hamstring is tolerating that. And we can get considerably heavy. We can use a barbell. And we can put 300 pounds on the bar if we wanted to. So you have the opportunity to keep adding on the weight, unlike the bridges where you can't put 300 pounds anywhere. But yes, it's heavy, it's progressive. We can work through a good time under tension. It's functional as well because it will work the hamstring tendon. It will work the hamstring muscle and tendon into an eccentric contraction. So... Usually like the lowering phase, if that's nice and slow, that's eccentric contraction of the hamstrings. But then as we come up, that's a slight concentric contraction. But importantly, it's also a lot of time under compression, tolerating more and more compression because you hinge at the hips. As you hinge back, it sort of pushes the tendon as it wraps around the sit bone. And so... we're doing more and more of that. So if there's an eccentric component, if there's a compression component, and then we do more and more and we progress and progress, that's gonna translate into better sitting, better running, better cycling, all of that functional stuff. And we can modify things pretty easily. We can modify the weight, we can modify the sets and reps. We can also modify the range of movement, which is pretty key for a lot of these people, because the... reason why I get people starting off with some deadlifts and people are like, oh, I'm nowhere ready for that stage. Like I'm only at stage one. You can tolerate deadlifts. It's just a matter of how light and how few and what range of movement. Cause you could do one quarter range of movement. You can get a broomstick, stand up, hold onto that broomstick and then do a deadlift type of maneuver and just go halfway down your thigh and then come back up. you could go just to above the knee and come back up. That's what I would call like a one quarter range of movement. I would say half range of movement. It's getting that bar just past your knees. Three quarter range of movement would be about mid shin and then full range of movement would be about three quarters of the way down the shin. Play around with that. And I'm yet to find someone no matter how severe their symptoms are, no matter how weak they think they are, they can tolerate deadlifts, we might just do three sets of five, 10 pounds, one quarter range of movement, there's your starting point. So once we can fall within acceptable limits, we then progress and progress and progress to then eventually meet where the tendons feeling like it's tolerating the or it's accepting the amount of load, the amount of tension, time under tension, and then progressing beyond that point. And so For a lot of people, they might be a bit scared to do some deadlifts. They might be scared to restart deadlifts if they've tried it in the past and it's just flared them up. To which I'd say to people, look, your starting point was too much. It's obvious because you did deadlifts once and if you're flared up for several days after that, it might've been an issue with the range of movement, the weights, the sets, the reps. That needs to be adjusted to find the appropriate amount. Like I said, I'm yet to work with someone who hasn't found the appropriate amount with their deadlifts. And so the other thing to bear in mind is like, I've said this again, but we're not aiming for symptom free exercises. A lot of people do bridges and they have pain with doing bridges. And then they feel like they're unable to progress their exercises because they're trying to set the trying to wait for their bridges to be pain free before then progressing to the more extreme. exercises and like I say you're going to be there for a very long time because the bridges aren't effective enough to get you pain free in the first place but pain free shouldn't really be the goal anyway. What we want to do is try to have acceptable limits of pain during less than a 4 out of 10 that settles back to baseline in less than 24 hours sometimes 12 hours but if we can do that then we progress and then we progress and then we eventually get to the point where we're lifting heavy enough. that the attendant starts to really enjoy it, starts to increase their capacity, and then the pain starts to come down. So people get really stuck when they feel like they've got too much pain during their bridges, and they're just gonna continue doing their bridges and not progress because there's too much pain. You're just, you're not getting anywhere. And so that's why we need to be aware. That's why I decided to do this type of episode because I'm, like I said, I'm jumping on chats with a lot of you and the... the story is still the same. So I'm trying to, you know, allay people's fears, give them reassurance, these sorts of things are okay. So what are some final tips? I would say you can do some bridges if you would like, like particularly during flare ups. If you're at a flare up state where, you know, deadlifts might not be appropriate, you can do some bridges just to try and keep some load and try to keep symptoms calm and try to. work your way out of a flare up, I would say, you know, you can do bridges during a flare up for like a week before then getting back into deadlift, seeing what type of variation is tolerated. I did an episode earlier this year, I think it was January 2024. The title of the episode is how often should you do isometrics and appropriate scenarios, dosages and those sorts of things for doing isometrics. So if you haven't listened to that one and interested in this sort of topic, you might be interested in that one as well. Another tip is just to incorporate those other exercises. I did mention incorporating curls, that being a prone hamstring curl, so lying on your stomach with a machine at the gym that allows you to curl your hamstrings. That's, you know, we have a preference for that, but if they don't have that, then a seated hamstring curl machine or using a cable or something to that effect could be helpful. If you're ready to do some sort of single leg stepping type of exercise, I would recommend like step ups, weighted step ups, or a lunge or a Bulgarian split squat. Some people that might be too high level, but there's always going to be modifications and variations of a similar looking exercise to then add into your program. So those exercises are important alongside the deadlifts. work on your deadlift technique, start off light if you're not familiar with the technique because it is quite foreign, it's quite unusual if you haven't done it before, it does take practice and what I would say is like some cues for people is try to keep as you hinge or go down into a deadlift try to keep your shins vertical, try to keep your arms vertical, try to just if you're as close to your body as possible. As you're going down, just have it slide down your thighs, still stay in contact with yourself. And then as it passes the knee, just slide it down the shin, so everything's staying nice and close. As well as on the way up, on the way up, everything just stays nice and close. You can just like slide up your pants or your skin and keep it there. Otherwise there's a little bit of strain on the lower back. And also hinge the chest forward. A lot of people sort of sit back and they feel like their overall body weight is moving them back and that their toes lift off and they sometimes like take a little stutter step backwards. It's only because you're not counterbalancing with the chest going forward, going over. And so hard to describe on a podcast platform, but like I say, drilling in technique is going to be helpful because even if you're just doing light stuff, if you drill in good technique, it's only gonna be better for when you. start lifting heavier and heavier and heavier. Another little tip, do double leg deadlifts. Don't bother about single leg. I've done episodes on that in the past. Single leg deadlifts, it's hard to control. It's hard to get a good consistent momentum. It's hard to, you know, control a three seconds down, two seconds up. Sometimes there's a little bit of shaking and loss of balance. And there's little like flutters of imbalance there and you can't get heavy enough. So... For those reasons, do some double leg stuff instead of the single leg, that's definitely my preference. And lastly, I'll finish with these tips. If your current plan isn't working, then change it. If within like a month you haven't seen any improvement, change it. It's very, very important because a lot of people that I jump on calls with, they've done the same thing for six months and there's just been no change, but they haven't changed things. Anyway, they've been doing bridges for six months and feel like they feel good when they do bridges, but over the long term they're not getting anywhere and That might be the case for deadlifts as well You might have started doing deadlifts and still not seen any change or maybe you saw an initial change for the first couple of weeks But it's plateaued ever since then if you're not continuously seeing improvements Then change something I don't know what that change is. That might be progressing, that might be modifying some exercises, might be adding in some new exercises, it might be changing how you sit, it might be changing how fast you run, like all those sorts of things. But if you do need help, that's why I'm here. I have these free injury chats that you can jump on. I also have one-on-one physio services. If you wanna go through the link in the show notes to then take you to my website to show how we can work together, that's my bread and butter. So. Hopefully you found this episode helpful. If anything, maybe it's just a helpful reminder if you've already known it, but just in a bit of more of a condensed version. And yeah, hopefully we can make some tweaks for the better and get you recovering a lot quicker. So thanks for listening. Thanks for listening to all these episodes that we do. And I guess good luck with your rehab this week for the next two weeks actually, because the next episode will come out in two weeks and we'll catch you next time. If you are looking for more PhD resources, then check out my website link in the show notes. There you will find my free PhD 5-day course, other online content and ways you can personally connect with me, including a free 20-minute injury chat to discuss your current rehab and any tweaks you might need to make. Well done for taking an active role in your rehab by listening to content like this, and together we can start ticking off all of your rehab goals and finally overcome P.H.T.