Why I’m a Physical Therapist

Rejected Title: Why do I do this?

I think the New Year is a good excuse to remind myself and inform my readers of why I do what I do. I also wrote about the strength coach side of this over on my other blog.

I am a physical therapist. I have a doctorate in what I do. I work in orthopedics and specialize in shoulders, knees and low back pain. I am self-employed as a PT.

Commitment to Helping Others

As cliche as it may be I feel I have a commitment to help others. Like almost all folks who work in healthcare I want to help people. 

Eagle scout

I swore my Oath as an Eagle Scout back in 1998. Part of the oath was to “country” and also, “to help others at all times”. It took me a while to figure out how to live up to those parts of the oath. But they were the parts that resonated most for me, so I felt the need to do so.

I actually tried to enlist in the Army first. But they didn’t want someone with terrible eyesight AND allergies. 

I studied criminal justice with the thought of becoming a police officer. Thankfully I was saved from that fate by my mother. While I was taking classes in community college she got me a job at the hospital where I worked. And it was there that I finally understood that I really wanted to work in medicine to help others.

Public health

Many years later I got my Exercise Science degree from UMass Boston. Unlike the other UMass campuses, the Boston campus’ exercise science program had a strong public health component. This resonated with me. 

As a physical therapist I play a small role in the greater project of improving long-term public health outcomes. Because I help people stay physically active. This reduces their likelihood of a wide variety of diseases such as cardiovascular disease and diabetes, amongst others. I’d already worked in a skilled nursing facility (what’s commonly called a nursing home) and seen first hand how much one’s life degrades from these diseases. And I also understand the tremendous burden that these diseases impose upon society. 

Mechanic

I like being a mechanic for people. My first healthcare job was as an orderly in the OR. And before that I had extensive first aid training, mostly thru Scouts. I enjoy the hands-on nature of this kind of work. I would never be satisfied with the more “look at test results and prescribe things” style of medicine that exists in many other specialties outside of orthopedics. 

I like basic physics and I like understanding how machines work. People’s musculoskeletal systems are weird, complex machines. It’s really neat! And fascinating. 

Puzzle solving

And I like the puzzle solving aspect of, “this machine is broken, how do I fix it”. Unlike with a car mechanic, I never just pull out a broken part and install a new one (tho that is amazing surgery and I am happy to work on those patients). I have to use what bits of the machine still work and take into account how well each part is working and develop a solution to the puzzle. 

I really appreciate the intellectual pursuit of this aspect of being a physical therapist specifically. 

Improvement

I like watching my patients improve. It is really satisfying to work with a person who starts off unable to do something important to them, or unable to do it without pain, and bring them to a point where they are capable again. Watching people’s pain get better or watching them resume physical activity or sports is really a joy for me.

One of the things that was clear to me from my years of prior healthcare work that differentiated PT from other orthopedic careers was this aspect of really seeing my patients get better. 

Bringing it All Together

Physical therapy is a vocation that allows me to: 

  • Help other people
  • Help my community
  • Work hands-on with patients
  • See my patients improve
  • Solve puzzles

That’s why I do this. 

Alas, actual jobs in physical therapy are terrible and exploitative so I work on my own as an independent physical therapist. If you’d like to help support me then you can contribute thru Ko-FI. Thanks.

Strength Training for Kids

Or how the AAP article drives me nuts

I have a child! Woo hoo!
I’m a strength coach professionally. At some point I’m going to want my kid to start strength training. So, let’s mosey on over to the American Academy of Pediatrics website and see what they have to say about strength training in kids: https://www.healthychildren.org/English/healthy-living/sports/Pages/Strength-Training.aspx (not on the AAP website per se but linked from the AAP as the top hit for my query)

Yikes! Looks like they forgot to talk to somebody who is familiar with the topic before putting this out.

Credit Where It Is Due

Certainly, plenty of this page is good. They recommend strength training. Usually starting around age 7 or 8. They recommend a reasonable approach: 8-15 reps, full ROM, appropriate supervision, progressive increase in resistance.

They talk about the benefits of strength training. They point out how strength training is both safer than other activities and improves the safety of other activities. 

This is all great and if the whole article didn’t also bother my professional sensibilities I could leave it at that. 

But . . .

The first paragraph has this sentence: “[strength training] is not the same as Olympic lifting, powerlifting, or body building, which requires the use of ballistic movements and maximum lifts and is not recommended for children.”

And, um, did they talk to somebody who knew about these things? Sure seems like they didn’t. They treat this trio of activities like they are all the same, which just shows a staggering lack of knowledge.

First they categorically state that this trio of activities are not strength training. Which is objectively nonsense. 

  • Powerlifting is specifically the sport of maximizing strength. 
  • Olympic lifting is specifically the sport of maximizing power – which is inseparable from strength in exercise physiology. 
  • Body building is resistance training and therefore, compared to not doing resistance training, will necessarily improve strength, even though that’s not the focus as such. 

Incorporating Olympic lifting into one’s training does not require maximum lifts. Competing in the sport does, but it is absolutely a reasonable component of strength training for athletic development. Strength training for athletic development is something I’ve done in (U.S. NCAA) division I athletes. Useful outcomes for athletic development can be done at only 5RM. And Olympic lifting based variants can be done with lower loads, such as the dumbbell snatch, that are low load on the body overall but still worthwhile.

Maximum lifts are part of the competition in powerlifting, and I wouldn’t recommend power lifting per se for children. Ballistic movements are not part of powerlifting. 

Maximum lifts are not at all a part of body building. The program actually recommended lower down in the article could function as a low-end body building program. Ballistic movements are not necessarily part of body building and are rather uncommon in that. 

Ballistic movement are not recommended

Uh, so children shouldn’t jump. Like, at all? Because seriously, the actual measured forces on the body from jumping, just on level ground, are significantly higher than the forces from Olympic lifting. 

The actual research into Olympic lifting doesn’t show any particularly higher risks for children from the activity. A significant factor in reported problems seems to be unsupervised children and home equipment. I’m totally on board with strength training being a supervised activity for kids.

The real determining factor in when to start Olympic lifting with children seems to be maturity/cognitive development. The child needs to be able and willing to follow instructions and refrain from playing with the equipment. (I’ll stress here that a kid who doesn’t want to do Olympic lifting is clearly higher risk than one who is engaged and intrinsically motivated.)

Programming

They recommend a strength training program that is only 20-30 minutes, PLUS 20-25 minutes of warm-up and cool down. That’s not good. The most efficient program I can write has six separate exercises in it. With 2 sets per exercise and appropriate rest periods, plus the reality of setting up/taking down exercises and switching time and water breaks, this program takes 24 minutes. This is the most minimal program that is still useful. 

A more reasonable program is 8 exercises and 2-3 sets – which takes 48 minutes. With acceptable warm-up and cool down this takes 60-65 minutes.

It is not always necessary to do 10-15 minutes of warm-up. Appropriate warm-up times depend on several factors. Cool down time is just overemphasized. 

Exercise Selection

This video from the AAP is their Upper Body Strength Training Recommendation. Their are just three exercises recommended: push press, biceps curl and what the presenter calls a deadlift high pull, but really ends up being more an upright row. 

The presenter just straight up acknowledges that the biceps curl is probably not the most helpful – but is still using up one of the only three exercises on it.

These three are presented as if they are a complete program for either upper-body strength training (the title) or overhead athletes (the presenters words). Neither is even close. 

I would not call complete an overhead athlete program that doesn’t include a rotator cuff oriented exercise. Even just a DB row. 

The “program” includes no conventional pulling exercises and only vertical pushing. It’s not complete. It’s just bad.

The video also specifies an intensity of 15RM or lower! The written guidance says 8-15RM. 15+RM isn’t even strength training. 

One other note about this video – the instructor to student ratio is higher than the AAP recommendation. And I agree that there are too many students.

I’m not going to spend time on how silly I think doing these exercises one-legged is, “for balance”.

Bodyweight is Better?

The accompanying general video is by the same guy, but isn’t consistent with the other video. In this video the presenter says that the exercises should be all bodyweight – in the other video the kids are using dumbbells. The presenter says, ”as long as they use their bodyweight it’s totally safe”.  This is a nonsense statement. Like, “does this person know what numbers are?” level nonsense. And what it really shows is that the person uncritically accepts “conventional wisdom” without applying any rational thought to it. 

This same presenter emphasizes the need to use light weights both in this video and the other video. But that’s not what bodyweight is. It’s actually plenty of weight for many exercises. It is perfectly normal for a person to struggle to do 8 push-ups when they start. That means that the bodyweight exercise is more intense than the AAP guidance recommends. For some children a push-up will be a maximal lift i.e. something they can only do once. That’s not safe according to them. 

The response necessarily requires some magical assertion that because it’s bodyweight it’s different without describing how. The muscles, tendons, ligament and joint surfaces can’t tell the difference between a 1RM pushup and a 1RM bench press. They are the same.

The fact is that bodyweight is frequently too low for lower body strength training and too high for safe upper body strength training. 20 air squats just isn’t strength training.

Conclusion

Sigh. Superficially it’s fine. And if somebody got their kid into strength training based on these pages and videos then that is great. And it is better than not doing so. Certainly.

But it really comes across as a minimal effort, barely better than nothing set of info.

Additional reading: https://www.fitpro.com/blog/index.php/olympic-lifting-for-children/