Using Kettlebells in the Using Kettlebells in the Rehabilitation of the CoreRehabilitation of the Core

Philip Johnson, MS, ATCUniversity of Michigan

Purpose of the Purpose of the PresentationPresentation

Understand the history of the Kettlebell

Basic knowledge of the fundamental exercises

Uses in rehabilitation of low back injury

Case reviews

“Core” definition

What is a Kettlebell?What is a Kettlebell?Best described as a “cannonball

with a handle”StylesFitness toolRehabilitative tool

History of the KettlebellHistory of the KettlebellRussian background18th Century Russia

◦Appeared in the Russian dictionary in 1704 (Cherkikh, 1994)

Red Army1900’s Strongman1985 Soviet Union Sport

History- continuedHistory- continuedFitness Certifications:

◦Russian Kettlebell Certification (RKC)

◦ International Kettlebell and Fitness Federation (IKFF)

◦Art Of Strength (AOS)Military Training/

Fitness- SS Snatch test◦10min: snatch 24kg,

200repsMMA/ UFCCrazy “fitness trend”??RehabilitationResearch???

Kettlebell Vs. Dumbell Kettlebell Vs. Dumbell Different weighted tools/ different load

◦KB 6-8 inches out of center of hand◦Positions load anterior, posterior, moving

KB: “offset” load◦Primary use to reinforce movement

patterns◦Focus on muscle group function in unison◦Less use in isolated strengthening

Momentum driven◦Convenient for explosive patterns◦Grip strength

KB vs. DBKB vs. DBCost $$: KB (PB/PS) DB

◦8kg/ 18lb $35/36 $30/26◦12kg/ 26lb 45/41 37/33◦16kg/ 35lb 60/55 52/46◦20kg/ 44lb 70/65 67/60◦24kg/ 53lb 80/75 82/72◦32kg/ 70lb 100/95 104/92

*reference: Perform Better(PB) and Power Systems (PS)

Kettlebell ManufacturersKettlebell Manufacturers Art of Strength Dragon Door K2 Kettlebell Concepts Gill Perform Better Ader Lifeline Power Systems Troy York Wright Apollo Muscle Driver

RETAIL

My ExperienceMy Experience**I am NOT a certified instructor** Not well educated/ experienced in

Weight RoomJune 2008: Perform Better Seminar

◦ Anthony DiLuglio◦ www.artofstrength.com

Enter The Kettlebell –Pavel Tsatsouline◦ Published 2006 ◦ www.dragondoor.com

Additional ResourcesAdditional ResourcesBlogs/ Websites

◦www.begin2dig.com◦www.chasingstrength.com Geoff

Neupert◦www.liftkettlebells.com◦www.mikemahler.com

YouTube: “kettlebells” ◦about 22,000 videos

GoogleDVD’s

Getting StartedGetting StartedDon’t be Intimidated!

◦“Average” Male 16kg, “Strong” Male 20kg

◦“Average” Female 8kg, “Strong” Female 12kg

◦“Heavy” >32 kg; traditionally 48kg is heaviest (Tsatsouline, dragondoor.com)

◦Can Find: 92kg

Benefits of Kettlebell UseBenefits of Kettlebell Use1. Strengthening- Muscle integration

rather than Isolation2. Endurance/ Cardiovascular3. Power output4. Grip5. Efficiency of training/rehab 6. Reduces space needs/ Cost7. Utilize a Balance of Tension and

Relaxation8. Hip Extension and Deceleration9. Variety and Versatility

Safety IssuesSafety Issues• Surroundings- keep clear space

• Start slow- practice

• Focus on movements- setting down KB• Low Back- flat back “anti-slouch”

• Use Safety “Sense”

Benefits of Kettlebell Use in Benefits of Kettlebell Use in RehabilitationRehabilitation

Postural Correction/ImprovementReinforce Movement PatternsStrengthen Gross Movements

◦CORE/HIPS!Improve Return to Olympic LiftsCardiovascular Stress

◦(Schnettler, et al., 2010)

““Core” Specific Core” Specific RehabilitationRehabilitation

Abdominal◦Unilateral loads; Single leg stance◦Functional abdominal activation

Hip◦Anterior (hip flexor)- Reciprocal inhibition◦Posterior (Glut/ Prox Ham)- Activation◦Restore normal Lumbo-pelvic-hip

functionLatissimus Dorsi

◦Eccentric arm control◦Spine stabilization

Upper/Lower Back◦Segmental stabilization

The SWINGThe SWINGTHE fundamental

kettlebell exercise◦ Base movement

for other exercisesGreat posterior

chain work“dynamic”

DeadliftHIP HINGE!!!

The SWINGThe SWING

The SWINGThe SWING

SWING- BreakdownSWING- BreakdownHip Hinge

◦ Push butt back◦ Keep back flat

Weight on Heels◦ Wiggle toes◦ Shins vertical

Eyes ahead◦ Focus on spot in

front“Hike” hands

◦ Hike football◦ Thumbs tight◦ Reach through legs

with straight arms

SWING- BreakdownSWING- BreakdownHip Drive

◦ Extend HipsChest out/ back flat

◦ Shoulder blades together

KB weightless◦ Be able to let go-

light gripPendulum arms

◦ Move passively- rope like

◦ Momentum dependent

SWING- breakdownSWING- breakdownPull patella superior

◦ Pull knee cap to ceiling

Glut tight/ squeeze◦ Hold a quarter in

cheeks◦ ER hip joint

Scapula retracted◦ Chest out

KB to shoulder height◦ Not crossfit-

“American” Swing◦ Control with

latissimus dorsi

SWING- videoSWING- video

Swing- problemsSwing- problemsNot enough weight

SWING- ProblemsSWING- Problems“Squatting the Swing”

Swing- problemsSwing- problemsWeight Forward

Swing- problemsSwing- problemsHands too Low/ Rounded T-spine

Swing- problemsSwing- problemsLow Back Hyperextension

The SWINGThe SWINGQuick Learning Curve

Active Core:◦Gluteals◦Hamstring- proximal◦Upper Back◦Low Back- no axial load, single plane, no

rotation Stabilization Load away from body but controlled by hips

◦Latissimus dorsi

Cardio◦30s on/30s off

Rehabilitative Goals of the Rehabilitative Goals of the SwingSwing

Back stabilization, muscular controlPosterior hip activation:

◦concentric glut to extend hip◦eccentric to decelerate

Anterior hip- reciprocal inhibition in erect posture

Improved hip musculature coordination

“functional” abdominal contraction lower back reciprocal inhibition

Static Carry-McGill Bottoms Static Carry-McGill Bottoms Up-Overhead Carry-SidebendUp-Overhead Carry-Sidebend

Deadlift VariationsDeadlift Variations

Deadlift- SUITCASEDeadlift- SUITCASE

Deadlift- Single leg w/ hand Deadlift- Single leg w/ hand variationvariation

Squat- SumoSquat- Sumo

Squat- rackSquat- rack

Squat- Goblet Squat- Goblet

Squat- Swing flip to a Squat- Swing flip to a SquatSquat

Turkish Get UpTurkish Get Up

Turkish Get Up- continuedTurkish Get Up- continued

Figure 8 to a HoldFigure 8 to a Hold

Clean (and Press)Clean (and Press)

Hi-Pull to a SnatchHi-Pull to a Snatch

Case #1- L4-L5,L5-S1 Case #1- L4-L5,L5-S1 DiscDisc

Symptoms: ◦ Pain- limiting hip flex,

knee ext ◦ Radicular symptoms

Started KB ◦ Decreased acute pain/

inflam◦ ~1week post injection◦ Tolerate ROM, ◦ table (open chain)

exercises◦ Bridge DL ROM DL

wt Static carryswingSupplement to return

to weightroom

L4-L5, L5-S1 Disc BulgeL4-L5, L5-S1 Disc Bulge*Caution: Anterior load and Opp side

load*Farmer walk

◦Abdominal bracingOverhead carry

◦Abdominal bracingSumo Squat

◦Core control, lumbar stabilityDeadlift

◦Lumbar stability, hamstring flx, gluteal control

Swing◦Lumbar stability, dynamic hip◦Cardio?

SI Joint DysfunctionSI Joint DysfunctionAnterior Hip/Groin painLateral Hip painProximal Hamstring painNo signs of muscle tissue

damageMay have SI joint painUsually functional but not

comfortableInnominate rotation on exam

Case #2- SI Joint Case #2- SI Joint DysfunctionDysfunction

Anterior Rotation of the Innominate◦Sumo Squat- modify

Glut/Groin loaded- activate

◦Single Leg Deadlift- modify Unilateral activation Reinforce manual therapy correction

◦Goblet Squat- if ROM tolerated Posterior rotation of pelvis

◦Swing Restore normal coordination of hips

SpndylolysisSpndylolysisTypically pre-existing

◦Overweight◦Lordosis◦Posterior butt

Aggravated in extensionSpasmFunction but pain

Case #3- Spondylolysis- Case #3- Spondylolysis- RT L3RT L3

*Caution: Posterior and same side load*

McGill Bottom Up◦Abdominal bracing

Rack Squat◦Unilateral load, core control

DL- modified ROM◦Lumbar stability, glut control

Swing ◦Lumbar stability, dynamic hips

Other Times of UseOther Times of UsePre-Lift

◦Warm Up: 30 swings >150bpm◦Poor Squat or Deadlift motion◦Chronic Problems: groin/sports hernia

Off Days (10-20min)◦Corrective: STM MT/Mob KB exer◦Rehab (Fine Tune): ex: chronic

hamstring◦Cardio: 5 min tabata; circuit

Kettlebell LimitationsKettlebell LimitationsAlways SAFETY 1st

◦Common sense dictatesTake time to teach movements

◦Learning Curve/ ProgressionsHand/Grip/Forearm injuryHip joint pathology?

REFERENCESREFERENCES Tsatsouline P. Enter the Kettlebell (2006) DiLuglio A. “Why Choose Kettlebells Instead of Dumbbells?” www.performbetter.com Brown J. “The Top 8 Reasons Why You Should Kettlebell Train”

www.performbetter.com Tsatsouline P. “Which Kettlebells Should I Get” www.dragondoor.com Kettlebell Buyer’s Guide www.kettlebellconcepts.com Kettlebell Safety 101 www.dragondoor.com “Safety as a part of, not the opposite of, Performance” www.dragondoor.com Schnettler C, et al. “Kettlebells: Twice the results in half the time?” ACE Fitness

Matters. Jan/Feb 2010 pp. 6-16 Weber K. “The Kettlebell Approach to Physiotherapy” 12/10/03

www.dragondoor.com McNamara S. “Scientific Evidence for the Russian Kettlebell in ‘Fixing Bad Backs’”

2/24/06 www.dragondoor.com Tyszkowski R. “Kettlebells and Lower Cross Syndrome” www.performbetter.com Bonafede B. “A Tip for Mastering the Kettlebell Swing” 10/3/06 www.dragondoor.com Minute of Strength #92, #112 The Swing www.artofstrength.com Glassman G. “The Kettlebell Swing” Crossfit Journal (25) 2004 “Why ‘Fire the Lats’ in a Kettlebell Swing?” 12/7/08 www.begin2dig.com McGill S. “Super Stiffness” www.backfitpro.com McGill S. “Selecting Back Exercises” www.backfitpro.com Jones B. “Deadlifting Tips” 1/26/10 Power by Pavel www.dragondoor.com Cook G. “Deadlifting (Balanced Body Series)” 2007, pp. 1-7

www.functionalmovement.com “The Refined Turkish Getup: Functional as well as Diagnostic” 8/15/08

www.begin2dig.com Minute of Strength #30 Windmill www.artofstrength.com

THANK YOU!THANK YOU!Special thanks:

◦Erik Rodriguez, ATC◦Kevin Undeen- UM Football video