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The Kettlebell Approach to Physiotherapy

December 10, 2003 11:10 AM

I guess one of the things I like most about being a physiotherapist or physical therapist is the wide variety of treatment techniques that I have at my disposal to help people recover from injury and optimize their performance. The true essence of physical therapy is combining manual therapy (myofascia release/joint manipulation) with modalities such as ultrasound and increasingly acupuncture to create the optimal physiological environment for healing to take place.

Of course a large component of this process is the implementation of exercise to stabilize the joints, rapidly improve function, and, particularly in athletes, to prevent future complications relating to the initial injury once returning to activity. Many of the methods typically used to improve strength, flexibility, and optimal neurological coordination have little functional carryover to sport and real world activities, and in many cases can lead to further problems for very deconditioned people. For example, many core stability exercises are performed while lying on the floor, although most of our everyday activities are performed in standing.

I remember how excited I was when I first read Russian Kettlebell Challenge, although I must admit it was for selfish reasons initially. The idea of a weight-bearing exercise that would do things like help an athlete improve strength, speed, coordination, and cardiovascular capacity, to name only a few, was very appealing to me for self-improvement. It wasn't until after I actually started using the kettlebells that I realized that these are the exact things exercise prescription for rehabilitative purposes strives to achieve. And the fact that it happens to come in a compact form that does not take up much room and is readily portable is a nice bonus.

Initially, I did an informal in-house study on people recovering from motor vehicle accident-related (a.k.a. whiplash) injuries. What I've always found is correcting the various bodily dysfunctions these people incur is relatively straightforward and usually takes 6 to 8 weeks, depending on the severity of injury. The tricky part is getting them back to level of strength they need to be at so they can function in their everyday lives without pain without setting them back in their recovery. The reason for this is the fact that most people are usually in pretty bad shape before they get hit, so even if you had them do some type of exercise that is new to them then, you would probably make them sore and feel pain. So the challenge is to give them something worthwhile and effective, but not too strenuous, but not too early in recovery, but not too easy either. It would be nice if there was a formula or something, but we all know everyone is different.

Kettlebells basically solve this problem, as most of the basic exercises are so global that specific soreness after using them is less of an issue. So I started teaching one group of whiplash people the 2-arm swing and had the other group do the regular regime of physioball core exercises and scapular retraction exercises on our Apex rowing machine after warming up for 10 minutes on the treadmill. The kettlebell group usually started with 3 sets of 10 with the 8 kg, and I had them add sets as they felt capable. They were usually done with their exercises in around 5 minutes, while the conventional exercise group took at least half an hour. One of my pet peeves is always having to stop treating another patient to rush out to the exercise area to get a person to focus on the exercise and/or correct their form as most people really don't "see the point" of the exercises and therefore don't concentrate on the task at hand. The same was not true with the group doing the swings, as they could feel the exercise through their entire bodies and, despite the fact that it is such a natural movement, really had to focus on what they were doing. Therefore injuries did not occur, and because the exercise bouts were brief, interest did not wane. Lo and behold, knots in the shoulders and stiffness in the spine seemed to disappear in the kettlebellers, while the conventional group still needed fairly intensive treatments for problems that kept propping up well after the eight-week mark. Further, the kettlebell group was generally more optimistic and less miserable than the other group, probably because they were producing natural endorphins for the first time in a long time! Also bear in mind that I randomly selected people into the 2 groups and did not let on what I was up to at any time.

Now that I have recently completed Pavel's RKC certification course, I feel like the possibilities are even more endless in terms of using kettlebells for rehabilitation. The one-legged deadlift is excellent for retraining proprioception in a sprained ankle or unstable knee. Holding the starting position of the Turkish Get-Up while rotating the torso away was an excellent technique for simultaneously strengthening and stretching the rotator cuff/shoulder complex. The windmill performed with the top arm unloaded while lifting the kettlebell from the ankle is proving to be awesome for weak low backs. Also since the course, I've really kept an eye on how most people breathe, and sure enough, most of us have forgotten how to use our diaphragms. The mere act of teaching a person how to breathe in their belly rather than with their intercostals seems to be solving a lot of chronically tight shoulder problems. The long-held belief of "drawing the belly-button in "to engage the transversus abdominus muscles to stabilize the low back" is no longer advised at our clinic.

My only regret now is the massive amount of money I've wasted on the shiny, high-tech gym apparatus that sits lonely, neglected, and abandoned right in the middle of an otherwise useful area of the clinic. I think I'll keep it there beside my row of scuffed and grass-stained kettlebells sort of as a reminder of how the more things change, the more things stay the same.

Keith Weber is a physiotherapist and certified Russian kettlebell instructor based in Red Deer, Alberta, Canada. He may be contacted at