Deadlifting from the Ground Up

Deadlifting is a common exercise used to improve strength of the hamstrings and glutes. There are so many variations of deadlifting including two legged and single leg variations. A lot of the variations of this exercise have different intentions. When I prescribe this exercise as part of a home program or exercise program, the variation I recommend depends on the goal and the ability to execute correctly.

KB Deadlift

Mechanically, deadlifting teaches one how to lift weight from the floor and how to load weight from the foot up through the pelvis. These are great skills to have especially for laborers and Mom’s who lift children and toys from the floor constantly! I truly believe it is a great skill to have, however not every deadlift variation is for every person. This why have many variations, adaptations are great!

Another added benefit that may be under utilized is the effect the hinging movement of a deadlift has on the pelvic floor. At the maximal hinge point where the buttocks is pushed backwards, there is a slight knee bend, the weight is over the mid foot, and the backside of the pelvic floor is in a lengthened position under load. This helps teach the body and pelvic floor to lengthen and stretch this tissue. When the pelvic floor is tight in the back and symptoms are at play such as constipation, painful sex, urinary leakage just to name a few; learning proper deadlifting mechanics can be helpful. I also find that commonly when the pelvic floor is tight, hinging can be uncomfortable for the low back. The low back is typically compensating for the pelvic floor being unable to lengthen through the backside.

Let’s dive in a little deeper to this topic. Ideally when lowering down into the bottom phase of the deadlift, the pelvic floor has to lengthen to allow the pelvis to sit backwards and open up. The sacrum has to nutate, the knee needs to flex, shin needs to shift forward over the mid foot so the foot can pronate. Then as you push into the ground through your feet, you use the pronation and foot push to generate the force to come back up and extend through the hip joint causing counter nutation of the sacrum, then reaching knee extension. If the mechanics are correct, there should be little change in the curvature of the lumbar spine.

Check out this video for the visual representation of what I am referring to.

One compensation I typically see includes flexing the lumbar spine due to a lack of range of motion through the hips and pelvis to achieve positioning. Also I commonly see excessive extension through the lumbar spine to make up for lack of nutation through the pelvis or lack of strength to stabilize and pull the weight up by pushing down into the floor. You can visually see what I’m referring to here. Towards the bottom end of the movement there should be a stretching or lengthening sensation through the hamstring and the back of the glute pelvis. At times, one can only feel the hamstring stretch. This may be an indication of the pelvic outlet being unable to to open and lengthen. If that is the case, it should be a focus of treatment to optimize positioning and functioning of the movement.

Here is a list of many of the different two legged deadlift variations that I use:

• Hex Bar Deadlift

• Barbell Deadlift

• KB Deadlift

• RDL

Here is a list of some of the single leg or single leg dominant variations I use! What I mean by single leg bias is that two feet are still on the ground but one side is being utilized more than the other.

• Kickstand RDL

• Offset Deadlift

• Single Leg RDL

• Wall Assisted RDL

• Single Leg Tap RDL

The movement and variation can be manipulated to assist with different ranges of motion or phases of foot/hip positioning. When I say phases, I am referring to the change in position of the foot/hip/pelvis during the different phases of gait or walking. If the goal is to work on force production through the foot with a propulsive phase, a kickstand variation make work best. If the goal is to potentially increase hip mobility and work on the earlier propulsive foot/hip position, the offset deadlift may be a better choice. Where the weight is held during the exercise can also influence range of motion at the hip. For example, if you are looking to increase hip internal rotation, the weight should be held on the contralateral (opposite) side to the affected hip. If the goal is to increase external rotation, then holding the weight on the ipsilateral side may be the best option. Adaptations can also be made such as raising the beginning height of the deadlift when beginning from the floor to accommodate mobility limitations and optimize execution. Here is a visual representation of some of these variations

The possibilities are endless with deadlift variations to find one that works for you! Not every variation works for every body. The way the movement is executed and what changes that option makes on the person’s body ultimately decides on what variation I like to recommend for the person in front of me! Happy Deadlifting!

When to Seek Help for Pain!

Low Back Pain

A common question I always get is “when should I go to physical therapy or seek help for my joint/muscle pain?” “Should I just train or do my activity anyway despite the pain?”

Here are some questions I like to present for you to consider about your current issue:

1. How long has the pain/discomfort been going on? When did the pain start? Is it an Acute or Chronic issue? Is it linked to a specific event or change in activity? Or did the discomfort start out of no where?

2. Is there a certain time of day when the pain is worse or better? Is there a pattern to the issue in terms of when you feel the pain?

3. What is the quality of the discomfort? Is it sharp, dull/achy? Is there numbness or tingling? Is there a muscle weakness in the associated limb?

4. What is the intensity of the discomfort? Is the pain consistent or Intermittent?

5. How has your quality of life been impacted by this issue? Are you able to partake in the activities you want or is your mobility limited?

Some of these questions can be easily tracked with a Pain journal. It can be as simple as making a note on your phone or in your calendar of the time of day, activity you were doing, quality of discomfort, length of time it lasted, and perhaps the intensity of the pain on a 0-10 scale. The Visual Analogue Scale (VAS) is a commonly used scale in the medical field to gage the intensity of the discomfort. A lot of the time, clients do not like answering these questions. There are two things I always tell people. 1. This scale just allows us to track how your discomfort may change over time. 2. It is also rated on your own pain experience and is not comparatively to anyone else’s. Let me repeat this, It is based on YOUR OWN PAIN EXPERIENCE! Not anyone else’s. Pain is just a complex sensation we continue to learn more about each day as further research is done. But, the bottom line is that pain is not black and white and is truly an experience given to you by the brain. There are many factors that go into this sensation including emotions. For further information on this topic, please reference the Neuro Orthopedic Institute. A great easy reference for understanding pain is Explain Pain Handbook if this is a topic you would like to learn more about.

Once you have some data to reference from your notes or thoughts on your pain, let’s dive into these questions more. There are some types of discomfort and issues that you just don’t mess around with and should seek help immediately. These are considered “red flags”. These red flags are additional signs that the pain is something more serious. Red flags may include but are not limited to the following: “severe trauma, history of cancer” (Bescia, 2017), unexplained weight loss or weight gain, area is red and swollen, area is hot to touch, “dizziness, loss of consciousness, clumsiness walking or handling objects, unexplained weakness, nausea, night sweats, fever, chills, change in bowel or bladder function, change in symptoms after eating or drinking, difficulty speaking, difficulty swallowing, paresthesia or anesthesia, and change in vision” (Bescia, 2017). The above issues listed are outside of the scope of practice for a Physical Therapist to deal with. If your discomfort is accompanied by any of the above listed symptoms, please seek the help of a Medical Doctor immediately.

Timeline: How long has this discomfort been truly going on for? Have you ignored or put it on the back burner to be addressed? Have you been exercising or training through it to reach a goal? This is typically the case with a lot of people. A specific event causing the pain is typically more explainable and appears more rationale. What I notice clinically, is that when a discomfort does not have a specific origin, it is more bothersome to the client. There is a tendency to need an “explanation” for every pain or discomfort. Sometimes, the truth is that we just don’t know. I find in these cases that there has been a potential issue or compensation brewing over time, but you don’t notice there is a problem or change until there is discomfort. Our bodies are amazing at figuring out ways to do what we are asking them to do even if we don’t technically have the range of motion or strength to do it. We will compensate to accomplish the task. Compensation can lead to other issues in the body. (It has accumulated over time and more than one thing may have contributed to the issue)

Pattern Recognition: Is the discomfort reproducible with a certain movement or activity? Does the pain change if you minimize or avoid the activity? Some patterns are easily recognized and others can be more complicated. If you are able to recognize specific activities or exercises that provoke the discomfort, try changing the activity or exercise. For example, say you feel the discomfort with a barbell bench press in your shoulder, does the pain change if you were to use two dumbbells in a neutral grip? Another example is, if you have increased pelvic pressure when performing jumping jacks, does it feel the same if you “walk” your feet apart and spread your arms apart. What if you slowed the jumping down, does the feeling change? Thinking about these responses now can assist you with the issue and help problem solve. This will also provide detailed information when you seek out PT services.

Quality/Intensity: The type of discomfort you are having can allude to different issues. When there is muscle weakness involved, please seek medical treatment. This can be as simple as decreased grip strength or you noticed a decreased ability to stand on the toes of one foot and maintain the position. It is usually the sign of a more emergent issue. Does the discomfort dissipate with intervention or change? Or is it consistent. If nothing seems to make it better or worse, please seek out treatment sooner rather than later! Tracking the intensity of the discomfort can be helpful to notice if the pain is worsening or lessening over time, even though you may not notice day to day. Pain can be like a roller coaster. Most of the time it is normal for pain to be up and down. You may have more “good” days than “bad” days which can show a positive improvement over time. There can be a lot of frustration when you have pain for 3 days straight then it completely disappears and you think you are “cured” to just return after two days of no discomfort.

Physical Therapy for Pain

Here is my Best Recommendations:

Our bodies are complex and each one is unique. Pain is our body’s alarm system trying to get our attention that something is going on. Perhaps it's time we listened! If you have been dealing with an issue for more than two weeks and it has been worsening or getting more consistent, it is time to seek help! I highly encourage you to try to do something about the pain when you first notice it. Change or remove the activity to see if the discomfort lessens. Try doing some self massage with a foam roller or massage ball against the wall. Try some gentle stretching and range of motion exercises in the area of discomfort or perhaps above and below. Being more mobile and having the connective tissue of the body slide and glide across each other can be helpful in most cases. Light strengthening can also be helpful as long as there is no pain. If things do not improve after two weeks of being consistent, please seek the advice of a medical professional. The longer you let things linger, the longer the recovery typically is.

Depending upon your issue, there are many different avenues to try. For a musculoskeletal complaint, physical therapy can be a great line of defense first if able. We are able to screen for a wide variety of issues. If the issue seems more severe, perhaps an Orthopedic Medical Doctor would be more suited especially if your day to day function is being severely impacted. If your issue appears to be more muscularly based, seeking the help of other practitioners can be helpful such as massage therapy, acupuncture, or cranial sacral therapy. If it appears to be more of a joint restriction, perhaps chiropractic care is a good option.

Musculoskeletal complaints are sometimes straightforward, but sometimes they are not. Your body could be producing a protective pattern that needs further assessment to rule out a central nervous system tension pattern, visceral protective patterning or joint/muscle dysfunction. No matter what the origin of your issue is basic health and wellness practices tend to come in to play as well. Prioritizing sleep, hydration, and nutrition are non-negotiables. If you are not able to rest, hydrate, and nourish your body well. It will not function well. This includes your ability to void and defecate regularly and efficiently. If you are having problems with these, then seek help for these issues first!

Exercising with Pain: I firmly believe that you can exercise around injury. If you are struggling to find activities or exercises that do not cause more pain, then seek the help of a physical therapist or knowledgeable trainer. Many exercises can be modified to an individual. Not every exercise is made for everyBODY. That is correct! If there is an activity or exercise that irritates the pain for more than 2 days, then it should be changed. This is a sign that it is potentially inflaming or irritating the current issue. I usually recommend not letting discomfort get above a 3/10 with exercise and it should never be sharp or shooting. Muscle soreness is an okay discomfort to experience with exercise! That is the difference between good pain vs. bad pain.

My hope is that this information empowers you to listen to your body a little bit better than you have in the past and know that it is the smartest thing in the room!

References

DPT, Dr. D. B. (2023, October 10). Screening for red flags by an orthopedic manual physical therapist. NMPT. https://www.napervillemanualphysicaltherapy.com/single-post/2017/03/15/medical-screening-for-red-flags-by-a-physical-therapist

Moseley, G. L., & Butler, D. S. (2018). The explain pain handbook: Protectometer. Noigroup Publications.

Why Out of Network PT?

What are your goals when you go in to see a practitioner? Is it for them to look at one joint or issue and treat your symptoms? Or perhaps hand you a standard handout of exercises for your diagnosis? Well if you answer yes to these questions, then stick with your standard run of the mill practitioners. If not, you may want to try and find and Out of Network PT.

Out of Network PT

Individualized Treatment If you are looking for something a little bit different, then you are in the right place. You are a whole person and should be treated as such. When having knee pain, there could be many influences contributing to this discomfort. Perhaps you struggle to push off your foot correctly or struggle to pronate. There could be limitations in your hips limiting your ability to internally rotate at your knee to push into the ground. Could there be a pelvic floor component? Why does your right knee hurt versus your left? Is it perhaps because you put more weight on your right leg than your left? Is this due to limitations in your diaphragm pulling down more on your right side or not? Are your ribs restricted from rotating from one side to the other? This is quite the thought process isn’t it? These are just some of the thoughts that go through my head when I’m working with someone. In order to go through this thought process, I need the time and freedom to explore. Being an out of network provider allows me to do that. Your needs are my priority. Care is always provided one-on-one while taking into account your individualized needs. Standard sheets of exercises are not an option. What if there are other things in your life contributing to pain? Did you know that high stress, lack of sleep, decreased hydration, and poor eating habits can leave you in pain for longer? Addressing and problem solving through some of your other health basics can drastically assist with your recovery. We have the freedom to discuss stress coping strategies and problem solve some of the other obstacles in your life in order to get you on a better track.

Goals and Timelines Think back to what your goals are when seeing someone! These goals are emotionally driven. You are passionate about these goals or they are essential for you to function. Sometimes goals take a while to reach. It could be as simple as being able to get off the floor without pain or lifting your child without urinating. Perhaps you have dreams of being able to play on a recreational soccer team, level up your aerial skills, or run a marathon while staying healthy. Whatever these goals may be, under an insurance model there is typically a finite timeline in which we need to accomplish them. Sometimes they will cut you off before you feel ready to be done. With your goals as priority, we can take as long as we need to reach them. Other Differences

• No Referral Necessary: Did you know that in the state of New Hampshire, we have what is called Direct Access? Direct Access means that you are able to come see a Physical Therapist without a Physician referral. It is typically certain types of insurance plans that restrict you from being able to do this.

• Productivity Requirements: Did you know that some practices have standards of what treatment codes need to be billed per treatment for reimbursement purposes? Have you every wondered why almost every patient prior to leaving ends up on Ice and an electrical stimulation unit? This is not the case at all facilities, but is true at some. Therefore, your physical therapist may have to do certain types of treatment to meet those productivity and reimbursement needs.

• What if I want to treat multiple things at once?: It can be challenging to treat multiple areas at one time under an insurance model, since they will not allot greater time with one person in a day. Insurance would prefer that you attend treatment multiple times per week to address everything. Most of the time, this is challenging to accommodate in your schedule.
  

Other FAQ’s Can I get some sort of reimbursement?

• If you have out of network coverage on your commercial insurance plan, then you may be able to seek reimbursement. All you have to do is call your insurance company and ask if you have out of network coverage. They may be able to reimburse you in partial or full with the submission of a superbill. Please note that this does not guarantee reimbursement for services. Also ask if there is an out of network deductible that may need to be met prior to this coverage taking effect.

Can I use my HSA or FSA to pay for Services?

• Yes! You can use your HSA or FSA to pay for Physical Therapy Services. Check with your HSA and FSA for specific guidelines. Most need a receipt and some require a superbill.

Can I come in Monthly to keep up with some Body Maintenance?

• Yes! We can get you on a schedule that works best to meet your needs!

If you have any further questions on Out of Network Services, please feel free to ask! I just wanted everyone to be informed of my big reasons for being an Out of Network PT! Bottom Line: You come first and I want to treat you as such!