The Kettlebell Swing: The Shotgun Exercise

KettleBell Swing:

Everyday benefits

By: Nicholas Parmigiano MSPT, BSHS, CKTP, ACE-CPT, FMS, Crossfit Kettlebell Instructor

         The Kettlebell Swing is a fundamental exercise of what is one of the most popular exercise techniques of today – Kettlebell Training.  Used for fitness by most, I have been successful gearing this ancient art of training into Physical Therapy and Rehabilitation treatments for my patients with great results.  I call it the ‘Shotgun Technique’ because you can get the most “bang for your buck” by incorporating it into your program.  I have listed below just a few of the many benefits of this excellent exercise.

Lumbar Muscle Endurance:

         Many therapists and trainers feel that their clients are suffering from lower back pain due to strength deficits in their core and lumbar paraspinals.  They focus their sessions on seated trunk extensions using gym equipment or Roman Chair hyperextensions without realizing that these exercises actually create more compression and shearing force on the spine, which inevitably leads to herniated discs!  Most of my patients complain of lower back pain upon performing the lifting and repeated trunk extension movements required by their occupation.  They also experience symptoms in static positions, such as leaning over the sink to shave or to wash dishes.  This is not due to a strength deficit, but rather a muscular endurance deficit.  With proper form, the kettlebell swing will rapidly improve lumbar muscle endurance.  

Body Mechanics 

         Learning the proper technique of the Kettlebell Swing usually includes the following instruction: “keep your weight on your heels - Hinge at your hips, not your lower back - Sit back as if you are lowering yourself into a chair - Drive with your hips.” Following these instructions will protect your spine from any injury, which can occur from even the simplest functional task such as transferring out of a chair from a sitting to standing position.

Psoas Flexibility

         The psoas muscle is a hip flexor.  Tightness of this muscle is related to lower back problems. The explosiveness of the Kettlebell Swing applies a repetitive dynamic stretch to the psoas muscle, maintaining its flexibility, thereby minimizing it as a cause for lower back pain.

Lower Extremity Strength and Endurance

         Anyone who has performed over 2 minutes of non-stop Kettlebell Swings will understand this.  Once you become coordinated with the technique, the movement pattern will improve and you will be able to swing a heavier weight for a longer period of time.  Your legs, as a result, will gain strength and muscular endurance.

Scapula Stability

         To begin ‘The Swing,’ grab the kettlebell handle with one or both hands and stand up tall, holding the kettlebell at groin level.  In this position, your shoulders will ‘want’ to roll forward.  It is your job to pull your shoulder blades back (scapula retraction).  You can then proceed to perform multiple repetitions of the Swing.  Upon each repetition, your shoulder blades will again ‘want’ to roll forward - again, maintain retraction.  Holding your shoulders back isometrically strengthens the middle trapezius and rhomboid muscles.  Strengthening these muscles will assist you in maintaining proper posture.

         The possible rehabilitative and functional benefits you can derive from Kettlebell Training is endless, limited only by your experience and imagination.  Confucius once said, “Every journey begins with the first step.”  He failed to mention that you first need to be on the right path.  Therefore, seek a Certified Kettlebell Instructor who will guide your early experiences and walk you through the exercises, demonstrating proper form.  Then, you’ll be on your journey to strength and recovery.

Popular Causes of Knee Pain

Knee pain is a very popular issue for Personal Trainers and Physical Therapists.  Although the pain is localized to your client/patient's knee, you must observe the peripheral joints as possible causes.  One of the first joints you need to assess is the ankle/foot.  Many times, your client may be flat-footed on one or both sides.  Pronation or "flat-footed" many times creates a "down and in" movement of that entire lower extremity.  "Down and In" refers to an internal rotation motion of that leg.  This internal rotation leads to a shortening/tightening of the Ilio-Tibial Band/Tensor Fascia Latae (ITB/TFL).  This then leads to more internal rotation and "down and in" and it becomes a viscious cycle. 

Tightness of the ITB/TFL may create an increase in lateral pull of the patella or knee cap.  Instead of the patella tracking superiorly upon knee extensor contraction (quadriceps), it tracks supero-laterally.  In time, this may cause knee pain.  Most of my "knee clients" are taught how to perform proper calf (gastrocnemius/soleus) stretches to help minimize the "down and in."  They are also educated on ITB/TFL stretches if I observe the patella tracking laterally.  Unfortunately, these stretches alone will not correct the "down and in" motion.  You must ensure proper carry over by immediately practicing the activity in which the "comparable sign" (your client's chief complaint) was observed.  During the practice, make sure that the "down and in" motion is minimized.  For example, many times this motion will be obvious during step downs.  Instead of the knee tracking over mid to lateral foot, the foot arch drops (pronates) and the knee track medially over or past the big toe.  This step-down (using the affected leg to lower the body) may create your client's symptoms of knee pain.  Teach the stretches, and have your client perform the step down during that same session, making sure the knee tracks properly over the foot.  Many times, if you correct the movement pattern, the involved muscles will begin to work properly and efficiently.  Oh yeah, and don't forget to check the VMO contraction which assists with medial pull of the patella during contraction.  The VMO is the tear drop shaped muscle on the inside aspect of your thigh just medial and superior to the knee cap.  This muscle helps minimize lateral patella migration.  So, stretch the calves and ITB/TFL and strengthen the VMO.  Then perform the required activity and make corrections.  Remember "Perfect practice makes perfect!"

On a side note, for those trainers with clients who want to train barefoot, keep the above information in mind.  Training barefoot may have its benefits.  However, if your client demonstrates any of the pronation and "down and in" movement patterns with shoes on, their form will very likely worsen without foot/ankle support (training barefoot).  If they are unable to correct this inefficient pattern when barefoot, you may want to scrap barefoot training for now.  This is especially true if they already require orthotics in their footwear to reduce pronation.  Make sure the benefits outweigh the risks of barefoot training.

Client Assessment: Part 5

 C.H.A.R.T.S.

The "T" section of the assessment stands for Tissue Characteristics.  This is where you assess the length, strength, play, and tone of the joints/muscles.  You perform manual muscle tests, palpate the muscle belly and insertion/origin areas in search on tenderness (comparable sign), nodules, etc.  You also conduct functional tests such as sit to stand transfers, bending/lifting and stair climbing.

The "S" section stands for Special Tests.  These are tests that will help assess the integrity and involvment of ligaments, joints and tendon in your client's chief complaints.  Some special tests can determine ACL laxity or tears, rotator cuff tendinitis, elbow tendinitis, etc.  This will help guide your program design.

The past few blog entries should provide you with basic guidelines for performing a thorough client assessment.    Feel free to email me at nicparm7777@aol.com with any questions or comments. 

Client Assessment Part 4

C.H.A.R.T.S.

"R" Stands for Range Of Motion (ROM)

During your client assessment, you will want to evaluate the range of motion, particularly of the area related to the chief complaint.  You are looking for the 3 R's (Range or quantity, Resistance or quality/willingness to move, and Reactivity to the movement).  Be  especially attentive to the "Comparable Sign." The comparable sign is the client's chief complaint or symptom.  If you have your client perform an action that causes pain, however it is not the same pain that he is usually complaining about, then it is not the comparable sign.  Reproducing the symptoms/comparable sign will help you figure out the source of the problem. 

First have your client perform the movement actively.  If he feels symptoms, then you take him through the movement passively.  Lastly, test that movement resistively to assess strength.  With each of these, you are always looking for the 3 R's.  If there is pain prior to applying resistant, your client is highly reactive. Pain with resistance means he is moderately reactive.  While pain after resistance means low reactivity. 

A normal result of active range of motion is as follows:

-smooth motion at all speeds

-full ROM

-Pain free

-Normal strength

Abnormal result of active range of motion is:

-client resists movement

-painful area in the movement

-pain at end range

-compensations are observed

-you hear joint noises/crackling

Limited active range of motion may be a sign of the following:

-weakness

-tightness

-nerve issues

-internal derangement (you can use special tests to figure this out)

-pain

-tight joint capsule

What does Passive Testing tell you (you take your client through the movement)?

-Normal and pain free means no lesion

-Normal and painful may mean a minor sprain

-Hypomobile and painfree may mean a muscle contracture or joint adhesion

-Hypomobile and painful means acute sprain with guarding

-Hypermobile and painfree means a complete rupture of the tendon

-Hypermobile and painful may mean a partial tear

What does Resistive Testing tell you?

-Strong and no pain: no lesion

-Strong and painful: minor lesion

-Weak and painless: nerve damage or complete rupture

-Weak and painful: partial rupture

When performing Resistive Testing, remember the following:

-Isolate one motion for the test

-Test one joint at a time

-Test the motion at its mid range

-Increase your applied resistance slowly (do not crank on it)

-Hold the resistance 5 seconds

The above information should help a great deal in figuring out the cause of your client's condition. 

Client Assessment Part 3

C.H.A.R.T.S.

"A" is for Asymmetries

After taking an extensive history and finding out what your client's chief complaint is, you will want to begin gathering objective measures as a baseline status.  The first observation should be your client's posture. 

From the back, look for the following:

1. Foot position: are the toes pointing in or out, or is the foot flat?

2. Check out muscle mass: Is one calf bulkier than the other?

3. Position on the knees: Are they pointed in towards eachother or is it bowlegged?

4. Check for scoliosis: Does the spine have an 'S' curve?

5.  What about shoulder position: Is one shoulder elevated?

From a lateral view:

1.  Is the knee flexed or hyperextended?

2.  Is there an arch in the lower back?

3.  Is there a rounded upper back, rounded shoulders or a forward head posture?

With this section, you rely heavily on your observation skills and vision to determine asymmetries.  Noting these asymmetries will help a great deal in customizing an exercise plan with goals for your client. Setting up a plumb line to assist in your facility may help. 

Next we will discuss Range of Motion ('R' in C.H.A.R.T.S.)

Client Assessment Part 2

C.H.A.R.T.S.

"H"  Stands for History

During the assessment, it is important to gather information regarding patient history in order to determine the "health state" (behaviors/activities) as well as the "injury/disease state."  Knowing where your client was, helps to determine their goals as well as the extent of their injury.  During the patient history, you will want to gather the following information:

1.  General demographics: age, gender

2.  Growth/development: hand/foot dominance

3.  Present problem/complaint

4.  Past medical/surgical history

5.  Present medications: pain meds, muscle relaxants, anti-inflammatories

6.  Family history

7.  Vocational/Recreational info: Is their occupation a contributory factor? Ergonomics?

Following this section of the assessment, you will plan an in depth physical examination.  This is where you ask yourself:

1.  What are possible hypotheses for the cause of your client's problem? 

2.  How aggressive can you be with their training?  

Next entry will be "A" for Assymetries.

Another Acronym To Help Organize a Detailed Assessment

C.H.A.R.T.S.

When first meeting a client/patient or upon re-assessing that client to assess progress, a good guidance system to help accurately collect information is to base the assessment on the acronym C.H.A.R.T.S.  In the next few blog entries, I will break down each section.  Today, I will discuss "C".

"C" stands for Chief Complaint.  This is the subjective section of the client/patient interview/assessment.  Here you are finding out why that person is seeking your assistance.  It is also during this interview that you will decide whether there are other possible causes of the client's issues, especially any life-threatening pathologies that may contraindicate your services.  If the client has a complaint of pain, you will use the O-P-Q-R-S-T question format (previous blog entry) to analyze that.  Again, it is during the interview process that you want to rule out any other serious pathology that the client may have.  Some things the client may tell you that would lead you to believe there is a more serious issue are the following:

1.  Unexplained weight loss - Was he/she trying to lose weight?

2. Malaise/decrease in energy level

3. Fever/chills

4. Weakness/numbness

5. Fainting (loss of consciousness) or syncope (no loss of consciousness)

6. Pain at night

7. Pain at rest that is not affected by position change

8. Bowel or bladder problems

Also check out the previous blog entry on "Red Flags"

Lastly, you will want to assess that client's response to working with you. 
1. Did he/she have an unusual response?
2. Was there any symptom magnification?
3. Did the symptoms improve but then return for no reason?
4. Was their pain unaffected by your session/treatment?
5. Was the pain worsened by the session/treatment (considering you were not being too aggressive)?

 

All of the above information should help guide you in obtaining an in-depth description of your client's or patient's problem and will later help you in developing goals and customizing a program.  Next entry will focus on "H" for History of the condition.