Aug 1, 2024
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Introduction: Welcome to the True Sports Physical Therapy Podcast with your host, Dr. Yoni Rosenblatt. Today, we explore the impact of kettlebell training on low back pain with Dr. Katie Dabrowski. In this episode, we delve into the benefits and techniques of incorporating kettlebells into rehabilitation and strength training programs.
Join us as Dr. Dabrowski shares her insights on how kettlebell exercises can be effectively used to alleviate low back pain, improve core strength, and enhance overall functional movement. Learn about the specific kettlebell movements, proper form, and progressive strategies to safely integrate this versatile tool into your practice or workout routine.
Whether you're a physical therapist, fitness professional, or someone dealing with low back pain, this episode offers valuable knowledge on the role of kettlebells in promoting spinal health and reducing pain. Let's jump right in.
Dr. Yoni Rosenblatt: What's up True Sports family? This conversation is with Dr. Katie Dabrowski, who's the head physical therapist at Old Bull Athletics down in Miami.
She just opened her second location and she is killing it there. She got her doctorate of physical therapy from the University of Miami. Back in 2019 and she lives and breathes kettlebells. Her focus lies in blending principles of neuroscience, strength, and movement, as well as pain reduction for people of all backgrounds.
We touch on the Turkish getup. We touch on the kettlebell swing. We touch on kettlebell deadlifts and how she approaches low back pain. So there's. A lot to learn in this conversation, as always share your feedback with us, share this podcast with all of your PT friends. There's so much to learn here, guys. Thank you so much for listening without further ado. Here's Katie Dabrowski.
Dr. Yoni Rosenblatt: We got Doctor Katie Dabrowski with us today. Welcome to the True Sports Physical Therapy Podcast. Katie, thanks for making some time. Thanks for being here.
Yeah. Happy to be here. Thanks for having me. I'm excited to chat today.
Dr. Yoni Rosenblatt: Hell yeah. So you have a lot of awesome things going on at the Old Bull. Give me a high level uh synopsis of what makes Old Bull unique and how you're kind of starting to spread those wings and education across the entire country.
Dr. Katie Dabrowski: Yeah, absolutely. Um, old blood athletics. We have two locations in Miami, florida. We're a hybrid training and rehab facility and we really are passionate about providing a health care experience that you never had before. So very one on one based, very individualized, um, never being seen with other people, always just you and your therapist or you and your coach, all of our physical therapists, also our strength coaches, or, um, have credentials in some sort of strength and conditioning domain.
And we don't really see a big difference between training and rehab. We think it's a, it exists on a spectrum. And part of our goal is if you were to walk into either of our locations, you wouldn't be able to tell who is there for therapy or who are the, who's there for training. So we're really passionate about that.
Um, also passionate about. making a better healthcare experience for the provider too. So we try to make sure that we have a really fun community and it's all about our team growing together. Um, we have a blast at work and, um, really encourage that type of environment as you know, like our field is really, really on the edge of a lot of burnout, um, and trying to mitigate that.
Like, how do we make sure that not only are we providing something different for the patient, but for the provider too. Um, and you know, we've been really fortunate that our team is growing. Um, our second location is just hitting our two year mark this August, which is crazy and exciting. And we've grown to sort of like an education branch as well, where we're really passionate about, um, sharing our experiences with other people in the industry.
And trying to create a big picture change in health care as a whole. Um, that's what I think it's all about. Like, yes, we can impact our community, but if we can, as providers, whether you're a trainer or a coach or rehab provider, a student, um, I think we can all move the needle so much and that's what we've been really focused on lately too.
Dr. Yoni Rosenblatt: That's really awesome. And how long ago did you start it?
Dr. Katie Dabrowski: Um, so Old Bull started back in 2015. My partner Frankie, um, is the man behind Old Bull. He is, um, just fantastic. He's an exercise physiologist and coach. And he started Old Bull when he was working at Equinox and realized, like, I think I can do this better.
Um, I think I can provide a more one on one experience. Um, and he started old bull that way out of like the back corner of a gym of a Pilates studio with a few kettlebells. And it's since grown to, I met him in 2019 and we've then had our second location open a
nd we joined forces then and really transitioned to this hybrid training and rehab model.
Um, so it's, It's been going on for a while now, which is crazy to think about, um, but it's been very cool to see the evolution of, like, I remember we were getting busy and he looked at me and he said, you know, you can hire another PT, right? And I just didn't like, I had this aha moment, like, oh, this could be something bigger than I even thought.
And here we are now with about 15 providers between the two locations and it's incredible.
That is awesome. I remember that feeling myself just like starting it on my own and thinking, Hey, I'm like, I'm the show I'm going to be treating. And then wait a minute. Like we can, we can, uh, scale this, like we can provide so much more care to more athletes.
And then like, like you're saying, this is so near and dear to my heart. How do we make this an outstanding place to work? Because you're right. It is a cancer for lack of a better term in our profession that. Therapists just burn out, right? They're, they're just like work to the bone. And I think they just fizzle out.
And that's why we have such a high attrition rate in the profession. So tell you said, okay, I'm making old bull a fun environment for my team, um, so that they stay and we can provide great care. How do you actually facilitate that? Why is Old Bull a great place to work?
Well, that's a good question. Um, yeah, I think the biggest thing first and foremost comes down to culture.
Um, and making sure that we're cultivating an atmosphere where everybody feels really safe and able to express themselves and learn and be curious and explore. Um, I want to nurture that feeling. I think that's why we all got into this industry in the first place and being in a space where when I walk in, Just by watching what my colleagues are doing.
I'm learning so much and I feel like I'm a better practitioner every single day. So all I really care about is making sure that it's a place where every provider can do that. While we have the baseline similar ideology of we're very active and movement based. We're very rooted in education and making sure our clients and patients understand what we're doing and are an active decision maker in the process.
Um, we're extremely passionate about encouraging people to do more rather than stop doing things. That's all the same across the board, but everybody has their own style. Everybody's unique. Every provider has things that they specialize in or they have expertise in. And my goal has always been like, I want to keep hiring somebody who's better than me at something that I can't do.
Because I want our team to be so stupidly good that you will be in amazing hands, regardless of who you work with. So I think empowering people and making them know like, yeah, you're here because you're the best. That's huge. Um, and we make sure we have fun together too. Like we're all about learning from each other.
We do a lot of continuing education together. Um, we train together all the time. We have dumb competitions because we're all so competitive and like right now we're doing a maxed single arm dumbbell row at 50, 50 percent of your body weight, how many reps you can get. Um, that's just like our July challenge right now.
And we just try to keep it fun. Um, I think those are really big features of how, how to do it though. Like you bring in the right people, you nourish them and you let them know like, Hey, you're here because you're the best. And you're here because we all want to learn from you.
That's really awesome. It sounds like an outstanding place to work.
Are you currently looking for more therapists?
We always are. Yes. Um, our team's growing a lot, which is pretty cool. Um, our second location is, you know, we're definitely going to be on the hunt for some more people in the near future. So, um, yeah, if anybody is listening to this, this is a good opportunity to get in touch with us.
If you're interested, um, we are always for
you is thousands of PTs are listening to this. So that's a plus. Yeah, there you go. Now, what does an applicant, what is it going to make them stand out to you? Because you're going to get a million applications. How do you parse through to say, Hey, this is the person I want to call back?
Yeah, I actually, I think one of the biggest things that I've learned over the years of really like talking to candidates and figuring out who's the right fit. Um, If you're in the space, I think with all of the access you have to all of our equipment and being around brilliant people, I think the clinical skills come no matter what, but what I'm really passionate about is people who are exceptional with education and communication and relationship building.
I think that's what sets us apart. Um, it's not so much about like fancy exercise selection. It's more about. Do you have a solid foundation of the principles of exercise, physiology, energy system development, strength and conditioning? Um, do you have that stuff? And then also, can you talk to people? Can you really sit and have a conversation with somebody through the most vulnerable part of their life when they're in pain?
Um, can you make them feel safe? Can you make them feel at home? And I think that's the stuff that we're looking for. Um, in addition to that, you know, I have a really big, uh, uh, I think one of the best things is if you have experience being a coach before, um, I really think like at the end of the day, if you've coached people, if you've trained people, you're set up to be such an excellent rehab provider.
And especially since what we do is a hybrid between the two of them. It's a prerequisite. Absolutely. So those are things we look for.
How are you going to, how is that going to jump off the page? I feel like that has to come up from what you just described in a, in a conversation. Right? Then you can understand how someone communicates, um, how someone, how empathetic they are, et cetera.
Right? Absolutely. How do I get Katie Dabrowski to call me back to say, I want to interview you?
Well, I will say I like to start with a zoom interview. For everybody who's reaches out, because I do think that's so important. I think if you've taken the time to write up a compelling resume, a cover letter that stands out, your email is professional.
I'm going to respond and I'm going to set up, even if it's a 30 minute zoom call, because I do want to see how you communicate that's phase one for everything. Um, I absolutely, that's like, no matter what, what I'm going to do. Because you're right. Like it's, it's maybe the communication stuff isn't as easy to see on paper, but regardless, I'm definitely looking for coaching experience or for something that shows me that they've worked with clients before.
Um, and they themselves are passionate about exercise. I think that's extremely important too. Um, you know, we have most of our team was, we were college athletes or we've been involved very deeply in some sort of athletic endeavor and we all still are, and we all still. like throughout the lifespan, we're working on different things.
So I think that's a huge part. If I'm seeing that I'm absolutely interested, but yeah, I'll talk to people on zoom first, always, and get to know them a little bit more.
Gotcha. Okay. Um, I think that makes a lot of sense. I think that's how you get to know someone, right? So, um, those are good tips for all those sports PTs that are listening, um, to apply.
Um, that's great. Okay. I want to get into training is. This is a course that, um, you're really starting to grow. It's your most popular course. Tell me about the course and then tell me where kettlebells fit into it.
Yeah, absolutely. Uh, trainees healthcare is the, basically the course that I've always wanted to teach and it's over the last couple of years taken off quite a bit.
Um, we're coming up this next weekend. Uh, in Newport beach in California, and we're completely sold out, which is super exciting. And the course is really centered upon wherever you fall on the spectrum of trainer, coach, or rehab provider, um, having a seat at the table, understanding a ton of overlap in all of those professions.
And how can we work together to create a healthier world? I think we are plagued by physical inactivity. We are really at a rough spot. With, you know, less than a quarter of Americans meeting physical activity guidelines. And I think as a whole, as an industry of healthcare, and I consider training and coaching to absolutely be within that umbrella.
Um, I think if we can understand how important our roles are. That's huge. And if we can be a little bit more on the same playing field of understanding pain, understanding patterns and injury, understand what are red flags that require referring out just like we as PTs have to do the same, but otherwise understanding all of the things that are still fair game.
And at the end of the day, if we can work to make people more physically active. So that's the premise for the course. And we really dive into, um, a very principles driven, non protocol driven, non diagnosis driven way of approaching, uh, things specifically like knee pain, low back pain, um, and running.
Cause those are really common things that people deal with and how can anybody along that spectrum of healthcare help their clients get there? Um, it's a lot of fun. It's a mixture of. Some lecture about understanding like stress and pain physiology, um, all the way to practicing different things to understand where somebody is at in terms of, do they have the capacities for running, for example?
And if they don't, how do we assess that? How do we intervene? Um, it's my favorite course. It's a lot of fun. And we have an offshoot of that course called kettlebells or healthcare, which is, um, where we actually dive into more of the, Fundamentals of teaching and coaching kettlebells, whether again, you're a coach or a rehab provider.
Um, and it's a mixture of a few different schools of thought. So a lot of kettlebell training is if you're familiar with like RKC or strong first, they're very rigid, very strict, and it's very intense, almost like militant. Um, and then there's other types of kettlebell coaching that are a little bit more free formed.
We're kind of in the middle. There's some principles to understand, but then there's also some expression of movement and not being as rigid. Um, so we're right in the middle between the two and we utilize kettlebells as an entry point for a ton of people who are new to coaching and strength training, um, and for people who are dealing with pain and injury.
I love that. I love the way you put that, um, how you get away from the protocol driven model that I think is pervasive in, um, education in the way we learn how to be a PT, right. And in start to get more, more functional, um, and pattern based. I think that's a great way to look at it. Why do you love the kettlebell?
Oh, so many reasons. Yes. I think it's an extremely like versatile tool. You can use it for so many things and you can help people build strength. You can help people build power. You can help people build athleticism and quickness. Um, you can get very creative with it. And I do think there's something so important with learning a new skill that makes training very fun or rehab very fun.
If we think back to a lot of the things that got each of us First excited about exercise because we were learning something new and a lot of people, especially if somebody is coming to us with maybe not a big history in exercise. And, but maybe they're realizing later in life, like, Hey, I'm learning that muscle mass is pretty important.
I'm learning that, um, I should be able to move fast if I have to. And I think getting somebody excited about learning a new skill is so fun. And that is very important for buy in. Um, you know, there's people talk about like rehab purgatory and they're just doing the same things over and over again. It's not very exciting.
And while I don't think you only need the kettlebell to get out of that, I mean, I love many other tools as well. I just think it's pretty inherent in a tool that most people haven't used before that there's learning involved. And we know with things to change, the brain needs to learn a new skill and create new context.
And I think that's baked in so much of what kettlebell training is.
Yeah, I mean, that's, that's a great way to look at it. Tell me physiologically, what is the difference between using a kettlebell and using, um, let's call it a, uh, grip based weight or something in which you're the, the weight. envelopes your hand instead of living in front of your hand.
And well, I'll be the first to say that I don't want to make it sound like kettlebells are the only way to achieve these things. You're not, you're not, you're not
making it sound like that.
Yeah. With any of those things, you're going to get very similar. like benefits across the board. Absolutely. What's cool about a kettlebell is because, um, the way that there is the technique and skill of how the, how you have to hold the kettlebell, keeping it close to your body, using your body for, to create momentum.
That's that does make it a little bit different. It does make it a little bit interesting. A lot of the grip components of a kettlebell require a ton of full body tension. So your body is learning how to create stiffness, which is hard, especially for somebody new to training. If you watch somebody new to training, they're usually just like Gumby kind of dropping in and out of a squat really quickly.
You don't really know how to create tension. When you have an offset round object that you have to keep close to your body, it kind of forces you into some positions. Um, there's also a lot of ease to just holding the kettlebell. People are scared of a barbell deadlift. A lot of people are not scared at all of standing up over a kettlebell and picking it up with a hinge.
So there's a lot of things that maybe you can take it. Further steps with a kettlebell than you might have been able to with a dumbbell or a barbell or maybe even something that people have preconceived notions and are scared about. Um, but there's like a concept in kettlebells. Um, and it's all about like the grip, engaging your lats, engaging your core and engaging your whole body for tension to create more neural drive, more control over the movement.
And I think that's priceless. If you hold a kettlebell implotations wrong without a lot of tension, you're going to feel it. It's going to slam into your wrist. It's not going to feel like it's sitting right. So it almost self corrects because you have to do it in a way that feels comfortable and that's going to get you set up for success.
So physiologically we're just getting so much tension and so much ability to control your body. We're getting all that neural drive from more like power based movements. That's so incredibly important.
I love that. I think that's, that's a great synopsis of, of why do you use a kettlebell over a dumbbell or anything else?
Hey guys, quick pause and a quick shout out to this new masterclass that we've just launched here at True Sports Physical Therapy. Myself and Dr. Tim Stone put together a masterclass of ACL rehab and we call it from table to table. To turf. And the reason we call it that is because it's going to teach you exactly how to get your athlete all the way from post op day one with the nitty gritty of regaining all of that range of motion with the tips and the tricks that we use here at True Sports Physiotherapy that gets our athletes.
Better, faster, and stronger. And that's early. And then how do you progress that athlete all the way onto the field with a ball in their foot or stick in their hands or whatever their sport is and teach them how to accelerate, how to de cell, how to change direction and all the mechanics that go in there, what drills do we use to.
To get our athletes exactly where they need to be back on the field and even better than before injury. And I want you to sign up for that class. Now you can find it on our website. You can shoot us a direct message and just say, Hey, send me the course. It's right now on sale. So make sure you sign up now.
It is fully accredited to get you all of your continuing education hours. Sign up for the true sports masterclass ACL from table. It's a turf. Thanks guys. Let's apply some of those principles to low back pain in the active individual. Mm-Hmm, . So, um, let's say I was active and let's say I lived in Miami and let's say I walked into Old Bull, right?
How do you break down? How do you assess what is causing my pain? How you talk about a diagnosis and then if and when you bring a kettlebell into it?
Yeah, that's a great question. Um, so for us, you know, the biggest thing and it's, it's funny because we learned this in PT school, but I think kind of in a different way.
I remember my professor is always saying like the history tells you everything. And, but then they still give you like the laundry list of tests and measures that you have to do and poking and prodding. But I'm really leaning into the history telling me so much information. As I mentioned earlier, I look for patterns and things like that's how my brain works.
And I'm trying to organize with what the person is giving me. Okay. Is this something that is a forced production versus force absorption issue? Is this something where, um, we have some chronicity to it? There's a lot of fear around what's going on. Is this a stress thing that's adding to the picture? Do I need to understand what their stress levels are like?
Um, I'm looking constantly for any sort of pattern that really drives from that, what my assessment is going to look like. Um, I'm also operating under principles where, you know, the patterns that we see with people with low back pain, and this is a sweeping generalization. Of course, most people have a hard time bending over.
That's usually what people have a tough time with. I think we can safely say that. Um, so part of my job, especially if I am really passionate about making sure people know that like movement is the good thing, not moving is what we want to avoid, I have to make sure I find an entry point in my very first session with them for the thing that they're most scared of, because if we avoid it, I'm just perpetuating the idea that it's bad and they're not ready for it yet.
So that's where the kettlebell comes in. I am making my client hinge in some way. The first day that I see them, regardless of the level that they're at, obviously I'm ruling out red flags to make sure things are safe, but I am finding a way to incorporate that just immediately because I want them to know that it's safe.
And I also want to give them a positive experience with it. If they've been told their whole life that bending over is bad, but we find a way for them to hinge and it feels awesome. We've just won like that is so impactful for this person and might change the narrative that they have about what back pain is.
And if we know anything about back pain, we know that that's actually one of the bigger contributing factors to prolong pain. It's not tissue damage, it's not anything structural usually, it's more often the ideas people have about pain. So the kettlebell is a great tool for that because it's not a barbell.
People aren't scared of it when they look at it and I can really change the range of motion, change the tempo, change the position to get them into a movement pattern that's as hinge like as possible and they feel really successful with it. Um, so that's usually where it comes in. Like I'm having my low back pain patients use a kettlebell for a hinge day one.
I love that. I love that. How much, how many um, special tests patient comes in with low back pain? How many special tests are you running through? And then I always say like every question you ask, every movement you ask them to do is building a case for your closing spiel saying, hey, here is why I think you are having this pain.
Here's what we are gonna do about it. Here's what you're gonna do about it. Here's about how long it's going to take, right? So how do you build that case and how in depth do you get with a diagnosis as you relay that to your patient?
Yeah, of course. With low back pain or with anything, we're ruling out red flags initially.
So we're going through our screening questions and asking about, When the injury happened, if there was a mechanism of injury, if there was a traumatic event, if we have changes in bowel and bladder, if we have changes in sensation, motor control, motor loss, all of those things, of course, we're going over from there.
I'll do more special testing if I need to. Um, but usually again, if we've ruled out those things, to be quite frank, I'm not getting too in the weeds about a specific diagnosis. If I've rolled out red flags, because I know that it's going to be more about, okay, what are all the positions that feel good right now?
Let's make them strong as hell there and feel super resilient. What are the things that don't feel great right now? Okay. Let's find an entry point today. Where are they at today compared to where they need to be? So I need to know about their training history. I dive into their programming if they have any, or I'm really learning about, okay, maybe there's some gaps in their programming along the way that we can address as well.
So it's much more of a deep dive into those things than going through kind of a laundry list of special tests, unless when indicated, you know, there's always, I'm not just flippantly saying, I don't do them at all. Um, but when it's most of the time, they're not indicated. So we're really looking more for what are the intolerable positions?
What are the tolerable positions? Let's find a happy medium. Um, and then from there, you know, the, of course, a lot of people come in wanting like a really specific diagnosis. But part of my job and part of something that I'm really passionate about is talking through the entire experience with my client and making them start to understand why it might not be necessary.
Um, or speaking of things and more in a functional way, like right now, this position is really uncomfortable. This is a very important position that your back has to be able to do. We're going to build you back up to it. That can be perfect in itself without having to say you have this specific pathology going on.
Um, and that's something that we really try to prioritize. We're painting a picture of where is the client currently? Where's their goal? How do we get them there in the meantime? And I'll be very honest with saying, sometimes I don't have a perfect answer for how long this is going to take. And I like to look at milestones instead of timeframes.
So I like to set goals that are more movement or functional based along the way. Instead of saying, okay, at four weeks, I'd like to see you here at eight weeks. I'd like to see you here because I'm good at my job, but nobody's that good. Like there are so many ups and downs. So that's really the way that we approach it.
That is why you would love our ACL masterclass. Cause that's our exact approach to how we take an ACL from the OR table. To the turf. Um, it's all about functional milestones and you have to know where to get them. And it sounds like you're taking the same approach with low back pain. Here's a big struggle that I've had in my career when I take this approach and I do take this approach.
How do you get objective with that? How do you actually show like what measurements are you taking or what function? What? Yeah. What measurements are you taking to then go back to the patient? Say, Hey, you were here. Now you're here.
Yeah, that's where a lot of it is. I have a conversation with the patient about, okay, here are some things that I would like to see to know that we're making progress.
What are some things you would like to see? So one of my mentors, Craig Liebenson, one of my favorite things he's ever said was, um, when you're evaluating a patient, have them show you their test. That's better than any special tests you'll ever have. You have them show you what they have a hard time with.
So similarly in our goal setting process, I want them to tell me what their outcome measures would be. What do you want to see? What would you like to be able to do? And we work together to create basically our battery of things that we want to get better at. So there's some things that we work on together.
And then additionally, um, again, kind of going back to patterns, I'm thinking of, you know, like buckets, what are things that this person needs to be really proficient in to hit their goal? And how can I build out something that I want to measure for each of those buckets? So it might be some strength measures.
It might be some agility measures. It might be some endurance measures and we're building it out in real time together. Um, I also find that that's helpful for buy in as well, because I'm not just giving them some arbitrary tests. That means nothing to them. I'm giving them a test that they've created and had basically a say in for the decision making process.
Yeah. I love that. Okay. So if, if their goal is, um, you know, I, I have trouble deadlifting or I can't get to the depth I want. Just walk me through like how you measure that so that. I want to give them feedback before they're all the way there. How do I tell them you are 25 percent of the way there? Now you're 50 now you're 75.
How do you, how do you measure that and then relay it to the patient?
Yeah, so that depends on if somebody is very well skilled and burst in the lifting world and they have a specific number they want to get to. That makes it easier because we can work percentages toward that number. If it's somebody kind of general population, I might utilize like a body weight deadlift as a good benchmark goal to be at.
And usually they get really excited and when they hit that, they want more. So there's some of those kind of normative values you could say for some lifts that are helpful. Um, similarly with the squad or any other movement that they're trying to get back to. Um, but then otherwise, yeah, we're keeping a record of the weight that they've lifted every session, just as if we would in a training session or the range of motion that we're using.
And if we're doing, let's say a deadlift from blocks and we're doing it from eight inches one week, and then in four weeks, we're doing it from four that's objective to show them that they've improved. Um, so all of those things are going into how I'm, you know, week over week progressing somebody. Whether it's the range of motion, the load lifted, the speed at which they're moving things, running, um, running is huge.
I work with a lot of runners too. So a lot of things we're looking at, um, you know, maybe in the beginning we're looking at keeping them with a goal of building their aerobic base. So we're keeping it very heart rate driven. So it's like progress for them is doing the same distance, but their average heart rate is lower the next time we test it.
So we're coming up with these metrics. Um, so we can be objective of course.
That's, that's really awesome. And I think unfortunately, sometimes that gets lost when you, when you become holistic or pattern driven, sometimes that objectivity falls away and that's where you start losing patient buy-in. So I love the way you approach that.
Um, tell me what the number one mistake that therapists make when using a kettlebell. Hmm.
Um, I think one of my biggest pet peeves that I see is wrist position with the kettlebell. Where should it
be and where do they let them go?
Yeah, if you just scroll through Instagram and see anybody using a kettlebell, you'll see, um, it's very much of like the wrist and extension and the bell is just like hanging in their wrist and they're not stacked at all.
Um, That's just, that's like doing an overhead press with the bar in this position. It's like you got to get that good grip. You got to get the knuckles toward the ceiling. That's one of the biggest things that's so important for keeping the bell in a position where you're able to keep your joints stacked.
You're able to use your muscles in a way that's going to be really helpful. Um, it actually feels better on the forearm with having the bell sitting against you. Um, people usually do that because they don't want the bell against their forearm because it feels kind of uncomfortable. But actually when you kind of just let it hang there, that's when it slams and moves around.
So the biggest thing that I'm like annoying with my clients about is that position just because it's so important and it sets the tone for every lift that you use with a kettlebell. If you don't have that down, good luck doing a front rack squat, good luck doing a clean, a swing, a snatch, any of those things because it's that important.
Yeah. Okay. And then how about with a kettlebell swing? What do you see people screwing up?
A lot of things. A lot of things. Yes. Um, you see a lot of people making it very squatty and upright and more vertical. The swing is a horizontal movement pattern. It's like a broad jump. You're getting very hingy. Um, that's why, you know, you should master your kettlebell deadlift first and make sure you feel so comfortable with that before you start.
adding momentum to it and swinging it. Um, so that's a huge, we also see a lot of people who really like grip it and use their arms. Uh, most kettlebell movements, they're momentum based they're the force being driven through your hips through triple extension. Um, it's a power movement that's coming from momentum from the rest of your body, not muscling it with your arms.
So you'll see actually a lot of people swinging way too light of a bell, way too light. Um, if you feel like you could front raise the bell. with your shoulders. It's too light. You need to have something that's heavy enough to be able to get that pop with your hips. Um, you'll see a lot of people too, who at the top of the bell, when they're in hip extension, they're really hyper extending back instead of staying very upright.
Um, and just kind of missing that really powerful hip pop. And they're getting a lot of extra movement with their back. Uh, those are three really common things that we see.
Yeah, I think I see that a ton. I think a lot of it has to do with the inability to stack their hips and to really express full hip extension, right?
And so the, I see a ton of, of patients, um, hopefully not true sports therapist coaching accordingly, but where that extension starts coming from lumbar spine and that's when they start to feel that pain there. What kind of cues do you give your athlete as they swing the bell through? What should they be feeling?
And I'm actually, I'm a huge fan of not over queuing a ton because I really. Um, my background's in neuroscience, so I nerd out over the brain's ability to do a bunch of sloppy things and learn from it and therefore make a better, uh, you know, choice for movement selection. I think it's so important for true motor learning is you have to make errors and your brain has to reorganize itself to be better.
So I, I allow for messy reps. I want messy reps. Um, but of course, when we're working on things like this, I will usually use some external cues to help. So it might even be, um, like I'll stand real close behind them and be like, if you hit me, you've gone too far. And that usually works. Um, just put your own life at risk and your client will comply.
I'll take it. Yeah. Um, or, you know, you can set them up in certain positions where you're using the environment to manipulate where they're going. So they don't have to think about it. With Kettlebell stuff, they're learning a new skill. It's already complicated. It's already something that they have to think about.
If I add another layer of making it too, too much to think about, it's going to be a disaster. So external cues are very helpful for that. And then also I'm using my co design looking, okay, if their hip extension needs to be improved upon, I probably need to do something from just like a regular old strengthening perspective.
And to get their glutes super, super strong. So they don't feel like they have to get extra work from their lumbar extensors. And, you know, I'm, I'm careful when I'm explaining this stuff too, because I don't want people to think it's bad or wrong. Like our back muscles have to be strong. They absolutely do.
But if our target tissue for this movement is your glutes, I want to make sure we're using them. So it's that whole conversation of like, this isn't bad or wrong, but a better swing, a more powerful swing is going to come from your glutes rather than those spinal extensors, then we'll strength train them appropriately to be able to handle that with the power and the force that is happening with a swing.
And so where do you go with that? What's your intervention to accomplish that?
Yeah. I mean, it depends on the person, what their fault is, but yeah, usually I might even just work on like, take them back to the basics and take them to a kettlebell deadlift and work on powerful, quick, like hip extension, getting to the top of that deadlift and not letting them hyper extend.
I might even film them from the side and show them because a lot of times they don't know people who have a tougher time with hip extension. It's appropriate section thing too. Um, so that might be a huge part of it. We might really get down and do some hip thrusts and work on that top position. Some isometric holds and pure hip extension are disgusting and very hard.
And we'll work on stuff like that. Um, so, or I might even, it might be a timing thing. I might have a metronome and have them make sure that they're hitting on the same time as a metronome. If they're kind of off timing, that's usually where you see a lot of these compensations happening with swings.
Yeah, that's, I mean, that's.
Yeah. Awesome. And good food for thought. And I think you're right. Like you don't have to get too fancy or use a huge amount of weight to teach proper expression of hip extension. Um, so those are great interventions. I love the idea of using auditory cueing as well. Um, it's also a good opportunity, um, to use something like a Tindex.
Or a force plate where they can actually see a difference, maybe a visual cue instead of just an auditory cue of here's how much force you're producing in totally said moat movement, right? Maybe, maybe there's something to chew on there. Um, when I like that, Thank you. That means a lot. True sports physical therapy is growing like wildfire.
We have 14 locations soon to be more. We are throughout the state of Maryland. We're in Pennsylvania, in Lebanon, in New York, Pennsylvania, as well as in Delaware, in Newark and Wilmington, Delaware, like I said, so many more practices to come and we always need. Outstanding sports physical therapists. Our treatment style is unique.
We are one on one with your athlete for 45 minutes, every single session, you do the entire treatment, you do the entire evaluation, and they are in state of the art facilities where you have room to run, throw, and jump, and really get your athlete all the way back to on the field and better and stronger than they were.
We also have outstanding salaries. comp structures, bonus abilities, 401ks, as well as a very strong continuing education offering, including in house continuing education. And we're looking for you. Now is the time as we are growing like crazy. Just shoot your resume over to Yoni, Y O N I at TrueSportsPT, or shoot us a DM and we will hit you back.
We will get you in for our unique tried and true interview process and really make a determination that this is the right place for you to grow your career and get your athletes better than ever. We can't wait to hear from you. Um, when do you start to introduce the Turkish get up and how the hell do you do that?
It is a process, that's for sure. Um, yeah, and I don't do it all the time because it just takes so much time. It takes a lot of time. It is a really cool, what I actually like it as is a warm up for somebody because like we're really intentional with our warm ups. I want it to be something that actually gets your heart rate up and preps your tissues.
Um, and that's usually where for most people I'm sprinkling in their plyos or their things that are going to truly get them warm. And then also working on important qualities for tissue capacity that we need. Turkish getups are great for that because Everything will absolutely be warm. It's full body.
Um, every step of it is a mobility and a strength demand. Um, you know, we have a ton of shoulder stability with keeping the bell stacked. We have a lot of like the lat packing, being able to stay on the arm that you're pushing away from the ground on tons of core. Your hip flexors are along for the party.
We're getting into a hip bridge. Like you're doing so much stuff. It's a really good movement for that. I teach it in parts. You can break it down. Depends on. How you break down the movement, but I usually break
it
down and like five or six steps. And for some people, I might only work on steps one and two for a couple of weeks and just get them really comfortable with it.
Um, there's so much value and just perfecting those beginning steps that I don't really rush it. Um, I also, for some people might have them for most people go through completely without wait for a while and get them really, really used to it because it's scary having a kettlebell over your head while you're doing a bunch of different movements.
Um, but definitely like piecing it together and having them practice part by part is huge. But I love this movement for, and even if we don't get to the full thing for everybody, it's still a really valuable movement, especially for our older adults too. Uh, it's a great way to work on getting up off the floor without making somebody feel old and telling them we're working on fall risk training.
There's nothing that makes an older adult feel worse than telling them that. So do Turkish get ups and you're working on it without having to bring it up. Um, it's a great way to work on getting up off the floor, um, which is, you know, Increasingly harder as we get older. Um, so it's a great movement regardless of age.
Yeah. And it's like the number one predictor of how functional we will be throughout age. Right. So it's a, it's a great way to, to put that in, like you said, without making someone feel like a dumb ass. So I think that's what you said.
It's exactly.
So, so one of the things that I, so I take a similar approach.
Um, in terms of breaking it down, I think that's huge. Cause you go all the way up, all the way down. There are just a billion things they're asking them to remember. So I learned from that pretty quickly. I look, this is one of the few exercises where I love, if I can putting an athlete in front of a mirror for talks, as they're able to watch it.
I also do it side by side with them and I make them earn the weight before they put that bell in their hand. Um, I learned this from a strong first guy, a guy named Dan Senodosa, who is A master kettlebell coach. Um, he also rolls up frying pans with his hands. So he's a strong ass dude, but he made me do a Turkish get up balancing a shoe on my fifth for it.
So you'll always see athletes in our gyms doing it like that. I think that's a great cue. And then I tried to go to really dumb it down to be. Supine elbow, palm bridge, and then that's where they, and then they come back down supine elbow, palm bridge, supine elbow, palm bridge, and just get them used to kind of moving through that.
What would you say the best cues you use are?
Um, I'm very similar to you. Actually I'll, we'll use a shoe or even a yoga block on your knuckles. I've also made people hold cups of water before, which is real fun. Um, so you can get creative with that, but yeah, very similarly, I break it down to like on your back, not your elbow to your hand, hip bridge.
Um, that's, I'm very similar with that because I think the shorter the cue for a really funky movement, the better. I think the number one cue I give is eyes on the bell. Because where your eyes go, the bell is going to go most people. Um, and if I see that happening, I'll actually on purpose, take them away from a mirror because most people want to watch themselves and when that initial, when you're coming up, if you're not looking at the bell and staying here, you're going to come up and just the bell is going to tip forward.
So that's a huge, important, important thing. And I'm not moving somebody like a forward, giving them a weight at all. If I'm seeing that happen over and over again.
Yeah. Yeah. I think that that is awesome. Um, okay. So tell me about some of the risks, um, and how we manage those when putting a kettlebell in an athlete's hands.
I think you could say a little thumbs up. I don't want to know where that came from. I think you could say that the risks would be quite similar for using any equipment in the gym, being smart about it. Like if somebody is, um, easy to flare up in their low back, I'm probably not starting with swings with them.
Day one. Um, I think really this is where you have to know your client and just like you would with any other tool that you're using in the gym, you know, start more conservatively than you think. I might never teach somebody a kettlebell snatch. Doesn't mean I don't like it, doesn't mean it's not good, it just might not be appropriate for them.
So, really, I'm starting so much more conservatively than, um, maybe people would think, because I do like to get people going, I do like to get people moving, but I'm always making sure they have the foundations mastered first. If their kettlebell deadlift looks like trash, I'm not swinging them. Like I have to get that cleaned up first.
Um, and so I think that's just like a blanket thing first and foremost. And then also, yeah, I mean, just in general being a stickler for technique, it is important here because it does become dangerous if you are holding the bell and you have a heavy ass weight in your wrist and your wrist is in this extended position and not stacked.
Like it's just, it's putting undue stress on the rents. It's just not smart. So there's techniques that exist for a purpose to make sure that. Those very important. Um, okay. Our wrist is stacked. The bell is close to your body. Um, when we're swinging all of the things that we talked about, like keeping your hips stacked, that stuff's important.
I don't think there's, um, in my opinion, and, and there's also in literature about like safety and efficacy of kettlebell programs. Um, I would treat it the exact same way as how I would work somebody through barbells, work somebody through dumbbells. I'm just not being a dumbass. Like I'm just making sure I'm being safe with them and progressing them really gradually.
Yeah. It's, it's pretty amazing how this thing that we do for a living is really not rocket science, but I would say just like, just like your, um, take on Uh, they can't do a deadlift. So why would I have him do a swing? Dude, I see that stuff with, with box jumps where I got athletes who are running and they can't handle the concentric portion.
They can't handle the eccentric portion, let alone over a hurdle where you got to control both. Right. So why is this athlete running? Um, I think it's very similar, um, to what you're saying with the kettlebell. Um, so keep that in mind, like all the PTs out there. through these things, you got to know if your end goal is a pattern is a swing or a snatch.
Like what are all the basics that go into that train them, prove that they can do it and then progress accordingly. Um, I think, I think there's a lot of, you know, I think there's a lot of value there. So, um, that makes a lot of sense. Now, when you were talking about some of the old bull courses, you have training as healthcare, and when you were, Working through that training is healthcare.
The next one was what kettlebell is healthcare. And you said it includes, um, PTS, obviously best profession in the world, as well as strength coaching. Um, and you can. Consider that a piece of healthcare. And I love that. What do you wish? Strength coaches knew that PTs are great at and vice versa.
Oh, I love this.
Yeah, I actually start my training as healthcare course showing examples of um according to most recent data on how often Americans see their uh general practitioner physician versus how many times you see a trainer. becomes very clear that the 2. 6 times per year that people see their physicians were seeing our coaches and our trainers more.
Um, and that speaks volumes of actually, in my opinion, who is the front line of health care. I think it's trainers and coaches. People see their trainer and coach while they're in pain before they ever see us. So I just think it's so important for people to understand that, um, and to like empower our professions across the board, like what we get to do is so badass.
And I think it's really important to know that, um, I wish PTS knew a hell of a lot more about program design, energy system development, strength and conditioning principles, actually providing enough of a stimulus to create an adaptation, um, progressions instead of regressions. I think there's so much information there.
That we don't get in PT school for some very strange reason.
Why don't we get it? Katie, this is the second time I've had this conversation on a pod this week. Like, why don't they get it in school?
I have no idea. It makes no sense to me. I, I don't know if there's this assumption that we're already supposed to know it, but we do not.
Do justice to actual like true exercise physiology. It blows my mind. I don't understand it. Um, when it comes down to it being non diagnosis driven and being non protocol driven, what I'm really doing with people is I'm identifying what energy system needs to be developed. What adaptation can I prove or what stimulus can I provide to get an adaptation and how do I make them work hard enough for something to change?
That is so important. We don't get that in PT school. I think that's where we are severely undereducated. Um, and it's a problem. It's why exercise is underdosed. It's why rehab, it's honestly why I think a lot of, um, the research and evidence we have for certain protocols or physical therapy as an intervention shows that stuff doesn't work because what the hell is the dosage that we're giving people?
I'm sorry, but they're a band like six week exercise program and you're not going to see any improved outcomes from that. So I think that's a huge, huge issue. Um, and I think on the other end of the spectrum, I think strength coaches is. Should be more exposed to, um, like understanding the science of pain, the physiology of pain and stress, understanding how the stress response plays a role.
Um, and more of the like biopsychosocial stuff of how many things are so deeply interwoven into somebody's pain experience. I think that strength coaches and trainers also need to be made more aware of red flags like we are. Because there is such a misunderstanding of what is appropriate for a trainer to continue to work on with somebody versus when it's appropriate to refer out.
And those are things that I go over day one in all of my courses. And it's stuff that is really drilled into our heads because we're dealing with people from like that medical lens. But I do think coaches need that education as well. If stuff swollen, don't jump on that limb. It's stuff that it sounds really simple, but it's, it's honestly not discussed or talked about.
And then also it's just not talked about. Okay. So if that stuff's not going on, how do you know that you can feel safe moving somebody? I think that's so incredibly important. That's why I love being a PT because I think, I think that's like the, The next little extra bit that getting to be a PT does for us, I can feel so confident and safe that what I'm doing is appropriate and not dangerous for my client.
That's like the biggest weight off my shoulders. That's what our profession gets us able to do. And if we can give a little bit more to that to trainers, I think that's huge.
Yeah, that is, that is huge. You know, I'm trying to live, um, in the world of bringing solutions and not just problems. So what about this?
What if, instead of just like bitching about stuff and not doing something about it, so what if. What if at least baked into our doctorate program, where they're taking 60 freaking grand a year for three years to give us a doctorate, why don't they bake in some type of CSCS course, why don't they bake in some type of understanding of periodization, like even if you go into neuro or you go into whatever burn care or cardiac care, those principles really still hold the same, I would love to see more of that.
From graduate schools. I just think they get, I think they get very nervous about the boards. Like they teach to the test. They want their kids to pass the test and that stuff's not on the test. Um, so, so, you know, maybe it's something there. The, the other blessing we have, how long you've been doing this, Katie, how long you been a PT
since 2019?
Oh, you're a rookie, but a very, very well versed rookie. Um, but it's amazing. Like how you've lessened the learning curve because there's so much awesome information out there. When I get out of graduate school, I'm a million years older than you. Look, we, where, where would I find information on how to do this stuff?
Now it's everywhere. Now the skill is how do you parse through appropriately? How do you find the right mentors? Even if it's a virtual mentor, even if it's. I'm just going to follow their Instagram. How do you find the good ones? Give me advice on that.
Yeah, I think that's even something that I've noticed, like starting PT school in 2016, that was when I think, um, it was just starting to become more popular for there to be people on Instagram talking about PT, but it was still very few and like few and far between.
So I think now the resources are endless and there's a lot more exposure. to things that even I didn't have when I was in school. Um, I like being solutions based too. I don't really think it helps us to just complain. Um, I do think that one of the biggest pieces of advice that I try to give people, um, if they are interested in this type of rehab, um, I think you should, no matter what, but especially if you're interested in this type of rehab.
Become a strength coach and a trainer. That's a phenomenal way to when you're at the MPT school, get a job in your school's gym and train clients because nothing is going to prepare you better than that. Um, I think it's hugely important to do that. I think also when looking for mentors or looking for people that you can trust, um, I would say.
steer clear of people that seem to be kind of gurus where they speak in absolutes and they are, um, constantly cutting other people down. Uh, that's something that I've like, I think it's grown to be really gross. And now the way to get content is to just talk shit about everybody else. And I think if you can, if you get stuck in that really negative thought bubble, it's so easy to just get like pissed off at our profession and think that everything is stupid and complain, where I really think like, Surround yourself with people who are passionate and excited about the industry and want to change it instead of bitching about it, as you said, like, there's so much negativity where I can create content by just making fun of somebody else's idea, instead of creating a new good idea.
I think that's huge when you're looking for somebody to maybe emulate your style after and learn from. Get excited about the industry from, uh, steer clear of that, like negative guru that can
storm. That's, that's a great point. Um, and that, that's an ideal, that idea of positivity or excitement around positivity.
That's something actually that we've started to incorporate here at TrueSports in the hiring process. I've learned that the people that come on that are successful, That helped the most patients are those who are absolutely thrilled to be working at true sports to be working at an old bull to be in a strength and conditioning environment.
They just they're not cut out for the for the cookie cutter pivots or 80 eyes and and even helps like I've seen unbelievable success of people who have seen that world. And they're like, this ain't for me, right? I need to make a change versus someone who only knows our world where we're providing this type of care.
Um, it, they just bring a different energy level to work, but, but I think your point is great in looking for mentors. Like that's a great way to look for a mentor or at least an influence, right. Um, to look out for, okay, so let me. Um, wrap up Katie. You're teaching me a ton. So I really appreciate this. Um, let me wrap up with our lightning rounds.
You ready? I did not send you these questions in advance.
Oh, great.
Short answers. I feel a little cheated. It's fine. Yes. This was a trick. This was a trick. Okay. To get you on the pod. Okay. Here we go. The best physical therapist in the world, not named Katie Dabrowski.
Oh my gosh. Can I say my entire team at old bowl?
No, you cannot. You can say one name.
Oh, that's impossible. Oh my god. You can use your first
and last name.
Okay. Um I would say Ryan Chao Reload Physical Therapy. He's the owner of Reload in New York. It's an amazing hybrid space as well. Um fantastic. If you want to mentor it, that's your guy.
Love it. Uh I'm looking for my next podcast guest.
So, I'm gonna hit that guy up. Oh, there you go. Um okay. Number two. Um who is Ryan Chao? Not who, what type of athlete is the best athlete you've ever treated?
Oh, my gosh. Um, really good question. I think, you know, we work a lot with, um, the U. S. Olympic sailing team at Old Bull, and that is one of the coolest, most, like, cognitively intense athletes ever.
They are making so many decisions as they're being destroyed by the elements and, um, the level of skill to hang your entire body outside of a boat and not get hit in the head with the sail and unclip yourself and clip things in and make decisions. It's so fascinating. They're badass athletes.
That is awesome.
Great answer for someone who did not get a chance to prefer that. That is a profound answer. Okay, what's the biggest mistake you've made in business? And what did you learn from it?
If you made a mistake, the
biggest, I mean, probably just overworking myself and not giving myself enough time to breathe. Um, like wearing way too many hats, seeing way too many people over committing. Um, and mitigating it is just being stricter with boundaries like here on a Friday. I don't see patients on Fridays and that's where I have my meetings and get a lot of things done that I used to try to do at like 10 p.
m. on a Tuesday. Um, but yeah, it's definitely like not having boundaries and just going like a million miles per hour all of the time.
Yeah. Okay. Well, that's, that's great knowledge. I definitely am still making that mistake. So thank you for saying,
yeah,
but, but thank you for, uh, making me more cognizant of it.
Okay. The book that changed your life.
Um, oh my gosh, there's so many books, um,
that you've read that you've read Katie.
Oh, thank you for the clarification. Um, I'm sitting in my room with all my books. Maybe I'll see which one. Um, I mean, range is an excellent book. Um, it's all about being a generalist rather than being like hyper focused and specific.
You could apply it to sports, business, practitioner, being a practitioner. Um, definitely really enjoy thinking about. More of like, how can I be really well rounded that I think in a world where we think we should like be hyper specialized, um, or we see a lot of people in our industry and I'm like, oh man, I don't really have like the elevator pitch for who my ideal client is in my bio.
Um, I think it's like being a generalist is important.
That's, that's awesome. That is why I still read the newspaper. Because because like when you're talking to a patient and they're talking about whatever, you should know a little bit about something to just engage with a patient to do that, that, that tip I remember came from my biggest pain in the ass patient who also happened to be my wealthiest patient ever, who asked me like something general about current events.
And I'm like, uh, Charlie, I don't know what the hell you're talking about. He's like, if you don't start reading a newspaper, I'm not interested in coming back. That almost made me not want to read the newspaper, but it was very good advice. Like it made me think like there's things going on more than just physical therapy, more than kettlebells.
Like there are things in the world that matter. Um, and I think it's, it's, and it's going to help your PT game.
Totally. Yeah. That's a very good, very good tip.
Um, okay. So Katie, nice, kettlebells. I loved it and learned a ton. Um, I love what you're doing at old bull and the coursework. Tell us how to find you and other big events that are coming up.
Yeah, this was very fun. Um, so you can find us on Instagram. Old Bowl athletics is our main account. Um, that's the best way to find us. You'll find all of our incredible therapists on there as well. Um, and upcoming stuff, we have training as healthcare in Newport beach, which is sold out July 20th through 21st.
We're doing another kettlebells or healthcare course in Miami at old bowl. November 9th and 10th, we'll be announcing that stuff soon. Um, we always have different events going on. So definitely like check out our Instagram. You'll get up to dates, uh, of all of our fun things that we're working on, but those are the two big things on my calendar right now.
Hell yeah. How many, um, reps of a bent over row, what'd you say? Single arm bent over row at what weight?
50 percent of your body weight.
50 percent of your body weight. How many you got Katie?
Mm hmm. I gotta do it still. It's the month of July. I'm prepping, you know, I haven't done it yet.
What's your prediction?
Cause I'm going to check back in a month.
I feel like I could probably do 15 to 20. I feel good about it.
Hell yeah. I was going to go 15. So way to knock that out of the park. Um, Katie, you have been a goddamn pleasure. Thank you for your time. Thank you for everything you're doing at Old Bull. You're making our profession better.
You made my Friday better. People are going to love this podcast. Make sure you check out Katie Dabrowski down at Old Bull. She's obviously a stud. Thank you for your time. Really appreciate you.
Thank you so much. This was fun.
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