Kettlebell Training Zone!

Master Your Craft: Introduction to the Kettlebell "Turkish Get Up"

By Robert "Skip" George, D.C., CCSP, CSCS

At a recent seminar called "Bridging the Gap: Rehab to Performance Training", I had the privilege of speaking with Craig Liebenson, D.C. and Charlie Weingroft, P.T.  regarding cutting edge approaches to rehabilitation, performance training, changes in   the fitness industry and in our healthcare system as well.  Whether chiropractors, physical therapists or physicians like it or not, personal trainers are treating back pain with corrective exercise and lifestyle coaching—and they are getting results!

The fitness industry is doing a comprehensive job of teaching personal trainers about the role of muscles, joints, and the nervous system in painful conditions of the spine and how to integrate rehabilitation with fitness training.  Because of this skill development, clients of many personal trainers return to them over and over without insurance reimbursement. 

One of the trends in many chiropractic, physical therapy and personal training practices is the integration or blending of rehabilitation and sport performance training.  By teaching patients and clients how to move and function well, this integration is becoming a perfect match for the 21st century practice and defines a critical niche in the rapidly changing healthcare marketplace.  

Gray Cook, Brett Jones and Mark Cheng have been combining the Functional Movement Screen (FMS) and the Russian Kettlebell Certification (RKC) training with tremendous results.   This training is known as CK-FMS.  The FMS can help you determine which client or athlete is at risk for injury, which movement patterns or regions are dysfunctional and what treatment or corrective exercise strategy is needed to address those issues.  Kettlebell training can then reinforce functional movement patterns and strengthen you and you clients in ways you cannot achieve with a typical training approach.

Regarding posture and patterns of movement, Mike Boyle and Gray Cook came up with what is known as the joint by joint approach that describes how our bodies move, stabilize and function. Essentially, the ankles, hips and thoracic spine need to be predominately mobile and the knees, lumbar spine and scapulae need to be stable. What contributes to or can cause dysfunction, pain and ultimately injury is the reversal of these patterns. 

For example, not enough hip mobility will result in an excess lumbar spine movement compensation.  How many of us have seen clients with a lumbar disc disorder or misalignment issues because of hip immobility and decreased lumbar stability ?  Shoulder conditions such as impingement, labrum or rotator cuff tears are often associated with unstable shoulder blades and decreased motion of the thoracic spine especially in athletes that use repetitive overhead motion.  Add rounded shoulders with forward head lean and headaches, neck and arm can occur.

As Gray Cook mentions in his book Athletic Body in Balance, we are walking around like turtles, head sticking out forward and a big shell weighing us down.  What happens when we get put on our back and try to get up?  It's not a pretty sight.

The beauty of the Functional Movement Screen is that those regions that need mobility or stability can be addressed with a proper assessment combined with exercise intervention that result in "movement competency".  This is one of the best descriptions of functional training.

By the way, the NFL has discovered this and many teams use the FMS to improve durability and performance of their players. Want to get into treating elite athletes in addition to your weekend warriors?  Get as many tools in your toolbox and get certified in the FMS!

What does a typical American look like in terms of posture, waistline and ability to function or move well?  I think that most of us can agree that the typical hunched forward and rounded shoulder posture with moderate to severe de-conditioning is a significant reason patients enter our clinics.  It is not a leap to observe that this de-evolution of sedentary human beings in a rapidly changing and highly stressful modern society is a major contributor to the unsustainable costs in our healthcare system. As trainers, we need to be at the "tip of the sword" when it comes to addressing what is needed to help heal our ailing healthcare system!

So what do we typically do for exercise? How about going to the gym, sitting on a machine and pulling or pushing weights while hunched over with lousy posture. Or, after sitting for 40-60 hours per week, let's go out and put staggering amounts of rotational force on our lower back and a de-conditioned core with a round or two of golf. Sounds fun to me!

In my opinion, most modern day gyms contribute to the dysfunction and ultimately the de-conditioning that is a consequence of preventable pain and injury to our clients and patients.

The "old school" gyms relied more on possessing skills needed to exercise with kettlebells, clubs, rings, ladders and ropes for strength and conditioning versus mass production and mindless machines!

In the early 1800's, the word "calisthenics" appeared as a form of exercise that uses body weight or a hand held weight for strength and conditioning.  Calisthenics actually comes from an ancient Greek word "Kalos" which means beautiful and "Sthenos" which means strength. Kalos Sthenos means moving well or beautifully and possessing great strength.

One of the best exercises that personifies "Kalos Sthenos" by integrating mobility, stability, symmetry(left, right, front, back), coordination, balance and yes, beautiful strength, is the "Turkish Get Up" or "TGU", using the Russian Kettlebell.

Russian Kettlebell training has become popular in today’s fitness, performance and rehabilitation world and is an important tool for rehabilitation or strength and performance training because it reinforces  movement where movement is needed, stability where stability is needed, strength, coordination, symmetry and especially proper posture.

There are seven distinct parts to the TGU.

Starting from the ground is Step One: Roll to Press
One of the most important parts of the exercise is gripping the kettlebell. A straight or neutral wrist holding the offset weight is used as well as "crushing" or squeezing the grip very hard.  This crushing of the grip leads to a progression of hand, arm, shoulder and chest muscle activation that will provide greater strength and stability throughout the movement.

Step two: Press to Elbow
It is simply rolling under the kettlebell to the elbow.  Force generation is required to overcome the inertia of being flat on your back.  Shoulder is "packed" or retracted down and medially towards hips. 

Step three: Elbow to Post
This is a continuation from the elbow to the hand and requires continual gripping, packing of the shoulder, extension of the T-spine, and mobility of the hips. Can you see where each step is starting to reinforce the joint by joint approach while moving in a coordinated, multi joint pattern?

Step four: Post to high pelvis
This illuminates the ability to extend the hips upward and forward creating a space to bring the leg back next to the hand.  Talk about taking bridging to a different level!

Step five: High Pelvis to Bend( a.k.a High Pelvis to Knee)
This step requires coordination with strength. Notice the mobility of the hips, extension of thoracic spine, stability and position of scapulae and lumbar spine.

Step six: Knee to Half Kneeling
Keep shoulders packed down towards hips (note: ears are poison to the shoulders!) wrist and hand vertical, T-spine elongated and relaxed, drive straight up to half kneeling.

Step seven: Half Kneeling to Stand
Continue with step six instructions for shoulders, hands, arms and spine then drive from the back foot to standing.

After each of seven steps are completed from the ground to standing reverse order all the way back to the ground. Then, switch and perform the TGU on the other side. 

This one of the most important exercises in rehab and sport performance training and is an important tool for the trainer, therapist or doctor who wants to integrate corrective exercise into their practice. The TGU reinforces the functional movement patterns including stability, coordination, symmetry, balance and strength that allow us to thrive in how we work and in recreation. It is also an ideal exercise to restore function after an injury, augment sport and performance training, has a low financial cost for equipment and doesn't require much floor space. 

The description and pictures are used for introducing you to the TGU. Only perform this exercise after you have been instructed by an "RKC" (Russian Kettlebell Certified) instructor, or become an "RKC", and have a minimum score of 14 or more with no asymmetries on the Functional Movement Screen. Without proper instruction and a proper movement assessment, there is a very real risk of injury and this exercise should be performed by fit individuals. And, it needs to be learned without weight first and then only appropriate weight is added based on the patient's age, fitness and functional level.

Remember, master your craft and keep growing everyday in the three areas that mean the most: personally, relationships and professionally!

References

1. Kettlebells from the Ground Up/The Kalos Sthenos Manual and DVD by Dr. Mark Cheng with Gray Cook and Brett Jones
2. Mike Boyle, Keynote Speaker Notes from the April 2011 American Chiropractic Board of Sports Physicians Sport Symposium,  "Joint by Joint" Approach
3. Movement by Gray Cook, MSPT, OCS, CSCS
4. Rehabilitation of the Spine, Second Edition, by Craig Liebenson, D.C.
5. The Selective Functional Movement Assessment Workbook, Advanced Clinical Integration by Phil Pliskey, DPT and Kyle Kiesel, PT



Robert "Skip" George, D.C., CCSP, CSCS owns Optimum Fitness and Health in La Jolla, CA where he integrates Chiropractic, Rehabilitation and Fitness/Performance Training. He coaches personal trainers, chiropractors and physical therapists how to build their practices through developing professional skills and creating a lasting personal connection to clients. He is a certified Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA) provider as well as a Functional Movement Screen Instructor. He can be contacted at Dr.George@sbcglobal.net.