Ep 113: Barbell Training for Physical Therapy and Injury Prevention with John Petrizzo
Today, I welcome John Petrizzo, a physical therapy advisor/coach of mine whom I met in Andy Baker's barbell club. John will debunk common myths about strength, recovery, and mobility. He’ll explain how to merge rehab and strength training to prevent injuries. You’ll learn why strength is a fundamental attribute that affects every aspect of your life, from post-surgery recovery to traditional PT to overall function and performance.
John is a Physical Therapist, Certified Strength and Conditioning Specialist, Starting Strength Coach, and an Associate Professor in the Department of Health and Sport Sciences at Adelphi University. He holds a B.S. in Exercise Science from Hofstra University, where he was a member of the football team and a Doctorate in Physical Therapy from the New York Institute of Technology.
John has worked in the fitness industry since 2006 and has helped many clients achieve their health, fitness, and sports performance goals through barbell training. In 2012, he began competing in powerlifting.
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Today you’ll learn all about:
[2:34] Combining physical therapy and barbell training
[7:46] Benefits of barbell training for the average person
[12:02] Counterintuitive lessons on human strength and mobility
[16:37] General philosophy on post-surgery recovery and linear progression in lifting
[25:58] Importance of strength as the primary physical attribute affecting human performance
[29:18] Limitations of mainstream fitness and PT methods
[33:03] Prescribing barbell training in a rehab setting
[35:12] Patients' reactions to barbell training as part of their rehab
[36:15] Differences between mobility and flexibility
[40:39] How physical therapy knowledge improved an athlete's performance
[45:30] How barbell training influences clinical reasoning in physical therapy
[47:06] Barbell training's role in injury prevention and reducing the recurrence of injuries
[49:17] One question John wished Philip had asked
[52:00] Where listeners can learn more about John
[53:08] Outro
Episode resources:
Progressive Rehab and Strength - https://www.progressiverehabandstrength.com/
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Transcript
John Petrizzo 00:00
Everything that you do in your daily life, in some part relates back to your ability to generate force, right? So get yourself up out of a chair to go up and down the stairs, right to keep your balance when you're carrying the groceries, all of those things relate back to your ability to produce force and the stronger you are, the more submaximal those tasks become.
Philip Pape 00:23
Welcome to the Wits & Weights podcast. I'm your host Philip pape, and this twice a week podcast is dedicated to helping you achieve physical self mastery by getting stronger. Optimizing your nutrition and upgrading your body composition will uncover science backed strategies for movement, metabolism, muscle and mindset with a skeptical eye on the fitness industry so you can look and feel your absolute best. Let's dive right in. Wits & Weights community Welcome to another episode of the Wits & Weights Podcast. Today I've invited on John Patricio, a physical therapy trainer advisor coach of mine whom I met in Andy Baker's barbell club. And I wanted to bring him on because of his unique combination of physical therapy and barbell training. He and I have had a few conversations leading up to and then after my rotator cuff surgery, where he gave me some great advice helped me accelerate the process of getting back to what I love, which is training, building muscle and being active. And I wanted to dive into some of these principles so you can benefit from his tremendous expertise, John will dismantle some of the more pervasive myths about strength, recovery and mobility. We'll discuss how to merge the worlds of rehab and strength in a framework that could drastically change your approach to injury prevention and rehab. From post surgery recovery to the cautionary advice you often hear in traditional physical therapy. You'll learn why strength isn't just about lifting weights. It's really a fundamental attribute that influences every facet of your life. John Patricio is a physical therapist Certified Strength Conditioning Specialist, starting strength coach and an associate professor in the Department of Health and sports sciences Sciences at Adelphi University. Sorry, man, that's a mouthful. He holds a BS in exercise science from Hofstra University, where he was a member of the football team, and a doctorate in physical therapy from the New York Institute of Technology. John has worked in the fitness industry since 2006, in a variety of roles and settings, and has helped many patients and clients achieve their health fitness and sports performance goals to barbell training. In 2012. John also began competing in powerlifting. John man, it is an honor finally to have you on the show.
John Petrizzo 02:31
Thanks so much for having me. It's a pleasure to be here.
Philip Pape 02:34
So let's let's get to know you a bit. You have this uncommon dual practice that I think it's uncommon, maybe it's not, but it combines physical therapy, and barbell training. So tell us how that came to be and tell us some of your guiding principles behind that.
John Petrizzo 02:48
Sure. So my interest in training started, you know, way back when I was a teenager, played a lot of sports growing up and became interested in lifting specifically to try and improve my performance and athletics, wanting to get bigger and stronger, like a lot of high school guys that play football. And I also played basketball and lacrosse in high school, and wanted to try and continue to play in college. So I saw, you know, weight training is kind of the key to that. And then once I got into college, I had to figure out, you know, what I actually was going to do there academically, and decided on majoring in exercise science, I didn't really know much about it. To be honest, at the time, I just knew that it sounded like it aligned with my interests. And once I graduated, I started working as a personal trainer at a large commercial fitness facility, which I really enjoyed. And finished up college I continued to train and true meaning train myself. And ultimately, I became interested in physical therapy a little bit because there was a PT clinic in the gym that I was training people at, and I just kind of became curious about was that they knew you know, about the body and about rehab and performance that I didn't know. And it kind of piqued my interest and made me want to pursue that. So I ended up applying for grad school for physical therapy and doing that. And, you know, once I was in the program, and certainly I mean, I learned a ton. But I also realized that not a lot of people that were involved in rehab really knew or had a ton of interest in strengthing conditioning, you know, so, so I was a little bit unique from that standpoint, I think it's becoming more common now. But that's really where it started for me, you know, and once I got out and started practicing, it really was about taking the things that I knew about training and strength and conditioning and kind of applying that to a real limitative setting, you know, I wanted to be able to work with people from across the continuum, whether they needed strictly rehabilitation, whether they're looking to improve their sports performance or, you know, get stronger, you know, I wanted to be able to do all of that. And that's really where it started for me.
Philip Pape 05:17
Yeah, and it sounds like it's a, it's a really natural combination of things, because we all experience injuries, surgeries, and issues over the years. And there does seem to be a gap, at least from the lay person's perspective, from both sides from trainers who don't quite understand movement patterns and, and injury and maybe don't even want to go there for liability reasons. And then physical therapists who just from personal experience, very few of them seem to understand lifting, you know, and or it's this attitude of like, well, you know, if they know me, as a lifter that, like, you've got your strength stuff, we're going to focus on the range of motion stuff and like, well, isn't there an overlap there? How comedy, do you think it is becoming? Even though it's still uncommon? Like in any given town in the US, for example, could you find somebody in your radius that is like, a guy like you?
John Petrizzo 06:03
Probably not? I mean, you know, so for me, when I say I feel like it's more common, you know, that's probably a little bit biased, because of the people that I associate with. And you know, that I tend to follow through social media and things like that, which makes it feel like yeah, this is becoming more common. But still, you know, when you think about in your, like, you said, your average PT clinic, you know, outpatient orthopedic PT clinic, you're probably not going to have a PT there that that really understands. Let's say, if you come in as a lifter, right, you're a competitive power lifter, you're an Olympic weightlifter or something like that, probably not going to have somebody there that necessarily understands what you're trying to get back to, you know, and that's unfortunate. But I think that's kind of the reality of the situation. I think, a lot of the people that do have that expertise, tend to they start their own businesses and things like that. They, they don't want to work with insurance, they're out of pocket. You know, what a you know what I mean? I mean, yeah, that's what my wife, she, she ended up doing. And, you know, so you may have some luck, maybe at like a CrossFit facility or something where they have someone there like that, but your typical, like, outpatient orthopedic insurance based clinic? Probably not.
Philip Pape 07:24
Yeah. And it's great that we do have the ability to connect online today, like I did with you. And I wanted to bring you on the show, because I just truly believe in what you're doing and how it can help people. So as people are listening or watching this, you know, John is a guy, you can reach out who may not be local, but to give you some, some direction, at least. So yeah, let's let's touch a little bit on training and rehab and combining the two. You're a big, big believer in barbell training, as am I, and you even compete in powerlifting. There, I guess there's some debate with people still about whether barbell training is beneficial or not for the average person, right, I get questions like, Is it safe? Can you train with barbells? Over the age of x? Right? 450? Whatever? Sure. Just just break it down in simple terms, you know, what's the philosophy behind why you believe in barbell training? Well,
John Petrizzo 08:11
you know, the first thing I would say is, does anybody have to do barbell training? I mean, the answer is obviously no, right? There's nothing that you absolutely have to do, can make plenty of progress in a variety of different ways using resistance training, right? But you know, barbell training, to me, is something that is a lot more accessible to people than they realize. And, you know, the benefit is, just from, in my opinion, the efficiency with which you can train large groups of muscles, right, large amounts of muscle mass, through long ranges of motion, using what we would consider to be fairly normal human movement patterns, like the squat, like the deadlift, which is just picking something up, like the press, you know, and, and those sorts of exercises, they have a ton of carryover to our everyday activities, you know, I think an additional benefit for people is that they incorporate the majority of them incorporate at least some sort of balance component, right? So so you can get a lot of benefit with just a handful of basic exercises or movement patterns. And, and that's what I think the average person doesn't really see, you know, they kind of look at this as that's a body building thing. That's, uh, you know, that's a weightlifter thing, and, you know, I don't need to be doing that and it's, again, you don't need to be doing that but you might find it to be way more beneficial than then you realized and, you know, to me, it's it's really just about finding an appropriate starting point and that's, that's where a coach or someone with experience in this stuff can really make the difference you know, so know knowing sorts of maybe equipment modifications do you need do you need a lighter barbells do you need you know what I mean? Do you need? Do you need to modify the range of motion of the exercises initially, those are the things where a coach can really help someone get off on the right foot and have a positive experience with this stuff. And and then it starts to build on itself over time.
Philip Pape 10:16
Yeah, I agree with everything you said. I mean, there's, there's some things in there, like the fact that it's accessible and safe, I think is lost on some people until you kind of run them through the scenario of increasing your barbells or increasing dumbbells with progressive overload and some of the safety challenges that come with that, or even just practical challenges of, you know, going up in certain increments and the availability of all these dumbbells, like you said, 15 pound bar, empty bar, whatever it takes to start. And then the balance and mobility stability. All of that is can't be overstated, I think for folks. Yeah. Yeah. So
John Petrizzo 10:51
yeah. And I would just say, people that haven't done it, they, they can't really understand what we're talking about. So that's kind of that's kind of the barrier for some people. And I think that's where it becomes an issue from a rehabilitative standpoint with physical therapists, right? So, or even lots of physicians, you know, they're very quick to tell people, no, don't do that, you're gonna hurt your back, you're gonna hurt your knees, you're gonna hurt your shoulders, whatever it is, when in reality, they're just that take that with a grain of salt, because it more than likely, they've never done it themselves. They've never gone through the process of learning how to do those things. And it's really outside of their area of expertise. But they throw those comments out there, because they just make assumptions about it. Right. And that's a hard thing to overcome. Certainly,
Philip Pape 11:40
it is. And I've had three surgeries myself, one of which was a back surgery. And without deadlifting, I'm not sure where I would be, in other words, the positive side of it being able to recover and get strong again, right, right, where oftentimes, you're told well, I'm not even sure you're gonna deadlift. Yeah, of course, things like that. So speaking of those kind of, I guess, counterintuitive, lessons, myths, whatever you want to call them, since you you've been in the game since like, 2006, right, working in physical therapy, and as a strength coach, what is what is one of the biggest or the most maybe counterintuitive lesson about strength and mobility that you've discovered in your years of practice?
John Petrizzo 12:17
Well, I think, again, this is probably something that is counterintuitive to a lot of people, but the two really go hand in hand, right? So you know, if you're, if you're training through a full range of motion, you know, you're squatting to below parallel, you're pressing over your head through your full shoulder range of motion, then you're building strength, and mobility simultaneously, you know, and, and I think that's another misconception people have is like, well, if I, you know, if I lift weights, I'm just gonna get Titan. You know what I mean? Like that, that kind of thinking still persists today, which is kind of crazy. For those of us that are, you know, a little bit more educated about this stuff. But I'm talking about the way like the general public kind of looks at it. Right. And, you know, they don't. And over the years, I've, there been a number of people that have told me, Wow, you know, I can't believe like, how much better I'm moving, how much more flexible I feel, you know, even though flex actual dedicated flexibility training really only makes up a very small part of what they're doing with me. So I think that that's probably the biggest thing. So let's
Philip Pape 13:25
take a very specific example that right, this morning, I did the PEC PEC deck flies for the first time, this was at the end of my workout, because I had left rotator cuff surgery and I'm trying to like work that capsule every way I can and get it stretched out. And I took video of myself and I noticed, you know, the affected arm. The angles are just way off from my good arm still, because it's an even on my head, they feel symmetrical. And the straight started to get looser and looser, even though it wasn't doing stretching. I wasn't using bands, I was just lifting, right? What, uh, I guess, when you think of the physical therapy concept? What's the value between the range of motion isometric and stretching type work versus just say lifting with certain movements that use the same joint? If that makes any sense?
John Petrizzo 14:12
Well, the way that I always kind of describe it to people is that you only get stronger through the range of motion that you're training through, right? So we want to train through the full available range of motion provided it's safe, it's, you know, not painful, right? Those sorts of caveats. Now, with like, specific flexibility work, you're obviously going to get some, you know, specific benefit from that but you don't get the the strength benefits simultaneously right. Now, with the flexibility work, you can you know, maybe work through a further range of motion, right, get to a further endpoint if that's your goal, but then you can with with the resistance training exercises, but, but in reality, you know, the way that I Look at it is if you have the range of motion to do everything that you need to do right in your day to day life, then do you really need to spend a bunch of additional time doing flexibility exercise, just to achieve some kind of arbitrary endpoint that you're trying to get to, you know, and obviously, like, if you're a gymnast or a dancer or something, then you need a different degree of flexibility and mobility than the average person does. But for most people, just doing full range of motion resistance training is going to give them a pretty good flexibility stimulus and, you know, keep their mobility at a, you know, above average sort of level.
Philip Pape 15:44
Yeah, I can definitely vouch for that. So, let's let's talk about post rehab or post surgery recovery, then, because again, I like to throw my personal story in there, because that's how we met and I'm experiencing it right now. After I was cleared to start lifting by my surgeon, I reached out to you for advice. You pointed me to some some rehab movements that could increase range of shoulder range of motion. So again, these weren't, these weren't loaded movements, they were rehab, just what you're saying. There's sometimes we do need those. Yeah. But you also made my day because you said, Hey, can you start benching again, you know, I was like, I honestly had not even thought that that would be possible. And I was almost scared to, you know, there's this fear, right? That like, just gonna tear the tendon again. And so here I am following a linear progression, again, back to getting to bigger loads, without the pain I used to have. So what is your general advice? We can't cover all the types of surgeries, right? What's the general advice and philosophy for recovering from surgery? Understanding everyone's situation is of course unique. Yeah,
John Petrizzo 16:43
so So the first thing I would say is, depending on the surgery, and you just went through this with your rotator cuff, there is going to be a period of time where for a lot of surgeries, you have to protect the surgical site, right. So I typically am not having people back to to doing anything overly aggressive on that surgical site right away. But I do want them to train everything else, as normally as possible, as soon as possible, right, because you want to maintain as high a level of fitness as you can, you don't want to totally de train. So if you have a rotator cuff surgery, and you're in a sling for anywhere from four to six weeks, you know, usually is the timeframe that most people are recommended by their surgeon. Well do as much lower body training as you can train your opposite arm, there's actually research that shows that there's some positive carryover to the affected side, even during periods where it's immobilized, if you're training the opposite limb, so So I definitely encourage people to train everything that they can during that initial recovery phase. And that could be you know, a couple of weeks, in cases where I'm kind of just consulting with somebody remotely like I did with you, I'll be a little bit more conservative than if I'm working with them in person, obviously. So a good kind of frame of reference for most surgical procedures, if there's a repair, right, like they reattached your tendon, right, your rotator cuff tendon, or a reconstruction like an ACL or something like that, I would say like four to six weeks before, you're really going to start to challenge that area, you know, and over the first, those first few weeks, you are going to do you know more kind of traditional rehabilitative stuff to directly for the surgical site. And in the case of the shoulder like you've had, really, initially it's about getting your range of motion back, and a lot of passive stuff because they don't want the surgeons don't want you really forcefully contracting that musculature that that's still healing because the repair is not very strong yet, right? So so that initial phase is really building back the range of motion in most instances, while you're kind of working on everything else that you can, you know, and then after that those first several weeks, then you can start to kind of directly challenge the area that you had surgery on. Right. And again, it'll vary depending on what you what you had done. But the approach that I always take is a linear progression type of approach. And when when you understand the reason why we use it in, you know, strength and conditioning way from from that perspective, it's because you're very far away from your ultimate potential right for strength development when you're first getting started as a novice lifter, so you can make very rapid workout to workout progress for at least several months, typically, right? Well, if you're a lifter that just had surgery, now that area is D trained. So you kind of by default, go back to being a novice to a certain extent right and you can utilize that very simple, linear type of Loading model for several months after surgery usually and you know, you're gonna find a starting point in terms of range of motion and in terms of load that is comfortable for you, right? That's pain is an indicator that you're maybe pushing a little bit too hard, right, you don't want your pain level to be getting worse while you're training. So if you kind of use that as a guide, and you find an appropriate starting point, then it's just about progressing a little bit each session, and you'd be amazed at how fast the progresses you can make,
Philip Pape 20:32
yes, firsthand for those listening. So what John had me try was bench pressing with a limited range of motion. So I used pins in a rack, I came down literally just a few inches below my, you know, taking it out of the rack from the top position, the first time with like an empty bar, and then I would lower the range of motion with an empty bar, then I would add, say 10 pound plates, with the same range of motion, right, and so kind of back and forth, until I got to a full range of motion bench, which felt great, by the way, it almost felt better than doing the, the pin version of it, right, because you get that natural stretch at the bottom. And each time I did it, I noticed that if I if I increase the load too much, you might get a little bit of feedback that maybe this is the gonna cause pain and that you back it off. But as long as you don't have the pain, it's incredible five pounds every time five pounds every time. And within a few weeks, you could go from wherever you were to double where you are potentially, because you're still submaximal relative to your personal original strength that you're at. So just for those listening, it definitely works. And you have to be patient, but you don't have to be so patient that you're not still making good progress.
John Petrizzo 21:43
And I think if you compare that to more typical physical therapy approach, you know, I've been in so many clinics and seen over the years and talk to patients over the years that go in, they have their exercises, they're very isolated exercises, right for this specific area that they had surgery on, the rest of the body kind of gets ignored. And they are not progressed over time, right. So it's kind of like, you start doing your shoulder internal and external rotation, and maybe some, you know, scaption exercises and different things like that with very light loads. And then you know, you're doing your couple sets of 1015 reps, whatever it is, four or five, six weeks later, you're still doing the same stuff, right with the same resistance and, and maybe they feel better. But it's not because of the exercise, right, the exercises and driving any sort of improvement, you're just feeling better, because now you have more time since you had the surgery and air sealing. So I think that there's a big misconception there. Right, I want to use the exercise as a driver of adaptation, right to help you get physically stronger and develop your muscle mass again, as opposed to just waiting around for things to feel better, you know? Yeah,
Philip Pape 23:02
absolutely. barn on for sure. So let me I wasn't gonna ask you this. But I in my gym, I noticed I had my BFR kit that I haven't used in a long time, because I bought it for fun a few years back, do you ever get into that blood flow restriction?
John Petrizzo 23:16
So I have some experience with that I've actually done a little bit of research in that area. And, you know, BFR is not a bad tool. And basically, what the research on VFR will tell you is that you can get a similar type of training effect to a heavier load using lighter loads, right. And the thought processes by partially including the blood flow, it kind of, you know, gives you this different adaptive stimulus. And what I would say is, it can be useful in certain situations, but it's not a necessity. You know, over the years, more recent research regarding resistance training shows that for relatively untrained populations, you can get a lot of benefit with lighter loads, you know, provided you're taking them very close to failure. Right. So BFR is kind of a similar concept. What I would say, in regards to training to failure and BFR, you know, those two approaches, which certainly can be effective, is that they're not for everybody, because they can be really uncomfortable, right? And to me, it's like if, if you're using a protocol that doesn't foster good adherence, right, if a person just as miserable and dreading having to go to the gym, because they know they're going to put this cuff on and it's going to be super uncomfortable to do their resistance stuff with it, then I don't see it as super valuable, but for people that can tolerate that and that enjoy that, you know, then it can be useful, you know, but I don't think it is I don't think it's a necessity by any means.
Philip Pape 24:50
Okay, I mean, the reason it came into my brain was I was like, I was unhappy with the diameter of my left bicep versus my right because of the the what do you Can't atrophied, I guess that occurred. Sure. Like, can I? Besides the just bicep, tricep work that I'm throwing in there? can I enhance that with a little BFR work? Or is it just a little bit more volume of standard lifting? That's going to do it? You know what I mean?
John Petrizzo 25:13
Yeah, and that's the issue. When you look at a lot of resistance training research. It's all done on relatively untrained populations, you know, everyone's very responsive, either, right? Exactly. So they're, so they're relatively untrained. So they're gonna get a really positive response. And, and it makes it a little bit trickier for someone like yourself, who's more highly trained to be able to pull from that research and say, How does this apply to me? You know, so yeah, so I, I would say you can try it, but I don't think it's a necessity. Got it?
Philip Pape 25:45
Curious, I don't think I've ever brought it up on the podcast. So people were curious. Alright, so one principle you've written about, I think in the starting strength website, you've got a few articles up there is just this idea, kind of taking a step back that strength is the most important physical attribute because it affects all other aspects of human performance and well being. So can you elaborate on that just so people understand, we talked a little bit about barbell training, but just strength overall.
John Petrizzo 26:11
Yeah, I mean, that's something certainly that has become more clarified for me over time, especially working as a physical therapist, you know, I think when you're younger, and you know, you're more into athletics, and you know, maybe training for aesthetics and things like that, you don't really understand how important strength is to your everyday life. Now, as a PT, I work with lots of older people, you know, I've had people up into their 90s that I've worked with, and when you see the difference that physical strength can make in their quality of life. It's amazing, you know, I've had people go from wheelchairs to walkers to canes, you know, just because they doubled the strength on the leg press said that they were doing you know, and it's just it, like you said, it has an influence on everything else that we do, you know, we talked about a little bit the the relationship to mobility and flexibility, getting physically stronger will have a positive impact on your endurance, again, certainly more of an impact if you're a relatively untrained and previously sedentary, if we're talking about a high level endurance athlete, that's going to be less the case, but so it just has carryover to everything that we do, every everything that you do in your daily life, in some part relates back to your ability to generate force, right? So get yourself up out of a chair to go up and down the stairs, right to keep your balance when you're carrying the groceries, all of those things relate back to your ability to produce force, and the stronger you are, the more submaximal those tasks become.
Philip Pape 27:53
Yeah, yeah, I mean, it reminds me of like solely John Sullivan's term, you know, the barbell prescription, which is the title of his book, and and that being, strength being the prescription for aging. Yeah, the point where I mean, I would go on, go out and state that you almost can't have to have it in your life if you're going to be, you know, fit for a long time.
28:12
Hi, this is Alan. And I just want to give a shout out to Philip pape, Wits, & Weights, for his nutritional coaching, because coaching is based upon science research, intellect, and wisdom, his coaching is safe, supportive, connecting. And it actually has helped reset my compass in terms of how I direct my health, the action steps I do, and really, really has helped me regain trust and belief in what my body can do and how my body can change.
Philip Pape 28:45
So on the other side of the coin, right, we have the mainstream fitness industry and the mainstream physical therapy industry promoting lots of methods of exercise. They don't always directly produce or increased strength like, well, we have cardio, I mean, cardio, cardio is good for a lot of reasons. But you've got cardio, you've got isolation work, single joint work, the functional movements, the lighter weights, higher reps, bands, and so on. What are the limitations of those? Is there a place for these, you know, people get very overwhelmed with all these ideas, you talk about barbell training, and then all there's all these other things. So how can we clarify it for folks?
John Petrizzo 29:20
Well, I think and the way that I describe this to my students that, you know, again, anything is better than nothing, right? If the choice is functional training, or sitting on the couch, you know, then go ahead, do as much functional training as you want. But if we're talking about you know, efficiency, and if we're talking about maximizing the benefit of the time that you spend exercising, I think that really the traditional strength training, exercises can't be beat from that perspective. The problem with all of those other modalities, if we're talking about functional training or isolation, exercise and things like that, is their ability to be progressed over time? Right? How do you progress a functional exercise? How do you progress an isolation exercise? You know, functional exercises are really more displays of the ability that you already have, right in terms of your balance and that sort of thing, as opposed to developing those characteristics further. And so that's different than if every time you go to the gym, you add five pounds to your deadlift, right, that is developing your strength, the isolation exercises, they're self limited by the fact that they don't involve a lot of muscle mass, right. So their ability to be loaded progressively, is is more limited, right? You can progress on a squat. For years, you can progress on a knee extension for weeks, you know, maybe, but you're gonna hit a wall at some point where you can't do more reps, you can't do more sets, you know, and it just becomes a limiting factor because the amount of muscle mass that you're that you're using, so. So to me, there's kind of a point where all of those other modes of training, at some point are you get more diminished returns than you get with the traditional strength training exercises.
Philip Pape 31:14
I love it. So you clarified it really to I'm gonna, I'm gonna just put words in your mouth, two big principles that I heard there. One is just the time efficiency perspective, right. And I like to call it the lazy persons way. And workouts like barbell training, when I found that I said, Man, I only had to work out three or four days a week for an hour, I don't have to do almost almost anything else, really, and still get a huge amount of results, which is liberating. When I have clients who come in, especially women who are working out seven days a week and running, doing a million things, I say, Well, we're just going to cut out a whole bunch of things. Yeah. And you get the look like really, and they start getting results and the stress goes down and the sleep goes up, you're just, you know, people are floored by that. And then the progressive overload can't be overstated. I'm gonna call it infinite progressive overload is kind of what you imply that there really is no end in sight, when you're using all that muscle mass and those natural patterns. And you're right things like knee extensions, they get tiring after a while, you have to rotate them out, you have to get clever with rep ranges and all this other stuff. But you don't have to do that so much with squats,
John Petrizzo 32:15
right. So so I would say, you know, if you enjoy that stuff, then supplement your basic training with a little bit of that, that's fine, you know, and there's nothing wrong with, you know, having some variety and doing some, you know, some of that stuff if you enjoy it. But, you know, I don't think that they're really good building blocks to like, form the foundation of a good program. Yeah, yeah.
Philip Pape 32:38
And that is a third of what you just mentioned, is it isn't fun, because really, at the end of the day, you do want to stick to something. And he's really good about that. In his program, he understands the practical side of it, you've got, you've got rip over here saying just do the program. Right. And, and then you can kind of add some variety over time. How do you determine when barbell training then is appropriate for or maybe contraindicated for a patient? like physical therapy patient comes in, you're not sure if their history from day one? When would would it be appropriate or not?
John Petrizzo 33:07
Well, I mean, one thing, when I'm dealing with patients, you know, first, I do get a lot of people that come to me because they strength train, right, so so that my perspective is probably a little bit biased. So those people it's a no brainer. I mean, that's what we're gonna do, right? But first selection bias. Yeah, right. Right. But for the average person, you know, one, they have to show a little bit of interest in it, you know, and in my clinic, when they see other people doing it, sometimes they'll start to ask questions about it, they'll say, hey, you know, and they see a 75 year old woman deadlifting. And they're like, Can I do that? And I'm like, Yeah, of course, you can do that. Do you want to learn how to do that? And they're like, yeah, why not? You know what I mean? So, so sometimes it kind of feeds on itself, when they see other people doing it, it makes it less intimidating, and it makes them realize that, hey, you know, I actually can do this stuff, look, that that that kid is doing that that older person is doing that and they look like they're fine, you know, so it makes it less scary for people. But you know, another way that I'll get to it sometimes, you know, if the person maybe is not naturally curious about it, which does happen. But, you know, let's say I start somebody on a leg press, and then I progress them to a bodyweight squat, and then I progress them to a goblet squat. And then I get to the point where I say, Well, you know what, that weight that you're holding? That's actually the same weight as the bar. So why don't we just try to do with the bar and they're like, oh, okay, you know, or if I'm doing like a deadlift pattern, and we're using a kettlebell to start and we kind of progress that to the point where I'm like, hey, you know, that's actually the same weight as this. Why don't we just do this and then they're like, well, if it's the same way, why not, you know, different tools. Yeah, exactly. So So that's almost kind of like a trick them. But that that seems to work pretty well too.
Philip Pape 34:51
for their own good. Well, that's cool. You know, I mean, you you are in a position of trust or authority or whatever you want to look at it where you kind of develop that over time. And that makes a lot of sense. Okay, cool. So do you ever get, you know, weird looks from patients when you recommend or prescribe barbell training? And they're not really sure. They don't really know you? I mean, does that situation come about?
John Petrizzo 35:13
I mean, yeah. And again, like I said, I don't force it on people. Like, if someone is like, listen, I just don't want to do this. I'm not. I've said, okay, you know, we'll, we'll figure something else out. But what I do try and be very upfront about is my rationale for doing things with people, you know, so I always try and explain to them, you know, this is what I want to do. And this is why I think it would be beneficial for you, you know, and if you have a good rapport with the person that you're working with, and they have trust in you, and they, you know, think that you're a competent person. And, you know, you can clearly explain your rationale, then that breaks down a lot of the barriers that people put up to it, you know, for sure. Great. Yeah. So I think just good communication is super important.
Philip Pape 35:55
Yeah, absolutely. And even what you just implied even more deeply than that is the empathy and, you know, meeting somewhere where that understanding people's where they're coming from, right. It's part of coaching, of course, yeah. Okay. So earlier, we talked a little bit about mobility and flexibility, which are sometimes thrown around interchangeably or entertain changeably, or people are confused about the differences. Let's take a squat, for example, just a typical squat, low bar back squat, and someone hasn't had success on their own because of fill in the blank, maybe they say, my hip, hip flexors are tight, right? Or, and they and you know, when you look at them, they're saying their 40s, they're relatively, quote, unquote, fit. And they're just for whatever reason not getting this full range squat. How would you address that situation?
John Petrizzo 36:41
Yeah, so for that sort of thing, a lot of times, it's not necessarily a flexibility limitation now. And when I say flexibility, meaning like a muscular tightness thing, you know, so like, the hamstrings get blamed on a lot of stuff, you know, then my hamstrings are tight, so I can't do this, I can't do that. And in reality, it's usually more about coaching the person through the movement properly, right, and making sure that and making sure that they know where they're supposed to get to, you know, what I mean, showing them, this is where I want you to go, this is how we're going to get there and kind of walking them through that process. Now, sometimes people do truly have a limitation, you know, maybe that's a limitation in their joint mobility, because they have osteoarthritis, or they have some sort of bony anomaly, you know. So those are the types of things that you can't force people through, you know, and that's really super important. You know, I think sometimes we just assume everything is like a flexibility issue. And a lot of times it that's not the limiting factor. If you've coached the person as well as you can, and they're still kind of having trouble, then it might be a joint issue that they're dealing with, you know, rather than like a muscular flexibility issue, but that's probably something that doesn't come up that frequently, you know what I mean? So I would say more often than not, it's just probably the person kind of having a lack of understanding of how they need to get to where you want them to go, you know, and it's more of a coaching thing than a flexibility thing.
Philip Pape 38:18
So let's take a specific scenario, if someone, let's say, someone could sit down to a box that's below parallel, right? Is there any reason they can't do that with load? Like, is there any reason where at some level of load not having progressed there yet, but if they do, they would hit some sort of wall because of mobility slash flexibility?
John Petrizzo 38:40
No, I don't think so. I think that and I start people squatting with boxes all the time, you know, one for someone who's never trained before, it's a little bit of a security blanket, you know, to know that, okay, I'm going to touch this and you know, something is behind me, so they don't feel like they're falling. And especially from a rehab standpoint, it can be really useful in a lot of situations. So, again, it's just about finding the right load for them to start with, and there's no reason why they can't progress from there. And, you know, a lot of times I'll take the box away at a certain point, and then I'll maybe have them do a pause squat, right, so that they really get comfortable in that bottom position before, I'll start to have them actually do you know, the full squat with the stretch reflex and the rebound, and that sort of thing? You know, so, but again, that's a lot of times that progression I'll use from a rehab standpoint.
Philip Pape 39:33
Yeah, no, I think that's important for people to understand. Because I always think in terms of like, what are the excuses we make to ourselves? And how can we get out of that thing? Yeah. So if you can start with this, and then that means you can eventually get to this. So if you can get this that's, that's great. Yeah, it's empowering. Yeah. And
John Petrizzo 39:51
even if it's starting with a limited range of motion, right, so maybe they really can't squat to a box below parallel to start because of pain or weakness, you know? and they can move through that full range of motion, start them with a higher box and then progress them, you know, gradually lower over time, you know, so. So there are all different strategies that you can use, you know, the key is just finding the right starting point for people.
Philip Pape 40:16
Oh, for sure. And if if you have like an elderly mother, for example, who has trouble getting off the couch? Maybe you work with her for with a slightly higher chair than the couch, doing some squats there and then eventually moving your way down? It definitely works. Yes. Yeah. Okay, so kind of on the flip side of this is you have experiencing all experience also working with athletes looking for performance gains? How does your physical therapy knowledge, improve their performance? How does that play into your work with them?
John Petrizzo 40:45
Well, I think it's helpful, really, from the standpoint of avoiding overtraining, and most of the athletes that I work with, their biggest problem is that they're over overtraining, you know, and they're just sore and beat up. And they don't understand why. And it's like, and so the biggest challenge with them, is to get them to take a step back, actually, and do a little bit less and pay a little bit more attention to recovery, that is hard for them psychologically, to say, you know, okay, I'm going to do a little bit less, if they do, typically, we see much better results, right, and they feel better, they perform better, their training goes better, you know what I mean? So that's the biggest thing is trying to get to, in my, from my perspective, is trying to get athletes understand that it's not just your training, it's your ability to recover from your training that is going to dictate how successful you are, you know, and when we're talking about athletes, they have to balance their their weight training, their conditioning work, and their practice, you know, their practice time. And that's the challenging thing, you know, so I think it's, it's really more stressing how important it is to recover in between your sessions.
Philip Pape 42:02
Yeah, and I think that applies to also just older lifters who also are so dedicated to their lifting, like many of us in the club, that you know, you are kind of athletes of a sort, right? We may not be practicing a skill for competition, but we definitely can get beat up. And I'm curious, in your experience, what are the most let's say, the top three parts of the body or type are things that get fatigued and I'm just gonna guess low back and shoulders are on the list? But that's Yeah, yeah, certainly
John Petrizzo 42:29
low back and shoulders. You know, it's funny, when you look at the research related to resistance training injuries, they're really not different than the general population, right? So like the general population, what's the number one type of orthopedic pain is back pain? Well, what's the what's the most common type of injury that lifters experience is typically low back injury, right? So so that's, I try and stress that to people too. It's like, well, you could hurt your back doing anything around your house is just like you can tweak your back. deadlifting. So it's not that that makes the deadlift dangerous, you know, it's not like you would avoid doing stuff in your everyday life. Hopefully, too, because you're worried about tweaking your back. So, but yeah, backs and shoulders. Certainly super common for lifters, hip and knee, maybe a little bit less. So you know, I see more nice stuff with like, my, like high school and college athletes and weekend warrior type people that are doing a lot of additional stuff outside of lifting, you know, but, but certainly backs and shoulders are super common, and, you know, stuff that lifters, you know, elbow tendinitis and, or tendinopathy, just from overuse, and that sort of thing is very common to but in terms of, like, little bit more serious stuff. It's usually backs and shoulders.
Philip Pape 43:47
Makes sense. Oh, yeah. And so speaking of the elbow stuff I used to have, definitely, because of my squat grip, what do they call it? medial epicondylitis. Right? Golf, right? Yes. Although, and I actually I actually follow the pin firing approach and switch to an easy bar for my curls and fix my squat grip. So three training variables, and I changed. Yeah, not sure which one fixed it, but something did. Right. What are your what's your opinion on pin firing? Because I know it's controversial. Yeah. I
John Petrizzo 44:13
mean, it's, it's typically not something that I do with patients just because it's so aggressive, right? And, and, and you know, that you're really going to flare things up in order to, you know, get it to heal. And that's not super appealing to most people. You know, what I what I maybe try it for myself. Yeah, I wouldn't be opposed to doing that. Right. But, but usually what I do is I look at, alright, what is the variable that's probably causing this and how can we address that you know, and like you just said you, you altered three variables. So I always try and do one thing at a time for a rehab standpoint, because then we can kind of assess Okay, so now we've modified your squat grip. Let's do that for a couple of weeks. Use this new grip and see how things start to feel if that's not working. Okay, maybe we need to adjust your grip on your assistant As exercises or whatever the case is, like you did with the EZ curl bar, you know, that's that's a super simple thing. But I try and kind of layer changes in one at a time.
Philip Pape 45:09
Yeah, that makes sense. I'm impatient. That's all. I get it. I mean, when you're doing stuff yourself, you know, it really is sometimes the process of experimentation too, because of course, yeah. All right. So here's another thing wanted to ask about in another one of your articles on starting strength, you talked about how barbell training has enhanced your clinical reasoning and decision making as a physical therapist. So I'm curious about that how to use the principles and methods in terms of diagnosis. And I don't know if you remember that article?
John Petrizzo 45:39
Well, what I would say is that just I think my my background with strength training, just gives me a little bit of a different perspective, when I'm looking at things and I look at how things work together, you know, from a larger scale than in terms of the more isolated approach that we tend to take in physical therapy. So you're recovering from a rotator cuff surgery, you know, the very typical approach is isolated rotator cuff exercise, right. And, in reality, when you're benching and you're pressing, and you're doing rows and pull downs, and those sorts of things, your rotator cuffs going to be very active, right, and you're also getting the additional benefit of training all the other muscles around it, right training through longer ranges of motion, you know, more normal type movement patterns. So So I think that it really just comes from, from having that perspective on things and kind of thinking more about the bigger picture of how all this stuff works together, as opposed to, you know, looking at things from a more isolated perspective.
Philip Pape 46:44
Okay. Yeah, that makes a lot of sense. And so in addition to recovery, what about prevention? Right? How does barbell training strength, reduce the risk of injury? I mean, you've alluded to it a little bit how, like, you know, deadlifting doesn't necessarily hurt your back, you can hurt your back anytime. So why not be stronger, but like, be very explicit about it. So people understand how valuable that is?
John Petrizzo 47:05
Well, I mean, what we see from a research standpoint is that people that are stronger, are more resilient to injury, right, you're less likely to, to hurt yourself, if you're physically stronger. So we see that in the research related to athletics and athletes that are prone to like overuse type injuries, you know, if we're talking about athletes with lower extremity, you know, overuse injuries, stress fractures, tendinopathies, things like that. And we break it down into looking at, let's say, their one RM, squat strength, typically, the stronger athletes have a lower incidence of those types of problems, you know, and to me that just kind of carry overs to, to everything, right? So it's just going to make you more physically resilient to the types of issues that, you know, people a lot of times suffer from, because you don't have your that as low of a threshold, right? So the way that I look at a lot of these injuries, it's like, you accumulate these little insults that, you know, maybe become painful at a certain threshold, right? Well, if your thresholds up here, because you're stronger, then those things are less likely to be a problem for you.
Philip Pape 48:15
Yeah, for sure. And I even like to think about when as you get older, and you think of frailty, with older folks, just the ability to fall or not fall at all, because you have better balance. But even if you do to kind of, if you're able to bench, you know, multiple times your body weight, probably supporting yourself in the fall is gonna be a lot easier.
John Petrizzo 48:34
Yeah. I mean, I get asked by older patients all the time, how do I get up from the floor? You know, I'm scared, if I fall, I won't be able to get up. Right. I mean, those are things that if you're stronger, I mean, you don't really have to have that same level of concern, you know. So yeah, I think that it just, it helps with everything. And it's, it's really can't be more simple than that.
Philip Pape 49:00
So we've covered so much. Before we wrap up, there's a question. I do like to ask all guests, not sure if you've listened to any of my other episodes, but it is what one question Did you wish I had asked, and what is your answer?
John Petrizzo 49:12
Hmm. That's, that's a good question. I. Well, I guess one thing that I would say and I don't know how, maybe you would have asked this, but I don't want to give the impression that I'm like, bashing on PT and physical therapy. And there's a lot of different areas within physical therapy, you know, and I deal with like, sports and orthopedic, you know, type issues primarily, you know, sometimes I deal with some neurologic issues and things like that. But you know, you can be a physical therapist in a, in a subacute facility in an acute care facility in a hospital setting. And from that standpoint, you know, it's a totally different type type of approach then than what we do, you know, in a in an outpatient setting. So, you know, I don't want to give the impression that I'm that I'm bashing on physical therapy. I mean, I think that I want the profession to be as good as it possibly can be so that patients get the most benefit from it. And, and that's, that's really where I'm coming from with this stuff.
Philip Pape 50:21
Yeah, and I think my perception or perspective, everything you said is from a positive value added, you know, wanting to help people kind of perspective so I get it, and honestly, if we will all want the profession to improve for everyone. So even if physical therapists hear this, and they're like, oh, that's an interesting idea. Maybe I should learn about barbell training, then we've helped the profession. And I know plenty of physical therapists who take the traditional approach, and they're great people who mean, well, right. And they have great attitudes, oftentimes. And so again, yeah, I agree. There's no need to do that.
John Petrizzo 50:52
They're still helping people. And, and one, one last thing I would add, because I do get contacted sometimes by, you know, young, like, Pts that are just starting out or student physical therapists, and they asked me, they say, Oh, I, you know, I want to get into this, I want to do strengthing auditioning and stuff. And they asked me, What do I need to do? And I always tell them, you have to train yourself first, right? So there are a lot of people that, you know, they like the idea of what we're talking about. But if you're not training yourself, if you haven't gone through the process of getting yourself stronger, and figuring out these little programming issues, and you know how to perform the exercises efficiently, yourself, you're not going to be able to translate it to other people, you know, so you have to train yourself if you want to get good at this stuff. And that definitely for coaching, or you know, from a PT standpoint, yeah, I agree. And as
Philip Pape 51:44
a nutrition coach, same thing, I would not want to help people with that unless I've gone through myself. And everybody listening to this show is interested in this. And hopefully everybody wants to do that, regardless of therapy tea or not, that they want to get stronger and do the things we're talking about today. So where can listeners learn more about you and your work, John?
John Petrizzo 52:02
Well, like you said, my full time job I teach at a Delphi University, which I love doing, I do work out clinic seeing patients part time, few days a week on Long Island here in New York, but probably for people that aren't in my area. Best way to get in touch with me would be through my wife's business, which is progressive rehab in strength. My wife is also a PT high very high level power lifter much more so than I ever have been. And strength coach in her business. We work with people remotely, you know, all around the world. So that would be the best way to get in touch with me.
Philip Pape 52:39
Okay, and that's progressive, rehabbing strength.com Yes, you got okay, we'll put that in the show notes. And this was a lot of fun. We covered a lot and I know that listeners is going to get to learn a lot hopefully shatter some of the misconceptions they might have had and really want to get out there and hit the gym and get strong. So thanks again man for coming on.
John Petrizzo 52:56
No problem. Thanks so much for having me. I enjoyed it.
Philip Pape 53:00
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