Dr. Brian Melrose // #ClinicalTuesday // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, Spine Division lead faculty member Brian Melrose makes his debut on the Daily Show to discuss how to come alongside powerlifters, the differences between raw & equipped powerlifting, the sport-specific demands of powerlifting, and how to keep powerlifters competing. 

Take a listen or check out our full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

BRIAN MELROSE
Good morning, PT on ICE Daily Show. My name is Brian Melrose. I'm one of the lead faculty in the spying division, teaching both cervical and lumbar courses. I'm stoked to be here on clinical Tuesday to talk about all things barbell isometric with a very particular population. That population that I want to talk about is with the power lifting athlete. And if you haven't had the chance to work with one of these guys before, then again, you don't know that when you lift 600 to 800 pounds of load, you tend to end up with some neck and some back pain. And so that's where this sport has crescendoed well with my clinical practice. And so I treat a lot of recreational, national, and even world-level powerlifters here in northern Colorado. And the story for me really begins about two years ago when Natalie Hanson walked into our clinic. And Natalie's a world-level powerlifter. She's won worlds multiple times and was in a new weight class and looking at returning to the sport. And so as I begin to work with her, as well as other powerlifting athletes, we can begin to understand, number one, why they have so much spine pain, but number two, how we can help them in the clinic to mitigate some of those symptoms, both leading up to competition and on competition day.

COMMON SYMPTOMS OF THE POWERLIFTER
And so the first thing I want to do is just provide a little bit of background as to why these folks end up running into some symptoms during competition. And so a typical powerlifting competition is going to consist of three different lifts. You get three attempts to get your highest lift total for the end cumulative sum. And so the powerlifting competition is always done in fleets or groups, and it begins with the squat. So everyone comes out going from the lowest weight to the highest weight, and they get three attempts to throw down the heaviest squat possible. After that, all of the athletes will transition to benching. Again, same style there. Three lifts to get the highest bench possible. And then they end the day with a deadlift. And to put this in context, right, in smaller events, like in Worlds, so last year I got the opportunity to go to Lithuania with Natalie and check out the World Competition. And there's only six other athletes that are throwing down similar weights. And so the entire competition takes about an hour and a half. So in 90 minutes, you are One rep max loads, again, either just below your one rep max or trying to hit the new PR. And so nine different lifts of, again, compound movements tends to really tax this system. And so both athletes are pretty gassed, usually by the time they get to the deadlift and then again at the end of the day. But when we begin to take a deeper look as a physical therapist at what's happening at the spine, we begin to see why things can kind of, again, become problematic. First, we have the squat, where again, there's a large compressive load through the spine. And then the athletes have to transition to benching. And if you've never watched powerlifting before, then you probably are unfamiliar with their unique benching position, which is extremely arched. And so the feet have to stay on the ground. The hips have to be in contact with the bench. all arch to end range, their end range in the lumbar spine. And what that allows them to do is typically decrease the distance the bar has to travel to their chest to complete the lift. It also helps pin the shoulder blades down. On the flip side, it makes it extremely difficult to maintain that arched position. The lumbar extensors are working incredibly hard to be able to maintain the hip contact down on the bench. And so they're in that lumbar extended position. The extensors are very shortened, but they have to be extremely active. All of the athletes, after benching, then have to switch gears and go out for the deadlift in an opposite position, where the lumbar spine is much more flexed, and those extensors have to then elongate. And so you can see why that can be challenging for a lot of those powerlifting athletes. But for someone like Natalie, it's even more challenging. And so Natalie, it's mostly because she has such a strong bench. So Natalie was just down in Austin, Texas a couple weeks ago and broke another world record. And because her bench is so high, she's typically one of the last people to go within that fleet. So she'll be the last person doing her third bench attempt. And then all the athletes switch gears, and they start doing the deadlifting. And so because of her geometry and history of back bend, she tends to be lower down in the pack when it comes to the deadlift. And so sometimes she has about 10 or 15 minutes to come off of the stage from the bench and then go ahead and switch gears and get ready for one of her first attempts warming up in the back with deadlifting and then coming out on stage and hitting a deadlift. And so for her in particular, that kind of, again, high bench, lower deadlift really decreases the time that her system can kind of switch. And so that's one of the reasons why we like using the barbell isometric.

RAW VS. EQUIPPED POWERLIFTING
But the other thing that I want to describe real quick is the difference between raw powerlifting, which I think a lot of us are imagining at this point, and what's called equipped powerlifting. And so raw powerlifting is a little bit more popular now, typically just done with a weight belt. Equipped powerlifting is what's done a little bit more historically. In equipped powerlifting, in the squat, you're allowed to use knee wraps as well as a squat suit. In the bench, you're allowed to use a benching shirt. And then in the deadlift, you can also rock a deadlift suit. And so these are single ply materials that are a little stretchy, but fairly rigid. And what they do is assist the athletes in some of the most difficult positions of the lift. And superficially, you might think, well, that probably makes things a lot easier for the athlete. And if they stayed at the same weights, that would be true. The thing is, though, is that these athletes tend to load the barbell way more aggressively and lift loads that physiologically they would not be able to do if they didn't have, again, the assistance of the equipment. And so the equipment becomes this other variable within competition or within the equation in the sense that they can They also have to almost fight the equipment to get into position. So with the bench, again, they're lowering down, have to balance the weight, and still have to touch their chest, but they're fighting the stretch of the shirt to get there. In the same way, when they end the day down in the deadlift, not only have they just taken those extensors from end range extension and activation of the bench, and now they're asking to kind of elongate for the deadlift, They have to fight the shirt to even get down and get into position.

COMING ALONGSIDE POWERLIFTERS
And so the answer to helping these athletes, either on competition day or in training, is really twofold. The first thing that we need to fix is, how can we get those tissues to be a little bit more pliable or extensible after benching in preparation for the deadlift? And so to do that, I'd like, again, referring to one of the things that we talk a lot about in our lumbar course, And we're talking about repeated motions, particularly folks that are recovering from a derangement and are reintroducing flexion. When we reintroduce flexion, we tend to start in non-weight bearing. And I do the same thing for my powerlifting athletes mid-competition. I like them to lay flat on the ground, on their back, and pretty much just rock their knees to their chest. postural tone, we already decreased some of the activation in those muscles. And then as the athlete brings their knees up, again, usually about 20 repetitions or about a minute, they flex the lumbar spine from the bottom up. So instead of reaching forward, they're kind of, again, coming at it a different way. And so usually that can help relax some of those muscles. Next, is what we typically like here. So again, looping a band behind the back, getting it down here, and then sticking in the first 50% of the range to begin to get a little bit more motion at the joint, as well as some muscular activation. Last, we end up going to the Jefferson Curl. So now in a weight-bearing position with a lighter load, but segmentally flexing that athlete all the way down to end range, and then coming back. And so what that can do is, again, take those tissues from a very guarded, shortened position, and gradually tease them in the right direction. In a powerlifting competition, especially for someone who's stacked like Natalie, that might be three or four minutes that we have. In the clinic, we can leverage things like manipulation, dry needling to mitigate those symptoms. But in the competition, it's going to be much more movement-based.

BARBELL RACK PULLS TO PRIME THE DEADLIFT
So now that we have the tissues relaxed, the next question becomes is how do we prepare them for the deadlift? And again, these athletes warm up a lot backstage, and they go out and pull something pretty heavy. And this is where the barbell isometric comes in. It's my favorite exercise to give as a primer in this situation, because we can control the environment and give them the work in the position where they feel most vulnerable, where the lift is the most difficult, and not have any movement of the bar. And so for most athletes, that is going to be right when it's coming off the ground. So they're fighting the suit to get down, but they're also trying to pull these extremely heavy loads from the floor. And so typically in the back, during a competition, we would bottom out the J-hooks or the arms and kind of standardize it at the height of where the Olympic plates would rest. And so what the athlete is able to do is get into their conventional or sumo position, get into the bar and then just hold and just maintain some good activation at the rig where they get maximal effort in terms of the extensors, but there's no change in the joints or the muscular position. And so our dosage on competition day is typically going to be something a little bit lower in reps and lower in terms of duration. And so if you've ever watched powerlifting, sometimes those folks are grinding a lift out for anywhere from 5 to 10 seconds. And so I tend to dose the isometric at 3 to 4 reps of around 10 seconds. And so that tends to, again, get some good primers on board during competition day. But you better believe that we've been leveraging these throughout the training leading up to the competition or event. And so the day I like to select for that, for a lot of these power lifting athletes, is on a day when they've done a lot of high volume or heavy benching in that arch position. Their back should be kind of locked up as much as it is. We run through that flexion progression, going from non-weight bearing to across gravity to standing. And then I have them end with some barbell isometrics at the rig. Now we can cook things a little bit longer. And so what we'll typically dose on a training day would be longer holds, anywhere from 10 to 25 seconds for four to five repetitions. And we really, again, want to tax those muscles all the way to work on the endurance and the positional tolerance where they have the most difficulty. And so that's how we really like to leverage the barbell isometric with powerlifting and athletes, both on competition day and in some of the training leading up to the event. It is helpful as this is for both powerlifting athletes. You may be able to transition this to other folks in the clinic. If they have some back spasms or issues at a particular part in the lift, you just match the isometric to where they need it. For a lot of folks, that's in the bottom. But if they were having trouble at mid-range, we would just move the J-hooks up and have them perform the isometric where they're having the most difficulty. And so this has been an incredible way to help these athletes train. Why are these folks having some pain and dysfunction in this area? We guys love the deadlift. The deadlift is king. If there's one exercise below the spine, you know that's what we're going to choose. But what do you do when you get an athlete that rolls into the clinic and they're already deadlifting? Or they're not only already deadlifting, they're doing it multiple times a week, and they're doing it We're going to be answering that question over the next couple of podcasts I'll be throwing down in the coming weeks. And I'm going to give you some seeds of things to kind of marinate on as we get there. But when it comes to loading the spine for folks that are already deadlifting, we need to consider things like planes of motion, as well as speed and fatigue. If we can get our athletes kind of oriented to some of those things, I think we help them create the most robust and resilient spine. So that'll be coming down in the future.

SUMMARY
Thank you for hanging out with us here on clinical Tuesday. I just want to plug a couple of courses we have coming up next. If you guys are looking to hop to any of our cervical courses, I'll be teaching down in Longmont, Colorado here in just two weeks. There's a couple of seats left, so go ahead and hop on that if you'd like a ticket. For lumbar, We're going to be kind of active April 6th and 7th. I will be out in Carson City, Nevada. Zach Morgan will be on his home turf in Hendersonville, Tennessee. And again, you can grab us on the road for both those surfable and lombar courses. Hope you guys have a great Tuesday. Thanks for hanging out and talking about barbell isometrics with the power lifters.

OUTRO
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