Physical Therapists and their experiences with GST

[Joaquin Malagon]

Hello GB Community, I was hoping some the Physical Therapists on here could share with their experiences with the GB Courses. Going into the field of Physical Therapy myself, I'd like to know how the GB courses faired with the methods taught in PT school within reasonable measures. Has it improved your ability to assess and rehabilitate patients? Are the modalities used for stretching, mobility & strength progressions superior to that taught in PT school? And has it expanded your movement vocabulary? I know the GB Courses are great and surpass anything out there on the market but I'd really like to get insight from a PT in the application of GST to their work. I'd really appreciate the feedback, if you want you could also PM me. Hope to hear from the community soon.

[Alexander Egebak]

I am a PT student but have been working with GST, stretching and normal weight training for a while.

- The courses challenge the dogma of moving within "perfect alignment"; a dogma which is slowly being outphased among PTs at least in my country. Especially the twisting squats and inside squats is considered harmful by the more oldschool-PTs but research over the last decade have shown how connective tissue structures easily can adapt to the imposed demands given that you are allowing it time to heal as well.

- The GST is known for its creative and can inspire and motivate many people unlike many clinical versions of the same exercises. Here I a am talking band exercises, machines and dumbbells which can sometimes seem very sterile. The simple feat of doing a tripod (headstand variation) can bring a lot of fun into the training, and since physical therapists are well-known for their inability to maintain the training of their clients GST may prove a much needed tool. On the other hand, however, GST is complex to learn to do "correctly", especially by people who wants to be spoon-fed - GST may prove to be quite a mouthful. But the main point is, GST is a set of tools which can be used in some occasions, while in others not so much.

- The stretching and mobility techniques are far superior to clinical variations, and this has to do with the job of PTs primarily being injury rehab and not prehab. Despite extensive knowledge PTs often lack the ability to come up with plans for more than just injury rehab. A careful and creative mind should however be able to use ideas from GST and weightlifting to help their clients with rehab as well as performance. Personal trainers lack the dept of knowledge (except for the few who attend quality courses after their education) that PTs have, especially in the rehab scene. If a PT can think outside of the box for performance instead of rehab they will do very well, and GST has its tools to help with that.

- It should be noted that I disagree with some of the programming in the courses from an exercise physiology, neurology and training periodization aspect, and this is my background and me being a PT student that dictates my opinion, primarily.

[Joaquin Malagon]

Hello Alexander, thank you for your valuable input. A couple more questions for you, in your opinion do you view the joint prep progressions helpful in the rehab phase of treating a patient? Or should progressions such as those be used for prehab exclusively? Also how does the program's focus on structural/biomechanical balance compare to such methods taught in PT school? (e.g. internal/external rotation, extension/flexion, quad/hamstring, etc. etc.). What methods would you recommend to improve your ability to asses/diagnose and improve movement functionality (e.g. GST, Feldenkrais, etc.). I would like to hear from more PT's and their experiences. @Mark Collins @Wesley Tan @Ryan Bailey

[Alexander Egebak]

Rehab and prehab are methods of categorizing treatment. A good question - when do we have an injury and when do we have a "deficit"?

Regarding the specific joint prehab/rehab from F2 SLS progressions; for some these exercises may be deemed too advanced and need regressions, however for some they may be adequate or too easy while they still have "deficits".

The protocols on here are probably a bit to the more advanced end of the spectrum as well as being innovative in the world of physiotherapy and movement diagnostics and will likely not be taught in PT schools; the few who will use them will probably do so in terms of performance/prehab aspects.

With that in mind some of these exercises may be sub-par for diagnosing deficits. In a clinical setting we want exercises to eliminate variables for testing, and therefore (and also in terms of saving time) the exercises have to be as easy as possible for diagnostics. An example, a basic tuck hollow hold may be substituted for a wall version to test for pelvic control - because it is easier in terms of testing. THEN, if building strength (or the wall version is too easy) you would move on to tuck hollow holds in this perspective; but as a diagnostic tool I believe the tuck hollow hold is too advanced.

As I wrote in my previous post GST is a set of tools. It is not "sometimes you use GST or not"; it is "you use some GST all times". GST also borrows from some clinical exercises and methods (or revese). GST is more of a set training regime; clinical practice should be as perfect as possible by using "what works" instead of being dogmatic about methods.

[Joaquin Malagon]

Again, thank you for your experience/insight Alexander. I completely agree with you on GST being a set of tools, which is why I believe it is best to have the most tools in your toolbox and using them when appropriate. Very,very interesting stuff. You mentioned that the protocols will be likely used in terms of a performance/prehab aspect, and that a PTs job is primarily in terms of injury rehab and not so much prehab. How much success do PTs have with the prehab aspect (If any)? It would be nice to hear from PTs and their experience applying modalities with their patients.

[Ryan Segervall]

Hey guys! Im currently a undergrad studying Integrative Physiology and have hopes and dreams of going to PT school one day. 

 

Was curious in if the mobility drills used in GST such as 2 minute pike hold, Jefferson curl, pancake stretches ect. Would ever be used in a clinical setting? most of the time I see range of motion being restored on the table as opposed to the patient doing mobility drills. Do you plan on integrating some of the mobility methods seen in GST into your approach? Also I am curious to what they are saying in PT school in regards to their approach to gaining mobility/flexibility, does it contrast with GST's approach? 

 

@Alexander Egebak

[Alexander Egebak]

15 hours ago, Joaquin Malagon said:

Again, thank you for your experience/insight Alexander. I completely agree with you on GST being a set of tools, which is why I believe it is best to have the most tools in your toolbox and using them when appropriate. Very,very interesting stuff. You mentioned that the protocols will be likely used in terms of a performance/prehab aspect, and that a PTs job is primarily in terms of injury rehab and not so much prehab. How much success do PTs have with the prehab aspect (If any)? It would be nice to hear from PTs and their experience applying modalities with their patients.

It depends on the therapist. Prehab is not something that is explicitly taught in school although we do have the skills to put something clever together. All it takes is an innovative mind. I have not explicitly had patient experience with this but I have done personal training for people which included both prehab and rehab (everyone has some bodily troubles although they may not recognize them at that time; since my job is to ensure the best possible progress for them I have to take into account deficits and future deficits - I dislike the the term injury because it is being used only for acute instances of pain; that is a long discussion).

Generally, I would imagine that training regiments for patients will hugely rely on how motivated people are on what their goals are. If their goal is to get back on their feet, then they will primarily do rehab. If they want more, they will eventually do prehab. I can only hope to motivate people beyond going the route of pain relief, I cannot force people to do what I think is best for them. I always tell myself that goals are not static; people can always change their minds.

13 hours ago, Ryan Segervall said:

Hey guys! Im currently a undergrad studying Integrative Physiology and have hopes and dreams of going to PT school one day. 

 

Was curious in if the mobility drills used in GST such as 2 minute pike hold, Jefferson curl, pancake stretches ect. Would ever be used in a clinical setting? most of the time I see range of motion being restored on the table as opposed to the patient doing mobility drills. Do you plan on integrating some of the mobility methods seen in GST into your approach? Also I am curious to what they are saying in PT school in regards to their approach to gaining mobility/flexibility, does it contrast with GST's approach? 

 

@Alexander Egebak

Not very likely. Their are a bit advanced, and they also provoke fear (especially JC). First step is to convince people to trust you (the hardest step - because they have expectations and beliefs that need to be dispelled and often they visit involuntarily due to instances like insurance policies and etc.), next is to convince them to do what you tell them to (second hardest). A PT grade is not a certificate of trust, necessarily.

With that said I am a huge proponent of active techniques. I only use passive (no muscles involved) to diagnose and explain. The real changes in the CNS and the peripheral body happens when you do something active. GST has some great tools for that, and many exercises from GST are actually stables in clinical treatments.

In PT school we are taught not to change anything that is not causing problems. This is due to wanting to a avoid the nocebo-effect which is placebo with a negative outcome. An example: If I say that you need to fix your posture in order to feel good, but your posture is not bothering you at all, I might associate bad posture with future pain and distress for the person in front of me. Additionally, a tangent to what I said, science has shown that bad posture does not correlate with pain at all. Performance then? That is different, and good posture usually correlates more with performance. So, in PT school, we are taught only to attempt to correct posture if that may relief pressure of certain body parts (which is vaguely associated with pain relief), and we are not taught to do performance enhancement as per the rehab/prehab discussion above.

[Ryan Bailey]

I can share a bit of my general experience of the GB courses as it relates to physical therapy.

First of all, completing over a handful of GB courses consistently for a couple years will teach you more about physiology than you will ever learn in a classroom setting, or by reading a book.  By giving the GB course work the attention and respect it deserves, you will discover real changes to the body that allows you to better discuss prognosis with your patients, regarding timeframes and expectations of true physiological outcomes.  Remember, physical therapy school also teaches the ability to work with a diverse range of populations dealing with a wide spectrum of pathology.  You may go from the patient with C6 quadriplegia (unable to move his arms or legs), to the marathon runner (bitching and moaning about the little ankle sprain), back to the next patient with multiple sclerosis (with buckling knees learning to use a new walking device), to the next person suffering from a recent stroke ( unable to move one side of their body), then to the professional athlete rehabbing a knee surgery with their job on the line.  It helps to learn a broad treatment approach when first starting school to feel confident treating any and every person you meet.  And this entails obtaining the skill to treat anywhere, from a mat or floor to the parallel bars, (not just on a table @Ryan Segervall.)

With that said, I have used components of what I have learned through the GB courses in the rehab situation in a very specific sense and also in a broad sense:

I have used bodyweight positions found in the GB elements and combined physical therapy science to treat rotator cuff tendinopathy.  My research regarding maximal voluntary contractions of the muscles surrounding the shoulder in combination with the science of analgesic (pain relieving) responses following intensive isometric contractions of the rotator cuff combine well with positions found in the straddle planche, side lever, rope climb, and HBP progressions. This combination works well with the athletic individual.

Regarding patients with a neurological condition such as Parkinson's, Stroke, Brain or Spinal cord injury I have used my PNF background (from the 2 year postgraduate school and employment at the rehab facility in northern California where PNF originated), using the PNF progressions (no not stretching only, but real PNF) at times in conjunction with the progressive rep structure found in the Foundation program.  This is combined with the PNF prone and supine movement progressions, starting from belly or back, to rolling, to sitting, to quadruped, to kneeling, to standing, then walking, utilizing manual PNF therapy in every position. It has been helpful to show patients a rep structure in combination with the movement progressions so they can see where they are headed in the rehabilitation goal process.  Along these lines of the GB progressive rep structure and core work, I have also used those "core" elements in Foundation 1 for rehabbing the trunk after orthopedic injury (Rib fracture, disc injury, or facet dysfunction).

In the broader sense, I have utilized the Foundation-GB coursework to also assess and treat a "strong" individual who was proud of their gym workout program.

I used 7 very beginning elements found in Foundation 1, taking them through the elements and their associated weighted mobilities in a 45 minute time frame, to discover the following deficits of this "strong" person.

1) Lack of work capacity.

2) Lack of connective tissue integrity resulting in limited joint function of the shoulders, spine, and hips.

3) Inability to move on the ground comfortably, or safely without high risk of injury.

The unique progression of the beginning GB course work improves those 3 deficits above.

An interesting point when looking at the body and how to structure the long-term goals with a patient is noticing the importance of a correct foundation; GST and the GB courses do not start off with dangerous skills, or unrealistic strength moves that bias large muscle groups only...

It trains mitochondrial density of the deep stabilizing muscles, giving both structure and form to the key joints or junctions of the body. In return, this allows for improved connective tissue extensibility; creating a body capable of moving and accepting later strength progressions. (For me this is a key concept when utilizing GST with patients)

Some continuing education courses, and grad school classes teach building "crap upon crap"; meaning strength over a weak foundation. I think this is one of the main impacts I have seen in my training of the GB courses.  I now utilize a more complete outlook, building from the ground up with strict attention to detail and form.  And I think that is an important concept to convey to our patients.

On a final note: If we are not utilizing GST or the GymnasticBodies curriculum directly with our patients, it is an excellent option for where patients may go following physical therapy discharge from the clinic to excel in their individualized HEP (Home Exercise Program).

Good luck to everyone in their physical therapy grad school adventures... after all its half studying... half partying!

Cheers,

Ryan

 

[Wesley Tan]

Evening gentlemen,

A nice topic you have brought up @Joaquin Malagon

I myself am an Osteopath trained in the UK, in my tenth year of private practice now and also run the GymnasticBodies UK affiliate for the last 3 years, although I began implementing GST into group classes 4 years ago.

You will likely find that a lot of exercises you discover in GST will directly go against what you have learned or will learn in your PT course. Flexion under load, pull ups from dead hang are a few that spring to mind. 

I frequently use movements from the course to screen my clients, monitor progress (physical ranges but also their subjective experience) as well as actual treatment tools alongside my hands on work. My sessions often include movement screens, hands on, and exercise.

You have to be free in your thinking to assess what you see, feel and hear help lead your decisions on what to do and how to intervene. In other words to not always do what you have learned by route, such as specific protocols for a specific diagnosis. 

Yes my movement vocabulary has been expanded. Yes it is superior to what PT's learn at school (based on what previous PT's have done and given to my clients before they meet me ) and from what I have learned more recently in discussions with Sports Therapists and Physio's who I have met and who have started training with us.

 

 

 

 

[Joaquin Malagon]

I appreciate the responses and input you have put out for the community @Alexander Egebak @Wesley Tan@Ryan Bailey@Ryan Segervall. I hope to learn as much from the courses as much as you gentleman have. I hope more PT's or people interested contribute to the thread, as there is a lot of useful and rather insightful advice/experience from the knowledgeable people on this forum.

[Jonas Winback]

I've been working as a physiotherapist for over 7 years now, mostly in primary health care with all kinds of patients and injuries. GB and Foundation has inspired me in a lot of ways to think outside the box biomechanically when it comes to how you can perform exercises in all manner of ways. Aside from being an extremely fun and gratifying way to train personally, I apply various principles of it in my clinical work, with good results, and training myself or with my patients has never been more interesting  

[Tanya Hill]

Glad to hear you are reaping the benefits of GST Jonas. Keep it up. Definitely the best therapy you can give your body.

[Ryan Segervall]

@Wesley Tan @Alexander Egebak @Ryan Bailey

I have a couple questions I thought I would run by the physical therapists in regards to adaptation. 

1) In foundation 1 the main goal is to increase work capacity. Now on a physiological level what is really happening here, what are some of the changes that are happening to the muscles,  connective tissue and so on.

 

2) Perhaps if possible could you elaborate on the importance of short rest times usually less than 1min in the foundation 1 exercises? To my knowledge strength is better build with longer rest periods of around 2 minutes but GB seems to not follow this, even in there foundations 2 work the rest periods appear to be no longer than 90seconds. Seems to be highly contradictory to what a lot of the literature suggests in regards to building strength, leaves me blindly following GB's advice without any real understanding of the rational behind the programming. 

3) In regards to gaining flexibility, what are some of the adaptations that are occurring? In my neurophysiology course at College they said gains in flexibility are due to increased stretch tolerance but I have a really really hard time buying this. Any insight? 

 

Just trying to gain a better understanding of whats going on in my body while I continue on with my GST

 

[Luke Searra]

Very interesting thread guys, thank you all for your contributions.

[Ryan Bailey]

On ‎4‎/‎25‎/‎2017 at 8:36 PM, Ryan Segervall said:

@Wesley Tan @Alexander Egebak @Ryan Bailey

I have a couple questions I thought I would run by the physical therapists in regards to adaptation. 

1) In foundation 1 the main goal is to increase work capacity. Now on a physiological level what is really happening here, what are some of the changes that are happening to the muscles,  connective tissue and so on.

 

2) Perhaps if possible could you elaborate on the importance of short rest times usually less than 1min in the foundation 1 exercises? To my knowledge strength is better build with longer rest periods of around 2 minutes but GB seems to not follow this, even in there foundations 2 work the rest periods appear to be no longer than 90seconds. Seems to be highly contradictory to what a lot of the literature suggests in regards to building strength, leaves me blindly following GB's advice without any real understanding of the rational behind the programming. 

3) In regards to gaining flexibility, what are some of the adaptations that are occurring? In my neurophysiology course at College they said gains in flexibility are due to increased stretch tolerance but I have a really really hard time buying this. Any insight? 

 

Just trying to gain a better understanding of whats going on in my body while I continue on with my GST

 

Some quick notes...

1) Improved mitochondrial density, proprioception, skill development, correct form and mobility for future elements ect. and much more. As you improve depth into the end ranges the connective tissues are going through weighted loads, eccentric lengthening, possibly increasing sarcomeres in series, strengthening agonist (Compression), inhibiting antagonists (Usually the posterior chain when folding for example), improving and ingraining the global movement pattern with repetition.

2) I would argue with the words "short rest times".  More on this in a bit, on the other hand... Some skills of strength require 5-15 minute rest intervals. This is not what is being worked here. It also depends on the type of skill or strength activity one chooses to participate in. For me, I want to be able to complete an activity, move around some, then repeat it again pretty quickly. 

Sticking to the main point of this thread and physical therapy, it directly depends on the goals of your patient or client regarding the type of strength and rest time. (It is not about maximal strength, relative strength, or whatever strength you might think is best, it is what the patient wishes to achieve as their unique goal for their life or current job situation)  For example, if someone is maximizing the goal of say pure isolated triceps or chest strength and building of mass then a long rest period will be given following the high intensity.

However, if you have a patient (take me right now for example) wishing to master these initially challenging Korean Dips that I am working on, you better not load my Korean Dip movement at 1-2 rep max intensity requiring >5 min rest period.  Instead once the final cycle is achieved into steps 7-9, where form has already improved, becoming solidified, I feel I could sometimes move to the next set a bit quicker than the 60 second "rest", however, the thoracic extension mobility work is gold.  At each "rest" or mobility work, thoracic extension improves, and this allows for improved thoracic extension needed for improving the body tension and form, improving each rep in the Korean Dip as each set goes by.  For example, Set 4 feels better than the warm up, and better than set 1 because of the "short" rest or integrated mobility that improves the global strength movement.

So in general, we are training a system that does not fit into the great research articles of isolated strength we are taught in physical therapy grad school.

And, in the end, the academic answers to your questions really do not matter...

I see you working consistency, making good progress, and you are physically representing your own answer to question #3 above. This is demonstrated through your excellent progress in the program.

And this is the most important answer... when you set out for consistency and see the positive results ON YOURSELF (N=1)... when diving into a complex system that addresses all these various systems of the body... all your important questions are answered.

 

 

[Ryan Segervall]

@Ryan Bailey

 

Thank you for getting back! 

 

It appears a lot of the GST training is ahead of the research so for some of this we dont really know the why but we know that it works. Kind of like what coach sommers as mentioned on his podcasts, it either works or it doesnt and they dont really care to wait around for the research to support the why before implementing it. 

 

Your response was very helpful tho and gave me a better insight/appreciation of what is going on in the background with my GST training