The Benefits of Rack Pulls for Rehabilitation Progression

Alan Fredendall // #TechniqueThursday // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, ICE COO & Fitness Athlete Division Leader Alan Fredendall discusses utilizing the rack pull as a way to begin to load the spine isometrically. Alan demonstrates the rack pull, how to set it up, how to modify & scale it, and how to prescribe & dose loading of the rack pull.

Take a listen to the episode or read the episode transcription below.

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EPISODE TRANSCRIPTION

INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today’s episode, I want to talk to you about VersaLifts. Today’s episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today’s show notes to get your VersaLifts today.

ALAN FREDENDALL PT on ICE Daily Show, happy Thursday morning, hope your day is off to a great start. My name's Alan, happy to be your host today. Currently have the pleasure of serving as our Chief Operating Officer and a faculty member in our Fitness Active Division. We're here on Technique Thursday, that means it's also Gut Check Thursday. This week's workout, we have a 15 minute AMRAP, so a little bit more chill than previous weeks. We have an ascending rep scheme of American or overhead kettlebell swings, 5, 10, 15, 20, so on and so forth. Recommended weight, 53 pounds for guys, 35 for ladies. And then you're going to pair that every round with 10 back squats. We're going to do that at 135, 95, and then 30 double unders after every round. So a good goal there is to get maybe four or five rounds deep into that AMRAP. accumulate a good volume of everything. You're going to end up at about 50 to 75 reps of the kettlebell swings, of the back squats, and of the double unders. So that's Gut Check Thursday. Courses coming your way. We are basically done with live courses for the year. We have live courses this weekend, but they're all sold out. And then our very last live course of the year is next weekend in Salt Lake City with Paul for dry needling. So if you're trying to make a course before the end of the year, that's the last one you can sign up for. All of our other courses starting up in 2024 are on our website, ptenice.com. Remember, price change going into effect January 1st. Our rates are going to go from $6.50 per course to $6.95. So if you already have an eye on a course, make sure you sign up before January 1st and save yourself 50 bucks. MASTER THE RACK PULL Today, Technique Thursday, what are we talking about? We're talking about the rack pull. So I want you to go back to last Tuesday's episode with Jordan Berry, episode 1608, Spine Isometrics, to talk about all the research and the clinical reasoning supporting something like a rack pull. I want to take a deep dive into this, because on the topic of spine isometrics, I think this is a very effective exercise to use in the clinic with patients with low back pain, folks who are having trouble deadlifting, to really build a strong, robust low back, so that bending over and picking up stuff from the floor is no longer bothersome. Today I want to talk about why we're doing this, I want to talk about keys to success, and most importantly I want to talk about how to load and dose this and prescribe this to patients. WHY THE ISOMETRIC RACK PULL? So, why do we do this? First of all, it's simple and effective. It's essentially a very small partial range of motion deadlift. It is very scalable based on your patient's presentation. Somebody who's very irritable has very severe low back pain, we can move the safeties and the J-hooks to maybe above the knee, maybe right below level of hip, so we have a very small range of motion that we're contracting through. And we can scale that back down though as somebody starts to feel better. We can take that all the way down to a rack pull from mid-shin as if somebody was lifting from the floor. We can meet our patients where they're at with the scalability of that. The nice thing, like Jordan said last week as well, the key to a lot of isometrics is that most people can do these at home. A lot of folks have a squat rack. or a barbell in plates in their garage or the gym. So they can set something up close to this at home and be able to do that for home exercise. Those individuals already active in the gym already have access to this equipment at the gym they go to, so they can also do this as part of their home exercise program at the gym. Now that's why we do it. KEYS TO SUCCESS What are some keys to success? The keys are The setup here is everything. So you'll see I have a pair of safety bars here and a pair of J-hooks. My preferred way to do this whenever possible is to set it up like this. Whether I have two pairs of J-hooks or cups in the rig, I have a pair of safety bars and a pair of J-hooks. I have basically two start and stop points that's gonna let me control that range of motion. So setting it up is really, really, really important. So set up your environment correctly. The J hooks should be upside down. So what we'd like to see is that they're actually upside down so we have more surface area to lift the barbell against. So I'm going to show you a rack pull right now. and show you what it should look like. So, in this example, I'm starting right at the top of the knee. The goal with the rack pull is not to finish the deadlift. If I'm standing at the top of my deadlift, there is no tension here, there is no work needed out of the low back. I need to somehow stop myself short of full range of motion, so my back has to work to keep myself in the position. So, from mid-shin, a nice hinged position, and now I'm gonna lift and pull up against the J hooks and now I can't reach full extension and here my low back is just working to keep this barbell in place and then when I'm done I don't have much room to go to set it back down. So again the issue with the J-hooks put into the rig like normal is that that barbell can actually roll off in a way and lifting a bunch of weight off like that, surprisingly, can upset some people's low back. So if you're going to use just J-hooks, again, take them, turn them, and then flip them upside down. Now we have more surface area. We also have kind of a framing here of the J-hook so that the barbell can no longer slip down, out, and around the J hook. So that's setting up the rack pull. Again, meet your patient where they're at. Adjust the range of motion as needed. If you don't have two pairs of J hooks, by a second pair or what you can use in place of two sets of J-hooks, you can place the barbell on some plates as the lower edge of your range of motion and use the J-hooks to stop the top motion. Again, the key here is that this is an isometric exercise, so we wanna be pulling up against something for 45 seconds. All the benefits that Jordan talked about last week, the stress relaxation response, strengthening, blood flow, pain relief, and then being able to reproduce this in the gym or at home. Now finally, why do we do this? How do we set it up? DOSING THE RACK PULL How do we actually dose this? Again, that's gonna depend, what is it gonna depend on? Your patient's current level of irritability. Somebody that is very flared up, maybe you're thinking about starting with something like a reverse Tabata, so you're gonna do eight rounds, 10 seconds on, 20 seconds off. progress them maybe to a full Tabata, where they're now doing eight rounds, 20 seconds of work, 10 seconds of rest. And then for me, my ultimate goal, following some of the tendinopathy literature, is to get to that 220 seconds time under tension. I like to see patients be able to progress to five sets of 45 seconds of work, and then really however much rest they need. 15 seconds is probably too short, so an EMOM timer is probably not appropriate. I like five seconds of 45 on, 45 off. 5 sets maybe of 45 on, a minute, a minute 15 off, so maybe you can set every 2 minutes for 5 sets on your timer. Something like that though, building to that 220 seconds time under tension, ideally showing the capacity to be able to hold that rack pull for at least 45 seconds. So meet your patient where they're at, progress them, progress them, progress them, time under tension. Now what about loading? This is a partial range of motion that you don't need to lift from the floor. What does that mean? That means this should be quite heavy. This should be near, at, or maybe even above that patient's deadlift max, if we know it. Again, we don't have to lift it from the floor. The hardest part of the deadlift is done for us. It's already sitting above our knee. All we need to do is just a little lift and then hold. So, that means that this should be quite heavy. How heavy? whatever weight they can feasibly hold for maybe that reverse Tabata, and then that full Tabata, and then that full 45 seconds on with the rest coming. The key human beings who come into your clinic are not gonna be challenged by an empty barbell rack pull, even if their low back pain is really irritable, so keep that in mind. SUMMARY So the rack pull, why? We like that it's scalable. We like that it is easy to set up. It basically requires no thought or mechanical skill to be able to get into that position, We'd like that we can transfer this to home. A lot of folks have access to a barbell and the setup needed to do this rack pull. We'd like that we are really easily able to make people successful with this by just modifying the environment, setting up with plates as blocks and J-hooks as the top limit, two pairs of J-hooks, squat safety bars or J-hooks, whatever. This is very easy to set up and be successful with it. And then we like that it is easy to dose. We can see patients make progress from maybe 10 seconds on, 10 seconds off for a couple sets, to a full reverse Tabata, through a Tabata, and then maybe into somebody who is probably now ready to start deadlifting from at least the knee through a partial range of motion, if not from the floor, is somebody that can come up here, lift and hold for sets of 45 seconds. Five sets of 45 seconds really seems to be the sweet spot for the back to start feeling good, for the back to start feeling strong, and to now reintroduce full range of motion deadlifting, things like kettlebell swings, back into a person's exercise routine if they're already doing, or now, maybe for the first time, instruct that patient in the deadlift. So, the rack pull, easy to set up, easy to mess up too if you don't have a lot of attention to detail, but relatively easy to set up, load, dose, and prescribe as homework for our patients. So try that out. Thanks everybody, have a great Thursday.

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