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 discusses details surrounding velocity changes and fatigue in both metabolic and cardiovascular systems when loading the spine.

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

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EPISODE TRANSCRIPTION

INTRODUCTION Thanks for watching! Hey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code ICEPT1MO at the time of sign up for a one month free grace period on your new Jane account. BRIAN MELROSEAll right, good morning, PT on Ice Daily Show. My name is Brian Melrose, teaching both cervical and lumbar courses in the spine division, and just here to kind of round out another clinical Tuesday, talking about loading the lumbar spine in a comprehensive program. Today, the aspects that I want to talk about is kind of loading the spine at different speeds and different fatigue levels. If you can do those two last things, I think you've really built a comprehensive loading program for either your patients or your athletes that you're working with. So a couple of weeks ago, you know, we've talked about all things at this point, barbell isometrics. Last time we were talking about leveraging different planes of motion. And not just sticking in the sagittal plane, loading into kind of side bend into rotation. And so if you miss those episodes, check those out, because all those rules still apply. But the last thing that we need to talk about is different speeds and fatigue levels. And so where this thought process really comes from, is kind of, you know, again, I was sitting at extremity, and I was thinking about loading the rotator cuff. And again, we can't just sit down here, we got to get in different positions, we have to load with variable resistances at different speeds. And I thought to myself, why would the spine be any different. And so that's really where I started messing with some of these things in the clinic. And so If we want to start leveraging some of those concepts for the back, we have to take something like the deadlift, and then start loading folks at different variable speeds, as well as fatigue levels. So just like last time, I made a partnered post here, it should be on our Instagram, it'll be in the reels. Again, that kind of outlines everything that I'm going to talk about for the next couple minutes. There's gonna be a lot of exercises I mentioned. And so again, there's visuals there if you want to check those out after listening to the podcast. WHY SPEED? And so when it comes to speed, the first question is, is like, why? Like, why would it matter? And that really comes down to something as simple as different muscle fiber types. We have type one and type two fibers, and those do different things. And so if you're only doing something like power lifting and lifting heavier loads, at lower speeds, you're going to really leverage type two type fibers. If you're moving lighter speeds quickly, again, you're going to be more oxidative, you're going to challenge different energy systems, and you're going to utilize a different kind of muscle fiber type. So if we want our comprehensive loading program to include both of those, you got to have lighter loads, you also got to have heavy loads to train both of those systems and move those kind of weights at different speeds. And so when I think about loading the lumbar spine on a spectrum, there's really a lot of different speeds that we can mess with. The first one you would have to kind of really begin with would be the barbell isometric where the barbell or the weight really isn't moving at all. And so we talked about some of the nuances of that weeks ago, but you can get that barbell underneath those J cups and have a very consistent pull with max effort without any movement. And so the first speed would be no speed. And you can set that at different kind of heights for something like the deadlift. Things really begin there and they can then swing the direction of normal movement. So looking at something like the deadlift, you could do something like a touch and go rep where the barbell is touching the ground and then you're almost using that momentum of hitting the ground and that reaction to pull the barbell back up. And so it's a faster movement and therefore typically a lighter load. We can compare that to something like a heavier deadlift where you're maybe again slowly getting that barbell all the way to the top of the rep. And a lot of athletes use different things to look at speed as a parameter. And so a lot of the powerlifting athletes that I end up working with use a barbell accelerometer. It's a thing that kind of sits on the ground, it's got a cord, it attaches right to the barbell. And as it's lifted from the ground, the device allows you to kind of record how fast you actually pulled it. And this can be a great way to use an objective measure to look at someone's kind of difficulty level. Are you programming it properly? Are they working in the right range? We love using things like reps in reserve, RIR, or RPE, Raiders Perceived Exertion. And we know that those subjective measures are actually pretty good at helping us vary load for our patients. But something objective can also help as well. And so those barbell accelerometers, I'm sure they have a bunch of cute apps that do it too, can really be a helpful thing in the clinic to kind of dial in your speed when you're working with those different athletes. The only other concepts I want to kind of throw out there would be leveraging different speeds with the concentric and eccentric portions of a lift. And so for the deadlift, again, as you're pulling that concentrically from the ground, you could do a fast pull up, and then a nice, slow, controlled lowering. You could also change that. You could do a slow, gradual pull up, and then a fast drop towards the ground, where either you come to a rested point right before the barbell hits the ground, or actually contact the ground. And so that's leveraging speeds within the lift to, again, challenge different muscle groups in different systems at those different speeds. The last thing is kind of what I call a reactive speed drill. And so, again, in my post, if you check that out, it'll have a band just looped around the barbell that's gonna accelerate the barbell down towards the ground each time I pull it. And so that can, again, really change your ability to slowly, eccentrically control a lift. A really cool way to, again, just leverage speed in a different position. Now, if you have access to chains, that's another thing you can put on the barbell. As those chains come off the ground, it increases the weight. So again, typically in the easier part of the lift, you're getting a little bit more load. As that barbell comes back to the ground and those chains kind of pile up, that load is removed. And so both banded or chain work would fall into kind of this reactive speed zone. And I think that's the last speed parameter that we need to kind of consider when we're thinking about challenging someone's system. So that's speed for something like the deadlift. TRAINING THE SPINE UNDER FATIGUE The other thing that I really want to talk about today is fatigue levels. And there's really two big buckets that that falls into. The first kind of fatigue bucket that you would want to consider is looking at somebody's kind of movement and taking something like the deadlift, which is primarily a sagittal plane movement, a hinging movement. And you wanted to really tax that entire muscular system, those same synergistic muscles that are doing that movement, and you just want to bury them, you're going to give them two or three exercises that are kind of varying the speed, the load, but they're all taxing that same muscle group. And so kind of the metabolic failure that I'm describing in this bucket, is one that's a little bit more energy specific. I mean, I want you thinking about how can I tax out that creatine phosphate system that's going to be the primary one used for the first 30 to 60 seconds of an exercise. And then it kind of switch it over to like Krebs glycolytic. all the way on up to oxidative. And so for leveraging different barbell speeds and loads, you can also again, give them that same stimulus to tax that muscular system. And so you could take something like the deadlift, have them rep some of those out, Then have them go to, again, a hinging pattern with a medicine ball slam. So same muscle groups working, again, different speed. And then last, put them on something like the reverse hyper, where, again, they're going to kind of tax the same muscle groups. They're all different exercises, but you are bringing that muscular system, that energy system, to complete an absolute failure. And so that would kind of be a position-specific failure scenario. The other big failure kind of bucket that we can push our folks into, and really I think we need to push all of our folks into, would be a little bit more of cardiovascular fatigue. And this can be something, again, that's nuanced all the way down to you're doing it with Doris or Betty, where maybe they're pumping some reps out on the new step, doing a reverse Tabata, and then going and lifting the kettlebell off an elevated step, on up to our higher end athletes, where they might be crushing something on the rower for a period of time, jacking their heart rate up, and then kind of transferring to the barbell. In either one of those scenarios, we want to tax the cardiovascular system. And so now I'm talking about fatiguing that, really the heart and the lungs. Can you keep up and continue to lift when you're absolutely gassed cardiovascularly? And so for more of a lifting athlete, this would look like, again, the last kind of swipe on that reel that I posted would be starting with something like the deadlift, And then maybe having them do something like a kettlebell swing, where they're jacking their heart rate up and moving a little bit more quickly, still a familiar hinging movement. But again, with a little bit more speed, a little bit more cardiovascular demand on board, and then having them for a third exercise, pump a bunch of reps out on the rower. So I like jacking the resistance up to like eight to 10, having them do about 30 seconds to 60 seconds, and then cycling those exercises. And really by round three or four, they are going to be absolutely smoked from that cardiovascular demand, those faster movements with the kettlebell, and it's not just going to be a simple deadlifting, hinging routine anymore. And so those would be the final concepts that I think we really need to consider when we're building somebody a robust strengthening program for the spine. You're nuancing these all the way down for some of our lower level folks, and then really challenging some of our higher level folks that might already be deadlifting, squatting, doing some of these movements a couple times a week. Now you got some different lenses to kind of either add or alter the lift, looking at different speeds, isometric, concentric, eccentric, touch and goes, heavier stuff where you're looking at a barbell accelerometer, all the way up to reactive things with a band or chains. That speed also fatiguing a particular muscle group, a specific position, a certain synergy of muscles, or the cardiovascular system. you can hit all of these different parameters and give your folks a nice robust back program to keep with. Again, I think the chances of them having future injury or issues significantly decreases. So just some food for thought. I hope this was helpful. I hope you guys have an awesome Tuesday. SUMMARY I just want to touch briefly on a couple courses we have coming up. There's only a couple spots left. May 18th and 19th. I'll be in Casper, Wyoming teaching cervical So if you want to learn how to twist some necks, we'll be doing that on Casper The next cervical course we have on the books is in Kent Washington on June 29th and 30th again You'll be stuck with me for that one for lumbar. We got two coming up here. We got Zach out in Chandler, North Carolina and on May 18th and 19th, and then we got Jordan up in Victory, New York on that same weekend. Those will both be lumbar courses. Again, if you guys are looking to get out to any of those, we go over everything comprehensively, the whole process, and then give you some manual therapy techniques on the weekend. So, hope to see some of you guys at those courses. I hope this information was helpful. Have a great Tuesday. I will see you guys next time.

OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.