Rehab To Robust

Putting the ‘Ham’ in Glute-Ham Raise
The glute-ham raise is a monster of an exercise for posterior chain loading, and you can tweak it to get exactly what you want from it. Allowing a little spinal extension will allow you to move more load, and I’ve had great carryover to a big squat & deadlift with this method.
However, if we want to focus on maintaining a position of posterior tilt and torching your hamstrings, try it this way.
... 1) Set up as you would for a normal GHR, and pull your tailbone down towards your knees to posteriorly tilt your pelvis using your hamstrings.
2) Wrap a band around your back and actively ‘reach’ your arms forward and allow your top half to round a little bit to minimise the chance of spinal extension.
3) Continue to reach long as your knees straighten and actively push your heels into the footplate to ground your feet and get more hamstrings.
4) Lead with your hips on the way back up, keeping your hips behind your shoulders to maintain tension on the hamstrings.
By reaching forwards with your arms, keeping your ‘tuck’, and planting your feet, you’ll give yourself the opportunity to really focus on your hamstrings with this GHR variation if you have trouble with dominating with your low back on this activity.
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Content may have been quiet of late, but there's a reason for that - and you won't have to wait too long to find out. There is a BIG group project with some great content available to you in the very near future.....

Hey guys - looking for a little help from my Canadian contingent who frequent this page please!
Can anyone recommend a decent therapist and sports/orthopaedic doctor in Vancouver? I've had a golfer reach out who needs some decent management for some hip pain that may include some investigations to consider a diagnosis of FAI.
If you can help - I'd be very grateful, thanks!!

4 Way Exercise Progression - Dead Bugs
The dead bug series is a great supine abdominal activity that can be useful with back, hip and pelvic pain as an early exercise. Maintaining a posterior tilt will help coordinate hip flexion and extension in this position, which can be really useful for those who hang out in a lot of extension or anterior tilt when exercising under load.
Having one leg moving on a slider whilst the other remains static has been a great addition to my pra...ctice of late, as it allows much earlier access to this exercise without provoking back pain, or failing to feel the exercise in the abdominals.
You can add the arm movements in at whatever stage you like. If you're holding the static 3 month position, arms stay static, but try and reach towards the ceiling without lifting your back off the ground.
If this position is problematic, the bear in quadruped is always worth a look, but I've found I've been able to get much more people going with this variation with the supported slider of late.
Want abs? Start here!
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4 Way Exercise Progression - Hip Bridge
I love the hip (or glute) bridge for low back pain, hip pain and knee pain. This progression works in identical fashion to the calf raise - in that we're progression from offloaded, to offset loaded, to single leg.
From top left to bottom right, this would focus on a particularly painful right hip;
... Offloaded and biased left leg hip bridge Bilateral bridge Offset and biased right leg hip bridge Single leg bridge
You can tweak the distance between the legs as much as you want during offset versions. The further apart the legs are, the greater the bias towards the heel closest to the hips. You could use the same principles with a hip thrust if you wanted to.
Hopefully you're noticing the theme now. Give it a shot and see how it feels!
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4 Way Exercise Progressions - Sidelying Hip Abduction
Like the calf raise for achilles and plantar heel pain, sometimes I see patients with real angry trochanteric pain. Using similar principles of movement and gentle load for desensitisation helps pave the way towards reloading and positive tissue adaptation over time. Here we go (top left to bottom right);
Sidelying hip reach... Sidelying isometric abduction Sidelying abduction Sidelying abduction with extension
I've found the sidelying hip reach to be really useful when isometric abduction is too much for patients with a lot of pain or who are just flat out deconditioned. In this instance, we are moving the pelvis on the femur to work the glute medius, not the femur on the pelvis.
The nice thing about this reach is you can factor into all the subsequent progressions which are pretty standard issue to give it some extra kick.
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4 Way Exercise Progressions - The Calf Raise
I don't think exercises for rehabilitation should be painful. They don't have to be pain-free, but I do think that some are missing an opportunity to make exercises more comfortable with some simple tweaks, rather than pushing into pain.
I've seen my fair share of patients with achilles and plantar fascia pain, and if I could only do one exercise with this group, it'd be the calf raise. The trouble is, some of these patients can ha...ve REALLY painful ankles and feet, and even a 2 legged calf raise can be too much for them to handle to start with.
This video series from top left to bottom right shows how I will progress a particularly painful left calf;
Offset and deloaded left calf raise Bilateral calf raise Offset and unilaterally-biased left calf raise Single leg calf raise.
Is an offloaded calf raise going to create positive tissue adaptation? Probably not, but it will do a much better job of desensitising said tissue than ploughing through unacceptable levels of pain. Calm stuff down before you build stuff up. This doesn't replace heavy calf raises, but it should precede them if someone is really struggling with pain.
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The Dose Maketh the Medicine or Poison
What's the best movement, posture or load to use? If you get an answer that isn't 'it depends', walk away slowly from the person answering the question. Thankfully, we are starting to see more and more trainers and clinicians agree that there is no universally 'good' or 'bad' stuff.
What is great for one person with a particular goal, would be terrible for another person. Context is king, and what matters is everything. Spine flexion ma...y be great for someone looking to get better at it, but for the patient with rip-roaring sciatica when they bend forward, probably not so much at that point in time.
How do you determine what's right for your client? Understand how motions, postures and loads interact with one another, relative to what your client is able to do, and what they want to be able to do.
This is a concept I'll be diving into in the context of flexion- and extension-based back pain in a very exciting project coming out in February. Stay tuned for more details!
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R2R Rant Time - Create Solutions and not more Problems
You know what really grinds my gears? When a clinician or trainer, however well meaning they are, adds to the problems their paying client has.
I had a consultation this week for someone dealing with some knee pain that'd been going on for 6 months, and they'd seen another therapist, who had identified they have a breathing dysfunction.
... The problem wasn't this interpretation or diagnosis. Breathing matters in varying degrees in different situations, and that's cool. But what's not cool is that there was that there was;
No explanation as to WHY it was a problem
No proposed plan or solution to deal with this problem
No plan for the knee itself!
There is nothing wrong with identifying a problem or a factor you feel is contributing to a problem, AS LONG AS you have a way to communicate it that doesn't disempower your client. Call it nocebo, iatrogenic disability or something else, but pointing out problems without solutions demonstrates a lack of empathy for your client.
Want to make them feel frail and a ball of fail? Point out all their problems and dysfunctions with no solution. Want to empower them? Give them solutions to problems and demonstrate what they CAN do.
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A Primer on Neural Tuning & Priming - Upper Body Strength Primers
In the same way that you can use lower body speed and explosive motions to potentiate a lower body strength exercise, you can do the same for the upper body. The variations you can use here may include;
Plyo Push Ups... TRX Rows McGill Pull Ups Med Ball Throws
As with the lower body moves, you do not want a length or demanding eccentric, so these exercises can be done with 3-4 reps at most. I doubt I’d use these before much else other than a benchpress, but if you’re looking for options for power exercises near the start of a session, you could plug these in here too.
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A Primer on Neural Tuning & Priming - Lower Body Strength Primers
If you want to use neural tuning & priming to enhance your strength, do something explosive first. This shouldn’t be exhaustive or time consuming - if it takes more than 5-10 seconds to do then you’re probably fatiguing rather than priming.
Here’s a few examples of things I’ve used in the past for Squats & Deadlifts;
... Countermovement Jumps Hard Stomps Kettlebell Swings Bird Dog Pulses
I’ve found 2-3 jumps, 3 stomps per side, or 5-6 swings to be ideal for me to turn up the sympathetic volume and creating maximum speed and explosion on each rep.
Bird Dog pulses are a little different - rather than consecutive repetitions, you are holding the position for 5-10 seconds, and trying to ‘ping’ in and out of a quick pulse. Again, 2 or 3 per side is sufficient here.
My preference would be to integrate this technique when you’re on sets of 3 or less. You shouldn’t need to use it for anything lower than that. If you’re not regularly working with triples, just work on getting stronger before trying to play with neurology.
Next time - we’ll look at upper body primers.
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Exciting news - R2R has it's own webpage!
www.rehab2robust.co.uk
The majority of content will still run across here and Instagram, but the website will serve as a home page that speaks to the service I continue to offer for anyone wanting to reach out and work with me.
... If you've read my content or worked with me in the past, thankyou! If you want to work with me - reach out and let's get going!
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A Primer on Neural Tuning & Priming - What is Neural Tuning & Priming?
Simply put, we are trying to turn up the dial on the sympathetic nervous system. If you want to move as quickly as possible, or lift as much weight as you can, the body needs to be able to follow the intent and intensity of the mind. If you can increase the neural drive and sympathetic ‘tone’ for a short period of time, you can temporarily increase performance that requires only short durations of activity.... Think lifts, jumps, throws and sprints.
My exposure and experience to this comes with strength training, but you could also implement it for other speed or explosive work. It’s not dissimilar to other methods of potentiation training (think french contrast & post-activation potentiation). If you want to use it for strength, do something explosive and quick first. If you want to use it for speed, do something heavy first.
Want some examples? We’ll go there next time!
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A Primer on Neural Tuning & Priming
When you’re looking to hit some high to max effort strength training, you need to be able to get in the zone. Some people achieve this by using smelling salts, getting a backslap, or generally making a bit of a show out of it. If this works for you, then cool. If you don’t want to make a scene, there are some other ways that are equally (maybe even more) effective. Enter – neural tuning and priming.
This is a strategy I have used to great e...ffect in this past in either putting more weight on the bar, or lowering the perceived effort of the lift at hand. It is not something that is worthwhile for every lift you do, nor does it come without its costs, but if you want to go from good to great, it is a tool you should consider investing some time in to learn.
Is it a neural hack, magic, or just making the most of your neurophysiology? Find out more next time!
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How cool is this? I'm currently putting together a webinar for an amazing project that's due out in the new year, and was looking through some research around the effects of lifting on bone mineral density.
Yes, these are 'elite' weightlifters and it may not match up to the other populations, but check out the impact regular lifting has on bone mineral density.
A spine that is as much as 133% denser than controls.
... ONE HUNDRED AND THIRTY THREE PERCENT!
Want big and strong bones, and to prevent or treat those with Osteopoenia or Osteoporosis? Lift heavy and then drink your milk and eat your cheese.
Just in case you needed another reason to lift, here it is.
Full paper link here;
https://insights.ovid.com/pubmed?pmid=823 1753
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#HiphopThursday coming at ya with a picture that speaks a thousand words today. How cool is this?
I've spent today delivering some teaching on the assessment and management of hip pain and thought it'd be interesting to see what variation we'd get in hip rotation amongst 18 Physio's in their right hip.
With the variation in gender, age, exercise habits and loading history, you can see there is a huge spread across various ranges of motion, in which no-one really reported a ...significant pain history.
Would you treat, rehab or train these people in the same way? Absolutely not, but that's what makes this job interesting.
Ps - if you wanted any evidence that 90-90 transfers and shin boxes work, my total motion was the highest. Totally not bragging. Ok slightly bragging.
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If anyone ever tells you your hip/rib/pelvis/whatever else is/has come 'out' - please direct them to this video to show them how it doesn't just 'happen'.
Also of note - this is without any connective tissue, muscle, or overlaying nervous system on top of the suction seal for the hip. You're not as delicate as someone has told you you are!

If you treat people with nerve related pain, take 5 minutes out of your Sunday to understand why you often need to go several steps back to find the right point of entry for neurodynamic activities, rather than jumping to a slider or glider.
This is an excellent video by Michael Shacklock - who is probably the best person to listen to on matters like this;
https://www.youtube.com/watch…

Sleep Stuff - Seriously, Make time for Sleep
In case the last 10 posts haven't encouraged you to think about sleep more, think about it once more. SLEEP IS A BIG DEAL. Get it right, and everything in life will get easier. Get it wrong and disturb it, and everything will get a lot harder.
Sure, being up for more hours per day may mean you can be busier, but are you actually getting more done? Or are you struggling to function, progress in your quest for gainz, or finding yours...elf in a bit of a cycle of pain?
Instead, give yourself an 8 hour opportunity for sleep every night, get into a solid sleep routine, and make the 16 hours you're awake for far more productive than the 17 or 18 you'd be awake for if you burnt the candle at both ends for more than a few days.
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Thanks for the great content. Cheers!

I came to Alex regarding chronic knee pain when going about my day with it being worst when climbing stairs. At the age of 24 I thought this is ridiculous as I try to keep fit and love lifting weights. He went way beyond the call of duty, introduced me to a range of new exercises which are now a staple part of my programming. I have thrived from the results they give me. He taught me so much about how my body ticks and for 6 weeks now my knee pain is almost nil and i honestly feel stronger than ever. Can’t thank him enough.

Great physiotherapist who knows the benefits of strength training which is very rare in my experience! If your based in the Essex area and your in pain then go see Alex for some rehab gains!

Thanks for the great content. Cheers!

I came to Alex regarding chronic knee pain when going about my day with it being worst when climbing stairs. At the age of 24 I thought this is ridiculous as I try to keep fit and love lifting weights. He went way beyond the call of duty, introduced me to a range of new exercises which are now a staple part of my programming. I have thrived from the results they give me. He taught me so much about how my body ticks and for 6 weeks now my knee pain is almost nil and i honestly feel stronger than ever. Can’t thank him enough.

Great physiotherapist who knows the benefits of strength training which is very rare in my experience! If your based in the Essex area and your in pain then go see Alex for some rehab gains!