Why ReTrain?
ReTrain was created out of my frustration and experience with Physical Therapy as a patient, as a student in PT school, and in my clinical career as a PT. I have always believed rehab should be similar to training: something that is challenging, involves loading and lifting, is a long-term and progressive process, and especially involves the barbell. In my experience through the years I have found this is certainly not the case and has left me beyond frustrated.
The earliest memory I have of rehabbing an injury and discovering that heavy lifting can be the way to heal and make something strong again was in high school after sustaining an ankle sprain. At the end of a basketball practice I landed awkwardly and rolled my ankle. I felt a pop in the ankle and had difficulty walking thereafter along with the eventual swelling and bruising. We lifted before school and I was supposed to do some heavy box squats that next morning. I was determined that I was not going to miss any lifting, thus I put an ankle brace on and decided to start warming up and see if my ankle could tolerate it. To my surprise, there was no pain while squatting, my ankle was able to handle the weight and up to my normal working weight, and it felt better with each set. This was incredible! I was able to still train with an injury and it actually helped! I have always been obsessed with lifting and how it makes you stronger and better over time. I love the process of training and the thought of how much better you can make yourself through hard work. Now that obsession had spread into healing injuries and rehab.
Contrast this with another injury experience I had while in my 3rd year of college. An experience that involved going to formal PT. During spring workouts for football, I injured my low back on 2 separate occasions while squatting and doing power cleans. I felt a pop followed by pain each time it occurred. After the second time, which was on a Friday afternoon, I had burning and aching down my R leg that was pretty intense that night. It had subsided through the weekend and my back was sore. Monday morning I was walking to class and noticed something felt off while walking. I eventually discovered I had foot drop in my right foot where I was unable to dorsiflex (actively pull my foot upward) and parts of my lower leg were numb. We had testing for football that week involving lifting, jumping, running, etc. and I noticed through the week that my R leg was definitely weaker. Spring ball started that next week and I further noticed that I couldn’t run as fast and my R leg was way more sore than normal. The following week was spring break and I eventually had an MRI to find out I had a bulging disc compressing on a nerve root causing the symptoms. I had to miss the last 3 weeks of spring ball and went to formal PT for a month or 2. The first PT I saw told me to never do squats or olympic lifts again because she wasn’t a fan of them and “they’re bad for you”. She explained there are other, better leg strengthening exercises I could do. I only saw her for 2 visits as this was in my home town while on spring break and I started with another PT when I got back to school. She gave me some “core” exercises involving laying down on a table and flexing my stomach muscles and lifting my legs that really were not much of a challenge but I didn’t know any better. The next PT put me on traction/spinal decompression each visit, had me run on a treadmill, do some leg exercises on a BOSU and similar, and some further “core” exercises. I also did not do any squats or lower body lifting during this time per their advice. This concerned me as I knew that to play collegiate football I would need to lift and load my body to get it stronger, but I didn’t know any better and these were professionals. Things did improve over time, although I am now convinced that was just the natural course of history and my body healing itself, not from the PT. I did eventually work back into some barbell squats and very light power cleans and those were tolerated pretty well. I don’t remember when I started to squat and do lower body lifting again and if it was at the direction of the PT or if I decided to start again on my own, but over time I just felt it out and did what I felt my back would let me-another realization of how you can lift with pain and injury and how it can actually help. Over the years after my playing career I was still lifting and decided to get back into olympic lifts, continued heavy squatting and eventually deadlifting. I was able to do all these things and get much stronger without any back issues despite the advice I was given by PTs. And the leg strengthening the initial PT was likely talking about-definitely NOT going to be better than weight training. PERIOD.
In my 5th and final year of school and football in college, I tore my left ACL in what would have been the second to last game of my career. I had it reconstructed about a month later and went through formal PT. I recall going 2-3x/week for the first month as I was home on winter break, then once I went back to school for my final semester I was going around once a week for periodic check-ins and progressions. My playing career was over so I was not doing as rigorous of PT as I likely would have if I still were actively playing. I went through a bit of a funk right after surgery as I was done playing football for the first time in about 15 years, so the drive and my reason at the time for getting stronger and better was gone. I was just doing the leg lifts and very low level “strengthening” exercises roughly daily but not doing much else. I eventually started to get some motivation to workout again and realized this is something I could still do and enjoy and the reason didn’t have to be just for football. I could get stronger because I wanted to and this is just who I am. I started doing some upper body lifting and a little bit of machine lower body work along with rehab exercises for my legs. During one of the check-in PT sessions roughly 2 months after surgery, I was put on a smith machine to do a set of light squats which was the first time I remember squatting after surgery. No one had told me I could squat and I didn’t know if I could even do this after an ACL surgery-there was little information on the internet about this either at the time. Once the PT had me try a few squats and I realized I could do them, I immediately started barbell back squatting at the gym 2 times per week. My knee did not particularly like going to full depth but I could not stand the thought of doing partial squats so I worked through it as best I could, not even sure if it was the right thing to do. My stubbornness to train outweighed my fear of damaging my knee. Over time this got better, my knee and leg got stronger and I started getting some muscle back in my leg. I wanted to power clean again and around the 3 month mark is when you typically start running and jumping after an ACL. I had no guidance with this but once I was told I could start doing some jumping, I reasoned that I could power clean since it was basically a jump with a bar. I started with some hang cleans with the bar and felt it out. I progressed over time gradually adding weight and eventually working down to the floor to a full power clean. Over the next couple of years worked up to doing deep squat cleans with 315ish with no knee issues. I did this all on my own without guidance, just started where I felt comfortable and felt it out while letting my knee tell me what was ok. This further increased my understanding of how to train to heal.
So, I’ve had experiences with pain and injuries and found out on my own through experimenting and stubbornness that you can lift to heal. Now I have learned through continuing education that this is ok and is actually the right thing to do. I also have and continue to have pain and injury issues at times where I implement this same process and have healed over and over again. It works. The barbell is the answer.
I had hoped to learn strength and conditioning and how it applies to rehab in PT school and be able to implement this as a professional once I became a PT, but this was far from the case. This left me beyond frustrated and angry. A profession that seems so dogmatic about knowing how to improve function and strength is so far off and ineffective in my view. It seems so hypocritical to me to tout getting people stronger and more “resilient” without using a damn barbell! There was basically no information on lifting weights and strength training in PT school. There was an elective course at the very end if you wanted to pursue a Certified Strength and Conditioning Specialist certification, but this was more of a self study and the instructor didn’t know how to demonstrate a power clean.
I then figured once I got through school and out into the field I could change this and do more of what I wanted with rehab. However, the “system” of healthcare and outpatient physical therapy as it typically operates doesn’t really allow for changing the way it’s practiced from the ingrained, outdated and systematic process that it is. I knew it needed to be different but didn’t quite know what that was yet. I had learned I could lift to rehab, but still didn’t quite understand how to implement this and hadn’t really learned how to effectively program strength training. I got into powerlifting a few years out of school and experienced the process of using the barbell to get a lot stronger than I had ever been in school and my playing career. I learned and realized how the body handles, responds to, and adapts to stress. I also further learned how to program to get stronger, eventually learning how to adapt this to rehab. This is how I learned that the barbell is THE answer I was looking for in terms of how rehab can be done effectively and you can live up to the “stronger than before” motto that most PT places promise but never really deliver on.
ReTrain is the culmination of what has been consciously and unconsciously in my head over the last 15+ years that has developed through experience, stubbornness, trial and error, frustration, and the push to not settle for the way things currently are. ReTrain and it’s methods is how I see Physical Therapy and how a Physical Therapist should be. I’m here to be the provider that says you can and should lift weights and this is the best thing you can do for yourself. I’m here to correct the harms of misinformation in the healthcare field about lifting weights. I’m here because this is that important. This is ReTrain Barbell Physical Therapy, LLC
Caleb Pazzie PT, DPT, BRM, CSCS