Using Kettlebells in the
Rehabilitation of the Core
Philip Johnson, MS, ATC
University of Michigan

Purpose of the Presentation
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Understand the history of the Kettlebell
Basic knowledge of the fundamental exercises
Uses in rehabilitation of low back injury
Case reviews
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“Core” definition

What is a Kettlebell?
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Best described as a “cannonball with a handle”
Styles
Fitness tool
Rehabilitative tool

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History of the Kettlebell
Russian background
18 th Century Russia
◦ Appeared in the Russian dictionary in 1704
 (Cherkikh, 1994)
Red Army
1900’s Strongman
1985 Soviet Union Sport

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History- continued
Fitness Certifications:
◦ Russian Kettlebell
Certification (RKC)
◦ International Kettlebell and
Fitness Federation (IKFF)
◦ Art Of Strength (AOS)
Military Training/ Fitness-
SS Snatch test
◦ 10min: snatch 24kg, 200reps
MMA/ UFC
Crazy “fitness trend”??
Rehabilitation
Research???

Kettlebell Vs. Dumbell
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Different weighted tools/ different load
◦ KB 6-8 inches out of center of hand
◦ Positions load anterior, posterior, moving
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KB: “offset” load
◦ Primary use to reinforce movement patterns
◦ Focus on muscle group function in unison
◦ Less use in isolated strengthening
 Momentum driven
◦ Convenient for explosive patterns
◦ Grip strength

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Cost $$:
◦ 8kg/ 18lb
◦ 12kg/ 26lb
◦ 16kg/ 35lb
◦ 20kg/ 44lb
◦ 24kg/ 53lb
◦ 32kg/ 70lb
KB vs. DB
KB (PB/PS) DB
$35/36
45/41
60/55
70/65
80/75
100/95
$30/26
37/33
52/46
67/60
82/72
104/92
*reference: Perform Better(PB) and Power
Systems (PS)

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Kettlebell Manufacturers
Art of Strength
Dragon Door
K2
Kettlebell Concepts
Gill
Perform Better
Ader
Lifeline
Power Systems
Troy
York
Wright
Apollo
Muscle Driver
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RETAIL

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My Experience
**I am NOT a certified instructor**
Not well educated/ experienced in Weight Room
June 2008: Perform Better Seminar
◦ Anthony DiLuglio
◦ www.artofstrength.com
Enter The Kettlebell –Pavel Tsatsouline
◦ Published 2006
◦ www.dragondoor.com

Additional Resources
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Blogs/ Websites
◦ www.begin2dig.com
◦ www.chasingstrength.com
Geoff Neupert
◦ www.liftkettlebells.com
◦ www.mikemahler.com
YouTube: “kettlebells”
◦ about 22,000 videos
Google
DVD’s

Getting Started
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Don’t be Intimidated!
◦ “Average” Male 16kg, “Strong” Male 20kg
◦ “Average” Female 8kg, “Strong” Female 12kg
◦ “Heavy” >32 kg; traditionally 48kg is heaviest
 (Tsatsouline, dragondoor.com)
◦ Can Find:
 92kg

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Benefits of Kettlebell Use
Strengthening- Muscle integration rather than Isolation
Endurance/ Cardiovascular
Power output
Grip
Efficiency of training/rehab
Reduces space needs/ Cost
Utilize a Balance of Tension and Relaxation
Hip Extension and Deceleration
Variety and Versatility

Safety Issues
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Surroundings- keep clear space
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Start slow- practice
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Focus on movements- setting down KB
• Low Back- flat back “anti-slouch”
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Use Safety “Sense”

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Benefits of Kettlebell Use in
Rehabilitation
Postural Correction/Improvement
Reinforce Movement Patterns
Strengthen Gross Movements
◦ CORE/HIPS!
Improve Return to Olympic Lifts
Cardiovascular Stress
◦ (Schnettler, et al., 2010)

“Core” Specific Rehabilitation
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Abdominal
◦ Unilateral loads; Single leg stance
◦ Functional abdominal activation
Hip
◦ Anterior (hip flexor)- Reciprocal inhibition
◦ Posterior (Glut/ Prox Ham)- Activation
◦ Restore normal Lumbo-pelvic-hip function
Latissimus Dorsi
◦ Eccentric arm control
◦ Spine stabilization
Upper/Lower Back
◦ Segmental stabilization

The SWING
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THE fundamental kettlebell exercise
◦ Base movement for other exercises
Great posterior chain work
“dynamic” Deadlift
HIP HINGE!!!

The SWING

The SWING

SWING- Breakdown
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Hip Hinge
◦ Push butt back
◦ Keep back flat
Weight on Heels
◦ Wiggle toes
◦ Shins vertical
Eyes ahead
◦ Focus on spot in front
“Hike” hands
◦ Hike football
◦ Thumbs tight
◦ Reach through legs with straight arms

SWING- Breakdown
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Hip Drive
◦ Extend Hips
Chest out/ back flat
◦ Shoulder blades together
KB weightless
◦ Be able to let go- light grip
Pendulum arms
◦ Move passively- rope like
◦ Momentum dependent

SWING- breakdown
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Pull patella superior
◦ Pull knee cap to ceiling
Glut tight/ squeeze
◦ Hold a quarter in cheeks
◦ ER hip joint
Scapula retracted
◦ Chest out
KB to shoulder height
◦ Not crossfit-
“American” Swing
◦ Control with latissimus dorsi

SWING- video

Swing- problems
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Not enough weight

SWING- Problems
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“Squatting the Swing”

Swing- problems
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Weight Forward

Swing- problems
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Hands too Low/ Rounded T-spine

Swing- problems
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Low Back Hyperextension

The SWING
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Quick Learning Curve
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Active Core:
◦ Gluteals
◦ Hamstring- proximal
◦ Upper Back
◦ Low Back- no axial load, single plane, no rotation
 Stabilization
 Load away from body but controlled by hips
◦ Latissimus dorsi
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Cardio
◦ 30s on/30s off

Rehabilitative Goals of the Swing
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Back stabilization, muscular control
Posterior hip activation:
◦ concentric glut to extend hip
◦ eccentric to decelerate
Anterior hip- reciprocal inhibition in erect posture
Improved hip musculature coordination
“functional” abdominal contraction  lower back reciprocal inhibition

Static Carry-McGill Bottoms Up-
Overhead Carry-Sidebend

Deadlift Variations

Deadlift- SUITCASE

Deadlift- Single leg w/ hand variation

Squat- Sumo

Squat- rack

Squat- Goblet

Squat- Swing flip to a Squat

Turkish Get Up

Turkish Get Up- continued

Figure 8 to a Hold

Clean (and Press)

Hi-Pull to a Snatch

Case #1- L4-L5,L5-S1 Disc
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Symptoms:
◦ Pain- limiting hip flex, knee ext
◦ Radicular symptoms
Started KB
◦ Decreased acute pain/ inflam
◦ ~1week post injection
◦ Tolerate ROM,
◦ table (open chain) exercises
◦ Bridge  DL ROM  DL wt  Static carry  swing
Supplement to return to weightroom

L4-L5, L5-S1 Disc Bulge
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*Caution: Anterior load and Opp side load*
Farmer walk
◦ Abdominal bracing
Overhead carry
◦ Abdominal bracing
Sumo Squat
◦ Core control, lumbar stability
Deadlift
◦ Lumbar stability, hamstring flx, gluteal control
Swing
◦ Lumbar stability, dynamic hip
◦ Cardio?

SI Joint Dysfunction
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Anterior Hip/Groin pain
Lateral Hip pain
Proximal Hamstring pain
No signs of muscle tissue damage
May have SI joint pain
Usually functional but not comfortable
Innominate rotation on exam

Case #2- SI Joint Dysfunction
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Anterior Rotation of the Innominate
◦ Sumo Squat- modify
 Glut/Groin loaded- activate
◦ Single Leg Deadlift- modify
 Unilateral activation
 Reinforce manual therapy correction
◦ Goblet Squat- if ROM tolerated
 Posterior rotation of pelvis
◦ Swing
 Restore normal coordination of hips

Spndylolysis
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Typically pre-existing
◦ Overweight
◦ Lordosis
◦ Posterior butt
Aggravated in extension
Spasm
Function but pain

Case #3- Spondylolysis- RT L3
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*Caution: Posterior and same side load*
McGill Bottom Up
◦ Abdominal bracing
Rack Squat
◦ Unilateral load, core control
DL- modified ROM
◦ Lumbar stability, glut control
Swing
◦ Lumbar stability, dynamic hips

Other Times of Use
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Pre-Lift
◦ Warm Up: 30 swings >150bpm
◦ Poor Squat or Deadlift motion
◦ Chronic Problems: groin/sports hernia
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Off Days (10-20min)
◦ Corrective: STM  MT/Mob  KB exer
◦ Rehab (Fine Tune): ex: chronic hamstring
◦ Cardio: 5 min tabata; circuit

Kettlebell Limitations
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Always SAFETY 1 st
◦ Common sense dictates
Take time to teach movements
◦ Learning Curve/ Progressions
Hand/Grip/Forearm injury
Hip joint pathology?

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REFERENCES
Tsatsouline P. Enter the Kettlebell (2006)
DiLuglio A. “Why Choose Kettlebells Instead of Dumbbells?” www.performbetter.com
Brown J. “The Top 8 Reasons Why You Should Kettlebell Train” www.performbetter.com
Tsatsouline P. “Which Kettlebells Should I Get” www.dragondoor.com
Kettlebell Buyer’s Guide www.kettlebellconcepts.com
Kettlebell Safety 101 www.dragondoor.com
“Safety as a part of, not the opposite of, Performance” www.dragondoor.com
Schnettler C, et al. “Kettlebells: Twice the results in half the time?” ACE Fitness Matters.
Jan/Feb 2010 pp. 6-16
Weber K. “The Kettlebell Approach to Physiotherapy” 12/10/03 www.dragondoor.com
McNamara S. “Scientific Evidence for the Russian Kettlebell in ‘Fixing Bad Backs’” 2/24/06 www.dragondoor.com
Tyszkowski R. “Kettlebells and Lower Cross Syndrome” www.performbetter.com
Bonafede B. “A Tip for Mastering the Kettlebell Swing” 10/3/06 www.dragondoor.com
Minute of Strength #92, #112 The Swing www.artofstrength.com
Glassman G. “The Kettlebell Swing” Crossfit Journal (25) 2004
“Why ‘Fire the Lats’ in a Kettlebell Swing?” 12/7/08 www.begin2dig.com
McGill S. “Super Stiffness” www.backfitpro.com
McGill S. “Selecting Back Exercises” www.backfitpro.com
Jones B. “Deadlifting Tips” 1/26/10 Power by Pavel www.dragondoor.com
Cook G. “Deadlifting (Balanced Body Series)” 2007, pp. 1-7 www.functionalmovement.com
“The Refined Turkish Getup: Functional as well as Diagnostic” 8/15/08 www.begin2dig.com
Minute of Strength #30 Windmill www.artofstrength.com

THANK YOU!
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Special thanks:
◦ Erik Rodriguez, ATC
◦ Kevin Undeen- UM Football video