Glute Self Release

So many people approach me and ask pain in their glute area. This pain can come for the low back, the hip, the SI joint and from any of the muscles in that region.

Foam rolling and lacrosse balls may or may not work. I like using the Accumobility ball. I do not sell them, nor do I get paid for this post. I just like how they work. Period.

Look at this video and shoot me your questions: https://player.vimeo.com/video/204910867


What Is Blood Flow Restriction

Getting Popular
Not just for patients, also for athletes
Improve strength, gain mucle mass and increase endurance

Blood flow restriction training is getting more and more popular in rehab setting and in the gyms. With good reason, as there is a substantial amount of research coming out that shows the benefit of BFR to improve strength and hypertrophy.

Research on Hypertrophy

With traditional workouts you need to load the muscles at least at 65% of their 1 Rep max. So if you can curl 50# maximally, you need to work with 33# to gain hypertrophy. Research on Blood  Flow Restriction shows that you can get the same results with loads as low as 20-30%, so with 10-15# dumbbells!

How does it work?

  • Blood flow restriction training does not break down the muscle like traditional resistance exercise because the loads are so light: So less Muscle damage!
  • But BFR creates huge amounts of protein synthesis due to the hormonal responses the body has to BFR training: So more Muscle growth!

Where do the cuffs go?

The cuffs should be placed either at the upper arm, or at the upper thigh.
Cuff pressure should be 4-5 on a scale of 10 (maximum pressure you can handle) for the upper body and 6-7 on a scale of 10 for the lower body. Always be on the low side. More pressure does not create better results!
If your Therapist or Trainer uses Doppler, its even safer and more accurate!

What Exercises should I do?

Results has also shown that there is a systemic effect: people that used BFR just for upper body exercises, gained lower body strength too. You can basically use any type of exercises, from bike or treadmill to dumbbell or barbell activities. The 30/15/15/15 protocol is what appears the most in the literature. So you perform 4 sets, the first one with a weight that you can lift for 30 reps and then 3 sets with 15 reps each. Rest only 30 seconds in between. If you can not complete all the reps, reduce the weight next session!

Do you want to try Blood Flow Restriction Training?

If you have never tried it, book a session and let me work with you. We have different cuffs, from different vendors and you can see which one you like the best. Email me with questions


How To

In this series we review popular exercises and show you the proper form, why you should do these exercises and when you should look for an alternative exercise

How To Perform a Hip Thrust

The Hip Thrust exercises has become a lot more popular and for good good reason. For function and overall lower extremity development, you also need to train the backside of the legs, the posterior chain.

Read More Here

How to do Bulgarian Split Squat

The Bulgarian split squat isn’t an all-around better exercise than the barbell back squat, but if you incorporate it into your plan intelligently, it can help improve your leg development while reducing your risk of injury and muscle imbalances.

Read More Here

How to Improve Thoracic Mobility

The Foam Roller can be used to improve thoracic mobility, esepcially to improve extension which a lot of use due to our forward bend posture.

Read More

How to train your hamstrings

The hamstring is is made of 2 groups, the semis and the biceps femoris. Each responds to different type of exercises.

Read More

How to Squat with knee pain

If you have knee pain, especially pain on the anterior (front) of the knee, give this exercise a try

Read More

How to squat with back pain

If your back is hurting, sometimes you need to alter your leg workout.

Read more

How to Bench Press

Follow these 4 steps to safely perform the bench press. If you have pain with Bench press this post also shows you some alternatives.

Read More

How to do a pull-up

We have videos to show you step-by-step how to master the pull-up

Read More

Coming soon

How to deadlift

How to Squat


How can exercise help chronic pain?


Although resting for short periods can help with pain, too much rest may actually make it worse and put you at greater risk of injury. Research has shown that regular exercise can ease pain long term by improving muscle tone, strength, and flexibility. Exercise may also cause a release of endorphins, the body’s natural painkillers. Some exercises are easier for certain chronic pain sufferers to do than others. Try swimming, biking, walking, rowing, and yoga.

Finding the right exercise for YOU is most important. Not every person with low back pain responds to one type of exercise. Not every person with rotatorcuff problems needs to do the same exercise. The “right” exercise is very individual. However, it has to be an exercise you enjoy!

For people suffering from pain, their initial response is to avoid activity and seek rest. And yet exercise therapy is often prescribed as a treatment option to manage pain. There are known benefits of exercise and regular physical activity. CDC lists following as the benefits of physical activity: controls weight, reduces risk of cardiovascular disease and metabolic disease, reduces risk of some cancers, strengthens bones and muscles, improves mental health and mood, improves ability to perform daily activities and prevent falls, and increases chances of living longer. Exercises and physical activity not only have benefits in healthy individual but also has proven benefits in people with pain and injuries

Aerobic exercise/endurance training and resistive exercise/strength training are two different types of exercises which can be aquatic or land-based. Pain control is achieved differently with different types of exercises.

Prescribing appropriate intensity and frequency of exercise is important in achieving the desired effects of hypoalgesia and therefore you want to seek out a professional who understands pain and will take the time to evaluate you and who will listen to your concerns and most importantly answers your questions about pain.


An immediate local mechanical hypoaglesic response has been shown to specific exercises of cervical spine in patients having neck pain for at least 3 months. Specific exercises included (1) cranio-cervical flexion with 10 second contraction for 10 repetitions with 10 second hold in between, and (2) cervical flexion endurance exercise of head lift in supine was performed for 3 sets of 10 reps at 12RM with 30 second rest in between sets (each rep lasted for 3 second with 2 second interval between reps).

A systemic review done by Hayden et al, concluded that supervised exercise therapy which consists of stretching and strengthening, and is individually designed improves pain and function in chronic nonspecific back pain.

Martin et al designed an exercise program which has shown to be an effective management for fibromyalgia in short term. Exercise program included aerobic training, flexibility exercises and strength training.

  • Thorén P, Floras JS, Hoffmann P, Seals DR. Endorphins and exercise: physiological mechanisms and clinical implications. Medicine & science in sports & exercise. 1990 Aug. 22(4): 417-428
  • Koltyn KF, Brellenthin AG, Cook DB, Sehgal N, Hillard C. Mechanisms of exercise-induced hypoalgesia. The Journal of Pain. 2014 Dec 31;15(12):1294-304.
  • O’Leary S, Falla D, Hodges PW, Jull G, Vicenzino B. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. The Journal of Pain. 2007 Nov 30;8(11):832-9.

Back pain? Want to lift?

This might vary from person to person

Everyone is different. Your pain is not the same as someone else’s pain. If you have pain, get a qualified Healthcare Provider that understands lifting weights to help you stay active 

If you have back pain you don’t have to stop lifting, but you may have to adjust your program. Find an exercise and a volume that you can safely perform.

Gradually increase your programming. Most of us get in trouble by doing too much too soon

Pieter de Smidt, PT, DPT, Cert. MDT, MTC

Knee Pain? Want To Work Out?

If you have #kneepain, weight training can help. However, you may need to modify your workout.
This chart shows you how different exercises compare, as far as strain on the knee.
We are all individuals, so different exercises may affect pain differently .
This information is intended for educational and entertainment purposes only.

Example only. Your program may vary

If you have knee pain you don’t have to stop lifting, but you may have to adjust your program. Find an exercise and a volume that you can safely perform.

Gradually increase your programming. Most of us get in trouble by doing too much too soon

Pieter de Smidt, PT, DPT, Cert. MDT, MTC

Shoulder Pain?What can do in the Gym?

Shoulderpain is one of the most common problems that happen to my fitness clients. The #benchpress #shoulderpress and even #bicepscurls often lead to #shoulderimpingement .
If you have pain, you don’t have to stop lifting. But you may have modify your #exercise #programming .
Get someone who understands #injurymanagement and #injuryprevention as well as #strengthandconditioning to help you with your #workout .
This information is intended for educational and entertainment purposes only. If your have symptoms, please see a qualified healthcare provider.

Everyone is Different. This an example, your program may vary.

Weightlifting is not bad for your knees, low back or shoulders


Weightlifting will not hurt you knees, back, shoulders
We need to stop telling people that weightlifting is bad for them.

  • Yes, before anyone start with weightlifting they need the prerequisite mobility and stability and know good form.
  • Yes, not everyone needs to use a barbell to do deadlifts. Actually most people do not, but they can use trap bar, rack pulls, Kettlebells, Dumbbells, or even do a dowel hip hinge
  • Yes, not everyone needs to lift a barbell overhead. They can use a machine, Dumbells or a landmine
  • Yes, not everyone needs to do a barbell squat ATG, but some form of squatting should be done by all of us, as its part of our daily lives

Research has shown over and over again that weight lifting is not bad for and actually can really help us. More strength, more resilience. Stronger bones and muscles won’t hurt anyone

Pieter L. de Smidt, PT, DPT

Knee Research:


Shoulder research


Back research


Training with pain?

We all will have to deal with this at some point. You may have some pain, but still want to workout. Should you? Can you? And if so, how?

  • Reduce the ROM
    By working a shorter range of motion (ROM) you can typically reduce symptoms. If you have pain, regardless of load and volume, in a certain part of the range of motion this works well. If you have pain in the bottom of the squat, try a box squat and see how you feel.
  • Reduce the load
    The key is to bring down the weight to a point JUST BELOW your pain threshold. If you have pain lifting 50#, can can lift 45# without pain: exercise for a few sessions at 45# and if all goes well, try to go back to 50#. Then slowly progress from there. This works well if you have pain during a specific lift
  • Reduce volume: less reps or less sets
    This works well for situations where you do not have pain during working out, but you have pain the next day. For example: if you have been doing 5sets of 5 reps with deadlifts, go back to 3 sets of 5 reps with same weight. If not pain next day, do one more session at 3 sets. Still no pain: got to 4 sets. if no pain after 2 sessions, go back to 5 sets. Keep monitoring how you feel during workout and for 24 hours afterwards
  • Slow down the tempo
    Often times you can develop pain when you go too fast with your lifts. You may not feel what part of the lift gives you discomfort. You may be compensating by going faster, but over time this can lead to injury. If you have any kind of tendonopathy, tempo changes can help your pain. If you have pain with faster reps, this may be an indication of pain generated from a tendon. Slow down your movement, focus on proper form and see how this affects your pain

Its NOT “No Pain, No gain” and its also NOT “Pain, so stop”. Modify your workout and see how your symptoms respond. But keep training, unless pain gets progressively worse

Pieter L. de Smidt, PT, DPT