The Turkish Get Up

TheKettleBellPhysioExercise, Uncategorized0 Comments

The Turkish Get-up (get it? 😂)

I am FMS and SFMA ‘Certified’. I was introduced to kettlebells through the FMS course in Melbourne at the end of 2013 as the course was hosted by Andrew Read (www.readpt.com) who at the time was the only RKC Master Trainer in Australia and one of the first people here to go through the FMS himself. Prior to that I had actively avoided kettlebells because I thought they were crap and certainly hadn’t ever tried doing a Turkish Get-up; from memory I had only ever seen it once in the gym and didn’t know anything about it.

Pavel Tsatsouline is the Russian widely accredited with introducing ‘hardstyle’ training to the west through the RKC and SFG who run training courses. Gray Cook and several of the high-profile individuals associated with the FMS e.g. Mark Cheung, Brett Jones and Dan John have also certified instructor through the RKC or SFG programs. After the FMS course I trained for roughly 10 months and received my RKC Instructor Certification from Andrew and Dragon Door in the USA.

Having trained in gyms for two decades, I initially felt like a fish out of water with the bells. The one exercise that sticks in my mind during the FMS course was the arm bar because I really struggled with it. Now, it’s one of my go-to exercises for shoulder issues.

The FMS frequently use kettlebells as a tool in their suite of ‘corrective exercises’. The FMS is also based on ‘developmental’ patterns – rolling, crawling, kneeling, standing etc.

I believe those exercises have a place but I don’t subscribe to either ‘corrective exercises’ or ‘development patterns’ in the way in which they’re taught. I’ve seen no evidence that they’re either are valid as they are ‘sold’ to us. I do however support the FMS principles of mobility, stability and fundamental patterns of movement, and to a lesser extent the joint-by-joint approach developed by Gray and Mike Boyle. Those messages are echoed by Pavel and the RKC/SFG and to date I haven’t seen anything from Pavel that I don’t agree with, perhaps because he’s a technician not a clinician.
I feel reassured by the fact that plenty of other very smart people across different professions and outside of the RKC/SFG community also use and/or promote the use of KBs – e.g. Prof Stuart McGill, Dr Craig Liebenson (DC), Dr John Berardi (PhD) – read post about ‘Health Movement’ here: http://www.precisionnutrition.com/healthy-movement.

I subscribe to the hashtag #movementformovement #movement4movement. I love kettlebells; my personal brand at ‘The Kettlebell Physio’ and my clinical practice is based upon them, but I don’t suggest that they’re necessarily any “better” or more effective than any other form of exercise or loading. I also understand that some people just aren’t into them and never will be – a bit like me and running.

The RKC/SFG course as far as I am aware are essentially identical (both founded by Pavel) and they are the only two which I support because they have very strict standards of execution which people must attain to become accredited – you can’t just rock up to a weekend course and get a Certificate. On the day of testing, after 8 months of training, Andrew failed me on my Turkish Get-up (my foot moved) and my ‘press’. I did however pass the endurance component ‘snatch test’.

I view ‘functional’ like ‘core stability’ – grossly misused and misunderstood but has some basis in reality. Something needs to stabilise the midsection (core) otherwise we simply could not function. If function is bending down to the ground and picking up a shopping bag or child, that would be ‘functional’.

A kettlebell is no more than a weight with a handle on it; so is a shopping bag. We have kettlebells which weight less that some of our client’s handbags. It’s rare to find kettlebells heavier than 32kg so it’s not ‘weight training’ – I used to easily press 10x that in a leg press as a warm-up.

A kettlebell ‘complex’ is a series of movements or exercises strung together. The TGU is a series of movements strung together; transitioning from lying down on the ground to sitting, from sitting to kneeling, and from kneeling to standing. That’s it.
If someone is lying on the ground and let’s face it there are many ‘functional’ reasons why that may be happening – relaxing in the garden enjoying the sun, working underneath a car, having fallen over, stretching, exercising, having sex – that person needs to be able to get themselves upright again. That transition from lying to standing is functional. If you ask someone to lie down and “get up”, they invariably demonstrate some variation of the TGU naturally.

The TGU as an exercise is little more than a structured means of standing up in a way which safely and effectively allows load to be added to it.
This weekend I saw two men helping a young overweight women back to her feet after she had tripped over. She was in a kneeling position and simply couldn’t get herself back up again. As a Physiotherapist I call that ‘functional’ (being able to stand up). If an adult doesn’t have the physical competency (requisite mobility, stability, strength and coordination) to manipulate their own body to perform ‘fundamental’ movement patterns like rising from a toilet seat, getting out of a car etc. I’ll be the first to call that ‘dysfunctional’ and suggest that they do something to change that. There are multiple reasons why someone may be unable to perform a movement or pattern of movements and that’s for the clinician to determine on an individual basis.

The sitting-rising test, although not strictly valid, has been linked with risk of mortality in people aged 50-80 years. How well someone can manipulate their own body into a sitting position on the floor and back to standing again as a measure of their physical health, typically mirrors their medical health. Generally speaking, I support that view but acknowledge there are exceptions.
After 25 years of training, almost all of that in traditional gym settings, I love kettlebells and it’s the only thing I’ve done now for the past 3 years.
So, back to the TGU. To perform the TGU well i.e. as per Pavel’s method in the RKC and SFG programs, requires the individual to possess the ‘fundamental’ components of mobility, stability, (relative) strength and coordination in the hips, shoulders and trunk (core). It’s no more fancy than that.

For example:
Long-sitting requires 90 degrees of hip flexion

Holding a weight overhead safely demands end range shoulder flexion and abduction

Transitioning from long-sitting to kneeling requires that someone can support and stabilise their bodyweight through a shoulder girdle with sufficient hip rotation to get from one position to the next

Holding a weight overhead while transitioning from one position to the next requires sufficient mobility in the spine to be mechanically efficient and stable shoulder

Breaking the TGU down into its’ component parts is like breaking down dressing yourself in the morning – most of the fundamental movements are used one way or another.

Can you do up a bra at the back?
Can you put your socks and undies on without having to sit down? You can comfortably slip a t-shirt over your head?
Can you pick your crying child up off the floor and tuck them away into that high cupboard above the oven?
When you’re lying on the ground, can you easily stand up?

There are plenty of people who simply cannot perform a Turkish Get-up pattern (without weight) and there may be valid and obvious reasons for that. For some it’s simply a motor control issue which can quickly change. Dancing for me is a motor control issue too, but that’s meaningless from a health perspective. Whether someone *needs* to be able to perform each of the component parts is debatable; there are always workarounds. If I had to be helped back to my feet from kneeling because I didn’t have the capacity do it myself, that would not be an acceptable workaround. Personally, and from a Physical Therapy perspective, if I cannot perform a Turkish Get-up, that’s not an acceptable level of function for ‘me’. My son is around 16kg bodyweight; I want to be able to continue picking him up and playing ‘dad’ because that’s important for me. I get that people have different values and I respect that.

Based on the above, I agree with the Ayash paper (see earlier post) and Pavel’s suggestion in the RKC Instructor manual that “it can serve as a corrective exercise, a movement screen, or a conditioning workout”. In my clinical practice I use it for each of those purposes with our clients/patients and myself. I don’t agree with Ayash’s description of it in regards to being used as a Movement Screen; I believe it’s more complex than described and the glute part I just don’t agree with – while there are universal human movement patterns, our specific movement habits are unique to us, and to our individual bioengineering. That needs to be considered on an individual basis and in the context of why that individual may be seeking Physiotherapy.

I also agree with McGill and Brumitt (see references in Ayash) that it can improve athletic performance and for injury rehabilitation. I also use it for those purposes too.

Generally speaking, and assuming someone has the physical capacity to be doing it, if someone is performing the TGU on a regular basis and progressively getting better (increasing load and reps etc.) I can see only good effects on their physical health (assuming safe technique and appropriate progression).

In response to Nick Efthimiou asking for reasons *against* the TGU, there are several.
There would be no point in doing it if someone is in pain. It’s a pattern-based exercise and pain changes patterns. Pavel talks of ‘greasing the groove’ – getting better at the pattern – and pain isn’t going to improve that, and neither would adding load in such a complex manner.

In FMS-terms, it’s rarely wise to ‘add fitness to dysfunction’ (strength being a component of fitness) i.e. adding load to someone lacking prerequisite mobility is unlikely to improve the mobility issue and will probably just increase the risk of harm. If joints and tissues are being pushed to compensate for deficiencies, there’s a good chance that something may be pushed beyond its’ normal tissue tolerance.

I start *everyone* off with a just a shoe regardless of how fit and able they may be. It’s blindingly obvious with zero load whether adding load is appropriate or not – hence the ‘screen’ and I’ve seen all sorts of weird and wonderful things happening during an unloaded TGU due to mobility, stability and motor control issue. If something isn’t working, then it’s time to try and figure out why. In addition to pain, there are plenty of clients/patients whom I see where the TGU simply wouldn’t register as being an appropriate exercise for them – disease, disability, emotional or psychological involvement, a history of being sedentary, not interested in ‘exercise’ – there are probably several more too.

People generally don’t like doing things they cannot do or having someone point out they cannot do something which they “should” be able to so. The deep squat for example; most people can’t do that due to poor mobility. It’s the minority who can. Even strong, fit, healthy, active individuals like Osteopath Health Williams @osteoheathprinciple4osteopathy have poor ankle range – likely meaningless but will limit the ability to perform some patterns. I don’t think he cares. Neither would I, but I’m glad my ankles bend more 😉

I’m selective with whom I teach how to do the TGU. I don’t think I’m anal about the ‘why’ like the corrective exercise, developmental patterns and, functional movement crowds, but I am a stickler for technique because I love the biomechanics of it and feel good technique is important. I don’t recall if it was from Precision Nutrition or the RKC but I agree with the moral that if we focus on excellence in execution first and foremost (rather than the end result), the achievement of goals becomes a natural outcome.

A get-up a day keeps the Physio away.

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