As a student Physio, I spent a lot of time learning about and practicing ‘transfers’; helping people from hospital beds to a chair or toilet, in and out of wheelchairs, up and down stairs, in and out of cars, up and down from the floor…. A transfer is simply the ability to manipulate one’s own body within our environment. There are many reasons why someone’s capacity to perform various transfers may be diminished or lost through disability, sickness or injury.
Disability, sickness and injury aside, having the physical capacity to use a toilet or get ourselves up from the ground if we fall over are as fundamental as being able to feed ourselves.
The Turkish get-up is nothing more than a series of transfers: lying to sitting, sitting to kneeling and kneeling to standing. Those transfers, or components of them, enable us to complete a multitude of other tasks and activities. It would be considered ‘normal’ function to be able to reach overhead, grasp an object and be able to do something with it for example.
There is no ‘best’ way for someone to sit down into a chair, however, observing how someone does sit down and stand back up again often gives a therapist insight into how they move. If someone is moving in ways which may not be helpful, or are just plain odd, we may then need to investigate further to work out why and if it might benefit from any input from us.
I use the Turkish Get-up (TGU) to assess people’s movement by their ability to perform those three ‘normal’ transfers. Just to be clear, this isn’t something I would ever do as part of any initial assessment, perhaps a single part of the get-up such as a lunge, but I’m not routinely asking people to perform a TGU 1) because it’s not necessary, 2) people would probably think I’m barking mad and 3) it’s a ‘sequence’ which requires time and effort to take people through. Think big picture. It’s similar to nutrition in that you can get an idea of what someone’s eating habits are without having them spell it out for you in a food diary, but if that’s what they’re wanting help with and it’s important to them, then that’s where we probably need to go.
The TGU is *supposed* to be performed in a very particular way and for good reason. Like a golf swing though, which also has an ‘ideal’ pattern, ideal doesn’t always account for variations in normal anatomy and so, acknowledging variations of normal and responding to them appropriately is important. The same applies to BMI; a muscular male may be classified as obese when they’re clearly not, in which case their BMI can be ignored. Our role is to identify the abnormal variations from the normal ones. In my experience training and watching people performing the TGU, there’s *always* a reason for someone changing the pattern when it’s not a normal variation. What’s also interesting is that people will do these things without consciously thinking about them and often seen visibly confused trying to complete the task differently.
I’ve been training with two people in particular, whose ‘normal’ is far from ideal. In both people I’ve missed the same thing because I haven’t investigated the ‘abnormal’ mistaking it for their normal. In one of them (aged 55) it’s taken 7 months for me to notice what was fundamentally missing, and in the other person (aged 68) it’s taken almost 18 months! Hopefully I won’t miss a third.
So, here’s a list of *some* of the more common things I’ve noticed from the TGU pattern.
• Some people are unable to role to a supported position in their elbow; they just can’t do it. That’s clearly not normal!
• Some people can role to their elbow just fine, but only if the bent knee collapses inwards towards the floor. I’ve seen several people go from rolling to a supported elbow with ease to not being able to do it at all simply by stopping the hip from rolling inwards. That’s another strategy to increase stability.
• If the supporting arm on the floor moves toward the head (usually with an elbow bend), that’s typically a strategy to increase stability in the shoulder girdle. In the two people I mentioned above, neither can actively depress their scapulae (motor control not strength) – this become ‘testable’ in sitting (next step).
• Almost everyone has sufficient hamstring extensibility to sit upright with one leg straight; if they can’t their mobility in hip flexion is very limited. I’ve only seen that once in the past 18 months.
• Some people don’t have the stability in their upper limb/shoulder girdle to lift their body weight clear of the floor sufficient to get the get the straight leg to kneeling. This isn’t common, but in both people above, they couldn’t do it unless they moved their support hand backwards. The inability to actively depress the shoulder blade was remarkable.
• If someone ‘needs’ to look at where they’re placing their knee, that should also raise an eyebrow as that should be an easy proprioceptive task.
• If a hip is *really* limited in its mobility, someone may have difficulty getting to kneeling. I’ve only seen this once, funnily enough in the same man who was unable to comfortably sit with his leg straight.
• In the supported kneeling position, an inability to align the arms vertically (any direction you look from) typically highlights limited thoracic mobility in combined extension/rotation.
• In tall kneeling, if someone has a natural tendency to rest the dorsum (top) of the foot on the ground rather than rest on the balls of the foot with the toes fully extended, that’s typically indicative of limited extension of the big toe. I’ve subsequently seen some peculiar gait patterns after noticing that.
• Difficulty standing from a kneeling position isn’t actually very common outside of ‘expected’ challenges, but altered foot positions and shifting the trunk over the lead leg are common. Those may or may not be worth investigating. For me, those would typically fall into the ‘room for improvement’ basket and practicing the TGU will help with that anyway.
• Someone should be able to transition from standing to kneeling, forwards and backwards, with a lunge; that’s just getting up and down from the floor! If it’s a struggle, that’s probably worth investigating.
• Throughout the movements, someone should be able to hold their arm vertically with the elbow straight throughout all three transitions. Swinging the arm towards the feet when rolling to the supported elbow position is very common strategy as it alters the biomechanics to decrease the relatively load and length of the lever (torso). It’s just as likely to be a stability issue (worth investigating) as it is a result of performing a new pattern (not worth investigating) so that’s a judgement call.
• From tall kneeling, someone should be able to hold their arm vertically and keep it pressed against their ear – that’s normal end of range. A common effect of poor lower limb function (whatever that may be) is for the arm to collapse moving from kneeling to standing. The weak link in the TGU is the shoulder.
• It’s also quite common to see someone able to perform the pattern quite well without load (i.e. not holding a kettlebell), but see things rapidly fall apart with the addition of a load, even a light one. Hence, it’s worth taking the time to explore it i.e. practice find the limit.
• If you want to find someone’s weak link, load will do that for you.
With my Physiotherapists hat on, I’ve found the Turkish Get-up to be a very effective movement assessment, not to be confused with a being a ‘screen’ for anything which it definitely isn’t, unless you’re lifting as Ben Cormack would say, a shit ton of weight, in which case it is a screen for awesomeness 😉 It’s also a good party trick or two.
Often the difference between good and great is that the great have mastered the basics. One movement ‘system’ works on the principle that movement revolves around having the right amount of mobility and control (stability) of the shoulders, hips and trunk. The TGU demands all of those and so training these three patterns with the addition of load simply means someone’s getting better at the basics.
If you want to be great, train the Get-up, but I would say that wouldn’t I.