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Old 02-21-2008, 10:35 PM   #1
Tom Meehan
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Hip arthritis

I'm currently training an overweight unconditioned individual with hip arthritis. His main goals are weight loss and regaining mobility. I'm testing him with the YMCA step test for cardiovascular fitness on Friday to get a baseline.

Iím looking for any ideas on scaling CF workouts to accommodate his condition (deep squats are out due to decreased range of motion and pain). Iím looking for good MetCon and strength exercises that I could use.
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Old 02-26-2008, 11:37 AM   #2
Corey Duvall
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Re: Hip arthritis

Fascial release of the contracted musculature should help improve his range of motion. Squats to a comfortable, safe depth are the way to go. I find that using a box or chair to set a depth goal is a great way to start. See how deep he can go with the correct motor control and set a box there. As he gains stability continually lower the box. I have found that utilizing the Russian set-rep scheme of pyramiding for endurance is a great way to start out with these folks. Set a box at a given height, see how many he can do... it should be a goal of 8-10 reps. Have him rest a bit, then perform another set with one fewer rep, and so on down to one rep. The next workout, lower the box a bit, again with the goal of 8-10 PROPER reps and move down the reps. Continue this until he can get a full range squat.

Also important is to perform one-legged squats as well. As his squat depth with two legs gets down towards parallel for 8-10 reps, you can also include one legged squats on alternating workouts. Again, set a box to a height where he can get 8-10 reps with correct motor control and pyramid down.

Before getting too carried away with met-con, he should be able to perform a full depth squat properly... inability to do so shows muscular imbalance that will impede his ability to perform the high rep met-con workouts anyway. If he wants more of a workout, utilize a lot of overhead work as well. Strength training to a max effort under proper motor control will leave you extremely tired especially with the completely deconditioned.

If you're concerned about met-con and cardio for weight-loss, get him on the paleo diet. You'll have much more success with that.

Good luck.
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Last edited by Corey Duvall; 02-26-2008 at 11:40 AM..
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Old 02-26-2008, 01:00 PM   #3
Tom Meehan
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Re: Hip arthritis

Thanks Corey,
That is pretty much the approach that I've been using - box squats, step ups, overhead lifts, modified pullups and pushups, joint mobilization for the hip as well as moving him towards a lower carbohydrate diet. My main metcon work with him at present is paired exercises (example - modified pullups and pushups 3 circuits no rest). It'll probably be a good while before any attempt at 1 leg work (weight is around 340lbs). Conditioning is at the level that he could only complete about 1 1/2 minute of the YMCA step test. Biggest challenge at present is restoring proper motor control - shifts away from the affected hip when squating and very poor thoracic extension (making some overhead lifts a challenge in addition to squat form). Basically, I've got my work cut out for me but I feel he can only get better. And thanks again Corey I'll try out the Russian set-rep scheme (is there a prescribed rest between sets).
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Old 02-26-2008, 01:20 PM   #4
Steven Low
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Re: Hip arthritis

Getting on a good diet can also help alleviate arthritis if you haven't looked into that already.
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Old 02-28-2008, 05:33 PM   #5
Corey Duvall
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Re: Hip arthritis

Is his hip painful even if he squats with one leg only an inch or two? Have you checked him for defacilitation through the hip musculature... most likely gluteus maximus and medius?

With defacilitated muscles, I believe the problem lies in the fact that the body has reset the angles at which the muscle will engage. Consistant seated posture will reset the muscle to not fire until the hip is flexed greater than the seated position, usually around 90 degrees. Muscle facilitation is based on the stress through the muscle as well as the current length. So in order to facilitate the muscle you must do one of those two things... either have him squat deeper than 90 degrees (which it sounds like is a difficult task at this stage of the game) or to increase the stresses placed through the muscle. The one-legged squat, even an inch or two to start will really help stimulate the muscles as well as his comfort level in doing so. If he is box squatting but shifting the weight, you aren't making any progress on the bad hip. Be there to guide him, start him with an inch deep squat and slowly increase from there. I think you'll see a good increase in his abilities AND his confidence in it.

This may not be the case with him, but if it is (as often is with chronic conditions) he may be fearing the pain in his hip more than the actually presence of nociceptive input. Craig Liebenson has an excellent chapter on the fear-avoidance behavior... it essentially says you must teach the patient the difference between musclular discomfort and pain and ensure them that these exercises (when done with proper technique under your guidance) will help strengthen his tissues instead of creating further damage.

Keep us informed.
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Last edited by Corey Duvall; 02-28-2008 at 05:36 PM.. Reason: clarification
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Old 03-17-2008, 11:39 AM   #6
Tom Meehan
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Re: Hip arthritis

Update. Squating has gone well, I've got him down to 22" for sets of 15. I don't want to add any external load until thoracic mobility is a bit better. Single leg squats not feasible yet, still developing better single leg balance - can now stand upright on one foot for 10 seconds (up from 5), prefer not to use an external support since in the past he has relied to much on it.
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Old 03-17-2008, 04:21 PM   #7
Corey Duvall
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Re: Hip arthritis

Sounds great. I'm sure his gains are great motivation for him.
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