Multiple joint replacements, and exercises

[Merrida]

I'd like to get some external, objective feedback from others here on DF on what types of exercises they'd focus on, and why, for someone with multiple joint replacements.

She's been my client for just over 2 and a half years now, so we're progressing nicely as it is. But I'm always open to learning, and gaining new perspectives. She's a 70 year old woman who has always been exercising in various forms all her life since her pre-teen years. She has both hips replaced, and both knees replaced. One hip was replaced roughly 15 years ago (thus began the sequence of joint replacements), and the most recent is her last knee replacement was done roughly 1 and a half years ago. Her other hip and knee were replaced roughly 8 and 4 years ago, - respectively.

We have come phenomenol distances with regards to her independence, mobility, function-ability, and strength. She is more flexible than the average person (of any age), even given her joints.

Her only "complaint" if it can be called that, is what presents as symptoms similar to that of a "frozen shoulder" (right shoulder) with some restrictions in mobility.

But other than that, as I said, we've progressed nicely.

So, if we're doing well, why ask? Because I think it would be educational and interesting to hear what some other people might think of focusing on or attempting with her (given her stats) with a goal of function-ability. She's more interested in not letting anything else slip, (she's happy "where she is")-- but doesn't want new injuries/degenerations to pop up. New viewpoints are always enlightening!

[.V.]

Maximum effort deadlifts?

Just kidding, seriously since it sounds like what you've got going on with her is working so well, just share what you are doing now - sounds like it must be great.

[Weston]

I too would like to hear how you are currently training your client. I am 46 years old and plan to be functionally fit until the day I die. For me, that means being fit enough to enjoy recreational activities (e.g. tennis, dancing, hiking), clean house (e.g. scrub floors, carry groceries, wash car), save myself in an emergency (e.g. climb stairs, run sprints, pull-ups), make love (e.g. push-ups, deadlifts, stretching), and be attractive enough to make love to (e.g. flat stomach, good posture, nose breather).

My fitness regimen includes exercises that mimic the functions I want to perform. I would never stand on a Bosu ball unless I was planning to join the circus. If my balance needed improving, I might climb stairs without holding the side rails.

Now that I'm older and have to spend more time warming up, I use isometrics as a warm-up to isotonics because I can focus on the muscles to be exercised and work on proper form. Isometrics mimic lots of functional activities where the muscles have to be held in position (e.g. carrying, squeezing, pressing).

One more thing I work on as I get older is my grip strength through exercises like pull-ups and deadlifts. I know many old people have arthritic hands and I think that may be due to not maintaining their grip strength.

[luke.w]

Originally Posted by Weston

I am 46 years old and plan to be functionally fit until the day I die.
One more thing I work on as I get older is my grip strength through exercises like pull-ups and deadlifts. I know many old people have arthritic hands and I think that may be due to not maintaining their grip strength.

My father 54years old suffers from a budging disk several years ago, he never exercised in his life,(knows nothing about weights) he went through some theropy with it, and found it all to be very boring, at his job he has to lift things from time to time, thats a problem when your not doing it everyday, because you ain't used to it and one day,,,, it happens, thats what happen to his neck.

well it's been alittle over a year since I started giving him literature in strength training, I let him borrow some "MILOS" from "ironmind" and then gave him "power to the people" (which he soon purchased) I gave him that one as I thought it was good for teach proper deadlifting and one-arm press form, I told him to focus on those two exercises, and showed him some plate pinching for grip.

he soon approched me and said the grip stuff made his neck feel good, so I purchased a "trainer" gripper from ironmind for him, in the meantime he used a sports store gripper, he then approched me about the thumb, (as grippers don't work the thumb) I told him to use the little collars and squeze them,(thumb and index finger) he got pretty excited about it, I told him not to train this stuff too much, do what feels good, and I never gave him a routine.

Months later (last week) he approched me and said he feels one part of his neck feels neglected, and thats where his diskproblem is, he stated that he's very happy doing deadlifts and presses as he feels indestructable in his back, I asked him how he's training and he stated he's deadlifting nearly everyday, it's not an ego workout for weights or size gain, he just does what he does, and he feels good about it (helps when he dosen't know much about ego boosting with heavier weight goals), he's also repping the trainer, so I'm getting him a #1 (probilly christmas), but what about his neck? I said well, I have a neck harness, that you hang on your head and add weight to it, and just do lifts with it (support deadlift hold) or full ROM movments with it, he got excited and said (through commonsense) "thats something I was thinking about, thats gotta help me"? well I'll drop off the harness sometime this week, and see how it goes.

all in all, his back feels better now than in years, even though his neck still gives him some problems (It may forever?) but makeing it feel better through the workouts seems to have it's ups?

[gymgirl]

Originally Posted by Weston

I too would like to hear how you are currently training your client. I am 46 years old and plan to be functionally fit until the day I die. For me, that means being fit enough to enjoy recreational activities (e.g. tennis, dancing, hiking), clean house (e.g. scrub floors, carry groceries, wash car), save myself in an emergency (e.g. climb stairs, run sprints, pull-ups), make love (e.g. push-ups, deadlifts, stretching), and be attractive enough to make love to (e.g. flat stomach, good posture, nose breather).

i'm not a trainer, but i can share with you what my dad does. he's 77 years old and runs 6-7 miles 3-4 times per week. he's never had back problems, neck problems, knee problems or arthritis. he's diabetic, but knows how to manage his diet, and takes a pill with is meal. his training aside from running consists of doing yard work on a 1.5 acre yard, and plays the occasional game of raquetball. he spends hours brining rocks up a steep hill up from the beach in a wheel barrow. shovels beauty bark and wheel barrows it all over the yard. lol he will spend hours chopping wood and hauling it, moving planters etc. on the average day he spends 3-4 hours outside working in the yard. honestly i can't belive he is 77, he looks and moves like he is in his early 60's.

oh, and he wasn't always into exercise. when he was in his late 40's or early 50's he was a smoker. the doctor told him if he didn't quit he wouldn't live to see me graduate high school. he quit that day, and changed his entire diet and lifestyle.

[.V.]

Gymgirl - that's interesting. I have a doctor friend who is a runner and he kept insisting to me that running was good for the knees - I didn't believe him though. Finally I gave it a try, I stunk at it and it was rough on the shins, back, and ankles until pierini and weston shared posts about improving running form. But it really does seem to make them healthy - not jogging but running.

[gymgirl]

that's interesting. do you know where that post is located,the one with proper running form from weston and pierini?

unfortunately, i think my dad jogs, he's definitely not full out sprinting.

[.V.]

I don't remember where it was - just do a search for running then look for the usernames. They have both given good advice for improving running. When I applied it to myself, I did improve. I didn't get good at it, or get to enjoying it, but I got better and really miss not getting to do it right now.

[Merrida]

Originally Posted by Weston

I too would like to hear how you are currently training your client. I am 46 years old and plan to be functionally fit until the day I die.
I would never stand on a Bosu ball unless I was planning to join the circus. If my balance needed improving, I might climb stairs without holding the side rails.

Now that I'm older and have to spend more time warming up, I use isometrics as a warm-up to isotonics because I can focus on the muscles to be exercised and work on proper form.

One more thing I work on as I get older is my grip strength through exercises like pull-ups and deadlifts. I know many old people have arthritic hands and I think that may be due to not maintaining their grip strength.

My personal take: That attitude of "never standing on a BOSU ball unless you planned on joining the circus," is one reason people as they get older have balance problems, limited proprioceptions, limited upper/lower body disassociation, weak ankles, instability, no sense of where they are in space, the inability to recover from sudden off-balance situations, ....they wipe out, sprain ankles, break hips, or worse.

I wouldn't encourage isometrics or isotonics "as we age" or at least I would limit how much and how....maybe to stabilize a multi-joint, multi-planar execution, otherwise, depending on the individual, there are too many other things to do without risking such elevations in blood pressure.

Grip strength gets worked on every time you lift DB's, BB's, rack and re-rack weights (like a good, respectful gym-going who doesn't leave their weights on the machines). White knuckle grips on any exercise (not implying you are, just making a statement) is another way to increase BP.

As for my regime with my client. That has been an ever changing program without set periodization (something I do not use with her in the traditional sense). We've spent years working around pre- and post-joint implants, pre-surgical strengthening and post-rehab transition. We focus on balance, gait training, ROM in joints (per her doc's instructions and specific recommendations), we carry over versions of her physical therapy exercises in rehab and advance/progress the difficulty. We work on flexibility as her muscles tighten up a lot quicker and easier now.

We do low-level step ups and step downs (short step) to monitor level pelvis stability, knee tracking, balance, coordination.

We also use a combinations of machines, and cables, focus a lot on core strength, posture (which has been continually compromised with each consecutive surgery). We do stabilization work to target those smaller stabilizer muscles around her joints as well as her agonists, primary movers.

It's a combination of strength training, and we vary planes/angles/tempos and increase load much slower. I want to keep all supporting musculature around her joints strong, supple, active, flexible. But I also need her balance and reaction time to be addressed. Between age, and the various sensations of so many artificial joints in her lower body, her body awareness means attention to patterning and coordination, muscle imbalance, and care to avoid moves, ROM's, rotations that are unsafe.

Upper body work is basic with components of balance tossed in to accomodate the low load poundage we use. Or, to do straighter strength work, we use machines.

That's a touch of what I do. Remember, we've worked for years, so the multiple things we've done have varied across time and to accomodate her conditions.

[CF-OC_gal]

I'm curious Merrida, do you also get involved in face to face consultations with the client's doctors/surgeons, physiotherapists to coordinate pre and post care?

That would be awesome if that kind of cooperation is going on in patient care these days!

[Merrida]

Originally Posted by Brat

I'm curious Merrida, do you also get involved in face to face consultations with the client's doctors/surgeons, physiotherapists to coordinate pre and post care?

That would be awesome if that kind of cooperation is going on in patient care these days!

Yep.

[Weston]

Merrida, How do you measure progress and fitness level with your client?

[Merrida]

Originally Posted by Weston

Merrida, How do you measure progress and fitness level with your client?

Well, that's a double-edged question, isn't it? The absolute truth distilled would infer progress and fitness level measurement ultimately is irrespective of my personal/professional judgment. Part of what what all personal trainers provide, (it's just a variable as to what degree each trainer measures the need/want to be around),...ultimetly, is determined by the client. It is the client who sets their goals, not me. It is the client who chooses and measures to the extent that it involves me.

I can tout all the specifics in the world re: measuring and specificity of goal setting and progressions in fitness as can be demonstrated scientifically (such as their performance, measuring their ROM, evidence of their endurance, their lowered RHR or BP, the reduction in need for other modalities of care, such as prescriptions)....and so forth.

But as push comes to shove, the realistic answer is a less succinct gray-shaded reply of: a blend of both. It's important the client feels progress is being made. I've had clients make progress but THEY do not feel they have (such as losing 10 pounds in a month when they felt they should have lost 20 because they saw it on TV on a Bally's commercial). I can't sway their emotionally-driven "logic." Likewise, it's important I listen to my clients goals, help them attain them (provided they are realistic), and be there for them in a capacity THEY deem warrants contribution to "success" or "progression."

Working with older clients, many are happy just to know they're staying strong and supple enough to "hold their own." The "progress" is that unlike their peers, they can stay out of nursing homes, ambulate under their own power, maintain independent living,....walk without a cane or walker.

Success is personal,...wouldn't you agree?

[rufiedog]

IMO, what keeps people motivated IS progress in some fashion. Sometimes (particularly the older one becomes) progress needs to narrow a bit. Compare yourself with 1 or 2 ”weeks” (or months) ago, as opposed to “years” ago.


But nonetheless since progress is a big key to staying motivated, some kind of measurement should be maintained. Depending on the goal, this can sometimes be hard to do.

For example aerobic fitness (especially the fitter one becomes) takes accurate record keeping. Occasionally (not all the time) an attempt to better your previous record (be it intervals or some sort of steady state) is fun to do, and is always very motivating, especially a successful attempt.

Dan

[rufiedog]

Originally Posted by rufiedog

IMO, what keeps people motivated IS progress in some fashion. Sometimes (particularly the older one becomes) progress needs to narrow a bit. Compare yourself with 1 or 2 ”weeks” (or months) ago, as opposed to “years” ago.


But nonetheless since progress is a big key to staying motivated, some kind of measurement should be maintained. Depending on the goal, this can sometimes be hard to do.

For example aerobic fitness (especially the fitter one becomes) takes accurate record keeping. Occasionally (not all the time) an attempt to better your previous record (be it intervals or some sort of steady state) is fun to do, and is always very motivating, especially a successful attempt.

Dan

Adding to this a bit---

Having some sort of goal by which to measure achievement is paramount to staying excited about training.

Dr. George Sheehan (to illustrate the importance of having a goal) talked about a friend who teaches a much in demand fitness course at a state university. The protocol is not unusual: lifting weights on one day and jogging the next. The student’s rarely drop out of class, however. The reason, Sheehan explains, is because it’s a mountain climbing course. The students are preparing to climb Oregon’s Mount Hood.


I realize this is a bit off subject but interesting nonetheless

Dan