Training Clients with Knee or Hip Replacements

Training Clients with Knee or Hip Replacements

Dan Ritchie, PhD, CSCS 16+ years experience personal trainer, manager, owner Certified Strength and Conditioning Specialist FallProof Balance and Mobility Enhancement Specialist Enhance Fitness Master Trainer 2014 PFP Personal Trainer of the Year Act!vate Brain and Body Advisory Board

FAI International Advisory Board Paul Holbrook, MA Debi Pillarella, MEd Lindsay Vastola Steve Young, DPT JR Burgess, MS Dianne McCaughey, PhD

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Dos and Don'ts To Protect Your New Hip Don't cross your legs at the knees for at least 6 to 8 weeks. Don't bring your knee up higher than your hip. Don't lean forward while sitting or as you sit down. Don't try to pick up something on the floor while you are sitting. Don't turn your feet excessively inward or outward when you bend down. Don't reach down to pull up blankets when lying in bed. Don't bend at the waist beyond 90 degrees. From the American Academy of Orthopaedic Surgeons

The Dos Do keep the leg facing forward. Do keep the affected leg in front as you sit or stand. Do use a high kitchen or barstool in the kitchen. Do kneel on the knee on the operated leg (the bad side). Do use ice to reduce pain and swelling, but remember that ice will diminish sensation. Don't apply ice directly to the skin; use an ice pack or wrap it in a damp towel. Do apply heat before exercising to assist with range of motion. Use a heating pad or hot, damp towel for 15 to 20 minutes. Do cut back on your exercises if your muscles begin

Total Knee and returning to sports and activities As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your knee replacement. Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist. Swimming is an excellent low-impact activity after a total knee replacement; you can begin as soon as the sutures have been removed and the wound is healed. In general, lower impact fitness activities such as golfing, bicycling, and light tennis will help increase the longevity of your knee and are preferable over high-impact activities such as jogging, racquetball and skiing. From the American Academy of Orthopaedic Surgeons

Think more about what the client can do, can achieve, and less about fear of restrictions and limits. In most client cases they had discontinued many high impact activities for several years so to return to them might not even be desired. The concern is primarily for wear and tear to the new joint replacement, not that certain activities must be avoided.

Huge variability in impairments means huge variability in functional abilities

Hierarchy of Physical Function

Functional Fitness Assessments

Senior Fitness Test Battery Chair Stand Arm Curl 8 Up and Go 2-min Step in Place Or 6 min Walk Chair Sit and Reach Back Scratch

Chair Stand Assesses lower-extremity strength under practical (functional) conditions Validated against 1RM leg press Number of times a person can rise from a chair in 30 seconds

Chair Stand Norms Women Men % Rank 60-64 65-69 70-74 75-79 60-64 65-69 70-74 75-79 90 20 18 18 17 22 21 20 20 80 18 16 16 16 20 19 18 18 70 17 15 15 14 19 18 17 16 60 16 14 14 13 17 16 16 15 50 15 14 13 12 16 15 14 14 40 14 13 12 12 15 14 13 13 30 12 12 11 11 14 13 12 12 20 11 11 10 9 13 11 11 10 10 9 9 8 8 11 9 9 8

8 Up and Go Assesses agility/dynamic balance How long it takes a person to rise from a chair, walk around a cone 8 away and return to their seat Older adults who required greater than 8.5 seconds to complete the UG were classified as fallers. Overall prediction rate of classification was 82%.

8 Up and Go Norms Women Men % Rank 60-64 65-69 70-74 75-79 60-64 65-69 70-74 75-79 90 3.7 4.1 4.0 4.3 3.0 3.6 3.6 3.5 80 4.2 4.6 4.7 5.0 3.6 4.1 4.2 4.3 70 4.6 5.0 5.2 5.5 4.0 4.5 4.6 4.9 60 4.9 5.3 5.6 5.9 4.4 4.8 5.0 5.4 50 5.2 5.6 6.0 6.3 4.7 5.1 5.3 5.9 40 5.5 5.9 6.4 6.7 5.0 5.4 5.6 6.4 30 5.8 6.2 6.8 7.1 5.4 5.7 6.0 6.9 20 6.2 6.6 7.3 7.6 5.8 6.1 6.4 7.5 10 6.7 7.1 8.0 8.3 6.4 6.6 7.0 8.3

Functional Circuits Level 1 New exerciser, frail to lower independent Level 2 Less experienced exerciser, independent Level 3 Experienced exerciser, independent to fit Level 4 Experienced exerciser, fit

Level 1 Circuit Low Function Focus: Strength, Balance, Mobility Chair Stands/Power Stands Walk the Plank (prop, bar against body, bar with body, tip and tilt) Standing two arm tubing chest press Single Leg Balance (prop, bar against body, bar with body, tip and tilt Standing March (prop, bar against body, bar with body, tip and tilt) Standing two-arm tubing row Step Ups alternating legs Ankle Sways Side Step with Reach Calf Raise on floor or step Modified Side Plank (no bar, with bar) Bridge (bar against body, bar with body) Bird Dog arms only Bird Dog legs only

Level 2 Circuit Mid Function Reverse Lunge (prop, bar against body, bar with body) Sleeping Dog front and back Pushup Monster Walk Standing reciprocating tubing row Sleeping Dog side to side Squat to Press Standing Rotation Staggered Stance Deadlift Heel-Toe Walk the Plank Side Step Ups with knee raise Side Lunge Bridge marching Bird Dog with alternating limb movement

Programming Strategies Sets and reps vs. Time intervals Pace, Rest Periods Volume Complexity Partner Drills, Group Work

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