Reviewing Common Hip Problems:
With group exercise an instructor is typically faced with a variety of clientele. Realize the Total Hip Replacements (THR) and Arthritic hips are two different medical conditions so there are some common recommendations as well as always specific recommendations.
HISTORY: Degenerative joint disease, also known as osteoarthritis, is a chronic inflammatory process marked by acute flare-ups. The disease has a progressive deterioration, which can be slowed by an appropriately designed exercise program. When the hip joint surfaces have worn thin, causing pain and a loss of function, a total joint replacement is an option. A total hip replacement consists of a prosthetic hip joint with two parts:
1. A metal ball and stem which fits into the femur (femoral component)
2. A plastic (high density polyethylene) cup commonly supported by metal shell which then fits into the acetabulum in the pelvic bone.
The general recommendations for programming with all common hip problems is t to work primarily in straight planes ( so no twisting and shearing of the spine). Utilize a lot of sideways & backwards walking patterns to maintain function and gait. Avoid rebounding and utilize a modified rebound technique for cardiovascular training. Modified rebound is a technique whereby the person does a squatting movement with one foot on the ground at all times and then lifts up from there and there is no rebounding or flight with the movement. In other words a person may work without impact or jarring on the joints. In doing so, you will train intensity without vertical stress or impact. Note that cardiovascular training is excellent for heart heath and circulation as well as it will elicit endorphins and a sense of “happiness”. However, it is not the main focus of the program. Stretching, strengthening, balancing and stabilizing the musculature around the joints is more critical. Therefore, utilize a lots of low impact exercises that are low to moderate intensity intervals.
For participant with total hip replacement (ideally check with surgeon) to determine the type of movements contraindicated ( if any).
Depending on surgery type an anterior incision has 3 contraindications. Realize that they may be fine with any movement ;however, if the client doesn’t know err on the side of caution and
1. Avoid crossing the midline with legs such as cross jax or ankle touches or a twizzle step
2. Avoid internal rotation of hip such as twizzle or a hand to opposite knee across the midline of the body, etc
3. Avoid flexing past 90 Degrees or hip height such as deep squat, high knees, flexion of the waist to go into front crawl ( if swimming) , V sit, L sit, etc
4. Decrease size of stride length and then gradually increase stride length
What you may focus on is strengthening & stabilizing the musculature around the joints.
Focus on Strengthen the gluteus maximus , hamstrings and abductors. The abductor muscles may be easily engaged with a sliding side walk or lead leg push out. Conversely strengthen the opposing adductor muscles groups with a pull in or slide in. Strengthen the gluteus maximus and hamstrings with a skateboarding ( pulling down and back and conversely reverse direction with the skateboard for strengthening the quadriceps and Tibialis anterior musculature. Avoid
Stretch the Abductors, Gluteus Maximus, Hamstrings, Quadriceps
Stretch the abductor and gluteus maximus with a modified stretch for THR is sitting off the hip for IT band or hip abductor or gluteus maximus. Be aware of buoyancy -be careful of end range stretching. Stretching too much range of motion will cause more damage. Always cue your clients to stop prior to 75% of range ( as buoyancy will assist the movement approximately another 10-15%)
Train Balance to prevent falls and maximize core work. Work on hip stability for better tracking and hip/knee/toe alignment. For example instead of taking a one foot hold with the knee up ( which would be past 90 hip flexion) take the leg back or one foot hold with the free leg back ( like a hamstring curl) This will inevitably helps to protect from falls and improve balance.
Work on Tracking of the Hips, Knees and Toes. Keep the alignment parallel or so that there is less torque and wear and tear on the hips, knees and back. Some people walk with knock knees whereas others walk with duck feet. Try to keep the hips, knees and toes facing forwards.
General Goals: To provide overall physical improvement for performing daily activities such as household tasks, social events and sports. A program that will improve quality of life by decreasing pain, swelling and stiffness and increasing joint range of motion, agility, balance and strength. Every exercise or movement should be PAIN FREE!. Note not all bodies move nor react the same to movement.
Safety Concerns: Participants need to be screened thoroughly before taking part in a program so that you know which surgery you are dealing with. There is no one size fits all approach. Establish a person’s pain, range of motion and muscle strength. Make sure that they are cleared for an exercise program by their orthopedic surgeon.
Note that many people have multiple conditions i.e , a hip or knee replacement, a mastectomy, lower back problems, osteoporosis, diabetes, hypertension or just general depression. Additionally, some people may have a much lower tolerance for pain than others. Always enquire how participants are feeling before beginning a program. Give permission for everyone to or encourage everyone to do as much or as little as they wish and, at their own pace. Advise stopping an exercise if pain becomes a factor and be ready to offer modifications or alternative movements. Some participants may not be able to complete a whole program when they first begin to exercise. Let them know it is perfectly acceptable for them to get out of the water, if necessary.
Hydrostatic pressure on submerged joints helps reduce swelling and decreases the load on the joints. Transitional depth water offers buoyant support with minimal joint stress, but this depth may be too deep for a non-swimmer or beginner which may make them nervous. Also the buoyancy at this depth may prove too difficult to balance and overcome the buoyancy for a successful workout. A participant should always work in a water depth that provides comfort, safety and success, both physically and mentally.
Advise participants to wear shoes to prevent slipping and improve stability. Use aquatic mitts for increased surface area for their posture and balance in the water. If the pool water is cool suggest dressing for success or adding a thermal vest, water shirt or leggings. It takes approximately 4.2 METS of energy to thermal-regulate at 84 F or 28.5 Celsius. That would be the equivalent of walking at a very brisk pace. Realize if the client has not done activity in awhile – it is more difficult to thermal-regulate as they no longer have the muscle mass to generate the heat or intensity.
For More Information Check Out
Programming for Common Medical Conditions – Laminated Cards.
Programming for Common Hip, Knee, Back and Shoulder problems ( DVD059-DVD063)
KCW021 Programming for Common Medical Conditions - 8.0 Hours
Written by Julie Twynham
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