I have a 74 year old male client who is awaiting a knee replacement (the other knee has already been replaced). He has had numerous surgeries (quadruple bypass, brain stem, removal of fluid from his knee, etc.) and is a real trooper. He cannot stand for very long so I have been doing most of my workouts with him in a chair. He would like to build more leg strength so he can stop using his walker and use a cane but it is very difficult to work his lower body with strength building exercises. Any suggestions on what I should be doing to (1) build his leg strength up and (2) keep him from getting frustrated until he gets his knee surgery?
maybe start by assessing his R.O.M. without pain with motions like assisted squats(utilizing hands to stabilize & guide his motion). Testing his neg & pos motion ability here SLOWLY…
I have also utilized isometric contractions n the past 4 clients with very limited R.O.M. in the lower body, thera bands offer moderate/adequate resistance.
If available, I like the idea of working n water also. What will b big I think is to have both of your confidence levels up. U can feed off each other, especially if he is willing 2 put n a good effort.
SAFELY is the key word here. When we take on clients w/medical complications we are @ as much risk as they. If u have his trust, work him, if he does well w/basics offer him a challenge like assited sitting & standing from & to seated position(1/4 motions) but stress to him the importance of HIP GUIDED MOTION(move hips 1st) & knee & toe alignment, then tempo(always SLOW).
Most things said here, I tend to agree with. Due to the circumstances, however, I think that for knee flexion and knee extension I would only work off of the recommendations offered by a physical therapist. I would also get all other exercises approved.
I think that Judy did a great job of keeping the client’s needs in mind here. Were this my client and I had the resources available to me, He would without a doubt start his training out in a pool setting using proper floatation assistance. I think there are only benefits here. Less load on the joint during motion being my primary concern. With this client not being able to stand up for an extended period of time, you have to train functionality and stability in that joint as much as you can. That limits the strength building part of this client’s plan quite a bit. A step at a time is the only way to go, especially with much older clients, having worked with a few of them, myself.
I think the pool would also be a fun addition to the training. I’ve never known someone not to have a fun time in the water! It’s a great change from the “land-lubber” existence that we have most of the time. =)
I agree with some of the others, just standing and sitting into a chair is a great way to increase his leg strength. After warming up, I always start my 85 year old client’s session with this exercise, with a small inflated ball between her knees to help with form. Other exercises I have her do are assisted step-ups onto a low platform. On her bed we do supine marching and bridges, a leg press (using my body as resistance). Recently we have started doing standing agility activities to increase her quickness, reaction, balance, speed (some assisted and some she can do on her own). We do these with her standing with her bed behind her and me in front of her, spotting her closely. Many times the frail elderly lose strength in their legs because of their fear of falling–they go from walking to shuffling-never picking up their legs. Agility drills can help with this, giving them a boost of confidence. Hope that helps!
All of the above answers sound great, but I would suggest adding some cardio to the routine as well. Part of his problem with standing for long periods of time may be that he doesn’t have the stamina. I usually start my older clients out on a recumbant bike or a Nu-Step for 5-10 minutes and progress them from there based on how well they are doing. This will also help build his knee strength. He may have already been riding a stationary bike after his first knee replacement so maybe that would be a good place to start. If you have access to his doctor or physical therapist it would likely be very beneficial to ask for their input.
Depending on his doctors restrictions and his physical therapists exercises, I would have him do “isometrics” lying on a bed with neck support, I use pillows for my clients. All leg muscles can be worked in this manner.
Have him sit up at the end of the bed in between exercises and do gentle shoulder circles or light bicep curls as he will need upper body strength as well.
Clear any new exercises with his doc