I have a new client who needs to avoid hip flexion exercises because of low cartilage. (She is young and otherwise fit.) I’m trying to compile a list of lower-body exercises. She’s allowed to do body-weight squats. She’s not allowed to do lunges or anything that brings her hip up more than 90 degrees. I’d imagine things like reverse hypers or hamstring curls or bridges are okay. What about romanian deadlifts? Hip thrusts?
Hi All! My client explained that she had a cam deformity. The top of her femur was thickened so it wore unevenly in the hip joint and partially tore the labrum. In the surgery, they reshaped the bone, but also scraped out some cartilage that was shredded. She’s now missing cartilage on about quarter of her femur. In general, she feels tight in her low back and glute. When she has pain, she feels like she’s been hit with a hammer in the hip joint and the pain radiates down the side of her leg.
When she did pt, they had her doing exercises like clam shells, bridges, single-leg squats, and side plank. (When I programmed for her first workout, I warmed her up with all of those exercises [except SL squats] and included SL machine knee extensions and SL machine hamstring curls in her workout.)
I can give her squatting movements and low step ups and other lower-body pushing movements, but I’m at at a loss for lower-body pulling movements that won’t put her hip into flexion and potentially exacerbate the issue. Do you think that’s okay or will that create/perpetuate an imbalance?
If your client can remember, you might want to find out a little more about the surgery, at least within your scope of understanding and practice. Not so that you can rehabilitate her if corrective exercise is out of your scope, but so that you can better anticipate what will work for her.
She might not remember. I have some clients that can recite their medical history by heard, and I have one client who cant remember which knee had which injury and whether it was the lateral or medial meniscus, because both knees still hurt.
If you don’t have a pool at your gym, you could recommend pool exercises for the days that she isn’t working out with you. It’s OK to recommend things that we don’t teach / train, as long as you define that as part of your training relationship. I use a sort of “hub and spoke” method of training. I’m the “hub” or “lead” trainer, but if there is someone else that would be good for my client, I’ll talk to that trainer first and say, “Hey, can you work with client X in the pool for four sessions and then report back to me what you learned?” then I’m comfortable cross-referring to another professional. It’s about building a network of other trainers who you trust and will mutually refer for specialties.
All good stuff in these answers. Swimming and deep water, and maybe shallow water exercises are my first thought. I would run it past her surgeon, physician and/or Physical Therapist. Working with anyone post rehab/surgery should include getting regular recommendations from her healthcare team. I would ask these folks if they want you to update them on her program as well. If she is young and has a cartilage issue, it will be an evolving treatment plan.
what kind of surgery did she have? Since it was in December, she can be at best 6 weeks post-op. Do you have a physician’s approval? Did she see a physical therapist?