Weight training after total hip replacement (Full Version)

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Kaden -> Weight training after total hip replacement (February 14, 2011 12:53:30 PM)

I see the occasional total hip in my clinic but not very often and was hoping to get input from those that see them more often.

Obviously we have folks doing leg press, squat and other closed chain activities but I had a patient ask me about returning to weight training in the gym.  I told him this would be the call of the MD but MD did not really have a very specific opinion other than what he could tolerate...seemed to vague to me.

So I guess I am wondering what advice others give to there patients returning to the gym.  How much weight can they load on these joints with leg press and squat activities.

Or for that matter, even the patient not returning to the gym, but continuing with HEP closed chain work...how much do you let them add to there standing squat/knee bend activities.

Thanks for the input



Eric E Douglass, PT, DPT, OCS, FAAOMPT -> RE: Weight training after total hip replacement (February 15, 2011 12:53:39 PM)

quote:

ORIGINAL: Kaden

I see the occasional total hip in my clinic but not very often and was hoping to get input from those that see them more often.

Obviously we have folks doing leg press, squat and other closed chain activities but I had a patient ask me about returning to weight training in the gym.  I told him this would be the call of the MD but MD did not really have a very specific opinion other than what he could tolerate...seemed to vague to me.

So I guess I am wondering what advice others give to there patients returning to the gym.  How much weight can they load on these joints with leg press and squat activities.

Or for that matter, even the patient not returning to the gym, but continuing with HEP closed chain work...how much do you let them add to there standing squat/knee bend activities.

Thanks for the input


Ideally this is a conversation that occurs between the potential surgeon and the patient pre-operatively so that expectations and anticipated outcomes are matched with surgeon, technique and prosthesis.

In absence of that, in my experience, the vast majority of these patients are going to be fine resuming a normal gym program that might include circuit training on the machines and some form of aerobic activity. I usually ask them to emphasize closed chain activities and I like the eliptical over something like a treadmill. If their goal is to simply get back into and stay in healthy shape I ask them to pick a weight that they can do 2 sets of 20 times which, based on MET or STEP principles, will allow them to work on the functional qualities of endurance/coordination without over stressing the hip components.

We do see that occasional patient who is interested in bulking up, working on the functional qualities of speed and power and for these folks, whom you might ideally like to work in sets of 8 to 10 reps I would recommend a discussion with the surgeon regarding the health and integrity of the bone and surrounding musculature and potentially even the manufacturer of the prosthesis so that everyone involved has an understanding of potential risk vs. reward. Same goes for those folks who might wish to get back to snow skiing, singles tennis, water skiing, rock climbing, etc. Hope this helps!

Eric



Kaden -> RE: Weight training after total hip replacement (February 15, 2011 1:42:41 PM)

Thanks Eric,

I spoke with his surgeon today and he wants him carrying no more than 60 lbs long term.   He is fine with squats without weight and he can leg press body weight.

I will follow these guidelines obviously but sometimes it is frustrating how little agreement there is in this area.  I could not find with a lit search any general guidelines.

When you say most patients are fine resuming "normal gym activities" what kinds of weight are they using with leg press and squat activities.

Thanks again



Eric E Douglass, PT, DPT, OCS, FAAOMPT -> RE: Weight training after total hip replacement (February 15, 2011 2:01:00 PM)

quote:

ORIGINAL: Kaden

Thanks Eric,

I spoke with his surgeon today and he wants him carrying no more than 60 lbs long term.   He is fine with squats without weight and he can leg press body weight.

I will follow these guidelines obviously but sometimes it is frustrating how little agreement there is in this area.  I could not find with a lit search any general guidelines.

When you say most patients are fine resuming "normal gym activities" what kinds of weight are they using with leg press and squat activities.

Thanks again



Hello Kaden,
First, think about the quote from the surgeon, "no more than 60 pounds" would preclude walking and certainly ascending a flight of stairs, a perfect example of why these decisions should be made in consultation with the physician but not in absence of you. "What weight are they using" is also a very common question but one that can't really be answered, there is to much variation within the individual and between different types of gym equipment that any answer could set you up for difficulty. A better way to approach it, in my opinion, is to look at the work done by Odvar Holten (MET) and later refinded by Ola Grimsby and Jim Rivard (STEP) OPTP carries the Gimsby line of exercise texts (Scientific Therapuetic Exercise Progressions #1,2,3) which we have found an excellent resource. They dose exercise based on the functional quality you are trying to achieve and it is based on sets and repetitions that the patient is able to perform at a given speed and quality at a specific % of IRM. Check them out.



honker23 -> RE: Weight training after total hip replacement (February 16, 2011 8:49:57 AM)

I have had this discussion before with our docs after a PA called me and chewed me out because a TKA patient was using 60lbs on the leg press machine in a short arc.  I asked the PA if the patient was WBAT and if it was OK for them to go up stairs...yes...and if they were aware they weighed in at 245 lbs.  There was a little pause and then the PA said that shouldn't be a problem. 

As far as squats and leg press, I would start with body weight shallow squats and just progress as able, at least for the first 3 months. 



VagusX -> RE: Weight training after total hip replacement (February 16, 2011 10:11:22 PM)

At this time the National Hip Association has come to the conclusion that weight lifting after total hip is appropriate "with experience." I did a presentation on return to sport after replacements and I found a wide array of parameters outside of the Hip Association. It usually ends up with a discussion with the Surgeon about their expectations following surgery.

I usually go by the body weight parameters during the initial few months of rehab. I don't find the leg press to be very functional so I tend to avoid it in my clinic, but if they are looking to perform it when they are discharged I tell them to not perform more than 1/2 their body weight through one leg max and to maintain their hip precautions. That will usually satisfy their need to pump up their legs.



Tom Reeves DPT ATC -> RE: Weight training after total hip replacement (February 16, 2011 11:27:44 PM)

Personally, I don't have a problem with any closed chain exercises but do have a problem with leg presses. simply because the weights push the hip into max or near max flexion and the lifter has to get off of the machine without loading the hip. i.e. the pressing is fine but when they go to get off of the machine, they are in end range hip flexion in an essentially open chain situation, placing the hip at risk for dislocation.

my 2 cents.



Kaden -> RE: Weight training after total hip replacement (February 17, 2011 4:55:58 PM)

Thanks folks,

Eric, just to clarify, the surgeon did not want him loading more than 60lbs on top of body weight.  Vagus, I tend to like your recommendations of 1/2 body weight single leg work and body weight for closed chain bilateral work.



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