We have discussed some training principles for a healthy hip, a hip with varying stages of osteoarthritis, and a hip post-surgery. In a group class setting, rather than calling a condition out, instructors should be prepared to provide safe and effective exercises with one or two variations that empower participants with options that best fit their personal needs.
Following are additional training principles that can be beneficial when teaching exercise to a participant with hip osteoarthritis.
1) Start small.
Teach exercise sets with lighter resistance and higher repetitions. SilverSneakers strength training principles recommend introducing the movement at a slower tempo with 2 – 4 reps, increasing or changing the tempo with 8 – 12 reps, and concluding the exercise with a moderate isometric hold or pulse, preparing to transition into the next exercise. This is only a guide. Use good judgement for the exercise, muscle group, and tool you are working with.
2) Provide rest.
Change repetitions to provide more pauses in training. For example, if you are teaching hip flexion to a participant in a seated position or a mixed group of both seated and standing positions, rather than teaching four or eight knee lifts in a row, teach two knee lifts followed by a calf raise with varying tempos. The movement continues functional training while providing a break for the hip flexors.
Instructor safety tip: Repetitive marching or knee lifts from a seated position is considered a higher risk and potentially inappropriate movement due to faster potential for hip flexor fatigue and overuse in a muscle group that is already generally “strong”. Encourage class participants to exercise from a standing position if possible. For those participants requiring exercise from a seated position, limit marching and knee lifts from a seated position.
3) Encourage pain-free movement.
Provide flexibility exercises that do not elicit pain and within a pain-free range of motion. Focus on stretching the muscles of the hip to include the glutes, hamstrings, hip adductors, hip abductors, and hip external rotators.
4) Challenge balance.
Progress balance exercise training from bilateral balance (two feet on the ground) to single leg balance exercises to balance exercises with changes in proprioception, such as rotating head or closing eyes. When performing balance exercises, avoid weight bearing activity for an extended period of time.
5) Teach functional movements.
Teach exercises that incorporate functional training in the five primary movement patterns such as:
- Bend and lift movements (standing up from a chair, lifting a laundry basket off the floor)
- Single-leg movements (walking, climbing stairs)
- Upper-body pushing (pushing a grandchild on a swing, propping oneself up from a side lying position)
- Upper-body pulling (opening a car door, vacuuming)
- Rotational movements (shoveling snow, putting on your seatbelt)
6) Choose impact options wisely.
Repetitive high-impact activities should be avoided. A non-impact version should be presented first, followed by a low-impact option. Higher impact variations may be introduced, but avoid repetitive high impact-training.
For example, a “jump rope” exercise may be introduced with a controlled “tempo” calf raise and wrist rotations. A low-impact progression may be offered by increasing the tempo to create a “double heel bounce”. A high-impact option may be suggested with “one jump” and continuing the low or non-impact version of the exercise.
7) Limit range.
Avoid deep squats or lunges. Provide range of motion and rhythmic variations for all movements.
8) Limit repetitive movement.
As an example, instead of a set of 8 single squats, teach 2 half-time squats followed by a walk in-place and progress to an alternating squat right and left followed by alternating knee lifts. The change in speed and orientation affects the load on the joint and may make the series of exercise more “doable” for participants with hip osteoarthritis or other limitations.