I have a male client in his mid 20s who is in quite good shape (he is in a healthy body fat range and until recently was training 5-6 times per week with full body strength training and cardio work). Recently, he was diagnosed with psoriatic arthritis in his left ankle and the first three digits of his right hand. While I have tried to modify his training accordingly, I am having issues with making sure that he receives a full body workout. He has no issues with squatting, though any lunges or single leg work are causing pain, and he lacks a lot of stability in his ankle. I have removed running from his training and any other cardio that puts a high force on his ankle. His pain is much more severe in his right hand, and he is currently unable to complete any pulling exercises. I know that now more then ever it is important for this client to exercise, but how do I go about designing a program that will give him a whole body workout without causing further pain? I am especially concerned that his inability to do any pulling exercises may cause imbalance.
Psoriatic arthritis is part of a classification of inflammatory arthritis, very similar to the rheumatoid arthritis family. This disorder affects the connective tissue around small joints and causes a degeneration of the integrity of the joint capsules and soft tissue structures around the joints, creating instability and degeneration of the joint from the outside inward (versus osteoarthritis, which degenerates joints from the inside outward).
The common considerations that must be kept in mind during exercise is that too much loading, either intensity (weight loads) or volume (number of repetitions) can cause discomfort, primarily by aggravating the soft tissue (i.e. fascia, tendons). Reducing the total load will be beneficial. Each workout session will vary, depending how your client feels during the day, so my advice is to start with lesser total volume and get a toning workout rather than going for hypertrophy.
As far as his ability to squat, you may want to try and see if he can lunge with an arm reach to the lateral side or opposite lateral side. This will cause the calcaneus to either invert or evert and “clear” the path for the ankle to function without discomfort. You may also want to try a lateral or rotational lunge and see how he responds. Also, light loading through the incline leg press may help, as this does not work the ankle through all three planes of motion.
As far as pulling exercises, have him perform those with lat straps to take the load off of the hands and wrists, as these can also help keep the wrist in a more neutral position during periods of inflammation and pain.
Cardiovascular exercise can be achieved through cycling or elliptical style equipment, although I am not a fan of them. The elliptical will limit his ankle action, so it may be appropriate for him. Also, swimming or walking in the water may be beneficial during episodes of discomfort.
As a sufferer of inflammatory arthritis myself, it is frustrating from a physical and psychological level. However, exercise is very helpful in both areas, and it is important to keep moving, because movement is the gift that can bring relief, yet keep the total volume and intensity under control, as I have found that of a workout is too intense, it causes increased discomfort. If I can help further, please contact me through PTontheNET.com.