I have a client who recently had a tumor removed from the thoracic section of his back. He is done with physical therapy, and wants to get back some of the proprioception he lost. He has a hard time controlling the right leg, which was greatly affected. He is still limping a lot. Besides unilateral exercises and balance drills, are there any other good ideas you can give me?
It is difficult to give a specific response without consulting with your client’s physical therapist. We strongly recommend interacting with the medical community on any post surgical condition (as well as other medical conditions). This allows for a smooth transition from physical therapy exercise programming to personal training. Many times, clients are not given the medical visits necessary to reach optimal functional status. This common situation gives the personal trainer a great opportunity to help the world – providing trainers create the right exercise program!
The key to exercise is creating the right exercise. The most important approach for your client is a low load, whole body exercise plan. When applied properly, the program will appropriately load the deconditioned tissues, stimulate repair, remodel, recondition and enhance proprioception, while improving basic life functions.
Listed, are ideas to help in your program design:
- Think patterns, not muscles. Life is not isolated; the exercises should not be isolated!
- Always stay away from painful patterns. If your client is free to move while performing an exercise, he will unconsciously migrate from pain. Use natural exercises to assess movement abilities, and do not train on fixed pieces of equipment!
- High repetition and low resistance exercises provide an effective starting point.
- If your client is unable to control his balance, chances are that standing exercises with repetitive loads will be uncomfortable. Solution: Start with the more challenging exercises first. Monitor your client’s fatigue levels carefully and adjust accordingly. If loss of balance and control becomes a factor, add as much outside support as necessary to control the movement. The extreme will be lying down. The key is to “micro-simplify.” If you simplify too much (fixed machine training), your client will not gain much from the exercise program.
Supported exercise examples that have functional relevance include:
De-weighted squat on a cable cross system, allowing you to de-weight your client. The cable(s) handle is placed above their head with an appropriate load to assist the squat (this has worked very well for many of my clients that have lower body dysfunction and cannot free squat).
Wall squat using a stability ball.
Dumbbell or cable chest/shoulder presses using a stability ball as the bench.
Stability ball pull (depicted)
Goal: While maintaining perfect posture (head, shoulders, hips, and knees parallel to the floor), pull one arm toward the body.
How your client benefits: To name a few: stabilizer strength, balance, strength in the neck, back, shoulder girdle.
- To balance and control the body in everyday movements, your brain must constantly process information. The seated American lifestyle can diminish and delay this ability. By performing exercises on the stability ball, specifically those that involve balance and coordination, you can improve sensory input. Increasing sensory input helps to improve every client’s life!
- Concentrate on the other 23 hours in the day your client is not with you. Too many clients think exercises are gym related. Movement, posture, and daily activities are all exercises with different levels of intensities. Teach your client how to sit at home, in the car, and at work. Work on movement skills that help regain control of body function.
- Once the program is designed, call the physician to confirm clearance and explain your exercise goals. Because the resistance program is designed to fortify function, you will probably end up with a lot of referrals!
Based on the information you submitted, your client will benefit from a functionally balanced program. Even if there were a protocol for every client’s problem, it would only target the problem at that point and time. The goal with all dysfunctions is to holistically approach the body; in other words, work with other specialists to get your client to function as best as he possibly can! Good luck!