PT on the Net Research

Injured, Fragile and Obese


I have a 52-year-old female client with a body mass index of 45.9. She has had knee damage due to someone falling onto her and has had two knee washes, although she still suffers. The bike proves manageable but uncomfortable. The rower and stepper are a complete no. The x trainer is okay at Level 1 for about four minutes. Ten minutes on the treadmill at an average walking pace causes a severe limp. Any ideas on how I can help this client lose weight/body fat with very limited exercises available? We do work the upper body and core using a Swiss Ball, but any lower body exercises, at the moment, are out of the question.


First of all, if you haven't already, I would recommend gaining a medical clearance to train the client from her supervising doctor(s) (i.e., medical, orthopedic, etc.). 

Secondly, I'm not sure by your question if she has/is/will be seeing a physical therapist. If she has been, I would recommend working closely with the individual(s) as well as any of her doctors to gain a specific understanding of your client's injury (i.e., the exact tissues involved), what rehab she is/has been participating in and what level of progress - or lack thereof - she has experienced. After learning of the specifics of her injury(s), you may come to the realization that your client’s condition is beyond your current level of education, and you may need to refer her out to someone more qualified. If this happens, fear not, for you have been afforded an AWESOME opportunity to up-educate yourself!

If you decide to keep her on as a client, than this is what I would recommend:

  1. Your client is obese and chronically injured. It is important to understand that obesity (as well as many other chronic degenerative diseases) is a huge red flag and essentially symptoms/manifestations of:
    • Digestive dysfunction (excess body fat is a display in inefficient energy conversion)
    • Hormonal dysregulation (everything we eat has a hormonal consequence)
    • Generalized toxicity (toxins the body cannot properly deal with get stored in bodyfat)
    • Energetic/spiritual blockage(s) (the holding/storing of energy[fat & calories] can represent a repressing of the soul's natural desire to express and create)
    • Chronic Sympathetic Stress (the stress response can contribute to weight gain/fat storage) 
    • Postural/orthopedic stress (due to excessive weight)
    • Many possible others...
  2. It is for this reason that I would be very careful about having her perform a lot of repetitive CV exercise, ESPECIALLY since it causes her joint pain. Remember that pain reprograms the CNS (central nervous system) quicker and more efficiently than virtually anything else. What this means is that every time she causes more damage/pain to the knee, the body is learning to compensate (read: cheat) more and more biomechanically. This compensation in her movement/gait patterns can potentially cause more problems now and in the future.
  3. CV exercise can also cause more harm than good in regards to your client’s current levels of sympathetic stress and how this relates to her ability to loose weight and heal. For more on this, please read “Cardio Training” by Paul Chek as well as my Q&A article titled “Stress & Exercise – the Good and the Bad.” 
  4. In fact, as much as this may shock some of you, she may need very minimal actual "intentional" exercise as this may only increase her body's current total excessive stress load at this time. For a couple of great articles on this topic go to and read the articles: "The 'No Workout' Workout" and "Flatten Your Abs Forever" both by Paul Chek. These will help to give you an understanding that exercise is not a cure-all. There must be other factors in place as well, which leads me to my next point.
  5. Your client must begin to implement what I've referred to over and over again as the "Foundational Health Principles" in order to give her body the opportunity to experience benefit from her exercise. There are no words to describe how vital these principles truly are in the context of regaining total health. For more on this, you can read several Q&As including:
  6. And finally, if you learn nothing else from this information, please learn this: Losing weight is a mere "by-product" of achieving optimal health physically, mentally/emotionally and spiritually.