Small Group Training – Is it Personal Training or Group Exercise?

As club owners, department heads or fitness professionals, we have to earn a living like everyone else. Some members can’t financially afford to purchase a private one hour session with a personal trainer so we began offering half hour sessions in the late 90’s. As a personal trainer I resisted this concept, however, as a program director I could see the financial benefits. The shorter sessions are more economical and allowed more people the financial flexibility to experience personal training and hopefully upgrade to an hour session. In fitness we often don’t have the ability to get what we want from the public so we end up lowering the benchmark. It’s like having a classroom full of unruly children who refuse to learn. Since they aren’t our children we can’t make them do anything, therefore in lieu of failing them all we grade on a bell-curve and a C becomes an A. It’s gotten to the point where we’re even begging people to take the stairs or park further from the grocery store to meet some basic exercise requirement. Now, we’re marketing small group training classes and charging for them in hopes to gain or regain personal training revenue.
Does it work?
Financially, it does. IDEA listed small group training as 9th in the Top Ten Programming Trends for 2011. A trainer was quoted stating she felt clients received the same or better-quality training from the small group. Is this possible? If the trainer is the constant then the only “better-quality” training received would have to come from the participants. Matching the participants successfully is the key.
Here’s where I believe we need to plan better.
If we’re going to separate small group training from group exercise in general then there should be some difference other than just the number of participants, otherwise riding in a chauffeured limo would be the same as riding in a bus. The benefits of one-on-one personal training is that the program can be constantly personalized every workout to adjust for improvements, sickness, work schedules, unexpected travel or unexpected life for that matter. Some fitness goals require specialized equipment and acute exercise variables that must be closely matched to reach those particular goals. This is very difficult to obtain in a small group unless the participants not only have the same goals but are at the same level in pursuing those goals. This is where the success lies with the instructor. A good instructor can modify an activity very quickly to serve the participant who is having difficulty completing the task or the task has become too easy for the participant.
My suggestion is to create specific guidelines in a macro-cycle for general specific goals. Selling personal training in macro-cycles also allows us to present long-term packages over a period of a year; which is really the way we all should train. There are four components to any workout:
• Strength
• Cardiovascular
• Proprioception
• Flexibility

Like four legs on a table they should be conceptionally balanced for the client’s specific goal. Some goals may require more of one or more of the components based on their goals and their bodies, but a trainer must consider these four components anytime we design programming.
For example:
Macro-cycle 1 (8 weeks)
Stability and aerobic exercise is the focus. Here’s an example of using one exercise and progressing over the macro-cycle for a small group meeting three times a week. The group begins the exercises on stable ground and slowly progress to unstable surfaces.

– Week 1: Stability ball wall squat
– Week 2: Two legged body weight squat
– Week 3: Back squat with a bar
– Week 4: Squat on a balance board
– Week 5: Squat on a ½ foam roller
– Week 6 : Squat on a dyna disc
– Week 7: Squat on a BOSU ball
– Week 8: Asymmetrical squat (descend with both legs but ascend with one)

As you can see, there is a progression. If a participant were to join the group in week 5 they might not be able to perform this type of exercise. Here’s another simple example of progression using a basic exercise like the dumbbell press while keeping the goal of stability in mind.

– Week 1: Lift with both hands standing with the legs at shoulder-width wide stance.
– Week 2: Progress to a single-handed or unilateral lift. Keep the dumbbells in both hands
– but only lift with one arm at a time.
– Week 3: Now drop one of the weights and lift with only one arm at a time.
– Week 4: Stand with a wide stance and lift one leg off the ground. Begin by pressing with
both arms.
– Week 5: Now progress to lifting with one arm and one leg; right foot is off the ground
and right arm is pressing, however, you still have weights in both hands
– Week 6: Still loaded on both sides, progress to the opposite arm over the unsupported leg.
– Week 7: Now, drop one of the dumbbells and repeat the same progression as above.
Right arm over the right stance leg, then left arm over the right stance leg.
– Week 8: Begin the entire sequence from the top with the non-dominant eye closed then repeat the entire sequence with the dominant eye closed.

By sitting down and planning different groups for different goals you’ll be able to match the participants correctly, have them look forward to their next macro cycle, train them correctly and easily substitute trainers when needed. Otherwise your small group training is really group exercise with less participants. This isn’t a bad thing, we get people exercising, but it might help in your validation for the extra fees for the small group classes.

Side Plank?

Mr. Dawes,

I was really surprised at the article published in the recent Strength and Conditioning Journal entitled “the Reverse Side Plank/Bridge: An Alternative Exercise for Core Training” I felt like I was looking at a Shape Magazine.

1. No human on the planet would ever have a reason to support their body, 90 degrees to the ground with a locked knee, especially on the edge of the foot. Gymnasts don’t even perform this in their sport! If they did, it would be for a few seconds; if even that.
2. Structure determines function. Since there is no reason for a human to ever be in that position, both the LCL and the MCL aren’t that strong in that plane of motion.
3. Even if the intent were to strengthen the tissue in those ligaments (pre or post surgery)how would measure it? What standard would you put a living ligament up against?

In my opinion, the premise of the article is absurd! How to alleviate forces to a ball and socket joint who’s structure is clearly more adept at dealing with forces at 90 degrees to any axis, so a person can introduce forces at 90 degrees to a hinge joint?

For example, in wrestling or MMA fighting, if an athlete were trying to get an opponent off of them they would never attempt a side plank with their leg locked. The moment arm is too long. Any fighter or wrestler would bend the knee to shorten the moment arm. The photo in Figure 1, letter A is a much better version for health care professionals to explore as a core exercise. However, if people are experiencing shoulder pain/fatigue because they’re leaning on their shoulder with a portion of their own body weight, then either they’re too heavy and/or, they need shoulder strength. Many people sleep on their side and although they’re not up on the edge of the foot (why would they be?)they should be able to lie on their side with their body weight for more than 180 seconds!
I’m a Stuart McGill fan but when it comes to a side plank I fervently disagree. The Biering/Sorenson mentioned in the article is a test for nonspecific back pain and is performed in the saggital plane. Mr. McGill may use the side plank in the same manner as a test, however, if he or anyone else uses the side plank as a training tool, I’d find it hard pressed not to question their judgment.

Here’s why:
1. Even if the side plank did increase core strength, what’s the point? There is no activity or sport performed in this position. Why strengthen a position that is never used?
2. The ground reaction forces are all wrong. No one performs anything on the lateral side of their foot.
3. It stresses the knee at 90 degrees to the joint.
4. Are the muscles used accordingly i.e., transference of training to what?
5. There are so many other options, why risk the knee?

Many times our desire to be creative gets in the way with the basics. In my opinion, not performing a side plank is just common sense. In fact, I never saw anyone perform a side plank prior to 2000. Maybe even 2002.
We need to be careful, magazine writers who are not fitness professionals often create exercises in order to have something to write about. Their criteria, often is what looks cool, not exactly
what is functionally correct. I see this all the time at magazine stands, in fact, I film videos to educate the public in regards to this matter. I don’t mean to be negative.
I tore my meniscus in 2007 performing a side plank in front of 300 people at a convention in Sao Paulo, Brazil. I have it on film. It took 30 seconds. I was demonstrating a study I had discovered that showed there was 33% more activation of the lower abdominals (it didn’t mention anything about force production)while performing a side plank on a stability ball. The point I was making, was although you might have more activation in the lower abdominals, the knee could be damaged. Embarrassingly enough, not to mention the pain and financial cost of the 30 seconds……. Unfortunately, I made my point.
Please forward this to Mr. Tvrdy. Hopefully, this will save some more knees.

Fat Loss Studies Can Be Misleading

Recently an article was published in the May, 2012 issue of the IDEA Fitness Journal trade magazine entitled Eating or Fasting For Fat Loss: A controversy Resolved, by Dr. Len Kravitz PhD.”

First, let me say I’m a big fan of Dr. Kravitz, however, I do have some questions and comments in regards to his article.
In the study, he had eight men who didn’t eat breakfast before they trained but a “normal” breakfast after their workout and then had the same eight men eat a 673-calorie Mediterranean breakfast before training to see which version burned more fat during the day by fasting or not fasting before a workout.

1. There were only eight “trained” men with an average height of 70 inches and weighing 207 pounds. At 5’10 and 207 pounds how were they “trained?” He never mentions their lactate threshold. Why is this important? Although he had the volunteers do a 36-minute cardiovascular workout on a treadmill at 65% of the heart rate reserve, it doesn’t tell me everything I need to know. For example, an aerobically trained athlete won’t go anaerobic until 90+% of the heart rate reserve so at 65% this kind of athlete wouldn’t be perceiving much intensity, therefore the post exercise consumption (EPOC) wouldn’t be much since EPOC increases because of intensity. An aerobically trained athlete wouldn’t be burning much sugar at that intensity either. I would have liked to have seen this data to help get a picture of what kind of aerobic fitness level these eight subjects had. I don’t have many male clients that are 5’10 and 207 pounds.

2. In a chart, Dr. Kravitz demonstrates the post exercise oxygen consumption at the 12-hour and the 24-hour mark. The chart shows the eight subjects burned slightly more calories because they had a higher EPOC and a lower RER (Respiratory Exchange Ratio). As RER rises the body uses more carbohydrate for its energy needs. In essence, the article misleading leads us to believe they were burning more calories but the calories were not from sugar which I will explain better below. I would’ve liked to see the rest of the math. Although, their EPOC was higher, they did eat 673 more calories for that day. Did the 673 calories offset the higher EPOC? At the end of the day, did the subjects end up in a caloric deficit? Did they lose body fat? In the fasting week, the subjects ate a “normal” breakfast after the workout. The caloric intake for that breakfast was never defined, so we don’t know the total daily caloric intake for both groups.

3. According to the chart, there was only a .3 ml O2/kg/min difference between the groups at the 12-hour mark and even less at the 24-hour mark! Although the RER was slightly higher (and I mean slightly) in the fasting group workouts, both of the groups were burning a mixture of carbohydrates and fat. An RER of 0.70 indicates that fat is the predominant fuel source, RER of 0.85 suggests a mix of fat and carbohydrates, and a value of 1.00 or above is indicative of carbohydrate being the predominant fuel source. The RER for the non-fasting week was 8.0 at 12 hours and 8.25 and 24 hours while the fasting group was at 8.25 and 8.75.

Without knowing the rest of the math, I don’t disagree that the controversy is “busted” or resolved.

Mufasa – The Angel Who Saved My Life

Last Friday night I was out riding my mountain bike with my dog Mufasa. We normally do this twice a day once in the morning and once in the evening. We regularly do a loop around a college campus by our house. On our way home I went to cross the street from the college parking lot and saw a car coming. It seemed to be slowing down to enter the college parking lot. It was too dark to see the driver’s face however, as I entered the lane to cross the street I realized he wasn’t going to slow down at all! I quickly tried to pull Mufasa out of the way. Mufasa is a 90lb boxer and he resisted a little. He probably didn’t understand why I would change direction when we were on our normal route home. I wasn’t able to get us out of the way. I guess the driver never saw us because there was no sound nor screech, however I’ll never forget the sound of the collision. He hit Mufasa first, sending him about 150 feet. Then he hit me….. It stunned me. I could see the headlights right above my head. I was hurting all over but all I could think about was my dog. Oddly enough, my cell phone rang but I ignored it. I couldn’t see Mufasa and spotted him down the road trying to get up…. but he fell. My heart broke. How could have this happened? I immediately got up to run to him but fell to the ground. I had a fractured leg. I then started to crawl. I just kept saying “my dog, my dog.” The man who hit me got out of the car and told me to stop moving and that I could be hurt. I just kept saying “my dog, my dog.” I asked him to help me up, which he did, and with his help I hopped down the street. When I reached Mufasa I fell to the ground and started to speak to him and pet him. He was alive but freaked out. His eyes wide open and panting heavily he made no sound. No whimper or whine, he just stared at me. This all occurred within one minute. I reached into my jacket pocket and called my girlfriend Stephanie. I was lucky; she normally doesn’t answer her phone. I told her what happened and hoped she would come soon. The paramedics were first to arrive. My hands were stinging, my shoulder and right leg were hurting, but it was my left leg that was killing me. It was huge and had a big dent in it. The paramedics wanted to put a neck brace on me but I wouldn’t be able to see Mufasa so I signed a document denying a neck brace. They placed me on a gurney but kindly left it low enough so I could keep talking and touching Mufasa. Luckily, Stephanie arrived with her Mother and helped with Mufasa. My leg felt like it was going to blow up, but all I cared about was Mufasa.

Mufasa was just over four years old. He was with me every day. He went to work with me, bike races, haircut, bike shop……. wherever I went, Mufasa went with me. He’s been to Utah, Nevada, Arizona and all over California. When I won Nationals, he was there. When I slept in my van at Onyx Summit for altitude training he was there. When I got hypothermia at last year’s Callville Classic bicycle race it was Mufasa who kept me warm in the van after the race. If it wasn’t for Mufasa I wouldn’t know any of my neighbors, the mechanics at the local gas station and most importantly, my wonderful girlfriend who was now at our side. My blood pressure was descending and the pain was getting worse and worse. The fire department and the sheriffs were at the site. One of the sheriffs asked the paramedic why my bike was so far away…….
My pain was increasing. We had to go. I asked Stephanie to take Mufasa to the pet emergency and to call me with whatever was needed. We headed out and in about two minutes my blood pressure dropped to 70/30! They hit the siren and in about four minutes I was being rolled into the emergency entrance of the hospital. The paramedics, Justin and Lindsay were compassionate, caring and gentle. I was very fortunate to have them. This kind of emergency had never happened to me before. A stove once blew up in my face but I didn’t go to an emergency. As they wheel you in, a whole bunch of people start asking you questions. A doctor asked why I wasn’t in a neck brace. I told him my neck was fine. He basically told me to shut up and let him do his job and I got a neck brace. Then the trauma surgeon came in. He introduced himself, asked a bunch of questions and began to check my trunk and pelvis first, then my extremities. My phone started ringing. I thought it might be Stephanie but it was my sister in Florida. Don’t know why she was calling at 11:00pm her time but with everything going on around me I couldn’t answer. I was going into shock. I started to shake and I was getting really cold. The phone rang again but it wasn’t Stephanie so I didn’t answer. I was embarrassed that my phone kept ringing while all these people were trying to attend to me. I had to keep it on in case Stephanie called. When she did, it wasn’t good. A fireman had helped carry Mufasa to the back seat of her car while she carried his head. A student from the college offered to drive her car while her Mother sat in the front seat. Another student put my bike and her car and followed them to the pet emergency. Mufasa’s heart had stopped in the car. As they arrived, Stephanie started screaming that his heart had stopped so they probably began a similar process that was occurring with me. Stephanie then asked me for permission for the vet to do open-heart surgery to save Mufasa. I told her they could do whatever was needed; I didn’t care how much it cost. They wheeled me down for a CAT scan but I was shaking so bad they couldn’t do it. After they covered me with three or four really warm blankets I was able to stop shaking enough so they could do the scan.
Back to the emergency room where I lay alone with my neck brace on. “Please don’t die, please don’t die, please don’t die,” I repeated over and over. My phone rang again. I called for someone to please hand it to me. It was Stephanie but she couldn’t speak. A voice came on the phone; it was the vet. Mufasa had passed. His spine had been fractured in two places and with all the internal bleeding he died. I just started to cry. It was the worst feeling I’ve ever had. I had lost my Grandmother and my Father but they were both older, had lived long lives and were unhealthy. This dog wasn’t even five years old yet. He was the sweetest, friendliest, innocent, living creature I had ever known. Because of him I had met all of my neighbors and my girlfriend. He taught me how to be responsible for another living thing. He taught me the meaning of loyalty and unconditional love and friendship. If he hadn’t been hit first, the man might have run me right over. Mufasa saved my life. I feel so guilty. He was better than me. He didn’t deserve this. He was in my care and I put him in harm’s way. He was just following his master like he always did; trusting in me. A wise older woman said that when horrific events like this happen we always tend to blame ourselves. What if I had just waited another 20 seconds? What if I’d gone a different way? What if I hadn’t been in such a hurry to get home? I go over those few seconds over and over in my head and it doesn’t do me any good. I can’t sleep and often just cry. A buddy of mine put it in perspective “you’ve done that same thing over a thousand times, it was an accident.”

Stephanie’s younger brother John surprised me and was the first person I knew to arrive at the emergency. He just held my hand. I was so sad. It was kind of him to come. Eventually, Stephanie came to get me and we went to see Mufasa. He looked like he was sleeping; no blood— no scrapes. All I could do was cry in the nape of his neck where I could smell him. Over and over I told him I was sorry, I loved him and would miss him. I wanted to take back those few minutes. My friend Debra who always watched him when I travelled by plane came and said goodbye as well. I couldn’t leave. I didn’t want to leave him there. My body was killing me. My leg felt like it was going to explode. I cried and cried. Each step towards the exit felt like a mile. I felt like I would die of a hole in my heart.
I find myself wanting to sleep, because when I sleep I imagine he’s alive. I can see his head at the foot of my bed waiting for me to wake, then following me into the bathroom where he patiently waits. He then studies me to see what footwear I’m putting on. As we go down the hall he happily scurries in front of me eagerly anticipating the day’s adventures. If I go to my computer, he knows that will take a few minutes so he mozies up on to his chair where he settles in until I close the computer and grab my briefcase. As I exit the kitchen door to the garage, he curiously gives me that look “am I coming?” All I have to do is nod and he’s out the garage door where he again patiently waits on the driveway for my cue. “Are we going for the ride, a walk or the van?” His greatest desire is to just be with me, no matter what, no matter where and no matter how long. It’s hard to wake from such a beautiful dream. If it wasn’t for Mufasa I might not be able to dream at all.
I love you Mufasa. I’m sorry. I will never forget you.

Femoroacetabular Impingement

(AKA: Femoral Acetabular Impingement, Femoro-Acetabular Impingement)

What is it?
Femoroacetabular impingement or FAI is a condition of too much friction in the hip joint. Basically, the femoral head (ball) and acetabulum (socket) rub abnormally creating damage to the hip joint. The damage can occur to the articular cartilage of the femoral head, acetabulum or the labral cartilage. A labral tear is very common in FAI. The labrum is ring of cartilage that follows the outside rim of the hip joint. There is a labrum in the shoulder joint as well. The labrum acts like a gasket on the outside of the socket to hold the ball of the femur in place.
Hip problems in general often involve labral tears however, these tears are often secondary to abnormal hip biomechanics such as the labrum getting caught by friction between the bone of the ball (femoral head) and the bone of the socket (acetabulum) the condition of FAI.
FAI generally occurs as two forms: Cam and Pincer. Cam comes from the Dutch word meaning “cog,” which describes the femoral head and neck relationship as aspherical or not perfectly round. This loss of roundness contributes to abnormal contact between the head and socket. The Pincer form comes from the French word meaning “to pinch which describes where the socket or acetabulum covers too much of the ball or femoral head. This excessive coverage typically appears along the anterior-top rim of the acetabulum and results in the labral cartilage being pinched between the rim of the socket at the anterior femoral head-neck junction. Most of the time, the Cam and Pincer forms exist together- i.e., mixed impingement. This is what I personally experienced.
FAI is common in high level athletes, but also occurs in active individuals.

How is it diagnosed?
Excessive hip flexion with external rotation or excessive hip flexion with internal rotation places excessive compression and torsional forces on the hip, especially the labrum. As a competitive cyclist I’m used to experiencing joint pain and muscle soreness. Prior to my diagnosis I had recently increased my involvement with racing the velodrome. I had borrowed a track bike that was too small for me which put me in a hyper-flexed position. However, the smaller frame provided greater control on the track. Track bikes have a fixed gear so the cyclist can never stop pedaling. The races are much shorter and faster, so the cyclist is almost always in the drops or race position. Because there are no gears there is an incredible amount of torque needed to accelerate the bike. The pain I felt in my hips seemed as if it were tight hip flexors. I figured I just needed more rest and more stretching. I was already strengthening the antagonists to the hip flexors but, neither the strengthening or the stretching was helping. It finally got to the point where I couldn’t ride at all.
Many people can be diagnosed with a good health history, physical exam, and plain x-ray films. Some believe that significant athletic activity before skeletal maturity increases the risk of FAI, but no one truly knows. There is usually a common complaint of hip pain (front, side, or back) and loss of hip motion. Plain x-ray films are used to determine the shape of the ball and socket as well as assess the amount of joint space in the hip. Less joint space is generally associated with more arthritis. In my case, I required an MRI of the hip. However, I had the first MRI without contrast. This was a mistake because it didn’t show us enough. I had to go back and redo the MRI with contrast. This meant they had to numb my hips and then inject them with dye before the MRI was taken. The MRI with contrast is most helpful in eliminating certain causes of non FAI hip pain including avascular necrosis (dead bone) and tumors. A normal MRI does not preclude cartilage injury, labral tears, or FAI. After my second MRI with contrast, we discovered I had torn the labrums in both hips.

What other diagnoses might be confused with FAI?
Hip Dysplasia (Adult Form)
Lumbar Spine Pain (Low Back Pain)
Lumbar Radiculopathy (Low Back Pinched Nerve, Low Back Facet Disease)
Sacroilitis (SI Pain/Dysfunction, back of pelvis)
Trochanteric Bursitis (Outside/Lateral Hip Pain)
Piriformis Syndrome (Back of Hip Pain)
Psychosomatic Pain Disorder (Stress Related Illness)
Iliopsoas Tendinitis/Tendonitis/Tendinosis (Hip Flexor Inflammation)
Groin Pull (Adductor Strain)
Sports Hernia (abdominal muscle strain)
Iliac Apophysitis (Front of Pelvis Pain)
Quadriceps Hernia/Strain (Thigh Muscle Pull)
Deep Gluteal Syndrome (DGS)
Hamstring Tendinitis/Tendinosis
Chronic Pain Syndromes

With what activities is FAI associated?
Some common activities:
Ice Hockey
Horseback Riding
Football (American)
Field Hockey
Bike Riding/Cycling
Martial Arts and Mixed Martial Arts
Deep squatting activities such as power lifting
Rowing Sports (Kayaking, Sculling/Rowing)
Car riding, flying in an airplane (deep seated position, bucket seat position)

Why does it occur?
No one knows if FAI is a condition that begins at birth or develops during periods of growth. It is likely a combination of one’s genetics and environment or activities.

How long can I wait before seeking treatment?
Typically, FAI that produces symptoms should be evaluated for surgical treatment. A delay in FAI treatment may compromise the cartilage of the hip.

Can I be treated with an injection of medicine or good physical therapy?
Generally, FAI is a chronic condition that does not typically respond to hip injections or physical therapy over the long term. I tried Platelet Rich Plasma (PRP) injections and it didn’t help. That being said, a core strengthening program instead of hip stretching may be beneficial. In fact, stretching or yoga may make the symptoms worse.

Do I have arthritis if I have FAI?
Both plain film x-rays and MRI scans are an incomplete view of the cartilage inside the hip joint. It is possible and common to have good joint space on plain x-ray films and no signs of arthritis on the MRI and still have significant loss of cartilage within the hip.

Can my other hip be involved as well?
Yes, it is possible for both hips to have FAI.

What are my treatment options?
Non-operative management of FAI is possible; however, it involves a change in lifestyle from active to less active and a commitment to maintaining hip strength. Non-operative management will not change any underlying abnormal hip biomechanics of FAI and may contribute to further hip degeneration.
Operative management of FAI can be addressed via hip arthroscopy or open surgery. A hip arthroscopy involving labral debridement (no repair) and no bony decompression usually takes less than one hour. A hip arthroscopy involving labral/cartilage repair and FAI decompression may take between two and four hours, depending on the amount of work performed.
The open surgical hip dislocation approach can typically be done in a few hours. The open approach is not generally recommended in older patients, in patients with significant hip degeneration, or in patients with significant athletic/activity demands.
Recovery time from most arthroscopic FAI surgical procedures is about three to four months to full, unrestricted activity. Your postoperative activity level will depend on your surgeon’s recommendation, the type of surgery performed, and the condition of the hip joint at the time of surgery. FAI open surgery may involve a significantly longer recovery.

What are the main risks of FAI treatment?
Complications from FAI hip surgery are uncommon but include the following:
DVT (blood clot)
Hip Instability & Dislocation
Femoral neck fracture
AVN of the femoral head (dead bone)
Heterotopic ossification (abnormal bone formation in soft tissues)
Nerve injury (Sciatic, LFCN, Pudendal, Peroneal)
Nonunion (open surgical dislocation only)

How do you rehabilate FAI?
In the end, I had both of my hips successfully operated arthroscopically. Now I had to rehab them.
Prior to surgery I visited five orthopedic surgeons, two doctors of physical therapy and spoke to a sixth orthopedic surgeon on the phone. All six surgeons recommended to ride the stationary bike within 48 hours of the surgery. This will improve the blood flow and maintain some mobility.
It’s important that the hip joints stay in neutral. After surgery, you’re given a hip fixator made of foam that velcros around your feet and hips so the hips won’t externally rotate at night. In order to repair the labrums the surgeon places an anchor in the pelvis so they can sew the lambrum. They don’t want you to pull that out by externally rotating at night.
Crutches are recommend for two – three weeks. For both surgeries I was on crutches for three days. I was able to weight-bear on the fourth day for each surgery so I started to walk slowly. Once the wounds had healed I went straight to the pool. I’ve had eight orthopedic surgeries and always successfully began my rehab in the pool. The water compresses the joint, you way weigh less and the resistance is accommodating.
Focus on range of motion. Stationary cycling and light gentle movements in the water are the best way I’ve found to rehabilitate orthopedic injuries. In the pool, do hip flexion, extension, abduction, adduction, internal rotation, external rotation, circumduction and walk. After about 10 days of stationary cycling and aquatics, you’ll be ready to move to a land based program. Hip flexion will be painful at the start. Try to passively stretch the hip flexors. It won’t be easy, but you must try. Concentrate on strengthening the hip extensors such as the glutes and hamstrings. The glute medius and minimus will be important to target as well; adduction and abduction can be done conservatively. Squats or lunges will be very difficult and will most likely cause pain. Start with partial range of motion as pain permits. As the range of motion improves and the pain subsides, continue to strengthen all the muscles surrounding the hips but be ever vigilant for tight hip flexors and internal rotators. Depending on where the surgeon made his incisions, the tissue surrounding those incisions will shorten and become tight.
Rehabilitating is different than strengthening. It must be gradual and not that strenuous. It’s more about fluidity of motion. Patience is a virtue. Don’t worry, the body revives itself and you will come back. Sleep and good nutrition is a must. Your body will need more of both.