Programming for older female novice

Jae Chung · 03-12-2010, 10:32 AM

I've got a 58-year-old female client with a bunch of mobility issues (both knees, right shoulder). She is about 5'4", about 150 lbs. (She's lost about 15-20 lbs. in the last 12 weeks.) Active, but no real prior weight training.

Diet compliance is relatively ok (she has greatly reduced grains, sugar, dairy, processed foods) but she does not eat or sleep enough, despite my constant harping. Takes a small amount of fish oil, probably 1.5-2g/daily on average (hates taking pills and hates the liquid even more), + 10,000 IU D3 most days.

Back squat and front squat are currently out of the question due to shoulder mobility issues (right "frozen shoulder"). Any advice on what else we can do? We've done goblet squats for several weeks and she is approaching her limit, meaning, the DB is getting too heavy for her to hold up for more than 2-3 reps at around 60-65 lbs.

I have been doing dumbbell press and push press with her, but the poundages are just getting to be too much. She is stuck at 20 lb. DBs for about 4-5 reps and is unable to use 22.5 lb. DBs with good form on the PP. We have already done a reset once, going back down to 10 lb. DBs.

We've been doing straight linear progressions, adding 5 lbs. to DL and goblet squats for around 3 weeks now, SS-style, about 3x per week. We started at very low weights to work on form, initially 3x5 and then 5x5 to get more volume out of the light weights.

Form has improved dramatically on all lifts, but we're approaching weights now that are not going to work for her.

Any advice on movement substitutions? Rep schemes? I'd really appreciate it!

Grissim Connery · 03-16-2010, 02:21 PM

does the frozen shoulder inhibit zercher squats?

Jae Chung · 03-16-2010, 09:26 PM

Wow, I had not considered zerchers. I think she lacks the back and arm strength to make them work with anything other than very light weights.

Maybe step-ups would work with dumbbells in the hang position?

Steven Low · 03-17-2010, 06:22 AM

Pistols, lunges variations, SL RDL, etc.

There's lots of stuff you can do unilaterally you just have to be creative.

Priority in correcting frozen shoulder though....

Jae Chung · 03-17-2010, 07:37 PM

I agree about correcting the frozen shoulder. Unfortunately I am not very knowledgeable about mobility issues. I am making my way through the sticky... hopefully that will give me some ideas?

Any quick suggestions? She hates rolling around on a rubber band ball but I make her do it sometimes. Mobility has improved somewhat just from doing ring rows, scaled push-ups, but I feel like it's time to do some dedicated mobility stuff.

Thanks!

Steven Low · 03-18-2010, 03:27 AM

Well, what is she doing for physical therapy?

Diet is one of the huge things though that I can see be corrected. The more chronic inflammation the worse off you are because it's called adhesive capsul-ITIS for a reason. The synovial tissues get inflammed and then get gummed up and stick to each other limiting mobility.

If she's getting good stretching and decent mobility work from PT then all you can really do is focus on proper sleep and diet.

If she isn't doing PT then I'll talk more about it here..

Jae Chung · 03-18-2010, 08:19 AM

She's doing no PT. I'm not qualified on that account and my knowledge of basic mobility is not good, either. I can do basic PNF stretches and warmup mobility drills, but I don't know enough anatomy to do a proper assessment and target specific issues.

So, any tips would be awesome.

I can post this in the recovery section, too, if that would be better.

Thanks!

Steven Low · 03-18-2010, 02:32 PM

What mobility does she have so far in:

flexion (raising arm above head)
abduction (raising arm above head sideways)
internal rotation (sleeper stretch, arm up behind the back)
external rotation (both with elbow near side, and arm abducted to 90 deg)

Jae Chung · 03-21-2010, 12:16 PM

Quote:

Originally Posted by Steven Low

What mobility does she have so far in:

flexion (raising arm above head)
abduction (raising arm above head sideways)
internal rotation (sleeper stretch, arm up behind the back)
external rotation (both with elbow near side, and arm abducted to 90 deg)

I finally got a chance to measure these last night.

Flexion: pretty good, but last 15 degrees of range is painful at the top for right side

Abduction: same as flexion

Internal rotation: arm up behind back: L side is ok, can get forearm near 45 degrees, hand ends up between scapulae. R side, cannot get behind back at all without pain, and forearm is parallel to floor.

External rotation: L side is fine, R side is short about 30 degrees.

Thanks Steven!

Steven Low · 03-21-2010, 12:32 PM

Gonna have to stretch out all of those back to full ROM.

It's fine to do after workouts.. and yes there is going to be pain stretching them out so beware that. Add in mobility work like wall slides and band dislocates.

Also, really stretch out the lats, pec major and minor.. get some tennis ball/foam roll, corner stretching, etc. with thise.

Ice afterwards.

I assume you are doing general strength work. Add in some rotator cuff strengthening as well.