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Training someone with avascular necrosis in the hips

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  • Training someone with avascular necrosis in the hips

    Hi Drs.,

    I have recently started taking clients as a personal trainer, and one of them is a 46 y.o. male with avascular necrosis in both hips. He is slightly overweight, but not obese. His range of motion in the hips is fairly limited, especially when it comes to hip abduction, and he is unable to perform a full squat pain-free. For now, I have been having him perform bulgarian split squats with light dumbbells, on which he is able to achieve nearly full ROM, and trap bar deadlifts with high handles, also fairly light for now.

    He has started mentioning new discomfort in the hip region in the days following training (describes it as aches and pains in hip joints, especially when standing up from sitting for a while).

    I am going to try to modify load, ROM, volume and/or exercise selection to see if these symptoms subside. In the meantime, I was wondering if you are aware of any evidence for or against resistance training in AVN, or do you have experience training people with such conditions?

    If the additional information can be helpful, he also suffers from gout, and is borderline hypothyroid (which he is discussing with his GP).

    Thanks in advance!

  • #2
    Luca,

    This is an instance where I would make sure the athlete has routine follow-ups with a healthcare provider. AVN is a diagnosis we do tend to treat a little more with "kid gloves" when it comes to training. Most evidence would advocate for a more aerobic approach to training and while I do agree that should be a major component, I think we just do not have any studies on resistance training with that diagnosis so instead recs tend to rely more on dogma.

    In general, where he is experiencing symptoms is a pretty common spot for anyone first getting into resistance training. However, the prior diagnosis would give me pause on just powering through in this instance. If you are just trying to get this individual more active I would likely start with some exercises like open kinetic chain knee flexion and extension in the initial phases to build some capacity for more typical exercises you would hear here. In this instance I would likely be much more interested in finding ways to increase his activity in ways that do not cause symptoms than trying to push a certain set of exercises. That being said, if he really wants to squat and deadlift, that is his decision and you can get some n=1 numbers.

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    • #3
      Hi Derek,

      Thank you for taking the time to reply!

      I will advise him to consult with a physiotherapist.

      We train at a small PT studio that does not have a leg press, leg extension or curl. I wouldn't mind sending him to another gym if that's what he needs, though. In general, would it be reasonable to be guided by symptoms, or is there a specific outcome we are trying to avoid by choosing open-chain over closed-chain? How would you feel about things like light sled pushes and hip thrusts/glute bridge variations?

      Last edited by Luca B.; 06-22-2021, 09:51 PM.

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      • #4
        Luca,
        I will be absolutely honest and say there is no strong literature to support this one way or the other. If I were handling the athlete I would likely let symptoms guide my decision making but I would also likely play more conservative with decision making than normal due to the base rate conversion of AVN to THA. Then I would have to wonder if my programming is contributing to that. So yeah, I don't think there is a good answer here given the information we currently have. I would be fine with sled pushes/hip thrusts, OKC, and CKC exercises so long as the patient was actively involved in the decision making process for how hard they are willing to push.

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