Meet Sandy. She’s an 84-year-old client of mine who was able to cancel her knee replacement surgery. How did she do it? That’s exactly what we’ll cover in this article. Here’s what you can expect to learn:

  • What Sandy’s life was like before she scheduled the knee replacement surgery
  • What she’s tried beforehand to relieve her knee pain
  • Highlights from the exercise program that I used to help her reduce her knee pain
  • The results that she’s achieved
  • How her life is different now

If you want to hear Sandy tell her own story, check out this 6-minute video:

And if you want some personal help with your own joints, we have a special program called the “Joint Freedom Formula.” If you want to see whether you qualify for that program, just fill out the application form on our home page.

 

Sandy’s Life

Long before Sandy started working with me, she was an active and regular gym-goer, doing 5 workouts per week. Good for her. Too bad that her activities in the gym didn’t reduce her knee pain at all.

Her knees hurt (especially the right) every time she walked, and even more so, going up and down the stairs. Walking up and down the stairs was so painful that she had to do it sideways and pull on the railing as well. That’s no way to live.

In fact, her knee pain got to be so bad that she was scheduled for a knee replacement surgery.

She’s a subscriber to Zoomer, and she saw my article about how to exercise for joint pain relief – which, by the way, is very different from exercise for other goals, like high blood pressure reduction, osteoporosis reversal, weight loss, type 2 diabetes reversal, etc.

I guess the article was compelling enough that she decided to book a complimentary initial assessment with me. We have enough clients (like Pat, Carol and others) who’ve prevented or cancelled joint replacement surgeries, that she had hope.

Although she booked the assessment, she still had a couple of major hesitations:

  1. Price – it ain’t cheap.
  2. Distance – she lives in Oshawa, and our gym is in Markham (for people outside of the Greater Toronto Area, that’s a distance of about 50 km).

But, she saw enough value in it, because what she was currently doing wasn’t working, the road back from a surgery is a long one, and there was enough of a history of success for her to take the leap.

 

Sandy’s Initial Assessment

As we do with all of our clients who have osteoarthritis, we started with an assessment of the muscles surrounding her knee, the ranges of motion, her levels of strength, as well as her balance.

Here’s what we found:

  • Her glutes weren’t working at all. If the glutes aren’t working, more pressure goes into the knees. We needed to get her glutes up to par.
  • Her range of motion was pretty good in her ankle and her hip, but at her knee, she was missing a bit of range of motion. Maybe about 20 degrees.
  • Her balance was terrible. We had her stand on one leg with her eyes open. She should be able to hold it for 30 seconds without problems. She only got 7 seconds on her right and 11 on her left before she lost her balance. Balance is an indicator of how the brain “sees” the body. If the brain “sees” the body accurately, it gives different muscles the appropriate amount of force, at the appropriate times. But if the balance is off, the brain isn’t giving some muscles enough force, and is giving other muscles too much force. It’s kind of like a symphony where the violins are playing too loudly at some points, and too quietly at others. We needed to improve how well Sandy’s brain “saw” her body.

But that was the case with Sandy’s knee osteoarthritis. Assessments help us personalize each client’s exercise program. Someone else with knee osteoarthritis would have different results in their assessment, which would necessitate a different approach. Hence the need to assess, and individualize each person’s exercise program to their unique imbalances.

Sandy’s Exercise Program

Only after we had Sandy’s assessment results did it become obvious what needed to be done in order for her to reduce her knee pain:

  • Strengthen her glutes.
  • Improve her knee range of motion.
  • Improve her balance.

So we got to work, and here are the highlights of what we did:

Step Ups

We didn’t really use step ups as an exercise. Rather, we used it as a test. One problem with most rehab programs is that the test does not reflect real life. In other words, everything looks good on the therapy table, but then you go back to your normal life, and what used to hurt still hurts. We want our rehab to carry over to life outside the gym. So we measure what really matters. In Sandy’s case, climbing stairs hurt, so that was our “indicator test.”

Every workout, I’d have Sandy step on to a 12-inch platform (regular stairs are 8 inches, so I wanted to go higher than that), and I’d ask her to rate her pain on a 0-10 scale.

I’m impatient. I want immediate progress. Not in 2 weeks. I want to know that what we did in a single workout had a tangible impact on her pain levels. So at the end of the workout, I’d have Sandy repeat the step up and rate her pain again. If it dropped, I knew we were on the right track. If it didn’t, we’re barking up the wrong tree, and we’d adjust the program next workout.

 

Glute Strengthening

We knew that Sandy’s glutes were weak, despite having gone to the gym before me for years. So we had to get to work strengthening her glutes.

As I mention in my article on the single most important variable in an exercise program, it’s the progression model. So here was Sandy’s progression:

  • Step 1: lying hip lifts on a stability ball. The goal was just to get Sandy to feel her glutes as opposed to hamstrings. Both of those muscles can extend the hip, but the hamstrings should be secondary to the glutes. It’s too easy to really be a strengthening exercise, and that’s why we only used it for one workout, until she got it.
  • Step 2: lying hip lifts on the floor. As with the previous exercise, the goal of this exercise is not yet to strengthen. Just to bring awareness to the glutes, and get them to be the dominant hip extensor, and not the hamstrings. It’s still too easy to have any strengthening effect.
  • Step 3: single-leg hip lifts. It’s the same as the previous exercise, but it’s done on only one leg. This now had a minor strengthening effect for a short period of time. We used this exercise for another 3 workouts.
  • Step 4: 1-legged deadlifts. Now that I was satisfied that Sandy was extending her hips using her glutes, we were ready to direct strengthening, which is when we started 1-legged deadlifts.

 

Knee Bending

Another goal that we had for Sandy was to restore normal function to the knees. What’s the normal function? It’s very simple. Knees bend. Sandy’s knees didn’t bend very much in the standing position. If she tried to sit down on to a chair, her knees hurt. That pain perpetuates itself, and it’s a vicious cycle into even more pain and immobility. We had to get out of that vicious cycle. Here are the progressions that Sandy followed:

 

  • Wall sits. Since Sandy’s knees hurt when they bent, we did static strength training at first. She’d bend her knees very slightly at first, because any more than a 20-degree bend hurt. So on the first workout, her wall sits were only to less than 20 degrees. Over the next 5 workouts, they progressed to 90 degrees – pain-free!
  • Assisted squats. Now that Sandy could hold a static squat at 90 degrees, we needed to get her all the way down – butt to heels. But that still hurt. So I had her hold on to a pole while squatting to the lowest depth that she could, pain-free. At first, that was only to 90 degrees, but over the next 2 workouts, she regained full range, pain-free. She was able to squat butt-to-heels. Complete knee function has been restored. They could now bend pain-free.
  • Limited range of motion squats. Now that Sandy could squat all the way down while holding on to something, it was time to build strength in her thighs, so that she could squat down without having to hold on to anything. We started off with her sitting on to a 23-inch height, because anything less hurt. In a matter of 3 workouts, she was squatting down on to an 18-inch height, pain-free. What’s special about 18 inches? That’s the height of standard chairs, couches and toilets. And pretty soon, she blew past that, and by her 15th workout, she was able to squat down on to a 9-inch height, pain-free. How many 84-year-olds can do that?

 

Knee and Ankle Control Drills

Over the first 4 workouts, Sandy was learning to control her knee and ankle, so we had her trace a circle with her knee, and another one with her ankle. At first, it looked awkward and jagged. It’s a very strange experience when the brain knows what it wants the body to do, and yet, the body isn’t doing it. Why? Because the brain doesn’t have great control of the body – at first. Over a period of 5 workouts, Sandy’s movement became a lot smoother, and then we stopped doing those exercises.

Their value is in the challenge. Once it’s not challenging anymore, it’s a lot less valuable. These exercises don’t build awareness. Rather, they improve the brain’s perception of where the body is in space.

 

Balance

Additionally, to help improve the brain’s perception of where the body is in space, I had Sandy work through the balance exercise progressions that I describe in this video.

As I discuss in my arthritis book, balance exercises and strength exercises have the greatest effect on joint pain.

 

Traction

Another one of the 7 types of exercise that I cover in my arthritis book is traction. With traction, Sandy’s husband would pull her shin bone away from her thigh bone. This one, she was doing at home. This was done 30 seconds at a time, for a total of 10 minutes, 3 times per week.

 

Upper Body Exercises

In addition to reducing her knee pain, Sandy wanted to improve her upper body strength, so we did:

 

If you just read about the exercises, you’d miss the “secret sauce” of the exercise program – the progression model, and the workout-by-workout adjustments that were made based on Sandy’s progress from the previous workout, energy/fatigue levels, injuries, and more. After all, no exercise program should be a static program, where you’re doing the same exercises for the same weights, sets and reps every single time. An exercise program should be dynamic, intelligently, purposefully, and systematically changing the exercise variables workout-by-workout to move the client forward… as opposed to haphazardly changing the program whenever you feel like it, without rhyme or reason… like a lot of personal trainers do.

Sandy’s Results

Sandy’s results are nothing short of extraordinary. In 15 weeks, here’s what she achieved:

  • Her 1-legged deadlifts improved from 15 pounds, up to 40 pounds.
  • She couldn’t even squat an inch. Now, she’s squatting all the way down.
  • Her lat pulldowns improved from 60 pounds, up to 72.5 pounds.
  • Her seated rows improved from 50 pounds, up to 62.5 pounds.
  • Her overhead presses improved from 15 pounds, up to 25 pounds.
  • Her balance is significantly better.

 

If I was to estimate her strength, I’d peg it in the top 1% for 84-year-old woman.

Yes, part of the credit goes to me for writing, and adjusting the program, but even more credit has to go to Sandy, because of how diligent she is. She only saw me once a week, but she did an additional 2-3 workouts per week outside of her sessions with me. That’s why she got such great results, so quickly. And of course, part of the credit also has to go to her husband, Rick, who supported her every step of the way, and helped her with her traction exercises.

 

How Sandy’s Life is Different Now

Nowadays, just 15 weeks since she started, she’s had a dramatic improvement. Gym numbers are nice to help us gauge progress, but Sandy didn’t start working with me to help her deadlift 40 pounds with one leg. That’s a nice side effect, but how’s her life outside the gym? Drastically different!

  • Before, she had pain while walking – that’s history now. She hasn’t had pain while walking in over 2 months.
  • Climbing stairs was extremely painful. To the point where she had to do it sideways, and pull on to the railing really hard. Not to mention the fear that her knees could “give out” at any moment. Nowadays, she goes up and down stairs normally, with only minimal and infrequent pain.
  • Her knee pain during step-ups dropped from 6/10 when she was first starting out to now, 1/10, and even then, occasionally.
  • She’s not planning on getting a knee replacement surgery anymore.
  • As an active traveller, her pain reduction has opened up a world of possibilities that would have been prohibitive when her knees were hurting a lot more.

 

Overall, we’re very proud of Sandy’s results, work ethic and diligence. If you want some personal help with your own joints, we have a special program called the “Joint Freedom Formula.” If you want to see whether you qualify for that program, just fill out the application form on our home page.