Maintaining and Building Muscle Despite Severely Worn and Arthritic Joints: Part 2
By William Wong ND, PhD, Member World Sports Medicine Hall Of Fame
While I had fully intended the second part of this piece to have been a video, things have conspired against my doing that. So for right now I will provide descriptions of my usual workout, lately, showing the equipment used and giving training protocols and include pictures of old time use of the power rack for partial Range Of Motion (ROM) with an Isometric hold. With this combination I hope to be able to pass on the information you need to create your own variations of the movements you may wish to do using this form of Progressive Resistance Exercise.
ONE VERY IMPORTANT POINT: During the isometric holds, DO NOT HOLD YOUR BREATH!
Breathe in through the nose and out through the mouth: forceful puffs through pursed lips, one puff for every one or two seconds of the hold. Holding ones breath causes increases in blood pressure. It’s very common for old powerlifters and strong men to try to work out as heavy and hard as they did in their prime. To help their stability they do a Valsava Maneuver, they breathe in and hold their breath for the duration of the lift. In many lifters this results in the brain blowing a pipe and a cerebral hemorrhage or wet stroke. On the regular lifts, breathe out on the power stroke and in on the recovery.
Knee Extensions: The knee is supposed to have 135 degrees of flexion (i.e. bend). One needs 105 degrees of bend to go up and down stairs. In most folks the most painful part of the ROM for an arthritic knee is the middle 1/3 of the movement where the knee cap presses down into its grove. So, I set the lever arm of the Knee Extension (straightening) to the last 1/3 of the Range of Motion. Sitting in the machine with my shins underneath the roller I straighten my knees against the resistance of the weights and hold that fully straight position for a slow count of 10. One rep = one set. I do 3 sets.
Knee Flexion (Leg Curls): I set the lever arm to the lower 1/3 of the knee flexion ROM. Pushing down on the roller I again stop and hold the bent knee position against the resistance of the weights on the lever arm. Fig 1.
Body Solid CAM Series Leg Extension-Curl
Anterior Tibialis: On the anterior tib machine I do 2 sets of 15 to 20 reps and on the last rep of each set I hold the top contracted position for a 10 count. Fig 2.
Titan Fitness Tibia Dorsi Calf Machine
Squat Machine or Calf Raise on a Leg Press: With the balls of the feet on the edge of the platform allow the heels to drop then go up on your toes. I do 2 sets with a weight to make 5 to 8 reps difficult and hold the top tippy toe position of the last rep of each set for 10 seconds.
or
Midsection Abs. Obliques and Lower Back: The bench I use from Titan, allows for working all around the waist. The lever arm has two settings one for forward flexion of the roller and one for back extension of the roller.
Titan Seated Ab-Back Extension Machine
I work from right oblique to abs to left oblique and then reset the machine for lower back. Sitting on the bench sideways / obliquely, have the roller about at the right armpit with the arm over the roller. The movement is to lean forward against the roller. Do any where between 2 sets of 8 to 20 reps holding the last rep of each set for 10 seconds. If even the lightest resistance is too much then simply do one repetition with a 10 second hold per set.
Then face fully forward, adjust the roller to get it to the chest while you’re sitting with an ever so slight backwards lean. Now push forward against the roller. Same numbers of sets and reps.
Left Oblique, done exactly as the right one was done but this time your sitting in the sideways / oblique position.
Lower Back: With all of the pain from my multiple injuries and fractures of the spine, this is the most comfortable lower back resistance exercise I’ve yet found, (and I’ve been around exercise machines since I was 14). With the lever arm reset to be able to push back on the roller; sit in the seat facing forward. The roller is at your mid to upper back. The lever arm adjusted to move the weight in the opposite direction than it moved for the ab work.
From a slightly leaning forward starting position, press back as far as is comfortable. Then return to the starting position. As with the abs you can do numbers of repetitions and then hold on the last one or just do one rep per set and hold for 10 seconds.
Since my shoulders both have extensive wear, (due mostly to doing and teaching gymnastics. As ANY non politically correct gymnastics teacher admits to other gymnasts spotting heavy set girls on the Un Even bars is murder on the shoulders)! And then, martial arts mostly from punching trees, (OK’s on people are easy after you can make a 30’ pine shudder when you punch it); I can no longer reach up to grasp a lat pulldown bar or do a chin up (which I loved and could do 21 of cold from 15 to 55), or if the machine still existed, do my FAVORITE torso exercises of all time the old Nautilus Pullover. So we must adapt to working the same muscles through lower parts of the shoulders ROM and for less ROM than we’d get with either the Chin Up movement of the Front Pulldown or the 160 degree shoulder extension ROM that the Pullover machine was capable of.
Seated Rowing: 70% of the upper body muscles pull. 70% of the lower body muscles push. Watch a baby crawling on the floor. To work most of the possible ROM we do seated rowing. This gives us 60 to 80 degrees of range of motion in shoulder extension. Sit with the chest against the support, reach forward grasp the handles and pull towards your chest. Use a weight that makes 5 to 8 reps difficult. Again on the last rep hold for 10 seconds. Or you can do 2 sets of 1 rep each both with the 10 second hold.
Next for the pushing muscles of the torso:
Seated Dip machine: Sit on the bench, grasp the handles and push down. Same rep and hold scheme as with the Seated Row.
Titan Loadable Seated Dip Machine
Have to admit, I LOVE these ab / lower back and dip benches!
Lastly for shoulders and Upper back, I do the partial ROM upright Row. Again due to the ROM limitations I deal with, I use only the lower and mid range of the movement and only 2 sets of 1 rep with 10 second hold. The lower bar stop is set at arms length or just a bit less. The barbell is then placed above the lower stops. Then a set of upper stops are set in place to match the desired amount of range of motion.
Standing I grasp the bar and lift it up to hit the upper stops and hold it there, hard pressed against the stops, while I count to 10.
On resistance: start off your first workout figuring out what resistance you should start with that will either allow you to do however many reps you’re aiming at or will give you a good amount of resistance in a one rep per set isometric hold.
The emphasis in this workout is to strengthen and increase the mass of the muscles that hold the body up straight and allow us to walk. The ranges of motion for exercise of severely arthritic joints needs to be in the ROM that hurts least when performed (as I did with the knees) or using all of the ROM that is still available as with the upper back and shoulders. The arms (elbow flexors i.e. biceps and forearms) are worked in the Seated Row while the back of the upper arm the elbow extensors (triceps), are worked very well in the dipping movement. But if you want more arm work go right ahead and add it.
My personal Partial Range of Motion Isokenetic into Isometric exercise program is designed for my abilities and disabilities. You need not follow my workout. You do need to remember to do part of the ROM of an exercise then hold the weights up or press or pull the weights up against a stop. Design your own on whatever equipment you have available or can fabricate.
As to how many times a week to work out, if you can, do two workouts a week. If working out sparks a few days of pain and stiffness a couple of days after an exercise session, then work each exercise only once per week.
Again, using my own workout as an example:
- Monday: Lower Extremity Exercises.
- Wednesday: Ab and lower back machine and the dipping machine.
- Friday: Seated Rowing and the Upright Row in the power rack.
Not doing many or all of the exercises in one workout, as kids would do, maintains the energy reserves, does not make one too tired or put one in too much pain in too many places at the same time. Youngish 40 -50+ may not yet understand that last statement. But if you’ve been active in hard physical labour, sport, dance or exercise for long enough, by the time you hit 55 to 65 you’ll understand for sure!
The only 60 + year olds who do great, look great and have full ROM in their joints, who workout like kids do are the guys who didn’t start working out till their 50’s and to enhance the effects of the workout they are on Hormone Replacement Therapy. I’ve no gripe against Testosterone, Progesterone and Thyroxin replacement. It’s magic for maintaining or recovering muscle mass, bone density, recovering from orthopedic injury or visceral (internal organ) surgeries and extends ones lifespan by being stronger just from taking the ‘juice’ (Anti-Aging Hormone Replacement Therapy). I recommend all over 40 to find an anti-aging doc and get on a program of raising your hormone levels to what they were in your 20’s or as close as the docs can get.
For those of us who’ve had hard physically active lives and weren’t couch potato or chained to a desk till 60, we don’t look that good anymore; can’t move as well anymore; aren’t as fast in movement as we used to be; and all sorts of things can start the owies screaming in our joints and muscles. To us the forever physically active, we should wear our disabilities as a badge of honor whether the joint or structural injury happened in war, in the factory, in heavy duty sport or physical activity; each owie shows we were doing, striving and achieving.
This modern study on partial ROM exercises confirms what exercise physiology professors discovered in the 1960’s:
Partial Range of Motion Exercise Is Effective for Facilitating Muscle Hypertrophy and Function Through Sustained Intramuscular Hypoxia in Young Trained Men
Below are old timey pictures of the great Olympic Weight Lifter and Mr. Universe Bill March demonstrating the then pioneering partial ROM into an isometric hold in various lifts:
The Overload Power System - Bill March
- In the pictures starting from the top of the page, he’s doing a: Midrange Bent Knee Deadlift to a stop and hold.
- A mid ROM shoulder press pressing up agains the stops for an isometric hold.
- The mid ROM pull an a Clean.
- And later down the page various positions in different ROM’s for shoulder presses,
- Lastly a mid range ROM squat pressing up against a stop.
Think that about covers it. One last thing. I don’t get a single penny or any special consideration for demonstrating the equipment linked to in this article. It’s the equipment I personally have and use every week.
Be well and God bless,
Dr. Wong