[Jean-Paul]

I start a new client today who is pretty fucked up to say the least. He is scheduled to do a full right hip replacement next Monday, and in a few months he has to have his right shoulder operated on. Here's the situation.

He's been training with a bodybuilder trainer for 5 years. 'Nuff said. The guy has him "pushing through the pain" on many exercises, including leg presses and other heavy bilateral leg movements. He is taking a week off after his surgery, and then wants to get right back on is program. I don't think he knows what he's in for.

He is not actually giving up the other trainer (yet--I need to work on him a bit). The other trainer is a bit of a head case. People who get injured or sick do so because "they are weak" and all problems are self-inflicted from a lack of self discipline. To his credit, he is in his mid 40's and he has never had a major injury and is rarely if ever sick. He doesn't have much of a life outside of bodybuilding, and I'm not sure how he hasn't burned out yet. He is so strict on his clients I don't see how they can even stick with him. He dumps them or gives them a verbal lashing if they slack on their diets or miss workouts.

He looks like a bohemian gladiator or something. He's 6'4", probably around 5% bodyfat and 235 or higher, and wild long hair. He would look much more comfortable wielding a 50 pound broadsword, with which he would probably be quite natural. In my opinion though, he is solely responsible for my new client's hip and shoulder problems. They have just gotten progressively worse, and the best this trainer can do is rev up the rhetoric, taking no responsibility of course. He has been a trainer for 25 years, but has never been certified. He's just a local "guru" (in every negative sense of the word), who is convinced that he is the only source of knowledge in the training world.

My client fractured his hip playing baseball abour 15 years ago, and trained through it instead of letting it heal. He is driven like few people you will ever meet, and based on my initial assessment, has a pain tolerance that is off the scale. Although he can barely walk though due to the pain, but I'm not sure he needs the surgery.

His piriformis is so short that I could not internally or externally rotate his femor even 5 degrees. He obviously also has complete GM and TFL restriction. I don't think he really has any tears, and his bone is not going necrotic from being broken, yet the surgeon is going to go in and saw off the top of his hip and give him a titanium ball and new titanium socket.

I did a quick piriformis and GM release on him and although the increase in ROM was negligible, it significantly decreased his pain. What I REALLY need is to send him up to Bill for a week. Money isn't a problem for this guy, but I am coming in really late in the game, and I'm afraid that if he doesn't actually need to have this surgery, he is only going to guarantee chronic hip pain for the rest of his life.

I don't know if I should talk him into putting off the surgery for a month or if I should just let him proceed and keep my mouth shut. After all, I'm not a doctor. But no one in this area specializes in soft tissue injuries. His past PTs have all just followed the book; ultrasound and some hip mobility stuff on a machine, and eventually they just gave up on him. He has layers upon layers of scar tissue in the hip, but my nagging intuition (which could be wrong) tells me that it is fixable without surgery.

I am seriously considering convincing him to go to Indy for a week if I can convince him. I think my first session with him yesterday may have convinced him that there are other options.

Moving on to his shoulder... He told me that he does have a confirmed tear to his infraspinatus and his labrum. He does a ton of chin-ups, rows and curls (his trainer LOVES preacher curls). Dips are murder for him, so he tries to avoid them, so he does a ton of tri pushdowns. I haven't done any assessments on his upper body mobility yet. If he has image-confirmed tears then I would think that curls (although he reports that they don't hurt him at all) would be ill-advised. For that matter, if his infraspinatus is actually torn, I would imagine that his teres minor is probably not normal either, so a lot of heavy tri work would also be ill advised.

In closing, this guy wants to maintain his shape desperately, but I don't think he should be training at all. I think he needs to just do mobility work and ART for as long as it takes to get some return to normal, pain free movement. Maybe he should do his shoulder first instead of his hip, if indeed his shoulder is confirmed as torn.

Any advice at this point will do. I see him today at 2:15pm CST, so if you can take the time to advise me before then it is all the more appreciated.