The Retired Nurse, the 12 kg Get-Up, and Osteoporosis
Denise, 58, a retired nurse, hires you for 12 weeks. Her goal is a full Turkish get-up with a 12 kg bell. At intake she can lie down and stand without using her hands. Shoulder flexion is 145° on the right and 160° on the left; seated thoracic rotation is 30° right and 40° left. Single-leg bridge: 8 reps left, 15 right. She can hold an 8 kg bell overhead in half-kneeling for 20 seconds on the left and 12 seconds on the right, with a slight right elbow bend. She has lumbar osteoporosis (T-score −2.6), no fractures, and written medical clearance for resistance training. She walks 30 minutes four times weekly, has never pressed overhead, and says she is 'scared of falling' during get-ups.
1. Interpret the assessment asymmetries and decide whether the 12 kg TGU goal in 12 weeks is realistic. What is your reasoning?
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The 12 kg goal is plausible but not the right first target. The right shoulder has 145° flexion, 15° less than the left, and the right half-kneeling hold is 12 seconds with elbow bend. The TGU requires a sustained overhead position with a locked elbow, plus thoracic rotation and single-leg bridging. Asymmetries in bridge (8 vs 15) and rotation (30° vs 40°) suggest right-side stability and rotation need work. Fear of falling is a real performance factor.
Set a process goal: full get-up with 8 kg by week 8, 12 kg by week 12 only if criteria are met. Explain that load is not the only variable; positions and confidence matter.
2. Build a 12-week progression with decision rules at weeks 4 and 8.
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Weeks 1–4: floor press, half-kneeling press, arm-bar, tall-kneeling windmill with no load, rolling patterns, half-get-up to elbow and hand without load. Week 4 decision: can she hold 8 kg overhead 30 seconds each side with a straight elbow and no pain? If no, repeat.
Weeks 5–8: half-get-up with 8 kg, full get-up with 4–8 kg, single-leg bridge 15 reps each side. Week 8 decision: full get-up with 8 kg on both sides, no fear report, shoulder flexion ≥155°. Weeks 9–12: load 10–12 kg. If she fails a criterion, hold load and add volume.
3. How do you address osteoporosis and fear of falling in your coaching and communication? Include what you would not say.
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Use bone-loading language: progressive resistance and impact are generally beneficial for bone health, and her physician has cleared resistance training. Avoid saying 'osteoporosis means you must avoid loading' or 'this is safe.' Teach her to keep the spine long during rolls, to use a padded floor, and to stop for sharp pain. Do not diagnose or give medical advice.
For fear, rehearse the get-up in parts, use a spotter, and practice falling/rolling mechanics on a mat. Document the physician clearance.