Help with a training plan

[Lamneth]

Hi coaches!

I'm hoping to learn to be a coach, and I'm taking on my first client. I want to make sure as much as I can that I set this up for success, so I'd like some feedback.

Client is 46 year old female, about 145#, about 5'8. She's fairly kyphotic. But the biggest issue is her hips. When younger, she was fairly active in martial arts. She's still reasonably active, running, or making it to the gym to use the elliptical machine on occasion, even though running especially, often causes hip pain.

She has pain in both hips, but different pain. The right hip pain is usually associated with fatigue, yet comes on suddenly, and results in difficulty lifting her right leg. The left hip pain is far more unpredictable and chronic. It occasionally interferes with sleep.

She's had an Xray and an MRI done, in an attempt to get a diagnosis.

Report from December, 2011 X-Rays:
On the right, the acetabulum is mildly shallow with upsloping acetabular roof. Mild uncovering of the femoral head. The finding is in keeping with mild developmental dysplasia. No secondary osteoarthritic changes. The left hip is normal in appearance. No other significant bony or arthritic abnormality.

Secondary opinion based off the same X-Ray, dated May 2012:
The bone density is adequate. The vertebral body heights are well maintained. No congenital bony anomaly is visualized. The medial acetabular floors intersect the Kohler's lines. The acetabular depths are adequate. The femoral angles are within normal limits. Mild facet sclerosis with hypertrophy is evident from L4 to S1. The sacroiliac joints are unremarkable. No joint space narrowing or sclerosis is seen in both hip joints. No dysplastic bump is seen at the femoral necks. No displacement of the periarticular fat planes of the hip joints is seen. no soft tissue calcification is detected.
IMPRESSIONS:
1. bilateral coxa profunda.
2. Mild facet arthrosis from L4 to S1.

Report from July 2012, MRI:
No significant joint effusion. On the right, there is a tear of the anterior labrum within the substance and free edge with small para labral cyst anteriorly. No focal hyaline cartilage defect. The acetabulum does not appear shallow on the MRI. The left hip is unremarkable. No focal muscular or tendon pathology. No focal osseous abnormality.

Those are the written reports I could get my hands on. On the follow up with the surgeon after the second (MRI) report, he acknowledged that her hips weren't "normal", and he wasn't surprised that she had pain, but that there was nothing that could be done surgically. He said given the (relatively low) level of pain she was in, and the typical outcomes of surgery, that he wouldn't recommend a surgical option at this time.

A few years ago, a moron of a coach, who only knew anything about squatting by listening to the Belgian, had her attempt to squat 5X5 with the empty bar. Afterwards, she complained of non muscular hip pain, serious enough to get her to stop. She tried again a week or so later (again, empty bar), and again, experienced substantial pain. (Yes, I was that moron of a coach.)

She's willing to give this another shot.

I took her through the squat progression from the seminar as well as I remembered it yesterday. She was having trouble with the movement, wasn't getting her knees out wide enough, and was very shaky.

My plan is to keep working with her on bodyweight squats until she gets the movement down better, and then progress to goblet squats with a dumbell. Assuming she's able to get that far without pain, I'd move her to the empty bar, and then carefully work up the linear progression from there.

So my questions -- does that seem like a reasonable approach? Does it even make sense to attempt to squat with a known labral tear? Is there anything else I should be watching out for especially? Any suggested alternative approaches? Also, how much should I be worried about the kyphosis before getting her to attempt to deadlift? That seems like the least of the worries, but I thought I'd ask. Any other thoughts? Other than that attempting to train my wife is a really terrible idea?

(Sigh -- sorry for the wall of text, but I don't know what I could cut....)

[Mac Ward]

I would ignore previous "training" and go very slowly. I would not take the time to teach her goblet squats, which is a completely different pattern. I would start with a very light bar the progress her I accordance with the program as written. Slow, steady progress. Strengthen her, the pain will go away.

[Lamneth]

Ok -- so nothing about a torn labrum or previous history contraindicates training, but skip the goblet squats, start with a lighter bar, and go cautiously. Gotcha. Thanks.