Starting Strength Case Study: Louise

by Inna Koppel, SSC | March 01, 2018

Louise is a 65-year-old mother, grandmother, and small business owner. She was sent to the Woodmere Fitness Barbell Club by her daughter, who started lifting under the Starting Strength method and immediately recommended it to her mom. 


Louise has Rheumatoid Arthritis (RA) affecting her hands as well as her hips. RA is a chronic disease, which causes inflammation in the joints and can cause deformity and immobility, especially in the fingers, feet, wrists, and ankles. This condition was made worse by two falls which resulted in a broken hip in 2011 and a subsequent fall in which she broke her shoulder in 2015. In both events Louise required surgery, leaving her with titanium hardware in her shoulder and hip.

Beyond injury, Louise had reason to be concerned about her musculoskeletal integrity; she was recently diagnosed with bone density loss and she knew that this could lead to higher propensity for fractures, and eventually limited functional capacity. She came to us with the hope of improving her strength and building stronger bones.

Louise went through our basic assessment, where we identified some postural issues, arthritic symptoms in her hands, a lack of flexibility, kyphosis, a slight hip shift when she walked, and overall weakness. In her first session following the assessment she had to be assisted in squats, with two coaches supporting her while she used both arms to push herself up to standing from a 15-inch box. She then progressed to one-arm supported squats from a box and eventually to no-arm support from her coach. We progressed her squats from the 15-inch box to the 12-inch box and eventually to squatting independently with kettle bells.

Because of the lack of flexibility in her injured shoulder and her inability to hold the bar in a low-bar position on her back we decided it would be easier for Louise to high-bar squat. This allowed us to still train the squat while giving her a more secure bar position. As she became gradually stronger Louise moved on to high-bar squatting with a 15-pound barbell. Her squat is presently at 105 pounds and progressing well with a moderate-day squat and a heavy day. We keep the volume low on her squats and she responds nicely to micro-loading.

Louise tried doing the press, but her lack of shoulder mobility and arthritis in her hands did not allow her to use this exercise safely. Because of this we programmed the bench for her twice a week, varying intensity with volume.

The bench press progressed steadily from a 15-pound bar up to 50 pounds, and then her limited grip no longer allowed a safe hold on the bar. We designed a new program alternating regular bench press and pin bench press, where the rack was set to a height right at her chest, and she started the bench from the bottom position. This served as a supplemental exercise to the regular bench and developed more upper body strength for Louise. We varied the bench press and the pin bench press until it was necessary to make another change because of the heavy weight. We integrated close-grip bench press at a lighter weight and higher rep range – that was successful and ran for quite a few months.

In the beginning Louise did not have the flexibility to reach down to a full range of motion in order to deadlift off of the floor. We programmed rack pulls for her instead. We started with a position below the knee at 35 pounds and then increased her range of motion by lowering the rack safeties. Louise was eventually able to deadlift 65 pounds from the ground but was losing her hold on the bar with a double overhand grip, so we began using wrist straps, which helped to connect her to the bar better.

She was able to begin progressing her deadlift once again, but stalled at about 100 pounds because of grip issues. Over the past year she has struggled with grip limitations and arthritic pain in her hip and hands during cold weather but it never stopped Louise from persevering.

We programmed light deadlift days into her routine to offer some recovery, and broke up her heavy deadlifts to 2 sets of 3 instead of 5 reps because the weight was too heavy to maintain a proper hold on. Eventually Louise went to some heavy singles prior to a drop set and her deadlift started moving again. Her deadlift made good progress and eventually even her light day began to surpass the 100-pound sticking point. Presently her deadlift is at 125 pounds and moving nicely.

When she first began to bench press Louise needed assistance to get up from the bench, but after several months she was able to sit up on her own. This gradual improvement of function went nearly undetected. Louise received a phone call from her daughter one day and she sat up by herself, reaching for her phone, not realizing what she had accomplished until later. This was her first big milestone, occurring at about 2 months.

In response to a fear of falling while alone, she set the short-term goal of being able to get up from the floor independently. She knew that this would be a challenge as she was starting with limited grip strength and painful RA symptoms. Recently, following the successful implementation of the training program described below, Louise met her goal, and demonstrated an ability to get up from a crawling position on the floor to a standing position without assistance.

Louise has made enormous progress, even if her numbers are not staggering. “I can’t believe I’m going to be able to do this set, but I’ll give it a shot if you say so.” This was her reaction to the workout as things became heavy; it seemed unbelievable to her that she had become strong enough to deadlift and squat over 100 pounds, but indeed it happened. 

Having confidence in your body even while acknowledging its limitations is life-changing to someone who worries about not being able to help herself. Louise is a tenacious and strong willed woman, we all have a lot of respect for her in the gym and the other lifters watch her in awe. Although she needs assistance from us she insists on participating in all of the heavy lifting and loading. Louise is already a stronger person, one who can withstand a fall and get back on her own two feet without help, and that means way more to her than the weight on the bar.