T Nation

Hip Replacement: Smith Machines vs. Power Rack

We received this email below from a reader. Any advice for him?

T Nation,

I am looking for some advice and guidance: COVID has closed down gyms for the time being and possibly for the duration of the year. I am interested in purchasing either a SMITH MACHINE vs a POWER RACK.

I have had THR (total hip replacement) in the past year and believe that a SMITH MACHINE would be safer and more beneficial for me at this time. At 58 my days of heavy lifting are over. In fact, I just started deadlifting again in June after a 15 month layoff due to THR and haven’t completed a back or front barbell squat since.

What are your thoughts? Which brand/type would you recommend? Marcy pro? Commercial?

Please guide me on my decision.
Respectfully,
Steven

Maybe @clee78 could give some insight here.

Great question.
I’m 61 and almost 12 weeks from my hip replacement. I’m also an Orthopaedic Surgeon and have been training at home for years.
I would go with a power rack , bar and adjustable bench. Pull-up bar to the rack is also available.
Add a pulley system, the one by spud inc works great and is a good price point. Buy the best product you can afford. I’m not a fan of half racks if you can afford the cost and space of a full. Check out your ceiling height. I own a powertec rack , it’s fine. I wish I had bought from Elitefts or Rogue. There are probably plenty of good brands.
The fact of the bar being able to move in the plane of motion you move in , to me is better than you moving to a fixed plane of motion that the Smith Machine offers. With a little creativity you can do lots of diff upper body exercises, as well as lower.
Good luck, be careful, don’t dislocate or overly stress your implant. Keep your body weight good and work the muscles not joint when lifting.

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When I was coaching in St-Louis (official training center for the Blues) one of my clients had a complete hip replacement. We never did any “fixed” multi-joints lower body exercises and he went on to become fully functional again. While I’m not an injury specialist, I can offer my two cents.

While the Smith machine might look like the safer option, and it might be in the VERY short term, it is not the right or even the safest option.

It can give you the illusion of safety but in reality it can be worse. Because you don’t develop the same body control and stabilization as you would with a free-weight movement.

Another point is that if you have slight movement imbalances, for example shifting a bit more on one side (which is bound to happen with a hip replacement, at first) or rotating the pelvis, the Smith machine will actually put the body under more torque; the reason is that both ends of the system are fixed (feet on the floor, fixed bar on the shoulders) since neither end can rotate to accomodate the torque, it’s the body that will absorb all the force, specifically the knees, hips and lower back area. This could lead to overuse issues quickly, in your situation.

With a free weight movement, we still want to avoid imbalances and torquing, but if it happens it’s not as dangerous as the torque is partly reduced through movement.

Finally, the Smith machine is more problematic for the main reason why it seems appealing: it. will get you back to squatting heavier, sooner.

Why is that a problem? Because it will get you squatting on a full range with significant loading before your body is ready for it. When you can do a proper back squat with free weights and without pain or discomfort, you know that your body is ready to go. But Smith gives a false sense of readiness that can lead to injuries.

When you have the choice, when the goal (in part) is to re-establish your capacity to move well, free-weights will always be superior to the Smith machine.

Now the thing will be to establish a gradual progression toward squatting and deadlifting again (I personally would use the Romanian deadlift and eventually pin pulls below the knees, not full deadlifts from the floor).

That will require unilateral work to balance out both sides. Lots of glutes work to be better at creating active hip stability and a very gradual introduction of the big basics, ideally with progressive increase in the range of motion THEN of load.

For a few months, do not see squats and hip hinges/deadlifts as movements to gain strength and size, see them as motor skills you want to acquire.

You will no get injured by doing a free-weight exercise with good mechanics and within your movement and loading capacities. You get injured when you use improper mechanics and a load that is excessive for what you can properly handle at the moment.

This can happen with any training tool, but the Smith machine can make it more likely by giving a false sense of confidence and the illusion that you can handle more than you really can at that moment in your recovery process.

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I had a Total Hip Replacement 5 years ago at the age of 47. I went back into the gym after 12 weeks and the only exercise which initially made me cautious was the leg press machine.
This probably lines up with what CT says above about natural planes of motion.
I just started very slow, body weight, then just the bar, and focused on form.Took me less than 6 months to get back to the weights I had been using before.
I’d definitely recommend going with a power rack.

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All great points and ideas. It seems most favor the rack over a Smith Machine. Safeties on the rack will allow progressive rom safely.
Interesting that concern for wear of the implant is not the main concern after rom and strength gains of the muscles.
My opinion on rom, strength, coordination of movement of the artificial hip is to preserve implant preservation. It has no healing or regeneration capacity.
In planning a return, I think the question is goals. Is it to develop a squat or deadlift or to gain the benefits of those terrific movements? For me it’s the benefits of the movements. I would recommend looking at incorporating some type of pre exhaustion training .
Enjoy the journey safely. Revision total hip replacement surgery is a bear.

Might be useful to link-in this thread.

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If I knew how, I would…
I ended up with a total hip on June 3rd. Anterior approach, home the same day. I feel great. Walking miles a day and easing my way back to the weights
My rom is good and pain free ,except flexion past 90 degrees, I feel a little pinch.

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Good to know you’re going well!

All you need to do to link a thread is to copy and paste the hyperlink

The surgeon claimed it would easily outlast the rest of me! Really hope the bugger’s right…

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I usually think 20-30 years is an excellent result.
There are way more younger people with total hips now then years ago.
We X-ray most folks in the USA every few years as follow up. Ask at your next visit.

Will do, thanks!

In the past two years I’ve had a posterior THR and a resurfacing on the other one. The only high risk movement for me is twisting while in a deep squat. I do BJJ and everything on my hips. The key is to get the biggest femur head to best replicate your old size and this provides all the stability you need regardless if it’s posterior or anterior. My resurfacing scar is huge and they cut all the deep internal rotators (and re-attached them) and that hip is not going to dislocate. I will add that I am careful with my depth on the leg press and Romanian deadlifts. Rehab was minimal and there is no reason to overly limit what you want to do.