Returning to exercise after injury or surgery

***Disclaimer***

When it comes to your health and wellbeing, first and foremost you should listen to the medical experts. Also, because there are so many variables here, I will only be able to give general guidelines. You cannot and should not think of anything I say here to be specific advice to you personally.

That being said, my experience of helping people return from injury or surgery has taught me a thing or two. And I actually snapped my achilles tendon at the start of July, so am having some first hand experience of this!

Post surgery rehab

Injury and surgery...what's the difference?

When it comes to the injury and surgery, I think of them as very similar things, except one is (hopefully) a lot more controlled and planned than the other. For example, when you have had either an accidental cut or surgery, your body doesn't know the difference and will react in the same way to repair itself. This means we can share some of the thinking and ideas between these two subjects. 

Injury or surgery can mean you taking time off to allow your body to repair. This is often followed by a limited period of rest or an exercise programme to help your body recover.

Immediate aftermath - Ask questions.

This bit is easy. I can't stress this enough: Do as instructed by your doctor and medical support specialists. Your situation is unique and they will know the best way for you to manage your recovery immediately following your injury or surgery.

Feel free to ask them any questions you have regarding your recovery. Here are a couple of good ones I asked:

  • What should I avoid doing, why and for how long?
  • What should I aim to do, why and what comes after that?

And top tip: Write down the answers. Trust me on this one. I have yet to meet anyone who can remember what they were told to do, particularly straight after surgery when your brain is pickled and body traumatised. We all forget the details, or (usually) mix up the instructions entirely and end up doing the wrong thing.

You need to know what to do to start your rehabilitation to give you the right foundations to progress, whether that be with movement, flexibility or strength. You also need to know what to avoid doing initially - what will do more harm than good.

It is also worth remembering that your rehabilitation is progressive. In other words, it builds and changes over time. So what is appropriate at the start of your rehab, will change as time goes by. A common mistake people make is to stick with just the first piece of advice they were given. I have met people who were told (quite rightly) to refrain from certain exercises straight after surgery or injury... And literally years later they are still afraid to do them! This stagnation, staying in the same, weakened, post surgery state for years isn't helpful and to avoid this you need to know when you have the all clear to progress.

Asking these questions will ensure you get the specific instructions for your specific injury, and in my experience you will also be told to get "moving" as soon as possible. Physical activity is an incredibly important part of your recovery, helping maintain the fitness and strength of the rest of the body and it is also vital for your mental wellbeing. You will recover quicker and more fully if you feel you are still a fully paid up member of the human race!

A client of mine had shoulder surgery. And whilst restricted in her upper body movement and strength, was still able to walk and get out of breath within a week of her operation. She said doing this 'kept me sane'.

Don't underestimate the toll an injury or surgery can have on how you feel generally. Being able to be active can help you with the following:

  • Feeling independent and not reliant, or a burden on your friends/family.
  • Interacting with people in the wide world, and not just the same few faces of your immediate friends/family.
  • Feeling you are taking a positive steps to get over your injury, instead of being overwhelmed or forced to be a victim of it.

I have worked with people who, through no fault of their own, have been forced into not doing any rehabilitation exercise to help them recover. And the physical and emotional impact on them is very real.

I cannot stress this enough...working through your rehabilitation plan and building up your physical strength will also help your mental resilience and speed up your recovery. 

Probably the best thing I learned when I was lucky enough to train with people with various injuries/conditions, is that our bodies - made up of tissue and muscle held together with scaffolding of bone and some seriously fancy plumbing and software - adapt to experience. Faced with physical stress and hard work, our body will adapt by getting better and stronger. Conversely, experiencing no stress or hard work results in weakening of muscles, reduced mobility and a longer journey back to full health. 

The basic rules of recovering from an injury are just the same as when we are in peak fitness:

Provide enough stresses to trigger an improvement, but not too much to cause damage.

Just because we are injured does not mean our bodies suddenly work in a totally different way. The same rules of biology apply to you, me, someone in a hospital bed, someone recovering from an RTA, a stroke survivor or an Olympic athlete.

Unfortunately, there are people in this world who think that an injured person can't or shouldn't do anything physical. I'd love to see them tell that to any number of wounded service personnel or Paralympians, then see what reply they get!

Quote from a client: “Gradually building up the flexibility and strength in my shoulder following my operation, helped me to recover and get back to netball.”

Feeling nervous/cautious is totally normal.

Mantal wellbeing

So now we know that we need to do some form of exercise during our recovery. But doing too much could hurt us, make things worse or cause the original problem to happen again...that is a scary thought! Sensible people don't want pain and suffering, especially a second dose of it! So it is natural to feel nervous about doing exercise, in case it is too much and hurts us again.

We know we need to step up the levels of exercise, but how quickly do we change levels? Every day? Every week? Every month? Every year?

First and foremost, if in doubt, ask a professional. That is what they are there for! But I would also like to introduce you to something I call "The Speed Of Confidence".

This means we take the time to get confident doing exercise at “Level 1”. Once we are confident with what we are doing, we raise the stakes a little bit and try “Level 2”. We stay there until we are confident. Then we try “Level 3” until we are confident...and so on.

If we start losing confidence at a particular level, that's ok, we just drop down a Level until we regain the confidence to go back up again.

Doing things this way helps us realise we don't have to do everything, all at once. We are not being pushed into something we would rather run away and hide from. We are actually in control! We can manage it! We can do this at our own pace.

So what is Level 1? And what if when you see it, you think:

“No way! I can’t do that!”

No worries. The we will just halve it and try Level 0.5! Or even Level 0.25! It doesn't matter to me, because we are going at the speed of your confidence. We will break it down again and again until we find something/anything you are confident with, then gradually build it back up again.

Because remember, being scared/nervous/anxious is totally normal.

Quote from a client: “My shoulder had been a long term problem. And even after my surgery it took time for me to build my confidence and believe I could use it again.”

Pain is bad. Hard work is good.

No pain, no gain bullshit

This sounds like common sense. But there are too many rubbish sayings like "no pain, no gain!"

Pain is the way the body tells us something is wrong. Especially if we have recently damaged our body! Listen to your body. A sharp pain, especially at the location of your injury, should be checked out, not worked through.

Having said that, as long as you are not saying "Owch! That hurts!" But instead you are saying "Wow, this is tiring and hard work! I'm knackered!" Then you sound OK. You are describing the symptoms of exercise!

So this is where you are going to have to learn from the greatest teacher in history...experience. And if you are unsure or nervous, then remember, break it down into smaller, easier chunks, gain experience and confidence, then gradually build it back up again.

Be a Glass Half Full person.

A very common mindset is to think:

  • "No, I can't do x"

Instead of letting that negative thought bring you down, try changing it to:

  • "But instead I can do y and z!"

For example, if you have a dodgy shoulder, don't make a list of all the upper body things you can't do any more. Make a list of all the lower body things you still can do!

I've worked with several people in wheelchairs. So obviously we have been very limited with the leg exercises we could do. But that didn't stop us from working their upper body loads and spending some serious time punching the pads!

A simple drill you could try is:

Every time you find yourself saying "I can't do that", add to your written list of things you CAN do instead.

Quote from a client: “Keeping my rehab varied and interesting helped keep me motivated and build my general fitness at the same time so when my shoulder was strong again, so was I.”

There are no right/wrong exercises. Only easier/safer and harder/riskier variations.

This is where you may need to get some professional help to guide you through (contact me here if you would like help). In exercise and training, there is never any absolute black/white, or right/wrong. For example, I have heard many people say they should not squat because of their knees.

But when I watch them, 99% of the time I can show them a variation where they feel no pain and they are now helping their knees.

There are many variables we can adjust to make an exercise easier/safer for you. And, at the speed of your confidence, we can gradually ramp up these variables to make things harder, the further along your recovery you go.

And finally...

A final thought for you to mull over:

  • Medicine helps us recover from illness.
  • Exercise helps us recover from surgery/injury.
  • Exercise is medicine.

So let’s help each other take our medicine!

If you are interested or have questions about this subject, or other aspects of health, exercise or training, you can contact me by clicking here.  And if you see me hobbling around town on my crutches, give me wave!

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