Easing into exercise after surgery

People might have to take a step back from their normal exercise routine after having surgery, but modified movements are encouraged during the healing process. While each surgery presents different roads to recovery, it is important to listen to your body when trying to regain your usual motions. A Baylor College of Medicine orthopedic surgeon discusses how to assess your journey back to physical activity.
 
“The most important thing is patient comfort. After surgery, there is often this apprehension of ‘If I move or do something, I will hurt or damage the area where I had surgery,’” said Dr. Adil Ahmed, assistant professor in the Joseph Barnhart Department of Orthopedic Surgery at Baylor who sub-specializes in upper extremity surgery. “We must counsel patients pre-op and post-op, telling them what is safe to do in terms of physical activity because they should be mobile.”
 
After surgery, start to do small tasks. Shoulder replacement patients are in a sling and have limited mobility in the first four weeks. But during that time, Ahmed recommends moving your fingers, opening and closing your hands, squeezing a stress ball and flexing and extending the wrist and elbow. These movements will keep the joints from getting stiff and prevent swelling.
 
“In those first four weeks, you’re doing very gentle, rotational motions because you want everything to heal, and then you progress in therapy and remove those restrictions. Once your motion begins to improve, you begin strengthening,” he said.
 
If your arm is in a sling, just focus on basic tasks. Try getting out of bed on your own, going to the bathroom alone or putting on and taking off clothes and shoes. Once you are able to do these basic household tasks, you can slowly start going back into physical activity, such as walking with gentle motion, until you get your range of motion back.
 
To modify your exercise routine during recovery, focus on the areas that you can move instead of being sedentary. After a shoulder replacement, use your free arm to hold a broomstick and move it around, then progressively start using heavier sticks to strengthen the other arm. If you break your wrist or have an elbow replacement, focus on working your legs and core, which is good for overall health and puts you back in the gym. As you heal and progress, you can gradually start incorporating your arm workout into your routine as well. Start with basic body weight workouts. Resistance bands are beneficial because you control the movement. Resistance band training applies constant tension and gradually strengthens the area.
 
“If you can get to the gym and do something, even if it isn’t your normal routine, that’s great. Something is always better than nothing,” Ahmed said.
 
Patients will be in pain directly after surgery while healing, so controlled movements are best to minimize that pain. Stationary bike provides a safe, reliable and low-impact workout that elevates the heart rate. This is a quick and easy workout to do early on, even if your arm is restricted in a sling. Walking will provide the same benefits and is encouraged after surgery. When you return to the gym, start light. If you previously did heavy bench presses, start doing pushups on your knees before building up to normal pushups and eventually weights.
 
“It’s always a progression, and you never want to hit the weights right away. You should start with light bodyweight exercises, much less than you were doing before surgery, because it’s not about getting strong right away. You must do everything within the same motion parameters because the natural body response is to power through pain, which is how you injure yourself,” he said.
 
Ahmed suggests using pain as your guide when beginning physical activity after surgery. If something hurts, that should be the upper threshold limit to you. Avoid suffering through the pain. Gaining motion is more important during the recovery period than strengthening the operated body part.
 
Surgeons typically see two types of patients post op: The overcautious patient is nervous and hesitant to move even though their surgeon encourages them to get active. When they choose to not move for some time, they get stiff, which can take months to recover from, in addition to add months to the rehabilitation period after surgery. The hyperaggressive patient ignores the surgeon’s orders to start gently, pushing it too far too fast. This will end up doing harm in the patient’s recovery. Patients with fractures that involve a joint need more care because if the joint surface does not hold perfectly (due to the patient pushing themselves in the gym), the joint can shift, which may cause the patient to develop arthritis for life.
 
While surgeons give patients necessary information for recovery and activity, they should make sure to ask questions in case an issue is left unanswered:
 

• Range of motion: Is it safe to move or not? Are there any restrictions on movement?
• Weight bearing: Can I weight bear or not? Can I push, pull or lift items?
• Immobilization: If I’m in a sling, can I take it off? Do I need to be in this sling constantly for a certain amount of time?
• Therapy: Do I need formal therapy? When do I start? Should I do basic home exercises?

 
“I try to make a point to tell patients this information, but it’s important with any type of surgery – not just the extremities – to ask these questions,” Ahmed said.
 
Surgery and recovery vary based on the patient and procedure. Ask your doctor the appropriate ways to incorporate physical activity into your routine and make sure to continue mobility, even at the gentlest form.