Hello everyone and I hope this day finds you feeling great and crushing goals! Today’s post is in response to some great feedback and questions I’ve recently received. Folks have asked “How can I train to prepare specifically for an upcoming surgery, what can I do to maintain at least some of my conditioning on both the front and back ends of a surgical experience, and ultimately how do I blend my rehabilitation with training in the longer term?”
These are fabulous considerations and there is a way to effectively address all of them. This is a true art form because each Lifetime Athlete will have a different level of conditioning, training age, goal, injury history, and surgical procedure. As a performance coach and physical therapist, one of my major objectives is to help people avoid the need for surgery. But life happens to Lifetime Athletes, myself included. You have accidents, injuries, and circumstances that sometimes require a surgical journey to get you back on track.
Just to clarify, we’ll be talking about elective orthopedic surgery here, not emergency procedures or those that fall outside the sportsmedicine realm. I’ll break down each of the three topics and offer a few suggestions for each. These are principles that I’ve used with many clients over the years and on myself as well, including recently with my shoulder reconstruction. In the companion podcast to this edition, Episode 211, I’ll share some stories of my personal experiences.
TRAINING SPECIFICALLY FOR A SURGERY
- Maintain your health. This seems like a no-brainer because it is. Healthy people, with normal levels of heart rate, blood pressure, oxygen saturation, body fat, etc. do better with surgery. They don’t get slammed as badly by the procedure and they bounce back quicker. Way quicker. Eat right. Get your sleep. Destress your work and relationships as much as you can. You are going into battle. Surgery is an injury inflicted upon you. Healthy warriors are more likely to have the best outcomes.
- Work on overall fitness where possible. Deconditioning sucks. It happens fast and it takes far longer to get back in shape than to get out of it. That stated, do whatever you can to keep your beast tuned. It won’t be perfect or pretty but it’s worth it to try. If your upper body is out, focus on the lower, and vice versa. If you can’t do strength work, concentrate on endurance or aerobic fitness. Usually, it’s only one arm or leg that’s delicate, so develop a repertoire of unilateral exercises that work for you. Work with your coach on this stuff and if you don’t have one, seriously think about getting one.
- Restore as much function in the surgical area as possible. This statement has to do with range of motion, strength, swelling, and desensitization. The better that area is working, the easier it will be for the surgeon to do his/her magic. And…your rehab will be much easier. Stiffness and weakness on the front end makes early postoperative rehab much more challenging. I strongly recommend getting a pre-op sesh or two with a PT to both work on this issue and also to prepare you for your initial post-surgical rehab so you can practice things and know what to expect. Waiting until you are in pain and on meds to learn something is not as prudent.
- Anticipate your functional limitations and prepare. Temporarily, and this time frame will vary depending on what you have done, you are going to be without the use of an arm or a leg (for the most part). This comment is in reference to extremity surgeries which are more common than spine surgeries but everything deserves attention. Figure out how you’ll get around and what you’ll need for comfort at home and work. Get the pillows and cushions ready. Remove tripping or slipping hazards. Determine which side of the bed will be easiest for you to get in and out of. How will you feed, bathe, and dress yourself (or maybe you’ll need help at first)? Practice doing things without using the injured limb. This is especially important if the surgery is going to “take out” your dominant upper extremity. Do your best to be thorough in getting everything (and everybody who is kind enough to help you) organized and ready. Make it as easy as possible (relative term here) for yourself and everyone around you. A preoperative visit with an occupational therapist can be of immense help.
TRAINING AROUND AN INJURY/SURGERY
- Use the parts that work. Too many times I’ve heard someone say “my blank is injured so I can’t train” and I’ve had to cringe. This is the old fixed or closed mindset and not the growth mindset. Here’s an example. Your leg is injured. You are a runner. You automatically assume “therefore I can’t train.” In reality, you can’t run. But you might be able to swim, bike, lift or do other training. Doing nothing, for anything more than a day or two, really hurts the Lifetime Athlete. Pull up the big kid britches and find something, virtually anything, that you can do to keep up with your training habit. You’ll never regret it. #createthewin!
- Avoid aggravating the surgical area unnecessarily. Don’t slam and bang into the problem, figuratively speaking. Be careful and protect the involved area. I call this the orthopedic workaround. It’s a dance. You’ll have to experiment and modify exercises, sequences, and programs. If being in a certain position is painful or doesn’t feel right, try a different one and change the angle or plane of what you are doing. #findaway!
- Be creative and open-minded. You’ll beat yourself up if you cling to pre-injury goals and patterns. Be willing to do what you can, and emphasize that as opposed to trying to force your body or mind into old or familiar patterns. I’ve seen a lot of folks who couldn’t do what they wanted after an injury and heading into a surgery, so they just shut down and did nothing. They ended up negatively impacting their experience and outcome because much of what I talked about previously was shit-canned. Resist the urge to self-sabotage. #nofriggingexcuses!
- Frame up new goals. It’s time to change. That’s hard for any of us. You are not going to be the same for a while, and maybe never. Deal with that first. You have to get to acceptance and then start figuring out how you are going to make lemonade out of this lemon. Maybe there is a silver lining. Life is throwing you a curve ball…see if you can knock it out of the park. This process can take a while. Get some help if you need it. The future is ours to shape. #mindbelievesbodyachieves!
TRAINING WHILE REHABILITATING FROM A SURGERY
- Design your programming to blend rehab and training. This is an often overlooked principle in program design. Sometimes you will find yourself at a physical therapy appointment with limited time and the need to focus only on direct rehab to your injured or surgical body part. But in reality, you’ll be spending much more time doing a home exercise program. In many cases, you can do this at the gym (commercial or home). Mix it up. Do a range of motion exercise that is appropriate or protocol-specific for your injury. Then, work on strength for your uninvolved side or top versus bottom. Spice things up by adding in some high intensity intervals in between other exercises, or tack a cardio sesh onto the front or back end. A little science, creativity, and motivation can go a long way into making training sessions that serve multiple purposes.
- With rehab, be conservative early and aggressive late. At first, focus on just plain healing and staying ahead of pain. Surgeries are not unlike car wrecks. Sure, things get repaired and you are initially medicated but this process is a huge shock to your body. It takes several weeks in most cases for the inflammation to calm down and for you to really feel like getting after it. Early on, and this can be anywhere from 2-6 weeks, emphasize nutrition, rest, sleep (as possible), and use medication as prescribed until you feel you don’t need it. I’m not advocating for extended drug use but in the short term it can help and that’s how it should be utilized. Move a lot when you are not resting, but keep it safe and gentle. That’s the recipe to help your body recover from the trauma of surgery and to start laying down new tissue, clearing waste products, etc. You’ll know when it’s time to pick it up. The chronic heat and aching will diminish, sensitivity to touch the surgical area will go down, and your mobility will break into the next plateau. Always confer with your surgical and rehab team on the progressions, but once you are initially healed, begin to apply some therapeutic vigor.
- Build progressively. Rome wasn’t built in a day and neither shall you be rebuilt in that manner. A post-surgical athlete is a bit more sensitive to workload progression than an uninjured beast. Stay patient, and celebrate the small wins, because most of them will be finite and gradual. You’ll get there. Never stop believing that. One brick at a time.
- Expect nonlinearity and adjust accordingly. The human experience, and the natural world, is decidedly nonlinear. Sometimes in our minds, we envision this perfect 45 degree slope of progress with things. Building projects. Training. Rehab. Embrace the FACT that there will be some ups and downs. The goal is to keep them minimal and not to overreact when they do occur. One of the best ways to do this is to have a great coach or physical therapist helping you in your journey. Design your programming to have natural regressions and plateaus. This is purposely inserting some ebbs into your flow. I use a method to help folks develop what I call instinctive wisdom, in which they really get good at tuning in and sensing what’s going on in their bodies. Others call this innate knowledge. No matter the term, being self-aware is essential.
- See where the new you ends up and enhance your training and performance knowledge. Old dogs. New tricks. In all probability, this ain’t your first rodeo in life. Learning is forever and those who embrace novel learning do the best in these journeys. Research even proves that they also enjoy higher degrees of overall life satisfaction as well as enhanced brain function. Don’t give up on getting back to doing the things you love or that are important to you. But try to figure out ways that work best for you. More flow, less flight. And don’t be afraid to try new things.
Hey, thank you for being with me today. I hope you found these suggestions helpful. If I can be of further assistance, reach out to me and schedule an appointment. You are a Lifetime Athlete. I salute you.