Post Surgery Core Rehabilitation

Surgery can be one of the scariest experiences a person has to go through. Whether it is minor or major the importance of post-surgical rehab is key! At Elite Health and performance we work with our patients to get their bodies back to their optimum functioning and strength whatever your goal is.

This topic is close to my heart as last year I went through my 3rd major abdominal surgery. This gem was a twisted bowel that was slightly necrotic (dying tissue). Luckily for me the excellent surgeons whisked me into surgery and after 3.5 hours I was in recovery healthy again with a 20cm battle wound!

After a week in hospital the hard part began, RECOVERY and REHAB. My surgery was very similar to a woman who has gone through a caesarean or similar to a person who has suffered a hernia operation. So these exercises will apply to all.

To further understand the intricate involvement of the abdominal muscles and what happens to the body when touched by the surgeon’s scalpel a brief look at the anatomy is key:

The musculoskeletal core of the body includes the spine, hips, pelvis, proximal lower limb and abdominal structures. When one of these components is compromised you effectively inhibit motor control, strength, stabilisation and endurance of the whole complex. The stability of the lumbo-pelvic region is crucial to provide a foundation for limb movement, support and to protect vital organs and bony structures like the spine.

The abdominal structures alone serve as a vital component in maintaining intra-abdominal pressure and tension in the thoracolumbar fascia. For anyone that has experienced abdominal surgery, disc or nerve injury or rib injury the loss of this abdominal integrity can make actions such as sneezing, coughing or standing up very painful and sometimes incomprehensible. For pregnant woman the hardest part of this is not being able to pick up your own child. This is where gentle rehab comes in.

Before we get into some of the exercises I would like to mention that you must always do these exercises within your limits. There is no award for the first person to do a sit up as this can cause increase pressure in the abdomen and may set you back.

During my recovery I set myself milestones in which to strive for. This is a marathon not a sprint so it is very self-satisfying when you can look back on your journey and realise how far you have come!

Week 1 – 3

Exercise will be minimal, walking to the letter box and down the street to get a coffee are fantastic achievements. Walking will help get the blood pumping which reduces the chance of DVT. During this time what your body needs is sleep, a healthy and nutritious diet and slow increases in your activities of daily living (ADL). Set yourself goals such as making dinner for you family. Little tricks include using a towel or pillow to help brace you abdomen when doing these activities as you’re creating a “false” core this will limit the pressure on your back and reduce low back pain.

Week 3-5

During these weeks most doctors are still discouraging heavy physical exercise. This is important to take note of, however increasing walking and light bike riding are great ways to get moving without exertion. The light cardio is great for numerous aspects of the body. It helps the circulation and delivering nutrients around your body and muscle strength as you would have lost a lot of your fitness conditioning.

During week 5 a great exercise to incorporate into your daily routine is the broomstick twist.

This exercise is very easy and is done while watching Tv: Sitting on a stool with your feet flat on the floor you will place the broomstick behind your back (similar to a barbell). Brace your stomach by thinking about holding it tight and bringing your belly button to your spine. You will then twist from left to right. When twisting you want to feel a slight pull but no sharp pains. This exercise is also great with the swelling and loose tissue that you have on your belly. It decreases water retention which if untreated can lead to pockets of fluid retention and “puffiness”.

Week 6-8

This is the exciting time! You would have got clearance from your doctor and will be able to increase your rehab and exercise.

During these weeks I found that bike riding and light boxing was the best thing for cardio. Running increases the intra-abdominal pressure on your lumbar discs. This may cause complications especially if you are already susceptible to back injuries.

Rehab exercises should be focused on the “secondary” and periphery muscles to the abdominals. Focusing on these muscles will in turn strengthen the core complex in time. Balancing exercises are fantastic for this time; uneven surfaces increase the activity of the stabilising muscles of the body. It also wakes the brain up to switch on the muscles associated in support ie the abdominals.

Bosu balls became my best friend during this time!

Exercise 1: Using the bosu ball stand on the flat surface with feet shoulder width apart. This alone may be tough for some so if that is the case you will stand on this for 30 seconds at a time and rest in between. For the more advanced we will try some squatting. Focusing on keeping the stomach braced, squat down as far as is comfortable. I would aim for 90 degrees. Stand back up and repeat. (Maintain good form in the squat and make sure you are not allowing the knees to come over the toes.)

Extension: Add in some dumbbells and press them above your head when you stand.

Extension 2: Add a lunge onto the bosu ball (flat side down)

Exercise 2: Lunges are a little tricker as you will be predominantly leading with one leg.

Phase 1: Walking lunges (10 is usually a good number to start), If you are feeling extra fit today add a broomstick or light barbell to behind your shoulders while you lunge.

Extension of walking lunges: Add some kettle bells or weights while you lunge. Again make sure you are bracing your stomach.

Exercise 3:

Cables: The twisting motion will activate your oblique abdominals which is great in reducing swelling and water retention that may have occurred as a result of your operation.

For this exercise you will need a very light weight. This exercise is about control not strength.

Exercise 4:

Glute bridges: Engaging your gluts is key in core rehab. As shown in the picture above there is a fascial sling that links the gluts, lat dorsi and the abs together. Strengthening these gluts will be imporatnt in taking some pressure of the abs and allowing them to continue healing and growing stronger.

Lying on the ground with your arms by your side and your feet comfortably on the floor in front of you brace your stomach and thrust your hips into the air. Make sure you squeeze the gluts as you raise your hips. If you feel pain or cramping in the hamstrings restart and concentrate on the use of the gluts as the key muscle group.

Exercise 5:

Leg press: One legged leg press are great at activating the hip flexors and gluts. I would discourage adding weights on the machine as it should have enough resistance from the plate alone. However if you are naturally a stronger person add some light weight to it. (Try with no weights first)

As you can see in the video my foot is up quite high. This is essential in activating the gluts. If you find there is some pinching in the front of your hip you may have some hip tension that needs to be released.

Week 9 – 12: During these weeks I would be increasing your workload whether that is cardio or weights. This is a long process of recovery so do not be disheartened if you are not lifting weights like you once were. You will get there!

Using the previous exercises as a basis you can start adding heavier weight or increasing the reps. However I have some more advanced exercises that can be included.

Again as you may have noticed a lot of the exercises require balance from the body or an activation of the core at all times. This is imperative in the rehab and for future maintenance.

Exercise 1:

Pistol squats: This little gem is tough. Standing on one leg with the other leg extended, squat down as low as you can go. Hang onto some rings or support while doing this as to maintain your form and to enable correct bracing of the core.

Again if you feel some pain in the hips or lower back there may be a restriction in the hips that needs to be addressed.

Exercise 2:

Back extension: This exercise is activating the posterior chain of the lower extremities. As you can see in the video it is pretty self-explanatory. However you will want to maintain a fluid movement as you lower yourself down and really squeeze your gluts to bring yourself back up.

Extension: Hold a weighted plate in your hand. This will increase the resistance on the way back up.

Exercise 3:

Double and single leg raise: Lying on your back place both hands behind the small of your back and raise your legs (straight if possible) to 90 degrees. If you find this hurts in the abs or you find it hard bend your knees and raise them in a table top position.

Exercise 4:

Ring pull: Standing a comfortable distance from the ring with arms out stretched (the closer you stand the easier it is, the further away and the flatter your body the harder it is) pull yourself to the ring with both hands and bring it past you, finishing at your chest.

With these exercises over some time the core will restore to full strength and you will be able to enjoy all your daily activities pain free and perhaps even stronger!