Exercise After Injury

I have had several comments about exercising after injury.  The observations that I would like to share with you are not meant to be a substitute for medical advice.  As a personal trainer, I have had many post surgical or injured clients referred by physical therapists or orthopedic surgeons for follow up strength training.  Many of my clients are active and participate in either golf or tennis.  Both of these sports are like “runners” in that many are playing with injuries.  Many injuries have their origins in muscle imbalances.  Tennis and Golf tend to cause muscle imbalances because of the asymmetry of their movement.  When returning to activity after an injury, it is helpful to understand the mechanism of injury.  Why did the injury happen in the first place?  It makes sense to address the underlying problem before a return to full activity.

Muscle imbalance exists when opposing muscle groups vary in flexibility and strength.  Quadriceps (front upper thigh) and hamstrings (back upper leg) are often out of balance.  In strength training hamstrings are usually weaker than quadriceps.  However, when the hamstrings are more than 60 percent weaker than the quadriceps, a muscle imbalance exists.  The trainer should work to minimize the difference between these two muscle groups.  Both muscle groups should have adequate ROM (range of motion).  One or both muscle groups can be tight. Tightness dramatically increases the risk of injury or re-injury.  Most people know they need to stretch more.  Weak elongated muscles are also involved in many injuries.  The opposite of strong tight muscles are weak, overstretched muscle.

In Yoga, clients are often proud that they can reach a pose that others cannot.  If you can reach the pose because the muscle is too weak and stretched, Yoga may actually aggravate the injury.  Instead, work on the poses with which you have difficulty.  Find out if the muscle group you are stretching is weak.  If the muscle group is weak, strengthen it.

After you have made an effort to understand why you had the injury, when can you return to full activity?  Many of my clients are type “A” personalities and want to be back at their previous level in a week or two.  The body just does not work that way.  It takes time.  There are some constants that we know.  Fractures that are not displaced usually take six weeks to heal.  Then you start slowly back to your activity.  The body is a wonderful machine that will usually tell you if it is hurting.  Listen to the feedback from your body.  Returning to full activity is complicated and usually should be supervised by someone who has professional expertise with your injury.  If your injury forced you from your activity for more than a couple of weeks, expect an equal amount of time to return to your previous level.  Sometimes it may take six weeks of incremental exercise to begin seeing progress.  The fastest way to return to normal activity is to give your body the time it needs to rebuild its strength and conditioning.

As our population gets older, we are seeing many more orthopedic injuries.  Meniscus (cartilage between the upper and lower leg) repairs are becoming more common.  Patients vary widely in their recovery from knee surgery.  As a rule, I will not work with post knee surgery clients until the client is able to walk down a staircase without holding a rail.  This practical measure tells me the client has adequate strength and ROM to begin strength training in the gym.  The surgeon will often refer a patient for strength training when they are ready.

The stress to joints resulting from obesity is causing more hip pain, knee and ankle/foot injuries.  Poor posture while driving and computer work also are increasing the neck and shoulder injuries.  The best solution to preventing these injuries is through better posture.  When an injury presents, take action early.  Ignoring a sore knee or shoulder often leads to injuries that are difficult if not impossible to reverse.  Anyone who has had a shoulder repair of the “rotator cuff” will testify that the intervention is painful and requires a long rehabilitation.

What is the solution?  Intervene early when you notice that your body is not working like it should.  Understand posture and how poor posture is involved in many, if not most the orthopedic injuries. There are many books that discuss the importance of posture.  I like Pete Egoscue’s book Pain Free. If you have had an injury, find a professional who will guide you to return to health.  Keep moving, your body needs it.