Being stuck in a boot or cast after an injury or surgery is no excuse to not move. It is actually quite the opposite, now is the time to take extra care of the rest of your body! While it is imperative to protect the integrity of the injury/surgical site and allow for proper tissue healing, we can still maintain the strength, range of motion, and health of muscles and joints above and below the area! This article will cover some of our favorite lower extremity exercises to do while “immobilized” or “non-weight bearing” to help regain strength after surgery or an injury. As always, check with your orthopedic surgeon and/or physical therapist to determine which motions and exercises are the right ones for you!
You Have To Do Strengthening Exercises!
There is research to support the notion that you can lose up to 350g of msucle tissue (~10%) and a reduction of 30% of muscle protein synthesis for every 2 weeks you’re immobilized after surgery.
To put things into perspective, 350g of muscle tissue is the size of an average human heart! How crazy is that?! Immobilization, bed rest, and being non-weight bearing (not allowed to bear any weight on a given limb) is an absolute recipe for disaster to your bone, joint, and muscle integrity. Typically with many foot/ankle surgeries, surgical precautions include a period of non-weight bearing for as long as 8 weeks. Even worse, some surgeons don’t even send their patients to physical therapy until 4-6 weeks after surgery. That’s over a month in which you’re losing precious muscle mass and your joints are getting stiffer. All too often we see the compensations the body has to make for these losses, causing abnormal movements or compensatory strategies throughout the rest of the body that can lead to other musculoskeletal issues!
Tissue healing after an injury or surgery is an important concept to understand as it helps to set realistic expectations. Below in our article on tissue healing, you can learn all about this concept and how you can optimize recovery after an injury!
The importance of early mobility after surgical procedures continues to be supported within recent literature. For example, one study showed that individuals who had hip surgery and were bedbound after had a complication rate of 52% whereas patients who were mobilized early had a complication rate of 36%. The study also showed that early mobilization was associated with a lower risk of complications, such as deep vein thrombosis, prolonged post-operative swelling, muscle atrophy, and decreased cardiovascular endurance.
It can be difficult to rationalize that you are still able to exercise after you have just had surgery, but fear not! There is always a way to stay active within specific precautions that your surgeon has specified for you. For example, just because you may not be able to bear weight throughout your foot after an ankle surgery does not mean you are unable to perform other modes of exercise, such as upper body weight training. Keeping your body as close to its previous level of function prior to surgery is going to help optimize outcomes throughout the rehabilitation process.
Rehab Your Foot and Ankle After Surgery
Finding direction as to where you should start after surgery can be challenging. Luckily, we at [P]rehab have designed a program that you can do from the comforts of your own home, starting immediately after surgery! Learn more about our Foot & Ankle Rehab Program HERE.
How To Regain Strength and Stay Strong After Surgery
Shown in this video above are a host of different strength and conditioning exercises as well as basic stretches to keep your affected limb in check while you are immobilized. These exercises will keep your glutes and quads strong and your lower extremity mobile. Do these exercises (+more) on the unaffected side as well! Exercises/stretches in order are Side-lying hip abduction, clams, evil clams, side planks, side plank clams, hip extension, fire hydrants, hip hinges, long arc quads, straight leg raise, hamstring curl, hamstring stretch, and hip flexor stretches. You can find detailed explanations and follow-along tutorials of all these exercises in our exercise library.
Looking to get a head start on your upcoming knee surgery with some knee prehab?? Check out this beast of an article for exercises you can do now to speed up your recovery!
Learn How Blood Flow Restriction Can Help You Stay Strong After Surgery!
Regaining Range of Motion After Surgery
There are numerous ways to regain knee range of motion prior to or after surgery. When it comes to ACL reconstruction, in particular, one of the best indicators for good post-operative outcomes is normalizing the range of motion prior to surgery itself. This is why, in addition to allowing swelling to decrease, surgery is usually held off for a bit after someone tears their ACL. Shown in the video below are just some of the many ways we like to gain back knee ROM. In general, we can classify the exercises as either passive, active-assisted, or active range of motion exercises.
Passive exercises rely simply on gravity to do the ‘stretching‘ work. Exercises like supine knee props, the bag hangs, or seated knee flexion all rely on gravity to stretch the knee.
Active-assisted exercises incorporate active movement into the exercise, in addition to an external force like gravity, your other leg, or even another person’s body. An example of this is the supine knee flexion against wall exercise. Gravity is pushing Craig’s knee into flexion, while he contracts his hamstring at the same time to add a further stretch to the quads. Note that this exercise and others can easily be made passive if Craig doesn’t contract!
Active range of motion exercises uses the agonist muscle to move into the range. Examples of this are the long arc quad to achieve full knee extension (using quadriceps) or supine heel slide to achieve full knee flexion (hamstrings).
The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!
We hope this article has been helpful to you as you are preparing for your surgery/casting, or if you just got out of the surgery room/cast! Even if you aren’t injured, share this article with a friend or loved one who will be getting surgery/casting as it will dramatically affect their outcome for the better. Take some of the principles from this article to enhance your understanding of staying strong after surgery!
Gain Your Foot & Ankle Health Back After Surgery
The foot & ankle is a truly unique design with 26 bones, 30 joints, over 100 muscles, tendons, ligaments, and over 7,000 different nerve endings! It’s complex but in complexity, we go simple because simple works! In the Foot & Ankle Rehab program, you will spend time developing the habit of consistency each week. Along with consistency, the goal is to increase confidence and decrease uncertainty by mastering safe, effective movements. As you work through the program make sure to take advantage of the education, training support, and assessments videos.
About The Author
Michael Lau, PT, DPT, CSCS
[P]rehab Co-Founder & Chief Product Officer
Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete.
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.