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Post-Surgery / Post-Injury Recovery Training – Bridging the gap between physical therapy and optimal performance.

In my article on Pre-Surgery Preparation Training, I have discussed why exercising and getting in the best shape possible (from where you are currently) is essential before any surgery, especially orthopedic surgery. At the same time, I also wish to emphasize the necessity of post-surgery recovery training to insure optimal surgical results. Your surgery does not magically “fix” your problem if you do not recover to an optimal state of functionality from your surgery. The intended effect of the surgery hinges on your compliance with post-surgery physical therapy, and most often, a willingness to continue strength training after the physical therapy stage is over. Thirdly, an understanding of exercise progression becomes essential, especially for those individuals that may already enjoy exercise and who may have the potential to overdo it and potentially try to progress too fast and injure themselves.

This component is where hiring a professional that understands both psychological and physiological issues with recovery is invaluable. Generally, most people will either underdo their post-surgery rehabilitation or not even comply at all. But there is also the group that may be prone to overdoing it. And I fully understand the eagerness to continue the active lifestyle these people seek. As a professional, I have a great deal of education and experience in knowing when it is essential to give someone a little push of encouragement to do more. Conversely, I also have the knowledge to understand when a person needs us to pull back on the reins a little too slow them down and give their tissue time to recover and strengthen. If you progress too fast and hurt yourself, you go backwards, not forwards, possibly even damaging the ability of the surgery to “fix” whatever it was supposed to and therefore not recover 100%.

(If you are interested in learning more about post-surgery or post-injury recovery training or have one of our professional trainers design a comprehensive 6–12-week program, click here)

At the time of this writing (9/25/21), I am 53 years old and have had two hip replacements, one in 2017 and one in 2018. The physical therapy (PT) for each was one week of in-home PT starting the week following the surgery, followed by one to two months outpatient PT. After my first hip replacement, because of a scheduling delay, I could not start outpatient physical therapy until four weeks after my surgery; therefore, I would have 2 weeks of “nothing” in between my in-home PT and outpatient PT. For me this was unacceptable because of the necessary tissue remodeling involved at that crucial stage. Two weeks of inactivity that soon after surgery could have lasting implications on my long-term recovery, and I knew this. So, I took the concepts I was given by the in-home physical therapist and added exercises I knew to be helpful applying sound exercise science principles and progressions. I genuinely designed my own physical therapy program. Now, I don’t suggest this for someone who does not have my background and qualifications, but inactivity is possibly just as bad as overdoing it. So, I did my PT on my own for two weeks before I was able to actually see the outpatient physical therapists (which again, I do not recommend for someone who does not have the background and experience I do). I might have advised someone who does not have my education and experience level with exercise, to get professional help for the two-week gap. Or, at the very least, continue to do the prescribed exercises for your in-home physical therapy until the outpatient therapy begins. However, in this case, I started to design my own system using applied principles of corrective exercise and rehabilitation science that I had learned over the years. As I waited for my outpatient physical therapy to begin, the therapeutic workouts I had put together for myself seemed to be going well. These included bodyweight exercises, light resistance training, mobility and flexibility, and included some exercise in the pool.

After the two weeks went by, time had come to go to the outpatient physical therapy office for the first session. I showed the therapists what I had been doing. I also explained that I was a trainer and strength and conditioning coach and had a master’s degree in exercise science, with a concentration in performance enhancement and injury prevention. After explaining and demonstrating what I had been doing, they then said to me, “You don’t really need us… you’re doing great on your own… you are weeks ahead of where most people would be… call us if you think you need help.” But please note from my story… even with my education and experience, I fully planned to attend, and comply with, the physical therapy program that the professional therapists planned for me. So again, don’t try to go it alone. They gave me the go-ahead to continue on my own, and if they had not, I would have continued therapy with them.

So, at that point, I continued with my physical therapy, and two months went by. I had been doing a better and more diligent job on my physical therapy than would usually be the case for someone working with a physical therapist. The average person working with an outpatient physical therapist would not have seen the same progress. Still, at the end of the two months, I realized I was far from genuinely recovered, even considering that I was probably way ahead of where most people would be. After all, do you sincerely think for one second that myself or anyone else is back to normal after surgery just because two months of physical therapy is over? That would be a ridiculous notion. This situation is not a yes or no/on or off one. It is a progression. So, this only confirmed what I had already known from dealing with injury rehabilitation in the past (my own and my clients and athletes); when medically prescribed physical therapy ends, there is still a massive gap to getting back to 100% function. Therefore, a training plan that takes a person from the post-physical therapy stage back to 100% function is necessary.

If you are interested in ongoing post-surgery or post-injury recovery programs to bridge the gap between physical therapy and optimal performance, click here)

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Then, once you are at 100% function, what would be wrong with taking it even further? About four months after my second hip replacement, my strength levels on my squat and deadlift were very close to my old maximum strength levels from 6 years earlier when I was regularly training those lifts. Note: at this time, I still had some mobility restrictions. But I was also of the opinion that if this was the best my hip replacements ever were going to be (the proverbial, as good as it gets), then the procedure was still worth it and was, in fact, a success. Who would have known about four months later, one year from a second hip replacement, and two years from my first, I would set my personal best records in these two lifts? My old deadlift maximum before late 2019 was 385lbs with perfect form, set about seven years early in 2012. At 5:09 PM on December 27th, 2019, after one year and six months from my second hip replacement, I pulled a 425lb deadlift and probably could have gone up in weight. February of 2020, I broke my all-time squat record of 365lbs for a one-repetition maximum, set in 2014, by doing 375lbs for a set of 3 reps.

Now among strong weightlifters, these are not great lifts. Pretty good but not great. On many powerlifting standard tables, these would be considered the high end of intermediate level or the low end of advanced level. Respectable for someone who is not a powerlifter with two hip replacements, however. I will take it. But there are still some limitations and movement restrictions that I continue working on and am still getting improvement on to this day.

(If you are interested in learning more about post-surgery or post-injury recovery training or have questions about our other personal training programs in Sarasota / Bradenton, click here)

As a 53-year-old athletic man with a history of two hip replacements and record-breaking lifts after those, here is my recommended approach for you:

-Prepare a pre-surgery and post-surgery exercise plan with a qualified trainer. You must work with your trainer to develop a personalized workout routine specific to your special recovery needs. Avoid making mistakes resuming workouts on your own, post-surgery, without qualified guidance, or you may suffer an injury or improper healing.

-If possible, make sure your medical practitioner approves your workout plan from the trainer before exercising after the surgery. At the very least, the doctor should give you what are called “contraindicated movements”. You can share these with your trainer, as doctors do not take any exercise-related coursework in medical school and often have a limited understanding of exercise. Your goal is to heal faster and heal well. If you do not do the necessary recovery work, you risk a poor recovery process and less than optimal results from your surgery.

-While this may sound cliché, I cannot stress enough the importance of a highly nutritious diet during the preparatory and recovery phases. A wholesome diet aids in the healing process and gives your body the energy to resume exercise. Your immune system and body will rely on the right foods for raw materials. The right foods will prevent infections, weakness, and deficiencies in the body and heal your bones, muscles, blood vessels, nerves, and even skin.

-Inspire yourself to pick up your healthy and active routine post-surgery but also remember not to overdo it. Remember to listen to your body when you cautiously resume working out post-operation. If it tells you it is hurting, stop immediately and consult your trainer. A good trainer should be able to guide you on how hard to push. Follow your body’s pace and not your ego’s when you are in recovery.
If you are interested in ongoing post-surgery or post-injury recovery programs to bridge the gap between physical therapy and optimal performance, click here)


Final Thoughts

Many people underestimate the impact of pre-surgery preparation exercise routines and post-surgery training programs on their recovery. Orthopedic treatment procedures have a significant effect on our bones and muscles and cause immeasurable stiffness etc. But with proper preparation and recovery, you give your body the best chance to keep your bones, joints, and muscles fully functional and hence get the most out of your surgery’s intended repair to your body.

It is important to remember the post-surgery exercise routine plays a vital role in the recovery process. While many believe bed rest and taking it easy is better, the truth is that light exercises can boost recovery. Start with your prescribed physical therapy, as it is likely to be covered by your medical insurance and is geared toward the post-surgical repair. From there, when physical therapy is complete, a post-surgery recovery training program will ensure a successful recovery for you.

Thanks for taking the time to read this article we prepared for you.

Best Regards,
John J. Bruno, MS, CSCS, PES, CSS, FMS, USAW
Master’s degree in Exercise Science – Concentration in Performance Enhancement and Injury Prevention
NSCA Certified Strength and Conditioning Specialist
USA Weightlifting Level 1 Sports Performance Coach
Precision Nutrition Level 1 Certified Nutrition Coach
AIS Active Isolated Stretching Practitioner Aaron Mattes Method
NASM Performance Enhancement Specialist
FMS Functional Movement Screening Specialist (Level II)
NASE Certified Speed Specialist
RKC Certified Kettlebell Lifting Instructor
AKC Certified Kettlebell Lifting Coach
Black Belt in Brazilian Jiu-Jitsu
Certified Associate Grappling Instructor, Harris International
Certified Apprentice L5 Jeet Kune Do, French, Filipino, and Indonesian Martial Arts Instructor

John Bruno Strength and Conditioning
Personal Training
Martial Arts
Nutrition Coaching

(If you are interested in learning more about post-surgery or post-injury recovery training or have questions about our other personal training programs in Sarasota / Bradenton, click here)

(If you are interested in learning more about pre-surgery preparation or have one of our professional Sarasota / Bradenton based personal trainers design a comprehensive 6–12-week program, click here.)

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