Working harder doesn’t equal faster healing when exercising post-surgery

Exercising after surgery should be attempted with caution. To that end, Sun City held a seminar Aug. 11 for residents on the topic Exercising Safely: Coming Back After Surgery.

The facilitator was Heather Senn, who has a degree in public health and is a certified physical therapy assistant.

Beatrice, who asked that her last name not be used, attended the seminar. She had her left knee replaced in April, and her physical therapy included using a machine that helped extend her leg. She found it so useful, she rented one to use at home.

"It helped me a lot, it really did," she said. "... Right after surgery, you can hardly (bend it) at all."

She credited the exercises with allowing her to walk again.

"One of the first things people want to know is, 'When will I be healed?' They need to understand that it takes as long as it takes," Senn said. "You don't get better faster by working harder. It's really that you need to work appropriately for the situation. Lack of pain is not a reliable indicator. It's a signal from the body saying, 'Be careful. Be cautious.' "

Different parts of the body heal at different rates, she said. One of her slides showed that:

— Skin and internal tissue healing depend on the depth and degree of the injury. As a general rule, it is very fragile for the first 20 days. The affected area may take as long as 15 months to heal.

— Bone takes six to 12 weeks to heal, slightly longer if there is a metabolic disease or using certain medications.

— Muscle takes eight weeks or more for a full repair.

— A tendon takes 50 weeks to heal.

— Ligament repair is difficult to determine.

"Ligaments do not have a blood supply, so they don't heal very fast at all," Senn said. "The blood supply is what brings in healing chemicals and takes debris away."

Peripheral nerves can regrow at a rate of an inch a month. Much of it depends on location and the severity of the injury.

The study "Merits of exercise therapy before and after major surgery" found that therapeutic exercise before and after surgery can augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate.

It found evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well-tolerated and effective, the same for thoracic, abdominal and major joint replacement surgery. Postoperative exercise should be initiated as soon as possible after surgery, it found.

In talking about rotator cuff surgery, Senn showed a slide from the Boston Shoulder Institute on the timeline for healing. It showed by week 16, patients could expect about 65 percent strength. By week 32, one could expect about 80 percent recovery.

"At week eight is when we hear, 'Why am I not better yet?'," Senn said of postoperative people who come to the Sun City fitness center where she works. "My theory is that people liken it to a car repair — you take it to the garage, they unbolt the bad part, put in a new one, and you drive out, like new."

Joint replacement involves opening up a large area and is more involved, Senn said, so expect a longer healing time.

"You're looking at about a year," she said.

Sometimes, exercising looks more like everyday activities. Shoulder surgery patients can merely walk — the natural swinging of the arms is beneficial, Senn said.

Hip surgery patients can do sit-to-stand exercises, getting up from a chair and standing straight, then repeating. Sometimes, patients are instructed to stop as soon as they're low enough to bump the seat cushion and then return to standing. Another variation is to put one foot slightly ahead of the other to make it harder.

Patients recovering from shoulder replacement should watch out for exercises that use repeated overhead moves, such as swimming.

Besides being clear on what your doctor says you can and cannot do, Senn said it's also important to be familiar with the equipment and know how to use it properly.

"One thing I recommend is asking for an equipment orientation," said Senn, "so you're sure that you're using it properly."

For any exercise routine, Senn said to check with your doctor first.

— To reach Summerlin Area View reporter Jan Hogan, email jhogan@viewnews.com or call 702-387-2949.