Always question your injuries!

Too often, doctors send you off after surgery or an injury and instruct you to strengthen a particular group of muscles.  If it is a knee, they will say strengthen the quads, or a low back injury will call for strengthening the core.  This all sounds great, but what does that really mean?  What type of exercises, how much weight, velocity, sets, reps etc. etc.  Sometimes, the doctor will just say that it is safe to resume activity.  Again, where do you start? The first question must be this:  Why did this injury happen? If it was a direct injury, such as an object or a person applied force and caused damage, the answer is easy.  However, most injuries come from non-contact activities.  Some happen right away, some are progressive.  Most injuries like these occur because of another joint or joints having a mobility and/or strength issue.  For example, an ankle that doesn’t move well can lead to knee pain due to compensation and excessive forces in the knee that it was not built to handle.  Many people will only look at the knee to try and solve the problem.  The solution may very well be to improve ankle mobility, not strengthening the quads.  The hip could also be a culprit as well.  The point is, do not focus solely on the area of pain for the solution.  Movement imbalances and asymmetries must be addressed for rehab and prevention.  If the problem isn’t fixed but the symptoms subside, the risk of re-injury upon returning to normal activity is high.  The following is a program developed for a client with an umbilical hernia (surgery performed) and a lumbar spine herniated disc causing pain in the leg.  The doctor said to resume activity and strengthen the core.  He is a golfer, skier, and overall very active outside of work.  I am not a doctor or therapist, my role comes after.  Explanations are provided, because if you cannot explain why you are doing an exercise, you shouldn’t be doing it.  This isn’t meant to be a generic program anyone should follow, I am just putting it up to get you thinking differently about injury prevention and rehab and perhaps cause you to ask your healthcare professional questions (if they cannot answer, seek the right help).  These exercises are never a bad idea, and can serve as warmups, active rest between sets, or on off days where you just want to do light exercising.

Phase 1 (1 month post-surgery, has been doing light cardio) -designed to get moving in sagittal plane (front/back), and lightly stabilize rotation & lateral movement -not aggravate injury, gently work muscles, develop a base -get hips moving correctly, develop mobility and strength.  It is my suspicion that hip dysfunction has leg to these injuries.

lower body foam rolling-decrease areas of density (trigger points), help keep the muscles ready for optimal function.   hams/quads/calves, 5-10 strokes, rotate leg  in, 5-10 leg out, glutes w legs crossed

stretch: short muscles in the leg and hip can lead to movement dysfunction and compensation.  Hold each stretch 1min
hamstring-turn from hips, not lower back!

glute-No lower back movement, from hip only lean slightly forward

psoas (boyle)-perfect posture, aligned 45 deg to box

-hip extension on all fours (McGill Birddog, beginner)- 2 sets of 15, do not use lumbar spine, all glute.  “Remembering” how to activate the glute is the key to getting the hips to do their job: move 2 sets 15
-T Spine mobility-no lumbar spine involvement. Thoracic spine was meant to move, in most people this function has been reduced. 25 each side

Ankle mobility-keeps the joint itself ready to take on motion and not transfer unwanted motion upward.  Do not let the heels rise up! start close to a wall and progressively move away as mobility increases 2 sets 15/side

-Cook hip lift-keep that tennis ball secure below last rib.  More hip extension aimed to get the glute muscles firing. 2 sets of 15

-hip flexion band (very light band).  Works the deep hip flexors often neglected and weak past 90 degrees of flexion. 2 sets 15

-pushups on incline (or wall)- gentle progression toward pushup 2 sets 15

-resistance band rows (one foot if pain free)-work the back muscles plus the stabilizer muscles that stop rotation 2 sets 15

-split squat-a progression toward lunges 2 sets 15

-X band walks-great for hip abduction (away) at least 30 steps/side.  I display what not to do when I raise my hip.

-adductor leg squeezes (on side, squeezing airex pad or small foam ball)-great for hip adduction (towards) 2 sets 15

In this order, we foam roll, we stretch, and go through the exercises.  These exercises and mobility drills will be the warmup once the client progresses through them for 2 weeks or so.

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