I’ve seen it countless times, and been there myself. You get injured mid-season, or just as you were finally making the gains you had been training for. Or you were a perfectly healthy snow-bird who face planted on your tropical vacation and broke your leg (true story)… No matter the reason you are down for the count, you probably remember the old acronym “R.I.C.E.”. I’m here to tell you that A) this information is now largely out of date and debunked, but also B) there are better ways to recover than sitting on your bottom doing nothing but rest and get you back to your life sooner vs. later! You have probably seen that Aaron and I have had a rough start to 2024, both undergoing procedures for nerve related conditions within the last 3 months. Here is how we are managing to return to work, playing with our daughter, and getting active again.
The effects of bedrest set in faster than you realize. It only takes 3 days of inactivity to have loss of cardiovascular endurance. Strength and muscle atrophy occur within 5 days. Inactivity, anesthesia, and narcotics can all contribute to decreased gut motility and constipation. With most post-operative visits not taking place until 7 or 14 days, what do you do in the meantime?! Well, there are over 20 published “enhanced recovery after surgery” or ERAS guidelines now demonstrating the evidence for early mobilization/return to activity following procedures, often as soon as you wake up from anesthesia and before you leave the hospital.
“P.E.A.C.E and L.O.V.E” is the new guideline for post-acute injuries for recovery. It stands for protection, elevation above the level of the heart, avoiding anti-inflammatories (which inhibit the natural cascade of healing in the body), compression, education regarding safe early activities, as well as loading, optimism, vascularization via pain free cardio, and progressive strength exercise. I feel it is important to note that protection is avoiding painful activities within the first 1-3 days, usually. In some cases, however, you may be immobilized in that joint/area for up to several weeks/months… so what do we do?
Depending on what procedure, injury or illness you have, the recommendations vary. Please consult your MD regarding your specific condition, however in my practice I have found that after that initial couple days post op, most people do well with a carefully devised program to mitigate the deleterious effects of bedrest. Having surgery or being laid up is hard enough, let’s not make it a longer process than we need to. If you have a spine or upper extremity condition, typically a walking program is advised ASAP (most often in post-op recovery!). Conversely, if you have a lower extremity or hip injury, upper body and core exercises done lying or seated are beneficial. If you have access to an upper body ergometer, that works too.
In any extremity condition, it is shown that strength training on the opposite side, even when the other side is immobilized, can have positive effects. This is called the “cross-training phenomenon”. Meaning, if you are casted in your left ankle, you can expect to have a 30-40% improvement in strength of the untrained side by doing eccentric calf raises on the right leg 3-5 sets of 8-15 repetitions. I don’t know about you, but that sounds worth it to me rather than getting out of a boot/cast with nothing to work with, even if it’s only a fraction of the other side. Something is better than nothing.
Personally speaking, I had to keep my leg above my heart for 80% of the day during the first week post op after compartment syndrome surgery. Even so, I have felt rapidly better with my lying and seated program without putting pressure on my leg and compromising the surgery than I did in 2007, when I did not have the knowledge I do today regarding recovery. Despite being 17 years older! Aaron was taking short walks within 24 hours of his 2 level disc replacement. Not only does it help our sanity, but also keeps us closer to our baseline. With all surgeries, there will be some deconditioning, unfortunately. It’s all about finding balance and ways to prevent further decline. I know not everyone has such a straight forward recovery. I care for many people whose pain is poorly managed, or they have comorbid POTS or underlying systemic issues which also require addressing. I have to say, however, there is never a case where I have found bed rest to be the only answer. There is always a modification, a regression, an exercise level to meet the client or patient where they are to begin rebuilding, even if you never leave the bed.
All that being said, please follow medical protocols and advice from your surgeon. Ask them how you can safely stay active and improve your recovery. If in doubt, enlist the help of a PT to design a program within those protocols and parameters during your recovery. When you are ready, continue guided mobility, strength and conditioning programs to build resiliency and prevent recurrence of the condition.
Feel free to reach out ot us if you need help on your journey! We’d love to hear your thoughts.