On Rehabbing…

Bouncing back after major surgery is challenging because your fitness can decline considerably. Whatever condition you just got fixed can limit your activities leading into surgery, then you are flat on your back for at least a couple of days, then you may have movement limitations prescribed by your surgeon after.

It helps to have a training plan to lead you back to your former levels, and have a positive attitude, enjoying “baby step” improvements, rather than being frustrated at how unfit you are compared to your previous level.

With my hip surgeries, it wasn’t too bad leading up to them because I always had enough range of motion to cycle briskly. But walking and hiking were severely impacted because of hip stiffness. After the surgeries, I wasn’t allowed to bike for a month because falling would have been a major no-no with my new hip implant not totally secure in the femur. I worked around that by using a stationary bike (actually a trainer I mounted my road bike on). But walking was great pretty much right away after surgery although I avoided hiking for a month because of the possibility of falling.

I was able to strength train leading up to and immediately after the surgery to keep my upper body fit. I planned this as “periodization”, trying to improve strength while doing as much as possible to maintain aerobic fitness in this time, which worked well.

My heart surgery was a much bigger challenge. Leading up to the surgery my aerobic training was way down because a side effect of my bum heart valve was afib (atrial fibrillation) which had been triggered multiple times by vigorous exercise. So I could now only do easy bike rides or walking on flat ground. I knew surgery was coming up soon and I’d have upper body limitations afterwards (called sternal precautions because they reduce the stress on your sternum, which is healing from getting sawed in half during the procedure). So I did as much strength training for the upper body as I could, to build up strength since I’d be losing some after surgery. A trick for strength training without working the heart too strenuously is to do one arm at a time. So, for example, I did single arm presses with dumbbells instead of a benchpress.

My fitness reached an all time low after the surgery. While still in the hospital, I was feeling pretty good about how I’d been able to get up and about walking the corridors. But then the physical therapist took me to a set of stairs. After going slowly up one flight, I was on the landing gasping for breath. She said “don’t worry, that’s normal”. I thought, “wow, what happened to climbing up steep hills fast on my bike or on hikes? This is going to be a long and challenging rehab.” A big part of the problem turned out to be a surgical side effect: fluid retention around the lungs (pleural effusion), which would take a few months to go away completely.

I really had to adjust my attitude about rehab. I’d actually made a schedule before I’d gone into the hospital which had me riding my bike full tilt within 2 months, based on average rehab results I’d read about, and the smug notion “I’m an athlete, it’ll go faster for me”. That went right out the window. Time for baby steps. Try to be able to walk a little further each day, try to get a little better at stairs each day. And be grateful you’re not in pain- a lot of people get severe pain in the sternal area and need narcotic pain relievers after the surgery, but I was lucky and that did not happen for me.

My at-home instructions were to start out walking 5 minutes a day, and add one minute each day. And no strength training for several weeks because of the sternum. After 6 weeks I was up to over 40 minutes a day and was cleared to go to an outpatient rehab program at the hospital where I’d had my surgery. It was great. The staff was very nice and competent, nurses and PTs specializing in cardiac rehab. The facility was like a gym, but they had you wear a monitoring device that was constantly checking your heart rate and for arrhythmias, plus they would come by to get your blood pressure and see how you were doing. I also could start using my arms on the elliptical machine. I routinely ran my heart rate up to as much as 140 and we never saw arrhythmia in any of the sessions. And it helped I could go hard with my arms on the machines without bothering my sternum. Even though I couldn’t do real strength training yet I think this kept my upper body from atrophying too badly. By the end of my 30 sessions, I was able to go quite strenuously without exceeding my heart rate limit, and it was a great confidence booster knowing that no heart abnormalities were detected.

But no mistake, even after that rehab my fitness was still a lot less than it had been before my heart valve troubles began. And several months of strength training were needed to get the upper bod back in shape. The positive attitude I mentioned above helped in this period- rejoice in the progress you are making rather than focusing on how much you’re down from your former peak.

I remember a couple of years ago Steph Currie sprained his knee during the playoffs and missed several games. He came back during the Trailblazer series in a game in Portland. They were playing very well in this series and the Warriors needed him. He was a bit rusty at first, but then took over the game in the second half. After one of his patented crazy 3-pointers he looked up at the crowd and said “I am back!”.

Looking forward to having an “I am back!” moment helps motivate you for rehab. For me I decided that would be when I could do a local combination bike/hike in less than 2 hours and 10 minutes, the fastest I’d been able to do it a couple of years previously. About 6 months before my surgery, on a steep section of the hike, I got an out-of-breath symptom that was like my heart announcing “ok, turn around, I’m done. Time to limp home with your tail between your legs”. I was finally able to set a new PR on this trail 7 months on my surgery and that was a great feeling.

I am now at almost 18 months post-op and feeling fitter than ever. Going through the tough times and bouncing back from them helps me appreciate it. There are many books out there by people who have gone through tougher challenges than I have and come back. Reading them helped me a lot and I recommend them if you are having to rehab. Two good examples are The Anna Meares Story and Iron Heart: The True Story of How I Came Back from the Dead . Anna Meares came back from breaking her neck in a track cycling sprint race accident to later win gold for Australia on the velodrome at the London Olympics. In Iron Heart, Brian Boyle.describes how he recovered from a horrific accident when he was hit by a car on his bike, with massive internal injuries. Eventually, after rehab, he finished the Ironman triathlon in Hawaii.

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