Ask The Trainer: Meet Anna
Female fitness expert at MotivatePT
Reps Level 3 Qualified / Pre & Post Natal
1) I recently had a knee operation. How soon can I start exercising again after surgery and what should my exercise plan look like?
It does depend on the type of operation and the safest approach is to check with your doctor. On average you may be able to resume your regular activities within 3 months. We work with clients across the spectrum who have had knee injuries and knee replacements.
There are some exercises that you can start doing before then to strengthen your leg muscles. Your physiotherapist will very likely recommend some of the following exercises soon after your operation:
Isometric quads (in seated position with back supported, straighten your knee, squeeze your thigh muscles and hold for a few seconds), chair seated knee flexion, straight leg raises in seated position with back support as well as heel sliding in that position. Always pass notes from your physio to your personal trainer, in any situation where we are creating a fitness recovery plan.
Walking short distances with a walking aid soon after operation will also help your recovery.
Climbing the stairs will be part of this process but your physiotherapist will explain it and let you know when you can start practicing. The next step will be independent walking and how soon you are able to do that will depend on your circumstances. Once you are able to walk independently you can start increasing distance gradually.
Your strengthening exercises will very likely add light external resistance after one to two months after surgery while you are doing standing or seated knee flexion. Around the same time you may be able to use a stationary bike for short intervals daily.
Once your legs are stronger, and if you were on a fitness plan with us, you will likely be doing mini squats and forward lunges, single leg balancing and heel raises, hip bridges and heel to toe walking.
In later stages of your recovery you will do more advanced exercises such as, for example, full squats from a chair, step ups or lateral step ups and more advanced balance exercises.
It is important to stick with your plan and practice all of the above exercises consistently for best results. Returning to sport activities especially those that involve impact such as running, skipping etc. will be allowed once your strength and range of movement goals have been reached. It is important to strengthen all your leg muscles above and below your knee as well as core and muscles around your hips. Your physiotherapist will be able to set and assess your strength goals if your aim is to return to sports involving impact. You should be able to start training with your Personal Trainer in the later stage of your physiotherapy but it is important to involve them in your physiotherapy plan so that they can be aware of the exercises your physiotherapist prescribed and be led by it.
2) I had a C-Section. When should I exercise again after labour and what are the top three exercises you would recommend?
“Although C-section delivery is quite common it is certainly a complex abdominal and pelvic surgery. That is why it is important to give yourself time to adequately rest and recover. Patience is going to be your best friend during that time so that you heal well and reduce the risk of any issues in future.”
During the first six weeks concentrate on:
-Resting and relaxing with your baby. This time for bonding is incredibly important.
-Allow your family and friends to help with daily tasks so you avoid lifting and injury.
– Practice Transverse Abdominal or ‘Belly Breathing’ at any time of the day: On your inhale breath, feel your rib cage and then let your belly gently expand and relax. On your exhale breath, gently exhale to encourage gentle activation through your pelvic floor and deep abdominal muscles. Learn to start your exhale breath right before you start a movement such as picking up your baby or getting out of bed.
-Get into the habit of rolling onto your side before getting out of bed. This puts much less pressure on your stomach muscles.
-Slowly increase walking
Paying attention to your pelvic floor health is as important during post vaginal delivery for the same reasons. Your body went through physiological changes whilst growing a uterus and the baby’s weight’s pressure on your pelvic floor muscles. Your posture would have likely changed, which may have impacted on the tone of your pelvic floor muscles.
Your doctor may clear you for exercise at 6-8 weeks at your post natal check up but it is prudent to do very light and gentle exercise only, top three being:
Practicing TA breathing.
Bodyweight exercises, such as connecting to your core (you may feel initially that you have no control or strength in the abdominal area and regaining that connection through low level strengthening is going to take patience). Standing or seated on physioball pelvic tilts, supine heel slides, glute bridges, single leg knee raises either lying or standing, clamshells etc.
Walking: You will not benefit from standard core exercises such as crunches, planks or leg raises and they are best to be avoided (as they can cause doming of your abdominal muscles and potentially make diastasis recti worse) together with heavy lifting , running or any other high impact exercise until you regain your connection to your core muscles (high impact activities may be detrimental to your pelvic floor health at this stage). More information on abdominal separation can be found here.
Once you have mastered the above you can start slowly returning to your training routine however be mindful that you still need to reduce the intensity, duration and frequency. This is why a post natal fitness instructor can be a really useful investment. They will put safety first!
You could start with 2-3 workouts per week for about 15 minutes and add 5 minutes every two weeks, subject to your goals and schedule. Start with bodyweight exercises and add a light form of resistance like bands and lighter dumbbells.
Examples of exercises are bodyweight squats, inverted rows, split squats, modified side plank, band rows or external rotations, Pallof press. Do avoid heavy overhead presses or heavy back squats, step ups as well as running or jumping so you do not put undue pressure on your pelvic floor. It is as important post c-section as it is following vaginal delivery to restore your pelvic floor and your core strength first and foremost.
3) What are the best mobility exercises you can recommend for Senior clients? My 70 year old mother is unsteady on her feet and had some falls recently.
If stability is posing a challenge it is good to start with some full body seated exercises. In time you will need to add some gentle strengthening as well as stability exercises in order to reduce the risk of falls.
Start with mobilising the neck and upper body by rocking the head from side to side, looking from side to side and up and down, gentle shoulder shrugs, arm raises, wrist circles and gentle seated forward reach, then move onto lower body exercises such as walking on the spot,heel to toe raises, knee extensions, straight leg raises, leg curls, hip hitching (rocking from side to side, from hip to hip).
In order to make exercises more interesting you can use some simple aids such as a small pilates ball, mini resistance bands, bean bags or light ball.
Work on hand eye coordination by asking your mum to catch a light ball, throw bean bags to a target or paint figure 8 with her arms while holding and squeezing a pilates ball.
Gradually start working on improving muscle strength by adding resistance bands to some of the above seated exercises and if a walking aid is available you can start practicing mini squats, standing leg extensions and abductions as well as high knee walking, standing on one leg and heel raises to practice balance and strengthen calves and eventually longer walking intervals. With time you will be able to introduce standing unaided from a chair and heal to toe walking.
The NHS advises around 150 minutes, so 3 and a half hours of moderate fitness activity per week, but really advising on a case by case basis is always the best option.
These are but a few examples of exercises that I would run through as a senior fitness instructor that will aid better coordination, strength and stability for a senior client.
Written By Anna: Female fitness expert at MotivatePT – Reps Level 3 Qualified / Pre & Post Natal