Post Rehabilitative Care

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Post rehabilitative care has moved beyond conventional sports related injuries to cover a host of lifestyle diseases and other medical issues

Post rehabilitation is a process of restoring full function after any type of injury, accident or surgery. The key reason of engaging in post rehabilitation exercises is to provide an optimum functional mobility. These exercises are part of a progressive conditioning program which includes strength, flexibility, functional and cardiovascular training specific to an individual’s needs and goals.

While earlier post rehabilitation exercised were mainly used to help people with sports injuries, today it is being used for recovering from a wide range of ailments including heart diseases and stroke.

Post rehabilitation exercise is a group of exercise prescribed by a medical supervisor t of post-therapy training. Post rehabilitation exercise – is a specialised post medical fitness and conditioning program for patients who are medically stable. In general, exercises are implemented by Physiotherapist, Exercise physiologist, Knowledgeable fitness trainers to clients, following post rehabilitation disorders, such as Total Knee Replacement, Lumbar Disc Herniation/Strain, Total Hip Replacement, ACL Rupture/Reconstruction, Hypertension and Cerebrovascular Accident, Shoulder Impingement, Rotator Cuff Tears. It aims at maintaining and improving functional deficits that remain following physiotherapy or medical care. “While many are aware of the fact that exercise plays an important role in preventing chronic diseases, one should also know that exercise can be a complement to traditional medical intervention. Patients suffering from chronic diseases like diabetes, hypertension and coronary artery diseases and doing daily exercise have shown amazing positive outcome,” says Hari M, chief physiotherapist, Westminster Healthcare, Chennai.

The duration of the post rehab exercises depends on the medical condition and the case history of the patient. It can vary from seven days to a month or even three months. “One needs to undergo post rehab workouts only under the supervision of a certified medical expert, physiotherapist or doctor. Post-surgery, many patients do not have adequate knowledge or the skillset to rehabilitate themselves in a safe manner. Therefore, they tend to find themselves in a significant amount of pain and frustration. For this particular reason it is important to address the pain in the right away to begin the healing process. Someone who is undergoing post rehabilitation exercises needs to keep showing the progress report to the doctor and they cannot discontinue until the injury or the ailment is healed. Also, it is important to avoid high intensity exercises till the rehab is completed,” says Roohi Merchant, health coach and fitness trainer at I Think Fitness.

Here are some conditions where post rehabilitative care can help.

Cardiovascular Disease (CVD)

Cardiac rehabilitation involves adapting healthy lifestyle changes for the heart to address the risk factors for cardiovascular disease. After undergoing heart surgery, or suffering from heart attack, or heart failure, the physician prescribes a cardiac rehab program for the patient. It is a medically supervised program that helps improve the cardiovascular health. For cardiovascular diseases, aerobic exercises are the most suitable rehabilitation exercise. Aerobic exercises help regulating blood sugar, strengthening your heart and other muscles, helping your heart work more efficiently, and helping you sleep better.

The best exercise post a cardiac event or after any surgery is walking and this will start on the first day after your operation. You might feel slight fatigue when you first start walking but it is normal. Within three to five days after surgery, people find it easy to walk. “Walking is beneficial because it promotes independence, reduces the risk of chest infections, wounds and urine infections. It also decreases the risk of developing blood clots and increases your strength, fitness and endurance. Do the following deep breathing exercises while sitting as upright as possible in bed or, preferably, in a chair. Relax your shoulders and upper chest. Take a slow, deep breath in through your nose to fill your lungs as fully as you can. Hold this breath for three seconds. Breathe out slowly through your mouth. Make sure you practice the breathing exercise at least three to four times every hour In fact post any surgery, when the patient is recovering in the initial few days at the hospital and also at home. Breathing exercises can be done to prevent any chest or lung infections because the patient’s mobility is restricted and would be on the bed resting for a long time,” advises Dr Adnan Badr, lead physiotherapist – Digestive Health Institute by Dr Muffi.

Parkinson’s’ Disease

Clinical guidelines suggest that a multi-disciplinary approach is ideal for battling Parkinson’s disease. Muscle strength training and mobilisation will help in increasing speed and amplitude of movements. Functional activities independently or in group would build up stamina. Aerobic, learning-based and random practice exercises are the best rehabilitation exercises for those suffering from Parkinson’s disease. While aerobic exercise enhances oxygen delivery, keeping heart, lungs and nervous system healthy, learning-based exercises are neuroprotective in ageing individuals suffering from neurodegenerative diseases.

Exercises performed in a warm swimming pool are extremely beneficial for patients suffering from Parkinson’s disease. “The buoyancy of water provides support to weak muscles, improves posture and balance, and allows you to move freely without the risk of falling. Strength and endurance training with gentle movements is achieved with light water currents in the pool. Stretching exercises for Parkinson’s patients are extremely useful to reduce stiffness, improve mobility, posture, gait and balance. Hamstring stretch, calf stretch, shoulder stretch, tandem walking (heel-to-toe walk), one leg stand are exercises that can help. People with Parkinson’s disease must exercise four to five times a week to delay the progression of the disease. If you start exercising when you get diagnosed with the disease, it’s more likely to prevent the disease’s progression,” avers Badr.

Stroke

Fitness and Mobility Exercise (FAME) Program is a community-based customised exercise programme, designed especially for those who have standing and walking disabilities due to stroke. “FAME aids in enhancing the amount of physical activity in people with stroke and reduce the risk of secondary complications like falls, fractures, heart disease and dementia. It also improves fitness and mobility after stroke. The exercises should be done for 30 to 40 minutes four or five times a week,” says Hari. “Knee extension and seated matching for the legs can be performed at home with self-body weight. Leg raises or reverse crunches are very effective for building core strength. For arms and shoulder strength, exercises such as unweighted bicep curls, front raises, external rotation, and wrist curls would be advisable,” says Merchant. FAME is a community based exercise programme implemented mostly by physiotherapist, occupational therapist, and exercise physiologist, who have strong knowledge base on client’s clinical condition in handling post-stroke survivors. FAME – Is a tailor made group exercise protocol to optimise physical ability of people living with post-stroke and minimize the risk of secondary complications such as falls, fractures, and heart disease. The main focus is to address impairments such as muscle weakness, slowness of movement, balance through functional strengthening, agility and fitness exercises, balance inducing exercises in paced manner.

Spine issues and slip disc

Any spine related injury or a weak back, or slip disc requires immediate rehabilitation as they cause spasticity, which means that your muscles and joints become tight and stiff. It is important to keep moving in order to prevent spasticity. “Core strengthening exercises are best for those suffering from spine issues as it targets muscles like abdominal, hip and back muscles that support the spine, pelvis and shoulder and provides a strong foundation for movement in the extremities. It enhances general performance, keeps recurrent injuries at bay and improves lower back pain. Knowledge on good posture and proper body mechanics are required to do this set of exercises. It must be done for 30 to 40 minutes, three to four times a week,” says Hari.

It is vital to improve your flexibility through passive range of motion exercises Passive stretches are done post workout. Passive stretching means holding a position and stretching to the farthest point and hold that stretch upto 15-20 seconds in which you don’t need to put a lot of effort. “Stretching exercises should be held for 20-30 seconds and repeated two to five times. Some exercises can be done without equipment with self-body weight under expert guidance to regain spine health. These exercises are shoulder flexion and extension, shoulder abduction, elbow flexion and extension, hip and knee flexion, hip abduction, neck flexion and extension, supine shoulder stretch, hip and knee bend, seated hamstring stretches and prone Superman stretches,” explains Merchant.

Spondylitis

This can shorten the spine and muscles in your back leading to rounded back and back pain. Knee to chest exercise helps reduce pressure on your lumbar spinal nerves and alleviate back pain. “Lie on your back with feet flat on the floor and bring your right knee toward your chest, using your hands to hold your leg in the stretched position. Hold for 10 seconds. Lower your right leg and repeat the exercise with the left knee. Hold for 10 seconds and repeat with each leg three to five times. After stretching each leg individually, perform the exercise by holding both knees in the stretched position. Hold for 10 seconds and repeat 3 to 5 times,” says Preety Tyagi, Lead Health Coach & Founder, MY22BMI, a platform that provides personalised diet plans to manage several health conditions

Likewise, lower trunk rotation helps increase your spine’s mobility and flexibility. Lie on your back in the hook lying position (knees bent and feet flat on the floor), rotate your knees to one side, holding them for three to five seconds. While contracting your abdominal muscles, slowly rotate your knees to the other side and hold for three to five seconds. Repeat up to 10 times on both sides.

Knee Replacement

Exercises for the knee primarily aim to increase circulation to the legs and feet to prevent blood clots post surgery. It is also important for strengthening muscles, preventing scar tissue formation and improving your knee movement. Ankle pumps where you move your foot up and down slowly is something that is very useful. Repeat this exercise every five to 10 minutes and this can be done either lying down or sitting on a chair. This exercise can be done immediately after surgery in the recovery room as it helps to prevent blood clot formation and swelling. Static quadriceps where you tighten the muscles on the front of your thigh and push the back of your knee down into the bed also helps. Take a break for five seconds and repeat the exercise 10 times every hour. Straight leg raises where you keep your knee straight on the bed and tighten your thigh muscle is also helpful. Lift your leg a few inches off the bed as you tighten your thigh muscle. Stay in that position for five to 10 seconds and then gently lower your leg. Repeat this exercise 10 times for each leg.

Hip surgery

Resistance training, cardiorespiratory exercise and flexibility exercises are the three most efficient exercises that are beneficial for patients who have recently undergone a hip or knee replacement. Resistance training enhances the strength of the muscle and connective tissue around the hip and knee joint. This is critical in restoring normal physical function. It has to be done at 10 to 15 repetitions, and three to five sets. Cardiorespiratory exercise is a gait-based training that can be a great help for individuals for gaining back aerobic capacity and endurance and making quality of life better. It is a simple, slow paced, repetitive exercise done for 30 minutes. Flexibility exercises are gentle stretches that can improve general performance, reducing muscle soreness. It is done at three to five repetitions with minimum 10 – 15 seconds hold. The exercise should be done for 30 to 40 minutes.

Rehabilitation Tips

  • Prior consultation with physician is a must.
  • Build up your activity level gradually.
  • Do not skip the cool-down.
  • Do not over do the same pattern of exercise.
  • Do not remain sedentary for the rest of the day.
  • Using good quality fabrics and shoes helps.

This story first appeared in Smartlife March 2019 issue here:

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