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Ask Ann: How Can I Train After Major Surgery?

This month’s question was a very interesting one about returning to training after being a living kidney donor:

“I will be having surgery to donate a kidney to my mother in a few weeks. The only advice about recovery I’ve been able to find is ‘refrain from lifting more than 10 pounds for 8 weeks after surgery.’  

How can I get back into my strength training routine safely?” – Adriene

 

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First off, I would like to commend this reader for being a living kidney donor. As readers may know, many patients with end stage renal (kidney) disease and kidney failure require a transplant. The average waiting time for a kidney transplant is 3-5 years. In the past 23 years, a total of 349,799 kidney transplants have been performed. Of these, 227,905 were deceased kidney donors and 121,894 were living kidney donors. (US Dept of HHS, http://1.usa.gov/1jBYpfn ).

The major benefits of having a living kidney donor include:

  • Better long term transplant kidney survival
  • Faster access to transplantation
  • Decreased risk of rejection

Thanks to GGS reader, Anum Yoon, for creating this infographic and sharing it with us!

Thanks to GGS reader, Anum Yoon, for creating this infographic and sharing it with us!
Click image to see at full size.

 

There are two types of surgeries used to remove the kidney from the living donor: laparoscopic and open. Most transplant centers currently utilize a laparoscopic surgical technique, which requires a small incision to access the kidney.

Laparoscopic surgery decreases recovery time, allows quicker return to activities, and decreases complications. Most patients who donate a kidney with laparoscopy will remain in the hospital for 1-3 days, and can expect about a 4 week recovery period before returning to work, driving and other activities.

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When an open surgery is required, it is necessary to create a 5-7 inch incision, dividing muscle and removing the tip of the 12th rib to access the kidney. Donors who undergo this technique can expect to spend about 5-7 days in the hospital, with return to work in 4-8 weeks (depending on the type of work).

Living kidney donors can expect to return to normal health and activity levels; but, should allow for healing to occur in the first 8 weeks following surgery. A general rule of thumb is to expect 4 weeks for recovery from laparoscopic donor surgery and 8 weeks for open surgery.

General lifting guidelines:

  • From date of surgery to 6 weeks lifting no more than 10lb
  • From weeks 6-12 lifting up to 30lb
  • From 12 weeks on, a gradual increase in activity and lifting with return to pre-surgery level of function in 3-6 months

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These guidelines are useful for the average donor who wants to return to normal activities of daily living; but this reader is a Girl Gone Strong who wants to lift more than 30 pounds!

So let’s get a bit more specific in helping her return to lifting heavy things! Here are some tips for a successful recovery:

  • Immediately after surgery you will be instructed in deep breathing and coughing techniques to keep your lungs clear and prevent pneumonia. You should perform these as instructed.
  • You will instructed in exercises for your legs by a physical therapist or nurse while you are in bed. It is important to keep your legs moving to prevent blood clots from forming due to inactivity.
  • Within 12-24 hours you will be assisted with getting out of bed and walking. Early ambulation is important to prevent blood clots, pneumonia, and muscle wasting.
  • During the first days home from the hospital, it will be important for you to get adequate rest to aid recovery. Walking is also important, so you will slowly increase your walking distance as you increase your strength and stamina. Keep your focus on walking and some light mobility drills to maintain the range of motion in all of your joints.
  • The restrictions on your activity are to allow adequate healing time for the incision (to prevent a hernia around the incision) and time for your body to adjust to functioning with one kidney. For most donors, this occurs very quickly. While you will be eager to increase your activity, you need to listen to your body. Prevent exhaustion by sleeping at night and taking naps during the day if needed.
  • Take your pain medication if you need it! The biggest issue I see with my post-surgical patients is that they do not stay on top of their pain meds due to fear of “becoming addicted.”This leads to a vicious cycle of waiting too long to take the meds, having a high level of pain, and then chasing the pain to get it back under control. You are much better off taking the medication as prescribed, and getting adequate rest in the immediate post-operative period. So, take them if you need them (and plan to have someone drive to to appointments, since you shouldn’t drive while taking narcotic pain relievers).
  • Maintain adequate hydration, especially as you increase your activity level. Drink water instead of surgery sports drinks. Focus on good nutrition to assist healing and overall recovery. Each of your three meals should contain protein, vegetables, and a serving of healthy fat (avocado, olive oil, coconut oil). Stay away from processed foods.
  • Once cleared by your surgeon to lift weights over 20 lb. begin slowly to lift weights focusing on form and technique. Start with low weights and listen to your body. Do not do anything that causes or increases pain. You will need to pay attention to how you feel later in the day and the next day to judge the appropriateness of your training. If you are overly fatigued or sore, you did too much. I always tell my patients to do less than they think they can until they get a good feel for how their body will respond.
  • Talk with your surgeon about returning to sports. Some donors are instructed to avoid sports with increased risk of heavy contact or collision (skiing, martial arts, and skydiving) to protect the arteries and veins to the remaining kidney.
  • Set a goal to make steady progress toward full activity within 3-6 months depending on the surgical technique used and your own individual response to the donor process. Be patient with your body to decrease the risk of injury. You may find it helpful to work with a physical therapist during the first few months post-surgery. We have extensive training in general medical and surgical issues and are experts at designing post-surgical exercise programs to help you safely reach your goals.

You can find a physical therapist in your area here.

With patience and determination, you will get back to all of the activities you love, and you will have given your mother the gift of health as well!

 

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What’s Next

When you’re ready to resume normal activity and training, we strongly recommend including injury prevention strategies in your training program to address mobility, stability, and overall movement.

If you’d like to learn more, check out our Modern Woman’s Injury Prevention Handbook, which includes exercises you can do in less than 10 minutes, before your workout or any time.

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Medical disclaimer: Girls Gone Strong/GGS and Ann Wendel (collectively, “the Author”) provide the above content and/or data (collectively, “Information”) for informational purposes only. The Author does not provide any medical advice on the Site, and the Information should not be so construed or used. Using, accessing and/or browsing the Site and/or providing personal or medical information to the Author does not create a provider-patient relationship between you and the Author. Nothing contained in the Site is intended to create a provider-patient relationship, to replace the services of a licensed, trained physician or health professional or to be a substitute for medical advice of a physician or trained health professional licensed in your state. You should not rely on anything contained in the Site, and you should consult a physician licensed in your state in all matters relating to your health. You hereby agree that you shall not make any health or medical related decision based in whole or in part on anything contained in the Site.

 

 

About The Author: Ann Wendel

Ann Wendel is an internationally-recognized women's health Physical Therapist (PT), a Certified Athletic Trainer (ATC), and a Certified Myofascial Trigger Point Therapist (CMTPT). In addition to owning and operating Prana Physical Therapy in Alexandria, VA, Ann writes, travels, speaks, and consults with other physical therapists and business owners. You can connect with Ann on Facebook and Twitter.