• Dr.Barry Triestman D.C.

Speed healing through proactive recovery

Most of this should be started before a surgery or injury but they will help anywhere along your path to health.


Rebuild

You need adequate protein to heal more then the recommendation for a sedentary person, enough to build and repair the tissues. The general recommendation is 1g of protein per pound of body weight. 150 lb person = 150 g of protein per day. So, as an example an ounce of red meat or fish has has 7 grams of protein you would need to eat 22 ounce of meat. The amount of protein varies by the cut but not by that much, so using 7grams per ounce works. A half cup of lentil beans has 9 grams of protein so you would have to consume 8 and 1/2 cups of lentils to make the 150g per day. If you have had trouble consuming adequate protein before the surgery I suggest that you get a powdered protein supplement and start taking it now. I like Orgain USDA Organic Plant Protein Powder, 2.74-pounds from costco or read this article from healthine to understand more. It would also help to try the powder before surgery so you know it agrees with your system.


Anti-inflammatory

Increase your consumption of Anti-inflammatory foods. In general anti-inflammatory foods are going to be whole foods that have very little processing. The closer the food is to picked the better. We also need to eat the rainbow, meaning lots of different colored foods everyday. Green, blue, purple, red and white. Stay away from processed carbohydrates flour, grains pasta, bread, etc. If you are having trouble consuming these foods or think you are pro-inflammatory you might want to take an anti inflammatory supplement.



Dehydration aka your dehydrated.

The less water you drink the worse the swelling is going to be, opposite of what most people think. If you are having a surgery like a total knee replacement it is not if you are going to have swelling, it is how much swelling is there going to be. So start by being hydrated and drinking adequate water. Drink 1/2 your bodyweight in ounces,150 lbs person drinks 75 ounces. You are going to need to get used to this and plan not to drink all of it before bed unless you want to pee all night. Realize that certain things are diuretics which cause you to lose fluid, like alcohol and coffee. The more of these you consume the more water you will have to drink.




Constipation

Constipation is a bad thing anytime but especially bad post surgery, when it is hard to move around. The drugs and the dietary and movement alterations that happen could promote a bit of binding. So get ready and be proactive, increase your dietary fiber and have some prune juice ready. Don't forget about the hydration. While we are here don't forget to get that toilet seat elevator.


Swelling

Don't let your body part look like a swollen tick from swelling. So be proactive and get ready. 2 weeks before surgery get you foot, ankle pumps up to speed. Set a goal of 100 pumps per waking hour. Make them count, give a good squeeze and hold for 2 mississippi. Realize that you should be holding/contracting in 2 positions, toes pointed and toes curled with a 70% of maximum contraction level and you should feel fatigued when you are done. Learn the legs up the wall pose. DO this before you go and get used to doing it. You may not be able to get in this position immediately after surgery. This position is so much more powerful then regular elevation. If you can't get on the floor do it in your bed, spin body around so your bum is close o the head of your bed, put some pillows under your bum and hang out. Do it at least 3 times per day for 3-5 minutes. After you go for a walk is a great time to do this.


Get some compression socks and have them fitted before surgery so you are ready. Your surgeon may arrange for you to get these for you. To take compression to the next level. Normatech and Game Ready. make full leg compression garments, controlled by computer that sequentially squeeze the swelling from the bottom up with cold. I got to use the game ready at the U.S. Olympic Training center when I did my internship there


Reduce the drugs

Decrease the pain meds To decrease your reliance on pain medication gently massage and touch your body below and above the surgery site. You should do this with your hands, a massage ball, a foam roller, a can of soda, the cold will feel good. What you are trying to do is put an input into the body other then pain, this will help decrease the pain.



ln addition it may make sense use some type of e stim to modulate the pain like the h-wave system. To do this you want to have some electrical pads ready to put underneath the bandages by the surgeon, so that immediately post surgery you are doing some stuff to alter the sensation of what you feel in the leg..


Lost control

Regain the lost control of our body parts. We need to reconnect the control of the body part. Whenever there is injury, or chronic joint damage, surgery or a combination of these we lose the ability to feel and control our body and movement. This loss is cumulative meaning that each problem increase the loss of control. We need to work hard to get these back.When we do a joint replacement all the nerves, and joint surfaces are altered/removed so we lose those and have to rely on other tissues to pick up the slack. We do this by paying very close attention to how we move, what we feel while we move. To do this we need deep concentration and focus and then move. We can also add challenges like unstable surfaces when ready and doing things in our bare feet. A great starting strategy is an unstable surface while sitting to start. An unstable surface could be a wobble board, a piece of soft foam, a partially inflated ball, be creative anything that causes you to pay attention to the area. When you go physical therapy this will be done. Adding massaging/rubbing/tickling the body part will enhance this.


Extra credit

An additional rehab accelerator is blood flow restriction training. To do this you exercise while you have a restrictive cuff similar to blood pressure cuff but computerized. How it works is that you exercise with what would normally be a very light wieght but is appropriate for where you are in your rehab. What the restrictions does is that it fools the body into thinking you are lifting a heavier weight without introducing the body to large forces. This accelerates how fast you get strong and decreases the risk of over doing it. This achieves a more rapid recovery and rehab. These 2 companies are great resources for blood flow restriction training Smart cuffs and Owens Recovery System

In addition to this if you strengthen the opposite limb the body in it's amazingness strengthens the other limb but to a lessor degree. So work the other limb, hard.




How long does it take to heal?

Hopefully you will be up within 24 hours of the surgery. You might want to practice using an assistive device like a walker, cane etc. In addition to prehab we have already talked about to get the lower body ready, the triceps muscle in the back of the arm is key one for helping us get up post surgery. Doing short dips with a walker or the corner of a kitchen counter or triceps extension are both great to get ready before surgery.

Remember the general thought is that thought that a bone fracture takes 6 to 12 weeks to heal depending on who we are and where the fracture is, soft tissue injuries take longer, a prime example is an ACL or an answer cruciate ligament injury that the research now tells us that we should not get back to sport for nine months, because if we do, failure of the ACL reconstruction is far higher. The general recommendation is the knee replacement will reach maximum strength 6-12 months post surgery.That doesn’t mean that you’re not doing anything but you’re not doing anything as explosive as rapid as playing your sport, so just be ready for the long-haul.


Kelly Starrett P.T. has put together some great videos about his journey through total knee replacement

Post surgery video from Kelly Starrett P.T.

A liitle bit longer after surgery Kelly Starrett

Pre-surgery video getting Ready from Kelly Starrett P.T.


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DR BARRY TRIESTMAN, D.C.

11464 E Ridge Rd

Truckee, CA 96161

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Tel: 530-550-1688

Fax: 530-550-1688

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