I have a client with four or five incisional hernias from a large abdominal scar after an abdominal operation about 20 years ago. She is very cautious of doing any flexion work as she feels it puts extra pressure on the hernias. She has very weak abdominals as a result, and I am trying to strengthen them with leg work while in a supine position with head down and isometric exercises. Do you have any recommendations or suggestions regarding training with this client?
There are a lot of organs within the anterior aspect of the body that lay posterior to the inner unit (transverse abdominus, internal oblique, multifidus, deep erectors, pelvic floor muscles, diaphragm and external oblique, in which Vladimir Yanda describes as a functional inner unit muscle). Anytime there is inflammation in any of the organs, the muscles over them will be inhibited. This creates inner unit dysfunction, inner unit to outer unit synchronization, altered motor unit recruitment, instability in the low back, facet inflammation, SIJ dysfunctions and so forth. As well, anytime we have surgery and MDs cut through fascia and muscle, these muscles get sensorimotor amnesia.
To regain sensory motor unit synchronization, nutrition and lifestyle principles need to be in alignment. Here are some recommendations for you to get started. If you feel your client needs more, I would refer out.
- THOUGHTS: Everyday you wake up, the first thing that is turned on is your mind. If you follow the Law of Cause and Effect (thoughts -> words -> deeds), then it should all make sense. If you begin the day with good thoughts, then your words and deeds for that day will be positive and will lead to success.
- BREATHING: After you wake up and have a thought, the second thing you do is breath. Most of us yawn, as well as have an increase in respiratory rate secondary to the release of cortisol (a stress and awakening hormone). The average person breaths 20,000 times a day. If you are stressed or if you are a chest breather, you breathe 40,000 times a day. It has been shown that 70 to 75 percent of most visits to the MD are all related to incorrect breathing patterns.
- HYDRATION: Most people wake up and race for the coffee. What you should do and need to do is go for WATER! You have been dehydrated for eight hours and coffee will just exacerbate that, leading to headaches, constipation, decreased concentration and performance. Water helps to stimulate digestion, eliminate toxins and hydrate the body.
- FOOD: The next thing most people think about is food. This is simple. Focus on the quality (organic vs. conventional) and quantity (do you eat or skip meals? Also, what are your ratios of protein, carbs and fat?). But most people wake up late and are too lazy to cook a meal, so they grab a bar.
- EXERCISE: This is the most confusing area for many. Some work out too much, and some don’t work out at all. As a society, we work, sit and eat more but move less! Whether it is Qi Gong, yoga, Tai Chi or just plain old exercise, get out there and move!
- CIRCADIAN RHYTHMS: This is a fancy word for sleep. I would have to say the most common complaint of all my clients is that they are fatigued and want more energy. A great place to start is with sleep. When you sleep, you release hormones to repair and regenerate. Up to 24 percent of the population falls asleep at the wheel each year.
- MASSAGE: With any surgery, there will be scar tissue and adhesions. If you try to facilitate healing without relieving the scar tissue, the brain cannot get motor or receive sensory signals to and from these muscles. You can start by teaching your client to rub Rose Hip oil on the scars four to six times per day. At the same time, she can begin massaging the scars. To learn more about this, refer your client to a Neuromuscular Therapy Specialist or a skilled massage therapist in your area.
- EXERCISE: The first thing with a client such as this, or any client for that matter, is you must assess and not guess. This will provide you with a blue print of her body. It will also allow you to design an individualized flexibility and corrective exercise program. I will give you some basic recommendations of what to do, but everyone is different. If you feel this is out of your knowledge, than I would refer out. I would begin treating her in a base conditioning phase that is targeting slower twitch muscles fibers, with functional movement patterns. Slow twitch or tonic muscles respond to time under tension or TUT (greater than 70 seconds total TUT requires about 60 seconds of rest and begins fatiguing at around three to five minutes). So you have to make sure that your tempo, sets and reps get her beyond the 70 seconds TUT. One example of this would be: 10 reps x 333 = 90s x 2-4 sets = 3-6m. You can use exercises such as the supine lateral ball roll, forward ball roll, 4pt tummy vac, lower abdominal series from Paul Chek, horsestance series, etc. As well, since she is human like all of us, you should begin her program with more functional movement patterns such as squatting, lunging, bending, pulling, pushing and rotating. Just make sure you regress or progress these patterns to meet her needs. I would still design it to target her slow twitch muscle fibers. This will correct posture and facilitate motor unit synchronization/inner to outer unit synchronization. After doing the above regime for six weeks, I would reassess and then move her into the second base conditioning phase. This should target more fast/phasic twitch muscle fibers (40 to 70 seconds TUT, 30 to 120 seconds rest and fatigue at around 30 to 120 seconds). An example of this would be: 10 reps x 202 = 40s x 1-3 sets = 30-120s.
There is a lot you can do with this client. Good luck, and I hope you found this response helpful. For more information, I would refer out to a CHEK, Poliquin or MAT Practitioner in your area.