I have a female client who has had a tummy tuck and gastric bypass. What exercises can I give her?
This is a very complex situation. Unfortunately, in today’s world of healthcare and rehabilitation, the only professionals who actually have time to work with people in complex situations like this are fitness professionals. If you truly desire to help this person, its important to make sure you are part of the solution and not part of the problem.
It would be irresponsible as a fitness professional to just give exercises without prefacing the framework for any program. Giving an exercise without considering some critical factors can be harmful to the client. To give you an idea of what you're in for with this person, let's flesh out some of the details of what was done.
- "Tummy Tuck" or Abdominoplasty is a cosmetic surgery intended to reshape and firm the abdominal wall. It involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle of the abdominal wall. It’s important to know whether this person had a complete, extended or partial procedure. From a fitness standpoint, the complete procedure involves a more in depth re-education of the abdominal wall musculature as the muscles are sutured in the process to create a tightening effect. The partial procedure involves just the skin.
- A gastric bypass is a process by which the stomach is divided into a small upper pouch and a larger lower pouch. The size of the stomach is reduced by as much as 90 percent. The intestines are rearranged to maintain their connection to the newly formed pouches. The operation leads to a significant reduction in the functional volume of the stomach, which is also accompanied by altered physiological and psychological responses to food. In 2005, 140,000 of these procedures were performed. It’s also important in gastric bypass to know which type of procedure was done. The distal bypass, while uncommon, will require a more delicate approach as nutrient absorption is greatly reduced and intestinal dysfunction will increase dysfunction of the abdominal wall. The proximal bypass is the more commonly used method.
This individual has had two major invasive operations. For the rest of her life (particularly from the gastric bypass), the functioning of her body will be altered relative to what she was given at birth. Realize that the alterations made to the stomach have altered its natural attributes and functions. Another factor that must be considered is the enteric nervous system, which is the neural network within the abdomen that is responsible for many functions and has more neurons than the entire spinal cord. This is a major center of the body that is now altered. To understand more about the enteric nervous system, read the book The Abdominal Brain by Byron Robinson. To understand the gravity of the situation, you must understand that energy production is the most vital process to a human being's functioning to nourish cells so they can perform their duties. Your client's digestion and metabolism that occurs in the abdominal wall has now been disrupted.
Reading the articles The Inner Unit and The Outer Unit are great reference points for the particular exercises you have to start with in order to re-educate the abdominal wall in proper sequence. You must understand the importance of getting the inner unit functioning correctly followed by the outer unit, otherwise you will be gambling with any other exercises you may give that person. The first thing you need to figure out is what was her reason for undergoing such surgeries. This will give you perspective on your effectiveness in this situation for there is no known surgery or operation that can fix destructive eating and lifestyle habits.
Inner Unit Conditioning
- Prone Transversus Abdominis Trainer
- Horse Stances
Outer Unit Conditioning
- Cable Rows
- Cable Push
- Supine Lateral Ball Roll
Functional Movement Patterns
Examples of the above movements and exercises can be found in the PTN Exercise & Flexibility Library.
How to Regain Optimal Function
Below are a few recommendations that will be critical to regaining optimal function. If these issues are not addressed, your exercises, time and effort will be a waste.
This is important. Before you give exercises, you need to address some of the musculoskeletal issues. There are plenty of articles on PTontheNET.com you can research about what good posture is and how to address it. To give just one example, your client may have a kyphotic thoracic region from holding on to so much weight. This will compress the ribcage downward, making respiration more laborious relative to someone without it. This makes it difficult to breathe, and due to the compression, the already reduced stomach can be pressured. Good posture will provide the most optimal environment for recovery, respiration and all other processes. Posture must be assessed from head to toe.
This is a major factor to address. Pain and reciprocal inhibition are a guarantee with such invasive procedures, and as a result, the abdominal wall will completely shut down from the trauma. Since the deep abdominal wall musculature or the inner unit play key roles in stabilizing the spine, there is a high incidence of low back pain. The lumbo-pelvic-hip complex and surrounding fascia will tighten and in some cases spasm to protect the back because the abdominal wall is asleep. Other muscles such as the glutes and hamstrings may become facilitated as a protective measure. A very specific stretching program must be implemented to stretch the tight muscles and strengthen the weak muscles.
Eating for your metabolic type is probably the most critical factor. Having an altered digestive system changes the amounts as well as the ratios of nutrients this individual consumes. The system of metabolic typing also includes diet check records, which will be very beneficial because it allows the individual to track the emotions, satiety, cravings and energy levels associated with the last meal eaten. This is powerful for a client like this because of the ability to track and know the direction you are going in is the right one. Also, as this person becomes healthier, her requirements of nutrition will change frequently.
This is a pretty obvious one. Organic food is far more superior than commercial food. Good quality sources of food must be sought after as they contain all of the enzymes necessary for digestion. Seek out high quality food from farm sources.
This is a big no no. Your client can't afford to divert any precious digestive energy to anything foreign in the body. If you think about it, your client is already working from a handicapped position in that her whole digestion has been altered. Processed foods will just tax a fragile digestive system, and problems will occur.
I would recommend supplementation of digestive enzymes (preferably from a whole food source) to aid in the breakdown of foods eaten. This will aid digestion, which has already been handicapped from the reduction and trauma to the stomach. Also, a specific pro-biotic protocol should be followed to aid the digestive and intestinal tracts. This will enhance the digestion and elimination for your already handicapped client. A pill form and lozenge form should be cycled as needed.
Also, monitoring of the key vitamins and minerals is necessary for gastric bypass. Food sources are preferable. The second best option is supplementation from a whole food source. Calcium and iron, absorbed by the duodenum, is bypassed in the surgery. Lack of gastric mucosa from the procedure reduces the absorption of B-12.
Water consumption should be high to facilitate function. She should drink half her body weight in ounces daily; however, due to the nature of her procedures, this will change rapidly with weight loss. With that in mind, I recommend you add three to five extra ounces on top of her requirement just to be safe.
I hope this helps. Good luck!