PT on the Net Research

Umbilical Hernia and Exercise


Question:

I have a 43 year old female client who just had surgery for an umbilical hernia approximately six weeks ago. In addition, she had this done by a plastic surgeon who preformed a minor "tummy tuck" at the same time. She has been given the OK to start light workouts with the caution that she do "no abdominal exercise or work" for 12 months. She has tried the pool and found swimming uncomfortable but did some water walking. She is walking on treadmills with little success.

Answer:

It seems to me that this person really has two issues to deal with, both of them involving the abdominal musculature. The hernia and the “tummy tuck” are direct “blemishes” on the muscle structure. I am uncertain as to why she had the tuck. Does she have excess fat stores around the waist (i.e., overweight)? If so, how much? I will also assume that the hernia was caused by some action vs. congenital or from wear and tear of obesity. With the above things in mind, an exercise prescription can cautiously move forward.

Hernias are generally a result of muscle wall defect. The integrity of the muscle belly is decreased by a decline in collagen strength. Intra-abdominal pressure is too high for the particular area, and either an excessive action or accumulated fatigue causes the collagen to split and the muscle to tear apart. The result is a portion of the intestine bulges out the opening. Obesity, pregnancy, heavy lifting, coughing and ascites (fluid that gathers in the abdominal cavity) are the most common causes for the herniation to occur.

The “tummy tuck” makes me lean toward obesity as the reason for the hernia. The surgery for the tuck may have created some “new” scar tissue or adhesions. This could cause pain while doing whatever type of movement. The no abdominal work for 12 months seems cautious enough, but if she is cleared for light workouts, then why is there a year wait to interact with the abdominals?

My exercise suggestions consist of starting with the stationary bike. Use range of motion to begin, for whatever duration is tolerated (under 12 minutes) to start. You may also have her WALK in the water about umbilical deep, with a casual pace. This will start her abdominal rehab without undue tension or strain. The water will help support the area like a girdle and at the same time provide resistance. I also suggest her lifting be done on machines only. This will help “isolate” the different segments and allow her to start resistance training without pain. I know isolation is a dirty word in the world of functional training, but it beats no training at all.