PT on the Net Research

Colostomy


Question:

I have a client who has recently had a colostomy. As a result of this surgery, she has a stoma, and her abdominal muscles are very weak due to repeated surgery in that area. I have been trying to find information on exercising and am finding very little. I have her currently doing basic beginner abdominal exercises and also some basic exercises for the chest, back and legs using light weights. All are functional exercises (i.e., no machines). What should I watch out for, how soon can I start increasing the intensity of the exercises and is there anything else I need to be aware of?

Answer:

These are some very good concerns of yours as a trainer. From working in hospital and rehabilitation centers for years, I can tell you that my experience from this type of surgery can be mentally and emotionally life changing for these patients. From my point of view, you need to be a coach in this situation. You need to assess your client using not only musculoskeletal assessments but nutritional and lifestyle assessments. From there, you can figure out what route to take with this client and when the right type of exercise is needed. Here is what I would do from the information you have provided, in this order:

  1. To support this client mentally and emotionally, I would make sure that she is working with a healer who is in alignment with her belief system. What does that mean? If you feel she is more eastern based, then find a good TCM practitioner, energy healer, reiki therapist or holistic lifestyle coach that she can work with. Visit these web sites for some recommendations: www.journeysofwisdom.com and www.chekinstitute.com.
  2. Any time one has surgery such as this, they are given large amounts of IV fluids, antibiotics, meds, etc. In addition, air can get into the open incisions, which could lead to a fungal infection in the long run. You should assess your client both on paper (read the book The Fungal Link and use the assessment and diet in there, if applicable) and by using the 401H (stool test) from BioHealth Diagnostics (www.biodia.com). You can call the lab or have her call the lab to set up an appointment with an MD there to get evaluated over the phone and get a lab mailed to her that can be done in the comfort of her own home. If you feel she may have a fungal infection, the best thing to do is an elimination of all sugars, fruits, root veggies, grains and alcohol from the diet. Fungus or mycotoxins thrive of sugar!
  3. The next thing I would do is find a visceral (organ) massage therapist (www.stjohnseminars.com) in order to release some of the visceral-visceral, visceral-somatic, somatic-somatic and somatic-visceral restrictions in her abdominal area. This happens from surgery (things getting moved around, O2 getting in and making soft tissue adhesions and from the scar that is left over from the surgery) and if not alleviated, your chances of getting her inner unit (hydraulic ampliphier mechanism, thoracolumbar fascia gain, intra-abdominal pressure, diaphragmatic breathing) to fire and work synergistically with the outer unit systems (anterior and posterior oblique, lateral and deep longitudinal sub-systems) will be null and void. This is secondary to Hilton’s Law, which states: a nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the attachments of those muscles.
  4. You are what you eat, you are when you eat, you are what you don’t excrete and you are what you don’t sleep! It is plain and simple. When it comes to healing, nutrition and lifestyle factors have the most influence on the body. My recommendation for her would be to first heal her gut using the 4R gut healing program, which is an easy four to six month protocol that anyone can follow in order to heal the gut. Along with this, following the holistic foundational nutrition and lifestyle principles will facilitate healing and prevent inflammation/gut discomfort from reoccurring. Refer to How to Live a Holistic Lifestyle and 6 Foundational Principles to Health on the resource page of www.eastwesthealing.com.
    • Remove: This phase entails removing all conventional foods, boxed/canned foods, foods with ingredients you cannot pronounce, gluten, dairy, flour, salt and anything that has a shelf life. As well, we recommend scanning your house and office for any potential stresses that might inhibit your progress (i.e., an alarm clock right next to your head while sleeping, using conventional hygiene products and/or deodorant, etc.). The main purpose of this phase is to reduce inflammation. Phase 1 is ongoing and can be ongoing forever!
    • Replace: Continuing with the Phase 1, Phase 2 includes adding in pancreatic, digestive and liver enzymes. There are a lot of supplements out there, but you want to find some that are organic or nutraceutical grade. A great one we recommend is Bio-Gest by Thorne Research Group. The main purpose of this phase is to re-establish digestion, once inflammation has been reduced. Phase 2 is typically one to two months long.
    • Reinoculate: Continuing with Phase 1 and 2, Phase 3 includes re-establishing good bacteria in the gut. This can be done by using a nutraceutical grade probiotic with FOS (prebiotic) in it. This phase not only reinocculates the gut with good bacteria, but it also protects it against pathogens. Phase 3 is typically about one to two months long.
    • Repair: Once you have finished the above three phases, you can begin Phase 4. This includes taking cod liver oil daily (4-6K mg) for one to two months and taking GI revive (from Designs For Health). This phase includes repairing the gut with l-glutamine, aloe, licorice root, vitamins and cod liver oil. The purpose is to bring everything together in order for the gut to work properly.
  5. The last thing I would do with this client would be to get a full musculoskeletal assessment, both static and dynamic. This will allow you to prescribe an individualized comprehensive flexibility and exercise program to her. From the information provided, the goal would be to establish inner unit coordination and strength through using lower abdominal isolation to integration exercises. Remember that intensity is not based on how hard the client thinks the exercise is, how much she sweats, complains, etc. It is based on the weight being lifted (i.e., a 1RM has a high intensity secondary to a heavy weight being lifted at an XXX tempo, where a front squat with at a 10RM could be a moderate intensity if done at a 222 tempo).

I would keep her exercise program at a low intensity, focusing more on her Type 1 system initially. Some guidelines to follow are: 60-120s rest and >70s TUT (this can be calculated by adding up tempo and reps to get >70s TUT). To learn more about this, purchase the Level 1 Theory manual from Poliquin Performance.

As for the exercises, my best recommendation would be to incorporate squatting, bending, pushing, pulling, lunging and twisting into her program, making sure the movement patterns match her skill level and what you find on her assessments. What does that mean? Use the Primal Patterns above, but descend them to meet her needs at this time. I would also add in some lower abdominal exercises from The Pelvic Girdle by Dianne Lee and Scientific Core Conditioning by Paul Chek.