We should train whatever muscles we’re capable of training, even with an acute injury, as well as pre and post surgery.

If I have a right knee problem, if I train my left leg, I am able to maintain my bone mineral density and my strength in the leg I’m not even working. Welcome to the Strength Changes Everything podcast, where we introduce you to the information, latest research, and tools that will enable you to live a strong, healthy life. On this podcast, we will also answer your questions about strength, health, and well-being. I’m Amy Hudson.

I own and operate three exercise coach studios. My co-hosts are Brian Saigon, co-founder and CEO of The Exercise Coach, and Dr. James Fisher, leading researcher in evidence-based strength training.

And now for today’s episode.

Today we’re going to be answering a very common listener question and that question is, I have an upcoming surgery. What are the recommendations for strength training pre and post surgery?” So let’s give a little bit of flesh to the question to Dr. Fisher. You know, oftentimes in our studios we’ll meet clients that have a joint issue of some kind and they know they’re going to be needing surgery. Maybe it’s a knee replacement, a hip replacement. They have an area of vulnerability that is causing them trouble and not too far down the road they may need a surgery to deal with that but they’re at the studio because they do still desire to strength train and they’ll wonder you know what what should I be considering leading up to the surgery and then as a post-surgery in terms of gaining and rebuilding strength, factoring in this area that is vulnerable. So that’s the question we’re going to be talking about today. All right, so Dr. Fisher, how’s it going?

Yeah, I’m doing great. Thank you, Amy. This is a fantastic question, so I’m really excited to get into this. It’s a common theme that I’ve had throughout my career in exercise physiology of when you can train around an injury or a surgery and how you can manage that training and so forth. So hopefully we can really provide listeners with some great information in this context. I guess one of the first things that we should start with is statistically, the biggest indicator of a successful surgery, if we’re going down that route of people going through surgery, but the biggest indicator of successful surgery, musculoskeletal surgery that is, is the strength prior to the surgery. So if you’re going for a knee replacement or a hip replacement, let’s say, then the stronger your quadricep muscles or your hamstrings or your gluteal muscles are before that surgery, the more likely you are to make a quicker and more successful recovery. Because of course, you’ve got almost that insurance policy, that cushioning of strength before the surgery. So anything that you lose in that surgery time, in that immediate short-term recovery time, you’ve built up that buffer to some extent. So I think that’s a really important, important point to make first off. But then do you think that we could talk about is of course, people get an injury and typically it might be an ankle injury or a knee injury, or there may be a shoulder or so forth and a common response. And even a common response response by some strength coaches is to take time off, you know, go away and rest. And it’s not great advice. Actually, if the body is capable of training, then we should train whatever muscles we’re capable of training. And there’s a number of reasons why. So, first of all, we want our body to be metabolically active. We want to keep the muscles working as much as we can. So even if we’ve hurt our lower limbs, we still want to train our upper body. Or if we’ve hurt our upper limbs, we might still want to train our lower body. I’ve worked with wheelchair athletes a number of times and other Paralympic athletes, and they, aside from being unaware of any disability that they have, and I mean that in the greatest possible way, they simply work around every disability. They find a different way to do things.

They will work every other muscle that they can. Um, so there’s things that they can’t do, but everything else that they can do, they do. And I think that’s a great mindset. But the second point might be that there is something called cross-education that occurs.

So if I’ve injured one limb on one side of the body, then by training the limb on the other side of the body, I can actually mitigate any strength loss or muscle loss or even bone mineral density loss by training that healthy limb. be true. So you are saying that if I have a right knee problem and I have to avoid working my right leg, if I train my left leg, I am able to maintain my bone mineral density and my strength in the leg I’m not even working? Yeah, absolutely. So we’ve got to remember that the body works as a single organism. So we often look at the way we train muscles and think if I contract that muscle, it will get stronger and it will get bigger. And to some extent that’s true. But there’s also the fact that if I train my contralateral limbs, or I train my healthy limbs, if I have an unhealthy limb, so you said about the knee, if my right knee is injured, but I train my left knee, or I carry on doing knee extensions or leg presses or whatever exercises it might be to keep those muscles on my left leg strong while my right leg is either injured and unable to train or even immobilized. It might be that I’ve broken my right leg in a skiing accident and now it’s in a full-length cast, hip to ankle, and I just can’t move the muscles. We know that when I get out of that cast, there’ll be muscle loss, there’ll be strength loss, you know, there’ll be a difference between the two limbs. And actually, yeah, the evidence is very, very clear that if we carry on training our healthy limb, then we first of all mitigate any loss in strength in our immobilized limb. But even if it’s not immobilized, even if it’s still able to sort of weight bear and carry on in day-to-day function, we can actually still continue to make strength increases in the untrained limb. So, yeah.

So do we have to be training the other limb or could we train other parts of the body? So let’s go back to the right leg. What if I only train my upper body?

Yeah, so that’s a really good question. And at present, the scientists are still out discussing this. There’s no clear evidence around this. We spoke with Dave Beam in a previous episode where we talked about stretching and he talked a little bit about non-local muscular adaptations. We talked about non-local fatigue. So if I train the upper body and it’s fatigued, then some of that fatigue will cross over. We talked about if you stretch the upper body, you will see an increase in flexibility in the lower body. So we do know that there is like a central, um, the central system that controls almost all muscles. That’s a neuromuscular system. So we definitely know that if I train my left leg, I can see adaptations in my right leg. But we’re not so clear whether if I train my upper body, I will see adaptations in my lower body. It seems to be clear from the flexibility point of view as Dave being alluded to in a previous episode, but from a strength and a muscle size point of view, that might be a bit of a stretch. We’re still waiting for more research and more data around that area. So is the reason this is true is because we have this neuromuscular system and basically when we strength train we are sending we are creating signals that this neuromuscular system is sending around our entire body to tell it to add muscle to build strength.

Is that is that a fair way to describe that? PW Yeah, there’s a couple of hypotheses around this theme. It’s often called contralateral adaptations, so the opposite limb, the contra being opposite, lateral being other side of the body, or it’s also termed cross-education. And the first hypothesis sort of suggests that when I train one limb, then the training can activate neural circuits that chronically modify the efficacy of the motor pathways of that opposite limb. So basically I train one limb, but actually the training improves the neural circuitry to the other limb. And that makes sense to some extent. And the other theory is that actually when I train one limb, I improve, um, the neural circuitry to that limb, but I improve it at a sufficiently high level that the other limb can access it. One theory says if I train this limb, I create adaptations in this limb. And the other theory says, if I train this limb, the circuitry of adaptation is high enough in my neurophysiology, the other limb can access it. I mean, they’re pretty similar in the grand scheme of things. But you know, scientists like to kind of be really clear on this, where is the adaptation occurring? And of course, the reality is there is an abundance of research around this. We’ve known the first scientific research around this dates back to sort of the 1890s that we first identified contralateral adaptations. But the exact mechanisms as to how it occurs is still unclear.

Okay, so I think a listener might have the question, is it possible if I’m training only one side of my body to ever get to the point where it becomes so much stronger than the other point or that the other limb won’t be able to keep up with the strength that I’m building?

That’s definitely a question. And the way that that question is often phrased to me is, oh, I’m building. That’s definitely, that’s definitely a question. And, and the rays of that, the way that that question is often phrased to me is, Oh, I’m really worried that if I, if I break my left arm and I can’t train my left bicep and I carry on training my right bicep, then when my right bicep get really big and my left bicep will look really weird because it’s so much smaller, well, the reality is that there’s probably unilateral differences in our anatomy anyway. You know, our left side might be a little bit weaker than our right side simply because it’s not dominant. We already know that there’s differences neurologically. And if you’re not clear on the differences neurologically, then go and try and brush your teeth with your non-dominant hand because it will feel completely alien and try and write with your non-dominant hand, because it will feel completely alien and try and write with your non-dominant hand, anything that requires a fine motor skill. Um, you know, we will suddenly struggle with, so there are, there are already disparities between our dominant and non-dominant side. Um, the reality is that we are going to struggle to exaggerate those beyond a certain point. So if, for example, I just stopped training the left side of my body, I just completely quit training the left side of my body, it would still make adaptations in response to training the right side of my body, simply because it doesn’t want that imbalance. As a single organism, we want to have that kind of balance between the two sides in both strength and both muscular size, in coordination and so forth. You know, there is some research to say that the more I do things with my right hand, like brushing my teeth or writing, the more I will improve my ability to do those things with my left hand. One of the earliest studies around this looked at a pegboard task where somebody simply moved pegs in and out of a board using their non-dominant hand. And when they were retested with their dominant hand, they found that they’d improved their time and ability and coordination to do it, you know, even with the hands that had not performed the task, that had not practiced doing the task. So we know that there’s definitely neural adaptations to this kind of training. But certainly it would be unrealistic to think that we will remove any imbalances, but it would be foolish to think that we will exaggerate imbalances to a comedy extent.

Yeah, I mean, that you know, comedy extent. Yeah. I mean, that, that makes a lot of sense. Um, have you ever seen anybody get to the point where they’re perfectly equal? I’m picturing a bicep curl and how on my right side, I’m able to curl higher number than, and higher my pounds than on my left and like you’re just talking about, right, like a stronger than the left, right?

And there’s always that difference. Um, I mean, how possible is it to get perfect equality in those and how much should the average person be striving to balance themselves out if they don’t have an injury, but they just noticed that discrepancy?

Is that something we should even bother with?

I think that there are times where we can identify it. And there are times that we can try to remove any imbalances. If it’s in the trunk muscles, um, then, or if it’s in our stability, which might be true, we might say I’m great at balancing on my right leg. I’m not so good at balancing on my left leg. Okay. leg, I’m not so good at balancing on my left leg. Okay, well maybe there’s an argument for spending more time doing a balance task on the left leg or if we’re stronger to our right side in the trunk or if we’re stronger in let’s say flexion, our abdominal muscles compared to our low back muscles, we probably want to try to reduce any drastic imbalances. Only drastic imbalances. I think we can be accepting to some point that there will be some, um, some imbalances between the two sides. Now as a physiologist working out of laboratories, we have, I mean, I’ve tested tens of thousands of people on different pieces of equipment. And if I taught any person and they had exactly the same strength on their left quadriceps compared to their right quadriceps, that wouldn’t be a big surprise. That would be completely normal. If they had an imbalance, it would be generally within a certain margin and it might favor arguably their dominant leg, although dominant can be sports dependent. For example, if I tested a soccer player where they kick with their right leg, they would probably be stronger with their right leg. If I tested a skateboarder where they push with their left leg, they’d probably be stronger with their left leg, even if their right leg was still their dominant leg. So, you know, that kind of imbalance will occur, but it’s not so extreme. But even if we saw exactly the same strength, exactly the same single momentary isometric force, it would be unlikely that we would see exactly the same muscular endurance, so the same capacity to maintain a submaximal force for an identical amount of time, or even perform repetitions with a submaximal load or anything like that. So there will always be some degree of imbalance, but as long as it’s kind of within a reasonable margin, it’s not something drastic to worry about. I did a workout an hour or so back, and if I went and did a lateral raise with one dumbbell on one side, I would know that my right shoulder would either find the reps easier, or I would get more repetitions than I would with my left shoulder. But as long as it’s only one or two reps, then I’m not overly concerned. It’s when I get to a point where I can lift twice as much weight with my right shoulder and almost no weight with my left shoulder, or can’t perform any repetitions, then I get to a point where I can lift twice as much weight with my right shoulder and almost no weight with my left shoulder or can’t perform any repetitions, then I have to start thinking, why is that happening? That’s, that’s when it’s probably a product of an injury or some sort of other condition.

So, I mean, just to summarize so far, what we’ve really said, you know, if, if, uh, if I’m a person that has an upcoming surgery in a joint that is, has an injury or I need some correction, I really want to prioritize finding a way to maintain strength training in my opposite limb. Uh, I don’t need to avoid that entire necessarily part of my body entirely.

No, 100%. If anybody has upcoming surgery, then as long as they’re capable, and of course, we would always encourage people to seek medical guidance, but certainly strength training of the exercise coach where it’s performed in a safe and a supervised manner can absolutely be included in a healthy regimen. And I would say it’s almost essential for anybody with an upcoming surgery because it’s more likely to improve their chances of a successful surgery and a successful recovery.

Okay, so now let’s talk about post-surgery.

Yeah, so we’re almost in the same position. Now immediately in the acute post-surgery time, there has to be a time away from training. Every surgeon will say, you know, especially after a general anesthetic, there is a time while that chemistry has to work its way out of your body, there’s a time where your body has to kind of find its balance again, it’s kind of homeostasis, and it needs to direct energy towards recovery. So the immediate, maybe first couple of days, certainly the first 48 hours at the least, and I would probably say for most cases, not training within the first week back. But beyond that, I would say it’s very individual specific and it might depend on the surgery itself. But for example, if I use myself as an example, just purely because I could talk about a single surgery, I had my knee rebuilt after I tore my ACL, my MCL, and my meniscus. And within a week, I was back within my home gym. I was training my other leg, my healthy leg. I was training my upper body as if nothing had happened, nothing had changed. So I effectively took about 10 days, maybe just over a week off training completely. And then when I went back to it, obviously didn’t train the leg that had surgery. And then once I was able to move it enough to build into rehabilitation, obviously at the early stages, any movement is rehabilitation, and then we can start to increase mobility and increase load, to increase strength and so forth, and a degree of different exercises and things like that. But certainly, by continuing to train my left leg in this circumstance, I was hopefully able to, you know, mitigate any strength loss in that right leg during that surgery and that recovery period. So, I definitely think that as soon as the person feels well enough to get back to strength training, and again, based on medical guidance, once they can get back, they can get back into the exercise coach and, and train at the least their upper body or lower body, depending on where the surgery was. Um, and potentially the, the opposite limb, if it was only on one leg, then they can train the other leg and so forth.

Excellent.

Yeah.

I mean, that is probably. Somebody’s number one, number one focus, right. Is, and the doctors will say this as well like to maintain to not lose too much strength So no, that’s not what anybody wants

Yeah

Not lose strength Maintain it as part of the routine because as soon as somebody takes you know a couple weeks off two weeks can become three weeks Three weeks becomes you know a month quite easily one month can two, and suddenly strength training is not part of the natural habits. And then all of the other problems associated with a lack of physical activity start to creep in, whether that’s poor metabolic function, whether that’s an increase in adipose tissue, overweight, obesity, and so forth. And of course, none of those things will help in recovery from surgery. So we want to maintain our physical function as well as we can maintain our strength. But we also wanna maintain our physical biology and our human functioning at its optimal level to accommodate recovery.

We promote blood flow, we promote the movement of nutrients around the body as we exercise. So we want to do that.

Excellent. Well, anything else to add? Any other closing comments on this idea?

I think perhaps less attuned for the exercise coach based on the population, but I’ve worked with a number of athletes who pick up this injury. You know, when I tore my ACL, for example, basketball players will often turn their ankle and then they can’t leg press or they can’t squat or deadlift, they can’t load through that foot. And a lot of the time, strength coaches or even sports medicine practitioners will say, you know, go away, take a week off and take time away and so forth.

And I really think that’s bad advice. I really think that when you work in a strength and conditioning environment where you have a coach or you have supervision, then simply go to that coach, go to that strength and conditioning practitioner and find a way to work around it. It might be if you’ve hurt your ankle, you can still do a knee extension and a leg curl. It might be if you’ve hurt a leg and you can’t leg press, you can still train the other leg. It might be if you’ve injured both ankles, you can still train the upper body. So I definitely think that we should utilize the expertise of coaches and strength training practitioners to Get guidance in how to maintain strength training in part of our routine Even with an acute injury as well as pre and post surgery

Yeah, well if you are in that boat if you’re a client or somebody who has some limitation because of an injury or an upcoming Surgery, I hope this episode encouraged you that you don’t have to stay on the sidelines, that you can participate and that there’s so much to be gained if done correctly. And so I appreciate the insights, Dr. Fisher, on this topic and answering the question for us.

Thanks very much, thanks for your time.

And we’ll see you guys next week. Hope you remember, strength changes everything. Thanks for much. Thanks for your time. And we’ll see you guys next week. Hope you remember, strength changes everything. Thanks for listening. If you enjoyed today’s episode, please share it with a friend. You can submit a question or connect with the show at strengthchangeseverything.com. Join us next week for another episode and be sure to follow the show on Apple Podcasts,

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