An Occupational Therapist Addresses Incisional Hernias That Result From Surgery

Healing from Hernia

Contributing Author: Rubin, Josh O.T.Josh Rubin

Joshua Rubin graduated from American International College with a B.S. in Occupational Therapy. After working with the geriatric population for many years, he decided to take his career to the next level. By incorporating corrective exercise, nutrition and lifestyle coaching with his rehabilitation background, he began working with individuals of all ages within the personal training industry. This is where he found his love for holistic coaching, and as a result of developing San Diego’s EastWest Healing & Performance in 2002, he is one of Southern California’s top Personal Trainer, Nutrition and Lifestyle Coach, and Rehabilitation Specialist.

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Hi. 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?

Many thanks.

You can do a lot for a client with all of these dysfunctions. To help a client with these ailments, here are the areas that I would research.

Many of our organs within the anterior aspect of the body lie posterior to the inner unit (transverse abdominus, internal oblique, multifidus, deep erectors, pelvic floor muscles, diaphragm and external oblique, which Vladimir Yanda describes as a functional inner unit muscle). When inflammation occurs in any of the body’s organs, the muscles lying over them will be inhibited, creating 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. Moreover, when we undergo surgery and a doctor cuts through fascia and muscle, these muscles experience sensorimotor amnesia.

Nutrition is key in the healing process for any client. To regain sensory-motor unit synchronization, nutrition and lifestyle principles need to be aligned. Here are some recommendations for you to get started. If you feel that your client needs additional recommendations, I would refer out.

    1. THOUGHTS: Every day that you wake up, your thoughts are the first to be turned on. If you follow the Law of Cause and Effect (thoughts®words®deeds), then this 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.
    2. BREATHING: After you wake up and have a thought, the second thing that you do is breathe. Most of us yawn, as well as experience an increase in our respiratory rate secondary to the release of cortisol (a stress and awakening hormone). The average person breathes 20,000 times a day. If you are stressed or breathe from your chest, you breathe 40,000 times a day. It has been shown that 70–75% of most visits to the doctor are related to incorrect breathing patterns. Call me and I can easily explain this to you!
    3. HYDRATION: Most of us wake up and race for the coffee. Instead, what you should do, and need to do, is drink WATER! You have been dehydrated for eight hours while sleeping, and coffee simply exacerbates this condition, leading to headaches, constipation and decreased concentration and performance. Water helps to stimulate digestion, eliminate toxins, and hydrate the body.
    4. FOOD: The next thing most of us do or think about is related to food. This step is simple: focus on the quality (organic vs. conventional) and quantity (whether you skip meals, the ratios of proteins to carbs and fat of the meals you eat). Most people wake up late and are too lazy to cook a meal, so they grab a breakfast or protein bar.
    5. EXERCISE: Exercise is the most confusing area for many. Some work out too much and some fail to work out at all. As a society, we work, sit and eat more, but move less! Whether you take up Qi Gong, Yoga, Tai Chi, or just plain old exercise, get out there and move!
    6. CIRCADIAN RHYTHMS: This is a fancy word for sleep. The most common complaints from all of my clients are fatigue and wanting more energy. Each year, up to 24% of the population falls asleep at the wheel. A great place to start is here, with sleep. When you sleep, you release hormones to repair and regenerate.

Massage: After any surgery, there will be scar tissue and adhesions. This is secondary to the body’s healing process, but also with oxygen getting into the tissues during surgery. If you try to facilitate healing without relieving the scar tissue, the brain cannot get motor signals to or receive sensory signals 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, your client 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: First things first with a client such as this—or any client for that matter. You must assess and not guess. Your assessment will provide you with a blueprint of his or her body and will allow you to design an individualized flexibility and corrective exercise program. I will give you some basic recommendations, but every body is different. If you feel this is out of your area of expertise, then refer out. Begin treating your client with Base Conditioning Phase 1, targeting slower-twitch muscles fibers with functional movement patterns. Slow-twitch or tonic muscles respond to time under tension (> 70 s total time under tension (TUT) requires about 60 s rest, and begins fatiguing at around 3–5 min). You have to make sure that your tempo, sets, and reps get her beyond the 70 s TUT. An example of this (and this is just an example) is:

  • 10 reps x 333 = 90s x 2–4 sets = 3–6 m

You may use exercises such as the supine lateral ball roll, the forward ball roll, the 4 pt tummy vac, the lower abdominal series from Paul Chek, the horse stance series, and others.

Moreover, since your client is human like the rest of us, begin her program with more functional movement patterns, such as squatting, lunging, bending, pulling, pushing, and rotating. Make sure you regress or progress these patterns to meet her needs. Design her program to target her slow-twitch muscle fibers, to correct posture, and to facilitate motor unit synchronization/inner to outer unit synchronization.

After doing the above for six weeks, reassess and then move her into her Base Conditioning Phase 2. This phase should target the more fast/phasic-twitch muscle fibers (40–70 TUT, 30–120 s rest and fatigue at around 30–120s). An example of this is:

  • 10 reps x 202 = 40 s x 1–3 sets = 30–120s

Good luck and I hope that I have provided some help to you. For more information, refer out to a CHEK, Poliquin or MAT Practitioner in your area.

Joshua Rubin