No Excuse.

So many times patients present out of shape: They have gained weight, lost muscle mass, and/or become depressed due to a significant joint injury or debilitating arthritis. They tell me they have not been able to exercise because of their joint pain. This is no excuse.

Our first job, as physicians, is to repair their joints. The other first job, however, is to teach the patient how to exercise around their injury and to become fitter, faster, and stronger than they have been in years. If we do this, successfully patients do extremely well—and the satisfaction for the physician is enormous.

Here are a few examples.

An injured back is the most common reason people stop exercising. And it’s possibly also the most important, as we will all have back pain at some point during our lives. 

Back pain is a siren call, telling the brain that something in the back is not adequately supported. While there are hundreds of causes of back pain, there is only one result: weakness of the muscles supporting the back. This occurs because pain is such a powerful muscle inhibitor. But a wide range of factors—including the person’s abdominal muscles, posture, and gait, to name a few—support the back.  

A person with back pain can exercise creatively in the pool, with balance exercises (on a pillow or other unstable surface), and with shoulder and scapular exercises that help maintain an upright posture. They can also do cardiovascular conditioning on stationary and outdoor bikes, Elliptical and Elliptigo devices. A sweat workout every day is crucial, in order to increase circulating endorphins, testosterone, adrenaline, and the millions of other compounds the body uses to remain both physically and mentally healthy. As long as creativity and motivation are there, the list of opportunities is endless.  

Knee and hip pain are other common causes of the refrain “I stopped exercising due to my painful joint.” Ouch! What I should be hearing is, “I hired a trainer and physical therapist to teach me how to work around my injury until I could come and get it fixed.” Often, the exercise works so well the person can actually avoid coming to get it fixed. There is no such thing as an arthritic knee or hip that cannot be exercised in the pool or, more commonly, on a bike. It is true that no patient suffering from arthritis has a normal gait or range of motion, since they favor the painful joint. Yet these are the very people who need exercise training the most. Every knee and hip feels better when the core muscles are exercised, the person’s weight is lowered, and the range of motion is increased.

What happens post-repair is the same story. The reason we see patients beginning on Day One after surgery, and re-start their rehabilitation exercises, is the same reason we exercise them in the first place. All surgery is improved by a total-body fitness program as long as it protects the repaired joint. Any patient with a surgically repaired knee can sit on a stationary bike and spin their well leg immediately—blowing off the anesthetics from surgery and reestablishing their self-image as an athlete in training rather than a patient in rehab.

This athletic immediacy is also critically important for patients in the performing arts. Our ballet dancers must be able to see their “line”—i.e., their operative leg extended, with toes pointed—in the recovery room to know that their form will be restored. (This is often easy to do, as the joint is filled with numbing pain medication.) Our violinists must permit their operated shoulders to be manipulated in a full range of motion to know that their musical careers are not over.

I am often asked: “How long will my recovery from surgery take?” The answer is, forever. It is an ongoing, continuing process. Our goal is to create athletes for life.

So whether you are in pain or in recovery, don’t see yourself as a victim. Injuries can be great opportunities to get into your best shape ever. The time to start is today. What is your excuse?

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