Key Considerations Working With Post-Surgical or Medically Complex Clients

When you are working with a physiotherapist after a major medical diagnosis like cancer or after complex surgery there hopefully comes a time when they say you are ready to focus on getting stronger. Getting to this point is a job well done!

Recovering from major surgery or illness requires you to do a lot of (unglamorous) work that puts you back on the road to having a stronger and healthier body.

Here's my checklist when I work with someone who needs a more cautious approach to getting stronger:

1. I ask them to make contact with their physiotherapist to find out what they still need to avoid and what they feel is the priority to progress. I do not go in and do what I "think" will be okay. This is critical. If someone has successfully completed their rehab I do not want to make them worse at this stage. I will also contact their physiotherapist (with permission) to find out more details

2. I ask them what their rehab work looked like, especially the last 3 months. This allows me to know what is a sensible starting point.

3. I do research on the condition/surgery to find out more about what they will have gone through. I need to understand the procedures, healing timelines and risks. Again, I will ask their physiotherapist about specifics of their condition/procedure I need to consider.

4. I take a full history of the condition. I need to know how their life has been and how they feel about their body. A clients mental health around their body is as important as their physical.

5. In the first session I am looking to assess their mobility, balance and core stability to see what their current abilities are. The key in the first session is to leave a client better than I found them and start to build trust in their body and me.

4. The start point of strength training needs to be decided with great caution. All of my new clients probably do less than they think they will. Experience has taught me that the amount of stimulus required when you are new to strength training is very small, even more so if they are still recovering from surgery or serious illness.

5. The first session is always about seeing how a client moves, finding what feels good and what does not. Can they move their joints through a full range of motion, and are they stable doing that.

These sessions are not about pushing anyone, they are about making a client feel good and to build hope and trust that they can build a strong body. Again, the mental impact with this type of medical history is huge and not to be underestimated. Imagine you have spent years in pain and multiple surgeries, how confident would you be that your body can be strong again?

6. I build a plan of what I think are the best exercises working around the physiotherapists guidelines. The first phase is usually for 12 weeks, repeating the exercises to see progress. My exercise selection is also based around what they are finding difficult to do or around areas where they are weak.

7. The first session itself I will plan 2 sets of the exercises and usually a maximum of 6-7 exercises. Bodyweight and light resistance bands are enough resistance for someone at this stage of rehabilitation.

8.  Progress requires a very gradual progression model. I ask clients for lots of feedback about how a movement feels, asking for signs of discomfort or pain. Their feedback is what dictates the pace of progression. I don't simply add reps or weight each week.

9. My focus in always primarily on making a clients body stronger. If they need to incorporate cardiovascular exercise I advise them to start focusing on their daily movement with an appropriate step count. goal. We build that very gradually.  At this stage, low impact exercise like walking, cycling or maybe swimming is definitely the right starting point.

10. Building trust with any new client, takes time. It's especially important with clients post surgery or with complex medical conditions to feel safe and comfortable with me. I need them to tell me in the moment how something feels, if an exercises is too difficult or causing pain I have to find an alternative.

11. I write detailed notes after every session. Comments from the client as well as recording the work they did. This means when I build the next weeks training plan I know what will be a reasonable progression. 

It also means if their physiotherapist needed to see what I have done, I have a detailed record for them. I aim to build a very clear record of their journey.

12. Once I have completed a session with a new client, I follow up with them 48 hours later. It's important to see how their body has responded to the stimulus in the session. Ideally, they can tell they have worked their muscles but there is no soreness and certainly no pain or recurrence of old symptoms.

13. I will discuss how much time they have to commit to strength work and then set them up in my training app with their workouts. That way we can both see the progress they are making and I can adjust the next session based on the progress they have made that week. I only give this type of client exercises I have seen them perform in person. It can be very easy for an exercise which seems "easy" to cause harm.

My aim is to create a supportive, safe, fun and effective program for my clients with complex medical histories or post-surgical recovery needs. 

My ultimate goal is to enhance their quality of life and help them regain confidence and strength in their body.

This comment from a recent client who has had 2 back surgeries in the last few years is exactly what I hope to instil in someone who is starting to rebuild their body:

"I felt so emotional after our first session. Now I believe I can have a strong body". 

Contact me here if you want to talk about how I could work with you or someone you know x