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Swimming for Recovery

We asked two of our specialists on how swimming can assist in recovery on lower limb operations.

Robert Lewis Carter
Consultant Orthopaedic Surgeon
BMI Ross Hall Hospital

Elaine Farquharson
Physiotherapy Manager
BMI Winterbourne Hospital

Swimming is currently one of the most popular sports in the UK. Why do you think it is popular?1

Robert Carter

It’s a great low impact sport that anyone of any age, size and fitness can do. Recent success of British swimmers in the Olympics and the World Championships has raised the profile of swimming. In addition, there has been an increase in the number of private gyms and fitness studios with swimming pools so you don't have to rely only on your local pool.

Elaine Farquharson

Swimming or water based movement is accessible for everyone of all ages and abilities; there’s nothing more fun than splashing around in the water.

For athletes it provides ever increasing challenges and with the mainstream growth of triathlon based sports there has been a huge investment into the clothing for swimming so we are seeing more members of the public enjoying the freedom of exploring their beautiful open water environments.

How does swimming assist in injury recovery?

Robert Carter

It helps to maintain or restore your muscle bulk, strength and improve your flexibility. Regular swimming following surgery can help you progress through the stages of rehabilitation more quickly - initially working on the flexibility of your joints whilst the water takes the weight and the load off them.

As the flexibility returns, patients can build up the length of time or speed of activities to help strengthen the muscles throughout the body; lower limb, upper limb and cardiovascular (heart and lungs) fitness.

Elaine Farquharson

Swimming allows a full body workout in a supported weightless environment. It cushions and assists joints through the buoyancy of the water. It helps to relieve anxiety and stress through the relaxing sensory experience. For people who are struggling with swelling, it can help to reduce this through improving the circulation through hydrostatic pressures on the muscles. It also is a method of improving your fitness and cardiorespiratory system when you are not otherwise able to exercise.

Does it benefit some joints more than others?

Robert Carter

Swimming is generally good for all joints. The benefits are most marked in the lower limb following surgery as patients can start the rehabilitation at a much earlier stage than land based activities.

In the water your body weight and therefore the load on your joints is taken off as you float so that your joints are "ready for action" at an earlier stage. Many of the elite professional sports clubs use AlterG reduced gravity running machines to push their players back to fitness at an earlier stage than traditional running activities - this uses the same theories as pool based activities.

Elaine Farquharson

It can benefit all joints but can with guidance, be used to target specific regions to improve mobility or to add resistance to strengthen and regain muscle power. Also the turbulence of the water can be useful to increase positional sense of the joints which improves balance and precision of movement.

If I am not ready to swim the full length of a pool, what pool exercises can I do?

Robert Carter

Stretching, walking and running in the shallow end of the pool is a good pool exercise even if you’re not able to swim the full length. Patients can start off by carrying out a stretching programme in the water and then progress onto walking with floats. Once you have progressed to this stage, then you can try walking across the shallow end of a pool and increasing the number of widths, pushing and walking with high knees and also jogging in the water. There are many good and safe exercises even if you can't swim confidently.

Elaine Farquharson

If you are a non-swimmer you can use the water to practise walking and balance, gentle upper limb movements or spinal mobility. There are lots of guided aqua-aerobic classes or hydrotherapy groups that help with this so you feel safe in the water.

For those patients that are carrying a minor injury, swimming can be used as cross training and adapting the stroke with drills or floats can completely avoid exercising the injured limb whilst still giving you a challenge. For patients suffering with neck or back pain or for those patients that are unsure of going in this environment alone then a physiotherapist will be able to offer you guidance or design a training plan.

I haven’t had my surgery yet, is it wise for me to go swimming?

Robert Carter

Yes it’s a great idea. There is evidence that improving cardiovascular (heart and lung) fitness in addition to general muscle fitness improves the quality and speed of recovery after surgery. If you train before the surgery you will find it easier and more enjoyable to recover and rehabilitate.

Elaine Farquharson

Particularly for those of you waiting for surgery, swimming can be extremely beneficial for your health and movement system; however it is normally adapted in some way to protect you. I suggest that you get some guidance first from a qualified physiotherapist so that the experience is positive and you get the best time in the water. Used sensibly it will help you to maintain movement, reduce your stress levels and keep you fit without over exerting your injury.

How soon after my surgery can I go swimming?

Robert Carter

As a general rule once the wounds have fully dried up - usually around 2-3 weeks following lower limb surgery. It may be possible to start earlier with specific waterproof dressing. The operating surgeon and physiotherapist can advise you specifically regarding your particular operation.

Elaine Farquharson

It obviously depends on the extent of your surgery and whether you are medically fit and well, but for all post-ops we would like the wound to be completely healed before you go to a public pool environment.

Some physiotherapy-led hydrotherapy pools can take you earlier so long as they assess your wound and protect it with waterproof dressings. The early hydrotherapy can be particularly beneficial for people who are on protected weight bearing as it gives you the freedom to move in a weightless environment. But again this is best assessed by a physiotherapist first.

How many times per week should I be getting into the pool?

Robert Carter

3-4 times is ideal but even once a week is likely to significantly help. The more you carry out your rehabilitation both in the pool and on land the stronger and quicker you will recover and improve your function.

What other therapy would be beneficial in my recovery?

Robert Carter

Guidance from your surgeon and physiotherapist will be provided regarding your surgery, but as a rule, walking, cycling, cross trainer and rowing are good exercises in lower limb surgery recovery. All of the low impact activities are easier to return to and will help push on recovery at an earlier stage. Once good healing and recovery has taken place your surgeon and physiotherapist will guide you on returning to running and impact activities.

Elaine Farquharson

Improving your biomechanics through coaching and exercise, massage, manual therapy, taping and in some cases electrotherapy or acupuncture are all useful therapies to aid in your recovery. Also for those with large swollen limbs lymphatic drainage can be helpful for relieving this

What other physical activity do you enjoy?

Robert Carter

Cycling and walking with my family and Springer Spaniel Archie.

Elaine Farquharson

I am a stand up paddle boarder sponsored by Naish UK and have been competing in the N1SCO championship series this year. However I love messing around on and in the water and have done lots of kayak expeditions all over the world.

I have also worked extensively with British Wheelchair Sports athletes and covered events for Paralympic swimmers at the Commonwealth Games. I now spend a lot of my spare time covering international triathlon events and providing physiotherapy support to my local water sports community.

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