Challenging Convention Post Major Surgery – A Client Case Study


They say “set backs are opportunities for come backs”, but what if a come back after a set back wasn’t needed at all. What if a set back was just another opportunity to continue progressing?

Convention would normally dictate that after major surgery on a vulnerable part of the body (such as the knees, hips, shoulders etc.) a long lay-off is required, combined with subpar food choices and lack of activity this can set back many individuals. This makes coming back to a regular health and fitness routine much harder. Many pile on the pounds and feel worse for it. The whole set back off major surgery can act as an unwelcome interruption to any exercise regime, with a lack of activity and poor diet spiralling to the point that it can make you feel like you’re starting from scratch when and if you eventually are ready to make a return.

There are some basic principles we should all adopt in our lives that see exercise, nutrition, recovery and goal setting as the cornerstones for a healthy productive life. And being one to always challenge convention, with the adoption of these basic principles post major surgery I believe it’s entirely possible to accelerate recovery and surpass any lay-off that may be originally anticipated.

So I guess it’s time to put my money where my mouth is. My client, Graham, 51, needing major knee surgery, due to years of wear and tear, has given us the perfect opportunity to put this theory into practice. Over the next eight weeks I’m going to bring you updates on our progress and to aim to show you, that a set back, like major surgery, needn’t force you right back to square one and can be seen as an opportunity to refocus and use exercise and diet as key factors in accelerating the healing and recovery process.

Before we go any further I thought it would be great just to give you a brief rundown of the procedure Graham is undergoing. Under the care of Professor David Barrett, Graham needed Lateral Knee re-surfacing. The successes and advances in total knee re-surfacing have allowed surgeons to develop and pioneer the concept of partial knee re-surfacing. This is a particularly useful procedure to help patients deal with early signs of osteo-arthritis. The general jist of the operation involves using a prosthesis implanted into the bony structures of the Femur and Tibia with the addition of a composite bearing that then acts as cartilage in the joint, preventing any bone on bone grinding. Should you want to learn more about Professor David Barrett and the services he offers see website here.

Major surgery
Pre-Surgery Goal Setting

Initial Starting Stats
Bodyweight: 80.5kg
Body fat: 10.1%
Fat mass: 8.1kg
Lean body mass: 68.8kg

Prior to any task it’s important to set some SMART goals and major surgery is no exception, so that’s exactly what we did. This is a goal that is:

Time bound

SMART goals are invaluable for having a laser guided focus, motivation and ultimately your success/outcome of a task. Our goals were set over an 8 week recovery period which we agreed was a challenging yet, acceptable time frame for recovery. They were as follows:

-Come back losing as little fitness as possible. Using a subjective 1/10 scale (if 10 being fitness prior to the operation) 8 weeks after the operation we want Graham feeling a 10/10 again.

-Minimise fat gain – One day pre-op body fat sitting at 10.1%, with a body weight at 80.5kg. 8 weeks we are aiming to see these numbers back here, if not lower!

-Back to driving within six weeks post-op.

Over the 8 week period I laid out a Skelton plan for exercise modes and frequency. This is something I know Graham will challenge over the coming weeks, but it is as follows:

Weeks 0-2 – Rest. Gym workouts upper body focused x 1-2.

Weeks 2-4 – Gym workouts upper body focused with light cross trainer work (1km) x 3-5.

Weeks 4-6 – Gym workouts upper body focused with med cross trainer work (2km +) x 3-5.

Weeks 6-8 – Gym workouts upper body focused with normal (pre-surgery) cross trainer work x 4-6.

It’s also worth noting knee physio and rehabilitation will be taking place every week.

As well as these goals, we also explored energy expenditure and planned this accordingly to Grahams BMR and predicted energy output. This is vital and something worth doing especially if you don’t want to pile on the pounds after a major operation. Many individuals make the mistake of eating the same amount of food, despite moving up to 80% less in a day!

We also took a look at supplements and I recommended some which should help speed the recovery process. These were as follows:

Omega 3’s (2-4g per day) – For joint,and heart health. Also good as an anti-inflammatory.

4:1:1 BCAAs (10g per day) – Amino acids with a 4:1:1 breakdown aim to reduce muscle breakdown, meaning Graham can maintain as much as possible despite his weights training not being full on par.

ZMA (one serving pre-bed) – For improved sleep which comes with added recovery benefits.

Glutamine (5g per day) – For improved immune function. No one wants to get sick after a major operation right?

Weeks 0-2

So no we’ve got the basics out of the way it’s time to get into the nitty gritty of the recovery process. You’ll be glad to know grahams procedure was a success, and as of writing this, we’ve just finished week two of the Skeleton plan I initially laid out. Here’s a quick summary of what’s been going on over the last 14 days.

-After the operation Graham was kept in for three days. Once recovered from the anaesthetic, hospital physios had him up and walking with the aid of crutches. Whilst recovering in bed they also used compression pumps on both legs to reduce the risk of any blood clots.

-Three days later Graham made his return home to continue recovery.

-On day four Graham made his return to the gym. This was the fork in the road than many face in this situation. Do you drag yourself (or get a family member or friend to drive you) to a workout despite not feeling 100%? Or do do you sit around on your butt for the next eight plus weeks? The choice is yours.

-Workouts initially consisted of handbike, purely for the fact that it can accommodate Grahams needs, help to work the cardiovascular system and burn some energy. Sessions ranged anywhere from 30/60 minutes.

-We reduced total calorie intake down slightly over this last two weeks and kept the protein intake relatively high. Obviously this was to prevent weight gain due to not being as active as a normal day and maintain lean muscle mass. I won’t bore you with the numbers here, because everyone is different. Everyone will have a different total daily energy expenditure, so what works for Graham, will probably be irrelevant to you. The recommended supplements I spoke about earlier are also in the mix.

-A few basic upper body resistance exercises were eventually introduced. This included bench press, cable flye, lat pull downs and an assortment of arms exercises. As to be expected strength was down slightly, but I’m pretty confident this will climb back up pretty quickly over the weeks to come.

-Other things worth noting are – the crutches were ditched completely 11 days post-op. Physio sessions involving stretching and massage have been happening 1-2 times per week. Graham has also regularly been using a Knee Cryo Cuff to help reduce inflammation and assist with recovery.

Body Stats Update
Bodyweight: 80.9kg
Body fat: 9.8%
Fat mass: 7.9kg
Lean body mass: 69.4kg

As you can see, after a couple of weeks post-surgery Grahams body stats aren’t too different at all. This is fantastic news and a great start for our journey over the coming weeks. The main slight difference is his fat mass is down, whilst lean mass is up. This may strike you as odd, considering he hasn’t been hitting the weights anywhere near as hard as he could. But let me explain. I’m going to take a punt and put this down to the fact his muscle cells are simply storing more glycogen/fluid purely because it’s not being expended through the weight training.

Lesson learnt #1
Along with each update, I’m also going to give you an important lesson we’ve learned along the way. A key piece of information, that if you’re going through the same or similar thing, will prove invaluable to your speedy recovery.

This lesson quickly became apparent and I think Graham would agree, the sooner you can be doing some exercise the better. Don’t hesitate, don’t put it off, don’t wait for your injuries to heal, just do something asap! Obviously a high degree of care and common sense is required here – for example Graham has had major surgery to the knee, so loading up the bar for some heavy squats on session one is completely out of the equation. But with that said there’s plenty of viable options that will still allow you to burn off some energy, get your blood flowing and do something special for your mental wellbeing.

Graham was fortunate enough to be able to have a support network that allowed him to get to the gym and back despite not being able to drive himself. If you don’t have that luxury, thats ok. You can still explore the idea of a bodyweight home workout, which can be just as effective.

Going back to my previous point of using common sense and working around the effected areas, take a look at the image below. This shows graham on a Hand Bike with his leg elevated slightly on a Swiss ball. This made the machine more accommodating to his current needs. As previously stated, many of his initial workouts post-surgery over the last two weeks have been highly constructed around this piece of kit.


Week 2-4

Moving into weeks 2-4 during the recovery process here’s a quick rundown of what’s been going on.

-Workout frequency has been bumped up to 5-6 times per week. With workouts slowly tapering away from using the handbike for “fuel work” and now more focused around stationary bike and cross trainer. This is beginning to challenge the knee and surrounding tissues and slowly starting to address the muscle wastage that has undoubtedly taken place post surgery.

-Resistance training has also now become a much larger chunk of a typical workout. With Graham now off crutches and able to move the knee into a greater range it’s allowed us to use a wider variety of exercise choices. We’ve also noticed strength improving, to a point where it’s almost on par with the typical poundage he was lifting before the surgery (not bad for less than four weeks post surgery!).

-Continued, regular physio appointments involving plenty of soft tissue massage. Plus some basic knee rehabilitation work such as leg presses, glute bridges and bodyweight squats.

-With increased energy output, not only from the gym workouts, but also during everyday life, Grahams caloric intake has been slightly increased to match this. Still sticking to the same supplement regime as originally discussed.

Body Stats Update
Bodyweight: 77.9kg
Body fat: 9.5%
Fat mass: 7.4kg
Lean body mass: 67kg

This is an interesting reading, yet an awesome one at that. If you can recall my point I opened this article with – what if a set back was just another opportunity to continue progressing? Well this proves just that! Graham has lost weight and body fat, whilst many in this stage of recovery will be piling on the pounds week after week and losing that hard earned muscle to an increase in body fat. Whilst we probably don’t want to see his bodyweight drop much lower than this over the next month, we’ll still continue with the outlined plan. Perhaps shifting our focus now to lean muscle retention, strength improvement and a continued quality recovery.

Lesson learnt #2
After gradually incorporating more cross trainer into Grahams workouts over the last two weeks and gently increasing the time, there came a point where Graham began to experience pain during the exercise. So lesson #2 is – listen to your body. During any recovery process after major surgery, or even just throughout any fitness/transformation routine, listen to what your body says. If you’re experiencing pain is it maybe time to take a step back? Or change things up?

Weeks 4-6

As week 6 comes to a close, here’s what’s been happening. You’ll notice not much has changed since weeks 2-4. It’s just all about progressing on the current path.

-Continued workout frequency at 5-6 sessions per week. Still plenty of work that’s sole aim is to assist recovery and prevent muscle wastage of the VMO around the knee.

-Resistance training still making up a bulk of Graham’s sessions. Again looking to progress loads where possible. The occasional short HIIT circuit as also been thrown in at the end of some sessions to maximise Excess Post-exercise Oxygen Consumption (EPOC) sometimes know as the after burn effect. This is done using tools such as battle ropes, slam balls and medicine balls.

-Continuing with regular physio appointments.

-Calorie base line has now been brought back up to match more or less what it was before the operation.

Body Stats Update
Bodyweight: 78kg
Body fat: 9.2%
Fat mass: 7.2kg
Lean body mass: 67.3kg

Are you seeing this!? Another strong stats update at the end of week 6 with Grahams weight now staying pretty stable, and his entire body composition beginning to shift positively. That means slightly less fat, slightly more muscle. Win!

Lesson learnt #3
“Fail to plan, plan to fail” is lesson number 3. After comparing Grahams body stats update over the last 6 weeks, we’ve already set out what we wanted to accomplish – to defy convention and at least maintain weight, body fat and lean muscle after a major movement inhibiting operation. It hasn’t been easy, but planning for it made the whole process effortlessly flow. Many of us set goals and plan for a body transformation, so why shouldn’t we do it as part of an injury or major surgery recovery programme?

Weeks 6-8

Here’s the final check-in from what has been a very interesting, exciting and successful journey. Once again, there’s nothing much new going on from the previous couple of weeks. Other than progressing on from what we’ve been working on by increasing loads, or distances etc. Apart from the occasional ache at night, I think Graham would agree his knee is operating at an almost fully recovered state now. Meaning we’ve not only positively improved his body composition, but also maximised the total recovery speed that was initially expected.

Body Stats Update
Bodyweight: 77.9kg
Body fat: 8.6%
Fat mass: 6.7kg
Lean body mass: 67.7kg

Lesson learnt #4
Create some accountability. It massively helps! Even the most successful individuals will have a team or circle of mentors behind them that hold them accountable. So you should too. You could hire a coach and they can blog your journey, like we’ve done here, but it needn’t be that sophisticated or extreme. Just tell a few family members or friends what you plan to do and when by. And then ask them to check up on you on that pre-specified date. It works for any goal whether it be rehabilitation, fat loss or financial etc.

Final Summary 

So just to wrap this all up, I’m going to hand over to Graham who can summarise his whole experience over the last 8-10 weeks:

The decision to have my knee resurfaced really was a last resort and something I had been putting off for a number of years. I had seen several consultants who had all suggested a full or partial knee replacement. It was only after research that I found Professor Barrett who offered partial knee resurfacing. I would strongly advise anyone to do their research before agreeing to major surgery. There are options, find what is going to work for you and the best surgeon for the job.

It would be fair to say that I viewed the prospect of major surgery with a certain degree of apprehension. My primary concerns could be split into two areas;

  1. What was outside of my control.

– How would it feel to have a foreign body inserted into my knee and how would my body react.

– How much would it really hurt post op and how long would the pain last.

– Would the results be as good as I was hoping.

– How would my body react to the pain relief.

  1. And what was in my control.

– My weight.

– My body fat.

– My overall muscle mass.

– My general fitness.

For the purposes of this blog, I will concentrate on the bits I could control.

The two primary reasons I stay fit are, because I enjoy staying in reasonable shape and being stronger and fitter than I was at 30. And because it helps with my mental well being. I have a stressful job and the primary way I manage my stress is through exercise. The idea of being unable to go to the gym for weeks on end was quite simply inconceivable for me.

I appreciate that many take the view that post major surgery it is best to rest and that rest will speed recuperation. My view was that, yes there is a place for rest, but the sooner I got back to my exercise routine the better my recovery would be, and mentally I would stay in good condition. I am sure we all know people who have had a major operation or physical injury and go into what can be best be described as a state of mild depression and use their condition as an excuse for many things including skipping the gym.

I guess I didn’t subscribe to this way of thinking and wanted to give myself the best possible chance to recover as quickly as possible. I guess I wanted to challenge the norm and prove that things could be done differently and a better result achieved. I am naturally a competitive individual!

I enlisted the help of Aaron to create and build a programme and agree targets for the whole recovery period. I guess the results speak for themselves.

grahams results

before/after with knee surgery

My overall message would be, don’t be afraid to challenge the norm, don’t use major surgery or injury as an excuse, listen to your body, it really does tell you everything you need to know if you are prepared to listen and finally get a great team around you. I have been lucky enough to have a great PT in Aaron, an excellent physio in Phil Rushmere and an incredibly supportive training partner. Finally, do your research and find the best surgeon for the work.

“Graham underwent a lateral resurfacing and realignment procedure of the knee and has a natural ability to focus and respond to a goal orientated programme. He took on his rehabilitation in a truly scientific and progressive way, ably assisted by Aaron. His immediate wish was to return to exercise and through exercise, accelerated and maximized his rehabilitation potential. He has done this extremely well and in each period has drawn lessons from his recovery and progress. He has worked well with Aaron to progress his exercise and rehabilitation on a week-by-week basis and has achieved one of the best results at six weeks that we have seen in this practice of partial knee resurfacing.

We have learnt a lot from Graham and Aaron’s experience in goal focused rehabilitation and would recommend this approach along with the learning procedure and the inclusion of exercise in a rehabilitation programme.”

David. S Barrett  B.Sc  FRCS
Consultant Orthopaedic Surgeon
Professor of Orthopaedic Engineering