My name is Josh Wageman and I’m a physical therapist. Most people do not need a formal course of physical therapy after an inguinal hernia repair, ventral hernia repair, or other abdominal procedure. However, after the structural problem has been fixed, some lingering tightness and soreness can persist, particularly in the adductor (inner thigh and groin) and hip flexor (front of the thigh) muscle groups. Some of this tightness is due to normal healing and tissue remodeling, and some of this is due to the neuromuscular “guarding” that occurs when the body experiences the localized insult of surgical intervention. Rest assured, THIS IS COMPLETELY NORMAL. After you have been cleared by Dr. Williams, the following links will show you stretches and mobilizations that can help to mitigate any residual tightness and discomfort so you can, in time, return to full activity better than ever!
When performing these exercises, you should feel a stretch, but no pain. Pushing to the point of true pain will only lead to further guarding and tension. Instead, gradually “tease” the edge of discomfort so that your muscles can adapt to a new resting length. Below are the links to videos that will demonstrate how to properly perform these movements:
Hip Flexor #1:
Hip Flexor #2:
In addition to these exercises, here are a few tips that can assist you in your recovery:
WALK TALL. Sometimes due to pain and discomfort in the surgical area in the early phases, you may walk in a hunched-over, stooped posture. This will only lead to increased tension in the hip flexors and adductors, which will result in more pain over time. Additionally, this can lead to increased shear stress on the spine, potentially leading to low back pain. So be cognizant of good posture when you are walking after your surgery.
Don’t get GLUTEAL AMNESIA. Once again, if you find yourself in a hunched-over posture after surgery, your gluteal (rear-end) muscles are incapable of being activated, leading to a whole slew of potential problems! A simple thing that you can do throughout the day is visualize squeezing a 100-dollar bill between your cheeks (the cheeks of your rear, that is!) and hold that contraction for about 3-5 seconds. Although it sounds a little awkward, it will effectively wake your glutes up and force you into a more optimal, upright postural position!
Focus on DIAPHRAGMATIC BREATHING. When you have discomfort, you subconsciously start to take short, shallow breaths in which you only utilize your upper lung fields. This can also lead to increased tension in the abdominal and hip musculature as well as the paraspinal muscle groups. A simple thing to do while you are lying on your back is focus on breathing through your belly; concentrate on expanding your stomach with air as you take full breaths in and out. Properly using your diaphragm, which is actually a muscle itself, will help relax global tension in your other muscle groups, paving the way to improved movement in the future.
These few little things can go a long way in maximizing your success after surgery. With proper adherence to any lifting restrictions and compliance with Dr. Williams’ recommendations, you’ll be doing fantastic soon!
Josh Wageman, DPT, CSCS