Q Ive recently undergone abdominal surgery, and the hospital physio has advised me to wait for three weeks before running. I think that this is on the excessive side because I feel fine, and the scar is healing rapidly. Do you agree?A This is actually a surprisingly common question, and while abdominal surgery sounds quite nasty getting into the abdominal cavity requires an incision through skin, fat, muscle layers and the peritoneum (the membrane that covers the internal organs) recovery should be relatively swift. Once sewn up again, and providing that there is no infection or other complication, the peritoneum will heal within days, as will the fat and skin.
However the muscle has to take the strain of intra-abdominal pressure, and as you will probably be aware, healing occurs in two stages. Initially a thickened, inflexible scar join forms with nerve endings that rebel if stretched causing pain. Only later does the scar tissue become more flexible and adapt to movement so that the pain on stretching disappears. The time that this takes is fairly constant in all individuals, whatever their state of fitness, and healing must be allowed to occur to prevent weakness in the scar line and the potential for rupture or herniation of the abdominal contents through the weakened muscle.
After surgery, mobilisation is always encouraged, particularly to prevent complications such as deep vein thrombosis. The patient is alerted to over-activity by pain in the scar, and as a result the advice given by most surgeons, for their own as much as the patients safety, is not to exercise for six weeks. Depending on the amount of pressure under which the scar is put, some people are able to exercise successfully earlier. For example, tennis champion Pat Cash won at Wimbledon in 1987, playing his first match just 10 days after an appendix operation.
It is quite possible that you could re-commence training in under three weeks after your surgery, but you might not be very pleased if the wound breaks down whilst you are doing so, so take care.
A great deal also depends on the intensity of the training. It is no good waiting for 21 days of nothing and then trying a flat-out track session. If you were to start running in less than three weeks, it should be at a gentle tempo without any pressure. You can then slowly increase intensity and mileage over time, building up to full training after the six-week mark.
Dr Patrick Milroy, RW Medical Advisor