ACHQC Abdominal Core Surgery Rehabilitation Protocol Patient Guide 6.17.20

Abdominal Core Surgery Rehabilitation Protocol [Version 6-17-2020]
Abdominal Core Health Rehabilitation
Abdominal Core Surgery Rehabilitation Protocol

Patient Guide
Version Date: 6-17-2020

Your Care Team
Patient: ___________________________________
Surgeon: ___________________________________
Surgery Site: ___________________________________
Physical Therapist: ___________________________________
Physical Therapy Site: ___________________________________

Overview
After undergoing abdominal wall reconstruction or hernia repair, your body has a new
ability to stabilize its “core.” Rehabilitation of your core after these operations is
important to maintain function and flexibility and can help reduce pain. This is a guide
to help you regain function and restore abdominal core health.
Some of the topics covered in this guide include:
Self-Care for Healing and Recovery

After your surgery, your tissues will continue healing for several months. The first
four weeks are when the tissue is most susceptible to re-injury. This section
includes information to help you protect your hernia repair and reduce your risk
of developing health problems during your recovery.
Stretching
Stretching helps reduce discomfort, improve your blood circulation, and maintain
mobility of the tissues. It also helps reduce scarring and scar tissue. This section
includes stretches with tips to protect your hernia repair.
Activities of Daily Living

Basic activities are usually more difficult immediately after surgery. This section
includes techniques to protect the hernia repair during daily activities such as
sleeping, walking, etc.
Exercises
Developing weakness after surgery is very common and can prolong your
recovery. This section contains exercises that will help reduce strength loss while
avoiding excess stress to your hernia repair.
Always listen to your body and assess how you feel. Your pain should not go up more
than 2 points on a 10-point pain scale with exercise or daily activities. Understanding all
the factors that affect pain can help with pain management. View this link to help you
throughout your recovery: https://www.youtube.com/watch?v=cLWntMDgFcs.
Rehabilitation Schedule
BEFORE SURGERY:
4+ weeks: Office visit with your surgeon. You will receive this guide from clinic staff.
2-4 weeks: Prehabilitation physical therapy visit to familiarize you with self-directed
exercises and correct form. If unable to make referral to physical therapy,
nurses can provide this education in clinic.
DURING YOUR OPERATION:

In-Hospital: Physical therapy visit for teaching, reviewing, and assessing mobility.
Increase in-hospital physical therapy as needed. You may begin
completing self-directed exercises and stretches as tolerated.
AFTER SURGERY:
0-2 weeks: Self-directed stretches/exercises from guide
2-4 weeks: Physical therapy 1x per week
4-8 weeks: Physical therapy 1x per week

8-12 weeks: Physical therapy 2x per week (bump up to increase core strength without
abdominal strain)
Test abdominal core muscle strength
12-16 weeks: Physical therapy 1x per week (with increased home exercise program)
Discharge: Re-test abdominal core muscle strength

Table of Contents
Before Surgery and Day of Surgery

Prehabilitation..................................................................................Section
1
Day of Surgery ………………………………………………………………………………Section
2
After Surgery
0-2 Weeks …………………………………………………………………………………….Section
3
2-4 Weeks …………………………………………………………………………………….Section
4
4-8 Weeks …………………………………………………………………………………….Section
5
8+ Weeks ……………………………………………………………………………………..Section
6 Borg Scale……………………………………………………………………………………………Appendix
A
Walking Log …………………………………………………………………………………….....Appendix B
Pain Scale …..............................................................................................Appendix
C
Rehabilitation Development Team ……....................................................Appendix
D
Before Surgery: Prehabilitation Visit
The goal of this visit is to familiarize you with what to expect after surgery and some of
the ways you can help your abdomen heal using various exercises and techniques. This
visit should take place approximately 4 weeks prior to your surgery. Either the surgical
team seeing you prior to surgery will review this with you, or a separate visit will be
setup with a physical therapist. This guide should be brought along to all visits to be
reviewed and completed with your surgical team or physical therapist.

Self-Splinting
Splinting is used to protect your surgical site during activities that cause strain,
such as coughing, sneezing, and laughing. To splint, apply gentle pressure to the
surgical site with a pillow or your hands. Splinting may also be used to practice
diaphragmatic breathing if it is painful.
Diaphragmatic Breathing
You may practice in any position, but you may want to begin lying down or in a
reclined position. Place your hands around the lower portion of your rib cage.
Relax your jaw and let your mouth open slightly.
Take a deep breath in through your
nose, letting your rib cage widen
into your hands and your abdomen
expand. Keep your upper chest,
neck, and shoulders relaxed as you
inhale. Breathe out through your
mouth, allowing your whole body
to relax and belly to deflate.
Remember to breathe slowly. Do not force your breathing.
Section 1 1
Desensitization Techniques
Sometime surgical scars become overly painful or sensitive. When this occurs,
desensitization can be used to help normalize the sensations around the scar. To
do this, gently rub the area around the incision with light touch using your finger,
a feather, cotton balls, or a t-shirt. Different textures may be used.
Bending
This motion is similar to squatting down to lift
something off the floor. Leaning over puts additional
pressure on your abdomen. If you need to bend down
to get something, come down to a kneeling position
first and keep your chest tall.
Pelvic Floor
These are the muscles that make up the base of your pelvis and run front to back
and side to side of your pelvis. They assist with continence and elimination and
are in integral part of your abdominal core. They also help with managing our
intra-abdominal pressure, or strain in your belly. Learning how to engage these
muscles can help your recovery.
Posture*
Avoid slouching by sitting with your buttocks
against the back of your chair. Keep your ears,
shoulders, and hips in a line to prevent strain on
your lower back. Do not hunch over.
Section 1 2
Stretching
Pectoralis Stretch
Standing in a doorway, place your arms at
shoulder level and forearms against the
doorframe. Place your feet with one in front
and one in back, and gently lean forward
until gentle stretch is felt across your chest.
Be sure to keep your back neutral. Hold for
15-30 seconds.
Quad Stretch*
Place hands on trunk to splint surgical site.
Bend at the knee to bring your leg behind
you and place the top of your foot on the
seat of a chair. You should feel this stretch in
the front of your thigh. Hold for 15-30
seconds.
Standing Hamstring Stretch*

Stand with one foot slightly in front of you
and flex your foot toward you, keeping your
knee straight. Hinge forward at your hip
without rounding your spine. Hold for 15-30
seconds.
Section 1 3
Calf Stretch*
Stand with one-foot back, keeping forward leg
slightly bent. With your back heel on the floor,
lean forward until you feel a stretch in your calf.
Hold onto wall or chair for support if needed.
Hold 15-30 seconds.
Upper Trap Stretch

Press your right ear to your right shoulder. Do not raise
your shoulder to your ear. Feel the stretch in the side of
your neck. Hold for 15-30 seconds. Return to looking
straight ahead.
Stand and Arch Back

Stand with feet hip-width apart and hands on the small
of your back. Gently arch your back to slightly stretch
your abdominal muscles. This can also be done against
an exercise ball, counter, or couch.
Side Abdominal Stretch

Stand with feet hip-width apart. While keeping your
chest upright, gently lean to the right, extending your
right fingertips down your side towards your right
knee to gently stretch your oblique. Return to center
and repeat on the other side.
Section 1 4

Sleeping*
If you sleep on your back, place a pillow under your knees while you sleep. If you
sleep on your side, place a pillow between your knees while you sleep.
Log-Rolling*
While laying on your back, bend
your left knee and splint surgical
site with left hand. Roll all in one
movement to the right. Reverse to
roll to the left. Always move as
one unit to avoid twisting the
spine. As you exhale and roll over,
gently pull your belly button in
towards your spine.
Section 1 5
Getting to Bed* Lower self to

lie down on one side by
raising legs and lowering
head at the same time. Use
arms to assist moving; do not
twist. Bend both knees to roll
onto back if desired. To sit
up, reverse this movement.
Squatting
Bend your knees, keep your head straight, and
slowly lower your buttocks towards the ground.
Keep your chest up and avoid leaning forward.
Exercises
Complete the following exercises multiple times per day, according to your fitness level.
Be sure to stretch before and after exercising. Your physical therapist may tailor these
exercises to your specific needs.
Activity Level Sets Times Per Day
Not very active 3 sets of 5 3
Fairly active 3 sets of 10 3
Very active 3 sets of 10 5
Section 1 6
Sit to Stand*
Sit on the edge of a chair. Activate your core
muscles by pulling your belly button in.
Maintain this while you lean your trunk over
your feet, until you shift your weight into your
feet. Fully extend your knees as you raise your
trunk up, exhaling as you stand.
Ankle Pumps*
Lay on your back and elevate legs. With legs
elevated, gently flex and extend ankles. Move
through a full range of motion, avoiding pain.
Gluteus (Buttock) Squeezes*

Lay on your back. Slowly tighten buttock
muscles. Hold 5 seconds and release.
Heel Raises*
May start with this exercise in a seated
position and progress to standing. Slowly
rise on balls of feet and lower back down.
Section 1 7
Seated Knee Extension*

In a seated position with back supported,
straighten one leg out in front of you.
Slowly lower leg and repeat on other side.
Shoulder Blade Squeezes* With elbows

bent to 90 degrees, pinch shoulder blades
together and rotate arms out.
Keep elbows bent.
Shoulder Rolls
Roll your shoulders backward in a circle. Rest
and repeat movement in the opposite direction.
Pelvic Floor Contraction with Breath Lay on your back. Keep your buttocks and
thigh muscles relaxed during the entire exercise. Breathe slowly. Notice your
stomach rises when you inhale and your
stomach falls as you exhale. As you
exhale, tighten the muscles that you
would use to stop the flow of urine
(pelvic floor muscles).
Section 1 8
Coordination of Movement with Breath

Get used to using belly muscles
appropriately. Practice exhaling as you
stand, as you rollover, as you bend
down, and as you stand up. Talk to your
physical therapist for additional
movement strategies tailored to your
specific needs.
Forward Lunges
Stand with one foot slightly in front of the other.
Step forward with your back leg and slowly allow
this knee to bend, without allowing your knee to go
out past the end of your foot. Return to standing
and repeat on other side.
Section 1 9
Day of Surgery
Please bring this guide with you when you come for your surgery. You may see a
physical therapist while you are in the hospital, depending on your surgery. Remember
that it is normal to have pain after surgery, especially in the first few days. It is ok to do
gentle exercises even with some abdominal pain. Moving around as much as possible
will help you heal faster.
Reminders:
Bring your abdominal binder with you on day of surgery.
Breathe with movement. Exhale with exertion.
Sit up in a chair for all meals.
Get up to walk 3 times per day for 5 minutes. Focus on breathing. Walk like
you’re walking alongside a toddler, taking slow, steady steps.
Wear your abdominal binder down over your hips. It may ride up towards your
chest while laying down, but it is important to adjust it to the correct place.
Exercises:
You can begin doing exercises in your hospital bed or the day you arrive home from
surgery to relieve pain and help the healing process. Refer to Section 1 for descriptions
of these exercises. Try doing these 2-3 times per day as tolerated to improve circulation
and help work your muscles:
Ankle pumps
Glute squeezes
Shoulder rolls
Shoulder blade squeezes
Knee extensions
Section 2 1
After Surgery: Weeks 0-2
Exercises to maintain your abdominal core health should begin as soon as you arrive
home after your operation. These instructions will guide you through the exercises and
things you can do at home to help you recover after your surgery. You should be
scheduled to see a physical therapist 2-4 weeks after your surgery. If it hasn’t already
been scheduled, please call to get an appointment. You can begin physical therapy prior
to seeing your surgical team for your post-op visit if necessary.

Binder Use
If provided a binder, wear it as much
as you can during the day and night
for the first two weeks after surgery.
To put the binder on, lay the binder
flat on a bed, then lie down with the
binder under your lower back. Secure
the binder so that it is snug but
comfortable. If in place properly, the binder should sit low and should at least
partially cover your hips. Re-adjust as needed to keep it in position.
Monitor pain, fatigue, and swelling. If pain increases by more than 2 points,
resume more frequent binder use. Refer to pain scale in Appendix C.
Walking Program
Begin walking program post-op day 1 with short distances up to 3-6 times daily.
Walk slowly, as if walking with a toddler. Increase in 5-minute intervals, or as
tolerated each day, with a goal of 30 min by the end of the 1st month. Reduce
intensity if you notice increased swelling, more than moderate fatigue, and more
than a 2-point pain increase. Complete walking log in Appendix B.
Lifting Precautions
For the first 3 days, do not lift more than 5 pounds (ketchup bottle, coffee cup).
After 3 days, do not lift more than 10 pounds (basket of laundry, gallon of milk)
until 2 weeks post-operatively.
Section 3 1
Avoid Holding Breath

Do not hold your breath with any activities. Remember to exhale with exertion.
You should not get red in the face. If you’re feeling dizzy or light-headed, stop.
Work on gently pulling in your belly while exhaling.
Stretching
Complete these stretches before your exercises. Refer to descriptions and visuals in
Section 1.
Quad Stretch
Standing Hamstring Stretch
Calf Stretch
Upper Trap Stretch
Stand and Arch Back
Side Abdominal Stretch
Toileting Techniques
Minimize straining as much as possible. Your
bowels may take several days to return to
your regular schedule. If you do begin
straining or having trouble using the
bathroom, try having your feet supported on a
stool in front of you. This helps relieve
pressure on your abdomen and encourages an
easier passage. Remember to exhale as you
bear down. Drinking plenty of fluids and over
the counter laxatives can help as needed.
Contact your doctor if you have dark, bloody, hard stool or struggle to pass a
bowel movement for 3+ days.
Maintain Good Posture Refer to diagram in Section 1.
Section 3 2
Diet
Your diet plays a major role in preventing constipation after surgery. After your
procedure, and especially while on pain medication, you should be eating 25-30
grams of fiber per day. Good sources of fiber include fruits, vegetables, beans,
and whole grains. Fiber supplements are also helpful. Drink as much water as
possible and ideally at least 2 liters daily.
Exercises
Be sure to stretch before and after exercising. Your physical therapist may tailor these
exercises to your specific needs. Refer to exercise descriptions in Section 1.
Sit to Stand
Ankle Pumps
Glute Squeezes
Seated Knee Extensions
Heel Raises
Shoulder Blade Squeezes
Pelvic Floor Contraction with Breath
You may progress to the next section once you can complete this section with no
increase in pain, or as determined by your physical therapist.
Section 3 3

Binder Use
At 2-4 weeks, you may begin removing your binder during sleep. Also, begin
removing your binder for 1-2 hours a day or as tolerated. Gradually decrease
time as tolerated, as long as pain, fatigue, and swelling remain low. Continue
wearing binder during lifting or more vigorous activities, such as vacuuming or
unloading the dishwasher, if you feel it helps you.
Walking Program
Gently stretch lower extremities before and after each walk. Hold onto counter
or back of chair for support if needed. Increase as tolerated each day. If you feel
an increase in pain, swelling, or fatigue, limit increase in walking to no more than
5-minute intervals. Walk slowly, as if walking with a toddler. Complete walking
log in Appendix B.
Do not exceed “talk test.” You should be able to carry on a conversation while
walking – you may be a little out of breath, but still able to answer. If you are
unable to maintain talk test with changing speed, add 2 more days to walking
program and then try again.
Lifting Precautions
You may lift up to 10-15 pounds
between 2-4 weeks after surgery.
Refer to Section 1 for more
information on how to lift safely.
Desensitization Techniques
Sometime surgical scars become
overly painful or sensitive. When this
occurs, desensitization can be used
to help normalize the sensations around the scar. Gently rub the area around
the incision with light touch using your finger, a feather, cotton balls, or a t-shirt.
Different textures may be used.
Section 4 1
Stretching
Continue with stretches from weeks 0-2, and add
this stretch:
Tensor Fascia Lata (TFL) Stretch*

Cross one leg behind another. Slightly lean
away from the side where the leg is behind
until stretch is felt in the hip.
Toileting Techniques
Minimize straining as much as possible.
Your bowels may take several days to return
to your regular schedule. If you do begin
straining or having trouble using the
bathroom, try having your feet supported
on a stool in front of you. This helps relieve
pressure on your abdomen and encourages
an easier passage. Remember to exhale as
you bear down. Drinking plenty of fluids
and over the counter laxatives can help as needed.
Contact your doctor if you have dark, bloody, hard stool or struggle to pass a
bowel movement for 3+ days.
Maintain Good Posture

Refer to diagram in Section 1.
Diet
Your diet plays a major role in preventing constipation after surgery. After your
procedure, and especially while on pain medication, you should be eating 25-30
grams of fiber per day. Good sources of fiber include fruits, vegetables, beans,
and whole grains. Fiber supplements are also helpful. Drink as much water as
possible and ideally at least 2 liters daily.
Section 4 2
Exercises
Your physical therapist will tell you which to include in your routine and help you set
goals. Once your incision has healed, you may begin participating in cardio as tolerated.
At this stage, cardio may include walking, jogging, swimming, cycling, elliptical, yoga, Tai
Chi, and Qi Gong. Be sure to stretch before and after exercising. If you feel significant
increase in pain while doing these exercises, stop the exercise, rest, and try again with
less force or intensity. If your pain persists with activity, take a break from exercising
for a few hours. Refer to exercise descriptions in Section 1.
Sit to Stand
Ankle Pumps
Glute Squeezes
Heel Raises
Section 4 3
Remember to bring this educational guide, your abdominal binder, and completed
walking log to your physical therapy appointments!

Binder Use
At 4-8 weeks, you may wear your binder only for comfort as needed. Continue
wearing your binder during lifting or more vigorous activities, such as vacuuming
or unloading the dishwasher, if you feel it helps you.
Outdoor Activity
Do not rake or shovel show until 8-week post-op. Limit to 2 hours of yardwork
per day until 12 weeks post-op.
Lifting Precautions
If still painful, no lifting more than 10-15 pounds. Be mindful of avoiding excess
lifting. Gradually progress, limit as needed based on pain, swelling, and fatigue.
Stretching
Continue with stretches from previous weeks. Increase reps and frequency as
designated by your physical therapist.

Childcare*
Small children can be carried at 6 weeks post-op, depending on weight. Refer to
Section 6 for more details.
Carrying Items
May begin at 4 weeks post-op. Start with double arm hang, like carrying 2 grocery
bags down at your side. You can also combine and carry, with one arm down like
a grocery bag and another on hip. You can also carry objects close to your body
to decrease strain on the repair site. Progress to single-side carry.
Section 5 1
Exercises
Exercises at this stage will vary based on your activity level. Your physical therapist will
tell you which to include in your routine and help you set goals. Once your incision has
healed, you may begin participating in cardio as tolerated. At this stage, cardio may
include walking, jogging, swimming, cycling, elliptical, yoga, Tai Chi, and Qi Gong. Be
sure to stretch before and after exercising. If you feel significant increase in pain while
doing these exercises, stop the exercise, rest, and try again with less force or intensity.
If your pain persists with activity, take a break from exercising for a few hours. Refer to
exercise descriptions in Section 1.
Sit to Stand
Ankle Pumps
Glute Squeezes
Heel Raises
In addition to these, add the following:

Straight Leg Raises
Section 5 2
Start with your right leg straight and the opposite

leg bent. Slowly raise the right leg off of the bed as
you breathe out. Keep your knee straight. Lower
the leg to the bed and breathe in. Repeat on other
side. Quadruped Rocking
On your hands and knees, find a neutral
spine with your abdominal muscles
engaged. Gently rock forward and back.
Hook Lying Bent Leg Lift Lay on your

back with your knees bent. While
keeping your abdominal muscles tight,
gently raise one leg a few inches off the
floor. Slowly lower leg back down.
Repeat on other side.
Elbow Flexion
Stand with your arms at your side or sit with your
arm resting on a surface, like a couch or counter.
With palm facing up, bend at the elbow and raise
your hand up towards your shoulder and lower
back down. Repeat on other side.
Shoulder Abduction
Start by laying on your back with
your arms at your sides. Move your
right arm out to your side and
towards your head as you breathe
in. Return your arm to your side as
you breathe out. Repeat on other side.
Section 5 3
Shoulder Flexion
Start with your arms at your sides. Lift
your right arm straight up and over your
head as far as possible as you breathe
in. Return your arm to your side as you
breathe out. Repeat on other side.
Clamshells
Lay on your side with your knees bent
and the soles of your feet in line with
your spine. Keep your hips square and
gently lift your top knee. Keep your hand
on your upper hip to prevent it from
moving back. Do this movement slowly
to active the glutes. Repeat on other
side.
Cat to Cow
On your hands and knees, inhale and gently arch
your back up while tucking chin to chest. Exhale
and relax your back and lift your chin. Repeat
with each breath.
Section 5 4
Section 5 5
After Surgery: Week 8+
Remember to bring this educational guide, your abdominal binder, and completed
walking log to your physical therapy appointments!

Binder Use
At 8 weeks or greater after surgery, you may wear your binder only for comfort
as needed. Continue wearing your binder during lifting or more vigorous
activities, such as vacuuming or unloading the dishwasher, if you feel it helps
you.
Outdoor Activity
You can perform outdoor activities as tolerated. If you have significant increase in
pain, ease your activity.
Lifting Precautions
You may lift as tolerated using squatting method (refer to Section 1). If you have
significant increase in pain, stop lifting. Maintain proper posture and head
alignment. Slide object as close as possible before lifting. Move obstacles out of
the way. Test before lifting and ask for help if too heavy. Tighten stomach
muscles without holding breath. Use smooth movements and avoid jerking. Use
legs to do the work and pivot with feet. Distribute the workload symmetrically
and close to the center of trunk. Push instead of pulling whenever possible.
Stretching
Continue with stretches from previous weeks. Increase reps and frequency as
designated by your physical therapist.

If you have specific concerns at this stage, please review with your physical therapist so
they can address your personal needs.
Section 6 1
Car Entry*
To get in the car without
putting additional
pressure on your
abdomen, stand facing
away from the car and
sit down on the edge of
the seat first. Once you
are seated, slowly turn
your body towards the
front. Reverse this
movement to get out.
Computer Work*
Position screen and keyboard directly
in front of you with screen at eye level.
Use proper work and seat height. Keep
shoulders back and down, wrists
straight, and elbows at right angles.
Use a chair that provides full back
support. Add footrest and lumbar roll
as needed.
Child Care
Move child to your height to avoid
bending over. Squat down to pick up
child, do not bend back. Carrying children
on your front places the most pressure
on your abdomen. If possible, carry your
child on your side. Keep your hips in
alignment with your shoulder – avoid
sticking your hip out to rest the baby on.
Section 6 2
When putting a baby in a car seat, activate your core muscles to lift away from
your body. Keep your back tall and straight and avoid bending over and placing
additional pressure on your
abdomen.
Laundry*
To load a top-loading machine,
support yourself on the washing
machine. Keep one leg back
behind you and keep it straight to
help keep your back straight. To
load a front-loading machine,
avoid leaning over to reach in
and out.
Exercises
Exercises at this stage will vary based on your activity level. Your physical therapist will
tell you which to include in your routine and help you set goals. Once your incision has
healed, you may continue participating in cardio as tolerated. At this stage, cardio may
include walking, jogging, swimming, cycling, elliptical or yoga. Once you can complete
these without pain, you may resume other forms of exercise, such as weightlifting.
Continue to perform the exercises below. If you feel significant increase in pain while
doing these exercises, stop the exercise, rest, and try again with less force or intensity.
If your pain persists with activity, take a break from exercising for a few hours.
Section 6 3
Bridging (with alternate knee extension)

Lie flat on your back with your knees bent
and pull your stomach towards your spine.
Keep your stomach muscles tight and your
shoulders on the floor. Lift your hips off
the floor as you exhale. Hold for 1-2
seconds and slowly lower your hips back
to the floor.
Curl Up (with abdominal bracing)
Lay on your back with your knees bent
(hook lying position) and place your
hands behind your head. Lift head and
shoulders when you exhale and engage
lower abdominals and pelvic floor.
Leg Press (with TheraBand)

Lying on your back, position the
TheraBand under your feet. Bend your
knees toward your chest and straighten
your legs out. Slowly return to the
starting position.
Lying Leg Lift

Lie down flat on your stomach.
Rest your forehead on your
hands. Squeeze the left side of
your bottom and slowly lift
your left leg off the floor as
high as you can. Keep your leg straight and hold for 1-2 seconds. Lower your left
leg back down to the floor. May raise opposite arm as leg raises for added
challenge.
Section 6 4
Quadruped Arm and Leg Raises

Start on your hands and knees.
Keeping your back straight and
abdominal muscles engaged,
extend your right arm and left leg
out. Hold 2-3 seconds. Slowly
return to the starting position.
Repeat with opposite leg and arm.
Plank
Lie down on your stomach. Bend
your elbows and keep them
shoulder-width apart. Lift your body
up on your elbows and knees. Keep
your elbows under your shoulders
and tighten your abdomen to hold your body in this position. Hold for 20-30
seconds and then relax.
Bilateral Scapula Retraction (banded)

Hold the TheraBand in both hands in
front of you. Open your arms out to the
side, keeping your shoulders square and
pulling your shoulder blades in towards
your spine.
Section 6 5
Push Up
Start in a plank position with your
hands shoulder-width apart, or wider
if that is more comfortable to you.
Keep your core engaged and back flat
as you lower your chest towards the
ground.
Modified Curl-Up
Lay on your back with knees bent and
hands resting under the small of your
back. Straighten one leg out and lift
head and shoulders slightly off the
ground. Hold for 5-10 seconds and
return to ground. This is a very small
motion to work the abdominal
muscles without straining the spine.
Section 6 6
Appendix A: Borg Rating of Perceived Exertion (RPE) Scale
Exertion Score Example
None 6 Watching TV
Extremely light 7-8 Brushing hair
Very light 9-10 Walking, household chores
Light 11-12 Able to complete while

hold a conversation,
without losing your breath
Somewhat hard 13-14 Exercise is somewhat hard,

but you can continue
Hard 15-16 Cycling, swimming
Very hard 17-18 Exercise that is tiring,

pushing yourself
Extremely hard 19-20 Quick burst that is

unsustainable
Appendix A
Appendix B: Walking Log

Date Time Walked Distance Borg Scale Notes
(see page 26)
Appendix B
Walking Log (Continued)

Date Time Walked Distance Borg Scale Notes
(see page 26)
Appendix B
Appendix C: Pain Scale
Choose the face that shows how much pain you feel and use the number under each
face to rate your pain. You should not be progressing with exercises if you are
experiencing extreme pain or discomfort. Be sure to communicate with your care team
about changes in pain.
Appendix C
Abdominal Core Surgery Rehabilitation Protocol Development Team
Vanderbilt University Medical Center

Jennifer Emery PT, DPT, MOT; Tiffany Priest PT, DPT, WCS; Julie Richard PT, CSCS;
Shannon Bell MSN, ACNP-BC; Richard Pierce MD, PhD
The Ohio State University Wexner Medical Center
Benjamin Poulose MD, MPH; Savannah Renshaw BS; Courtney Collins MD, MS; Laura
Ward PT, DPT, MTC; Stephanie Bobinger PT, DPT, WCS; Maggie Abrams PT, DPT, CYT,
WCS; ReNea Owens PT, Michelle Graf PT; Kenneth Kozlosky MS, CCC-SLP; Andrew
Morris PT, DPT; Emily George BS
Furman University
Phil Gregory PT, DPT, OCS, CSCS
Prisma Health
Jeremy Warren MD, FACS
The Cleveland Clinic
Michael Rosen, MD; Ajita Prabhu, MD; David Krpata, MD; Clayton Petro, MD
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*Illustrations reprinted with permission. Copyright 2020, Abdominal Core Health Quality
Collaborative.
Illustrations reprinted with permission. Copyright 2020, The Ohio State University
Wexner Medical Center, Columbus, Ohio, Patient Education. All rights reserved.
Appendix D

ACHQC Abdominal Core Surgery Rehabilitation Protocol Patient Guide 6.17.20

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Abdominal Core Surgery Rehabilitation Protocol [Version 6-17-2020]

Abdominal Core Health Rehabilitation

Abdominal Core Surgery Rehabilitation Protocol

Version Date: 6-17-2020

Your Care Team

Surgery Site: ___________________________________

Physical Therapist: ___________________________________

Physical Therapy Site: ___________________________________

Some of the topics covered in this guide include:

Self-Care for Healing and Recovery

Activities of Daily Living

DURING YOUR OPERATION:

0-2 weeks: Self-directed stretches/exercises from guide

2-4 weeks: Physical therapy 1x per week

4-8 weeks: Physical therapy 1x per week

Discharge: Re-test abdominal core muscle strength

Before Surgery and Day of Surgery

Before Surgery: Prehabilitation Visit

Self-Care for Healing and Recovery

Standing Hamstring Stretch*

Upper Trap Stretch

Stand and Arch Back

Side Abdominal Stretch

Activities of Daily Living

Getting to Bed* Lower self to

Activity Level Sets Times Per Day

Not very active 3 sets of 5 3

Fairly active 3 sets of 10 3

Very active 3 sets of 10 5

Gluteus (Buttock) Squeezes*

Seated Knee Extension*

Shoulder Blade Squeezes* With elbows

Coordination of Movement with Breath

After Surgery: Weeks 0-2

Self-Care for Healing and Recovery

Avoid Holding Breath

Standing Hamstring Stretch

Upper Trap Stretch

Stand and Arch Back

Side Abdominal Stretch

Activities of Daily Living

Maintain Good Posture Refer to diagram in Section 1.

Not very active 3 sets of 5 3

Fairly active 3 sets of 10 3

Very active 3 sets of 10 5

After Surgery: Weeks 2-4

Self-Care for Healing and Recovery

Tensor Fascia Lata (TFL) Stretch*

Activities of Daily Living

Maintain Good Posture

Not very active 3 sets of 5 3

Fairly active 3 sets of 10 3

Very active 3 sets of 10 5

After Surgery: Weeks 4-8

Self-Care for Healing and Recovery

Activities of Daily Living

Not very active 3 sets of 5 3

Fairly active 3 sets of 10 3