fitness coach injury recovery strength training
That tumble can take you out for a long time. Focus on getting back to actual movement as soon as you can. (Photo: August Allen/Flickr)

Can Thinking About Strength Training Make Me Stronger?

I just had surgery after a skiing accident, and my wrist is in a cast for several weeks. What can I do to avoid losing strength while I can't move it?

fitness coach injury recovery strength training
August Allen/Flickr(Photo)

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If you’re healthy, you can’t Walter Mitty yourself into superhero strength.

However, research suggests that if you are in a situation in which you literally can’t move a muscle—because you’re injured, not because you’re lazy—simply imagining yourself in motion can help you retain some of the strength and function you’d otherwise lose.

Imagery, also known as visualization, is nothing new to athletes, who often use it before competition to picture themselves successfully executing their sport. Nor is it new to physical therapists, who regularly employ it in rehabilitation for stroke patients. In fact, several studies since the 1990s have shown that the force of a muscle’s voluntary output comes at least partially from the brain, rather than the muscle tissue itself.

“People assume strength is directly proportional to the size and amount of muscle mass, but it’s far from the sole factor,” says physiologist Brian Clark, director of the Ohio Musculoskeletal and Neurological Institute at Ohio University. “The muscle is basically a puppet to the nervous system; the brain and spinal cord need to be able to activate it optimally in order for it to work as it should.”

Clark and his colleagues recently wanted to see if imagery could help with the loss of strength associated with prolonged immobilization. To do so, they put study participants in rigid wrist casts for four weeks, and asked half of them to regularly perform a visualization exercise in which they imagined they were contracting their wrists for five seconds at a time.

After four weeks, both groups had lost more wrist strength than a third group that didn’t get casts. But the imagery group lost about 50 percent less. “That gives us an indication that at least 50 percent of this weakness is driven by the nervous system and the brain, instead of by the muscle itself,” says Clark.

To try it yourself, follow these instructions given to the study participants:

  1. Imagine that you are maximally contracting the muscles in your left (or right) forearm, and imagine that you are making your wrist flex and push maximally against a hand grip with your hand. Keep pushing for five seconds, then stop.
  2. Rest for five seconds.
  3. Repeat 13 times in a row, followed by a one-minute break; that’s one round.
  4. Do four rounds per session; five sessions per week.

For someone stuck in a hospital bed or a cast, says Clark, practicing imagery is a good way to keep the connection between your brain and your muscles active, even when your damaged limb cannot be: It’s free, it’s not going to hurt you, and his research suggests that it may give you an advantage when your real recovery actually starts.

But, he cautions, anyone who can do actual physical therapy should be doing it, as it has many more benefits than just mental exercises alone. “If it’s safe for someone to go ahead and start rehab and do things like weight-bearing moves and resistance training, there’s no reason for them to stick to just imagery.”

Bottom line: Yes, picturing yourself doing exercises can be better than nothing, and may help you maintain some strength in an immobilized muscle. But you still need the physical benefits of movement and weight training—so once you’re cleared to do actual exercises, don’t hesitate to get started.

More Tips for a Fast Recovery from Injury

“Ask the doctors what you can and can’t do, and get their idea of how long they think your recovery will take,” says Long Island, New York–based physical therapist Annette Marshall Franey. “Then, make sure you’re getting regular assessments—in measurements—of where you are in terms of range of motion and strength.”

A good physical therapist will also work with you to make sure that the joints and muscles surrounding your injury are being properly cared for as well, since they’ve likely also been compromised. For a broken wrist, for example, you’ll lose some range of motion in your fingers and elbow, as well.

Once you’re out of your cast, you’ll want to start each session by applying heat, to increase blood flow to the joint. You can also ask your physical therapist about soft tissue massage (or “manual therapy”), which can loosen up muscles that may be stiff because of scar tissue and disuse, Franey says.

Under your doctor’s guidance, you’ll then start with actual movement—opening and closing your hand, moving your wrist side to side and up and down, and using an upper-body ergometer, also known as an arm bike. Eventually you’ll progress to isometric contractions and strength-training exercises, like wall push-ups.

Throughout your recovery, it’s important to stay well hydrated, get plenty of Vitamin C, and stock up on anti-inflammatory foods (which can speed healing), and to avoid cigarette smoke and excess alcohol (which can hinder it), Franey says.

And in addition to following doctors’ orders and putting in the work, a positive outlook is always helpful, too. “People who think they’re going to get better always get better more quickly,” she says.