This is a part of the Hot Topic podcast series from the Model Systems Knowledge Translation Center on Exercise After Burn Injury. Jessica Guilbert, Physical Therapist, discusses Tips for Exercising After Burn Injury.

Jessica Guilbert, PT, DPT

Physical Therapist

Spaulding Rehabilitation Hospital

In general there’s no reason after a burn that you can’t do anything that you want to do. It might be that you need to work up to it. If you’re doing something and you’re incredibly sore the next day and you can’t walk for three days, you probably did a little bit too much, which you could say for anyone.

Or if you’re doing something and you’re causing your skin to open up where you had maybe a recent surgery or a wound, that would be something that would be unsafe. But in general there’s no specific exercise that’s unsafe to do after a burn, as long as a body can handle that.

So I like to talk to all of my patients, while they’re in-patient about expected versus unexpected pain so if I’m stretching your ankle and you have pain in your ankle because I’m stretching it, that’s expected pain, and not that we don’t pay attention to it, it’s not that we ignore it, but it’s expected, so we’ll continue the stretch because we know the benefits of that stretch.

So if you’re doing an exercise and you have some of that expected pain, if you’re doing lots of squats and your hips are getting sore or your quads are getting tired, that’s normal pain. But if you’re exercising and you suddenly have chest pain, or you know, a really significant headache, or pain that you’ve never had before, that would be something I would tell people to stop doing.

I would say that you can’t overstretch a scar, because usually the skin will limit you and usually you will reach someone’s pain tolerance before you reach the tolerance of the skin in general that’s been my experience. I would guess burn survivors might have a better answer than I do. But generally there’s no reason not to continue to stretch unless you’ve had a recent surgery and burn surgeon has told you that they want you to not do certain range of motion or certain stretches for a period of time.

There are ways to do scar massage, which could help your skin stretch a little easier, so that might make exercise more comfortable. And there are actually people who are massage therapists that might specialize in working with patients with scars, so seeing someone who specializes in that to work on the scar management could be helpful to make it more comfortable when you then go to exercise.

So moisturizers can help with the scars definitely. It’s definitely something that people should try on their skin, because the same moisturize might not work for every patient. So, that’s something that they want to try before they’re exercising. And when you sweat and your pores open up that could make more of the moisturizer seep in. So sometimes people are okay with the moisturizer when they’re not exercising, and then when they get hot and start to sweat in areas of their skin that can sweat they might get the reaction.

So some patients wear pressure garments and I, you know, whether or not you need to wear pressure garments I always leave up to the burn surgeons, because they definitely know that much better than we do as physical therapists, but it is one other thing to consider, whether they want you to wear them while you’re exercising or not. You know, they can certainly help scars to heal flatter. They also, if you’re wearing a pressure garment that’s opaque it helps protect you from the sun, because that’s another thing you need to be concerned with, is your sun exposure after burn. But they also can make you warmer, so needing to stay cool when you exercise it can kind of make that more of a challenge.

Hydration is important. The issue that you have to talk about is balancing out how much you’re sweating and how much you’re taking in, because if you’re not sweating, you’re not getting rid of as much fluid and as much sweat as you would for someone that sweats a lot. So, if you drink too much water, you can deplete your electrolytes, so you’re sodium and potassium could decrease which could be a very large problem. So if you’re not able to get rid of your volume, you might not lose as much water.

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