There is nothing more frustrating than being stuck in a boot or a leg cast for weeks.
But then you have to watch as all that leg strength disappears before your eyes.
Fun fact: you lose muscle up to three times faster than you gain it!
To add to the drama, you’ll tend to gain body fat as you lose muscle, making the challenge of a successful return seem even harder.
So if you spend six weeks in a boot, the rebuilding process can take up to 18 weeks! And that’s assuming you don’t have any joint stiffness or pain to slow you down.
This frustrating statistic often leads our Physiotherapy team to get asked “What exercises can I do in a boot?”, “Can I still squat in a walking boot?” and (my personal favourite) “Is running definitely not allowed while I’m in the boot?”
(Spoiler alert: the answer is a definite “NO RUNNING” to that last one).
For every question, there’s an answer and it’s actually more possible than you realise.
The strength plan
The good news is that there are still plenty of strength exercises you can do, including squats while in the walking boot.
They’ll maintain or even improve your strength while you are non-weight bearing or partial weight bearing in the boot or leg cast.
(It depends on how well trained you were beforehand – non-trained people get stronger, well trained people will still lose strength but not as much as sitting around and not exercising.)
And if it seems pointless because you can’t put weight through your injured leg, remember these points:
- Your good leg will be working harder on your return and needs to be stronger than your injured side to effectively compensate
- The injured side actually gains about 15-20% of the performance improvement from a strength exercise performed on the good leg – you get stronger on the injured side even if you don’t load it directly!
- You need to keep a training routine for your mental as much as physical health
You’ll need to manage your body weight during the recovery as well – it’s more than just not gaining weight on the scales, it’s about providing your body with the nutrition it needs to build muscle and repair the injury.
Good nutrition has been shown to speed up injury recovery and tissue repair, but good nutrition can also be quite calorie-dense.
That means it’s prone to adding additional bodyweight if the portion sizes aren’t spot on.
We strongly recommend the CSIRO Wellbeing diet – it’s well designed based on current research, cost-effective (with a full refund for successful completion) and easy to follow.
Injuries you can train through
Some injuries won’t react well to muscle loading across the injury, even is the injured foot isn’t touching the ground.
Be cautious and always ask your medical team about muscle loading across the injury if you’re not sure.
Here’s a general guide to loading different types of injuries
Ligament injuries around the ankle can be safely loaded if the joint is stable and in a neutral position.
So if you’ve got the boot on, you can be guided by your symptoms.
Fractures in the foot won’t like any pressure on the toes or ball of the foot, regardless of the fracture location within the foot.
Pressure on the heel is OK after 2-3 weeks and based on symptoms, as it will exert muscle loading across the foot.
Fibular fractures can be loaded after 1-2 weeks as the bone isn’t exposed to much bodyweight loading.
It is under pressure in dorsiflexion so it’s best to leave the boot on to maintain a neutral ankle.
You’ll generally need to stay away from any bodyweight loading for 4-6 weeks and avoid excessive calf muscle loading (due to resisted knee bend, such as a hip bridge or thrust) for 2-4 weeks.
Any surgery is taken on a case-by-case basis as there are slight variations.
Consult your surgeon and rehab team for specific restrictions.
Goal of modified strength work
This type of program differs in some ways from your typical gym program. But it’s also got a lot in common.
Both normal and modified gym programs should focus on quality movement patterns.
Smooth, well controlled movement will always beat ugly, heavy lifts.
Work on controlling the movement throughout your range before you add or increase the load.
And there’s no need to clench or squeeze muscles just so you can feel them!
Clenching a muscle doesn’t add anything to the gains from an exercise but it can compromise your movement patterns.
If you can’t feel the exercise in the intended muscles, choose a different exercise.
Normal gym programs focus on building strength. This modified program may focus on maintaining strength, or even slowing the loss of strength.
Just because you’re sliding backwards doesn’t mean it’s a waste of time. You’d go backwards at a much faster rate if you didn’t train.
Remember to constantly adjust your loading to account for potentially declining strength in the early stages of injury recovery.
This may mean less reps and/or lighter weights.
You will probably end up doing a different number of reps on each side, with the unaffected side doing double of the injured side.
As a guide to cutting down on your reps, if you can’t maintain the speed of movement of a rep, stop the set there.
Pushing on will only lead to technique issues and additional injuries.
Balance and symmetry
Normal gym programs should focus on balanced strength work, both between sides and between muscle groups.
This program will probably be focused on training the good leg and affected areas.
That good leg is going to be doing the bulk of the workload on your return so it needs to prepare for it.
So don’t be afraid to do some exercises just for the unaffected leg.
Remember that some of that strength will cross over to the unaffected leg, even if you don’t or can’t train it!
Sure, it will lead to asymmetrical strength gains – but the later stages of your recovery will have asymmetrical demands on the legs, so you’re training for purpose.
Our list of potential exercises and modifications
Remember that this isn’t a complete program. Use your normal strength program as much as possible and hand pick options from this list to fill gaps due to injury restrictions.