10 Tips For Rebuilding Fitness and Strength After Long-Term Injury, Illness or Atrophy

Maybe it’s an injury that took months to overcome. Maybe it’s an illness that left you bedridden (or demotivated). Maybe it’s simple disuse and neglect that dragged on and on—or lasted your entire life until today. Or maybe you read my recent post about claiming health in later life and want to get back on the road to vitality. For whatever reason, almost everyone will be forced to recover and rebuild their fitness and strength after an extended period of inactivity. But there’s a wrong way and a right way to do it.

Here are some tips for doing it the right way:

1. Do Anything You Can

Isometric contractions in the hospital bed (only if allowed by your doc, mind you). Single leg squats when standing up from the couch with your good leg. Bicep curls with the one arm that isn’t incapacitated. Whatever movement you can muster, get moving.

While it’s definitely “better” to train your entire body, training just a single body part or limb is better than doing nothing. It sends a signal to your body that you haven’t thrown in the towel, that you still need your metabolically-expensive muscle mass.

2. Motion Is Lotion—but Only If It’s High Quality Motion

The quicker you can get back to normal movement, the better. Normal movement, not normal speed. Quality over everything. For instance, say you sprain your ankle. The best thing you can do to recover is to start walking on it with good technique. Once you can walk with good form, however slow you go, get walking. Walk without a limp, even if it’s 1 MPH. Walk without a limp, even if you have to use crutches or a cane to bear some of the load. Don’t roll onto the outside of your bad foot. Don’t splay that foot out like a duck to avoid the pain.

The point is moving—and moving well.

3. Eat Tons Of Protein

Inactivity increases the protein requirement. When you’re on bed rest (mandatory or self-imposed), your protein metabolism shifts toward that of an older person’s—lower efficiency, higher substrate requirements to attain the same result. You need more protein just to stay on top of daily maintenance. Plus, since you’re actively healing and recovering and laying down or repairing tissue, you need extra protein to handle the extra processes.

Eat a good 1 gram protein per pound of lean body mass as you prepare for your return to activity. Consider including whey isolate, as it’s an easy additive source of protein that’s been shown to improve recovery after bed rest and surgery.

4. Learn To Distinguish Between Pain and Soreness

When recovering from an injury or just getting back into exercise, you want to avoid pain. Sharp pains in the joints, strains in the tendons that you feel for days after, a pulled muscle—these are not okay.

But you will and should feel discomfort. Muscle soreness after a session is fine. It’s normal. Burning in the muscle during a session is fine. It’s normal. Pain is not. Avoid pain.

5. Go For Walks

Regular walking is a powerful signal of “abundance” to your body. It tells your body that you’re still in the game, that you’re engaged with the world and have places to be. Walking is also the simplest, most fundamental way to get the blood flowing, get your joints lubricated, and apply a low-level stimulus to your musculoskeletal system. Pretty much everyone can walk.

If you have access to hills, even better. Walk up and down hills as often as possible. A brisk uphill walk is a legitimate way to build strength and endurance.

Work your way up to 5 times a week of 30-45 minutes. Throw on a weighted vest or throw some books in your backpack to add resistance.

6. Do Bear Crawls

Slow bear crawls are a great way to loosen up your joints and prepare your shoulders and hips for more complex, weighted movements. They’re actually a good exercise in their own right, especially if you haven’t done them since you were a baby.

Do these several times a week, preferably in the morning or before workouts, for a few minutes each day. Crawl forward, backward, sideways in a controlled fashion, making sure you feel the movements.

7. Do Balance Work

One basic way to improve balance (or just get more comfortable in unstable positions) is to stand on one foot and slowly sweep the opposite foot across in front of and behind you. Switch feet and do this every day for a couple minutes, or whenever you have down time—standing in line, for example.

You can also buy a 2×4 from the hardware store, place it on the ground, and practice walking forward and backward along it. You get the benefit of balancing on a narrow surface without the risk of falling to your doom.

8. Start With Bodyweight Exercises

Basic movements: knee flexion (squat, lunge, split squat), hip hinge (deadlift, kettlebell swing, trap bar DL), push (pushup, overhead press, dip), pull (pullup, chinup, row variations). You can do just about all of them with bodyweight, with the only one that’s really hard to do without external weights being the hip hinge.

Grab the Primal Blueprint Fitness ebook. It’s free and provides a step-by-step progression for all the movements, from total beginner doing pushups on the wall and assisted pull-ups to experienced lifter doing feet elevated pushups and weighted pull-ups.

9. Consider Finishing With Bodyweight Exercises.

Bodyweight exercises are totally sufficient for most people. It’s all about the amount of work you’re willing to do and the amount of effort you’re willing to give. In fact, I made the case in this post that you could build incredible strength and general fitness simply using bodyweight exercises plus some weighted resistance for the lower body (perhaps, say, my new favorite exercise: the trap bar deadlift and its many variations).

10. Take Fish Oil or Eat Fatty Fish.

The benefits of seafood on recovery and bounce-back-ability are multifold:

First, seafood is a great source of bioavailable high-quality protein—protein you need to recover from whatever sidelined you.

Second, the long chain omega-3s have a potent anti-inflammatory effect that can improve your recovery and speed up your return to normal activity. They reduce pain and inflammation without curtailing the healing process. One study even found that high dose omega-3 intake increased physical activity, maintained physical function, and reduced the incidence of joint replacement in older adults.

Third, the long chain omega-3s also increase muscle protein synthesis, particularly in older adults (presumably with higher baseline inflammation levels). In other words, they make physical activity more anabolic. They improve your ability to build muscle, muscle that you’ve probably lost being injured and inactive.

That’s it, everyone. These are the tips and methods I’ve used to get myself back on my feet after a long layaway, and to help others do the same. If you have anything to add or questions to ask, do so down below. I’d love to hear what worked (and what didn’t) for you. Thanks for reading.


Arentson-lantz EJ, Galvan E, Ellison J, Wacher A, Paddon-jones D. Improving Dietary Protein Quality Reduces the Negative Effects of Physical Inactivity on Body Composition and Muscle Function. J Gerontol A Biol Sci Med Sci. 2019;74(10):1605-1611.

Alfaddagh A, Elajami TK, Saleh M, Elajami M, Bistrian BR, Welty FK. The effect of eicosapentaenoic and docosahexaenoic acids on physical function, exercise, and joint replacement in patients with coronary artery disease: A secondary analysis of a randomized clinical trial. J Clin Lipidol. 2018;12(4):937-947.e2.

Smith GI, Atherton P, Reeds DN, et al. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr. 2011;93(2):402-12.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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29 thoughts on “10 Tips For Rebuilding Fitness and Strength After Long-Term Injury, Illness or Atrophy”

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  1. Thank you for this! You have given some wonderfully timely advice over the years. Happy Holidays and New Year to you and everyone who helps create this blog!

  2. #10…hemp seeds are a good source of omega 3 and omega 6 in a very good ratio. The price is a little high now but, now that farmers are allowed to grow hemp in this country, the price should come down.

  3. Thanks for these timely tips Mark. I was struck down on December 1st with Transverse Myelitis. The 19 days in the hospital were filled with PT and OT, then a week at an Acute Rehab Facility, which I crushed because of 25 years of exercising. It feels totally weird not to have the strength or stamina that I had previously, plus I’ve got a left leg at 25% of normal and numbness in my torso.
    So your tips are just another form of motivation to keep moving and improving!

  4. Thanks for the post, it was a good read. I have access to hills and walk up and down hills as often as possible.

  5. How much omega 3 do you recommend per day for recovery?

  6. Mark

    Thanks for the point #2. It’s so easy to limp along with a strained glute , favouring the sore side. But it’s so much better to go slow but use proper form.

    1. I’m glad to hear that point – having the idea of my right leg (sciatic) mimicking the left in the way it walked – it seemed to work somehow – and made me think of potential rather than pain. Somehow I’ve moved onto other trials that haven’t seemed to work yet; so refocussing on point #2, plus a few of the others swill be a New Year resolution.

  7. Thank you for this article. I need to start slow and get myself serious about taking care of my health. I’m 66, about 80 lbs overweight and I’m a cardiac patient. I had a quadruple bypass 2 1/2 years ago and I don’t plan to repeat it. My biggest problem or maybe excuse, is pain in my knees when walking or standing. I know that will improve with weight loss, but I’m having problems getting motivated. I do want to check out your books and guides and I think I may already have downloaded some. I guess I want to say thanks for all the good tips and information you share. Wish me luck!

    1. Try collagen powder daily. Really helped with my joints. It was recommended by my dentist to rebuild bone under an implant, but I noticed a lot of ancillary benefits after 2-3 months.

  8. Thanks Mark, great post as always!
    I’m 51 and have limped since age 3.5 when I had the head of my femur removed (osteomyelitis, a complication of measles – vaccinate people, vaccinate). I had a hip replacement at age 28 which certainly helped with hip pain, but didn’t make me normal in any way! I have walked with a stick to “straighten” me up a bit for the last 3 years, because I absolutely subscribe to the high quality motion being the only type worth doing, but my affected leg gets weaker because of this, so walking without the stick now I have a very pronounced limp. I swim 3 times a week, but experience chronic pain (it’s something I’m used to and think of as normal for me). I guess I’m just asking if people have any thoughts on dealing with chronic, unavoidable abnormal motion and the associated inflammation and pain? I have used fish oil, and will give it another go for the health benefits (I didn’t find any relief from inflammation).
    Thanks for the wonderfully informative and supportive site and community.

    1. Hi there – I have experienced chronic inflammation and found that Tumeric helps

      1. Thanks Laura, do you need to take the turmeric for a while before you notice a difference? I have tried it in the past but maybe didn’t stick with it for long enough?

    2. “a complication of measles – vaccinate people, vaccinate”

      and your child could end up with all sorts of dreadful consequences as an effect of the vaccine. Do your research, get all the information you can (not just mainstream) before taking that decision. I hear what you say Deb and I know that for a % of people measles is very serious, but so is the vaccination, especially when in combination and/or given too young.

      1. Thanks Catherine, I shouldn’t have made the vaccination comment, I know it is a highly divisive issue!

        I really am after some useful recommendations for people in my situation with chronic physical issues that almost any movement (besides swimming for me) is abnormal. Maybe I’ve just answered my own question, and I should up my level of exercise by increasing what I can do, swim.

        1. Hi Deb
          Thanks for hearing me. I too have chronic issues – scoliosis and multi-joint osteoarthritis. I agree, it’s really difficult to find exercise that does not start off a whole tirade of pain etc. One thing I realise though, is that trying to frame ourselves as “normal” and ‘aligned” is not going to work – cos we’re not 😉 And lots of people aren’t. My osteopath works with the shape I am and advises me to do the same. Swimming sounds good. I do recommend a good osteopath who can do fascial release. Fascia is amazing – keeps us moving and communicating within ourselves internally – but it gets dehydrated and stuck (like clingwrap) if we don’t move or hydrate enough. I suggest hydration and collagen and lots of short, regular dynamic stretching through the day. I hope this helps.

          1. Thanks for the suggestions, I haven’t been to an osteopath, but I will look for a good one near me. I have slowly come to the realisation that my alignment will never be normal, and most of the physiotherapists I’ve worked with have tried to normalise my walk (not a bad aim, I just don’t have all the muscle connections necessary), so someone willing to work with the shape I am sounds perfect.
            Thanks again,

          2. I’ve had great results recently adding B2, niacinamide (read the Amazon reviews re joint pain) hyaluronic acid and collagen, and subtracting vitamin A (almost all supplement forms are synthetic retinyl palmitate which can CAUSE joint pain). Also doing Trauma Release Exercises (TRE) which has helped with hip tightness and misalignment.

  9. Thank you so much for this and references to being sedentary without any judgment. I’ve slowly become sedentary without realizing just what I was doing and how far I’ve backslid – and how hard it seems to get moving again. These are simple and help me feel I can take a small step forward!

  10. As always some thoughtful suggestions I would like to add one more spend at least 20mins outdoors if at all possible if not then find ways to connect with nature.

    Of course if I could go on then 12) be consistent do something to respect your body (physical, mental and spiritual)everyday
    Looking forward to reading your thoughts on 2020

    1. Hi Mark,

      Regarding #3, “Eat Tons of Protein”, how would that look for someone recovering from injury but considering going keto (where protein would be kept moderate)? Would a high protein intake take precedence vs keto, or can there be some kind of reconciliation? Thanks.

  11. Hi Mark,

    Regarding #3, “Eat Tons of Protein”, how would that look for someone recovering from injury but considering going keto? Would a high protein intake take precedence vs keto, and keep keto for post-injury (so one can afford to keep protein moderate and can better strength train as to reduce risk of muscle loss)? Thanks.

    1. Hi Mark

      Just to clarify…Protein 1 gm per lean body mass
      ( % body fat ??) say at 150 lbs = 150 gms is a lot
      of gms into a morning drink when my one level
      scoop of whey = 35 gms of protein or over 4 scoops!
      You would have to break that up over the day..not?
      Comment please

      1. Definitely break up the protein over a day.
        There’s a limit to how much your body can make optimal use of in one meal.

  12. Thank you so much for this post. I am working to recover from a fractured femur and your suggestions are in line with the exercise I have been doing for the last 3 months with my PT. I will be continuing at the gym and with my walking routine at home. I like the idea of putting weight in my backpack and walking uphill. BTW I am 66.

  13. I broke my wrist 16 months ago and I’m still not back to 100%. Not sure what I can do other than to keep stretching and using the joint.

  14. Good Morning

    Could a person moderating this site and postings perhaps
    answer my question on quantity suggested for whey
    protein intake/day? I am miss interpreting the comment
    I think.


  15. I agree with eating tons of protein and also consuming the vitamins you need. Currently I’d say that my protein intake is about 50% my carbs are about 35% and my fat is about 15%. I wish I saw this post back when we were still in quarantine because then I could apply most of this information even though I wasn’t hurt. The only time I had to take a break from lifting it was because my tendinitis got extremely bad!

  16. Great read. 30 year old male recovering from a motorcycle accident. Feeling great