Lifters: Here are some rules to follow and some to break when returning from injuries requiring surgical intervention.
As a person who’s had three surgeries to remedy athletic/musculoskeletal misfortunes, I can share some truths about what it means to come back from being sidelined.
In each case, there was indeed a comeback, but each of those comebacks had to go hand in hand with an adjusted mindset and a whole lot of trial and error. If you’re in a similar situation and need to have a joint or connective tissue repaired surgically, this one’s for you.
I had surgery for an inguinal hernia in 2011. This is a fairly common surgery, and as a 24-year-old athletic man, the recovery was fairly swift.
But in 2017, I suffered a full rupture of both patellar tendons while playing basketball. That required double reconstructive knee surgery and being wheelchair-ridden for two months, along with taking several more months off work.
This was a difficult but eye-opening experience when it came to training – not only as a lifter myself but as a coach who writes programs for clients. It gave me different expectations and goals. The name of the game shifted from short-term gains and personal records (PRs) to longer-term strength that’s smart, sustainable, and ultimately free of frustration.
Here are the truths I learned:
Straight up, listen to your surgeon. I understand the stigmas attached to sometimes-sanctimonious medical professionals when their directive to fix an injury is to “stay off of it” or when they think your pre-injury lower-back pain will be made worse by lifting.
However, if you’ve had a part of your body surgically repaired, the next move should be to trust the process and listen to what that surgeon (and maybe a PT) tells you about rehab.
In the case of my hernia and knee rehab, I wasn’t a guy who was big into stretching. I found other methods of creating tissue elasticity or mobility to be a better fit. But these were special cases. I wasn’t an average Joe with a clean slate. I was, like you, presumably, an experienced lifter/athlete.
Not only did I employ stretching, but when the time was right, I also frequented my chiropractor for some Active Release Technique. This definitely accelerated my recovery process.
But many lifters are proud to say that their rehab and comeback are happening well ahead of schedule compared to what the surgeon projected. That should not encourage you to continue to push the envelope.
I see this happen all the time. The gold star that a practitioner pins on you for being able to move well or bear load weeks before predicted goes straight to a lifter’s head. He assumes he’s a supernatural being endowed with restorative powers well beyond the great unwashed, and he gets overzealous in the gym. He then strives to break into new territory week after week. But hear me now: pushing yourself too hard, too fast, is the perfect recipe for a setback.
Trust the process. Surgeons aren’t stupid. They’re going to add some padding to their projected recovery time to ensure that a) you’ve indeed recovered and b) their professional reputation isn’t compromised due to recklessness.
Giving a conservative estimate is a smarter move than giving an aggressive one. If you’ve been told your recovery should take three months of hard work, then work hard for all three months. It’ll only do you good. You can wait to enter the Olympia or the World Championships next year.
This may be the most significant truth and the toughest pill to swallow. It’s important to acknowledge that a surgically repaired articulation is not a miraculous restoration – it’s a giant patch job. It’s someone’s best (hopefully) effort to piece your body back together.
You can’t expect it to ever be the same as before. It simply won’t be. When you combine that reality with the fact that you, as a human being, are only getting older, it’s necessary to reset your expectations. (See Lifter’s Over 30 Need to Get Real.)
Your repaired shoulder may never bench 385 pounds again. And even if it does, it doesn’t mean that it’s the smartest thing to do. The same goes for your back surgery and a 550-pound deadlift, or your hip or knee surgery and heavy squats.
Now it’s true that you might be able to access almost all of your old strength, which is massively commendable. But what matters next is how you use it, so you don’t end up in the same situation as before.
Before the double knee surgery, I had a max effort squat of 435 pounds:
After the double knee surgery, I was able to work my way back up to 405 pounds:
Pretty good, if I don’t say so myself. But that 405-pound squat is a squat that’s 30 pounds away from my healthy lifetime PR.
Truth be told, I don’t spend too much time chasing numbers like this. Call it wisdom. Chasing a higher max effort when I’m already working with numbers in this ballpark adds no real value to my life.
It might be a different story if I was a 240-pound man squatting 155 pounds, but that’s not the case. In my case, I’m strong enough and smart enough to know that it’s time to change the narrative so I can remain strong and last the test of time… and avoid reinjuring myself strictly for ego.
These days, I challenge the squat pattern by resetting my mind where PRs are concerned: It’s not about the weight I can lift – it’s about the weight I can own.
I express my strength through my mastery of slightly lighter loads so I can salvage my joints while still setting up my muscles and nervous system for a similar perceived challenge.
For example, it’s almost impossible for me to squat today without taking a distinct pause at the bottom:
It’s those kinds of mods that should satisfy any “ego” for the heavy stuff because it still allows high-end strength training and requisite quality control (form and technique) while sparing the joints from crushing weight.
The key? Handle your situation maturely, and don’t get curious to see where your true 1RM is using regular tempos and techniques. We ain’t getting any younger.
All that leads to the question: How should we train if we’re on the other side of a major procedure? Does it mean abandoning all the movements that brought us our gains?
No. It’s about respecting those movements while adding the necessary variety to your program to keep you strong and healthy. Squats, bench press, and deads can only get you so far. Depending on the nature of your injury and surgery, it may mean regular inclusion of mobility work or bodyweight exercises. Maybe some isometric training.
Or maybe you’ll need to apply a shift in volume. Let’s say you suffered a spine or lower-back injury, maybe from relying too heavily on your favorite lift, the deadlift. After being sidelined, the main order of business was getting that posterior chain in proper working order again so that you could return to that important lift and get it strong again.
Nothing wrong with any of that. But to make sure things don’t regress, it’s also smart to slash the amount of volume applied directly to the deadlift pattern and choose other hinge-based, posterior chain dominant movements that may not be quite as trying on the lumbar spine.
Examples: Reverse hypers, hip thrusts on a decline (see below), single-leg hinge patterns, or kettlebell swings. This can be the difference maker between a happy, healthy joint and a joint that exists in a world of chronic pain.
Also, who made the rule that dictates a large compound movement has to be performed first in your workout? Yes, in theory, a case can be made for that idea, but the injury-afflicted trainee is no longer a standard case.
Doing a big lift later in the workout can be beneficial for a healthy lifter. Sometimes it just takes longer to warm up a muscle group or joint so that it can be pushed a little. In the case of my knees, I like using hamstring activation-based work first (like a prone curl) to make squatting feel terrific. I’ve also found warming up with some aerobic work helps with my feeling of readiness in my lower body.
While this defies the standard “nervous system first” principle of training, the standard principles of training don’t always apply to the injured trainee! Train intuitively and intelligently.
If your situation requires you to train your core hard before you deadlift, break the rules and do it. If pre-fatiguing your triceps before bench pressing makes your repaired elbow feel fantastic, don’t let the books tell you otherwise.
Protect your body and train for longevity. Your lifetime PRs matter only so much.