Coming Back from Surgery: The Truth

by Lee Boyce

Ditch the Ego and Misguided Instincts

Lifters: Here are some rules to follow and some to break when returning from injuries requiring surgical intervention.


Been There, Hurt That

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.

For Context

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:

1. It Isn’t Worth Trying to Set a Recovery World Record

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.

2. You Won’t Be the Same. And You Should Stop Trying to Be

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.

3. Exercise Modifications Will Keep You Healthy

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.

4. Rules Need to be Broken

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.

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If I may offer a rebuttal…

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I had surgery to repair a torn bicep tendon and rotator cuff. The recovery took forever (over 1 year) but I stuck with the guidelines I was given and had successful repairs. That said it was very frustrating to go so slowly and do so little for so long.

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As someone with a fused neck, lower back, and replaced hip, this article is a fan reminder of what I can and shouldn’t do. Thanks for this article!! Hoping to see more like this for the walking wounded who refuse to give up!!

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Love the username!

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Maybe a DPT? I would never listen to a surgeon talk about something they know nothing about. They know how to cut. Find a good DPT and get on the right track. Work with a personal trainer and suffer the consequences.

This is truly good advice. Thank you for posting it. As a WBFFPro Classic Fitness Diva who trains 6 days a week, I found recovery from a recent series of eye surgeries devastating to my heavy lifts and balance. The oil necessary to reconstruct my eye blurred vision and obstructed my true sense of balance. Being patient with myself was a challenge. After 3 months of “being good” and a second eye surgery, I found that by adding stretching, more but lighter reps, and being patient with during recovery kept my physique intact, but smaller, and helped me recover to my normal lifts within the year and learn new techniques. It’s important to get a trainer to help you with recovery techniques you aren’t used to. Yes, I missed the Int’l World’s competition that year, but am more than ready to compete in future years. The biggest road block was my own stubbornness. My best advice is to overcome it to continue to lift for years to come.

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I really like the article - I’m always a fan of practical vs. academic. Each of the principles listed above resonates for me.

I’ve found creating a chronological barrier in my brain has helped - there’s “old me” that had his own PRs. Now I have “nowadays me” that can set PRs for current conditions.

I do think a question of goals and timeline comes into play - the first couple times I got hurt I wanted to come back in time to play ball before they stopped wanting me to (joke’s on me, I don’t think they care that much to begin with…) and then for a job. I had to take more risks and “old me” still mattered, not to mention I can’t modify the expectations to suit what I feel like doing. That’s not the case anymore, and I’ve rehabbed more in line with the article since. That was a ramble to, most importantly, remind everyone I was once awesome, and reiterate every opinion exists within context.

To “other side” myself a bit, there is a huge risk (especially, it seems, in our current world) of just using every little nuisance as an “I can’t” and excuse to be a giant, smelly turd. This is no good. I think “knowing thyself” or “finding a way to yes” or whatever tool you want to throw in here helps avoid this. As others have mentioned, a trainer can be the objective-based person to guide you here. I do think it would be better if it’s a coach with whom you’ve built some trust prior to injury; you don’t want someone happy to tell you the world really is against you while cashing your checks.

I guess my $0.02 is if you’re going to be dumb, you better be tough. When you’re done being tough, there’s options to smarten up a little.

Anyway, thanks for the article!

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After surgeries to correct problems with both shoulders, 1 knee, 1 elbow, 1 hand, and my spine I can say that this is not just good but GREAT advice. Setting aside the EGO is tough and having a higher tolerance for pain is not a good substitute for intelligence and listening to your body.

You can still lift to be big and strong, but if you can’t be big and strong for life, what’s the point? I wish 25 yo me could have had a beer with 57 yo me and learned about the points Mr. Boyce makes in this article and their impact on my health and strength goals. I’m not sure I would have listened, but if I did I would have learned that the one and only workout program gym teachers, (pre-“trainer” days) staffed exclusively with coaches from the football team, taught was not the path to long term health and strength. (I acknowledge it DID help with playing time FWIW.)

Thanks for the great article.

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Same page and that’s what I mean about goals. We weren’t playing the long game back then, and I wouldn’t change it. Your candle can burn bright or long; I’m happy with the trade-off of using 4/5 of my limited potential quickly and just milking this last 1/5 for the remainder.

3 months post achilles rupture. Surgery went great and rehab is going great. I definitely wanna get back to my pre rupture self, or as close as possible. Working out twice a day back then and hella athletic. I was planning on trying to start back up this week and pushing myself, but after reading this article, looks like it’ll be a stretching and mobility program until my doctor gives me the green light. It’s like this article was meant for me at this moment in time. My wife was just telling me last night not to rush to get back to work cos we can’t afford for me to get hurt again. Funny how things work out. Thanks T-Nation.