T Nation

Upper Body Exercises After ACL Surgery


#1

Sup all, I'm getting an ACL+LCL reconstruction in about a month and according to the doc I'll be able to get back in the gym within a week after the surgery however certain lifts will probably not be allowed for a while.
I'm gonna be on a test C+eq cycle during recovery and wanna take the time to build my upper body strength. Any opinions on what effect the juice might have on my recovery?

From your experience, are the standing exercises a big NO-NO after an ACL?

I've actually got enough stability right now in my knee where I can squat deep and heavy, run around, jump, shoot hoops hang from a basketball rim etc. Doc says I got good supportive muscle. However with a bunch of screws in your knees its probably not a good idea to do these for a while once you go under the knife.

So here are the standing exercises in my routine and I'm trying to figure out how the hell to do them while I'm recovering:

-Heavy BB shrugs
-Standing BB curl
-T-Bar row
-Standing BB row
-Standing Tri Extension
-Bent over lat
-One arm bent over row
-Cable rows (not standing but they strain the legs)
-Lat pulldowns (same as above)
-Standing upright rows
-Good mornings
-Calf raises on the leg press using a ton of weight
As well as back Hyperextensions and Abs using the knee locking machines.

Can I do some of these right away (doc says 1 week and I'm back in the gym if everything turns out right). How can I replace some of these if I can't do them standing?

How should I change up my split routine if I can't have these in there?
Right now it's Chest, Back, Shoulders n tri's, Legs n bi's (no squats anymore, just good mornings and calf raises).

Seems like my back day will really suffer if I can't get all those rows in as well as bicep day if I can't barbell curl, and some others, so what the hell can I do to get a decent workout?

I don't wanna be sitting around hitting the gym 3x a week for 30 minute sessions just cause I can't do a bunch of exercises. How to compensate?

Doc says if I recover well I can start some of these these in about a month but I'm not so sure about that.

More importantly how long has it taken some of you guys with ACL's to get back to these lifts? Squatting or good mornings or deadlifts is obviously out of the question at least until 10 months down the road.

Thx to all in advance


#2

First, what type of repair are you getting? Patellar Graft? Hamstring graft? Cadaver graft?

Second, I'd be interested in knowing how the ACL/LCL tear occurred. Was it a contact or non-contact based injury? Also, what is your training history? How long have you been doing body part splits for? And what are your ultimate goals? Lifting for aesthetics, bodybuilding, sports, competition, etc?

It is also hard to give exact advice without knowing what is going on in the knee. MRIs are great, but don't always tell the whole story. If there is meniscal involvement and a meniscal repair is used, that will set back your weight bearing ability about 3-4 weeks.

The fact that you say you have the ACL and LCL injuries and are still able to squat deep and still be active in sports is a good indicator of current leg strength. But once you go under the knife, the muscles will begin to "shut down" and become inhibited. So it isn't just the screws in your knee that will be an issue with training post-surgery. You need to take into consideration the strength of the graft, the muscle activation of the surrounding muscles, as well as the hardware being put into your knee.

I have some ideas for advice floating in my head, but I'd like to get my above questions answered so I can be more detailed. But in the end, always follow doctor's and therapist's orders.


#3

you're in good hands with LH but I can tell you after my recent surgery, don't plan on making any gains anytime soon.... standing exercises involving weights... don't count on it


#4

Watup LH thanks for the time to read my post. I'm getting a double allograft ACL replacement plus an allograft LCL repair. Arthroscopy for the ACL's, open surgery for the LCL. The tissues themselves will be strong and thick but obviously the revascularization with allograft is slower so I'm worried about that part. I'm 300+ lbs (hence the decision for a double ACL graft) so autografts are out of the question.

The injury was a non-contact injury. It happened out of bad running technique while running agility drills around a year ago. Foot got planted in the turf during a cut. No meniscal damage is present, confirmed by various MRI's. Doc feels pretty confident about my leg muscle being able to support the knee but I got a feeling he's being a tad optimistic. He does predict a return to certain exercises on the short term.

Been doing body splits for about 3 years now and just recently started cycling Test C. One thing I wanna point out is I'm gonna be doing at least some test during rehab and maybe EQ too. Test I expect will prevent excessive muscle loss in the injured leg, and EQ will help with the collagen synthesis.

I'm lifting for mainly strength and some mass. Along the 5-8 rep range. There's a littlebit of a powerlifting philosophy to my routine where every week you increaase the weight (esp. flat bench, deads and squats which are in the 2-3 rep range). It's a Joe Carini routine (the guy trains pro football linemen). You could say its a mix of PL and BB. I'm planning on returning to competitive amateur football when I'm done with rehab. I play O-lineman.

Like I said I'm worried I'll have to scrap the rows and a bunch of other exercises (standing bb curls, tri ext's, upright rows, etc.)

Hope that clears things up. Thanks for replies in advance.


#5

Thank you for the kind words. And you are correct in that Ziggajay shouldn't rush into any standing based exercises.

To Ziggajay,

Let me start by saying in terms of cycling PEDs, I have absolutely no background in it, so just be careful and if needed/able to, seek medical guidance regarding its usage. I have no idea about how it will effect your recovery.

In regards to training guidance, here is my outlook and advice on things:
1) Your ACL/LCL injury was non-contact, which to me makes me assume that you have some structural imbalances, whether they be mobility based or strength balance based. You should look into this, determine where your imbalances lay, and develop your program based towards fixing those imbalances/pathologies present. Obviously, you need to address your surgical needs first for your injured knee, but you can start to work on the healthy leg and other body parts.

2) You have followed a body part split for quite some time now (3 years), so it may be time to change up your routine to see how you respond. I personally am not a fan of body part splits, but I am much more performance minded in my training approach. Not to say that you can't improve performance from body part splits, but I do not feel it is optimal.

Also, from my experience with athletes/people I've worked with and other people I have talked with, body part splits tend to lead to more imbalance based problems due to most people not balancing the exercises properly in their workouts and stressing certain exercises more than others. Also, body part splits generally are too much volume for people who are looking for performance based benefits when you begin to include their sport training as well.

I am in no way telling you to switch your training methodology nor am I saying what you have done is wrong, but just giving my opinion. With your goals of PL/BB mix, what you have done may have been great, but with your injury you may want to rethink your programing, at least through your rehab phase.

3) In terms of standing exercises, you first need to be able to weight bear on the surgical leg, unless you plan on doing the exercises single legged. For when you will be able to weight bear - as long as there is no meniscal repair, microfracture, or other similar procedures done, generally ACL/ligamentous repaired limbs are allowed to begin weight bearing once tolerated by the client within the first week, usually starting with partial weight bearing then progressing to full weight bearing.

Let me also point out that once you are able to weight bear, you will be in a straight leg immobilizer for a bit and depending on how the surgery goes and what is done, you may be restricted to specific ROM limitations and have the brace locked within that specific range.

This will factor into exercises where you may need to have your knees bent to a certain degree but may not be capable/allowed to bend you knee to that range. Even once allowed to weight bear, the doctor will ideally not want any external load placed on that knee, meaning you shouldn't do heavy loaded standing exercises.

From the list of exercises you put up in your first post, here are some that you will not be able to do for quite a while IMO: Heavy Shrugs, Standing BB Rows, Standing Upright Rows, Good Mornings (Def not for a LONG time), Calf Raises with substantial weight on leg press.

4) You are getting an allograft repair, which means you will be getting tissue from a cadaver to replace your damaged tissue. The recovery rate can vary depending on how your body reacts to the outside tissue and how quickly it "accepts" it. There is also a chance of the body rejecting the tissue and the graft failing. This is a small chance, but generally I have seen recovery times last a bit longer in those who chose the allograft option over the autograft. I'm just explaining this to you because depending on how your body reacts to the graft, it may take longer before you are able to push the limits and loads of your lifting.

I commend you for trying to plan out some training in advance to your surgery. I think too many people stop all training together for too extended of a timeframe. For the first 2 weeks after surgery, I think you will be best off concentrating on recovery of your knee without thinking of any extensive extra outside training. Afterwards, up until the 3-4 month mark, you probably won't be allowed to do any type of jogging or jumping based drills. But you should progress as your body allows with your other lifts.

Modify and adapt your program as you need to. Cable stack machines are a great tool if you have access. You can perform varieties to drills standing or rowing or seated, including rowing and pressing movements. Just be intelligent about the stresses you put on your knee during the healing process and place the majority of your focus on rehab for your knee, but realize that you do have 3 healthy limbs that you can train.

It is hard to say when you can begin standing exercises, but I would lean more towards the cautious size as you do not want to risk damage to the repair and re-injury. There are tons of variations to standing exercises, including just making them seated, that you can perform.

To summarize it all, focus on your recovery from surgery at the start. After recovery from the surgery, begin training your healthy limbs without over-stressing the surgical knee, but the bulk of your focus should still be on your rehab for your surgical knee. Use variations of exercises to limit the stresses on the knee. If you continue to perform body part splits, I'd recommend splitting your legs day to do single leg variations for the healthy leg and rehab exercises for the surgical knee.


#6

If I can suggest anything buy this

which ties into what LH said regarding to training splits.

As far as I have seen allografts allow a quicker return to "functionality" but like LH said it will take a bit longer for the graft to completely assimilate. On the upside you will not have a hamstring to rehab or any meniscal damage which stack the odds significantly in your favour.

You just have to approach the following 3 months with the attitude of minimizing the losses and fixing the knee. There will be lots of time afterwards to ramp it up again and you will regain the strength fairly quickly.

A good alternative is to get a set of gymnast rings and try working on some of those acrobatics, lots of strength with not a whole lot of load on the knee as well as some "goals" (l-sits, iron cross etc) to work towards so you will feel like you are making some kind of progress.