By Chris Vachio
Disclaimer: This article is not intended to provide medical advice or guidance. Always seek out the advice of a trained medical professional with regards injury and rehabilitation. Every situation is different and what worked for me may not necessarily work for you. I am not a physician, nor do I play one on TV, and neither did I stay at a Holiday Inn Express last night.
My story in brief: On May 27, 2017, I completely tore the infraspinatus and supraspinatus in my left shoulder. That particular shoulder had been giving me issues on and off for over a decade, but never quite bad enough to warrant a doctor visit. Training axle continental cleans, however, pushed the shoulder past its limits. On July 6, 2017, I had surgery to repair both of those tears, plus clean up a lot of arthritis in the shoulder capsule, plus preemptively repair the proximal head of the left biceps tendon since the MRI showed it could go at any moment. 12 weeks later, on September 30, 2017, I cleaned and pressed a 267 pound log in competition.
POP! CLANG! “Motherfucker that hurt! Oh shit…this is bad.” That was roughly my mental dialog in the seconds after I tore my rotator cuff on that fateful afternoon. There was no denial…my shoulder was FUBAR and I knew it. That I was unable to hold up a 20 ounce beverage without pain with that arm a couple of hours later just reinforced that reality. I knew I was in for either a long rehab or surgery, followed by a long rehab. Neither choice was pleasant…neither option was one I wanted. Five weeks out from USS nationals where I felt I had an excellent chance at a podium finish. Well, shit.
Even though I still have a long way to go, my recovery has blown the mind of my doctor, my physical therapist, and just about everyone I know who has had this sort of injury. This is the story of the process I followed, along with what I would have done differently in hindsight. There is no guarantee that what worked for me will work for you or for anyone else, but at the very least, it can give you some food for thought and might help you tweak your own recovery plans.
One caveat to the next paragraph is to enlist the help of someone who understands actual medical research if you do not. My wife is an RN, I also have a perverse interest in anatomy, physiology, and kinesiology. Point being, I can read medical research and understand it. If you cannot and are not inclined to learn, obviously, you need someone who does. There is no shortage of them in the strength community and they’re usually geeky enough to love shit like this.
The first and most important thing: RESEARCH, aka DO YOUR HOMEWORK. And by research, I don’t mean a quick google search and browsing WebMD. I mean actual, legitimate research. I probably did a good 20-30 hours of detailed research. I studied the shoulder anatomy and biomechanics. I researched the hell out of my injury, the actual surgical procedure, and the rehabilitation protocols commonly used (using real medical resources). Seriously, go to your local college medical library if you need to. The closest one is over an hour away, you say? Then fucking get in your car and drive there! This is your life and your recovery here, treat it accordingly. Recall what I said earlier about the link between patient proactivity and recovery. It’s a real thing. Do you want to come back strong or do you want to sit around at family gatherings and whine about how you were never the same after the injury? Your call.
I talked to as many really smart people as I could find. We have a WEALTH of very bright people in strength sports, nearly all of whom are super generous with their time and knowledge if you will simply ask and not abuse their time. That second part is huge. Think about the question you want to ask beforehand, ask it, thank them, and then leave them alone. Just because they took the time to answer one question for you doesn’t give you the right to ask them 500 more. Rant over.
I also talked to a lot of friends in strength sports who had this same surgery. Specifically, I wanted to know what they did for rehab and where they thought they screwed up. Information is your friend, I cannot stress this point enough. Do what you can to build up as much expertise on your injury and the rehab process as you can.
Second rant. This education is not so you can tell your doctor or PT how to do their job. This is so you can fill in the blanks to what they tell you (more on this later), ask them intelligent questions during the process, and so you can take an active role in YOUR recovery. At no point did I assume my 20-30 hours of research trumped the years of medical school and practice of my doctor. People who watch an episode or two of Doctor Oz and think they know more than the trained medical professionals piss me off.
Here’s the rub with medical advice. Doctors get sued. A lot. Therefore, they are cautious in the extreme. I do not blame them for this, it’s simply a product of the environment we live in. So, it’s not that I completely ignore the doctor’s advice, I listen to it with the understanding that it is going to be the absolute most conservative advice they can possibly give. It’s a huge legal risk to the medical professional to suggest a more aggressive approach. They are going to err to the side of the overly protective mom who covers her kid in bubble wrap before she lets him try to climb a tree. Therefore, the onus falls on me, as the patient, to educate myself on the more aggressive rehab approaches and make use of them at my discretion, taking the risk upon myself based upon my own goals for my rehab.
I feel the way I viewed my medical professionals is key, too. I did not view them as dictators or overlords, where I was supposed to blindly follow all their orders to the exact letter. I viewed them as tour guides through my recovery journey. Partners in the process, if you will. If your doctor refuses to treat you like an intelligent human being who wants to take an active role in their rehab, find a different doctor. There is a wealth of medical data showing recovery is better and faster with those sort of partnership-based arrangement between the patient and the doctor, known as patient proactivity in the literature. Based on my research (and prior experience with surgery and rehab), I asked a lot of “hypothetical” to my professionals and their answer was typically along the lines of “While I cannot recommend you do that, it could possibly benefit…” Occasionally, their response to my hypothetical question was “Please God, no.” Again, this may not be everyone’s cup of tea and there is no shame in taking the safe, secure, and longer path. Taking over a year to get back into competition was simply not something that interested me.
Here’s another very key point. If you are a strength athlete of any level, you are very abnormal compared to the rest of the population. Even the weakest among us are massive outliers when compared to “normal” people. The vast majority of the data the medical folks have at their disposal is based on normal people. I submit to you that there is a huge difference between a person whose major life goal is to regain enough strength and mobility to pull his tattered underwear out of his ass when he gets up off the couch and a person who wants to press their bodyweight overhead for reps. Even the athlete data pales in comparison to us. We have distinct physiological differences in our bone structure, connective tissues, bone marrow, pain sensitivity, and pain threshold. We are different, very different, and it should be taken into account when formulating a rehab approach.
Point in case. At 9 weeks post-surgery, the PT had me do a strength test. I produced the highest number he had seen in 8 years of practice…with my surgically repaired arm. About twice the strength of a normal person’s healthy shoulder and about 30% stronger than a healthy college athlete. So it’s fair to say I was as strong, or stronger, than normal person within a couple of days of surgery. We’re freakish like that. Knowing these facts, I was fairly secure in taking a more aggressive approach to my rehab.
The second thing, and nearly as important, is mindset. And maybe this is the most important thing. At no point did I believe that my recovery was going to be anything other than way beyond average. After gathering all of my data before the surgery, I had 100% confidence that I was going to come out of this stronger and better than I was before the injury and that my return to sport would be quick. Belief is a powerful thing.
The key thing to remember is this is YOUR rehab. Not your doctor’s, not your physical therapist’s, not your significant other’s, or your mom’s, your dad’s, or any of your sibling’s or friend’s. It is yours and yours alone. YOU must take responsibility for it and do everything in your power to make it a success. If you do anything else, shame on you.
At my first physical therapy appointment, my PT asked me what my expectations were. I told him that I expected to be training normally by 12 weeks post-surgery and close to 100% back at 24 weeks. I could tell from his expression he thought I was insane, but he conceded that given my range of motion at that point, my goals might not be completely out of the realm of possibility.
Planning my rehab
First thing I did was to plan out my nutritional needs post-surgery. This may sound odd coming from a fat guy, but nutrition is huge. See, I actually eat a lot of healthy stuff. I’m just still hungry afterwards and life is too short to say no to cheesecake. Based on the surgical procedure I was about to undergo, I knew there would be a lot of muscle healing and bone healing going on as the anchors fused permanently with the bone. So, extra protein, extra calcium, and extra vitamin D were high on my list of things to make sure I would have on hand.
I planned out my post-surgery environment. I bought a recliner to make sure I could sleep because EVERYONE who had gotten this procedure done said sleeping on a regular bed was impossible in the first few weeks post-surgery. I also made sure to set up a table and put food items, my CPAP machine, etc. within easy reach.
In my research, I talked to several people who had assisted with the same surgery I was about to have. They all told me that the doctors yank the hell out of the arm in every direction immediately post-surgery to test the anchors and make sure they’re solid. I found some surgery videos online and sure enough, I witnessed that very thing. This gave me a lot of confidence that I wasn’t going to screw up their work by being more aggressive with my rehab than they suggest.
I also talked to people who had some excellent products available that seemed like they would help speed things along. More on this in the details, but seriously, exhaust ALL of your resources and leave no stone unturned.
I also planned out my non-rehab training. With a major surgery, everything else has to adjust. I was looking at no back squats for approximately 12 weeks. Back squats are a staple of my training. Deadlifts were also out until the shoulder was healed enough. There went another staple of my training. No atlas stones! I was a sad panda! So I had to figure out what I could do in order to keep training everything else and maybe even get a little stronger in some neglected areas. One of my adaptive athlete friends, James Spurgin, told me bluntly “You’ll be amazed at what you can figure out when you have no other choice.”
Ergogenic aids…there are a lot of substances out there that can help speed healing. Some legal, some illegal, some somewhere in between. As I said above, RESEARCH. And I mean actual medical literature research here, not just the broclopedia. Again, if you aren’t able to decipher actual medical literature, talk to one or more of the many smart people in strength sports who are. But above all, get REAL information before you start using any extras. I include OTC supplements in this category. Don’t just take random shit without a plan. It’s not as simple as pumping a shitload of GH into the injured area and you’ll be magically healed in record time post-surgery. There is a LOT of bullshit out there regarding what works and what doesn’t. To be fair, there’s also a lot of sketchy research out there (the results often depend on who is funding the study). You need to get the hard facts and they’re not always easy to find. Not to say the stories of the brosphere are completely useless (or even entertaining), you just can’t base your rehab on it. It can give you some ideas where to look in the actual research that you may not have considered before.
The actual rehab
The day of surgery, it was all about getting home and getting comfortable. This is where planning your environment out ahead of time comes in handy. You don’t want to be trying to figure out where shit is while you’re still half-looped on anesthesia. Also, have someone around to help you the first couple of days if at all possible. My wife saved me that first day. Inexplicably, my right leg was almost completely numb when I got home. My bladder was so full I could have pissed out a 4 alarm fire by myself, with urine to spare for a couple of camp fires. With the right leg numb and the left arm in a sling and useless, going upstairs to our one functional toilet wasn’t in the cards. So, my wife had to help me limp outside so I could pee off the back porch. The neighbors were thrilled.
I did as little as possible for the first couple of days. Just let things heal. Actually following doctor’s orders for the most part. About day 4, I started working on some passive movement exercises. Yes, this was NOT according to protocol, but I knew if they yanked the shit out of my arm immediately post-surgery, there was no way in hell I was going to do any harm with passive movement after several days of healing. Thus, I proceeded. ***note: This assumption is not valid with all types of surgery – as stated ad nauseum, do your homework and don’t jeopardize your long-term health and recovery.
At 9 days post-surgery, I decided it was high time to get back to training the other stuff that I could do. Thanks to my work with adaptive athletes, I happened to have a Viking press at the gym with an attachment to make it usable one-handed. I also hooked a strap up to my belt and pulled my truck in the lot behind the gym. The key factor here…I chose exercises to train my body that had a minimal chance of doing further damage to the injured body part. There are very few injuries you cannot train around if you get creative enough.
For the shoulder itself, my aim because to regain as much range of motion as I could. I did a lot of pendulum swings and I used a product called the Rotater to help with passive range of motion. I did not force anything, just went until I felt a stretch and held for time aiming for 1 minute stretches. The non-injured arm got a heavy dose of every cable exercise I could dream up along with a shitload of dumbbell movements.
For legs were sled drags and truck pulls (using a belt to remove any possible strain on the shoulder), and belt squats. I did both belt squats standing on boxes and belt squat machines from Westside Barbell and one designed by Matt Wenning. The one by Matt Wenning was by far my favorite and the easiest one to use if you’re lifting alone. If you are going to do them on boxes, here’s a pro tip: Use the lowest boxes you possibly can. When you stand up on 24 inch jerk blocks with 700 pounds on a loading pin between your legs and said loading pin starts to swing, bad things happen. You’ve been warned.
At 3 weeks, I started working on active range of motion. Going back to my earlier comments, if they were yanking the hell out of my arm in multiple direction as soon as they finished surgery, the odds of me screwing up my shoulder by simply moving my arm as pain allowed seemed slim. Another key distinction which I think separates strength athletes from normal people is that we understand the difference between injury pain and discomfort pain. So, I did as much active movement as I could within an acceptable amount of discomfort. I should also note that I ditched the sling at about 3.5 weeks. Doctor’s recommendation was 6 weeks, but shortly after starting active movement, wearing the sling longer than 20 minutes caused my traps and all the muscles around my scapula to start cramping up. Made trying to sleep a hoot. So, onto the old clothes pile it went.
At 5 weeks, I had my first post-operative physical therapy appointment. Upon seeing that my active and passive range of motion was way past where it was expected to be, I was given some exercises to do. Although tough at first, they quickly became way too easy. This is another key point. The PT said do up to 5 pounds for sets of 15-20 reps. Once I got to doing 20 rep sets effortlessly with the weight, I went up to bring me back down to the 15-20 rep range. Typical weight lifting progression stuff. It blows my mind how many people continue doing the prescribed sets and reps when they know damn well it’s not doing anything for them. The idea is to move forward, not keep jacking off with the same old thing into eternity.
I also started making use of some other pieces of equipment for the rehab at this point. I found light weight static bench holds with the Bandbell Bar were a great, higher intensity replacement for a couple of the exercises I was prescribed. I found my strength and stability improved my leaps and bounds using that bar with a couple of kettlebells attached to it. I stayed relatively light, moving up in weight when I reached three sets of one minute holds. Towards the end of my rehab, I was using 70 lb kettlebells on each side for 90 second holds.
As stability and strength improved, I started trying things. Small things. Incline presses with an empty bar, log press with an empty log, overhead press with a small dumbbell. Push the boundaries, but don’t be stupid was my mantra. It still is. I failed miserably at them to begin with. Spotters are a huge help. Don’t try new shit alone. Part of the “don’t be stupid” thing…
Later, I added is some single arm work with the short Bandbell Bar. As the name implies, this is a shortened version of the classic Bandbell, about the length of a typical monster bell. I kept things very light – to the point of having to borrow kettlebells from the kids class. But the added stability work was huge. I honestly think the short Bandbell is a game changer.
As the PT gave me new exercises to try, I incorporated them into my program as they fit, modifying them as needed. Generally, I needed to find ways of increasing the intensity without increasing the risk to the joint. As mentioned earlier, the protocols and exercises are designed for normal humans and the needs of the strength athlete differ. I continue to include several of the better ones to this day and plan to keep them for pretty much ever.
I’d be remiss if I didn’t mentioned how huge a role the mental game is in recovery. You will experience depression and you will experience fear in the wake of an injury. When you wake up from that surgery and you’re nearly helpless, that’s hard as hell to deal with. I’m a very independent person. I hate needing someone else. I’m cool with wanting someone, but not needing. So being semi-helpless with the nagging thought in the back of my head that I would never be strong again…that sucked. It sucked a lot. It took a lot of self-talk that it’s OK to need someone else in certain situations and even more self-talk about the strength coming back.
During recovery, it’s a lot easier to get into a funk after a subpar training session. The doubts and the fears creep right in mercilessly and with ridiculous speed. Then there is the fear of re-injury, known as kinesiophobia – if you’d like to look it up. Your progress has been good. All the movements are pain-free, the range of motion is good, the stability is good…you’re clearly ready for the next step…but you’re fucking terrified to take it. Recently, I was playing around with my giant monster bell. 135 pounds of suck. Super easy to press on the non-injured side. Cleaned on the repaired side, felt great…felt stable…and as soon as I went to press it, my body shut down. Physically, I was ready. Mentally, I was shitting my pants. It took me four tries to convince my brain that my body was ready, but it finally went up. The mental barriers will be the toughest ones to break through.
Things I would do differently in hindsight…For starters, I would get even more creative on my exercise selection. Ab strength, for me, is huge in strongman. My go-to exercise is the ab wheel. Well, with a repaired shoulder, that was right out the window. Neither could I hold anything across my shoulders – front or back, so hoping heavy squats would be enough ab work was out, too. Rather than scour for ideas to do heavy ab work creatively, I just hoped they would maintain their strength. Well, 12 weeks later, when I could finally do things with a bar across my shoulders, I discovered my abs had gone to complete shit. And when I was able to train them again, they responded slowly. As of this writing, they’re still my weak link.
Another thing I would do differently is not push quite as hard to get the weights back to pre-surgery levels. I set myself back a couple of times by pushing too hard and trying to will myself back to full strength. This was a particular issue on accessory movements, oddly enough. Giving myself more back off weeks to recover would have made my overall recovery somewhat faster, I think, because I almost always experience a big strength jump after I back off for a week. My typical method was three weeks heavier, one week lighter. Looking back, I would have alternated light and heavy weeks to give more recovery.