How to Train Before You Go Under the Knife

Pete Hitzeman

Managing Editor and Coach

CrossFit, Cycling, Endurance Sports, Running

“I think I’ll go get injured in a few weeks.”
These are not words that you expect to hear an athlete say. Injuries are to be avoided wherever possible. They interrupt training cycles and cause you to miss competitions. They are painful, expensive, and damned inconvenient. There are even strong arguments that, for non-contact sports and non-professional athletes, injuries shouldn’t happen at all.
But as I was driving home from the surgeon’s office a couple weeks ago, I realized that I was in a unique position of foreknowledge of a relatively serious injury. I finally got around to scheduling the removal of the plate and screws that pieced my shattered collarbone together a couple years ago. That means surgery, and after the seven screws are taken out, the bone itself will be about as strong as perforated Styrofoam. Until all those holes heal closed, I’ll be stuck on light duty for weeks.
Damn. So much for #StrongSeason, right? Well, maybe not.

Ride the Curve

From a programming perspective, you can treat an upcoming surgery like any other singular event. For a big race or competition, you overload the body in a specific way through a training cycle, then taper off a week or two before game day. The body supercompensates, you end up stronger or faster (or both) than you were before the cycle started, and you arrive at your competition rested and ready to rock and roll. If you don’t have a competition, you just start your next training cycle.
supercompensation curve
For my present circumstances, the overarching concept is to arrive at the hospital almost totally spent from a hard, hard training cycle. That way, at least a couple of the weeks of rehab will be usefully spent on the recovery side of the curve, rather than already sliding into de-training.
There is a balance to be struck with this concept, of course. I don’t want to be so beat up that it compromises my ability to recover from the surgery, but neither do I want to be all rested up and feeling perfect. If the latter situation were the case, it would mean I was probably already in the supercompensation part of the curve, and the only place for my fitness to go from there, without continuing to train, is down.

Specific Training Considerations and Goals

The other unique element of my circumstance is that I have been through basically the same injury and rehab protocol before. After the initial collarbone injury and repair, I worked with my surgeon and my coaches to get back in the gym as quickly as possible. The result was that I regained about 95% of my previous maximal strength within eight weeks of surgery. There was a somewhat bigger toll on my cardiovascular performance, but even that was recovered within about 12 weeks post-op.
There are subtle differences between that surgery and this one, however. When the bone was first repaired, I had to be very careful not to jostle it, especially in the first few weeks, as the several pieces began to mend back together. Static load, however, wasn’t much of a concern, since the plate itself is plenty strong enough. This time, that situation is almost reversed: the bone will already be in one piece, so I may be allowed back into dynamic activity sooner. But it will also be substantially weakened, so I will need to be more conservative returning to heavy loads.
So how does all of this translate into a pre-surgery training plan? What do I need to do differently to be ready?
First and foremost, the biggest concern after most limb surgeries is muscle atrophy. With the full knowledge that I have a short timeline in which to accomplish much, I want to pack on as much muscle as I can. I’ve shifted my rep schemes and added more volume to my strength work, especially anything having to do with the shoulders. I’m doing some variation of upper-body pressing or pulling just about every day, even incorporating some bodybuilding movements that aren’t a regular part of my program (welcome back, bicep curls).
The second consideration is the loss of cardiovascular performance, both in terms of capacity and endurance. I’m addressing the former on the track, with sets of 400s and 200s at well under my current mile pace. The endurance work is happening on my bikes, as I prepare for a 60-mile gravel road race the weekend before my surgery. I don’t relish putting in long miles in the damp cold of the Midwestern autumn, but it’s the right tool for the job. My wife (the most wonderful woman in the world and my hospital buddy on more occasions than we’d like to count) has even indulged me with some new cold weather gear.
If it all works out, I’ll slip into anesthesia as strong, jacked, fast, and fit as I’ve ever been.

Your Lifestyle Should Prepare You for Setbacks

Lifting weights, running, and riding my bike—maybe that doesn’t sound like I’m doing a lot differently than normal, leading up to being on the DL for several weeks. In truth, that’s because a well-designed fitness lifestyle should create the sort of capacity and resiliency that enables you to overcome temporary setbacks like this. So, the overall pattern of my training won’t change, only a few details, and with perhaps a bit more focus and intensity than I usually apply in this part of the year.
The process I’ve described here could be used in any similar situation, even those not involving surgery. If, for example, you know you’ll have an extended period of travel, where your preferred modes of training won’t be available to you, you could make the same logical adjustments to your plan in the weeks leading up to your departure.
If you are facing an upcoming surgical procedure, do your homework and grill your surgeon to find out as much as you can ahead of time. Find out what restrictions you will have, and for how long, then use that data to adapt your program for the best possible return, once the leash comes back off.
My post-op training plan is still in the works, but I’ll be sure to come back and update you all on how it’s going, and how I feel my pre-surgery program worked. If it does what I hope, I’ll be able to come out swinging in the spring, almost like it never happened.
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