2 Injuries, 2 Surgeries, 1 Me...seeking advice from Dante et all.

[BigGoals2Bdone]

I've only competed once years ago, and then decided to dedicate more time towards improvements, so didn't compete, well while I was in a good bulk and at the biggest/heaviest i'd ever been, POW end up injuring myself, pec tear doing 285 for reps on bench. Fast forward a year (approx) I hurt my knee at work, meanwhile i've been fighting to get the torn pec fixed, and getting so much opposition the whole way. Fast forward a couple months, I get surgery on my knee to fix it (lateral release + cleaning up the joint) and about a month and a half later FINALLY get pec tear surgery in Ottawa.

So I thought i'd use this forum to log my progress back from all this, get feedback from anyone, tips or tricks, since i'm sure some of you have been injured.

Got a week off from work after knee surgery, came back got told nope no work or physio, your leg is way to swollen so another week, at this point I was walking, but it was definitely more of a hobble. It took about 3-4 weeks (post surgery) to get full ROM back, at the time I didn't know i'd have my pec tear surgery so close to this one, I got lucky to get in so fast.

So pretty much whole time I kept up my leg exercises, except for the week or 2 I got off work after the pec surgery.

Did the 6 weeks in the sling, Docs said no pushing past 15 degrees for the first few weeks during physio, just doing active assisted ROM stuff, basically like my leg learning to use it all over again. By week 6 or 7 I was pretty much back to my normal (60ish degrees external rotation, and arms over my head, etc)

FINALLY! started this past friday (July 1st aka 8weeks post surgery) to do strengthening exercises, started with a yellow thera-band, but now I can do the red band.

Disturbingly enough my knee bothers me more then my shoulder does at the moment. I think its due to my tear being at the musculo-tendinous junction, and the doc said my tendon was intact (also was not a complete tear) but obviously because it took about 1.5yrs to get the surgery lots of scar tissue and significant atrophy in the detached portion, but after the swelling went down post-surgery, I could already tell a difference in look.

On a good note, Pec doc said i'm ahead of scheduling on recuperation, and he doesn't need to see me after the 2month check-up (which i've had) unless there's emergency. Also said I should be back to my normal activities in 1-2 months.


Lost like 15-20lbs since knee surgery approx 3months ago. Pre-surgery = 212-215, Now= 194-196 (I was down more...but put 2-3lbs back on lately)

I was actually wondering for insight about how I can incorporate the training the rest of me with physio for now...I am really hitting up the 1 legged and 1 armed stuff (not at the same time lol) to try to bring back symmetry, also wondering since there is a lot of info on here, any recommendations on supps or super supps to take to help heal/recover or when I should even touch that again, etc.

Can't wait to hear what Dante and all you guys have to say !!

[BigGoals2Bdone]

Just to keep updated, took some measurements to see the imbalance from side to side, not that bad for arm, my left thigh is 1" smaller then my right, and i've lost a good 2 inches everywhere

My thoughts are that I should be eating in surplus or around maintenance to rebuild the tissue i lost, so as to even out from side to side, if i'm wrong in this i'd love for someone to point me in the right direction, also besides EFA's and multi-vits what supps should i be taking consistently to promote healing as well as regaining a lil mass.

I've been cleared to lift light upper body, everything but chest is good to go to train in the gym, so i've been doing light rows, curls, pushdowns, overhead ext, db shoulder presses, etc

[Knickerbocker24]

Well, I guess I'll bite since you're not getting any feedback. I don't typically give much advice in this section since I don't consider myself a DC expert, although this topic isn't really DC related so (maybe posted in the wrong section), so here goes. I won't get into the diet/supps/super supps convo, although if you're over 20%bf I don't see any reason to eat in excess, but I digress. I will talk more along the movement/kines/structure lines because I think it bears discussion.

Despite little knowledge of how your injuries occurred, it kinda has the ring to it that it was likely influenced by some structural imbalances. And, while this won't necessarily help answer your immediate question about how to incorporate training into your physical therapy, it may give you a better understanding of how to program your training, what's going on with your body, and to take a look at the big picture as to why these injuries are happening in the first place, which to me is a more important concept than the quick fix. It's impossible to tell if any structural issues are developmental or congenital abnormalities or whether they developed from poor postural habits or improperly balanced training.

My suggestion to you is to have someone take 3 pictures of you. Take one front the front, back, and side, all full body and preferably with only your underwear or small shorts on (and not in front of a mirror so you don't correct). If you don't want to post it, just do it for yourself. From the side shot you should be able to draw a straight line between the middle of your foot and take it up through the knee, hip, acromion process (bump where scapula meets clavicle), and mastoid process (bump behind your ear). This line is also perpendicular to the ground.

This is a little trick I learned this from one of my strength coaches to evaluate some of our athletes and ourselves, but it's certainly not original to us. It will tell you just how dysfunctional you are. Take out a blank sheet of paper and make six columns at the top. The columns will be labeled as follows:

1. Excessive lordosis (includes anterior pelvic tilt)
2. Excessive kyphosis
3. Internally rotated humerus
4. Forward head posture
5. Internally rotated femurs
6. Externally rotated feet

Here’s a checklist of things to examine on your side-posture analysis, starting from the ground up:

1. Can you make a straight line between your feet, knees, hips, acromion process, and mastoid process? If so, is this line perpendicular to the ground?

2. Examine your knees. Do they have a slight bend or are they locked? If they’re flexed, give yourself a check in the internally rotated femurs and externally rotated feet columns.

3. Look at your shorts. Is the waistband parallel to the ground or is the front pointed towards the floor? If it points down, give yourself a check in the lordosis column.

4. Examine your lower back. Is there a minimal curve or is it exaggerated? (if you have an anterior pelvic tilt you also likely have an exaggerated lumbar curve). If it’s exaggerated, give yourself a check in the lordosis column.

5. Examine your arms. Are they carried alongside or in front of the body? (Be sure to look at each side independently; sometimes one side is tighter than the other). If they’re in front, give yourself a check in the internally rotated humeri column.

6. Examine your upper back. Are your shoulders rounded forward? If “yes,” give yourself a check in the internally rotated humeri column.

7 Can you see any of your upper back? If “yes,” give yourself a check in the kyphosis column.

8. Finally, examine your head position. Can you draw a line straight up from the acromion process of your scapula to the mastoid process (anterior portion)? Or, is there a noticeable angle? If you answered “no” to the first question and “yes” to the second, put a check in the forward head posture column.


Front Posture

1. Can you make straight lines between your feet, knees, and hips? If you answered yes, keep going anyways.

2. Do your feet have arches or are they flat? If they’re flat, give yourself a check in the externally rotated feet column.

3. From your knees down, do your lower legs and feet turn out? If “yes,” put a checkmark in the externally rotated feet column.

4. From your hips to your knees, do your legs turn in and the kneecaps point inward? If “yes,” put a check in the internally rotated femurs column.

5. Finally, examine the backs of your hands in the photo. Are they turned out to the sides or are they internally rotated and facing the camera? If they’re facing the camera, put a check in the internally rotated humeri and kyphosis columns.


Back Posture

1. Do the medial, inferior borders of the scapulae remain down and back (somewhat close together), or do they “wing out?” If “yes” on the second question, put checkmarks in the internally rotated humeri and kyphosis columns.

2. Do the superior scapular borders point upward or do they seem to “disappear” and point forward (anterior tilt)? If “yes” on the second question, put a check in the kyphosis column.


Now that you’ve completed the postural analysis, add up how many checkmarks you have in each column, the more checks you have under each column, the more signs you have of that specific postural condition. If you're still participating come back with where your checkmarks are and we can talk about the conditions that often develop from each of them and see if it correlates to the injuries you have seen.

[BigGoals2Bdone]

Sweet thanks, i'll get the gf to take the pics this weekend, i'll do what you said, but I can also send them to you via PM so you can verify that I did it properly, as well as giving you more info.

I realized all to late, that I should have put it elsewhere, my thought process was that because this was how i've trained for so long, that this is where modifying my training/way of thinking about training should be changed, but as you said, totally not getting the amount of response I thought, then again i'll take quality over quantity!

[Knickerbocker24]

totally not getting the amount of response I thought

I think that some shy away from giving advice regarding injuries because it's beyond the scope of our expertise. You'll see a lot of shared experiences about injuries, but not much on how to rehab them. I also won't talk about rehab either as it's beyond my scope as well. But, I hopefully can at least shed some light on kineseology, your body and any structural/postural imbalances you may be dealing with, how that may have influenced your injuries, and how to properly balance your training going forward to avoid similar issues in the future.

[Knickerbocker24]

Alright BG, I took a look at your pics, but before we get into all that I want to discuss quickly a little bit about kineseology. First, let’s talk about muscular contraction, specifically the sliding filament theory. Actin and myosin filaments are the contractile unit of skeletal muscle. The myosin cross bridges attach to the actin filaments, pulling them inward to shorten the muscle fiber. When a bunch of fibers do this at once, we get a concentric muscle action.

Obviously changes in the length of a muscle fiber can affect the ability of the muscle to contract optimally. For example, when a muscle fiber is too short, it can’t generate peak force because of the preexisting overlap of actin filaments. Conversely, when the fiber is excessively lengthened, the actin filaments are too spread out for all of the myosin cross bridges to reach them for attachment. Hence, a muscle fiber is strongest at it's ideal resting length for ease of argument...in all other positions it can't generate max force.

Training, or lack thereof can alter a muscle’s normal resting length. Simply put, the more you train a muscle, the shorter it wants to get. The response of the antagonist however, is to lengthen more and more over time to allow the agonist to shorten. When this happens the agonists become chronically shortened due to poor training and/or lifestyle. So, we get shortened overactive muscles and lengthened inhibited muscles opposing each another.

The end result of this is that we develop this out of whack relationship from head to toe which leads to a whole slew of dysfunctions that we mentioned before. So, I will try to give my best opinion of yours...

[Knickerbocker24]

After looking at your pics I have checks excessive lordosis and/or anterior pelvic tilt, excessive kyphosis, internally rotated humeri, and externally rotated feet. From the front view you can see a slight internal rotation of the humeri and laterally rotated feet and pronation. From the side view you can see an anterior rotated pelvic tilt, moderate kyphosis, and internally rotated humeri. From the back it's difficult to see your scapula, but you can see rounded shoulders, and a slight discrepancy in the hips (right hip dips).

Shoulder pain is often consistent with kyphosis and internally rotated humeri, which can contribute to decreased space between the acromion process and humeral head. Have you had any previous incidence of shoulder pain? Simply balancing out your training in terms of scapular retraction/protraction, scapular depression/elevation, and humeral internal rotation/external rotation will help, especially the last (but often if you have issues with internal rotation of the humerus you also have issues with the scapula, I just couldn't tell from your pic, so all three of those are important to balance in terms of volume). I can elaborate on what exercises are included in each of them if you need me to.

An anterior pelvic tilt can cause a lot of issues. It has implications on the femur as it forces the femur into internal rotation. This places stress on the lateral part of the thigh, most notably the vastus lateralis muscle and the tensor fascia latae (TFL) and iliotibial band (ITB). These areas become shortened, tight, and are usually implicated in cases of lateral knee pain. To fix this you should work on activating your glutes with things like glute bridges, strengthen your anterior core with things like prone bridges, rollouts, etc., stretch your hamstring group, and do tissue work on your lateral thigh like foam rolling.

Inward rotation can also affect the tibiae in genu valgum or knock knees. It looks like this may be slightly occurring with you. With this condition, the tibia abducts (moves away from the midline of the body) relative to the femur. This can place stress on the medial aspect of the knee. Sometimes the root of this dysfunction can be occurring at the pelvis. It can drive pronation from the top down due to poor hip strength and mobility.

The tibia internally rotates on the talus. This internal tibia rotation is associated with pronation of the subtalar joint, which makes your feet flatten. The pronated foot scenario is related to tightness of the plantarflexors (calves). Sometimes the person pronates the foot to overcome a compromised range of motion in dorsiflexion. Here obviously improving dorsiflexion ROM is helpful and tissue work like foam rolling or lax ball work and stretching the calf complex will help.

Sometimes barefoot training can help. Deadlifting barefoot, bowler squats barefoot, etc. may help. Basically, just use it for situations where foot positioning doesn’t change. Strengthening the small muscles of the feet and improving proprioception may also be beneficial. And, improving dorsiflexion ROM would be an added benefit by doing things like the 3-way wall ankle mobility drill.