How I Got My Post Surgery Client Lifting Weights Again

One of my clients at the moment is doing incredibly well with their rehab. It makes me cry a little bit every time they make progress, as at the start, we weren't even sure if they would ever be able to walk normally again. My job can support people when their life is changing, and I'm here for this.

This person has had a massive surgery, and we have been progressively increasing their activity tolerance. To do this, I always try and "sneak up" on my client's capacity, so, for example, if they can walk 10 minutes, but then have to sit down for the rest of the day, we would make 10 minutes the max dose for the day, but break it up into smaller chunks, including 1 minute walks on the hour.

This client, we started just like this, and this week, they reported

1. walking 4.5km, and getting up in the morning and being able to do chores without even thinking about the fact that they have previously had pain until everything was done.

2. Planning on starting lifting weights (I did a little dance) and wanting some guidance (more on this below).

3. Starting an exercise class with no symptoms (we had plans on how to start this, as doing the whole thing is often too much when we have had

   1. a long period of time off exercise

   2. significant pain or long term pain and or complex pain

I absolutely love my job and this stuff is exactly why I do it.

An addendum - this client lives in the South Island, and I live in the North. They are a wee distance from physio, and seeing me online, while initially a trial, to see if it worked, (because it's a bit out of what we know isn't it?) has been incredibly successful.

They have also asked me for a plan to return them to lifting. There are obviously a few nuances here, so, in addition we have set up a 6 month plan to return to running and 6-9 months to return to running and direction change at speed.

I've also consulted other people, because while I'm all about Feral Fitness, I don't have a focus on strength programmes for people at the moment. We have this client working on a progressive strength programme, starting at the very bottom (which they are modifying, because they are smart, and pay attention to their body).

Here's our rough plan.

Block One

Isometrics - holding your body in a single position with effort. This builds tolerance and capacity and is a nice way to start exercising. This way we also challenge the muscles, but don't add other variables to the mix. This is especially helpful for rehabilitation.

For lifting after a break, I typically recommend dedicating a period of 2 to 6 weeks to focusing on isometrics (getting into a position and holding it) - building to 45 second holds for three sets, before moving on to endurance-type loads specifically in the rep range of 12 to 15.

This approach allows for the development of muscular endurance and helps to reinforce proper lifting mechanics, which is essential for long-term progress.

How long to make this phase? 2 weeks if you haven't lifted for 8 weeks or more, continuing through to 6 weeks if it's been more than a year.

During this initial phase, I emphasize the importance of maintaining beautiful form throughout each repetition, as this not only minimizes the risk of injury but also maximizes the effectiveness of the workout.

In the first two weeks of this regimen, the focus for everyone is entirely on honing form, with no requirement for high intensity. I suggest working at an intensity level of around 4 to 6, which correlates to a perceived exertion that is manageable and allows for focus on technique.

It's crucial to maintain at least a 4-rep-in-reserve (RIR) during this period, as pushing too hard can lead to unnecessary muscle soreness, commonly referred to as delayed onset muscle soreness (DOMS), which offers no real benefit at this stage.

DOMS actually adds no benefit to anyone at any time (sorry if that's what I told you in 2004, because that's what I thought then).

The goal here is to re-establish a strong foundation without the added stress of heavy loads. This increases the tolerance and capacity of all the tissues, not just the muscles, and if you have a grumbly tendon anywhere, then this is a great way to settle them down too.

Block two:

As we transition into the next 2 to 4 weeks, the intensity can be gradually increased.

During this phase, I recommend progressing to an intensity of 7 to 8, while still maintaining the rep range of 12 to 15 and performing 3 to 5 sets.

While it may seem like you can only lift little weights in this phase, the effort still should be high, with higher reps allowing the body to tolerate increased load, without compromising form and overloading tissues which do not yet have the capacity.

At this point, it's important to continue prioritizing beautiful form, as this will help facilitate the development of strength and endurance simultaneously. The gradual increase in intensity, while still keeping a 3 to 4 RIR, allows for a safe and effective adaptation process.

Block Three

Following this endurance phase, I suggest a subsequent period of at least four weeks, though extending this to six-eight weeks can be beneficial, where the focus shifts to slightly lower reps in the range of 8 to 12.

The principles of maintaining good form and appropriate intensity levels apply here as well, ensuring that lifters continue to build upon the foundation established in the earlier weeks.

When we start it's often a good idea to do lighter, more complex, full body exercises (done well) at higher reps to get the body used to moving, before we move to heavier weights and lower reps. There are still significant benefits to exercising lighter with more reps as long as the intensity is high.

Block Four:

In this phase you can, if you want, start lifting much heavier weights, in lower rep ranges. The rest needs to be maintained, and the weight needs to be at a point where you have 1-2 reps left in reserve, while lifting 5-8 reps.

If you don't like lifting super heavy, or don't have the weights, an alternative is to continue with 8-12 rep range, but making sure that the effort is high - you aren't just "going through the motions".

At some stage, you have to increase the intensity and load of your exercise to make the changes you require. It doesn't always have to be all the plates, and honestly, for a start, body weight is enough, but at some stage, you have to start thinking about bigger weights.

Plyometrics:

If you want to get back to real world activity where you can sidestep and jump and pivot (these all happen in the yards by the way, not just the sports field), then plyometrics are an absolute must. These can start relatively early once a baseline for activity has been established, and you are happily progressing through your rehab.

Plyometrics can be easy to leave out of programmes, but are the secret sauce to being able to do things as we get older that we won't be able to do otherwise.

A word on rest:

We use rest to allow our muscles to be ready to do the work again. More quality reps mean more quality work, higher muscle load and higher adaptation. Puffing and feeling the burn are great sensations, but don't always translate to an increase in muscle changes. Take the rest.

Caveats:

This is a very generalised plan, which always needs tweaking, depending on the human in front of me, their goals and daily activity and their inury type, location and how long it's been there.

What do keep doing:

Ongoing and regular strength training (2 x 20 mins per week should do it, obviously with caveats) is particularly vital as we age, as our bodies exhibit a reduced capacity to handle increased loads.

Therefore, my recommendations are rooted in a cautious approach to loading and progression, ensuring that the body adapts appropriately without risking injury.

Extra Tactics:

Additionally, (because you can't make muscle out of nothing) you must maintain a proper nutritional strategy during this period. I advocate for a protein intake of around 2 grams per kilogram of body weight, even during phases when one may not be lifting heavily (actually, especially so for this (for more info, try this snippet from Mikki Williden). This level of protein consumption supports muscle repair and growth, which is crucial for recovery and adaptation.

Other important lifestyle factors include staying well-hydrated—keeping your urine pale is a good indicator of adequate hydration (this keeps your muscles and tendons flexy)—and prioritizing quality sleep, which is fundamental for recovery and overall performance.

By doing the best you can around these guidelines because it's all in the same container, humans focused on maintaining long term function can effectively prepare their bodies for more intense training while minimizing the risk of injury and maximizing their long-term progress.

If you want to know more and get individualised advice focused on you, what you do and where you want to be - book with me here to see me online or in person.