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  • Training

    Training
  • Ripped from the Bone: Recovery from a Tendon Tear

    It can sound like a loud pop or a gun shot, or you can just feel a snap. You can have sudden and severe pain, followed by swelling and bruising. It doesn't matter if you're a novice or a pro with years of hardcore training under your belt. You can tear or "rupture" a tendon.

    Your tendons connect muscles to bones, so that your bones can be bent (like in a biceps curl) or straightened (like in a triceps extension) at a joint. In a partial tear the muscle loses some strength, and in a complete rupture the muscle will have no power at all. A complete rupture requires surgery to fix it. In the past year here on "Strong Island," New York, we've seen a rash of ruptured tendons. I know of two guys who've torn biceps, two who've torn their quads, one who tore one pec and then the other a few months later, and I tore my right triceps tendon at the elbow, ripping the muscle from the bone. Everyone in the bunch, myself included, needed surgical repair to reattach the muscle. And while I figured the injury wouldn't wreck my day-to-day legal practice or my monthly columnist gig for Muscular Development, I was extremely concerned about the impact it would have on my training.

    THE INJURED TENDON: SEE A DOCTOR RIGHT AWAY

    What do you do if you think you've ruptured a tendon? Stop training, go home and ice the crap out of it. Then get your butt to a doctor right away. Getting a reliable opinion from a specialist as soon as possible is crucial you only have a window of about two to three weeks in which to do the surgical repair with a maximal chance of success. Since your family doctor or internist may not be able to distinguish between a strain and a tear, get an opinion from an orthopedic surgeon. He'll likely do an X-ray and an MRI to see what's going on. In my case, the X-ray showed where the tendon was ripped from the bone, leaving a trail of flecks of bone through the tissue, and the MRI confirmed it. I thank my surgeon, Dr. Neil Watnik, for the great job he did on the surgery, even though I complicated things for him-after 30 years of hardcore training, my bones are so dense that they caused a drill bit to snap!

    For a period of weeks following the surgery, you won't be able to train with the affected limb. Your arm will be in a sling if you tore a pec or rotator cuff muscle, or your injured limb will be in a brace if you tore an arm or leg muscle. During this period, the area will atrophy, losing size and muscle tone from disuse, sometimes very dramatically. After that you'll start passive movement and supervised physical therapy to work out the stiffness and regain your range of motion (my thanks to Dr. Mike Camp and his team at Bethpage Physical Therapy for their awesome assistance on this). You'll move the muscle against increasing resistance over the span of several months until, hopefully, full strength and size is recovered.

    THE REST OF THE BODY: TO TRAIN, OR NOT TO TRAIN?

    In the days before the surgery, and for weeks afterward, you will not be able to train with the injured body part. The question is, what do you do with the rest of your body?

    There's a school of thought that training one side of your body— "unilateral" training— and not the other will cause symmetrical imbalance. I pretty much dismissed that concern right out of the gate, because my goal wasn't to make dramatic gains but simply to maintain size and conditioning as I recovered from the surgery. Others argue you shouldn't do any intense training at all during recovery from a serious injury, under the theory that the body must be allowed to direct its maximum recuperative abilities to the task. Some guys I know have followed this approach and stayed away from the gym for a couple months following a tendon rupture, only returning when the injured body part was healed enough to begin training again. Some claimed to enjoy having the free time to devote in other directions, while others slipped into self-pity and bad eating habits in their time away.

    That approach wasn't for me. Training has been in my blood for as long as I can remember. The gym has been part of who I am since I was a kid trying to figure out who I was. I remembered all the wheelchair bodybuilders I'd seen through the years, and others who despite their limitations did the very best they could with what they had. If they could drag themselves into the gym to pump heavy iron day after day despite their challenges, could I do anything less?

    My friend Ron Noreman, who's suffered more surgically repaired torn tendons than anyone I know during his 26 years of bodybuilding competition (35 first and second place finishes in 45 shows), has trained his uninjured side hard throughout the surgical recovery period as far back as 2004. And science supports his pioneering idea. It was first observed over a century ago that training one limb will produce a strength gain in its untrained counterpart. In 2003, Australian researchers examined pooled data from multiple studies to conclude that this "unilateral" training of one limb will increase the strength in the other ("contralateral") limb (the improvement in the untrained limb was about 35 percent of the effect in the trained limb).1 So, you can actually get a mild strength gain without even training a muscle just by working the other side of the body. The mechanism is not fully understood, but clearly appears to be neural.

    Of course, after a tendon tear you're not looking to build strength in the injured limb, but simply to prevent or reduce the loss of muscle size. A study published in the Journal of Applied Physiology looked at that lesser task.2 Researchers at the University of Saskatchewan did a controlled study in which casts were put on the arms of volunteers. One group trained the free arm, and the other did not. The results: strength training the free limb reduced strength loss in the casted arm during the three-week period the casted arm was immobilized. An even more intriguing finding was that there was no significant change in muscle size of the casted arm of the group that trained, while there was a significant decrease in muscle size of the casted arm in the group that did not, suggesting "that muscle atrophy was somehow prevented or delayed for the group that received unilateral strength training during immobilization." In fact, the loss of muscle size in the casted arm was three times less in the group that trained the free arm! Follow-up research found that strength training a free limb provided a beneficial effect for muscle thickness and strength in an immobilized limb after four weeks of wearing a sling and swathe.3 While the researchers urged further studies before drawing clinical implications, it's a pretty compelling argument for unilateral training!

    THE NUTS AND BOLTS OF UNILATERAL TRAINING

    OK, let's say you're sold on minimizing your loss of size, strength and conditioning through post-surgical unilateral training. There are a variety of approaches you can take. Here are the five rules I followed, and they served me well.

    1. Be careful in the gym. Training around an injury can be tricky. Discuss your intent to train your uninjured body parts with your doctor, and proceed cautiously. You don't want to hamper your recovery or cause further damage. Advertise your injury by keeping your brace or sling on at all times in the gym. The last thing you want is someone to give you a slap on the back or shoulder the results can be devastating immediately post-surgery! Your sling or brace will also provide some protection if you accidentally bump something or someone. If you have an upper body injury, be sure not to use the hand of your injured side to lift plates or adjust equipment. If you're using plate-loaded machines, have someone else load the plates. If you need a seat adjusted, do not attempt it yourself. Ask someone else to help you. A great tip: I found that carrying a hand towel in the fist of my injured arm was a constant reminder to not even attempt to use that hand.

    2. Don't flex the injured limb! Pay careful attention to putting all the tension on the healthy side and keeping the injured area completely relaxed. That may take a few workouts to get used to, as you'll find, for example, that your left pec will seem to want to contract when you flex your right one. You can't let that happen. I developed a technique of hanging my injured arm straight out to the side while doing chest or back exercises with the other arm getting it as far away from the action as possible. I looked like a bull rider in the rodeo! Also, you'll be surprised at how many exercises, including leg and ab exercises, require gripping with both hands. If you have an upper body tendon rupture, you'll absolutely need to avoid this. It will take some time to get used to, and you may need to avoid certain exercises. Obviously, you can't do supported one-arm dumbbell rows or certain leg presses that require gripping with both hands to stay in place. Choose exercises with this in mind.

    3. Use machines. Obviously, barbells are not an option for unilateral training, and using a single dumbbell can throw your body alignment off balance on most exercises. But luckily, today's equipment options make unilateral training easy. There are terrific Hammer Strength machines for chest and back. Cable pulleys are great for many shoulder and arm movements. If your rupture is in the lower body, you've got countless options because most leg machines can be used one leg at a time. If you're training in a reasonably well-equipped gym, there's no reason you can't get a full workout with lots of variety.

    4. Plan out the process. I mapped out the process of my recovery training in advance, and for the most part I stuck with it. The process was broken into three phases. Phase 1: Training only the healthy side as hard as possible during the weeks that I could not train the injured side at all. I worked out with my regular training posse, who were kind enough to choose machines that I could do. I actually worked up to record poundages on some exercises! Phase 2: When I got the green light to begin training the injured arm (at about seven weeks post-surgery), I trained the healthy side as before, with my training team, but trained the injured side at my physical therapist's office, gradually increasing the resistance under his guidance. Phase 3: When I felt ready (at about 14 weeks post-surgery), I finally began training both sides of the body concurrently (on two-handed movements), but with unequal weights. Hammer Strength machines were perfect for this. Each week, I added more to the weaker side to gradually even out the resistance. Proceed slowly! Add only about 10 to 15 percent resistance weekly.

    5. Use the time to bring up weak points. Even if your focus is on only maintaining your upper body due to a chest, shoulder or arm injury, there's no reason you can't blast your legs into new growth. While squats are likely out of the question due to excessive stress at the shoulder and the need to grip the bar, you can use advanced intensity techniques like supersets and high-rep pump-outs on various leg machines to get great results. If you've suffered a leg injury, maintain your lower body with one-legged movements and hit the upper body hard.

    6. Don't neglect cardio and diet. There's absolutely no reason why you can't stay lean or get more shredded while you rehab the injury. When you first get on the treadmill, you'll be a little wary as you recognize that a slip or misstep can be devastating. But you'll soon be burning fat like crazy. Even if you have a leg injury, don't sweat it you'll be surprised at how quickly your physical therapist will have you pedaling on a stationary bicycle. And, of course, staying on a smart meal regimen will keep you looking good and maximize your readiness for full-bore training as soon as possible.

    Nobody ever wants to suffer a serious tendon injury, but don't despair if it happens. Maintain your "Alpha Attitude" and persevere. I'm now better than 90 percent back to form on all pressing exercises and 100 percent on everything else. Keep pushing iron and you'll minimize the time to get back to your best self.

    By Rick Collins, JD, CSCS


    References:
    1. Munn J, Herbert RD and Gandevia SC. Contralateral effects of unilateral resistance training: a meta-analysis. J Appl Physiol 96: 1861-1866, 2004.
    2. Farthing JP, Krentz JR and Magnus CRA. Strength training the free limb attenuates strength loss during unilateral immobilization. J Appl Physiol 106: 830-836, 2009.
    3. Magnus CRA, Barss TS, Lanovaz JL and Farthing JP. Effects of cross-education on the muscle after a period of unilateral limb immobilization using a shoulder sling and swathe. J Appl Physiol 109: 1887-1894, 2010.






   
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