Post Operative Barbell Rehab

Rip, I know we have had a few discussions over this topic, but I thought I'd post in here to show we actually do practice what we preach.

On 6 January I underwent a triple right elbow surgical procedure consisting of a posterior elbow arthroscopy with osteophyte excision, a right Ulnar Collateral Ligament (Tommy John) reconstruction, and a right ulnar nerve anterior transposition, as well as a Palmaris Longus tendon harvest from the left forearm (I have an anatomical variance where I did not have a Palmaris Longus in the right arm). After surgery, I was placed in a bulky, posterior elbow splint locking me at 90 degrees of elbow flexion and a short arm cast on the left arm.

The first three days immediately post-op were pretty awful. The swelling in the posterior and medial elbow was legendary. I also had an ulnar nerve injury during the surgery, and it produced a fairly wicked neuralgia, coupled with pronounced weakness in the hand. At 5 days post-op, I had the surgical splint discontinued, and I was placed in a Bledsoe elbow brace with a range of motion lock and valgus stabilizing bar. Much like all post-post-op patients, I began with range of motion, and truthfully, my elbow didn't move a whole lot after the surgery. I spent the next week working on getting a functional range of motion (still can't wipe my own ass, wash my hair, or shave with my right hand).

This brings me to just about 2 weeks post-op. I started squatting, using only as much weight as I could balance on my back without causing any medial elbow pain. I started off with a weird Hulk Hogan like pose with my left arm in the standard position and my right arm (in the brace) extended as much as possible and resting my hands on the plates. My first day in, I was only able to squat 225 for sets of 5. The first couple of sessions, I could not bench the empty bar, so I used the (drops head in shame) Smith Machine with 5s on each side, and I was only able to pull 45# off the floor on deadlift.

I have been training most days, and after speaking to you, I bumped up to two a days. Today I was able to easily manage 315 on squats for sets across of 5s, and I was able to deadlift 135 for a set of 5, and bench 75 for sets across of 5s.

For clarification, for my particular situation, the rules of engagement are as follows:
1) posterior elbow pain is of no concern.
2) any medial elbow pain during any activity will cause me to immediately stop and wait a week before attempting that again.
3) I am not doing any upper extremity training to the level of fatigue in order to keep from damaging the ulnar nerve any further.

Excellent progress, Will. Keep us posted as you Walk the Walk.

Excellent job! And thank you for sharing. :)

With this level of record keeping, maybe one day there'll be enough data to publish a series of case studies in barbell rehab.

Will, it sounds like your elbow was in a bad way before surgery. What led to its condition?

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Originally Posted by spacediver

Will, it sounds like your elbow was in a bad way before surgery. What led to its condition?

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I think, overall, the several years of military directed CrossFit was the biggest cause. I am also a very hard thrower, but almost a decade of bodyweight dips, kipping pulluos, thrusters with 65#, etc started making itself known about three years ago.

I had a medial elbow sprain catching a clean and jerk that went bad. I sprained my UCL, and over the next year, I had a progressive loss of extension in my right arm. At the time of surgery, I had lost approximately 30 degrees of extension. The laxity in the medial elbow allowed the olecranon to shift side to side during flexion and extension which crested the osteophyte. The laxity also started causing a raging case of ulnar neuritis. This all came to a head this past September when I was attempting a 350# bench. At the bottom of the bench, my elbow buckled, and I partially tore my UCL again. Once this happened, my Ulnar nerve would subluxation out of the cubital tunnel during flexion and snap back during extension.

I probably also need to add this: this is not my first rodeo with orthopedic surgery. I had a complete left medial meniscus menisectomy (removed the entire meniscus), and I have had two right ankle reconstructions. Nothing I have ever experienced before prepared me for the level of debilitating agony the first two days after upper extremity surgery.

Thank you Will,

I hope you have a fantastic recovery, and continue to document and inspire.

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Originally Posted by Will Morris

I think, overall, the several years of military directed CrossFit was the biggest cause. I am also a very hard thrower, but almost a decade of bodyweight dips, kipping pulluos, thrusters with 65#, etc started making itself known about three years ago.

I had a medial elbow sprain catching a clean and jerk that went bad. I sprained my UCL, and over the next year, I had a progressive loss of extension in my right arm. At the time of surgery, I had lost approximately 30 degrees of extension. The laxity in the medial elbow allowed the olecranon to shift side to side during flexion and extension which crested the osteophyte. The laxity also started causing a raging case of ulnar neuritis. This all came to a head this past September when I was attempting a 350# bench. At the bottom of the bench, my elbow buckled, and I partially tore my UCL again. Once this happened, my Ulnar nerve would subluxation out of the cubital tunnel during flexion and snap back during extension.

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This is an excellent example of an indication where surgery may help. As you have posted, Will, pain is not.

Quick update -

Have reduced to once per day because the weights are starting to get heavier.

Last workout:

Squat- 365 x 5 x 3
Bench - 155 x 5 x 3

Back up to squatting 405, although I can only do them for singles. It is a little difficult to keep the bar on my back with the awkward positioning of my right arm.

Benched 225 for 3 sets of 5, with the first three reps each set being paused reps. I still bench with the Bledsoe brace on. It takes a lot of warm up reps to get ready, but the weight still goes up pretty easily.

Pulled 225 for an easy single, but it reproduced pain exactly where I don't need it. Will wait another week before attempting it again.


I cannot press yet because of the brace. I have been pressing with dumbbells (going up to 50#) on that arm with no pain.

My bicep and tricep on the right side is still pretty atrophied because of the reduced available range of motion. I have added a few extra exercises.

Last note, per protocol, I am cleared for strength training (isotonic with a 1# dumbbell) in two weeks.