Latest thinking on retuning to training after inguinal mesh repair?

[BPJ]

Coach,

I’m finding lots of your “see a doctor” advice when presented with hernia questions. I have followed that advise as crazy as it seems, and I’m going in for bi-lateral laparoscopic mesh repair next week. Doc says 2 weeks off, then 4 weeks at nothing more than 40-50#. I guess by then I’ll have my range of motion back.

But what do to recommend then - back to day one novice linear progression and ride it out? If it makes any difference, I’m 50, weigh 215, and was squatting 400, deadlifting 360.

Does Starr protocol have any role here?

Thanks for your time.

Joe

[Steve Hill]

Coach(es),

I’m finding lots of your “see a doctor” advice when presented with hernia questions. I have followed that advise as crazy as it seems, and I’m going in for bi-lateral laparoscopic mesh repair next week. Doc says 2 weeks off, then 4 weeks at nothing more than 40-50#. I guess by then I’ll have my range of motion back.

Everyone has an opinion. Here's mine (and note that I am *not* a medical professional (just like your doc is not a lifting professional - he's just repeating what he learned. I wonder if he ever questioned it....)

OK, the mesh repair is a mechanical repair that covers a defect in the abdominal wall to prevent your intestines from pushing through said defect. You get opened up, and mesh gets put in place, and then sutured into place, usually with a post-op suture material that will eventually dissolve / be absorbed. It hus provides a mechanical barrier to prevent protrusion of the intestine through the defect, and it serves that function immediately. Hence why it's ok to sneeze and cough post-op. The question is not "Can it be loaded," the correct question is "How much load can it withstand, and how quickly can that load be ramped up?" So, while legally recommending that you follow your doctor's advice, I will relate that several lifters that I personally know or coach, including myself (triple repair), have been successful in getting back under the bar as soon as pain subsided enough to squat - for me, this was 7 days. Note that during surgery you will be injected with a long-acting anesthetic, and you'll feel pretty good for a short while (1.5 days for me) after you wake up, and during THIS post-op period you need to be very careful. After that anesthetic wears off, THEN it'll hurt and when that pain subsided, I got back under the bar. Just the bar, for several sets of 5. I added weight as pain allowed - if the pain subsided during the sets, I kept working. It's uncomfortable while the mesh is integrating, and I felt several instances of stretching sensations and some pulling, but that's part of the process - getting the mesh to integrate while the body is moving through a normal ROM. I was back at 185# when I went back in for my surgical follow-up, upon hearing my surgeon had kittens. But stress-recovery-adaptation applies to injuries too.

But what do to recommend then - back to day one novice linear progression and ride it out? If it makes any difference, I’m 50, weigh 215, and was squatting 400, deadlifting 360.

It'll be an accelerated LP, but follow your doctor's advice.

Does Starr protocol have any role here?

Thanks for your time.

Joe

No, it's not a muscle belly tear. 5's are appropriate, in incremental increases. But follow your doctor's advice - because I don't wish to be sued.

[Jonathon Sullivan]

I AM a medical professional. Also a coach, with clients who have undergone this procedure.

Read Steve's post again. He is right on everything, except one minor detail: The mesh isn't used to cover a defect in the abdominal wall. The defect is repaired. That's what hernia surgery is. The mesh reinforces the repair. It's not like you have a defect with mesh on it. You have a repaired defect, with mesh making the repair stronger.

But Steve has basically nailed it.

Also: Hi Steve. Long time, no talk.

[Michael Wolf]

FWIW, I had a triple hernia repair this past summer and my experience was totally different than the 10+ people I know and spoke to about it. Maybe it was because mine was an open procedure, not laparoscopic, but it took almost 5 months post-op till I could lift any appreciable weight again without pain and irritation that didn't seem good. I tried to come back too quickly, based on my assumptions about what should be going on rather than paying enough attention what was actually going on.

I am sure my situation is not unique in the history of hernia surgeries, but it is the only one among the 10-15 people I know who had hernia repairs and who I spoke to about it, that had such a long, difficult road back. In very stark distinction to my shoulder surgery last year, which was supposed to be a super big serious surgery with a 12-18 month time to full recovery, and I was back to 100% in about 5-6 months. I mention that only because it indicates that this isn't some general "poor/slow recovery from surgery" issue that I have. When you get cut open and repaired, even with all of today's technological advancements and medical knowledge, sometimes things just go differently than you expect.

[Culican]

For some reason (maybe to avoid endless phone calls) many surgical practices post their hernia recovery instructions online. Having looked at numerous ones it seems that for laparoscopic inguinal hernia repairs the time to "unrestricted" activity ranges from 4 weeks down to 2 days, depending on the surgeon.

For instance (I won't link it but you can Google the bolded part and find it) this surgeon says 2 days:

For the first 48 hours after the surgery, you should not drive an automobile, have sexual intercourse, do core exercises or lift over 15 lbs.
On the third post-operative day, unless told differently by me, you have FULL UNRESTRICTED physical activity. There is no limitation, and the more you do, the quicker the pain and discomfort will disappear. Some discomfort and pain is nomal. Your body will set your limits, though it is ok to be aggressive.

It is amazing what different surgeons say regarding recovery times and protocols.

My surgeon said 4 weeks but as I lost them (or maybe they didn't give them all to me in the recovery room...my mind was kind of hazy in that post anesthetic bliss) I went back to the gym in 10 days. I think he suspected that because at my follow up appointment two weeks after surgery he smiled and said, "Just don't lift anything too heavy." He didn't define "too heavy" and I purposely didn't ask.

[Ryan Arnold]

I'm 39 and have had two inguinal mesh repairs in recent years. The first one I waited a while to train again but the second one I realized I probably didn't need to be so conservative. I believe I squatted up to 95x5 11 days post op and competed in a Meet 6 weeks out. Just my experience - not a medical doc

[Steve Hill]

I AM a medical professional. Also a coach, with clients who have undergone this procedure.

Read Steve's post again. He is right on everything, except one minor detail: The mesh isn't used to cover a defect in the abdominal wall. The defect is repaired. That's what hernia surgery is. The mesh reinforces the repair. It's not like you have a defect with mesh on it. You have a repaired defect, with mesh making the repair stronger.

But Steve has basically nailed it.

Also: Hi Steve. Long time, no talk.

Yup, I should have educated myself beyond how my surgeon explained it to me. Bummer that.

I'm doing well, and yes it has been a bit, but I'll see you at StengthCon.

FWIW, I had a triple hernia repair this past summer and my experience was totally different than the 10+ people I know and spoke to about it. Maybe it was because mine was an open procedure, not laparoscopic, but it took almost 5 months post-op till I could lift any appreciable weight again without pain and irritation that didn't seem good. I tried to come back too quickly, based on my assumptions about what should be going on rather than paying enough attention what was actually going on.

Yes, the open repair is a lot more invasive. Probably more akin to my non-laproscopic appendectomy. And that was a doozy. I walked around like an 90-year-old for a week.

[Gregory Brown]

I had robotic bi-lateral inguinal hernia repair 9 weeks ago. My surgeon said I could resume lifting after 4 weeks but only if there was no pain in doing so. An oft repeated claim from surgeons is that after 6 weeks a surgical incision has about 90% strength and takes perhaps a full year to heal completely. How true that is for people who weight train, I do not know. I had every expectation that an accelerated LP would get me back to where I was in 2-3 months. Nope. My first attempt at an LP for the squat got me up to around 185 before I was forced to admit that I was completely ignoring the "no pain" suggestion. I went back down to 95, up to 145 and now back down to 115. Both the press and bench LP were somewhat slowed due to creeping pain with higher weights but not like the squat. The DL was always completely pain free and I am back to my working weights now. Bottom line is there are individual differences in recovery rates due to factors we cannot always wish away.