2 questions: Training post Inguinal Hernia Repair & Training w/ Lupus

Medical Q&A [Moderated]
1

Hey Doctors Baraki and Feigenbaum,

I’ve posted here a few times, but I’ve finally found my stride with consistent strength training using your resources, so thanks for all the great content as always.

I’m prepping for my first meet, which I’m planning to participate in somewhat casually/for fun later this year. Otherwise I live a fairly active lifestyle and have young kids that I try to keep up with regularly.

On to the medical questions:

  1. I had an inguinal hernia repair (open) in 2018 that is obviously fully healed at this point. My surgeon cleared me for exercise maybe 6-8 weeks after the procedure. I have been able to train with no issues until very recently when I started developing some very sharp ‘tearing’ like pain in my center line under my waist band area, which coincides with the medial portion of the repair incision scar. I first noticed this while rock climbing, and it has since happened once or twice while doing deadlifts or bench press (not so much with squat). It seems that it doesn’t correlate with the weight or effort level, and has more to do with my positioning. If I am in extension and bracing my core tightly it seems to cause pain, but I am usually able to adjust my positioning slightly and work through it. Each time it has resolved on its own after resting it for a day or so, but I’m curious if there is any major concern here? My philosophy with it has been to stop doing a movement if it hurts and try to find positioning that works for me, if none can be found call it for the day (luckily this hasn’t been necessary yet). I feel like if I had ripped open a years-old incision or created a new herniation I’d know without a doubt, but I want to be sure I’m not likely to be doing any major damage.

  2. I was recently diagnosed with Lupus and have finally gotten my treatment dialed in pretty well. I take Plaquenil and Methotrexate to manage disease activity, and I very rarely will take Prednisone to manage acute flares per my rheumatologist’s recommendation - but I have only needed that once since coming off it as my initial treatment around October last year. This has given me substantially improved and consistent energy levels, but I do still have times where my fatigue is higher, joint and muscle pains are worse, etc. My approach for these days is to decrease my RPE across the board by 1 or even 2 if it’s really bad. This has allowed me to stay in the gym lifting even when I’m on the downswing. Any issues with this approach? Or anything further to consider in the management of Lupus alongside my regular training?

Thanks in advance for your advice.

2

Napcaptain,

Best of luck at the first meet :slight_smile:

  1. I have no real concerns here given the remote surgical history and focal nature of the pain. If it continues to bother you, we’d recommend checking in with your physician.

  2. You can manage it like this, or just use the prescribed RPE with reduced loading, which would naturally take place using RPE in the first place, right? I’m not sure that I feel strongly either way, but the use of autoregulation is important in this context. I don’t have any other specific considerations here.

Keep up the good work!

-Jordan

3

Thanks for the input! That tracks perfectly with my current plan. I’ll keep at it and hope it resolves on its own, resting as necessary.

On the autoregulation topic - Ha, yes exactly. That’s the whole idea with autoregulation, of course. However, I think this is one of those grey areas where I tend to have a hard time distinguishing between what an 8 feels like on a good day for example, and matching that effort when feeling poorly. It’s almost like the limiting factor is somehow something other than muscular strength. Perhaps it’s muscular or cardiovascular endurance or mental energy, or maybe this is a situation where it’s important to distinguish set RPE vs session RPE; I’m not sure. It feels very unscientific to say that, but on those days I often feel I could “dig deep” and eke out a similar level of effort/performance without overshooting RPE, I could just be wrong about that. Going just a little easier on those days tends to give me some mental space (or something?) to have a quality session rather than a grindy one. Which is something I prefer given that those days are growing fewer and further between and it allows me to continue building volume rather than complete rest, which I know you wouldn’t recommend. :slight_smile:

In any case, generally speaking I’ll try to match the prescribed RPE, and if I just can’t muster the energy at that level for the day, I’ll decrease the RPE by 1 and make sure I’m putting in the work. I also think that more practice with RPE will help this resolve itself more or less in the long run.