Greetings from Poland!. First of all, let me say that I think you’re doing great things by sharing your combination of medical knowledge and training experience.
My situation is following: I’m a 32 y/o male, I’ve been following Starting Strength since October last year, and though I was not always Doing The Program for one reason or another I’ve had significant progress. Then in July this year, I started noticing a bit of pain and a soft mass in my navel, got diagnosed with a small hernia, and since eventually even my opening warmup weight of 60kg on deadlift caused minor pain I got it fixed on 24.10. It was open surgery with mesh, though I don’t know how is the mesh exactly positioned, onlay or otherwise. I would like to return to lifting as soon as it’s safe, but I’m facing very different recommendations:
In the discharge papers from the hospital the recommendation is lifting up to 3kg for 3 months and then up to 5kg for the next 3 months. Nothing about sports etc., and I didn’t get to speak with the doctor that wrote this.
The surgeon that did the procedure deems the hospital recommendation a bit strict, and recommends about 5 kgs now, return to light activity after 5 weeks, gym after 3 months, but only with exercises than don’t increase intra-abdominal pressure. He couldn’t say when I can reintroduce exercises that increase IAP and said that it depends on my “collagen quality”, which is unmeasurable, and to “take it slow” whatever that means.
There is a plethora of recommendations from different practitioners around the world, ranging from giving it a couple of weeks and then doing anything as long as it does not cause any pain, up to never lifting heavy again. One of the more relaxed recommendations was given here, where the doctor says 10-20 lbs for 3 weeks, and after that one can slowly build up from light weights up to whatever was being lifted before surgery.
I’ve seen in other topics that you had clients undergo hernia surgery and then return to the gym, so what is your approach? Is there any kind of a cookie-cutter strategy, or is it highly individual? What would you do? Is there any kind of research comparing recovery strategies when it comes to recurrence rates? I have tried to find something myself but I was unsuccessful.
I’m 6’3", 200lbs and have a goal weight of 225. I’ve been resistance training for around 2.5 years. The first year or so involved compound movements but had a heavy bodybuilding bias, and the next year and a half involved trying various approaches to barbell-focused training until arriving at Barbell Medicine training for the last 3 months or so. This January I was training with a program I had built that due to no RPE or RIR awareness or periodization of volume and intensity whatsoever involved a lot of fatigue and grinding. I felt a pop in the last few reps of a set of bench press, and the inguinal hernia was repaired a few weeks later. I was told I was probably genetically predisposed due to an unclosed inguinal cavity and this made sense to me.The doctors advised no exercise whatsoever for the next 6 weeks then a gradual increase in intensity, so I did as such. In hindsight this didn’t actually detrain me in itself very much, because after the 6 weeks I went right back to normal bench training and my max and working weights were roughly the same. The problem was that I took a very long time to work back up to heavy squats and deadlifts due to irrational fear of heavy lifting after the hernia, and this caused my maxes to go from 315 to 255 on deadlift and from 275 to 225 on squat. After a bit of using my own programs some more, I did the beginner prescription to get back into normal volumes then the bridge. I wasn’t seeing a whole lot of strength gain but I probably just needed more volume (I’ve been getting 8 hours of sleep per night and at least 1g of protein per pound of bodyweight as well as eating enough calories to maintain my weight). I did however gain 20lbs the summer that I did it and my bodyfat% didn’t climb a whole lot so I think a decent amount of it was muscle. I’ve been taking physical classes as part of my Fitness Technician degree at Salt Lake Community College, and while I can work with this somewhat (replace one conditioning session with my cardio class once a week etc.) sometimes my lifting class has us do surprise intense circuit workouts, and in the 6th week of the bridge, I had just done a tough training session the day before and in my lifting class we did a super difficult medicine ball circuit workout that left me light-headed. I never noticed a pop but the next few days it became clear that the bulge had returned and things like sneezing caused some pain (Hooray for beating the odds of hernia recursion! They’re apparently 1-3% after the first surgery). I plan on getting it repaired soon and I know you guys recommend keeping most training variables the same but decreasing intensity pre-surgery, but what’s your opinion on how long to wait to train after surgery? You guys seem to recommend mainly listening to your practitioner as opposed to just getting advice online from someone who isn’t your practitioner, but I tend to trust you guys’ training recommendations more than the average doctor due to some doctors overprescribing not training.
Thanks for the posts and I hope both of you are doing well.
We do not have any set guidelines for returning to training after hernia repair that we would feel comfortable doling out to the masses. That being said, a discussion with the surgeon about their recommendations and the risks/benefits of engaging in resistance training at various time points, e.g. 2 weeks, 4 weeks, 6 weeks, etc. would be beneficial to determine the risk vs. benefit to you, the individual. These may be different based on the type of repair, medical history, previous training, surgical complications, etc.
Recurrence rates are independent of activity types, in general, as other risk factors are more important. That said, there’s no data on different types of exercise post inguinal hernia repair that I’m aware of.
Tl;dr- We don’t feel comfortable recommending specific actions other than discussing the risks vs benefits with your provider. If it were me, I’d probably try doing some upper body work 1-2 weeks post op and try doing some lower body work at ~4 weeks. This probably wouldn’t be full-ROM squatting with a barbell, however.
I understand. If it would help in any way to clear things up, I don’t have much of a medical history, just some URIs. I had a <1cm defect, the position of the mesh is onlay (just under the muscle fascia) and there were no complications.
When it comes to exercise selection - what upper body exercises would be ok, and what to avoid in the beginning? Is bench press fine to start with? What about OHP? I would guess barbell row is out of the question for now.
What about the lower body? You have mentioned that you’d avoid full-ROM barbell squats for now, so what lower body exercises would be fine?
I would greatly appreciate your help as I’m kind of lost concerning resistance training, I don’t trust my judgment when it comes to exercise selection after the surgery I had.
Hello! My name is Alec i’m a new member thanks for having me.
I was diagnosed with 2 very small ventra hernias above my belly button and have to undergo open surgery for mesh repair or else they will eventually get bigger. Sometimes theres pain but mostly just discomfort. The surgery is on Thursday. I have been weight training for 4 years. I am 26 years old, 5’11, lean 170lbs (if any of that is relevant).
The doctors and surgeons say I will be able to go back to normal activity post recovery but does “normal” mean I can’t push hard in the gym or practice handstands, heavy deadlifts and do burpees ect?
I did my own research and found that I suffer from Diastasis RectI which contributed to the hernia. This was later confirmed by the surgeons.
Not sure how this happened I use the valsalva maneuver on all my lifts which I suppose caused a lot of abdominal pressure. I guess I mostly ignored direct core work in my first years of lifting so is it possible I was living with this for a long time and didn’t know? Either way this past year I made TVA and other core work a focus up until I found out about the hernia and DR condition.
I read that I can reverse the separation of my abdominals by strengthening the TVA. I am constantly doing stomach vacuumes, leg lifts and planks but is there a better approach to engage my TVA in everyday activity?
I’m also a singer and so I’m constantly having abdominal pressure from either signing from my diaphragm or lifting heavy in the gym. I also notice that I don’t engage my core overtime I go to pick something off the ground. I have to be hyper focused on utilizing my core to bring me up instead of my back.
I guess I am looking for some positive encouragement that I will go back to intense exercise in a few months post surgery.
Any advice on what to expect or how to not have a reoccurrence or hernia somewhere else in my separated core? Or am I looking at no more PRs for strength ever again? Will I be able to at least do intense calisthenics? Also any insight on how I got ab separation as a thin healthy 26 year old or how to repair it would be appreciated. The doctors and surgeons don’t think the hernia or the DR is a big issue but I if It wasn’t for me flexing in the light in front of them they would have sent me home without any diagnosis.