Bouncing back from Sickness & Injury

Embracing the Concept of Creeping Incrementalism

As a competitive athlete with 60 years in the saddle, I have dealt with my share of injuries, mild to career-ending. I developed strategies to accelerate my own recovery. My prescriptions for rebounding from my own injuries proved effective for other athletes and those recovering from illness and surgery. The overarching strategy is to strengthen the musculature, improve stamina and endurance, and manipulate body composition via the expert use of regular food.

The key idea is creeping incrementalism: start with what you can do today, then nudge it upward, ever so slightly, next time. If a battered body can do one technically sound rep, one careful walk, one short session, that becomes the jump-in point. Next session, we improve it by a hair.

Don Berry’s Rebuild

Most recently, my training partner, Don Berry, had to have a considerable amount of his intestines removed. For six weeks leading up to surgery, he was not allowed to eat solid food. The medical professionals indicated that, post-surgery, it would be six weeks before he would be able to work. He dropped in bodyweight from 200 pounds to 170 pounds in the no-food lead-up. The surgery was successful.

To make a long story short, because he was strong and resilient going into the surgery, instead of being out of work six weeks, he was out of work one week. Ninety days post-surgery, Don bench pressed 235 x 5 and deadlifted 405 x 3. This was roughly 98% of where he was prior to surgery.

That is Don’s story, not a universal medical timetable. A return from surgery, sickness or injury must be cleared and guided by the appropriate medical professionals. Don’s case illustrates what can happen when a strong, disciplined man rebuilds carefully with progressive resistance training, cardio, nutrition, and patience.

In Don’s case, the severe deprivation leading up to the surgery and the post-surgery combination of progressive resistance training, power nutrition, and sustained-strength cardio drills created what I would call an extended anabolic burst. This is old-school strength language, not medical terminology. An anabolic burst is a perfect storm of exercise and nutrition. If a delicate balance between resistance training, cardio, and nutrition is attained and maintained, physical synergy occurs and results can exceed realistic expectations.

The success of an anabolic burst is dependent on the depth of the depletion headed into the supercompensation phase and the skill with which the post-surgery, post-rehab phase is undertaken. You can’t get much more depleted than not eating solid food for six weeks.

• Kettlebell drills were used to create a cardio effect three times a week.
• The Core Four lifts were done on Sunday, with light dumbbell benching and arm work mid-week.
• Exercise volume and intensity post-surgery were purposefully low; each week volume and intensity increased.
• Food volume post-surgery was purposefully low; each week volume was increased ever so slightly.

In 90 days his bodyweight shot back up to 200, 10 pounds a month for three straight months. The principles Don used can be adapted by serious trainees recovering from severe injury or illness, but only after medical clearance and with intelligent scaling.

Build Back Better, One Measurable Step at a Time

The goal is to rebuild and re-strengthen a battered and weakened body. In addition to rebuilding and strengthening, non-existent cardio capacity needs to be rebuilt. To support healing, growth, and recovery, nutrition underpins the consistent exercise effort. Food and exercise are synchronized.

Precision nutrition supports the process. Conversely, poor nutrition is like a boat anchor dragging down the exercise and recovery efforts. One ironic advantage to being completely broken down and out of condition is that, handled right, progress can occur rapidly, steadily, and readily. What is the magical prescription, the remedy that jump-starts the process?

The Three Core Disciplines

Three separate and distinct strategies are used for three separate and distinct disciplines: resistance training strengthens a weakened body; cardiovascular training rebuilds non-existent aerobic capacity, endurance, and stamina; precision nutrition provides the body with the nutrients needed to support recovery and fuel new muscle growth.

The expert combination of the right exercise dose, underpinned with quality nutrients ingested in appropriate amounts at the right times, supports the healing and rebuilding process. What is the proper exercise dose? What is the definition of quality nutrients? And what are the right times to ingest these quality nutrients?

Each of the three disciplines needs to be put in place and pursued simultaneously. Periodized resistance-training and cardiovascular-training programs are created. Nutrition is synchronized with the training. When all three elements are in place and practiced with the requisite regularity and intensity, a physical synergy can occur. There are different flavors of Don Berry’s anabolic burst.

Logging Results Builds Enthusiasm

Logging results: workout results need to be logged. Each successive week, the goal is to exceed the previous week’s exercise benchmarks and attain the specified bodyweight goal. Once columnized categories are established and weekly results logged, the trainee has benchmarks to improve upon. Decades of empirical experience working with the injured and the health-afflicted have enabled us to devise a strategy for having the trainee “buy into” and become excited by the process.

Enthusiasm for the process occurs when the afflicted or injured obtain tangible, measurable results on a consistent and recurring weekly basis. Nothing fires up a trainee’s enthusiasm like consistent weekly increases in strength, measurable improvements in cardio capacity, and the consistent attainment of weekly bodyweight goals. Enthusiasm for the process is regenerated on a weekly basis as results are logged and limits exceeded.

Resistance training sets, reps and poundage are recorded; bodyweight increases or decreases are noted; cardiovascular stats, often generated by a heart-rate monitor, are logged. The idea is to create a wide range of expectations, all obtainable, all slightly more than the previous week. The periodized elephant is eaten one bite at a time.

Exercise Jump-In Strategies

The comeback trainee needs a jump-in point. The jump-in point is not what you used to do. It is not what you wish you could do. It is what you can perform today, safely, honestly, and repeatably. Once the jump-in point is established, the entire process becomes wonderfully simple: improve slightly, log it, recover, repeat.

Walking Comes First

The most elemental form of cardiovascular exercise is walking. This is often the first exercise for the injured, or for those coming off surgery or illness, when medically cleared. Walking is underrated as an aerobic exercise. The overweight, out-of-shape and unfit can sometimes generate a high heart-rate response simply by walking with purpose, intent, and coordinated arm motion. Don’t just carry your arms around when walking; make them help power the effort.

Transform mall walking into power walking. If you can walk, make walking the entry-level cardio exercise. If, by way of example, on day one, session one, you can walk four minutes to the end of the block before tiring, turn around and walk back home. Your cardio jump-in is 8 minutes.

In session two the next day, you can either walk faster, go to the end of the block and back in less than 8 minutes, or extend the duration: walk for five minutes, then turn around and walk back, creating a 10-minute elapsed time. Increase the walking pace or increase the duration, and do so ever so slightly every session. This is the definition of creeping incrementalism.

Resistance Training Jump-In Strategies

There are strategies for implementing resistance training for those who cannot lift the lightest dumbbell. There are four key resistance-training exercises that need to be practiced: squat, bench press, deadlift and overhead press.

The first rule is to earn everything. Start with a shortened range of motion, reduced payload, elevated implement, assisted variation, or bodyweight version. Do not force the body to a range, load, or intensity it has not earned.

Squat

• Partial repetitions: how does a person who cannot squat down and stand up once under their own power create a squat regimen? The trainee begins by standing erect and assuming a shoulder-width squat stance. Allow the hands and arms to rise up and forward as a counterbalance as you squat down with control. Lower to the point where the first hint of discomfort appears. Reverse direction. Do as many repetitions as you can. Even if it is a single repetition, that becomes your jump-in benchmark. The goal is to try to add a single partial repetition per session. When you can do 10 reps, start anew with 2 sets of 7 reps. Build that to 2 sets of 10. Now 3 sets of 7 on the way to 3 sets of 10. With each session, that stunted range of motion will naturally increase. Optimally, you work up to 3 sets of 10 reps, using a deep, pain-free, controlled range. Then you are ready for kettlebell goblet squats.
• Lighten the weight of your torso: another way for those coming off injury or debilitating weakness to get leg strength back is to lighten the payload of the body as you squat. There are several ways to do this: using a suspension trainer such as a TRX or CrossCore allows the squatter to pull upward with the arms during descent and ascent. This tactic reduces the squatter’s payload, thereby enabling the weak to attain deeper squat depth and perform more squat reps. Those lacking a suspension trainer can create their own version by looping a rope over a chin bar or simply tugging upward on a door frame or pole while squatting.

Bench Press and Overhead Press

• Incline pushups to pushups: the entry-level pressing exercise for those in recovery is the steep incline pushup with no added weight. Think of doing a pushup while standing up and leaning forward while planked. Position yourself 2 to 3 feet from a countertop, place your hands on the edge of the counter and inhale as you break the elbows and lower the torso to the counter. Hold for a beat before pushing erect. Exhale as you push to a full and complete lockout. The higher the push surface, the easier the pushing. Over time, increase reps and lower the push surface until you can perform classical floor pushups. The transition is gradual: work up to 3 sets of 10 reps at a particular incline height, then lower that height a few inches. Jump in at the new, more difficult, lowered surface with 3 sets of 5 reps. Over time, work up to 3 x 10. Lower yet again. Once on the floor doing pushups, start off doing pushups on the knees before graduating to pushups on the toes. Once pushups have been mastered, begin light dumbbell work.

Deadlift

• Partial sumo deadlift: the ability to bend over or squat down and pick up objects, some heavy, is a critical aspect of life and living. The deadlift, done right, teaches the ideal biomechanics for hoisting objects. Whereas in the squat the payload presses downward, in the deadlift the trainee pulls the weight upward. The best entry-level exercise for those enfeebled or brand new to progressive resistance training is the partial deadlift done using a sumo-stance technique. A kettlebell, dumbbell set on its end, paint can or case of bottled water can provide the payload. The payload is elevated to shorten the rep stroke. Assume a sumo deadlift stance, torso upright, shins close to vertical, and squat down to the payload. Do not bend over to grab it; squat down. Once the elevated kettlebell, dumbbell or weighted object is grasped, stand straight up. Inhale at the top of the rep, exhale as a rep approaches lockout. Think of the sumo deadlift as a reverse squat. Jump in light. Establish perfect technique using a short rep stroke. Over time work up to 3 sets of 8 reps. When 3 x 8 is attained with a particular poundage, increase the length of the sumo rep stroke by lowering the support. Eventually the trainee is performing 3 sets of 8 reps with the payload on the floor. Make haste slowly.

Equipment Notes for Rebuilding Strength Gradually

Recovery training does not require exotic equipment. It requires tools that let the trainee start where they are, control the range of motion, and progress in small measurable jumps.

For gradual strength rebuilding, lifters and facilities can compare kettlebells, dumbbells, weight benches, power cages and platform racks, Olympic weightlifting bars, and weight plates.

A simple rebuilding setup might include IRON COMPANY urethane kettlebell sets for goblet squats and partial deadlifts, the PowerBlock Elite USA 90 adjustable dumbbell set for controlled dumbbell work, and a rack / bench combination such as the Body-Solid SDIB370B bench and squat rack combo when it matches the lifter, room, and intended loads. More advanced rebuilding can use a bar such as the Iron Grip Competition Series 20 kg needle bearing bar only after technique, clearance, and strength have returned.

The equipment does not create recovery. The body, the medical clearance, the plan, the food, the logbook, the patience, and the creeping incrementalism do that.

Safety Note for Recovery from Surgery, Sickness, or Injury

This article preserves Marty Gallagher’s RAW recovery philosophy and firsthand experience. It is not individualized medical, surgical, rehabilitation, nutrition, or programming advice.

Anyone recovering from surgery, serious illness, significant injury, intestinal surgery, major weight loss, hospitalization, infection, cardiovascular symptoms, neurological symptoms, uncontrolled pain, wound complications, or medication changes should follow medical guidance before increasing activity, lifting, walking intensity, food volume, or bodyweight goals.

Stop or scale back for chest pain, faintness, dizziness, unusual shortness of breath, wound pain, new swelling, fever, sharp joint pain, numbness, abdominal pressure, bleeding, loss of coordination, repeated technical collapse, or any symptom that differs from normal training discomfort.

Creeping incrementalism means progress slowly enough to heal. It does not mean forcing a comeback on a medical timetable the body has not earned.

Related Recovery Reading

For another recovery-focused IRON COMPANY article, read Training Recovery Acceleration Therapies.

RAW with Marty Gallagher, J.P. Brice, and Jim Steel Podcast.

About the Author: Marty Gallagher

As an athlete Marty Gallagher is a national and world champion in Olympic lifting and powerlifting. He was a world champion team coach in 1991 and coached Black's Gym to five national team titles. He's also coached some of the strongest men on the planet including Kirk Karwoski when he completed his world record 1,003 lb. squat. Today he teaches the US Secret Service and Tier 1 Spec Ops on how to maximize their strength in minimal time. As a writer since 1978 he’s written for Powerlifting USA, Milo, Flex Magazine, Muscle & Fitness, Prime Fitness, Washington Post, Dragon Door and now IRON COMPANY. He’s also the author of multiple books including Purposeful Primitive, Strong Medicine, Ed Coan’s book Coan, The Man, the Myth, the Method and numerous others. Read the Marty Gallagher biography here.