Modified FT after distal biceps detachment surgery

[theswami]

   

Greetings Dr. Scott,

This is my first post, but I read just about everything I can find that you post.  I purchased the FT program and have had some very good results.  I recently had a major setback.  I detached my distal biceps tendon playing weekend warrior sports and it required surgery to reattach it.  It is a lengthy recovery:  6 weeks of complete immobilization followed by 6 weeks of nothing but stretching and ROM exercises.  I cannot touch a weight or even a resistance band for a total of 12 weeks post op.  Then, I am hearing up to 9 months before I can really get after it in the gym.

I am 54 years old so at my age, I really don't have 9 months to sacrifice, but I have no other options at this point.  I have been training consistently since 1984 and was a (marginally) successful competitive powerlifter for 15-20 of those years.  About 10 years ago I had a paradigm shift and now all I care about is looking better in the mirror.  I train like a bodybuilder using the framework of those like yourself, Dante Trudel and Jordan Peters.

Here is the crux of my question.  The left side of my upper body now has severe atrophy and it is getting worse by the day.  My left arm and deltoid in particular are bearing the brunt of this shrinkage.  On a positive note, I have been crushing legs using the TURBO version and doing my best to train with only my right arm.  When I am cleared to start using my left arm again, is there a way to modify FT to focus on building my upper body back up....and perhaps even more emphasis on the left arm/deltoid so they can catch back up (if you even recommend this idea)????

Thank you in advance for your correspondence,
Jeff

[Scott Stevenson]

Greetings Dr. Scott,

This is my first post, but I read just about everything I can find that you post.  I purchased the FT program and have had some very good results.  I recently had a major setback.  I detached my distal biceps tendon playing weekend warrior sports and it required surgery to reattach it.  It is a lengthy recovery:  6 weeks of complete immobilization followed by 6 weeks of nothing but stretching and ROM exercises.  I cannot touch a weight or even a resistance band for a total of 12 weeks post op.  Then, I am hearing up to 9 months before I can really get after it in the gym.

I am 54 years old so at my age, I really don't have 9 months to sacrifice, but I have no other options at this point.  I have been training consistently since 1984 and was a (marginally) successful competitive powerlifter for 15-20 of those years.  About 10 years ago I had a paradigm shift and now all I care about is looking better in the mirror.  I train like a bodybuilder using the framework of those like yourself, Dante Trudel and Jordan Peters.

Here is the crux of my question.  The left side of my upper body now has severe atrophy and it is getting worse by the day.  My left arm and deltoid in particular are bearing the brunt of this shrinkage.  On a positive note, I have been crushing legs using the TURBO version and doing my best to train with only my right arm.  When I am cleared to start using my left arm again, is there a way to modify FT to focus on building my upper body back up....and perhaps even more emphasis on the left arm/deltoid so they can catch back up (if you even recommend this idea)????

Thank you in advance for your correspondence,
Jeff

Hey Jeff!

Thanks for posting this here on the board.

I want to make sure I'm with you here. How long ago was the actual surgery?  I'm not sure where you are in the timeline, especially along the 9 month period before you can really get after it (see below for my best guess).  

Is that a suggestion / prescription of the surgeon / PT that you spend 9 mo before going back to what is normal training for you, or is that what the average person might expect?... 

In other words, what does this "clearance" actually mean in terms of what you're allowed to do.

The below Q's are not any attempt to provide medical info. - just getting a handle on where you are... 

Also, what was the mechanism of the injury?... What exactly were you doing when it tore?...

Do you have full ROM back now?...   (I'm guessing you might be just finishing the 6 weeks of just stretching and ROM exercises and now are "cleared" to start some kind of exercise?...)

-------

First thought would be to ask your PT or find / get a referral to a PT to evaluate where you are.  I can see there is a good size and likely a huge strength differential, but I can't assess that with one pic (and legally can't delve into that from a prescriptive standpoint).

The PT may have some specific exercises that can be / should be done give the nature of your injury and how it was repaired.    

--------

As far as training completely around the injury (for back, delts and chest), you can use and Isolator fitness set-up, although it may be hard to find. (I picked one up a couple years ago, just to have it, and for variety of exercises here at home:

https://www.youtube.com/@IsolatorFitness

That should get you going with a lot of things you might not be able to do.  

You can also use (I have some vids doing this on my Instagram from a few years back) hanging abs straps (that hook at the elbows) to fabricate that same set up as the isolator. (Check out that system and you'll see what I mean). The abs straps can be used for delts and back on a smith machine, for instance.

I personally would also avoid doing alternating grip deadlifts which tend to be cause biceps tears, as well as heavy rows and deads, for just now.  (Those just tend to put a lot of strain on the biceps as secondary muscles and you'll be MUCH strong on the prime movers that that weak biceps can support.)

You can also, perhaps with use the isolator / ab straps to pre-fatigue the lats before doing any kind of compound back movement.  (Also pullovers, "stretchers" etc. can be used.)

Per your PT's suggestion, I'd also start with very high reps / light weight on the direct biceps training. (You can stimulate muscle cell growth this way but be kind to the healing tendinous insertion.)

Those are some basic initial approaches you can take, but it will largely depend upon how you are adapting.  I would be wary of any excessive inflammation / soreness. IT's not going to take much at ALL to create soreness in that biceps and since it's atrophied, it will be even weaker and more likely to be injured again (perhaps even with a mid-belly tear).  It should come back though, quite well, I would imagine, if you give it sufficient time.

Hope this helps!

-Scott

[theswami]

Scott,
Thanks for the prompt response.  Here is my timeline:

Playing a charity softball game Dec 2, 2022....reached to catch a ball with my arm fully extended as the runner collided with me and drove his elbow into my biceps.  This caused both blunt force trauma but also over extended my already extended arm and I knew right away it was detatched.  It balled up toward my shoulder and felt lifeless.  Almost a sickening feeling as it just kind of floated around under my skin.  

Fortunately I was able to get surgery on Dec 8, 2022 ... which is just about 7 weeks ago.

I was immobile until Jan 19 (6 week mark) which is standard albeit conservative compared to others I have spoken too.  So 6 weeks is generally the max you will spend immobile, which is why my atrophy was so significant.

I was told I need 5 more weeks of just PT, stretching and ROM before I can even start with any type of resistance training.  12 weeks is generally considered standard before resistance is introduced.  

Beyond that, I am not sure how long before I will be 100% but based on my google searching and speaking to others it could be 9 months to a year before I am full strength.  

My goal is simply to get my size back as soon as possible and then get back after it once I get my swagger back.

I have ZERO confidence in my PT.  The guy is probably 70 and all his patients are older than him.  He took a look at me and almost seemed embarrassed working with me.  He had me squeeze a racquetball, do so hand supination/pronation with no resistance and some air curls.  Then sit with a heating pad on my arm.  Entire PT session was about 15 mins.  I am sure he charged my insurance for the full hour.

Overall my range of motion is good.  I would say 85%.  Supination/pronation hurts a bit in the forearm area.  That is where they cut me to pull the biceps tendon down.  I have no pain in the biceps.

Ultimately, I guess what I am asking is this.  Once I am cleared to train again (at least 5 more weeks, likely double).... I want to continue FT, but I want to know the best way to modify it to focus on arms/delts because that is what has shrunk the most so far.  My legs are doing great since they are getting Turbo version tier 3 exposure while I baby my upper body.

Thanks once again for your prompt response! 

[Scott Stevenson]

Scott,
Thanks for the prompt response. 


Ultimately, I guess what I am asking is this.  Once I am cleared to train again (at least 5 more weeks, likely double).... I want to continue FT, but I want to know the best way to modify it to focus on arms/delts because that is what has shrunk the most so far.  My legs are doing great since they are getting Turbo version tier 3 exposure while I baby my upper body.

Thanks once again for your prompt response! 

Hey Jeff,

You're welcome!

Firstly, I'd try to find new PT. Maybe ask around and see if someone can take over instead of this guy.  An Athletic Trainer would be the way to go, so finding someone to pay out of pocket at a local gym / rehab facility might be worth it. 

As far as training, once you're cleared, the suggestions I made above would still apply.

*I* would avoid stressing that biceps with compound movement initially. I would train biceps  only with Pump Sets initially and eventually working toward  modified MR's with a load you can get to the 6 set in before failure - very light to start off.   

I would void anything that causes odd pains in the biceps, e.g., an overhead pressing where you can feel somethings not quite right.

I would make sure you also don't neglect the stretches (occlusion would be my preference) as well, as this will help you maintain ROM as well as improve it (the biceps crosses the should joint so stretching the biceps entails 1.) extending the elbow, 2.) Pronating at the wrist and 3.) extension  / horizontal abduction at the shoulder.  This means basically like a isolateral (one side only) pronated (palm facing backwards) pseudo chest stretch where you're focused on the biceps stretch.  

The isolator / ab strap solution I noted above could be very useful. 

There's little more I can tell you, as what you do will depend on your rate of progress... You can though do unilateral biceps work to get a solid idea of how you're progressing compared to the uninjured arm.  I would make note of that, for instance, when you start working towards muscle rounds, or perhaps in just doing a pump set in a straight set fashion (i.e., a very high rep straight set; weight used and reps being the tell-tale sign).

-S

[theswami]

Hey Jeff,

You're welcome!

Firstly, I'd try to find new PT. Maybe ask around and see if someone can take over instead of this guy.  An Athletic Trainer would be the way to go, so finding someone to pay out of pocket at a local gym / rehab facility might be worth it. 

As far as training, once you're cleared, the suggestions I made above would still apply.

*I* would avoid stressing that biceps with compound movement initially. I would train biceps  only with Pump Sets initially and eventually working toward  modified MR's with a load you can get to the 6 set in before failure - very light to start off.   

I would void anything that causes odd pains in the biceps, e.g., an overhead pressing where you can feel somethings not quite right.

I would make sure you also don't neglect the stretches (occlusion would be my preference) as well, as this will help you maintain ROM as well as improve it (the biceps crosses the should joint so stretching the biceps entails 1.) extending the elbow, 2.) Pronating at the wrist and 3.) extension  / horizontal abduction at the shoulder.  This means basically like a isolateral (one side only) pronated (palm facing backwards) pseudo chest stretch where you're focused on the biceps stretch.  

The isolator / ab strap solution I noted above could be very useful. 

There's little more I can tell you, as what you do will depend on your rate of progress... You can though do unilateral biceps work to get a solid idea of how you're progressing compared to the uninjured arm.  I would make note of that, for instance, when you start working towards muscle rounds, or perhaps in just doing a pump set in a straight set fashion (i.e., a very high rep straight set; weight used and reps being the tell-tale sign).

-S

Got it thank you.  And YES, I just got reassigned to a new Physical Therapist today.  Hopefully someone more progressive.  

[Scott Stevenson]

Got it thank you.  And YES, I just got reassigned to a new Physical Therapist today.  Hopefully someone more progressive.  

Oh, that's great to hear about the PT!  (Sounds like maybe the person you were seeing realized you could better be helped by someone else?... )

Either way, sounds like you're on the right path.

-S