Maintaining Your Lower-Body Strength After Tommy John Surgery

STACK Expert Mo Skelton suggests what to do if you want to maintain strength while you recover from a serious injury.

When you're recovering from an injury, it's important to focus not just on the site of the injury but also on your overall body weight and the strength around your healthy joints. After a significant upper-body injury that requires Tommy John surgery and some kind of immobilization in a sling, cast, or brace, exercises such as jogging, sprinting, Pull-Ups, Push-Ups, CrossFit and Olympic lifts are out of the question for awhile. It takes about two months of recovery before you can really begin to Squat, and even longer before you can do Pull-Ups, Deadlifts, Bench Presses and Cleans.

If you want to maintain strength during this interim period, here are some things you can do while you recover.

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1. Lifestyle Changes

  • Get enough sleep.
  • Turn your phone off.
  • Maintain proper hydration and nutrition.
  • Get the advice of a registered dietitian.
  • Manage the pain, swelling and inflammation related to your injury.
  • Try a HyperIce unit.

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2. Exercises

Go with some simple movements for balance and mobility.

  • Toe Walks: Walk on your toes forward, backward and sideways for 20 yards.
  • Heel Walks: same as above on your heels.
  • Monster Walks: Legs straight, kick up and then step forward.
  • X-Band Walks: Band twisted into an X around your waist and stabilized on your feet. Take big steps sideways.
  • Hip Up Out Down: As if you were stepping over a 2- to-3-foot hurdle sideways, raise your hip and knee up out to the side and down over the hurdle.

3. Progressing Without Resistance

  • Create Tension: Contract your muscles as forcefully as possible to gain as much strength as possible. Even when doing a knee extension, fire your quads as strongly as possible.
  • Maintain Time Under Tension: Create tension. Focus on your pace, pause at the contracted portion of the lift and slowly return to the starting position.
  • Do Tempo Periodization: Understand the need to be under control and safe in the acute phase. During this period, your tempo will be slow and safe.

In the intermediate phase, as you add resistance, you can increase the pace. You're not ready for plyometric activities, but an increase in pace will prepare you for those movements. In the final phase, you can begin a more typical strength training program and add fast twitch movements and plyometrics.

4. Workout Programs

Acute Phase

These exercises are best done the first month to six weeks when you are in a sling or an immobilizer. Machines that isolate muscles come in handy and are often necessary after an injury.

  • Leg Extensions - 3x20
  • Seated Hamstring Curls - 3x20
  • The Abductor and Adductor machine, seated or standing - 3x20
  • Leg Press: If your shoulder is the problem, stay light. Start with a high rep range and progress to 5x5.
  • Tabata intervals (maximum effort for 10 seconds followed by 20 seconds of rest) on an elliptical machine, stationary bike or walking on a treadmill. Jogging is not safe early on, as it could lead to a fall and a re-injury. Also, the pounding of the movement can increase swelling and pain, which can slow down the healing process. Stay low impact early.

Core Stability

Core exercises can begin early with assistance and under control. Perform all in sets of 20 repetitions. Once you're able to add resistance, drop your rep scheme to 3x15, then 3x10.

  • Floor Wipers: Do these without holding a barbell. Control the pace and amount of movement to challenge your core.
  • Russian Twist on the floor or exercise ball: twist your torso while keeping your upper body stable.

Hip Thruster Progressions

  • Two Legs to begin, without resistance.
  • Single Leg, adding ankle weights for strength.
  • Full Hip Thrusters with a barbell on one and two legs for strength (get a partner to help you load the barbell). For safe set-up, max effort and resistance, do not begin until you are cleared to progress to the final phase.)
  • Stability Ball: Another good way to train early and strengthen your core. Perform high-rep sets, up to 50 reps.
  • Marching in Sitting: Sit on the ball and slowly march your knees up and down.
  • Straight Leg Raising: Supine position (back on the ball, feet on the floor).
  • Supine (back on the floor): Single-Leg Bridging, Two-Leg Bridging, Leg Curls.

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Intermediate Phase

You should be feeling better, hopefully off pain medication. Swelling is more controlled in the injured area. It should be safe for you to try more activity, and your balance is better. Begin this phase after you have spent four to six weeks on the machines and progressed to core exercises.

  • Squats with a dip belt: Gradually add resistance. Work from 3x10 to higher resistance with a rep range of 5x5.
  • Cossack Squats: Do the same with this variation. This movement requires you to get in a wide stance, then squat down to the right as deep as possible on that side.

To work on mobility, perform either of these on steps or boxes to increase the distance traveled.

  • Rear-Foot Elevated Squats: One foot on the ground and the other propped behind you on a bench. This is a great mobility and strengthening exercise.
  • Lunges
  • Pistol Squats: A Single-Leg Squat with the leg "not squatting" held to the front. Hold onto a squat rack with your strong arm for support.
  • Single-Leg Romanian Deadlifts: Initially they are a good balance activity and can be progressed to a strengthening exercise as you can hold more weight or wear a weighted vest.
  • Step-Ups: Another functional lower-body strength exercise.

Final Phase

The time frame for this is a general guideline based on what you can do with your upper body. After major surgeries, it's usually beyond 4 months; after a fracture, it's 6 to 8 weeks. In the final phase, resume plyometric activity, sprints, loading the joint while squatting or beginning to deadlift. It is essential to work with a trained professional guiding you on safe progressions and amount of resistance. For some problems squatting is fine, but deadlifting is dangerous. Get help to get back on the field or the court.

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Photo Credit: Getty Images // Thinkstock

Topics: LOWER BODY | REHAB | MOBILITY | EXERCISE | TRAIN | INJURY | BARBELL | LIFTS | STANCE | RECOVER