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I just got back from my first day of rehab after my quad rupture. This is a huge step for me, because my steadfast rule after my first nine sports-related surgeries has always been:
- I don’t do follow up visits.
- Rehab is for old ladies.
In the past my form of rehab was to wait about 6-9 weeks after major tendon reattachment, and then just start training hard as possible again and force the joint and surrounding muscles to keep up. Guess what? IT FUCKING WORKED! It’s what I call Paleo Rehab, it’s what a caveman would’ve done if he had major surgery. He would probably wait until he could walk again and then he would go HUNTING, or he didn’t eat! He wouldn’t worry about those tiny supporting muscles and connective tissue, imbalances, flexibility, future health, the mind body connection . . . BECAUSE HE JUST WANTED TO EAT A MASTADON!
So, I sat there while I got a mild electronic charge of stimulating current shot through my knee, with a side order of a hot thing that sat on top. I was then put through a series of exercises that were so mild…I couldn’t feel them. Truthfully, getting in and out of my wife’s Volvo requires way more muscle, effort and flexibility, so I should just do that about 20 times instead. The therapist was telling me how we were working the small muscles that help keep things stable and blah blah blah…
I said “I ONLY TRAIN THE BIG MUSCLES BOY!” I didn’t become the dominator by training small muscles dammit!
Now I’m on the fence about what I’m going to do about this rehab bullshit. I basically have to jump through hoops just to get out of the gym to get to the rehab place. Should I just go all Paleo and use my strength training instincts?
So stay tuned my little Pulcimaniacs and see if Uncle Steve can bull his way through his own rehab with total disregard of the advice of doctors, friends and family without ending up with a permanent pimp walk.
PDF 
Steve Pulcinella has been passionately strength training since he was 13 and competing in strength athletics ever since the age of 14. Fueled by his early influences of Strength and Health Magazine and the Wide World of Sports airing the Worlds Strongest Man, he strived to build the biggest and strongest body that he possibly could. He started out as a powerlifter and progressed into doing strongman. His biggest pro strongman title was the 1993 North American Champion and he was selected as a competitor in the 1994 Worlds Strongest Man Contest. He has also been a Highland Games Professional since 1994 and still competes as a top ranked master competitor. He also started Iron Sport Gym in 1995. It is a commercial gym in Philadelpia specializing in strength training, powerlifting, olympic lifting and strongman. www.ironsport.com
View Steve’s Training Log 
Steve,
Just a thought, if this is your 10th “sports-related” surgery it might be time to try a different approach to rehab. Perhaps it might be beneficial to follow through with this rehab protocol… even if only to compare the results to your previous “Paleo Rehab” strategies.
Either way, I wish you a swift recovery.
Good luck!
What’s the worst that could happen…
Mike posted exactly what I was going to say. For someone who has been injured so often, yet never done rehab, maybe it’s time to give the whole rehab route a try. Best of luck.
Ha, ha – funny as ever, especially the line about the pimp walk. On a serious note, good luck with the rehab whatever option you choose to take.
I hope I make it out to your gym someday. It sounds awesome. Hope you have someone to help with the everyday stuff.
As far as rehab goes I’m no expert. You’ve had 9 successful surgeries so you probably know a bit more than me but I have had 1 and it was a surgeon who works on pro athletes. He told me an I verified it takes 75 days to reach full tendon integrity and depending on the severity of the damage to the tendon you may need all 75. Up to that just stim and no weight movement. Why train a muscle with weight before you have the full ROM back. Thats step 1 and that takes like 1-2 months. Also cave men did it cause they had to,then again maybe the woman just picked up the slack.
You said your competitive days are over (probably an exaggeration because every time you pick up an object its a competition with yourself) so play it conservative you’ll get back. I’d talk to some bodybuilders that’s the people who experience this most.
Your looking at 9months – 1yr to get back safely. I’m at 8 months dead stronger squat 5wks from peak bench still down but respectable. Could I have chanced it yea but why ill be better than ever here in a bit.
Maybe you should talk to mike Robertson. he has a great reputation as a knee guy, knows a thing or two about strength sports and he might give you a team elitefts discount
Steve,
I’m a powerlifter and a Registered Nurse. I’m as bullheaded as you are, but to be honest it would be a good idea to do the rehab. Often times we don’t want to do it, but those guys know what they are doing for the most part. I used to fucking hate mobility work, but now realize after 20 plus years that it is important and how I wished I would have done it in the past because my flexibility is for shit. I have a feeling from an educated opinion, that if you don’t do it, in the future you will have wished you had.
I fucking loved the planet fitness parody commercial. Laughed my ass off. I hope you decide to do the rehab dude.
Chuck
I vote find a physical therapist that works with athletes and may be able to cater to your abilities. I worked with a fair number of PTs who were great with hip and knee replacements but would then give the same program to a 25 year old rehabing an ACL. Just figure out what clinic local sports teams or colleges refer to, it’s usually a good start.
Mr. Pulcinella I also take your article as 100% serious and have well-meaning advice to offer.
I’ve played football and have suffered one serious separation and one minor (opposing shoulders), went to rehab and did that whole shabang. My shoulders would get aches sleeping on it or doing moderate weights for about 2 years.
Got into powerlifting and the pain was gone after 3 months of training. I’m with Steve on this…but im sure a little rehab thrown into the mix wouldn’t hurt.
Why not do both?
The reason for all my injuries wasn’t my lack of rehab it’s because I have always trained and competed with wild abandon like a maniac. Every surgery I have ever had I have come back from with full ROM, just as strong and MUCH faster than standard protocal. Am I impatiant? You bet I am. At the time I was making a lot of my money competing so I NEEDED to get back quickly.
For those of you that have never tried them, the highland games events are just awkward and stressful on the body, its nothing at all like lifting weights in a gym. You are spining a 300lb body, holding a 56lb weight as hard and a fast on uneven grass and mud surfaces. A lot of things can go wrong and sometimes you get hurt even when things go right. Hell, back in 1999 I was warming up and another guy was near me warming up and the hammer he had in his hand came apart and hit me in the leg shattering my tibea. Shit happens.
Check out Matt Kroc’s article on tnation about his rehab experience, it’s basically what I have been doing after a hamstring graft for my shoulder’s AC joint reconstruction. My surgeon who works with professional athletes said I could stop therapy and continue strengthening on my own (even though that is what I’ve done all along). 12 weeks out, so far so good. I’m moving more weight every week. http://www.t-nation.com/free_online_article/most_recent/a_ballsy_approach_to_injuries
I’m not sure the paleo logic really applies to rehab. Cavemen wouldn’t have got surgery and then just started hunting like you describe. They would have NOT got surgery since there were no doctors and then just died when the injury didn’t heal.
Surgery is a modern invention so applying “paleo” to it doesn’t really make sense IMO.
Steve,
Mark Rippetoe has a video in his starting strength series where he interviews John Wellbourn (former eagles lineman) about the rehab of NFL players after surgery. It may not have delivered the best long term results but those guys don’t fuck around, body weight on it the following day and back in the gym in 48 hrs. John talks about how he was injured on Sunday had surgery on Monday, missed that weeks game but played the following week. You are still an elite athlete and the run of the mill rehab for an average sedintary couch potato probably isn’t going to cut it.
Dude Really?
Mark: I’m not sure the paleo logic really applies to rehab. Cavemen wouldn’t have got surgery and then just started hunting like you describe. They would have NOT got surgery since there were no doctors and then just died when the injury didn’t heal.
Surgery is a modern invention so applying “paleo” to it doesn’t really make sense IMO.
Call Charlie Weingraff: Training = Rehab; Rehab = Training. They go together, but obviously it wouldn’t hurt to put some science behind your methodology. I am biased, being a P.T., but I didn’t spend 7 years getting a doctorate for someone to come in my clinic 1 time and call it BS. There is a process to recovery. After 10 times I would think you had learned, but I am just a weak, dumb P.T. What do I know?
For what it’s worth, I tore my miniscus and the doctors all told me I had to have surgery, saying that was the ONLY way it would heal; I blew them off, did lots of squatting and rowing and it healed on its own. Now if only I could figure out how to fix plantar faciitis I’d be in ship shape.
Thanks for all the great articles, Steve!
Charlie Weingroff? From what I can see on facebook he obsessed with comic books, disney characters and thinks pro wrestling is real. I have science behind my rehab. I know which way I want my knee to bend and i’m going to fucking force it to bend that way whether it wants to or not. What could possibly go wrong.
Eveyone keeps forgetting, I am sequestered at my job from 12-14 hours a day, every day. I don’t have the luxury to just leave and go to appointments. And no, I never leave here.
Mo: Call Charlie Weingraff: Training = Rehab; Rehab = Training. They go together, but obviously it wouldn’t hurt to put some science behind your methodology. I am biased, being a P.T., but I didn’t spend 7 years getting a doctorate for someone to come in my clinic 1 time and call it BS. There is a process to recovery. After 10 times I would think you had learned, but I am just a weak, dumb P.T. What do I know?
Just like coaches and trainers have varied skill sets and backgrounds, so do rehab professionals.
Find someone that speaks your language and truly understands the stress that you ultimately want to put on your body.
This might be tough however….best wishes for a speedy recovery!
Hey Steve, Me- Complete patella tendon rupture, did the Dr recommended PT along wi th advise from Harry Selkow.
But, now have been using stuff Jesse Burdick recommended. I’m gonna go balls out soon myself. I think, instead of you stopping the ‘fluffy’ PT and going balls out.
Maybe transition to sled, TKE, ect..and more aggressive stuff Jesse might suggest(whatever your injury needs are) for a little…….and then ofcourse..GO BALLS OUT AND GO FREAKIN CRAZY. Just get hold of him, I know you can…..(I’m a FB stalker, HA.) Good luck.
hi steve on your article:
i dont believe in traditional rehab. im train whit tons of grade students and no pro sportpeople and i see no major defrerence beetwen rehab and no rehab. mayby becouse the long time that involve the rehab procese produce a detraining atrofy. okey is good to be in sauna, masages, hot-cool showers, or another form of therapy, but i think you are on something whit “paleo rehab” becouse you force the adaptation and finaly thats is what excercice is…to mantein to recuperate o to go beyond the actual state of perfom. if you take bigger muscles or small muscles or do the rehab to recuperate the movility cant do apart the strenght. its all depends of your adaptability, sport and perform background, will, desire, support. etc.
best wishes.
pd thanks for the article
http://charlieweingroff.com/
Check him out…He thinks the way you do…From a training perspective. There is a lot more to rehab than small muscles and bending knees. But, it sounds like you have made your decision. In theory, you’re right. The knee is mostly a hinged joint. You are strong so you obviously understand that to squat takes more than the quadriceps muscle group. You have dedicated yourself to a craft…as have I. We each know the intricacies of our craft. I can teach an 80 year old with a stroke to walk again or a football player how to sprint faster. They use the same muscle groups, only differently. I m not saying YOU need a therapist, at least not physical, maybe other kinds, Ha. You’re lumping an entire profession into one garbage can. Like me saying everyone that benches over 400 is on steroids. You going in for one session and being done is like a 500 lb man going on the Biggest Loser and quitting after day 1 cause he didn’t lose weight. It’s all a process. Im not trying to push your buttons. Just giving my perspective.
this is something i did for my acl tear reconstruction in my right knee. every week in rehab i made progress, not because of the bullshit these specialists had me do. i was pulling a homemade sled and walked with that, did body weight squats,and lunges. all were progressed by how my knee felt.
The rehab stuff sounds a bit wishy washy, I’m sure it works generally but you’re not exactly an average Joe. And are mild electrical currents really that effective as strength enhancers? They obviously work a bit but I’m yet to see an “electrocute yourself to a bigger bench” video.
I think you should listen to your instincts and hit it hard. I love your attitude and I hope it works out for you.
I have huge respect for you steve, but this paleo rehab is insane BS.
The only problem with rehab is that they are not used to trained athlethes that handle way more stress.
A reattached tendon needs slowly increasing resistance for the inferior tissue to adapt and reorganize – waiting without resistance and then going nuts is the worst one can do you are lucky you didn’t suffer from more injuries.
A challenging rehab is the only way to go, you should be intelligent enough to do it on your own, so skip the appointments. But time and patience is essential for quality tissue and a good healing!
You don’t put 500lbs on the bar if someone comes to your gym who has never trained. Don’t put excessive force on tissue, that has never had stress.
The average life expectancy of a caveman was sixteen years. If said caveman sustained an serious injury he’d die of thirst within a few days. Doing something simply because it’s what a caveman would’ve done is retarded. We’ve moved on in the previous 26000 years.
Steve: Yes really.
What you’re doing may be a good idea, or it may not be. But doing it because “it’s what a caveman would’ve done if he had major surgery” makes no sense. Cavemen never had major surgery so you have no idea what they would have done. Indstead, as N. E. Anderthal says, when they got injured they just died instead.
Steve,
The paleo approach might work if you had the life span of a caveman (early 30′s). By now you would have been taken out by a snow leopard or infected tooth!
its obv Steve…some of these guys just dont understand you…Give it hell brotha..
Estim is not made to build you back up to your prior strength levels. Your quad is inhibited and atrophied because it ruptured. The estim should be used to help you build back voluntary control of it. It has its place, but can be overused. Once you can do a straight leg raise with your knee locked out, you don’t need it anymore.
It’s been said already, but it does sound like you need to find a PT who works with high level athletes. Putting a hot pack on top while getting estim sounds hokey (because it is).
Rehab is not protocol-driven, it is patient- and therapist-driven.
I’m a sports medicine physician, and I would say about 75-80% of physical therapists out there in the community do not rehab athletes appropriately. They treat most people like 90-year-old debilitated and frail, osteoporotic, senile, sedentary ladies.
I’ve gotten to know the therapists in my community who know how to push an athlete of high physical preparation appropriately. Hopefully your doctor can redirect you if the PT is not being paced in a manner that’s right for you and your goals.
Give the therapist a few visits to crank it up a bit, and if you feel that it is not coming along, discuss with your doc.
Evan
I am getting more and more angry as I read the replies.
Since when did the Elitefts readers become a bunch of wussy bookworms?
I can defenately see where Steve is coming from. If you have taken the time, to read a bit about steve you would realise he is no ordinary dude, who no doubt knows his body, its limits and how it reacts to certain stimulus. Sure rehab has its place, but does that mean we have to permanently ditch the squat rack for a wobble cushion?
Come on guys man up!
And btw I’m pretty sure there was an element of sarcasim in Steve’s article to make all of you bite…. and you did. =)
Steve, I was in your same shoes with a 100% rupture of the quadriceps tendon. While I agree with you that most rehab outfits will not realize what it feels like under a loaded bar or your anxiousness to get back under the loaded bar you must work toward getting that full range of motion back. They probably had to shave the tendon a bit to get it reattached and you will have lost flexibility in that knee. It will take a while to get that back. meanwhile work aggressively but cautiously. Hopefully that last statement make sense to you. So yeah, screw the little muscle routine, work hard and get that range of motion back. Best of luck to you, William
God you are a scholar….I love it. I pooped a stink nugget in my pants at work from laughing so hard when I read this.