It is now nearly 10 weeks after my complete, laparoscopic hysterectomy, and I figure it’s about time for an update on my progress! When I last wrote, it had been about a month, and I was working on following my own fitness plan. (If you haven’t read that post, you can find it here.) My goals at that time were to do what I could to maintain healthy habits and to preserve as much strength as I could without compromising healing. The plan was to do a bands-based resistance program and daily walking. Today, I’ll discuss some overall impressions and get into the weeds a bit about where I’m at with lifting. I’ll do a separate post about my ongoing efforts to return to running.
So, how did the plan go?
During that first month of exercises (post-op weeks 3-6), my strength and endurance varied quite a bit from day to day. Some days I felt great and had to force myself to keep things easy, other days, all I could handle was lifting up and washing the dishes in the sink. I did my best to honor the time I needed to rest. There was one week when I seemed tired all the time, and I wasn’t sure if that meant I’d been overdoing it or if it was something else going on. I rested a few days, and then I returned to my resistance bands and walking but with reduced volume. For several days there, I was tired before I got started but found that a little movement helped my mood and energized me, which reinforced that those were the right decisions.
For the most part, pain continued to not be a major concern. I had some discomfort for sure, but it was most often a generalized achiness, especially on the right side of my abdomen, rather than sharp pains. Bending over at the waist and pushing/pulling heavy objects were the most-limited movements, giving me the immediate feedback that I was still healing inside. Sometimes I thought some activity I’d done had exacerbated the aches, but plenty of times I couldn’t correlate the pain to any particular increase in activity.
The only time I had severe pain, it was while I was out wandering through a neighborhood garage sale with my husband. I hadn’t done anything strenuous in the previous 24 hours or so, and suddenly, every step resulted in a tearing feeling in my side. It completely stopped me in my tracks and brought tears to my eyes. We very gingerly walked home, with shallow, baby steps so I wouldn’t jostle my insides any further, and I laid down on the sofa for the rest of the day. This happened to be only a couple days before the 6-week post-op appointment with my surgeon, so I mentioned it to her at that time. Her hypothesis was that it was “scar tissue disease” that had formed and was being pulled and separated again, causing the tearing feeling I had. Her response to this surprised me–she advised me to stay as active as possible. She didn’t want scar tissue to limit my activities down the road, so the more I can prevent these tissues from sticking and forming together, the better off I’ll be long term.
Back to the gym
At that 6-week appointment, my doctor released me to “gradually return to regular activities.” She made it clear that she didn’t want me holding back too much, as that would slow down my progress. “You can’t hurt anything now,” she said after examining my vaginal sutures, which were apparently healing as expected. So, I left the appointment with her blessing to get back to the gym, to do all the stretching, twisting and bending that I felt ready to do.
I have been back to lifting for a little over 2 weeks now. I decided to go with a 4-day upper/lower split program that I’ve done before. I’ve modified the lifts to avoid undue abdominal pressure (no push-ups, planks, or similar poses). I wasn’t a great squatter before the surgery, but now I’ve gone back to light goblet squats just to parallel. I’m trying to feel out how my pelvic floor responds to the increased loading. As far as I can tell, it’s going ok, although honestly, there isn’t an obvious way to measure it.* My surgeon informed me that my pelvic floor was “more pliable than predicted,” given that I have never been pregnant. She did not know if this was due to my being a lifter or to my history of obesity. It’s not clear to me how careful I need to continue to be to protect my pelvic floor health going forward. And as discussed in the first post, there’s very few evidence-based resources out there to help people navigate this situation.
I’m lifting about 60% (in terms of both weight and volume) of what I was doing before surgery. My preferred programming is usually pretty high volume, and I hope to keep working on increasing it over the next few weeks. I started with 2-3 sets, and I plan on adding a set every couple of weeks until I’m back to doing 5 sets of the major lifts. Only after I get the volume up do I expect to progress the weights heavier again. I’ve dropped out almost all accessory lifts other than those I do to maintain mobility, and I’m focussing on the big, multijoint movements. Here’s how that looks:
Goblet Squat, 1×6-8, lower weight by 10%, 2xAMRAP (as many reps as possible)
Leg Curl (Machine), 3×12-15
Offset Split Squat, 3×12-15
Monster Walks and lower body mobility work
Upright Dumbbell Press, 1×6-8, lower weight by 10%, 2xAMRAP
Assisted Chin-up, 2×6-8, 1×10-12
Incline Dumbbell Bench Press, 3×12-15
Cable Row, 3×15-20
shoulder mobility work
Deadlift, 2×5-6, 1×8-10
Goblet Squat, 3×15-20
Pallof Press, 2×12-15
Alternating Reverse Lunge, 2×15-20
Monster walks and lower body mobility work
Bench Press, 1×6-8, lower weight by 10%, 2xAMRAP
1-arm Dumbbell Row, 2×8-10, 1×12-15
Arnold Press, 3×15
Palms Down Cable Pulldown, 3×15
Dumbbell Lat Raise, 2xAMRAP (up to 20)
Dumbbell Reverse Fly, 2xAMRAP (up to 25)
shoulder mobility work
The mobility work is feeling especially important right now, as it seems like I’m stiff any time I’m not warmed up. I’m hoping that feeling will decrease as I get back to the rest of my usual routines and is not a new normal. I’m aware that I’m recovering from this surgery in my forties, and older lifters are frequently discussing the increased need for mobility work to keep lifting. I’ve never been sure how true that would be for me, since these folks are usually lifelong athletes, and I’m a relative noob. I have neither the benefit of a foundation of strength, nor the detriment of a lifetime of activity-related aches and pains.
So as far as the lifting part of my recovery plan goes, I’m feeling pretty good about it. The old advice to “lift nothing over 10 pounds,” clearly wasn’t the right advice for me. I was able to do more than that after the first two weeks of total rest, and I didn’t injure myself or create problems for my healing. Even still, my muscles are acting like I haven’t lifted in two months, and I was especially sore with lactic acid burn the first week back. It’s a bit disappointing to be so stiff and sore, given I was continuing to train in some fashion for most of the last couple months. However, I’m pleased that I kept it part of my routine, so that it usually does not feel hard to get myself to the gym–that moment of “ugh, do I really have the energy to do this?!” is less common than it might have been. It’s too early to know how the hysterectomy might impact my lifting options long term. I’m considering going back to the physical therapist to have her evaluate where I’m at, to see if there’s anything I’m missing as I continue to recover. Regardless, it’s clear to me from my experience that the typical lifting advice is more conservative than necessary, at least for some of us.
*Fun fact–in research, apparently they measure internal abdominal pressure by inserting a balloon up the rectum of test subjects. Then, when they do particular lifts, researchers can measure changes in the pressure upon the balloon. For the record, I will not be signing up for this, even in the interest of science!
(You can find my post on returning to running here. Update from 1 year later on Sex and Trauma after Hysterectomy)
Marjorie Hundtoft is a middle school science and health teacher. She can be found picking up heavy things and putting them down again in Portland, Oregon. You can now read her at Progressive-Strength.com .