I don’t wish injury on my worst enemy when it comes to the gym life, but sometimes circumstances get compromised, and you can find yourself amid a forced reality check by way of a setback.
Many things can explain the reasons for a lifting injury – you could have been using poor form, you could have been overtraining and under-recovering, or you may even be hereditarily susceptible to the injury you received.
In the case of hernias, any or all of these can be the case, so here’s a blueprint to make sure you come out on top.
First: What is a hernia?
Simply put, a hernia occurs when tissue “pushes through” the lining of your muscle fascia. This can happen as a result of weakness in the area, or from a buildup of pressure in the region due to physical exertion. Hernias can occur on various sites of the body, but most commonly to lifters are three main spots:
- Inguinal: The hernia occurs with tissue breaking through the groin fascia and descending towards the scrotum.
- Umbilical: The hernia occurs with tissue breaking through the abdominal fascia by the belly button.
- Hiatal: The hernia occurs with tissue breaking through the abdominal fascia of the upper stomach region.
In each case, you’ll notice a bulge or protrusion that, long story short, shouldn’t be there.
Hernias require surgical repair, and depending on the tissue that makes its way through your fascial lining, can be quite painful and demand immediate attention. Some hernias are of a fatty tissue omentum which is much less of an emergency than those where an organ pushes through (like the intestine).
As a lifter who’s had surgery for an inguinal hernia in 2011, I speak from experience when it comes to knowing the right things to do to ensure it doesn’t happen again.
Never Had One? Good. Here’s How to Make Sure you Never Will Either
I couldn’t be too sure, but I speculated my inguinal hernia came from a weak core relative to the activities I was performing and weights I was lifting. Looking back, it would have been a great benefit to me if I spent more time strengthening it through movements like ab wheel rollouts, four point touches, vacuums and hanging leg raises – and did so consistently.
The abdominals serve several functions, and what’s probably the most important to preventing weakness in the fascia would be the function of anti-extension. The fascia would be stretched the most during movements of this nature, exploiting the length-tension relationship and improving the rectus abdominus’ contractile strength from a stretched position.
Plus, this trains the spine to remain neutral while the extremities move overhead, and this translates nicely to heavily loaded movements like strict presses and deadlifts.
Choosing anti-extension movements like hand walks or TRX body saws (seen here) are a smart choice to get the correct training in.
Having your abdominals contract strongly and stabilize the spine is a great place to start, but a true prerequisite to almost anything you do in the weight room will come from your breathing.
Understanding diaphragmatic breathing patterns is one of the most understated but significant factors in determining your abdominal health. Simply put – if you don’t know how to breathe, it’ll come back to bite you at some point in your training journey, and a hernia is definitely not off the table in terms of possible setbacks.
Start things off by going through deep diaphragmatic breathing techniques in a progression of beginning positions that progress in their level of advancement.
- Supine – lying on your back.
- Quadruped – on all fours.
- Half-Kneeling – One knee down, one foot planted.
- Tall Kneeling – both knees down.
In each of the above positions, focus on breathing slowly and deeply, filling the stomach with air. Your ribcage shouldn’t flare, and your shoulders shouldn’t raise. Once you exhale, focus on removing as much air as possible from the body, while contracting the abs slowly and strongly.
Each breath should be about 5 seconds in, and 5 seconds out. Aim for sets of 10 breaths per position before moving to the next.
Now Add Weight
The next step is to learn how to control your breathing while actually training and moving heavy things. Especially in the case of big lifts, it’s of prime importance not to lose your bracing and tightness.
Applying the Valsalva maneuver to your squats and deadlifts can be a lifesaver to not only your spine stability but your intra-abdominal pressure to protect against hernias. In a nutshell, it basically asks for you to stay full of air through the entire hard part of the lift.
At the bottom of a squat or deadlift, your gut should be full of air, and you should only exhale and refill through the very top phase of the movement (the last 20 or so degrees). Releasing your air pressure too early can cause a total breakdown under heavy loads, so get used to this breathing practice even during your lightest warm up sets.
In the case of other movements, aim for a normal exhale on the exertion cue to be applied, and avoid straining or pushing through the pelvic floor muscles.
If You Weren’t Quite as Lucky
If you’ve had a hernia and have gotten surgical repair, it’ll mean making minor adjustments to the way you train going forward. As long as you respect the surgeon’s directives regarding recovery, and allow the incision to fully heal, you can return to basically full strength if you play it safe.
It may mean taking it easy on aggressive rollouts and other extension movements, and choosing the trunk isolation movements that feel best for you. Remember, once you’ve had a hernia repair, there’s still a chance you can reinjure in the same spot, and blow your stitches wide open.
Here are things I did to help my inguinal hernia recovery:
Get soft tissue work done on the hip flexors: The inguinal region is next-door-neighbor to the hip flexor complex, and an invasive surgery like a hernia repair can really mess with the tissue quality of the entire region.
It’s easy to lose flexibility and mobility at the joint due to scar tissue buildup, inflammation, and the healing process. Getting A.R.T. on my psoas and iliacus muscles was a real help.
Kill the big lifts early on: Of course, big squats and deadlifts were out of the picture until I was both cleared and confident enough to return to them.
When I did return, I kept movements slow and controlled and avoided explosive fast lifts like jumps or kettlebell swings. This will change after time has passed.
Start doing dead bugs: They’re the easiest way to hit the abs as a vehicle to transfer forces, and they’re just as easy to modify to your current levels of capability.
In the video below, I’m performing a very simplistic version – My knees are bent, and I’m actively pushing against the wall. To progress this, I’d instead pull on a band or immovable object, and extend my legs fully on each stride.
No one wants a hernia.
Whether you’re someone who’s never had one or someone who’s undergone the surgery for one, these pieces of advice can do you well in bolstering your trunk and your confidence at the same time.
We’re likely not going to go too long in the gym life without earning a few battle scars, but how we react to them once they’ve reared their ugly head is what will determine our fate in the long haul.