Recovering from Bicep Tendon Surgery and Rotator Cuff Repair - My Personal Experience with Injury Recovery using "Built from Broken"
Introduction
When injury strikes, the path to recovery can seem daunting and unclear. "How do I get through this? How can I heal this without losing the fitness that I've worked so hard to build and maintain?" If you're over 40 and find yourself in this position, I entirely sympathize.
This was my reality after undergoing biceps tenodesis and rotator cuff repair surgery in the spring of 2023.
I had suffered from chronic shoulder pain that had gradually become worse for years since partially separating my right AC joint (the right shoulder) and in the process partially tearing my supraspinatus tendon. I did this while in the MMA studio at our gym, ground-fighting a big Irishman who outweighed me by nearly 50 pounds.
Yes, I did some stupid things back in my thirties.
At the time of the injury, I didn't realize or even consider that I'd torn something that should have been addressed by a doctor. I simply carried on my merry way. As the old saying goes, spit on it and rub some dirt in it.
Twenty years passed, and by that time it had gotten so bad that my right biceps tendon had degraded to the point that lifting my hand to drink a cup of coffee was painful.
I finally had no choice but to get both the supraspinatus repair AND a right biceps tenodesis repair at the same time.
I'd already had 3 knee surgeries and a right hip resurfacing. Both involved a significant degree of post-op pain, so I figured "how bad could the pain be after shoulder surgery? Surely not that bad."
Ha.
Little did I know what I was in for.
The long and short is that the recovery process is painful and lengthy. Unfortunately for me, the post-op physiotherapy regime in Japan, where I live, is not at all up-to-date, nor is it particularly useful. It involves a whole lot of soft tissue manipulation but no resistance training or workout routines are given to the patient to address injury recovery and recover strength.
As a CrossFit L2 trainer and CrossFit Mobility trainer, this was a tough thing to realize.
In my search for guidance, I discovered Scott Hogan's "Built From Broken," a comprehensive guide that promises to help readers rebuild their bodies from the ground up after injury and orthopedic surgery.
"Built From Broken" is not just another fitness book. It's a meticulously crafted roadmap for anyone looking to overcome pain, prevent injuries, and build resilience. The book's main premise is that by understanding joint function and dysfunction, optimizing nutrition, and following a carefully structured training program including corrective exercises, anyone, regardless of fitness level, can build a stronger, more durable body, improve joint health, relieve joint pain, and prevent injuries.
In this review, I'll dive into some of the key concepts of "Built From Broken," and explore how I applied these principles in my own recovery journey. Whether you're an athlete, a fitness enthusiast, or someone struggling with chronic pain, this review will help you determine if "Built From Broken" is the guide you've been searching for.
Overview of Built from Broken
"Built from Broken" by Scott Hogan is a comprehensive guide to overcoming pain, preventing injury, and optimizing joint health. Hogan is a Certified Orthopedic Exercise Specialist and founder of "Saltwrap," a company dedicated to helping athletes rehabilitate and prevent injury through novel supplementation and training methods.
Drawing from his personal experience as a certified orthopedic exercise specialist, Hogan presents a holistic approach to injury recovery and building a resilient, pain-free body.
Built from Broken begins by challenging common misconceptions about joint health and pain management. The book explores the importance of understanding postural faults, joint mechanics, and movement patterns. Hogan explains how poor movement patterns and muscle imbalances can lead to pain, dysfunction, and injuries. He then provides techniques for improving overall joint and tendon health and function.
A key focus of Hogan's book is the role of connective tissue in overall body health. He explores the functions of tendons, ligaments, and other soft tissues, explaining how these structures adapt to stress and the strategies for improving their strength and resilience. He introduces readers to the concept of progressive tissue loading, highlighting its crucial role in injury prevention and recovery.
One of the best things about "Built from Broken" is you don't need to be a scientist to understand the concepts and make use of them to build or rebuild a more functional body. Complex concepts are made easily understandable so that anyone can apply them.
Nutrition
Nutrition plays a significant part in Hogan's approach. He outlines the importance of inflammatory foods and their role in contributing to joint pain and inflammation. He also discusses key nutrients for tissue repair and regeneration. The book provides practical advice on supplements for joint health and inflammation management and reduction, and emphasizes the role of proper hydration in maintaining optimal tissue function.
I had already been taking collagen for some time but added anti-inflammatory and collagen supporting supplements to my regimen. And importantly, I increased my protein intake as much as possible.
When you're dealing with this sort of recovery and pain, always look for solutions that could have upside with little or no downside.
Strength Training
The core principle Hogan advocates is Load Training (resistance training). He presents a methodical approach to gradual strength building, introducing the concept of "minimum effective dose." This approach allows individuals to progress in their exercises without aggravating existing injuries or jeopardizing post-surgery recovery. Hogan provides guidance on adapting common exercises to suit individual needs and limitations, making his methods accessible to people at various fitness levels and with different physical challenges.
He points out that strength training is often the one thing that people wrongly believe they should avoid when rehabilitating injuries.
This is the part of the book I found extremely helpful for my post-surgery training program to heal my tendon repairs and recover my strength. For those of you who have had shoulder surgery, biceps tenodesis, or both, you'll know that utmost care has to be taken in the first couple of months to avoid stressing the anchor point of the tendon repair.
And the pain is off the scale.
Once I was out of the danger zone, proceeding to strengthen the tendon and mitigate muscle loss over the next 8-12 months of recovery became paramount.
The importance of Resistance training for building strong, resilient joints and tendons
The corrective routines and strength training programs he recommends and explains in detail are carefully constructed to improve body mechanics, movement quality, and collagen synthesis. Injury prevention and injury recovery are central to his training program. Buy the book to get into the nitty gritty. I'll provide a basic overview.
Hogan's corrective exercise routines teach readers how to identify and address muscle imbalances, compensations, and poor movement patterns. Hogan provides specific exercises for improving joint function, with a particular focus on key areas such as the shoulders, hips, and spine. He emphasizes the importance of integrating these corrective exercises into daily routines for long-term benefits.
One of his central tenets is that there are "5 primary causes of joint pain and dysfunction." He stresses that joint pain is NOT caused by weight training. Rather, it is caused by the following:
Postural faults
Poor movement quality and lack of variation (causing repetitive stress leading to overuse injuries and joint pain)
Muscle imbalances
Tendinopathy
Arthritis, aging, and collagen degradation
His thesis is that most of us have the cause of joint pain, injuries and dysfunction completely backwards. The prevailing attitude is that joint pain and injuries, and all of their associated problems are caused by weight training, but the truth is that weight training is the solution to preventing injuries and rebuilding damaged tendons and joints, not the cause.
You might be thinking "but my knee pain is lifting related. How can lifting be the solution, not the cause?"
The long and short is that lifting per se didn't cause your knee pain. Long-term postural faults resulting in poor body mechanics and muscle imbalances caused the joint issues and pain you're experiencing. Weight lifting simply exposed this chain of faults, bringing all the pieces together and manifesting in things like low back pain, painful joints, and often a cascade of other injuries.
Your poor or substandard movement quality is one of the culprits, not weight training.
That's precisely what I experienced. Although I had a minor supraspinatus tear to begin with, it was worsened by poor posture that cause my shoulders to be in a chronically weak, dangerous position when under a load. I would argue that my osteoarthritis in my left knee was a long-term result of a lifting injury I experienced long ago from poor technique and posture during a deadlift and overhead press.
Torn cartilage in my right hip was a result, once again, of a compromised position due to chronic poor posture. All of these joint issues could have been avoided with corrective exercise and a training program rooted in injury prevention.
The worst part of all of this is that most of us will experience some joint pain early on and just ignore it as "normal." Eventually our joints are chronically painful and we quite literally feel "broken."
Sleep and Stress Management
Recognizing that recovery extends beyond physical exercise, Hogan dedicates sections to sleep optimization and stress management. He explains the critical role of rest and sleep in tissue repair and pain reduction, offering strategies for improving sleep quality. The book also explores the connection between mental stress and physical tension, providing techniques for stress reduction and advocating for mindfulness practices in pain management.
The sleep issue was a real problem for me because of the post-surgery pain in the bicep tendon and shoulder area. I did my best to get as much sleep as possible, and to help with that, I took time-release Melatonin. Honestly speaking, sleeping while in the arm brace is close to impossible, but once out of the brace, then real sleep happens and recovery speed increases.
The Big Picture
Throughout "Built from Broken," Hogan focuses on long-term joint health maintenance. He guides readers in creating sustainable exercise habits and introduces strategies to prevent future injuries. Acknowledging the changes that come with aging, Hogan provides advice on adapting training methods over time and emphasizes the importance of movement variety for joint health.
What sets "Built from Broken" apart is its blend of scientific research and practical application. Hogan backs his methods with current studies while making the information accessible to a general audience. He provides detailed exercise descriptions, nutrition advice, and recovery strategies that readers can implement immediately.
The book is not just for athletes or fitness enthusiasts; it's designed for anyone dealing with chronic pain, recovering from injuries, or simply wanting to improve their overall joint health and physical resilience. Preventing injuries, however, is the fundamental principle of this science based guide.
"Built from Broken" offers a roadmap to not just recovering from injuries, but building a stronger, more durable body. It challenges readers to take an active role in their health, providing them with the knowledge and tools to understand their bodies better and make informed decisions about their training and recovery.
Through this comprehensive approach, Hogan empowers individuals to take control of their joint health and build a foundation for long-term, pain-free movement.
My Personal Journey: Applying "Built From Broken" Techniques
Brief Explanation of Biceps Tenodesis
Alright, let's talk about biceps tenodesis - it's not your everyday surgery, but it's a game-changer for anyone dealing with certain painful shoulder and bicep issues. Basically, this procedure relocates the long head of your biceps tendon. Normally, this tendon connects to the top of your shoulder socket, but when it's causing trouble (think pain, instability, or just not playing nice with your shoulder), surgeons step in to move it to a new spot on the upper arm bone.
In many cases of biceps tenodesis, the surgeon removes a portion of the tendon, particularly the thinner, more degenerated part near the original attachment point. That's exactly what I experienced.
Here's why:
The long head of the biceps tendon often becomes frayed, inflamed, or partially torn at its attachment point in the shoulder socket (glenoid). This damaged section is typically thinner and weaker than the healthier part of the tendon further down. During tenodesis, the surgeon will trim away this compromised tissue, focusing on reattaching the thicker, healthier portion of the tendon to the humerus.
By removing the damaged section, the surgeon accomplishes two things: first, a potential source of ongoing pain and inflammation is eliminated.
Second, this ensures that the newly attached tendon has the best chance of healing solidly to its new location. The thicker, healthier part of the tendon is better suited for secure fixation and has a higher likelihood of successful healing and function post-surgery.
Here's the breakdown: The surgeon detaches the problematic tendon from its original attachment point and then secures it to the humerus (that's your upper arm bone) using either screws, anchors, or sometimes a combo of both. It's like giving your biceps tendon a new home where it can function properly as it did prior to injury.
The result (hopefully) is a fully-functioning shoulder and bicep.
In my case, I had the biceps tenodesis done along with my rotator cuff repair (supraspinatus tear).
Degradation of the biceps tendon is a common result of a long-term supraspinatus injury.
Rotator Cuff Repair and Recovery
A supraspinatus tendon repair is a common procedure for treating rotator cuff tears, particularly those involving the supraspinatus muscle, which is crucial for lifting your arm. During this surgery, the torn tendon is reattached to its original insertion point on the humerus (upper arm bone).
The surgeon typically uses special anchors drilled into the bone, along with strong sutures, to secure the tendon back in place. This procedure aims to restore the function of the rotator cuff, reduce pain, and improve shoulder strength and range of motion.
I had suffered increasingly from the supraspinatus tear for many years, culminating in the gradual degradation of my biceps tendon.
Interestingly, a supraspinatus repair often goes hand-in-hand with a biceps tenodesis. Why?
Well, the long head of the biceps tendon runs right through the shoulder joint, close to where the supraspinatus attaches. In many cases of rotator cuff injury, especially chronic ones, the biceps tendon can also become damaged or irritated. This is because when the rotator cuff isn't functioning properly, it can place extra stress on the biceps tendon, leading to inflammation, fraying, or partial tearing.
If I had known this years ago, I would have opted to get my rotator cuff repair done sooner. Hindsight.
Performing a biceps tenodesis along with the supraspinatus repair can address both issues simultaneously. By relocating the biceps tendon attachment to the humerus, the surgeon can alleviate pain and prevent further irritation in the shoulder joint.
This combined approach often leads to better overall outcomes, as it addresses multiple potential sources of shoulder pain and dysfunction in a single procedure. It's like killing two birds with one stone – fixing the rotator cuff while also taking care of a problematic biceps tendon that might otherwise continue to cause issues down the line.
Techniques from the book I used - Progress and challenges
After a biceps tenodesis, the first thing you'll notice is your biceps has no firmness at all. It sags like a sack of jello. It looks horrific and the first thing I thought was "is this going to ever look normal again?"
My exercise program would have to address strengthening the muscle without overly stressing the tendon while the tendon remodeled and healed. At the same time, strengthening the rotator cuff muscles had to be addressed.
All exercises that I used would be with extremely light weight using extremely slow eccentric movements. Concentric movements were only introduced after enough time had passed for the biceps tendon to be out of the danger zone of dislodging the new attachment to the humerus. The slow eccentrics also were effective at gradually reducing pain.
The workout routines that I did over several months barely resembled what I'd been used to for years as a CrossFitter, but this was an absolute necessity for healing and injury prevention during the rehab period.
I'll give you a brief list of the main movements that I used at the beginning (when I was in the safe zone).
VERY slow, assisted dumbbell curl negatives. These were a 5-6 second count, assisted with the opposing arm (my left).
Slow incline pushup negatives, gradually moving to slow pushup negatives.
Slow negative bench dips.
Slow dumbbell pronation/supination (I started with a 1 lb plate and then graduated to a 3 lb hammer)
Notice the common theme here: SLOW NEGATIVES.
That's the way forward for rehabbing tendons.
(Disclaimer: I'm not a doctor nor am I recommending that you do anything here. I'm simply relating Scott Hogan's recommendations in Built from Broken and explaining how I used them).
Slow negatives with light weights forces you to focus on the movement with real mental intensity from the beginning to the end of each movement. This is Pure Gold.
By following Hogan's exercise prescription for rebuilding tendons and rebuilding the broken machine that was the reality of my body, I came back strong and feeling better than ever. No more joint pain, fewer muscle imbalances, overall better well being, and a body that feels better than it has for years.
Just the pain relief alone is worth it. If you have or have had a messed up biceps tendon and/or rotator cuff issues, you know that pain relief using anti inflammatory medication is not a permanent solution.
Conclusion
Biceps tendon and rotator cuff injuries don't have to be the end of the line in your journey to build a strong, healthy body. Overuse injuries are so common now that people tend to think they just have to live with them. Life shouldn't be an endless journey of chronic pain. Load training to rebuild those injuries slowly and gradually will also fix muscle imbalances that you didn't even know you had.
I highly recommend Scott Hogan's "Built from Broken." It will change the way you think about your joints, injuries, body, and exercise programming. No downside, all upside.
Disclaimer: All information provided on this website is for informational purposes only. No information provided is to be construed as medical advice. If you have medical issues, always consult your doctor..
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