So theoretically, you could be fine, you're lifting and
all of a sudden, bam, it comes out, ugh. oh, that looks like a pain in the balls.
What's up guys, Jeff Cavaliere, athleanx.com. And Jesse Laico, altheanx.com.
So today we're talking about hernias. And before you say, "Oh, I never had one, I have to worry
about one." It's actually one of the more common injuries, especially for those that like to pick
things up and put them down. Like our question for today. This is an "Ask Jeff" video where you get
your question featured and I answer it for you. Leave your question below. Maybe you'll appear
in a future video like this one. So, we have from ALEXALMOST40, "Hey,
Jeff, I just went to the doctor and it turns out I have an inguinal hernia. He said no heavy
lifting. Are me and my gains screwed unless I have surgery? Thanks. You're the best. Jesse,
you're even bester." You like that one?
ALEXALMOST40. Yeah, that sounds like the intelligence level of somebody that would
like Jesse, actually. That's not very nice.
I like Alex, but I'm just saying the use of the words Let's talk about what this is, I can relate
exactly to what Alex is talking about. Because I have had not one, but two hernias.
Two hernias? Two hernias. One of which I had repaired
and one of which I live with to this day. So, the one I had repaired back in 2011, I had it for
three years and at that point I finally started to get to the point where I was so uncomfortable
that I had to go and get it repaired. Okay.
We'll talk about the options in terms of what repair looks like for those who have to go
down that route. The other one that I had was in 2013, and ironically, I was filming an exercise
that I recommend you not do, which I'll get into in a second here, and of course,
in filming the exercise not to do, I incurred my second hernia. Ironically, the same thing that
happened to me the first time that caused a hernia on the first day of doing that exercise.
Is that why you have been demonstrating all the bad exercises?
That is why Jesse demonstrates many exercises for me. So, what is a hernia and basically what causes
it? Okay, so I got this right here. So, what this is, is basically your intestines inside,
your abdominal muscles on the outside. And what happens is you start to get a little breakdown
in the outer abdominal wall and there are very thin muscles down here,
we're talking about inguinal hernias, down in the groin just to the right or left of your junk.
That's a weak spot. And a lot of times we are born with this weak spot that
never actually fully closes. If we get any type of increase of international pressure,
if we cough, if we sneeze, if we lift heavy, if we bear down and we push out, that can cause the
inside to start pushing out against the outside. And if we keep doing that, what happens is you'll
get this sort of gradual breakdown in the area. It's not an incident that happens just like that.
The actual tear you could feel as a one-off incident, but it was an accumulation of
a lot of things that led up to it. So, if you look at this band here, it looks like
it's fine, it's intact, it can actually function. But if I were to pull it and show you a little bit
closer here, you can see that there's a tear in that band. Okay. So, that tear over time is
going to eventually wind up breaking and snapping the band. You'll feel the zipper like pain when
that actually happens. But it's an accumulation of those stresses, the increased IAP pushing against
that that leads to that eventual breakdown. So, in my case, I actually felt this zipper like pain
the moment I did that rep, but it was probably an accumulation of a gradual weakening of that
tissue in that area over time. Right.
Very similar to what I talked about the pec tear that happens, we covered a few videos
back. Though the pectoral happen on a single repetition, it was the accumulation of the
breakdown of the tissue over time that led to that weakening in that spot that allowed it to break.
So, who does it affect? 25% of the time men will have this happen to them in their lifetime. That's
a lot. That's a lot of inguinal hernias, it is actually one of the most popular repairs that
we have surgically done every year. Women actually get it about 3% of the time.
That's it? But it's still a lot. Three out of every 100
women, it's still a lot. It's the fact that men are sort of predisposed by carrying a little extra
anatomy down in that area. Unless you're Jesse, you don't have to worry about that as much.
Whoa, whoa, whoa. I'm just saying. Listen, so if you were
to get one, what happens? Okay, so you've got two options always when you get a hernia. Number one,
watchful waiting or surgical repair. Now, let's go down the surgical repair, because again, I did
that. You have two options in terms of surgical repair, and one of them is really not even that
much of an option anymore. And it's the tension free or the tension of repair and what they do
with the tension repair, is they actually suture the tissue, the whole and that our abdominal wall
together. But what's not so good about that is you're basically holding it together with stitches
so that if I were to increase the pressure on the abdominal wall from the inside out
Then it causes the sutures to open up. Yeah, so it's going to it's going to pop that hole
again. So, you have to really be careful about the type of pressure you're developing from the inside
out. However, they came out with the mesh repair and the mesh repair actually goes behind the
hole. So, this is the hole here. I put the mesh behind the hole like this from the inside out. So,
the hole is actually never repaired. And what I do is I make sure the mesh is large enough to cover
that hole. So even if the hole starts to get a little bit gradually bigger over time, they're
still being covered by the mesh and it doesn't increase, there's no tension on that repair.
I'm holding this in place, so actually, if I were to increase abdominal pressure
from the inside out, I'm pushing the repair more into the abdominal the wall
and actually causing more stability of the repair as opposed to less. So that would be the way you'd
go. And that's how I went and again, I haven't had any issues with that repair now for 10 years, so
that's a good thing. Now we've got the other room, watchful waiting. You can train with a hernia.
Can you? Yes. Contrary to what people say, you
have to just be careful that you do two things. Number one, I have now trained with my hernia
for eight years. You have to be careful about the use of exercises that dramatically increase
intra-abdominal pressure. We'll talk about that in a second. You also have to be careful
not to utilize exercises that increase that inguinal vulnerability, I like to say.
And let's start with that one, because that's the one I've covered before in videos and I mentioned
earlier here talking about like a One Arm Row. Again, the tissues in this area of the groin are
already thin and rather weak and sometimes already compromised genetically by the fact
that that inguinal canal never fully closed. So, as you start to put yourself in a position
like a One Arm Row, with one leg of one leg down on the bench, you've already got a lot of stress
and tension in that area, especially for the leg that's down on the ground that's causing that
stretch at the same time. And then you go when you lift that heavy weight awkwardly, oftentimes
that causes that area that's already under tension that potentially could have already had a little
bit of that breakdown to just simply open the hole large enough for the insides to herniate out.
Now, if that were to happen, by the way, what I had to do, I know it sounds kind of graphic,
but I got to lay down on the ground, I see the bulge coming out and I got to push it back down.
Okay, and put it back in. Because the worst thing that can happen is if you train with this and it
comes out to the point where it gets stuck out of the hole, so, it's out here and I can't get it
back in, that's called an incarcerated hernia. And basically, if it stays out there or even twists
when it's out there, it can get strangulated and at that point, if it cuts off blood supply, that
tissue can necrosis and die. And at that point, we could get some kind of a sepsis and that would
be a very, very ugly, dangerous situation. So, they always recommend, that's when people
tell you, "Hey, I think it's better off that you go in and get it repaired." Especially if you're
younger and healthier, it's going to be easier to overcome the repair. But again, I think that you
may not have the rush it as often because a lot of times they don't become strangulated. That's
a risk that you play with and I've been playing with one now for eight years.
So, the other thing we want to do, though, is talk about the intra-abdominal pressure exercises. So,
squats, deadlifts, these are the exercises that are going to require a lot of bracing,
pushing from the inside out that is going to push all of your abdominal contents sort of into the
wall against it, you know the bracing of the wall from the inside out, which increases stability
of the spine and increases core rigidity. But again, at the same time,
if you've got a hernia there, you are asking to push the contents further out.
So, one of the things you can do is decrease the weight a little bit. Right? Or you can
just simply utilize a belt in that case. So, I'm not often a fan of utilizing belts,
but especially in this instance here where people are dealing with unrepaired hernias,
the belt at least gives your abdominal cavity something to stabilize and push into. So, when the
intra-abdominal pressure increases, it pushes up against the belt, which helps to keep the contents
in, where we want them to stay inside. The other thing is you can use alternative
bracing techniques, just by utilizing different ways of breathing and stabilizing the torso.
But the fact is, you're going to want to make some sort of an adaptation there to decrease
the risk of increasing intra-abdominal pressure to degrees that can actually push this thing out
and cause the hole potentially to even get larger. All right. So, are you screwed? No. Alex, you can
actually still train, like I said, just be mindful of those incidents where you feel you're going to
feel it. You're going to feel that sometimes as you do this, you can feel sort of a bulging or the
pressure in that spot and you might even be able to visually see it. In those cases, you're going
to want to lay down, like I said, let gravity do the work for you and help to push it back in.
The last thing I'll say is, if you went down the surgical route, how fast can you get back
into stuff? I mean I was the sick bastard that was down on the floor doing abdominal isometric
exercises the night of my surgery. That's because you're a mutant.
I was down there trying to do some additional like just isometric contraction
because I wanted to waken the muscles up there knowing I wasn't going to be pushing on the repair
and damaging the repair. And because I had it done laparoscopically, I wasn't really too disturbed,
I was definitely in pain, but I wasn't too disturbed because I didn't have to cut through
a lot of muscles to get there. So, your return to activity is best advised by your doctor what
to do. But again, they can oftentimes be a little conservative, right, because they don't screw up
their work. But we do a laparoscopic repair with that mesh on the inside there really
is not that much you can do to damage it, but your pain levels can be a little uncomfortable,
you have to work around that. Right.
But you're going to have the fastest recovery that way. So, I will say this, Alex, regardless
of what direction you decide to go in, if you go to the watchful waiting route, about 23% of the
people wind up crossing over within five years to actually need surgery, but that leaves a lot of
people who don't have to cross over. So, you could train for a long period of time without having to
worry about getting this thing fixed. Just like you.
Just like me. And fingers crossed because I want to jinx myself.
So, guys, I hope you found the video helpful. Remember if you want your Ask Jeff question
answered in a future video, make sure you leave your question in a comment below and I'll do my
best to get those to you. In the meantime, if you're looking for smart training where
we don't utilize exercised that place you in a vulnerable position like that, we kind of have
a mindful approach to how we train. All of our exercises and plans and programs are laid out
over at athleanx.com step-by-step. Also, click subscribe and turn on your
notifications so you never miss a new video when we put one out. All right guys see you soon.