How Should You Exercise After Chest Wall Surgery, and What Is the Overtraining Epidemic Costing Women?
(Based on a recent podcast conversation with Dr. Shannon Ritchey, DPT, founder of Evo Fitness - https://www.youtube.com/watch?v=NMsk7CUMYQs)
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The first question most patients ask after surgery is when they can exercise again.
It is rarely the last.
I recently sat down with Dr. Shannon Ritchey, doctor of physical therapy and founder of Evo Fitness, for a conversation that started at a dinner and needed a full episode to finish. Dr. Ritchey's method, which she calls "gentle consistency," is built around a specific and evidence-informed idea: you can build significant muscle and change your body composition without breaking your body down in the process.
For patients recovering from chest wall surgery, that idea is not just relevant. It is the framework I wish more people arrived at surgery already understanding.
What follows is a summary of what we covered: the overtraining problem, the return-to-exercise timeline after chest wall surgery, what the research actually says about building muscle, and how nutrition fits into all of it.
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The Overtraining Problem Is Not What Most Women Think It Is
Dr. Ritchey has her own history with overtraining. She speaks about it not as a cautionary anecdote but as clinical context, because it shapes how she approaches patients who arrive with the same patterns she once carried.
The cultural message that most women have internalized about exercise is this: more is better, effort is moral, and rest is a failure of discipline. That message is not benign.
When exercise stimulus exceeds the body's capacity to recover, the stress response escalates. Cortisol rises. The inflammatory signaling increases. The body shifts into a protective mode where it is trying to conserve energy rather than adapt.
What follows is a set of symptoms that are frequently misread as a need to exercise more: fatigue, fluid retention, joint pain, hormonal disruption, reproductive irregularities, and low energy. Some patients add more training. The cycle deepens.
Dr. Ritchey describes this directly: "your body when it senses an energy deficit in the way of lots of exercise and potentially under fueling goes into savior mode." The body is not failing. It is doing exactly what it is designed to do. The problem is that the person doing the training has been taught to override that signal rather than listen to it.
For patients preparing for surgery, this matters because many arrive with that inflammatory baseline already elevated. Correcting it before the procedure is part of what the SHARP preparation protocol addresses.
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What Exercise Looks Like in the First Days After Chest Wall Surgery
I send patients home with one clear instruction: walk.
Walking the day after surgery is not a concession to limitation. It is a clinically appropriate choice. Walking does not spike heart rate or blood pressure in ways that increase bleeding risk in the early post-operative period. It supports circulation. It is weight-bearing. It is real exercise.
What we are avoiding in the early weeks is anything that places direct load on the chest wall before soft tissue healing has advanced, that creates tension across a repair, or that elevates heart rate significantly.
The pectoral muscle is involved in most of the chest wall surgeries I perform. When I repair a pec major, the origin remains intact at the shoulder but the insertion has been disrupted. The muscle has often been in an abnormal position for an extended period, which means atrophy has already changed its tissue quality and the degree to which I can restore it to its original position depends on what was done before and how long the muscle has been displaced.
The functional implication is that the return to upper body loading needs to be measured. Not because the patient is fragile, but because the repair needs time.
One pattern I see in the post-operative period is that patients guard in a way that creates new problems. Internal rotation, forward shoulder posture, collapsed chest. This shortens the pec minor and creates a compensatory tension that, if it persists, compounds the surgical challenge. I show patients in the office how to roll the shoulder blades back and hold that awareness during the early weeks. It costs nothing. It matters.
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Transitioning to Lower Body Work and Then Upper Body Loading
Because the surgery involves the chest wall and not the lower extremities, lower body work can begin sooner.
I use a general framework of six to twelve weeks for chest wall healing before returning to upper body loading with any intensity. That range accounts for variability in what was done surgically, how recovery proceeds, and whether any setbacks occur.
The cases where patients return to upper body loading too quickly are instructive. One of the outcomes is a tear of the repair, which creates a choice between managing a hematoma conservatively or returning to the operating room. Neither outcome is what anyone planned for.
Dr. Ritchey's return-to-exercise framework aligns with what I want my patients working toward once they are cleared. Start with strength training as the centerpiece. Train each muscle group close to failure, twice per week on non-consecutive days. Take recovery days seriously. Layer in other modalities from there.
I had a patient who came in from the military, had chest wall surgery, and then had a full year to get her physical fitness test bench press back to her pre-surgical number. She came within five pounds. That is the kind of result that comes from consistent, appropriately progressive loading over time, not from rushing.
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What Training Near Failure Actually Means
One of the most practically useful things Dr. Ritchey covered was the specific meaning of training near failure and why it is the key variable in muscle development.
The stimulus that drives muscle adaptation is not the weight on the bar. It is how close to muscular failure you take each set. True failure is the point at which you cannot complete another repetition. Research indicates you do not have to reach that point, but you do need to get within one to three repetitions of it.
At that threshold, pace slows. The last few repetitions feel heavy. You are working to complete them but you can. That experience at the end of a set, not the absolute load that produced it, is what drives adaptation.
This matters for patients returning to loading after surgery because it removes the requirement for heavy barbell work. A relatively light dumbbell, taken close to failure, produces a comparable stimulus to a heavier one. For someone rebuilding after a chest wall repair, where the goal is progressive but careful loading, this is genuinely useful.
It also removes the framing in which exercise choices are binary between high-intensity programs and doing nothing. There is a wide and evidence-supported middle ground that works.
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What CrossFit Gets Wrong and Why It Matters for Chest Wall Patients
I have an opinion on CrossFit that I share with patients who ask: it is not a good program for the patients I treat.
That is not primarily about CrossFit specifically. It is about the category of training that prioritizes intensity and variety in a way that compromises movement quality and loads joints, particularly the shoulder complex and chest wall, in positions they are not prepared for.
Dr. Ritchey offered a more measured clinical perspective: CrossFit is popular because it gives people a program, a community, and a structure. People want those things. But the research on building muscle does not require Olympic lifts, heavy barbells, or workouts that leave you unable to move the next day.
Her point is that if someone cannot show up and train again two days later, the workout was too intense to produce the consistent stimulus that adaptation requires. Good strength training should not feel like you got hit by a truck.
For chest wall patients specifically, the populations that most need to hear this are the ones who were doing high-intensity programs before surgery and plan to return to them after. The conversation about what exercise will actually serve their recovery is one I have regularly.
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Protein: The Most Consistent Gap in Recovery Nutrition
Dr. Ritchey and I spent a portion of our conversation on protein because it is the variable that comes up more than any other in post-surgical nutrition.
Patients routinely arrive at the recovery period not eating enough protein to support tissue repair and muscle development. Getting 100 grams of protein per day feels overwhelming to many. The number sounds arbitrary until you understand that protein is the substrate from which muscle tissue is built and repaired.
Dr. Ritchey's current intake is approximately 200 grams daily, a number she arrived at gradually and that is now part of her routine rather than an effort. That level is appropriate for someone actively building muscle. For post-surgical patients, the target depends on body weight and recovery phase, but the principle is consistent: protein intake is not optional.
In our Austin practice, we address this practically. We have protein supplements available, amino acid powder, and the conversation about reaching adequate intake is ongoing throughout the recovery period. For patients who are vegan or vegetarian, reaching adequate protein is more challenging, and we use plant-based protein sources specifically designed to provide a complete amino acid profile.
One specific note that came up in our conversation: collagen is not a high-quality protein source for surgical recovery. It does not carry the amino acid profile that supports muscle repair, and we steer patients away from counting collagen supplements toward their protein targets.
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Low Impact Is Not the Same as Low Joint Stress
A specific clinical point from Dr. Ritchey's training methodology that I want to highlight for patients returning to exercise: low impact and low joint stress are not interchangeable.
An exercise can involve no jumping or running and still place significant load on a joint if it puts the joint in a position that violates that individual's anatomy. Conversely, a small amount of impact can be beneficial for bone density and joint loading without causing harm.
Dr. Ritchey's guideline is direct: movement should feel smooth, coordinated, and should stop because of muscle fatigue, not because of joint discomfort. If a movement is pinchy, creates a sensation of joint loading, or produces pain, that movement is not the right movement for that body. Change the exercise, the range of motion, or the load before deciding that strength training is not possible.
This matters clinically for the patients I see who have knee concerns, shoulder history, or movement limitations from prior procedures. The range of options for loading any given muscle group is wide enough that there is almost always a version of the movement that works for that person's specific anatomy.
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How the SHARP Framework Applies to This Discussion
The SHARP program (Strategic Holistic Accelerated Recovery Program) addresses the systems that shape how patients move through surgery and recovery: nutrition, inflammation, immunity, hormonal balance, gut health, and genetics.
What Dr. Ritchey describes as the three primary levers of body composition change, building muscle through structured strength training, fueling appropriately with adequate protein and calories, and recovering consistently with rest and low-stress days, maps directly onto what SHARP addresses before and after surgery.
For patients preparing for or recovering from chest wall surgery:
Nutrition: Protein intake is the most consistently underestimated variable. Meeting protein targets is not optional for patients in a recovery period. It is the raw material for tissue repair. We address this practically in the practice and through supplementation when dietary sources are insufficient.
Recovery: SHARP treats recovery as a clinical input, not a personal preference. Sleep quality, targeted supplementation, and structured stress reduction support the anti-inflammatory conditions that allow tissue healing to proceed. Dr. Ritchey's framework for non-consecutive training days and built-in recovery days is the practical expression of this principle.
Inflammation: Chronic overtraining is an inflammatory stressor. For patients who arrive at surgery with an elevated inflammatory load, often from overexercising and underfueling simultaneously, addressing this before the procedure is part of the preparation protocol. The exercise habits that maintained that inflammatory state need to change before surgery, not after.
The full SHARP methodology is detailed in my book, available at https://drrobssolutions.com/products/sharp-by-dr-robert-whitfield.
Learn more about the framework at https://drrobertwhitfield.com/sharp.
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Evo Fitness: A PT-Led Program for Patients Who Are Ready to Load Again
Once patients are cleared to return to full upper body loading, they need a program that respects the principles Dr. Ritchey outlined: structured, progressive, anatomy-respecting, and designed to produce muscle growth without requiring high-intensity modalities.
Evo Fitness is a strength training app built by physical therapists with follow-along classes designed for home use. For patients who have been cleared by their surgical team to begin training near failure and want a structured program without the learning curve of designing their own, it is a direct-to-use option.
More information is available at evolfitness.com.
Dr. Shannon Ritchey is also on Instagram at Dr. Shannon DPT and hosts her own podcast, The Dr. Shannon Show.
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Take the Next Step
If you are approaching surgery and want to understand how to prepare your body, or if you are in the recovery period and looking for a structured approach to returning to exercise:
- Schedule a Discovery Call: https://discovery.drrobertwhitfield.com/form
- Shop Pre and Post-Surgery Essentials: https://drrobssolutions.com/collections/pre-post-surgery-essentials
- Learn About the SHARP Framework: https://drrobertwhitfield.com/sharp
- Buy the SHARP Book: https://drrobssolutions.com/products/sharp-by-dr-robert-whitfield
- Explore the BII Resource Hub: https://drrobertwhitfield.com/breast-implant-illness
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Medical Disclaimer: This content is for educational and informational purposes only. It does not constitute medical advice and should not be used as a substitute for professional medical evaluation, diagnosis, or treatment. Individual outcomes vary. Consult a qualified healthcare provider before making any decisions about your care.