Will Cain Velasquez Be The Same After Shoulder Surgery?

ANAHEIM CA - OCTOBER 22: UFC Heavyweight fighter Cain Velasquez weighs in at 244 lbs at the UFC 121 weigh-in at the Honda Center on October 22 2010 in Anaheim California. (Photo by Josh Hedges/Zuffa LLC/Zuffa LLC via Getty Images)

Cain Velasquez injured his shoulder against Brock Lesnar at UFC 121, tearing both his labrum and rotator cuff. As someone who has lived both injuries, I can confidently say the road back to normalcy is not simple or even a given. Will the UFC heavyweight champion be the same after these surgeries?

We tend to think of fighters as invincible, at least relative to the ordinary person, with their armor and durability only capable of being compromised by another fighter. Like us, however, they are frail humans whose bodies often fail them. The threshold for inflicting meaningful damage seems higher, but their ligaments snap, bones break, skins cut and brains rattle. They are human, all too human.

Cain Velasquez serves as an illustrative example. Once a gym rat whose sole existence revolved around training and applying lessons learned in training in marquee prize fights, the UFC heavyweight champion now finds himself healing from invasive shoulder surgery to repair a torn rotator cuff and labrum.

I've yet to hear even a faint whisper from fans or media about how Velasquez will perform when he returns to action. After all, most athletes of this caliber get attended to by the country's best athletic surgerons. And Velasquez is a world-class athlete with regenerative and recuperative powers that far surpass the typical person. Maybe his shoulder will be perfectly fine.

Or maybe not. Velasquez is human, all too human, and the shoulder which he injured is not only arguably the human body's most complicated joint, it's easily the hardest to rehabilitate.

Velasquez tore both his rotator cuff and labrum at UFC 121 in his title fight with Brock Lesnar. I'm certainly no professional athlete, but I am familiar with the experience of these injuries. In 2001, I tore the rotator cuff of my right shoulder weight lifting. I was able to use physical therapy without surgery to heal the injury. In 2009, I had my left shoulder surgically repaired for a torn labrum, also from weight lifting. Both injuries have profoundly affected my athletic life.

Before we can understand what the long term effects maybe for Velasquez, let's ask: what are the rotator cuff and labrum and why is injuring them potentially devastating?

The rotator cuff is actually a grouping of the four muscles in the shoulder and is essential for all motion:

The labrum is cartilage that helps hold the the bone in the upper arm in the shoulder joint:

Velasquez damaged both and did so in one fell swoop. Dave Meltzer spoke to Velasquez about his situation and the champ provides an update:

And there’s one other big difference, at least temporarily. Due to surgery for a torn rotator cuff and labrum in his right shoulder, suffered in his title win over Lesnar, Velasquez hasn’t been able to train for months. He still doesn’t know exactly when during the fight the injury happened, only knowing that when he woke up the morning after the fight, the shoulder was hurting. Ultimately, the injury required surgery.

"I got cleared two weeks ago," said Velasquez. "I can kick all out. I can’t punch or do any wrestling. What a lot of people don’t realize is that when you stop training kicks, your shins get soft, and right now it’s going to take time to toughen them up."

This is the first real lengthy layoff Velasquez has had in his combat sports career. When he broke his hand, as he’s done twice, he could still work lower body. When he had knee surgery, he could still work upper body. With this injury, the champ wasn’t allowed to do anything because even a light jog could jar the healing shoulder.

The road back from this magnitude of shoulder injury is long, arduous, uncertain and while I'm mostly pain free and able to do most things I love, I've clearly lost athletic ability.

My right shoulder where I tore the rotator cuff is almost back to normal. There are certain pulling motions where my hand is upside down that are impossible to do. When I was training jiu-jitsu, I had to tap to kimuras much quicker than most. Generally speaking, however, the shoulder is back to normal.

With the repaired labrum, I didn't really notice what I had lost until I started hitting the weight room hard. It took months to get to that point, at least seven or eight, all of which were filled with gradually more difficult stress tests and long, careful physical therapy sessions. Eventually I got to the point where I could lift heavy, but I had to do a full 30 minute warm-up directly dedicated to getting the shoulders warm before a single rep could be conducted. That is still the case to this day.

My limitations dawned on me the first time I tried to bench press with a bar. I didn't think much of 135lbs. I'm 250lbs and had been lifting weights throughout my entire twenties. Before surgery 135lbs was easy warm-up weight and I thought given all the push-ups I could do (a part of the advanced physical therapy), the weight should be no issue. I remember pushing it off the bar and without a second delay feeling searing pain shooting into my left shoulder. I immediately put it back down. My first inclination was maybe it was too soon. Maybe I was trying to go too fast with the weights. To be on the safe side I took all the weight off. I then laid back down on the bench, took a deep breath and slowly lifted the empty bar off the rack. Again, searing pain shot into my shoulder although not necessarily as bad as it had been with the extra weight.

I wasn't clear if I had reinjured my shoulder trying to bench press, so I made sure to do every rehabilitation exercise I could followed up with ice and rest for a week. I eventually tried again, back to the naked bench press bar of 45lbs. I laid again on the bench, pressed the bar off the rack and without a second of delay felt strong discomfort in my shoulder.

I eventually figured out it didn't matter if the bar weighed 5lbs, it was too much. My shoulder was no longer able to handle the motion. Fortunately I was able to use dumbbells and even with very heavy weights. It was probably the mobility dumbbells offered that made the difference, but whatever the reason, the straight bar with both hands pressing is an exercise I'll never be able to do for the rest of my life. A friend's brother who had a similar surgery complained of a nearly identical problem.

A year after surgery I went back to my doctor for a check up. My shoulder, he told me, was "completely healed". But how could that be? It still ached, I couldn't even bench press a bar and I noticed I had lost a significant amount of range of motion. My surgeon explained that what I was experiencing was the medical version of "mission accomplished". In other words, given the extent of my injury, having an ache, reduced range of motion (a surgical intention to protect the joint) and a few compromises in the weight room was the best possible outcome. There was no such thing as going back to the old me or having a normal shoulder as I had understood.

Coincidentally, my doctor and I discussed athletes with these types of injuries. He told me labrum repair can significantly affect or end the careers of professional baseball pitchers, boxers and weight lifters. A surgically repaired shoulder, by design, isn't able to handle the same stresses or deliver the same performance as a normal, healthy shoulder because the joint is made "safer". Pitchers loose zip on their fastball. Boxers lose steam on their hooks. There are plenty of documented cases where professional athletes have been able to recover from these surgeries and achieve previous levels of greatness, but it's far more often that some athletic trade off is made in the name of health.

Another key difference for Velasquez: he's seemingly torn his rotator cuff and labrum on the same shoulder, his right side, which is also his strong side. That is likely complicating the rehabilitation portion of his recovery.

What does these mean for Cain Velasquez? It's too early to say, obviously, but the question deserves to be asked: in order to repair his badly damaged shoulder, what athletic trade offs did he make? Will he regain his punching power? Will he be able to defensively wrestle, pummeling in with double under hooks and pull opponents off of his hips? The conditioning that made Velasquez famous will still be there and so will his indomitable attitude, but will his body answer the call to action?

The MMA game is diverse enough where unlike a boxer who can't lose a patented power right hook because punching is so central to fighting, the MMA fighter still has a variety of offensive opportunities or paths to take. That gives Velasquez or any other fighter with a surgically repaired shoulder hope. The converse argument, though, is that all of those myriad stresses the fighter puts on the joint compromise it in the long run. It's hard to train wrestling, boxing, jiu-jitsu and perform strength and conditioning without the shoulder being nearly attacked.

Perhaps Velasquez emerges from surgery and picks right up where he left off. An athlete of his ability and natural fighting acumen has the capacity to be an outlier in terms of what's possible post-surgery. The problem is we shouldn't be glib about when he'll return and who he'll face as the only relevant concerns surrounding the champion. It isn't time off, per se, or ring rust that should concern us. It's more about what's left of his shoulder and what that means for the future of his still-promising career.

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