Exercise Under Doctor's Orders (Part 1)

Okay, before I even begin this rant, let me say the following:

None of what follows constitutes medical advice.  I am not telling you to override the clinical professional(s) in charge of your care, and I am not a clinician myself as of this writing.  Even if I were a properly credentialed healthcare provider, I would need to evaluate you directly before being able to speak on your specific circumstances.  This piece is simply intended for the purposes of education and provoking thought about some of the variables involved in exercise modification.  Cool?  Cool.

Alright.  Now that that's out of the way, let's get to the actual topic for today.

Injuries happen.  Life happens.  We get knocked down a peg (maybe several) and are put in a position where we have to slow down for a while.  If you've had the good fortune of being able to see a physician or otherwise qualified professional for your injury, pain, etc. you've probably been told something to the effect of "Just take it easy for a while, and don't overdo it."

Fair enough (even if it's pretty vague advice that leaves everything up to you).

Sometimes, however -- particularly in the context of an acute injury or post-surgical recovery -- you get much more specific and rigid guidelines.  It may be something to the effect of "Don't lift more than X pounds until next time I see you" or "No free weights for the next 3 months."  You're given some clear, definitive limitation on what you're allowed to do, with the implication that exceeding whatever numbers or modalities the clinician gives you will increase your risk for reinjury or complication.

Also fair enough... right?

Kind of.  Maybe.  It depends.

While you should *always* stay within the limits of your clinician's instructions -- at least unless you believe they're being reckless/negligent, and if that's the case, you should seek another clinical opinion -- many of the instructions give very simple, firm rules without consideration for ways that those rules can be interpreted, individual mechanical differences, ways a person can alter loads that stay within the rules while still being risky, etc.

What this could mean is that you might get away with greater absolute loads (read: weight on the band, stack, bar, etc.), but it could also mean that you may have to reduce the load further.  It depends on the circumstances (as frequent readers will notice is almost always the case for anything I talk about).

So let's explore some examples of instructions you might receive after an injury, surgery, etc. that limit the amount/type of exercise that you are supposed to do.  Again, this is primarily to highlight that these situations are more complex than a simple rule might illustrate, and with proper understanding, you may be able -- in concert with your care provider(s) -- to come up with some creative strategies for training that still allow you to respect the limitations of healing tissues.

Three common types of instructions you might encounter are:

1. You can do bodyweight exercises ONLY.
2. Bands are okay, but free weights are not.
3. Lift absolutely no more than [X] pounds.

For now, I'll unpack this first one:

You can do bodyweight exercises ONLY.

On its face, this seems to make sense.  If you're injured, deconditioned, or otherwise suffering from limited physical capacity, then the last thing you want to lift weights when your body is already enough, right?

A big issue here is that this assumes that "body weight" (as a vague exercise load) is necessarily going to be less taxing than something that you might do with free weights, machines, bands, etc.  While this might sometimes be the case, it is absolutely NOT always the case. 

Consider a simple squat.  It is generally true that a squat with even a small additional weight will be more mechanically demanding than doing the same task without any externally applied resistance (barring some situations where the weight causes you to shift posture/alter technique enough that it actually offloads stresses from the injured area).  However, there may still be alternative ways of training the injured tissue(s) that are less taxing -- or less risky if balance/control of the weight, including the body, is a concern -- than doing a movement where you're having to overcome some/all of your body weight as the resistance.

Yes, machines can be a great option.  Just... try to make sure that the lights are on in your gym if possible.

This is where machines are often a fantastic choice.  Whether (for the sake of our squat example), the limitation is in the foot, ankle, knee, hip, spine, or anything else, you can almost certainly find ways to load things in a more strategic and controlled manner with something *other* than a body weight squat.  Depending on the exact circumstances, a properly designed and utilized machine may provide an opportunity to do several things, such as:

• apply less torque to the injured joint(s)
• control range of motion more easily
• control tempo more easily
• concentrate more completely on only the muscle(s), joint(s), tissue(s), etc. that you're trying to train
• create smaller incremental changes to the resistance (torque) that must be overcome
• apply resistance from angles other than "straight down" (because gravity), which may be far more comfortable for the injured area

Options could include (or rule out, depending on the nature of the injury/surgery/limitation) machines such as the leg press, leg extension, calf raise, abductor/adductor, glute/ham, and a near-infinite constellation of cable exercises if you have a FreeMotion machine or anything else using pulleys with freely adjustable anchor points.  Literally every machine you'll find in a gym can provide at least some options that provide less resistance -- or more easily controlled resistance -- than simple "body weight" exercises.

Note that this isn't saying that body weight exercises are bad at all.  Far from it!  It simply should not be considered a universal truth that "body weight" equates to "easier" or "safer."  There are too many variables involved, and machines often allow you to manipulate these variables with more precision.

There are also cases in which free weights could be less taxing on the body than body weight.

This is a bodyweight exercise, but I'm *pretty* sure it's way more taxing on the
shoulder girdle than a lot of machine, free weight, band, etc. exercises.

Note that all of the above points apply for people of relatively "normal" weights, and they are even more applicable in cases of people who are carrying more body weight (since the a heavier body equates to greater resistance, all other things being equal).  Thus, for people dealing with obesity, these points may be of even greater importance.

So all of that rambling was only scratching the surface, as you can get into all kinds of fun (or not-so-fun) discussions about how you might exercise a specific body part, how that training might change over time, how your priorities might influence -- or be influenced by -- the injury, etc.  There is a lot more that can go into the decision to modify or progress an exercise, even when you don't have to follow a doctor's orders.  Those are beyond the scope of this blog.

And yes, I know I only got into item #1 so far.  The entry has gotten long enough that this feels like an appropriate stopping point.  However, fret not!  If you found this interesting and would like to see further exploration of items 2 and 3, stick around for more content that will carry this on.

- To Be Continued...

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 - G