Starting Strengths for a Female with Dyautonomia and EDS

[Adrijana Kiefer]

Good evening,

I was hoping to get some feedback on whether or not the Novice Linear Progression would be applicable for a female with several chronic health conditions. I believe the use of barbell exercises to increase body composition and strength would greatly improve her quality of life. The following is a summary of her current conditions:

Sex: Female
Age: 22
Illness History & Descriptions:

• Dysautonomia (postural orthostatic tachycardia syndrome: POTS) - In short, the brains ability to regulate functions controlled by the autonomic nervous system is impaired. The most significant symptom is that her body is incapable of properly regulating her heart beat and blood pressure. So in her current state if she is standing for too long a period, her blood will pool in her feet and lower body resulting in syncope since the brain is not receiving as much blood as needed. Other symptoms include respiratory dysfunction, internal body temperature irregularity, chronic fatigue, and other general cardio vascular dysfunction.
  
• Ehlers-Danlos Syndrome - This is a genetic illness which causes hypermobility in both large and small joints produced by a deficiency in collagen. The trainee in this case is able to hyper extend her shoulders and elbows and frequently dislocates her knee and hip joints. This leads to frequently present pain.
  
• Median-Arcuate Ligament Syndrome - The celiac artery (and celiac plexus nerves) are crushed by excessive ligament tissue from the median-arcuate ligament. This constricts blood flow to the stomach and other digestive organs preventing proper digestive functions and significant chest pain.

Injury History

• MALS Release Surgery - This procedure was a laparoscopic operation where the stomach was moved out of the way and the median-arcuate ligament was trimmed and the celiac plexus was killed to minimize/neutralize the pain. The surgery was a success with some complications emerging from the recovery process itself. However, this had more of an impact on digestive and nutritional factors which is a totally different discussion.

Medication History

• Metropolol - beta blocker
• Midodrine Hypochloride- a blood pressure regulator which is an anti-hypotensive

If more information is needed on the illnesses or procedures please let me know. I tried to keep it brief for easy reading.

With those factors in mind, would a starting strength linear progression be appropriate for someone in this position? If yes, what modifications should be made for her programming? If not, are there any other strength training protocols which would be appropriate in this case?

Thank you in advance for the help.

[Mark Rippetoe]

Way out of my bailiwick. We'll ask the board.

[JordanNewell]

A key question is being clear what form of EDS she has. Is her diagnosis supported by genetic testing?

[Adrijana Kiefer]

Hey Jordan,

She recently saw a geneticist but is still waiting on the results of the test. They presume that she has type 3 EDS which is predominantly characterized by joint hypermobility.

[JordanNewell]

The importance is that some types of EDS are associated with vascular abnormalities (such as a aortic root dilatation), which can be a contraindication to heavy training. Although rare, this has been reported in hypermobility EDS. Check if she has had an echocardiogram and suggest one if not.

I don't imagine there would be any problems training with "type 3" hypermobility EDS but someone else here will have more experience of this.

As for the POTS, her symptoms will almost certainly improve with better conditioning and nutrition. Unfortunately, at least in the UK, it's hard to convince these patients that this is the case! Make sure she drinks plenty.

The only caveat is again being sure about the diagnosis. There are other causes palpitations, and depending on her symptoms it might be worth considering these (eg, with a 24 hour EKG/ECG).

As for the Median-Arcuate Ligament Syndrome - I have no direct experience of this, but I would imagine that if there is a problem, it will be immediately obvious (eg, she will get pain during a particular exercise).

In summary: she will probably benefit much more from training with you than seeing yet another doctor, but, depending what investigations she has already had, it would be prudent to get a cardiology opinion first.

Disclaimer: not medical advice, etc.

[Emily Socolinsky]

Good evening,

I was hoping to get some feedback on whether or not the Novice Linear Progression would be applicable for a female with several chronic health conditions. I believe the use of barbell exercises to increase body composition and strength would greatly improve her quality of life. The following is a summary of her current conditions:

Sex: Female
Age: 22
Illness History & Descriptions:

• Dysautonomia (postural orthostatic tachycardia syndrome: POTS) - In short, the brains ability to regulate functions controlled by the autonomic nervous system is impaired. The most significant symptom is that her body is incapable of properly regulating her heart beat and blood pressure. So in her current state if she is standing for too long a period, her blood will pool in her feet and lower body resulting in syncope since the brain is not receiving as much blood as needed. Other symptoms include respiratory dysfunction, internal body temperature irregularity, chronic fatigue, and other general cardio vascular dysfunction.
  
• Ehlers-Danlos Syndrome - This is a genetic illness which causes hypermobility in both large and small joints produced by a deficiency in collagen. The trainee in this case is able to hyper extend her shoulders and elbows and frequently dislocates her knee and hip joints. This leads to frequently present pain.
  
• Median-Arcuate Ligament Syndrome - The celiac artery (and celiac plexus nerves) are crushed by excessive ligament tissue from the median-arcuate ligament. This constricts blood flow to the stomach and other digestive organs preventing proper digestive functions and significant chest pain.

Injury History

• MALS Release Surgery - This procedure was a laparoscopic operation where the stomach was moved out of the way and the median-arcuate ligament was trimmed and the celiac plexus was killed to minimize/neutralize the pain. The surgery was a success with some complications emerging from the recovery process itself. However, this had more of an impact on digestive and nutritional factors which is a totally different discussion.

Medication History

• Metropolol - beta blocker
• Midodrine Hypochloride- a blood pressure regulator which is an anti-hypotensive

If more information is needed on the illnesses or procedures please let me know. I tried to keep it brief for easy reading.

With those factors in mind, would a starting strength linear progression be appropriate for someone in this position? If yes, what modifications should be made for her programming? If not, are there any other strength training protocols which would be appropriate in this case?

Thank you in advance for the help.

Hi Aaron,
I have a client right now that I am currently training who has been diagnosed with POTS and I have trained in the past a woman with EDS. If you would like to contact me directly to discuss how I have trained these women, please feel free to email me at emily@fivex3.com. I work with many individuals who have complex cases and I have found that all of them are able to do some type of modified novice progression. Please email me.

This is an article I wrote about my client with EDS.
Client Profile of the Month: Meet Kristi | Fivex3 Training - A Starting Strength Gym

Emily

[Adrijana Kiefer]

The importance is that some types of EDS are associated with vascular abnormalities (such as a aortic root dilatation), which can be a contraindication to heavy training. Although rare, this has been reported in hypermobility EDS. Check if she has had an echocardiogram and suggest one if not.

I don't imagine there would be any problems training with "type 3" hypermobility EDS but someone else here will have more experience of this.

As for the POTS, her symptoms will almost certainly improve with better conditioning and nutrition. Unfortunately, at least in the UK, it's hard to convince these patients that this is the case! Make sure she drinks plenty.

The only caveat is again being sure about the diagnosis. There are other causes palpitations, and depending on her symptoms it might be worth considering these (eg, with a 24 hour EKG/ECG).

As for the Median-Arcuate Ligament Syndrome - I have no direct experience of this, but I would imagine that if there is a problem, it will be immediately obvious (eg, she will get pain during a particular exercise).

In summary: she will probably benefit much more from training with you than seeing yet another doctor, but, depending what investigations she has already had, it would be prudent to get a cardiology opinion first.

Disclaimer: not medical advice, etc.

Jordan,

She does have some other cardiac abnormalities which I'll ask her about in more detail. If there are counter-indicators then I will back off the heavy training. The POTS in combination with the EDS makes it difficult to identify which illness is causing what symptoms.

With MALS, the surgery she had effectively fixed the problem. But it could add to the other cardiac issues that already exist since it added additional abnormal strain to the heart.

And I definitely agree. She has bounced from doctor to doctor. She's stabilized since her first diagnosis but there hasn't been much improvement. Just more medicine here and another consultation there. I think at this point improving her physical capacities would be the best treatment to get her back to life.

But really, I greatly appreciate the input.

Hi Aaron,
I have a client right now that I am currently training who has been diagnosed with POTS and I have trained in the past a woman with EDS. If you would like to contact me directly to discuss how I have trained these women, please feel free to email me at emily@fivex3.com. I work with many individuals who have complex cases and I have found that all of them are able to do some type of modified novice progression. Please email me.

This is an article I wrote about my client with EDS.
Client Profile of the Month: Meet Kristi | Fivex3 Training - A Starting Strength Gym

Emily,
I would greatly appreciate the help. Being in contact with someone more experienced would be super. From my understanding of POTS it varies greatly from case to case so I figured something a bit specialized would be required.

[Emily Socolinsky]

Jordan,

She does have some other cardiac abnormalities which I'll ask her about in more detail. If there are counter-indicators then I will back off the heavy training. The POTS in combination with the EDS makes it difficult to identify which illness is causing what symptoms.

With MALS, the surgery she had effectively fixed the problem. But it could add to the other cardiac issues that already exist since it added additional abnormal strain to the heart.

And I definitely agree. She has bounced from doctor to doctor. She's stabilized since her first diagnosis but there hasn't been much improvement. Just more medicine here and another consultation there. I think at this point improving her physical capacities would be the best treatment to get her back to life.

But really, I greatly appreciate the input.


Emily,
I would greatly appreciate the help. Being in contact with someone more experienced would be super. From my understanding of POTS it varies greatly from case to case so I figured something a bit specialized would be required.

Email whenever you get the chance. I would be happy to share what I have done.

Emily