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Thread: Petechiae in experienced lifter?

  1. #1
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    Default Petechiae in experienced lifter?

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    After (during, actually) my two workouts this week I've noticed what appears to be petechiae on my hands, shoulders, the base of my neck, plus where the bar sits on my back for squats. I've been lifting consistently for more than seven years now and never had this happen before. I know it's not terribly unusual among lifters and not of any real concern as the patches fade overnight, but I'm just wondering if others have seen it appear out of the blue like this. I can't think of anything that has changed in my daily routine (eating, sleeping, precription drugs, etc.) other than I hadn't been in the gym for about 18 days due to a vacation prior to the first workout this week. I've got my annual physical coming up soon and will mention it to my doctor, just for completeness.
    Thanks.

  2. #2
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    What do you expect your doctor to say when you mention it to him?

  3. #3
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    Quote Originally Posted by Mark Rippetoe View Post
    What do you expect your doctor to say when you mention it to him?
    You know, I was going to leave that last sentence out because I just knew what the response would be. :-) I included it because my limited research on petechiae indicates there can be underlying causes other than lifting heavy weights (admittedly none of which seem applicable to my situation). My doctor is your typical GP and he knows about my lifting and doesn't discourage it. To answer your question directly, I expect him to say it's due to my lifting and not to worry about it. The main point of my post was wondering if others have had the experience of lifting for several years without experiencing this and then having it suddenly appear and why that might happen.

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    I think it happens a lot, but it's not an "injury" per se. I have no idea what causes intermittent petechiae -- may have something to do with hydration status, but maybe not -- but it's not something anybody but GPs worries about.

  5. #5
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    So after today's squat and bench workout, virtually my whole neck and head, from collarbones on up, is covered with red splotches. WTF is going on here? I make sure to Valsalva with an open mouth, but certainly still feel pressure in my head during the lifts. I made sure to be better hydrated before today's workout as well. If the splotches take 2-3 days to dissipate, and I keep my current workout schedule, I'm always going to be the red-faced guy, and I don't really want that. Again, just wondering if anyone else has had this experience.

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    Quote Originally Posted by Rob Plano View Post
    So after today's squat and bench workout, virtually my whole neck and head, from collarbones on up, is covered with red splotches. WTF is going on here? I make sure to Valsalva with an open mouth, but certainly still feel pressure in my head during the lifts. I made sure to be better hydrated before today's workout as well. If the splotches take 2-3 days to dissipate, and I keep my current workout schedule, I'm always going to be the red-faced guy, and I don't really want that. Again, just wondering if anyone else has had this experience.
    Probably won't help, but since you asked, my n=1:

    I have intermittent petechiae from lifting, and have for years, ever since training got hard. As a matter of practice, I pull my lips back from my teeth to keep my Valsalva proper (think an aggressive snarl sort of look). They come and go, they seem to accumulate around noteworthy grinds, though not exclusively. I've always had a tendency toward generally flushed skin under exertion, like in high school wrestling, so maybe it's related to a predilection of my circulatory system...or maybe that part's just me being melanin-deprived.

    Either way, I've had no ill effects from them. For me, it's unavoidable with my training, so I don't give it much thought, because the alternative would fall under "What're you gonna do, not train?"

    Conveniently, my doc doesn't have a problem with it - he even whole-heartedly supports my training. He's a DO, not an MD, so I'm not sure if that has anything to do with it.

  7. #7
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    I'm not really bothered that this is happening, more wondering why it suddenly decided to appear. However, I am a bit bothered by the thought that I might be going through the rest of my training life with my face and neck covered in red splotches, scaring young kids as I walk by.
    Since the spots also appear on my hands and shoulders, I don't think it is Valsava-related.

  8. #8
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    Quote Originally Posted by Rob Plano View Post
    So after today's squat and bench workout, virtually my whole neck and head, from collarbones on up, is covered with red splotches. WTF is going on here? I make sure to Valsalva with an open mouth, but certainly still feel pressure in my head during the lifts. I made sure to be better hydrated before today's workout as well. If the splotches take 2-3 days to dissipate, and I keep my current workout schedule, I'm always going to be the red-faced guy, and I don't really want that. Again, just wondering if anyone else has had this experience.
    This seems to be a phenomenon that some lifters experience (I don't see it), and it seems to be well-tolerated by those who do. Petechial rash is a sign, not a diagnosis. One can certainly conjure demons from it, however: Petechiae make me think platelets, because I'm an ER doc, and TTP and sepsis and DIC are nightmares.

    You don't have ITP, sepsis, or DIC, but if you came to me all worried for an answer I'd still be bound as a physician to think platelets and hemostasis and vessels and toxins and meds and hematologic malignancies and bizarro infections. And of course, as anybody who's ever watched L&O, Quincy, or CSI would know, there's strangulation. Let us for the moment assume you're not engaged in erotic auto-asphyxiation between worksets.

    The point to be made here is: The differential diagnosis for petechiae is galactically huge, ranging from entirely benign to Total Protonic Reversal, and from the entirely mundane to the exotic.

    You have a choice:

    (a) You can attribute this phenomenon to teeeny leeetle burst capillaries from effort (possibly under an incorrect Valslava) and move forward, or

    (b) You can let your doctor chase it down.

    We can't tell you what to do. Let us know how it all unfolds.

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    Quote Originally Posted by Rob Plano View Post
    I'm not really bothered that this is happening, more wondering why it suddenly decided to appear. However, I am a bit bothered by the thought that I might be going through the rest of my training life with my face and neck covered in red splotches, scaring young kids as I walk by.
    Since the spots also appear on my hands and shoulders, I don't think it is Valsava-related.
    Ah, see that's why it doesn't bother me. I already scared young kids as I walked by. ("Face for radio", "Dear God! What is that thing?", and all that...)

    Quote Originally Posted by Jonathon Sullivan View Post
    ...as anybody who's ever watched L&O, Quincy, or CSI would know
    Quincy...wow. That takes me back...

  10. #10
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    Thanks for taking the time to reply, Sully, I appreciate it.

    Obviously, there is no choice. I'm preparing for a meet in August where I intend to break the USAPL AZ state age/wgt class deadlift and squat records (I broke the deadlift and tied the squat records at a meet in March), so the training goes on, plan on pulling 455 for reps tonight.

    I'm 100% convinced that the petechiae is a benign phenomenon, somehow related to lifting. My main question in this thread has always been: Does anyone have any idea why this would happen now, after I've been lifting seriously for over seven years? Since I get the rash at the base of my thumbs after benching, I don't think it is entirely due to Valsava, properly performed or not. I would like to avoid going through life looking like I was shot in the face with multiple (very soft) shotgun pellets, if at all possible, without giving up lifting heavy stuff.

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