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Thread: Pathologies prohibiting training

  1. #1
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    Default Pathologies prohibiting training

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    Rip,
    At the Q&A in Brooklyn this weekend, one of the attendees said that he trains an individual who is (electively) in a hypocaloric (1200-1500 kcal/day) state. You identified this as an eating disorder and recommended that the trainer RUN, not walk away from the trainee, as this condition opens the trainer up to significant liability from the eventual injuries.

    We have seen you and other SS coaches train people with a variety of illnesses, and it is pretty clear that training either causes no further harm, or in many cases mitigates or reverses the effects of the disease. A severe eating disorder obviously does not fit this model, is impossible to train around, and can leave the trainer holding the bag when everything hits the fan. From a liability standpoint, what are some other "run, don't walk" pathologies?

  2. #2
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    I don't have a list, maybe Sully can help. But it would include any condition predisposing to death on your premises, or death that could be directly attributed to your activities with the individual. Certain types of heart conditions, obviously.

    Why didn't you ask this yesterday?

  3. #3
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    Why didn't you ask this yesterday?
    I thought of it on the ride home. It's the culmination of the Q&A and a conversation I had with Nick while he was coaching my platform. We talked about a facility near me that does therapy (PT, speech, etc.) for kids with a variety of conditions-- mild, serious, and every point in between. I wondered out loud how a resistance training program for these kids could help, and speculated that most parents of disabled kids would probably not get on board anyway. Then it was time to lift and I filed it away.

    On the ride home, I thought it over some more and decided that not getting any volunteers could be a blessing in disguise. Somebody'd probably get their ass sued off the first time a kid caught a cold. This is the turd in the punch bowl. On the one hand, there exists a protocol that would probably help at least a few kids feel better. On the other hand, if you even let the wrong kid near your place, a pack of lawyers will bury you in paper and padlock your doors. Worse, you could guess wrong and hurt a kid even more.

    Between the two, there must exist an area where at least some kids could benefit, but there's not much room to get it wrong. Since to my knowledge nothing like this has been tried, the only thing that occurred to me was to extrapolate from experience with adults. Yeah, it's probably a pointless mind exercise, but after watching Sully's lecture and learning more about the coaching process at the seminar, I'm convinced the idea has merit.

  4. #4
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    I does have merit, and I probably overstate the case for being worried about a lawsuit. After all, CrossFit is still in existence.

  5. #5
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    Quote Originally Posted by crerus75 View Post
    Rip,
    At the Q&A in Brooklyn this weekend, one of the attendees said that he trains an individual who is (electively) in a hypocaloric (1200-1500 kcal/day) state. You identified this as an eating disorder and recommended that the trainer RUN, not walk away from the trainee, as this condition opens the trainer up to significant liability from the eventual injuries.

    We have seen you and other SS coaches train people with a variety of illnesses, and it is pretty clear that training either causes no further harm, or in many cases mitigates or reverses the effects of the disease. A severe eating disorder obviously does not fit this model, is impossible to train around, and can leave the trainer holding the bag when everything hits the fan. From a liability standpoint, what are some other "run, don't walk" pathologies?
    Quote Originally Posted by Mark Rippetoe View Post
    I don't have a list, maybe Sully can help. But it would include any condition predisposing to death on your premises, or death that could be directly attributed to your activities with the individual. Certain types of heart conditions, obviously.

    Why didn't you ask this yesterday?
    This is one of the reasons why i wonder if i should ever cross the border to the USA.

    Is there a stereotype person who is more likely to go and try to get your money when upset/dead and if so, can you identify&avoid these people/cases?

    Quote Originally Posted by Mark Rippetoe View Post
    I does have merit, and I probably overstate the case for being worried about a lawsuit. After all, CrossFit is still in existence.
    Religions do not count?

    Makes me sad - this shit.

  6. #6
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    The Y where I workout does a lot of community involvement, and they work with a couple of the local facilities for kids/adults with Downs/Developmental problems. The biggest problem alot of them have are with being able to do RT or barbell movements in the first place. For example, one guy has downs and requires a walker, so while light benching has helped him make progress with upper body strength that will clearly aid him day to day, the PT has him doing some kind of stupid leg fly thing that is clearly having less impact than just walking around. On the other hand, there's a kid who had some kind of brain surgery that's left him partially disabled with speech and cognitive issues. He does smith machine squats, partial ROM benches, and some kind of stupid machine work. While he's a wobbly motherfucker who needs two guys spotting him all the time, he's definitely made progress and has had a really positive impact, not only on his health but his attitude.

    Talking with his family (I got his brother to try SS), you'd be surprised how supportive they actually are. When faced with a life-long illness that has little to no expectation of improvement, people are willing to give a wide range of possibilities a shot and will sign just about any waiver you put in front of them.

  7. #7
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    Stride, you bring up an interesting point. A family with a kid that has no expectation of recovery using traditional therapy may indeed be desperate enough to sign a waiver. In your case, this is good-- the kid's neurological condition does not prohibit training, nor does it cause undue risk (that I know of). You can help, and you are, which is great.

    But what if the next kid has an eating disorder instead of the aftereffects of brain surgery? Not all parents know that their kids have eating disorders, after all, and the parents of a skinny kid might bring him to you to get him to "put on a little weight." Even if the parents' consent has been given, the trainer has to be particularly careful not to take on a kid with a run-don't-walk pathology, because no matter how many waivers the parents sign, somebody's going to court if the kid gets hurt.

    We don't have perfect foresight, especially in a situation like this. There are people on this board right now who are training with heart defects. Even their doctors don't know whether this will lead to complications or not, or under what particular set of circumstances. Every trainer assumes some risk of liability, no matter how healthy their trainees are. All anyone can do is to try to weed out the cases that are likely to lead to additional injury.

  8. #8
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    For purposes of excluding clients in my own trianing business, I would consider the following to be absolute contraindications to barbell training:

    1. Uncorrected cardiac valvulopathy (aside from mitral prolapse).
    2. Abdominal aortic aneurysm, any form of aortic or vascular dissection, or any form of aortic graft.
    3. Known uncorrected intracranial pathology (aneurysm, tumor, arteriovenous malformation).
    4. Known history of malignant ventricular tachyarrhthmia.
    5. Children (I like 'em fine; parents are a different story).
    6. History of recalcitrant seizure disorder (frequent breakthrough seizures despite adequate anticonvulsant therapy).
    7. Splenomegaly.
    8. osteogenesis imperfecta.
    9. Imperforate anus.

    This list is for illustrative purposes only, and does not represent medical advice for any specific patient, injury, illness or condition. People with abdominal aneurysm and impreforate anus should see their doctor.

    "But I don't work with Albanians! And children and pets are extra."

    -- Uncle Duke

  9. #9
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    starting strength nutrition camp
    Thanks for the information, Dr. Sully. You've given me some reading to do.

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