https://youtu.be/J1BROqADN_c
Rip, you are exactly right that the "don't lift more than 10 lbs" recommendation is folklore rather than evidence-based medicine. One thing to remember, is that all medicine used to be based on "expert opinion" or "common practices," which are essentially folklore. Evidence-based medicine, as we currently define and understand it, didn't really gain traction until the 1970s. We believe that EBM is better than relying on experts and common sense, although there are limitations to this approach. One is that there are lots of areas for which we don't have any evidence, or only poor-quality evidence. That leaves us with relying on folklore to guide what we do. The 10lb restriction falls in this area. Here's where I think it comes from:
1. Genuine concern for recovery: There has to be a limit to what is safe to do. If you go out and squat 1000 lbs the day after an abdominal surgery for some reason, you are almost certainly going to bust your sutures. Nobody knows where the safety line is, but we all know 10 lbs is safe. And the sad fact is that most people, outside of jobs that require it, do not routinely have to lift much more than 10lbs, except for mothers with young kids. A better recommendation might be, don't lift anything that "feels heavy to you." For most Americans, who don't train, I would believe that 10-15 lbs is where things start to feel "a little heavy." But the bottom line is, 10lbs is obviously safe and will allow most people to do most of their things, so the docs say let's go with it.
2. Fear of litigation: because this practice of recommending <10lbs is nearly universal, giving a more liberal recommendation exposes the doctor to risk. It is easy to imagine an attorney sitting a doctor on the stand and reading off the post-surgical guidelines from Mayo Clinic, Mass General, Cleveland Clinic, Johns Hopkins, etc., all of which recommend lifting no more than 10 lbs. "So doctor, what makes you qualified to give different advice than all of these established, reputable, cutting-edge institutions?" It would be easy to make the doctor seem like a narcissistic maverick (which most jurors suspect all doctors are, anyway) who gave reckless advice. All the while, the young family of the guy who lifted and got an incarcerated incisional hernia then died from sepsis, sits weeping in the courtroom. This scenario makes malpractice lawyers drool and keeps surgeons up at night.
3. Respect for master practitioners: We have all encountered people who are experts, who get the best results, and who have little use for guidelines or instruction manuals. They use intuition that stems from hard-won experience, and because you can't see someone's past experience, they seem more like wizards than experts. Medical and surgical trainees encounter people like this all the time, and it is not hard to be swayed by their example. If you trained with DeBakey, and he said to lay surgical instruments on your tray in alphabetical order by the name of their inventor, you will probably do that your whole career, even if you know it's nonsense. Rip, you have probably been in the position of making an off-hand comment that you didn't think about and immediately forgot, then found out later that it somehow became "established dogma." You have probably even been attacked on miles-long Reddit threads for things you do not care about in the slightest. So, if the best surgeon you ever encountered told people to lift no more than 10lbs, you will probably do the same.
I recently had abdominal surgery myself, and received the 10lb recommendation. I asked my surgeon about it, and he basically said: "look, just take it easy until the incisions heal." There is very little risk that your appendectomy, gall bladder removal, colon resection, hernia mesh installation etc.is going to be harmed by lifting (see below), but it does seem wise to allow abdominal muscles, fascia, and skin layers to knit together well before subjecting them to above-baseline stretching forces. Most of the lifting we do does not do this, BUT it is easy to envision a scenario where this happens in the weight room inadvertently: a plate starts to slip out of your fingers and you lean over quickly to secure your grip lest it smash your foot, your press gets out in front of you and you have to use your abs while you pull it back and stabilize it, a gym-bro takes a plate off one side of your barbell while you are resting between bench sets because he thinks you aren't doing anything and you get torqued over to one side when you lift it. OK, these are exceptions and rare, but exceptional and rare things happen all the time, and if the cost is that you get an incisional hernia or wound dehiscence and have to go back to the surgeon, you will have paid a high price to save what, two weeks of gains? And that surgeon is going to be damn smug about those recommendations you didn't follow. Don't give them the opportunity. Most of them are smug enough already.
Here's what I would say. I AM NOT A SURGEON, AND THIS IS NOT MEDICAL ADVICE FOR YOUR PARTICULAR SITUATION. But... having surgery is time for a deload. It's fine to carry your groceries, probably even if they weigh 25 lbs. It's OK to lift your kid if you can do it carefully and slowly to stay in a good position: i.e. if they are heavy and squirmy, maybe not. LET YOUR INCISIONS HEAL. Don't do anything, including barbell lifts, that will put tension across an incision. If it hurts, don't do it for now. If you feel a tearing pain, stop doing what you're doing (duh) and wait a few days before trying it again. If you just had your knees done, you can probably bench pretty heavy but will probably want to back way off on your squat weights. If you just had your shoulder worked on, or had your chest cracked for a bypass, you should not bench heavy for a while. If dumbbells, rows, benches, squats, etc. can be done slowly, at lower weights than you are happy about, and don't cause incisional pain, they're probably fine. If you don't know what weights and movements will jeopardize your incision or shiny new joint, ask your coach.
As far as the valsalva goes, we do actually have at least a little evidence. As Dr. Sullivan and others have said, if your doctor is worried about your valsalva, they should also tell you not to cough or have a bowel movement. I did find a pretty amazing study that looked at this. Amazing because they got 10 healthy volunteers to have a Foley catheter and NG tube placed (neither of which is pleasant, look it up if you don't know what these are). And then, with pressure-monitoring tubes in place in the stomach and bladder, they had them cough, bench press up to 114 lbs, then gave them some water followed by ipecac and measured pressures while vomiting and dry heaving. They did not say how much they compensated these volunteers, but man, that was a bad day for them.
The whole study is here, for those interested who have access: A study of intragastric and intravesicular pressure changes during rest, coughing, weight lifting, retching, and vomiting.
They found that the 114lb bench produced the lowest pressure by far (Now, 114lbs would not be considered a heavy bench around here, but hey that is a workset weight for some new or masters lifters):
Attachment 7177
And the pressure from lifting weights did not statistically increase over baseline pressure:
Attachment 7178
Pretty cool, right?
Look, you out there may feel really good about starting up your TM program exactly where you left off, 2 days after surgery, and you just might be able to do so without problems, but you won't get a medal for this. We are in this for the long haul. Let your incisions heal. Moving around and moving modest weights is generally good for this. Setting 1RMs or rep PRs is probably not. It may be that 10lbs is significant weight for most Americans. You are not in that category and you know as well as your surgeon does that 10lbs is silly, but it doesn't mean there is no limit for you. It means you have to determine it for yourself, and you get full credit and responsibility for the outcome.
I can't imagine the influence it took to get that study approved by the IRB.
I used to be an IRB member. This would have been easy to get approval, as it is very low risk, as long as the IRB felt that the subjects were told exactly what they were consenting to. I am curious how much they paid the subjects. The usual $25 Dunkin Donuts card and a parking voucher wouldn't cut it in this case.
You are an MD. Try being a Ph.D. and getting anything through an IRB full of MDs!Quote:
Originally Posted by jfsully
Point taken. And we would never let a PhD place NG tubes or Foleys, it is true. Not that you'd want to. Turf wars are fun though, right?Quote:
Originally Posted by Joel Chapman
