Contraindications to Barbell Training?

[JHG]

Rip,

I wonder if you have constructed a list of contraindications to barbell based training for special populations and whether you have experience working with people with SCI, ABI, stroke etc. If so, may you provide modified training recommendations for these individuals?

I imagine the following conditions would pose as contraindications to training with barbells:
• Abdominal aortic aneurysm (risk of dissection)
• Spinal stenosis (especially with the deadlift and press)
• Ehlers-Danlos syndrome (risk of joint dislocation)
• Marfan syndrome (risk of joint dislocation)
• Osteogenesis imperfecta (risk of bone fractures)
• Spinal cord injury resulting in paraplegia (perhaps can perform the press)
• Malignant primary bone tumors (risk of bone fractures)

Thanks

[Bill Coyne]

Aortic aneurysm is probably a greater concern with Marfans than anything else. AAA aside, take each case-by-case.

[JHG]

Aortic aneurysm is probably a greater concern with Marfans than anything else. AAA aside, take each case-by-case.

Thanks Bill. I agree that AAA is the primary concern. My concern from a musculoskeletal perspective would be loading for those with greater susceptibility to joint dislocations. I haven't worked with anyone with these conditions hence my curiosity.

[Bill Coyne]

Spend some time looking through the literature and the forum. Both scientific and anecdotal evidence show that you can train through damn near anything including Ehlers-Danlos, osteogenesis imperfecta, et cetera et cetera.

[JHG]

Will do. Thanks.

[Ivey]

Well, if you'd like to ask someone with Marfan's what it is like to train with a barbell you are free to ask me. Happy to answer in an open forum. However, the chances of coming across someone that knows they have a connective tissue disorder AND is coming to you for training is probably akin to locating a unicorn ridden by a chupacabra (which is probably a pretty amazing sight). Every single piece of literature says to wrap yourself in bubble wrap and sit quietly in a locked closet in hopes of achieving old age. Ignoring this takes a pretty special person (stupid, stubborn, or persistent depending on how you view them).

It is more likely that they don't know they are at risk of aortic aneurysm (ascending being the big winner here) until they drop dead playing basketball. That may no longer be the norm. I assume doctors are more aware in 2017 than 10, 20, or 30 years ago. I'm turning 40 this year and most of my experiences with random doctors is that they've never seen someone with marfans in person. Therefore, someone with this condition needs to fly to a clinic that specializes in the condition, get checked out, and then have them help find local doctors with experience. The beauty of being special is that you can usually get in to see any doctor no matter if they are taking new patients or not. Most of them like to see a freak so you might as well use that to your advantage.

These being syndromes, they manifest themselves in different ways for everyone impacted. Therefore, a guy can look pretty normal before he drops dead. Conversely, he may never make it out of bed under his own power. Funny how genetic mutations manifest themselves.

The risk I think you coaches have are with high school and college athletes. The marfan forums online are riddled with kids that are competitive athletes, find out they have a problem, and refuse to believe it. They don't want to give up their sport. Those that need surgical intervention (let's say an aortic root replacement) even believe they will return to competitive sport. These are the kids you need to watch for. Blindly taking risks is not something anyone needs to be a part of in my opinion.

However, remember this is a syndrome. It is highly individualized. That said, the risk of aortic dissection is just a fact that can't be avoided. Contact sports introduce the risk of a sudden rupture in an aorta that could have looked fine on a scan the day before. Also, dislocating a retina is a risk that seems to be pretty bad to me. Those are pretty absolute and constant risks that can't be mitigated.

Other issues include skeletal and the lungs. I don't have issues in either area which is just a great example of how individual this can be.

I have run a marathon, rowed (indoor and on the water), and lifted (stronglifts before starting strength) with the full blessings of my entire team of doctors. How could that be? Well, I guess there's a lot of value to having individualized medicine, challenging doctors to look beyond blanket guidelines, and taking calculated risks. There is no data on what exercise does to someone with my condition. We can't even quantify the years I am likely taking off the back end of my life. However, I'm confident that I'm not about to drop dead unexpectedly .

Whether you want to take the risk of training a unicorn-riding chupacabra or not is up to you. That's your choice. However, whether or not he trains is his choice. These people are sovereign human beings and what medical care they get and what risks they take are their decisions alone to make.

I've been poked, prodded, and paraded naked in front of so many doctors that I've lost count. I have a little scar from a DNA sample taken off my arm for research at Johns Hopkins. A researcher from UTMB flew to my valve-sparing aortic root replacement to take a sample of my aorta back for analysis. I've woken up in the ICU once, but that was planned. I've had so many surgeries that I keep a Word doc on my phone just to remember them.

If you did decide to train someone, this is the type of person you want. They need to know what they are doing inside and out. They need to be confident that they understand the risks they are taking. Cover your backside all you want with waivers and releases (or don't train them).

Personally, I would not rob someone of the opportunity to be properly trained because I think that I know their medical state better than they do. However, no human being has the right to demand services from another and you shouldn't feel bad about declining to train someone with this condition. Either you feel comfortable with them or you don't. You might even counsel them to talk to their doctor if you sincerely believe they aren't fully informed. However, it ends there. It is a pretty simple thing.

[Bill Coyne]

Awesome. Thanks for the post, Ivey.

[MBasic]

Spend some time looking through the literature and the forum. Both scientific and anecdotal evidence show that you can train through damn near anything including Ehlers-Danlos, osteogenesis imperfecta, et cetera et cetera.

I have this...et cetera et cetera.

It's tough, but I manage OK

[JHG]

Ivey and MBasic, thank you both for sharing your experiences with us! It is always nice to obtain first hand accounts of people who train with conditions and syndromes that the literature would lead us to believe are contraindicated to weight training.

Ivey, as you are clearly aware, Marfan’s syndrome is a very rare condition that most providers only read about in books. As an aspiring physician who hopes to integrate exercise medicine in clinical practice, I am always thinking of which people I can help and where my limitations may lie. I am glad to hear that you are able to train and have participated in great and challenging physical pursuits!

MBasic, at Bill’s advice, I did some searching on resistance training for people with EDS and found a small, albeit encouraging pilot study on the adaptation of tendons and skeletal muscles to resistance training in 3 patients: Functional adaptation of tendon and skeletal muscle to resistance training in three patients with genetically verified classic Ehlers Danlos Syndrome

[Ivey]

Ivey, as you are clearly aware, Marfan’s syndrome is a very rare condition that most providers only read about in books. As an aspiring physician who hopes to integrate exercise medicine in clinical practice, I am always thinking of which people I can help and where my limitations may lie. I am glad to hear that you are able to train and have participated in great and challenging physical pursuits!

Enjoyed sharing! I've been waiting to reveal this in my training log as it is just a big story to unwrap. The reality is that I'm blessed and can have some experiences, and take some risks, that others cannot.