Doctors and Exercise Advice

On nonsense promulgated by doctors

by Mark Rippetoe | February 04, 2016

I was in the doctor's office last week – some guy stuff needed dealing with – and the urologist told me some interesting facts about why and how I should "alkalize" my urine. I had a kidney stone or 3 several years ago, but I've had no symptoms in the interim, and I was seeing him for an unrelated issue.

He told me that I should take a teaspoon of sodium bicarbonate (baking soda) in a glass of water a couple of times a day. He said it raises the pH of the body as well as the urine, which prevents against acid-based stones as well as general inflammation, and helps with athletics by lowering levels of lactic acid in the muscles. Acid in the body is bad, you see, and anything you can do to raise the pH should be done.

I won't bore you with the specifics of the physiology, but every word of this is complete bullshit – of the kind you'd expect from a bartender, not a doctor. Let's assume the urology advice to alkalize the urine is correct – he is a urologist, after all, and there is good evidence for this. The part about lactic acid in the muscles is absolute nonsense, and has been known to be absolute nonsense for decades now. You cannot ignore the gastric acid rebound effects of repeated doses of soda. You cannot ignore the fact that "acid" does not cause inflammation. And you cannot ignore the fact that lactic acid does not cause muscle soreness, and its accumulation cannot be "controlled" – even if you wanted to control it – by the ingestion of baking soda.

This is an example of a physician practicing outside his knowledge, training, expertise, and experience. My urologist knows absolutely nothing about sports physiology, as demonstrated by his "lactic acid" comment, but he still felt perfectly justified in giving me advice pertaining thereto. And this is a relatively benign example thereof.

It becomes less benign when doctors, Physical Therapists, chiropractors, Physician's Assistants, and even nurses hand out advice about exercise when that advice has no basis in fact. People pay attention to things their doctors tell them, whether they are true or not (this is a side-effect of paying heinous sums for an office visit).

Admit it: You've said, "Well, after all, he is a Doctor."

I say, "Yes, he is only a doctor. He is not a strength coach."

Every day, I deal with the nonsense promulgated by doctors practicing outside their expertise. Usually this takes the form of bad advice about barbell exercise distributed as part of an orthopedic surgeon's consultation with a potential surgery patient, or in the post-operative phase of the patient's rehabilitation. Here is a short list:

• Squats are bad for the knees.
• Squats will "blow out" your knees.
• Squats are bad for the back.
• Deadlifts will destroy your back. "Blow it out."
• Squat with as vertical a back as possible – shear force will "blow out" your back.
• Overhead presses will destroy your shoulders.
• Lighter weights for higher reps build the same strength as heavy weights for lower reps – but they're safer.
• Lifting weights will stunt a kid's growth.
• Lifting weights and getting too strong makes you less "athletic."
• Lifting weights reduces your flexibility.
• Lifting weights makes you slower.
• Lifting weights will give you arthritis.
• Lifting weights will make your arthritis worse.
• Lifting weights will give you a heart attack/stroke/aneurysm.
• All that muscle will turn to fat when you stop lifting weights.
• You don't need to hear good bass, man – you just feel good bass. (Wait... that was back in high school. Sorry, same type of bullshit.)

If these stupid things sound a lot like what people who don't know what they're talking about say, it's because that's exactly what they are. Except it's not your bartender. It's your doctor.

He should know better than to bullshit you. After all, he refers you to medical specialists when your case is outside his specialty. Urologists don't practice neurology, and dermatologists don't practice oncology – at least not for long. But they all feel perfectly qualified to bullshit about exercise.

So, as a strength coach, how do I explain that the information you obtained from your Physical Therapist about strength training isn't exactly correct? Your orthopedic surgeon told you to just lift light weights real slow instead of trying to lift progressively heavier weights – after all, they both make your muscles burn, and after all he is a Doctor, and here I am, some guy in a gym, telling you that your doctor is, uh, wrong.

When people who operate under the imprimatur conferred by professional licensure and a terminal degree decide to practice outside their bailiwick, it complicates an already difficult situation.

I don't practice brain surgery. It requires training and experience that I don't have. I'm not even entitled to an opinion about brain surgery. The problem is that doctors fail to recognize the fact that strength coaches and exercise professionals possess expertise and experience which physicians do not, and this means that they should limit their advice to their own specialty. Like I do.

Coaching human movement under a load is not the academic equivalent of brain surgery. But it requires a different skill set than the brain surgeon uses in his professional practice. Expertise in the one field does not guarantee expertise in the other, since they are two completely separate fields of endeavor within different areas of the biological and physical sciences.

Unless the doctor is also a lifter who has coached other lifters for years, the doctor should practice medicine and leave me to practice strength coaching. If I need his help, I'll ask for it. And maybe someday he'll learn to ask for mine.