Have you gotten useful advice from a doctor about martial arts training with an injury?

Discussion in 'The Study' started by MetalBoar, Aug 22, 2019.

  1. MetalBoar

    MetalBoar Green Belt

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    WARNING: Wall of text ahead!

    I was reading yet another thread with someone asking whether their medical condition would prevent them from training in martial arts. And of course they got the usual nearly universal "talk to your doctor" responses. I admit I usually say something along these lines as well, especially if it sounds like a dangerous matter or falls outside my range of experience. Even if I do offer advice I couch it in terms of "Well, I'm not a doctor and you should talk to yours because they're going to know a lot more about what's going on with you than I do."

    I don't disagree with either approach (saying simply, "see your doctor", or giving advice within the context that they should see their doctor before proceeding) but I got to thinking about how this differs from the way I approach things with my strength training clients. When I can talk with someone in person and supervise their training I'm far more willing to take responsibility for helping them make the decision to work out or not. I will always ask what their doctor has told them and I never tell people to reject the advice of a medical professional, but I will push back and give them some questions to ask their doctor if I think the doctor is full of it.

    I've come to this place because I hear a lot of nonsense or useless answers from doctors when it comes to strength training. They often know next to nothing about the topic or are so afraid of being sued that they are afraid to give any advice. I've seen countless examples of this but I'll use my mother's case specifically to illustrate my point.

    She's an older woman, in her late 70's when this took place, and had to have heart surgery for something relatively minor as far as you can ever say that about heart surgery. After she'd been through the recovery process she asked her doctor if there were any concerns with going back to weight lifting. I live in a different state so I don't train her and I don't know exactly what she was lifting before the surgery but she'd been lifting for a couple of decades at that point and while she lifts lighter than I would have her do in my gym she was far from weak. Her cardiologist told her she could lift weights but not to lift more than 25 pounds. She and I were talking about it on the phone and she was really confused about what this meant and of course so was I.

    I told her to make sure the doctor knew what her weight lifting history was and then ask some clarifying questions. Did he have concerns about lifting more than 25 pounds for some specific structural reason related to the ongoing healing process or due to limitations created by the surgery? Was it 25 pounds period, regardless of whether that was on a leg press machine or a military press with free weights? Could she do unlimited reps and sets at 25 lbs, but none at 26? Since progressive overload is a key principle of strength training was there some point at which she could graduate from 25 to 25.5 say? Why 25 lbs and not 20 or 30? The guy literally had no answer for her to any of these questions and yet reiterated that she shouldn't lift more than that. As far as either of us could tell he'd pulled the number out of his tush because he looked at her and thought, "Gee, this is a little old woman, 25 lbs. seems like a lot!".

    You might think this was just one anomalous case but you'd be wrong. I've come to expect essentially this kind of response the majority of the time when one of my strength training clients asks their doctor a question about how an injury or other medical condition might impact their ability to do strength training. So, what has your experience been? Have you gotten more useful advice than this from your doctors? If yes, I'd love to know if you live in the US or some other, perhaps less litiginous society? Was it the first doctor you asked or did you have to get passed around to specialists a bit first?
     
  2. gpseymour

    gpseymour MT Moderator Staff Member

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    My personal physician is a sports medicine doc, so does a bit better than others would with some of this.

    But, yeah, wish someone I know and am familiar with what their condition is, I’ll feed them some questions to ask, because most doctors (my own included) won’t really understand the movements and strains involved in martial arts.

    EDIT: and that includes sometimes the doc giving the okay too soon.
     
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  3. MetalBoar

    MetalBoar Green Belt

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    Yeah, it's funny, in my experience doctors seem to be far more conservative about weight lifting than martial arts even though the statistics show that weight lifting is just about the safest physical activity you can pursue.
     
  4. gpseymour

    gpseymour MT Moderator Staff Member

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    I've seen them go both ways on that. Some doctors tell folks not to do any MA for a while, without really letting them know what to avoid (perhaps thinking it's all-out all the time). Others send folks back in with little caution (perhaps thinking it's all soft and cushy). I really think what happens is, for instance, a doctor gets Karate in their head, and decides the patient should or shouldn't be able to safely do what they think Karate is, which might be a reasonable approximation...unless the patient is a BJJ player. Then they're considering pretty much all the wrong things for that patient.
     
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  5. MetalBoar

    MetalBoar Green Belt

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    Sure, that seems about like what I'd expect and it speaks directly to my point. If doctors (in general, not all of them) don't or can't actually give good advice about participation in physical activities most of the time why do we feel the need to tell everyone to talk to their doctor? On reflection I've come to think that it's really wasting both my time and that of the person asking the question and perhaps reflects a lack of courage or intellectual honesty on my part.

    I've been thinking that in the future when I don't feel comfortable advising someone online instead of just advocating a medical professional I should say something more along the lines of, "Hey, sorry, that's rough. I can't really help you online. If you haven't spoken with your doctor about this you should, but I expect there's a good chance they won't have anything useful for you. You'll probably have to really shop around to find a doctor who can and will give you good information. When talking with medical professionals make sure you ask clarifying questions and try to be specific. Things like, "What specific kinds of movement, range of motion, stress, heart rate or impact are you concerned about?", "What are the likely consequences of exceeding the limits in this regard, will it hurt, will I be broken, will I die?", etc. based on what medical problem they've expressed concerns about.

    These could and should be rephrased if theiir doctor isn't addressing their concerns about how they might hurt themselves. In that case the questions should be more like, "So, in my martial art we do things like [whatever concerns you], is there any reason to think that if I do that forcefully or at the end of my range of motion it might be made more risky due to my condition?".

    EDIT: And I guess in addition I may also start telling people that regardless of whether they can get good advice from their medical professional or not they are the one most responsible for their own health and welfare and have to make the final decision about what risks they want to take. If unable to get good information and barring any indication of significant risks of death or long term disability, if they're at a school where it's possible to take things slow and ease into greater and greater levels of intensity they might consider carefully testing the waters and then evaluating on a continuing basis whether they are comfortable with the level of injury and risk of injury that they're experiencing and stage things up or down as they gain experience with what their limitations may be.
     
    Last edited: Aug 23, 2019
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  6. gpseymour

    gpseymour MT Moderator Staff Member

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    I do sometimes suggest folks look for a doc with experience in sports medicine, but that's a tough request. For some injuries/situations, I suggest they talk to an orthoped, who at least is likely to really understand the movement of the affected joint/limb.

    We could probably help them - if we're familiar with what they train - by suggesting some of the questions they should ask their instructor. If they trained something similar to what I do, I'd be able to suggest some questions specific to whatever injury/situation they've described.

    At the very least, the generic questions you've suggested are a good start.
     
  7. dvcochran

    dvcochran Senior Master

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    If I had listened to my doctors over the years I would only be lifting 5 pounds. Doctors have a tough job in todays climate. A LOT of people go to a doctor in the hopes they will be told to lift only 5 pounds (for example) so they have an "excuse" not to do much of anything in life. It has to be very hard for a doctor of any ilk to process the information they are given and figure out what it really means. "My leg hurts" the patient says. How does a doctor score that? Countless variables have to be considered. What is pain? What, if any, value does the old "rate your pain from 0 to 10" mean? Oh, and there are 30 other patients waiting on the doctor.
    In the U.S. I think it is even worse. Hospitals and insurance companies drive an agenda of profit before service so even the doctors with the very best of intents are often forced into compromise.

    It is impossible to glean much information from reading a new persons post on a forum and give any kind of sound advise. The best we can do is offer our experiential knowledge and let them do with it what they wish.

    My experience with doctors is a mixed bag. I have had 36 surgeries for various reasons. Early on, my noggin was pretty messed up and I cannot tell you much other than a lot was going on just to keep me alive. It took time for me and the doctors to figure out what all was messed up.
    One thing I believe without doubt. The health of a person before an injury(s) fully effects the efforts and decisions medical professionals will take. What I mean is the more effort and struggle a patient takes to get better will help a doctor in the decision making process as to whether certain procedures/repairs are worth the risks.
    I remember having heated arguments with a surgeon about repairs to my left leg. There was a 2 week period that it was going to be cut off just above the knee. Not from infection. It was just that messed up.

    My apologies fo off track. My point is this. I hope/believe we are pretty insulated from any legal ramifications on any forum no matter what we say. I believe most here make an effort to give sound advise. We are wise to point out that we are not medical professionals (if we are not). Beyond that we can give our experiences where they apply and try to guide a person in the questions they ask. The best we can give are suggestions. What an OP does with it is up to them.
     
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