DVT and weight training

[BJB82]

Mark,
First, thanks for the books and the barbell seminar. I attended in Arlington, VA this year and it was the most useful money I have ever spent on fitness. Unbelievable amount of information packed into 2 days.

Within a week or two of attending the cert I came up with some pretty intense pain in my calf muscle. It got better after a couple weeks and so I went back to lifting heavy. Second workout it hit me again the night after a heavy thruster workout. Woke up in the middle of the night in some pretty good pain with much swelling in the calf.

Turns out I had 4 clots in my lower left leg. Further testing showed I have a genetic blood clotting disorder.

So here?s the question. I?m on Coumadin to thin my blood. No one can really give me a straight answer on what I can and cannot do weight training wise. The Hematologist has seemed to be the most helpful at this point explaining that exercise will not be a problem on Coumadin or when I come off as long as I ?don?t lift anything heavy?. His reasoning behind this is that a heavy back squat, for example, would place my calf muscle in contraction for however long it takes to complete the set. This will restrict blood movement in the lower leg which will increase the chances of developing a clot.

I have no idea what ?lifting heavy? means to an Hematologist. I had a 450# DL and 300 BS before the clots. I?m sure he would consider this heavy.

Do you have any thoughts on this or could you direct me to anyone who may be able to help me out? I?m 32 yo, 6?2? and 220# before the clots. I?ve already dropped 15 pounds Crossfitting without any heavy barbell work and I?m loosing strength month by month.

Thanks Mark

[Mark Rippetoe]

I'm completely out of my bailiwick here, but I'd like to know how the hematologist knows how much more calf contraction occurs in a "heavy" squat vs. a "light" squat, how long the set takes, and what the time frame for the occlusive clotting mechanism might be.

[Dave76]

So here?s the question. I?m on Coumadin to thin my blood. No one can really give me a straight answer on what I can and cannot do weight training wise.

I'm glad you asked the question. I, too, developed a blood clot and I'm on Coumadin. The best answer I was able to get from a medical professional was that my leg would tell me when I was doing too much. If the leg doesn't hurt and doesn't swell up, it's Ok. I have no idea if this advice is correct but it's the advice that I chose to believe.

I started squatting again with 95 lb work sets and have very slowly worked my way back up to 240 lb work sets. If there has been a problem, I don't know about it. I go back to the doctor next week for the 6 month check up. Maybe I'll know more next week.

If anyone has a definitive answer, I'd love to hear it.

[TPrewittMD]

Hey Rip, long time, no talk.
Hope the shoulder is good.

I'll throw in my two cents worth.

First, I suspect the hematologist made recommendations without any prospective, randomized trials testing recurrent DVT rates in athletes doing heavy and light squats. We see many similar situations reported on this board by various lifters who go to well-meaning, yet maybe uninformed, docs. If there is such a study, I would like to see it.

Second, I wonder about the etiology of the DVT. If BJB82 traveled to the barbell Cert on a plane or long car trip, that could be what instigated the DVT, particularly in the setting of a hypercoagulable state. Sitting still for long periods of time, as in travel or after surgery, is a well-documented etiology of DVT.

That gets me to the third point. Calf contraction actually prevents DVT. Muscular contraction improves venous circulation. Veins are thin walled vessels which contain one-way valves. The muscles in the legs contract, compressing the veins, and this essentially squeezes the blood up the legs. Calf contraction shouldn't cause a DVT. On the other hand, a Valsalva maneuver, i.e. exhaling against a closed glottis, increases intrathoracic pressure and reduces venous return to the hear. But mere moments of breath-holding during a lift should not cause enough stasis to have a negative effect.

This sounds like another example of a doctor's recommendation against heavy lifting made without supportive data and physiologic reasoning.

Physicians do not understand the implications of these recommendations on the serious athlete who lifts heavy, recreationally or otherwise.

[Mark Rippetoe]

Thanks, Dr. Prewitt. Your comments are always welcome here.

[BJB82]

Thanks for the interest in my problem and taking the time to offer some help.



Second, I wonder about the etiology of the DVT. Sitting still for long periods of time, as in travel or after surgery, is a well-documented etiology of DVT.

That gets me to the third point. Calf contraction actually prevents DVT. Muscular contraction improves venous circulation. Veins are thin walled vessels which contain one-way valves. The muscles in the legs contract, compressing the veins, and this essentially squeezes the blood up the legs. Calf contraction shouldn't cause a DVT. On the other hand, a Valsalva maneuver, i.e. exhaling against a closed glottis, increases intrathoracic pressure and reduces venous return to the hear. But mere moments of breath-holding during a lift should not cause enough stasis to have a negative effect.

I had a short drive to the cert, no flying in a couple years, don't smoke, no trauma recently....He also explained the same thing you did above about the vein walls. This is exactly why he recommended lower weight higher repetition stuff like "running". These activities would promote venous flow but a long contraction of a calf muscle would restrict venous flow and could cause another problem. I'm not saying it makes sense, just explaining what he told me. Thats why I'm here because it doesn't make complete sense to me.


I'm glad you asked the question. I, too, developed a blood clot and I'm on Coumadin. The best answer I was able to get from a medical professional was that my leg would tell me when I was doing too much. If the leg doesn't hurt and doesn't swell up, it's Ok. I have no idea if this advice is correct but it's the advice that I chose to believe.

I started squatting again with 95 lb work sets and have very slowly worked my way back up to 240 lb work sets. If there has been a problem, I don't know about it. I go back to the doctor next week for the 6 month check up. Maybe I'll know more next week.

If anyone has a definitive answer, I'd love to hear it.

Thanks Dave76. I had already made my mind up to take a similar course of action. Let me know if you come across any additional info and I'll do the same. Good luck.

He also told me I could come off coumadin in 6 months. This really made little sense to me because it is a genetic disorder, nothing is going to change over the next several generations so how/why come off coumadin if there's a chance this thing will come back?