What it means when you hear "don't lift more than X pounds"

The Question

Hi Casey!

I have a heart condition that prevents me from lifting heavy. Before being diagnosed, I was powerlifting pretty consistently, and I absolutely loved it. I loved being strong, I loved the efficiency of it, I loved the movements.

However, doctors have advised not lifting anything heavier than 100 lbs. and to avoid the Valsalva maneuver. I want to follow their guidance, but I also loved progressive overload! Is there a way to build muscle staying within those constraints? I’m trying to do like, 100 squats with the empty bar and it’s... okay.

Thank you!
—Madelyn

Hi!

First off, I’ve been a silent lurker on your social media for a long time. I started lifting ~2 years ago, and it’s been an amazing journey. I love your content and appreciate everything you do to make lifting more accessible.

My question is about lifting and all the stages pre- and postpartum. I recently started an IVF cycle, and the information on the internet about if and how to safely exercise during IVF is just wild. Same with pregnancy generally—every possible POV from “the only safe exercise is walking until your kid is at least one year old” to “I ran a marathon in my ninth month and went into labor as I crossed the finish line” is out there. And my doctor is not very helpful either! I got a vague “You can keep exercising, but nothing too high-impact. And no twisting. And also just rest a lot.” Which is... confusing!

Anyway, I know this may not be a topic you have personal experience with, but it’s an issue that is in desperate need of thoughtful content! I can’t bear the idea of just “walking” for the next 1-2 years as I go through this fertility (and, hopefully soon, pregnancy!) journey. Help! —Esther

The Answer

This is difficult for people like me, because as someone who doesn’t know you personally, my top-line message always has to be “consult with your doctor or favorite medical professional,” for both liability and safety reasons. This post is for educational purposes only, and if you don't listen to me and go to any emergency room with your resulting lifting-related injury saying “but Casey said,” I will find you and finish what the lifting started.

That said: I frequently hear from people who are frustrated by these kinds of directives. They want to know if they are “real,” or if the doctor is simply being stupid and potentially discriminatory. They have a sense that lifting is actually good for them and may be attached to their existing lifting routine. They don’t want to go against their doctor, but they feel disregarded and hamstrung by these restrictions.

So here we are going to dig into where this rule comes from; what it actually means; what its limitations are; and why the fact that lifting poses a risk to some people, sometimes, definitely does not mean it is a risk with only downsides for everyone.

Yes; doctors can still be pretty dumb about lifting generally

Many, many doctors out there have regressive opinions about strength training and lifting weights. Here are a bunch of ways that doctors ignorantly run their mouths about lifting:

“I used to lift weights. Then I got injured”

“Heavy weights are unsafe”

“Squats are the single worst thing you can do to your body”

“You need to stop trying to impress other people”

“Your low-back injury is from all that free weight stuff you do”

If a doctor discourages you from lifting, ever, generally speaking, that’s a time to exercise your freedom of “getting a second opinion.” If your insurance situation allows, I would suggest trying a sports medicine doctor; they tend to have much more flexible/positive attitudes toward varying forms of exercise. (Doctors, if you have other suggestions: Please leave a comment!)

That all said! It’s still common in certain situations for doctors to steer people away from “lifting more than X pounds” in various situations. It’s a directive that sticks in the craw, even for people who don’t lift weights, because it seems so clearly flawed and/or incomplete as a recommendation. A jug of water or milk weighs eight pounds; is filling my own glass almost unsafe? My own leg weighs more than 10 pounds; am I not even allowed to walk, lest I lift a foot? For lots of people, and seemingly even for some doctors, this rule seems to inspire a fear of weights as “not worth the risk.”

Vintage Swole Woman: What "heavy weights" means, and why they are good>>>

Where “don’t lift more than X pounds” comes from

Lord almighty; I tried my darndest to figure it out. I trawled Google Scholar and EurekAlert; I asked doctors of physical therapy; I asked people who know the landscape of strength-related research much better than I do. No one could give me a source for these specific weight recommendations. This doesn't mean everyone is safe to ignore them, as we will get to in a second. But they are on shaky-ish ground.

There is some not-bad evidence that doctors miiight stop painting with this particularly broad brush, eventually. I loved this section from a 2021 survey paper on “Recommendations on postoperative strain and physical labor after abdominal and hernia surgery,” which includes what have to be some of the most obvious lifting-restriction scenarios. The authors wrote:

It has been shown that even lifting a weight of 50 kg led to a negligible rise of the intra-abdominal pressure. Of course, physical activity and lifting weights can easily be adapted in the postoperative period, but the effect of these restrictions should be questioned and the impact of lifting weights on intra-abdominal pressure and fascial shear stress might be overestimated. Some studies found involuntary actions such as coughing, wheezing, or defecation to cause faster and more significant increases of intra-abdominal pressure, which were way higher than that caused by physical activity or lifting.

It’s always difficult to prove a negative. But I feel secure in saying, as we will see below, that even the people who should know, do not know where this sort of directive/recommendation comes from, as a concept. It seems like something someone just started saying one day to patients who they didn’t want to put too much stress on one or more of their biological systems, and it stuck.

“A lot of the random diagnoses, we are realizing, hold no weight; they just become someone’s bias and then this massive game of telephone,” Andy Chen, a doctor of physical therapy and PT at Moment Physical Therapy and Performance, told me.

This is not to say that everyone who’s been told not to lift more than X pounds should go right out and do it. But people who receive these restrictions often assume (very fairly) that they are meant to follow them forever.

Those specific weight-restriction numbers are actually usually meant to be followed for a set period of time—sometimes only a few days, sometimes several weeks, sometimes months—following a particularly intensive or stressful episode for bodies, such as IVF implantation or surgery. That fact is often poorly communicated.

“You definitely hear similar precautions from certain orthopedists who work with people recovering from spinal or knee surgery—with the former, I’ve gotten lots of prescriptions from MDs saying a patient literally shouldn’t lift more than 20 pounds, but without qualifying any time frames or other details,” Clinton Lee, another doctor of physical therapy, certified strength and conditioning coach, and owner of PhysioStrength told me. “No one should have a standing, lifelong order to never lift above 10 pounds, barring some sort of medical issue,” he said.

“Avoid strenuous exercise, including and especially heavy lifting” used to be a blanket recommendation for pregnant women that is, fortunately, becoming less and less common.

“For pregnant women, most of the concerns are related to blood pressure,” Greg Nuckols, the proprietor of Stronger by Science, told me. “Blood pressure acutely increases during almost any form of exercise. However, we now know that this concern was largely overblown, and that exercise during pregnancy has a host of benefits and minimal risk. Regarding resistance training specifically, the American Council of Obstetricians and Gynecologists lists resistance exercise as a type of Exercise That Has Been Extensively Studied in Pregnancy and Found to Be Safe and Beneficial. However, there are still some concerns about the use of the Valsalva maneuver.'"

Why the “don’t lift more than X pounds” guideline is not totally meaningless, even if it’s made-up

I do not have to be a doctor to tell you that this is a “guidelines, not rules” situation. Why? Because X pounds can mean very different things in different contexts. If your supposed limit is 10 pounds, it’s much easier to squat 10 pounds than to curl it, or to hold it in your hand straight out away from your body. Conversely, each of your legs and arms almost certainly weighs more than 10 pounds.