Weight Loss Isn’t Rehab (Part One).

I read this great article the other day, and it reminded me that for many of us – when we are injured, and we go to the doctor, we are told that we should try to lose weight to keep pressure off our joints. It sounds good in theory, but in reality weight loss is not rehabilitation.

We know that the dynamic interaction of gravity, weight and movement can create a great deal of pressure in our bodies. When running, the pressure your feet and joints have to negotiate can be around 300% of your body’s weight. I don’t mean to freak you out. The reality is this – if you weigh 100 kilograms and you manage to lose 10 – the difference in terms of stress applied to your joints? It’s negligible. We’re comparing 300 kilograms of impact forces to 270 kilograms. Losing weight will simply not give your joints the downtime you’re seeking.

And if we consider further – protein isn’t just about rebuilding and repairing muscle after exercise. They talk about tissue repair in general fitness terms, but in reality – tissue repair is a pretty broad term, and it includes recovery from all kinds of injuries. Many people like to claim that it’s safe and achievable to shoot for a loss of up to 4 kilograms or 8 pounds in a month. If you’re losing weight at even half that rate, you’re ‘doing better’ than most, and frankly – for that to be possible, you’re most likely in a state of pretty serious dietary restriction.

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Where is the protein coming from?

The idea with weight loss is this – you restrict food intake, or you increase your demands for energy (by exercising more), and your body makes up the difference by burning it’s fat reserves. Nowhere in this equation is more protein coming in to help you heal, unless you’ve made a conscious effort to increase the amount of protein you are eating.

Also, low carb? – you can’t heal tissues properly without carbohydrate. Protein is what your tissues are made of, so protein is what you build new flesh from, but carbohydrate provides the energy for tissue repair to take place. It’s a bit of an oversimplification, but in essence, that’s what we’re working with.

So even if you are successfully losing weight, what are you actually losing? In five or six months if you have managed to lose up to 20 pounds or 10 kilograms, that’s not a huge reduction in ground-impact forces through your body, and it’s half a year of restricting food intake even if you are cycling re-feeding days into your week – the only upside to all this is that maybe if you’re not using your injured body part, maybe it’s been given enough time to heal. But resting isn’t rehab either. And if you can’t suddenly make yourself 40 pounds lighter, how worthwhile is this weight-loss approach to even consider?

So then, where does that leave you? Slowly (maybe) losing weight while depriving your body of the building blocks it requires to undertake repairs.

For complete and efficient tissue repair, you need to be eating enough food in general terms, and you certainly need to be eating enough of your three macronutrients.

This has been written about by many others before: restriction, more often than not, doesn’t result in the weight loss we desire, but it does result in joint damage and an impaired ability to heal and recover.

So in my experience this is true: trying to lose weight in an attempt to resolve injuries just interferes with your body’s ability to recover. It’s a kick in the teeth, really.

So what can you do? In broad terms, we need to think about nutrition and circulation. Muscles get a good supply of blood. Tendons get less, and ligaments less again. If you have a ligament or tendon issue, they take a long time to heal, largely because with such poor blood circulation, it’s hard for them to access the nutrients or building materials they require. You can try to maximise your ability to heal by eating a whole lot of food, and by doing what you can to improve circulation to the injured area. This can include massage and exercise.

But it gets a little controversial here too: in the acute, or early stages of an injury, the general approach is to ice and compress, to reduce circulation, because we want to suppress swelling and inflammation. I’m not actually convinced that this is the most sophisticated approach, but it is simple and easy to follow. Also, in the case of injury, your range of motion and strength will most likely be diminished, and a subtle touch is required when it comes to progressing your injured area, and building it back up to robust health and function.

And then, specific injuries aside, there are more vague issues that many of us face regarding fatigue and aches and tightness. Weight loss as a method of trying to deal with generalised back pain? It’s a waste of time. If successful, it can take years, but you can actually start working right now on strengthening your back, your buttocks, your abs and hamstrings, and increasing your range of motion. All this can be incredibly effective, depending on the specifics of your particular condition, as long as you go about it the right way. I have seen far more people successfully build muscle and develop strong, stable joints, than I have seen successfully lose weight and keep it off. And with this approach we are really focusing on growing, on building our bodies, and we don’t have to worry half as much about relapse because stability is strength, and weight loss does not magically give you more stable joints.

Weight loss as a method for healing and injury management simply isn’t logical. It only plays into existing fantasies that if we were lighter our lives would be better, but instead – if successful, weight loss really only has the capacity to turn a fat injured person into a thin injured person. Injury and joint dysfunction can occur at any weight, and processes of rehabilitation can also be undertaken at any weight.

Part two deals with more specific examples of rehabilitation (strength and mobility) issues.