"No Load" Exercise For Those With Impaired Function
It is commonly believed that lifting weights is impossible for many dealing with disability. However, the reality is that lifting weights is not terribly different from many of the movements we do in everyday life. We take common motions which our bodies are capable of, and add weight to challenge our bodies and push our limits.
We train the squat, for example, because it requires the simultaneous extension of both the knees and the hips - and we extend our knees and our hips regularly in everyday scenarios, whether or not we specifically perform movements that look exactly like a squat. Some with impaired function may shy away from the idea of squatting, yet they perform individually many of the component muscular movements that make up squatting, on a regular basis!
Recently, research has supported the idea of “no load” training. In this study, some participants were asked to lift weights as normal (HIGH LOAD), while others were asked to essentially mimic lifting weights by forcefully contracting through the same range of movement (NO LOAD).
For example, a HIGH LOAD lifter might perform a biceps curl, lifting a dumbbell as normal, while a NO LOAD lifter would forcefully contract the bicep as if they were lifting a weight, even though there was no external load.
What the study found was that there were similar results for muscle growth for both groups. However, the group which lifted weights gained a significantly greater amount of strength - this should be obvious, since only lifting heavy weights gets you used to lifting heavy weights. This is just an example of exercise specificity at work.
There are also limitations to this study, as Bret Contreras has explored. For one, this was a study with a limited length, so while it showed good results in the short term, there may be a more significant difference between load and no load training in the longer term.
This is supported by the fact that getting stronger generally allows you to handle more work, and the rule of progressive overload is necessary for long term growth. So, it may work well for a short time, but it’s probably not a great long term solution.
What are the applications of no load training?
I’ve actually been implementing a similar approach since long before this study arrived, and I’m happy to see evidence provided for a hunch I had as a trainer several years ago. In many cases, I found that clients were unable to perform weighted movements, but were still capable of performing stretches that carefully mimicked those weighted movements. This served as a way to build up their movement quality and prepare for weighted movements without risking injury.
Here are a few examples of times that “no load” exercise has been very helpful:
When Returning From Exercise After Injury
I once worked with a client who had recently been through a serious car accident. She was lean and had always been active and in great shape, but the accident left her with serious back issues which prevented her from doing much of any lower body work. Worse, she was so demoralized by the injury that she feared the use of literally any weights in her lower body training, even though she was generally capable of good movement and mobility.
My approach for training this client involved a lot of unweighted exercise. We did all upper body work in a supported fashion (chest supported rows, seated shoulder presses, bench presses) to avoid stressing the lower back in the process. She was okay with doing some lower body work, but it had to be very light, and we often had to stick to machines. The hardest part was training the hip hinge movement, which of course trains the lower back.
For this, we instituted a simple and basic toe touch as a form of lower back training. This meant assuming a standard hip hinge position and then, with hands placed on the front of the legs, slowly lowering the hands down the legs, while keeping the back straight, lowering deeper into the toe touch, stopping if there was any pain or discomfort. Essentially, this mimicked a barbell or dumbbell deadlift in form, but we used no weight.
Over time, as she practiced reps of these unweighted hip hinges, her range of motion improved and so did her strength. It took considerable time and was honestly quite boring for her at first - for example, she would do 3 sets and we built up to 30 slow reps at a time.
We were able to start slowly adding in weight - a 1lb dumbbell held in the hands, a 2lb dumbbell held in the hands, and slowly on up from there. By the time we were done working together after several months, she was effectively able to hip hinge with 20lbs - even though she would have absolutely denied she could do so just a few months previously. She was shocked and amazed by the range of motion and strength she had with her back.
From there, we were able to add in more weight to other exercises, and try exercises which involved less stability. At the end of our time together, she was able to do full planks again.
When Old Age Has Reduced Function
In a similar approach, another client was a bit older and had never been active any time in her life. As a result, she had little muscle mass and little strength, and was in many ways very immobile. She was starting from a pretty low standard.
Unlike the previous client, she wasn’t coming back from any particular injury, so she had some strength, but her range of motion was compromised. So, she was able to start out the hip hinge movement with a bit more weight, but we had to further reduce the range of motion to avoid potential injury.
This approach was similar, but instead of starting off unweighted, she started off with a 5lb dumbbell and I set up an exercise step in front of her. She would lower the weight only to the height of the step, so we started with a relatively high step. Each week, we would reduce the height of the step, little by little, until she was able to work within a full range of motion without issue. From there, we were able to start adding weight as usual.
It helped that we weren’t working around the mental block of a serious injury, and so the process was a bit quicker. This approach isn't always going to work - everyone's flexibility limitations are different, and you may be inflexible due to the actual physical structure of your body, not the need to train your movement patterns. For many, however, a sort of "weighted stretch" like this will go a long way.
Due To Serious Surgery
A current client of mine is going through a very rough period - she's been diagnosed with breast cancer. However, she’s lucky in that they managed to identify it early and that her survival rate is very high. Last week, they did initial surgery to remove the tumor and related tissue. Soon, she’ll be doing chemo to eliminate any further traces of cancerous cells in her system.
Due to the surgery, her movement in one arm is severely limited. She fatigues easily, and cannot fully extend her arm over her head. However, she’s a real fighter and was excited to be able to keep at her exercise routine. Her doctors recommended some basic stretches and weightless exercises, and these are the current focus of her training. As her coach, my main priority at this stage is simply to encourage her to do more of those exercises - which she's been gladly throwing herself into.
Aside from that, she’s an avid drummer - and her doctors cleared her for drumming. Even the light activity of drumming involves repetitive arm movements that can count as a form of endurance training, so she’s been drumming as a form of basic movement training to help her recover.
Essentially, her entire workout strategy for the time being is to use weightless exercises until she’s able to regain full function. Once her doctors okay that she’s healed up enough to start using weights again, we’ll be easing her back into her normal routine, starting with light weights.
She’s kicking ass!
In Conjunction With Blood Flow Restriction
Blood flow restriction, or BFR, is a relatively new type of training in which a tight cuff is placed above the bicep or the quadriceps to restrict blood flow out of the muscle. For a greater analysis of what BFR is and how to use it, I recommend this article by Greg Nuckols.
Many have been concerned about potential negative side effects due to the pooling of additional blood and metabolites in the restricted muscles, including increased risk of hypertension-related injury (bruising, blood pressure issues, etc). These effects CAN occur, and this approach should be used with care. For further guidelines on safe usage, I recommend this article from Strength and Conditioning Research.
BFR has numerous benefits. Because BFR helps retain blood in the muscle, it can lead to a very intense and almost painful “pump” sensation, but also supercharges the effectiveness of the exercise. Since BFR necessitates the use of lower loads, it’s surprising in that the effects of a set of BFR training with a low load rivals the effect of a set with regular weight at a higher load.
For this reason, the effectiveness of BFR for post-injury training is potentially high, since exercisers post-injury aren't able to handle much weight safely. I think it’s not much of a stretch to assume that we can expect its effects to apply to no load training as well - and it would be a way to increase the effects of no load training without having to add weight.
While many use BFR as a way to increase strength and muscular growth for performance reasons, it's also particularly useful for those who are unable to add a lot of weight to their movements for any reason.
I Can’t Lift Weights!
I feel it should be clear by now that “I can’t lift weights” is a bit incorrect. There are many ways that we can perform unweighted movements to increase strength or size or increase mobility. If you are capable of flexing a muscle and moving through a particular range of motion without instantly inducing pain or injury, chances are that you can add weight or exercise that range of motion, provided that you take the right approach.
Likewise, I’ve argued in the past that yoga and other stretching routines, provided they’re modified to suit the needs and movement limitations of the exerciser, can be a powerful first step in the process towards regaining strength and function. Stretching alone may not be a great long term plan in the same way that no load training may not be a great long term plan, but it can be a key bridge between disability and regular movement.
It is true that there are some lifts or movements which may simply be impossible due to injury or other physical limitations. However, I think this is more rarely the case than many think.
I'm planning a second post in this series to examine some common movement patterns and how we can approach them with no load training before building into traditional weighted training.
EDIT, 11/2/17: The second post, focusing on a practical exercise routine for no load exercise, is now out!
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Takeaway Points:
Research has recently come to support the principle of "no load" training for building muscle. This approach involves training a muscle by simply flexing forcefully without any external load.
This probably isn't a good long term approach. No load training is hard to properly progress without adding weight. However, it can be an excellent short term approach for those with compromised movement patterns.
I've successfully used this approach in the past for clients returning from injury, surgery, and lack of mobility and muscle mass due to aging. In all cases, movements were first modeled with unweighted versions before adding in a great number of reps and then slowly adding in weight or range of motion.
Blood flow restriction (BFR) is a form of training in which a cuff is used to restrict blood flow in the arms or legs, causing a pooling of blood in the trained muscle and enhancing the effectiveness of exercises performed. This enables you to get a greater effect out of lighter weights, so it's an attractive approach for those who can't go very heavy due to disability. However, it does carry risks and should be used with care.
Many people think that they are incapable of lifting weights, but a no load approach may help them bridge this gap.
Further Reading:
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