How to lose weight with core injuries?
June 1, 2014 11:20 AM   Subscribe

I'm in physio and working on my core. But every time I try to exercise, I injure myself. I'm gaining weight like crazy and really can't afford to only do core exercises. Is there anything I could do to help lose weight?

I'm working on rehabilitating my core, given injuries to my back, neck, pelvis and more. Physio is pretty sure it is all muscular and the result of past injuries, deconditioning and the challenges of parenting children with special needs.

I do not even eat the recommended caloric intake for my age/weight/height/gender, but I've been steadily gaining weight. My doctor is sending me for bloodwork to rule out any issues there.

My budget only allows for a limited amount of physio time and I'd rather she work on the rehab stuff, rather than have a big long discussion about calorie-burning exercises. I'm looking for ideas to help me burn calories and keep my weight from going up, but ideally start going the other way.

I'm doing all my core exercises. But I need to burn calories. I'll definitely run any ideas by my physio or doctor before embarking on them. Right now, even something as simple as a bike ride is making my back and neck go out. And walking more than a few blocks is hurting.

I'm scared that the four months of core work I have ahead of me will just see me continue to gain weight. I'm very nearly at the obese mark now and increased weight will just put more strain on my core.

If you have any ideas, I'm all ears. Again, I'll run everything by my medical professionals. I'm just wondering what else I could be doing. Weight gain is freaking me out and I'm frustrating that, in spite of tracking everything I eat, I'm gaining and gaining.

Tl;dr: injured mom with weak core is in physical therapy and needs to lose weight. Will run all ideas by physio/doctor. How to lose weight during rehabilitation period?
posted by Chaussette and the Pussy Cats to Health & Fitness (27 answers total) 5 users marked this as a favorite
In what manner does walking a few blocks every day hurt?
Ligaments? Muscles? Joints? Sciatica? What kind of pain is it?
Has your doctor told you not to walk?

Your core needs strain to get stronger. That's how muscles work. You must suffer *some* discomfort to increase your core strength. Start slow, but keep working to increase the distance that you walk. I'm very fond of the Oregon Scientific PE-326CA pedometer for my recordkeeping.

Walking is nearly the gentlest thing that you can do. If you can't walk, then you are on a slippery slope that ends up with a lot of medical intervention, where you are not strong enough to exercise enough to stay healthy.
posted by the Real Dan at 11:31 AM on June 1, 2014

Do you have access to a swimming pool? Swimming is often gentler on the joints because you are cushioned in water. Maybe water aerobics? (Which are not just for old ladies, though many older people with more fragile joints and bones like water exercises.)
posted by Rosie M. Banks at 11:33 AM on June 1, 2014 [6 favorites]

Warm water therapy pool. Even just kinda hanging onto the side doing scissor kicks in a vertical position. Plus it's probably good for your muscle injuries. They could give you few exercises/stretches to do to work on that core injury and a few slightly-aerobic things to do to work on building your cardiovascular fitness.

Can you walk around ONE block? Three times a day? Studies show that building up small amounts of physical activity every day has many of the same benefits as one longer session. Maybe walk around the block after breakfast and after dinner, not so far you have any pain, just maybe 75% of your non-pain distance ... but twice. (Plus, a little passagiata after eating is good for the digestion.)
posted by Eyebrows McGee at 11:50 AM on June 1, 2014

Response by poster: Sorry. I should clarify. Sometimes, I am in pain after a few blocks (e.g 1 km). Other times, I can walk several kilometres.

I could probably find a local pool, but I find the schedules hard to match up to having my kids with me. Is doing it once a week any good?
posted by Chaussette and the Pussy Cats at 11:58 AM on June 1, 2014

I was having terrible troubles with joint pain after running / walking quite short distances. I started taking a Pilates class 3 times a week and doing my cardio immediately afterwards, and the difference has been extraordinary. I know it's time, and not just time but blocks of time, but if you can make that happen even occasionally it might be worth it. Memail me if you want to hear more.
posted by KathrynT at 12:05 PM on June 1, 2014

Reduce your calories. The charts telling you how much to eat are pretty much useless for a lot of people, and the surest way to lose pounds is generally expending more calories than you take in. You can either work it off (exercise) or not bring it in. Since you're injured, lowering calories would be the way to go, temporarily.
posted by xingcat at 12:05 PM on June 1, 2014 [6 favorites]

I'm in a similar bind. Advice I got was just to watch calories and try to do 30 minutes a day of gentle cardio. My PT's given me guidance on appropriate activities and tips on biomechanics -- takes about 5-10 minutes out of any given session.

That said, the exercise is not really geared to serious calorie burning -- it's more to just keep things functional. As with non-injured people, most of any weight loss action happens via dietary reduction in calories. But remember that a lot of the calorie burn assumed in the charts takes place via NEAT (non-exercise activity thermogenesis). If your pain keeps you sitting a lot of the time, it might be you need fewer calories than the charts indicate. Conversely, better pain management might help you move more often and let you keep your intake where it is.

I hope your blood test offers insights. (Mine did. Among other things, it uncovered a severe vitamin D deficiency, which I was told could contribute to musculoskeletal pain.)

Lack of sleep and too much stress will affect weight gain/loss, too.
posted by cotton dress sock at 12:14 PM on June 1, 2014 [2 favorites]

Try making every meal protein and vegetable dense (mostly vegetables with a decent side of protein like whey powder, tuna, eggs, chicken) and cut out as much sugar and carbs (no bread or pasta or cereal, even no sugary fruits) as you can stand.

I'm fairly sedentary so I notice the difference my diet makes really quickly. The diet book "The Last 15" by Joey Shulman helped me sort out what to eat to lose/maintain my weight healthily.
posted by lafemma at 12:19 PM on June 1, 2014 [4 favorites]

Yes, cut carbs, not calories. I started a low - ish carb diet around the same time I stopped exercising; I swam 30 minutes every single day for a year and a half, and lost not a single pound. On my low-ish carb diet (I'm not that strict, just basically not white flour and low sugar) I dropped 20 pounds in 3 months.

I will also say that I've tried cutting calories in the past and didn't find it to work at all. Or if it did work, it was very temporary and I gained the 5 pounds or so that I lost right back.

Low carbing feels a lot more like a sustainable lifestyle choice than a "diet" too, it's really easy because since protein and veggies really fill you up, you never feel hungry. And if you pick 1 or 2 nights a week to have things like pizza or cake, it doesn't feel depriving at all, because nothing is really off limits.
posted by rabbitrabbit at 2:25 PM on June 1, 2014

Response by poster: Thanks. As I noted, I am already eating below the recommended calorie counts, but I'm gaining weight. I would cut back to the 1200-1500 calorie range, but I wasn't sure if that was safe for someone my size (pm me if you need the weight) or if it would result in my body attacking muscle.
posted by Chaussette and the Pussy Cats at 3:53 PM on June 1, 2014

If you're exercising to lose weight, you gotta do a lot of exercise. Like a lot. Crunch the numbers on a calorie counter to see. Frankly your injuries sound so bad, I'm not sure your body could take the amount of exercise needed.

Nthing swimming (a great calorie burner and very gentle), but you're gonna need like for times forty minutes a week, minimum, to really make a ding.

I don't want to sound like a downer, but it might be better focus on getting yourself into shape so you can safely ramp up, i.e. more rehab stuff, before looking into burning calories up in a serious way. Best of luck.
posted by smoke at 4:32 PM on June 1, 2014 [2 favorites]

I'm another person who is finding that low-carb is the best way to lose weight. I've pretty ruthlessly pared out "white" carbs and desserts for the past couple of weeks, and, voila, the pounds are finally budging! And I find that eating some chicken and a salad (WITH dressing!) is plenty filling. And this is without drastically upping my physical activity.

If you want to lose weight, try low-carb. I have insulin resistance, which makes it hard for me to lose weight if I have too many carbs. Low-carb is like the magic bullet (doctor and I agreed that we want to try this before putting me on Metformin). I wanted to mention the insulin resistance because if you are gaining a lot of weight in a short time, it's possible this is the culprit. Have your doctor run a blood panel, and check your thyroid levels too. If you're female, it's SO SO SO common to have hypothyroidism (another thing I have, and I take Synthroid for it).
posted by Rosie M. Banks at 4:49 PM on June 1, 2014 [2 favorites]

Exercising to burn calories (i.e., 800 cals on the bike today!) is a sucker's game. Get rid of the excess fat by eating less. Forget "recommended values" and figure out what is too much or too little FOR YOU, since that is what matters.

Your physical exercise should be focused on building strength, which will build muscle - I know, I know, eponysterical. It's unlikely you have much muscle to be "attacked" (this is called catabolism) in the first place, but lifting weights will both stave off catabolism and actually help build new muscle which you clearly are in desperate need of. In any case, your body will mostly burn off fat before it catabolizes muscle, at least in the beginning.

A body with more muscle has higher calorie requirements and will help you lose the fat. Not to mention, being strong is basically a prerequisite for being fit and will help keep you uninjured once you are finished rehabbing. Get your PT to give you exercises that work for you given your injuries.
posted by mrbigmuscles at 4:49 PM on June 1, 2014

Unless you're weighing food and way more accurate than most people, you're probably underestimating your intake. Either way, your body is nowhere near being harmed by reduced caloric intake. Make sure to keep your protein decent and keep cutting calories until you're at least not gaining.

The issue with reducing calories to lose weight is that it's doable and you'll lose weight, but it can wreak havoc on your mood and/or energy levels. So first have the goal of not gaining, which should feel totally sustainable, and when you're feeling up to it you can push into actual weight loss.

But don't be afraid to eat too little according to calorie estimates--they're really not accurate enough to tell you more than "I've found by experimenting that this is approximately how much food it takes for me to lose/maintain/gain".
posted by the young rope-rider at 5:26 PM on June 1, 2014 [1 favorite]

Here's a calculator that I like because it at least lets you estimate how much you're burning given what you're spending your time on. (I would guess that any exercise you could feasibly do at this point would be "light". Also, nb, the default gender setting is male, so if you're not that, change the setting.) You're fine as long as you're above your estimated basal metabolic rate [which is very likely to be below 1500]. But logging trials and outcomes is really the best way to tell what works for you. You do need calories for healing (and mood/energy, as the young rope-rider says), so reducing by a little at a time might be a good strategy if it was one you wanted to try.

High-veg/fiber/protein diets are an easy way to get satiating, nutrient-dense food in for fewer calories, and I'm also persuaded by the metabolic argument.
posted by cotton dress sock at 5:46 PM on June 1, 2014

Chaussette and the Pussy Cats: "I could probably find a local pool, but I find the schedules hard to match up to having my kids with me. Is doing it once a week any good?"

I had to do warm-water therapy pool when I was pregnant, and the reason my doctor prescribed it was that I was in terrible, terrible back and hip pain. The warm water pool a) relaxed the muscles and b) lifted the weight off my hips and spine so that the muscles/tendons/joints/etc. got a bit of a break and weren't knotted up ALL the time. Generally spending 45 minutes or an hour in the warm water pool left me noticeably looser and more mobile for the next three days. (They had me do gentle range-of-motion exercises to keep my hips and back moving, but at least 75% of the benefit was floating in warm water for longish periods.)

So it's possible that finding a warm-water pool and spending an hour in it even once a week would give you a real benefit for the next several days so that you could do NON-pool exercise more. Your PT will know if there's one in your area, and can give you a "prescription" if you need one to visit. (Mine was free (alone) or covered by insurance (working with a PT) for people with Rxes, $1/visit for those without, run by Easter Seals.)
posted by Eyebrows McGee at 6:48 PM on June 1, 2014 [1 favorite]

Response by poster: Thank you for all the responses. It sounds like I should stick with the work I'm doing at physio and add in more walking and pool time. I will see if I can find a pilates class that will work with my schedule - I think that part is trickier, but I really need a strong core to do the kind of exercise that will help me burn more calories and stay fit and happy.

I'll see if I can change up what I'm eating a little. I eat fairly healthily and I'm pretty certain of how much I'm eating, which is why it worries me that I've been gaining. It's not like I am completely inactive, but my body seems to react like it is. Maybe changing what I eat will help. Thanks.
posted by Chaussette and the Pussy Cats at 10:22 PM on June 1, 2014

I do not even eat the recommended caloric intake for my age/weight/height/gender, but I've been steadily gaining weight.

Not eating *enough* calories is counterproductive as it will slow down your metabolism. So make sure you're eating at least 75% of your recommended maintenance-level calories. And don't skip breakfast.

The exercises you're doing at your physio appointments may be causing you to gain weight because you're gaining muscle. I recommend ditching your scale for a tape measure as inches lost is a better metric than pounds lost if you're trying to get in shape. Try keeping track of your waistline instead of your weight for a while.

My doctor is sending me for bloodwork to rule out any issues there.

Then these questions are premature, as it's entirely possible that all your problems will be solved with a $4/month thyroid pill. So get all that bloodwork done (make sure they check thyroid, iron, vitamin D, and vitamin B12) and see what it says before deciding what to do.
posted by Jacqueline at 10:58 PM on June 1, 2014 [1 favorite]

You should be able to do some rehab weight training in legs and upper body, even with your injuries. Consult with physio. With an adjustable 10 lb ankle weight, some resistance bands, and/or some dumbbells, you can put on muscle and not gain weight.

With this equipment you can do non weight bearing strength training in legs, such as seated leg extension, hamstring curl, standing hip abduction/adduction, rear leg extension. I assume you are doing your bridges and clamshells. Upper body program can be anything recommended by physio with low weights, high reps - I didn't have back problems but I can't see why you couldn't do bicep curls, triceps extension, wall pushup (with arms in triceps pushup position).

The nice thing about home gym is you can do it whenever. If you go fast it's a circuit and you get cardio. Setup cost for me was $150, with another $30 for foam roller and tennis balls for mobility. The resistance band set and dumbbell set got are adjustable, so they transition into the more traditional squat/lunge/push/pull functional program you will be on eventually by adding cheap weight plates/bands.

If you are not a swimmer I might skip the pool. Swimming makes me really hungry. It's also surprisingly hard to come up with an effective program for your set of injuries unsupervised. Warm water does help with mobility, but for strength and weight maintenance I think you could spend your time more effectively elsewhere. Swimming is a time suck.

Btw it kinda sounds like your physiotherapist sucks. I don't know why you're stuck on four months of core rehab only, that sounds way too long if you're doing your exercises as prescribed. I would get a second opinion or try another approach. Some people are better at diagnostics and prescribe more effective exercises.Active rehab is cheaper than physio and you are hands on with a trainer for an hour, not kicked into physio gym for 30 min. I have had good results with IMS (aka dry needling) as part of a physio program that includes core rehab and functional training for what is now a soft tissue injury of some unknown provenance in the pelvis. I know it sucks to burn your rehab budget to shop around but shop around. Not all physio is created equal.

And for God's sake eat when you're in rehab, push protein like it's going out of style. You can wear gym shoes and eat protein bars and pretend you're going to be a muscle head doing burpees. Just make sure you're trying to build muscle.
posted by crazycanuck at 11:29 PM on June 1, 2014

I am not a doctor, or physical therapist, or have in any way done a scholarly study on nutrition and exercise. And you should always listen to your doctor over internet strangers. But let's take a simple look at your own statements:

1. I'm gaining weight like crazy...

2. I do not even eat the recommended caloric intake for my age/weight/height/gender, but I've been steadily gaining weight.

3. I'm very nearly at the obese mark now...

4. Weight gain is freaking me out...

5. I am already eating below the recommended calorie counts, but I'm gaining weight.

Contrast with:

I wasn't sure if that was safe for someone my size [...] or if it would result in my body attacking muscle.

If you're still gaining weight then you're still eating too many calories. Those first five statements I've highlighted tell us you are no where near the caloric intake where you need to worry about losing muscle mass. If you were actually starving to the point you were cannibalizing muscle, you'd at least be losing weight. Not good weight loss, mind you, but you would be asking an entirely different question.

You don't need complex calorie calculations, analysis, or charts to figure this out. Take an honest look at your eating habits, identify week points, and cut them out. Look hard for leaner alternatives and even healthier options (they're out there). Keep doing this till you stop gaining weight. Keep doing this till you start losing weight. When you'd at -1 to -3lbs per week (averaged) you know you're at the right caloric intake for your goals.
posted by sbutler at 12:12 AM on June 2, 2014 [4 favorites]

The exercises you're doing at your physio appointments may be causing you to gain weight because you're gaining muscle.

It is extremely unlikely that OP has gained muscle mass by doing core work at the physio's. It's hard to put on appreciable muscle without working hard at it in a deliberate manner, for women especially. A woman living off protein shakes/tuna and lifting like a beast might get a pound of muscle a month (but of course more that is not muscle along with it).
posted by cotton dress sock at 1:22 AM on June 2, 2014 [1 favorite]

I would want to see what your doctor comes back with. Gaining fat even while cutting calories and being weak/prone to injury makes me think you have issues building muscle. I would not worry so much about cutting calories as making sure you are getting the protein you need and the nutrients necessary to build/repair muscle. This really sounds like an endocrine problem to me. My father had similar issues and it turned out to be low testosterone. Ladies can have androgen issues too. We don't require as much as men, but it is necessary for muscle growth and maintenance.
posted by domo at 5:20 AM on June 2, 2014

Most people seriously underestimate how many calories they eat, which is why weighing all your food is a much better approach when counting calories then estimating or relying on volume measurements.
posted by inertia at 10:34 AM on June 2, 2014 [1 favorite]

You're nowhere near a slowed metabolism if you're gaining.

In a general sense, our bodies love calories and we all compensate in unconscious ways to counteract exercise expenditures by eating more and/or doing less activity in other areas of our daily life. Especially if you're already dealing with physical limitations, it's significantly easier to lose weight by cutting your caloric intake.

I never dieted a day in my life before this year and it was surprisingly easy to lose 20 pounds without adding any serious exercise. It's staying off easily, too. I chose foods based on them being high protein and low carb. If you eat animal products, this is pretty easy. I ultimately measured my progress based on the scale, not my estimated intake, because my goal was to move the scale, not move my estimate of my intake. It worked and I was rarely hungry. I was notably crabby, though it seems worth it since not losing the weight will have long-term effects including chronic pain and disability (bad knee, bad feet, scoliosis, etc.)
posted by the young rope-rider at 12:01 PM on June 2, 2014

So it sounds like you have a real chronic pain issue that does not benefit from weight gain. I had a horrible car accident and gained 40 pounds in a flash....comfort food became comfort butt and belly. I found very gentle yoga poses to be as helpful with my core and my weight gain. That and the 30 squats that I worked up to wasn't fancy but it works.

But in the end weight gain is most often more calories in than out. Keep a real record. I use an app that records all this for me and as long as I am honest with the app I get a good picture of what I am eating....I became much more educated about what the real calorie count was. I used high protein/low carb to get out of the bad eating rut and I am now down 22 pounds...good luck. Weight issues are a pain in the ass.
posted by OhSusannah at 3:02 AM on June 3, 2014

Response by poster: Honestly, I don't think I'm miscounting calories. I've cut calories before and lost weight. My physio, doctor, former trainer and new physio all say that my stress level from parenting children with special needs is most likely to blame. But I hope to have blood work soon and I have imaging scheduled to rule out some other potential health problems.

Since posting this question, I have it back calories further and put more of a focus on protein and produce. And my weight is up 4 lbs, which I hope is a fluctuation, as it is continuing to jump upward.
posted by Chaussette and the Pussy Cats at 10:46 PM on June 3, 2014 [1 favorite]

Cutting calories only affects half of the equation. If your BMR changes, i.e. eating and activity habits stay the same but weight gain occurs, there is something going on in your body. More so if you are experiencing other symptoms like muscle soreness. This may be normal hormonal changes like menopause, or it could be a sign of something wrong. If you are gaining or losing weight and your habits have not changed, see a doctor!
posted by domo at 8:18 AM on June 11, 2014

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