Bonus Episode: Vaccinations and Exercise, Deadlifts For Hypertrophy, and Recovery from Disc Herniations

0:00Jordan Feigenbaum:Hey, it's Jordan from Barbell Medicine. Now this episode preview is from exclusive content that regularly goes out to our Barbell Medicine Plus subscribers. In addition to exclusive content, Barbell Medicine Plus subscribers get early access to episodes and products, ad-free listening, discounts on products and services, and the ability to ask Dr. Baraki and I questions, all for about the cost of a cup of coffee each month. And in case you were wondering, the first month is free. To join, head over to barbellmedicine.com slash plus and sign up to be a Barbell Medicine Plus member today. That's barbellmedicine.com slash plus.

0:32Jordan Feigenbaum:All right. Thanks for your consideration. On to the show.

0:40Jordan Feigenbaum:Welcome back to the Barbell Medicine Plus podcast where we bring modern medicine to strength, conditioning, and other items depending on what you asked us. So let's just get into it. The first one is on flu slash COVID vaccine questions. Good thing is because it's only going out on Supercast, Barbell Medicine Plus podcast. We're not going to get flagged and just get, you know, a bunch of hate messages. So this question says, I did a quick search on the forum and found some things from about 2021. So apologies if this has been asked slash answered before, but tis the season to get these. This individual says, I, without fail, have the same symptoms after the COVID booster every single year, Moderna in my case.

1:24Jordan Feigenbaum:My joints hurt. I have headaches, sweats, muscle aches like delayed onset muscle soreness and generally feel like hot garbage. These are all things that in my day-to-day life of training four to six days a week I do not have. What's that about? Is my immune system doing its thing in the least pleasant way possible? I remember that there was some guidance when these rolled out to avoid painkillers slash fever reducers like ibuprofen. Is that still the case? Would really love to have some of these medications next year. This year, I scheduled my shots after my Friday session, which is my last session of the week.

1:57Jordan Feigenbaum:But are there any reasons to not train after the shots? I've generally pushed through if I happen to have a training session the day of or after the shot. I remember there being some weird guidance to avoid activity for a week or some such nonsense from the early vaccine rollouts. So likely outdated. Long question. But, yeah, adequate, adequate, especially because it is the season. So we did cover some of this. I mean, granted, that was podcast episode 96, which is almost 300 episodes ago. Yeah, 300. So – and it is interesting, maybe just an aside, like people will bring up topics that we've covered before, for example, and be like, any new thoughts, which is a reasonable question, especially if some years have passed.

2:41Jordan Feigenbaum:But we try our best if something is like practice changing, which is the fancy doctor speak for like, hey, look, we thought this before. Now based on new evidence, we think this. We try our best to update that. And if there's like no news is kind of good news with respect to most of our material, I won't say all because there's some stuff floating around out there. I'm sure that's over a decade old that I wish I could update. In any case, symptoms like joint pain, headaches, sweats, these muscle aches, they are certainly signs of your immune system mounting a response to, in this case, the vaccine.

3:13Jordan Feigenbaum:Your body is basically learning how to fight the potential viral infection without you having to get sick from an actual infection. So it's more controlled. But this is well characterized. So this is not like that one weird thing that happens to you and you alone. It happens to a significant proportion of folks, not all folks, obviously. And so, yeah, you can feel like you have delayed onset muscle soreness, general feeling not so hot. Your immune system is doing its thing, releasing cytokines. They cause inflammation, signal other molecules to come and play. You get these systematic effects. But, again, this is more of a controlled type of experience than what we would predict from an active viral infection.

3:52Jordan Feigenbaum:I did some digging on this as far as, you know, should you avoid ibuprofen or antipyretics, anti fever medications? Yeah, you can take these. Like I'm not giving you medical advice. This is not medical advice. But yeah, there was maybe some concern that that would blunt like the response of an individual to the vaccine. But that hasn't panned out. So carry on. Should you want to do something like that? And last thing, and this is probably where we'll spend the bulk of our time on this question, is like there's no reason to avoid training after or before a vaccine. And in fact, we covered this on our previous discussion of immunizations and training.

4:27Jordan Feigenbaum:There's maybe some like potential benefit there with like not only blood flow, but stimulation in the immune system, better surveillance or whatever. So I don't know. How confident do you feel that that is something that occurs? Meaning that if you took a thousand people, right, and you put half of them in a group that trained immediately after they got a vaccination and the other half did not, do you think there would be a significant difference in like immunologic response and potential like infection risk down the road? Yeah. Yeah. I was wondering, as you were laying that out, knowing where you were headed, I was waiting for the pause that happened, because the key element of that question is right where you paused to think about what outcome am I paying attention to here, right?

5:14So I remember when we did that original podcast, number 96, and we talked about this, I found that evidence reasonably convincing as it related to the effects of activity around the time of administration of an immunization. But what I don't recall off the top of my head, as it was several hundred episodes ago, was the outcome that was being measured. For example, we can measure antibody titer levels, so how, like, your blood, circulating blood levels of antibodies, that can be measured in the short term. There's obviously going to be a significant increase in the short term, no matter what, if you are responding to an immunization.

5:55You can measure it long term, how much of it persists versus how much of that circulating antibody wanes, which tends to happen with a lot of immunizations. And that's not necessarily a bad thing, or it doesn't even necessarily mean that you have lost your, you know, your immunity to something because memory cells can wake back up and restore, you know, higher levels when needed with some things better than others. That's why boosters are only needed for some conditions and not necessarily others. Or is your outcome not going to be some serologic measurement like this, but rather what's your risk of infection at all?

6:31or is it going to be what's your risk of symptomatic infection or is it going to be what's your risk of hospitalization or is it going to be what's your risk of death right so we have all these different tiers and obviously death is the one that we care about the most followed by like critical illness and hospitalization and disability as a result followed by symptomatic infection followed by any infection followed by like what are your blood levels that's like the tiers of importance uh if you're a patient right and so am i confident that like exercising after a vaccine versus not exercising after a vaccine is going to have a large impact on your ultimate risk of death from the infection, pretty tough for me to feel confident in that.

7:12You know, in general, much less because we don't actually have that kind of direct evidence, that would be exceedingly difficult to prove. But on the other hand, at the opposite end of the spectrum, do I feel more comfortable if the idea is like, hey, if you're able to do some vigorous activity around that time, it maybe it boosts your short term immunologic response and you might get some higher antibody titers or something. I'm like, yep, maybe slash probably. Now, how much of a relationship there is between those, you know, near nearer term outcomes and like the more significant ones we care about of like symptomatic infection or hospitalization death that is unknown.

7:51Yeah. All this is to say it's an interesting thing to point out, like all the different outcomes that you could look at. But more importantly, I have no concerns about you exercising around the time of a vaccine. I think that people in general are overly cautious about this sort of thing, including after an actual infection. We've talked about this before, too, this risk of be it pericarditis or myocarditis or something. It's like, yeah, there's probably a non-zero risk. And everybody gets to weigh this risk and benefit for themselves. But, you know, I think that if you are somebody who is of such risk intolerance that you're going to say, because of this minuscule risk of getting myocarditis after a flu or a COVID infection because I exercised, there is no way that you should ever be getting in your car to go anywhere.

8:42Don't drive.

8:42Jordan Feigenbaum:Yeah. Like, you know, that's that's it's an incoherent kind of risk benefit calculation there to hold those two things, you know, at the same time. So, yeah, those are some of my thoughts. I have two additions. They're not additions. It's more just like, hey, you said this and I kind of want to add on. I guess you can't call that an addition. I feel very confident that exercising around or directly after vaccination does not impair the response to that. I feel very confident about that. I feel minimally, perhaps moderately confident that exercising after a vaccine may improve short term markers of the immunization working as far as like serologic levels go.

9:27Jordan Feigenbaum:And I have no confidence that it's actually going to like affect somebody's chance of not only getting a symptomatic infection, but also like subsequent outcomes from that. The second thing is about this like concern over exercising either after a vaccination or after an infection. And I'm of the opinion that generally speaking, our public facing message should be do you do not need to be restricted from exercise after you're feeling well to go exercise after an infection or after a vaccination. That should be the public facing message. And my caveat like would be if you're very well trained, you exercise regularly.

10:05Jordan Feigenbaum:I don't care. Like if you want to take a little bit of time off because you don't feel your best and whatever, I'm more accepting of that than people who do not currently participate, regularly participate in exercise because those people, I just want you to get started. And however, I can interface with you and recommend that. So it would be interesting to me as like a quality improvement project for people, healthcare professionals administering vaccinations if they were like, hey, by the way, you should exercise after this. Oh, yeah. Just something like that because people are like, wait, what?

10:33Jordan Feigenbaum:Or like if you saw a physician after an infection and you were just like your follow-up and they were like, and by the way, you should exercise today. Just to sort of like nudge people in that direction. Sure, sure. That would be an interesting thing to link it together as like a necessary – not even though it's not strictly necessary, but like if there's stronger evidence that it would boost or protect somebody, if we could get that evidence, then you could make a more compelling case that that ought to be introduced. Sure. I just feel like every time you interface with a healthcare professional, if somebody's not currently exercising, just maybe, hey, you should exercise.

11:06Jordan Feigenbaum:Yeah, you should exercise and maybe eat a vegetable today. Something, something. Next question, we're talking about deadlifts for hypertrophy. Of the big three, why do you think the deadlift is so contentious in regards for being a good exercise for hypertrophy when the Romanian deadlift is often regarded as a staple for hamstrings in a hypertrophy-focused program? Obviously, there are differences in the movements, but surely not enough for these to be at opposite ends of the gains spectrum. I agree. Okay, next question. yeah as far as why this is so contentious i i think there are like four major like areas of concern that are all lumped into one when people just say i don't don't don't do deadlifts for hypertrophy one is this concern over injury risk the second is this lack of eccentric focus within most deadlifts how people perform them right it's mostly focused on the concentric the way up and down it's like well set the bar down don't drop it third is maybe a more global or systemic muscle loading kind of nature of the regular deadlift compared to the RDL, which is more like focused on the posterior chain.

12:13Jordan Feigenbaum:You could make maybe that argument, not strong argument, but an argument. And then concerns over fatigue. And so I think between injury risk and concerns over fatigue, that's what most like, quote, science-based lifters might refer to. So let's go through each one of these. I think the concern over injury risk, I'll get your take on this, Dr. Baraki. I think this is misplaced because it assumes within this context that an RDL has a significantly lower risk of injury than the regular deadlift. And I don't know that to be true. In fact, I would say, again, if you took a thousand people who are untrained, you gave them the same program.

12:47Jordan Feigenbaum:One group did the RDL and the other group did the regular deadlift. I would predict they would have the same injury risk at the end of a year. Does that sound reasonable to you? Sounds like a reasonable starting hypothesis. Yeah, I'm not convinced that there would be likely. No. The lack of eccentric focus, that is real, the way that most people perform their deadlifts. So, yeah, most people with a regular deadlift, whether it's sumo, conventional, whatever, the up, you're just trying to get the weight up. And then when you set it down, it's not really under much control other than you keep your hands on the bar.

13:21Jordan Feigenbaum:Whereas the RDL and a stiff-legged deadlift, for example, both have a more controlled eccentric, which you would predict is probably better for hypertrophy. Just you're getting a paired, you know, eccentric and concentric movement. I would predict that to work a slightly better for hypertrophy than no eccentric, for example. And to test that, so you would have to test it. That's my starting hypothesis. But to test it, you would have to have people do like a conventional deadlift for the same rep sets, proximity to failure, et cetera, and then drop every rep compared to the RDL, which would be performed with like a 2-1-0 tempo or something like that.

13:58Jordan Feigenbaum:Yeah, the more global versus local muscle group loading, I think that's made up entirely. Like people are like, I feel my hamstrings more when I'm doing RDLs than when I'm doing regular deadlifts. I'm like, well, yeah, because the eccentric component is slower. Not because the lift itself is like loading different muscles. It's the same muscles, just more eccentric focus. I think that's more of the second. But this fatigue concern thing, this to me is the most – it's just annoying, mainly because people are like, oh, deadlifts are uniquely fatiguing. And I'm like, well, yeah, compared to like a biceps curl, right?

14:33Jordan Feigenbaum:And if we think about things that generally would increase fatigue, heavier weight, more volume, more muscle mass being activated or loaded, sure. But like there's a limit to how far you can get with that. So for example, if you would predict that fatigue levels would be lower from the squat compared to the deadlift, they both work a similar amount of total muscle mass. The deadlifts, though, use more weight, right? And so you would predict that any marker of fatigue that is validated or we think is reasonable to track, it would be higher after squats. And multiple studies, at least two that I've linked here in the show notes, show that's not the case.

15:12Jordan Feigenbaum:And you're like, okay, well, those are both a lot of muscle mass. Let's give a more extreme example. How about the bench press versus the deadlift? And so one way to track fatigue would be like, look, if you do a session of deadlifts compared to a session of bench press, how quickly does your force production potential come back afterwards? You would predict a less fatiguing exercise for force production to return more quickly and a more fatiguing exercise for force production to take longer to come back. And when that's tested, that doesn't show up either. So I don't think these fatigue concerns are particularly useful when picking a hinge variation because you're not picking between a biceps curl and a deadlift.

15:55Jordan Feigenbaum:You're picking between a deadlift and a Romanian deadlift or a deadlift and a stiff-legged deadlift or a deadlift and a hip thrust. And I'm like, I predict these all to globally cause about the same amount of fatigue if they're programmed the same. The focused eccentric component, though, may be more useful for hypertrophy with an RDL or a stiff-legged deadlift over the way that people mostly perform deadlifts. But ultimately, it's a silly premise to me because you've got to pick one exercise. And I'm like, why aren't you doing more exercises? Because that's what I would generally pick for hypertrophy.

16:28Jordan Feigenbaum:Use multiple exercises to work the muscle groups of interest from different angles, relatively large range of motions for all of them, and get somewhat close to failure and go from there. But picking the one exercise to rule them all, should it be an RDL or regular deadlift? I'm like, por qué no los dos? Why wouldn't you do both? or because of you know the fact that they involve so much muscle mass that can also be broken apart such that if you had no interest in performance of a particular lift if you had no interest in function in your daily life but you were purely of the interest of hypertrophying particular muscle groups um you also don't even have to deadlift you know yeah like you could become a exceptionally competitive bodybuilder, I'm sure, uh, without training the deadlift very much by, uh, training a lot of these muscle groups more, more individually.

17:23Neither of us would claim to be bodybuilders. Um, we have experienced some hypertrophy over the course of our training career, but that's not been like the, the, the primary focus. Uh, but you know, you could also, why not snatch grip RDL? Why not snatch grip deadlift? You can get even more range of motion about, you know, the hamstrings and the low back. Why not, you know, do deficit snatch grip already like you could take this to an extreme, right? Or you could do, you know, prone hamstring, you know, leg curls or all sorts of other single leg things. There's the thing is with respect to hypertrophy, you have enormous options.

17:57That's the nice thing about bodybuilding and hypertrophy oriented training. There is absolutely nothing that you have to do or that you can't do. You can do absolutely anything. What sucks more about competitive powerlifting is you have no choice but to squat, bench press, and deadlift within certain arbitrary rules. And if you don't like that, too bad. If you can't tolerate that, too bad. If an injury limits you from doing those movements to the competitive standards, too bad. But in bodybuilding, none of that matters. You can achieve a lot of hypertrophy in all sorts of ways without any consideration of rules of how I got there or which exercises I did and didn't do.

18:38And so, yeah, similar, similar to your thoughts on, on the premise here. I'm just like, this is not something that I concern myself with at all, because you can hypertrophy in tons of other ways. And I don't even really think of them as building that particular outcome in a unique way.

18:53Jordan Feigenbaum:Yeah. Yeah. It's one of the interesting, maybe pushbacks against that is, you know, some guy, the talking face over somebody else's video, it'd be your video, this video of you saying you don't have to deadlift. And then somebody's head pops up, stitch incoming. And they're like, well, why is it then that all like top level bodybuilders started out, you know, doing heavy deadlifts and squats and bench press and whatever. And I'm like, I have a perfectly rational and likely true response to that. When you get bit by this resistance training bug, whether you end up as a bodybuilder, a powerlifter, strength enthusiast, whatever, it's just, we all kind of enter in the same funnel.

19:30Jordan Feigenbaum:It's like, get big, get strong, get jacked, all this other sort of stuff. And you kind of get led into these movements, which have this arbitrary importance across most enthusiasts for the gym for some relatively long period of their life. Whether or not that's better or worse, we don't know. It just seems to be that like the track from untrained to like gym rat is pretty much the same. You start with the interest in the big compound lifts and then you specify later on perhaps or you burn out and you never lift again. Like whatever. Those are the two kind of pathways there. Yeah. I mean, they're generally appealing things.

20:06They are easy to compare one to another, both within person and across people. They generally can enjoy pretty rapid progress, you know, just in terms of plates over plates over plates at the beginning. Whereas assessing your hypertrophy progress as a beginner or something, especially if you start out with like an excess body fat, it's like, man, it's going to take a long time before we can totally feel confident that you're making tons of progress. And so, yeah, I get the appeal of like, yeah, your deadlift went up 350 pounds in the first, you know, three months of your training or something like that.

20:34Uh, neat. Uh, that's a very, that's a very appealing thing. Whether, you know, a decade later when you step onto a bodybuilding stage, whether that was, you know, heavily influenced by your first few months of training the deadlift, probably not, you know, by the, by that point in your training career. So yeah.

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