by Neil Anderson
This question is not so easily answered. Not scientifically, yet. Mainly because science hasn't really weighed in on the subject. Also because it may be related to MANY different things. Some of these might include:
In my career I have experienced every single one of the above (and many more) as explanations for folks becoming sick and throwing up during a workout. But, there is one which is more specific to us, which I haven't mentioned yet. It is a condition that I believe primarily responsible for folks blacking out, feeling sick and meeting the Yak due to over-exercising.
It is probably related to SHOCK.
Shock is a very serious, life threatening condition. It often accompanies severe injury or illness. Medical shock is very different from psychological or emotional shock that can occur after a traumatic or frightening emotional incident. Medical shock is a condition that can result in insufficient blood flow throughout the body. It can lead to other conditions such as lack of oxygen in the tissues (hypoxia).
The key signs and symptoms of shock (that we experience) are:
rapid, shallow breathing
cold, clammy skin
rapid, weak pulse
dizziness or blacking out
Any of that sound familiar?
The thing to know is, exercise IS injury to your body. Calculated, metered injury, with good purpose, but still injury. And some of us do a ton of damage to ourselves during a workout. Especially those who are new to GPP training. Also our Superfits have got such high degrees of fitness that they can absolutely decimate their bodies with some of our workouts. It is not unreasonable to believe that your body would respond to this "damage" any differently than it would respond to a traumatic car accident or even a crushing incident. Too graphic? Ha.
Years ago, I was taught that if someone gets sick during a workout it was likely due to poor nutrition. The poor guy probably didn't eat before his workout, so if he gets sick - get some orange juice in him. This was thought to perk a person "right up." The problem with this is that MORE THAN ONCE I was forced to clean up OJ off the floor that looked like it was hurled from Mt. St. Helen itself. I saw this happen a lot, both with my clientele and the clientele of other trainers I worked with. It actually became a joke. We'd watch another trainer's client go green, the trainer would run to the fridge to get OJ and we'd all set our stop watches and make bets on what time she'd blow!
The frustrating thing was that this OJ thing we were all taught by our Certification Agencies (I don't have much faith in those anymore) didn't work.
One day I was training an ER Doc. During his workout, one of my peers got a little over aggressive with his client (a teenaged boy) and the kid went green (no color in the lips, black under the eyes). The trainer sat the kid down & trotted off to the fridge to get OJ. While I was giggling and setting the timer on my watch the Doc goes, "That kid looks like he is in shock." Remembering my boy scout first aid training (Eagle - two palms) I ran over and put the kid on his back and elevated his feet. To our surprise - no projectile vomiting. In fact, he got better within a few minutes. Not well enough to continue the workout. But, well enough to drive himself home without fear of blacking out.
We've been putting people on their backs with their legs up ever since. No, we haven't been successful at keeping the Yak at bay EVERY time, but - we have been successful WAY more often than not. We've learned a thing or two along the way, too. Here are some of the things we've learned:
1. Not everyone is experiencing shock when they get sick from a workout. Sometimes individuals are experiencing conditions that go much deeper, are much more dangerous and that can even be life threatening. We don't trivialize it when someone gets sick and feels like Yaking.
2. If you or someone you are storming with starts to feel sick, with one or any combination of the symptoms above, get them to the floor, flat on their back and get their feet above their heart. I know it is embarrassing. I know it is the last place you want to be seen, but it helps. In fact, it is the ONLY THING I know of that actually works.
3. When someone goes to the floor, they are generally done for the day. Understand that shock is a very serious illness. Most people who are killed in a traumatic accident die from the effects of shock before they succumb to their specific injuries. To think you might rejoin a workout after hitting the wall THAT hard, probably isn't very smart. Err on the side of caution and just go home.
4. After you hit the wall and go to the floor from a particularly hard workout, you should know - you are now more likely to hit the wall FASTER and HARDER than before. This can last for several days to a week. We've had reports of ladies (plural) who had to "lay one off" while at the gym, then several hours later they were carrying a large basket of laundry up the stairs. The laundry basket was just heavy enough to make their legs burn. Next thing they knew they were on the ground waiting for the room to stop spinning. Most don't go through this, but you might. So, keep it in mind.
5. We suspect that one of the primary culprits of getting sick at the gym is very low blood pressure. This makes sense, because low blood pressure accompanies many types of shock. If you go to your back because you got sick during a workout, you'd be wise to build back up to you feet (when you're ready) VERY slowly.
One pig-headed trainer I used to work with put his client on the floor (using one of MY workouts - ha!) in the office of the gym I used to work at. She laid there for a few minutes. Pretty soon he got sick of waiting for her and stood up saying, "You're fine! Let's get back at it." With this, he jerked her to her feet and began walking out of the office. By turning his back and her and heading for the door, he didn't see all of the color drain out of her face, her eyes roll into the back of her head and then take a header into the corner of the desk she was standing near. That little mistake cost a mere 14 stitches above her eyebrow.
If you are on the floor after a rough workout with your legs up trying to avoid the Yak, build your way back onto your feet in stages. Those stages are:
Stage 1 - from flat on your back with feet up, to feet down, head up body resting on elbows.
Stage 2 - from elbows, to seated on floor with head down (between your legs).
Stage 3 - from seated on floor with head down, to sitting with head up while on floor.
Stage 4 - from sitting on floor with head up, to sitting in chair.
Stage 5 - from sitting in chair, to standing.
If anywhere along the way you become lightheaded, simply revert back to the previous stage, or back to the floor with feet up.
6. Don't drink or eat anything while on the floor, unless you feel like experiencing it for a second time and showing it to the world.
You should do all you can to avoid making yourself sick from a workout. There is no fitness in it. There is no glory in it. There is no benefit in it. You can get every bit as fit and healthy, every bit as fast, without going there. That being said, even the best of us hit the wall from time to time. Sometimes it's nobody's fault and there is nothing you can do about it.
If you start to feel nauseous, you'd best be for backing off or quitting in a hurry. Know this, that little voice in your head that goes, "Don't worry. You're not going to puke this time." DOESN'T KNOW CRAP! Every puke pile I've ever seen constructed was preceded by those words. Generally it happens within seconds or minutes of that little voice.
Also, if this (you feeling shocky and nauseous) is an all too common occurrence, or you've gone from never really feeling it to feeling it quite often, it is time to get in touch with a good physician. You may have something going on that is preventable with treatment, at best, or serious, at worst. Don't take it too lightly. I had a client once (actually several) who used to storm workouts like a maniac. Total Superfit. Then all of the sudden, he hit a wall. Not only couldn't Rx the workout, but sometimes couldn't even finish. This went on for a couple of weeks. Sent him to the doc to get checked (after a fight). Turns out he had a very serious heart condition. One that could have been fatal if not for treatment.
No one knows exactly why you get sick from a workout. But we know a lot about preventing it. We also know how to treat it (if you can catch it early enough). Hopefully exercise scientists will take the lead on this and create a standard for prevention and treatment based on more than our (fitness experts') hunches soon. In the mean time, we'll keep doing what works.
If you have another way, or some good info on any of the above - please post to comments. We all learn from each other at GPP.