What is the muscle hypertrophy potential for a person with full-thickness thermal burns (90% of body with skin grafts--all muscles involved)? This individual's injury occured over 10 years ago. She also has severe range of motion limitations to 110 degrees arm flexion/abduction. This client is 35, in otherwise terrific health, eats a well balanced diet, and has been active for most of her adult life with activities like Spinning and yoga and step aerobics. She often does cardio 6 days/week and appears to be very fit-- 5'6" and around 125 lbs (although it would be impossible to measure her body comp due to burns). She has not tried to put on muscle mass in the past although she has done many basic weight exercises with light weights in group fitness--this will be her first real attempt. With burns and skin grafts, I'm not sure what the muscle hypertrophy potential is.

This is a complex case, so I am going to summarize how I would help this person heal. Anytime something happens to the skin (as with a burn), there is inhibition to the muscles below it (as well as the viscera). In this case, she has been burnt over 90% of her body, so I would have to say that muscle hypertrophy will be affected. “Never say never,” but if she has taken the time to properly heal (physically, mentally/emotionally, spiritually, nutritionally) from this traumatic experience, then everything is and will be affected.

With such a great amount of her body burnt, the amount of sympathetic stress to her body was and most likely still is profound. We grow from the inside out, so focusing on exercise is just giving her something to do. Using a holistic approach, I would recommend the following to heal her internally, re-energize the organs/muscles, and detoxify her systems.
1. Eat right for her metabolic type
2. Sleep at least 8 hours a night (10pm-6am)
3. Drink half her bodyweight in ounces of water a day with a pinch of Celtic Sea Salt
4. Move right? postural exercise, proper programming/periodization, follow the stability, strength, power paradigm and remember sometimes “Less is more” principle. At this point I would focus on incorporating Zone Exercises, meditation, Qi Gong, Tai Chi, or something of the like into her program. I could explain to you the benefits of these, but I would recommend doing the research yourself as well as on yourself. The answers and results are astonishing.
5. Think right? As well as inhibition to the muscles, she most likely has much inhibition to her viscera. This can cause a myriad of physiological and mental/emotional dysfunction. I would refer her to a skilled acupuncturist and energy healer. She has a lot of superficial wounds, but the physical body is a manifestation of the mental, emotional and spiritual bodies. These professionals will assist her with healing from the inside out.
6. Buy Paul Chek’s book How to Eat, Move and Be Healthy and apply the principles to you, as well as her. You will learn a lot of important info that will assist you in working with clients with any kind of dysfunction. AS well, you can take his Nutrition and Lifestyle Level 1-3 certification for more in depth information.

If she was my client, I would focus more on her nutrition and lifestyle factors, incorporating the suggested above principles into her life, and not so much on the exercise at this point until she truly heals. Working out 6x a week for her is just causing more stress to her body. The only form of exercise I work on at this point would be low intensity exercises (60-70% or what I call a -2 to -4 rep range), as well as some core conditioning. Like I said before, sometimes “less is more!”

Joshua Rubin