Table of Contents

• What if I’m in a Hashimoto flare-up?
• Why physical therapy doesn’t work for Hashimoto’s (most the time)
• What should I do if my muscles are tight?
• Here’s what we know about Hashimoto’s from the research:
• My experience with Hashimoto’s
• Where do I start to exercise despite having Hashimoto’s

The fatigue with Hashimoto’s can feel crippling, debilitating, and life-altering. Trust me, I know. I’ve lived it, which doesn’t really feel like “living” at all. Us women with drive and families dream of an abundance of energy, vibrancy, and radiance. We hope to be someone who attracts and puts out good energy. We imagine playing alongside our kids, having an invigorating relationship with our partner, and realizing our personal and professional dreams left and right. Unfortunately, I was far, far from this dream. Instead of getting out there, I regularly slept 12 hours a night just to feel like I could get by, and when I was awake I was always tired. Needless to say, I did not feel like my best self. 

Was this it?

What if I’m in a Hashimoto flare-up?

If you are in a Hashimoto’s flare-up, just do what you can to get the body moving. I know just getting out of bed can feel like a miserable strenuous journey. But once you’re out of a flare-up, strength training is WHERE IT’S AT to start to lose weight and beat that stubborn fatigue.

So why aren’t doctors who manage the thyroid medications also making better recommendations for how women with Hashimoto’s should be working out? They may recommend working with a physical therapist or trainer, which is a good idea in theory.

Why physical therapy doesn’t work for Hashimoto’s (most the time)

The problem is most trainers and physical rehabilitation specialists don’t know what to do with muscle aches and joint pain related to Hashimoto’s except to massage, foam roll and stretch. 

Again, not to be negative Nancy here, but how many times have you seen a physical therapist that doesn’t look like they have ever worked out or a trainer that appears to have a “everything in moderation” problem. In my experience working with Hashimoto patients for the last 12 years and struggling with Hashimoto’s in my own body, all these recommendations will put you on the path to more pain and more muscle tension. 

What should I do if my muscles are tight?

When you feel a muscle tightening up and locking down, the brain goes to “massage that bad boy out” or how can I loosen that muscle up and get some relief already?!?! But that tight muscle is usually a compensation for weakness somewhere else in the body. 

It’s like a bad group project in high school or college that you never wanted to participate in anyway but was required to pass. The people who are the Type A overachievers are overworking for the lazy Slackers. So you can’t ask the overachievers (ahem, the tight muscles) to keep working harder and harder to pick up the slack, they will get so wound up they will burn out. You gotta get the slackers (the weak muscles) to start moving and grooving and making things happen. You gotta ask the slackers to pick up the slack and start engaging.

So if your neck and upper back are tight from hunching all day at your computer with Hashimoto’s, and you are not using your core properly then no amount of stretching the neck will give long term relief.

That’s right we want long term relief.

It may feel good for a couple hours to a couple days but usually after  2 days, it’ll come right back with a vengeance. Your brain will think, ok time for the massage again. I’ve literally had women with Hashimoto’s tell me they get 3 massages a week to keep the muscle pain and joint aches at bay. 

My solution is less time consuming but requires a little more mind-body connection. If you train your core properly, the neck and upper back tightness will melt away. I’ve seen it happen within minutes because you were targeting the right area. It doesn’t hurt to set your desk up for ergonomic success, take frequent breaks so your shoulders don’t get tight, and do some breathing drills and exercises every hour on the hour for 1-2 minutes to help relieve the tightness but those are just icing on the cake. 

Here’s what we know about Hashimoto’s from the research:

1. A low functioning thyroid leads to low muscle mass.

The common response is “Who cares? I don’t want get bulky anyway.”

Well ladies, if you want to shed those unwanted pounds, you need to train and maintain the largest organ in the body, your muscle. To do this you need to strength train, full stop. It is non-negotiable. Not yoga, not bodyweight squats, not bicep curls with pink 5 lb dumbbells. Strength training looks like picking up something heavier than you would think you are capable of, owning your form, putting the weight down and doing it again. Rinse and repeat. 

Don’t worry you won’t get bulky, but what you will do is maintain a baseline of strength to help you be better at life like when you need to pick up a heavy suitcase or your kiddo. I recommend my ladies with Hashimoto’s work up to strength training 2-3 times a week for 20-30 minutes. Note, I mentioned “work up to” that frequency, not start at that frequency in order to avoid a flare-up.

If you want to totally nerd out with me, check out the supporting research here on Thyroid hormones and Muscle Mass.

2. There is a slower tendon turn over with a low functioning thyroid.

What the heck does that mean?

It means that it takes longer to recover, full stop. How do I manage this recovery piece in a strength training program for women with Hashimoto’s? Low reps and long rest breaks.

The typical trainer recommendation is 3 sets of 10 reps, however I’ve never seen this go well with a woman struggling with Hashimoto’s. I typically don’t give more than 5 reps of an exercise in one go because I’m having my ladies go heavier weight.

Long gone are the days of 50 reps with a pink dumb bell to trainand tone the “smaller muscles” and the days of 45 minutes of straight dance cardio. That’s a great way to pack on the pounds and burn out. 

As for rest breaks, I like a longer rest breaks in between the 5 reps to avoid burnout and total exhaustion that can happen with Hahimoto’s. It may be up to 90 seconds to 2 minutes of rest, shaking out the body and catching the breath. These are very specific strategies to manage the slower tendon turnover with Hashimoto’s.

Again, if you want to nerd out with me, here’s the research to back the slower tendon turnover.

3. With a low functioning thyroid, there’s a decrease in the quality of our muscle tissue.

Again, what the heck does that mean in layman’s terms?

It means our muscles lose their quality and tone. To be specific, our fast twitch fibers (type 2A muscle fibers) that are found in higher densities in sprinters, turn into slow twitch fibers found in postural muscles that hold us up against gravity (type 1).

We have more type 1 fibers when we are babies and learning our movement patterns and squishy, at a time in our lives when being “skinny fat” or pudgy was cute. But to be a dynamic moving human being on this planet, who is strong and confident in her body, we need more type 2A fibers and quality muscle tissue.

Type 2A fibers don’t get built, trained, and fed through yoga, walking, or pilates unfortunately. They get developed through strength training. You need the feedback of the weight to challenge the muscle tissue in order to have quality muscles tissue aka not soft doughy tissue. Notice a trend here?

Nerd out with me already, here’s the supporting evidence.

My experience with Hashimoto’s

What I know about working with women who have Hashimoto’s but this insight is not in the research aka its a clinical finding:

1. Women with Hashimoto’s also struggle with hypermobility.

Again, a clinical finding from my 12 years experience but the research hasn’t been done on this topic. Physical signs of hypermobility or tissue laxity can get picked up in a Beighton Test. It’s graded on a 9 point scale, 5 moves, 4 passive bilateral and 1 active unilateral move.

Here’s the test:

1. Passive hyperextension of pinky finger beyond 90° 
2. Passively pushing the thumb to the soft part of the forearm
3. Passive hyperextension of the elbow beyond 10°
4. Passive hyperextension of the knee beyond 10°
5. Standing forward bend with the knees fully extended so that the palms of the hands rest flat on the floor

The ladies with Hashimoto’s I see usually have a rating of 7 or above on this scale.

So you can see why stretching and doing yoga would be terrible recommendations if you have this tissue laxity and hypermobility. Stretching and lengthening of the muscles or ligaments that hold the joints together will only make you more sore. Your muscles will tighten down to try and create stability leading to massive muscle tension. 

How do you combat this? Strength training to build the muscles to help stabilize the joints. That’s it. Long gone are the hours figuring out what yoga, pilates or HIIT class to go to. Strength training is your new best friend.

2. Women with Hashimoto’s have a harder time finding their center

With those loose joints and hypermobility, women with Hashimoto’s will “hang” on their joints leading to more joint pain and muscle aches. They will have a hard time finding “center,” feel ungrounded and anxious due to this lack of stability in the joints. 

Imagine trying to feel calm and confident in your body if you are subconsciously making little shifts in your body to find where you feel most grounded and centered. If you can’t do it, then you’ll feel off base or airy and anxious. 

The fix?

Strength training to stabilize the joints and train good movement patterns to find your center. It’s much easier to find your center under load or holding weight because the slightest pitch off and you’ll fall over and not be able to maintain the weight.

3. Women with Hashimoto’s who have muscle pain usually have a biomechanical compensation (and don’t need a massage)

Remember that group project gone wrong I was talking about earlier? Some muscles in the body are tight because another area of the body is weak. Another way to say it is,  “a mobility issue compensating for an underlying stability issue.” 

So what’s the solution?

Work the stability issue with some strength training and the mobility issue aka tight muscle will melt like butta’.

Where do I start to exercise despite having Hashimoto’s?

I want to reach all the women struggling with Hashimoto’s who were told to do 45 minutes of cardio followed by 45 minutes of weight training and gained 30 lbs. I want those women never to be accused of being lazy or sneaking food because their trainer was burning them out.

I want to help the women who were told to walk 20 minutes a day and do yoga but feel even more sore and achy because their doctor has ever worked out. It’s all online and it’s all in my online course for women with Hashimoto’s called Thyroid Strong: Ultimate Beginners.

Because I believe every woman with Hashimoto’s can lose weight and beat fatigue through the right work out. With a new found abundance energy, maybe you’ll get out of that bad relationship or ask for a long overdue raise or stick up for yourself when you didn’t have the energy to do so before.

Ladies, this one’s for you, developed from my own struggles and my own guilt of letting my family and new baby down when I had Hashimoto’s. I offer it up because I’ve seen the transformation in the women I’ve worked with and my own body.

Want more Thyroid Strong goodness? Join my private Thyroid Strong Facebook group. 

Drop all your questions in there or reach out directly at hello@dremilykiberd.com

In Good Health,
Dr Emily Kiberd