Starting Strength Weekly Report


October 23, 2017


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  • Ask Rip #56 – Training for "Tactical Athletes," factors influencing the skewing of weight gain toward lean mass, and the important yet subtle influence of hard barbell training on psychological health.

In the Trenches

rip coaches deadlift
Rip coaches Monica Rosenberg through her last set of deadlift at the Starting Strength Seminar held at Woodmere Fitness Club in Woodmere, NY. [photo courtesy of Nick Delgadillo]


Best of the Week

Safe to train post-hysterectomy
tomskarda

I have a family member who is about to have a hysterectomy and is being given the usual line of "you'll never lift anything heavy again." As an avid gardener and someone who enjoys the outdoors this is a problem.

The individual in question is 72 years, multipara, and a former landscaper. The hysterectomy is for prolapse of the uterus. The procedure will involve removal of the uterus and Fallopian tubes. Ovaries will not be removed and transvaginal mesh will be applied. Meniscus is missing from one knee following knee surgery and an artificial knee was not applied.

Due to the missing meniscus, I understand how squatting could be a problem. Is there any reason why this individual couldn't deadlift or press?

Mark Rippetoe

Are these fools actually telling the woman she can never again apply force against an external resistance as the result of perhaps the most common abdominal surgery in the world? Why don't they fix her knee under the same anesthesia and actually get something accomplished efficiently?

tomskarda

“No more than 10 pounds” for TWELVE weeks and “you’ll have to be really careful after that.”

The individual in question is a little scared. Being on a small farm where throwing around hay bales and 40lb bags of chicken feed is a daily requirement this is no small concern.

Frankly, I’m more pissed about the MD’s rampant fear mongering for the sake of malpractice lawsuit avoidance than anything else.

Cliff

I've done a lot of hysterectomies. Upon proper repair and sufficient healing, the arbitrary limitations for lifting are simply for CYA. CYA is an unfortunate reality in medicine. In reality, she will be unlikely to be able to apply enough stress to cause a vaginal vault prolapse if the repair was adequate. There are case reports of delayed vaginal cuff (scar left at the vaginal apex after hysterectomy) dehiscence and subsequent bowel prolapse following valsalva or intercourse but this is very rare. More likely with smokers and diabetics with poor wound healing. I am of the opinion that a proper valsalva with squatting or deadlifting applied over the usual linear progression of gradually increased stress actually improves pelvic floor support.

Pluripotent

There is CYA and then there is utter ridiculousness. It's one thing to give an extreme healing time before business as usual (although this probably delays healing in a patient willing to train – in patients unwilling to train – i.e. most patients – what can you do?), but to say that afterwards you will never have a normal life again? If surgeons cannot repair their incisions well enough for a person to be able to lift "heavy things" again, then perhaps the patient should forego the surgery entirely and just sign up for home hospice, since they are basically saying that the post-surgery quality of life will be about hospice level anyway? (Are they then going to be responsible for the end-of-life frailty that this advice will undoubtedly induce, if actually followed?)

Maybe ask the surgeon, "So you don't believe that your repair of your surgical incision will be adequate for normal bodily function?" Suddenly, the surgeon might provide a different opinion.

We don't have health care in America. We have sick care. Physicians and Surgeons are used to treating sick, helpless people who have to be cajoled into doing the bare minimum just to be able to walk 10 feet without getting short of breath, or at all, since that's mostly who we see. Unfortunately, many can no longer tell the difference between those patients who will work to recover and those who won't. Advice should be tailored accordingly, but there is no incentive to do so, and every incentive to treat for the Lowest Common Denominator – i.e. the sick and dying.


Best of the Forum

Barbell training as spinal rehabilitation
JohnW

14 years ago at the age of 28, I elected to have spinal surgery to bone graft the pars defects on my symptomatic L5/S1 spondylolysis. Having nearly died from a post operative infection I was left, 6 months later, with a virtually non existent paralumbar musculature with spinous processes protruding from the scar tissue in a ridge. After a further 6 months of extremely uncomfortable daily soft tissue mobilization, I started to return to some activity; i.e walking on a daily basis. Eventually, after a decent amount of effort, I got back into some low level recreation (surfing, skiing). A spell using a Concept2 improved things (quite a bit) further but I was still rather weak although conditioned.

I started "playing" with weights in a slightly clueless manner in 2009, but fortunately discovered Starting Strength in early 2010. As everyone here knows the level of detail describing the basic exercises just does not exist elsewhere. It was immediately clear to me that as long as I trained with excellent form I would not injure myself further and, indeed, might actually improve. Obviously, the rate-limiting step was my paralumbar musculature meaning that my novice progression was not particularly lengthy.

Over the past 4 years I have had many layoffs; some for travel but others simply because it felt like I would snap if I put another 2.5 kg on the bar. I filmed or asked my wife to observe all my early workouts until I was confident of maintaining a natural lumbar lordosis at all times. Although it is unlikely that I’ll ever reach a level considered strong by strength athletes, taking my deadlift from 50 kg x 5 to 150 kg x 6 (done in good form with a controlled eccentric phase) has made a massive difference to my life. I no longer feel like a spinal cripple with chronic pain.

Mark Rippetoe

Excellent job, John. Join the ranks of Those Who Refuse Their Fate.


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