Any considerations for persistent strength imbalances?

I've been coaching my 65-year-old father for several months. He has seen tremendous strength gains, as well as noticeable quality-of-life improvements. He was tested for Facioscapulohumeral muscular dystrophy (FSHD) many years before he began training -- it is a genetic test, and he does have the deletion. For those unfamiliar FSHD involves muscle weakness and wasting in the face, shoulder, and upper arm (as the name implies). In addition, he had surgery on his right shoulder to move one of his shoulder muscles to improve his mobility 5 or 6 years ago and has nerve damage in his left leg that results in foot drop. I do not recall the details of the shoulder surgery but at the time it occurred he was unable to raise his right arm above his head without severe pain.

Based on his training progression, I think the surgery is the largest contributing factor to the imbalances I see. He has a clearly observable difference in the sizes of his right and left arm -- his right arm appears shriveled when compared with his left -- and he is unable to lockout his right elbow above his head. As a result, his progression on the press and bench press are slow and at least for the time being he does not deadlift from the floor (his right arm is unable to keep the bar against his legs).

His left arm is capable of far more than his right arm. I do not think it wise to include additional work for his right arm, as that would compromise his recovery for the main lifts. Am I doing him a disservice by not including additional accessory work for his left arm?

He needs no unilateral work. Have him rack pull instead of deadlift, since his lat function is compromised for shoulder extension off the floor. Have him press up the side of the rack, bench press as best he can while you spot him closely, and lat pulldowns. You didn't mention squats.

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Originally Posted by Mark Rippetoe

He needs no unilateral work. Have him rack pull instead of deadlift, since his lat function is compromised for shoulder extension off the floor. Have him press up the side of the rack, bench press as best he can while you spot him closely, and lat pulldowns. You didn't mention squats.

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His squat is progressing nicely. Currently he's at 110lbs for sets of 3. His hips shift from left-to-right frequently, but we worked on some cues to correct that (stamp on Nancy Pelosi's face -- yes, I'm serious). At first I suspected a leg length discrepency, but his chiropractor laid him out and found nothing. Initially I thought the foot drop in his left foot (from nerve damage) might cause problems, but I do not think it has. The bar is high, but he's been able to get it a little lower.

Thanks for the tip on the press. Due to my ceiling height we have to use the seated press (7' ceiling and a 6' man), but I assume it is still possible. He is able to press overhead currently (25lbs for sets of 3 last session, 0.5lbs jumps). I cue his right shoulder to fire hard, first. If he does that he is able to complete the rep smoothly, without that it gets wonky.

He is able to lock out his bench press. His next session will be 56lbs for sets of 3.

A cable machine is my next gym purchase, as soon as I'm able to free up some floor space. I have had him doing RDLs (85lbs last time) but I started noticing the bar drift at around 90lbs when he was deadlifting. I'll switch him to rack pulls.

Thanks Mark!