"Distal clavicle sublaxation w/ osteolysis (AC joint)"

[Scaldrew]

Hi Coach

I'm posting this thread as proxy for a friend of mine who's suffered from a hefty arm fracture in the (relatively) distant past. Today he mentioned he'd try "heavy dips if his shoulder allows for it" and I pursued the matter, told him to post on this forum. He told me he didn't have an account, so I asked him to give me the details and I'd see if I could elicit a response from you.

The injury is concerning the shoulder, the clavicle, the arm, and the elbow, all on the right side of the body. My friend was involved in a moped accident 6 to 7 years ago in which he "shattered his entire right arm". The doctors who diagnosed and operated on him told him he could've lost his arm completely. The surgery equipped him with "titanium plates" and was followed by some form of physical therapy. Afterwards he was told he wouldn't regain full ROM in his shoulder and he can never hyperextend his right elbow anymore ever (so at least there's that). He provided me with an X-ray scan of the right arm post-op and I've enclosed it for you to look at.

There's not really any pain any more. There used to be a burning, nagging pain which radiated to the "middle point/portion of his upper trap" and his front delt. Nowadays, he feels a lack of stability and control of the scapulae (plural) and the right scapula often pulls forward on the bench. At rest, the afflicted shoulder feels as though it's "resting forward in the joint". He also mentions his internal and external mobility isn't at all what it's supposed to (ideally) be. This would also be why he includes an excessive warm up routine at the start of his workout with the use of a foam roller, a lacrosse ball, a rubber band, and a kettlebell. I'll let your imagination go wild as to how these objects all work together. (Ladies.) This warm up does relieve the feeling of the shoulder "feeling forward" and increases motor control of the scapula. Additionally, the AC joint clicks, is unstable, and gets dislocated a lot. However, throughout the training, no real pain is felt until a set or rep of heavy dips actively dislocates the shoulder after which there is considerable pain. Throughout performing dips, he has problems keeping the upper body stable and thus proceeds with caution.

The accident happened (long) before he started lifting. His (European) stats are now:
age 23
bw 80kg
height 173cm
squat 170 (1RM)
bench 95 (1RM)
deadlift 190 (1RM)
"Z-press" 60kg (old 1RM; no OHP because of "excessive lean backwards and 'lack of upper back activation'". Double scare quotes seemed appropriate. He says he'd like to "get a feel of the Z-press before switching to OHP"; he hasn't been pressing for long.)

Any help, input, or comment at all would be great. I know you don't have to do this sort of thing, so thanks.

703329_10201608293763190_1498732235_o.jpg

[Mark Rippetoe]

Dips, but no presses. What do you want me to tell him?

[Scaldrew]

Dips, but no presses. What do you want me to tell him?

Don't worry about a thing. Every little thing is going to be alright?

I, too, was sceptical of him not pressing and nagged to him about it. Shall I just tell him to start pressing, then?

[Mark Rippetoe]

To the extent he can, he needs to Do The Program.

[Scaldrew]

To the extent he can, he needs to Do The Program.

Thanks, Coach. I relayed your responses back to him. He seems receptive to doing standing presses with good form (not sure if he'll do press 2.0, though; many people seem reluctant as I'm the only person I know in my vicinity that performs the press in this way). He's still somewhat stubborn as he considers himself intermediate "by the numbers" (or experience; I'm not quoting directly here, but he wouldn't call himself a novice) and so probably won't do the programme the way you intended it to be done. After pressing him on it, he said he has "different goals" than weighing 200lb and being stronger more quickly. I'll keep reminding him of what to do should he make no progress on his injury hoping that'll change his mind.

[Mark Rippetoe]

How disappointing, that he will not behave as I command.

[Scaldrew]

How disappointing, that he will not behave as I command.

I see it more like "he will not behave as you advise." Seems counterintuitive to ask for advice and then to have your own confirmation bias hamstring your progress. You can have your own opinion and it's a free world etc, but if what you've been doing hasn't been working, maybe taking someone else for his/her advice isn't such a bad idea, especially when that someone has a positive track record as a coach and probably knows a thing or two more than the average novice.

[Mark Rippetoe]

The only way to get people to follow your advice is to charge them a lot of money for it. A LOT of money. Free advice is seldom heeded, since it is -- by definition -- not valued.

[Scaldrew]

The only way to get people to follow your advice is to charge them a lot of money for it. A LOT of money. Free advice is seldom heeded, since it is -- by definition -- not valued.

For what it's worth, I wouldn't consider advice like this worthless. You're certainly giving me a lot to think about.

[Mark Rippetoe]

The only way to get people to follow your advice is to charge them a lot of money for it. A LOT of money. Free advice is seldom heeded, since it is -- by definition -- not valued.

Of course, since this is not a Pay Site, this is bullshit.