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September 11, 2023
Mylar Edition
On Starting Strength
- Coaching Crutches and Wasting Client Money – Rip discusses his article, The Inappropriate Use of the Rack Pull, and how coaches often use modifications to the basic lifts as a crutch instead of learning to fix technique issues.
- New to the Bench Press? Start Here – Starting Strength Coach Steve Ross explains how to bench press using the Starting Strength method and discusses how to avoid some common problems new lifters encounter.
- The Value of Apprenticeship by Steve Ross – In the fitness industry, some professionals take their job seriously – though unfortunately, many do not. Too often, personal trainers are little more than paid babysitters…
- How to Pick Stuff Up – Mark Rippetoe shows you how to avoid a back injury by explaining the proper and safest way to pick up non-barbell shaped objects at home and at work.
- Which Book? by Mark Rippetoe – We are often asked about books to read for information on the lifts and programming. I really hate to be this way, but if I thought…
- Weekend Archives: Harder to Kill by Bruce Trout – Who am I? Well, I suppose that depends on who you ask. I am a husband, a father, a son and to some a hero…
- Weekend Archives: Why You Should Not Be Running by Mark Rippetoe – If you are a competitive distance runner or cyclist who is serious about your sport, this article has not been written for you. This highly informative discussion…
In the Trenches
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Best of the Week
Connection between low T and SSRI
Griffin727
Do you know of any correlation between low testosterone and use of SSRI in men? My friend takes celexa 20Mg and seems to have lower fatigue when on the SSRI. Yet on the other hand when he gets off of celexa for a month he has more energy, but his OCD behavior starts acting rogue again. Mind you he isn’t a big lifter like I am and only does upper body movements and can press 185 for a single and bench 295 for a single. His body weight is 205 at 5’ 7”.
Mark Rippetoe
Not aware of any relationship between the two. But you didn’t mention anything about testosterone.
Griffin727
I was pretty much wondering if you were aware of any connection between the two? Since when he stops taking the med he has more energy and drive. I’m guessing this is something that we would need a case study to find out. Being that we live in a pro anti-masculine society I feel we may never see that. I don’t understand why testosterone isn’t a part of a basic metabolic panel?
Mark Rippetoe
I guess I don’t understand your point.
Griffin727
My point or question is, if he has more energy being off the drug, could it be it affects testosterone when on it; which is why he has less libido and energy when taking the drug?
Mark Rippetoe
Could be. SSRIs are a really bad idea, as we know.
Best of the Forum
Balloon Implant for Massive RC Tear
misspelledgeoff
I’m a 52 YO male, 5’10 @ 235#. I’ve been training for > 10 years and my pre-injury lifts were SQ: 495, DL: 575, Press:198, Bench: 330.
Two months ago I injured my right shoulder while training BJJ. The original injury happened during a light pummeling drill—nothing violent or seemingly traumatic at all. I thought I had popped a few fibers loose from the muscle-tendon junction. So I did Starr rehab for a week and eased back into training. I re-injured my shoulder almost immediately. I repeated this cycle a couple more times until I decided maybe to stop being a dumbass and go visit the ortho.
Ortho gets the MRI report and says I have massive RC tear involving both infraspinatus and supraspinatus tendons with retraction to the AC joint level and atrophy of associated muscle bellies. He thinks he can reattach them, but needs to perform the surgery soon before even more retraction occurs.
If he can’t reattach them, he plans to use a balloon implant in the subacromial space. As I understand it, this is a new technique for massive RC tears with promising results. But it’s a biodegradable implant, and I have no idea what happens when the implant dissolves in 18 months.
Moreover, I finally read the radiology report for myself and it mentions “diffusely irregular appearance to the labrum favored to represent labral tear rather than prominent degeneration and fraying”. My ortho didn’t say anything about fixing a labral tear—just the RC tendons.
My gut tells me I should get a second opinion. But perhaps I’m being a back seat surgeon. What do you think?
IMPRESSION: 1. Full-thickness tears of the supraspinatus and infraspinatus tendons with retraction as above. 2. Severe AC joint DJD. Mild glenohumeral arthritis 3. Diffusely irregular appearance to the labrum favored to represent a labral tear rather than prominent degeneration and fraying. 4. Swelling and edema with fluid along the soft tissues and muscles. 5. Bursal and joint fluid probably with small loose bodies, debris or synovitis changes.
Mark Rippetoe
You fucking BJJ guys. I’ve never heard of this procedure. We’ll have to ask.
John Petrizzo
I am sorry to hear about your shoulder injury. Based on what you have told us, I would agree that a second opinion could be useful. The balloon procedure is fairly new, and while the information I have read on it is encouraging, I have not personally treated anybody who has it. The balloon is typically recommended in cases when there is a large tear that is not considered repairable. If your orthopedist is confident that they can successfully repair your rotator cuff, then you should probably go that route. Also, regarding your labrum, a guy your age is bound to have multiple abnormalities on MRI (as noted in the impression you shared: GH joint arthritis, irregular labrum, DJD of AC joint, etc.). It is entirely possible that the labrum tear has been there for a while and is unrelated to your symptoms. Regardless, if you do go the surgical route, it is highly likely that the surgeon will debride your labrum (if not repair it) as well as clean up your AC joint a bit too.
misspelledgeoff
I was most worried about the ortho not mentioning the labrum. John’s comments put that fear to rest. The ortho was confident he could repair the RC if done soon–the balloon is plan B. I think I prefer plan B to a total reverse shoulder replacement or sewing me back up as is.
Thanks again. And I’ll be staying off the BJJ mats for a while, maybe indefinitely.
misspelledgeoff
An update: Ortho was able to reattach everything so no balloon implant. He also debrided the labrum and repaired a bicep tendon tear that I wasn’t aware existed. Looking forward (not really) to starting the ring rehab you detailed as part of your shoulder recovery here in a couple of weeks.
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