Overhead Presses And Rotator Cuffs
by Mike Robertson T-Nation
Overhead pressing should be a staple in almost everyone's workouts. Unfortunately, some people can't overhead press pain-free, period.
I know I'm going to catch some flack. "But Mike, back in the day guys overhead pressed all the time and never had shoulder issues. What gives?"
I hate to break it to you, but a lot has happened since then.
Computers. Gaming. More driving. And a much more sedentary lifestyle. These things have greatly affected our ability to not only overhead press, but often to just reach overhead!
Look, I think overhead pressing is awesome. I'd rejoice in a world where everyone could do it safely and effectively, building the kind of superhero deltoids that any pro-level bodybuilder would be proud to sport.
But for many that's not the case. If you're serious about training, and not just getting strong but staying healthy and doing it for a long time, you need to be qualified to overhead press.
An Anatomy Primer
Let's quickly discuss the pertinent anatomy involved. Effective overhead movement begins and ends with the thoracic spine. Quite simply, if you're in an excessively kyphotic or "slouched" shoulder position, there's no way you're going to safely press overhead.
When the thoracic spine is excessively kyphotic, it places the scapulae in a poor position. Instead of being tucked down and back a bit, it's forced to ride up higher on the ribcage. This forward drawn position also narrows the subacromial space, which will force you to impinge sooner.
(Granted, there's some degree of "impingement" any time you press overhead. The real issue is when your mechanics are off and this impingement becomes excessive, problematic, or causes pain.)
Finally, by being excessively kyphotic you lose the ability to fully flex the shoulder.
Try this right now.
Slump forward while sitting at your computer.
Reach up as high overhead as you can. Note how high you get.
Now, sit up as straight as you can and repeat the test.
Chances are your shoulder range of motion improved dramatically. You just learned how important the thoracic spine is!
Quality overhead movement goes further than just the t-spine. You also need quality upward rotation of the scapulae. The upper traps, lower traps, and serratus anterior all play a role in promoting upward rotation.
Finally, a strong rotator cuff will help depress the humeral head and position it appropriately in the glenoid fossa.
To summarize, you need three things to overhead press well:
Adequate thoracic spine extension.
Adequate upward rotation of the scapulae.
A strong and stable rotator cuff.
Note. One thing you have absolutely no control over is the shape of your acromion, which decides how much space your rotator cuff has to "breathe."
There are three types of acromions, and they're roughly distributed between thirds of the population. In other words, 1/3 of you have a Type 1, another 1/3 have a Type 2, and the final 1/3 have a Type 3.
Type 1. Genetically blessed and probably able to overhead press without issue. I would imagine most high-level Olympic lifters fall into this category.
Type 2. 50/50, could go either way. You might be fine pressing overhead (especially if your mechanics are on point), but then again, you might not.
Type 3. Your shoulder genetics are giving you the middle finger. You may do many things right in your programming but overhead pressing still gives you issues.
I'm a huge believer in mechanics. You can't "fix" your anatomy, but you can absolutely take an active role in improving your movement. Some people may not be the most genetically blessed to overhead press safely and effectively, but you'll never really know unless you take the necessary time to fix your mechanics.
That said, let's look at some things you can implement in your program immediately to qualify yourself to overhead press.
Moving and Shaking with the T-Spine
The t-spine is a driver to the rest of the upper body. If your t-spine is out of whack or in poor alignment, it throws off everything else down the kinetic chain.
Poor t-spine extension may not necessarily manifest itself in shoulder issues, either. I've seen many people with crappy t-spine mobility compensate by excessively arching and compressing the hell out of their lower back. Either way, your lack of t-spine motion will cost you.
Best case? Your performance suffers. Worst case? You end up seriously injured.
To get the t-spine in better alignment, I like a multi-pronged approach.
Specific mobility drills.
Let's examine each.
Behavior modification is easy. If you sit all day long, you need to improve the position in which you sit. Sounds simple, right?
When you read that, did you just adjust your posture? Did you sit up a bit taller?
I'm assuming you did, and that's fine. What we need is a subtle cue that you can use throughout the day to get tons of these little "corrections."
While paying the new kid in accounting 10 bucks a day to jab you with a cattle prod every time he sees you slumping at your desk may be effective, it likely isn't practical, so I have a more tech-savvy approach.
I'm assuming you have a cellphone with a timer on it. If not, go to any department store and pick up a cheap kitchen timer. Whenever you're working at a desk, driving your car, gaming, etc., set the timer for 15 minutes. When the timer goes off, check your posture and if it ain't kosher, fix it.
Once you've done that, start the timer up again and repeat this process throughout the day. So if you work a standard eight-hour shift, and you correct your posture four times every hour, that's 32 postural corrections every workday!
Does this excite anyone else or is it just me?
In all seriousness, this is a simple but critical step. If you want to improve your t-spine posture, get serious about fixing it throughout the day.
Next, mobility drills are key. You need a blend of thoracic spine extension, and thoracic spine rotation.
For extension, there's nothing better than working to wrap your upper back over a foam roller pre-workout. It's like what I predict a date with Lindsay Lohan will be in 2013, cheap, easy, and effective.
Once you have more extension, it's time to get more rotation. Concerning the t-spine, extension is the key that unlocks rotation. If you can't extend, you sure as heck won't be able to rotate well!
One of my favorite drills to unlock t-spine rotation is the quadruped extension-rotation.
Start off in the quadruped position and place the fingertips of one hand behind your head. From here, take your elbow down towards the opposite side knee, and then reverse the motion and "open up" towards the ceiling. I find that using the head and eyes as a driver really helps with the motion.
You can use these movements pre-workout as well as before bed, or within a "mini-mobility" circuit that you perform on off days.
Scapular Upward Rotation
Once the t-spine is in proper alignment, we need the upward rotators to be on point so they can help "drive" the scapulae into the correct position.
As mentioned, the upper traps, lower traps, and serratus anterior all play a role in upward rotation. It's very rare to find a truly "weak" upper trap, so let's focus on the other two muscle groups.
The lower traps are not only involved in upward rotation of the scapulae, but in scapular depression (think about tucking your shoulder blades into your back pockets).
Similarly, push-ups not only upwardly rotate the scapulae, but protract them (think about gliding them around your rib cage towards the front of your body).
What you often see in gyms are guys and gals trying in vain to "activate" these muscles. Activation is fine, but at some point you need to cement that activation with actual strength.
Fortunately, there are non-sissy options for developing both the lower traps and serratus, and they're exercises you may already be incorporating into your routine. The key, however, is doing them with precision and focusing on the little things that most trainees gloss over.
For the lower traps, I've found nothing better than chin-up and pull-up variations. However, most people take that term "chin-up" too literally. I almost prefer the term "chest-up" as your goal should be to get your chest/collarbone to the bar.
As you're approaching the midpoint (top) of each repetition, think about keeping your chest out and pulling the shoulder blades down into your back pocket.
This is true scapular depression, and for many, those last 2-3 inches of getting to the bar will be incredibly difficult. If this is the case, don't let your ego get in the way try either a chin-up ISO, or a band-assisted chin-up to ensure you can get to that top position.
Push-ups are cut from a similar cloth. Many know about the benefits of doing push-ups, but there's one subtle thing most miss out on.
When performing push-ups, folks rarely finish the rep. In other words, they don't exaggerate pushing their body away from the floor. I almost hate the name "push-up plus." I want everyone doing the "plus" at the end of their push-up, as that's what really develops the serratus.
When performed correctly, you should feel a burn along the side of your ribcage. Many will confuse this with the lats, but it's really the serratus doing the work.
Furthermore, don't feel constrained to simply doing push-ups with body weight. There are many awesome push-up variations such as X-vest push-ups, band-resisted push-ups, and of course, chain push-ups. (Deep down, we all know that any time you use chains, you're immediately more badass.)
If overhead pressing just isn't happening for you, make these lifts a priority over the next 2-3 months. I think you'll be pleasantly surprised with the result.
A Strong, Stable 'Cuff
The final component to safely pressing overhead is a strong and stable rotator cuff.
People assume far too often that if they do some internal and external rotations at the end of their workout that they're somehow free and clear of any shoulder pain.
The rotator cuff is much more dynamic than people give it credit for. Instead of focusing on basic rotation exercises, your goal should be to get more integrated in your approach. The goal is to get your 'cuff to naturally or reflexively turn on when it's supposed to, so it can put the humeral head in the right position.
Rather than finding 50 more external rotation variations, try these two exercises below.
A final option is to just setup several med balls next to each other and "walk" across them using your hands. This is incredibly taxing on the rotator cuff and integrates the core to boot!
One Last Thing
I know some of you will incorporate these tools into your program and then immediately want to throw down a PR overhead press. Please don't do this!
It's much wiser to ease back into overhead pressing. For example, start with a single-arm, neutral grip overhead press to start. This will get your core engaged, open up that subacromial space, and get you back into pressing without killing yourself the first workout.
From there, use a two-dumbbell variation (still with a neutral grip), or even go back to a more standard grip for a month.
Once you've worked your way through that progression, test the waters with a barbell and see where you stand.
Although it warms my heart to see the sheer awesomeness of the overhead press finally being recognized, it unfortunately isn't a lift that certain populations can do safely or effectively.
For those who qualify to press overhead, I wish you all the best in your efforts to fill out your sport coats. For those who don't quite measure up, there are other methods you should explore before hoisting the heavy iron to the ceiling.
Got a question or comment? Leave them in the LiveSpill and I'll do my best to help you out!