Using a movement-based approach for a strength training program design, one of the basic tenets is to push or press load. That can include both horizontal and vertical directions. Pressing a load horizontally with success requires that you select the proper load amount. A push-up is a horizontal press, but for either a beginner or a deconditioned person, it may be too high of an entry point. In that situation, we can opt for a TRX chest press, where we can adjust the load by positioning the person appropriately, or a standing press using a resistance band. The band press also has the benefit of increasing load when the person is at their strongest point in the strength curve. Vertical pressing has a few other considerations, other than simply load selection. Tissue quality of the thoracic spine and pectoralis, scapula movement and control, postural issues, and alignment all play a role in determining if a person is a suitable candidate for overhead pressing. Ignoring any or all these elements can set someone up for pain and/or an injury. I like to use the analogy of driving with your emergency brake on. You can get your car to move with the brake on by pressing the gas, but understand that you are prematurely wearing down parts. Pressing a load overhead with poor posture and lack of mobility in the upper back can produce a similar outcome of excessive wear of joints and connective tissue.
ASSESSMENT
Prior to having someone attempt to press a weight overhead, I first assess if they have the ability to get their arm efficiently overhead without load. This is called shoulder flexion. Load just magnifies the force placed upon the joint, so if there is a compromise of movement without weight, weight will only make matters worse. When putting the shoulder into flexion the humeral head rolls posteriorly and glides inferiorly on the glenoid fossa (shoulder joint) for the first 60° of movement. After this, the humeral head remains stable within the glenoid fossa. As far as joint range of motion, the normal range for shoulder flexion is approximately 0–180°, starting from the arm at your side to fully extended overhead. I am currently using the Functional Movement Screen (FMS) to determine this. There are other assessments available, but I like this option for ease of administration. It requires you to take a measurement. Regardless of which assessment you choose, let’s agree that some type of assessment or screening should be applied. I follow the credo of “If you’re not assessing, you’re guessing.” If they can display adequate movement, then we must exercise good judgement with what load to use. If they don’t, we should investigate why and then use a strategy to improve the disfunction. One example of this, which I frequently see is poor thoracic (upper back) extension or the inability to dissociate thoracic movement from the glenohumeral motion, which creates a restriction of shoulder mobility. This often leads to compensatory movements like excessive spinal arching during overhead activities. We’ve experienced success by having this person initially foam roll their upper back using Grid and Rollga foam rollers and then graduating to trigger point work using hard balls, such as the Acumobility balls.
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SCAP “J” MOVEMENT
During healthy shoulder flexion the scapulae glides upward on the ribcage in a “J” shape. Internationally recognized physical therapist and author of Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann, states that “scapular disfunction occurs due to dominance or stiffness of downward rotators (e.g., rhomboids, levator scapulae, latissimus dorsi (lats), pectoralis minor/major) and reduced activity of upward rotators like the serratus anterior and trapezius.” To address this, we have used a two-step process of foam rolling the lats and pec minor area partnered with scapulae CARs (controlled articular rotations) or overhead reaches performed using a band or by rolling a foam roller against the wall using the forearms. The end goal of re-establishing good scapulae “glide” can take some time, depending on the amount of time the person has been in this state of impaired movement.
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CONTROL
Sometimes the person will possess the ability to get the arm overhead without proper control. This can lead to winging of the scapulae. As compared to the shoulder blade sitting on the ribcage, it starts to detract, giving the appearance of a wing on their back. After observing this, one of the exercises we like to implement is the TRX “Y” flye. We coach the person to maintain a plank by stacking their body, ribcage over pelvis, as they pull themselves into the “Y” finished position without shrugging in the upper traps.
There are times when pressing overhead is contra-indicated for someone and should not be in their program. This is when having a coach is helpful and can redirect their focus and energies to other areas to focus on. I don’t believe in categorizing exercises as bad, but rather, exercises some people should not perform.