Overhead (OH) shoulder exercises are some of the most commonly performed exercises across all exercise and fitness domains. With the ever growing participation in resistance training and functional fitness, such as Crossfit, overhead shoulder exercises have become a staple in developing muscle and strength in the shoulders. These exercises can include a variety of movements from an overhead shoulder press, pull up, overhead squat, handstand, barbell snatch, clean and jerk, and multiple variations of exercises where your arms are in a position above your head. For the sake of this article, I am going to specifically address movements where you are pressing or holding a weight overhead.
Within the realm of health and medicine, you may have heard the dangers of performing a movement like a shoulder press. You may have heard some of the perspectives:
“Overhead pressing causes shoulder pain”... and should be avoided
“You have shoulder pain, this may have been caused by OH exercises… therefore you should no longer perform OH exercises in the future”
“Overhead pressing is bad for your rotator cuff/ causes impingement/ etc….”
So, are overhead exercises inherently bad or to be avoided? The short answer is no, but I will also throw the (at times) frustrating answer of “it depends.” To be clear, I am in no way saying that overhead pressing cannot cause shoulder pain or you should perform OH exercises despite your pain or shoulder issues. There are specific people who may be injured, rehabilitating, or are just not appropriate for a shoulder press. I am suggesting to take a more pragmatic approach to this question. So let’s ask this question in a different way. Is it the overhead shoulder exercise that caused your shoulder pain? Or rather, was it the poor mobility, poor stability, and/or poor training habits that resulted in having pain while performing these types of exercises? The latter sounds like the more likely scenario.
If we take a closer look at normal activities in life, we can find motions that look very similar to an overhead press. Putting that coffee mug on the top shelf, loading your roof rack with your skis, or hanging that large picture frame all look fairly similar to a variation of an OH press through what is called a functional movement pattern. All movement patterns require adequate range of motion, mobility, strength, and stability of joints and tissues of the body.
So what is required for optimal health and performance with the overhead press?
1. Adequate Overhead Mobility
The most basic prerequisite is having the ability to lift your arm fully overhead without large compensations with low back arching, shrugging, or any variation of twisting. This lack of overhead mobility can come from many areas including the shoulder (glenohumeral) joint, scapula-thoracic joint, or thoracic spine. Muscular imbalances can also play a significant role in limiting mobility in the overhead position. If you cannot lift your arm overhead, you probably should not press a weight overhead.
2. Shoulder Complex and Spine Stability
Adequate stability in your shoulder girdle is required to match the demand of how much weight you are trying to lift. The more weight you lift, the more stability is required. Shoulder girdle stability refers to the ability to create a strong foundation or platform through your upper back, scapular muscles, rotator cuff, and even your trunk and core. Due to postural or training habits, common muscular imbalances and stability deficits to the muscles of the upper back and scapula are typically found in the clinic. Stability also refers to the ability to perform controlled movement as well as resist abnormal forces and movements. This is where rotator cuff integrity and strength plays a vital role with shoulder joint stability.
3. Load Management
An often overlooked factor for optimal shoulder health and performance is appropriate programming in regards to intensity(weight), volume (sets,repetitions), and frequency (how often). Even with adequate mobility and stability, overloading of one or more of the variables mentioned can lead to sore and achy shoulders over time. Too frequent, too soon, or too much load with inadequate recovery can lead to a scenario where the amount of stress to the body tissues exceeds how fast the body can recover. This is the basis for tissue injury. This is a similar concept on why baseball pitchers track their pitch counts. We have to understand that more is not necessarily better when it comes to longevity of fitness and performance.
4. Exercise Modification and Scaling
Another concept that is essential to long term shoulder health is understanding modification, regression, and scaling of exercises. Any functional movement pattern can be modified or scaled into many different variations or positions to achieve the same goal of building strength and improving fitness. For example, if a barbell OH press is too stressful or uncomfortable, utilizing a dumbbell OH press allows more freedom of movement that may take stress off of the shoulders compared to pressing a fixed barbell position. The same can be said about utilizing what is called a landmine setup for pressing when a full overhead position is not able to be trained. Scenarios where you cannot perform an overhead press due to mobility restrictions, return from injury, sore/achy shoulders, or any other limiting factors may warrant modification or scaling of movements to allow success in order to limit excessive tissue stress. In these scenarios, it would be best to find a health or fitness professional who has a good understanding of modification, regression, and scaling.
To conclude this article, let’s revisit our original question asking if the overhead shoulder press is safe. The short answer is yes. However, if you are injured or incapable of meeting the requirements of the movement, then maybe the shoulder press is not good SPECIFICALLY for you. We have to take ownership in understanding that the actual exercise pattern of an overhead lift is not bad. It was not the exercise that injured you and it is not the exercise itself that will be bad for you in the future. Poor mobility, stability, and training habits are what are really bad for you and can be unsafe. Understanding this mindset puts you in control of what your body is capable of performing. Also, find the right physical therapist or other healthcare provider who understands your goals, activities, and sports to help guide you to reach your full potential.
Always keep in mind if you are new to exercising or are dealing with an injury, it is best to seek the advice of a qualified healthcare provider. To learn more about how a physical therapist can help you, click here to find an Activcore location near you.
ABOUT THE AUTHOR:
Gavin Ongsingco is a Doctor of Physical Therapy (DPT), board certified Orthopedic Clinical Specialist (OCS), and Certified Strength & Conditioning Specialist (CSCS). He works at Activcore in Denver, Colorado, located just a mile from the popular Cherry Creek Shopping District.
As a Crossfitter himself, Gavin has a special interest in treating strength and fitness athletes. He holds a Bachelors degree in Exercise Science from California Lutheran University, as well as a Doctorate degree in Physical Therapy from the University of St. Augustine. He is also a graduate from Rancho Physical Therapy's Orthopaedic Residency Program.
Gavin goes beyond the symptoms and looks at the whole body to help you recover from pain and injury, and safely return to a fulfilling life of sport, activity and wellness. He is among less than 10% of all physical therapists to have earned the prestigious OCS designation as an orthopedic clinical specialist, making him exceptionally equipped to treat you from head to toe. Additionally, he is recognized nationally as a leading authority in the application of Redcord, a suspension exercise system designed to help you develop a smarter, balanced body through the power of neuromuscular activation. [READ MORE]