Jessica Bento, Physical Therapist/Director of DVRT Education (Creator of DVRT Restoration Certification, DVRT Rx Healthy Knees, Pelvic Control, & Shoulder Courses)
As a young therapist first out of school I would look towards the more senior therapists in the clinic for advice and of course, to learn from. In fact, looking back I learned the most from those I worked with.
One thing in particular that just about every therapist I worked with did was whenever someone would come in the clinic with shoulder pain the first thing I would hear from the clinicians is them telling their patients to stop lifting overhead ( of course if this was something they were currently doing).
A lot of people that came in for therapy were consistent with their fitness and working with trainers as I typically worked in sports clinics, but yet the first thing most of the therapists would do is have them stop training all together and just focus on therapy and of course tell them whatever they do they MUST stop lifting/pressing overhead.
This always confused me. First, telling someone to completely stop training is strange and not reaching out to the trainer was one thing, but there was a bigger question to be asked. Why was lifting overhead such a contraindicated movement? Was that really what was causing the pain or discomfort? I never saw any therapist actually watch the patient press or lift overhead and examine what was going on…they just said don’t do it and it was never apart of their rehab program.
This is coming from someone who has destroyed their shoulders from competitive swimming in their youth!
It was (kinda still is) actually quite common in the therapy world to avoid overhead pressing. I think it stemmed from the thought that it would cause shoulder problems or impingement and also seamed an unimportant movement to many in the therapy world. It was easy to just say don’t do it as it appeared to have no benefit when in actuality it has the great benefit of upper body mobility with stability and integrates all the chains of the body at once.
The real issue is that people don’t know how to press overhead or were not properly taught, this goes for a lot of physical therapists as well at no fault of their own as its not taught in school. I can’t tell you how many therapists I see with poor technique when it comes to pressing overhead, the world wide web has let me see a lot of things I can’t unsee.
This is the biggest issue and why people experience shoulder pain or even neck pain with pressing movements. They don’t know where to begin or what they should be doing, they are just fixated with pressing the weight overhead and not paying attention to what needs to be occurring.
So where do we begin with how to achieve a pain free overhead press? We need to understand how to create tension. I am sure you are all tired of hearing about proximal stability for distal mobility as it shows up in just about every blog post but its important and what tends to be the issue if people are having shoulder pain with pressing, it usually is a sign that the person is not bracing or creating that proximal stability.
Our Press Outs are a great starting point to teach this concept and often where I begin my patients. We often begin the Press Out in the tall kneeling position because being in a somewhat unstable body position FORCES us to use our feet to create stability in the body. With that said, we don’t HAVE to use the Press Out in tall kneeling only. In fact, we can start people that are not ready for such a challenging position in a standing posture as well as we can progress people to more challenging ones. Using our DVRT concept of body position as a form of manipulating intensity, we have many options in people being successful.
DVRT Master, Cory Cripe helps me break down the details that people often miss in our Press Outs that make this such a powerful drill.
Talking about feet we can’t forget the importance of the hands and feet, another topic you have heard time and time again but it really can change the outcome of any exercise. Getting someone barefoot or in minimalist shoes and having them really grip the ground with their feet can change how that overhead press feels and looks in an instance, as well as properly gripping the implements. Too many times I see people barely gripping the tool and missing an opportunity to create a better connection from the hand to shoulder to the core.
We can move to our Arc Press once the understanding of how to create that stability has shown itself. The other benefit of the Arc Presses is that we bring in not only the frontal plane, but resistance of the transverse plane. This is a key concept in building true core strength, but also allows us to build unilateral “push/pull” of the upper body. Yes, these are more single arm pressing and pulling movements. Don’t forget that once we achieve lockout with the arms, we begin to focus on a pulling of the weight back towards our body.
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Cory is back to give us some important coaching cues on how to perform the Arc Press correctly and get the benefits that I am referring to that make this such a powerful drill for strong and healthy shoulders.
I have really loved the use of bands as well with single arm pressing movements. We can use super bands to create tension on the opposite side of the arm pressing. The press out of the band gives off a “plank”where we have more of that core stability allowing for the shoulder to perform an overhead press with ease.
Below you will see 3 DVRT drills using a variety of tools in a progressive manner. I realize there are those that simply can’t go overhead (right now) and need to have a different starting point. However, as Josh has written about before, landmines don’t really do the job. When we press up or out with any other tool or core braces harder giving us that proximal stability that results in better moving shoulders and greater strength. However, with landmines the reverse happens. Instead of having our core brace because the leverage of the weight increases on our body, the weight becomes more upright and reduces the stress on our core because the weight actually is mechanically getting lighter. So, what can we do instead? I love using the split position to increase the need for the feet, pelvis, core, and upper body to work together, but you will see below how I can put all three progressions into a sensible series that improves strength and mobility to give us healthy shoulders.
So to recap if you are having shoulder pain with overhead pressing focus on better overall integration whether that be gripping the ground with your feet, pressing into the ground and making that connection. Gripping the tool/ implement with intent whether it be an Ultimate Sandbag, Kettlebell, dumbbell or so forth, use that grip. Make sure you have learned how to properly brace and “turn on” that proximal stability so that your shoulders can move better.
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