Jessica Bento, Physical Therapist (Co-creator of DVRT Restoration, Pelvic Control, & Shoulder Course)
I will be the first to admit, I didn’t really have a clue as a new physical therapist, my initial instinct when it came to anyone that had shoulder pain when lifting overhead was to tell them to just stop, logical right? I didn’t even watch them lift or press overhead, I just simply said don’t do that, which we are often taught is the first step any time a movement is painful…if it hurts don’t do it. Yet, if you think about it, the flaw with that line of thinking is we never look to see if HOW the movement is performed is the real culprit.
It was kind of ingrained in me that overhead pressing wasn’t even necessary. Heck, there are schools of thought that believed pressing overhead was a sure fire way to destroy your shoulders. You can imagine coming from such background, that led me to believing that not only was pressing overhead not necessary, it could be damaging. Combine that with the fact that I had to end my athletic career in swimming because of badly torn up shoulders, it wasn’t a hard sell for me not to do something that could be problematic for shoulders.
Fast forward to today and all my workouts contain a press that is either horizontal or yes, vertical in nature. Knowing what I know now, I can’t imagine just telling someone to just not do it if it hurts their shoulder. My first instinct now is to have them perform the movement and see where we might being going wrong.
The fact I can press heavy and pain free is a testament to the information I am going to share with you about pressing.
Why the change in my mentality? If you truly understand movement, you see that not being able to perform a movement due to pain isn’t a fitness issue, it is a health issue. There are circumstances that no matter what type of training we do that we can’t restore such movement, but that tends to be the exception than the rule.
Why is it a health issue? Not being able to perform innate human motions is something that should concern us. In not being able to perform certain movement patterns, like pressing, without pain or limited mobility could be a sign that something else is at the root of the problem. Instead of trying to give you super complex assessments or exercises to check if there is something else holding back our movement, I’d rather try coaching the movements better first!
Both vertical and horizontal pressing requires strength from the ground up, stability of the core, and understanding the true intent of the movement (no, getting the best chest pump isn’t going to be our goal) really can make a profound difference in so many people. Once you realize that any type of pressing is a full body movement, you start to appreciate that exercises that are pressing have a deeper role that just building an impressive upper body.
Keys In Creating Strong and Healthy Pressing
Is there a “secret” to pressing well and not having a lot of pain? Assuming you truly do not have any structural damage that is keeping you from pressing, the simple answer is no. What Josh and I see a lot (we have been guilty of ourselves over the years) is actually a poor understanding of what happens during pressing as well as using cues that really don’t make any sense. Such as?
Using Your “Core”:
I can chuckle because I could hear myself doing the same thing as a young therapist. Telling a patient to “use your core” was probably a cue I thought was good and used during my early career. Upon reflection, what the heck was I doing? What does it mean to “use your core”? Man, what an utterly meaningless cue right? After all, how do we want people to use their core?
Yes, the core does play an integral role in pressing as the shoulder is heavily reliant upon what happens below the joint. Most notably, the core that also involves the pelvis. The easiest way to understand why the core is so important to pressing is to simply think about trying to build something tall and strong. If you have a weak foundation, then how strong is what you are building going to be? Not very right?
There is so much science that shows us this is the case, yet, it is fascinating how many people purposefully remove the core from the pressing and pulling exercises!
Having the core be active is key, however, HOW do we do it? When we realize that our core is highly impacted by the use of our hands and feet then it makes sense where we should start our cuing. Our first contact with the outside world is via our hands and feet and if you look at the chain reaction that occurs when these segments are active, it makes sense why we must begin there. No, not with protraction or retraction drills, not trying to “isolate” the serrates anterior, no simply making sure we are getting our core to fire correctly.
I always look at the feet when it comes to someone that tells me they have shoulder pain when lifting and you might be asking yourself what the heck do the feet have to do with the shoulder. Well, what I am looking for is a good ground engagement, is that person “gripping” the sound with their feet and creating a good connection from the ground up. If this is not happening then we might be a weak link in the chain. The foot engagement gives us stability or that base we need in order to build a good press.
Verbal cues may not be enough. We use bands and even getting hands-on with people to help them realize they need to be actively grabbing the ground with their feet.
Often when we are using bands around people’s feet we are doing so more to give a reminder to keep their feet engaged during the movement. Yes, during certain exercises it can create resistance as well, but especially in half kneeling or any vertical position of the body, it is more to keep the lifter reminded of their feet!
I see it too often people pressing a kettlebell or dumbbell and their hand is wide open and they have very little grip on the implement. As do the feet create the stability we need from the ground up the hand brings stability along the chain of the upper body. There is such a strong correlations of rotator cuff strength to grip strength, meaning the stronger the grip the better the rotator cuff performs. So the hands can also give us another opportunity to create more stability and strength when we press.
That is often the missing component when people see us performing some of our DVRT movements like the one’s below. I am not simply holding or gently grabbing the Ultimate Sandbag, I am aggressively trying to pull it apart!
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I’d love to tell you that I already knew it. Going through physical therapy school you would think I did! We cover A LOT in school from assessments, manual therapy, and so much more, it makes you wonder how we miss it? What is “it”? The fact that our core is so essential to not just low back health but heathy knees and as I show in this post, strong and stable shoulders as well. So, while as a young therapist I would have probably prescribed an exercise like you see in the first slide, now I would use the one’s that follow. ______________ The core serves as a foundation for our extremities to move. A stronger and more stable core, better and more mobile shoulders you create. In the first slide, I isolate the shoulders taking away the core and lower body, that is the OPPOSITE of what we should be doing. In the #DVRT drill I show following the first slide you see how much more integrated our training and the better results we can achieve. ______________ Using my hands gripping the ground, or trying to actively “pull apart” the Ultimate Sandbag helps be engage the whole shoulder complex and the core as well! So, it isn’t just doing the exercise, but being mindful of the details of each drill that make it powerful and effective or actually makes the shoulders sore and uncomfortable. Being intentional with your movement is one of the biggest things I have really learned working with @joshhenkindvrt and that has allowed me to create better solutions for patients and coaches alike! That is pretty exciting to me as when we understand how to create better solutions we can help more people!
You see why drills like the stability ball one above isn’t appropriate for building better pressing or healthier shoulders.
This one is HUGGGGGEEEEEE and it gets me all types of crazy when I see people lifting with poor shoulder positioning. This goes with just about every implement but I see it most with our Ultimate Sandbag. The shoulder actually has an optimal position or open packed position which means this position is where motion or joint pay is maximized. We actually designed our Ultimate Sandbag to give you one the best positioning to press overhead via our handles but people time and time again still use the wrong ones as they try and simulate a barbell press. Placing the shoulder in the most optimal position will allow for a rather pain free lift, this is where I see the majority of people go wrong and this is what tends to cause a lot of the pain and discomfort is that they are actually in a more closed packed position or one where the joint motion is limited and then you get the pinch.
DVRT Master, Steve Di Tomaso does a great job breaking down why this all too common mistake is actually harming your pressing and shoulders.
Lats & Glutes
I am starting to see a lot of old time lifts coming back or just strange ones for that matter and honestly this is where I would step in and say there is more potential for harm than good. There is a profound difference in surviving an exercise and an exercise actually helping you move, perform, and be better. Any movement that takes out the feet, the lats and glutes, is a big “no-no” for me. Why? Because it will put the entire stress of the press upon the shoulder joint. If you have noticed, I haven’t once referenced any pressing by saying “chest” or “shoulder”, that is because the entire body plays such an integral role in the proper performance of these movements.
This even goes for mobility and stretching exercises and you would be surprised how many drills that are touted to help the shoulder remove ground contact, the core, and the lats from the equation. Knowing how our body works allows us to be far more critical in realizing what is a good vs. a bad exercise. The shoulder works with our lats, our core …it’s never isolated moments that allow us to function its integrated to a lift like this goes against our principles . This also goes for exercises that largely have people sitting on benches, machines, or even on the ground. There simply isn’t anything there to help the shoulder be strong and stable except the tiny (relative to the body) joint itself.
These are great things to look at to see if you can help the problem of shoulder discomfort as you press (if you feel actual pain I would recommend you seek out the appropriate health professional), you would be surprised how looking at the foot, grip and adjusting the shoulder position can go a long way with improving your vertical press. Take it from someone who has learned these lessons themself!
If you are apprehensive about starting to put overhead pressing back into your programs, start with these movements and many that are outlined in our DVRT Educational Programs HERE