This one makes me want to pull out my hair. The bench press and its variations have tremendous value in training the upper body; problems arise when people train their egos and not the movements. This egotistical bench approach can be summed up with the following:

1 Lack of balance in training volume

This imbalance is present in a) internal and external rotation of the humerus, b) lack of balance between scapular protraction and retraction (and often inappropriate protraction substitution patterns), and c) horizontal adduction and horizontal abduction. The solutions are actually quite simple: bench less; do more horizontal pulling, external rotations and horizontal abduction exercises (i.e. posterior deltoid work); and incorporate some isolated scapular protraction work to activate the serratus anterior (see the Neanderthal No More series for specific exercises).

2 Poor technique

Unless you're a powerlifter in competition, don't get caught up in just using the grip (usually an ultra wide one) that allows you to move the most iron. Instead, you should choose a grip that takes into account shoulder health, recruitment patterns and carryover to sport.

In terms of shoulder health, in almost all cases, a narrower grip will be the safest, with anything outside of 1.5 times shoulder-width putting you at markedly greater risk (1,2). From a recruitment pattern standpoint, a close grip will overload the triceps to a greater degree, whereas a wider grip will involve the pectoralis major more. Using a 14-inch grip tends to have the greatest carryover to athletics. Just think of the position from which you block in football, throw a chest pass in basketball, check in hockey, grapple with an opponent in mixed martial arts, or support your body weight while in the missionary position.

A comprehensive description of benching technique is beyond the scope of this article, but if I had to give ten cues, they'd be:

1. Chest High
2. Elbows Tucked
3. Scapulae Retracted
4. Lower Back Neutral or Arched
5. Feet on Floor
6. Tight Core (Braced)
7. Elbows Under the Bar
8. Get a Lift-Off
9. Pull the Bar Down to You
10. Spread the bar as you think about pressing yourself away from it (through the bench)

Also, in terms of bar speed, a controlled eccentric is much easier on your shoulders than ballistic work (3), so if you have a history of injury, you'd be best off avoiding bench throws and speed benches unless you're completely in the clear. I cannot overstate the importance of keeping the chest high and elbows tucked, as doing so will prevent hyperextension in the bottom position of the bench press. This hyperextension has been linked to anterior glenohumeral instability related to capsular trauma and too much traction on the acromioclavicular (AC) joint.(4,5) Osteolysis of the distal clavicle can also become a serious problem in those who hyperextend the shoulder in the bottom position of the bench press.(6)

3 Lack of flexibility, or excessive flexibility

On one hand, we have the average gym rat that has benched his way to posture so bad that it would put Quasimoto to shame. With such internally rotated humeri and anteriorly tilted, winging scapulae, the subacromial space (space in the "shoulder" joint) is markedly compromised, and the rotator cuff can be easily irritated with various overhead activities and horizontal pressing. This situation is known as external impingement, and affected individuals need to fix their posture in order to bench safely.

On the other hand, you'll encounter individuals (commonly overhead throwing athletes) with hypermobility at the glenohumeral joint; essentially, there's too much room in the socket, and the humeral head clanks off of the rotator cuff and eventually leads to rotator cuff damage (internal impingement). These folks may need surgery to tighten things up, although many can work around the injuries and hypermobility with specific rotator cuff and scapular strengthening exercises as well as modification of form on (or completely avoiding) certain exercises.

4 Training through pain

I don't think I need to go into much detail on this one. Suffice it to say that the overwhelming majority of lifters experience shoulder pain at some point during their time in the iron game. If something causes you pain, don't do it.

Bench pressing is not inherently evil; it's only a problem when stubborn lifters apply it inappropriately in their programming and perform the exercise itself incorrectly.

If this is the case, I guess I better not store anything on the top shelf, huh? Okay, in all seriousness, we need to understand the rationale behind such an assertion before we can get into all the finer subtleties. There are two broad camps: those who say "you just don't need it" and those who insist that "it's dangerous."

In the former case, the fundamental rationale is essentially one of training economy. If you have a limited amount of time to spend in the gym, and a limited recovery capacity, you need to choose the exercises that will give you the most bang for your training buck without exceeding your body's capacity to recovery. Many insist that one simply doesn't need direct "shoulder work" (and I put that in parentheses because I abhor body part training) simply because the deltoids receive adequate stimulus from horizontal pressing (benches), and pulling (rows), and vertical pulling (pull-ups/pulldowns). These folks insist that at the very most, you need a few supplemental sets of lateral raises to target the middle head of the deltoid, and with that completed, you can sit back and wait for your cannonball delts to emerge.

Personally, though, I view recovery as systemic more than muscle-specific, so I examine how my overall volume is distributed and then make that determination. In other words, trainees with better recovery capabilities can afford to do this extra volume. Moreover, I look to consider if I need more biomechanical balance in my programming; will some overhead pressing help to "cancel out" some vertical pulling I'm doing?

Finally, I look at the demands of the athlete's sport or the bodybuilder's goals; if an athlete needs to be strong overhead (e.g. basketball player) or a bodybuilder needs to bring up his taters, I'm going to incorporate overhead pressing at the expense of something else. Ever since I wrote Cracking the Rotator Cuff Conundrum, I've been inundated with emails from frustrated trainees with bum shoulders. You know what the vast majority of them share in common? Poor balance in programming, mostly as a result of insisting that they need to have a separate day just for shoulders.

Next, we have the "it's dangerous" camp standing on their soapboxes trying to frighten us all off with a gross generalization. The basis for this allegation is that overhead pressing is dangerous because when you move with the humerus abducted/flexed past 90 degrees (upper arm parallel with the floor), you're compromising the subacromial space. The tendons of the rotator cuff pass through this space, and IF the rotator cuff is weak and/or the scapula is anteriorly tilted, the space is limited to the point that the tendons will become impinged (hence the term external impingement) between the humeral head and the glenoid fossa (shoulder socket) of the scapula.

Did you notice the big, bold "if?" For those with normal positioning of the scapulae and strong, healthy rotator cuffs that can depress the humeral head effectively, there is absolutely no need to avoid overhead pressing out of fear of injury, as there will be sufficient room for the tendons to pass through this space without irritation. Performing the movements in the scapular plane can further reduce the likelihood of subacromial impingement. This plane allows for improved joint surface conformity; appropriate rotator cuff alignment, which leads to increased activity of the infraspinatus and teres minor in stabilization of the humeral head (4,7,8), and minimized stress on the inferior glenohumeral ligament.(9) The scapular plane is located about 30 degrees anterior of the frontal plane. In other words, raise your arm as if you were about to start a rep on the pec deck, and then do 1/3 of cross-chest fly. One can also use a neutral grip to make overhead pressing with dumbbells more safe; this movement at the lower arm corresponds to external rotation of the humerus, which decreases the likelihood of subacromial impingement.(10)

Now, there are going to be a ton of individuals who I don't feel should be overhead pressing. Incidentally, almost all these trainees are outstanding candidates for the programs Mike Robertson and I outlined in Neanderthal No More IV and V. The anteriorly tilted position of the scapulae and internally rotated humeri are problematic in themselves, but when you consider that these postural issues correspond to altered length-tension relationships, and therefore weakness of crucial scapular stabilizers and rotator cuff muscles, overhead pressing is the last thing that these individuals need to consider. In fact, those who are already experiencing shoulder pain shouldn't even be doing back squats or good mornings until they get these issues resolved.

So, to summarize, overhead pressing is cool if a) your shoulder girdles are healthy and strong, b) it can be incorporated without messing up structural balance in your programming, c) your sport/weaknesses necessitate its inclusion, and d) you're factoring it in to your overall volume equation. And, you can potentially make it even cooler if you're pressing in the scapular plane with a neutral grip.

Concurrent extreme external rotation and abduction has been termed the "at-risk" (or 90/90) position by many practitioners, so behind-the-neck lat pulldowns and presses have been blacklisted. These individuals cite potential problems with anterior glenohumeral instability(4,5), external impingement, internal impingement (a new-age diagnosis common in overhead throwing athletes with hypermobility), acromioclavicular joint degeneration, and even the risk of intervertebral disc injuries (due to the flexed neck position). The infraspinatus and teres minor are shortened in the 90/90 position, and may therefore be ineffective as depressors of the humeral head due to shortcomings in terms of the length-tension relationship.(7)

In my opinion, you must view the two exercises independently of one another. For starters, one must differentiate between exercises involving traction and approximation at the glenohumeral joint. Pulldowns (like most cable exercises) are an example of a traction exercise, as they pull the head of the humerus away from the glenoid fossa. Various pressing exercises, on the other hand, involve approximation; they drive the head of the humerus further into the "socket." Approximation exercises increase the likelihood of subacromial impingement much more than traction exercises, and this is why exercises like pulldowns, pull-ups and shrugs can be integrated into rehabilitation programs before various presses. So, on paper, pulldowns in the "at-risk" position are less dangerous than presses.

However, in comparison to all the pulldown variations you can do in front of the neck, going BTN is just going to shorten your range of motion and reduce activation of the very musculature you're trying to train.(11) Plus, it's just painful to watch people do these because this exercise invariably turns into a jerking, seizure-like motion. The in-front version poses much less risk and offer a better training effect, so why anyone would opt for BTN pulldowns is beyond me. I guess it's for the same reason some people listen to John Tesh; they just enjoy pain, misery and being looked at like they're nuts.

In spite of the approximation issues, I think that you can make a great case for the inclusion of BTN presses for certain individuals. This position allows for comparable loads to the anterior position without compromising range of motion. If you're considering implementing the exercise, there are several factors that must be taken into account:

1. Cumulative Volume of the 90/90 position: If you're already doing back squats and good mornings, you'd likely be better off holding off on BTN presses in order to avoid overloading this potentially harmful position. If you decided to front squat or use a deadlift variation instead of good mornings, though, you might clear up some "space" for BTN presses. You need to consider this cumulative volume from both an acute and chronic sense. There may even be times in the year when you avoid the 90/90 position altogether.
2. Cumulative Trauma to the Anterior Shoulder Capsule: The 90/90 position isn't the only thing that can irritate the anterior shoulder capsule. Bench pressing and pulldowns/pull-ups also contribute to cumulative stress on this area. I know that I can't handle BTN pressing with my powerlifting volume, and I can't say that I know many powerlifters who utilize BTN presses on a regular basis. We simply get enough stress on this front (pun intended) from squats, good mornings, and bench press variations. As is the case with #1, you need to consider both acute and chronic trauma.
3. Goal of Inclusion: Very simply, you need to ask yourself: why are you doing this exercise? If you're someone with much to be gained from BTN presses, then they deserve much more consideration than if you're a regular ol' weekend warrior or senior citizen who is just interested in getting in shape and staying healthy. As I noted with good mornings in Part I, it all comes down to how much you're willing to risk.
4. Flexibility: In order to be able to perform BTN movements with the most safety, one needs to have a considerable amount of humeral external rotation range of motion. As a rule of thumb, if someone has trouble back squatting with anything narrower than an ultra-wide grip, I don't want them doing BTN pressing.
5. Injury History: If you have a history of rotator cuff problems, I'd advise against performing BTN movements unless you've been asymptomatic for an extended period of time. Even then, approach the exercise with caution in your programming and carefully consider your alternatives.
6. Posture: This issue parallels #4 for several reasons. First, if you've got significant anterior tilt and winging of the scapulae and internal rotation of the humeri, you aren't going to have the flexibility to get into the proper position to do BTN presses. And, even if you can manage to squirm your way under the bar, when you start to press, you'll be at greater risk of subacromial impingement due to the inability of the scapulae to posteriorly tilt with overhead pressing. This is a common scapular dyskinesis pattern related to weakness of several scapular stabilizers, most notably the serratus anterior.

Of perhaps greater concern is the tendency to want to compensate for this lack of flexibility by either flexing the neck–something you want to avoid at all costs in a weight-training context–or allowing forward head posture (where the chin protrudes off a less-flexed neck) to take over. Most people have problems with forward head posture, so the last thing you want to do is reinforce it.

The take-home message on BTN movements is that BTN pulldowns belong in the garbage can, and BTN presses should be used sparingly only in those who meet certain criteria, can effectively write strength training programs, and are willing to assume a bit of risk.

I'll be blunt: in my experience, of all the potentially harmful exercises for the shoulder girdle, this one warrants the most apprehension. Remember how I spoke earlier about using a neutral grip to "open up" the subacromial space when overhead pressing? Well, the theory behind this recommendation is that supinating the forearm to the neutral position corresponds to externally rotating the humerus and, in turn, adjusting the alignment of the humeral head in the glenoid fossa to mechanically make room for the tendons of the rotator cuff to do their thing.

A barbell upright row does the exact opposite of this; the maximally internally rotated position of the humerus that corresponds to the pronated grip isn't an ideal position–especially if you're going to be abducting/flexing the humerus (as in an upright row).

You may be someone who has seen fantastic results with upright rows, but personally, I don't write them into any of my programs. If I want to overload the delts, I can do so via more effective means (benching, overhead pressing, rows, pull-ups and lateral raises). If I want to overload the upper traps, I'll stick with deadlifts, Olympic lifts, and shrugs; all allow for greater loading and a more systemic effect. If you feel like you really need to include some sort of upright rowing variation, I'd encourage you to use dumbbells, which allow you to adjust the plane of motion and grip to some extent, and thus reduce the aforementioned risks.

Now, you may be wondering why barbell upright rows aren't on my list of favorites, yet I don't advocate against Olympic lifts. Good question! Here's my rationale....

For proper functioning of the glenohumeral joint beyond 50 degrees of abduction or flexion, you need some external rotation to occur.(12) Obviously, dumbbells are very practical and safe in this regard, but you might be surprised to discover that barbells are in fact just as safe when the Olympic lifts and their variations are executed correctly. There are several subtle, yet significant differences between (for example) the high pull and the upright row.

First and foremost, the upper body aspect of the high pull is assisted by the hip and knee extensors and ankle plantarflexors; this triple extension lessens the burden on the shoulder girdle. In essence, the lifter is executing a lower body exercise, but integrating a violent shrugging motion while maintaining the extended elbow position for as long as possible. Effectively, this teaches the lifter to pull with the lower body and upper traps – not with the deltoids and biceps.

If O-lifting makes you sorer in your shoulders and arms than in your upper back and posterior chain, I suggest you find a good USA Weightlifting coach before your next session. Overdeveloped deltoids (relative to the depressors of the humerus) are a common culprit when it comes to subacromial impingement; by lessening their involvement, there is less "encouragement" to humeral abduction than that which is generated simply from momentum from other muscles.

Second, the explosive manner in which the Olympic lifts are executed corresponds to partial temporary deloading at the portion of the movement where the rotator cuff is most at risk of impingement, whereas the resistance is constant in a slow-paced movement like the upright row. This effect is even more pronounced in clean and snatch variations where the lifter attempts to get under the bar as quickly as possible; in experienced weightlifters, the bar doesn't even reach the 50-degree mark.

Even if it does pass the 50-degree point, you're still externally rotating the humerus to complete the clean or snatch, so you're in the clear. In ACSM Recap: Part I, I quoted accomplished weightlifter and coach Gary Valentine recalling that the late Joe Mills used to say, "Any weight that you can get past your belly button with some momentum, you can clean."(13) No delts needed; my apologies to the bodybuilders in the crowd.

Third, the movement of the torso is markedly different between the Olympic lifts and the upright row. In the former, the lifter is extending the torso as the bar is pulled upward, so while the upper trapezius is primarily active as a scapular elevator, it's also active (along with the middle and lower trapezius and rhomboids) as a scapular retractor in an attempt to keep the bar close to the body.

Watch anyone do an upright row, and you'll see that they don't really care about bar path unless they're trying to make the movement easier by bringing the barbell closer to them. This movement is accomplished by positioning of the deltoids–not active contraction of crucial scapular stabilizers. Because the trapezius complex works synergistically with the serratus anterior in posteriorly tilting the scapula (which mechanically increases the subacromial space with overhead activities), activating the whole trap shebang helps to keep the shoulders healthy.

Fourth, typical volume schemes for upright rows and Olympic lifts are completely different. O-lifters rarely (and shouldn't) exceed sets of 5-6 reps, as the Olympic lifts and their variations are highly technical movements that should be performed rapidly. Conversely, upright rows are performed at bodybuilding tempos (read: slower than molasses going uphill on a cold winter day) with as many as 15-20 reps per set in some programs. Over time, this volume adds up, especially when it's accompanied by loads of pressing lateral raises, and pull-up variations.

Fifth, you need a significant amount of upper body flexibility to execute the Olympic lifts properly. Any schmuck can walk into a gym and try an upright row. As such, the former carries much less risk; think of this flexibility as the ID you need to get into the Olympic lifting nightclub. If you have it, you're on the inside with fancy martinis and gorgeous women. If you don't, you're stuck in the alley with a "40" in a paper bag, some homely old skank, and a bum shoulder to boot...or something like that. Just use your imagination.

We might as well conclude with one of the oldest–yet still unresolved–debates in our industry. As a little background, there's considerable opposition to the use of sit-up variations in exercise programming for several reasons:

1. Generally, individuals perform sit-ups because they assume they're training their abdominals; it's too bad that sit-ups preferentially recruit the hip flexors! When compared to the curl-up (which is about as good as they come in terms of "isolating" the rectus abdominis), the sit-up elicits significantly higher activation of the rectus femoris and psoas major (two hip flexors).(14,15) Contrary to popular belief, performing sit-ups with the knees bent does not take the rectus femoris out of the movement; in fact, its activation is higher with the knees flexed !(14,16)
2. The psoas major has attachments on the T12 and each of the lumbar vertebrae. When activated, it imposes significant compression (~3,300 N, 730 lbs.) on the spine. Coincidentally, McGill (2004) reported that 3,300 N is also the action limit for low back compression in workers as set forth by the National Institute of Occupational Safety and Health (NIOSH, or the Canadian equivalent of OSHA). In other words, each sit-up you perform exceeds the level of loading that is associated with an increased risk of on-the-job injuries!(17)
3. In the classic postural distortion patterns, the hip flexors are overactive and the rectus abdominis is relatively "dormant." Curl-up variations offer greater activation of the rectus abdominis without the compressive loading and shear stress on the lumbar spine (15), and can therefore be a valuable part of programs to prevent or rehabilitate low back injuries and improve lumbo-pelvic posture.

These three reasons are sufficient justification for omitting sit-ups altogether if you're purely looking to "isolate" the rectus abdominis and train for general health; there are clearly numerous other options available to you that offer greater efficacy at lower compressive loads.

What about sit-ups for performance, though? One of the limiting factors to sprinting performance is hip flexion power; however, one must be very careful with direct training for the hip flexors due to the aforementioned spinal compression imposed by the psoas major. Traditional sit-ups are certainly a means of training for both power and strength of the hip flexors, but personally, I use them very sparingly in the programming for athletes. Very simply, direct hip flexion training is not placed at a high priority, as many athletes have more pressing needs–most notably those related to the classical postural distortions referenced earlier. For these individuals, sit-ups simply compound the problem.

There are those, however, who can derive benefit from training dedicated specifically to hip flexion. In these instances, I prefer movements that incorporate simultaneous hip extension on the opposite leg and some arm action, preferably in the standing position. Sled dragging and exercises with cables and bands are useful in this regard, as are sprinter sit-ups.

As far as I'm concerned, most athletes did enough sit-ups in grade school to last them a lifetime; I'd rather give them some safer exercises with greater functional carryover to sport. Occasionally, though, I'll write them into programming to offer a bit of novelty. Regardless of the hip flexion exercise, it's imperative that the athlete maintains a neutral spine position and braces the abdominals. And, even before undertaking such an exercise, the coach should be considering whether or not that athlete could be doing something more productive instead.

One thing that I've tried to emphasize throughout these two articles is that I want you to think for yourselves when deciding if some of these exercises are acceptable for you. I recall Dr. Ken Kinakin once wisely saying that people–and not exercises–should be contraindicated. Be honest with yourself in your evaluation of your own risks, your injury history, your goals, and the cost-benefit ratio should be clear.

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