It’s pretty common at Champion to have some clients that are experiencing shoulder pain but want to get back into the gym and perform overhead exercises.
There can be many reasons behind their pain, but a sound strategy can help you get them back into the gym as soon as possible.
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#AskMikeReinold Episode 308: Getting Back to Overhead Exercises in the Gym
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So we have Paul from Florida wants to know, “I have seen several people with shoulder pain that want to return to the gym but have limited overhead mobility. It seems that the only thing that hurts them is doing exercises overhead in the gym. How do you get people back to the gym pain free in the future?”
That’s a great question. I like that too. And I like how this is a particular population that the only thing that bugs them is the overhead activities at the gym. Which you know, can almost argue to me that’s like stage one and if they keep flaring it up, then things around the house are going to start bugging them too. But that’s an interesting question.
I know we could probably go in a lot of different ways. I definitely want to hear about how the strength coaches regress and progress them and stuff like that. But I don’t know, who wants to take the lead on some of the strategies here? Maybe Dan? I mean, they want to be pain free in the future. That sounds like fitnesspainfree.com to me. So again, when you have somebody like this, what’s some of your keys to work with them?
Yeah, I think the big one, and this is a personal opinion, I think it’s a misconception… Is that when you have pain doing overhead motions and you have limited overhead mobility, the reason why you hurt is because you have limited overhead mobility. Now, the reason why I feel like this is probably wrong is that most folks, when they press something overhead, they have kind of this painful arc.
So simply when you press, it’s not like the lockout kills, and certainly it could be in some folks it’s more the midrange. As you press the barbell from shoulder level, it’s maybe forehead level. That’s usually what kills most folks. And the thing is, if you mobilize a shoulder joint, just open up the range of motion more and more. Then essentially when you finish a press, you’re at the very, very end range of your motion.
And I would argue that’s actually a little tougher on your joint than being in more of a partial range. I think that when folks have limited overhead mobility, it’s going to limit their ability to let’s say, snatch or jerk well. And it may increase the amount of extension their lower back takes when they press overhead, which leads to some injuries.
But I think when you’re trying to get someone to be less painful with overhead pressing in the gym, just doing a ton of mobility work is not going to fix it. So I think A, that’s a big misconception. Do you need the mobility? Yes, certainly work on it, but I don’t know if that’s going to make you pain free. And then for me, I just do a lot of strengthening in movements that are relatively tolerable. So you might have to go from pressing overhead to doing more of a horizontal press.
So maybe you’re doing more flat bench, maybe you start with some incline stuff. Eventually you work towards landmine work. You start with kind of lighter loads, slower speeds and work up the faster speeds over the course of time. I also think that adding a lot of specific rotator cuff stuff is helpful. I know there’s a lot of arguments out there right now in terms of whether or not we need to do rotator cuff work. I still do. I think it’s very relevant. Helps to reduce pain and allow you to press more overhead and it’s just a slow progression back.
And then once they’re back to pressing in the gym, let’s make some smart decisions. Do we need to be doing strict military overhead press? Maybe, maybe not. If this is a CrossFit person, then yes, they really want to do it, then yes. They’re going to have to be able to tolerate those positions. But once they get pain free, you have to be smart with your programming over the course of time.
Yeah, I like the way you brought up the thing about overhead mobility and I think that makes a lot of sense. It’s not often that you just only have pain at extreme end range overhead position. I like that. Dan, do you think there’s a chance though that their limited overhead mobility is kind of screwing up their scapulohumeral rhythm and the way those work together? And maybe, I don’t know if I’m ready to completely say that that’s not correlated to a lack of mobility.
But I do agree with you, it’s probably not 100% either. Sometimes it’s just a painful arc from just rotator cuff irritation, for example. But I do wonder though, if that decreased mobility is either changing the scapula’s ability to move and position of the humeral head. Or even the humerus ability and maybe that end range motion is just further down the chain.
What are your thoughts on that? I know I kind of threw that back at you, but do you think that that is relevant or do you think it’s just a completely different mechanism?
I think so. I would say it probably comes down to the individual a little bit. I tend to think of solutions in terms of lowest hanging fruit. And I think mobility is probably a part of that. But I think people are missing that the big players, which is progressing loads gradually over the course of time. And I’ve certainly seen folks where they have weird shoulder pain. So I have an Olympic weightlifter right now, and he’s very limited with his glenohumeral range of motion.
So he is the type of guy that has limited motion on one side and he has a ton of upward rotation on the side that’s stiff and painful. And he’s got pain right around the shoulder blade. So I think for him, he actually needs to have more mobility within the glenohumeral joint or maybe the teres major. One of those players that’s going to allow a little less upward rotation because he’s probably getting too much motion there is my best guess.
And you probably have folks that are on the opposite end of the spectrum that need to have a little bit more motion coming from the shoulder blade. I think you make the argument for folks that have a lot of instability. They tend to have a little less upper rotation. We have to teach them to use their scaps a little bit more. So I guess to answer your question, yes, I think it’s relevant for most, but it probably is going to depend a lot on the individual. And you just kind of supply what that person needs.
I think this is just backlash for me. Maybe I just get triggered, I got to just calm down a little bit, but I see so many folks who are like, “My patients can’t press overhead because they have pain. It’s mobility. That’s the reason, and how do I mobilize them?” It’s like, well, it’s a player. But there’s a big… We’re missing some of the bigger points there. I think.
Yeah, I mean just like everything else, it’d be very rare for it to just be one thing and not another. I mean it depends on the person. There’s so many things that build into that. So that’s a great way of doing it. And I just want, again, to emphasize Dan’s point here that what we probably do wrong more than anything else is that we either completely deload them like 100% or we don’t load them enough on their progression back and work through a little bit. That’s not how you help people get better.
So I thought that was an excellent statement in there. Dave, from your perspective, I know you were talking about getting back to the gym with overhead activities. But obviously you have a sport with overhead activities. Does this change at all, Dan’s kind of treatment approach to that training at all for you, for athletes that need to perform at their end range overhead?
Well, I think the interesting thing that’s different about gymnastics and circus gymnastics, whatever, is our overhead stuff is, pretty much the majority of it is really high traction and compression forces. So we’re not getting a ton of just pressing volume. It’s either a lot of overhead hitting posterior inferior glenoid and stuff like that. Or it’s really high traction forces. So I think the argument that Dan makes too, which I’m actually more of a fan of pushing the strengthening and the isolated cuff work and some of that.
Sure, some soft tissue stuff will be helpful, particularly if they’re lax overhead and you think maybe, okay, we have some excessive joint motion coming capsular and straining the cuff possibly. But I tend to see a lot of people who are not really just handling pure load. It’s like a workload issue combined with, not to be harsh about it, but you’re just weak. You know what I mean? You’re just generally doing a sport that’s 10, 15, 20 times your body weight and you’re 13, 15.
Certain release skills in particular that young male and female gymnasts do, they’re enormously high traction forces. And I just think it’s just straight up an equation of overload and volume and workload to maybe not having enough baseline, personally.
You know what you guys both made me think of a little bit here too is I see some of these rabbit holes that early career professionals can go down through social media and stuff. Where this is isn’t going to work, this isn’t going to work, this is going to work. This is the only thing that works. Where, when it comes down to it, I think, and this person, if you’re not addressing isolated rotator cuff weakness, if you’re not addressing a mobility issue, if you’re not addressing good scapular movement… And this is just the basic biomechanics. And then if you’re not addressing load progression, if you’re not addressing a work capacity type thing, you’re going to miss the boat somewhere.
I mean, you have to address everything in everybody, because it’s all an equation of those factoring together. It’s very rare that it’s only one thing. So I see a lot of early career professionals try to get on these trends where that’s not that good, that’s not that good. I’m just going to do load. And sometimes they miss the boat on that.
And one more thing is, to jump in, that I think I see a lot of things on Instagram, particularly with hard, maybe drifting towards there’s three components, mobility, strength, dynamic stability. You could argue workloads and umbrella, but I just see a lot more people just doing the most insane dynamic stability drills only. They think if you have the shoulder at a certain angle, just do wall stabs and then bottoms up, kettle bells, then earthquake bar, and those things have benefit. But just making someone’s shoulder shake a lot is not going to help out with pressing pattern.
You miss something. I mean it comes down to it, you missed it. And I think Dan said it really well in that second part there, whereas there could be a lot of reasons. It depends on the person in front of you, but I think there’s a solid chance that it’s many reasons in each person. It’s very rare that it’s just, “Oh, it’s just one thing that we need to do. Everything else is great. Just this one thing.”
Jonah, what do you think from a gym perspective when somebody’s coming into you for getting back into the gym? I know Dan talked about going horizontal versus vertical. Any other tips that you have for helping athletes get back or people just get back into the gym? Back in the overhead if it’s been bugging them?
Yeah, I think a lot of what Dan said is exactly what I would do. Couple little things to just add on that he touched on a little bit, but figuring out where those mobility restrictions may come from. And so if we’re telling somebody to do some self myofascial release or any specific stretches… If we can figure out if their pec is tight or if teres is tight or if lat is tight, those types of things can help make sure that we’re making good use of our time. Rather than, “Oh, here’s our standard six overhead mobility drills. Go spend the next 15 minutes doing this stuff.”
And then yeah, I think the other big piece of it really is finding the exercises that are tolerable. Things that you can load up pretty well. I think some people might go wrong where they try to do, say, a half kneeling, one dumbbell overhead press. And they can only use a few pounds for like, “Oh awesome, we can do this with just a couple pounds.” I would rather be on a slight incline on a bench in an exercise that they actually can load up so they actually can build some strength through it.
If you have someone who’s overall pretty strong, I don’t think you’re going to get a ton out of a really light loaded exercise unless it is like your direct rotator cuff work. So I think really just trying to find those exercises that they can tolerate, ideally as close to the overhead motion as possible. Playing around with dumbbells versus barbell versus landmine, all that sort of stuff. And then if you are going to do mobility work with them, really working hard to try to figure out exactly where their restrictions are coming from so that you can save your client time and give them a more direct plan.
I like that specificity too. I think that’s the key. You’re trying to get the best results in the shortest amount of time. You got to be laser focused on that. Good stuff. So we talked a little bit about just regressing and changing exercise a little bit.
Dew, anything from your perspective on workload management? How do you get them back in terms of workload management, Jonah’s regress, Dan’s worked on their stability, their mobility, anything they may need, set up a program with Jonah on regressions, and starting to load them. How do you manipulate workloads for somebody in there? Is there anything you do in that fashion?
Yeah, I think initially you got to have a little bit of that time period of not constantly irritating whatever area is irritated. So if overhead pressing for the time being is very irritable, get rid of it for a little bit. Don’t be afraid to do so. Now with that said, you guys have all mentioned it already. We don’t not train. We still train, but like Dan said, do a little bit of horizontal. When a horizontal feels good and we can load it up a little bit, introduce a little bit more angle. When that feels good, introduce even a little bit more angle and then you can kind of slowly get there.
And then as far as when we actually get into the true overhead work, start conservative with the amount of volume and intensity that you are prescribing. So your overall workload has to almost disappear for a little bit in the true overhead work. And then slowly get reintroduced, start conservative while you’re kind of building all the other ends of the things that you guys talked about in terms of mobility, dynamic stability, general strength for specific rotator cuff work. But also the specific musculature that’s involved for pressing like your pecs and your deltoid and all that stuff. So that’s kind of how I would attack it.
Yeah, makes sense too. I’m sure, like Dan, you probably see a ton of people that just want to just jump right back into where they were. Same workload, same intensity, same load. So that’s a good tweak. I think that’s a good one. Awesome.
Well, Paul, I hope that helps. I think that was a good multifaceted approach on how to help these people, some of the concepts behind it. Really appreciate the question. If you have something like that, head to mikereinold.com, click on that podcast link, fill out the form, and please subscribe. Apple Podcast, Spotify, whatever you do to listen to your podcasts. We would really appreciate it. Thanks so much. See you on the next episode.