The Best Damn Overhead Press Article for Physios

Now we come to the final article in this series – the overhead or military press. About 10-15 years ago the overhead press got a very bad rap in both the strength and conditioning and physical therapy realms as it was associated with impingement, rotator cuff tears, poor technique, and shoulder/neck/back pain. In reality a lot of those issues come down to:

1. Lack of understanding of pain
2. Improper loading strategies of the shoulder
3. Poor technique
4. Poor choice of pressing variations relative to individual client factors

I’m a huge fan of overhead pressing and, even for a lot of my rehab clients recovering from shoulder pain, like to implement it (or some variation) as a late-end stage rehab exercise. The 4 exercises that (at face value) have the most carryover to day-to-day life are squatting, deadlifting, carrying, and overhead pressing. Hence, while the overhead press isn’t as popular as the other lifts I’ve covered in this series it’s still worth mentioning.

To reiterate my disclaimers from previous articles:

• This is strength training, not hypertrophy training biased
• This is also an article on technique & modifications, not how to improve overhead press performance
• Perfect technique is not the “be all and end all” of injury prevention. Refer to my two part series on The Pillars Of Sports Injury Prevention here and here.
• I also highly recommend checking out the masterclass by Travis Pollen on Injury Prevention Theory into Practice to understand the complex aspects that can influence and contribute to injury prevention.

Part 1: Setup (from bottom to top)

Foot position

Mostly, I like having the feet side by side at shoulder width, or slightly closer, but Jim Wendler got me into the idea of having a staggered stance with one foot in front of the other. It really comes down to personal preference. Some clients feel less likely to hyperextend their back with a split stance whereas some feel more stable with an even and symmetrical stance.

Spine position

For barbell or dumbbell overhead pressing – always neutral. If you are pressing a larger implement such as a log or a swiss bar you may need to hyperextend your back a bit just to stabilize the larger implement on your chest.

Scapular position

I think we’ve largely gotten away from this, and for good reason, but I’m not a fan of the cue some people use of “shoulders down and back” when doing any overhead movement. Scapular research is a conflicting and confusing mess so I just like letting the scapula move freely. However, I’m not a huge fan of people shrugging during the motion.

Elbow and wrist position

This is a more controversial one (expecting hate comments here) as some recommend more of a vertical wrist and forearm position, whereas others recommend a front rack position of the elbows facing forward, the wrists extended (cocked) and the bar resting more on the collarbone (as opposed to the chest in another example).

I prefer the front rack style position for the overhead press, similar to that seen in an olympic front squat or jerk, as it enables the lifter to have the bar more supported and in line with the body while keeping a neutral spine. The issue I have with the neutral wrist & vertical forearm position (more so for more slender clients) is that the clients feel like they are having the bar falling away from them and have to:

1. Hyperextend the back to counterbalance the weight with a longer moment arm
2. Press the bar further

Whereas the front rack position has better leverage and a shorter bar path.

That said, I am of the belief that everyone is individual and if that position is aggravating the wrists, I’m fine modifying it by having a more vertical wrist/forearm position or by using dumbbells, a log or a swiss bar that allows for a neutral wrist position.

Grip width

Shoulder width, or just inside or outside, works better for most people. People with bigger chests/torsos may need to go wider while people with smaller chests/torsos can go narrower.

Part 2: Common form issues

Shrugging

This largely comes down to:

1. Poor body awareness: I find this can usually be fixed by:
   1. Making people aware of what they’re doing versus what proper technique is (i.e. mirror coaching)
   2. Exercises such as landmine presses and forearm wall slides can be helpful to cue people to upwardly rotate through the scapulae rather than shrugging the shoulders. Because of the nature of this area – I haven’t found a good external or verbal cue for this.
2. Too much weight/fatigue
3. Lacking mobility in the shoulder and/or t spine

As with any other form issues – always coach and cue before going down the corrective exercise bandwagon. At least 80% (if not 90%) of the form issues I work with, assuming the client can anatomically do the movement correctly, are dealt with by proper coaching and cueing.

Hyperextending the back

This can also be due to:

1. Too much weight/fatigue
2. Lacking mobility in the shoulder and/or thoracic spine

But first I like to look at cueing proper core control by using the following cues:

1. “Make sure I can see the logo on your shirt”: this cue keeps people from going overhead too high
2. Other cues that I use are :
   1. Teaching 360 degree breathing and bracing (I simply reference Chris Duffin’s work, which you can find in the below link)
   2. Pull the ribs down two inches.

Not pressing the bar fully overhead

Sometimes this can be a mobility issue but more often than not it’s an awareness issue. Giving people a target to aim for overhead (I’m 6’5” and usually just reach up there and get them to reach my hand) or mirror cueing fixes this issue.

Poking the chin forward

Again this comes down to awareness. I like to cue people to tuck the chin in slightly (if they aren’t already) when pressing.

Part 3: Modifications for injury

The main issues I see with overhead pressing, other than the once in a blue moon wrist pain that I mentioned above, are back pain & shoulder pain.

Before making big modifications you have to look at:

1. Is the movement being done right?
2. Is there proper programming? By that I mean:
   1. Are weight and volume progressing appropriately or too fast?
   2. Is there enough volume of other muscle groups in there (i.e. lats, triceps, rear delts, rotator cuff)? This is more anecdotal than hard evidence but I do believe pressing (particularly overhead and bench pressing) WAY more than pulling can be a problem.
3. Is there proper eating, sleeping, stress management, hydration, bodyweight management etc?

With back pain it usually comes down to again not hyperextending the back during the movement. Usually the above cues do the trick but sometimes you have to drop the weight and/or work on an exercise variation (such as landmines or incline presses) that can be done without extending the back.

Usually with shoulder pain; assuming the above factors have been accounted for; it’s usually a case of dialing it back to a more tolerable variation and then building up from there. I encourage you to read my article on Returning To Pressing With Shoulder Pain but in general my progression goes as follows:

1. Full shoulder ROM without pain and ability to do all other pressing exercises without pain. There are exceptions I’ll make to this, but in general that’s what I like to work with.
2. Landmines
3. Bottoms Up Kettlebell Presses
   1. Start in scapular plane if needed, or
   2. Regular Bottoms Up Kettlebell Presses
4. Scapular Plane Dumbbell Overhead Presses
5. Regular Dumbbell Overhead Presses
6. Barbell Overhead Press

Wrapping up

That wraps up my series on the barbell lifts. Thanks for reading – and if you find this stuff interesting I hope you check out the two following Masterclasses by:

• Dr. Teddy Willsey: Exercise Prescription In Sports Rehab
• Dr. Travis Pollen: Injury Prevention – Theory Into Practice