This article is the 2nd in a series I am writing on traditional strength & conditioning movements, and how they can be applied in a rehab setting as well as traditionally in the gym.

Using the Overhead Press as a Rehabilitative and Post-Rehab Global Strength & Conditioning Movement for all Populations

Joshua Slone, NSCA-CPT, B.A., ACSM-EIM 1, MFN-P

Introduction

            The glenohumeral, or, shoulder joint, is one of the most complex and capable joints in the human body. It is a ball and socket type joint, with enormous degrees of freedom in nearly every plane, held together along with the scapula by a network of ligaments, muscles, and tendons. It is also the most injured joint in the human body for a variety of reasons. Usually, injury occurs during rotational movements such as throws, low-to-high movements past 90 degrees of shoulder flexion, and in movements where the humerus is horizontally abducted up to 90 degrees and maximally externally rotated, which is known as the “high five” position.

            Some movement professionals advocate avoidance of these kinds of movements for most people even though we put ourselves in these “compromised” positions multiple times every single day. We reach overhead to replace a light bulb; up and behind our head to wash our hair and upper back; and we play sports both professionally and recreationally. “Normal” human movement includes movement both with and without load, through nearly all degrees of shoulder range of motion (ROM). Therefore, both recreational and therapeutic physical training should reflect these ADLs in their program design and exercise selection.

The Overhead Press (OHP) is a multi-joint bilateral or unilateral movement that primarily recruits the anterior and lateral (middle) deltoids, upper trapezius, serratus anterior, supraspinatus, and triceps brachii. There is minor contribution from the clavicular head of the pectoralis major, but it is not of primary concern as the pectoral’s role in the OHP is to stabilize the humerus through the course of the movement along with the muscles of the rotator cuff.

This article will examine the OHP as both a global strength & conditioning (S&C) movement, as well as explore variations of the movement that may be appropriate for orthopedic rehabilitation and return-to-work/sport programs.

Benefits of the Overhead Press

            The OHP has significant and beneficial carryover to multiple Activities of Daily Living (ADLs). Motions mentioned before such as reaching overhead to manipulate objects benefit from the overhead press. Occupations such as auto repair and construction often involve substantial work in either the overhead or high-five position with chronic, repetitive motion (such as turning a wrench or using a hammer) and the exertion of substantial muscular force. Workplace constraints often prohibit positioning the body in the most advantageous position, and it is for this reason and others that training the overhead and outer reaches of shoulder joint ROM is important for general joint health and injury prevention.

            The tricep extension portion of the movement has significant carryover to ADLs such as rising or lowering oneself into a chair. Even though the load is superior to the hands, whereas in a sit-to-stand the load is inferior, the demand for tricep extension power and strength remains the same.

The gains in motor control, endurance, and stability in the overhead position are worth examining. The ability to stabilize the shoulder joint while under load or while exerting force in the overhead or high-five positions is essential for not just performance of an activity, but safety during the execution of the task as well.

Psycho-motor gains include increased self-efficacy with respect to lifting and movement tasks as well as global self-confidence and self-esteem as the lifter progresses in training, setting new personal bests, improving time trial times, and as they develop more physical work capacity.

Global gains for the OHP include increase in bone mass from compressive, axial loading, hypertrophy, connective tissue health, intravertebral disc health, and increased muscular power, strength, and local muscle endurance. Calorie expenditure increases as loading and difficulty of the movement is progressed, such as moving from seated OHP to standing OHP, or substituting bilateral or unilateral dumbbell variations. For the purposes of metabolic stress and weight loss, the massive gross motor unit recruitment does an excellent job of demanding energy from the body.

Prepatory Movements for the Overhead Press

            To prepare a lifter for the overhead press, certain requirements must be met. First are mobility requirements:

The lifter should be able to horizontally abduct their arm without pain to between 60-80 degrees. Horizontal abduction past 80 and to 90 degrees or more places the shoulder in mechanical disadvantage due to the humeral head’s translation out of the glenoid fossa, and thus stresses the rotator cuff more than staying within 60-80 degrees.

            The lifter should also be able to reach at least 120 degrees of shoulder flexion (for a partial press), and for a full overhead press shoulder flexion should reach 160-180 degrees (will vary based on lifter’s shoulder mechanics and pain-free ROM).

            Finally, full tricep extension is required to lock the load out above the head during the final stages of the overhead press.

Also foundational for safe execution of the OHP is neuromuscular control of the load through the entire range of motion. If a client cannot manage a barbell properly, start them with dumbbell, band, or kettlebell loading until they have developed the muscular coordination and strength to progress to the barbell.

            Foundational work for the Overhead Press can start with partial ROM pressing within pain-free ROM. If the lifter is unable to abduct the humerus significantly, the press can be performed with the humerus in full adduction, in-line with the torso and in front of the body.

            Eccentric-only training can be used as well, with the lifter starting with their arms in a comfortable overhead position, and the trainer adding the load and spotting the client as they move through a 3-5 second eccentric movement.

            Weight machines such as front and lateral raise and machine overhead press can be used prior to barbell or dumbbell loading if the client needs to build a strength base prior to these movements. Progress and periodize training to promote hypertrophy, recovery, and strength.

            A popular and highly effective dumbbell movement that will build the overhead press and the shoulder joint and upper back is the Arnold Press.

This OHP variation starts with the arms adducted in front of the body, with the elbows fully flexed and the palms facing towards midline. The movement begins with simultaneous horizontal abduction of the upper arm, shoulder flexion, and tricep extension. The arms adduct horizontally to 70-90 degrees (will depend on comfort/pain levels and shoulder geometry) and then the lateral deltoids, trapezius, and triceps finish raising the load above the head to a comfortable and stable position. Lowering the weight involves the reverse of the concentric action, starting with elbow flexion, shoulder horizontal adduction, and extension of the shoulder, as the arms move back to the starting position. 

The Arnold Press is best programmed as a supplementary movement to the OHP, preferably in the 6-15 repetition range, beginning with higher reps and lower loading or sets initially.

Programming the Overhead Press as a Global S&C Exercise

                Now that we understand how to prepare for the overhead press, we can look at how to program the OHP for general strength & conditioning in a healthy client.

            Maximal strength is best developed in the 1-5 repetition range, with multiple sets (3-6) and longer rest periods of 2-3 minutes between sets. The loading will be high in terms of RPE as well as absolute loading (percent of 1-rep maximum). Training in this fashion is not recommended initially, as a high degree of technical proficiency is required under maximal loads to keep the client safe as well as make the lift effective.

            Muscular power is best developed across the 4-8 repetition range, with moderately low to moderate loading (40-55% 1RM, RPE 4-6), with multiple sets (3-6) and long rest periods like in maximal strength programming. With power training, the velocity of each individual repetition is the focus, with the goal being to maintain bar speed across all reps and sets. This will mean that subsequent sets may require the loading to be reduced to maintain bar speed.

            Gains in hypertrophy occur across the 6-15 repetition range, with higher repetitions leading to more metabolic conditioning rather than strict hypertrophy. Sets should range from 2-4, with an RPE of 5-7, and each set should be within a few repetitions of failure, based on the target RPE for that set or session. Increases in work capacity, or strength-endurance, can also be expected from working in higher repetition ranges when RPE is kept moderately high.

Guidelines for Programming the Overhead Press for Strength:

1. Start low and slow, build movement proficiency before heavy loading. If they cannot perform the OHP for reps with light to moderate loading with proper form over the course of 3-4 weeks, do NOT increase the loading!
2. Start with 2-3 sets, 2-5 repetitions, with 3-4 minutes between sets (autoregulate this based on the client’s conditioning as they progress)
3. Keep the loading moderate (RPE 5-6, 50-65% 1RM) until they have built confidence and strength with those loads.
4. Progressively overload and periodize the loading until the client reaches maximal loading (90+% 1RM), deload for 1-2 weeks using roughly 40% 1RM/RPE 4-5, and then resume at 55-65%/RPE 5-7) after the deload period. Deloads should be conducted every 3-6 weeks and will depend on your client’s state of conditioning and ability.

Guidelines for Programming the Overhead Press for Power:

1. Start low and slow with respect to loading and speed, build movement proficiency and consistency before emphasizing the speed of the bar.
2. Use loads in the 40-55% 1RM/4-6 RPE range. These are sufficiently heavy enough to spur neuromuscular adaptations such as rate coding, which contribute to increased power output.
3. Start with 2-3 sets of 4-8 repetitions. Use cues appropriate to the client to elicit maximum speed while also maintaining core brace and overall form. The lifter might be tempted to extend at the low back or mid back as they struggle to lock the load out overhead. Discourage this as it increases the risk of spinal injury.
4. Progressively overload and periodize the movement increasing the loading through the 40-55% 1RM/4-6 RPE range, and coaching the client to hit the top of the repetition range before advancing loading (i.e., the client should be doing 3 sets of 8 reps with consistent bar speed at 45% 1RM loading before advancing to 50% or higher loading).
5.  

Guidelines for Programming the Overhead Press for Hypertrophy & Work Capacity:

• Start low and slow with respect to loading and speed. Emphasize a powerful concentric movement and a controlled, slightly longer eccentric movement.
• Use loads in the 40-65% 1RM/4-7 RPE range. These are sufficiently heavy enough to spur neuromuscular adaptations such as rate coding, which contribute to increased power output. This will also permit the lifter to accrue mechanical tension and metabolic stress, which will promote muscle growth and work capacity (endurance) gains.
• Start with 2-3 sets of 10-12 repetitions. Use cues appropriate to the client to elicit maximum speed while also maintaining core brace and overall form. The lifter might be tempted to extend at the low back or mid back as they struggle to lock the load out overhead. Discourage this as it increases the risk of spinal injury. Regress to a seated OHP if the lifter cannot maintain proper core bracing while in a standing position.
• Progressively overload and periodize the movement increasing the loading through the 40-65% 1RM/4-7 RPE range and coaching the client to hit the top of the repetition range before increasing loading. E.g., the lifter should perform 3 sets of 15 repetitions before increasing the load, which will also result in a decrease in reps per set.

Use of the Overhead Press in a Rehabilitative Context

            The overhead press and its variations can serve a purpose within the context of injury rehabilitation, especially if the injury is in the shoulder of a patient who performs a lot of overhead or “danger zone” work daily.

            Coaching the OHP in rehab is the same as it is for general S&C, with appropriate considerations for ROM, pain tolerance, and physical work capacity. Physical therapy patients may be severely deconditioned with respect to general fitness clients and will require a lower starting point for loading in most cases.

            Use of variations, such as partial concentric actions, eccentric-only actions, and limited horizontal abduction may be indicated in your patient. For example, if the client can raise their arms past 90 degrees of shoulder flexion without load, but cannot perform it with load, then have them perform the concentric action load-free within pain-free ROM, and add the load at the top of the movement and have them perform 3-5 second eccentrics as tolerable.

            For patients with posterior RC pathology, the anterior translation of the shoulder complex during the OHP may cause pain. In these cases, limit performance of the OHP to the pain-free ROM of the patient, and as they heal and progress, slowly work into new ROM and build strength in it.  

            For patients with anterior RC pathologies, to include impingement, start within pain-free ROM, balancing strength around the joint and using mobility or flexibility drills and training as indicated. If the patient is unable to flex the shoulder comfortably to 90 degrees or higher, perform partial concentric pressing within pain-free ROM, and use full-pain-free-ROM eccentrics if tolerable and appropriate to the patient.

                In general, you will know the capacity of your patient and what movements are safe for them. I urge you to not discount traditional S&C movement such as the overhead press, as the global benefits aid physical therapy outcomes.

Final Thoughts

                The overhead press is not the only way to train the body in overhead and “danger” positions, nor is it the single “best” movement for rehabbing injured patients. Exercise selection should always be driven by the Principle of Specificity and the current physical capacity and ability of your clients or patients.

If you do not know how to perform the overhead press safely and effectively, or you are not confident with your press and variations, LEARN! Squat University is a fantastic evidence-based resource for the major lifts, including Olympic lifts. You can also hire or coordinate with a colleague who is competent in the deadlift to teach and train you. Either way, expand your toolbox and skillset. You, your clients, and patients will benefit.

            If you’re one of the few who passionately despise the overhead press and other overhead or “danger zone” movements, and believe it to be useless or needlessly “dangerous,” perhaps that mindset is because you or someone you know was injured during a press, I strongly encourage you to LEARN the OHP properly and explore it’s application and benefits for yourself. Mastery of the overhead press and all associated variations is expected of a personal trainer, S&C coach, and physical therapist. Take the time to educate yourself, expand your mindset, and perhaps your view on the deadlift will change.

            Finally, remember that the overhead press is only one of myriad ways we can learn to Move Well and Live Well!

Serving Through Strength,

Josh