A number of commonly performed exercises are more likely to result in injury than benefit.  Some should be replaced by safe and effective alternatives, while others need only be modified in order utilize better and less stressful mechanics to reduce the potential for injury.  This focus on “Exercises in Futility” is a three part series.  Parts two and three focus on the lower body and core respectively, while this piece addresses prime offenders that target the upper body.  These include:

  1. Behind-The-Neck Pull-Downs
  2. Military Presses
  3. Upright Rows
  4. Empty Cans
  5. Full Dips
  6. Shrugs

images-10 1. Behind-The-Neck Pull-Downs

This exercise is also known as a Lat (latisimus) Pull and is best performed by drawing the bar down toward the chest rather than behind the neck.  The lats are large muscles in one’s back that attach to the shoulders.  They act as extensors (moving the arm from front to back) and internal (inward) rotators of the shoulder joints.

It is virtually impossible to avoid straining/flexing the neck forward if the exercise bar is pulled behind the head.  Not only is this bad for the neck, the position shuts down the already narrow (subacromial) space occupied by the rotator cuff tendons, thereby leading to impingement of these structures.  The behind neck posture also necessitates that the shoulders be placed in extreme extension (with the arms behind the plane of the body), thereby overly stressing the front of the shoulder joints.

Some alternatives for the Pull Down Machine include doing Pull Downs with resistive elastic bands or the weighted cable column.  The lats can also be strengthened with Straight-Arm Lifts (to the plane of the body) using free weights in a prone position (lying on your stomach).

images-92.  Military Presses (Shoulder Presses)

The primary reason to avoid the military press is that repetitively raising the arms directly overhead is also likely to cause impingement unless the muscles that stabilize the scapulae (shoulder blades) are strong enough to promote normal mechanics.  This is rarely the case.  Most of us, even those who weight train, exhibit weakness in the scapular stabilizers (middle and lower trapezius, rhomboids and serratus muscles).  The poor shoulder mechanics that occur with overhead lifting causes stress to the rotator cuff tendons and the bursa (a gel-like filled sac) in the subacromial space (the space just above the head of the humerus and under the prominent extension of the shoulder blade) at the top of the shoulder.  Repetitive stress to these structures may lead to bursitis (inflammation of the bursa), tendonitis (traditionally defined literally as an inflammation – “itis”- of the tendons), tendonosis (degenerative wearing of the tendons) and ultimately to more severe rotator cuff tears.

*It should be noted however, that in current orthopedic literature, tendonitis and tendonosis are really one and the same, implying breakdown of affected tendons. The degree of pain and loss of function are then related to severity of the condition.

Before progressing to weight lifting above the horizontal (shoulder level), it is important to exhibit normal (translated to mean strong) and (totally) pain-free strength below shoulder level.  Each of the scapular stabilizers should be strengthened in isolation so as to avoid substituting stronger muscles for those that are weaker.  Middle trapezius as well as rhomboid exercises are best done with free weights and in a prone position (see the descriptions that follow of horizontal abduction), whether on a bench or over a ball.

Lower traps can be strengthened via Seated Presses, Wall Raises or, the more demanding and higher level, prone Supermans.

A Push-Up Progression is used to strengthen the serratus.  This begins with simple Serratus Punches and progresses gradually to Wall Push-Ups and Table Push-Ups (the lower the placement of the hands/upper body, the more weight-bearing on the arms, and the more difficult the exercise) before graduating to Bent Knee or Standard Push-Ups. Review the accompanying photographs for guidance.

images-53. Upright Rows

The increasing inward rotation of the shoulder demanded by the upright row as the elbows rise jams the humeral head (top of the bone of the upper arm) toward the acromion (bony prominence) above. In other words, raising the arms with the shoulders internally (inwardly) rotated is yet another prelude to impingement.  Natural mechanics of the shoulder entails external (outward) rotation of the humeral head with elevation. The role of the outward rotators with elevation is to center the humeral head in the socket and to prevent it from migrating upward.  This illustrates why the external rotators, like the scapular stabilizers, are vital to good shoulder mechanics.

Alternatives to the upright row for strengthening the deltoids include Forward Raises (palms down) and Lateral Raises (with bent or straight elbows and palms down).  The posterior (rear) delts are also strengthened via Prone or Bent-Over-Rows and by other exercises that involve retraction of the shoulder blade (squeezing it back toward the other shoulder blade) and movement of the arm toward, but not necessarily into, the extension plane (behind the body).  These are performed in the prone position (on your stomach) and entail keeping the arm at shoulder height (the horizontal) and moving it from the plane in front of the body (the flexion plane) toward or slightly past the level of the body. This motion from front to back in the horizontal is called Horizontal Abduction and the variations are performed either with the thumbs up (primarily for the mid trap) or thumbs down (targeting the rhomboids). As for all scapular/shoulder exercises, an emphasis should be placed on avoiding the elevation of the shoulders toward the ears – a sign that the upper traps are compensating for weakness in the targeted muscles.   The compensation will limit the strengthening of the intended muscles, inhibit the correct recruitment of these muscles, and may result in neck and shoulder soreness. 

images-124. Empty Cans

The Empty Can exercise also involves elevating the arm with internal rotation, and for that reason is a no-no.  The motion of the empty can exercise is in the plane of the scapula (shoulder blade).  While standing or sitting, the Empty Can traditionally entails raising the arms from your side toward the ceiling at a 30-degree angle from the lateral (or 60 degrees from forward) and with the thumbs pointed downward toward the floor.  The scapular plane is less stressful to the shoulder than lifting at other angles, and so elevating in this manner is a good thing.  However, the exercise should be performed with the thumbs up (with the shoulder outwardly/externally rotated).  This exercise is called SCAPTION.  As previously discussed however, the arm should only be raised to the level of the horizontal until the scapular muscles are strong enough to safely support lifting it higher with good mechanics.  Ultimately, especially for those training to play overhead/throwing sports, it is imperative to strengthen above the horizontal in order to prepare for the demands of activity

images-55. Full Dips

Dips are intended to target the lower trapezius and triceps muscles and can cause injury because many people dip so low that the shoulders are hiked very high, the shoulder moves into more extreme extension and the muscles are at a mechanical disadvantage, thus cannot handle the load.  This causes the upper traps to kick into high gear.  In addition, the lowered position places undue stress on the front of the shoulder joint.

One viable alternative for the lower trap is the Seated Press, which, like the dip, involves pushing the trunk upward, though from a seated position rather than a lowered starting point.  Emphasis (as for all exercises targeting the scapular muscles) should be on squeezing the shoulder blades together as you push upward. Another lower trap exercise is the previously mentioned prone (on your stomach) Superman, elevating the arms upward toward a flying position with the thumbs up (without allowing the shoulders to elevate toward the ears).  This is a demanding exercise that does entail working above the horizontal and so is not right for the novice exerciser.  A viable and deceptively difficult alternative is a wall exercise for the lower trap. Here the exerciser stands facing the wall as shown (this is a modified version) and slowly glides the arms upward, extending (straightening) the elbows at the same time.  Arms should be raised and then lowered (repeatedly).  When you are proficient, advance this exercise by repeatedly moving your arms away from the wall (to retract the shoulder blades) and back again while the arms remain overhead (and the elbows remain high).  Again, caution is necessary to ensure that the shoulders are not elevated toward the ears using the upper traps.

Triceps can be strengthened safely by straightening the elbows against resistance using the rope on the cable column or with resistive bands.  Another alternative is doing free weight Kick-Backs against gravity in a bent-over-row position.  All of these triceps exercises involve repetitive straightening of the elbow against resistance while keeping the upper arms at your side.  The triceps exercise performed overhead is not advocated as an alternative for the non-athlete.  Other muscles must come into play to maintain the overhead position and the upper traps are likely to kick into overdrive.

OLYMPUS DIGITAL CAMERA6. Shrugs

Shrugs are intended to isolate the upper trapezius, a muscle that is rarely weak because it is so overworked.  The comparatively weaker middle traps, lower traps and rhomboids (those all important scapular stabilizers) also often fatigue more readily, allowing the upper traps to take over, evidenced by the hiking of the shoulders toward the ears as the arms are elevated or with lifting/carrying. This compensatory recruitment of the upper traps is one primary cause of neck pain.  If you’ve ever held the phone to your ear with your shoulder to keep your hands free to work, you’ve experienced the upper traps in overdrive.  Instead of focused strengthening of the disproportionately strong upper traps, emphasis (as previously discussed) should be placed on strengthening the weaker muscles to promote normal joint mechanics.   The exception might be the football player or wrestler with optimal strength of the shoulder girdle whose sport demands unusually strong neck musculature.

Part II of this series will address lower body exercise don’ts and viable alternatives.


About the author

Abby serves as the Injury Expert for CBS New York where, since 2010, her Injury Breakdown Blog examines injuries in professional sports. She also blogs on health & fitness as well as sports injuries for Huffington Post, and Recovery Physical Therapy.com, where her blog earned a top ten mention for physical therapy blogs in 2012 @ WorldWideLearn.com. In a ranking of the Top 30 Healthcare Blogs for 2012, Top Masters in Healthcare also rated Abby’s blog in the top three in Physical Therapy! Abby is the founder of Fit-Screen and she welcomes your comments and questions!

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