Q: Eric – some thoughts on the overhead pressing and a question. Obviously, if the motion was symptomatic, you wouldn’t do it. However, if after soft tissue work and then thoracic mobilization and activation work on the scapular muscles, the athlete could do the ROM without the symptoms, would that be a time to introduce very light OH pressing to reinforce the activation work, and re-teach the motor pattern. As Dr. Eric Cobb says, ‘strength training “cements” your neural patterns.’

A: First off, I agree with Dr. Cobb completely; it’s why resistance training is a strong foundation for most of modern physical therapy.

For your question, though, the answer is maybe. It depends on whether you’ve got someone with a lot of bone spurring. Even if you’ve optimized upward rotation patterns, you’re still dealing with a 5mm subacromial clearance zone before the bone spurs are taken into account.

Additionally, you have to take into account the population in question. Laudner et al. found that at 60 and 90 degrees of humeral elevation, pitchers had less upward rotation than position players. We might be able to make it better, but that’s not to say that we can ever optimize it – especially under load – with the amount of throwing they do. We don’t do anything overhead with humeral head approximation except for isometric DB holds where upward rotation isn’t occurring (we’re cueing a specific scapular positioning). Gray Cook has some excellent ideas on this front in his Secrets of the Shoulder DVD.

My personal rule of thumb is that if someone feels like they need to get back to overhead pressing after a shoulder injury, they need to be pain-free for at least six months before we do so. We start with steep incline pressing with a neutral grip and move to a 1-arm DB push press – and go from there.