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I received this question from a friend of mine who is currently in physical therapy school and thought I'd share my response here. Q. Had a question. I know that at [X clinic he worked at] some of the therapists told me that overhead press was bad to do due to some impingement of the supraspinatus. This is also something we've learned in school but im not sure if this is specifically for those who just aren't strong enough or those recovering from injuries and such. Do you do overhead shoulder press w/ dumbells or BB and what is your take on the subject?
A. As usual, this is a question of contraindicated exercises versus contraindicated people. To make a blanket statement such as "no one should overhead press" would be both remiss and short-sighted. For example, if this is the case, should I avoid taking down and putting up my 5lb container of protein powder on top of my kitchen cabinet each morning? But I digress.
Getting to your the center of your question: Is the overhead press a fantastic exercise? Absolutely! Can the majority of the population perform it safely? Eh, not so much. In fact, this is a very similar subject matter to the back squat. The squat is arguably the greatest exercise to add lean body mass and increase athletic prowess, but may not be the wisest exercise selection depending on the person/situation. Chris actually addressed this very question in THIS post as to why he doesn't back squat the Division 1 baseball players he works with over at George Mason.
First things first: Look, I LOVE the overhead press. In fact, nothing makes me feel more viking-like than pressing something heavy overhead.In my personal opinion, the barbell military press is one of the BEST exercises to develop the deltoids, traps, serratus, and triceps, along with (if performing it correctly) the abdominals, glutes, low back, and upper thighs. HOWEVER, a lot of "stuff" needs to be working correctly in order to safely overhead press:
- Soft Tissue Quality
- Thoracic Mobility (specifically in extension)
- A Strong (and Stable) Rotator Cuff
- Upward Rotation of the Shoulder Blades
- General Ninja-like Status
Improved thoracic extension will positively alter your shoulder kinematics as you press overhead, a strong and stable cuff will help keep the humeral head centered in the glenoid (the shoulder socket) in order to free up that subacromial space (decreasing risk of impingement) , upward rotators will keep the scapulae in proper positioning, and I don't think I need explain how obtaining ninja status will help you overhead press like a champ.
If you can get all the things above up to snuff (via specific drills/exercises), then you're in pretty darn good shape. In reality, this comes down to ensuring you lay down a sound foundation of movement before loading up that very pattern. If the movement patterns and necessary kinematics are there, then chances are you get the green light to overhead press.
However, it doesn't stop there. A few other things need to be taken in to consideration:
1. Training Economy. If you only have X number of hours in the gym and Y capacity to recover, then you need to choose the Z exercises that will give you the most bang for your buck without exceeding your (or your athlete's) capacity to recover. Considering that the "shoulders" already receive tons of work from horizontal pressing movements (on top of horizontal and vertical pulling exercises), I really don't feel that most trainees - especially those that are contraindicated - need to overhead press if the primary goal is to further hypertrophy the deltoids and/or elicit some sort of athletic performance improvement.
2. Injury History. Partial thickness cuff tear? Labral fraying? Congenital factors? All these (and more) will come into play with deciding if overhead pressing will set you up for longevity in the realm of shoulder health.
3. Population. Are you dealing with overhead athletes? They're at much greater risk for the traumas listed in #2, and, not to mention, they already spend a large majority of their day with their arms overhead so you need to consider how mechanically stable (or unstable) their shoulder is, along any symptomatic AND asymptomatic conditions they may possess. Conversely, if you're dealing with a competitive olympic lifter, or an average joe who moves marvelously, then the overhead press may be a fantastic (or even necessary) choice to elicit a desired outcome.
4. Type of Injury. Ex. Those with AC joint issues may actually be able to overhead press pain free due to the lack of humeral extension involved (whereas the extreme humeral extension you'd find in dips or even bench pressing could easily exacerbate AC joint symptoms). Using myself as example, I can actually military press pain free, whereas bench pressing quickly irritates my bum shoulder. I don't have an AC joint issue (as far as I know...), but I've still found that my pain flares up when my humerus goes into deep extension (past neutral) in any press such as a pushup, barbell press, dumbbell press, etc. so the military press actually feels pretty good for me PERSONALLY. With regards to pushups and dumbbell pressing, I can usually do it fine as long as I'm cognizant to avoid anterior humeral glide.
As for pressing overhead with dumbbells vs. barbells, I find that, frequently, it's best to start someone with dumbbell pressing with a NEUTRAL grip (palms facing each other) as this will give your shoulder more room to "breathe" by externally rotating the humerus and lowering risk of subacromial impingement. From there, you can progress to the barbell as long as the items listed in the beginning are in check.
In the end, this comes down to how well you move, your posture, and your individual situation. With technology currently PWNING our society's movement patterns via increased time in cars, sitting in front of our computers, gaming, and overall sedentary lifestyle, we have to fight much harder than our ancestors to turn that "red light" to a "green light" in the sphere of overhead pressing.
Note: to conclude, feel free to watch the video below by Martin Rooney. Hopefully, you can read the central message portrayed: