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72 VOLUME 32 | NUMBER 3 | JUNE 2010 Copyright National Strength and Conditioning Association
that performing frontal plane pressing
exercises will predispose an athlete to
shoulder injuries. Although it is difficult
to determine the actual cause-and-
effect relationship between the type
of exercise performed and the occur-
rence of injury, a majority of shoulder
injuries, pain, and limited function are
believed to be because of faulty me-
chanics rather than a particular exercise
(25,31).
RATIONALE FOR USING THE
PUSH-UP AND BODY WEIGHT
BEND-AND-PULL TO SCREEN
UPPER-BODY MOVEMENT
COMPETENCY
The exercises introduced in this sec-
tion for screening upper-body move-
ment competency occur in the sagittal
Figure 1. (a, b) Proper push-up technique is demonstrated with the head held in a plane. Although the 2 chosen move-
centered and stable position, shoulders held down away from the ears, ments do not directly challenge all
elbows close to the body, lower back and hips in a neutral position, and the planes of movement, they do challenge
legs are aligned with the hips and held stable. the musculature that contributes to
movement in each anatomical plane.
specialist with prognostic information considered to occur in the frontal The standard push-up (push-up) is a
about an athletes upper-body move- plane. Push-ups and the bench press common upper-body push pattern
ment competency. are examples of push exercises that exercise that challenges shoulder girdle
occur in a sagittal plane. Pull-ups and mechanics under load, has a compara-
UPPER-BODY MOVEMENT seated cable pull-downs are exercises tively small learning curve, and is an
COMPETENCY that occur in the frontal plane. Bench accommodating exercise to load for
It is the authors observations that rows, supine pull-ups, and dumbbell the novice to elite athlete (69,12,
many strength and conditioning pro- rows are common pull pattern exer- 1417,24,26,31,33). The peak force
grams consist of push and pull exer- cises that occur in the sagittal plane. generated by an individual performing a
cises that are performed in the frontal Many strength and conditioning spe- push-up with hands and feet on the
and sagittal planes. Push pattern ex- cialists tend to load the push pattern in ground is equal to 70% of body weight
ercises such as overhead pressing (e.g., the sagittal plane to a greater degree (15). A modified push-up (e.g., knees
dumbbell overhead presses, military than in the frontal plane. This may be on the ground or hands positioned
press, handstand push-ups) are in part because of the misdirected belief above the knees or feet) requires less
Figure 2. Body weight bend-and-pull technique. The numbers represent the start to finish position. Start and finish with the hands
overhead (1), bend forward let the arms drop so that they hang under the shoulders, then pull the arms demonstrating a pull
pattern (2 and 3). Return the arms to the hang position (4) and then return to the starting position with the hands overhead (5).
force and offers an effective alternative through the review of relevant litera- by a sports medicine professional may
for those individuals unable to support ture (1,59,11,18,19,21,24,25,33). Bio- be warranted and exercises to stretch
70% of their body weight. mechanical evidence is provided to and/or strengthen the muscles that
The body weight bend-and-pull is a highlight the effects the head position, support the head and connect to the
hybrid exercise that involves 2 move- shoulder girdle mechanics, core stabil- shoulder girdle may be advantageous.
ment patterns, the bend pattern and ity, and lower limb position have on the The shoulder girdle plays an important
the pull pattern. Screening the bend performance of the proposed exercises. role in both facilitating upper-body
pattern will be addressed in a future movement and helping to identify
Researchers have yet to investigate the
publication and will not be addressed movement strategies that may be ineffi-
effects of various head positions on the
in great detail in this article. The cient. The screening criteria for the
kinetics and kinematics of the push-up
authors believe that the body weight push and pull patterns are not com-
or body weight bend-and-pull. How-
bend-and-pull effectively challenges plex; nonetheless, a fundamental un-
ever, research has been conducted on
pull pattern mechanics. Although the derstanding of the structure and
the effects of head position on trunk
load experienced during the body function of shoulder girdle is impor-
mechanics during movement (13). The
weight bend-and-pull is significantly tant to appreciate the consequences
authors believe that the head should be
less than that of the push-up, there is that faulty movement may have on
held in a neutral position and kept
benefit in screening the pull pattern an athletes long-term health and
motionless throughout either exercise
with minimal load. The push-up will performance.
(2,4,21). The head should not appear to
highlight issues an athlete has with The shoulder girdle is a complex
be projected down (i.e., flexing the
scapula muscle strength and control structure consisting of the sternocla-
cervical spine) or held up (i.e., extend-
under load. However, the authors have vicular, acromioclavicular, and gleno-
ing the cervical spine). Although
observed that sometimes movement humeral joints and the scapulothoracic
empirical evidence is lacking, the
patterns under load present a false posi- interface (Figure 3). The scapulothora-
position of the head will influence
tive and do not challenge the athletes cic interface and glenohumeral joint
shoulder girdle mechanics and expose
awareness of how to move properly. have been identified to be of great
the cervical spine to unnecessary
Therefore, the body weight bend-and- importance when qualitatively screen-
stress due to the fact that many of
pull is effective at highlighting the ing upper-body movement (19,20,25).
the shoulder girdle muscles attach to
athletes awareness of how the scapula The scapulothoracic interface consists
the skull and cervical vertebra. If an
should be controlled in a pull pattern. of the scapulae, the thorax, and those
athlete is unable to maintain a centered
The authors recognize that the pull stable head position, then assessment muscles that provide stability and
pattern could be screened without of the neck and shoulder musculature movement. The scapula is a flat blade
involving the bend pattern; however,
combining the 2 patterns for the pur-
pose of screening complex movement
appears to have practical value. There Table 1
are a number of pull pattern exercises Screening criteria for the push-up
that involve a bend pattern (e.g., bent-
Anatomical Screening criteria Viewing Commonly observed
over row variations), and there are region position problems
a number of sport-specific movements
that require the bend-and-pull patterns Head Centered and held stable Front Projected down
to be performed together. In addition, Shoulders Held back and down away Top Shrugged toward the
an athlete may demonstrate good pull from the ears ears
mechanics and good bend mechanics
in isolation, but when these 2 patterns Elbows Tucked to the side Side Flared out
are combined into a complex move- Thoracic spine Neutralwith fluid and Top Scapulae winged
ment, the athlete may be challenged. controlled scapulae
This is critical to expose before loading movement
and further confirms the authors view
Lumbar spine Neutral Side Extended
that using the body weight bend-and-
pull to screen an athletes upper-body Hips Aligned with the ankles, Side Dropped during descent
pull pattern is of great value. knees, and shoulders
Knees Aligned with the ankles Side Bent
SCREENING CRITERIA and hips
The screening criteria presented in
Feet/ankles Aligned with the knees Side/back Flared out or in
Tables 1 and 2 has been validated
lying along the thoracic wall. The 10,17,19,20,25). However, the extrinsic stability by providing compression of
functional design allows for smooth muscles that attach along the lateral the humeral head into the glenoid
gliding along the thoracic wall and aspect of the scapula, the deltoid, socket (19).
provides a large surface area for biceps brachii, and triceps brachii that The numbers of muscles that contrib-
muscular attachment (19,33). There provide gross motor activities for the ute to shoulder girdle function high-
are many muscles that are involved in glenohumeral joint should not be light the complexity of the shoulder
shoulder girdle function. For example, ignored (19). The intrinsic muscles of girdle. It should be no surprise that
the muscles that receive the most the rotator cuff (Figure 4) attach along a considerable amount of research has
attention are the trapezius, serratus the entire surface of the scapula, which been devoted to understanding the
anterior, and levator scapulae (7 contribute to shoulder movement and position of the scapula, the scapula
muscles that influence scapula position,
and their influence on shoulder girdle
mechanics. Movement dysfunction of
the scapula has been termed scapulo-
thoracic dysfunction. Scapulothoracic
dysfunction has been detailed to be the
alterations in the resting position of the
scapula affecting shoulder girdle me-
chanics and is considered a major
contributing factor to shoulder pain
and impingement syndromes (9,33). It
has been well documented that a re-
lationship exists between static posture
and dynamic movement (3,18,22,33).
An athletes standing posture may be
used to identify the resting position of
the scapula (18,22,33). Weak or poorly
activated scapula muscles may influ-
ence the resting position of the scapula
(9,33). If the scapula is not in the correct
starting position, glenohumeral joint
integrity may be compromised (33).
Figure 3. Diagram of the shoulder girdle. For optimal glenohumeral joint motion
DISCUSSION
When screening an athletes upper-
body push and pull patterns using the
push-up and body weight bend-and-
pull, the athlete should be instructed to
perform each exercise in a natural and
comfortable manner to a depth they
can control. The screener should give
primary attention to the shoulders,
lower back, hips, and knees and sec-
ondary attention to the head, ankles,
feet, depth, and balance. On screening,
Figure 8. Body weight bend-and-pull demonstrated with lumbar flexion highlighted the athlete refers to Tables 3 and 4 to
with curve line. help determine the appropriate load
Table 3
Push pattern movement competency progression paradigm
Load level 1 Load level 2 Load level 3 Load level 4 Load level 5
Head centered and Incline push-up Floor push-ups Common upper-body Drop and stick Explosive
held stable push pattern exercises. push-up push-ups
Band-assisted Example: bench press,
Shoulder held down push-up Single arm dumbbell press, and Clap push-ups
and away from incline handstand push-ups
the ears push-ups
Elbows tucked to Weighted push-up Explosive staggered
the side of the push-ups
body during the
descent
Obvious scapula Band one-arm
movement explosive
push-ups
Lumbar spine neutral
and held stable
Progression to the next level should only occur if the athlete can demonstrate the pattern with all coaching points maintained through
a complete range of motion.
Coaching points Load level 1 Load level 2 Load level 3 Load level 4 Load level 5
Elbows tucked to the side of Vertical Pull Up Single-arm pull-ups Common horizontal pull Vertical Pull-Up Quick hands
the body during pull exercises: dumbbell
rows, machine T-bar
Both legs on the ground row, seated row, and
so on
Obvious scapula movement One foot on the ground Vertical Pull-Up
one foot raised and
held straight
Lumbar spine neutral and held Assisted: using strength Vertical Pull-Up Weight added to the Quick hand pull-up Jump squat pull-up
stable during the bend bands or performing waist or between the and stick
the supine pull-up legs in the form of a
from an incline will medicine ball,
reduce the required dumbbell, and the like
pulling force
Bending occurs at the hips Chest touches the bar Common vertical pull
exercises: Seated
pull-downs of varying
hand position and grips
Progression to the next level should only occur if the athlete can demonstrate the pattern with all coaching points maintained through a complete range of motion.
Table 5
Description of exercises prescribed in both the push and pull pattern progression tables
Exercise Description
Incline push-up Set an Olympic bar in a squat rack at waist height, higher if the load needs to be reduced further.
Perform push-ups as normal but with hands on the Olympic bar. Move the bar lower as
competency improves.
Band-assisted Hang a strength band overhead on something stable and secure fit just below your chest around
push-up sternum level. Perform a push-up with good form; the band will reduce the load of the push. Use
an appropriately thick band to enable the athlete to push with good form without struggle.
Floor push-ups A push-up performed on the floor requires the athlete to push up 70% of their body weight.
Single arm push-ups Start in push-up position. Spread the feet wider than hip width to increase stability. Place the
nonpushing arm on the stomach. Lower the body to the floor on one arm, keeping the elbow
tucked to the side and resisting trunk rotation. These can be performed on an incline to provide
progressive loading using the same setup detailed for the incline push-ups.
Weighted push-up Place the feet on an 8-inch step to make the trunk parallel to the floor. Add weight to the shoulder
blades for additional loading. A good indicator of upper-body horizontal push pattern strength is
if the athlete can perform 10 repetitions with 30% of their body weight on their back.
Drop and stick Start in push-up position and drop to the floor by quickly lifting your hands so that your thumbs touch
push-up your chest. Catch the body just before it hits the ground and stick the landing position maintaining
all coaching points. Watch the athletes shoulders do not elevate toward their ears on impact.
Explosive staggered Start in push-up position with one hand level with the head and another hand directly under a
push-ups shoulder. Forcefully push into the ground to elevate the body to allow the hands to change
position. Alternate hand positions with each repetition.
Band one-arm Secure a strength band overhead on something stable. Set up in one-arm push-up position. Push
explosive forcefully into the ground to elevate the body off the ground. Alternate hands with each repetition.
push-up
Horizontal or supine For all supine pull-up variations, the bar should be set at waist height to accommodate full arm
pull-ups extension. The athlete should start with the shoulder directly under the arms. Technical variations
are as follows.
Legs on the ground: Feet positioned shoulder width with the torso held stable and flat throughout
the pulling pattern.
Legs on a box: Legs positioned hip width on the box resting on the heels with the toes pulled
back toward the knees. The body should be held stable and flat throughout the pulling pattern.
One leg: Raise one leg up and hold straight with one leg on the ground. Trunk should be flat
throughout the pulling pattern.
One arm: Remove one arm from the bar but keep the hand that is holding the bar in line with the
shoulder. Pull up keeping the elbow tucked to the side.
To reduce the pulling force, use a strength band. Simply loop strength bands over the bar and
position the body inside the bands.
Vertical pull-ups To assist a vertical pull-up, use a strength band looped around a pull-up bar. Place either one or both
feet or knees to reduce the pulling force.
Supine quick hands To perform a quick hand pull-up, simply pull-up and slide the hands together so that they touch and
back to shoulder width as fast as possible before full arm extension occurs. This technique can be
used for vertical or horizontal pull-up variations.
Supine quick hands Perform a quick hand variation as described above. Only catch and hold the position once the hands
and stick slide out. Lower the body down to the start position and repeat.
Jump squat pull-up Standing under a high bar, jump up, grab the bar, and pull-up. Drop back down to the ground and
repeat.
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