Strength & Conditioning Journal:
Screening the Upper-Body Push and Pull Patterns Using Body Weight Exercises
Kritz, Matthew MSc, CSCS1; Cronin, John PhD1,2; Hume, Patria PhD1
1Institute of Sport & Recreation Research New Zealand, AUT University, Auckland, New Zealand; and 2School of Biomedical and Health Science, Edith Cowan University, Perth, Western Australia, Australia
Matthew Kritz is a PhD candidate in strength and conditioning at the Institute of Sport & Recreation Research New Zealand, AUT University. He is the director of strength and conditioning for the New Zealand Academy of Sport North Island.
John Cronin is a professor at AUT University in exercise science, strength and conditioning.
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Patria Hume is a professor at AUT University in exercise science, human movement.
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STRENGTH AND CONDITIONING SPECIALISTS USE UPPER-BODY PUSH AND PULL PATTERNS IN AN ATTEMPT TO IMPROVE THE FORCE AND/OR VELOCITY CHARACTERISTICS OF THE UPPER-BODY MUSCULATURE. HOWEVER, BECAUSE OF THE INFLUENCE FAULTY MECHANICS HAVE ON PERFORMANCE AND THE PREVALENCE OF OVERUSE INJURIES IN SPORT AND SPORT-SPECIFIC TRAINING, SCREENING AN ATHLETE'S UPPER-BODY MOVEMENT COMPETENCY BEFORE EXTENSIVE LOADING MAY PROVIDE INSIGHT INTO MOVEMENT STRATEGIES THAT ARE INEFFICIENT AND CONTRIBUTE TO INJURY.
The use of the upper body in sport and sport -specific training is considerable. Strength and conditioning professionals design programs to improve the force and/or velocity capabilities of the upper-body musculature using exercises that can be categorized as either upper-body push or upper-body pull, given the patterns of movement they involve. It has been suggested that strength and conditioning specialists should screen an athlete's movement ability before prescribing a program designed to improve physical performance (6,22,23). A benefit of screening movement for the strength and conditioning specialist is to identify the appropriate loading level that corresponds to the athlete's movement competency to minimize injuries related to overloading biomechanically specious movement patterns (22,23). Screening movement is a relatively new professional practice for the strength and conditioning specialists. Historically, sports medicine professionals conduct assessments to measure the structure and function of the body (18,33). Traditionally, sports medicine assessments provide information about range of motion, structural weaknesses, or movement dysfunction using isolated movements (18,32,33). Assessing isolated single-joint movements has proven effective for diagnostic purposes. However, they provide little information about how an athlete would perform complex multijoint movements. Strength and conditioning specialists program complex multijoint movements to help prepare athletes for the demands experienced in sport. Therefore, a movement screen should provide information about how an athlete performs the complex fundamental movement patterns strength and conditioning professional regularly prescribe. The multijoint movements commonly prescribed in strength training programs can be categorized into 7 fundamental patterns; squat pattern, lunge pattern, upper-body push pattern, upper-body pull pattern, bend pattern, twist pattern, and single-leg pattern. Screening fundamental patterns before exercise prescription gives the strength and conditioning specialist information about which patterns should be aggressively challenged and which patterns require developmental attention. Many factors have been identified that influence an athlete's movement competency specifically: awareness, changes in muscle length, strength, stiffness, and patterns of participation that arise from repeated movements and sustained postures (33).
This review article investigates the kinetics and kinematics of the upper-body push and pull patterns for the purpose of screening. This review aims to introduce 2 body weight exercises, the standard push-up (Figure 1) and the body weight bend-and-pull (Figure 2). These exercises challenge upper-body push and pull mechanics, can be performed by athletes of all ages, and provide the strength and conditioning specialist with prognostic information about an athlete's upper-body movement competency.
UPPER-BODY MOVEMENT COMPETENCY
It is the authors' observations that many strength and conditioning programs consist of push and pull exercises that are performed in the frontal and sagittal planes. Push pattern exercises such as overhead pressing (e.g., dumbbell overhead presses, military press, handstand push-ups) are considered to occur in the frontal plane. Push-ups and the bench press are examples of push exercises that occur in a sagittal plane. Pull-ups and seated cable pull-downs are exercises that occur in the frontal plane. Bench rows, supine pull-ups, and dumbbell rows are common pull pattern exercises that occur in the sagittal plane. Many strength and conditioning specialists tend to load the push pattern in the sagittal plane to a greater degree than in the frontal plane. This may be in part because of the misdirected belief 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 occurrence of injury, a majority of shoulder injuries, pain, and limited function are believed to be because of faulty mechanics 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 section for screening upper-body movement competency occur in the sagittal plane. Although the 2 chosen movements do not directly challenge all planes of movement, they do challenge the musculature that contributes to movement in each anatomical plane. The standard push-up (push-up) is a common upper-body push pattern exercise that challenges shoulder girdle mechanics under load, has a comparatively small learning curve, and is an accommodating exercise to load for the novice to elite athlete (6-9,12,14-17,24,26,31,33). The peak force generated by an individual performing a push-up with hands and feet on the ground is equal to 70% of body weight (15). A modified push-up (e.g., knees on the ground or hands positioned above the knees or feet) requires less force and offers an effective alternative for those individuals unable to support 70% of their body weight.
The body weight bend-and-pull is a hybrid exercise that involves 2 movement patterns, the bend pattern and the pull pattern. Screening the bend pattern will be addressed in a future publication and will not be addressed in great detail in this article. The authors believe that the body weight bend-and-pull effectively challenges pull pattern mechanics. Although the load experienced during the body weight bend-and-pull is significantly less than that of the push-up, there is benefit in screening the pull pattern with minimal load. The push-up will highlight issues an athlete has with scapula muscle strength and control under load. However, the authors have observed that sometimes movement patterns under load present a false positive and do not challenge the athlete's awareness of how to move properly. Therefore, the body weight bend-and-pull is effective at highlighting the athlete's awareness of how the scapula should be controlled in a pull pattern.
The authors recognize that the pull pattern could be screened without involving the bend pattern; however, combining the 2 patterns for the purpose of screening complex movement appears to have practical value. There are a number of pull pattern exercises that involve a bend pattern (e.g., bent-over row variations), and there are a number of sport-specific movements that require the bend-and-pull patterns to be performed together. In addition, an athlete may demonstrate good pull mechanics and good bend mechanics in isolation, but when these 2 patterns are combined into a complex movement, the athlete may be challenged. This is critical to expose before loading and further confirms the author's view that using the body weight bend-and-pull to screen an athlete's upper-body pull pattern is of great value.
The screening criteria presented in Tables 1 and 2 has been validated through the review of relevant literature (1,5-9,11,18,19,21,24,25,33). Biomechanical evidence is provided to highlight the effects the head position, shoulder girdle mechanics, core stability, and lower limb position have on the performance of the proposed exercises.
Researchers have yet to investigate the effects of various head positions on the kinetics and kinematics of the push-up or body weight bend-and-pull. However, research has been conducted on the effects of head position on trunk mechanics during movement (13). The authors believe that the head should be held in a neutral position and kept motionless throughout either exercise (2,4,21). The head should not appear to be projected down (i.e., flexing the cervical spine) or held up (i.e., extending the cervical spine). Although empirical evidence is lacking, the position of the head will influence shoulder girdle mechanics and expose the cervical spine to unnecessary stress due to the fact that many of the shoulder girdle muscles attach to the skull and cervical vertebra. If an athlete is unable to maintain a centered stable head position, then assessment of the neck and shoulder musculature by a sports medicine professional may be warranted and exercises to stretch and/or strengthen the muscles that support the head and connect to the shoulder girdle may be advantageous.
The shoulder girdle plays an important role in both facilitating upper-body movement and helping to identify movement strategies that may be inefficient. The screening criteria for the push and pull patterns are not complex; nonetheless, a fundamental understanding of the structure and function of shoulder girdle is important to appreciate the consequences that faulty movement may have on an athlete's long-term health and performance.
The shoulder girdle is a complex structure consisting of the sternoclavicular, acromioclavicular, and glenohumeral joints and the scapulothoracic interface (Figure 3). The scapulothoracic interface and glenohumeral joint have been identified to be of great importance when qualitatively screening upper-body movement (19,20,25). The scapulothoracic interface consists of the scapulae, the thorax, and those muscles that provide stability and movement. The scapula is a flat blade lying along the thoracic wall. The functional design allows for smooth gliding along the thoracic wall and provides a large surface area for muscular attachment (19,33). There are many muscles that are involved in shoulder girdle function. For example, the muscles that receive the most attention are the trapezius, serratus anterior, and levator scapulae (7-10,17,19,20,25). However, the extrinsic muscles that attach along the lateral aspect of the scapula, the deltoid, biceps brachii, and triceps brachii that provide gross motor activities for the glenohumeral joint should not be ignored (19). The intrinsic muscles of the rotator cuff (Figure 4) attach along the entire surface of the scapula, which contribute to shoulder movement and stability by providing compression of the humeral head into the glenoid socket (19).
The numbers of muscles that contribute to shoulder girdle function highlight the complexity of the shoulder girdle. It should be no surprise that a considerable amount of research has been devoted to understanding the 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 scapulothoracic dysfunction. Scapulothoracic dysfunction has been detailed to be the alterations in the resting position of the scapula affecting shoulder girdle mechanics and is considered a major contributing factor to shoulder pain and impingement syndromes (9,33). It has been well documented that a relationship exists between static posture and dynamic movement (3,18,22,33). An athlete's standing posture may be used to identify the resting position of the scapula (18,22,33). Weak or poorly activated scapula muscles may influence 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). For optimal glenohumeral joint motion to occur, the head of the humerus must remain compressed and centered in relationship with the glenoid (33). In order for this to occur, the muscles of the scapula must be conditioned to support good alignment and precise timing between the scapula and humerus (19). This is referred to as the scapulohumeral rhythm and is defined as the relationship between the scapulae and humerus during movement. The coactivation ratio of the trapezius and serratus anterior is thought to have significant influence on scapulohumeral rhythm and is key when determining shoulder dysfunction versus function (6-9,19,33). Many suboptimal shoulder postures are reported to be a result of an over development of the upper area of the trapezius as compared with the middle and lower areas of the trapezius and serratus anterior muscle during shoulder function (17,33). How the trapezius and serratus anterior muscles work together (i.e., force couple action) can be observed during a push-up and body weight bend-and-pull. When the shoulders are observed to elevate toward the ears during either of these movements, there is considered to be greater upper trapezius muscle activity (19,25,31,33). For example, an athlete with pronounced kyphotic posture (Figure 5) may present with the upper area of the trapezius to be considerably stronger than the middle and lower area of the trapezius, serratus anterior, and levator scapula muscles (3,18,22,33). Kyphotic posture is often observed in athletes participating in sports such as baseball, swimming, water polo, tennis, gymnastics, wrestling, and volleyball where the use of the upper body is essential (22). The athlete in Figure 6 is upper trapezius dominant and is unable to achieve the correct starting position and therefore maintain proper alignment and function of the scapula when performing upper-body push and pull pattern exercises. This athlete's scapulae are forced to elevate toward the ears to provide the protraction and retraction necessary to facilitate the movement patterns. This movement strategy has been reported to sacrifice the alignment of the humerus within the glenoid, possibly affecting the compression of the humerus in the glenoid, resulting in shoulder complex muscle weakness and limited glenohumeral joint range of motion. These factors have been reported to contribute to shoulder impingement pathologies and negatively affect upper-body movement competency over time (17,18,33). Therefore, an important screening criterion of shoulder function during push and pull pattern exercises is the ability of the athlete to keep the shoulders down and away from the ears.
However, the scapulae should not appear to be “stuck” in the attempt to keep the shoulders down away from the ears during movement. The scapula should appear to be protracting and retracting during all push and pull pattern exercises. Protraction and retraction of the scapulae are important movements for sport performance. The movement ability influences the proximal to distal sequencing of velocity, energy, and forces that contribute to common sport-specific actions. For example, in an overhead throwing movement, over half of the total kinetic energy and forces that are generated come from the lower body and are transmitted up through the trunk and delivered to the shoulder, arm, and hand to complete the kinetic chain (19). Proper scapulae retraction and protraction provide the most advantageous anterior trunk muscle tension. This provides efficient force transfer from eccentric to concentric motion of the anterior muscles of the trunk and concentric to eccentric motion of the posterior muscle of the trunk for efficient performance of overhead throwing, tennis serving, the recovery phase of the swimming stroke, and many upper-body strength exercises (19). Therefore, aligned and fluid scapulae motion involving protraction and retraction with the shoulders held down and away from the ears during upper-body push and pull pattern exercises would epitomize the ideal push and pull movement strategy in either the frontal or sagittal plane (6,33).
The muscles of the trunk generate force and stiffen to stabilize the lumbar spine during lower- and upper-body movements (15,26,28). Push-ups have been used as core training exercises, given how they challenge lumbar spine stability (15). Freeman et al. investigated the forces incurred by the lumbar spine during different kinds of push-ups and found that abdominal activity and lumbar spine loads increased with push-up intensity (i.e., standard push-up versus clap push-up) (15). The body weight bend-and-pull requires the athlete to bend forward to self-selected depth and demonstrate good pull mechanics. Lumbar spine movement during the body weight bend-and-pull has not been empirically studied. However, research has investigated the effects of flexion and extension to the lumbar spine under load (26,28-30). The consensus of spine researchers is that the lumbar spine should not be flexed or extended under load because of the negative effects that shear and compressive forces have on lumbar vertebral integrity (26,27). Figure 7 features an athlete performing a push-up with lumbar extension, and Figure 8 features an athlete performing a body weight bend-and-pull with lumbar flexion. A stable lumbar spine has been reported to be able to resist excessive flexion, extension, and rotation (26,30). When performing a push-up or body weight bend-and-pull, the lumbar spine should remain neutral and not be allowed to extend, flex, or rotate. The bend pattern should be initiated with the hips not the lower back. The hips should move back as the trunk moves toward the floor. To assist the bend pattern, the knees should be slightly bent to avoid knee hyperextension and accommodate tight hamstrings. A lumbar spine that experiences extension, flexion, or rotation during either the push-up or body weight bend-and-pull may indicate lumbar instability or an athlete's lack of awareness that this area should remain stable during movement (15,24,26,30). Core training that challenges the athlete's ability to resist flexion, extension, and rotation may be warranted to improve their core competency.
Researchers have not yet investigated the effects of various leg positions on the kinetics and kinematics of the push-up or the body weight bend-and-pull. However, the correct position of the lower body during a push-up consists of having the legs held in line with the hips and remaining motionless (2,4,21). During the body weight bend-and-pull, the legs should be aligned with the hips and the knees should be slightly bent to avoid excessive compressive forces for those athletes who can hyperextend their knees. If an athlete is unable to control the position of the legs during a push-up or body weight bend-and-pull, further assessment may be required by a sports medicine professional.
When screening an athlete's 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 secondary attention to the head, ankles, feet, depth, and balance. On screening, the athlete refers to Tables 3 and 4 to help determine the appropriate load level for the push or pull pattern. Tables 3 and 4 detail each patterns progressive loading paradigm and provide exercises that will challenge the pattern in a progressive manner. The pattern progressions follow a compendium of assisted, body weight, external load, eccentric, and plyometric trainings. The objective of the load progression is to challenge the pattern with a load that facilitates a good pattern. In other words, use the load level that allows the athlete to perform the fundamental pattern with all coaching points maintained for the sets and repetitions prescribed. Level 1 assists the pattern by attenuating the force required to complete the pattern through a full range of motion. Level 2 challenges the pattern with a body weight load. Level 3 introduces modalities to the body weight that provide further external resistance such as free weights. Level 4 challenges the athlete's eccentric strength. This is a critical level for the athlete to demonstrate that they can maintain the coaching points detailed in Tables 3 and 4 under high velocity with moderate to high force. If the athlete cannot demonstrate a good movement pattern under high velocity and moderate to high eccentric force, then plyometric training may be too advanced. Level 5 loads the pattern with plyometric or ballistic training. Table 5 provides descriptions of the exercises detailed in Tables 3 and 4. Regular screening is recommended (e.g., before and after a training block) to confirm the effectiveness of the loading progressions and to ensure that improvements in power production are not achieved to the detriment of movement competency.
When performing the push-up and body weight bend-and-pull, the athlete should demonstrate a centered and stable head position. They should demonstrate fluid scapulohumeral rhythm, which means the scapula will be in good alignment and protract and retract with precision. They should also be able to perform upper-body push and pull pattern exercises with the shoulders held down and away from the ears, demonstrating good shoulder girdle muscle balance. The trunk, particularly the lumbar region of the spine, should be held neutral and stable during either movement. Screening an athlete's movement competency related to fundamental movement patterns provides a framework for the strength and conditioning specialist to prescribe a strength and conditioning program that is most appropriate to the athlete's movement abilities.
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movement competency; scapula; shoulder function; push-up; posture
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