The Upright Row: Implications for Preventing Subacromial Impingement Brad Schoenfeld, Msc, CSCS,1 Morey J

Flexibility and Rehab Tips

The Flexibility and Rehab Tips column provides practical information on the role of rehabilitation and ﬂexibility on both performance and the modiﬁcation of injury risk.

COLUMN EDITOR: Helen M. Binkley, PhD, ATC, CSCS*D, NSCA-CPT*D The Upright Row: Implications for Preventing Subacromial Impingement Brad Schoenfeld, MSc, CSCS,1 Morey J. Kolber, PT, PhD, CSCS,2 and Jonathan E. Haimes, BS, CSCS2 1Department of Exercise Science, Lehman College, Bronx, New York; and 2Department of Physical Therapy, Nova Southeastern University, Davie, Florida

SUMMARY However, when considering the shoulder degeneration of the musculoskeletal complex, these benefits are not obtained anatomy, a congenitally narrowed TRAINING PROGRAMS ARE OF- without risk. A survey of 110 recreational subacromial space, and precipitating TEN INCLUSIVE OF EXERCISES WT participants revealed that 61% had activities, such as exercises, that lend to DESIGNED TO ACHIEVE reported shoulder pain during the course aberrant biomechanics. From a WT STRENGTH AND HYPERTROPHY of WT in the past year, whereas 33% perspective, impingement has been OFTHEMIDDLEDELTOIDSAND hadpainduringWTinthepast3days postulated to occur from exercises that UPPER TRAPEZIUS. THE (10). Moreover, research indicates that require elevation of the arm (raising ‘‘UPRIGHT ROW’’ IS ONE OF THE up to 36% of WT-related injuries and the arm away from the body out to the MORE COMMON EXERCISES disorders occur at the shoulder complex side or to the front) overhead without PERFORMED; HOWEVER, ITS EX- (13,17,18). Of the more common disor- proper mechanics (11,21). ECUTION IS NOT WITHOUT RISK, ders that may be attributed to WT, The upright row is a popular exercise PARTICULARLY IN THE POPULA- anterior instability, rotator cuff (RTC) often employed both by athletes as well TION WITH DOCUMENTED pathology, and subacromial impinge- as by the general public to target the SHOULDER DISORDERS, SUCH ment are most often described in the middle deltoid and upper trapezius AS SUBACROMIAL IMPINGEMENT. literature (6,16,26,29). musculature. In addition to recruiting IMPLICATIONS SPECIFIC TO THE Pathology of the RTC comprises the middle deltoids and upper trapezius, UPRIGHT ROW EXERCISE ARE a considerable proportion of shoulder the upright row has been advocated DISCUSSED IN THIS COLUMN AS disorders in both the general and the for strengthening the scapular stabil- WELL AS MODIFICATIONS APPLI- athletic population (23,24,29). Although izers (19) and is integral to the sport of CABLE TO BOTH THE SYMPTOM- the etiology of RTC pathology is multi- weight lifting, where it is a component ATIC AND THE ASYMPTOMATIC factorial, subacromial impingement is of the high pull portion of the clean. POPULATIONS. often implicated (5,7,22). Factors con- Despite the intrinsic benefits associated INTRODUCTION AND tributing to subacromial impingement with the upright row, performance of EPIDEMIOLOGY (impingement of soft tissues, namely the exercise as traditionally described he health and fitness benefits the RTC, between the bony structures has been postulated to place individu- ascribed to weight training of the shoulder during arm elevation) als at risk for subacromial impingement T (WT) are well known (1,2,8,12). include RTC weakness, age-related (9,11). Specifically, performance of

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the upright row requires the arms to be BIOMECHANICAL rotated position of the arms. Elevating elevated (raised away from the body) CONSIDERATIONS the arms above the shoulder height above shoulder height while in an The upright row is a multijoint exer- while internally rotated violates normal internally rotated position (Figure 1). cise, with movement taking place at biomechanics because the shoulder Performing this exercise in the afore- the shoulder complex and elbow joints. should externally rotate as a means of mentioned manner leads to aberrant Electromyographic studies indicate that preventing impingement of the suba- biomechanics because normal shoul- the upright row elicits considerable cromial structures. activation of the upper trapezius der elevation requires the arms to External rotation may begin at 60° of and middle deltoid at 85 6 5% and externally rotate to prevent subacro- elevation; however, it is most critical 78 6 6% maximum voluntary contrac- mial impingement (20). Essentially, between 90° and 120° to avoid im- tion, respectively (3). Activation of the when elevating the arm overhead, pingement (20). Researchers using mag- upper trapezius approaches that of the normal biomechanics dictates that netic resonance imaging and surgical shrug but with the use of lighter loads, the shoulder should externally rotate exploration have reported the greatest potentially making it a suitable alterna- to avoid subacromial impingement. degree of subacromial impingement to tive for those with chronic neck pain (3). Thus, elevating the arm overhead with occur from 70° to 90° when raising the internal rotation as done with the Performance of the upright row requires arm overhead without external rotation upright row may directly cause sub- elevation of the arm at an angle that is (14,15,25). The upright row exercise as acromial impingement or perpetuate slightly anterior to the coronal plane traditionally prescribed requires individ- the existing impingement. Effective (bringing the arm straight out to the uals to raise their arms into elevation at and safe performance of the traditional side). The traditionally prescribed tech- angles beyond 90° while maintaining upright row exercise requires modifi- nique for executing the lift requires internal rotation, thus placing individu- cations that are inclusive of both individuals to internally rotate their als at risk for subacromial impingement anatomical and biomechanical factors. shoulder during elevation as a means (7,20,25). In our experience, individuals This column presents modifications for of targeting the middle deltoid (3,4). with previously diagnosed RTC pathol- the upright row exercise that respect Furthermore, traditional technique (Fig- ogy or subacromial impingement may normal biomechanics while maintain- ure 1) often dictates that individuals report symptoms (pain or an ache) ing the exercise’s intended purpose of elevate their arms to bring their elbows during this exercise, with the severity of improving upper trapezius and middle into a position above shoulder height reports often correlating to the height deltoid muscle performance. (90°) while maintaining an internally of arm elevation. Mitigating this risk involves modifying the exercise to respect normal biomechanics; however, suitable modifications must maintain the exercises intended purpose in regards to adequate muscle recruitment.

MODIFICATIONS TO TECHNIQUE The upright row can be a safe and effective exercise, provided proper precautions are followed. Performance must take into account both individual genetics and pathophysiology of the shoulder complex. As a general rule, the bar should be pulled as close to the body as possible throughout the movement so as to maintain optimal stress on the middle deltoid. In addition, it is important to pull through the elbows, not the wrist, so as to maximize muscle activity at the shoulder. What constitutes a safe degree of shoulder elevation during upright row performance remains a topic of controversy. As previously noted, Figure 1. Illustration of traditional upright row with arms elevated above 90°. Dashed studies indicate that impingement typ- line indicates the 90° angle. ically peaks between 70° and 120° of

26 VOLUME 33 | NUMBER 5 | OCTOBER 2011 glenohumeral elevation (7,14,15,20,25), the upper arm should not exceed 60°, individual’s activity-specific demands thus the authors recommend that assuming the lift is performed properly. require endurance, a volume assignment asymptomatic individuals elevate their Those new to the lift, however, often of 2–3 sets of 12–20 repetitions is arms during the upright row to just tend to pull the bar beyond a safe prescribed at a load of less than 67% below 90° (shoulder height) (Figure 2). range. Not only does this bring about of the 1-repetition maximum (1RM). To Similar recommendations have been impingement but, given the high rate achieve the shared goals of both put forth by other authors (21), who of acceleration during performance, strength and hypertrophy, the exercise suggest limiting shoulder abduction to creates forces at the shoulder joint that is performed for 3–6 sets of 6–12 approximately parallel with the floor. are exceedingly high, thereby height- repetitions at 67–85% of the individual’s This can serve as a general guideline ening the extent of soft tissue damage. 1RM with rest periods of 60–90 seconds as long as no pain is sensed during Beginners are therefore advised to between sets. Individuals with a pre- or immediately after exercise perfor- practice the clean at a reduced speed disposition to shoulder injuries—such as mance. Those individuals with pre- with light weights until basic technique overhead athletes—may be best advised viously diagnosed subacromial is developed. Once a modicum of to begin in the lower end of this range impingement or who may report pain proficiency is attained, part practice and then gradually move into higher with the exercise should decrease the may be beneficial in mastering the skill. ranges. Moreover, the threshold for angle of elevation to a height that does This is best accomplished by the use of advancement should not be indepen- not provoke symptoms. segmentation, whereby the high pull is dent of pain because premature pro- The upright row is sometimes used to practiced separately from other aspects gression of load and/or volume may maximize power production. This is of the lift (28). Such a strategy can help lead to delays in healing among the particularly true when performing to solidify neuromuscular control and injured population. In cases where variations of the clean (e.g., hang clean thus ensure that impingement does not a 1RM is not appropriate, such as in and power clean). During the clean, occur during performance. the rehabilitation setting, an estimated a lifter’s focus is on generating explo- In regards to training volume and 1RM may be obtained using higher sive upward movement of the bar load, considerable variability may exist repetitions and a prediction equation. during the high pull portion of the among the injured versus asymptomatic Readers are advised to consult the text exercise (27). Impingement generally is population. Among the asymptomatic Essentials of Strength Training and Con- not an issue here because elevation of population, it is suggested that if the ditioning, third edition, by Baechle and Earle (4), for details regarding prediction of the 1RM from the multiple repetition maximum. For those rehabil- itating injury, it also is advisable to consult with a physician, athletic trainer, and/or physical therapist to ensure safe and effective prescription.

CONCLUSION One of the main advantages of the upright row is that it is perhaps the only open chain multijoint movement that targets the middle deltoid, making it a desirable exercise for many lifters. Although the exercise has known beneﬁts, execution is not without risk as a result of the exercise’s propensity to produce subacromial impingement. This risk may be mitigated through instruction of the individual to avoid elevation of the elbows above the shoulder height. Those with existing subacromial impingement who have pain during performance of the upright row are advised to elevate to an angle below the shoulder height that does Figure 2. Illustration of modiﬁed upright row with arms elevated below 90°. Dashed not provoke symptoms or to avoid the line indicates the 90° angle. exercise altogether.

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