Is Rippetoe's advice about the press terrible and wrong?

Question

Mark says that your rotator cuffs will strengthen in the appropriate amount if you just press correctly:

Pressing actually strengthens the rotator cuff muscles.

When you press overhead and finish the lockout correctly, all of the muscles of the shoulder are tight and contracted. As the weight goes up over time, the strength of the finish must increase and the force produced by all the contracting muscles must therefore increase as well.

Since the press uses the rotator cuff muscles isometrically to stabilize the lockout position at the top, and since proper form ensures that they are active in this capacity as well as safe relative to a position of impingement, it seems as though the logical way to strengthen the cuff muscles — even cuff muscles weakened by injury and surgical repair — is to press correctly.

In the correct press lockout, the weaker muscles are supported by the healthy ones, and as the injured muscles heal, they are able to resume an increasing amount of their normal functional load if correct technique is utilized with weights light enough to permit it.

In this way, the injured muscles can be brought back to normal function while performing their normal function, in effect given no choice but to heal by doing what they normally do.

Is this terrible, wrong advice?

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Bill Starr seems to agree with this advice:

The very best way to insure that you keep those groups that make up the rotator cuff strong and healthy is to do overhead lifts: presses, push presses, and jerks. Holding a weighted barbell overhead for several seconds hits the rotator cuffs directly. Lifting a weight overhead forces those muscles known as the scapular control groups, lower trapezius, lats, and serratus to work. These also get worked with heavy pulls, but a double dose of exercise that hits them directly is even better.

Whenever someone tells me he’s feeling a twinge right where his rotator cuffs are located, I have him do overhead presses to strengthen the weak area. Standing dumbbell or barbell presses done with fairly high reps, 15s and 20s, and if the injury is not advanced, the presses solve the problem in a matter of a month or six weeks.

Answer 1

Is it terrible and wrong? I'm willing to concede he knows a fair amount more about training than I do with his multiple years under the bar. Bill Starr is also a very reputable source. There are some subtleties that I think are worth calling out:

• Bill Starr recommend sets of 15-20 for rehab--which is consistent with all the rehab advice I've read.
• The rotator cuff work is actually done on the isometric hold at the top.
• The high rep work recommended by Starr forces you to stick with lighter weights

As with any rehab, you should be lifting a weight that does not cause pain in the injured area. The higher reps help get blood flowing through the injured area more which in turn speeds up the recovery.

For normal strength training, keeping overhead work in your routine will help maintain and strengthen your rotator cuffs. I think that was the point that Rippetoe was wanting to make.

Is overhead pressing the only way to work on the rotator cuffs? No, but they also provide other benefits such as increased core strength and confidence under the bar. Overhead pressing to a full lockout helps keep your shoulders healthy. I've also found that hang snatches help with shoulder health as well as dumbbell shoulder exercises. Rippetoe's target audience is newbie and beginner lifters, so he is trying to give them the best bang for their training buck.

Answer 2

To answer this question, we need to break the quote into two sections.

Pressing actually strengthens the rotator cuff muscles.

When you press overhead and finish the lockout correctly, all of the muscles of the shoulder are tight and contracted. As the weight goes up over time, the strength of the finish must increase and the force produced by all the contracting muscles must therefore increase as well.

Since the press uses the rotator cuff muscles isometrically to stabilize the lockout position at the top, and since proper form ensures that they are active in this capacity as well as safe relative to a position of impingement, it seems as though the logical way to strengthen the cuff muscles ... is to press correctly.

This statement is absolutely correct. Any shoulder work, by necessity will incorporate the all of the muscles of the shoulder girdle; anterior, lateral and posterior deltoids, as well as the numerous muscles of the rotator cuff. More to the point the will be exercised in their correct capacity in this role. If the role of the rotator cuff is to stabalise the shoulder during lifts, then they will be worked out and strengthened effectively for this role.

However, this falls down right about here:

— even cuff muscles weakened by injury and surgical repair —

This is a statement of absolutes. That says a way (granted not the only way) to strengthen an injured rotator cuff is through the overhead press, or other normal movements.

In the correct press lockout, the weaker muscles are supported by the healthy ones, and as the injured muscles heal, they are able to resume an increasing amount of their normal functional load if correct technique is utilized with weights light enough to permit it.

This is what usually termed a "compensation pattern" where the body is forced to perform an activity outside of its normal movement pattern. A common example is limping when a leg muscle is injured. The above passage advocates for continuing a movement, when a required muscle is injured, and working around it.

In most cases this may be possible, but if the movement breaks down, as happens towards the ends of workouts, the a primary stabilisors of the shoulder girdle may be unable to work due to injury. This would require additional effort from alternative muscles in unnatural ranges of motion, either at full extension or flexion. This may in turn lead to further injury.

In this way, the injured muscles can be brought back to normal function while performing their normal function, in effect given no choice but to heal by doing what they normally do.

The above is contradictory to the prior statement, as while the movement may look similar, different supporting muscles will be active during the movement. Injured muscles would not be worked as normal, thus no active recovery could take place.

Can a compound exercise be performed while recovering from an injured stabilising muscle? Yes, but at a significant deload.

In this case we can consider the bench or overhead press and an injured rotator cuff muscle, or a squat variation and an injured hip flexor, or an similar pairing. While it is important during recovery to test the progress of the muscle, the exercise should be performed at a deloaded weight that will not place undue strain on the rest of the joint if the injured muscle were to spasm or fail.

Similarly, a good recovery pattern would include (under the guidance of a trained physical therapist) exercises that specifically engage and aid in the recovery and strength-building of that muscle.