The 5 Worst Shoulder Exercises (& What To Do Instead)
Every day I treat patients who have either an acute or a long-standing issue with their shoulders. Some of the most common issues are rotator cuff tears, shoulder instability, impingement syndrome, bursitis, and adhesive capsulitis (a.k.a. frozen shoulder).
Regardless of the injury, however, a shoulder injury is debilitating, limiting formerly independent people from being able to perform activities of daily living like putting on a short or washing their hair.
According to the American Academy of Orthopaedic Surgeons, more than 7.5 million people visit a doctor for a shoulder problem each year in the United States. These shoulder injuries tend to become more common as we age. The rotator cuff tear is a good example of this with a prevalence rate of 9.7% in those less than 20-year-olds and greater than 62% in 80-year-olds.
The shoulder is one of the most complex joints of the body. It's critical for the things that make us human: climbing, throwing, and even running, yet it's the most unstable joint in the body with a very limited blood flow. This combination means that there's a high likelihood of injury. One of the most common places that shoulder injuries occur is in the gym. Shoulder injuries account for up to 36% of all weightlifting injuries, according to a study published in the Journal of Strength and Conditioning Research.
There are many ways to avoid a shoulder injury, including a good warm-up and using proper form, but one of the most important considerations is avoiding exercises that are more likely to cause injury to the shoulder joint. Here is a list of the 5 worst shoulder exercises.
The 5 Worst Shoulder Exercises
Behind the neck shoulder press
Upright row
Lateral raises with heavy weights
Lat pulldowns behind head
Front dumbbell raises
The 5 Worst Shoulder Exercises
1. Behind The Neck Shoulder Press
The behind-the-neck shoulder press involves pressing a barbell or dumbbells overhead from behind the neck. This movement strengthens the anterior and medial deltoids, upper pecs, supraspinatus, upper and lower traps, the serratus anterior, and the triceps. Performing the behind the neck shoulder press is also been associated with a higher risk of shoulder injury, including shoulder impingement, rotator cuff strain, and spinal misalignment.
A study published in the Journal of Strength and Conditioning Research found that the behind-the-neck press led to significantly greater anterior (front) and superior (top) humeral head translation, which may increase the risk of impingement in the shoulder joint. Shoulder impingement is when the rotator cuff (primarily the supraspinatus), the long head of the biceps tendon, and the subacromial bursa (the protective sac on the highest point of the scapula) become compressed and inflamed beneath the coracoacromial ligament. This tends to happen when the arms are raised and internally rotated.
The behind-the-neck shoulder press compresses this subacromial space and increases the risk of this shoulder impingement which can lead to shoulder pain and injury.
This movement also forces the arms to externally rotate and the head to protrude forward. When the arms are excessively externally rotated under force, this places the rotator cuff muscles in a position which can increase the risk of rotator cuff strain. The protrusion of the head and neck (specifically the cervical spine) can lead to spinal misalignment and an increased risk of injury. A study published in the Journal of Strength and Conditioning Research confirmed this, finding that the behind-the-neck press resulted in greater cervical spine extension and greater compressive forces on the cervical spine compared to the front shoulder press.
Do this instead
Start by making sure you have adequate range of motion (ROM) in your shoulders. A good test for this is the goalpost assessment where you stand with your low back and shoulders against a wall, put your forearms against the wall in a goalpost position, and move them up above your head. If any part of your body is pulling away from the wall as you lift up then you don't have enough ROM to perform this exercise safely.
If you do have the range then avoid movements behind the head or neck, consider one-handed overhead presses, presses in standing to allow more trunk movement, and use lighter weights with a focus on the eccentric activation (lowering phase).
Shoulder press. Credit: Theraxpro.
2. Upright Row
The upright row involves lifting a barbell or dumbbells from the waist to the shoulders, with the elbows raised high and the hands close to the body. This movement strengthens the anterior deltoid, medial deltoid, supraspinatus, biceps brachii, upper trapezius, rhomboids, and the levator scapulae. Performing an upright row, however, is associated with a higher risk of shoulder impingement, AC joint strain, and a worsening of posture.
The upright row can cause shoulder impingement of the rotator cuff tendons (described above), which can lead to shoulder pain and injury. A study published in the Journal of Orthopaedic and Sports Physical Therapy found that the upright row led to greater compression and shear forces in the shoulder joint compared to other shoulder exercises, which may increase the risk of impingement.
The upright row can also put stress on the acromioclavicular (AC) joint which is the joint between the collarbone and the shoulder blade. This can lead to an AC joint strain, which can cause pain and inflammation in the joint, and may even lead to separation or dislocation of the shoulder.
Performing upright rows also encourages poor posture. The upright row requires lifting the weight with the elbows raised high and the hands close to the body, which can cause the shoulders to round forward and the neck to tilt forward. Over time, this can lead to muscle imbalances and poor alignment in the neck and shoulders promoting kyphosis and that C-curve/tech-neck/turtle posture.
Do this instead
Substitute upright rows with other exercises that will target the upper traps such as overhead presses and farmer's walks.
3. Lateral Raises With Heavy Weights
The lateral raise involves raising the arms out to the sides. The movement strengthens the medial deltoid, trapezius, and supraspinatus. Performing lateral raises with heavy weights, however, is a recipe for a shoulder injury.
One of the main issues with lateral raises is the position of the arm. Performing a lateral raise with the dumbbells positioned parallel to the floor (i.e. pronated grip) forces the shoulders to internally rotate. When the arm internally rotates, the narrow space in the shoulder (the subacromial space) where the rotator cuff and long head of the bicep run through, narrows. This narrowing causes a shoulder impingement which results in inflammation and pain.
When using heavy weights with lateral raises, your body is often forced to compensate in order to achieve the goal which leads to a tucked position of the body. This tends to require momentum in the form of excessive swinging to raise the weights. This puts unnecessary stress on the neck, shoulder joint, and rotator cuff muscles and it can lead to poor posture and an increased risk of muscle strain.
Do this instead
Keep your thumbs pointed upward ("neutral"), use light weights, avoid "swinging" the weghts, and limit the height you are raising the dumbbells. If this causes pain or discomfort then move your arms slightly inward to do this movement in scaption (the range between your arm directly in front of you and to the side of you).
4. Lat Pulldowns Behind The Head
Lat pulldowns behind the head (a.k.a. behind-the-neck lat pulldowns) involve pulling a bar down behind the neck while seated. This exercise targets the latissimus dorsi (lats), rhomboids, biceps, posterior delts. and traps. Doing a lat pulldown behind the head puts excessive stress on the shoulder, rotator cuff, neck, and upper back muscles which increases the risk of shoulder impingement and poor posture.
Behind-the-neck lat pulldowns can cause shoulder impingement of the rotator cuff tendons (described above), which can lead to shoulder pain and injury. An article in the Journal of Strength and Conditioning Research compared three types of lat pulldowns: with a V-bar, in front of the neck, and behind the neck They concluded, "Because there is a theoretical risk associated with BNL [behind the neck lat pulldown], although there is no strong evidence of a relationship between BNL and shoulder injury, as shown by cohort studies, it appears that BNL is unnecessary and should be avoided..."
They go on to indicate that the risk isn't worth the reward. "Moreover, there is no sport or daily activity that elicits movement patterns even similar to BNL, whereas FNL has many sport-specific applications. It appears then that the correct question is not, ‘why not do BNL?’, but ‘why do BNL?’”
Just like the behind-the-neck shoulder press, the behind-the-head lat pulldown can promote poor posture by forcing the protrusion of the head forward. With time this leads to muscle imbalances, poor spinal alignment, and pain.
Do this instead
A normal lat pulldown (in front of the head).
5. Front Dumbbell Raises
Front dumbbell raises involve lifting dumbbells from waist height to about shoulder height. This exercise targets the anterior and medial delts as well as the serratus anterior, traps, and the pecs. This movement is commonly performed with dumbbells positioned horizontally (i.e. pronated grip) which increases the risk of shoulder impingement and muscle imbalances.
Raise your arm up to reach for an imaginary cup in a cabinet. Notice how your thumb is pointed up (“neutral”), your elbow is bent, and your shoulder raises slightly outward and not directly in front of you. This is a natural and functional reaching position. THe front dumbbell raise puts your arm in a position where your arm is in front of you and your shoulder is internally rotated which narros the space in the shoulder and increases the risk of shoulder impingement.
Front dumbbell raises can also create muscle imbalances in the shoulder. Overuse of the front shoulder muscles can lead to tightness and weakness in the muscles that support the shoulder blade, which can alter the mechanics of the shoulder joint and lead to pain and injury.
Do this instead
Keep your thumbs pointed upward ("neutral"), use light weights, avoid "swinging" the weights, and limit the height you are raising the dumbbells. If this causes pain or discomfort then move your arms slightly outward to do this movement in scaption (the range between your arm directly in front of you and to the side of you).
Takeaways
The shoulder complex is an important but injury-prone part of the body. These five exercises are not "bad" but doing them improperly or excessively increases your risk of injury.
When performing any exercise, it's important to consider your available range of motion (ROM) when performing shoulder movements. Regard the recommended variation in the exercise or avoid these movements altogether to decrease your risk of a shoulder injury.
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