If You Do Dips; Corrective Exercise and/or Surgery Are Inevitable (Revisited)


The topic of dips comes up at workshops that I teach pretty frequently. They have been a staple of the body building, group exercise and body weight training scene for years. A simple take off on the parallel bars or rings in gymnastics.

So what’s the big deal about dips??? Well Google shoulder pain and there are over 11,100,000 hits. Too many shoulder problems! See the end of my post for more rationale on taking care with shoulder movements* I wish I learned more about biomechanics and corrective exercise before I did too many dips!

Optimal r.o.m. for humeral extension (sagital plane) is @45 degrees. Most people do not have optimal posture or r.o.m. Forcing the humerus past it’s natural end point will yield 2 negative results 1) excessive pressure of the humeral head into the anterior capsule of the gleno-humeral joint 2) tipping of the scapulae.


It is common that many people will have restrictions in the posterior and inferior capsules of their shoulder which forces the head of the humerus to migrate interiorly and superiorly respectively. Bones move away from tightness/restriction and create ligamentous and capsular laxity, joint instability and/or impingement while moving in the opposite directions. Forcing the head of the humerus anteriorly repeatedly, especially under load and with momentum with little focus on eccentric deceleration as most people who perform dips do, will wear out the anterior capsule of the shoulder. Once the passive stabilization of the joint is compromised (this is a permanent situation by the way) the active system (muscles and tendons) must become more active to protect the joint. This can have an impact from one joint throughout the entire kinetic chain. Take for instance the latissimus dorsi tightening up to make up for a stretched out joint capsule in the glenohueraml joint. The Lat originates in the thoraco lumbar fascia and has insertion points into the sacrum, illium, lumbar spine, thoracic spine and inferior angle of the scapulae. All of these joints can be negatively impacted by loss optimal force coupling around them which can in turn impact the femur and further down the kinetic chain leading to increases susceptibility of ankle sprains, patella femoral pain and low back pain. So the argument of I have been doing dips for years and my shoulders do not hurt is a tough one to make.


Also, repetitive and excessive tipping of the scapulae can alter Length Tension Relationships and Neuromuscular Efficiency around the shoulder complex, head and cervical spine, traumatize the rotator cuff tendons (mostly infraspinatus and supraspinatus in this scenario), aggravate bursae sacs and increase cervical extension yielding increased pressure on the cervical discs. Know anyone with tight necks? Headaches? Over-active levator scpulae?

This…


Plus this…


Will lead to this…

Do to the seated posture and “upper cross syndrome” apparent in most clients personal training clients and gym goers today, the above scenario will contribute to their preexisting imbalances and accelerate wear and tear on components of the passive system. Ligaments wear out like the rubber on the bottom of your sneakers…it’s just a question of when they wear down? 30?40? 85? or in the grave???


This is a high risk exercise option for the triceps, pectoral complex or shoulder complex. These muscles can be targeted with much safer alternatives with minimized risk regardless of the patient, client or athletes goals..

if someone MUST “dip”…1) the Life Fitness Signature Series Tricep machine looks and feels like a seated dip machine, but does not allow the user’s humerus to extend past 45 degrees it is very comfortable and fills the need most people are looking for.



2) Sitting on a bench with your hands on two dumbbells at tour side for lower trap activation can be pretty helpful. Having trouble loading my picture of this one.

3) other than that..shallow range of motion dips that do not let the humerus extend more than 45 degrees are a better option than what is seen in most gym, classes or health clubs.

I know they FEEL GOOD sometimes and can be good for the ego…but there is life after ego and plenty of exercises to blast away at those muscles with a much lower risk of trauma.

There is more to talk about of course…but I think that is enough for now.

What do you think?

A typical Corrective Exercise program for someone who has been trashing themselves with dips might look something like this;

I wanted to add some more in, but Murphy my lab wanted out of his crate and my 5 year old was itching to play…sorry, he is tough to turn down:)

Thanks for reading!

Eric Beard

Athletic Performance Enhancement Specialist

Corrective Exercise Specialist

theericbeard.blogspot.com

www.ericbeard.com

Shoulder pain and dysfunction rank among the most common of peripheral joint complaints (1)(2)(5)(9)(11). Incidence has been estimated to be between ten and 25 per 1000 patients (1)(2)(11). Pain, injury and instability can be either the cause or the effect of shoulder joint dysfunction (1)(5)(6)(7)(8). The two most frequent diagnoses for patients presenting with shoulder pain are impingement and rotator cuff tendonitis (1)(2)(6)(7)(9)(11). Approximately 48% of patients who have presented with shoulder pain have been diagnosed with impingement syndrome in Dutch general practice (6). Bankart lesions, bursitis, dislocations, separations, rotator cuff disease, osteoarthritis and rotator cuff tears are other common diagnoses (1)(2)(5)(6)(7)(8)(9)(11). In order to select the appropriate treatment, the appropriate diagnosis must be made first (6)(7)(8)(11). Treatments range from palliative to curative and may include over-the-counter medications, manual therapy, therapeutic exercise and surgery (1)(2)(3)(4)(5)(6)(7)(9)(10)(11).

References:

1) Bang, Michael and Deyle, Gail. (2000). Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients With Shoulder Impingement Syndrome. Journal of Orthopaedic & Sports Physical Therapy, Volume 30 (3), pp. 126-137.

2) Bergman, MScGert J.D. Winters, PhD, C. Jan. Groenier, MsC, H. Klass. Betty. Pool. Meyboom-de Jong, PhD, MD, Betty. Postema, PhD, MD, Klass and van de Heijen, PhD, Geert J.M.G. (2004) Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain. Annals of Internal Medicine, 141, pp. 432-439.

3) Eccles, Nyjon K.,M.R.C.P., Ph.D. (2005). A Critical Review of Randomized Controlled Trials of Static Magnets for Pain Relief. The Journal of Alternative and Complimentary Medicine, Volume 11, Number 3, pp. 495-509.

4) Fabbriciani, C. Milano, G. Demontis, A. Fadda, S. Ziranu, F. Mulas, PD. (2004). Arthroscopic Versus Open Treatment of Bankart Lesion of the Shoulder: A Prospective Randomized Study. Arthroscopy, May-June; Volume 20, pp. 456-62.

5) Gursel, Kurtai Yesim. Ulus, Yasemin. Biligic, Ayse. Dincer, Gulay and van de Heijen, Geert

JMG . (2004). Adding Ultrasound in the Management of Soft Tissue Disorders of the Shoulder: A Randomized Placebo-Controlled Trial. Physical Therapy, Volume 84, pp. 336-343.

6) Johansson, Kajsa M. Adolfson, Lars E. and Foldevi, Mats OM. (2005). Effects of Acupuncture Versus Ultrasound in Patients With Impingement Syndrome: Randomized Clinical Trial. Physical Therapy, Volume 85, pp.490-501.

7) McClure, W. Philip. Bialker, Jason. Neff, Nancy. Williams, Gerald. and Karduna, Andrew. (2004). Shoulder Function and 3-Dimentional Kinematics in People With Shoulder Impingement Syndrome Before and After a 6-Week Exercise Program. Physical Therapy, Volume 84, pp. 832-848.

8) Park, Hying Bin, MD, Yokota, Atsushi, MD, PhD, Gill, Harpreet, MD. Rassi, George, El, MD and McFarland, Edward, MD. (2005). Diagnosis Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingement Syndrome. Journal of Bone and Joint Surgery. Volume 87-A, Number 7, July, pp. 1446-1455.

9) Razavi, Mahanaz and Akuten, Kvaters. (2002). Effects of Acupuncture and Placebo TENS in Addition to Exercise in Treatment of Rotator Cuff Tendonitis. Clinical Rehabilitation, 2004, Volume 18, pp. 872-878.

10) Sperling, John W., MD, Cofield, Robert, MD and Schleck, Cathy, BS. (2004). Rotator Cuff Repair in Patients Fifty Years of Age and Younger. The Journal of Bone and Joint Surgery, Volume 86-A, Number 10, October pp. 2212-2215.

11) van den Dolder, Paul A. and Roberts, David L. (2003). A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Australian Journal of Physiotherapy. Volume 49, pp. 183-188.

12) Effects of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes J Strength Cond Res. 2008 Jan; 22(1):140-5. J Strength Cond Res. 2008


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10 Comments

  1. Naresh
    Posted July 25, 2009 at 11:52 am | Permalink

    Hi Eric,

    Everytime I do a Parallel bar dip, I feel a shooting pain in my left shoulder (in the Infraspinatus, I think). I was thinking of replacing it with a much safer exercise which could still train the same muscles (front shoulder, chest, triceps).

    I don’t have a dip machine in my gym, so was wondering what would be a good alternative exercise to a parallel bar dip. In a few weight training sites I checked, some folks recommended an incline/decline bench press as a good substitute.

    Please advice if this is a viable alternative and if yes, do you recommend a close grip or shoulder width grip for it. Of course, if there’s a better and a safer exercise, please let me know.

    Thanks,
    Naresh

  2. admin
    Posted July 28, 2009 at 6:47 am | Permalink

    Hi Naresh,

    Thanks for reading and asking a question! A Decline press with an angle of about 45 degrees or less would be a great solution. hammer Strength makes a few good chest pieces if your arms are long enough and frame large enough to fit into. Their “Vertical Decline Chest” and “Wide Chest”

    You mus have good mobility and muscular balance/strength of your thoracic spine, surrounding aspects of the shoulder girdle as well. don’t over look alignment and function in yoru training.

    Have a great day!

    Eric
    http://ericbeard.com

  3. Naresh
    Posted July 28, 2009 at 12:10 pm | Permalink

    Thanks Eric. If you don’t mind me asking a further question on your response, would you suggest doing the Decline Press with a barbell or dumbbells and with close or shoulder/wide grip?

    Regards,
    Naresh

  4. admin
    Posted July 29, 2009 at 10:49 am | Permalink

    Hi Naresh,

    Dumbbells will allow great range of motion and allow fro a friendlier movement at the shoulder joint, but can be more dangerous laying back with them in your hands. If you are doing max strength training (@1-3 reps) then a barbell will allow you to use more weight. Generally, I say dumbbell especially with any shoulder concerns, but there are times when the barbell is a solid option.

    Eric

  5. cvelee
    Posted December 15, 2009 at 6:22 am | Permalink

    Eric,

    This is wonderful article, really. Thank you for it.

    Let me put my story short – I spent my 29 years of life in front of computer, running long distance and doing dips and chinups. Now I have clearly visible protruding disks (c3, c4) on MRI and cervical foramen narowing (c6,c7) aka – have cervical spondylosis and TOS. Also some clicking in left shoulder and right knee are evident indicating non-painful osteoarthritis of these same joints.

    Which means no more rope jumping, running, rebounding, etc… for me. Just elliptical and swimming.

    One way to correct these imbalances is to do isometric exercises on deep neck flexors (longus colli…). Which I do. These were prescribed by my physical therapist.

    Problem is – somewhere I have found that Shoulder shrugs are great for cervical problems, so I have started doing them. Posturewise – I do them in correct manner (weight by my side, neck retracted, tongue resting on mouth wall). But knowing that upper trapezius connect somewhere at C3, C4, I do not think this is smart thing to do. It obviously compress my cervical disks.

    I contact you because picture on this page “upper cross syndrome needs corrective exercsie.jpg” got me thinking. Idea is to forget about pecs and work on scapular retractors (laevator scapuale and rhomboids and trapezius middle fiber I think) and deep neck flexors to correct forward head posture? Tell me if this is correct?

    I must say that worse problem for me is lumbar area – so that I often feel my feet numb. Especially useful for me is hanging. But because of TOS I must not hang (you know – just hang). Yet having great strength in upper body I can hold chin up for some 30seconds (which is ok regarding TOS) and hold myself on parallel bars (elbows just slightly bent , maybe 160degrees) for few minutes. Does this seems ok to you in relation to that picture and problems I have mentioned? You seem like authority on the subject, so..:)

    I know this post is kind of long one:) But I think that lot of guys with spinal problems who were sportsmen before would find it useful:)

    All the best Eric,
    Cvelee, Serbia

  6. admin
    Posted February 3, 2010 at 10:25 am | Permalink

    Thank you for sharing your story! Very helpful for people to read. I would not say to ignore the pecs, there is a benefit to perform “pushing” motions (horizontal abduction), people just do too much volume of this movement compared to horizontal abduction, “pulling” or scapular stabilizing exercises and thoracic spine mobilizations. Why should you still do a “chest press”? As you lower the weight to the floor/return it to the stack the pectoralis complex must lengthen eccentrically. It must learn how to lengthen under load, this can be quite helpful in developing muscualr and neurological balance in the shoulder complex.

    Hope that helps:)

    Eric

  7. John
    Posted November 15, 2010 at 11:27 pm | Permalink

    I’m not sure that I completely agree, brother. Heavy weighted dips (nothing silly–50-150lbs), focusing on scapular retraction and depression, have played an integral role in enabling me to bench pain free. I’m a competitive powerlifter, so I know this won’t apply to most of your audience, but this exercise has enabled me to easily bench 400-450lbs raw w/o pain when I couldn’t do so w/ 315lbs only a couple of months ago.

    Perhaps it’s a matter, much like with other exercises, of awareness of one’s position and doing the exercise correctly.

  8. admin
    Posted October 6, 2011 at 5:37 pm | Permalink

    Hi John,

    Sorry for the long delay in my response. I feel that full range of motion dips for anyone is unhealthy for the anterior capsule of the shoulder and upper cervical region. However, for advanced users such as yourself who have the awareness to maintain a safe range of motion, there can absolutely be a benefit. Thanks for the post!

    Eric

  9. Big Dipper
    Posted December 30, 2013 at 6:01 pm | Permalink

    I’ve been doing dips for over 20 years. I did 115 today. I’m 40 years old and the only ‘injury’ I’ve had was 20 years ago when we strapped multiple 45 lb. plates around our waists to impress the girls in college. I felt a pinch in the shoulder and a pain for a few days, took a couple months off and have been dipping off and on ever since without incident, sans plates of course.

    Don’t fear the dip any more than any other calisthenic. That’s my two cents.

  10. Ash
    Posted December 9, 2014 at 4:44 am | Permalink

    I gave up all forms of strength training, weight lifting, bodyweight resistance exercises and even most forms of cardio. Now the only exercise I do is walking. Why? Because for every exercise, there is a risk of injury even if you do it with the best form and technique, and the best way to avoid them is to not do them at all. Walking is enough to lose the fat and to improve cardiovascular health without the constant need to worry about overtraining, muscle and bone strains and sprains and fractures and all that bullshit.

One Trackback

  1. By Exercise Police – Tricep Dips | Brent Brookbush on January 14, 2015 at 4:14 am

    […] searching through his blogs. I'll drop him a line and see if he can help me out. Jonathon Schetzsle http://www.ericbeard.com/2009/06/24/if-you-do-dips-corrective-exercise-andor-surgery-are-inevitable-revisit… If You Do Dips; Corrective Exercise and/or Surgery Are Inevitable (Revisited) | ericbeard.com […]

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