In recent years, chronic shoulder pain has begun rivaling lower-back pain as the preeminent pain complaint among the active population. Considering how prevalent back pain is, that's some sad and surprising news. But here's what's worse: In the case of the shoulder, trends are starting to show that active people are getting hurt more than those who live a purely sedentary lifestyle.

As a coach who specializes in pain-free training and injury prevention, that idea literally keeps me up at night. How could this possibly be? By training and living a physically active lifestyle, we are not only getting hurt more, our shoulders are bearing the brunt? Something needs to drastically change.

Sure, the rise of chronic shoulder pain and injuries is a complicated problem, potentially linked to everything from the rise in handheld technologies to sedentary daily postures. But I'm also a realist, so I know the solution to this complex problem isn't as simple as restricting iPhone usage or forcing desk jockeys to stand up and complete marathon workdays from their own two feet.

Pull Three Times As Much As You Push

So, what is the solution? Negating these major societal postural pitfalls through daily maintenance. And where better to do this than in the gym, while building muscle and developing strength?

Here's where to start. If you want to unlock your true physical potential inside the gym and out, then you need to be adhering to these golden pain-free shoulder-training ratios. This is the training that will help rebuild your posture, rid your shoulders of chronic aches and pains, and have you performing at an optimal level.

Time to take notes, people. These ratios are guaranteed to be absolute game-changers.

Pull three times as much as you push

Old approaches surrounding symmetry and muscular balance have notoriously recommended that all muscles and muscular regions of the body be trained evenly—with the same total volume, the same set and rep schemes, and the same types of loading parameters. But guess what? Back in the dark ages of exercise science we weren't battling the current-day challenges of postural stress disorders—yes, that's a real thing—that present in everyone from professional athletes to sedentary office workers.

Over a decade ago, when I started coaching athletes, my programming reflected what, at the time, I thought to be an extremely innovative upper-body pull-to-push ratio. I pushed 2:1 between exercises that pulled load closer to the body's center, and those that pushed load away from the body's midline. These ratios yielded extremely positive benefits for those athletes coming from a more archaic 1:1 ratio setup. But as the years went on, trends in texting and handheld technologies started to chip away at the effectiveness of the 2:1 ratio.

Pull horizontally twice as much as vertically

In recent years, I've re-established a new pull-to-push ratio that more accurately reflects the dire need of our athletes and clients to negate the postural stresses that their head, neck, thoracic spine, shoulder blades, and true shoulder joints have undergone. This new ratio I prescribe is three times as much pulling as pushing for the upper body, as quantified in a rep-by-rep volume approach.

Simply put, for every rep of a pushing movement pattern, there needs to be 3 reps of pulling programmed. The 3:1 ratio is now a staple in the starting programming structure I use across the board for my athletes and clients.

Of course, there will be outliers that present with unique needs based on individual mechanical or neuromuscular presentations, but chances are you are not one of these outliers; approximately 80 percent of the population will thrive in performance and shoulder injury resilience adhering to the 3:1 ratio.

Pull horizontally twice as much as vertically

Many coaches, trainers, and athletes have started to buy into the "pull more than you push" programming mindset out of pure need. But I find it's necessary to further break down the pulling pattern into two distinct planes of motion: the horizontal and the vertical.

Why? It all comes down to the balance of internal and external rotation.

Poor daily postures are typified by an internally rotated and protracted (shoulder blades spread) position. The two most popular pushing movements, the barbell bench press and overhead press, also position the shoulder in a way where they train internal rotation.

That on its own is a good case for doing more pulling, to balance out all that internal rotation. But guess what? The two most popular pulling movements in a big box gym, the pull-up and the deadlift, also both place the shoulder into internal rotation.

You need something else, and you need lots of it: the horizontal pull, or row. The row motion has the ability to keep the glenohumeral (shoulder) joint in a strong, neutral position throughout the pull, and can even move the shoulder into a more externally rotated position. Most people find their shoulder can tolerate far higher volumes, intensities, and total workloads of rowing than in vertical pulling.

How to optimize these ratios in training

There's plenty of room for coaches and athletes to fine-tune the ratios, but my recommendation to start is 2:1, meaning row twice as much as you do pull-ups. This will make the pull-ups you do far safer, and probably stronger as well.

How to optimize these ratios in training

In order to get the very most out of these pain-free shoulder-training ratios, we must appreciate a few key programming factors in order to properly adhere to the 3:1 pull to push ratio, and the 2:1 row to pull-up ratio:

  1. Ratios are based on total reps over a week's time, or a training block.
  2. All types of reps count equally. From prehab, to warm-up, to working sets, everything counts. That's one reason I like what's come to be known as the Rusin banded shoulder warm-up so much: it allows you to rig the ratios in your favor from the start of a workout, and set yourself up for stronger presses in the process. You can read about it in my article "Your Old School Bench Warm-Up is Getting You Hurt."
  3. The success of these ratios depends on sound execution of all movements. Sloppy rows help no one.
  4. These are general recommendations, so they'll play out differently for everyone. But I'm confident that at least 80 percent of athletes will have noticeable success with them.

If you're like most lifters I cross paths with, simply adhering to these pain-free shoulder-training ratios will revolutionize the way your shoulders look, feel, and perform.

It's just a matter of sticking with them, because success won't happen overnight. You need intelligent programming, pristine form, and weeks or even months of accumulating volume to let the ratios work for you. But the payoff is worth it; stronger lifts of all types, better posture, and the potential to perform at your highest level while staying resilient against injuries.

Establish your ratios, work hard, and bulletproof your shoulders now, rather than becoming another statistic later.

About the Author

John Rusin, DPT, CSCS

John Rusin, DPT, CSCS

Dr. John Rusin is a coach, speaker, and writer who runs a sports-performance physical-therapy practice in Madison, Wisconsin.

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