Several months ago, a research paper titled ‘Glenohumeral extension and the dip: Considerations for the strength and conditioning professional' [1] popped up in my Twitter feed.
This blog has been bouncing around in my mind ever since and the reason it has taken me so long to write it is that I’ve been wrestling with three different perspectives.
1. The findings of the research paper
2. The views of other coaches who engaged with the post
3. My own personal experience
I have been left questioning whether the dip should be labelled an outlaw or whether this actually points to a bigger conversation we need to have about how we train the upper body.
THE RESEARCH PAPER
If you read the research paper in isolation the chances are, you’re likely to change the way you think about the dip exercise. You even might choose to stop using it altogether.
The main premise of the paper is that the dip movement pattern places the shoulder in end range glenohumeral extension with a degree of abduction. Add in the potential high eccentric loads* and the pectorialis major could be placed under significant stress. [2] In addition, repetitive loading through the dip pattern could ‘wear loose’ the anterior band of the inferior glenohumeral ligament and contribute to anterior shoulder instability.
* This is, of course, is relative to an individuals’ strength levels and prescribed exercise intensity
THE COACHES PERSPECTIVE
The second point comes from the shared experience of some fellow and very well-respected strength and conditioning coaches. The main question as to using the dip was around the risk/reward ratio. Some of the reasons cited as to why it might not feature on the training programme include:
A) It causes pain
B) Athletes struggle to perform it well with correct technique
C) The potential benefits don’t warrant the investment of training programme real-estate and coaching time.
These are all good reasons not to include any exercise in any training programme, but especially when:
The architecture of the glenohumeral joint and the lack of supportive bony or ligamentous structures mean that passive stability is not in large supply
Range of movement around the shoulder is often sub-optimal for a variety of reasons
The quality of dynamic stability is often reduced due to poor neuromuscular control
Fatigue has a greater negative effect on joint position sense at end ranges.[3]
Combined with the findings of the research paper, the evidence for the dip to be outlawed is adding up. The risks identified in the movement pattern plus the general dysfunction often seen in an athletes’ shoulder mechanics might be enough to sway the decision.
CASE STUDY
If you’re interested in a campfire story, read this article about the 36 pec major tears that happened at the CrossFit Games Regionals in 2017. The culprit: high volume single-arm dumbbell snatches superset with ring dips performed in the fastest time possible. I mean, I almost didn’t include this link in the article because it’s an example of ridiculous programming, but it highlights the point.
Overloaded and fatigue-inducing flexion and extension patterns, both in end ranges, both in exercises with a high stabilisation requirement, in a population renowned for having smashed up shoulders.
'WE CAN LEARN MUCH FROM CROSSFIT, JUST NOT HOW TO LOOK AFTER OUR SHOULDERS'
But with this aside and everything else in mind, is it time to banish the dip and all its variations?
PERSONAL PERSPECTIVE
I think that would be a little bit hasty.
I question if whether sometimes in strength and conditioning we have become too quick to cast aside exercises that are a little bit awkward. Perhaps we tried it and subsequently saw an increase in injuries or upon reflection, an exercise didn’t return the performance improvement we were expecting. Maybe it takes too long to coach and is chewing up session time for little gain.
These are all legitimate concerns but when it comes to the dip and more broadly speaking, the shoulder, my question is, could we be decreasing our standards of expectation? Maybe the real issue is that we are letting the athlete population standing in front of us determine the parameters of what we expect the human body to be able to do.
What I currently believe to be true is that shoulders perform best when they have fewer limitations, roadblocks or weak links. The reality is that many of the participants of research studies and the athletes under our tutelage already have existing shoulder issues, whether they present as technically ‘injured’ or not.
So, to lay the blame of increased injury risk on the dip is like judging a book by its cover.
If an athlete has good range of movement, postural control, dynamic stability, muscular endurance and has earnt the right to do higher intensity upper body exercises that require them to deliver multiple motor qualities simultaneously, is the dip still so risky?
Of course not. So, therefore, it is not the fault of the exercise but more an issue with how we are training the athlete’s upper body during the period up to the time when we ask them to do a dip.
It is not difficult to increase upper body strength on a stable shoulder that moves well through full range of motion. To build and maintain this in a developing athlete population is however much more taxing than writing ‘bench press, military press and bent over row’ on a training programme. Creating long-term high performing shoulders requires more skill than this.
FINAL THOUGHTS
I wonder if we are becoming afraid and all too conservative in the way we train the shoulder. I’m reminded of the question ‘which movements should I train’? To which we would answer, ‘the ones we want to keep’.
The author of the research paper concerning the dip writes in the conclusion that ‘end range glenohumeral extension is seldom experienced to the same degree in any other resistance training exercise involving the shoulder complex’.
Is that not a reason in itself to allow the dip to stay within our circle of trust?
I believe so because;
LIFE + SPORT DOES NOT OFTEN RESPECT ONLY THE MOVEMENTS WE TRAIN IN THE GYM
Whether you use dips or not, whether you train partial range of movement, use a bar or rings or where you place the exercise within a training programme is a coaching decision. But physiotherapists, strength and conditioning coaches and trainers each have a responsibility to strive for good range of motion, neuromuscular control and appropriate strength in a range of positions that gives athletes movement options.
The point will come where we have to decide when to trade off the progression of physical literacy for sports specificity. I strongly believe however that these decisions must be made with a performance focus. Not because it is a bit ‘difficult’ to equip athletes with high performing shoulders for the duration of their career and for their enjoyment of life when they are no longer competing.
How great it would be to give athletes as many movement options as we can so they can thrive in both endeavours.
REFERENCES
[This isn't designed to be an extensive list, just a few papers you might be interested in reading]
1. McKenzie AK, Crowley-McHattan ZJ, Meir R, Whitting JW, Volschenk W. Glenohumeral extension and the dip: Considerations for the strength and conditioning professional. Strength & Conditioning Journal. 2020.
2. Provencher CMT, Handfield K, Boniquit NT, Reiff SN, Sekiya JK, Romeo AA. Injuries to the pectoralis major muscle: Diagnosis and management. Am J Sports Med. 2010;38(8):1693-1705.
3. Herrington L, Horsley I, Whitaker L, Rolf C. Does a tackling task effect shoulder joint position sense in rugby players? Physical Therapy in Sport. 2008;9(2):67-71.