forward by Eric Cafferty, author, and owner, The Mecca Gym

In this paper, I look in detail at the Bench Press exercise.  This movement is the cornerstone of upper body strength development and being an elite-level powerlifting coach I have devoted an extensive amount of time researching and developing techniques associated with increasing the efficiency and force production while printing injuries associated with the bench press. 

This paper is different than your typical literature on the bench press for a few reasons.  First, it highlights the key biomechanics movers of the bench press, listing out the exact muscles involved with their activities as well as synergists and antagonists in a chart format.  Next, I have included pictures and videos as a reference and a guide to assist in evaluating the technique.  Last I have included a practical and theoretical case study specifically looking at pectorals major ruptures and examples of how to prevent and potentially rehab that specific injury.  There are lessons that can be learned here to bench press with better technique, more strength, and less likelihood of injury keeping your progress coming and leading you to bigger numbers in the gym and on the platform.  As always I have included citations and provided resources for you to explore the bench press further.  ENJOY!

Introduction

The bench press is often considered the king of upper body movements and is a ubiquitous resistance training exercise.  This movement is often thought of as a chest exercise, when in fact it works almost every muscle and joint in the upper body.  The reason it is widely considered the best movement to test upper body strength is that it can be loaded with a small or large amount of resistance depending on the subject and incorporates the entire upper body.  The bench press is a ubiquitous movement performed in the gym for physical fitness as well as one of the three movements performed in the sport of powerlifting.  There are many different techniques for performing the bench press.  The subject can choose different techniques depending on the muscle groups and mechanics they would like to strengthen and practice.  For example, a football player may choose to perform a close grip bench press to strengthen the chest and triceps in the sagittal plane closer to the midline because that is specific to an offensive lineman driving into the defensive player.

For this case study, I will be looking at the bench press technique most closely associated with powerlifting and moving as much weight as possible with the intent of increasing one rep max strength.  Powerlifting is a sport that requires countless hours of training and time spent in the gym resistance training.  Those who dedicate themselves to increasing their strength spend countless hours in the gym to overcome physiological and genetic limitations and build strength and muscle mass.  The upper body can be an especially hard area to build considering the relative size of the muscle groups being used.  Therefore the bench press requires the synergy of many different muscle groups in order to progress.  It is very common for both competitive athletes and recreational lifters to hire strength and conditioning professionals to assist them in their pursuit of strength.  This will lead to not only better strength improvements but aid in injury prevention in conjunction. 

Injury rates in competitive powerlifters were calculated to 1 injury per 1000 training hours based on a sample size of 245 according to Siewe et al. Lower-level powerlifting competitors appear to be at most risk for injury (Keogh, 2006). From my professional experience, I would hypothesize that injuries are more common in lower-level lifters.  Lower-level powerlifters with less experience have had less formal instruction leading them to perform incorrect techniques and being more prone to injury.  The most commonly injured area reported is the arm/shoulder. (Siewe, 2011).

Injuries of the pectoralis major are not uncommon in the bench press.  Lehman et al. found that more muscle activity for the sternocostal head of the pectoralis major was found with a wide grip.  The most common cause of a pectoralis major tear is the bench press (Lipman, 2016) as it places the fibers at a mechanical disadvantage while under heavy load.  Once considered a rare injury, pectoralis major tears and occurring more frequently.  El Maraghy et al. found that between 1822 and 2010 76% of pectoralis major tears happened after 1996.  The bench press elicits maximum power through the Pectoralis major and disproportionately high fiber excursion of the inferior sternocostal fibers with the arm in zero to thirty degrees of extension.

With this information, one can deduce that the further the arm is abducted and internally rotated, the more tension and load are placed on the pectoralis major during the bench press. 

After a particularly heavy bench press session, recreational powerlifting complains of sharp pain in the distal portion of the pectoralis major.  The lifter experienced this on the concentric portion of the bench press on a particularly heavy single repetition.  Power was lost and a spotter had to grab the bar.

Movement Breakdown

Correct Technique:

The subject is seen supine on a bench press bench with five points of body contact.  The points of contact are the head, trapezius muscles, and gluteal muscles on the bench as well as both feet on the floor.  The subject grasps the bar with a closed double overhand (pronated) grip in the most mechanically advantageous position.  The subject lifts the bar off of the rack by extending the elbow joint and extending the shoulder.  It is important to note the subject should be in a position under the bar so that they do not have to flex and then extend at the shoulder joint more than is necessary to avoid hitting the hooks when performing the movement.  From the hooks, the shoulder will extend bringing the bar over the subject’s chest.

Incorrect Technique:

The subject in question is seen positioned supine on a bench press bench with five points of body contact. The subject has not had any previous injuries however they now experience sharp pain in the distal insertion on the sternocostal portion of the Pectoralis major.  The points of contact are the head, rear of the trunk, and gluteal muscles on the bench as well as both feet on the floor.  The subject grasps the bar with a closed double overhand (pronated) grip in a wide position.  The subject has fully extended wrist joints as well as internal rotation at the glenohumeral joint.  The subject keeps his elbows far away from the body and lowers the bar down toward the neck.  The subject complains of pain when he attempts to contract the pectoralis major.  After performing the bench press again the subject reports sharp pain even holding the bar in the top position. 

Links to a side, front and rear video with the correct bench press form can be seen here:

Side:  https://dartfi.sh/c9jmbx9Tuwf

Front:  https://dartfi.sh/3pLeewSQp35

Rear:  https://dartfi.sh/6TSdjhQj2Yc

Common improper bench press form involves beginning the lift with the glenohumeral joint abducted too far and internally rotated as well as scapular protraction.  A video demonstrating this can be seen here: https://dartfi.sh/NpFdjnkeY40

All Key Positions

Key Position 1: Starting Position. Flexion of Cervical Vertebrae and Extension of Thoracic  Vertebrae.  See the video of the key position: https://dartfi.sh/c9jmbx9Tuwf

Flexion of the cervical vertebrae is isometric during the bench press keeping the chin tucked toward the chest throughout the entire movement.  These muscles will contract to keep the head in position allowing extension in the thoracic spine throughout the movement. Extension in the thoracic spine is key in order to allow the movement of the scapula throughout the movement.  The muscles involved in flexion of the cervical spine are sternocleidomastoid (bilaterally), anterior scalene (bilaterally), longus capitis (bilaterally), longus Colli (bilaterally) (Biel, 2014).  These muscles synergistically contract to flex the cervical spine and keep the head in the proper position throughout the movement.  The extensors of the vertebral column are: Latissimus dorsi, Intertransversarii, Interspinalis, Spinalis, Semispinalis capitis, Rotatores, Multifidi, Quadratus lumborum, Iliocostalis and Longissimus. The primary muscles that produce flexion of the vertebral column are Transverse abdominis, Rectus abdominis, External oblique, Internal oblique, Psoas major, and Iliacus.  These muscles will synergistically contract in order to see the trunk tight throughout the movement so the scapula can move, the glenohumeral joint is adequately supported and leg drive can be utilized.

Key Position 2: Isometric Flexion of the Wrist. See the key position displayed in the video: https://dartfi.sh/c9jmbx9Tuwf

Proper bench press technique includes flexion of the wrist joint so that the force of the bar in the hand is transmitted directly down the forearm to the elbow.  The wrist should be in a neutral position and the load should stay stable in the hand.  This prevents force from being lost from the elbow to the bar.  The muscles recruited for wrist flexion are  Flexor Carpi radialis, Flexor Carpi ulnaris, Palmaris Longus, Flexor digitorum superficiali, Flexor digitorum profundus (assists), and Flexor pollicis longus (assists). (Biel, 2014)

Key Position 3: Initiation of Eccentric Phase. Retraction and Depression of Scapula. See the key position in the video: https://dartfi.sh/c9jmbx9Tuwf

At the beginning of the eccentric phase, the subject will retract and depress the scapula before the humorous begins extension.  Putting the scapula in this position is going to put the glenohumeral joint in the safest and most mechanically advantageous position.  This allows the latissimus dorsi, teres major, teres minor, and infraspinatus muscles to support the labrum and associated tendons and ligaments to best support the joint while under a heavy load.  The scapula depresses first, getting pinned in place by the tension from the bench and the traps, helping to depress the scapula.  The synergistic contraction of the depressors and retractors of the scapula will also aid in keeping the thoracic spine extended throughout the movement.  After the scapula depresses the scapula retracts completely, enabling the subject to begin the next phase of the movement. The muscles recruited in the retraction of the scapula are the middle fibers of the trapezius, rhomboid major, and rhomboid minor (Biel, 2014).

Key Position 4: End of Eccentric Phase. See the key position in the video:  https://dartfi.sh/c9jmbx9Tuwf

At the end of the eccentric phase, The scapula should remain retracted and depressed, the humorous should be tucked toward the trunk in slight external rotation and the rest of the body should remain tight in an isometric contraction.  The bar should be lowered to the thorax superior to the xiphoid process and inferior to the middle of the pectoralis major.  Muscles recruited in this phase function isometrically to maintain bar stability and hold the bar touching the chest.  Refer to Table 4 and Table 5 for muscle actions.

Table 5. External Rotation of Glenohumeral Joint

Key Position 5: Beginning of Concentric Phase.  External Rotation, Horizontal Adduction, and Abduction of the Glenohumeral Joint.  See the key position in the video:  https://dartfi.sh/3pLeewSQp35

At the beginning of the concentric phase, the latissimus dorsi is engaged and elicits an antagonistic contraction to the external rotation occurring at the glenohumeral joint.  This functions to stabilize the joint as the subject begins flexion and horizontal adduction.  The literature is not very clear on this but the latissimus dorsi has been shown to be more active in elite-level lifters.  The concentric phase continues with the lifter heavily recruiting muscles the flex and horizontally adduct the shoulder to bring the bar back to its starting position.  The muscles recruited in this type of shoulder flexion are the anterior deltoid, pectoralis major, and coracobrachialis (Biel, 2014). The muscles recruited in horizontal adduction are the anterior deltoid, and pectoralis major (Biel, 2014)

Key Position 7: End of Concentric Phase.  See the key position in the video: https://dartfi.sh/3pLeewSQp35

Throughout the movement the feet should stay flat on the floor with no movement, the head should remain on the bench, the hips hold to remain in isometric extension, the lumbar spine should stay in slight extension and the thoracic spine should stay arched in an extended position.   The subject’s grasp on the bar should influence a neutral wrist position and fingers should remain flexed throughout the duration of the movement.  Wrists should remain above the elbow throughout the movement.  In order to achieve this neutral wrist position, the bar should be resting parallel to the first metacarpal.  Breathing during this movement should occur before the eccentric phase and remain held using the Valsalva maneuver until the bar has reached the end of the concentric phase.  Typically the subject takes one breath before the bar is un-racked and then exhales and takes another breath at 80% of full tidal volume immediately before the eccentric phase of the movement.  The end of the concentric phase of the movement should be identical to the beginning of the eccentric phase of the movement. 

Discussion

While many individuals choose to simply lay supine on a bench and start performing repetitions on a bench press without formal instruction, doing so can be very dangerous.  The bench press is one of the most commonly performed movements in a fitness facility and has many more moving pieces than the average individual thinks through.  There are many technical directives that must be adhered to in order to minimize the risk of injury.  In the case of a pectoralis major rupture, common mistakes are abducting and internally rotating at the glenohumeral joint as well as failing to retract the scapula during the bench press.  As seen in the incorrect video example, the subject makes the mistake of not externally rotating at the glenohumeral joint, abducting at the glenohumeral joint, and failing to retract the scapula. 

While it is common for extrinsic factors to occur, intrinsic factors are harder to control.  Intrinsic factors to success with a particular movement such as proper warm-up, state of recovery, and technique are common sources of injury (Baechle, 2008).  A pectoralis major rupture has many contributors however the ones we will look at the incorrect positioning and muscle activation, putting more force and load on the pectoralis major.  In the incorrect video, you can see the subject begins the eccentric phase with the elbows flared out displaying abduction at the glenohumeral joint.  This lengthens the pectoralis major while it is already in a mechanically disadvantageous position.  This increases the risk of failure of the sternocostal head of the pectoralis major.  The second influencer of shearing force on the pectoralis major is the failure to retract the scapula before and during the eccentric phase of the bench press.  As seen in the incorrect video, the subject is laying very fat on his back as well as keeping the scapula protracted throughout the movement.  This is going to increase the stretch and pressure on the pectoralis major and lead to a higher risk for injury.  Leaving the shoulders protracted throughout the movement will limit the involvement and decrease force generation from supporting muscles of the glenohumeral joint, causing more force to be applied to the pectoralis major in an already mechanically disadvantageous position. These issues are corrected by making adjustments to the technique.  One way to start correcting techniques is by reducing loads and another is by hiring a strength and conditioning professional to give the proper cues and demonstrations.  The technique must be practiced by the individual in order to relearn the proper motor pattern.  In this case study, it is possible the supporting muscles are weak.  After recovery from a minor pectoralis major rupture physical therapy comes highly recommended (Guity 2014).  After physical therapy, the individual will still need to continue rehabilitation exercises to prevent another injury as well as exercises to influence better technique in the bench press movement.

The factors causing this injury lead me to my prescription for corrective exercises for the subject post pectoralis major rupture after a formal physical therapy regimen has been completed.

Exercise Prescription:

The first step to take with any injury is to step back and assess the area in question.  In this case study, we find a minor pectoralis major rupture.  This injury was caused by a single repetition during a single training session however it is likely that the incorrect movement pattern performed over a greater length of time left the subject more vulnerable to injury because of micro tears and a lack of recovery in the pectoralis major.  Once the subject utilizes the RICE (rest, ice, compress and elevate) technique and receives proper therapy from a physical therapist, a more accurate assessment can be made, and post-physical therapy corrective exercises can be utilized.  After a formal assessment, we determine that the athlete needs better positioning, technique, instruction, and corrective exercises to remedy the areas of weakness and perfect cueing during the bench press.

It is very common that the athlete to have poor mobility in the glenohumeral joint and has not been instructed on what the scapulothoracic joint is responsible for during the bench press.  The exercises I have prescribed will both strengthen the weak areas, improve mobility and reinforce a proper movement pattern in the bench press.  The two exercises I have chosen to influence these changes are loaded protraction and retraction of the shoulder joint and external rotation of the glenohumeral joint resisted with constant cable tension. 

Exercise 1:  Scapular Protraction and Retraction. Video Demonstration Seen Here: https://dartfi.sh/hYhkIatRZek

Isolated scapular protraction and retraction will help to influence the activation of the serratus anterior on the barbell bench press as well as strengthen the serratus anterior assisting in the scapular rhythm during the bench press. (Kim, 2019)  To perform this movement the subject will sit upright on a chest press machine.  It is important to use a machine where the resistance can be reduced to zero.  Using a machine where the muscles of the back are placed on a pad similar to a bench press is important to translate the movement to the bench press movement.  It is important to start with a low load.  The subject starts with the arms extended (in the beginning stages an assistant will have to lift the handles into position) and the scapula in a protracted position.  The subject will then retract the scapula actively forcing against the pad in an eccentric load from the weight loaded on the machine.  Once full retraction is achieved the subject will protract the scapula.  It is important to keep the elbows stationary in a near lockout position throughout the movement.  It is important to watch for elevation and depression differences from side to side.  The scapula should stay depressed throughout the movement.  See table 4 for muscle recruitment.  This exercise can be done as frequently as daily for 3-4 sets of 10 to 30 repetitions.

Exercise 2:  External Rotation of the Glenohumeral Joint.  Video Demonstration Seen Here: https://dartfi.sh/dLxR6LDB1sk

This exercise begins with the subject standing upright with a cable machine immediately to his side.  The subject grasps the handle in the hand further away from the machine with the elbow isometrically flexed at 90 degrees and the wrist kept extended in a neutral position.  The subject then externally rotates the head of the humerus in the glenoid cavity utilizing the external rotators of the glenohumeral joint (see table 5 for muscles activated).  It is important for the subject to keep the humerus and the elbow of the active arm adducted against the trunk for optimal stimulation of external rotators.  It is important to prevent anterior tipping, protraction, retraction, elevation, or depression of the scapula throughout this movement allowing the subject to focus on isolating the external rotators.  Weight should be kept light enough for an optimal technique to be performed in the 10-30 rep range for 3-4 sets.  This movement can be performed as often as daily.  It is important to continue this movement after formal physical therapy protocol. (Lipman, 2016)

If the subject experiences pain in the injured area during one of these exercises it should be stopped immediately.  The subject should then consult a professional and the load and technique should be evaluated.  If pain persists the exercise should be discontinued until the area can be evaluated by a professional.   The performance of these exercises will supplement a strength training program and will encourage rehabilitation while helping prevent weakness in the glenohumeral joint as well as strengthen the supporting muscles of the pectoralis major during the bench press.

---

References

Baechle, T. R., & Earle, R. W. (2008). Essentials of strength training and conditioning: Human kinetics.

Biel, A. (2014). Trail Guide to the Body (5th ed., pp. 275-342). Boulder, CO: Books of Discovery.

El Maraghy AW, Devereaux MW. (2012) A systematic review and comprehensive classification of Pectoralis major tears.  J Shoulder Elbow Surg. Mar;21(3):412-22

Elliot, B., Wilson, G., Kerr, G. (1989) A Biomechanical Analysis of the Sticking Region in the Bench Press.  Journal of Medicine and Science in Sports and Exercise. 20(4). https://www.researchgate.net/profile/Bruce_Elliott/publication/20377649_A_biomechanical_analysis_of_the_sticking_region_in_the_bench_press/links/59e49e910f7e9b97fbf07216/A-biomechanical-analysis-of-the-sticking-region-in-the-bench-press.pdf

Guity, M., Sharafat Vaziri, A., Shafiei, H., & Farhoud, A. (2014). Surgical Treatment of Pectoralis Major Tendon Rupture (Outcome Assessment). Asian Journal of Sports Medicine, 4(6), 129–135. Retrieved from http://search.ebscohost.com.cucproxy.cuchicago.edu/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s8419239&db=s3h&AN=97416204&site=ehost-live

Keogh, J., Hume, P., & Pearson, S. (2006). Retrospective injury epidemiology of one hundred one competitive Oceania powerlifters: The effects of age, body mass, competitive standard, and gender. The Journal of Strength & Conditioning Research, 20(3), pp.672-681.

Kim, J.-S., Kim, M.-H., Ahn, D.-H., & Oh, J.-S. (2019). Comparison of Shoulder Protraction Strength and Electromyography Activity of Serratus Anterior and Pectoralis Major in Subjects With or Without a Winged Scapula. Journal of Sport Rehabilitation, 28(3), 272–277. Retrieved from http://search.ebscohost.com.cucproxy.cuchicago.edu/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s8419239&db=s3h&AN=135355827&site=ehost-live

LEHMAN, G. J. (2005). The Influence of Grip Width and Forearm Pronation/Supination on Upper-Body Myoelectric Activity during the Flat Bench Press. Journal of Strength & Conditioning Research, 19(3), 587–591. Retrieved from http://search.ebscohost.com.cucproxy.cuchicago.edu/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s8419239&db=s3h&AN=18119469&site=ehost-live

Lipman, A., & Strauss, E. (2016). Treatment of Pectoralis Major Muscle Ruptures. Bulletin of the Hospital for Joint Diseases, 74(1), 63–72. Retrieved from http://search.ebscohost.com.cucproxy.cuchicago.edu/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s8419239&db=s3h&AN=113776702&site=ehost-live

Scott, B., Wallace, W., Barton, M.. (1992) Diagnosis and Assessment of Pectoralis major Rupture by Dynamometry.  The Bone and Joint Journal. https://doi.org/10.1302/0301-620X.74B1.1732236

Siewe J., Rudat J., Röllinghoff M., U. J. Schlegel U. J., P. Eysel P., J. W.-P. Michael W.-P. (2011) Injuries and Overuse Syndromes in Powerlifting. Int J Sports Med; 32(9): 703-711 DOI: 10.1055/s-0031-1277207.  https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0031-1277207

Vasiliadis, A. V., Lampridis, V., Georgiannos, D., & Bisbinas, I. G. (2016). Rehabilitation exercise program after surgical treatment of pectoralis major rupture. A case report. Physical Therapy in Sport, 20, 32–39. Retrieved from http://search.ebscohost.com.cucproxy.cuchicago.edu/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s8419239&db=s3h&AN=116247989&site=ehost-live