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.

Power

For this case study, we will examine the bench press technique commonly used in powerlifting, focusing on maximizing strength and increasing one-rep max performance. Powerlifting requires dedicated training and significant time in the gym to overcome physiological and genetic limitations while building strength and muscle mass. Given the relatively small size of the muscle groups involved, upper-body strength development is particularly challenging. Consequently, the bench press relies on the synergy of multiple muscle groups to achieve progress. Many lifters, both competitive and recreational, seek the guidance of strength and conditioning professionals to optimize performance and prevent injuries.

Safety

Injury rates among competitive powerlifters have been estimated at 1 injury per 1,000 training hours based on a sample size of 245 (Siewe et al.). Lower-level powerlifters are at a greater risk due to limited formal instruction, leading to improper technique and increased injury susceptibility (Keogh, 2006). The most commonly injured area is the arm/shoulder (Siewe, 2011). Pectoralis major injuries are prevalent in the bench press, particularly with a wide grip that places the fibers at a mechanical disadvantage under heavy load (Lipman, 2016). Studies indicate that pectoralis major tears have become more frequent, with 76% of reported cases occurring after 1996 (El Maraghy et al.). The further the arm is abducted and internally rotated, the greater the tension and load on the pectoralis major, increasing injury risk.

A common scenario involves a recreational powerlifter experiencing sharp pain in the distal portion of the pectoralis major during the concentric portion of a heavy single repetition. The loss of power necessitates assistance from a spotter. This highlights the importance of proper technique and injury prevention measures.

Performance

Correct Technique

• The lifter maintains five points of body contact: head, trapezius muscles, gluteal muscles on the bench, and both feet on the floor.
• A closed double-overhand (pronated) grip is used in the most mechanically advantageous position.
• The bar is lifted off the rack by extending the elbow joint and shoulder, with minimal flexion and extension at the shoulder joint to avoid interference with the rack.
• From the hooks, the shoulder extends, positioning the bar over the lifter’s chest.

Incorrect Technique

• The lifter maintains five points of body contact but experiences sharp pain in the distal insertion of the pectoralis major.
• Uses a wide grip with fully extended wrist joints and excessive internal rotation at the glenohumeral joint.
• Elbows are positioned far from the body, and the bar is lowered toward the neck.
• The lifter reports pain when attempting to contract the pectoralis major, experiencing sharp discomfort even while holding the bar at the top position.

Video References for Proper Bench Press Form:

• Side View: Video
• Front View: Video
• Rear View: Video

Common Improper Bench Press Form:

• Abducting and internally rotating at the glenohumeral joint
• Scapular protraction throughout the movement
• Video demonstrating improper technique

Key Positions in Bench Press

1. Starting Position – Proper flexion of cervical vertebrae and thoracic extension (Video).
2. Isometric Flexion of the Wrist – Maintaining a neutral wrist position to transmit force effectively (Video).
3. Initiation of Eccentric Phase – Scapular retraction and depression for joint stability (Video).
4. End of Eccentric Phase – Maintaining retracted scapula, slight external rotation of humerus, and a stable thoracic position (Video).
5. Beginning of Concentric Phase – Engaging the latissimus dorsi for joint stabilization before shoulder flexion and horizontal adduction (Video).
6. End of Concentric Phase – Ensuring stability in feet, head, hips, lumbar spine, thoracic spine, and wrist positioning (Video).

Discussion and Corrective Measures

Many lifters perform the bench press without formal instruction, increasing injury risk. Incorrect positioning, muscle activation, and lack of scapular retraction are common errors leading to pectoralis major ruptures. To mitigate these risks, individuals should:

• Reduce training loads to refine technique
• Engage a strength and conditioning professional for proper cueing
• Develop motor patterns through repetition and corrective exercises

Post-injury, physical therapy is essential for recovery and reconditioning. Corrective exercises should focus on mobility, technique reinforcement, and strengthening weak areas.

Corrective Exercise Prescription

1. Scapular Protraction and Retraction – Enhancing serratus anterior activation and scapular rhythm (Video).
2. External Rotation of Glenohumeral Joint – Strengthening external rotators with constant cable tension to reinforce shoulder stability.

By following these guidelines, lifters can optimize power, ensure safety, and improve overall performance in the bench press.

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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