The Affect of Grip Width on Bench Press Performance and Risk of Injury

Abstract

summary: Bodybuilders, athletes, and recreational lifters select a grip width during the bench press that they believe will produce a greater force output. Research has demonstrated that a wide grip (> 1.5 biacromial width) may increase the risk of shoulder injury, including anterior shoulder instability, atraumatic osteolysis of distal clavicle, and pectoralis major rupture. Reducing grip width to <=1.5 biacromial width appears to reduce this risk and does not affect muscle recruitment patterns, only resulting in a +/-5% difference in one repetition maximum.
(C) 2007 National Strength and Conditioning Association

Full text

The Affect of Grip Width on Bench Press
Performance and Risk of Injury
Carly M.Green,CSCS
Sports Injury Specialist Clinic, Gidea Park,Romford, United Kingdom
Paul Comfort,MSc,CSCS
London Sports Institute,Middlesex University,Queensway, Enfield, London, United Kingdom
© National Strength and Conditioning Association
Volume 29,Number 5, pages 10–14
Keywords: bench press; injury; performance; glenohumeral joint;
pectorialis major
Weight training, as an increas-
ingly popular culture, was es-
timated to attract more than
40 million Americans in 1998 (18), with
an increase in the number of athletes
and coaches using resistance training to
supplement their sport-specific training
regime and regular gym users training
for aesthetic purposes. The bench press
is a very popular exercise, especially for
individuals seeking aesthetic improve-
ments. However, due to incorrect tech-
nique, individuals are at risk from acute
shoulder injuries involving a sudden
traumatic episode, such as a rupture of
the pectoralis major, during the bench
press (4, 20).
The musculoskeletal system of the
glenohumeral joint has to provide a
base of support for the motion of the
barbell during the bench press. The
performance of the bench press may
place the glenohumeral joint in a posi-
tion approaching 90° of abduction, and
the position may include some external
rotation. Ninety degrees of abduction
combined with end-range external ro-
tation (Figure 1) has been defined as
the “at-risk position” that may increase
the risk of shoulder injuries (10). It has
been reported that a hand spacing of ≥2
biacromial width (shoulder width as
defined by the distance between
acromion processes) increases shoulder
abduction above 75°, whereas hand
spacing <1.5 biacromial width main-
tains shoulder abduction below 45° (8).
However, the level of external rotation
is minimal during the flat bench press,
but increases in proportion to the angle
of inclination during the incline bench
press.
Acute injuries (rupture of pectorialis
major) and chronic over-use injuries
(anterior instability and atraumatic os-
teolysis of the distal clavicle) are com-
mon. The risk of both acute and chronic
shoulder injury may be increased by
repetitive movements performed with
the shoulder close to the 90° of abduc-
tion, as seen during the bench press
when performed with a grip >1.5 times
bi-acromial width (10, 19, 20). This risk
may be increased with a greater level of
external rotation, leading to the at-risk
position.
Mechanism of Injury
During the bench press extension of
the shoulder on the descent phase caus-
es increased traction to the acromio-
clavicular. Technique performance er-
rors (10, 16, 18) increase the risk of
anterior instability, atraumatic osteoly-
sis of distal clavicle, and pectoralis
major rupture (10, 19, 20). Exercises
reported to produce pain include wide-
summary
Bodybuilders, athletes, and recre-
ational lifters select a grip width
during the bench press that they be-
lieve will produce a greater force
output. Research has demonstrated
that a wide grip (>1.5 biacromial
width) may increase the risk of
shoulder injury, including anterior
shoulder instability, atraumatic os-
teolysis of distal clavicle, and pec-
toralis major rupture. Reducing grip
width to ≤1.5 biacromial width ap-
pears to reduce this risk and does
not affect muscle recruitment pat-
terns, only resulting in a ±5% differ-
ence in one repetition maximum.
10 October 2007 •Strength and Conditioning Journal

grip bench press, incline flys, and be-
hind-the-neck military press, all of
which position the humerus into ab-
duction and external rotation (10, 16,
18).
The loads, repetitions, and sets per-
formed in weight lifting encourage
over-use, chronic-type injuries as ath-
letes will perform 1–12 repetitions
with loads of 80–100% of the one-rep-
etition maximum (17). A variety of
techniques, such as super sets and com-
pound sets, eccentric contractions, and
forced repetitions to muscle failure, are
used by athletes (7, 18) combined with
a number of different exercises (varia-
tions of shoulder press, pec-dec, pec-
toral flys), leading to muscular fatigue
(10). The use of forced repetitions and
eccentric repetitions increase the load-
ing on the skeletal and musculo-tendi-
nous structures and further increase
the risk of injury, especially if used reg-
ularly. Case studies have indicated that
ruptures of the pectoralis major may
occur during the eccentric loading
phase when the musculo-tendinous
junction is at its highest point of
stretch; therefore, regular use of eccen-
tric repetitions may increase the risk of
this injury (4).
The repetitive nature and use of heavy
loads in weight training may provide a
fertile environment for chronic injuries
(18), and it is normal for athletes to
push themselves to the highest weight
limit possible in spite of pain (16),
thereby increasing the risk of injury.
A grip of more than 1.5 biacromial
width increases shoulder torque by 1.5
times that of a narrow grip (8), thus
increasing the risk of injury. Research
has also demonstrated that altering
grip width from 100% biacromial
width up to 190% does not signifi-
cantly (p> 0.05) affect recruitment of
the pectorialis major or the anterior
deltoid; however, the narrower the
grip, the greater the activation of the
triceps brachii (6).
It is the general consensus that the use
of a narrow grip during the bench press
produces less stress for the acromio-
clavicular joint, the inferior gleno-
humeral ligament, and the pectoralis
major (8, 11). By adjusting hand spac-
ing to no more than 1.5 biacromial
width, the component angles of abduc-
tion can be decreased. This in turn will
decrease the peak torque and stress oc-
curring at the shoulder joint (8, 11),
thereby potentially decreasing the risk
of injuries to these structures. It is in-
teresting to note that one article de-
tailed that the narrow grip caused pain
for patients with osteolysis of the distal
clavicle (2); however, as this was not
noted in any other research and because
the exact distance of the grip was not
expressed, it is possible that the nar-
rower grip was still greater than 1.5 bi-
acromial width.
The major mechanisms of injury sug-
gested within the literature are:
• Hand spacing >1.5 ×biacromial
width (1, 8, 13).
• High or intolerable exercise dose or
repetitive strain (2, 5, 10, 18).
• Altered proprioception (postinjury)
(8, 15).
Common Injuries
Anterior Glenohumeral Instability
Anterior glenohumeral instability, de-
fined as the inability to maintain the
humeral head centred in the glenoid
fossa, appears to be the most common
shoulder injury experienced by competi-
tive weight lifters (19). Anterior shoul-
der stability is largely dependant on the
inferior glenohumeral ligament (IGHL).
The IGHL is found attached to the ante-
rior inferior aspect of the humeral head
and to the anterior glenoid and labrum.
The IGHL is responsible for restraining
anterior translation at 90° of abduction;
if the IGHL is damaged, the shoulder be-
comes more susceptible to anterior insta-
bility (19).
Anterior instability is considered a
chronic condition that may occur in
individuals who regularly perform
weight-training exercises with the
11
October 2007 •Strength and Conditioning Journal
Figure 1. At-risk position.

shoulder approaching 90° abduction
and may be increased with external ro-
tation (10). However, losing control of
a heavy load during a lifting exercise is
the most common mechanism for
acute subluxation or dislocation and
concurrent instability (16).
Atraumatic Osteolysis of the
Distal Clavicle
A stress-failure syndrome of the distal
clavicle is a pathologic process of bone
destruction to the subchondral bone
of the distal clavicle (2). The injury
appears to be a chronic condition
mostly caused by repetitive weight-
training exercises, as seen in body-
builders and powerlifters (20). The
weakness of the clavicles makes this
area of the shoulder girdle highly sus-
ceptible to trauma (11). The extension
mechanism of the shoulder during the
eccentric phase of the bench press ex-
cessively stresses the acromioclavicular
joint and is thought to contribute to
osteolysis of the distal clavicle (18)
caused by repetitive microtrauma dur-
ing weight lifting (20).
Atraumatic osteolysis of the distal clavi-
cle appears to be caused by repetitive
movements performed with the shoul-
der at 90° abduction, which is ap-
proached during the bench press when
performed with a grip >1.5 times biacro-
mial width (10, 20) and worsened if ex-
ternal rotation also occurs, as seen in the
inline bench press and behind neck
press.
The incidence of osteolysis mimics the
increase in the number of athletes using
strength training, although large num-
bers of weight-lifting subjects with oste-
olysis do not seem to exist (2).
Pectoralis Major Rupture
A rupture of the pectoralis muscle oc-
curs mainly during strength training
and especially during the bench press
(11). It is characterized by a sudden
acute injury often occurring during the
eccentric loading phase when the mus-
culo-tendinous junction is at its highest
point of stretch (4). Due to the twisting
orientation of the inferior pectorialis
fibers that converge onto the proximal
aspect of the humerus, the inferior fibers
of the pectoralis major are at a higher
risk of trauma (11). The injury occurs
during the concentric phase after the ec-
centric lowering that stresses the inferior
pectorialis fibers as the humerus con-
trols the barbell up to finish the press
(1). When the glenohumeral joint is in
extension during the descent phase
where the bar touches the chest, the pec-
toralis muscle is stretched and contract-
ed and it is the load in this position that
forces the inferior pectorialis fibers to
tear. The inferior fibers are lengthened
disproportionately during the final 30°
of humeral extension, creating a me-
chanical disadvantage during the eccen-
tric phase, resulting in an increased risk
of injury (21).
Ruptures occur commonly at the tendi-
nous insertion on the humerus after ex-
cessive weight is applied to a maximally
contracted muscle (5). Prior research
noted that 24 out of 33 subjects suffered
a pectoralis rupture during power lifting
and bodybuilding with a bench-pressing
mechanism (1).
Bench Press Performance
The bench press should be performed
with a grip <1.5 biacromial width,
lowering the bar in a slow, smooth,
controlled manner to the lower por-
tion of the pectorals (Figure 2) to re-
duce the level of abduction and rota-
tion at the shoulder. The bar should
move through the same plane of mo-
tion during the lifting phase, but
should be more rapid.
The action of the bench press has a var-
ied kinematics pattern (13). The more
experienced lifter will control the bar to
and from the chest following a path that
keeps the lever arm closer to its center of
gravity (using a narrow grip <1.5 biacro-
mial width, lowering the bar to the
lower portion of the pectorals), which is
created by the support base of the gleno-
humeral joint. The experienced lifter
will also take longer to complete the ex-
ercise, therefore resulting in a decrease
12 October 2007 •Strength and Conditioning Journal
Figure 2. Mid-range bar position.

in force exerted on the musculo-tendi-
nous junction (13).
Research has demonstrated a nonsignifi-
cant difference ±5% (p> 0.05) in one
repetition maximum with a grip width of
100% and 200% biacromial width, (3,
12). Electromyographic results showed
that grip width did not significantly af-
fect activity of the sternocostal head of
the pectorialis major (p> 0.05). Howev-
er, the narrow grip significantly in-
creased the activity of the clavicular head
(p< 0.01) and the activity of the triceps
brachii (p< 0.05) compared to the wide
grip (3, 12). Therefore, this demonstrat-
ed that force is not dramatically reduced
and neither is there a reduction in the
contribution of the pectoral muscles
when grip width is reduced.
It may also be advisable to avoid incline
variations of the bench press, unless the
angle is specific for sports performance,
as this will lead to a greater level of exter-
nal rotation and possibly an increase in
the risk of injury. Research has also
demonstrated that the level of inclina-
tion does not alter activation of the clav-
icular (upper) portion of the pectorals,
but does decrease activation of the ster-
nal portion, resulting in a reduction in
force (9).
Recommendations
To potentially minimize the risk of in-
jury, the bench press should be per-
formed with a grip ≤1.5 biacromial
width to maintain shoulder abduction
within 45° (8, 10). It has been suggested
that the descent phase should finish 4–6
cm above the chest (11), and the nar-
rower grip width could potentially re-
duce the risk of injury by reducing the
level of stretch on the inferior pectorialis
fibers. However, this would only be ap-
plicable to the recreational lifter, as
competitive power lifters must lower the
bar and touch the chest prior to the lift-
ing phase. The adjustments to the grip
width will decrease the angle of abduc-
tion and possibly external rotation at the
shoulder, in turn potentially reducing
the risk of shoulder injury without alter-
ing the benefits or performance of the
exercise (3, 6, 12).
It is also essential that altering technique
loads are reduced to allow increased lev-
els of proprioception and perfection of
the new technique (10), especially if re-
habilitating postinjury, as this can result
in reduced proprioception, and the coac-
tivation of rotator cuff muscles can be al-
tered greatly, leading to an increased risk
of recurrent instability (15). ♦
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Carly M. Green is a Graduate Sports Re-
habilitator, Strength and Conditioning
Coach, and the Founder and Director of
Sports Injury Specialist Clinic (SISC).
Paul Comfort is a Senior Lecturer and
Strength and Conditioning Coach, Lon-
don Sports Institute, Middlesex Univer-
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14 October 2007 •Strength and Conditioning Journal
Green
Comfort