Pull-Up Pain: Grip Position Matters
Grip position matters when it comes to pull ups.
Pull up training is a core training exercise for climbers.
I likely prescribe grip variation more often than most (for rehabilitation purposes), but coaches must also understand the difference. The implications on your athletes are significant, especially those with shoulder and elbow pain.
see the difference:
The images above show the three most studied grip positions and muscle activity during each portion.
Here's what we find when we look closely at the EMG data on specific grip positions.
Regular grip: Increased demand for elbow flexion (Bicep Brachii and Brachialis).
Reverse grip: Increased muscle stress in the bicep, tricep, and infraspinatus muscles.
Wide grip: Increases muscle activity in the trapezius, lat, and rhomboids. Reduced activity in the supraspinatus.
The eccentric portion of the pull up increases the abrasive effects on tendons around the shoulder joint. The deltoid muscle elevates the humeral head into the AC joint upon lowering. This increases physiologic impingement and could be an injury risk at too high a dosage. This is particularly problematic with fatigue during pull up training.
Impingement risk is highest in the lower portions of the movement (20-60%). The wide grip starting position reduces subacromial space and increases this risk. In this position, the bicep long head serves to depress the humeral head.
Key takeaways:
Elbow flexion is secondary to moving the arm towards the trunk (adduction/extension) during the pull up.
Grip position changes load sharing through the deltoid and rotator cuff, mainly with the regular and reverse grips.
The reverse grip increases load to the deltoid and rotator cuff. Avoid this position with tendon pathologies. Instead, you'd be better off using the wide variation to stress the back muscles.
The regular grip loads the front of the elbow. Avoid this position with climbers elbow (front sided elbow) and front sided shoulder pain (most common in climbers).
Full range pull ups should be avoided until the end stages of rehab for clients with subscapularis tears (highest at end range).