Advanced Programming Principles for Shoulder and Knee Health

The whole point of strength work is to balance the body and make it more resilient, not increase the risk of injury.

First things first: I have to be honest. I have deliberately misled you with the title of this article to get you to read it. No one wants to believe they are a novice when it comes to lifting. These aren’t really advanced programming principles. Most people think they are advanced in their training or need advanced programing when frankly, they don’t. If most people had a great 5-10km run, ride, swim or row time, got strong on variations of the big six lifts (deadlift, squat, row, pull-up, overhead press, bench), did a fair bit of mobility work, and got a decent amount of movement variety, then we’d all be pretty damn fit.

What many people lack in their programming is balance. There is a bias toward training the “mirror muscles,” and general overuse. Repetitive motions or positions like excessive overhead work, pressing, or squats can lead to shoulder and knee injuries, something that we currently have an abundance of.

Programming for Balance

It is of critical importance for strength development and injury prevention to balance the shoulders by balancing pushing and pulling in the vertical (frontal) and horizontal (sagittal) planes. Likewise, you must balance the lower body between quad- and hip-dominant pushing and pulling.

Typical hypertrophy-based programs can be very anterior-chain dominant. The body never works in isolation. Even on “arms day,” we are working the anterior shoulder and chest as well. On “back day,” lat pulldowns and pull ups still overload the anterior shoulder, utilize shoulder internal rotation, and the chest musculature. They do not balance out all the pushing and chest exercises, unlike the row and its variations such as face pulls, which are often last in the order of exercises, if included at all.

I like to break my upper body programs into horizontal push and pull exercises, and vertical push and pull exercises. These distinctions help to create balance, and allow us to even up the load and volume. Looking at the lower body, it would be easy to just separate things into lower body push or pull. It would also be easy to put all squat and lunge variations into the quad-dominant realm. But it doesn’t actually work out that way.

Mike Robertson proposed a better way of thinking about it:

  • Angled Torso + Vertical Tibia = Hip Dominant
  • Vertical Torso + Angled Tibia = Quad Dominant
Quad Dominant Gray Area Hip Dominant
Front squats

High bar back squats

Bulgarian split squats

Most lunges

Leg press

Low bar back squats

Sumo deadlifts

Trap bar deadlift

Conventional deadlifts

Romanian deadlifts

Box squats

Hip thrusts

Kettlebell swings

Single-leg Romanian deadlifts

Nordic hamstring curls

The thing is, even this isn’t black and white. If you start any of your deadlifts with your knees more forward, like in a trap bar deadlift, it becomes more quad dominant. If you take a long lunge and keep the tibia vertical, drive off the lead foot heel and angle the torso forward (it’s a pretty cool pistol progression) it becomes more hip dominant. How you perform an exercise can often determine whether something is more hip or quad dominant.

Muscle Balance and Injury Prevention

Why balance the quads and hips? The functional hamstring-to-quad ratio refers to the ability of the hamstrings while lengthening (eccentrically) to brake the quads shortening (concentrically). This is important because if the ratio isn’t 1:1, you could be setting yourself up for injury. Let’s put this into simpler terms.

Say you’re running. As your knee straightens, your quads shorten or contract, and your hamstring lengthens. If your hamstrings are too weak, then your quads pull your hamstring faster than it can lengthen, so you end up “pulling your hammy.”

When you injure your knee—specifically the anterior cruciate ligament (ACL)—the likely cause is relatively weaker hamstrings. When you are running and stop or change direction suddenly, the femur (thigh bone) wants to continue travelling forward over your tibia (shin bone). Your hamstrings help your ACL stabilize the knee by stopping the forward movement of the femur on the tibia. If your quads are too strong compared to your hamstrings, a sudden change in direction or awkward landing can cause the knee to slide forward, and cause an ACL tear. This is particularly important to female athletes, as they are more susceptible to ACL tears.

Did  You Really Balance Your Push and Pull?

Now that we have a basic understanding of upper body pushing and pulling, and lower body pushing and pulling, some additional things to consider when programming are:

  1. Type of exercise matching
  2. Order of the exercises
  3. Load
  4. Volume

Let’s look at an example of how all of this is important to building balance and health in the shoulders.

Say today is your “chest” day, and you do 3 sets of 10 reps on bench press at 100kg. That’s 3000kg of total volume. Let’s say tomorrow is back day. What is your first exercise? For most people, it’s pull ups or lat pull downs, which are not the functional opposite of the bench press. But of course you know that, so let’s say you do a bench-supported, wide grip row, or a wide grip seated pulley row, or a bent over row, which are as close as you are going to get to the functional opposite of a bench press. You do 3 x 10 x 70kg, which is 2100kg of total volume.

If you chose a narrow grip seated pulley row, it isn’t really the functional opposite of the bench press. Just as likely, the row is not first in your program, so it doesn’t get the same focus or effort as your bench press. That aside, the load is not as high, because you are you not able to pull as much as you can push, and you end up with a 900kg difference in volume!

We haven’t even touched your accessory work yet. Most chest days have incline and decline bench press variations, as well as pec flys or crossovers, and pullovers. Back days usually have only one to two row variations, later in the order of exercises, and at a lesser load and volume. When all’s said and done, it is very easy to see how shoulders start to get banged up and we lose balance through the body.

The problems are the same on leg days; lots of squatting and lunging, and not a lot of hip-dominant pulling variations. Most people will squat or leg press considerably more volume than they can deadlift or pull from the ground. Even professional athletes with big squat or leg press numbers have disproportionately low Romanian deadlift (RDL) numbers.

The Outline of a Balanced Program

Overall, considering most people are desk-bound most of their day, it is evident we need to see a lot more horizontal pulling in our programming. Secondly, as most people are quite strong already in the quads and literally sit on their butts, they develop what has been called gluteal amnesia. What we need is more hamstring- and glute-dominant pulling exercises to balance the hips and get that functional hamstring-to-quad ratio back to 1:1.

With all that in mind, a rough example of some smart programming might look like this:

2-day Full-Body Program: Workout A

A1: Activation

A2: Power work/skill work

B1: Mobility/activation (active recovery)

B2: Horizontal pull

B3: Quad-dominant double-leg push

C1: Mobility/activation (active recovery)

C2: Horizontal push

C3: Hip-dominant single-leg pull

D: Conditioning/finisher/core

2-day Full-Body Program: Workout B

A1: Activation

A2: Power/skill work

B1: Mobility/activation (active recovery)

B2: Vertical push

B3: Hip-dominant double-leg pull

C1: Mobility/activation (active recovery)

C2: Vertical pull

C3: Quad-dominant single-leg push

D: Conditioning/finisher/core

Exercises listed as “A” are done in a superset, or tri-set for “B,” and so on. Some activation work to light up the body is followed by the highest skill, balance, or power demand work, which should come first while the athlete is fresh. I also like to use mobility or activation exercises as active recovery in between sets, rather than looking at my phone or the TV in between my main exercises. Conditioning work or a finisher is done at the end, depending on time remaining energy levels.

The Best Program Is the One Written for You

It is important to remember that injury prevention and resilience is part of performance, not separate from it. Becoming well-balanced should be every athlete’s goal. Programming needs to focus on addressing weaknesses, such as the functional quad-to-hamstring ratio and shoulder health. Strength work should, first and foremost, serve to balance out all the sport-specific training to prevent injury.

I hope this gives you some ideas on how to program this way. Rather than follow a cookie-cutter program which may not be suitable for your goals or limitations, try to integrate these principles and concepts to design your own, based on your own needs.