Concurrent extreme external rotation and abduction has been termed the "at-risk" (or 90/90) position by many practitioners, so behind-the-neck lat pulldowns and presses have been blacklisted. These individuals cite potential problems with anterior glenohumeral instability(4,5), external impingement, internal impingement (a new-age diagnosis common in overhead throwing athletes with hypermobility), acromioclavicular joint degeneration, and even the risk of intervertebral disc injuries (due to the flexed neck position). The infraspinatus and teres minor are shortened in the 90/90 position, and may therefore be ineffective as depressors of the humeral head due to shortcomings in terms of the length-tension relationship.(7)
In my opinion, you must view the two exercises independently of one another. For starters, one must differentiate between exercises involving traction and approximation at the glenohumeral joint. Pulldowns (like most cable exercises) are an example of a traction exercise, as they pull the head of the humerus away from the glenoid fossa. Various pressing exercises, on the other hand, involve approximation; they drive the head of the humerus further into the "socket." Approximation exercises increase the likelihood of subacromial impingement much more than traction exercises, and this is why exercises like pulldowns, pull-ups and shrugs can be integrated into rehabilitation programs before various presses. So, on paper, pulldowns in the "at-risk" position are less dangerous than presses.
However, in comparison to all the pulldown variations you can do in front of the neck, going BTN is just going to shorten your range of motion and reduce activation of the very musculature you?re trying to train.(11) Plus, it?s just painful to watch people do these because this exercise invariably turns into a jerking, seizure-like motion. The in-front version poses much less risk and offer a better training effect, so why anyone would opt for BTN pulldowns is beyond me. I guess it?s for the same reason some people listen to John Tesh; they just enjoy pain, misery and being looked at like they?re nuts.
In spite of the approximation issues, I think that you can make a great case for the inclusion of BTN presses for certain individuals. This position allows for comparable loads to the anterior position without compromising range of motion. If you?re considering implementing the exercise, there are several factors that must be taken into account:
1) Cumulative Volume of the 90/90 position: If you?re already doing back squats and good mornings, you?d likely be better off holding off on BTN presses in order to avoid overloading this potentially harmful position. If you decided to front squat or use a deadlift variation instead of good mornings, though, you might clear up some "space" for BTN presses. You need to consider this cumulative volume from both an acute and chronic sense. There may even be times in the year when you avoid the 90/90 position altogether.
2) Cumulative Trauma to the Anterior Shoulder Capsule: The 90/90 position isn?t the only thing that can irritate the anterior shoulder capsule. Bench pressing and pulldowns/pull-ups also contribute to cumulative stress on this area. I know that I can?t handle BTN pressing with my powerlifting volume, and I can?t say that I know many powerlifters who utilize BTN presses on a regular basis. We simply get enough stress on this front (pun intended) from squats, good mornings, and bench press variations. As is the case with #1, you need to consider both acute and chronic trauma.
3) Goal of Inclusion: Very simply, you need to ask yourself: why are you doing this exercise? If you?re someone with much to be gained from BTN presses, then they deserve much more consideration than if you?re a regular ol? weekend warrior or senior citizen who is just interested in getting in shape and staying healthy. As I noted with good mornings in Part I, it all comes down to how much you?re willing to risk.
4) Flexibility: In order to be able to perform BTN movements with the most safety, one needs to have a considerable amount of humeral external rotation range of motion. As a rule of thumb, if someone has trouble back squatting with anything narrower than an ultra-wide grip, I don?t want them doing BTN pressing.
5) Injury History: If you have a history of rotator cuff problems, I?d advise against performing BTN movements unless you?ve been asymptomatic for an extended period of time. Even then, approach the exercise with caution in your programming and carefully consider your alternatives.
6) Posture: This issue parallels #4 for several reasons. First, if you?ve got significant anterior tilt and winging of the scapulae and internal rotation of the humeri, you aren?t going to have the flexibility to get into the proper position to do BTN presses. And, even if you can manage to squirm your way under the bar, when you start to press, you?ll be at greater risk of subacromial impingement due to the inability of the scapulae to posteriorly tilt with overhead pressing. This is a common scapular dyskinesis pattern related to weakness of several scapular stabilizers, most notably the serratus anterior.
Of perhaps greater concern is the tendency to want to compensate for this lack of flexibility by either flexing the neck?something you want to avoid at all costs in a weight-training context?or allowing forward head posture (where the chin protrudes off a less-flexed neck) to take over. Most people have problems with forward head posture, so the last thing you want to do is reinforce it.
The take-home message on BTN movements is that BTN pulldowns belong in the garbage can, and BTN presses should be used sparingly only in those who meet certain criteria, can effectively write strength training programs, and are willing to assume a bit of risk.
The above taken from EC's article found here: