Your shoulder hurts.
The pain started out as a little “twinge” after you trained your chest. Now it hurts whenever you lift your arm.
You’ve been training through the pain, hoping it will just go away.
But it hasn’t. In fact, it’s getting worse rather than better.
This is a common problem. Train hard enough and long enough, and chances are that you’ll end up experiencing some kind of shoulder pain.
Yesterday, I was talking to a guy in the gym who’d injured his shoulder. The pain and damage had been accumulating over time, but he just ignored it. Then one day, something went “pop” and he had to take a few months off training.
Now he’s back, using the exact same routine that led to the injury in the first place. As a result, the pain in his shoulder is likely to make an unwelcome return sooner rather than later.
Today, I want to take a trip back in time and look at some of the steps he could have taken to avoid getting injured in the first place.
Make Your Shoulders Stronger
Most people think of the shoulder muscles as the deltoids and traps. But there’s also a network of smaller muscles that are called into action whenever you move your shoulder, many of which you’ve probably never heard of.
Opposing muscle groups pull in opposite directions to control the joints they cross. Think of it like a tug-of-war. If one set of muscles becomes so strong that it completely overpowers its partner, you’ll end up with a shoulder that’s as unstable as the current geopolitical situation in Eastern Europe.
More often than not, the first sign of this instability is a pain in your shoulder.
The shoulder joint, also known as the glenohumeral joint, is a ball-and-socket joint. The “ball” of the joint is the top of the upper arm bone. The “socket” is formed by the glenoid fossa, which is found on the edge of your shoulder blade.
The ball doesn’t actually fit into the socket. Rather, it sits on top of it, a little like a golf ball sits on top of a tee. The ball is kept centered on the tee by a set of muscles known as the rotator cuff .
Most advice on shoulder injuries centers on the rotator cuff, and not without good reason. Without it, your shoulder would fall apart. However, while the rotator cuff is important, it’s only half the story.
If you want to eliminate any muscular weakness that may be contributing to shoulder pain, your best bet is to train both the rotator cuff and the muscles controlling the shoulder blade [1, 2]. It’s not unusual for several of these muscles (particularly the lower traps and posterior rotator cuff) to be relatively weak, even in people who have been lifting weights for several years .
Here are five simple exercises that work the posterior rotator cuff, serratus anterior and lower trapezius, all of which play a key role in shoulder stability [3, 4].
Bilateral External Rotation
Side Lying External Rotation
Cable External Rotation
Perform them in the following order 2-3 times per week at the end of a workout. Pick one of three external rotation movements, then do a different one in the next workout. The idea is to do all three over the course of three workouts.
Y Raise 3 sets x 10-15 repetitions
Dumbbell Protraction 3 sets x 10-15 repetitions
Bilateral External Rotation 3 sets x 10-15 repetitions
OR Side Lying External Rotation 3 sets x 10-15 repetitions
OR Cable External Rotation 3 sets x 10-15 repetitions
This routine is just a template, and a relatively basic one at that. But if all you want is a quick and simple way to keep your shoulders healthy, it will do the job just fine.
How much weight should you use in each exercise?
For your muscles to grow stronger, they need to be trained rather than just exercised. The weight should be challenging, but not so challenging that you can’t perform the exercise properly.
If the weight is too light, increase it. If you can’t increase the weight without compromising your technique, then add repetitions. Although you should steer clear of muscular failure, don’t limit yourself to the same weight and fixed number of repetitions week after week.
Lift in the Scapular Plane
One quick and simple way to relieve shoulder pain is to move your upper arms closer to the center line of your body. In other words, rather than positioning them straight out to the side (the 0° position in the image below), your arms should be tucked in at an angle of around 30° degrees.
This is known as lifting in the scapular plane. It reduces the stress placed on the “anterior capsuloligamentous structures” and prevents impingement of the rotator cuff under the shoulder blade . It’s a much more shoulder friendly position during many exercises, particularly the overhead press and lateral raise.
Retract and Depress
You’ve probably heard how important it is to do at least as many pulling as you do pressing exercises. Although this is good advice, there are some caveats.
Firstly, you need to consider your starting point. If the training program you’ve been using up to this point has involved lots of pressing and very little pulling, chances are there’s going to be some kind of muscular imbalance that needs to be fixed.
If you’re starting out with a muscular imbalance, your training program will need to be imbalanced in order to correct it.
It’s also a good idea to have a balance between horizontal and vertical pulling movements, as well as horizontal and vertical pushing movements. In other words, don’t focus exclusively on pull-ups or pulldowns at the expense of rows. Equally, any horizontal pressing should be balanced out by an equivalent amount of overhead work.
Second, you need to make sure that you’re performing each exercise properly. A lot of people use too much weight on pulldowns and rows, and end up swinging and jerking the weight from point A to point B.
As a result there’s very little scapular retraction (pulling the shoulder blades together) or depression (pulling the shoulder blades down) going on. This means that some of the muscles involved in shoulder stability are missing out on the stimulation they’d otherwise receive.
Put differently, even if your training program involves a balance of pressing and pulling exercises, it’s still possible that the muscles responsible for retracting and depressing your shoulder blade — most notably the rhomboids and middle/lower fibers of the trapezius — aren’t as strong as they could be.
With any vertical pulling exercise (e.g. lat pulldown or chin-up), make sure that your shoulder blades come down and together. Likewise, the shoulder blades should be pulled back during any horizontal pulling movement (e.g. seated cable row).
Fix Your Bench Press
When it comes to shoulder pain, it’s usually the gradual and progressive accumulation of damage that’s responsible. It’s rarely the case, with the exception of a traumatic injury, that one single exercise is to blame.
But if there was, it would be the bench press.
Unfortunately, the way a lot of people do it anyway, the bench press is responsible for more than its fair share of injuries. Before you give up on it altogether, here are some simple steps you can take to ease the pain in your shoulders.
Arch your back. When you’re lying on the bench, your lower back should be slightly arched rather than flat against the bench. For most people, maintaining the natural curve of the lower back is sufficient. Unless you’re a powerlifter, there’s no need to arch your back to the extent that your hips come off the bench.
The video below, which comes courtesy of Jim Smith of Diesel Strength and Conditioning, shows the correct starting position. Although Jim is using dumbbells, the same rules apply if you’re using a barbell.
Tuck your elbows in. The stock answer usually given to anyone who finds the bench press painful is to use dumbbells instead. This isn’t bad advice, but you also need to consider the position of your hands and elbows.
More specifically, if your elbows are out wide and your palms face forwards, that’s exactly the same position they’re in if you’re using a barbell. If the barbell bench press causes pain, then doing the same thing with dumbbells isn’t going to help.
Rather than flare your elbows out to the side, or going to the other extreme and tucking them all the way in, they should be somewhere in between.
The video below explains how to position your arms during the bench press.
Lift your chest. Just before you lower the bar, take a big breath in and allow your chest to rise. This helps to ensure your shoulder blades stay back. Make sure to keep your chest lifted and shoulders pulled back throughout the entire rep.
Keep your feet on the floor. Not only is the “feet off the floor” position unstable and potentially unsafe, it also reduces the amount of weight you can lift. The people benching the most weight are usually the ones with their feet planted firmly on the floor.
Don’t go too wide. Your hands should be slightly wider than shoulder width apart, which means that the index fingers will be around 25 inches (64 cm) apart, give or take a few inches on either side.
A wide grip does allow you to lift more weight, as well as increasing muscle activity in pectoralis major. The figure below is taken from a study looking at the difference in muscle activity between a shoulder width (the index fingers lined up with the acromion process, which is the bony bit on top of your shoulder) and wide (twice shoulder width) grip .
Although there was an increase in muscle activity with the wide versus the narrow grip, the difference between the two is relatively small. It’s a difference that will diminish even further if you set your grip somewhere between the two extremes.
What’s more, muscle activity during the bench press will drop to zero if you can’t do it anymore because you’ve destroyed your shoulders by using an extremely wide grip. Ideally, your hands should be positioned no wider than 1.5 times the width of your shoulders .
Here’s a good example of what your bench press should look like.
The feet are in contact with the floor rather than shuffling around all over the place, the back is arched (but not excessively so) and the chest is lifted. The elbows are tucked in slightly and the grip isn’t too wide. In fact, you could go a little wider without compromising the health of your shoulders.
Tweak and Tinker
There are certain exercises — upright rows, dips, flyes and anything that involves pressing or pulling behind your head — with a reputation for causing shoulder pain.
That’s not to say that performing these movements is a cast-iron guarantee that you’ll end up with a shoulder injury. But there are more shoulder-friendly options available.
If a particular exercise causes pain, the solution is simple. Stop doing it, and find a similar one that doesn’t. Despite dogmatic assertions to the contrary, there is no single “must do” exercise that can’t be replaced with something else.
For example, you might find that performing a pull-up or lat pulldown with your palms facing forward causes pain in your shoulders. If so, try bringing your hands closer together and turning them round so that your palms face you.
If pressing a barbell over your head causes pain, switch to dumbbells and use a neutral grip with your palms facing each other. You can also try the kneeling landmine press, which is somewhere between a vertical and horizontal pressing movement.
Kneeling Landmine Press
Something else to consider is your range of motion. There are many different body types, and some people are built in a way that makes them more likely to suffer from shoulder problems than others.
If you have long arms and a small rib cage, bringing the bar all the way down to your chest during an exercise like the bench press means that your shoulders have to go a lot deeper into extension than someone with short arms and a large rib cage.
It may be the case that no matter what you do, you won’t be able to perform any horizontal pressing exercises through a “full” range of motion without pain in your shoulders.
If so, try the decline bench press or even the floor press, both of which involve a much shorter range of motion than the flat bench press.
Ignorance Is Not Bliss
You can often relieve shoulder pain simply by avoiding the exercises that cause it. But rest by itself is rarely enough. Unless you fix the root cause, there’s a good chance the pain will return when you go back to your old routine.
If your shoulder hurts, don’t ignore it. Training through pain can lead to a serious injury that could take months to heal, and may even need surgery.
Popping a few pain killers isn’t a great idea either. Anti-inflammatory pain killers (NSAIDs) have been shown to slow the healing of injured muscles and tendons. Used on a regular basis, they could make an injury worse, either by weakening connective tissue or limiting its ability to adapt to exercise.
Unfortunately, I can’t tell you how to treat a shoulder injury because I have no idea what’s causing it. And I’m not a therapist or doctor, so it’s outside my area of expertise to diagnose anything anyway.
Shoulder impingement syndrome, which is probably the most common disorder of the shoulder, covers a range of different injuries, from subacromial bursitis to a full-thickness rotator cuff tear.
However, a syndrome is just a collection of symptoms. It’s not a precise diagnosis. Even if the symptoms are identical, the underlying injury, as well as any deficit in strength and/or flexibility that may have contributed to that injury, could be very different .
In other words, there are many different things that could be causing the pain, and no single set of guidelines or exercises that will “fix” all shoulder injuries all of the time.
Some minor twinges and niggles can often be worked around, and tend to resolve themselves over time. But if the pain persists, it’s worth getting it checked out by a physical therapist rather than trying to sort it out yourself. Self diagnosis isn’t always accurate, and can lead to problems getting worse instead of better.
Any exercise program designed to treat a shoulder injury by correcting a deficit in strength and/or flexibility should be based on a patient-specific assessment rather than general advice. A good physical therapist will be able to identify any muscles that are weak or “tight” and tell you how to correct the problem.
Find one that specializes in shoulder injuries. A therapist with experience of working with overhead athletes (e.g. cricketers, tennis players, or swimmers) is likely to have come across many people with the same injury, and will know the fastest way to get you back in the gym and lifting pain-free again.
If you enjoyed this post, there’s a good chance you’ll also like Truth and Lies about Building Muscle: 10 Muscle Myths Debunked By Science.
It's a FREE 20-page special report (PDF) I put together to debunk 10 popular myths that are still widely believed, despite all the evidence to the contrary. You can download a copy here.
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About Christian FinnChristian Finn holds a master's degree in exercise science, is a certified personal trainer and has been featured on BBC TV and radio, as well as in Men's Health, Men's Fitness, Fit Pro, Zest, and Perfect Body magazine. You can contact Christian using Facebook, Twitter, Google+ or via e-mail.
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