Shoulder pain from weightlifting in the gym is a very common condition in Fitness Bodybuilding enthusiasts. The shoulder joint is in fact the most prone to injury in gym-goers and weight training enthusiasts.
The pains are often described as “spiked pains inside the shoulder”, which can negatively affect the execution of the exercises or make it impossible due to the intensity of the pain, often accompanied by the fear of damage to the joints and muscles.
Shoulder Pain In The Gym: Causes And Effective Exercises
To prevent and relieve shoulder pain from weightlifting, an integrated approach is often useful, which aims to evaluate any dysfunctional pictures based on the specific knowledge of the causes and in this case of the causes of shoulder pain attributable to the specific environment of the gym.
In this sense, in-depth knowledge of the biomechanical dynamics of the exercises and of the rehabilitation clinic validated by scientific evidence is essential. Now let’s see what the symptoms and causes of shoulder pain in the gym can be, and then analyze the most effective remedies and exercises
Common Shoulder Injuries In The Gym
Shoulder pain perceived during exercises in the gym is in most cases attributable to pictures that fall within the ” subacromial pain syndrome ” with the presence of tendinopathy of the rotator cuff (in particular of the supraspinatus muscle ) and possible tendinopathy of the long head of the biceps and/or inflammation of the sub-deltoid bursa ( bursitis ).
Other pathological pictures capable of causing shoulder pain in the gym may be situations of shoulder instability (with the possible presence of a past or recent history of shoulder dislocations), often accompanied by lesions of the glenoid labrum.
The latter are frequently found in pitchers and in overhead sports athletes (such as volleyball and water polo). Problems affecting the acromion-clavicular joint are also found among the causes of shoulder pain in the gym.
Finally, shoulder pain can be caused by a problem in the cervical or thoracic spine, pain that in these cases originates from these areas and can spread to the shoulder area.
Shoulder Pain In The Gym: What Are The Symptoms
Shoulder pain felt in the gym often has a slow onset and in the absence of a real trauma that can justify it, it often begins for no apparent reason and gradually gets worse (acute phase) and then stabilizes (chronic phase).
It is generally deep, very localized, most typically anteriorly, posteriorly, or laterally on the shoulder, in a narrow area that never radiates beyond the insertion of the deltoid.
It’s a pain acute, described as a “spiked” or something “that stings in the shoulder,” or as pain like a stab, and intermittent, evoked, and reproduced each time a certain movement or exercise is performed.
The movements that can typically evoke this type of pain are abduction/flexion by bringing the arm above the head (as in Military Press), horizontal adduction by bringing the hand towards the opposite shoulder (as in the Flat Bench ) and extension bringing the hand in the rear direction (as in Pulley).
During the execution of the offending movement/exercise, there is generally a so-called ” painful arch “, with a specific part of the movement in which the pain is present and with the remaining part in which it disappears.
There are often periodic relapses of pain during periods of intense training. For some, once onset, shoulder pain becomes almost a “training partner” with whom they have to live with even for a long time.
Causes Of Shoulder Pain In The Gym
The main causes that can lead to the development of shoulder pain in the gym can be divided into causes of intrinsic nature and causes of an extrinsic nature. The intrinsic factors are the following:
- Tendon aging and degeneration, with possible correlation to age (common after 40 years), to a genetic predisposition, or to poor vascularization of the tendons. These changes weaken the tendons which are therefore less resistant to loads and more susceptible to injury.
- Excessive functional overload, which determines an alteration of the tendon matrix. For both beginners and advanced subjects, it is essential to set a rational progression of workloads and respect the recovery and tendon reconditioning times, avoiding overdoing the functional load on the shoulder.
Even approximate and suboptimal techniques of execution can contribute to increasing the risk of injuries and shoulder pain.
In this regard it is good to make a clarification: shoulder pain often manifests itself after months or years of joint wear from incorrect execution or forced exercises in predisposed subjects.
For this reason, it is good to place oneself in the perspective of prevention and applied science, abandoning the superficial mentality of “I’ve never seen anyone get hurt with …” or “I’ve always done it like this and I’ve never hurt myself …”.
In fact, there are no “totally right” or “totally wrong” exercises, but there are exercises with a more or less high-risk factor, which must always be analyzed taking into account the general context of the subject.
Among the factors of an extrinsic nature, we find some joint dysfunctions and structural alterations such as:
- Glenohumeral stiffness with consequent alterations in the alignment and biomechanics of the humeral head during shoulder movements. A common finding in those who train in the gym is the rigidity of the posterior capsule associated with laxity of the anterior capsule of the shoulder, with the humeral head placed before it.
- Morphology of the “hooked” acromion and advanced osteoarthritis of the acromion-clavicle joint (conditions typically reported in subjects over 40 years of age).
- Glenohumeral instability is caused by the poor performance of the rotator cuff muscles (weakness or poor resistance and motor control) and scapular stabilizers, resulting in poor humeral head control during shoulder movement, with excessive upper migration of the humerus in abduction. This condition is typical in very lax people or in people who have undergone shoulder surgery.
- Alteration of normal static alignment and normal scapular dynamics during shoulder movement
- Combination of some movements such as abduction and internal rotation, and abduction and anterior scapular tilt, which by their nature increase the compressive stresses on the subacromial soft tissues.
- Postural alterations such as thoracic hyperkyphosis and interposed shoulders.
Shoulder Pain During And After The Bench Press
The barbell bench press is one of the exercises that put the most strain on the joint complex of the shoulder, and consequently, there are really many people who develop shoulder pain when doing this exercise.
The pain in the shoulder felt during the flat bench press and in similar exercises (inclined bench press, crosses, push-ups, etc …) usually presents with the characteristics described in the previous paragraphs.
The typical painful arc corresponds to the first degrees of movement, all beginning of the concentric phase when the barbell or dumbbells are pushed from the chest.
The pain usually tends to vanish once this range of motion is overcome, and then recur in the same way in the next repetition.
The possible causes of this pain can also be found among those previously mentioned: shoulder pain during bench pressing is in fact often accompanied by pictures of ” subacromial pain syndrome ” and tendinopathy of the rotator cuff muscles and/or the long head of the biceps, with the possible association of bunions.
In these cases, there are also often situations of functional overload, little gradual training, joint dysfunctions such as the stiffness of the posterior capsule.
Both static and dynamic impaired scapular alignment can also contribute to pain, particularly shoulder pain when the arm is raised.
In general, we can say that a badly positioned scapula at the start (static alignment) or one that moves badly (dynamic alignment) is one of the main contributing factors to shoulder injuries in a fitness environment.
The width of the subacromial space is strictly influenced by the intimate relationship between the humerus and the scapula.
The condition that most increases the compression of soft tissues during movement is the association of abduction and internal rotation.
A combination of movements of this type is easily reproduced during improper performances on the flat bench.
Performing the bench without the correct scapular position is very unstable and can easily generate unwanted internal rotation of the humerus, especially if the trajectory is not linear and the subject is fatigued.
This can be easily seen by observing the subject from above, pushing by bringing the elbows “up” and losing linearity with the wrist.
The anterior scapular tilt is also a condition in which the subacromial space is decreased in width, exposing the soft tissues to a greater risk of compressive stress.
It is a static picture typical of those who carry out sedentary jobs, with hyperkyphosis and shoulders placed in front. Greater attention to the correct technique of performing the exercises must be paid to these subjects.
The flat bench (and in general all the push exercises while lying down) create inertial forces that bring the scapula into this particular alignment, exposing the shoulder to potentially damaging forces.
For this reason, the correct scapular structure must be treated in a maniacal way, which will increase the width of the sub-acromial space (adduction, depression, and posterior tilt) during the execution of these exercises.
The remedies for shoulder pain in the flat bench press will be based on the avoidance/limitation of the painful lines of motion and on the adaptation of the offending exercise (in our case the bench press) through a change of the work surface and/or the ROM movements.
In some cases it will be useful to temporarily replace the execution of this exercise with a barbell with the same exercise performed with dumbbells, as these allow a greater joint release, thus resulting in more adaptability and functionality in the search for a painless movement plan.
During the execution of the bench, it will also be essential to maintain a correct scapular position in scapular retraction, depression, and posterior tilt.
The trajectory must also be taken care of, with a thrust that from the lower sternum will reach the level of the neck and chin, avoiding “raising” the elbows.
From a programming point of view, it will be important to modulate the training parameters in the best possible way, being careful not to exceed the training volume and with the loads and avoiding (in case of pain) work to failure, long series with final fatigue that the structure and the executive technique, and forced repetitions.
On the other hand, jobs with a large buffer and a gradual progression of loads will be preferred.
The inclusion of some exercises aimed at correcting possible muscle and joint dysfunctions can be very useful.
These include mobility and proprioception exercises, capsular and muscle stretching exercises (small and large pectoral muscles), and strengthening exercises for the stabilizing muscles of the scapula and for the rotator cuff.
Shoulder Pain During Slow Forward (Or Military Press)
Another category of exercises that very frequently is involved in pictures of shoulder pain is the one that concerns the so-called “overhead” exercises, such as the Lento Avanti or Military Press, proposed in order to stimulate muscles such as the deltoid and the upper trapezius and to train the upward thrust movement.
Also in this case the pain is often intermittent and highly reproducible, described as “a pin” or a twinge anteriorly, posteriorly, or laterally on the shoulder.
The painful range of motion, in this case, tends to be reported approximately between 60 ° and 120 ° of abduction or when the arms are completely extended above the head, with the pain always reproduced in the same way with each repetition. The rest of the movement is free from pain.
Once again in these cases, the pain can be traced back to tendinopathy of the cuff and/or long head of the biceps, of subacromial pain syndrome, and bursitis, the causes of which are identifiable in the extrinsic and intrinsic factors listed above, often combined with volumes of excessive training and the lack of a gradual progression of training parameters over time.
The remedies for shoulder pain in overhead exercises will follow the same principles as those followed in case of pain during the bench press: avoidance/limitation of painful lines of motion and adaptation of the offending exercise (Military Press) through a change of the work plane and/or the ROM of movements.
In some cases it will be useful to temporarily replace the execution of this exercise with a barbell with the same exercise performed with dumbbells, as these allow a greater joint release, thus resulting in more adaptable and functional in the search for a painless movement plan.
During the Military Press, it will also be important to pay attention to the movement of the scapula as a function of the humerus. In this case, the movement is a complete abduction of the humerus and the scapula, as the scapula-humeral rhythm teaches us, must perform a natural movement of elevation, cranial rotation, and posterior tilt.
Subjects with altered static alignment (scapula caudally rotated, depressed, and/or tilted anteriorly) may struggle to achieve the correct position of the scapula during movement, exposing themselves to an increased risk of compressive stress.
Correct supervision of the movement under examination and possibly correcting any asymmetries and emphasizing the correct scapular movements through tactile and verbal feedback will be important.
During the execution of the Slow Forward, it will also be advisable to constantly maintain the linearity between elbow and wrist throughout the execution of the movement, avoiding bringing the elbows too far back and thus reproducing a potentially stressful internal rotation.
Staying in this perspective, the pure internal rotation variant of the Lateral Raises and the Pull to Chin exercise performed in a classic way with very high elbows exceeding the height of the chest is also inadvisable.
In the first case, less stressful variants such as those in neutral rotation or partial external rotation will be advisable, while in the second case execution with low elbows, brought maximum to chest height, in order to neutralize the associated internal humeral rotation as much as possible.
From a programming point of view, here it will be important to modulate the training parameters in the best possible way, not exceeding the volume and intensity of training and avoiding (in case of pain) work to failure, long series with final fatigue and forced repetitions.
On the other hand, jobs with a large buffer and a gradual progression of loads will be preferred.
The inclusion of exercises aimed at correcting possible muscular and joint dysfunctions (capsular and muscular stretching exercises and strengthening exercises for the stabilizing muscles of the scapula and for the rotator cuff) will be very useful.
Shoulder Pain After The Gym
In most cases, shoulder pain in the gym is intermittent, felt when certain movements or exercises are performed, and absent once those exercises are finished and when the gym workout is over.
In some cases, however, it may happen that the pain does not disappear at the end of the offending exercise and that, on the contrary, it remains present (or even increases) in the 24 hours following the training, even with trivial movements or even by being a rest.
Conditions of this type are typical of very acute phases of shoulder pain, with the presence of high rates of tissue irritability and possible inflammation of some of these.
In these cases, the current functional capacities of the musculoskeletal structures are probably not high enough to handle the loads imposed during training, thus making them more prone to injuries and injuries.
Sometimes, in pictures of very acute pain with high irritability, a short period of rest from training is advisable, in order to let the physiological healing process take its course.
However, given the non-inflammatory nature of some shoulder pathologies (such as tendinopathies) and the inflammatory nature of others (such as bursitis), it will be essential to evaluate each case individually in detail to understand what is the most optimal management of the recovery process.
How Long Does The Shoulder Pain Last
Shoulder pains can be very different from each other, as well as the possible causes, and consequently the duration of the symptoms: a pain that has arisen a few days ago, perhaps after a sudden movement or a bruise, will be very different from a pain that has lasted for years (with the possible presence of sensitization of the central nervous system), and inevitably also the time that the two conditions will need to recover will be very different.
For this reason, it is impossible to define with certainty and a priori a healing time that is the same for each shoulder pain.
In some cases, the pain can fade after a few days or weeks, while in other cases it can last for months or even years.
Given the multifactorial nature of pain, a multitude of factors will decide and/or influence recovery times, some modifiable and others non-modifiable.
In any case, shoulder pain tends to persist for a time interval ranging from approximately 2 to 12 weeks. In the case of rotator cuff tendinopathies (one of the main causes of shoulder pain).
The literature considers 12 weeks as an average time for a possible recovery; a time that may be longer (up to 24 weeks) in the event that other concomitant pathologies are present (diabetes, hypercholesterolemia, obesity) and/or in case of relapses of previous shoulder pain.
Effective Remedies For Shoulder Pain
Once you have analyzed the possible causes of shoulder pain in the gym, what are the possible remedies for its correct management? As already mentioned above, also in this case the pain management will have to be contextualized based on the characteristics and history of the subject, the type of pathological picture, and the current functional abilities.
In general, we can say that the most effective strategies for managing shoulder pain during training, both from a preventive and rehabilitative point of view, are the following:
- Respect for the correct execution of the exercises, especially in the exercises more prone to shoulder pain such as the Piana Bench, the Military Press, and the Lateral Raises. Variants with the lowest possible risk factor should be preferred, and the constant maintenance of a correct scapular structure during the exercises will be essential.
- Avoidance/limitation of painful lines of motion by temporarily seeking painless planes of motion and ROM, then gradually returning to the original motor patterns when the pain has subsided.
- Respect of the graduality in the programming and progression of the training parameters, avoiding (in cases of pain) work with failure and long and forced series, preferring instead work with a discrete buffer.
- Insertion of specific exercises aimed at correcting any joint and muscle dysfunctions found with a specific evaluation. This category includes strengthening / resistance/muscle performance exercises (often necessary for the rotator cuff muscles and some periscapular muscles such as the middle and lower trapezius or the large dentate), muscle and/or capsular stretching exercises, mobility and proprioception exercises.