The shoulder pain on the bench press is a real nightmare for many gym-goers dedicated to fitness and bodybuilding young and old, they often have to deal with this problem and have no idea how to face it and solve it.
The flat bench press with a barbell is one of the exercises that put the most strain on this joint, also judging by the fact that there are really many subjects who develop shoulder pain while bench pressing.
Shoulder Pain During And After Bench Press
It is undeniable that many of these cases are attributable to incorrect executions, in particular lacking the correct scapular position on the bench, and to workouts that are too intense and/or bulky and not gradual enough.
Also, some particular conditions, such as the altered alignment of the humerus, can negatively influence the execution of this exercise.
We try to understand step by step how to solve shoulder pain through an integrated approach between physiotherapy and personal training.
Symptoms Of Shoulder Pain During Bench Press
The pain felt during the execution of the bench press often has a slow onset and in the absence of a real trauma that can justify it, it often begins without an 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 acute pain, described as a “pain that stings in the shoulder,” or as pain like a stab, evoked and played each time the bench press is performed.
During the execution of the exercise, there is generally a so-called ” painful arch “, with a specific part of the movement in which the shoulder pain is present and with the remaining part in which it disappears.
In the flat bench press and similar exercises, the typical painful arc corresponds to the first degrees of movement, at the 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. There are often periodic relapses of pain during periods of intense training.
Causes Of Shoulder Pain On The Bench Press?
The pain perceived during the bench press is in most cases attributable to pictures that fall within the ” subacromial pain syndrome ” with the presence of tendinopathy of the rotator cuff and possible tendinopathy of the long head of the biceps and/or inflammation of the sub-deltoid bursa ( bursitis ).
The main causes that lead to these conditions can be classified into two categories:
- The degeneration of the tendon with concomitant alteration of mechanical and metabolic properties of the rotator cuff tendons
- A dysfunctional picture of the shoulder characterized by joint stiffness
First of all, we can affirm that many of the painful pictures can have as a cause or contributing cause the excessive volume of training and the poorly dosed load over time.
In other words, we can have scenarios in which a novice subject begins to train and, anxious to improve, does not respect a correct progression of the load on the bar or exaggerates with the weekly training volume, preventing the tendons, capsule, and ligaments from adapting to the new one.
Similarly, more advanced subjects can undergo tendon degeneration from excessive overload perpetrated over time, especially if genetic or age-related factors are added to this, with the over 40s physiologically involved in a picture of cuff degeneration independent of training with weights.
Secondly, we can indicate the causes on which to focus attention in the approximate executive technique and joint dysfunctions.
The joint/functional factors that can contribute to the onset of shoulder pain during the bench press are:
- Excessive stiffness of the posterior/inferior capsule of the shoulder, with a possible association of excessive anterior instability. During the bench press, physiological flexibility of the capsule and of the external rotation muscles of the shoulder is necessary to guarantee the physiological accessory movements of posterior sliding of the humeral head necessary in this exercise. If this is missing, the possibility of an anterior (interposed humerus) and superior translation of the head of the humerus will arise, a condition that increases the pressure on the sub-acromial tissues such as the supraspinatus and the bursa.
- Altered static and/or dynamic scapular positioning in anterior tilt and protraction, caused by a possible weakness of the great dentate, middle and lower trapezius muscles, and by a retraction of the pectoral minor. This altered scapular positioning narrows the subacromial space, favoring greater pressure on the tissues located within it.
Shoulder Pain And Causes
In the photo, a subject with “pin-point” pain in the right shoulder with the presence of calcifications, pain that arose over time and recalled during the execution of the bench press even with a medium-low load (shoulder pain accompanied by loss of strength).
The subject, assessed on a pre-treatment bed, by means of the appropriate test for the length of the external rotators of the shoulder, reveals a retraction of these muscles, a condition that causes stiffness of the posterior capsule of the joint which consequently pushes the head of the head forward.
The latter is therefore not able to position itself adequately inside the scapula (despite the correct position) during the execution of the flat bench press and this creates a compression of the soft tissues, increasing the stress on the latter and evoking pain (the right shoulder is found higher than the left: red line).
The manual correction on the arm by the physiotherapist (verification test), with the right humerus being pushed back while the subject holds the barbell, makes the pain vanish.
Shoulder Pain Remedies When Bench Pressing
What to do in case of shoulder pain while bench pressing? There are two principles that will need to be followed:
- Avoid/limit painful lines of motion
- Adapt the offending exercise (in our case the bench press) by changing the work surface and/or the range of motion.
One feasible strategy is to support healing and recondition the tendons through a gradual progression of a pain-free range of motion.
As seen above, the classic painful ROM during this exercise is encased in the first degrees of pushing the barbell or dumbbells from the chest.
In this sense, a rational progression involves starting with a bench floor (or floor press) with dumbbells while lying on the floor.
Later, as symptoms improve, a barbell execution may be reintroduced with partial ROMs through a fixed reference (such as a rolled-up towel under the shirt or an external stop).
A further progression towards the original execution involves reaching the chest with a very controlled eccentric and a chest stop and then finally reintroducing the dumbbells for a full ROM execution in extension.
Another strategy you can do in case of pain is to switch from a barbell to a dumbbell run. The handlebars, in fact, allow a greater joint release, greater adaptations of the work surface, and the position of the shoulder.
During the execution, it will be good to look for the work surface free from pain and move the shoulder in that plane.
Often a useful adaptation is to “squeeze” the elbows along the body with a tight grip, shifting the thrust along the sagittal plane with a pure shoulder flexion (this is also feasible in the barbell bench press).
The depth of the descent of the handlebars must also be well modulated: very often, in fact, an excessive extension generates pain and for this reason, it is good to limit it, not going with the elbows too far beyond the trunk.
The discourse on the asymptomatic lines of work also applies to other exercises such as Crosses and Push-ups. During the execution of the bench, it will 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.
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. We will see these exercises in the next paragraph.
Even manual therapy performed by a physiotherapist can have a useful therapeutic role in reducing dysfunction and pain.
The subject in the photo was treated by the physiotherapist for about 30 minutes, carrying out mobilizations of the humerus head in the posterior direction through specific techniques of manual therapy bed.
In the photo below you can see the subject re-evaluated immediately post-treatment in the study, with a discreet recovery of the mobility of the external rotators and a partial release of the posterior capsule.
Returning immediately to the tool room, this release of the previously stiffened posterior capsule allowed the subject a better positioning of the humeral head in the glean during the execution of the bench, favoring joint congruence and avoiding excessive compression of the subacromial tissues.
The subject was then retested during the execution of the exercise showing almost pain-free with the same loads used at the beginning of the session, implying that the treatment performed in the studio was successful, directly affecting the primary cause of the shoulder pain.
Exercises For Shoulder Pain
Within the possible dysfunctional framework described above, both from a purely preventive point of view and from a pain management perspective, some exercises may be useful to intervene on the alterations found during the evaluation.
The exercises in question will aim to increase the flexibility of the retracted tissues and to strengthen the weak tissues, improving their mechanical properties.
In this case, the following will be useful:
- Stretching exercises such as the Sleeper Stretch or the Cross Body Stretch independently stretch the capsule and the posterior tissues of the shoulder. This is in the case of a significant internal rotation deficit of the shoulder revealed by the specific test.
- Stretching exercises for the small and large pectoral muscles. This is in the case of anterior scapular tilt and interposed shoulder girdle alignment.
- Strengthening exercises for the lower trapezius muscle (such as prone Y-lifts) and scapular retraction proprioception exercises (combined adduction, depression, and posterior tilt). This is in case of overt weakness of this muscle and in case of posture with shoulder girdle interposed and shoulder blade in an anterior tilt.
- Reinforcement exercises of the rotator cuff, in particular at 90 ° of humeral abduction, a condition that faithfully reproduces the same position assumed by the shoulder during the flat bench press. This is above all to work on the mechanical properties of the tendons and in case of overt muscle weakness highlighted by the appropriate tests.
Obviously, it should be noted that these exercises must not necessarily be offered in full to everyone without distinction.
They are simply a reservoir of exercises to draw from depending on the subject and its characteristics.
Correct Execution Of The Flat Bench
How to avoid shoulder pain over time by bench pressing?
From a preventive and rehabilitative perspective, compliance with correct execution will be fundamental, which respects the joint physiology and the biomechanics of the shoulder joint complex. So let’s analyze how the push-up exercise on the bench press should be performed.
The flat bench can be performed with a barbell, dumbbells, or in its substitutes for the Multipower and the Chest Press. The focus is on the importance of a push performed with scapular stability.
One of the most common mistakes is a push of the barbell or dumbbells from the chest which, thanks to inertia, drags the shoulder blades into protraction and anterior tilt.
We have already underlined how this type of alignment is a risk factor for a shoulder injury, due to greater pressure on the tendons exerted at the sub-acromial level.
In other words, pushing an overload by “losing” the shoulder blades, especially if this overload is high (as rightly happens in the bench press) can constitute a risk factor for injury and inflammation of the shoulder.
For this reason, during the flat or inclined bench press, or in general during all the push exercises for the pectoral major such as Crosses and Chest Press, a push performed with the shoulder blades in retraction, depression and the posterior tilt, a combination of movements that on the contrary, it widens the subacromial space and decreases tissue pressure and stresses at this level.
Therefore, before gripping the tool we have chosen to perform the exercise, whether it is a barbell or a dumbbell, a cable or a machine, the correct positioning of the shoulder blades and their maintained stability under load will be important, a fundamental condition to guarantee joint safety and congruence.
The scapular structure maintained will have some important consequences. The elbows will be closest to the torso and never at shoulder height. Incorrect scapular position, the humerus will physiologically reach about 60 ° of abduction, and it is from this position that it must move in thrust.
Having “high elbows” is a symptom of bad scapular trim. The correct trajectory involves a movement of the barbell that goes from the height of the nipples/end of the sternum, up to the height of the neck when the elbows are extended.
This slightly inclined trajectory, together with the scapular structure, will allow you to always push with the elbows under the wrists.
The thoracolumbar spine, in response to the correct scapular structure, will undergo a physiological movement of extension which will result in an accentuation of the curves with the pelvis resting on the bench ( “arched” back ).
Do not worry, the extension of the spine is not a danger or a possible source of pain in healthy subjects.
The flat bench performed with the feet on the ground will give stability to the whole exercise, favoring an optimal attitude.