Anterior Shoulder Pain When Benching

Q: I've been pushing my bench pretty hard in the past 6 months with mostly good results, but i'm starting to get some pain in the front of my left shoulder. I took a few days off training intially, the pain subsided, but then came back the very next time I did bench. So now I'm lifting lighter and periodically I try to go up but every time I go up there's pain at the front of my shoulder.

What can I do?

Thanks,
Jay H.

A: Jay, there could be a number of different causes for your pain. Without watching you bench in person, it will be hard to be specific. But I'll go over a couple scenarios for you.

Firstly, if your subscapularis muscle is weak, then you may be getting some anterior humeral head gliding. Anterior glide of the humeral head will often lead to stretching of the anterior joint capsule and subsequent loss of glenohumeral stability. When you bench, your pec pulls the humeral head forward forcefully and it's the job of the subscapularis to pull it backward and down into the correct position.

To remedy the problem, first, you would need to back off on lifting anything heavy, and then start doing 3x15 tube or band internal rotations from above (See Fig 1.1 & Fig 1.2).


Fig 1.1 - Tube internal rotation from above - Start and Finishing position.


Fig 1.2 - Tube internal rotation from above - Midpoint position.


Do this daily for about a week and then move to every second day and increase to 4x15. Finally drop it to twice a week and then try to keep it in your program at least once a week to keep that muscle strong as you gradually return to pressing.

Second possibility is that you've got some impingement going on in the shoulder. Impingement is usually the cause if you have pain when raising your arm to the front or side in between about 60 or 70 degrees and 120-130 degrees of flexion. If this is the case, again you'll have to back off from anything heavy, and perform a few sets of the pendulum exercise (See Video 1.1) to help open up the sub-acromial space Be sure to use only 5-8 lbs. Going heavier than 8 lbs tends to cause the outer muscles to take up the tension, when we want it on the ligaments in the shoulder.


Video 1.1 - The Pendulum Exercise - Creating distraction at the humeral head to increase sub-acromial space.

When you get impingement, the humeral head is being pulled upward against the sub-acromial bursa and supraspinatus tendon. This pressure causes pain and often swelling (which further reduces the sub-acromial space). A bit of time off from heavy benching will be required to allow any swelling to go away.

Once you can raise your arm through the normally painful range without pain, this means you're ready to start strengthening a few areas that need to be stronger to prevent the re-occurence of the pain. This doesn't mean you're ready to bench again, and if you can bench a little that's fine, but DON'T go heavy yet.

Tube external rotations (See Fig. 2.1-2.6) from a few different angles will help to strengthen the external rotator cuff muscles. The teres minor and the infraspinatus being heavily involved in stabilizing the shoulder joint during bench press.


Fig 2.1 - Tube External Rotation (Focus Teres Minor) - Start & Finish Position
Note: Place a small towel or similar object in between arm and ribcage.


Fig 2.2 - Tube External Rotation (Focus Teres Minor) - Midpoint Position
Note: Place a small towel or similar object in between arm and ribcage.


Fig 2.3 - Tube External Rotation 90/0 (Focus Infraspinatus) - Start & Finish Position



Fig 2.4 - Tube External Rotation 90/0 (Focus Infraspinatus) - Midpoint Position



Fig 2.5 - Tube External Rotation 0/90 (Focus Infraspinatus) - Start & Finish Position



Fig 2.6 - Tube External Rotation 0/90 (Focus Infraspinatus) - Midpoint Position

Additionally, spend a few weeks doing extra rows, dumbbells, barbells, cable rows, they will all help. Also spend some time doing some rope face pulls or prone incline trap raises which allow the upper and lower traps to work without involving the rhomboids. Some people tend to be rhomboid dominant, which means scapular stability is created mostly by the rhomboids and with very little help from the traps. Often people with rhomboid dominance have weak serratus anterior muscles. Weak serratus anterior muscles can contribute to a host of other compensation patterns which ultimately produce anterior shoulder pain. To strengthen the serratus anterior muscles perform 2-3 sets of 10-15 reps of Serratus/Scapula Pushups (see Video 2.1). Keep your elbows locked and sink between your shoulder blades. You'll feel them squash together as you sink down, and then push yourself back up and pull your shoulder blades as far apart as possible at the top. Try to avoid creating the upward movement simply by rounding your upper back.



Video 2.1 - Serratus/Scapula Pushups


A third possibility for your shoulder pain involves the long head biceps tendon. Speed's test is a good way to determine whether or not the long head biceps tendon is involved. To perform speed's test, make a fist and pretend you are doing a dumbbell curl and bring your fist up towards your shoulder. Continue to move your fist up a few inches further by flexing your shoulder joint. From this position have a friend or training partner pull down on your fist while you resist. If you have pain or significant weakness in your shoulder during this test, some or all of your shoulder pain involves the long head biceps tendon.

If there is inflammation, again some rest time is needed. Icing the afflicted area and some ibuprofen will help to bring the swelling down. Once the pain has subsided, heat will help encourage blood flow to the area, which will help speed healing. Use the speed's test again but ask your partner to pulldown with much less force and resist them less as well to see if you still have soreness in the shoulder. If you are doing the test and you pull too hard you might aggravate the area again. So always perform subsequent tests at a lower intensity.

After a couple weeks of adding these exercises into your program, you can gradually bring benching back into your program. But spend the first couple weeks using loads close to 60%-80% of the loads that were causing your pain. After a few weeks at these lighter loads, and continued use of the tube exercises and serratus/scapula pushups, you'll be ready to resume some heavier lifting.

When you resume training, for a while, try to do most of your overhead pushing and pulling movements using a closer hand spacing. Same thing for horizontal pressing movements. Spend some time working on your close grip bench press. This movement puts less stress on the shoulder than the wider grip varieties.

Don't rush it. Remember this... one or two additional weeks off training to really prepare those shoulder tissues for loading again can save you months off with serious inflammation.

A final word... It can be very discouraging to find out you've injured yourself and that you have no choice but to take a lengthy break from bench pressing, but if you're like most people in the gym, you probably spend a disproportionate time on your bench anyway, so use this opportunity to work on your deadlifts and squats. When you come back to bench, hopefully your squat and deadlift will have benefitted!

:)
Shane

Why I Get Frustrated!

About three years ago, I was contracted by a group of professionals to do a nutrition seminar for them. It was one of my first, so I was a little nervous. When I arrived and set up, people slowly started filling the room. It wasn't a huge room, but by the time I started there was probably 45 or 50 people in attendance.

I had already set out a few sheets of paper and a pen on the tables where everyone sat.

I introduced myself and asked a few people in the room what their occupations were. These were legal secretaries, lawyers, brokers, entrepreneurs, doctors, and a couple travel agents. So I had a room of pretty smart cookies here.

I joked that if they were all so smart, why did they need me to tell them how to eat to be healthier and change their bodies?

I got some laughs.. but then they all kept staring at me.. obviously because the still felt they needed my help. Well either that or they were thinking I was a smart-ass! ;)

So I asked them to all write down on one of the sheets of paper, what they thought a perfectly balanced meal plan would look like for just one day. It took about ten minutes, there were some little discussions here and there, but as people finished writing, they all seemed to have sort of puzzled, unsure expressions on their faces.

I continued and asked them to now take a second piece of paper, and to the best of their recollection, write out EXACTLY, what they had eaten the previous day. From the time they got up, to the time they went to bed.

It was as I expected...

The postured perfect day of food consisted of eggs (some bacon), cereals, fruit, milk, nuts, lean meats, vegetables, milk, and I even had a few people list "a protein shake".

The order of foods, and the combinations wasn't necessarily the best, but the content was great. It was mostly foods that you eat in their natural state, with but a few exceptions.

Then the laughter came...

Having some of the audience read out what they'd consumed on the previous day was met with snickers, and smiles across the room.

One gentleman proudly read out his list:

Breakfast
nothing
Lunch
nothing
Dinner
Fettucini Alfredo
4 Scotch drinks
1 piece of Tiramisu

Late Evening
1 bowl oreo ice cream


His was definitely the worst, but most of them weren't that far off. Missed meals, carbohydrate only diets, donuts and coffee for breakfast, it was quite funny.

Funny, that these "smart" professionals could all list off what a fairly healthy diet would consist of, yet most of them were eating pretty horrible diets.

At this point I really wanted to make it clear to them that they had hired me to provide knowledge. But Knowledge without it's application is useless. I could give them some pretty amazing meal plans with carb-rotation diets to really help them peel off their last few pounds of bodyfat, but if they don't follow the diet, then what's the point.

This is what gets me frustrated!

Almost everyone you know.. knows how to eat healthy! But so many don't! So many people don't eat healthy because they don't see it change their health for the better.. immediately!

Yet all you doctors, lawyers, investment bankers all tell people that they need to stop smoking, get proper legal advice, or put away money for the future, because it pays off down the road.

The same thing goes for intelligent eating habits.

Don't keep reading new books on diets and food, don't keep hiring nutritionists to tell you what to eat (again!), and don't keep asking your doctor what to do to be healthier.

Just write out what you think will make you healthier and do it!

That's it.. that's all!

Almost any positive change will make you healthier. Start with just one or two, make them stick, and then introduce more changes. But whatever you do, don't try to do it all at once. That's why people stop eating sensibly because it seems so overwhelming when they do a full 180 degree diet makeover.

Just make small changes and stick to them. The rest will follow!

Yours in Health,
:)
Shane