Shoulder Pain While Training: Causes, Relief and Exercises

Bodybuilding is so much more than simply spending as much time in the gym as possible. You can’t simply lift heavier or do more reps than everyone else and expect to be the best. It requires a tremendous amount of self-discipline, balance, optimizing recovery time, preparation, and countless hours of research to develop specialized knowledge about nutrition and training techniques—all with the goal of molding the body into a living work of art; to put a product on stage that represents the personification of the perfect human form. 

Throughout this pursuit of perfection, the chance of injury at some point within the span of a competitive athlete’s career is high.

One of the most common injuries for anyone who trains for any length of time is shoulder injury.

Often times athletes complain of pain in the shoulders when they’re bench or shoulder pressing keeping them from training properly.

Subacromial Impingement Syndrome

One of the most common shoulder injuries I see with athletes in my practices is called Subacromial Impingement syndrome.

This is a condition when the soft tissue between the humerus (arm bone) and the acromion of the scapula (shoulder blade) are compressing soft tissue structures that lie between the two.

The most common structures, the supraspinatus, the long head of the biceps tendon, and the shoulder bursa may all be pinched between the greater tuberosity of the humerus and the acromion of the scapula. This can lead to swelling, bone spurs, pain and tenderness in the front of your shoulder or when lifting the arm (usually above 70 degrees), and oftentimes pain during sleep. If this condition is not corrected, it is not uncommon to tear the supraspinatus or biceps tendon.

So how does impingement syndrome develop?

Normally, when you raise your arm above your head, your humerus must externally rotate to prevent the greater tubercle from coming into contact with the acromion of the scapula.

This external rotation usually begins at about 60-70 degrees of arm elevation and becomes critically important above 90 degrees to avoid impingement.

With bodybuilders, this can become increasingly problematic for several reasons:

(1) First, most bodybuilders spend a lot of time focused on larger muscle groups like the pectoralis major, latissimus dorsi, and anterior deltoids. All three of these muscles are internal rotators.

Comparatively speaking, the smaller external rotators are not as strong, combine that fact with the overdeveloped internal muscle groups above, and proper external rotation may not occur during arm abduction, eventually, leading to impingement. So spend some time at the end of your shoulder routine training your external rotators and stretching your internal rotators. One hallmark sign that your internal rotators are tight is to look at your posture. Your hands should face your body when your arms are relaxed and handing down. If your palms are facing back, you can bet that your internal rotators are tight.

To strengthen your external rotators, this can be done standing, using resistance bands or a cable, or lying down with a dumbbell.  Keep your arm at the side of your body and be sure to place a towel under your elbow to slightly abduct the arm. This will decrease the stress on the supraspinatus tendon as well as to allows for better blood flow.

(2) Secondly, some exercises that may be good at isolating a particular head of a muscle or providing a better angle of stress, may not be biomechanically safe to perform. Let me explain.

When it comes to training the medial head of the deltoid, we all do side raises.

While this exercise is universally loved, you have to be careful that you’re not turning your hands into an internally rotated position, as in a motion like you were pouring something out of a pitcher.

You also want to make sure that your elbows aren’t pointing directly down toward the floor because both of these positions can certainly set you up for impingement.

Additionally, do not raise your arms above 90 degrees (70 if you are having impingement symptoms).

Another exercise that has a high risk for impingement is wide-grip bench presses or If your shoulders are rounded forward during a bench press.

When the hands are out wider than the shoulders in the lowered position with the weight down to the chest, it can put an excessive amount of stress on the anterior portion of the shoulders or if your shoulders are rounded, your arm will be more internally rotated. Either of these scenarios are setting set the stage for impingement.

To prevent this, never take a grip wider than shoulder width and ensure that you pull the shoulders back by squeezing the shoulder blades together and down while you push up at mid-chest level.

Next, let’s talk about the upright row. A favorite exercise amongst most bodybuilders for hitting the middle delts and traps. Performance of the upright row requires the arms to be abducted above shoulder height while in an internally rotated position. Doing this way goes against normal shoulder biomechanics because shoulder elevation requires the arms to externally rotate, as stated above, to prevent subacromial impingement. Elevating the arm above 90 degrees with internal rotation as done with the upright row may directly cause subacromial impingement 

Don’t worry, with a few modifications, you will be able to keep this beloved exercise in your toolbox. First, the bar should be kept as close to the body as possible throughout the movement to maintain optimal stress on the middle deltoid. Limit your range of motion of shoulder abduction to approximately parallel with the floor provided no pain is felt throughout the movement. And lastly, try to pull through the elbows, not the wrist, so as to maximize muscle activity at the shoulder.

(3) We cant talk about shoulder impingement without mentioning postural distortions and the spine.

A forward head posture is an extremely common distortion that leads to impingement of the shoulder, including, but not limited to a downward rotated scapula combined with an anterior tilting of the superior aspect. In this case, the lower trapezius and lower fibers of the serratus anterior muscles are lengthened and the upper trapezius, levator scapulae, and pec minor tend to be shortened.

With forward head posture, as it relates to shoulder impingement the shoulders tend to round forward due to a shortening of the pec major and minor as well as the subscapularis which can be observed by the typical posture distortion of the hands facing back. The middle trapezius and rhomboids tend to be lengthened and weak and the lower trapezius and serratus anterior muscles tend to be neurologically disinhibited.

Fixing a forward head posture is critical to fixing the neurological potential to operate a smooth shoulder complex.

Do you have a Forward Head Posture?

To determine if you are suffering from a forward head posture, elicit the help of a friend to take a picture of you from the side. Your ear should be approximately above your shoulder. Forward head posture or rounded shoulders are extremely common in our modern world, both of which can put the scapula in a biomechanically disadvantaged position for proper shoulder function.

Unfortunately, the topic of shoulder impingement is a complex one that cannot possibly be dissected in one article. We have only scratched the surface. I left out any talk of scapula dyskinesis, myofascial adhesions, and trigger points, as well as describing any specific exercise due to my assumption that the average bodybuilder is very well educated on these exercises.

By making small changes to your routine can help ensure your shoulders stay healthy and functional throughout your fitness career.

If you are already suffering from impingement syndrome and need help, give my clinic a call. Typically these can be fixed in a relatively short period of time, allowing you to get back in the gym and train at 100%.