It's All Fun and Gains Until You Get Shoulder Pain
Rotator cuff pathology, impingement syndrome, and other shoulder issues fall into the larger category of mechanical shoulder pain. That's the "it hurts when I do this, Doc" brand of shoulder problems.
There's no trick that cures all mechanical shoulder pain. However, there's no reason informed and otherwise healthy lifters can't troubleshoot their way back to happy training.
To help you get started, I've modified procedures from shoulder experts and added some tactics I've picked up along the way. Here are five strategies that can be accomplished using minimal equipment.
Note: These work best with shoulder pain provoked by raising the arm up and/or out, which can interfere with overhead lifting, presses, and front raises. The goal is to identify strategies that reduce or eliminate pain during these lifts, potentially allowing you to keep lifting and making gains. Check out the techniques first, but be sure to read below to learn how to use them.
The rotator cuff muscles prevent unwanted joint motion and stabilize the shoulder. You can use bands to apply resistance to these four muscles, amp up their activity, and potentially make the movement pattern more comfortable.
Check out the three exercises below. When you do them, use minimal band resistance. A thin, flat 12-inch loop of tubing is best. Longer, very light resistance (1/4 inch thick) bands may work but will need to be double looped for the first two techniques. Since the band applies an added challenge, drop the weight by approximately 50% when first attempting these exercises.
Loop a circular band around your wrists and begin with the dumbbells just above shoulder height. Press the dumbbells overhead while maintaining tension on the band.
Loop a circular band around your wrists. Press the dumbbells over your chest while maintaining tension on the band.
Anchor a light band at your side at chest height. Loop it around your wrist. Perform a front raise with a slight bend in the elbows. Maintain tension on the band. You can also do this exercise with both arms simultaneously with a circular band around the wrists.
The scapula should move when your shoulder moves (with possible exception to a competition-style bench press). Maintaining the shoulder blade in a certain fixed position throughout a movement is likely to disrupt normal shoulder mechanics.
Shoulder pain can be equally disruptive to shoulder mechanics. The following exercises encourage scapular movement and enhance the activity of the muscles that act on them.
Christian Thibaudeau wrote about the Scrape the Rack Press in 2017, and John Meadows performed it here.
I've used a variation of it – scraping a dowel against a doorjamb – with patients who've had post-surgical and extremely banged-up shoulders. It's been a game-changer. Applying a forward pressure during the press recruits the serratus anterior and promotes scapula upward rotation – the natural movement of the scapula during this exercise.
- Set up with bar resting on the safety pins at collarbone height. Use a staggered stance – one foot slightly ahead of the other.
- Simultaneously drive the bar up and forward as you press. Maintain contact between the bar and the rack. Continue pushing forward against the rack as you lower the bar.
Note: Respect your gym. If you're training with equipment you don't own, ask whether this exercise is acceptable. If scrape pressing is a no-go, try the exercise below instead.
Another way to focus on the scapula is to press with a landmine or Viking press setup. The horizontal vector of resistance applied by the landmine facilitates upward rotation and protraction of the shoulder blade. The arced path of the landmine may also benefit those with end-range overhead shoulder pain because it avoids this position. Use a resistance band to counteract loss of resistance at the top of the landmine press.
Kneel on the same side as your working arm. Focus on reaching up and out as you press.
Overhead lifting requires adequate extension of the mid-back (thoracic spine). When more thoracic extension occurs, achieving the overhead position requires less motion from the shoulder.
On top of that, changing the thoracic spine position may change the length-tension relationships of muscles of our shoulder complex and even how the shoulder blade (scapula) moves on the ribcage. So improving thoracic extension is low-hanging fruit for helping the shoulder.
Tuck your chin toward your chest, hug across your body and lie with the foam roller across your mid-back. Use the foam roller as a fulcrum by arching or extending the part of your spine immediately above the roller. Keep your chin tucked and your abs engaged to better localize the movement.
After 60-90 seconds of thoracic extensions, retest the painful movement, but this time with more mid-back extension. Focus on keeping your chest up with abs engaged, which encourages movement from the thoracic spine rather than the low back.
Think of these techniques as self-joint mobilizations for the shoulder during movement. Joint mobilization may enhance the natural gliding that occurs during movement. They may also promote beneficial neurophysiological effects for your shoulder pain.
You'll need a moderate-thickness band (around 1 inch or 2.5 cm). The band will apply a mobilization force to the joint during painful exercises. While a clinician may assess joint glides in many different directions, these are my most commonly effective techniques.
For each of these, place the band over the head of your upper arm bone (humerus), as close to the joint as possible. If needed, use a towel under the band for comfort.
An inferior (downward-directed) glide of the head of the humerus is traditionally associated with the shoulder moving up and out. These movements occur during the overhead press. So here's what to do.
Anchor a stretch band under your foot and loop it over the top of your shoulder, just outside of the acromion – the boney bump atop your shoulder. Then do controlled overhead presses.
A posterior (backward-directed) glide of the head of the humerus is traditionally associated with the shoulder moving forward and up. These movements occur during the front raise.
Anchor a band behind you and slightly outside of your body. Loop the band around the front of your shoulder and step out into tension. Perform controlled front raises with neutral rotation of the arm in a "thumbs-up" position.
Performing a well-established multi-joint movement pattern along with the painful shoulder movement may be helpful.
Kinetic energy from large movements of the lower body might help overcome the resistance's inertia, thereby decreasing demand on the shoulder. It may be that triggering a familiar movement pattern helps us re-establish or normalize shoulder mechanics disrupted by pain or injury.
Movement is a complex neuromechanical phenomenon. Fortunately, we don't have to completely understand the mechanisms at play to try these simple techniques.
You'll get more out of this exercise by doing it unilaterally.
Stand holding a dumbbell at your side. Take a step forward with your opposite leg as you perform a front raise. Lower the dumbbell with control as you return to the starting position.
Substitute your strict overhead press for this Olympic lifting supplement. This is a dumbbell variation, but the barbell push press is also an option.
Set up with your feet shoulder-width apart, holding the dumbbells just above your shoulders. "Dip" quickly by flexing the hips, knees, and ankles. Then immediately and powerfully drive upward as you press the dumbbells overhead.
Lower the dumbbells back to the starting positions with control.
Traditionally, sports medicine pros use a slew of special tests to inform clinical diagnoses for mechanical shoulder pain. Most of these tests are intended to stress tissues of the shoulder. Reproduction or provocation of pain typically constitutes a "positive test," which hints toward a diagnosis.
Regardless of whether these tests accomplish an accurate diagnosis, they do little to tell us what we can do right now to address the problem.
More than a decade ago, physiotherapist Dr. Jeremy Lewis described an algorithm for managing mechanical shoulder pain. (1) Rather than provoke pain and tell you all the stuff that hurts, symptom modification procedures are intended to reduce or alleviate shoulder pain.
Symptom modification procedures are instructive. When a procedure is identified that improves your symptoms, the conversation shifts from "don't do that" to "do more of this."
Certain pathologies will not respond to these techniques. If one of the procedures eliminates the shoulder pain, it's a not-so-subtle message that we should be doing more of that (at least in the short term). If only partial improvement is noted, the next step is to attempt to combine multiple procedures at once to see if we can obtain additional improvement.
For example, you might try thoracic extensions with the foam roller immediately before pressing with a banded rotator cuff facilitation technique. Or, you might try combining a scapular technique with a kinetic chain technique. Use the technique(s) that work in lieu of your traditional shoulder exercises that are unacceptably painful.
Note that several of these techniques may require you to reduce the weight you use. This is a good thing. As much we might hate to admit it, regression is indicated when dealing with an injury.
Furthermore, if you suspect an "overuse" injury, you may also need to reduce training volume by reducing training frequency, sets, and/or reps. If none of the techniques help, it's time to make a trip to a trusted physical therapist or sports medicine doc for advice.
After all, you deserve an effective pathway back to lifting.
These exercises may not be appropriate for those with recent trauma, possible fracture, or dislocation. Individuals with constitutional symptoms (e.g. fever, night sweats), hypermobility disorders, loss of sensation, or radiating pain should also seek qualified medical attention. The info provided here is for educational purposes only and does not constitute individualized medical or rehabilitation advice. No client-provider relationship is implied.
- Lewis, J.S. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? British Journal of Sports Medicine. 2009;43:259-264.