Shoulder injuries are common, but there's no need to miss workouts or forge ahead despite the pain. Here are three tactics you can use to avoid lost time and regression while maximizing results.
1 – Cross Education: Train Only the Healthy Shoulder
Discontinue shoulder training altogether and you'll see rapid strength loss followed by muscle atrophy. Instead, choose to continue to train the healthy shoulder while resting or modifying training on the injured side.
Research shows that when we continue to train the opposing limb, we preserve the muscle size and strength of the injured muscle. This phenomenon, called "cross-education," is believed to stem from neural pathways where training the healthy side enervates the corresponding muscle of the injured or immobilized side.
In a study by Andrushko et al. (2018), researchers immobilized the forearms of 16 participants for four weeks and randomly assigned them to a training or control group. The training group performed eccentric wrist flexion exercise three times a week with the arm that wasn't immobilized while the control group didn't train at all.
After four weeks, the trained group preserved the strength and muscle thickness of the forearm flexors on the immobilized arm. The control group lost strength and muscle thickness. Several subsequent studies have found similar results.
This means that as counterintuitive as it seems, you can break a bone, tear a tendon or ligament, or sustain some sort of serious injury requiring total training shutdown of that limb and still preserve your strength and muscle mass of the injured limb by training only the opposing limb.
The take-home point: Train the healthy shoulder as hard and heavy as normal to continue progress while preventing strength and muscle loss of the injured shoulder. Bilateral barbell work is out, but all unilateral shoulder exercises are fair game.
2 – Low Load, High-Rep Training to Failure
Train the injured limb normally; just use lighter weights and higher reps as tolerated. These lighter loads, done to failure, create the mechanical tension and volume needed to drive muscle growth. Add in the metabolic stress of sets done in the 20-plus range and you check off several key hypertrophic drivers.
In one study, Schoenfeld et al. took 18 experienced lifters and split them into two groups for eight weeks of training. A high-load group did sets of 8-12 reps to failure and a low-load group did sets of 25-35 reps to failure.
Results? Both groups saw similar muscle growth. The high-load group saw significant improvement in pure strength over the low-load group, but when dealing with an injury, we'll certainly take what we can get.
3 – Heavy Eccentric Reps
Not only will some injuries tolerate heavy negatives, they're often a key to rehabilitating injuries. Depending on the nature of the injury, eccentric overload of injured tendons is critical to tissue remodeling.
Researchers Chaconas and Kobler compared heavy eccentric training against conventional training of shoulder external rotators and found heavy eccentrics improved shoulder pain, function, and rotator cuff strength after six weeks. Other studies on different muscle groups have confirmed these findings.
Here are some exercises using the tactics above:
1. Landmine Press into Landmine Negatives
The landmine press is well tolerated by all but the most messed-up shoulders. Train each side evenly with single-arm landmine presses, adding weight as permitted, until the injured side starts to bark.
Then use both arms to press the weight into the top position and control the negative with only the weak side. Repeat eccentric reps to near failure.
If the injured side can't support heavier eccentric training, do 2-3 additional heavy sets on the strong side to ensure the weak side benefits from cross education.
2. High Rep, Neutral-Grip Dumbbell Press
Instead of pushing through pain or abandoning a workout entirely, find middle ground and focus on light to moderate loading for high reps done to near failure.
Hinky shoulders often tolerate neutral-grip dumbbell pressing. Tuck your elbows to the midline of your chest and press the dumbbells upward to where shoulder, elbow, and weight are vertically stacked. Your palms should be facing each other.
Avoid touching the dumbbells together at the top as this may pinch already damaged soft tissue against boney structures. Repeat for rep ranges of 15-35 to near failure. These will create mechanical tension, metabolic stress (pump), and lots of volume.
3. Heavy Unilateral Dumbbell Shoulder Press with Offhand Isometric Hold
After pumping up your shoulders and fatiguing the injured side with high-rep presses, push the strong side to its limits. Choose a heavy dumbbell and aim for three more sets of 8-12 reps.
Meanwhile, hold a lighter dumbbell in the hand of your injured arm. Tuck the elbow to your chest midline, with your palm facing you. Draw back your shoulder blade to pull the head of your humerus into its socket.
This distractive force (meaning it creates more "space" inside the joint) works your rotator cuff and the muscles around the shoulder blade and helps rehabilitate and strengthen the injured shoulder. Your front delt and biceps benefit from isometric loading, too.
The lighter offhand weight also serves as a partial counterbalance against the heavy opposing unilateral press. Brace your obliques to avoid tilting and press the strong side weight to near failure. If your injured shoulder is immobilized (in a cast), forgo the counterweight.
4. Single-Arm Lateral Raise
Injured shoulders often fail to tolerate abduction under progressive load, if at all. Choose the lateral raise option that best applies:
- Train bilaterally (both arms simultaneously) using a lighter, tolerated weight for the injured side and a heavier weight for the opposite side.
- Train light load, high reps on both sides to failure.
- Focus solely on the healthy side and allow the inactive shoulder to benefit from cross-education.
5. Farmers Carries
Farmers carries are among the most under-utilized shoulder rehabilitation tools. Farmers carries light up the muscles that retract your shoulder blades. Your lats, rhomboids, middle traps, and rotator cuff all work hard.
The distraction force from carries pulls the shoulder ball deeper in its socket, offsetting the anterior humeral glide you experience while pressing or doing rows with bad form. Ensuring the strength and health of your shoulder girdle goes a long way to keeping healthy shoulders for pressing.
Choose a trap bar, carry handles, heavy kettlebells, or dumbbells and pick them up using a strict deadlift. Pull your shoulders back and brace your core as you walk 20-50 meters.
Strongmen do these while walking as quickly as possible with forward posture, but for everyday training, stay upright with neutral head position and use a slow to medium pace to emphasize grip and shoulder health.
Related: 4 Easy Ways to Fix Shoulder Pain
- Andrushko, et al., "Unilateral strength training leads to muscle-specific sparing effects during opposite homologous limb immobilization," Journal of Applied Physiology, 2018
- Camargo, et.al., "Eccentric training as a new approach for rotator cuff tendinopathy: review and perspectives," World Journal of Orthopedics, 2014
- Chaconas, et al., "Shoulder external rotator eccentric training versus general shoulder exercise for subacromial pain syndrome: a randomized controlled trail," International Journal of Sports Physical Therapy, 2017
- Farthing, et al., "Strength training the free limb attenuates strength loss during unilateral immobilization," Journal of Applied Physiology, 2009
- Farthing, et al., "Changes in functional magnetic resonance imaging cordial activation with cross education an immobilized limb," Med Sci Sports Exerc, 2011
- Magnus, et al., "Effects of cross-education on the muscle after a period of unilateral limb immobilization using a shoulder sling and swathe," Journal of Applied Physiology, 2010
- Schoenfeld, et al., "Effets of Low- vs. High-Load Resistance Training on Muscle Strength and Hypertrophy in Well-Trained Men," J Strength Cond Res, 2015