A Closer Look at Shoulder Pain

man lifting heavy weights

It's Monday, otherwise known as National Bench Press Day. Like so many others in the same weekly routine, you dutifully head to the gym after work, get to the locker room and toss your gym bag into a locker, give your training partner a fist pump and head out to the gym floor to get your bench on.

Set one, and you feel like a rock star. You turn up your iPod a little louder and add some more weight.

Set two, and you notice something weird. The shoulder that's been a little "tweaky" for the past few weeks is starting to act up again. You've been ignoring it, taking the attitude that it's just something that comes with the territory when lifting. You shrug it off, add a little more weight and think to yourself, "Once I'm warmed-up, it'll be fine."

man lifting heavy weights

Sometimes, and imbalance in exercise — too much push, not enough pull — can cause shoulder pain. Here are a few tips to avoid pain in the future.

Set three, and the pain is still there. But you'd sooner jump into a live volcano than skip bench day. There's no chance you're bowing out. So you add more weight.

Set four, and "Houston, we have a problem!"

For many, the above scenario is a familiar one. One of the most common areas that trainees injure is the shoulder. More often than not these injuries can be prevented. With a bit of knowledge and a few simple tips, you can greatly reduce the likelihood of ever having shoulder issues again.

Anything we can do to help promote more extension -- particularly in the midback region -- not only bodes well for shoulder health but for our overall posture as well.

Mark Young, owner of MarkYoungTrainingSystems.com

Improve Thoracic Mobility

Let's start with a simple test. Right now, no matter where you are, stand up and reach toward the ceiling as high as you can. Stretch and hold that position for 20 to 30 seconds.

Seriously, do it. This article isn't going anywhere.

Welcome back. Feel better?

Now, don't get mad, but that simple drill wasn't the actual test.

Presumably, you've been sitting in front of your computer for who knows how long, and that little exercise you just performed essentially "reset" your spine and helped counteract the flexed position that's been destroying your back for the past few hours.

"We live in a very flexion-based society," said Mark Young, certified strength and conditioning specialist and owner of MarkYoungTrainingSystems.com. "And more often than not, with few exceptions, anything we can do to help promote more extension -- particularly in the midback region -- not only bodes well for shoulder health but for our overall posture as well."

With that said, stand up again. This time, though, purposely round your shoulders forward. Now try to lift your arms up above your head by bringing your arms straight out in front of you.

A little difficult, right?

Now do the opposite. Stand tall, chest out, shoulder blades back and depressed. Imagine you're trying to put your shoulder blades into your back pockets. Again, try to lift your arms above your head.

This time it should have been infinitely easier. The reason for that is simple. You reduced your kyphotic, or rounded, upper-back posture, which placed your shoulder blades in a more advantageous position, allowing them to move more easily and optimally.

While standing tall and reaching toward the ceiling is helpful, two other exercises can help as well.

Quadruped Extension Rotation

Kneel on all fours -- knees directly beneath your hips, hands directly in line with your shoulders, and chin tucked so your neck makes a straight line with your spine.

Place your right hand behind your head.

Keeping your left arm completely straight and making sure there is absolutely no movement coming from the lower back, rotate the elbow of your right arm toward the left knee.

From there, extend back toward the starting position, "opening up" the right side by driving the same elbow toward the ceiling and again making sure that all movement comes from the midback.

Do the same with the left hand and elbow.

Perform two or three sets of eight to 10 repetitions per side.

Bench Thoracic Spine Extension Mobilizations

Kneel on the floor with a pad beneath your knees and your elbows on a bench. From there, simply rock back so that your butt moves toward the lower part of your legs while your midback simultaneously sinks into the stretch. Hold for a 2- to 3-second count, then return to the starting position.

Perform two or three sets of eight to 10 repetitions.

Improve Shoulder Stability

Although mobility in your mid-back is crucial to overall shoulder health, shoulder stability is perhaps even more important.

Placing your shoulder blades in a more advantageous position -- pulled down and back -- will go a long way toward keeping your shoulder joint happy. In fact, as counterintuitive as it sounds, movement in your shoulder blades is what usually causes your pain.

Let's use the bench press as an example. Your shoulders are your anchor, and they allow you to safely (and effectively) press more weight. Having unstable shoulders is like trying to shoot a cannon from a canoe.

Strengthening the region around your shoulder blades will create more stability, which will improve not only your overall shoulder function but also your bench press.

An exercise to add to your arsenal is the standing shoulder W. Popularized by Mike Reinold, head athletic trainer and physical therapist for the Boston Red Sox, the standing shoulder W is an exercise to help your shoulders and all the tiny muscles that protect your rotator cuff.

To perform the standing shoulder W, grasp a piece of rubber tubing with your hands about shoulder-width apart while holding your thumbs up, instead of pointing them back. This last point, as Reinold explains, is important.

Keeping your elbows glued to your sides, rotate your arms outward to resemble the letter "W." Be sure to squeeze your glutes so you don't compensate and use any body language. Hold for a 1 to 2 seconds, then return to the starting position.

Do two or three sets of eight to 10 repetitions.

Stop Benching

The bench press: This piece of equipment seems to hold a certain, irresistible power over many fitness enthusiasts. For these people -- and they are typically male -- common sense just does not apply. When faced with shoulder discomfort, no matter how bad the pain, they remain absolutely compelled to take on the bench press.

A compromise does exist, however. Fitness professionals often stress the importance of structural balance in programming; that is, for every training movement you perform, you should perform an equal and opposite training movement. So, for example, if you perform a pushing movement like the bench press, you should also perform a pulling movement that targets the upper-back muscles, like a row.

In general, using a one-to-one push-to-pull ratio is a good idea. So for every set of bench press, do an equal number of rows. But for those with shoulder issues, it's often beneficial to use a 1:2 or even a 1:3 ratio of pushing movements to pulling movements.

In a sense, by purposely focusing on more pulling exercises, you're undoing the imbalances that led to shoulder issues in the first place.

So a typical upper-body day might look something like this:

A1. Neutral-grip pullups: 4x5 -- pulling movement A2. Bench press: 3x5 -- pushing movement B1. Seated cable row: 3x10 -- pulling movement B2. Half-kneeling cable lift: 3x8/side -- core stability C1. Quadruped extension-rotations: 3x8/side -- thoracic mobility C2. Standing shoulder W: 3x10 -- rotator cuff

Do More Pushups?

As far as effective exercises go, pushups rank right up there with "the big boys" like squats, deadlifts and chinups to name a few. Pushups are typically ignored completely because they're deemed "too wimpy" compared to -- what else? -- the bench press.

After all, what's so great about pushups?

For starters, they help develop upper-body strength. With no equipment at all, you're able to work your chest, shoulders and triceps, as well as your core.

Additionally, unlike the bench press, which is an open-chained exercise -- that is, your hands are free to move -- pushups are a closed chain exercise, which, among other things, is advantageous shoulder health in general.

Think about it this way: When you bench press, your shoulder blades are pretty much glued to the bench, unable to move.

Conversely, with pushups, your hands do not move. The shoulder blades are "unglued" and are able to work their way through their normal range of motion.

Pushups are one of the most versatile exercises out there. For many, body weight alone will be challenging enough. But those who are more advanced can add resistance bands, chains or weight vests to the exercise for a greater load.