Shoulder pain

Rotator Cuff Injury From a Bench Press

The shoulder is the most complex joint in the entire body, and most bodybuilders will experience some form of shoulder pain at some point throughout their lifting career.

Your shoulder is made up of several joints combined with tendons and muscles that allow a great range of motion in your arm. Because so many different structures make up the shoulder, it is vulnerable to many different problems. The rotator cuff is a frequent source of pain in the shoulder.

Anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

Your arm is kept in your shoulder socket by your rotator cuff. These muscles and tendons form a covering around the head of your upper arm bone and attach it to your shoulder blade.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.

Rotator Cuff Muscles

The supraspinatus, infraspinatus, teres minor and subscapularis are the core muscles of your rotator cuff. The supraspinatus sits above the shoulder blade and holds the top of your upper arm bone, the humerus, in place. Your infraspinatus comprises the area below the ridge of your scapula, or shoulder blade, and is the main muscle to rotate your arm outward. The teres minor muscle also helps to rotate your arm outward, while the subscapularis holds the top of your humerus in place and prevents it from moving forward.

Bench pressing weight requires the work of several major muscle groups.

Your rotator cuff is a group of muscles that work together to move your shoulder joint through its range of motion. When you bench press a barbell, you use your rotator cuff muscles. Strengthening these muscles may help improve your bench pressing technique and increase your maximum weight. But improper technique and too much weight can injure your rotator cuff, potentially tearing one or more of the muscles.

Bench Press Motion

The major muscles involved in the bench press are your pectoralis major, triceps and anterior deltoid. By changing your elbow's position, you can focus more on one muscle group. The farther out you place your elbows, the greater the stress on your shoulder capsule. If you have a rotator cuff injury, try placing your elbows 45 degrees from your body, which will decrease the pressure placed on your shoulder capsule and its surrounding muscles.

Prevention

Strengthening and increasing the flexibility of your shoulder muscles is important in preventing rotator cuff injuries. Aim for a balanced workout program; the front chest muscles are typically emphasized, but it is just as important to strengthen the muscles in the back of the shoulder and around your shoulder blade. Regular exercise and stretching, as well as adequate rest in between workouts, is important for maintaining the health of your muscles. Talk to your doctor if an injury occurs.

Muscle Tears

Acute and chronic tears are common rotator cuff injuries and can occur during a power move, like bench pressing a high weight. You may experience a sudden tearing feeling in your shoulder as well as severe pain through your arm. Your range of motion will also be affected. Chronic tears happen over longer periods of time. Often located near the end of one of the tendons, they can occur due to friction of the bone rubbing on the tendon. This type of injury occurs more in people over age 40 and will eventually limit the arm's mobility.

The AC Joint

The Bench Press heavily involves the shoulder girdle.

It consists of the shoulder blade and the collarbone, which are joined together by the acromioclavicular joint (AC joint) and three other ligaments. The AC joint is where the outer portion of the clavicle joins a small projection on the shoulder blade known as the acromion process.

Injuries to the shoulder complex among bodybuilders are relatively common. A recent study published by the National Strength & Conditioning Association reported up to 36% of documented weight-training-related injuries occur in the shoulder complex.

More alarming, however, is the reported 28% prevalence of an injury to the AC joint known as “weightlifter’s shoulder.” If an injury is named after your sport, this means it occurs way too frequently, just look at the “Tennis elbow”.

“Weightlifter’s shoulder,” medically known as osteolysis of the distal clavicle, is characterized by widening of the AC joint, stress fracture(s) below the cartilage of the AC joint, and an erosion of the outer part of the clavicle bone. Research indicates weightlifter’s shoulder has been specifically associated with the bench-press exercise as a result of repeated microtrauma at the AC joint during the lowering phase of the exercise when the elbow drops past the trunk. 

This isn’t to say you should avoid the bench press altogether. Quite the contrary, you should incorporate it into your training program as it’s very effective at developing the chest, triceps and even shoulders. Unfortunately the bench press is definitely overused by many trainers to the point that inexperienced bodybuilders often make it their backbone exercise and do it 2-3 days per week. Additionally, the bench press is a great ego exercise. Nothing is better than loading the bar with Godzilla-like poundage and busting out a few reps in front of every pair of eyes in the gym.

Like most exercises, however, you can do too much of a good thing because it can lead to unwanted injuries.

If your AC joint is bothering you – if you’re not sure see a sports-medicine practitioner pronto – avoid performing any pressing movements for at least seven days and ice the area for 15 minutes 1-2 times per day.

Over-the-counter NSAIDs might be beneficial during this rest period. When you come back to pressing movements, avoid the bench press during first 1-2 weeks back and perform your presses with about 50% of your usual weight. Every other week add a little more resistance until you’re back to pressing with no pain. If your pain persists, seek the help of a qualified medical professional such as a sports-medicine physician, certified athletic trainer or licensed physical therapist.

The Dumbbell Bench Press

Does the Dumbbell Bench Put Less Stress on Your Shoulder Muscles? The bench press exercise may be done with a barbell or dumbbells. Not static.

The shoulder joint has the largest range of motion of any of your joints, which makes it the most vulnerable to injury. The joint has the ability to move into 1,600 positions throughout a three-dimensional space. This freedom of movement makes the shoulder vulnerable because of an inherent lack of stability that allows for movement. The dumbbell bench press is an example of an exercise that may compromise the shoulder due to stress on the joint.

Injury

Weight lifters who overtrain their chest, shoulder and middle back muscles often suffer from primary shoulder impingement, it is also common in athletes in their 30s, according to Sports Injury Bulletin's website. Impingement is when the rotator cuff muscles are squeezed between the upper arm bone and a bony area of the shoulder called the coracoacromial arch. Weak rotator cuffs increase your chances of developing impingement. The dumbbell bench press is a traditional weight training exercise for the chest and shoulders. It places stress on the shoulder joint, though less than some exercises and more than others.

A dumbbell bench press targets the anterior and medial deltoids, pecs and triceps. The anterior and medial delts are the front and side portions of the major shoulder muscles. The pecs are the major muscles of the chest. This exercise also works the rotator cuffs as secondary muscles. If you have strong rotator muscles to stabilize and assist during this exercise, you are unlikely to experience pain or injury. To perform the exercise, lie face up on a bench, holding dumbbells next to your armpits with the elbows bent. Press the arms straight up and not out to the sides.

Barbell Vs. Dumbbell

A barbell bench press may place significant stress on your shoulders. Holding a barbell using a wide grip stresses the ligaments on the front of the glenohumeral -- or ball and socket -- joint because of the horizontal abduction movement. Horizontal abduction is when you move your upper arms sideways away from the middle of your body. A wide grip means that your hands are far apart. The farther apart you hold them, the more horizontal abduction your shoulders perform during a bench press. Using spacing narrower than 1.5 times your shoulder width avoids stress. Because a dumbbell press limits the width of the arms, it places less stress on the shoulders than the barbell bench press.

Bench Press vs. Closed-Chain Exercises

Closed-chain exercises such as pushups are safer for your shoulders than open-chain exercises, such as bench presses. A closed-chain exercise involves a fixed position at the end of the limbs you are moving. For example, during a pushup your hands are in a fixed position on the floor. Your hands move during the dumbbell bench press, so it is an open-chain exercise. Since the hands are far away from the shoulders, the bench press creates more stress to stabilize the arms and shoulder joints.

 The Best Exercise for Strengthening Your Shoulders

Pressing a barbell overhead has somehow acquired the reputation as a dangerous exercise for the shoulders. Doctors and physical therapists routinely advise against the exercise weightlifters refer to as simply The Press on the false assumption that an injury known as "shoulder impingement" is the inevitable result. Not only is the press perfectly safe for the shoulders -- as evidenced by the fact that shoulder injuries are the least-common injuries for Olympic weightlifters who use the barbell overhead -- but the correctly performed press is the best exercise for keeping shoulders strong. Here's why.

Shoulder Impingement Is Misunderstood

Shoulder impingement occurs when the rotator cuff tendons get "pinched" between the head of the humerus and the AC joint, formed by the end of the collarbone and the bony knobs at the end of the shoulder blade. Impingement means an entrapment of soft tissue between two bones in the area of a joint. You can safely experience this entrapment feeling for yourself: sit or stand up straight and raise your arms from your sides to a position parallel to the floor, with the palms of your hands facing the floor and your elbows bent at 90 degrees. Now, raise them just a little more. The pressure you feel in your shoulders is the impingement of your cuff tendons against the AC.

Now, rotate your hands up so your palms face forward, elbows still at 90 degrees, and raise your hands up over your head. Then shrug your shoulders up at the top, like you're trying to reach the ceiling with your hands and shoulders. Pressure's gone, right? This is the lockout position of the press, and notice that at no time in this process did your shoulders feel impinged. This because the shrugging of the shoulders at the top pulls the AC knobs away from the head of the humerus, so that impingement is anatomically impossible in the correct press lockout position. The press simply cannot impinge your shoulders.

In fact, shoulder impingement injuries are common only in athletes that use their arms overhead without a shrug. Swimmers, volleyball players, and the racquet sports report most of the shoulder impingement injuries. They'd be far better off if they trained the press as a part of their sports preparation.

Why The Press Is the Best Exercise for Shoulder Strength

Since a correct press is done in a standing position, the exercise works all the muscles in the body. Everything between the bar in the hands and the feet balancing against the floor participates in the exercise. Legs, abs, and back muscles, as well as the obvious shoulder and arm muscles, all work together in a correctly performed press. Sixty years ago, the press was the primary weight room exercise for the upper body. For men who trained with weights, a bodyweight-on-the-bar press was considered a good starting point.

And back then, shoulder injuries were essentially unheard of because the press made the shoulders strong -- the whole shoulder, not just the front of the shoulder like the bench press does. The takeover of upper-body training by the bench press was an unfortunate development. The bench allows the use of heavier weights, but at the expense of the involvement of more of the body, and more balanced shoulder strength, front-to-back. As a general rule, more muscle mass working at the same time all over the body is much better for strength training than isolation exercises. The coordinated use of all the muscles while standing on the floor with a barbell in your hands produces the most useful strength adaptation -- one that actually applies to all natural human movements.

What You Know About Rotator Cuff Muscles May Be Wrong Physical therapists like to isolate the function of a muscle to rehab it when it's injured. The isolated function of the muscles that lie on the shoulder blade is "external rotation" of the upper arm. This motion occurs when you lay your arms down against your ribs, bend your elbows and rotate your forearms out so that your palms face forward. Your humerus rotates "externally" along its axis when you do this, and the rotator cuff muscles make this happen in isolation.

The question is: what is the normal daily role of a rotator cuff muscle? Does it make your shoulder externally rotate, and that's all? Or does it primarily function as a muscle group that stabilizes the head of the humerus in its socket, the "glenoid fossa"? Think about it another way: who named it "external rotator"? God? Or physical therapists? Maybe a better name for it would be the keeps-the-arm-in-the-shoulder-ator, and it also just happens to externally rotate the arm. When you're not in physical therapy, the rotator cuff muscles are just another muscle group that helps hold the shoulder together.

There Is No Single Muscle Group in the Entire Human Body That Works in Isolation as Its Normal Function Not even your tongue. It therefore makes no sense to train muscles in a way in which they do not function. Physical therapists may be able to isolate your rotator cuff muscles, but you may have noticed that this motion is not a normal part of your day.

If the cuff muscles work during a press (they do), and if they are aided in their function by all the other muscles in the shoulder (they are), then as the progressively heavier press makes the shoulder stronger, it makes the rotator cuff muscles stronger too. It is much better to strengthen the cuff muscles while their shoulder-muscle friends help lock out a press, than when they are made to work all alone, all by their skinny little selves in the PT office.

So, if you start pressing with a light weight and grow stronger by adding a little weight each time you train, all the muscles you use in the press get stronger. From your hands to your feet, and even your rotator cuff muscles, your whole body benefits from this perfectly safe and very important exercise. Once you're able to handle heavy weights correctly overhead, you'll know that strong shoulders are healthy shoulders, and the best way to make them strong is to use them correctly, by pressing the barbell overhead.

A Torn Rotator Cuff and Military Presses

Improper technique while performing the military press can cause a rotator cuff tear. Like in the pic some people lift from behind the neck and lower the bar to deep.

The military or overhead shoulder press is a common strength exercise for your deltoid muscles, but improper technique along with other risk factors can increase your risk of a torn rotator cuff muscle, the muscle that helps stabilize the shoulder joint. A torn rotator cuff while performing a military press can cause symptoms such as pain, muscle weakness and decreased range of motion. Immediately stop lifting weights, use ice and seek medical attention.

Causes and Risk Factors

Common mistakes made while performing a military press include poor posture, lifting the weight too far forward or back, and lifting the weight too fast. Training errors include lifting too much weight, not allowing adequate recovery time between sets, overtraining and not stretching. Other contributing factors include muscle strength imbalances, shoulder instability, weak rotator cuff muscles and a previous shoulder injury.

Symptoms

Symptoms vary depending on the severity of the rotator cuff tear, which can be a partial tear or a complete rupture. Symptoms include shoulder pain, muscle weakness, decreased range of motion and shoulder instability. You also might feel or hear a pop when the rotator cuff tears while performing the military press

“The Arnold Press”

Arnold Schwarzenegger trained a lot, long sessions with many reps. I guess he must have felt his shoulders many times. He always emphasized in articles that working with dumbells had less impact on the shoulder joint due to its different range of motion. He said that you must perform the exercises with the pink up and in a round move. The Arnold Press was performed sitting and starts just before the collarbone with the palms to the chest (see graphic).

Treatments

Stop all lifting, ice and take over-the-counter pain medications such as acetaminophen. A physical therapist or athletic trainer can help with rehabilitation and provide guidelines for returning to normal activities. Rehabilitation exercises might include resisted shoulder internal and external rotation, shoulder extension and shoulder abduction to strengthen your rotator cuff muscles. Once pain subsides and you regain shoulder strength and flexibility, you can add more strength exercises, including the military press.

Technique and Modifications

Performing military presses following a rotator cuff tear might take several weeks to several months. In a seated position, hold a light barbell or dumbbells just in front of your shoulders and along your upper chest. Lift the barbell or dumbbells straight up without letting them drift forward or back, and while keeping an upright posture throughout the entire lift. If the military press still is uncomfortable, you might perform a shoulder press lying on your back or a shoulder press using a resistance machine as alternatives. A lying shoulder press will provide support for your upper back and shoulder, which might reduce the stress on your rotator cuff muscles. The resistance machine also will provide additional support and help control the weight in a one-plane movement. Perform one to three sets of 10 to 15 repetitions.

Considerations

Perform the military press and other strength exercises two to three times a week, not on consecutive days and gradually increase weight. Include a warm-up for your shoulders using resistance bands or lighter dumbbells prior to performing the military press to prevent pain and re-injury. Initially, avoid going to muscle fatigue with the military press, which increases your risk of re-injury. Ice your shoulder after lifting to manage pain and inflammation.

Don’t bench press every week

There are dozens of chest exercises you can choose from, so do others (e.g., dumbbell presses/flyes, machine presses, incline/decline presses, cable flyes). Unless you’re specifically trying to increase your bench press during a given time frame, do the bench press every second or third chest workout (even if training chest just once a week). 

Don’t always go as heavy as you can

We didn’t say to avoid going to failure, per se, but you can go to failure with lighter weight. You don’t need to pile on weights for your one-rep max every time you train (especially on the bench press).

Pay attention to technique

Avoid bouncing the weight at the bottom of the rep as this is where the joint gets the most stress.

If necessary, shorten the range of motion

If needed, roll up a towel and place it on your chest to prevent the elbows from going past the plane of your trunk and shorten the range of motion. You can also do this with safety bars in the power rack.

Description

The rotator cuff is a common source of pain in the shoulder. Pain can be the result of:

• Tendinitis. The rotator cuff tendons can be irritated or damaged.
• Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
• Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain. The acromion "impinges" on the rotator cuff and bursa.

Symptoms

Rotator cuff pain commonly causes local swelling and tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.

Beginning symptoms may be mild. Patients frequently do not seek treatment at an early stage. These symptoms may include, minor pain that is present both with activity and at rest, pain radiating from the front of the shoulder to the side of the arm, or sudden pain with lifting and reaching movements.

Athletes in overhead sports may have pain when throwing (baseball) or tennis (serving a tennis ball).

As the problem progresses, the symptoms increase to pain at night, a loss of strength and motion and difficulty doing activities that place the arm behind the back, such as buttoning or zippering.

If the pain comes on suddenly, the shoulder may be severely tender. All movement may be limited and painful.

Doctor Examination

Medical History and Physical Examination

Your doctor will test your range of motion by having you move your arm in different directions.

After discussing your symptoms and medical history, your doctor will examine your shoulder. He or she will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. He or she will also test your arm strength.

Your doctor will check for other problems with your shoulder joint. He or she may also examine your neck to make sure that the pain is not coming from a "pinched nerve," and to rule out other conditions, such as arthritis.

Imaging Tests

Other tests which may help your doctor confirm your diagnosis include X-rays.

Because x-rays do not show the soft tissues of your shoulder like the rotator cuff, plain x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur. A special x-ray view, called an "outlet view," sometimes will show a small bone spur on the front edge of the acromion.

Magnetic resonance imaging (MRI) and ultrasound. These studies can create better images of soft tissues like the rotator cuff tendons. They can show fluid or inflammation in the bursa and rotator cuff. In some cases, partial tearing of the rotator cuff will be seen.

Treatment

The goal of treatment is to reduce pain and restore function. In planning your treatment, your doctor will consider your age, activity level, and general health.

Nonsurgical Treatment

In most cases, initial treatment is nonsurgical. Although nonsurgical treatment may take several weeks to months, many patients experience a gradual improvement and return to function.

Rest. Your doctor may suggest rest and activity modification, such as avoiding overhead activities.

Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling.

Physical therapy. A physical therapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder.

Once your pain is improving, your therapist can start you on a strengthening program for the rotator cuff muscles.

Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.

Surgical Treatment

When nonsurgical treatment does not relieve pain, your doctor may recommend surgery.

The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will remove the inflamed portion of the bursa. He or she may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.

Arthroscopic technique. In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around your shoulder. Your doctor examines your shoulder through a fiberoptic scope connected to a television camera. He or she guides the small instruments using a video monitor, and removes bone and soft tissue. In most cases, the front edge of the acromion is removed along with some of the bursal tissue.

Your surgeon may also treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.

Open surgical technique. In open surgery, your doctor will make a small incision in the front of your shoulder. This allows your doctor to see the acromion and rotator cuff directly.

Rehabilitation. After surgery, your arm may be placed in a sling for a short period of time. This allows for early healing. As soon as your comfort allows, your doctor will remove the sling to begin exercise and use of the arm.

Your doctor will provide a rehabilitation program based on your needs and the findings at surgery. This will include exercises to regain range of motion of the shoulder and strength of the arm. It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year.