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Progressing Through Shoulder Pain

The shoulder is at least anecdotally one of the most frequently seen injured regions of the body in a clinical setting. This is especially true in athletic, active populations. The pain can be severe, but even more debilitating is the negative impact on function. You don’t realize how often you put your shoulder under stress until you can no longer put it under stress.

One of the big reasons the shoulder is so frequently injured is because of the anatomy of the joint. It is a ball-and-socket joint, with the arm being the “ball” and the shoulder-blade acting as the “socket”. The shoulder has an amazing range of motion when compared to other joints like the elbow and knee. This can be beneficial, however there is a trade-off of stability in exchange for mobility. The very reasons that allow the shoulder to move so freely (and hence allow us the capability to use our hands in almost any position) are the same causes for the lack of stability. There is relatively little surface area in contact between the “ball” and the “socket”.

In terms of shoulder musculature, there are the rotator cuff muscles (4 of them). They are typically smaller muscles that help to stabilize the shoulder joint among other actions. Some larger muscles like the lats and deltoids also have an impact on the shoulder joint. The rotator cuff muscles for the most part, live in small anatomical spaces which leaves them vulnerable to injury. There is not a lot of room for error in movement patterns.

With all of this being said, humans are absolutely NOT fragile. Given a shoulder injury, there is always a way to progress through it in a pain-free (or pain “low-ish”) manner. In doing so, there are a few concepts that you won’t want to overlook, such as the importance of upper back strength and stability, lat activation, core stability, scapular control/awareness, and joint angle/orientation in a given movement.

Upper back strength/stability

In pressing movements such as the bench press, the upper back is the foundation on which the movement is performed. You wouldn’t squat without legs strong enough to handle the weight, yet people bench press all the time without an upper back that can handle the weight. If you want to ensure your shoulders are not enduring unnecessary load, make sure your upper back is not your limiting factor.

Lat activation

The largest lever affecting the shoulder is the latissimus dorsi. The lat goes from the upper arm all the way to the lower back. It is a staple in creating rigidity in the core by stiffening the lower back, but it can have a similar effect on the shoulder if engaged properly. Engaging the lat will also keep your elbows tucked which means you avoid flared shoulders that frequently lead to pain.

Core stability

Core stability could be at the top of any list regarding keys to strength training. There is almost nothing that a stable core won’t improve. Try to keep your ribcage stacked over your pelvis while you are pressing or pulling with the shoulder.

Scapular control/awareness

Half of the shoulder joint is the shoulder-blade (scapula). Therefore, the ability of the scapula to glide on the ribcage and the resulting position of the shoulder joint directly impacts shoulder function. Generally, the better you are at controlling your scapula, the better you are at avoiding shoulder pain.

Joint angle/orientation

This is partly a by-product of the aforementioned principles. However, you can also manipulate joint angles by changing the incline on a bench when pressing or pulling with the shoulder. For example, someone who has pain in the overhead position may be able to do a flat bench press without any pain. You could gradually increase the incline on the bench as tolerance improves. Generally, the higher the incline, the more stress on the shoulder joint (however there is some person-to-person variability with this depending on numerous factors).

An example of progressing with shoulder pain:

1. Farmer carries, Roman chair holds/leg lifts, band pull-aparts, single-arm lat pulldown

2. Shoulder airplanes, Bottom-up kettlebell press (light), low-incline back flies, lat pulldown

3. Floor press, low-incline dumbbell row

4. Flat bench press, barbell row

5. Low-incline bench press (gradually increase to steep-incline)

6. Standing overhead press

*This is just an example, but it is very dependent on the individual’s exact presentation. Time spent on one stage may be a few days or several months.

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