Friday, November 8, 2019

Why Your Shoulder Pain Won't Go Away

 At some point in your quest for fitness, I am sure you have experienced some form of shoulder impairment. It could be a general "it hurts when I do" so and so movement to a full-blown rotator cuff tear.  Why do I know that you have experienced this? Because this is one of the most common injuries in the gym from beginner lifters to advanced. The most common movement associated with shoulder pain and discomfort is The Bench Press. The Bench Press is designed to build strength as well as muscle on the chest. So why is it that your shoulders are hurting when performing this lift? The answer is simple; you're not doing the movement correctly.  Over the next few paragraphs, I will lay down some guidelines to help not only prevent injury to your shoulders but also show you how to get rid of pain and rehab your shoulders, all while getting stronger. I can promise if you follow the steps below, your strength will increase, and your pain will decrease. This is a system I have used with many clients throughout my coaching career from those with minor strains to shoulder replacements and everything in between, and it has yielded incredible results.

Step 1: Learn To Use Your Lats and Protect the Shoulder.
Using your lats is the key to success when it comes to all lifts in the gym. Your lats are responsible for shoulder extension, protecting your spine to its fullest potential when activated properly, scapular retraction, and, most importantly, depression of the scapula. When we talk about scapular retraction, I want you to think about pulling your shoulders down towards your back pockets. By doing this, you are not only protecting your spine by putting it in a neutral spinal position, but you are activating your lats, which will allow for a safer and more effective lift. Most people do not use their lats properly, and most of that is because of ineffective cues. I very rarely tell people to pull their shoulders back because, as I tell my clients, its a bad cue to get a semi-good action out of a client that does not know the muscles or have good body awareness. You will hear many coaches use this cue because the general population will hear that know what it means. They will pull their shoulders back, and the chest will come up. It looks good on the surface, but the lats are not fully activated in this position, and the shoulder joint is not packed down safely, which can cause shoulder strain and pain if you are performing a lift in that position. Instead of pulling the shoulders back, envision yourself trying to take the top of your head to the ceiling while pulling your shoulder blades towards your back pockets. You will see that your posture will be upright, and you will feel the lats at work. To improve on scapular retraction, you need to strengthen the muscles responsible for it( serratus anterior and lats specifically)  and do all your lifts with this form in mind.

Step 2: Fix Your Technique.
    So your one of those people who say Benching with an arch in your back is cheating, and you can slam(literally into your chest with no control) 225lbs for multiple sets and reps, so why change it?  Well, I hate to tell you, but it's only a matter of time before that shoulder pain creeps up on you. The sole purpose of the arch is to allow for maximal force and to protect the shoulders from excessive stress. With the arch in place during the eccentric movement or downward portion of the Bench Press, the force moves through the chest, into your upper trapezius muscles and your lats. During the concentric or upward portion of the lift, that force is now primed as if you drew back a bow ready to lose your arrow. That force now travels back into the arms and chest.  The reason for this is because when you're in an arched position, your shoulders are packed down, also known as scapular retraction. During this process, your shoulder joint externally rotates or turns outward, packing the shoulder joint down.  By doing this, it activates your lats during the lift allowing for more power, better stability because the shoulders will not move into a shrug or roll while pressing and allowing for a better bar path.  With the arch and your shoulders pulled down, the bar will not go above your nipples. Why is this important? Because if the bar comes above the nipple, you shrug your shoulders as the bar comes down and will stay shrugged until the bar is back at it's starting position. By doing this, as you apply force to move the bar off your chest, the shoulders and rhomboids take the majority of the stress and can lead to injury in the rotator cuff. Have you ever seen someone's head leave the bench as they are pressing? This happens because they are only focusing on pulling the shoulders back instead of back and down. In the pulled back position, the scapula doesn't have room to move properly because there isn't as much muscular support for it. Because of this, the scapulas push into the bench, and the shoulders rotate. As a result, the head comes up as compensation to make room for the improper movement. Again this puts a ton of stress on the shoulder and can lead to impingement of the shoulder, neck strain, and other injuries.

Step 3: Press Variation Is Key.
    You absolutely must hit every range of motion and press variation. I am talking about low incline, incline, high incline, and shoulder presses. This will help ensure your shoulders are stable in every plane of movement. Keep in mind you will still need to pull the shoulders down towards your back pockets during all presses, no exceptions. Another exercise that should be included in your accessory lifts is external shoulder rotations. These should follow after every pressing session you do. Not only will it help keep your shoulders from rolling inward due to tightness in the chest from all the press work, but it will strengthen joint, your lats, and help reinforce that great shoulder position of down towards the back pockets, which will overall keep you from rounding your back.  We very rarely need to focus on internal rotation. Almost everyone is internally rotated or compensating for a lift in this position. The goal is to break that habit.

Step 4: Grip Variations.
    Using dumbbells is also the key to helping your shoulders and also improving your bench or overhead press. The key is changing the way you hold the dumbbells while performing these lifts. When under the bar, the bar is in charge. We have to take that pronated grip( palms facing away from you), but when using dumbbells, we are able to perform the lifts in a more natural position. That position is a neutral grip.  When using a neutral grip, it becomes easier to set the lats( Scapular Retraction). A neutral grip allows the shoulder to take even less of the stress while still allowing the muscles around it to grow and become stronger, making the joint itself stronger and more stable. A neutral grip also allows for a greater range of motion(ROM), and more ROM equals more strength and muscle gains.  This same rule applies to our back accessory lifts. When performing lat pull-downs, do not just use one grip variation( usually pronated grip and traditionally done with a wide grip). Try using a supinated grip to perform reverse lat pull-downs. Use a pronated grip and go shoulder-width apart. Give that V-grip attachment some rest and instead try using a mid-neutral grip attachment. The rules for the lat pull-downs can also be applied to cable rows, although I do not usually have people cable row with a supinated grip. For this type of work, barbell supinated bent-over rows are a great variation.

Step 5: How To Deal With Shoulder Pain.
    If you currently have shoulder pain and it is restricting your ability to press heavy weight on the bar or dumbbells, the cure is simple, don't press heavy weight or any weight that causes pain. Now I'm worried that the way you read that last sentence was "don't lift at all because it hurts" when what I said was don't lift a weight that causes pain. This means your still benching with the bar, empty bar if need be( again if no pain), and working through those neutral grip dumbbell presses. If the barbell is too heavy, use dumbbells until you can get back under the bar without pain. Now you're asking how many sets and reps right? Well, that depends on how the shoulder feels. I would suggest 3-5 sets of 8-10 reps. You will have to play it by feel and listen to your body. You may also want to include some banded shoulder mobility work into your routine which can be done before or after lifting depending on how severe the injury or strain is. Banded mobility drills are a great way to both functionally loosen, and strengthen the shoulder joint. I have included some photos of some banded shoulder mobility drills below for you to check out and easily implement for yourself.

Let us know how you feel going through the steps above, share your progress, and tag @rttraining and @coach_christos on your social media pages. Please feel free to send in any questions you have. I am more than happy to answer them.

                                         Video 1: Introduction to Banded Shoulder Mobility

                                     Video 2: Second Variation of Banded Shoulder Mobility

Video 3: Example of Banded shoulder mobility drill with Elderly Personal Training Client and Coach Christos.

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