The Lifter’s Guide To Training Through Shoulder Pain

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2017-08-16T12:30:14+00:00 By |

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Put An End To  Shoulder Pain Once & For All

If you’re reading this then you are probably one of 45-million Americans who regularly engage in some type of resistance training. If you’ve been resistance training for any length of time there’s a good chance that you may have been or are currently experiencing some type of shoulder pain or injury.

Up to 36% of documented resistance-training related injuries have occurred around the shoulder joint. If you haven’t yet figured it out, taking care of your shoulders is a big deal. You don’t just need them to push big weights around and to look jacked, you will need them around for the rest of your life working for you, not against you. You won’t need them to still lift big weights and look jacked but rather to get up from a toilet seat or grab a can of food from over your head.

Maybe you’ve tried a few things here and there to address your shoulder issues, maybe some simple rotator cuff exercises and some pec stretching. Because your knowledge was limited maybe you haphazardly performed these going through the motions then proceeded with business as usual. How’s that working out for you?

Still having pains? Has your acute shoulder strain turned into something chronic? Here’s what you need: you need a complete overhaul that affects every area of your training. Stop doing the stuff that’s hurting you and start doing stuff that will help you, all while still accomplishing your physique and strength goals.

Here are six of the most common problems that can occur when we try to address shoulder joint training, and how to strategically fix them in order to bulletproof your shoulders against injuries and unlock your pain-free performance potential once and for all.

#1 You Lack Stability & Are Too Focused On Mobility

When I was in physical therapy school we learned a simple maxim that goes something like this…

“Proximal stability leads to distal mobility”

What does that even mean? Here’s the deal, you probably don’t lack shoulder mobility. Can you comb your hair? Can wipe your bottom after going number two? Congratulations, you probably have normal shoulder mobility.

What you need first is stability, postural stability followed by shoulder complex stability, that is. The further away you hold resistance from your body the more stability is required to hold it. If you don’t believe me try carrying your groceries away from you next time you go shopping.

Stability starts in the core muscles, the function of these muscles is to PREVENT movement in places that shouldn’t be moving while we are moving our limbs. When you deadlift, you don’t want your lumbar spine to be flexing or extending too much; your core muscles prevent this from happening. The same idea is true with movement at the shoulder joint.

What’s the secret to core and shoulder complex stability? Full-body tension! In other words, you keep everything tight (not necessarily holding your breath) while moving. One of the single best exercise you can do to facilitate core and scapular stability and train you to develop full-body tension is the traditional farmer’s walk and it’s many variations.

Whether it’s just core stability or stability at the shoulder joint, holding heavy loads steady while you walk a distance requires a very strong core and a very stable shoulder joint. Loading here needs to be HEAVY! Want to prioritize shoulder stability over core stability as well strengthen your grip? Use dumbbells, a trap bar or farmer’s walk implements.

Another key point regarding posture is that most of us only train 1-2 hours per day, compared to the other 22-23 hours usually spent in postural poor positions. In that time you can really work yourself into good posture and facilitate stability for heavy loading. However, after that time is over your body tissues will tend to revert back to wherever they are at while resting.

So if you sit at a desk with slumped shoulders, tight hip flexors, and tight hamstrings then you won’t be able to undo all of that in an hour’s time. Take standing breaks, stretch your chronically tight muscles at work, and do this at least once every 2 hours. Changing positions does a body good!

#2 Your Shoulder Mobility Efforts Are Misdirected

Ok, so maybe you’ve started doing some mobility work and you’re not really seeing notable results. Mobility work has become increasingly popular over the last few years. People beating their tissues with foam rollers and lacrosse balls daily and yet we really haven’t seen a significant decrease in the prevalence of shoulder injuries.

Let’s face it, most people don’t know what they’re doing when it comes to mobility and warming up. The dynamic warm-up that incorporates mobility has several purposes:

  • Increase core temperature
  • “Unlock” stiff tissues
  • Activate stabilizer muscles and prepare joints to prepare them to handle heavy loads

Once you understand this, you can develop an effective plan of attack with mobility and you unleash your full fury on the weights with minimal risk of injury.

Some of the most popular exercises for shoulder mobility include the traditional rotator cuff exercises with external rotation with a light band or dumbbell. With minor isolation based shoulder drills like these, it’s pretty easy to go through the motions and end up doing absolutely nothing to help protect your shoulder joint.

First things first, your shoulder joint needs to have permission to move through it’s full range of motion. That means opening up your thoracic spine before trying to mobilize the shoulder joint.

Here’s a simple test to prove my point: Slump your shoulders and round forward, now try to raise your arm over your head, can’t do it can you? Making sure your T-spine is opened up is critical to making sure you are ready for lifting heavy while protecting your shoulders.

Jerky shoulder movements and poor posture during those exercises and stretches will not help you bulletproof your shoulders and they could even do more harm than good. In addition to this, to take your shoulder joint through its full range-of-motion (ROM) the humerus needs to externally rotate otherwise it will be hitting the acromion every time you to move that joint past 90 degrees. This is why, as you’ll see, I recommend doing all your mobility work for the shoulder maintaining external rotation throughout! Do banded pull-aparts with this technique shown here.

You also want to be mindful of other joints while warming up. Remember that posture includes your entire body. If you have a joint that is away from the plumb line,  you want to get yourself as close to normal alignment as possible without weakening tissues.

So besides stretching your pecs, your lats, and deltoids you’ll want to stretch your hip flexors. Tight hip flexors pull your entire upper body forward, including the shoulders. It’s also good to stretch your traps and neck musculature in order to relax them if they tend to be overactive during your upper body pressing and pulling.

One of the best ways to pull your body into better postural alignment while stretching both your pecs and your lats is hanging from a bar, you can even incorporate some core work by doing hanging leg raises, or stretching the hip flexors from half kneeling. Do these at the end of any workout for up to 1 minute.

What about tissue work? Do it at the end of your workouts.

Cold and tight muscles don’t respond well to tissue work as well as warm muscles. General foam rolling of the upper back can be helpful, but often there are knots that form that can develop trigger points and need to be released. Using a lacrosse ball, or even your own fingers/thumb you can emphasize the trigger point and release it. You can learn more about self myofascial release techniques from Dr. John Rusin HERE.

#3 You’re Training The Wrong Muscles The Wrong Way

Oftentimes when lifters are trying to work through shoulder problems, they end up looking at generic information on the internet. Typically, they will end up doing rehab exercises, in particular isolated external rotations that don’t really address the root of their problems, which is mostly likely in their programming.

The rear delts are often underdeveloped on most people and it is often to the detriment of not only that person’s physique but also the health of their shoulders! Because most training programs are imbalance and the postures of daily living pull us into poor positions for the shoulder joint, you need to up the ante on posterior deltoid training. I recommend training the rear delts every time you do chest or shoulder pressing, every time you train your upper back, and even when you train your arms. That’s a lot of frequency and volume, but if you want healthy shoulders that’s how this regions responds best.

The posterior deltoids can take a beating and are very hard to overtrain, especially since those exercises help to essentially pull your shoulders back towards a normal postural alignment. You should incorporate very high reps, partial reps with heavy weights, and various metabolic stress techniques such as supersets and drop-sets. Here’s a basic breakdown of how I suggest dividing up your rear delt work, with three of my favorite rear delt exercises in a more common training split:

This is just an example split, there are endless ways to do this, but rear delts need to hit at least 2-3x per week to optimize shoulder health. Do between 10 and 60 reps for each movement.

One of the most difficult parts of training the posterior deltoid is the fact that oftentimes it’s not recruited properly. The functions of the posterior deltoid include both external rotation and horizontal abduction and shoulder training should include these motions. However, many times lifters incorporate these movements and other muscles take over.

Doing high reps, as well as isometrics, can help with this as the burn that develops will help clue you in as to what muscles are really doing the work. Face pulls are the cream of the crop when it comes to hitting the rear delts and developing. If you’ve never done this before, start in a supine position as shown in the video to ensure you are maintaining proper postural alignment during the exercise.

The other neglected muscle that tends to be under-trained are the lower trap muscles. The trapezius muscle has several functions affecting the movement of the shoulder blade.

The upper traps (most commonly overused) are involved in shrugging, or scapular elevation. The middle traps help bring the shoulder blade back (called retraction). The lower traps responsible for pulling the shoulder blade down (depression) and is actually antagonistic to the upper traps. When the middle and lower traps activate they help bring the shoulders into what is known as a “packed” position that helps facilitate stability.

You can train those muscles with rows but also in isolation (or both) as show here.

Strengthening other postural muscles is vital to protect your shoulder joint while lifting. I already mentioned earlier that core strengthening and stabilization can be facilitated with the farmer’s carry exercises. The other critical muscle to train here is the glutes.

The glutes are involved in stabilizing the whole body and maintaining full-body tension. You should include some direct glute work involving isometric holds at the point of maximal hip extension for 2- 5 seconds each, even with heavy loads. I recommend hip thrusts with either a band or a barbell.

#4 You Keep Yourself Up With The Wrong Exercises

All of the corrective exercise in the world won’t do you a bit of good if you are continuously feeding a destructive movement pattern with exercises that aren’t suited to you. Overhead presses and pulls are the most notorious culprit here, especially when performed with maximal weights. Remember that end-ranges of motion in a joint are where stability is often lost. Unless you are an olympic lifter or a strongman competitor, there is no need to train overhead presses and pulls with heavy loads.

If your goal is to build massive, capped, boulder shoulders, then heavy overhead pressing is certainly not necessary. Big shoulders can be built from heavy horizontal pressing and pulling as well as metabolic stress techniques with direct deltoid training.

Drawing from my own experience, I used to press 100 lb dumbbells overhead, I haven’t done those in 8 years and yet my shoulder development has improved significantly. At the highest level, you can see that IFBB John Meadows drastically improved his shoulder development in spite abandoning regular heavy pressing (as well as improved back development in spite of minimal heavy training with vertical pulling exercises).

Remember that no one exercise is mandatory, period! Great chests have been built without flat barbell bench presses, great legs without back squats, and the same logic applies to building great delts.

The key to remember is that heavy overhead pressing is a privilege. You must be able to move correctly and demonstrate good mechanics before loading up. Here’s a basic test to see if you are appropriate for heavy pressing:

If you can push an empty bar overhead without arching your back and while keeping your chest up then you can start loading that movement. Otherwise you are just beating yourself up! More on overhead mechanics and whether or not you can safely overhead press from Dr. Rusin and Coach Christian Thibaudeau HERE.

Remember that other exercises can affect your shoulder health besides the ones directed at the shoulder joint. One of the most basic examples are squatting variations. Whether it’s front squats or back squats, the bar positioning requires maintaining external rotation at the shoulder joint throughout the movement. Any discomfort or limitations with this will hinder your ability to perform the exercise effectively. Look for ways to modify your technique if you don’t have the mobility to consistently hold the bar in its proper position, such as using wrist straps to complete your front squats.

#5 You Don’t Know When To Back Off

Hey I get it, you’re hardcore, you have a champion’s mindset and nothing is going to stop you… except for some screwed up shoulders that have just had enough! When you consistently return to exercise at a joint that is being consistently damaged, you’re basically re-injuring it every time you train.

If your shoulders are mad at you and chronically inflamed, then back off! You won’t lose a terrible amount of progress if you are consistent with lower body training and mindful of your nutrition. Either way, you have to respect the fact that it takes a certain amount of time for your body to heal from injury and that may mean several days, several weeks, or in cases of post-operative care several months.

Are you a glutton for punishment? Are you dead set on making progress at any cost? Are you willing modify your exercise technique in order to say that you made progress that day? This is the type of mentality that leads to injuries.

It’s the type that doesn’t know how to read the body’s signs that an injury has occurred or may occur. If you have swelling, tenderness, and/or abnormal joint pain in an area that is a sign to back off. It’s great to have a plan and be mentally tough, it’s equally as great to be smart and help yourself ensure long-term progress and longevity in your training career.

I love self-management techniques. I wouldn’t have written this article if I didn’t believe in self-management. Educating my patient population on self-management techniques is the wave of the future when it comes to what health and fitness professionals do for their clients. However, you can’t fix everything on your own, and you certainly can’t assess everything on your own.

I learned this the hard way myself at the beginning of 2017, when I went in for three physical therapy sessions to work on my knee pain. I’m back now to squatting heavy and pain-free and I was fortunate to work with a therapist who understood my goals. If you’ve been dealing with chronic injuries and/or you have to spend 30 minutes or more on “mobility and tissue work” before you can get a decent workout, it’s time to seek professional help from a qualified healthcare practitioner.

#6 Your Movement Patterns Are Deficient

Many times when we are trying to assess what is causing joint pain we look at the movement pattern. How do you do this on your own? The simple solution is filming your sets, both your ramp-up sets and your working sets.

The vast majority of us have smartphones now and many people are using their phones in the gym anyway for selfies, why not put this practice into something useful like examining your form? Examining your form on presses and pulls is the best way to identify where there are problems in your movement patterns.

Another common problem with managing shoulder pain (or any joint pain) is the quick and easy solution is to lighten the load instead of going heavy. While it can be beneficial to reduce the load and make light weights feel heavier, this doesn’t always work. If you have a deficient movement pattern on say bench presses, then doing that repetitively under a high volume can cause just as many problems. The key is to actually address your movement pattern rather than just lower the weight and do more repetitions.

You should also know that there may be some proprioceptive issues that may prevent you from optimizing your movement pattern. What’s proprioception? Besides being a $15 physical therapy term, it essentially means the sensation of where our body parts are at in space.

Someone with a deficient movement pattern may think that they are performing a movement correctly when in reality they are not. Again, this is where filming becomes an invaluable tool. A couple of examples of proprioceptive issues that can occur in people with shoulder problems are not understanding the difference between shoulder extension and scapular retraction. The other deficit would be confusing extension at the thoracic spine with extension at the lumbar spine.

You can address these with proper cues. My preferred cues for thoracic extension are “nipples up” and for scapular retraction (as opposed to shoulder extension) would be “shoulders down and back” as opposed to elbows back. (see images)

Another simple hack that can make a big difference that protects your shoulders during pressing is changing (at least temporarily) the plane of movement on your horizontal pressing. Flat bench pressing is traditionally done in the transverse plane, which means that the elbows are flared out. This is ideal for emphasizing pectoralis stimulation but if you have shoulder problems it can put your shoulders in a compromising position where they may not have the most stability.

Bringing your elbows in towards your trunk puts the shoulder in a more neutral position and can make pressing safer again. Powerlifters often recommend this position, but for reasons of better leverage as well as safety. Bodybuilders often argue that this position isn’t ideal for stimulating the pecs, but the truth is that it can still stimulate the pecs as that muscle also is active in flexing the shoulder joint (elbows in) as well as adducting the shoulder joint in a horizontal plane (elbows out).

An End To Frustrating Chronic Shoulder Pain

There you have it. Self-management of the shoulder complex covering all of the major aspects of preventative care and performance. If you do all of these things and there are no changes in your pain or function as a lifter, it’s definitely time to seek professional help. You should see some immediate relief by implementing these six principles shown here.

Keep in mind, however, that if you have been dealing with shoulder pain for a long time, these types of techniques aren’t going to fix things in a week, or maybe even a month. Real imbalances take time to correct. Execute the tweaks recommended here and you’ll be well on your way to addressing them.


About The Author

jon habeshyJon Habeshy, BS, PTA, CSCS

Jon is a licensed physical therapist assistant, personal trainer, competitive bodybuilder, and contest prep coach with over 10 years of experience in the healthcare and fitness industry.

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3 Comments

  1. […] The Lifter’s Guide to Training Through Shoulder Pain by John Rusin Dr. John Rusin brings it all back to proximal stability before distal mobility. […]

  2. Oliver Chapman August 23, 2017 at 6:16 am - Reply

    Very comprehensive article. I like your point “Remember that no one exercise is mandatory, period!” Unfortunately it took my years to learn this after being sold that I must squat deadlift and bench press, although I was luckily not to have shoulder issues, I did suffer years of lower back issues from stubbornly trying to continue deadlifting when all it did was aggravate my lower back and cause lots of pain.

    Once I finally left it alone my issues went away and i’m stronger, leaner and in better shape than ever, because as I learnt, there is more than one way to skin a cat.

  3. […] Lifter’s Guide Through Shoulder Pain […]

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3 Day Strength Overhaul

Improve your mobility by 30 degrees, injury proof your workouts, and avoid self-sabotage.
START NOW

3 Day Strength Overhaul

Improve your mobility by 30 degrees, injury proof your workouts, and avoid self-sabotage.
START NOW
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