Hockey Shoulder Injuries

Shoulder Pain with Pressing Exercises

Last week I got an email from my step sister saying that she’s been getting shoulder pain during bench pressing and dumbbell raising exercises. I had a similar conversation with a hockey parent a week before about one of his son’s teammates. In both cases, it’d be impossible for me to say with 100% confidence that I know exactly why they’re in pain and what they can do to fix it. As you know, non-traumatic pain tends to be multi-factorial and necessitates considerations to static and dynamic postures. In other words, how we hold ourselves throughout the day and how we move plays a large role in soft-tissue overload.

With that said, I’d bet my car (an estimated value of $137), that in both of these cases, the bench press is performed with a similar fault – the elbows are out too wide. Let’s walk through this:

It’s somewhat hard to tell from this picture, but my elbows are approaching 90 degrees off my side. In other words, my upper arm and the side of my rib cage form about a 90 degree angle. This puts a tremendous amount of stress on the anterior shoulder capsule at the bottom of the lift. It also increases the risk of having the glenohumeral head impinging on the structures superior to it.

Ligaments of the shoulder

The picture above illustrates the ligaments of the shoulder. As you approach the bottom of a bench press with your elbows flared out, it tends to put excessive stretch on the IGHL and MGHL ligaments displayed above and increases the chances of impinging the ligaments and tendons between the acromion and glenohumeral head (long head of biceps brachii tendon and subacromial bursa are two notables).

The same is true for push-ups, although there tend to be some other differences between bench pressing and doing push-ups. For instance, push-ups allow free movement of the scapulae, allowing the shoulder a bit more freedom than during bench pressing, which may delay the onset of pain from resulting from the elbows being out too wide. Of course, because your body isn’t supported by a bench during a push-up, it also means more freedom of movement for other joints; as a result, it’s common to see people with sagging hips, excessively arching backs and protruding chins (or what I call “bird neck syndrome” or BNS).

Brutal Push-Up…but decent display of BNS

In both exercises, the goal is to keep the elbows within 45 degrees off the side of the body and to retract the scapulae (squeeze the shoulder blades back and down) as you go down. Because the scapulae aren’t free to move during a bench press, it’s important to set up on the bench with your scapulae in the correct position, packed back and down, and to keep them there throughout the movement.

Bench Press with correct positioning

With push-ups, the shoulder blades aren’t wedged between your rib cage and the bench so they can move freely. When going down in a push-up, think of pulling your chest down to the floor and pulling your shoulder blades back and down along the way.

Push-Up with proper technique. Notice how the hands are beneath the shoulders, the elbows are within 45 degrees of the sides of the body and the chin is tucked back.

If you already have shoulder pain, it may be best to back off the pressing exercises for a week or two and focus more on rowing exercises, emphasizing pulling the shoulder blades back and down as you pull the weight toward your chest. If it’s not that bad, the floor press is a great exercise to reteach a proper pressing pattern while limiting the stress on the shoulder because of the decrease in range of motion.

Dumbbell Floor Press

With regards to push-ups, I think most of the problem comes from people assuming they can do push-ups on the ground right away. This stems back to an interesting paradox in youth training, where there is still the perception that lifting weights is dangerous but people are free to do as many push-ups as they want. In reality, I’ve come across very few athletes 14 and under that can do a single push-up the correct way on the floor. As with any exercise, it’s important to progress the loading as the individual develops the strength to perform it correctly. In this case, the overwhelming majority of people need to start performing push-ups on an inclined surface and focus on proper body positioning and proper movement (e.g. moving as a unit connected from ears to ankles, descending so that the lower chest is the first region to touch the ground or raised implement and keeping the elbows within 45 degrees of the side). As people progress in strength, you simply lower the implement closer and closer to the ground.

At Endeavor, we use the safety bars in our squat racks to accomplish this. This way it’s easy for us to objectively assess progress as each level is numbered. As the athlete gets stronger, they approach higher and higher numbers as the bar lowers closer to the ground.

Incline Push-Up

In a team off-ice training setting (especially with younger teams), this can be tough. In these situations, I’m more apt to use our jump boxes, which are set at heights of 24, 18, and 12 inches. Using these, I can start everyone at the top box and progress them lower on an individual basis as they demonstrate sufficient strength. If someone mastered the 18″ box, but isn’t quite ready for the 12″, you can just lengthen the negative or “going down” phase of every rep to make it a bit tougher.

Pressing movements are an essential part of any person’s training program. Unfortunately, they’re also one of the most common causes of upper body pain. Making the simple corrections discussed above will help make you stronger than ever, while keeping you pain free!

To your success,

Kevin Neeld

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12 Responses to “Shoulder Pain with Pressing Exercises”

  1. Valentines Day | Endeavor Sports Performance | KevinNeeld.com:

    [...] as she was the original founder of the “bird neck syndrome” diagnosis I mentioned here: Shoulder Pain with Pressing Exercises. She’s even been receptive to altering her pre-Kevin workouts to something more in-line with [...]

  2. Theresa:

    Pain sucks. :(

  3. Tom:

    Thanks for the write-up. I started having a bit of pain in the front area of my shoulder (right above my armpit) and I know it happened because of bad form on the bench press. Your article makes sense and I appreciate you taking the time to write it up.

  4. Firas:

    Thanks man for the info, my one day i went to the gym and I couldn’t do 1 bench press cause of my shoulder pain, it’s been 3 weeks and the shoulder is starting to heal, I would have never known that the pain was caused by the bad technique.

    And on top of that I started to watch out for the bird neck thing.

    Thanks again man, keep it up!!

  5. John H:

    This really opened my eyes to the need for progressive incline pressing to reinforce form as strength increases, thanks.

  6. Wayne Button:

    I want to say thank you. I am a chiropractor who deals with sports injuries and although im informed on treating the injury itself I am not knowledgable on “technique”. This post was extremely informative

  7. Kevin Neeld:

    Thanks Wayne. Always great to hear feedback from guys like you. I’m always open to ideas for future posts, so if there’s any area you’d like me to cover please let me know!

  8. Teaching Proper Push-Up Technique | Push-Up Regressions | Kevin Neeld Hockey Training and Athletic Development:

    [...] Push-ups, because they require no equipment, and therefore are space and large group friendly, tend to be a go-to for youth hockey organizations. I’ve discussed the common flaws in horizontal pushing patterns before, especially as they pertain to shoulder pain. You can check out one article on that topic here: Shoulder Pain with Pressing Exercises [...]

  9. Chris Lee:

    Thank you so much for this! I have been doing push ups incorrectely (as pointed out in this article) and it was causing allot of pain in my shoulder ligaments. I wouldn’t be able to do more than 60 without fear of tearing something. Hopefully this will help me!

  10. Patrick:

    I am 62 years old and have pain when I am doing a push up. When I was in my 40′s I was bench pressing and blew out my right shoulder where I could not lift the bar only. I did not have it looked at and now I am experiencing pain by doing a simple push up.

  11. Kevin Neeld:

    Hi Patrick-Thanks for your comments. No surprise there really. If you have a significant injury that has never been addressed, it’s unlikely to spontaneously heal completely without further complications. Regardless of your injury history, there are better and worse ways to perform pushing movements so I’d recommend both going to a physical therapist to get your shoulder looked at and adhering to the advice in this article regarding performing the push-up pattern properly.

  12. Bernard Lahey:

    I suffered for years with shoulder pain, no doubt as a result of poor weight lifting technique. The pain prevented me from doing much in terms of upper body strength training. For me, the ONLY solution turned out to be physio – professionally supervised stretching and strengthening. Only now can I start training again. Next time, I’ll do the physio BEFORE the years of suffering rather than AFTER.

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