Today’s Thursday Throwback is one of my most popular posts ever. This post gained traction quickly as it discusses the largest underlying factor in why so many athletes and lifters alike get shoulder pain while benching and doing other pressing exercises.

Since this post was first published over 3 years ago, I’ve continued to emphasize the importance of having some sort of screen to pre-qualify yourself (or your athletes) for specific exercises, and the necessity of having a system to make program changes if a specific exercise is not a good fit for an athlete. This is the system I use at Endeavor: Optimizing Movement

Enjoy the post and if you know anyone that has experienced shoulder pain while benching or doing push-ups, please share this with them!

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
OptimizingMovement.com
UltimateHockeyTraining.com
HockeyTransformation.com

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By Lex Gidley and Kevin Neeld

There are a myriad of sources in print and on line which explain the ins and outs of why a cyclist’s back and neck hurt.  Many proclaim that proper bike fit, technique, and even helmet fit can be the sources of the pesky pains we suffer as the season wears on.  And while these and other sources may be the reason our seasons feel so long sometimes, let’s face it, even if we followed all the recommendations we would probably still have pain.  The human body was not meant to be in one position for so long.  This article will not be a synopsis of all the literature telling fellow riders what to do to decrease the pain, but it will address what the pains are and how one can help ease the pain.  Many of us don’t have the money to get all the “best” equipment, the best bike fit, or have time to really work on technique; we just get on and ride.  So, how can we fight the pain?  With a few corrective exercises!

What are the pains?  Simply put, it is muscle and/or nerves.  Sometimes the muscles are stressed due to what is termed “over-use” injury, and based on the positions we sit in for hours on end we can be pinching nerves.  Our necks are held in hyper-extension as we try to look up to see where we are going, shoulders are usually held in a forward position as we stretch forward bracing ourselves against our handlebars and to make things worse we are stuck in this position unless we make the effort to relax our arms and use our core for support or shift from the hoods to the drops periodically or get off our bike.  So, as we slowly chip away at easing the pain by paying money for proper bike fitting appointments, buying new helmets, handle bars, and for massages to release the stress, we can also participate in some exercises that may ease our body and make our seasons more enjoyable.

The hunched over biking position we all adapt to rather quickly can lead to some specific postural changes.  Notably, the shoulder blades (scapulae) drift outward, the upper spine (thoracic spine) becomes more flexed and loses mobility, the head sits forward, and the arms become internally rotated.  First, the most important thing to remember when addressing these problems is that you need to avoid this hunched over position throughout the rest of your day.  Most of us practice this “biking position” throughout our normal activities: at the computer, talking on the phone, even walking can be altered due to our new “relaxed” upper back position.  While many of the changes will need to be conscious: “I will sit up straight!” some may be prevented by changing your surroundings.  For example, if you spend a considerable amount of time in front of a computer, use a chair with a supportive backrest and armrests.  You can also take care of yourself at work or home by changing your posture constantly and by taking frequent breaks to stand up and stretch out, e.g. microbreaks.

Additionally, there are a few exercises that can be performed quickly that can help minimize the discomfort associated with these undesired structural changes.  If performed in a circuit these exercises shouldn’t take more than 8-10 minutes.  These exercises should be used in conjunction with (not as a replacement for) a structured resistance training program.

Exercises

Chin Retractions 2 x 20sec
Simply put, with a support for your head and shoulders, like a wall or the floor, forcibly try to push your neck flat against the surface.  Think of “tucking” your chin or making a “double-chin.”  You should feel the muscles in the front of your neck working.  It may help to push your tongue against the roof of your mouth.  While stretching your neck after a long ride makes your neck feel better, this exercise is more active, retraining your neck muscles to keep your head in alignment through muscular activity.


Thoracic Mobility: Foam Roller Extensions 1 x (3 x 5 sec)

Lie on a foam roller placed just below your scapulae.  Spread your shoulder blades apart by pulling your elbows up.  Use your hands to support your head.  While keeping your butt on the ground and your core tight, arch your back over the roller.  Hold this position for 5 seconds, then move the foam roller slightly up your back and repeat.  Perform this exercise in 3 positions for 5 seconds each.  All three positions should be within your shoulder blades (not too high up your neck or too low on your back).  This stretch just feels really good.  Don’t get spooked when you hear/feel your upper back crack, it will the first time, but the second and third time will be good stretches and feel really good on the stiff upper back.


Stick Dislocations 1 x 12

Using a broom handle, golf club, ski pole, etc. grab it with both hands more than shoulder width apart.  Slowly raise your hands above your head, proceeding carefully behind your head until the stick reaches its lowest point nearest your hips.  When the “stick” is overhead, pin your shoulder blades together and keep them pinned until the end of the movement.  Return to the starting position and repeat.  This exercise will increase the range of motion in your shoulders which can be reduced by the limited motion experienced while sitting in the saddle.

Stick Ups 2 x 10

Just as the name implies, this is a stick-up!  Put your back against the wall and put your hands up.  Use the starting position as a clean start to not arching your back and trying to keep your scapulae flat on the wall.  As easy as that sounds, be sure to not arch your back to help put your arms flush with the wall.  Keep your core tight to keep your back from arching, pulling your stomach muscles towards your spine.  Pull your elbows in tight to your side, and then raise your arms straight overhead.

Push-Up Hand Switches 2 x 10

From a push-up position, lift on hand off the ground, shift your weight and place it on top of the other hand.  Return to the starting position and repeat with the opposite hand.  Make sure to keep your core tight throughout the whole movement!  This exercise helps awaken some of the muscles around the scapulae that can become problematic from being in the same hunched over position for too long.

Glutes Bridge Hold 2 x 20sec

While keeping your heels on the ground (toes in the air), squeeze your glutes (butt muscles) to raise your hips off the ground.  Try to maintain a straight line from your knees to your shoulders.  Hold your hips off the ground by tightening your glutes, not by arching your back.  Keep your hands on your stomach to make sure these muscles stay tight!  Muscles can become weakened when they’re in a stretched position for too long.  Sitting all day and biking all night keeps your glutes on stretch for most of the day.  This exercise is helpful, when done correctly, to help restore the functioning of these powerful muscles.

Front Plank 2 x 20sec AND Side Plank 2 x 20sec (each side)

These drills are designed to develop core strength and stability, but they have the capability of strengthening the whole body like a push-up would, without the upper body stress.  Place your two arms (front plank) or either arm (side plank) with your forearm flat on the ground.  During the front plank, it is alright to have a slight bend in your waist in order to keep your hips from sagging.  Notice on the side plank, the body is fairly straight, without a break between the upper and lower body.  Arm is straight in the air, not pulling you backwards.  Neither of these exercises should cause strain in your shoulders or neck.  Using your core will relieve the stress in your shoulders and neck.  Brace your midsection during these exercises as if someone was going to kick you in the stomach.  Although your core (in the front AND the back!) is tight, you should still be able to breathe normally!

Scapular Stabilization Exercises 2 x 10-12 per position

In these exercises you will lie face down on a workout bench.  Initially you will make an “I” with your arms (up and out in front of you), keeping the arms down, hands grazing the floor, then lift the arms up as high as possible.  Then proceed to making a “Y” (arms out at a 45° angle) and then a “T” (arms straight out to the side) and lifting from each position.  Think of initiating each of movement at the scapulae as opposed to just moving your arms and keep your thumbs pointed up.  This exercise will help keep your scapulae from sliding forward and closing your chest, the way cycling can tend to do because of the position in which one remains for hours: hands out in front, arms stretched out, back hunched.  Especially when we get tired and tend to lock out the elbows this position becomes accentuated and the muscles in the upper back become weak and can no longer keep the scapulae in place.

“I”

“Y”

“T”

This article was originally published on SportsRehabExpert.com, an athletic development website where some of the world’s experts in strength and conditioning and sports rehabilitation print their articles and discuss current issues.

Lex Gidley, MS, is currently a doctoral student at the University of Massachusetts, Amherst studying biomechanics.  She is a level 3 ski instructor and clinic leader in the PSIA-Eastern division and actively competes in cycling, mountain biking and triathlon events.

Kevin Neeld, BSc, MS, CSCS is the Director of Athletic Development at Endeavor Fitness in Sewell, NJ and the author of Hockey Training University’s “Off-Ice Performance Training Course,” a must-have resource for every hockey program.  Through the application of functional anatomy, biomechanics, and neural control, Kevin specializes in guiding hockey players to optimal health and performance. Kevin developed an incredible ice hockey training membership site packed full of training programs, exercise videos, and articles specific to hockey. For a FREE copy of “Strong Hockey Core Training”, one of the sessions from his course, go to his hockey training website.

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