The End of Shoulder Pain

If you’ve reached this article, you’ve likely done so for one of two reasons.

1. You have shoulder pain and want to do something about it. The discomfort could be acute (“Ouch! I did something and now my shoulder hurts.”) and only occur when you perform certain moves, or it could be chronic like an achy soreness. Or…
2. Your shoulders don’t hurt, and you want to keep it that way.

Either way, you’ve come to the right place. I’ve spent my life working with a mix of rehab patients and strength athletes, which means my job requires me to become an expert in pain management and prevention. Because let’s be honest: no one likes shoulder pain, and — even worse — no one likes doing a bunch of exercises that don’t seem to solve the problem. 

Many people who perform a bunch of rotator cuff exercises to protect their shoulders are misusing their time.

You see, there are many shoulder movements that go unnoticed by many, but that can have a massive impact on whether you’re able to perform an exercise without causing damage or irritation. The mechanics of your shoulder are complex, which means exercise technique matters a lot. But as you’ll soon see, there’s one factor that’s even more important.

Let’s start out with four facts that apply to your shoulders.

Fact #1: Shoulder pain is common among people who lift weights. It’s not just amateurs or weekend warriors getting hurt. It also applies to Powerlifters, CrossFitters, Bodybuilders, and even the Highland Games guys. And studies of highly-trained Olympic lifters show that they also struggle with shoulder pain.

Fact #2: As a general rule in life, if you’re fixing the wrong problem, you aren’t actually fixing anything.

Fact #3: A lot of exercises that are intended to protect the shoulders from injury are fixing the wrong problem.

We’ll explain why in a second.

Fact #4: No Internet article can diagnose and fix your problems. If you fall into reader category #1 listed above, and the pain you’re experiencing is severe, or it’s more toward the chronic (hurts all the time) side than the acute (feels “kinda off” when you do such-and-such motion), then you should get checked by a medical professional to see what’s going on. Or, if you have a specific injury and are considering adding new moves like the exercises and recommendations you’ll find here, first consult with your doctor or therapist.

While this is what I do for a living, it is impossible for anyone to diagnose over the internet without seeing your body. Your doctor or therapist can help you determine whether your shoulders glow with warming happiness or hate your face for the remainder of your days.

With that out of the way, let’s make sense of your shoulder pain.

Shoulder Pain in the Gym: Identifying the Cause

The exercises that tend to cause the most trouble are pressing movements like the bench press or standing overhead press (also known as the military press).

Here’s the thing about those exercises: the movement itself usually isn’t the problem. In fact, the movement is quite simple—you just push the weight in a straight line. It’s pretty hard to mess that up.

So if the movement isn’t the issue, then what is? It’s the position you’re in when you go to perform the exercise.

Let’s take the overhead press and start with a simple example of why this causes problems. An easy way to relate is if you think about running. If you rarely (or never) run and then are asked to sprint multiple times, what is likely to happen? Maybe you pull a muscle, feel a strain, or suffer some other injury that occurs from going from one extreme (no use) to another (high-intensity reps).

The same is true for overhead movements. Most people go through their days without bringing their arms over their head at all. Instead, they spend the day in various hunched positions: looking at phones, staring at laptops, slouching in desk chairs.  

Over time, you lose the ability to extend your mid and upper back (this is known as your thoracic spine). To “extend” your upper back here would look like a “head up, shoulders back” position. It’s opposite is the shoulders-rounded-forward hunchback that is your existence.

The thoracic spine directly impacts what your shoulders can (and can’t) do. If you’re unable to extend your thoracic spine, that in turn limits how your shoulder blades can move. The more your upper back starts to look like Quasimodo, the more difficult it is to get your shoulders into the proper position to press a weight overhead.

In other words: you struggle with the movement because your shoulder blades don’t know how to move correctly. I’m going to get technical for a moment to explain exactly why this is such a pain in the ass…or in your case, your shoulders. Just know this: if you can’t move your shoulder overhead correctly, all the other small structures around your shoulder blade are working overtime, and like most things in life that get overworked — they quickly become pissed off and that’s why you have shoulder pain or get injured.

Nerd alert: If you want to skip the detailed reason why your shoulders are not moving correctly, simple skip the next 2 paragraphs.

In order to lift your arm 180 degrees overhead, the scapula, or the triangular bone on the back side of your shoulder that kinda looks like a wing, must rotate about 60 degrees.

source: bestperformancegroup.com

You get into trouble when you can’t get this movement to occur. If your thoracic spine is rolled forward, it limits your ability to move your scapula (a.k.a. the shoulder blade. We’ll use those terms—scapula and shoulder blade—interchangeably). As a result, in order to get your arm overhead, you’d have to move the entire shoulder joint—which requires a lot of its structures to move through a bigger range of motion than they can manage properly. This also limits the ability of the upper arm bone (humerus) to make solid contact with the socket of the shoulder (glenoid fossa) to help bear the load of the weight being moved. As a result, the soft tissues of your rotator cuff and joint capsule have to pull double duty.

Think of your shoulder blade rotation here as being like hip mobility on a deadlift. If you can’t move your hips back far enough so you can grab the weight, something else has to move in order for you to get down and grab the bar. That “something else” usually winds up being your lower back. And if your back is doing the work of your hips, it’s not going to go well.

The same goes for shoulder movement. If soft tissues and joint capsules are doing the work that the bigger muscles like your deltoids were intended to do, you may get away with it for a while. But on a long enough timeline, you’re going to have a problem.

Knowledge bomb: This is why many people who perform a bunch of rotator cuff exercises to protect their shoulders are misusing their time.

No amount of band rotations (those exercises where you bend your elbow 90 degrees, grab a resistance tube, and then rotate the forearm to pull the tube away from the body) will improve your thoracic spine mobility. Doing those moves will help your rotator cuff be strong and powerful, sure. But it’s sort of like just grabbing a bigger bucket to catch water from a fire hydrant instead of just turning off the hydrant itself. If you address the things that are really causing poor shoulder mechanics, you can stop the problems at their source.

Why the Bench Press Causes Shoulder Pain

The bench press can cause similar issues for the shoulder, but for a slightly different reason.

In order to set up properly for the bench press, you have to pull your shoulder blades together and down in order to create a strong and stable base of support. Here’s what you should do before every bench press set. (The first 15 seconds of this video are the most important):

There are just two problems:

1. Not everyone realizes that pulling the shoulders together and back is part of the setup. (And if that’s you, now you know. Go forth and conquer.)
2. Some do know this but don’t have enough thoracic mobility to pull the shoulder blades back and tight.

In either case, without that proper setup, the front of your shoulders wind up paying the price. If your shoulders aren’t pulled back and locked in, when you lower the weight toward your chest, your upper arm bone has to move around within the shoulder capsule to allow the bar to get down. This can result in the arm moving forward—a motion called anterior glide. And anterior glide puts a lot of pressure on the tissues meant to keep the joint together, like the biceps tendon and rotator cuff muscles, causing them to be irritated or even damaged.

How to Fix Your Shoulder Pain Problem

Here’s the good news: Since many of the problems with the overhead press and the bench press are rooted in issues with your thoracic mobility and shoulder blade movement, fixing those issues will help you feel better during both of those exercises (and plenty of others, too).

Instead of loading up on 15 different variations of rotator cuff exercises, let’s address both of these common movement problems—thoracic and scapula issues—at their source. Then we can set the stage for more appropriate shoulder pressing movements with less discomfort.

The best news of all? You don’t need to do a bunch of yoga or crazy mobility drills to get what you want here. In fact, you can fix a lot of the problems without having to move much at all.

Shoulder Pain Solution #1: Breathe (Yes, Breathe…but do it correctly)

The first thing you should do to correct your thoracic positioning is to spend just a few minutes doing a little breathing drill, which my friend Tony Gentilcore is going to demonstrate for you here:

We know what you’re thinking right now: Breathing? What? But stay with me. We could get really complicated in explaining how all of this works, but the summary is this: Your breathing holds a big influence over the position of your torso. Not breathing tends to limit thoracic motion, which as we discussed earlier has a direct effect on shoulder motion. So when you perform these drills:

• Breathe deep, with long slow inhales and forceful exhales.
• Go slow and focus on getting more movement versus just doing the reps. Quality should always come before quantity.

Shoulder Pain Solution #2: Foam Roll (The Right Way)

Next up you’re going to bring in the foam roller to work on the tissues in your thoracic spine directly. But PAY CLOSE ATTENTION to how we’re going to use it here:

Those are called T-Spine Extensions. Let’s talk about what the movement is not:

• It is not you rolling around a whole bunch. In fact, watch that video again. Notice that the roller doesn’t move at all.
• It is not you trying to get a bunch of movement by flaring your ribcage out. You want to keep your abs engaged throughout this drill so that the movement is coming entirely from your upper back.
• It is not your goal to touch the ground with the back of your head. You’re not trying to be Gumby here.

What you are trying to do is get a little more up-and-back movement out of your thoracic spine. That’s all. The motion will be subtle and may be difficult to feel at first. But work at it, and you’ll soon feel a little more freedom in your upper back and shoulders. That’s what you’re going for here.

You’d go a long way toward having better shoulder mechanics just by adding the moves shown in those two videos to your warm-up. But if you want to go further, you can jump into the deep end of the pool with this clip from The Complete Shoulder & Hip Blueprint:

In this video, you’ll find more awesomely impactful breathing drills—including one that works the smaller muscles in the thoracic spine, so much that a guy actually starts shaking. The clip starts out with those. And if you’re the type of person who secretly loves band rotator cuff exercises, be pumped: Later in the clip, you will find band exercises, except these will have a lot more impact on improving your shoulder movement and position overall:

• Beginning at 7:08, you’ll find the “Band W,” which activates the muscles around your shoulder blade and the lower part of your trapezius.
• At 8:56 you’ll see Tony demonstrate two more band exercises—the Windshield Wiper and the Wall Walk—that will light up the muscles in and around your back, especially your serratus, or the muscles on the sides of your ribs up by your armpits. Bonus: A strong serratus helps give you a “V” shaped torso.
• Lastly, when you reach the 12:12 mark you’ll get a move that lets you correct some of these issues in one shoulder at a time—a helpful way to correct imbalances.

These movements can act as a warm up for your workout, fillers between sets of presses to help keep the motion gliding along nicely, or as the workout itself if you’ve been experiencing pain and want to improve your mechanics.

But again, if your shoulders always hurt, you should speak with a qualified therapist. There may be something more specific you could be doing, and you’ll want to make sure these aren’t going to do any harm. (The moves are very much safe, but it’s worth checking.)

Here’s one more thing to keep in mind whenever you perform a shoulder exercise: Use your abs. If you have limited movement from your thoracic spine, a common mistake (it’s because you’re compensating) is to just lean back with your low back and avoid doing anything with your upper back. This is both risky and counterproductive since you’re simultaneously putting extra pressure on your lumbar spine while also decreasing tension on the muscles you’re trying to work in the first place. By bracing your abs, you can help limit this and be sure that you’re getting movement in the places you actually want to move.

Dean Somerset is a kinesiologist, strength coach, author and public speaker who specializes in injury and medical dysfunction management through exercise program design. The seriously in-depth “The Complete Shoulder & Hip Blueprint,” which Somerset and Gentilcore teamed up to create, is available online and—if you’re reading this before July 5, 2017, it’s available for 50% off. Born Fitness is not an affiliate and has no financial stake or interest in the product, other than our general want for Dean and Tony to succeed in life since they’re good guys who offer great info.     

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