Diagnosing Shoulder Pain

Bigger Stronger Leaner Injuries and Rehab
1

Lately I have been dealing with shoulder pain issues that doesn’t seem to go away. The pain presents itself when I bench and I was wondering if anyone knows what this could be and possible remedies.

The simplest way I can describe this pain is the way it limits my mobility. If I was to keep my arm straight and palms facing towards the back as I am standing (thumbs pointing to body), then raise the arm to the side while keeping it straight so eventually thumbs point to the ground. The shoulder pain will kick in as I am halfway up through process mentioned above. Any takers? Thanks for your time!

2

Where is the pain exactly? What is your frequency of pressing exercises? The reason I ask is I used to do too much pressing and my bicep tendon would let me know it just at the base of my shoulder.

3

[quote]Doh wrote:
Lately I have been dealing with shoulder pain issues that doesn’t seem to go away. The pain presents itself when I bench and I was wondering if anyone knows what this could be and possible remedies.

The simplest way I can describe this pain is the way it limits my mobility. If I was to keep my arm straight and palms facing towards the back as I am standing (thumbs pointing to body), then raise the arm to the side while keeping it straight so eventually thumbs point to the ground. The shoulder pain will kick in as I am halfway up through process mentioned above. Any takers? Thanks for your time![/quote]

Age???

Could be rotator cuff tendonopathy sounds almost like you are describing the " Empty Can Test"

4

From the sounds of it, it is imbalance. I’m a professional trainer and so often people who have trained on their own come to me with shoulder pain, it is usually from benching too much at the expense of everything else. Shoulders internally rotated, I’ve seen more guys than I can count who can bench 300 plus and can’t do a single pullup or squat over 185. I had a kid who came to me with pain so bad he could barely work the shifter in his car. I fixed it by balancing him out.

I’ve done this a bunch of times and this fix will almost always work:

drop all benching

Start maximizing effort in things like pullups, rows, anything pulling related. I usually have them add in things for ‘fun’ like rope climbs. Anything to get them pulling with their upper body.

For pressing start overhead pressing-the big caveat is that you must do a proper lockout. A proper lockout is where the bar is balanced over the crown of your head. Usually the arms will be covering the ears or just behind them with the arms fully straight. Give your self a 3 second pause at the top of the press. This engages the back and the rotator cuff fully, both of which will balance the shoulder joint.

Go for progression on all these things: more weight or more reps or both.

Spend a few months doing this aggressively and the pain will begin to subside (if this is indeed the problem).

Once recovered leave benching out for a while and instead focus on full ROM weighted dips combined with OHP for your pressing movements. For dips make sure you’re aiming for fist-in-the-armpit depth and you’ll get massive carry over. Any shallower will give you no benefit. The dip is great if done this way. You’ll probably have difficulty and pain with depth if you are over-benched and internally rotated, but the above should fix most of that, just work on the dip depth and it’ll come. Most guys who are over benched will get new PRs just by balancing out and not benching for a while.

Hope this helps.

5

[quote]1000rippedbuff wrote:
For pressing start overhead pressing-the big caveat is that you must do a proper lockout. A proper lockout is where the bar is balanced over the crown of your head. Usually the arms will be covering the ears or just behind them with the arms fully straight. Give your self a 3 second pause at the top of the press. This engages the back and the rotator cuff fully, both of which will balance the shoulder joint.

Go for progression on all these things: more weight or more reps or both.

Spend a few months doing this aggressively and the pain will begin to subside (if this is indeed the problem).[/quote]

Obviously I’m not the OP.

Every time I’ve attempted overhead pressing with a proper lockout (but no hold), it seems to aggravate the shoulder pain for a few days. Fine during the lifts themselves, but very painful hours later.

Have you run across that before?

6

Never heard of that being an issue before with anyone I’ve trained. Obviously online I can’t fix anything, only give suggestions. I’d have to physically see the movement to see if it is the cause. Of course there is the possibility of pre-existing issues or something else causing it that is showing pain when you press.

The only thing I can come remotely close to was a personal issue I had about 5 years ago, though not due to pressing in itself. I ended up with a severely painful right shoulder, so painful I couldn’t lift it up from my side it was so irritated (this was inside the joint). It would go away when I would lay off of it, but even after a month it came back as soon as I did anything. Doctors couldn’t figure it out and nothing worked. I got a cortisone shot and it fixed it completely, never had an issue again. It was just severe inflammation.

Hope that helps. But it could be anything.

7

[quote]1000rippedbuff wrote:

Once recovered leave benching out for a while and instead focus on full ROM weighted dips combined with OHP for your pressing movements. For dips make sure you’re aiming for fist-in-the-armpit depth and you’ll get massive carry over. Any shallower will give you no benefit. The dip is great if done this way. You’ll probably have difficulty and pain with depth if you are over-benched and internally rotated, but the above should fix most of that, just work on the dip depth and it’ll come. Most guys who are over benched will get new PRs just by balancing out and not benching for a while.

Hope this helps.[/quote]

I agree that most uneducated lifters spend too much time on the traditional bench using poor form, too much weight, too much volume, etc. and this often leads to shoulder dysfunction.

The use of the OHP for those with shoulder issues is debatable, and, as I see it, is situational dependent.

However, I’m curious regarding your stance on the weighted dips performed, as you put it, “fist-in-the-armpit depth.”

I have a few questions. Obviously, you don’t have to answer if you don’t want to.

  1. What is the average age of the people you’ve helped with this method?

  2. What is the average training age of the people you’ve helped with this method?

  3. What is the average height (yes, height, as irrelevant as that may sound) of the people you’ve helped with this method?

  4. What were the exact nature of their shoulder injuries? This information can be gathered from a formal medical exam.

  5. What type of assessments did you perform before the rehab, during, and post?

  6. Roughly how many people did you help relieve their shoulder issues using the “fist-in-the-armpit depth”?

You’ve no doubt surmised that I do not subscribe to your particular method of performing dips. Take note that I’m not baiting you. Rather, I’m genuinely curious as to why you claim such success with this protocol.

Again, if you don’t want to answer the questions, no harm no foul.

8

Thanks for the answer. There’s definitely been plenty of tendon inflammation.

Interestingly, I can do behind-the-neck presses… just something about the front rack position and pressing from there seems to be problematic.

It’s healing though, and I’ve got a sports med doc and PT. Asking mainly out of curiousity, since (for me) I had been told to lay off overhead pressing altogether… and every time I thought things would be ok, I had issues the next day.

Thanks.

9

[quote]LoRez wrote:
Thanks for the answer. There’s definitely been plenty of tendon inflammation.

Interestingly, I can do behind-the-neck presses… just something about the front rack position and pressing from there seems to be problematic.

It’s healing though, and I’ve got a sports med doc and PT. Asking mainly out of curiousity, since (for me) I had been told to lay off overhead pressing altogether… and every time I thought things would be ok, I had issues the next day.

Thanks.[/quote]

It’s definitely something else then. Most of the time PTs and doctors will say lay off OHP, its standard practice. I had a class 3 AC separation in 2004 from a BJJ match where I landed on it the wrong way. I was told not to OHP, but I literally fixed it with that.

10

[quote]56x11 wrote:

[quote]1000rippedbuff wrote:

Once recovered leave benching out for a while and instead focus on full ROM weighted dips combined with OHP for your pressing movements. For dips make sure you’re aiming for fist-in-the-armpit depth and you’ll get massive carry over. Any shallower will give you no benefit. The dip is great if done this way. You’ll probably have difficulty and pain with depth if you are over-benched and internally rotated, but the above should fix most of that, just work on the dip depth and it’ll come. Most guys who are over benched will get new PRs just by balancing out and not benching for a while.

Hope this helps.[/quote]

I agree that most uneducated lifters spend too much time on the traditional bench using poor form, too much weight, too much volume, etc. and this often leads to shoulder dysfunction.

The use of the OHP for those with shoulder issues is debatable, and, as I see it, is situational dependent.

However, I’m curious regarding your stance on the weighted dips performed, as you put it, “fist-in-the-armpit depth.”

I have a few questions. Obviously, you don’t have to answer if you don’t want to.

  1. What is the average age of the people you’ve helped with this method?

  2. What is the average training age of the people you’ve helped with this method?

  3. What is the average height (yes, height, as irrelevant as that may sound) of the people you’ve helped with this method?

  4. What were the exact nature of their shoulder injuries? This information can be gathered from a formal medical exam.

  5. What type of assessments did you perform before the rehab, during, and post?

  6. Roughly how many people did you help relieve their shoulder issues using the “fist-in-the-armpit depth”?

You’ve no doubt surmised that I do not subscribe to your particular method of performing dips. Take note that I’m not baiting you. Rather, I’m genuinely curious as to why you claim such success with this protocol.

Again, if you don’t want to answer the questions, no harm no foul.
[/quote]

I posted a reply and it didn’t take…

Anyway I have no problems answering questions.

  1. Average age, don’t know, but the ages range from late 20’s to mid 40s.
  2. These are all people who had trained themselves at a commercial gym for a number of years.
  3. Heights range from average to pretty tall. The kid I reference was 6’4".
  4. I’m not a medical pro, this method works for internally rotated shoulders that are imbalanced.
  5. I use movements as assessments. I work with what they can do and mobilize, strengthen, balance out the joint and they can normally do this stuff pain free.
  6. I don’t use the fist to the armpit as the fix, its what I recommend as opposed to frequent benching. But using the method described where I balance out and mobilize the joint, roughly in the range of 100.

I’m not trying to sell my way of doing dips, but I’ll explain how I came about them. I dropped them for a long time in my training career when I would find that I got no carry over and little in terms of muscular size when doing them to a more traditional depth. I usually got a lot of pain in my sternum when I got heavy. I ended up working with some gymnasts at one point and they always did them in this manner. I took the time to work to doing that depth and then found I got carry over to benching and pressing and built some muscle with them. Most people won’t be able to do it right off the bat, but I can always get them to that depth with no issues as long as it is trained to get there. In fact once to that point my trainees will usually say their shoulders never felt better. I’ve had a lot of success with it and that is my standard way of doing dips because of it. So I’d say if you want to give it a try go for it. If not, its your judgement call, no problem from me. It’s become my belief that the bench, if not done in the context of a good program (and it almost never is) will mess up shoulders in the long run. I think most people have a lot of messed up shoulders from benching too much and the ends up making it hard to do deep dips and OHP without pain and those things get the bad rap. Just my opinion.

11

^^^ 1000rippedbuff, thanks very much for answering my questions.

12

[quote]56x11 wrote:
^^^ 1000rippedbuff, thanks very much for answering my questions.
[/quote]

No problem. Just to ask, what don’t you like about deep dips? I’ve seen a lot of people say dips of any variety are dangerous or harmful, but I find that if you balance out the shoulders anyone can do them, so long as they don’t have a pre-existing injury. That’s just my experience, so I’m interested in hearing from someone first hand.

13

[quote]1000rippedbuff wrote:

[quote]56x11 wrote:
^^^ 1000rippedbuff, thanks very much for answering my questions.
[/quote]

No problem. Just to ask, what don’t you like about deep dips? I’ve seen a lot of people say dips of any variety are dangerous or harmful, but I find that if you balance out the shoulders anyone can do them, so long as they don’t have a pre-existing injury. That’s just my experience, so I’m interested in hearing from someone first hand.[/quote]

I sent you a pm.

I don’t mind talking shop with fellow S/C Coaches and sharing best practices.

However, I strongly prefer, as a professional courtesy, that you only share the information with people you train.

A disturbing trend I’ve noticed on this site as well as others is that some of the established writers and posters have shown a tendency to selectively borrow from others in the pretense that they came up with the idea. It’s not exactly plagiarism, but it’s disgustingly close. These people sicken me to no end and I’d be very unhappy if certain ideas that I formulated from lengthy studies and empirical evidence based on work with actual trainees is regurgitated by one of these hacks (even if the sheep want to raise them on a pedestal).

14

Ok great. I don’t do any writing or blogging, at least as of yet, on the internet. I’ve known of many ‘trainers’ who do that sort of thing. Many of which don’t ever really actually train people but just write articles for various websites. I’ve noticed this when Joel Jamieson wrote his book and several writers took certain aspects and twisted it into something totally different than the principles he actually stated. Not to mention when you get trainees who, as you stated, read something without understanding it. I’ve learned over the years that the fitness business is full of dirty people and almost antagonistic to those trying to do the right thing.