T Nation

Flat Bench Shoulder Pain

I’ve been having progressively worsening left shoulder pain when bench pressing. I’ve tried using dumbbells, machines, partials, and different angles, but the pain in my shoulder worsens. Also, I get tightness in the back of my neck and medial scapula. Ironically, I have no problems with overhead or incline presses. I can get a pretty intense shoulder workout with no symptoms and have been making strength gains with these lifts. I just cannot do flat and/or decline bench; even with very light weight. My shoulder is especially painful when lowering the bar to my lower chest or when doing dips. As long as I keep the bar and/or dumbbells high on my chest, I’m OK, and have good power. My form is such that I’m maintaining good scapular retraction while tensing my upper traps and glutes on the bench. I’m worried about a cervical nerve entrapment or disc problem. Any suggestions? I do not want to lose strength and/or size in my chest.

[quote]Jimwoop wrote:
I’ve been having progressively worsening left shoulder pain when bench pressing. I’ve tried using dumbbells, machines, partials, and different angles, but the pain in my shoulder worsens. Also, I get tightness in the back of my neck and medial scapula. Ironically, I have no problems with overhead or incline presses. I can get a pretty intense shoulder workout with no symptoms and have been making strength gains with these lifts. I just cannot do flat and/or decline bench; even with very light weight. My shoulder is especially painful when lowering the bar to my lower chest or when doing dips. As long as I keep the bar and/or dumbbells high on my chest, I’m OK, and have good power. My form is such that I’m maintaining good scapular retraction while tensing my upper traps and glutes on the bench. I’m worried about a cervical nerve entrapment or disc problem. Any suggestions? I do not want to lose strength and/or size in my chest.[/quote]

This is a good example of a subject I am debating on today’s Live Spill for the article “20 Almost Laws.”

Some folks in the spill argue that unilateral lifts are not important. I argue that they are to discover and address discrepancies.

When you bench, it’s a safe bet the barbell is moving parallel to the floor. Yet, your body is going through a series of compensatory patterns in which both sides are not working in harmony. The result is that your left shoulder is irritated. I bet even the db work you do is performed in a bi-lateral fashion (pressing both dbs simultaneously).

A few things stood out as I read your post. The most obvious, for me, is:

“My form is such that I’m maintaining good scapular retraction while tensing my upper traps and glutes on the bench.”

“I have no problems with overhead or incline presses.”

“My shoulder is especially painful when lowering the bar to my lower chest or when doing dips.”

I suspect the following:

When you are “tensing” upper traps, could it be that you are elevating the humeral head superior on the glenoid fossa? This may explain why it doesn’t bother you on the incline press. You see, as the angle gets closer to vertical (as in the over head press), it can help some people to forcefully engage the upper traps. This can, for some, actually lessen the chance of impinging the supraspinatus tendon.

However, as the angle gets closer to the flat bench, most people are better off by RETRACTION AND DEPRESSION of the scaps. This better centers the humeral head within the glenoid fossa. When you are engaging your upper traps, I suspect this is overwhelming your lower traps’ ability to depress the scaps.

Now, bear in mind that many benchers also employ the technique of forcefully pressing the back of their head into the bench to increase the drive. This does require activation of the upper traps. Nothing wrong with this - as long as you are still able to first and foremost engage the mid/lower traps and rhomboids to retract and depress during the flat bench.

This also may explain why the dips are causing so much pain. The nature of this movement almost guarantees impingement of the supraspinatus tendon.

Very similar scenario with the decline bench. The load is driving your humeral head superior.

You also state:

“My shoulder is especially painful when lowering the bar to my lower chest…As long as I keep the bar and/or dumbbells high on my chest, I’m OK…”

I suspect that there is a superior migration of the humeral head when the bar is lowered to your lower chest. This, again, creates an impingement. When the bar is lowered to your upper chest, it could be possible that: a) there is less of a superior migration of the humeral head; b) you could also be getting better pec engagement, which would take just enough of a load off the shoulder.

This is speculative, of course. After all, I haven’t seen you bench in person (and not even on video).

You do owe it to yourself to get an in person examination first and foremost. Once you do get the green light to go back to training, consider the things I stated. And be sure to incorporate true unilateral lifts into your program.

Another point. Once you are cleared by a professional to resume training, be sure to tuck the elbows in about 45 degrees when benching.

Thanks for your help and insight 56x11. I think you’re probably right about having weaker scap depressors. I’ve been doing front squats with a crossed handed grip and saw a video, with Christian, explaining why its not optimal for the upper back and scapula musculature. I’ll be doing front squats with wrist straps from now on. I’ll also try unilateral DB presses, as you suggested, to build up my left shoulder stability. Also, I’m going to focus more on scapular retraction than contracting my upper traps on flat bench presses. My Dr. thinks its bicepital tendonitis with an unstable anterior left AC joint. I’m going to take it easy, but will NOT stop working out. Again thanks for your reply.

[quote]Jimwoop wrote:
Thanks for your help and insight 56x11. I think you’re probably right about having weaker scap depressors. I’ve been doing front squats with a crossed handed grip and saw a video, with Christian, explaining why its not optimal for the upper back and scapula musculature. I’ll be doing front squats with wrist straps from now on. I’ll also try unilateral DB presses, as you suggested, to build up my left shoulder stability. Also, I’m going to focus more on scapular retraction than contracting my upper traps on flat bench presses. My Dr. thinks its bicepital tendonitis with an unstable anterior left AC joint. I’m going to take it easy, but will NOT stop working out. Again thanks for your reply.[/quote]

You’re welcome. It’s refreshing to see someone actually get an in-person exam when that’s the logical next step. You would be absolutely amazed how many intelligent, well-educated adults choose to rationalize and stick their heads in the sand. These folks are just hurting themselves but they just don’t get it.

The bicipital tendon/ac doesn’t surprise me. On dips, the humeral head will be prone to anterior (forward) movement along with the superior (upward) movement.

Your original post strongly implied that this started with flat bench pressing. The original post only mentions the dips as another movement that causes pain. Therefore, I based my theory on the flat bench as the primary cause of trauma.

And this is why I also stated that I was speculating and that you need an in-person exam. I’m glad you took that advice to heart.

No matter how descriptive you or any other poster on a forum describes an issue, there is ALWAYS a certain bias in reporting the facts. You can have ten different people look out the same window and they’ll report what they see in ten different variations. It’s human nature.

Now this bias, in turn, presents anyone who tries to help with an incomplete picture. And this is why the best I or any other ethical professional can do - on an online forum - is point the compass in the right direction.

It is certainly possible the dips initiated the trauma, which predictably altered how your body moves, which then manifested into the bench. That technique you describe of lowering the bar lower on your chest can also promote anterior glide. So these two movement patterns may have been the original cause. Also, you mentioned that you used to front squat with the arm crossed method. Simply cross your arms as if you are front squatting this way and you can easily see the anterior glide.

Now it’s important to mention that dips, lowering the bar or dbs lower on the chest, arms-crossed front squats are not inherently bad in and of themselves but, like all repetitive movement patterns, creates a potential for injury if performed with a disregard for variety.

There’s that “v” word. You’ve met or you will meet plenty of lifters and know-it-alls who’ll preach that you just need a handful of exercises. It’s true that most of us will respond best to a small number of movements. However, if all you do are just those movements, the chance of repetitive stress injury is simply too great. This is why I believe it’s paramount that you or anyone else do something different from time to time.

When you get back in the game, not only will you need to work on the retractors and depressors, you will also need to be extra cautious when performing movements that create anterior (and possibly superior) migration. Take the time to learn things the right way and be that less than 3 percent of the gym population that actually knows what they’re doing.

This is easier said than done. For example, even in movements such as the cable row, you have the potential of anterior migration if you bring your elbows in too close to the body and/or allow the weight to pull your hand too far forward.