So as mentioned in quite a few of my topics, I’ve had a nagging shoulder injury (according to a physical therapist and chiropractor, it’s an impingement in my subscapularis) for almost 5 years now. It flares up quite regularly though, but it’s more of an irritating deep ache as opposed to actual pain at this point. I can do full range of motion in every exercise (chest exercises tend to bug it though).
But I’m curious if I should just push through the pinching feeling I get when I do pressing/chest exercises? Or should I avoid them?
The best thing to do would be to find exercises that are effective but don’t flare it up.
What is the prognosis for fixing the issue? Surgery? Seems like PT is not getting it done?
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pain is not an indicator of tissue damage, but is more an indicator of the brain feeling threatened by something. Longstanding pain often works a bit like a smoke alarm, where it can go off to benign stimulus. This is called hypersensitivity, and occurs due to changes in the nervous system itself in individuals with long-standing pain. So, you can have pain in your shoulder, without any mechanical problems to be worried about.
As such, I recommend that:
- you find exercises that are minimally irritable and get bigger and stronger eith those
- if you flare up, remain calm and modify your activity accordingly
- if the pain isn’t impacting your quality of life or making you anxious, I wouldn’t give it much though
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I for one find this to be a controversial statement.
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I stand by it.
Pain is the result of cortical processing of nociceptive input, and is therefore modulated by other psychological/emotional factors. Discharge frequency of afferent nociceptive neurons could be a measure of tissue damage, but even then this is highly subject to other factors such as the chemical balance at the site of interest, the balance of neurotransmitters at the nociceptor’s synapse with the spinal cord, and whether or not there has been any sprouting of peripheral a-delta neurons into the spinal cord laminae associated with nociception.
Pain may be associated with tissue damage, especially in the acute phase, but the effect of structural and chemical changes in and around the nervous system, as well as modulation of nociceptive input in the brain, make the relationship of pain and structural damage tenuous
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Basically what I’ve noticed is that the only movements that really cause it to pinch/flare up are any regular chest presses or low to high cable flyes. Everything else feels okay. Back exercises like a dumbbell row might feel kind of weird at first, but a day or two after I feel stronger and my shoulder bothers me less.
I do feel like I must have some damage that has remained after all these years because for example, if I contract my lats, there’s a bit of numbness in my right lat that has never completely gone away.
I’ve done all the PT exercises recommended for many weeks and nothing really improved it. Surgery is definitely not something that I can see happening any time soon, especially since it’s just not in serious pain 
To my regrets I have incurred tissue damage noticing very little pain. My left shoulder was real bad. My continual training, with little pain, if any, made it much worse.
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I hope this isn’t me. I get shoulder issues, but don’t get much pain. My arms go numb if I don’t move them enough. I had one arm all of a sudden lose about 75% of it’s pressing and 50% of pulling strength. It is fully back now, but I do worry about my shoulders.
I am going to have a PT look at it today though, and hopefully get some specific stretches to do to relieve any impingement I have.
How long is a bit of string? This question is that open.
Luke Stoltman has REALLY bad elbow and shoulder issues when he does heavy log press. He still does them. As he wants to be the best in the world. And he needs to do them for that to happen.
Pete from accounts once saw a guy get hurt in the gym and now wont go with in 10m of the entrance.
These are two ends of the “how much pain is allowable” spectrum. Asking us where you should sit on it depends on what your goals are.
So the real question is: Will training through this pain bring me closer to or take me further form my goals? As training through pain can result in injury.
So what are your goals?
- If you want to be a competitive any thing (BB, SM, PL) bench & press are required. You will need to find a way to deal with the pain. And accept that you might be doing long term damage to your joint health.
- If you just want to feel confident taking your top off in public - then I dare say there is a way around training that does not hurt you. Iso hold, press ups, work out with no pressing still hitting the muscles (lots of cable cross overs, lots of flies and lateral raises).
- If you are just lifting for health and fitness then pressing is not an absolute requirement. Although again press ups might be a good idea.
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I would definitely not push through a pinching feeling. And I say that as someone who pushed through a lot of pain, used lots of NSAIDs, etc. to get to some powerlifting goals.
I do hope to compete in bodybuilding again. I did a show once about 5 years ago and it’s been a dream to do again ever since.
When I do chest presses or low to high flyes, I feel the pinching feeling for only a little bit. But hours after or even days after, my shoulder doesn’t fee any worse, which makes me think that I should just push through it.
I’ve thought of just increasing my pulling exercises for a while because I think my shoulder injury was caused by an imbalance - too many pressing to pulling exercises for 4 years 
And to see if maybe doing more pulling exercises will help the weakness in my shoulder/lat to go away so that I can then slowly add back chest exercises.
I do know though that I spent too much time doing absolutely nothing to help my shoulder and I feel like that made it way worse. Movement is it’s own form of medicine - I’m just trying to figure out how much I should actually just work through
This answers your question.
If you want to be a competitive BB can you drop the movements that hurt?
Can you elevate the problem?
The answer is no to both. So it looks a fairly easy call.
FYI this is in no way an endorsement. You could be going some real damage.
Jesus Christ this thread. OP has been diagnosed with shoulder impingement–an extremely well-recognized clinical entity notorious for both its staying power and its likelihood to progress. As such, it is not the sort of condition about which one should muse philosophically on the nature and meaning of pain. Even less relevant is the observation that one can become injured in the absence of pain. So?
OP, pain in this area means you are actively degrading the tendon of a rotator-cuff muscle. If you value the prospect of a relatively pain-free future, and one that doesn’t require shoulder surgery, refrain from performing exercises that causes any impingement-related pain.
/thread
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Im going to have to disagree with you.
Shoulder impingement has fallen out of favour as a meaningful clinical diagnosis.
- pathologies commonly attributed to impingement within the subacromial arch occurs naturally in asymptomatic and symptomatic shoulders Redirecting
- if impingement were to exist, we are unable to assess for its existence with clinical techniques It Is Time to Put Special Tests for Rotator Cuff-Related Shoulder Pain out to Pasture - PubMed or imaging Multimodality imaging of subacromial impingement syndrome - Skeletal Radiology
- surgically increasing the size of the subacromial arch (and therefore reducing the mechanical impingement) does not have any greater effect on shoulder pain than a placebo surgery, which is why subacromial decompression surgeries are falling out of favour Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis - PubMed
- individuals previously diagnosed with impingement may resolve their pain without any change in the amount of mechanical impingement occurring within the subacromial arch.
Mostly, this is all due to the low specificity of all measures of subacromial impingement
Again, not necessarily. Asymptomatic and symptomatic rotator cuff tendons exhibit pathologic changes at the same rate. If you imaged an individual’s painful shoulder and identified RC tendinopathy, you are extremely likely to find identical findings on the asymptomatic side. The only truly meaningful rotator cuff injuries are massive RC tears.
This was my advice regardless
However, I think it is highly important that we do not catastrophise and fear pain, since it is at best a poor indicator of tissue damage, and tissue quality is a poor indicator of function.
I’ve had this happen to me every 2 or so years where I wake up with my arm locked straight out and in pain, not being able to move it for a good minute, to not being able to put on a seatbelt (the range of motion).
So, off topic advice: I would seek another chiropractor. Mine is able to pop it back in place and I’m good to go the next week. He’s retiring in 2 years… so I hope I find one again. And follow the advice of the chiropractor who can fix it: Rest for a week and you should be good.
Though, as I feel around, I’m uncertain if mine is subscapularis or supraspinatus as it’s right behind the bone knob…
So just a routine centred around behind the neck lat pulldowns, behind the neck HEAVY ohp with full ROM (really cram the bar back there), regular ohp, tons of upright rows with elbows flared as much as possible, ring dips with a very, very deep stretch at the bottom
His shoulders will be good as new!
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