T Nation

Shoulder Problem


#1

I didnt know where else to post this, but i've been having a problem with my shoulder for a while and was wondering if anyone could help me out. The only time it really bothers me is when I do flat bench, and mainly when I try to max. Also its only my right shoulder . When I looked into details online the muscle was the anterior deltoid. Before it started really bothering me my brother saw me bench and told me that I was favoring my right arm some. Anyway my thoughts originally was a strength inbalance, anyone have any ideas/suggestions?
Thanks..


#2

Any info?


#3

There's ALOT that could potentially be going on here, Bro.

Alrighty, have somebody perform a ROM test on ya to identify the problematic muscles/tendons/ligaments, etc...

Was there a single incident that caused the shoulder pain?

Are you a bench press fanatic (with a concomitant kyphotic posture)?

When your brother says you are favoring your right side, what does it look like?

All these questions, (and potentially more) can help me ta help ya out.


#4

I have had a similar problem. I am a family physician and have looked into it biomechanically (I also have a background in Physical therapy) and talked to a couple orthopods about it. Most anterior shoulder pain that comes from benching is either related to the pec minor or the biceps tendon. The pec minor and biceps tendon both insert under the anterior deltoid. Sometimes rest, ice, anti-inflamatories will help. Other times you need steroid shots into the area. I have had two and have really seen minamal improvement. I am considering MRI. Good luck,

Humanator


#5

it wasnt really a single incident, more like just getting worse to the point where if I do anything to bother it, it bothers me for a few days. I used to max pretty much every week. its hard to describe, but basically my right arm pushes through more then my left? dont know how to better explain it. i can max on incline bench with no pain or problems. How would I do a ROM test?


#6

Thanks guys, Humanator, the anterior deltoid itself is the muscle that is bothering me. Behind the neck presses also bother it too, and I used to be able to do them.


#7

My shoulder when i don't do flat bench for awhile doesnt really bother me unless i agrevate it, but when i start back up it always bothers me. I'm wondering if someone could give me some advice on fixing my shoulder.
Thanks alot guys.

P.S. Awesome site, definitely the best one i've come across.


#8

Maybe you might want to cut out over head pressing, go back to sub max eccentric stuff for a while, no max stuff and build up from there. Do plently of external rotator cuff and also do so rowing exercises to balance out push/pull for upper body. I've seen some guys doing alot more push and they look funny with rounded shoulders. You said that you max almost every week? Sounds like westside. I use westside but i don't always go for 1RM max, usually alternating 3RM and 5RM with occasional 1RM.


#9

Sounds like we have a comparable problem. My left shoulder gets sore on max effort bench and on some incline presses and behind the neck presses. I've been working on fixing this problem for a few months and feel like I've had some success. I've been doing benches as a primary horizontal pushing exercise for many years now. I was balancing it with bent over rows, but unfortunately I was using a close, supinated grip. I've since learned on this site that my grip was focusing on the lats and teres major which are both internal rotators of the shoulder. So basically, I've been compounding the problem. I started fixing this problem by doing the Neanderthal No More program. That program was a good start and helped me learn some new exercises to get the upper back more balanced. I moved on to a rotator cuff specific program, doing cuban presses, L-laterals, and various others. Now I'm doing a lot of push presses and power cleans and feel like my shoulders are finally getting balanced out. I'm not sure if your problem is due to an imbalance but if it is you might look into a similar progression to fix it. Next on the list is the shoulder overhaul program!!!


#10

Haven't benched much in awhile, so far my shoulder feels good. I've been doing alot of heavy military pressing and its been going good. The only time it really bothers me on that is when it has already been agrivated. For now i'm taking a break from benching. Thanks for the help so far guys.


#11

I have really long arms and as such the bench press is a real high wire act for me.

I have found that a wide/normal grip bench press really hurts my shoulders.

But if I use a close grip (i.e. thumbs against the curling) and keep my elbows close to my body (i.e. not flared out) I can bench press without pain and get good results. At first the weight is a little low but its builds up quickly.


#12

Tstud_9:

You think you have problems now? Wait a few years....it will get worse as you age!

There are two things that you can do to prevent damage and even reverse the damage that you have already caused.

  1. Stop Barbell Bench Pressing. It is an inherently dangerous movement which loads your shoulder joints with weight and then places them in an unstable position.

Replace the Barbell Bench Press with Dumbbells which give you leverage in hand positioning. Also when performing your reps do not go down all the way. Lower them only to the point of plates touching shoulders. You could Barbell Bench press and not bring it down all the way, however the hand positioning is not as good as with Dumbbells.

  1. Use a Shoulder Horn. This one device brought me back from shoulder pain. I highly recommend it. There is a thread on this device and the dangers of Barbell Bench Pressing. Do a search.

I maintain that unless you are "built" for the Bench Press (short arms barrel chest) it is just a matter of time before you get a shoulder injury.

Good Luck,

Zeb


#13

Okay advice, but there's a lot missing. First off, the long head of the biceps and the pec minor are only half of the story; you'll usually see irritation of the supraspinatus (and relatedly, possibly the infraspinatus) or subscapularis. Pec minor injuries aren't as common as you seem to imply, and the bicipital tendonitis is really just a by-product of a later-stage impingement of the supraspinatus tendon. You may also see irritation of the levator scapulae as it works overtime to try to elevate the scapula to compensate for the lack of humeral abduction strength that the irritated supraspinatus has to offer.

The reason that you haven't had any improvement with the cortisone shots is that you haven't done anything but mask the underlying problem. Take care of the issues causing it and your shoulder will be fine; there's no need to subject yourself to the long-term risks of excessive cortisone usage. This is one of my biggest problems with the medical profession today.

Also, a good doctor's examination can be as good - if not better - than an MRI; they're overused, and tend to be a reassurance for people who insist that they need an MRI to really know what is going on. If there's a question of whether the labrum is involved, a contrast MRI is a good bet, but otherwise, you'd be better off going with PT first to see what shakes free.

More to come...


#14

Here's a Q&A I wrote elsewhere:

"Q: I've just been diagnosed with impingement syndrome in my right shoulder. My shoulder is clicking and I can't even comb my hair without wanting to cry like a schoolgirl. What is impingement, and how do I get rid of it?

A: I recommend you have the entire right side of your body amputated; it'll save time.

Seriously, first off, check out my article, "Cracking the Rotator Cuff Conundrum" to learn about the structure of the shoulder.

Now that you've done that, I can assume your realize that the muscles of the rotator cuff function not only in humeral motion, but also in humeral stabilization within the glenoid fossa during upper body movement. That said, when they are weak or at a mechanical disadvantage due to structural deformities, they don't work properly, and the humeral head moves in ways that it shouldn't. The subacromial space becomes problematic here. Basically, primary external impingement syndrome means that the rotator cuff tendons (always the supraspinatus, usually the infraspinatus) and subacromial bursa are pinched between the humeral head and the coracoacromial ligament and acromion of the scapula. Over time, the glenoid labrum and long head of the biceps can get irritated as well. Eventually, tears and fibrotic changes can occur in any of the involved structures. I should once again note that I'm speaking only in regards to primary external impingement (the diagnosis most common to bodybuilders). Internal impingement is a newer diagnosis more commonly seen in overhead throwing athletes; it's a whole other ballgame and is thus beyond the scope of this column.

Scapulohumeral rhythm refers to the movement of the scapula during abduction/flexion (i.e. lifting) of the humerus. Try this: feel someone's shoulder blade (scapula) with their arms at their sides. Then, have them raise their arms 30 degrees; you won't feel the scapula move because all the motion is at the glenohumeral joint. Once they pass 30 degrees, though, the scapula must begin to upwardly rotate. There's a tremendous amount of synergy among several muscles at work here. Basically, for every 2 degrees of humeral abduction beyond 30 degrees, there is 1 degree of scapular upward rotation. Here are the muscles involved:

Upward rotation: Mid and lower trapezius, serratus anterior

Downward rotation: Rhomboid major and minor, pectoralis minor

If your scapulohumeral rhythm is out of whack, you'll eventually develop some faulty movement patterns and muscular imbalances.

Basically, to treat impingement, you need to strengthen the external rotators (infraspinatus, teres minor, and posterior deltoid) to control superior displacement of the humeral head and the mid/lower traps and rhomboids (both scapular retractors) to prevent chronic anterior positioning of the scapula. Additionally, you need to really stretch all the internal rotators (pecs, lats, anterior delts, subscapularis, teres major) to keep the posterior muscles from getting tight and allowing the protracted scapula problem to continue. This should be gentle stretching, however, as exaggerated movements can irritate the impinged structures. Simultaneously, you have to kill down the inflammation in the involved structures by limiting irritating activities (overhead movements, horizontal adduction, and protraction especially). Generally speaking, acute cases respond well to this conservative modality of treatment.

In the worst-case scenario, though, an orthopedist will mechanically make room for the tendons/bursa by shaving off part of the acromion process. This used to be a very messy surgery; nowadays, there are arthroscopic methods available.

Before you even consider surgery, I highly recommend you look into Active Release Techniques (ART). This form of soft tissue manipulation is highly effective; I've known individuals who have had cases of impingement fixed in only two sessions with a certified ART practitioner. You can locate a provider and learn more about the techniques at www.activerelease.com.

As a final thought, for all of you who don't think this is important because you don't have impingement now, I recommend you take this information to heart. With the sheer volume of bench-happy trainees and the ubiquitous nature of "only-train-what-you-can-see-in-the-mirror" syndrome, it's no surprise that we see a lot of rounded shoulders and poorly developed midbacks and external rotators. You'd be wise to nip these issues in the bud before they become real painful problem."

-EC


#15

I had a very similar problem. When I would do a low-rep "max effort" bench(1-4 reps) I would feel a stabbing pain in my right should on the first rep and then my whole shoulder would be sore for a coupla of days (and weaker thereafter). It didn't bother me on narrow grips, flat-dumbell press, or incline barbell or dumbell press, but it did bother me on barbell front or behind the neck press. I did favor my shoulder doing bench. I bought the "7-seven minute Rotator cuff solution" book" (a very good book) and did all the stretching and strengthing cuff exercises. My shoulder would get better then I'd go for a low-rep max effort on flat bench and it'd start all over.

I had some noticable instablity in my shoulder during a bench press (my arm moved kinda of like a Wal-mart buggy with a bad wheel). I went to my regular doctor and he refered me to an Ortho. I started therapy and after two therapy sessions, my shoulder was worse. My Othro suspected an loose/stretched ligament and scheduled some minor orthoscopic surgery where they insert a thermocouple heat the joint up which would in theory could cause the ligaments to tighten up as they cool.

When he actually got into my shoulder, he found that I had bone spur that had grow into a "hook" that had punctured my rotator cuff and the stabbing feeling I felt was it slicing through my rotator cuff. He removed the spur, cleaned the joint up, and did a rotator cuff reconstruction. He said if I had let it go that my rotator cuff would have eventually tore apart and been unrepairable. I woke up with my arm in an inmobilizer(strapped to my side for six weeks) instead of a sling. The therapy was pretty intensive, but the good news is that three years later it's good as new(it took about a year to return to really heavy lifting).

Anyway thats my shoulder story. My recomendation is go to a good ortho and get an MRI once your should pain becomes chronic.

Lee


#16

Once again thanks alot to everybody who contributed here, definitely will help alot. Zeb i was actually hoping you would write something, I've seen alot of your posts and they're all great. Chin ups are probably the best thing i've ever done for my biceps. Keep up the good work everyone.


#17

Close grip benching never gave me a problem, i tried the elbows in and other things recomended by Dave Tate in one of his articles. Felt weird and i couldnt lift nearly as much, but i suppose i'll get used to it like you said.


#18

I got the idea of elbows in pressing from reading the old school triceps article here at t-mag.

Also found that keeping elbows in makes rows, pull-ups and military presses easier and more productive too.


#19

I've had similar problems... over the last few years have dealt with the pain until got a lot worse, bench press is where most there pain comes from. You can develop weakness in back of your shoulders causing the imbalance. I had an MRI almost a year ago which didn't show anything, then went back to specialist again who said i have shoulder impingement syndrome, and that the pain caused around the subclavicular. Weakness in supraspinatus and infraspinatus muscle, which is really a small muscle right there on top of your shoulder joint. I also had cortisone injections, my last option as surgery I got to the point where couldnt do anything in the gym, researched ART on here and has worked miracles for me. The pain is only going to get worse, i would recommend rehab. Shoulder exercises like internal and external rotators with cables, empty can exercise, is the pain coming from back of your shoulder where mine is? It really sux because im so used to working out a lot, could be caused from an overuse, its only going to get worse, you not be in the same situation as me just thought would share some info. from my situaton