The shoulder is one of the most vulnerable spots for those who train with weights. Pain during pressing or pull-ups leads many either to give up the gym entirely or to grit their teeth and keep training. Both routes are far from best. The editorial team has broken down how to train with shoulder pain sensibly and when a doctor is unavoidable.
Why the shoulder is injured so often
The shoulder joint is the most mobile in the human body, and it is precisely this mobility that makes it vulnerable. The head of the humerus is considerably larger than the glenoid cavity of the scapula, so stability is provided not by bones but by the rotator cuff muscles, the labrum, the capsule, and the ligaments. Any imbalance in this system is quickly felt under load.
A review by Keogh and Winwood on injuries in weight-based sports showed that the shoulder, together with the lumbar spine and the knee, is among the most frequent sites of injury in powerlifting, bodybuilding, and weightlifting. In most cases the issue is not acute trauma but gradual overload.
Among the typical conditions in people who train with weights are pain related to the rotator cuff (tendinopathy, so-called impingement), irritation of the long head of the biceps tendon, labral injuries, and also osteolysis of the distal end of the clavicle, which is described in bench-press enthusiasts.
The causes are often combined: a sharp increase in pressing volume, a large share of overhead exercises without preparation, insufficient upper-back work, poor scapular control, and technique with excessive flaring of the elbows in the press.
When to go to the doctor rather than the gym
The first rule is to distinguish discomfort from overload from signs of serious injury. “Training through pain” on your own is acceptable only when the diagnosis is clear and the pain is moderate. But if warning symptoms appear, a consultation with a doctor — an orthopedist or sports physician — is mandatory.
- sharp pain with a sensation of “clicking” or tearing during an exercise;
- noticeable weakness: you cannot raise your arm or hold it out to the side;
- deformity, swelling, or bruising in the shoulder area;
- numbness or tingling radiating into the arm;
- night pain that interferes with sleep, and pain that does not pass in 2–3 weeks;
- shoulder pain together with shortness of breath or chest pressure — a reason for emergency care.
An acute rupture of the pectoral muscle tendon during the bench press is a well-known injury in strength athletes, one that often requires surgical treatment within the first weeks. That is why sharp pain in the armpit and chest area during pressing should not be “waited out.”
A doctor may order ultrasound or MRI, but it is important to understand: changes on imaging occur frequently in people without pain. Therefore the decision on treatment is based on a combination of complaints, examination, and imaging, not on the MRI description alone.
Principles of training with shoulder pain
Modern approaches to treating rotator-cuff-related pain bet on active treatment. Systematic reviews by Kuhn and Littlewood with colleagues showed that exercise programs are an effective treatment for subacromial pain and cuff tendinopathy, often no worse than surgery in the long term.
The key idea is load management. Complete rest is usually unnecessary and even harmful for a tendon, which needs mechanical stimulus. Instead of giving up training, you select exercises, ranges, and weights at which pain remains acceptable, and gradually expand these limits.
It helps to separate training into “what does not hurt” and rehabilitation work. Legs, the core, most rows and torso exercises can often be performed without restriction, while presses are modified. This approach preserves overall fitness and psychological tone.
The rehabilitation block usually contains isometric and isotonic exercises for external and internal rotation, work for the lower and middle trapezius and the serratus anterior, and scapular control exercises. The specific selection should be made by a physical therapist after examination.
How to modify exercises
Pain is most often provoked by overhead presses, deep dips on parallel bars, arm raises in extreme positions, and the wide-grip bench press. You do not have to give up these movements forever, but during a flare-up they should be replaced with more “friendly” variants.
| Exercise that provokes pain | Possible substitution during a flare-up |
|---|---|
| Wide-grip barbell bench press | Neutral-grip dumbbell press, press with a limited range (from a board) |
| Standing overhead press | Angled press (“landmine”), incline-bench press |
| Dips on parallel bars | Push-ups from the floor with scapular control |
| Upright barbell row to the chin | Lateral raises in the plane of the scapula to shoulder level |
| Wide-grip pull-ups | Neutral-grip lat pulldown |
For the bench press it helps to narrow the grip and keep the elbows at an angle of about 45–70° to the torso instead of 90°, and to retract and stabilize the scapulae. Such technical changes reduce the load on the front of the shoulder without losing effectiveness for the pectoral muscles.
The progression of weights after a flare-up is restored gradually, guided by the shoulder's response the next day. If pain after a workout intensifies and does not pass by the next morning, the load was excessive.
As prevention, it helps for the volume of pulling exercises for the back to be no less than the volume of presses, and for the program to regularly include work for the rotators and scapular muscles. This does not guarantee protection, but it evens out the load on the joint.
Painkillers, injections, and other “quick fixes”
Many athletes try to “shut off” the pain with pills and keep training as usual. Non-steroidal anti-inflammatory drugs can briefly ease symptoms, but their prolonged use carries risks for the stomach, kidneys, and cardiovascular system. They should be taken only on a doctor's recommendation.
Glucocorticoid injections into the subacromial space are used in medical practice for short-term pain relief. However, they do not treat the cause, and repeated injections into the tendon area are associated with a deterioration of its structure. The decision on such procedures is made by a doctor.
Dangerous is the practice of self-administering peptides, “regenerative” drugs of dubious origin, or injections of unknown composition. Evidence of their effectiveness in humans is often absent, while the risks — infection, contaminants, hidden effects — are real.
The most well-founded tools remain simple: correcting the load, progressive exercises, working on technique, sleep, and time. Tendon recovery is measured in weeks and months, not days.
Editorial conclusions
Shoulder pain is one of the most common problems for people who train with weights. In most cases it is overload related to the rotator cuff and adjacent structures, which responds well to proper load management.
Complete rest is rarely needed: it is better to modify exercises, train what does not hurt, and perform the rehabilitation program prescribed by a specialist. Warning symptoms — sharp pain with a “click,” weakness, numbness, night pain — require a visit to a doctor.
Prevention consists of gradually increasing pressing volume, balancing pulls and presses, technical work with the scapula, and regular exercises for the rotators.
We also recommend our articles on training with knee pain, on core muscle training, and on the deload week.
References
- Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sports Med. 2017;47(3):479–501.
- Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA. Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res. 2010;24(6):1696–1704.
- Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138–160.
- Littlewood C, Ashton J, Chance-Larsen K, et al. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012;98(2):101–109.
- Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Man Ther. 2016;23:57–68.
- Gabbett TJ. The training–injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273–280.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
