Shoulder pain is a frequent reason why people seek the help of our clinic. Shoulder pain can be caused by many different reasons including shoulder impingement, rotator cuff tears, or tendinitis to name a few. There are a few common exercises that seem to irritate the shoulder such as bench press, push ups, dips, and rows. In this post, we will discuss the reason why some of these exercises irritate the shoulder and modifications that can be done to reduce the pain.
The bench press is one of the most common exercises used to build upper body strength. While it can be an effective exercise for strengthening the biceps, triceps, and pectoral muscles, there are a few biomechanical issues with the bench press that can lead to irritation of the shoulder.
One issue with the bench press is that the bottom position stretches out of the pectoral muscles and pushes the head of the humerus forward. Stretching of the pectoral muscles in the bottom position decreases the amount of force they can generate because there is less overlap of the muscle fibers. This creates a mismatch between the amount of force needed to lift the bar from the bottom position and the amount of force the pectoral muscles can generate leading to an increased risk of injury.
Another issue with the bench press is that using a bar restricts the movement of the shoulder throughout the exercise. The bar forces the elbows to flare out during bench pressing, which is a less stable for the shoulder to be in. The shoulder naturally rotates during movements, however, this movement is restricted by holding a bar.
An alternative exercise to the bench press is the floor press with dumbbells. The floor prevents your arm from going too far into extension which will cause the head of your humerus to push forward while the dumbbells allow the arms to rotate freely.
Similar to the problem with bench press, many perform push ups with the elbows flared out placing the shoulder in a vulnerable position. A better way to perform push ups is to tuck your elbows into your sides which creates a more stable shoulder joint.
Another issue with push ups is the depth of the movement. Push ups don’t have to be chest all the way to the floor to be beneficial. When the chest goes all the way to the ground, it causes the head of the humerus to compress the tissues on the front of the shoulder which can cause irritation of the rotator cuff tendons and joint capsule. Modifying the push up so the elbow doesn’t go past the side of your body will reduce the amount of compression of the tissues on the front of the shoulder.
The main muscle targeted with dips are the tricep muscles. To perform dips, the shoulder has to go near the end range of extension which will cause the humeral head to translate forward. As stated previously, this causes compression of the rotator cuff and joint capsule on the front of the shoulder which can lead to irritation and pain in the shoulder.
Instead of dips, an alternative exercise would be tricep extensions. Tricep extensions can be performed without putting the shoulder in full extension allowing the shoulder to function in a more stable position.
While bench press, push ups, and dips may cause shoulder irritation, this doesn’t mean that they can never be performed. In the beginning these exercises may need to be avoided so that the shoulder pain will subside, but this doesn't mean that you can never do these exercises again. The shoulder can be strengthened to better tolerate these exercises and these exercises can be gradually reintroduced into a training regimen if desired.