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Shoulder pain during bench press, dumbbell overhead press seated vs standing - How to DIY

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There is no doubt that the flat bench press is an extremely good way to grow a big chest – hence its abiding popularity among certain gym-goers! The same levels of pectoral growth cannot be achieved with standing cable presses, or single arm dumbbell presses on swiss balls, even though biomechanically they are profoundly safer, as they spread the load across numerous body parts.
The high levels of injury associated with the FBP are primarily caused by the bench itself.
Crucially, at the bottom of the press movement, where the head of humerus lurches forward, the subscapularis tendon (as it rises from the armpit at the front of the shoulder) is unable to exert its counter-balancing, stabilising force. The progressive tightness at the back of the shoulder socket leads to the head of humerus being nudged anteriorly and superiorly (forwards and up) into the socket during the press movement. Typically the top, side or frontal aspects of the shoulder will begin to ache after training or the next day, perhaps during warm-up, under heavy loads or with fatigue.
In my opinion every strength coach and trainer should know how to activate or enhance the protraction and retraction movements of the scapula, in order to prevent rotator cuff overload and shoulder pain.
The following two approaches will allow you to start the process of correcting bad mechanics and enforcing good movement patterns without the need to ban the bench press from your exercise repertoire. Lie supine, as normal, with the noodle placed longitudinally under the length of the spine (including the head) on the bench. During this simple modification of the bench press, the scapulae will be able to protract and retract. On the latter part of the push-up phase, you can bring your scapulae somewhat further around the rib cage (protraction), but care must be taken to not allow shrugging of the shoulders (over-activity of upper trapezius and levator scapulae) or flexion of the trunk. Start by performing the bench press (with the pool noodle ideally), using a low weight on the bar.

As you perform your bench press, ask your trainer to gradually increase the pulling force on the tubing, creating additional torque (rotary force) around the shoulder. In my experience, this activation mechanism is frequently extremely effective in removing pain from pressing movements. Yet despite the growing recognition of this risk, the flat bench press remains very popular with personal trainers and strength and conditioning coaches. It is relatively common to find that someone will experience shoulder pain with the FBP, but none if they are doing normal prone push-ups.
The scapula is unable to retract on the latter part of the down phase, as the elbow moves past the point of the shoulder (the humerus is horizontally hyper-extending); and is unable to protract with the latter part of the up-phase as the elbow moves to the ceiling (the humerus is horizontally hyper-flexing, see figure 2).
Excellent drills have been developed and are available these days for the training and activation of this key shoulder stabilising muscle. The scapula must retract sufficiently at this point to give the tendon better traction to prevent the destructive anterior shear of the humeral head. This frontal shear creates overload of the long head of biceps tendon as it crosses the front of the shoulder, and the upwards shear creates compression of the supraspinatus tendon under the acromion. The pain may emanate from inflamed tendon structures or from the labrum (cartilaginous rim of the socket) or subacromial bursa or up-regulated neural structures.
The pectoralis minor will begin to dominate the press movement, preventing the pectoralis major from developing as it should. The first physically alters the bench to give you a chance to use your scapula, the second gives movement feedback to challenge you to isolate and activate key muscles. This is because the effect of most benches is to severely restrict the movement of the scapulae (shoulder blades), thereby artificially exaggerating the movement of the glenohumeral (main shoulder) joint (see figure 1 for an illustration of the key muscles under discussion in this respect).

In the end, the precise diagnosis matters less than understanding  the mechanism that has caused the pain. The glenohumeral lurching will ensure that the pec major does not have a strong base from which to operate, again preventing its normal development. While there may be an argument for this early in the training regime of those with very poor muscular development and body awareness, all the research and anecdotal evidence strongly suggests that the scapulae should not be locked if one wants to protect the fragile structures of the glenohumeral joint and develop the muscles of the shoulder optimally. As the scapulae retract to their limit, the elbows should not descend any further, thus preventing even the slightest lurching. This extra level of activation of subscapularis braces the anterior aspect of the glenohumeral joint, preventing it from lurching forward and upwards in the socket. It is possible to find very narrow benches, but there is a real risk of falling off sideways during the exercise, especially when fatigue sets in! Instead the shoulders just become rounded, possibly with a tendency to develop the anterior deltoids and triceps over pec major. The noodle needs to run the length of the spine, so that head to pelvis can lie on it during the exercise (see figure 3). And although a unique type of bench does exist that has notches cut out of it to allow the scapulae to retract, it is rare to see one in the gym. If the noodle sits too high off the bench, it makes it too unstable to perform the exercise safely; if it is too soft (eg, a hollow-core pool noodle) it will not act as a stimulus to change the movement of the scapula.

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