Updated 7/15/21:

Key Points: This article is a monster so I’ve included the main points to getting out of shoulder pain and back to training below:

1. Learn the basics about shoulder pain
   • Strengthening helps improve the majority of shoulder problems
   • Pain often times does not improve unless strengthening is initiated
   • Getting out of pain and back to training can take several months
2. Temporarily modify training and lifestyle activities to allow the irritated shoulder to calm down
   • Eliminate or modify aggravating lifestyle activities like working overhead, reaching behind the back and putting on a jacket / shirt with the painful side
   • Modify presses, rows, olympic lifts and other painful gym movements to variations that cause minimal pain 
3. Identify and correct mobility limitations in the shoulder, thoracic spine and the rest of the kinetic chain
   • Mobility limitations can increase stress in the shoulder 
4. Correct technique issues in overhead exercises and olympic lifts
   • Proper technique reduces stress on the shoulder and maximizes performance
5. Start gradually loading the shoulder through a progressive strengthening program
   • Emphasizing progressively more challenging exercise variations and loads
   • Target the shoulder and scapular stabilizing muscles

1: Shoulder Pain Basics

Shoulder pain is a fairly common problem when training in the gym.  If you've been training for long enough you've probably encountered some shoulder issues at some point that have thrown a wrench in your training.  

Where Is Most Shoulder Pain Felt? 

Usually it starts with a little bit of irritation and tightness in the front or side of the shoulder.   Over time this tightness can turn into some pretty serious pain.  Before you know it you're forced to modify your training in the gym and even basic things like putting on a jacket, reaching in the back seat of the car when driving  or sleeping at night can be painful.

What Exercises Usually Aggravate Shoulder Pain?

The biggest offenders for shoulder pain are usually press exercises like bench press and overhead press.  Some folks have trouble tolerating end ranges of motion overhead like fully hanging on a bar or the catch position of a snatch.

Does Shoulder Pain Naturally Go Away?

Shoulder pain can be a chronic condition that sticks around for months to years.  In some folks the pain tends to go away with simple rest and time.  In others it can continue on without resolution. (1)  In one study in patients diagnosed with shoulder pain 40-50% of those patients still had pain at 1 year follow-up. (8)  For a lot of folks shoulder pain is not something that goes away with rest and time and requires a strengthening program and a lot of patience to improve over time.  (28)

On top of this shoulder pain tends to have a pretty high recurrence rate. (2)  Research shows us that shoulder pain recurs at about a 25% rate over the course of a year. (8)  In other words if you have a bout of shoulder pain and it goes away, you've got a 1 in 4 chance of getting the pain again before the year is over...

Basically once you think your pain has finally gone away, it comes right back again with a vengeance.  Shoulder pain can also be variable.  On some days you may be able to perform your favorite lifts without pain and on other days they can be an absolute no go...

Shoulder pain in the gym is generally an overuse condition.  If you think about it, the shoulder joint was probably not designed for the stresses we throw at it.  Sure, we may have evolved as human to perform tasks such as climbing, throwing, crawling and working overhead but you can't convince me the shoulder was designed to bench press and push jerk several hundred pounds overhead.

The joints of the lower body (ankle, knee and hip) were designed to bear our body weight.  We spend large portions of our days standing and walking.  These joints were designed to handle the forces of running and jumping.  

One of the major issues with training in the gym is that we expect the shoulder joint to be as robust and strong as the hip and knee joint.  We throw maximal loading at the shoulder several days per week expecting the shoulder to handle it.  Well, sometimes the shoulder can't handle it and it gets painful.

Is Shoulder Pain a Common Problem in Strength Sports and in the Gym?

It's no surprise that survey data shows that the shoulder is regularly reported as the top most injured (if not #1 then usually in the top 3) joint in strength sports like powerlifting, olympic weightlifting, strongman and CrossFit (TM).  (3,4,5,6)

Don't get me wrong, training in the gym and even training at the most elite level in strength sports is still relatively safe in comparison to other sports (just check out the infographic below).  I'm not intending to throw these sports under the bus in any way.  I love training and wont stop until I'm dead.  However, people do get hurt from time to time and the shoulder is not immune.  In fact it's generally a bit more at risk when compared to other joints.

What Helps Heal Shoulder Pain?

Fortunately for us, shoulder pain is actually improved by strengthening it. (4)  This is music to the ears of gym lovers.  It means we don't have to give up what we love and what we love is actually helpful for getting out of pain.  We actually have a plethora of medical research to show that a strengthening program is helpful for all sorts of shoulder pain issues:

• Rotator Cuff Tendinopathy (9)
• Rotator Cuff Tears (7,9)
• Subacromial Impingement / Bursitis / Biceps Tendinitis (7, 9)
• SLAP tears (10)
• Anterior Shoulder Instability (7)
• Multi-directional Shoulder Instability (11,12,13)
• AC Joint Injury (7)

Lastly, if we make the shoulder more strong and robust then it can help improve our performance and probably help to reduce re-injury rates in the future.

How Do I Know if Something More Serious is Happening in my Shoulder?

Now, we always need to be on the lookout for more serious issues like fractures, cancer and infections when your shoulder hurts.  If you're experiencing any of the following issues with your shoulder pain then you need to speak to a physician immediately (14):

• Acute pain that came from trauma like falling on your shoulder or a car accident (especially if pain restricts all motion)
• Systemic symptoms such as fever, night sweats, weight loss, or new respiratory symptoms
• Abnormal joint shape; local mass or swelling
• Local redness over a ‘hot’, tender joint
• Severe restriction of movement

In general, if your symptoms are not improving over the course of 30 days you should always consult a physician to see if something more serious is occurring.  If you're unsure whether or not your condition is more serious be sure go to the doctor as well.  When in doubt, get it checked out. 

What Causes Shoulder Pain in the Gym?

Weight training simply places stress on the shoulder.  Think about maxing out on a bench press, the shoulder is subject to a lot of stress during the lift.  If the amount of stress we apply to the shoulder exceeds it's ability to tolerate that stress, an injury occurs.  In weight training and strength sports we're often pushing the envelope in terms of loads lifted during upper body exercises like presses, rows and olympic lifts.

So the two most important factors that relate to injury are going to be stress and recovery.  We're got to balance these two for optimal success.  Excessive training stress can come in the form of sub-optimal technique, programming issues as well as poor recovery and regeneration strategies.  Here are some commons reasons why I believe shoulder injuries occur in the gym:

• Introducing a bench press program, olympic weightlifting program or any other intense upper body training program too quickly (Not being prepared for a given program and jumping straight into it) (14,15,16,17)
• Being a novice trainee (<6 months to 1 year training experience) (18,19)
• Lack of consistency with training (18, 21)
• Excessive training volumes (eg: too much training via sets, reps, frequency, etc.) (14,15,16)
• Excessive training loads (using more weight then your shoulder can handle)
• Spikes in training volumes (eg: a sudden spike in training volume) (14,15,16)
• Lack of coaching and poor technique (17, 20)
• Poor recovery (nutrition, sleep, stress management, lack of recovery days between intense sessions) (23, 24)
• Mobility issues creating more stress on the shoulder (more on this later)
• Not taking prior shoulder injuries into account (22)

The take-away here is that shoulder injuries are generally multi-factorial in nature and usually can't be attributed to any one major cause.  This also means that if we want to prevent future injury we'll have to address the factors that led to injury in the first place.  This is an article for another day though.  Onto the good stuff...

How Do I Get Out of Shoulder Pain and Back to Training?

Now, I know I just said that strength training is helpful for getting out of pain, but if you're dealing with some serious pain then the last thing you probably want to do is load up a barbell for some heavy bench press.  There's definitely a process to this and I'm going to help guide you through it.  

I've created a 4 step plan to help you get out of pain and back to training squats, deadlifts and the olympic lifts.  Here are the steps:

1. Modify training and lifestyle activities to allow the irritated shoulder to calm down
2.  Identify and correct mobility limitations in the ankle, hip, shoulders and thoracic spine to reduce stress on the shoulder
3. Correct technique issues in the bench press, overhead press and olympic lifts
4. Start gradually loading the shoulder through a progressive strengthening program 

So let's begin shall we?

2: Modify Training and Lifestyle Activities to Allow the Irritated Shoulder to Calm Down

 After a shoulder injury, what's important to understand is that pain is a natural and normal protective response our brains produce (26) to make sure we don't do anything stupid and hurt ourselves further in the gym. So initially after an injury it's very important to temporarily avoid aggravating activities to give the shoulder time to heal and pain levels to calm down.  

How to Modify Your Lifestyle to Heal Your Shoulder

This means 2 things:

• Your regular lifestyle activities should be temporarily modified to avoid aggravating your shoulder
• Your regular gym training should be temporarily modified to avoid aggravating your shoulder

After a shoulder injury there are predictably things that feel pretty good and things that feel pretty bad. Things that aggravate the shoulder should be temporarily modified or eliminated.  A few things that traditionally hurt with shoulder pain:

• Reaching behind the back 
• Reaching into the back seat of the car from the front seat
• Lifting something heavy with the arm fully extended (Picking up a gallon of milk from the fridge)
• Reaching across the body
• Turning the steering wheel
• Working overhead
• Taking a shirt off / putting a shirt on
• Putting a jacket / backpack on
• Sleeping with the arm overhead
• Sleeping on your shoulder

It's important to understand that these are just a few things that can irritate the shoulder.  If other movements really hurt, then modify those movements temporarily as well.  How do we modify?

• Lift heavier objects with the opposite arm
• Put on jackets / shirts / backpacks with the injured arm first.
• Sleep on your back or on the uninjured side with a pillow under the injured arm

It's also important to understand that everyone will have a specific "flavor" of shoulder pain.  What I mean by that is that everyone's shoulder injury will be a little different.  If these movements don't hurt you, then don't worry about modifying them.  Just modify what does.  

My general rule of thumb is "to be nice to your shoulder."  Basically I mean do a lot of activity that feels good and temporarily modify and or leave out the activities that feel bad.  Like I said earlier, exercise (and motion in general) is good for the shoulder.  Over the course of time we'll re-introduce these movements gradually as pain improves.

The second part of the solution will require making some major modifications to any exercises that are aggravating in the gym.  

We're going to want to temporarily unload the joint by avoiding aggravating movements for somewhere between 4-6 weeks following an injury to the shoulder

I know this is tough to hear for someone who absolutely loves to lift, but it's important for long term success during rehabilitating and if we skip this step we could be setting ourselves up for long term failure and frequent future exacerbations.  Also keep in mind that if a given movements feels great, then there's no need to modify.  We only need to modify the movements that are painful.  

Common culprits that may need to be modified initially:

• Bench Press
• Overhead Press
• Pull-ups
• Olympic lifts (cleans, snatches, jerks)

My general rule of thumb for modifying exercise is that any movement that creates more than a 3/10 pain (on a 0-10 pain scale) during, that night or the day following training needs to be modified.  Obviously this is going to be different from person to person and it will take some experimentation to get right.  I'll show you exactly how to do this for every common movement above.  We'll also cover pain in depth and what's ok to push into and what's not later in the article.

How long you'll have to modify also depends a lot on the individual.  Some take longer, some shorter.  I've had bouts of shoulder pain that had me modifying for over 6 months.  I've worked with people where that process is a year or longer.  Some only take a few days or weeks.  

Stay patient and do your best not to get frustrated along the way.  Remember, shoulder pain is super common and you've got plenty of people fighting the same fight as you and plenty more who have come through in a better place after.  

To help you navigate through the modification process I've created principles for modifying the bench press, overhead press and olympic lifts to help you stay within the pain parameters discussed above when training.  

You'll learn some simple principles that allow us to increase or decrease stress on the shoulder (decrease stress for now).  With these principles we can adjust exercise technique to decrease stress on the spine and if these modifications aren't enough to decrease pain within our pain guidelines (< or = 3/10) then I've supplied a series of exercises to try until we find a movement we can load.  

How to Modify Training to Heal Your Shoulder

How to Modify the Overhead Press for Shoulder Pain:

Overhead press is generally one of the toughest things to perform when the shoulder is painful.  It often needs to be taken out of the program temporarily to allow the shoulder to calm down before being introduced again.  Here are 5 things to keep in mind when overhead press is painful:

1. Greater loads increase stress to the shoulder - The more weight on the bar generally equates to more stress on the shoulder.
   1. Faster lifting speeds also increases stress on the shoulder.
2. The shoulder is very prone to overuse issues - Unlike the hip and knee, the shoulder was not designed to bear weight (walking, running etc.).  For this reason the shoulder is more prone to overuse issues if too much overhead pressing is utilized.
3. Different grip widths and pressing implements can help with pain - Often times switching grip widths or pressing implements (Barbell vs. dumbbell vs. kettlebell) is not enough eliminate pain during overhead press
4. When overhead pressing is painful, sometimes more horizontal pressing is well tolerated - For this reason different angles of pressing can substitute for overhead pressing to get your training in for the day.
5. Substituting a row variation for pressing is often helpful for painful shoulders - When you can’t find a pressing variation that can be accomplished without pain often times substituting a rowing variation works well and is well tolerated.

Changing the implement or grip width alters the shoulder abduction angle and may help unload a painful structure in the shoulder

6 Pro Tips For Reducing Shoulder Pain During Overhead Press

1. Decrease total load or slow down speed of movement - Less total load decreases stress on the shoulder.  

1. Increase number of reps (Decreasing the total load you can use for the set)

2. Slow down the speed of the lift 

2. Press less frequently throughout the course of the week for less reps - Often times decreasing total pressing volume will be enough to get out of shoulder pain.

1. Reduce total sets of overhead press in a given session

2. Substitute 1-2 pressing exercises for rowing exercises within your program

3. Vary the grip - A more narrow grip may help with shoulder pain

4. Vary the pressing implement - Switching from a barbell to dumbbells, kettlebells or a landmine is often enough to eliminate pain

5. Vary the plane of pressing - Switching from an overhead press to a more horizontal press like an incline press can be effective for reducing pain and continuing to train for the day.

6. Substitute pressing for rowing - If all else fails then try substituting a pressing variation for a rowing variation.

1. Seal row, chest supported row, single arm dumbbell row etc.

Overhead Press Modification Ladder for Shoulder Pain - When you are unable to eliminate pain by slowing down reps or attempting a higher rep range use the ladder below to find a pain free overhead press variation.

How to Modify the Bench Press for Shoulder Pain:

Here are 2 things to keep in mind when bench pressing is painful:

1. Greater loads increase stress to the shoulder - The more weight on the bar generally equates to more stress on the shoulder.
   1. Faster lifting speeds also increases stress on the shoulder.
2. The shoulder is very prone to overuse issues - Unlike the hip and knee, the shoulder was not designed to bear weight (walking, running etc.).  For this reason the shoulder is more prone to overuse issues if too much bench pressing is utilized.
3. Specific bar paths and ranges and positions can become overused - Overusing specific grips, angles of pressing and specific ranges of motion can create overuse problems within the shoulder.
4. Wider grips and deeper pressing increases stress to the shoulder (AC joint) - The further the elbow get away from the body and the further toward the floor the elbow travel, the more stress on the shoulder.

5 Pro Tips For Reducing Shoulder Pain During Bench Press

1. Decrease total load or slow down speed of movement - Less total load decreases stress on the shoulder.  

   1. Increase number of reps (Decreasing the total load you can use for the set)
   2. Slow down the speed of the lift or add “pauses” in the bottom of the bench press

2. Press less frequently throughout the course of the week for less reps - Often times decreasing total pressing volume will be enough to get out of shoulder pain.

   1. Reduce total sets of bench press in a given session
   2. Substitute 1-2 pressing exercises for rowing exercises within your program

3. Vary the pressing exercise - Changing the angle, grip or implement is often enough to get out of pain while pressing

   1. Try changing to an incline or decline press
   2. Try changing grip width or switching to a neutral grip bar
   3. Try using dumbbells

4. Narrow the grip and limit the range of motion - A more narrow grip and less depth will decrease stress to the AC joint

   1. Switch to close grip
   2. Try floor press, board press or spoto press

5. Substitute pressing for rowing - If all else fails then try substituting a pressing variation for a rowing variation.

   1. Seal row, chest supported row, single arm dumbbell row etc.

Bench Press Modification Ladder for Shoulder Pain - When you are unable to eliminate pain by slowing down reps or attempting a higher rep range use the ladder below to find a pain free bench press variation.

How to Modify the Pull-up for Shoulder Pain:

Fortunately for us, pull-ups are generally not as difficult for the injured shoulder then other forms of pressing exercises like bench press and overhead press.  However, when pull-ups are painful we need to know how to work around it.  Here are few things to keep in mind when pull-ups are painful:

1. Greater loads increase stress to the shoulder - More weight simply increases stress to the shoulder joint.
   1. Faster lifting speeds also increases stress on the shoulder.
2. Different grips can help with pain - Often times changing to an underhand or neutral grip is enough to make the movement pain free.
3. When pull-ups are painful, sometimes more horizontal pulling is well tolerated 

3 Pro Tips For Reducing Shoulder Pain During Pull-ups

1. Decrease total load or slow down speed of movement - Less total load decreases stress on the shoulder.  

   1. Increase number of reps (Decreasing the total load you can use for the set)
      1. Add band assistance or utilize lat pull-down to accomplish this
   2. Slow down the speed of the lift 

2. Vary the grip - A neutral or chin-up grip may help with shoulder pain

3. Vary the plane of pulling - Switching from a pull-up to a more horizontal pull can be effective for reducing pain and continuing to train for the day.

   1. ½ kneeling overhead pull-down
   2. Other horizontal rowing variations

Pull-up Modification Ladder for Shoulder Pain - When you are unable to eliminate pain by slowing down reps or attempting a higher rep range use the ladder below to find a pain free pull-up variation.

How to Modify the Jerk for Shoulder Pain:

The Jerk is generally one of the toughest things to perform when the shoulder is painful.  It often needs to be taken out of the program temporarily to allow the shoulder to calm down before being introduced again.  Here are 5 things to keep in mind when the jerk is painful:

1. Greater loads increase stress to the shoulder - The more weight on the bar generally equates to more stress on the shoulder.
   1. Faster lifting speeds also increase stress on the shoulder.
2. The shoulder is very prone to overuse issues - Unlike the hip and knee, the shoulder was not designed to bear weight (walking, running etc.).  For this reason the shoulder is more prone to overuse issues if too much overhead pressing is utilized.
3. Different grip widths and pressing implements can help with pain - Often times switching grip widths or pressing implements (Barbell vs. dumbbell vs. kettlebell) is  enough to eliminate or substantially decrease pain during the jerk
4. End ranges are tough for the shoulder - Pressing into end ranges of motion of shoulder flexion like a barbell requires (think of the fully overhead lockout) can be tough on the shoulder.  Shortening the range with kettlebells, landmine or high incline press variations can help.
5. When jerk work is painful, sometimes more horizontal pressing is well tolerated - Overhead work can be painful due to overuse of this plane of pressing while other planes of pressing are still tolerated quite well.  For this reason different angles of pressing can substitute for the jerk to get your shoulder training in for the day.
6. Lowering barbells from overhead is often the most challenging part of the jerk - The lower body helps drive the bar overhead but doesn’t help on the way back down.  For this reason eliminating the eccentric by dropping the bar from overhead back to the floor or jerk blocks can eliminate pain or substantially decrease it.
7. Substituting a row variation for pressing is often helpful for painful shoulders - When you can’t find a pressing variation that can be accomplished without pain often times substituting a rowing variation works well and is well tolerated.

7 Pro Tips For Reducing Shoulder Pain During Jerks

1. Decrease total load or slow down speed of movement - Less total load decreases stress on the shoulder.  

   1. Increase number of reps (Decreasing the total load you can use for the set)
   2. Slow down the speed of the lift (on the lowering portion)

2. Press less frequently throughout the course of the week for less reps - Often times decreasing total pressing volume will be enough to get out of shoulder pain.

   1. Reduce total sets of overhead press in a given session
   2. Substitute 1-2 pressing exercises for rowing exercises within your program

3. Vary the grip - A more narrow grip may help with shoulder pain

4. Vary the pressing implement - Switching from a barbell to dumbbells, kettlebells or a landmine is often enough to eliminate pain

5. Vary the plane of pressing - Switching from an overhead press to a more horizontal press like an incline press can be effective for reducing pain and continuing to train for the day.

6. Use jerk blocks - Eliminating the lowering portion of the lift by dropping the weight back onto jerk blocks can help reduce pain but still allowing a training effect.

7. Substitute pressing for rowing - If all else fails then try substituting a pressing variation for a rowing variation.

   1. Seal row, chest supported row, single arm dumbbell row etc.

Jerk Modification Ladder for Shoulder Pain - When you are unable to eliminate pain by slowing down reps or attempting a higher rep range use the ladder below to find a pain free jerk variation.

So now you should be armed with the knowledge required to modify your training to unload the shoulder. Just keep in mind that after an injury often times the area won't tolerate the loads and volume that it normally does. For this reason you may also have to reduce not just the weight but also the sets, reps and or frequency (how many times you perform the lift per week) on some of your shoulder intensive lifts.  Onto the next step...

3: Identify and Correct Mobility Limitations in the Ankle, Hip, Shoulders, Thoracic Spine and Wrists to Reduce Stress on the Shoulder

In order to perform olympic lifts and overhead press we need adequate mobility.  An important concept to understand is that if you're lacking mobility at one joint then you'll be forced to make up that mobility at another joint.  If we're lacking mobility in any of these areas, we'll end up making up for some of this at the shoulder.  This increases stress to the area and can perpetuate injury.  

Here's a specific example.  If we're limited with ankle flexibility then it will force the torso to incline forward when we squat.  More torso inclination will force extra motion at the shoulder to keep the bar overhead  Basically if we can't bend well from the ankles then we force more stress on the shoulder.  Check out the video below to see what I'm talking about:

What Muscles and Areas Should I Mobilize When I Have Shoulder Pain?

Here are the areas we need to assess and then correct to ensure the shoulder isn't working overtime:

• The thoracic spine and shoulders
• The hip
• The ankle
• The wrist
• The front rack (for the clean)

Shoulder and Thoracic Spine Mobility Assessment, Stretches and Mobilizations

Having adequate mobility from the thoracic spine, shoulder (and shoulder blade) is all very important for not only shoulder health but also being able to get into better overhead positions in general:

You can see just how promoting a bit more thoracic extension mobility can drastically change overhead position.  The good things for us is that we can easily assess our own shoulder and thoracic spine mobility.  Check out the video below to see my favorite assessments:

If you find that you've got a restriction in the thoracic spine then gaining some mobility here can help reduce some of the stress in your shoulders during the olympic lifts. Here are a few of my favorite thoracic spine mobility exercises below:

Here are some other great mobility resources for thoracic spine or shoulder mobility restrictions:

• 5 Minute Overhead Mobility
• 3 Unique Exercises for Overhead Mobility

Hip Mobility Assessment, Stretches and Mobilizations

Hip mobility is going to be important for shoulder health during the clean and especially for the snatch.  Just as with lacking ankle mobility, hip mobility restrictions will incline the torso forward in the bottom of the squat and force the shoulder to move more to make up for the hip restriction.  Check out the video below for an explanation and how I assess for hip mobility issues in the squat:

If you find you have a mobility restriction in the hip here are some of my favorite mobility drills to help improve that problem:

Ankle Mobility Assessment, Stretches and Mobilizations

As discussed previously, ankle mobility is important for reducing stress in the shoulder but also for achieving enough depth in the squat and maintaining an upright torso in the bottom of the snatch and clean. Check out the video below to learn how to assess your ankle mobility:

If you find a restriction, it's a good idea to work on correcting this. Check out the video below to see some of my favorite ankle mobility exercises:

Wrist Mobility Assessment, Stretches and Mobilizations

A lack of wrist extension mobility can force extra motion to occur at the wrist during overhead work.  Check out the image below to see what I'm talking about:

That being said, we still need to assess for wrist mobility deficits. Here is a very easy test I originally picked up from my colleague Dave Tilley at shiftmovementscience.com to assess for mobility deficits:

Basically you're just putting your hands together and bending both wrists maximally.  The goal here is getting the crease of the wrist below the level of the elbow without the palms separating. If you can accomplish this, then you don’t need any more mobility in your wrists. You’ve got enough wrist mobility.  Now if you don't you've got some mobility work to do for the wrist.  Here are 3 of my favorite mobility exercises for the wrist:

Front Rack Mobility Assessment, Stretches and Mobilizations

If there is a restriction in front rack mobility it will lead to compensation and increased motion at the lower shoulder. Fortunately for you I've created an in depth article to help you figure out if you have any mobility restrictions in your front rack and how to improve it:

The Ultimate Front Rack Mobility Guide

These mobility drills can be started immediately after starting rehabilitation and should be continued throughout. Once we have adequate motion in all joints involved we'll also have to ensure that we have adequate technique.  

Keep in mind that you may have spent years developing a specific exercise technique.  If this was with poor technique then this will be a tough habit to break.  Just because we have the mobility to get into a specific position doesn't necessarily mean we'll use that technique (especially if we don't have the strength in that position as well).  

Let's use ankle mobility as an example.  Just because we now have the motion doesn't mean that we'll use it.  After mobilizing the ankles we may need a few cues to now use this new motion.  Check out the video below to see what I'm talking about:

In this case a few cues were needed to get into a position that reduces stress on the shoulder.  We'll be discussing technique in more depth later on in the article series...

4: Correct Technique Issues in the  Overhead Press and Olympic Lifts

Now, we just spoke about how important mobility is for optimal technique during our gym lifts.  This is of course only if you actually use good exercise technique.  Next we'll discuss a few key points during overhead lifts like the jerk and snatch.

Proper Technique for the Snatch

Basically what we're looking for in terms of optimal overhead positioning is keeping the bar over the crown of the head.  What this ensures is that we're not excessively flexing the shoulder during the jerk or snatch.  Hyperflexing the shoulder joint does a few things.  For one it stretches the shoulder ligaments that help create stability within the joint.  Second of all it places the shoulder in a poor position to control motion within the joint.  Lastly, it may be placing unnecessary compressive stress on the rotator cuff.  If you'd like to read more theorized and rationale behind avoiding hyperflexion click HERE for my guide on the rotator cuff.

Check out the video below to see what I'm talking about:

Keep in mind that as discussed previously, if we're lacking ankle, thoracic spine and wrist mobility, we simply won't be able to get into a position that maximizes efficiency of the shoulder.  

Proper Technique for Kipping Pull-ups, Muscle-ups and Toes to Bar

The same thing goes for the back swing of the kip for movements like pull-ups, toes to bar and muscle-ups.  We want to ensure that we're getting the majority of the motion generation for the movement from our core and spine and not the shoulder joint:

For more information about proper kipping technique and how injuries occur from kipping click HERE.

Proper Technique for Jerks and Overhead Press

We'll also want to ensure that we get adequate thoracic spine and scapular motion when going overhead.  We're looking for a combination of scapular posterior tilt, upward rotation and thoracic spine extension.  

The reason why we want these motions is because they help to provide the most amount of space for the rotator cuff to do it's job appropriately.  Again, if you'd like to read more about the rotator cuff then click HERE to check out my guide on it.

Fortunately for us, once we've acquired the necessary mobility to go overhead we just need to reinforce solid technique during overhead lifts.  Just as with the snatch we want the bar over the crown of the head at lockout.

We can promote these positions of the shoulder, spine and shoulder blades through a few easy cues.  Getting tall and lifting the chest up promotes both scapular posterior tilt and thoracic extension.  As long as we're not actively attempting to bring the shoulder blades "back and down" during the overhead press then we're allowing the scapula to upwardly rotate as well.  Easy.

5: Start Gradually Loading the Shoulder Through a Progressive Strengthening Program

How Does Strengthening Heal My Shoulder?

Exercise helps us rehabilitate from an injury through a process called mechanotransduction (27). Basically exercise causes a cascade of reactions that leads to our tissues healing and adapting to the stress that we're throwing at it (27). In other words, you need to show your body (our shoulder in this case) the same stresses it needs to be able to handle so that it can adapt and heal.

With this in mind, exercise dosage becomes incredibly important. When you have a headache taking 2 aspirin can get the job done and have you feeling better. If you decide to take the entire bottle then you'll most likely end up dead. The aspirin wasn't the problem, it was the DOSAGE of the medicine.

Imagine having a shoulder injury and going into the gym and doing 10 sets of 10 bench press at your 10 rep max weight.  You just swallowed a bottle of aspirin.   2 or 3 sets may have been just right but we went way beyond that and probably did more harm then good. 

Exercise is the medicine that will heal your shoulder. We just need to get the right dosage of exercise medicine.

What needs to be kept in mind is that exercise dosage actually needs to start pretty low and then will need to ramp up over the course of time as the shoulder improves.

Remember that pain is your body's way of trying to keep you safe. Your body is smart. It remembers the past stresses you've thrown at your shoulder that created issues in the first place. It isn't going to allow you to bounce straight back into training for fear of repeating past mistakes. You've violated your body's trust and it's going to take some time and diligence to win back trust and get pain to go down and get you back to hitting bench press and jerk PRs. 

Does Pain During Exercise Mean I'm Causing More Damage to My Shoulder?

So, how do we dose exercise, build back our body's trust and get back to training?  Check out the images below to see two styles of training that lead to a lack of results:

In this example we see that not enough training stress may not get the effect we want and too much stress and we go backwards.  It's kind of a goldilocks situation. Too much stress and we violate the body's alarm system and get more pain. Not enough stress and we may not make a change. Remember that exercise will help heal our tissues and if we don't apply the medicine we may not get the improvement we want.

How Much Pain is Acceptable During Exercise?

I like to use pain as a guideline for loading the shoulder.  Basically if we're keeping pain below a certain threshold then we're probably doing things appropriately. Having small amounts of pain is not only normal but can be a sign that we're applying the right amount of stress to the joint (26). 

As you progress over the course of time we just dial up the stress to match where the shoulder is in terms of rehabilitation. What this also means is that as our shoulder improves we can slowly start leaking exercises back into our training program that were previously too painful.  As discussed previously I like to use pain as a guide for exercise dosing in rehabilitation programs.  Here are my guidelines to help determine dosage of exercise during rehabilitation using pain as a guide:

• Pain should be minimal or at or below a 3/10 on a 0-10 pain scale during exercise
• Pain levels should return to baseline following exercise and the following day
• Pain and function should be improving on a weekly and monthly basis
• Exercises should be introduced with low volume and intensity initially (low loads, sets, reps, days / week)

For more information about how much pain is OK to push through during exercise then click HERE to see a prior article I've written on the topic.

The other important thing to keep in mind is that progress can be made in ways other then improvements in pain (1).  If we're having improvement in function and pain levels are staying at similar levels, that's also progress (1).  For example, let's look at an athete's training journal while recovering from shoulder pain: 

• Week 1: 5 x 5 Bench Press @225lbs - Pain level 3/10
• Week 2: 5 x 5 Bench Press @245lbs - Pain level 3/10
• Week 3: 5 x 5 Bench Press @265lbs - Pain level 3/10
• Week 4: 5 x 5 Bench Press @285lbs - Pain level 3/10

In this case pain levels stay at a 3/10 over the 4 weeks of training.  For some this would feel like no progress.  However, the weights go up by 20lbs every week.  This is great progress and I bet at week 4 in this example our athlete could probably bench press 225lbs with less pain then on week 1.  So if pain levels are staying similar but we're seeing improvements in:

• Weights lifted in the gym 
• Difficulty of exercise variation (i.e. Barbell overhead press over dumbbell incline press)
• Exercise volume (total sets, reps, frequency of training)  

then you're moving in the right direction...

Now, my general guidelines for athletes trying to rehabilitate a given injury is to modify training in the gym AS LITTLE AS NEEDED.  Basically, if your training program is well thought out for your goals and individual needs then any deviation from that path is a step away from the direction you're trying to move.  We want to keep training as similar as possible.  

So if a few small modifications of our lifts will keep us in these pain parameters and have us improving every week and month then great.  Over the course of time as things start improving we can slowly progress back to previously painful movements like bench press, overhead press and olympic lifts.

How Long Will It Take for My Shoulder to Recover?

Keep in mind that this is a slow process.  We do have some research to guide us with expectations for recovery as well.  In our literature on rotator cuff issues and subacromial impingement (the most common forms of shoulder pain) most exercise programs last 8-12 weeks (28).  In the majority of studies, exercise is helpful for reducing pain and improving function. (28)  However, it's not like at the end of the exercise program people are back to 100%.  They still have pain and disability but they've made improvement.  For many people an absolute elimination in pain is not a reasonable goal.

According to rotator cuff researcher and shoulder expert Chris Littlewood some patients won't expect to make much progress until they're over the 4 month mark. (29) I have personally had my own shoulder pain issues that haven't completely resolved for 6-9 months and have seen some of my athletes take over a year to get fully back to their training.  It's a long slow and frustrating process but keep in mind that if you aren't seeing fast progress right away it doesn't mean you're not on the right path.  

So, now that you've got the educational component down, you've been modifying your lifestyle and exercises in the gym, now we need to get to the strengthening part.  Remember, exercise is the medicine to heal your shoulder.  Also recall that dosage is important and strengthening should be progressive in nature.  It also needs to train the specific muscles that are used in your typical training program.  This means a lot of strengthening for the shoulder and all of the muscles around it.  

Here are some of my favorite strengthening exercises I like to use commonly with my shoulder pain athletes:

What Are the Best Rehab Strengthening Exercises For My Shoulder Pain?

For the Rotator Cuff and Scapular Stabilizer Muscles:

For the Pecs, Delts and Triceps:

For the Lats, Biceps and Posterior Delts:

Also keep in mind that your exercise program needs to slowly progress back to bench press, overhead press and olympic lifts (if those are the lifts you want to get back to) over time.  That means slowly introducing these movements as the shoulder tolerates them. Keep in mind the modification ladders discussed earlier in the article. One easy strategy for returning to these lifts is to start with the easiest variations on the ladder and progress up the ladder every 2-4 weeks as the shoulder tolerates each movement.

So now that we went over these principles to help get you out of pain, how does the program end up looking?  Let's put it all together.

How to Get Back to Bench Press, Overhead Press and Olympic Lifts After Shoulder Pain Program

I wanted to give you an outline of a typical program to get you out of pain and back to training.  Now, this isn't going to be exactly the same as for you or anyone else's needs.  It's always best to be evaluated by a licensed professional and have a program developed specifically for you.  However, I wanted to give you an idea of what a program looks like after going through all of the principles outlined prior in the guide. Here's what it might look like:

Phase 1 - Unloading

Week 0-4: Train 3 days / week

• Eliminate aggravating exercises - Heavy loaded bench press, overhead press, jerks and snatches
• Modify bench press, pull-ups, overhead press, jerks and snatches to continue training while allowing the shoulder to calm down (Use modification ladders to find appropriate modifications) eg:
  • Bench Press --> Dumbbell Floor Press
  • Overhead Press --> Landmine Press
  • Jerks --> Landmine Push Press
  • Snatches --> Cleans
• Begin shoulder strengthening program - 3x per week
• Begin mobility program to address limitations - 5x per week
• Progress to the next phase when mostly pain free with daily activities (~2-4 weeks)

Phase 2: Intermediate

Week 4-8: Train 3 days / week

• Advance bench press, overhead press and olympic lift challenge for the shoulder
  • Dumbbell Floor Press --> Close Grip Bench Press
  • Landmine Press --> Dumbbell Single Arm Overhead Press
  • Landmine Push Press --> Landmine Jerk
  • Cleans --> Power Snatch
• Advance shoulder strengthening program - 3x per week
• Continue Mobility Program - 5x per week
• Progress to the next phase when ready to tolerate more challenging exercise variations (~2-4 weeks)

Phase 3: Advanced

Week 8-12: Train 3 days / week

• Advance bench press, overhead press and olympic lift challenge for the shoulder
  • Close Grip Bench Press --> Normal Grip Bench Press (2 second lower)
  • Dumbbell Single Arm Overhead Press --> Barbell Overhead Press (2 second lower)
  • Landmine Jerk --> Barbell Push Press / Jerk (2 second lower)
  • Power Snatch --> Squat Snatch (pause bottom position)
• Advance shoulder strengthening program - 3x per week
• Continue Mobility Program - 5x per week

Phase 4: Return to Training

Week 12+: Train 3 days / week

• Continue building back to your normal training program

So that's it!  What a long article huh? Who would have thought there was so much to write about with the shoulder huh? Anyway, I hope this article was helpful in showing you how to get out of pain and back to training your favorite lifts.

If you want a little more guidance on how to get out of shoulder pain I have a completely done for you training program to help you get out of pain and back to training. It's called "The FPF Shoulder Program" 

I've taken the guesswork out of finding the right amount of sets and reps and which exercises to use and which to avoid. It's all 100% outlined. Consider it your roadmap to get out of pain and back to training. 

The FPF Shoulder Program

Click HERE to Learn More and Get Started

Here's to Shoulder Pain Eradication,

Dan Pope DPT, OCS, CSCS, CF L1

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