Shoulder pain? How to keep going in the gym
Suffering from shoulder pain? You don't need to stop everything in the gym! Here are some great alternative exercises to keep you going.
Whilst you are recovering from shoulder pain, it's really important to maintain or build your strength, but how can you do this without aggravating your condition?
First up, what exercises are generally well tolerated with shoulder pain?
Upper body horizontal pull: Rows (inverse row, bent over row)
Lower body exercises: lunges, Squat (safety bar, goblet), Farmers carries
Core: e.g. plank variations, pallof press, deadbug, bird dog
Then what about those exercises that need modifying? This list includes:
Overhead press: including handstands, handstand pushups, thrusters
Vertical pulls: pull up/chin up, lat pull down
Let's next discuss how to modify the above exercises for shoulder pain.
1. Push ups
Firstly modifying the push up. Starting with the wall push up, you can gradually make you way down to the floor by progressing to the incline push up. Once on the floor you can progress the load by performing the push up on your knees, and then moving onto the toes.
Once on the toes, there are a number of variations that you can use:
Firstly altering the depth of the push up: start shallow and work up to full depth
Altering your hand width can also vary the load on the shoulder: a narrow hand width will decrease the load on the shoulder, but increase the work in the triceps. As you go wider, the load on the shoulder increases.
Turning your hands in and out will also modify the load on the shoulder.
2. Bench press
Next up the bench press. Firstly try scapula protraction with the elbows locked. Alternate overhand and underhand grips.
You can then progress to:
Partial ROM underhand grip
Partial ROM overhand grip
Full range underhand grip
Full range overhand grip
Other alternatives that can be used with the bench press are changing the grip to wide or narrow, using dumbbells, and also performing a decline bench.
Overhand versus underhand grip?
Traditional overhand grip internally rotates the shoulder more which gets the biceps tendon out of the way of the acromion but does load more the supraspinatus. The underhand grip does the opposite: it can place the biceps tendon more in compression.
Narrow or wide grip?
The normal space between the hands in the bench press is 1.5 times your acromial distance (distance between points of shoulder).
A narrow grip:
decreases anterior & posterior rotator cuff, distal clavicle and biceps tendon load.
reduces shoulder ABDuction and extension needed during the movement
Puts clavicular border of pec major and biceps brachi in advantageous position to assist with shoulder flexion
Although the narrower hand spacing increases horizontal adduction at the shoulder, maintaining shoulder abduction below 45° decreases compressive forces at the distal clavicle
Also changes the touch position on chest to superior to xihpoid process
A Wider grip:
increases shoulder torque 1.5 times greater than the narrow grip and increases the shoulder abduction above 75°
can be better suited for those with posterior shoulder instability
Decline bench versus standard bench:
The decline bench limits the shoulder flexion angle to under 90 degrees
It can also be good for those with anterior inferior shoulder instability
3. Overhead press
Firstly start with front raises. These can be done with either the thumb pointing up or pointing down. Keep this movement below 90 degrees.
Next you can progress to side raises. For this one keep the thumbs facing forwards, and again avoid going beyond 90 degrees.
Once passed through these, you can then progress to isometrics at different angles. To perform the isometrics, either have the spotter arms or J hooks set to the appropriate height. Then with the bar, push up into them for 5 seconds. Repeat this for 10 reps. Once you are able to perform with the arms at 60 degrees, you can then progress to 90 and then 120.
If able to perform isometrics then move onto shoulder press lockout. This is performed by racking the bar near lockout position, taking it out of the rack and then pressing at end range.
Lastly if all going well then you can perform a full range of movement overhead press.
Other variations that can be used for the overhead press are the incline press and landmine press performed in either half kneeling or standing.
Also worthwhile noting that for the overhead press that it’s generally best to avoid behind the neck press unless your sport requires it. Pressing from behind the neck can increase the load on the rotator cuff and neck.
4. Pull ups
With pull ups, generally the hardest position for the shoulder is the bottom position when the arms are fully raised overhead. If you are using kipping pullups, it is suggested that you hold off on these until you can perform a full pull up pain free
Negatives: partial range then full range
Assisted pull ups: partial range then full range
Partial range bodyweight
Scap pull ups: these are best performed with the overhand grip
Full pull ups bodyweight
Underhand (chin up) or overhand (pull up) grip?
Both variations can be used, although most with shoulder pain find when getting into the bottom position, the overhand position is more comfortable.