More on Shoulder Training and Straining

I continue to encounter patients and people attending lectures asking me about their shoulder pain associated with training. They have pain in their rear shoulder, usually citing the bench press as the cause. The problem is, once that kind of shoulder pain has developed, it often strikes during chest and/or shoulder exercises too.

When patients point to their rear shoulder, they usually ask, “Why does it hurt? What’s wrong with my shoulder?” There are several possible causes of shoulder pain in that location. One is a tear of the cartilage ring around the shoulder socket. The rings called the labrum, and the most common tear from athletic movements is called a SLAP tear, which stands for superior (upper) labrum (cartilage ring) anterior (front) posterior (rear). Simply put, the ring is torn at the top in the front and/or back.

A SLAP tear can cause clicking and popping with or without pain, a deep ache in the shoulder and pain when you’re performing bench presses, flyes, incline presses or cable crossovers. A bench press or pushup-type movement causes the ball to move forward in the socket. That stresses the tear of the labrum and causes pain. Most patients can rehab their shoulder to a satisfactory degree by strengthening the rotator cuff muscles. A small percentage of people with SLAP tears who don’t improve may have to have the labrum arthroscopically tacked down.

Another cause of pain in the back of the shoulder is the fatigue and inflammation of the rotator cuff, a set of four small muscles that hold the ball securely in the socket. If the rotator cuff muscles are weak, injured, strained or fatigued, they secure the ball in the socket. The pain from a rotator cuff injury can be in the front, side or rear of the shoulder. If the patient also has a SLAP tear, he or she may feel worse if the rotator cuff is weak or injured because the ball will move more in the socket.

Some cases of rear shoulder pain are caused by impingement in the shoulder. It’s called subacromial impingement, which means that the impingement, or entrapment, occurs under the roof of the shoulder and the structures that are impinged include the rotator cuff, biceps brachii and a fluid-filled sack called the subacromial bursa. Those structures are impinged by exercises I have addressed many times—upright rows, laterals done with the fronts of the dumbbells turned down, front raises that go all the way up. A bony attachment near the ball bumps into the roof and impinges the tendons during those exercises.

You should not assume you know which problem you have. If the rear shoulder pain continues, preventing you from training the way you want, you should see a board-certified sportsmedicine chiropractor or board-certified sportsmedicine orthopedic surgeon for an evaluation. Try the various rotator cuff exercises with light weights. Don’t use bands to strengthen the shoulder.

Editor’s note: Visit www.SoftTissueCenter.com for reprints of Horrigan’s past Sportsmedicine columns that have appeared in IRON MAN. You can order the books, Strength, Conditioning and Injury Prevention for Hockey by Joseph Horrigan, D.C., and E.J. “Doc” Kreis, D.A., and the 7-Minute Rotator Cuff Solution by Horrigan and Jerry Robinson from Home Gym Warehouse, (800) 447-0008, or at www.Home-Gym.com.