So about a decade or so ago I used to do a lot of bench press, just like every other jack bag in the gym. Sure, I could push more than my body weight for a few reps while my legs flailed around, looking like an epileptic spider monkey trying to eat an apple, but eventually I developed a partial thickness rotator cuff tear (SHOCKING!! Bad technique lead to an injury!!) and had to give up the bench because of the pain and lack of being-able-to-brush-my-own-teeth-ness that followed. Every time I tried to go back to it, I wound up feeling some sort of pain in the shoulder whenever I got even a single 45 a
side on the bar and did a few reps, which makes life suck more than having a relative ask me about work.

Hi auntie. How are you doing today? How’s your shoulder feeling?

When are you going to get a real job, Dean, and quit wasting time on this training thing?

Thanks for keeping it real, auntie.

This was a vicious cycle of injuries, beginning with low back pain and occasional anterior knee pain, then into shoulder pain. I went to about three dozen physios, chiros, massage therapists and reggae voodoo priestess’ to try to figure out the problem. Some knew what they were doing and offered some semblance of assistance and some were completely out to left field, prescribing everything from long walks to colonics to getting my chakras aligned, which left me to my own devices to try to figure out how to get jacked and dieseled out like I wanted.

Along the way I came up with a few interesting tidbits that I tried out with my clients, got some good results, some bad, went back to the drawing board, and then figured out what the hell was happening. So as a result, I’ll share the big 5 points to getting your bench up when you have shoulder pain.

#1. Stop doing rotator cuff specific work

#2. Change your grip on bench press a thousand different
times, then change it again

#3. Dumbell press on an angle, not on an incline

#4. T-spine and scapular mechanic work MUST prevail above all else

#5. For the love of God STOP BENCHING WITH YOUR FEET IN THE AIR!!

Now that you’re all probably sufficiently pissed off or curious or possibly a little hungry because it’s close to breakfast time, I’m going to tell you why each point is so important.

#1. Stop Doing Rotator Cuff Work

While the rotator cuff function is undoubtedly one of providing stability to the glenohumeral joint and allowing it to have a pivot rotation versus a gliding within the capsule, it doesn’t need a lot of direct work when training for the bench press, even if the problem is a rotator cuff tear. That’s sort of like how physios were telling me to strengthen the VMO in my quads when I had anterior knee pain. First it didn’t do anything, and second it didn’t address the adductors or IT band, which have a lot more to do with the anterior knee pain than the VMO, as I outlined HERE.

The rotator cuff is rarely the issue when it comes to rotator cuff injuries. Most often it comes down to a lack of thoracic mobility, scapular mobility, poor bar placement, elbows doubling as wings flapping in the breeze on the press, and a lack of balanced strength between pulling and pushing movements. If you’re rocking some wicked thoracic kyphosis, doing set after set of tubing external rotations won’t make you any more beast mode with a bar crushing your sternum, champ.

In light of performing set after mindless set of fatiguing external rotation work prior to getting under a bar where the stabilizers are fried from the warmup, I would opt in more for some low trap and serratus strengthening exercises that can help improve thoracic range of motion, scapular motion, and actually help stabilize the entire complex for the lift. That being said, if you want to do some rotator cuff specific work, opt for more stabilizing movements, like Jeff Cubos demonstrating a bottoms up kettlebell screwdriver here:

Unless you have some severe weakness in your rotator cuff, like you’re unable to complete a set of 10 reps with a 5 pound resistance in a side-lying external rotation, you don’t need a lot more strengthening work if there are some other big issues around the corner causing all the dysfunction.

My big issue was the fact that at the time I was a starving student living on Kraft dinner and saving the cheese for my sandwich in the mornng, so spending countless hours hunched over a desk or sitting in boring lectures listening to people with all the personality of a wet fart talk about stuff left me somewhat kyphotic. The kyphosis altered my scapular mobility, which lead to a holy whuppin being laid on my rotator cuff whenever I went to bench. It took me a few years to figure out how to correct this on my own without causing my own low back issues to flare up. Performing rotator cuff exercises did absolutely nothing as that wasn’t the problem.

#2: Change Your Grip a Thousand Times

As I’ve stated previously, the vast majority of overuse injuries are as a result of pattern burnout, and the easiest way to avoid pattern burnout is to change your grip, set-up, direction of loading, etc, etc etc to make the exercise something novel to the muscles and neural patterns involved. For the bench, this could include using narrow, wide, moderate-width, and even snatch grip width on occasion, as well as placing your thumbs on the same side of the bar as your other 4 (presumably that’s what you have) fingers, commonly called a suicide grip, and even venturing into reverse grip.

This should not, however, be confused with Will Ferrell’s discussion of Western Grip in his parody of George W. Bush during his broadway play.

 

If you don’t know what I’m talking about, Google that and be prepared to laugh your ass off.

By using a varied grip, you alter the neural engramming of the movement and cause different muscles and different muscle fibers within the muscles being used to fire differently than usual, which can decrease the chance of pattern burnout by using a different pattern. Some research has shown that neural adaptation can occur in as little as 6 bouts of a pattern, so considering the fact that some workouts will involve anywhere from 3-6 sets of bench, it could be said that each set is a bout of the pattern, meaning grip should be altered, even slightly, at least every second workout.

#3: Dumbell Press on an Angle, Not on an Incline

I’m all for people pressing on inclines if they want to, and there is some benefit to it. One thing that occurs when people press on an incline is they continue to hold the weights with a grip pattern and bar position that worked when they were on a flat surface, even though their scapular positioning has altered. As the positioning of the bar moves from horizontal to vertical, the positioning of the elbows and hands should move from more of a pronated position where the palms face towards the feet, to more of a supinated position where they get to say Hi to each other. This helps to reduce the compression under the acromion, but also encourages a lot more thoracic mobility and improves scapular mechanics.

To take it a step further, if someone has some issue with their shoulder during pressing, alter their plane of action and shoulder position while on a flat bench by supinating the grip slightly.

Yeah Seal, you SING about that shit!! God I hate our music.

The main reason to put the arm into more of a neutral grip like this is one based on research, because that’s what all the cool kids look to these days. Reinhold et al showed that by performing side-lying rotations with the elbow close to the body you could get a lot more activation out of the teres minor and infraspinatus, and less activty as the arm moves away from the body with an increasing amount of deltoid and supraspinatus. Does this mean you can get maximal stabilization due to this up-regulation of the rotator cuff by putting the arm into a position where the rotator cuff can work best, which means less irritation and a strengthening benefit to the affected area? My thought is yes, even if it is just due to a correlation to a similar activation when in side-lying, so by keeping the elbows closer to the body, you can increase stability of the movement and reduce the chances of creating subacromial impingement. Double-whammy, baybayyyy!

While you’re at it, throw in some pushup variations with handles to work on core stability as well as scapular mechanics and pressing strength.

#4: T-Spine and Scapular Mechanic Work MUST Prevail Above All Else

You’d probably be surprised to see how many people come in to see me with shoulder pain and who have almost no T-spine mobility through either extension or rotation, and if they have rotation it’s probably lop-sided with a lot on one side and none on the other. Then again, you may not be surprised, but whatever. As a result of this, most sessions begin with a warmup of thoracic extension and some rotational work.

From there we work on getting some movement of the arm into an overhead positions without loading in order to loosen up the lower traps and rhomboids to allow the scapula to rotate efficiently. It should be noted that in order to get the arms overhead you need a good amount of T-spine extension mobility, so that’s why I work on the mobility first.

Once that’s done, I have them work on pulling mechanics, and then finally pushing work with less than maximal loads. Ideally for the initial phase of training I want them to work in a 3:1 ratio of pulling to pushing, and then in the second phase once there is no pain, I will change it up to beginning with pushing movements and finishing with pulling, this time in a 2:1 ratio of pulling to pushing. Each workout still starts with T-spine and scapular mechanic work unless they have spectacular movement capacity from these directions.

#5: For the love of God, STOP BENCHING WITH YOUR FEET IN THE AIR!!!

There’s about a dozen reasons not to do this. First, you reduce stability, which reduces the amount of weight you can successfully move. Second, due to the lack of stability in your feet and hips, your upper body and rotator cuff have to work harder, and if you’re in pain we already know that area is weak, so stop it. Third, raising your feet rotates your pelvis into a posterior tilt, which puts more pressure on the low back and reduces the ability to utilize a pre-stretch through the anterior fascial line to increase stability through the abdomen and rib cage, which again reduces stability. Fourth, you look like a tool and no member of the opposite sex will want to see you naked in the near future if you continue to do things like this, so put your feet on the ground. No matter how “functional” you think reducing your base of support may be, stuff like this is only functional at making the wall by my computer have a hole in it from me ramming my head through it..

This is in no ways an exhaustive list of things to help bench big with a shoulder owie, but it’s the five biggest things I’ve found with my own shoulder and the shoulders of a lot of my clients looking to gain some strength and reduce their overall pain. But what have you found effective? Leave me a comment below if you’ve ever had an injury like this you had to train around and even managed to fix and share with the world what you were able to do!