I thought I’d share my recent shoulder pain experience after a few discussions in the clinic with patients assuming that injuries do not happen in relatively young, relatively fit people, & also challenging the assumption that injuries are always the result of doing something wrong that could have been avoided (I have found this is rarely the case - it is often only in retrospect that the contributing factors can be seen more clearly). 

Take home thoughts:

• You do not need to completely rest when you have an injury 
• A lot of the time, injuries are not caused by “moving wrong” and do not require in depth movement analysis to address (but I would always check how my patients move just to screen for anything really significant that may be relevant)
• Load management is often a big part of the picture with injuries in active people, however it is not always as straight forward as just looking at overall volume. in this case, it was most likely in part a change in how I was doing an exercise that led to the onset of my symptoms - the wider grip on the bench, as that seemed to be the main thing that hurt - however it was decreased exposure to this movement that caused symptoms rather than the movement being inherently wrong
• The human body de-conditions quickly to things it may have been very conditioned to (within weeks) which can be really hard to fully appreciate when it happens to you
• Acute pains HURT, but often can resolve quickly if treated properly 

Back in 2019, when I started bench pressing a lot more often, I developed quite bad shoulder pain on my left side. Because it was so sore, I went looking for reasons it might be hurting. I would record myself training and notice that it moved differently to the other side. It wasn’t good at doing really small, isolated, end of range exercises (like prone Y lifts). I became convinced that this was the reason why it was so sore - that I ‘moved wrong’, my shoulder blade was tilting forward too much, and this is what was causing the problem.  

I ended up consulting my favourite specialist shoulder physio Adam Meakins about it (online) once the problem had gone on for more than a year. He pointed out a few things: 

• The difference in range of movement in my shoulders was probably because of different demands on my skeleton when I was growing up, as I played tennis - not better or worse on one side, just different
• There was generally equal strength in my shoulders, despite one being very sore 
• There was a clear change in loading (adding bench press) which coincided with my symptom onset

He recommended cutting the volume of my pressing movements by at least 50%, and lo and behold, gradually my symptoms abated over another few months. The reason this took SO long is because it was most likely a type of bony stress reaction, where the end of my collarbone was never quite recovering between loading doses. Bones recover very slowly and need more significant rest than I was willing to give (COVID & Gym closures may be the only reason it got better, if I’m honest!). 

This experience highlights something I have found so often in my physio practice - that load management is so commonly a major culprit in new onset pain. It may be relevant that my shoulder moved differently to the other side - possibly why this side became painful instead of the other one (though the right one ended up developing a similar problem at some stage as well), however most of the time, we can’t change things like this, particularly if it relates to the literal shape of our skeletons! 

 As my physio practice and understanding of pain and movement evolved, I started thinking a lot less about these tiny specifics of how I moved, and in the following years, I bench pressed more often and more heavy than ever (4x a week most weeks, as my sport at the time powerlifting involves lots of bench press), with no problems. Having been given the permission and freedom from Adam not to worry about how I moved, I barely thought about my shoulder again. 

This year, after having a month off weight training in January for my sister’s wedding overseas, I returned to the gym, but for training Hyrox instead of powerlifting, meaning I was doing a lot more running, a lot more cardio in general, and a lot less bench pressing - just once a week. 

About 2 months ago, I noticed my shoulder was feeling sore again, in the same place. It started off fairly gradually - I would notice it was a bit sore for a day and wasn’t quite sure what was causing it. It’s pretty normal for something to hurt now and then when training hard (I am nursing a few other niggling long term lower body problems), so I opted to just keep my eye on it and not change anything straight up. 

One day, however, it was particularly painful training, especially doing the bench press. I ignored it, and pushed through, but once I cooled down my shoulder was so painful all day that I found I could barely move it. It continued into the next day. 

Initially, I couldn’t understand why it was so sore. My updated understanding of how things work meant my brain didn’t immediately leap to thinking I ‘moved wrong’, or was ‘lacking strength’ for this issue, but when I thought about my loading profile, I couldn’t understand it from that perspective, either. Objectively, I was doing so much less pressing than ever before! The pain also only re-started months after returning to training, so the month off didn’t feel that relevant, either.

Eventually I realised that at about the time the pain started, I had swapped from training on a commercial gym bench, which is a bit more slippery & meant I had a narrower bench press grip (ring finger on the bars) and was pressing a bit less weight due to feeling unstable, onto a powerlifting bench, where I had a wider grip (index finger on the rings) and could lift a bit more weight (~15% more). I realised that the pain was present with most pressing exercises, but it was pushed into unmanageable territory on the bench press in particular. 

Despite having done this ‘powerlifting style’ bench press at weights heavier than my bodyweight 4x a week for literally years, re-introducing it once a week after ~4 months off that particular variation was enough to give me shoulder pain bad enough I could barely move my arm for a couple of days. There was pain simply from the pressure of my jumper resting against it when I walked.

I am at about week 6 since the worst of the pain, and it seems to be almost completely resolved - some tenderness to touch after heavier upper body sessions and some aching after long walks or runs, and it still hurts to reach behind my back with that side. 

Here’s how I managed it: 

Relative rest, but continued training

• Stopped any heavy weighted pressing until the more severe pain stopped (~ 2 weeks)
• Continued all leg exercises, including things like squats and deadlifts that involve the arm but don’t directly train it
• Continued hyrox training, involving burpees & wall balls; continued to teach my gym classes involving push ups & relatively light barbell push presses - would increase symptoms for a few hours but manageable 
• Avoided sleeping on it 

Gradual re-loading

• Re-introduced weighted upper body exercises that didn’t hurt too badly after 2 weeks such as rows, pulldowns and chin ups
• Continued hyrox training & classes as above
• Re-introduced heavy dumbbell chest presses at week 4 but ensured they were pain free. Weights were about ~20% lighter than my max pre-pain
• Re-introduced barbell bench press at week 6 (trialled at week 4 and 5 but much too painful still), at ~ 80-90% previous load. 
• Have avoided dips all together - priority is feeling good for Hyrox in 2 weeks and there doesn’t seem any point in testing it out on these yet

Technique adjustment 

• When I returned to the bench press I made sure to really drive through my feet and create a big arch through my back to reduce shoulder range (this is a powerlifting technique)- this is what my body has conditioned to over the years & reduces pressure on the shoulder
• No other changes 

It is always interesting to go through the process of having an injury yourself when you are a physio and I think it is always worth sharing these types of experiences, in particular to challenge the narratives out there that training hard is inherently risky, that there are hard and fast right and wrong ways to move, and that you shouldn’t train while injured - of course nuance to all of these things which I hope I have covered well enough in this blog!

Injuries are of course multi-factorial and so there were likely other contributing factors as well that are harder to specifically identify (lifestyle/stress/etc), but I thought I'd talk about this aspect as I find it is often so surprising how such seemingly small changes can have such significant impacts. Figuring out what might be a main contributor to someone's new pain or injury is so important, and is largely why we try to take really detailed histories with our patients at FKB.

Frances