Pain In The Front Of The Shoulder With Bench Press

Are you tired of the constant nagging shoulder pain during bench press? Whether you’re an everyday gym goer or an elite powerlifter, frontal shoulder discomfort can become extremely frustrating and cause a cascade of setbacks in training.

This is a common presentation that we often have people present with; however, a lot of the time they have been misdiagnosed with “biceps tendinitis.” This is because for most people, the pain is usually located directly over the biceps tendon at the front of the shoulder socket. However, pain is a symptom and not usually the cause or source of the underlying dysfunction.

In this article, we will cover important shoulder anatomy, causes of shoulder impingement and frontal shoulder pain during bench presses, how to fix it, and common mistakes when performing the bench press.

Shoulder Planes Of Movement

Firstly, it is important to understand the basic movements that the glenohumeral joint (shoulder) and scapula (shoulder blade) have on shoulder function and movement to be able to understand how a shoulder injury may occur in the region and what to do to resolve your pain.

Glenohumeral Planes of Movement (Upper Arm Bone)

The shoulder joint is a ball-and-socket joint that meets the glenoid fossa of the scapula and the thoracic cavity to form the scapulothoracic junction. It provides the most extensive range of motion in the human body. However, its downfall is that it can become injured very easily when placed in vulnerable positions. Below is a list of the movements that the glenohumeral joint performs:

1. Flexion/Extension (forward and backwards)

2. Abduction/Adduction (away/towards body)

3. Internal/External rotation (inward/outward rotation)

Scapular Planes of Movement (Shoulder blade)

The scapula plays an important role because it provides the socket for the humerus (upper arm) to articulate with. It also provides an attachment site for various shoulder muscles of the shoulder and mid-back, as well as connecting with the coracoclavicular and acromioclavicular joint to form the rest of the shoulder complex. It is very important as it provides shoulder stability, support, and ensures coordinated movement patterns through five planes of motion, which are extremely vital for overhead, pulling, and pushing movements.

1. Upward/Downward rotation

2. Anterior/Posterior tilt 

3. External/Internal rotation 

4. Elevation/Depression 

5. Retraction/Protraction 
   

Muscles Of The Shoulder

The Rotator Cuff (Glenohumeral joint stabilisers)

The rotator cuff consists of four muscles that play a crucial role in stabilizing the shoulder joint.

1. Supraspinatus (Abduction)

2. Infraspinatus (External rotation + Adduction)

3. Teres Minor (External rotation + Adduction)

4. Subscapularis (Internal rotation)
   

Supraspinatus: It is located at the top of the shoulder blade and is responsible for abduction (lifting the arm out to the side). It is the strongest of the four rotator cuff muscles and is the most commonly injured. It helps keep the humeral head within the glenoid fossa as the arm moves through abduction.

Infraspinatus: It is positioned on the back of the shoulder blade and its primary movement is external rotation (outward rotation) of the arm. It is also responsible for adduction (bringing the arm into the side) of the arm, which is important when positioning yourself during the bench press.

Teres Minor: It is positioned on the back of the shoulder blade beneath the infraspinatus, also contributes to external rotation and adduction of the arm.

Subscapularis: It is located on the front of the shoulder blade and is primarily responsible for internal rotation (inward rotation) of the arm.

These four muscles are crucial for coordinating smooth movement and maintaining stability of the glenohumeral joint. As the arms move away from the body, the demand for these stabilizers to work harder increases, preventing excess motion within the joint. It is important that these muscles are doing their job properly, to avoid placing unnecessary stress on the passive structures within the shoulder joint (ligaments, tendons, bone, labrum).

Scapular Stabilisers 

There are a bunch of muscles that attach to the scapula (shoulder blade) and are responsible for providing a stable base and foundation, which allows the arm to move from. These muscles play an important role in maintaining scapula positioning and allowing the arm to move to and from the body, as well as overhead, ensuring shoulder stability.

1. Trapezius (Upper/Middle/Lower fibres)

2. Rhomboids 

3. Levator Scapulae 

4. Serratus Anterior 

5. Pectoralis Minor
   

Trapezius: It is a large muscle that spans across the upper back, shoulder joint, and towards the base of the skull. It has three different fibres (upper, middle, lower) that are responsible for elevation, retraction, depression, and upward rotation of the scapula. These are important when shrugging or lowering the shoulders, as well as pulling them back together.

Rhomboids: The rhomboid muscles are made up of a major and minor component. They are located around the mid-back area between the two shoulder blades. Their main role is to retract (bring shoulder blades together) the scapula, but they also play a role in elevating the scapula.

Levator Scapulae: This muscle spans across the top of the neck down towards the inner portion of the scapula. Its primary role is to elevate the scapula, but it also helps rotate it downwards.

Serratus Anterior: It is located along the outer part of the chest wall and spans across multiple ribs, attaching to the front part of the scapula. Its main responsibilities are to protract (reach arm forward) and upwardly rotate (arm overhead) the scapula, which is essential for shoulder mobility.

Pectoralis Minor: This muscle is situated underneath the main chest muscle (Pectoralis major) and its main role is to depress and protract the scapula.

Glenohumeral Positioners 

It is important to cover the role of particular muscles that attach to the arm bone itself. These muscles also help provide a strong position for the glenohumeral joint (arm joint at the top of the shoulder) but primarily are involved in force production.

1. Pectoralis Major

2. Deltoid

3. Teres Major

4. Latissimus Dorsi

Pectoralis Major: This muscle is the larger of the pec muscles on the front of the chest. This muscle attaches to the arm bone, clavicle, and sternum (breastbone) and is responsible for flexing the shoulder, adduction (bringing the arm towards the body), and internally rotating the arm (inward rotation).

Deltoid: The deltoid muscle covers the shoulder joint and has multiple fibres that make up the muscle, each providing a different movement. It produces force by flexing the shoulder (bringing the arm forward), abducting (lifting the arm sideways), and extending the shoulder (bringing the arm backwards).

Latissimus Dorsi: The lat is a thick and broad muscle that attaches from the upper arm and spans across the majority of the back, attaching at the pelvis. It is an extremely important muscle in providing force during any pulling or pushing movements. Its role is to extend the arm, adduct, and internally rotate it (The missing link to a strong bench press!).

Teres Major: This muscle sits on the back of the shoulder and is commonly referred to as “The Lats’ little helper.” This is because it assists the lats in providing extension of the arm, adduction, and internal rotation.

So, now that we understand the anatomy….

What Are Some Potential Causes Of Frontal Shoulder Pain During Bench Press?

1. Muscle Imbalances and altered shoulder mechanics 

   Shoulder mobility is vital for a proper range of motion during bench presses. Restrictions in mobility in the shoulder socket, neck, or mid-back can cause pain or discomfort during pressing movements.

   • Reduced Backward Bending, Rotation, or Side Bending of the Mid Back
     Reduced flexibility or mobility in the thoracic spine can affect your posture and the overall stability of the shoulder, increasing the likelihood of shoulder pain bench during the press.

   • Reduced Forward Bending, Backward Bending, Rotation, or Side Bending of the Neck
     A lack of neck mobility can affect overall posture and lead to compensatory movements, causing strain on the shoulder joints, especially during pressing exercises.

   • Reduced Shoulder Flexion/Extension, Abduction/Adduction, or Rotation
     Limited shoulder mobility can restrict the necessary range of motion during bench presses, placing undue stress on the shoulder joint and increasing the risk of shoulder impingement.

2. Limited Shoulder, neck, or mid back mobility 

   Shoulder mobility is vital for a proper range of motion during bench presses. Restrictions in mobility in the shoulder socket, neck, or mid-back can cause pain or discomfort during pressing movements.

   • Reduced Backward Bending, Rotation, or Side Bending of the Mid Back
     Reduced flexibility or mobility in the thoracic spine can affect your posture and the overall stability of the shoulder, increasing the likelihood of shoulder pain bench during the press.

   • Reduced Forward Bending, Backward Bending, Rotation, or Side Bending of the Neck
     A lack of neck mobility can affect overall posture and lead to compensatory movements, causing strain on the shoulder joints, especially during pressing exercises.

   • Reduced Shoulder Flexion/Extension, Abduction/Adduction, or Rotation
     Limited shoulder mobility can restrict the necessary range of motion during bench presses, placing undue stress on the shoulder joint and increasing the risk of shoulder impingement.

3. Improper bench press technique

   A common cause of shoulder discomfort is poor bench press technique, such as flaring the elbows too much or using too much weight without proper form.

   • Flaring of the Elbows
     This improper form during the bench press places extra strain on the shoulders, especially the rotator cuff muscles and the front of the shoulder socket.

   • Internally Rotated Shoulders (Rounded Shoulders)
     Shoulder instability caused by rounded shoulders can place added stress on the front of the shoulder during pressing motions, leading to pain or injury.

   • Lack of Engagement of the Lat Muscles
     The lat muscles act as a stabilizing powerhouse during the bench press. Neglecting to engage them can compromise shoulder mechanics and cause pain.

   • Lack of Core Stiffness and Stability When Setting Up for the Movement
     Core engagement is crucial for proper posture and shoulder alignment during the bench press. A lack of core stiffness can lead to inefficient movement patterns and shoulder discomfort.

   • Lack of Leg Drive and Power from the Lower Body
     Bench pressing requires full-body engagement. Poor leg drive can lead to poor technique, which places excess strain on the shoulders, increasing the risk of injury.

4. Prior injuries to the neck, shoulder, or elbow

   Previous shoulder injuries or neck issues can impact shoulder mechanics and increase the likelihood of pain during bench pressing.

   • Previous Dislocations, Strains/Sprains, Ligament Instability, Cartilage Damage
     History of shoulder injuries, such as frozen shoulder or ligament instability, can make the shoulder more vulnerable to pain and further injury during the bench press.

   • Inflammatory Conditions (Can Irritate the Shoulder During Repetitive Pressing Movements)
     Conditions such as tendinitis or bursitis can lead to shoulder pain bench by irritating tissues around the shoulder joint during repetitive pressing motions.

   • Nerve Compression or Irritation (e.g., Thoracic Outlet Syndrome, Cervical Disc Herniation)
     Nerve compression issues can result in pain radiating into the shoulder area, contributing to shoulder discomfort during bench press movements.

5. Training structure  

   • Too much training volume with ‘pushing movements’ can exacerbate shoulder discomfort and lead to overuse injuries.

   • Going too heavy too often can place excessive strain on the shoulder muscles and joints, resulting in injury.

   • Not enough variation in training can limit shoulder mobility and contribute to muscle imbalances.

   • Neglecting accessory exercises that target shoulder stability can create muscular imbalances that affect your bench press performance and cause pain.

A Common Misdiagnosis - It’s Not Biceps Tendonitis

Many in the lifting population experiencing frontal shoulder pain have been misdiagnosed with biceps tendonitis and are often advised to rest or undergo injections. This is because when asked to “point where it hurts,” many point directly over the biceps tendon at the front of the shoulder.

However, this presentation is frequently a result of a trigger point referral from the infraspinatus muscle, not the actual site of the problem. Similar to how leg pain from lower back disc injuries can radiate up to a metre from the actual site of injury, shoulder pain can be referred from other areas, like the rotator cuff or scapular stabilizers.

Infraspinatus Referral Pattern

The infraspinatus muscle runs from the scapula (shoulder blade) and attaches to the humerus (arm bone). It is one of the four muscles that make up the rotator cuff and plays a key role in shoulder stability and shoulder health by stabilising the glenohumeral joint.

The infraspinatus trigger points often refer pain to the middle of the shoulder blades, as well as the front of the shoulder, near the biceps tendon. This referred pain can often be misinterpreted as biceps tendonitis. It's important to assess the shoulder muscles, as trigger points in the infraspinatus can contribute significantly to shoulder discomfort, especially during the bench press.

During pressing movements like the bench press, poor shoulder mobility or imbalances in the rotator cuff muscles can lead to improper movement patterns, exacerbating pain and discomfort. The infraspinatus is a vital muscle to consider when evaluating shoulder pain bench, as its dysfunction can mimic other shoulder pathologies, including those involving the rotator cuff.

Trigger Point Refferal

To test for an infraspinatus trigger point, start by locating the top of the scapula (shoulder blade). Then, move slightly down from it and apply pressure. If any tenderness is felt or you experience the same frontal shoulder pain that occurs during the bench press, this could be a contributing cause of your pain. The infraspinatus is a key stabiliser of the glenohumeral joint, and trigger points in this muscle can refer pain to the front of the shoulder, mimicking issues like biceps tendonitis.

It’s essential to rule out issues with the shoulder muscles when assessing shoulder discomfort. Dysfunction in the rotator cuff, particularly the infraspinatus, can affect shoulder stability and lead to poor shoulder mobility, which exacerbates pain during pushing movements like the bench press.

How Do We Muscle Test The Infraspinatus?

We can test the infraspinatus in multiple ways to assess its strength when load is applied.

Test 1

Step 1: Position elbows tucked by the sides with elbows bent to 90°.

Step 2: The clinician applies inward pressure from the outside of the hands, and the patient must try to resist this inward pressure.

Outcome: If there is discomfort around the shoulder region or a lack of strength, this could indicate a possible rotator cuff injury, muscle strain, or even a tear of the infraspinatus muscle. Weakness or pain during this test can also highlight shoulder instability or poor shoulder mobility, which might be contributing factors to shoulder discomfort during movements like the bench press.

How We Can Fix This?

Manual Therapy 

Firstly, it is important to address the soft tissue structures around the shoulder and neck region to reduce symptoms and improve shoulder mobility. Reducing muscle spasm and tightness can allow the shoulder joint and neck to move more freely, placing the shoulder joint in a much more optimal position during the bench press.

If you cannot access manual therapy techniques to relieve muscle tightness, then try these soft tissue stretches and self-releases to help improve shoulder health. Focus on releasing tight areas in the rotator cuff and scapular stabilisers, as these are crucial for maintaining shoulder stability during pressing movements.

1. Pec Stretch https://youtube.com/shorts/Dp3gWmXhDk4?feature=share

2. Pec Minor soft tissue release https://youtube.com/shorts/3alEcBmgzgM?feature=share

3. Rotator cuff soft tissue release https://youtube.com/shorts/qttRn5oMlrI?feature=share

4. Banded lat stretch https://youtube.com/shorts/A9H-6sfjxbI?feature=share
   

Pre-activation warm-up exercises 

It is important to utilise specific warm-up exercises that target the shoulder stabilisers and force-producing muscles prior to your bench pressing session. These exercises help activate the necessary muscles for shoulder stability and mobility, preparing the shoulder joint for heavy lifting and preventing discomfort. Give these exercises a try before your next bench press session!

LOCK BIG 3 https://youtube.com/shorts/XQ8RMAgyWRE?feature=share

1. Start lying face down with your forehead flat and resting on the ground. Keep your arms straight and locked out, resting by your sides.

   • Position 1: Arms by sides, palms facing up  

   • Position 2: Arms by sides, palms facing down (infraspinatus specific!)

   • Position 3: Arms straight out the the side, palms facing down 

2. While keeping the arms straight, lift them up off the ground until you feel a squeeze through the muscles near your shoulder blades, then gently return them by your sides. 

3. Perform 15-25 repetitions in each position. Complete two full sets in each position before moving on 

Banded Lat Pull https://youtube.com/shorts/teDKB08Js-c?feature=share

1. Begin by looping a resistance band around a supportive structure that is half a metre above your head. 

2. Grip the band with one hand and step back so there is a reasonable amount of tension on the band.

3. To help perform this exercise correctly, think about cueing  “pull elbow to pockets.” As you pull your elbow towards the pocket on the same side, slightly lean towards that pocket to help activate your lat!

4. Perform 2 sets x 6 - 8 reps each side, pausing for 1 second at the bottom of the pull. 

Banded bottoms up kettlebell bench press https://youtube.com/shorts/1jd80E8NUe0?feature=share

1. Position a light resistance band around both wrists. 

2. Lay down on a bench press with a kettlebell in one hand, gripping it from the handle so the kettlebell is positioned upside down.

3. Position your elbows just like you would for a normal bench press, this will create tension on the band that you need to resist!

4. While controlling the Kettlebell steadily, perform a normal bench press with the kettlebell. Keep the wrist neutral and in line with the forearm, making sure the kettlebell does not tumble over!

5. Perform 2 sets x 6-8 reps each side. Make sure you are controlling the kettlebell during the lowering and pressing phase. This is designed to challenge the small stabilising muscles of the shoulder. 

Thoracic Mobility 

It is particularly important that we have enough thoracic extension mobility during the bench press, as this allows us to create that natural arch in the mid-back and keep the shoulders in a stable position. If thoracic mobility is an identified issue for you, then give these exercises a try prior to performing your bench press.

Thoracic extension mobilisation https://youtube.com/shorts/7jUXpBTLWEI?feature=share

1. Set yourself up on the ground with a foam roller placed under the mid back. 

2. Cross your arms (give yourself a hug) and lean back over the foam roller. Perform 2 sets x 10 repetitions of moving through flexion (bending forward) and then into extension (leaning backwards). 
   

Rotator cuff stability 

If you experienced pain or discomfort during testing for infraspinatus, as well as weakness during the movement, then strengthening this muscle will be important. These exercises help to improve rotator cuff stability and promote shoulder health during your bench press.

Isometric Internal rotation https://youtube.com/shorts/BvwmMgl0sy8?feature=share

1. Standing near a wall with your elbow tucked by your side and elbow at 90°

2. Apply firm outward rotation into the wall, keeping your elbow tucked in towards you side. Apply enough pressure that you do not feel any discomfort or sharp pain in the shoulder, rather muscle fatigue. 

3. Maintain this outward pressure for 30 sec. Repeat this 3 times on the affected side. 
   

Side lying dumbbell external rotation https://youtube.com/shorts/tOuNPWHXx9E?feature=share

1. Laying on your side with a towel or a small yoga block between your torso and elbow.

2. Keep your elbow tucked in towards your side, with your forearm at 90° (similar to the previous exercise.

3. Hold a light dumbbell in your hand, anywhere from 1-3 kg to begin with. While keeping your elbow tucked in against the yoga block or towel, rotate your shoulder outward in a controlled motion, then return back to the starting position.

4. Perform 10-12 repetitions on the affected side for 3 complete sets. You should not feel any discomfort in the shoulder, rather muscle fatigue on the back of the shoulder muscles.
   

Banded 45° external rotation https://youtube.com/shorts/XfEqzcd9f7Q?feature=share

1. Tie a light resistance band onto a supportive structure just above waist height. 

2. Grip the band, take a few steps away so there is a small amount of tension on the band. Instead of keeping the elbow tucked into the side, move the elbow away from your torso towards a 45° angle. 

3. While maintaining the elbow in that position, rotate the shoulder outward against the tension of the band. Then return back to the starting position.

4. Perform 10 - 12 repetitions of a slow and controlled motion. Repeat this for 3 complete sets on the affected side. 
   

Bottoms up kettlebell press https://youtube.com/shorts/iIUYDb_1r_s?feature=share

1. Begin by kneeling on the ground with one knee out in front, keeping your torso tall and straight.

2. The knee of the leg that's on the ground should be directly under your hip, and the other leg should be bent at a 90-degree angle in front of you, foot flat on the ground.

3. Grab the kettlebell and hold it steady so it is upside down. It should be positioned on the opposite side as your front leg. 

4. Position your elbow and shoulder on a 45° angle, in a slow controlled movement begging to press overhead. Make sure your wrist is kept in a neutral position and the kettlebell does not bend over your wrist. Slowly control it back down to the starting position. 

5. Perform 6 - 8 controlled repetitions. Complete 3 sets on the affected side. 

Note: Holding the kettlebell upside down is designed to challenge the small stabilising muscles of the shoulder! This movement will naturally feel unstable, hence we use a lighter weight and focus more on control. 

So Now What? Can I Seek Help From A Health Professional?

The team at Elite HP offers a range of manual therapy techniques that are used to help alleviate symptoms and improve motion to get fast and efficient results. We will then combine corrective exercises to strengthen and stabilize the surrounding muscles so your issue does not come back in the future.

If you are struggling with a similar issue, get in contact with one of our team members who will be able to assess your injury and provide a treatment plan suited to your needs!