Disclaimer: I am [was] a certified personal trainer, have been lifting on and off for more than 20 years, and consider exercise physiology and nutrition my favorite hobbies. I am not a doctor or a physical therapist. Take this advice at your own risk. Shoulder injuries are NOT to be taken lightly.
What qualifies me to provide any advice at all?
I’ve sustained several shoulder injuries since the age of 16. Some were the result of physical contact in sport, others were sustained during weight training. The most serious injury was to my right shoulder when I separated it while sparring in Brazilian Jiu Jitsu eight years ago. It was a grade II separation, with a noticeable displacement of my right clavicle that persists today (and forever). It took six months to get back into the weight room. Over the course of recovering from each injury, I learned new things about the types of work that helped and hurt progress (hint: improving shoulder stability is key). I’m currently working around a mild AC joint sprain in my left shoulder.
A quick shoulder anatomy primer
A common misconception exists that the shoulder is a ball-and-socket joint like the hip, but it’s far from it. In the hip, the socket that the femur sits in is much deeper than the socket in which the humerus sits, which is really more like a golf tee. So the shoulder is less a joint than it is a gruesome junction of connective tissue and muscle that works in a complex balancing act to “strap” the humerus, scapula and clavicle together. The trade-off for the tremendous range of motion in the shoulder is the lack of stability relative to other “real” joints like the knee and elbow. There are many types of shoulder injuries–some involve tendons, others involve ligaments, still others involve muscle. An injury can potentially involve a combination of all three.
Lifting with a shoulder injury
My first rule of safe lifting is this: if the lift hurts, stop immediately. It might be on the first rep of the first set, it might be in the third set. Whenever it is, put the weight down and assess. Run-of-the-mill muscle soreness is very different than joint pain or muscle strain. To get a better sense of where the problem lies, I deload the lift and slowly perform the same movement until I feel the pain again. I mentally note where in the plane of motion the pain begins and where it ends. That is the danger zone. I then either: 1) temporarily select lifts that don’t operate in the danger zone, or 2) continue to operate in the danger zone if deloading the offending lift(s), increasing the rep range, and focusing like a laser on maintaining form and tension is an option. I’ll speak specifically to my current injury to explain these two options more completely.
1) Temporarily select lifts that don’t operate in the danger zone
I originally strained my left shoulder several months ago. Overhead motion–both pressing and pulling–in addition to abduction along the frontal plane (raising arms to the side) causes discomfort. Does this sound like you? Even at a lighter weight and higher rep range, the fixed lat pull causes discomfort, so I’m avoiding it altogether until my shoulder tells me it’s ok. But since I still need to hit the lats and rhomboids, I’ve switched to performing other lifts [and more of them] that incorporate low and flat rowing (dumbbell and cable varieties).
2) Continue to operate in the danger zone if deloading the offending lift(s), increasing the rep range, and focusing like a laser on maintaining form and tension is an option
The majority of lifting-induced shoulder injury (as opposed to impact-related) is the result of a weakness in one or more of the many small muscles that stabilize the shoulder through its range of motion. They’re not as strong as they should be in relation to the big prime movers involved in the exercise. The prime mover engaged in the incline bench press (i.e. the target of the exercise) is the clavicular head of the pectoral muscle (a.k.a. the upper pec), while other big muscles and muscle groups, including the triceps, anterior deltoids, lats and traps are also heavily engaged for both movement and stabilization. At the same time, the little stabilizers that keep the shoulder together are also firing away.
But what tends to happen as the weights get heavier and the small stabilizers fatigue is that the large stabilizers begin to take on more of the small stabilizers’ burden, leading to a reduction in overall stability at the joint. A symptom of this is that proper form begins to break down as the lifter starts to “muscle through” the motion, subconsciously trying to shift work off of those small muscles. That shift puts the small stabilizers at risk of strain.
While pressing motions, like the incline bench (bar and dumbbell versions) currently disturb my shoulder at higher loads, at a lighter load they don’t. Accordingly, the lighter load can be used to more specifically train those weaker muscles while still effectively stimulating the prime mover. An important thing to note here is that by lighter load I don’t mean a light weight. I mean something along the lines of 60% of a one-rep max, or, alternatively, around 75% of the weight used for an eight-rep set taken to near failure. But since I also want the same quality of prime mover activation and stimulation as the heavier weight would have provided, I have to do two more [really important] things: increase the rep range and move more slowly. Until my shoulder is healed, my target range is 10-12 reps. Under normal circumstances, you establish your target range first and then set the weight so that failure or near-failure is occurring in that range. But since my shoulder injury is limiting the weight I feel comfortable with, the weight is already established. I also know I don’t want to get above 12 reps. But since I can pretty easily push out more than a dozen reps at this weight at my normal tempo (even with the injury), I have to reduce the tempo and alter the range of motion so that I’m approaching failure in the 10-12 rep range. This means keeping as much tension on the muscle as possible through all phases of the motion while maintaining perfect, totally rigid form by: not locking out at the top of the press, lowering slowly (as long as a three-count), pausing just before the bottom of the motion (not resting or bouncing the bar and the bottom of it), and contracting forcefully on the way back up.
Again, shoulder injuries are nothing to screw with, and will chow down on a big ego in the blink of an eye if you don’t give them complete respect. If your shoulder injury is agreeable to the course of action I describe above, take it slow and easy. You can still hammer your muscles this way. When confident, you can slightly bump up the weight while continuing to maintain perfect form. But remember, if you experience pain at any time, you have to stop. It’s not worth prolonging the healing process. Of course, the best idea is to go see a doctor if you don’t notice improvement over time.