Pain In The Front Of The Shoulder With Bench Press
Are you tired of the constant nagging pain in the front of your shoulder during a bench press? Whether you’re an everyday gym goer or an elite powerlifter, frontal shoulder pain 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. 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 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.
Flexion/Extension (forward and backwards)
Abduction/Adduction (away/towards body)
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 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 stability, support, and ensures coordinated movement patterns through five planes of motion which are extremely vital for overhead, pulling, and pushing movements.
Upward/Downward rotation
Anterior/Posterior tilt
External/Internal rotation
Elevation/Depression
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 stabilising the shoulder joint.
Supraspinatus (Abduction)
Infraspinatus (External rotation + Adduction)
Teres Minor (External rotation + Adduction)
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 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 stabilisers 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 scapular (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.
Trapezius (Upper/Middle/Lower fibres)
Rhomboids
Levator Scapulae
Serratus Anterior
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 scapular. 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 scapular, 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 scapular. Its main responsibilities are to protract (reach arm forward) and upwardly rotate (arm overhead) the scapular.
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.
Pectoralis major
Deltoid
Teres Major
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 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 arm forward), abducting (lifting 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?
Muscle Imbalances and altered shoulder mechanics
Poor control between the scapula and thoracic spine
Weakness and lack of activation of the muscles around the scapula
Poor control of the glenohumeral joint
Weakness and lack of activation of the muscles around the glenohumeral joint
Poor control of the rotator cuff muscles
Limited Shoulder, neck, or mid back mobility
Reduced backward bending, rotation, or side bending of the mid back
Reduced forward bending, backward bending, rotation, or side bending of the neck
Reduced shoulder flexion/extension, abduction/adduction, or rotation
Improper bench press technique
Flaring of the elbows
Internally rotated shoulders (rounded shoulders)
Lack of engagement of the lat muscles (powerhouse muscles during the bench press!)
Lack of core stiffness and stability when setting up for the movement
Lack of leg drive and power from the lower body
Prior injuries to the neck, shoulder, or elbow
Previous dislocations, strains/sprains, ligament instability, cartilage damage
Inflammatory conditions (can irritate the shoulder during repetitive pressing movements)
Nerve compression or irritation (e.g. thoracic outlet syndrome, cervical disc herniation)
Training structure
Too much training volume with ‘pushing movements’ (need a balance between push and pull movements)
Going too heavy too often!
Not enough variation in training (focus on controlled reps, higher reps, lighter loads etc)
Neglecting accessories exercises (this can create muscular imbalances)
A Common Misdiagnosis - It’s Not Biceps Tendonitis
Many of the lifting population with frontal shoulder pain have been told they have “biceps tendonitis,” and given injections or told to rest. This is because when asked to “point where it hurts,” many point directly over the biceps tendon.
However, this presentation is usually a sign of a trigger point referral from the infraspinatus muscle, and not actually the area of the underlying problem. Compare this to leg pain felt in lower back disc injuries, it can be felt distant upto one metre from the actual site.
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 muscle and assists in stabilising the shoulder joint.
The infraspinatus trigger commonly refers to the middle of the shoulder blades, as well as the front of the shoulder where the bicep tendon is located. It is an important area to assess and rule out as it may be a potential contributing factor especially during bench press.
Trigger Point Refferal
Firstly we can test for the infraspinatus trigger point by finding the top of the shoulder blade, then moving slightly down from it and applying pressure. If any tenderness is felt when pressure is applied, or you experience the same frontal shoulder pain that is felt during bench press, this could be a contributing cause.
How Do We Muscle Test The Infraspinatus?
We can then test the infraspinatus multiple ways to assess its strength when load is applied.
Test 1
Step 1: Elbows tucked by sides elbows bent to 90°
Step 2: Clinician applies inward pressure from outside of the hands. Patient must try resist this inward pressure
Outcome: Discomfort around the shoulder region or a lack of strength can indicate a possible tendon, muscle strain, or tear of the infraspinatus muscle
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 movement. Reducing muscle spasm and tightness can allow the shoulder joint and neck to move a lot better, 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 give these soft tissue stretches and self releases a go!
Pec Stretch https://youtube.com/shorts/Dp3gWmXhDk4?feature=share
Pec Minor soft tissue release https://youtube.com/shorts/3alEcBmgzgM?feature=share
Rotator cuff soft tissue release https://youtube.com/shorts/qttRn5oMlrI?feature=share
Banded lat stretch https://youtube.com/shorts/A9H-6sfjxbI?feature=share
Pre-activation warm-up exercises
It is important we utilise specific warm-up exercises that target the shoulder stabilisers and force producing muscles prior to our bench pressing session. Give these exercises a try prior to your next bench pressing session!
LOCK BIG 3 https://youtube.com/shorts/XQ8RMAgyWRE?feature=share
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
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.
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
Begin by looping a resistance band around a supportive structure that is half a metre above your head.
Grip the band with one hand and step back so there is a reasonable amount of tension on the band.
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!
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
Position a light resistance band around both wrists.
Lay down on a bench press with a kettlebell in one hand, gripping it from the handle so the kettlebell is positioned upside down.
Position your elbows just like you would for a normal bench press, this will create tension on the band that you need to resist!
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!
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
Set yourself up on the ground with a foam roller placed under the mid back.
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. Give these exercises a try to improve stability during bench press!
Isometric Internal rotation https://youtube.com/shorts/BvwmMgl0sy8?feature=share
Standing near a wall with your elbow tucked by your side and elbow at 90°
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.
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
Laying on your side with a towel or a small yoga block between your torso and elbow.
Keep your elbow tucked in towards your side, with your forearm at 90° (similar to the previous exercise.
Hold a light dumbbell in you hand, anywhere from 1-3 kg to begin with. While keeping your elbow tucked in against the yogo block or towel, rotate your shoulder outward in a controlled motion, then return back to the starting position.
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.
Banded 45° external rotation https://youtube.com/shorts/XfEqzcd9f7Q?feature=share
Tie a light resistance band onto a supportive structure just above waist height.
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.
While maintaining the elbow in that position, rotate the shoulder outward against the tension of the band. Then return back to the starting position.
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
Begin by kneeling on the ground with one knee out in front, keeping your torso tall and straight.
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.
Grab the kettlebell and hold it steady so it is upside down. It should be positioned on the opposite side as your front leg.
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.
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 offer 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 stabilise 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 who will be able to assess your injury and provide a treatment plan suited to your needs!