For many individuals, weightlifting is a crucial component of their training regimen. However, due to its wide range of motion, the shoulder joint is highly susceptible to injury, particularly from repetitive lifting exercises. Shoulder pain from weightlifting can range from mild discomfort to severe, activity-limiting issues, so understanding the causes and treatment strategies for shoulder pain from weights is critical for keeping you in the gym.  

Common Causes of Shoulder Pain from Lifting Weights

Rotator cuff tendonitis

Weightlifting places extreme loads on the rotator cuff muscles and tendons. Over time, repetitive overhead activities can lead to tendonitis, calcification or even partial or full-thickness tears.

Generally, rotator cuff tendonitis causes pain in the front of the shoulder. The pain is more pronounced with specific exercises, such as the incline bench press and military press. As the condition progresses, shoulder weakness and restricted range of motion can occur.

Acromioclavicular joint degeneration

The AC joint connects the shoulder blade (acromion) with the collarbone (clavicle). As we age, the AC joint can undergo degeneration. Heavy gym exercises increase the load on this joint, leading to inflammation and pain.

AC joint pain presents with localised pinpoint pain at the top of the shoulder. Heavy overhead shoulder exercises, such as incline presses and dips, often aggravate AC joint pain.

Distal Clavicular Osteolysis 

Distal clavicular osteolysis, also known as weightlifter’s shoulder, causes pain at the outer edge of the clavicle. It is believed that repetitive high forces on the outer end of the collarbone lead to bone swelling and break, resulting in intense bone pain and swelling. Often, extreme loads from heavy bench presses, dips, and incline bench presses are more aggravating.

Pain from distal clavicular osteolysis is similar to AC joint degeneration. Pain is localised to the top of the shoulder and worsens with heavy chest and shoulder exercises. The pain improves with rest but quickly re-flares when you return to heavy lifting.

Less Common Causes of Shoulder Pain from Weights

Labral tears

The labrum is a ring of cartilage that surrounds the socket joint (shoulder joint). Labral tears can occur from trauma, such as a fall, shoulder dislocation, or repetitive shoulder movements, such as lifting heavy weights. Tears can occur at the top, front, or back of the shoulder joint. Tears at the top of the shoulder are also called ‘SLAP’ tears.

Generally, labral tears produce pain, a clicking sensation, and a catching feeling with shoulder movements. Sometimes, the shoulder can feel loose or slip out of place, causing sudden pain sensations or a sensation of ‘deadness.

Frozen shoulder

Frozen shoulder, also called adhesive capsulitis, is caused by an inflamed joint capsule. It leads to pain and restriction in movement and generally affects people between 40 and 60 years of age. Causes of frozen shoulder include trauma or shoulder pain from other structures, such as rotator tendinitis. However, most cases occur without a trigger or cause.

Shoulder Arthritis

Shoulder osteoarthritis is the degeneration of the cartilage in the shoulder socket joint. Its causes include ageing and previous trauma, dislocations, or fractures.

Typically, patients report a gradual increase in shoulder pain and limitation of motion. Symptoms usually develop more gradually than those of a frozen shoulder. People with shoulder osteoarthritis are typically older than 50, although it can also occur in young individuals. 

Referred pain from the neck

Sometimes, cervical spine disc or joint degeneration can be misdiagnosed as affecting the shoulder. Generally, this pain starts in the neck and can radiate into the shoulder blade (scapula) and the front or back of the shoulder.

Assessment of Shoulder Pain from Weightlifting

young weightlifter doing bench press

Your doctor will ask questions about your shoulder pain related to lifting weights, such as its onset, location, and factors that aggravate and relieve it. A shoulder examination will provide clues as to whether the pain is originating from structures within the shoulder, such as tendons, joints, or cartilage, or from outside the shoulder.

Imaging is often needed to confirm a diagnosis. An X-ray helps visualise the AC and socket joint, while an ultrasound or MRI scan demonstrates the tendons, cartilage, and capsule structure. Often, a combination of tests is required to make a definitive diagnosis. 

Managing Shoulder Pain from Weightlifting 

If shoulder pain arises, it’s essential to take action to prevent further injury. Here are effective management strategies:

Rest and Modify Workouts

Resting the shoulder or modifying workouts allows inflamed or strained tissue to heal. Avoid exercises that trigger pain, such as burdensome overhead or pressing movements. Substitute overhead exercises such as incline and military press with lateral raises, upright rows, and decline presses.

Apply Ice and Anti-Inflammatories

Ice can reduce inflammation and numb pain in the initial stages. Applying ice for 15-20 minutes post-workout or using nonsteroidal anti-inflammatory drugs (NSAIDS) can help manage shoulder pain from lifting weights. 

Rehabilitation

Rehabilitation will focus on the following:

  • Rotator cuff and scapular stabilisation exercises.
  • Mobility work for the neck and mid-back
  • Soft tissue work for the anterior chest

Gradual Return to Lifting

Once pain subsides, a gradual return to lifting with proper form is crucial. Start with lighter weights and lower volume, focusing on shoulder-friendly exercises such as push-ups, rows, and cable exercises.

Consider an ultrasound-guided injection for persistent shoulder pain caused by weights.

Often, an ultrasound-guided cortisone injection can be helpful for persistent pain. Cortisone is effective for treating rotator cuff tendonitis, rotator cuff calcification, frozen shoulder, and osteoarthritis of the acromioclavicular (AC) or glenohumeral joint. Moreover, hydrodistension is effective for frozen shoulder.

Some doctors are using PRP, or platelet-rich plasma, for specific shoulder pathologies. For example, recent evidence suggests that PRP injections are effective for pain associated with partial tears of the rotator cuff tendons. 

Other Commonly Asked Questions about Shoulder Pain from Weights:

Should you continue with exercises that are causing shoulder pain from weightlifting?

No. Consider using a less painful substitute if you develop pain with a chest or shoulder exercise.

For example, substitute a barbell bench press for a dumbbell bench press, dumbbell squeeze press, or loaded push-up. Similarly, for a barbell military press, consider doing a barbell seated press with a neutral grip or upright rows. Finally, substitute a pull-up for a neutral-grip lat or a straight-arm pulldown.

Final Word from Sportdoctorlondon about Shoulder Pain from Weights

Shoulder pain is a common issue among weightlifters, often resulting from overuse, poor form, or muscle imbalances. Possible causes include rotator cuff tendonitis, distal clavicular osteolysis, labral tears, shoulder arthritis and frozen shoulder. Rest and modify your routine to prevent further pain from arising, and consider consulting a sports medicine specialist.

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