Shoulder Pain with Bench Pressing / Acromialclavicular (AC) Joint Pain

Why do you have shoulder pain with bench pressing?

Shoulder pain during bench pressing can occur for several reasons. Here are some common causes:

Poor Form: Incorrect technique can place undue stress on the shoulders. For example, flaring your elbows out too much can cause strain on the shoulder joint. Ideally, elbows should be at about a 45-degree angle to your body, not too wide or tucked too much.

1. Weak Shoulder Muscles: If the muscles around the shoulder (rotator cuffs, deltoids, and scapular stabilizers) are weak or imbalanced, they might not properly support the joint during the movement, leading to pain or discomfort.

2. Overuse or Repetitive Stress: If you're bench pressing too frequently or using too much weight, your shoulder muscles and tendons can become overworked, leading to inflammation or irritation of the tendons (tendinitis).

3. Poor Mobility: Limited range of motion in the shoulder joint and decreased flexibility of the pecs or lats, can restrict proper movement mechanics during the bench press. Tight muscles around the shoulder can lead to discomfort and injury.

4. Acromialclavicular (AC) joint dysfunction: Pain or discomfort in the AC joint. See below.

What is Acromialclavicular (AC) joint dysfunction/pain?

AC Joint Dysfunction refers to a condition involving pain or discomfort in the acromioclavicular joint, which is where the clavicle (collarbone) meets the acromion (part of the shoulder blade).  (see image below).

Image from Complete Physio

The AC joint plays an important role in shoulder mobility, particularly in overhead, reaching, and lifting motions.

AC joint dysfunction can occur due to various causes and can be classified into different types based on the severity of the injury or condition.

Common Causes:

1. Injury or Trauma:

• A direct blow to the shoulder (such as falling onto the shoulder or a collision) can injure the AC joint. This is often seen in contact sports or accidents.

• A shoulder separation (where the ligaments that stabilize the AC joint are torn) is a common result of trauma.

2. Overuse:

• Repetitive overhead activities, such as lifting weights, throwing, or swimming, can lead to wear and tear in the AC joint and result in dysfunction over time.

3. Arthritis:

   • Over time, the cartilage in the AC joint may wear down (degenerative arthritis), causing pain and stiffness. This type of arthritis typically affects older adults, but it can develop earlier in individuals who frequently stress the shoulder joint. According to this article, arthritis is the main cause of AC joint pain and it develops as a consequence of constant stress on the shoulder, often in people who perform repeated overhead lifting activities.

4. Posture or Biomechanical Issues:

• Poor posture, muscle imbalances, or improper movement mechanics can put strain on the AC joint, leading to dysfunction.

AC joint pain symptoms

If you have AC joint pain, you may experience the following:

• Pain at the top of the shoulder: Often worse with activities like lifting, reaching overhead, or carrying weight.

• Swelling or tenderness: You may notice swelling over the joint or tenderness when pressing on the area.

• Limited range of motion: Difficulty moving the arm, especially in overhead or pushing motions. According to this article, functional limitations of ACJ pain include difficulty with resistance-training activities that place the shoulder joint in an extended position (such as the bottom position of a bench press).

• Clicking or popping sounds: In some cases, you might hear or feel a clicking or grinding sensation in the joint during movement.

• Pain when lying on the affected side: Lying directly on the shoulder can aggravate the pain.

How to fix AC joint pain: AC joint treatment

Physical therapy is one of the most important treatments for AC joint pain, especially if the injury is due to muscle imbalances, poor posture, or overuse.

• Stretching and Strengthening: Your therapist will teach you exercises to stretch tight muscles (like the pectorals or upper traps) and strengthen the muscles around the shoulder (like the rotator cuff and scapular stabilizers).

• Improved Posture: Proper posture can help reduce stress on the AC joint. Physical therapy can address posture issues and teach you strategies to maintain alignment.

• Joint Mobilization: Manual therapy techniques from a physical therapist can help improve joint movement if stiffness is contributing to pain.

According to this article, non-acute AC joint pain can be treated successfully and conservatively with physical therapy that includes the use of manual therapy.

Treatment for AC joint dysfunction should address the impairments found on clinical examination. These are the most common impairments for AC joint dysfunction:

1. Decrease joint mobility of the AC joint

2. Decreased strength and endurance of the rotator cuff and scapular muscles

   • Most commonly the lower trap and serratus anterior

3. Tightness in the posterior capsule of the shoulder (behind the shoulder)

4. Shortened pectoralis minor muscle length

5. Tissue stiffness in the infraspinatus muscle (posterior rotator cuff muscle)

6. Decreased mobility of the thoracic spine (especially into extension)

In the initial phase of treatment, manual therapy and activity modification is helpful to enhance short-term improvements in pain and function. Manual therapy techniques are beneficial to modulate pain and to complement exercise to improve mobility, muscle activity, and strength. Our therapists utilize manual therapy techniques that target the AC joint, shoulder joint (glenohumeral joint), the shoulder blade (scapulothoracic joint), and the thoracic spine.

When symptoms are less irritable, our therapists will transition from exercises with a symptom modulation focus to interventions that target muscle performance and other impairments related to the patient’s movement dysfunction. Exercises to strengthen the shoulder blade muscles and load the shoulder into elevated and extended positions are essential components of rehabbing AC joint pain.

AC Joint pain recovery time: how long does AC joint pain last?

AC joint pain recovery time will be dependent on how long it takes to improve tissue elasticity, capsular mobility, neuromuscular control, and muscular strength. This may vary from case to case, depending on the degree of involvement and the chronicity of the injury. It is reasonable to expect it to take at least 6 weeks, but up to 12 weeks or more to see a resolution of your pain and restoration of your prior level of fitness and function.

Best exercises for AC joint pain

Lower Trap / Y progression

Scapular Push Up Progression

Push Up Progression

Row with Band

Quadruped T

AC joint pain stretches/mobility exercises

Foam Roll Thoracic Spine

Child Pose with Side Bend

Pec Doorway Stretch (both sides)

Wall Slides with Towel

Exercises to avoid with AC joint pain

In the more irritable stages of AC joint pain, you’ll want to temporarily avoid activities and movements that involve end-range overhead movements, reaching across your body, and reaching away from your body. Examples of these activities include rock climbing, olympic weightlifting, and lifting overhead, etc.

Exercises to avoid and their modifications include:

• Bench press

  • Temporary modification: Floor press

• Vertical Overhead Press

  • Temporary modification: Incline Press

• Lat Pull own / Pull Up

  • Temporary modification: Row with Band

• Rear Deltoid Fly

  • Temporary modification: Hooklying Band Pull Apart

Conclusion

If you are experiencing AC joint pain or shoulder pain with bench pressing or overhead lifting, click the button below to speak with one of our Doctors of Physical Therapy. 

Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.

Dr. Vincent Liu, PT, DPT

Doctor of Physical Therapy

The Game Plan Physical Therapy