Shoulder pain during lifting almost always gets the same label: “it’s my rotator cuff.” Sometimes that’s right. But often it isn’t. Or, at least, it is only part of the story.
The shoulder is the most mobile joint in the body, which means a lot of structures share the same small space and can produce similar feeling pain. Knowing roughly what’s going on matters, because the fix for one can be a little different from the fix for another.
Here’s how we approach it.
We have to strongly consider what the pain is telling you. Before worrying about which structure is involved, pay attention to the pattern. When does it hurt? Pressing overhead, pulling, benching, racking the bar, or just reaching into a cabinet? Where does it hurt exactly? The outer upper arm, the front of the shoulder, the top of the shoulder, deep inside the joint, or up into the neck? What does it feel like? A dull ache, a sharp catch, a pinch at one specific point, or up into the neck? What happens after? Does it settle within a few hours or ache all night? These are just four questions that start to narrow things down for us.
Rotator cuff related shoulder pain is a common one! It’s really just an overloaded cuff tendon, not necessarily a dramatic tear. It typically presents as pain on the outer arm that gets worse with overhead pressing or reaching. Often a painful “arc” in the middle of range rather than pain everywhere. Frequently aches at night, especially lying on that side.
Progressive strengthening of the cuff and the shoulder blade muscles and modifying the aggravating movements (not stopping entirely). Total rest tends to make these issues worse!
Biceps tendon irritation typically presents as pain in the front of the shoulder. It’s worse with front raises, bicep curls, or at the bottom of a bench press. Similar loading principles, with attention to how the shoulder sits during pressing. This often overlaps with a cuff issue rather than existing alone.
AC joint pain is often felt at the top of the shoulder. This pain is worse with ups and reaching across the body. Modifying range of motion on pressing movements is helpful. As it is calming down, it is helpful to work in a limited range.
Referred pain from the neck is achy and harder to pinpoint. It can sometimes travel down the arm into the elbow and forearm. You may notice increased numbness and tingling or weakness. Neck positions can improve or worsen symptoms. More rotator work won’t help this problem. The neck and mid back must be addressed.
A lot of lifting related shoulder pain resolves with smart loading and a few form changes. But you need to get it checked out if:
- You feel a pop followed by weakness
- You can’t lift your arm
- You have had a significant trauma
- You have numbness, tingling, or weakness traveling down the arm
- You have pain that’s been worsening for weeks despite backing off
- You have night pain that wakes you
In the meantime, it is helpful to:
- Don’t stop training entirely.
- Use a pain threshold, not zero pain.
- Look at your volume trend.
- Strengthen the shoulder blade
“Rotator cuff” is a reasonable first guess, but it’s only one of several possibilities. The difference determines whether your rehab actually works. If your shoulder has been bothering you for more than a few weeks, or you’ve been guessing at exercises from the internet without progress, a proper assessment will save you months. We happen to be top notch in Paducah, Kentucky at diagnosing and treating shoulder issues. If you want to learn more about how we treat shoulder issues, click here!
Dr. Rachel Atufunwa PT, DPT