An active male weightlifter sought consultation for ongoing left shoulder pain of several months to determine if a surgical repair was needed to get back to his recreational weightlifting.
The patient reported his pain was typically aggravated with bench pressing. This is not uncommon, due to the tremendous stress placed on humeral head stabilizers – primarily the rotator cuff muscle group and the long head of the biceps brachii muscles. In addition, the biomechanical pattern can lead to repetitive compression but the bench press can be modified to allow most athletes with an injured shoulder to perform the lift.
We advised conservative correction/modification after a thorough whole-body assessment to help restore pain-free weightlifting. Upon assessment, we noted increased thoracic kyphosis and anterior humeral head position placing excessive stress onto the anterior labrum and glenohumeral ligaments.
Our comprehensive interregional approach began with correction of thoracic kyphotic position to provide a stable foundation for controlling shoulder blade movement pattern.
A stable shoulder blade decreases irritation and stress on shoulder structures. From improved position, we focused on scapular muscle strength and coordination to continuously engage supporting muscles to decrease the load on the shoulder joint by providing a stronger platform to handle heavy load.
Next we added progressive form re-training to return to bench pressing pain-free. With collaborating with his personal trainer, we were able to progress up to 225 pounds of bench press safely.
Here are key biomechanical modifications that we corrected for him based on his response and evidence-informed practice (Fees at al's study from The American Journal of Sports Medicine).
First off, the bench press hand grip width was adjusted to 1.5x the patient's shoulder width to place the head of the humerus in the most open and advantageous position for power output. The patient was advised to bring the bar 2-3 inches north of the xiphoid process and limit shoulder extension to 15 degrees and horizontal abduction to 45 degrees.
Alteration of the shoulder angle better aligns the pectoralis major and biceps brachii muscles into a mechanically advantageous position to assist shoulder flexion through the initial and middle range of motion, thereby decreasing the stress on the long head of the biceps muscle at the bicipital groove as the humerus moves into horizontal adduction.
The referred to analysis and subsequent modifications allowed our weightlifter to return to his preferred recreational activity of bench press without pain.