Upper Limb Pain in the Lifter
One of the main areas you’ll hear lifters and workout junkies complain about is shoulder pain – but upper limb musculoskeletal pain in the lifting and weight training audience isn’t limited to the shoulder and can also occur in the elbow and occasionally the wrist.
In Part II of this IV part series, I tackle Upper Limb Pain in the lifter. If you haven’t read it yet, first I recommend checking out this blog on common mistakes lifters make.
I would also highly recommend checking out the following masterclass: The Sporting Hand and Wrist by Ian Gatt, for more in-depth learning about these topics.
Part 1: The shoulder
Common issues you see with shoulders are:
- Rotator Cuff Related Shoulder Pain
- Bicep tendinopathy
- AC joint pain
- Pec tendinopathy
- AC or Glenohumeral Joint Osteoarthritis
Problematic exercises and modifications
Usually the main exercises that are problematic for the shoulder are pressing movements (i.e. Bench Press, Pushups, Dips, Shoulder Press) and front + side deltoid specific movements (i.e. Front/Side raises and Upright Rows).
Other exercises that fall outside of the chest and shoulder that can be aggravating are Straight Bar Back squats, Pulldowns and Chins/Pull Ups.
The best modifications I’ve found are:
- Replacing Straight Bar Squats with Safety Bar Squats (if possible) or switching to Machine Squats, Leg Presses, or Dumbbell based leg movements where supporting the bar with the shoulders isn’t the problem.
- Sticking to Rows for back training
- For Front/Side raises:
- Switching to a thumbs up as opposed to palms down position
- Working within a comfortable ROM
- Lowering the weight
- Shifting the arms to the scapular plane
- Usually Upright Rows are introduced in the latter stages of the rehab process. If you’re dead set on trap training, then Shrugs are simply the way to go.
Look at my blog on Returning to Pressing with Shoulder Pain for how I get clients back to pressing.
Exercise technique modifications for the shoulder
For Rows and deltoid exercises the main issues I see are people heaving the weight and/or shrugging up with the shoulders as they lift the weight. Dips follow a similar suit. These issues can be due to poor body awareness, lack of strength in the targeted muscles and quite simply too much weight.
I discuss Bench Press technique in my Best Damn Bench Press blog which I recommend you read.
In terms of squatting – higher bar and narrower grip squats generally work better if those modifications can be done pain free. The one area to be cognizant of is that narrower grip may irritate the elbows. Again in these situations Safety bar Squats, Dumbbell exercises, or machines may be a more appropriate choice.
General programming considerations for the shoulder
Other programming modifications are (for most people) to:
- Focus on chest and t-spine mobility if it can be done pain free
- Decrease the volume of pressing and shoulder work, along with that of Low Bar Back Squatting, and increase the amount of pulling work
Part 2: Elbow pain in the lifter
You can get lateral and medial epicondylalgia (aka tennis and golfer’s elbow, respectively) as well as triceps and distal biceps tendinopathies – but most of the elbow pain I see in lifters is either referred pain from the neck or shoulder or is more of a “non-specific” elbow pain.
Common problematic exercises and modifications
General programming considerations for the elbow
Other tips are:
- Tricep Extensions and Skullcrushers should be done later in the workout.
- Another big thing to consider is to be cognizant of the volume and frequency of Heavy Pressing and Barbell Squatting as that can load the elbows quite a bit and be problematic.
- Focus more on chest and t-spine mobility if it can be done pain free to help with bar support for squatting. Using a wider grip may be more beneficial as long as it doesn’t irritate the shoulders.
Tennis elbow is its own can of worms and can be an extremely frustrating condition to work around as activities that involve gripping (basically anything holding a barbell or dumbbell or kettlebell) can set it off. My biggest recommendation for upper body exercises is to use cables and/or resistance tubing to allow a more open hand position as I demonstrate here.
Part 3: Wrist pain in the lifter
Wrist pain, outside of people who do Olympic Lifting or Crossfit, tends to be rarer in clientele who lift weights. I find they tend to be aggravated by forced wrist extension in either a front rack position (i.e. Clean, Olympic Front Squat, Barbell Back Squat in some cases), or with weight bearing exercises through the arm (i.e. Pushups, Birddogs, sometimes even Barbell Bench Press).
The squatting substitutes and tips that apply to the shoulder and elbow also apply here. Bodybuilding-style Front Squats can be used as a substitute for the Olympic Lifting style. I often recommend people squat with a more vertical wrist position, as I demonstrate here. However, that may require some pec stretching, shoulder external rotation mobility, and thoracic spine extension mobility work.
In terms of pressing movements:
- Barbell Bench Press can be substituted with dumbbells or with a Swiss or Football Bar which allows for a more neutral grip
- Pushups can be done with pushup bars or (if you have access to them) hex dumbbells or powerblocks which won’t roll on the ground. This will allow you to have a neutral grip.
This is again by no means intended to be a universal guide to every single upper limb issue in every single weight training client as pain, performance, and people are all complex. That being said – I hope this provides some guidance on some common issues that myself and other clinicians see in the weight training clientele, some guidance on programming and how to modify people’s workout routines to keep them active in the presence of pain.
For more detail on a related topic, check out this excellent masterclass on The Sporting Hand and Wrist by Ian Gatt.
Thanks for reading!
Want to learn more about the hand and wrist?
Ian Gatt has done a Masterclass lecture series for us on:
“The sporting hand & wrist”
You can try Masterclass for FREE now with our 7-day trial!
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