Physical Therapy for Bench Press Shoulder Injuries

It's normal for weight training to put a strain on your muscles, which at times, can feel uncomfortable. That said, you should not feel pain, especially acute pain during or immediately after an exercise such as the bench press. If this happens, you may be dealing with a bench press shoulder injury.

Exercises like the bench press, when done incorrectly, can cause shoulder instability. The most common mistakes when performing this move are using too much weight, failing to use proper form, flaring your elbows from too wide of a grip, relying too much on your shoulders to push the weight and doing the exercise with existing upper body pain or injury.

When this happens, the muscles and ligaments that hold the shoulder together are stretched beyond their normal limits, which leads to the shoulder becoming unstable, and consequently, a bench press shoulder injury.

The bench press can cause other injuries to the shoulder, with the most common being a rotator cuff tear, osteoarthritis and overuse or strains, according to the University of Rochester Medical Center. Additional injuries include bench press shoulder impingement and labrum tears.

"Often people develop pain deep in the shoulder over time and turn out to have a labral tear in the shoulder," Dr. David Geier, MD, orthopedic surgeon and sports medicine specialist tells LIVESTRONG.com. The labrum is the cartilage bumper along the socket that stabilizes the ball and socket. While this injury does not usually result from one event or rep, Geier says it often requires surgery to repair it.

Read more: Major Muscle Groups Used in Bench Press

While the shoulder is susceptible to several injuries during the bench press, it's not the only area that takes a hit when performing this move. The bench press can also cause injuries to the pectoral muscles and surrounding tendons, including tears or strains.

According to the Hospital for Special Surgery in New York, the pectoralis major tendon is most commonly injured during an eccentric contraction, which happens when the external force on the muscle (the weight you are lifting) is greater than the force than the muscle can generate.

"This is the dramatic tearing when the weight slips or the arm gives out; you will feel a tearing sensation and immediate sharp pain, and you will quickly develop swelling and bruising in your chest, shoulder and upper arm," says Geier.

The easiest way to prevent this injury from happening is to use lighter resistance and focus on form. If you're using a standard Olympic barbell, remember to account for the weight of the bar, which is typically 45 pounds.

Add plates on slowly, ensuring you can perform the desired amount of receptions with proper form before progressing to a higher weight. When using dumbbells, start with a weight lighter than you think you can lift, and progress from there, following the same guidelines you would when using a barbell.

Whether you're dealing with a bench press shoulder injury or a tear or strain to the pectoral tendon, physical therapy will likely be recommended. The therapist can show you exercises that strengthen the small muscles that support and stabilize the shoulder. They can also educate you on exercises to stay away from that can add stress to the injured structures.

You can treat some injuries with a conservative approach and use physical therapy before resorting to surgery. But others such as pectoralis major tendon injuries or a labral tear may require immediate surgery with a round of physical therapy to help rehab the area.

For pectoralis major tendon injuries and labral tears requiring surgery, you will typically be immobilized in a sling for three to six weeks. During this time, you will be asked to perform pendulum exercises that help with range of motion.

Once the sling comes off, your physical therapist or physician will instruct you to perform passive and active exercises such as shoulder flexion, extension, abduction and internal and external rotation moves for a few months.

The goal here is to regain shoulder flexibility and stability. When you hit the four-plus mark, light weight lifting can be introduced using Thera-bands or light dumbbells, with the goal of increasing strength and function in the shoulder and pectoral area.

Read more: Exercises That Could Hurt Your Shoulders (and What to Do Instead)

In general, you can expect to resume normal activity around six months post-surgery. When you head back to the gym, Geier says you can test your recovery by doing an exercise, such as the bench press, with very low weights to see if you develop pain. Front shoulder pain from bench press injuries will continue to hurt if the area is not healed.

Which means, if you experience pain, your shoulder isn't ready for that exercise. If it doesn't hurt, then you could slowly increase the weight and decrease the reps over your next five or six workouts to prepare your shoulder for the stress and weight of that exercise.