Managing Shoulder Pain from Gym Training: An Evidence-Based Physiotherapy Approach
- endurancehealthlab
- Apr 17
- 5 min read
Updated: 5 days ago
Shoulder pain during or after gym training is common among recreational lifters, bodybuilders, CrossFit athletes, Olympic weightlifters and overhead sports enthusiasts. With the shoulder’s high mobility and dependence on muscular control, it becomes vulnerable under repetitive loading — particularly when training volume, biomechanics, or recovery are suboptimal.
Why the Shoulder Is Prone to Injury
The glenohumeral joint offers extensive range of motion at the cost of stability. Gym-related shoulder injuries often stem from a combination of:
Scapular dyskinesis: altered scapular movement impairs shoulder mechanics and joint clearance. Kibler et al. (2003) emphasised its clinical relevance in overhead athletes.
Muscle imbalances: overdominance of phasic muscles (e.g., pectoralis major, latissimus dorsi) paired with under-recruited rotator cuff and scapular stabilisers.
Poor thoracic extension and shoulder mobility, which restrict overhead mechanics and scapular upward rotation, leading to impingement-like symptoms (Lewis, 2016).
Overtraining without adequate recovery or technical refinement.
Common Shoulder Pathologies in Gym Athletes
Rotator Cuff-Related Shoulder Pain (RCRSP)
RCRSP refers to a spectrum of conditions affecting the rotator cuff and surrounding subacromial structures, including tendinopathy, partial-thickness tears, and subacromial bursitis. It is commonly observed in gym-goers due to repetitive overhead or pressing movements that place excessive load on the shoulder complex, particularly when movement control is suboptimal.
Although symptoms are typically load-sensitive, not all exercise interventions deliver equal benefit. Dubé et al. (2024) reported that motor control-based exercise programmes, which focus on improving movement precision and joint coordination, resulted in modest yet meaningful improvements in functional disability. Importantly, the review highlighted a lack of strong evidence favouring one type of exercise over another, reinforcing the importance of individualised rehabilitation that targets specific movement impairments.
In a gym-based setting, this supports a staged rehabilitation approach — commencing with low-load, control-focused exercises to build foundational movement competency, before progressing to heavier resistance training and performance-specific work.
Subacromial Pain Syndrome (SAPS)
SAPS involves symptoms consistent with mechanical impingement under the coracoacromial arch. In a landmark RCT, Holmgren et al. (2012) found that a targeted exercise program (including eccentric rotator cuff work and scapular retraction exercises) was superior to corticosteroid injection and general exercise, both in short- and long-term outcomes.
Internal Impingement & Labral Pathology
Internal impingement occurs when the rotator cuff (typically supraspinatus and infraspinatus) contacts the posterosuperior glenoid in positions of abduction and external rotation — commonly during snatch or jerk motions. Reinold et al. (2009) stress the importance of posterior cuff strengthening, posterior capsule mobility, and scapular retraining in this subgroup, particularly in overhead athletes.
AC Joint Stress or Osteolysis
Repeated heavy loading (e.g., bench press, dips, flys) may irritate or even degrade the distal clavicle. Beitzel et al. (2013) reviewed AC joint pathology and supported activity modification, scapular retraining, and progressive strengthening as effective conservative treatments.
Risk Factors to Screen Clinically
Factor | Impact |
Scapular Dyskinesis | Reduces scapulohumeral rhythm and joint clearance (Kibler et al., 2003) |
Posterior Cuff Weakness | Limits dynamic stability during load and deceleration (Reinold et al., 2009) |
Thoracic Hypomobility | Inhibits scapular upward rotation and shoulder elevation (Lewis, 2016) |
Volume Overload | May cause tendon irritation and microtrauma |
Technical Errors | Flaring elbows in bench press or limited retraction during overhead work |
Shoulder Pain Physiotherapy Management: An Evidence-Based Framework
Phase 1: Symptom Control & Load Management
Temporarily reduce provocative loads (e.g., bench press, overhead lifts)
Apply manual therapy to address mobility deficits in thoracic spine, glenohumeral joint, or soft tissue restrictions (e.g., pec minor tightness)
Educate on pain science and load tolerance — Hanratty et al. (2012) emphasise the importance of patient education, self-efficacy, and reassurance as cornerstones of rehab.
Phase 2: Scapular & Rotator Cuff Rehabilitation
Serratus anterior activation
Rotator cuff loading
Thoracic mobility
Cools et al. (2008) showed that a scapular-focused rehab program enhances outcomes in overhead athletes — especially when addressing muscle activation patterns and motor control.
Phase 3: Rebuild Load Capacity & Return to Strength Work
Start with neutral-grip pressing and landmine variations to reduce joint stress
Emphasize tempo, eccentric control, and correct scapular motion
Gradually progress to barbell pressing as mechanics and strength permit
Where tendinopathy is present, eccentric or heavy slow resistance loading (Beyer et al., 2015) has been shown to improve tendon remodeling and function.
When to See a Physiotherapist
Shoulder pain that lingers beyond 1–2 weeks, worsens with pressing or overhead lifting, or interferes with your training progression should be professionally assessed.
At Endurance Health Lab, we combine objective strength testing, hands-on treatment, and sport-specific rehab to help you train pain-free and perform at your best.
📅 Book an assessment today or Email us to chat about your shoulder issue.
Located in Chatswood, 2067
References
Beitzel, K., Sablan, N., Chowaniec, D. M., McCarthy, M. B., Apostolakos, J., Cote, M. P., & Mazzocca, A. D. (2013). Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 29(2), 387–397.
Cools, A. M., Witvrouw, E. E., Declercq, G. A., Danneels, L. A., & Cambier, D. C. (2008). Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. British Journal of Sports Medicine, 42(11), 874–878.
Dubé, M. O., Lafrance, S., Charron, M., Mekouar, M., Desmeules, F., McCreesh, K., Michener, L. A., Grimes, J., Shanley, E., & Roy, J. S. (2024). The efficacy of exercise therapy for rotator cuff-related shoulder pain: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 54(8), 499–512.
Hanratty, C. E., McVeigh, J. G., Kerr, D. P., Basford, J. R., Finch, M. B., Pendleton, A., & Sim, J. (2012). The effectiveness of physiotherapy exercises in subacromial impingement syndrome: A systematic review and meta-analysis. Musculoskeletal Care, 10(4), 242–251.
Holmgren, T., Hallgren, H. B., Öberg, B., Adolfsson, L., & Johansson, K. (2012). Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: Randomised controlled study. BMJ, 344, e787.
Kibler, W. B., McMullen, J., & Uhl, T. L. (2003). Shoulder rehabilitation strategies, guidelines, and practice. Orthopedic Clinics of North America, 34(4), 527–538.
Lewis, J. S. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. British Journal of Sports Medicine, 50(19), 1134–1138.
Reinold, M. M., Escamilla, R. F., & Wilk, K. E. (2009). Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. Sports Health, 1(4), 343–352.
Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 25(1), 123–132.
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