Tips to help avoid shoulder injuries when weight lifting

Some of the most common causes cited in the research for shoulder injuries from weight training include training at too high intensities, wrong technique, and lack of concentration. In this article I’m going to focus on ways that you can adapt your technique in the bench press, overhead press and lat pull-down to reduce your risk of shoulder injuries.

Here's a video of the livestream I did about this in the Sports Injury Group:

Some of the links in this article are to pages where you can buy products or brands discussed or mentioned here. We earn a small commission on the sale of these products at no extra cost to you.

Bench press

The bench press is a very popular upper body strength exercise, but can place very high loads on the shoulder stabilisers – mostly the rotator cuff and long head of biceps. It is commonly advised in the research that you avoid doing 1 repetition max lifts or if it’s needed for your sport limit the practice of these very heavy lifts to only a few times a year.

Hand spacing:

A narrower hand spacing (no wider than 1.5 times the biacromial width) minimises the peak torque in your shoulder and places less stress on the ligaments and capsule at the front of the shoulder as well as the rotator cuff and long head of biceps. This narrow hand grip is better for athletes who are prone to shoulder impingement, rotator cuff injuries and anterior instability.

Grip Selection:

The overhand grip (with forearm in pronation) brings the shoulder into internal rotation. In this position the biceps tendon is moved out from under the acromion while the supraspinatus tendon is moved underneath the acromion. If you’re prone to bicep tendon injuries, you may benefit from using this grip.

The opposite happens when you use the underhand grip – it places the long head of biceps tendon under the acromion during the pressing motion while the supraspinatus tendon is moved away from the acromion. If you’re prone to rotator cuff injuries, you may benefit from this grip. This can be a bit of an awkward grip to get used to and it’s best to use a spotter to help you.

You could benefit from using a mix of these grips to prevent over-straining the same muscles all the time.

Flat vs. Incline vs. Decline:

The flat and decline bench press positions are advised for anyone who has or is at risk of developing anterior shoulder instability, because it limits the amount of external rotation that the shoulder goes into. In fact, it is advised that athletes who have undergone anterior shoulder stabilisation surgery avoid the incline bench press positions because it places a lot of strain on the structures over the front of the shoulder.

Shoulder press

It is advised that you avoid the behind neck position when doing the shoulder press, because it places significant strain on the anteroinferior glenohumeral ligaments and neck. It also places the shoulder in a position where it is quite easy to cause impingement injuries. Doing the shoulder press from your chest may be a better option.

Lat pull-down

The main aim of doing a lat pull-down is to strengthen the latissimus dorsi muscle. When you observe people using the lat machine in the gym most of them pull the bar down behind their heads. Interestingly, research has shown that this is actually not the best way to do it.

In a study, where they tested the activity of different muscles in several different latissimus dorsi pull-down positions, they found that the optimum position for latissimus dorsi and scapular retractor muscle involvement was to do the exercise with the trunk reclined 30° and pulling the bar onto the chest, near the bottom of the sternum. They found that the popular behind neck position actually worked the biceps more than the lats.

Picture from Fees, M., et al. (1998). "Upper extremity weight-training modifications for the injured athlete." The American Journal of Sports Medicine 26(5): 732-742.

I would also recommend using the chest pull-down position from an injury prevention point of view because the behind neck position places the shoulder in a position where it can more easily cause impingement injuries and potentially also strain the neck.

Let me know if you have any questions! Need more help with an injury? You can consult me online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.

References:

1. Brukner, P, et. al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon)

2. Fees M, Decker T, Snyder-Mackler L, et al. Upper extremity weight-training modifications for the injured athlete. The American journal of sports medicine 1998;26(5):732-42.

3. Reichel T, Mitnacht M, Fenwick A, et al. Incidence and characteristics of acute and overuse injuries in elite powerlifters. Cogent Medicine 2019;6(1):1588192.