Barbells, dumbbells and loaded plates are excellent tools for a long healthy life — until the shoulder or knee decides it has had enough.
PATIENT STORY
“I have lifted consistently for fifteen years. My shoulders and my knees have always been my weak spots. I push through the pain because I feel like if I stop, I lose everything I have built.”
*Composite patient story. No identifying information used.
I am always delighted to see the patients that lift weights consistently. It takes discipline, self-knowledge and a genuine commitment to your own health. The research is unambiguous: consistent resistance training reduces the risk of osteoporosis, metabolic disease, cognitive decline and all-cause mortality! I recommend this and practice what I preach. As someone who believes that movement is foundational to a long and healthy life, I consider the weight room one of the best investments a person can make in their future self.
of recreational lifters report chronic shoulder pain
most common lifting injury location: the shoulder
of lifting-related shoulder issues resolve with targeted PT before surgery
of knee pain in lifters involves patellar tendon pathology
The Shoulder Under the Bar: What Goes Wrong and Why
The most common lifting-related shoulder injuries I see fall into four categories: acromioclavicular (AC) joint injuries, rotator cuff pathology, SLAP tears and shoulder impingement syndrome.
The AC joint — the small joint at the top of the shoulder where the collarbone meets the shoulder blade — is particularly vulnerable in lifters. Heavy bench pressing, dips and heavy loaded carries place direct compressive and shear stress on this joint. Over time, this produces AC joint arthritis or osteolysis — a condition where the end of the collarbone actually begins to dissolve from repetitive stress, can be seen in heavy bench pressers. The hallmark symptom is pain directly at the top of the shoulder, often worst at the end range of a horizontal press or when reaching across the body or behind the back movements. Your scapula, shoulder blade function may also be to blame and must be evaluated.
Shoulder impingement is another incredibly common complaint among lifters: a pinching sensation at the front or top of the shoulder, typically with overhead movements or the early arc of a lateral raise. It occurs when the rotator cuff tendons become compressed between the humeral head and the acromion, often due to a combination of tight posterior capsule, weak lower trapezius and poor scapular positioning during overhead loading.
Non-Surgical Treatment for the Lifting Shoulder
The majority of lifting-related shoulder problems respond very well to targeted conservative treatment when caught before they become severe. Physical therapy focusing on posterior capsule stretching, lower trapezius and serratus anterior strengthening and rotator cuff rebalancing is my first-line recommendation. Airrosti treatment is particularly effective for the soft tissue tension patterns that drive impingement.
AC joint pain that does not respond to activity modification and physical therapy often responds very well to a targeted corticosteroid injection. PRP injections are an option I discuss with patients interested in orthobiologic approaches, and can be considered for partial rotator cuff tears and chronic tendinopathy.
LIFTING MODIFICATIONS THAT PROTECT THE SHOULDER
While you rehabilitate, these adjustments significantly reduce shoulder stress: use a closer grip on the barbell bench press and bring the bar to the lower chest rather than the upper chest; replace behind-the-neck pressing with front pressing; swap flat barbell bench for a slight incline with dumbbells; control the descent on overhead press; and reduce volume on exercises that provoke symptoms while maintaining those that do not. Consider two pull exercises for each push, ensuring that the scapula is controlled. Training through sharp or worsening pain is never the answer.
When Surgery Is Needed for the Lifting Shoulder
- Arthroscopic acromioplasty and distal clavicle excision — for refractory AC joint arthritis or osteolysis. The end of the collarbone is trimmed back by a few millimeters. Outpatient procedure, very reliable outcomes in lifting athletes.
- Rotator cuff repair — for full or large partial tears that have not responded to conservative care. Return to lifting typically 4 to 6 months.
- SLAP repair or biceps tenodesis — for confirmed labral tears with overhead loading pain. Return to heavy lifting typically 5 to 7 months.
The Knee Under the Bar: Squats, Deadlifts and What Can Go Wrong
The two most common conditions I see in dedicated lifters are patellar tendinopathy and patellofemoral syndrome. The patellar tendon connects the kneecap to the shin bone and transmits the enormous force generated by the quadriceps during squatting and deadlifting. When training load exceeds the tendon's capacity to recover, the tendon develops microscopic damage that accumulates into tendinopathy.
Patellar tendinopathy is one of the conditions that responds remarkably well to a specific rehabilitation approach: heavy slow resistance training. Research consistently shows that eccentric and isometric quadriceps loading — performed slowly and under significant tension, remodels tendon tissue and restores pain-free function.
These issues are often due to overuse and imbalance, weakness in the gluteus medius and tight quadriceps muscles and lead to dramatic, disabling knee pain. Reach out to determine what is causing your pain.
A WORD ON LONGEVITY AND THE WEIGHT ROOM
I want to say this clearly to every lifter reading this article: lifting weights is one of the best things you can do for the longevity of your shoulder and knee joints — not one of the worst. The research on resistance training and joint health is overwhelmingly positive. The goal of treating a lifting injury is not to get you out of the weight room. It is to get you back in it, safely, sustainably and for as many decades as possible.
Shoulder or knee pain slowing down your training?
Dr. Jamie Lynch evaluates and treats lifting-related shoulder and knee injuries. TruOrtho, San Antonio.
Book an Appointment: www.sportssurgeryspecialist.com |
REFERENCES
- Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA. Shoulder injuries attributed to resistance training. Journal of Strength and Conditioning Research. 2010;24(6):1696-1704.
- Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine. 2015;49(19):1277-1283.
- Gerber C, Gallay SH, Espinosa N, Hersche O. Symptomatic distal clavicle osteolysis. Journal of Shoulder and Elbow Surgery. 2004;13(2):142-148.
- Liddle AD, Rodriguez-Merchan EC. Platelet-rich plasma in the treatment of patellar tendinopathy. American Journal of Sports Medicine. 2015;43(12):2981-2988.
This blog is for educational purposes for personalized medical advice you must see me or another qualified physician for diagnosis and treatment of any medical condition. | Dr. Jamie Lynch, M.D. | TruOrtho, San Antonio, TX | www.tru-ortho.com | www.sportssurgeryspecialist.com
