Shoulder Pain and Exercise

Q: I've been experiencing some shoulder pain lately and I've been told to stay away from overhead pressing. Is that good advice?

A: Most people "wear their shoulders too low" according to Shirley Sahrmann, a professor of physical therapy and author of the book Diagnosis and Treatment of Movement Impairment Syndromes. "There are more problems with shoulders depressed than elevated. Get the shoulders up for people with neck pain; if you raise the shoulder girdles up, you will get greater cervical rotation."

Sahrmann emphasizes that the body adapts to the posture it trains in. Many exercises are performed incorrectly, thus accelerating the rate of joint degeneration. For instance, it's common practice in weight training to set the scapula by retracting and depressing it during just about any upper body movement. This disrupts normal scapulo-humeral rhythm and actually leads to an impingement syndrome rather than preventing it.

Also, Sahrmann isn't a fan of all these isolated exercises for the shoulders. We're often told to avoid overhead pressing because of the impingement risk, but this is one of the most effective and safe exercises for the shoulder joint!

The key, according to Sahrmann, is to perform it in the saggital plane with elbows forward (not out to the side). The frontal and posterior head of the deltoid neutralize each other in this position while the rotator cuff muscles work very hard to stabilize the joint. I call it the Sahrmann Press.

Using a semi-supinated grip (palms facing each other) and the elbows forward, press the weight upwards just shy of locking out. Make sure to keep your forearms perpendicular/vertical to the ground at all times (i.e. the shoulders are externally rotated.)

It's common for the elbows to flare outward near the top of the movement as evident in the photo. Use dynamic (i.e. AIS) and PNF stretching techniques as I discussed in an earlier installment of this column to help correct this. Also, consider getting some ART (Active Release Technique) for your internal rotators, particularly the lats.

By the way, the exercise to avoid if you're concerned about impingement would be lateral raises as the medial deltoid depresses the joint and training the supraspinatus further decreases the subacromial space.

One more thing, if you look as sluggish as the model in the first photo, load up on Biotest Power Drive with additional ephedrine and caffeine. Ephedrine HCL is still available in Canada in 8 mg tablets!

[This Q&A piece originally appeared in T-Nation on Jan. 6, 2005 and can be accessed online at]