Shoulder Pain When Lifting? A Physical Therapist's Guide to Safe Spring Training

Spring brings renewed motivation to get back in the gym, and for many people, that means returning to strength training after a slower winter. But within a few weeks, we start seeing the same pattern at Nashville Physical Therapy & Performance: shoulder pain that starts subtle and progressively gets worse with overhead pressing, bench pressing, or even just reaching overhead.

If your shoulder hurts when you lift, you're not alone. Shoulder pain is one of the most common complaints we see in active adults ramping up spring training. The good news? Most shoulder pain responds well to simple modifications and targeted exercises if you catch it early.

Let's talk about why shoulders get irritated during lifting and what you can do about it.

Shoulder Pain When Lifting? A Physical Therapist's Guide to Safe Spring Training:

Why Shoulders Are Vulnerable During Spring Training

Your shoulder is the most mobile joint in your body, which makes it incredibly versatile but also inherently unstable. Unlike your hip (which is a deep ball-and-socket joint), your shoulder relies heavily on muscles, tendons, and coordinated movement to stay centered in the socket.

After a winter of less activity, a few things happen that set the stage for shoulder problems:

Reduced overhead activity: Most daily life happens in front of your body at waist to chest height. If you haven't been consistently reaching overhead during winter, the muscles and tissues that support overhead movement lose conditioning.

Decreased thoracic spine mobility: We talked about this last week on our blog. A stiff upper back forces your shoulder to compensate during overhead movements, increasing strain on the rotator cuff and shoulder structures.

Strength imbalances: Winter deconditioning often affects posterior shoulder muscles (the ones in your upper back) more than anterior muscles (chest and front shoulder), creating imbalances that alter shoulder mechanics.

When you return to pressing movements, overhead lifts, or high-volume upper body training, these factors combine to overload shoulder tissues before they're ready to handle the demand.

Research in the Journal of Shoulder and Elbow Surgery found that rapid increases in overhead training volume are strongly associated with rotator cuff tendinopathy and shoulder impingement.[^1] The pattern is clear: too much, too soon creates problems.

Rotator Cuff Problems vs. Impingement: What's the Difference?

Most shoulder pain in lifters falls into two categories, and understanding the difference helps you address the right problem.

Rotator Cuff Tendinopathy

Your rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) that stabilize your shoulder and control rotation. When these tendons get irritated from overload, you develop tendinopathy.

Common symptoms:

• Pain on the outside or front of your shoulder

• Worse with overhead pressing, reaching behind your back, or sleeping on that side

• Often feels like a deep ache that lingers after lifting

• May have specific painful arc between 60-120 degrees of shoulder elevation
  

Common causes: Rapid volume increases in overhead work, poor shoulder positioning during presses, weak rotator cuff muscles relative to larger prime movers.

Shoulder Impingement

Impingement occurs when the space between your rotator cuff tendons and the bone above them (acromion) becomes compressed. This pinches soft tissues, causing pain and inflammation.

Common symptoms:

• Sharp, pinching pain at the top of shoulder movement

• Pain when reaching overhead or across your body

• Painful arc during lifting (usually 60-120 degrees)

• Relief when you lower your arm below shoulder height
  

Common causes: Poor scapular (shoulder blade) control, forward shoulder posture, inadequate thoracic spine mobility, weakness in serratus anterior and lower trapezius muscles.

Here's the truth: these conditions often overlap. Many people have both rotator cuff irritation and some degree of impingement happening simultaneously. The good news is the management strategies overlap significantly.

The Self-Assessment: Is Your Shoulder in Trouble?

Try these three tests to assess whether your shoulder pain needs attention:

Test 1: The Empty Can Test

Stand and raise your arm out to the side at a 45-degree angle in front of your body with your thumb pointing down (like you're emptying a can). Have someone apply gentle downward pressure on your wrist while you resist.

What it means: Pain or significant weakness suggests possible supraspinatus (rotator cuff) irritation.

Test 2: The Painful Arc

Slowly raise your arm out to the side, all the way overhead, then lower it back down. Pay attention to where you feel pain.

What it means: Pain between 60-120 degrees (roughly shoulder to ear height) suggests impingement or rotator cuff issues. Pain at the very top of the movement often indicates AC joint involvement.

Test 3: Scapular Assistance Test

Stand and raise your painful arm out to the side. Now have someone gently push your shoulder blade upward and backward while you raise your arm again.

What it means: If the assisted version is less painful or allows greater range, your scapula (shoulder blade) isn't moving properly, contributing to impingement.

If any of these tests recreate your pain, you've identified a shoulder problem that needs to be addressed before you continue high-volume training.

The Biggest Lifting Mistakes That Cause Shoulder Pain

We see these patterns repeatedly in our clinic. Here are the most common technical errors that lead to shoulder problems:

Mistake 1: Elbows Flared Too Wide on Bench Press

Flaring your elbows out to 90 degrees during bench press puts excessive stress on the anterior shoulder. Your elbows should be at roughly 45 degrees from your torso, not perpendicular.

Mistake 2: Overhead Pressing Without Scapular Upward Rotation

When you press overhead, your shoulder blades need to rotate upward. If they don't (often due to tight lats or weak serratus anterior), your shoulder gets pinched at the top of the movement.

Mistake 3: Excessive Volume Without Balanced Pulling

If you're doing lots of pressing (bench press, overhead press, push-ups) without equal or greater pulling volume (rows, pull-ups, face pulls), you create imbalances that pull your shoulders forward and create impingement.

A good rule: for every pressing movement, do 1.5-2 pulling movements.

Mistake 4: Ignoring Pain During "Just One More Set"

Shoulder pain during lifting is a signal, not a challenge to overcome. Training through sharp or pinching pain accelerates tissue damage and turns a 2-week issue into a 2-month problem.

How to Modify Your Training While You Recover

You don't have to stop lifting entirely, but you do need to respect pain and modify intelligently. Here's how:

Reduce Range of Motion

If overhead pressing hurts at the top, stop the movement before the painful range. Floor press instead of bench press. Push-press to a limited range instead of full overhead press. You can still load the muscles without aggravating the injured tissues.

Adjust Grip and Angles

Sometimes a simple change makes a big difference. Neutral grip (palms facing each other) instead of pronated grip. Incline press at 30 degrees instead of flat bench. Landmine press instead of barbell overhead press. Experiment to find pain-free variations.

Increase Pulling Volume

Even if pressing hurts, pulling movements often don't. Use this time to prioritize rows, face pulls, band pull-aparts, and scapular strengthening. This addresses the imbalance contributing to your shoulder pain.

Temporarily Reduce Load and Volume

Drop the weight by 20-30% and reduce total sets. This maintains movement patterns and muscle activation while allowing irritated tissues to calm down. You're not losing gains in 2-3 weeks. You're preventing a much longer layoff.

When Shoulder Pain Needs Professional Evaluation

Some shoulder pain responds quickly to rest, modification, and targeted exercises. Other shoulder problems need professional assessment. Seek evaluation if you experience:

• Pain that doesn't improve after 2 weeks of modified training

• Significant weakness when lifting your arm

• Night pain that disrupts sleep

• Sharp, catching, or popping sensations in the shoulder

• Pain that radiates down your arm

• Inability to reach overhead without pain
  

At Nashville Physical Therapy & Performance, we specialize in helping active adults resolve shoulder pain and return to full training. A comprehensive shoulder assessment identifies the specific structures involved, movement dysfunctions contributing to pain, and strength imbalances that need correction.

Shoulder Pain When Lifting? A Physical Therapist's Guide to Safe Spring Training: Getting Back to Full Training

Shoulder pain doesn't have to end your spring training goals. With early recognition, smart modifications, and targeted rehab exercises, most lifters can resolve shoulder issues within 2-4 weeks and return to full training stronger than before.

The key is respecting the signals your body gives you, addressing the root causes rather than just symptoms, and building a more balanced training program that keeps your shoulders healthy long-term.

Dealing with shoulder pain that won't resolve? Schedule an evaluation at Nashville Physical Therapy & Performance. We'll identify exactly what's causing your shoulder pain, create a personalized rehab plan, and get you back to lifting pain-free. Call us at 615-428-9213 or book online at nashvillept.com.

References

[^1]: Seitz AL, McClure PW, Finucane S, et al. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Journal of Shoulder and Elbow Surgery. 2011;20(3):379-390.