Shoulder Pain When Lifting: Impingement, Rotator Cuff Problems, and How to Keep Training
A pinch at the front of the shoulder on bench press, an ache when you lift your arm overhead, pain lying on that side at night — shoulder pain is one of the most common reasons people stop training. Here is what is usually going on, why scans and surgery are less useful than people think, the exercises that help, and how to keep training around it.
By Taha Raza
Published
Shoulder pain often starts quietly: a twinge on the last rep of bench press, then a dull ache when reaching for a high shelf, then pain lying on that side at night. Many people either push through until they can't lift, or stop training completely and wait. Neither works well. The shoulder usually needs load — just the right kind.
What is shoulder impingement?
'Impingement' is the old name for pain at the top and front of the shoulder when lifting the arm, especially between shoulder and head height. The idea was that a tendon gets pinched under a bone. Clinicians now usually call it subacromial pain or rotator cuff related shoulder pain, because the problem is mostly an irritated, overloaded tendon rather than a bone pressing on it — which is why strengthening works and shaving bone does not.
Do you need a scan or surgery?
Usually not at first. A 2014 pooled analysis in the Journal of Shoulder and Elbow Surgery found rotator cuff abnormalities in people with no shoulder symptoms rose from 9.7 percent at age 20 or younger to 62 percent at 80 or older. An MRI report of 'tendinopathy' or a 'partial tear' is very often normal ageing, not the cause of your pain.
| Treatment | Evidence | Result |
|---|---|---|
| Decompression surgery | CSAW, The Lancet 2018 (313 patients) | No clinically important difference versus placebo (arthroscopy only) |
| Decompression surgery | FIMPACT, BMJ 2018 (210 patients, 24 months) | No clinically relevant difference versus placebo surgery |
| Exercise therapy | Steuri 2017 meta-analysis, BJSM | Reduced pain more than non-exercise treatments; specific exercises beat general ones |
| Steroid injection | Same meta-analysis | Better than nothing in the short term; ultrasound-guided better than blind |
| Anti-inflammatory tablets | Same meta-analysis | Small to moderate benefit over placebo |
Surgery still has a place — for full-thickness tears after an injury, dislocations and some other conditions — but for the common gym-goer's sore shoulder, a structured exercise programme should come first.
Which lifts to change
| If this hurts | Try this instead |
|---|---|
| Flat bench press with a wide grip | Narrower grip, elbows about 45° from the body, or dumbbells with palms facing each other |
| Overhead barbell press | Landmine press or a slight incline dumbbell press; press in front, not behind the head |
| Behind-the-neck press or pulldown | Drop it — pull and press in front of the face |
| Dips | Leave out for now; use close-grip push-ups or pushdowns |
| Upright row with a narrow grip | Wider grip to chest height only, or cable lateral raises |
| Lateral raises to above shoulder height | Raise slightly in front of the body (scaption) and stop at shoulder height |
Pulling exercises — rows, face pulls, pulldowns to the chest — are usually comfortable and help, so keep them in. A useful rule from rehabilitation: pain during exercise up to about 3 out of 10 is acceptable if it settles within a few hours and is no worse the next morning.
Shoulder rehab exercises
| Exercise | Sets × reps | Notes |
|---|---|---|
| Isometric external rotation against a wall or door frame | 5 × 30–45 s holds | Useful when movement is very painful |
| Band or cable external rotation, elbow at your side | 3 × 12–15 | Slow; a towel under the elbow helps |
| Side-lying dumbbell external rotation | 3 × 12–15 | Light — 1–3 kg is plenty at first |
| Scaption raise (thumbs up, 30° in front) | 3 × 10–12 | Only to shoulder height, light weight |
| Face pull or band pull-apart | 3 × 15 | Squeeze shoulder blades together |
| Chest-supported or cable row | 3 × 10–12 | Keep shoulders down, away from ears |
| Push-up plus (extra push at the top) | 2–3 × 10 | Strengthens the serratus muscle around the shoulder blade |
Add weight or reps every week or two as the pain allows. Most people notice improvement within 4–6 weeks; tendons need around 12 weeks of steady loading to really adapt. Meanwhile, keep training legs and pain-free upper-body movements so you don't lose the rest of your fitness.
When to see a doctor
- Urgently: shoulder or left arm pain with chest pain, breathlessness, sweating or nausea — this can be the heart. Call Rescue 1122 or go to an emergency department.
- Soon: you cannot lift the arm after a fall or a heavy lift, the shoulder dislocated or felt like it slipped out, or there is a visible deformity.
- Soon: pain with fever, unexplained weight loss, or a history of cancer.
- Soon: numbness, tingling or pain running down the arm — this can come from the neck.
- If there is no improvement after 6–12 weeks of consistent rehab, see a physiotherapist or orthopaedic specialist.
This article is general information, not medical advice. Get shoulder pain assessed by a doctor or physiotherapist, especially after an injury, and seek urgent care for shoulder or arm pain with chest pain or breathlessness.
Frequently Asked Questions
Should I stop working out if my shoulder hurts?
Usually not completely. Change the lifts that hurt, keep pain-free exercises and add shoulder rehab work. Pain up to about 3 out of 10 during exercise is acceptable if it settles by the next morning. Stop and get checked if pain is sharp, worsening or follows an injury.
What are the best exercises for shoulder impingement?
Rotator cuff external rotations with a band or light dumbbell, scaption raises to shoulder height, face pulls, rows and push-up plus, two or three times a week for 6–12 weeks. Specific shoulder exercises beat general exercise in a 2017 meta-analysis.
Is bench press bad for your shoulders?
No, but a wide grip with elbows flared out to 90° stresses the front of the shoulder. A narrower grip with elbows about 45° from the body, or dumbbells with palms facing in, is usually more comfortable.
Do I need surgery for shoulder impingement?
Usually not. Two placebo-controlled trials in 2018 found decompression surgery was no better than sham surgery. Exercise therapy should come first; surgery is for specific problems such as full-thickness tears after an injury.
How long does shoulder impingement take to heal?
Many people feel better within 4–6 weeks of consistent rehab exercise, and tendons adapt over about 12 weeks. Recovery is faster if you keep training around the pain instead of resting completely.
My MRI shows a partial rotator cuff tear — is that why it hurts?
Not necessarily. Rotator cuff changes are common in people with no pain at all — about 10 percent at age 20 and 62 percent over 80 in a pooled analysis. A doctor or physiotherapist will judge it alongside your symptoms and examination.
Sources
- Steuri R et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. British Journal of Sports Medicine, 2017
- Beard DJ et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 2018
- Paavola M et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial (FIMPACT). BMJ, 2018
- Teunis T et al. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of Shoulder and Elbow Surgery, 2014
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