Ever have a persistent ache in the shoulder with certain exercises in the gym?  I am talking about a nagging pain along the top or end of the shoulder with bench press, flies, dips, military press or even pull-ups?

Well, one of my staff members has just this type of pain.  He first asked me to look at his shoulder about 6 weeks ago.  I felt there was nothing substantially wrong with the rotator cuff or labrum and recommended he work on rotator cuff and scapular strengthening while backing off the heavy strength training (he is a natural body builder preparing for a show).

He told me about 2 weeks ago that it was still not better.  He complained of more site specific pain along the AC joint.  There was no obvious subluxation present but he was tender right along the end of the clavicle.  I suggested he see a shoulder specialist I know.

The AC joint below (joined by ligaments not visible on x-ray)

ac_joint2

His MRI results revealed a micro fracture of the distal clavicle.  Doc says he can continue to train but needs to back off the weight on bench press and avoid pull-ups.  I also suggested he skip dips and he has been now for some time.  So, what caused it?  Good question as he only recalled pain when doing flies during a workout a few months back. 

Could this have caused it?  Maybe.  Pulling the arm across or toward the mid line of the body brings the clavicle into close approximation with the acromion of the shoulder.  There may have been a loading moment (especially with heavy dumbbells) where he strained the joint.  Or, perhaps it was the result of repetitive micro-trauma as the result of lots of heavy chest work.

Regardless, the take away points here are:

  • Repetitive upper body lifts (especially those requiring lots of clavicle spinning, elevation and rotation like pressing, dips, pull-ups, and upright rows) may cause stress to the AC joint. 
  • Flies do cause approximation and in people with any AC joint arthritis mild compression of the AC joint as the arm comes toward mid line
  • Chest movements are likely to affect pain as the pecs attach directly to the clavicle
  • Obscure chronic shoulder pain may be related to AC joint irritation that does not show up on an X-ray
  • Shoulder pain with lifting may be related to AC joint pain rather than rotator cuff dysfunction in some cases

As a general rule, I caution all my clients over the age of 35 to go easy on the dips for sure as I find this one exercise more than any other tends to flare up an arthritic AC joint fast.  That is the double edged sword of strength training – repetition is necessary to get results but the repetitive nature is capable of taking good exercises and wreaking havoc on the body long term.  Form matters as does avoiding harmful range of motion with lifting.

In the end, let your shoulder guide your decision making in the gym.  In my staff member’s case, he will be fine and recover 100%, although he will likely have to modify his lifting and endure some pain as he pushes on toward his competition.