AC Joint Pain from Benching

[Kirl]

Good afternoon doctors,

I am 22 years old and have been lifting weights relatively pain-free since 15. In May I was in a phase of desperately trying to increase my benchpress. I was benching to multiple sets of failure at least three times a week. Though my body felt fine, I suppose was overtraining that movement. One morning after a hard session on the bench press the day before, I woke up with very acute AC Joint pain. I took a week off of training my upper body and it seemed that the pain had subsided. I loaded the bar with only 135 to warm up and it felt like my ac joint was rubbing together like a rusty door hinge. It swelled up like crazy again and I took another week off training my upper body. Then, this summer I had the opportunity to train really hard with a group of guys who were doing more CrossFit type workouts paired with lots of endurance training. This meant no more benching. I found that I had zero pain while doing shoulder press and only slight pain while doing pushups. In our workouts, we would do hundreds of pushups. I felt fine during this summer of hard training, but my AC joint never really got better. Since December, I have stopped doing pushups or dips to let it heal, but I still can't bench. in fact, if I'm laying down I can't even push my arm up vertically without that sharp pain. Amazingly, the shoulder press still does not hurt at all. Is there anything you guys would recommend to help me get back to benching without ac joint pain?

[Derek Miles]

Kirl,

I'm going to take this in segments from your original post and make some general comments regarding training as there appears to be some themes which may have gotten you in this situation.

In May I was in a phase of desperately trying to increase my benchpress. I was benching to multiple sets of failure at least three times a week.

Typically whenever the words "desperately" and "increase" are in the same sentence, that is problematic. It is likely safe to say that you were overtraining the movement as you were taking multiple sets to failure. If you are familiar with our content at all, that is not something we recommend for either long term health or long term gains.

I took a week off of training my upper body and it seemed that the pain had subsided. I loaded the bar with only 135 to warm up and it felt like my ac joint was rubbing together like a rusty door hinge.

While pain does not always equal injury, feeling good does not always equal ready to go when coming back from an injury. If you did elicit some symptoms to your AC joint, you likely would have needed a little more than a week before being ready to push again. The analogy I will typically use here is if someone punched you in the arm as hard as they could, you would likely still have a bruise a week later. Just because you can't see the bruise, that doesn't mean there is not still some healing going on. If it did swell afterwards, that is a pretty good sign that you pushed beyond capacity and you may need to work around the issue for a little bit before going back to benching. This gets back to the paradox of training desire, the more we want very specific results, the harder they typically are to obtain.

Then, this summer I had the opportunity to train really hard with a group of guys who were doing more CrossFit type workouts paired with lots of endurance training

We're back to the really hard theme here. Training to failure on a regular basis is not recommended. Healing often involves building up some capacity by working around an injury as much as just trying to push through. In the same regard, absolute rest is rarely indicated. There are things that would likely help you get back to benching, but in this instance I think you need to work with a professional to help guide you through some of this. If this has been going on for almost 10 months it likely needs a little more of a guided path than very general recommendations.

[Kirl]

I appreciate the response, Derek. You are correct that the programming (or lack thereof) that led to injuring my shoulder is against the training ideology of Barbell Medicine. Unfortunately, I found out about you guys after my injury.

That's a really good analogy. Up to this point in my life pretty much all of my minor injuries healed in a matter of days or weeks, and as a wrestler, I'm somewhat used to pushing through pain. But I have come to realize AC joint problems are usually longer recoveries.

When you say "a more guided path" are you recommending that I see a doctor in person? Just trying to clarify.

Also out of curiosity what are the general recommendations? I read a different post of a guy with a similar issue except I think his problem was worse since he also had pain in the shoulder press. He was told to pin press at a height that doesn't cause pain and slowly decrease the height of the pins.

[Derek Miles]

For the general recommendations, starting by modifying range of motion is a good start. We often will begin with a pin press through the symptoms limited range of motion. It typically gives two variables from which progress can be had in that weight. can increase through the restricted range, or range can increase with less symptoms. The trick here is not trying to do both at once. In terms of addressing the issue the differential here would also likely include some biceps involvement. If that is the case I will also often supplement with either some preacher curls or concentration curls under the typical tendinopathy guidance shooting for 3-4 sets of 8 at RPE 7/8 at 3-0-3 tempo. Once again, if this has been going on for a while it is as much about finding that entry point and titrating back accordingly. When I say a more guided path, I don't think reaching out to one of us at pain and rehab is a bad idea for programming as there is a bit of a history of out kicking coverage. Sometimes our roles in the rehab process is just serving as a governor as people return to prior levels, but often that is exactly what we need to be. There is no hard and fast rule on the last recommendation but people often tolerate changes in grip width as a means of allowing reintroduction of bench as well. For some people it is narrow and others wider, but either way, if you find you tolerate one of these positions better, stick with that one. As with the pin press, the goal is to slowly work back to normal range and weights.

[Kirl]

A more narrow grip with my lats engaged is definitely the best way that I've found, although I've read about some guys doing reverse grip bench after AC Joint injuries which I may start to incorporate.

I will definitely start doing your curls protocol immediately.

If my ability to bench doesn't increase in the next month or so I will definitely fill out the questionnaire for a pain and rehab consultation since I've only really been listening to my body and decreasing my volume in that range of motion since December. It has been bothering me since May, but during that time, while I wasn't benching, I was doing a high volume of pushups and weighted pushups which probably hindered the ability for it to heal.

Thanks for all the amazing information, I only wish I knew about this website sooner.