Pain with Bench Press: Locations, Symptoms, Causes
Pain during the bench press is a common issue for gym-goers, whether beginners or experienced lifters. While pain or other symptoms may be localized to a specific area—such as the shoulders, wrists, or chest—it’s crucial to understand why the symptom or injury presented there. Pain often arises from a combination of factors, including muscle imbalances, poor movement mechanics, and mobility restrictions. Addressing only the site of pain without considering these underlying contributors may lead to recurring issues. Physical therapy plays a vital role in diagnosing the root cause and developing a targeted treatment plan to restore pain-free bench pressing safely and effectively.
Common Pain Locations During Bench Press and Their Symptoms
1. Pain at the Front of the Shoulder (Anterior Shoulder Pain)
The front of the shoulder is a common location for pain during the bench press. This pain is often associated with shoulder impingement syndrome or rotator cuff tendonitis. It may also be the result of bench press technique, particularly when the elbows are flared out at an extreme angle, or rapid increase in horizontal pressing exercise volume.
Symptoms:
Sharp or dull pain in the front of the shoulder, often felt during the lowering phase of the bench press.
Pain that worsens with overhead movements or arm raises.
Clicking or popping sensations in the shoulder.
Common Causes:
Rotator Cuff Weakness: The rotator cuff is a group of four muscles responsible for stabilizing the shoulder joint during movement. When these muscles are weak or underactive, they struggle to keep the humeral head (upper arm bone) centered within the shoulder socket. This lack of stability can lead to excessive movement in the joint, increasing the risk of irritation, impingement, and even long-term overuse injuries such as tendinopathy. During the bench press, inadequate rotator cuff strength can cause the shoulder to shift forward excessively, placing strain on the anterior structures of the joint and potentially leading to pain or dysfunction. Strengthening the rotator cuff with targeted exercises, such as external rotations and scapular control drills, can help reinforce shoulder stability and reduce stress on surrounding tissues.
Impaired Movement Patterns: The way an individual performs the bench press significantly impacts the amount of stress placed on the shoulder joint. One common faulty movement pattern is excessive elbow flaring, where the elbows move out too far from the body (closer to 90 degrees) rather than staying at a more optimal angle of around 45 to 75 degrees. This flared position increases strain on the shoulder joint by altering force distribution, placing more stress on the anterior shoulder capsule and rotator cuff tendons. Additionally, improper scapular positioning—such as failing to retract and depress the shoulder blades—can lead to inefficient force transfer and increase instability in the press. Addressing movement patterns through coaching, mobility work, and muscle activation drills can help optimize pressing mechanics and reduce injury risk.
Subacromial Impingement: Shoulder impingement occurs when the rotator cuff tendons or subacromial bursa become compressed, leading to irritation and pain, especially during pressing movements like the bench press. Poor scapular control, weak rotator cuff muscles, and excessive internal rotation of the shoulder can contribute to this issue. Overuse and a rapid increase in horizontal pressing volume can also overload the shoulder structures, leading to inflammation and reduced joint space. Lifters may experience pain at the front or top of the shoulder, particularly during the lowering phase of the bench press. Addressing impingement involves improving scapular positioning, strengthening the rotator cuff, and modifying training volume to allow for proper recovery. A well-structured rehabilitation program can help restore pain-free bench pressing by optimizing movement mechanics and shoulder stability.
How Physical Therapy Can Help: A physical therapist will assess your shoulder mobility, strength, and movement patterns. Through targeted exercises, PT can help strengthen the rotator cuff muscles, improve shoulder stability, and teach proper muscle activation patterns during bench press to avoid impingement.
2. Pain at the Elbow (Medial or Lateral Elbow Pain)
Elbow pain, particularly on the inside (medial epicondylitis or “golfer’s elbow”) or outside (lateral epicondylitis or “tennis elbow”), is another common complaint during bench press exercises. This type of pain may result from overuse, muscle imbalances, or poor technique.
Symptoms:
Tenderness or sharp pain on the inside or outside of the elbow.
Pain that increases with pressing or pushing motions.
Swelling and warmth around the elbow joint.
Common Causes:
Triceps Tendonitis: Repetitive stress on the triceps during the bench press can lead to irritation and inflammation of the tendon, often resulting from excessive volume, poor recovery, or improper technique. Weakness or imbalance in the surrounding muscles can force the triceps to overcompensate, increasing strain on the tendon. Pain is typically felt near the back of the elbow, especially during the lockout phase of the press.
Overuse of Forearm Muscles: Constant gripping and improper wrist positioning can overload the forearm muscles, leading to discomfort and strain at the elbow. This is particularly common when lifters rely too much on their grip strength to stabilize the bar, rather than properly engaging the shoulders and upper back. Over time, repetitive stress can lead to conditions such as medial or lateral epicondylitis (golfer’s or tennis elbow), making pressing movements painful.
How Physical Therapy Can Help: Physical therapy for elbow pain focuses on strengthening the muscles around the elbow, including the forearms and triceps, to prevent overuse injuries. Stretching and strengthening exercises can help reduce the load on the tendons. PT may also incorporate modalities such as ice or heat therapy to reduce inflammation.
3. Pain at the Wrist (Wrist Flexor or Extensor Pain)
Wrist pain is common when the wrists are held in an improper position during the bench press, often resulting from hyperextension or excessive flexion. This can place strain on the wrist joint and the associated tendons.
Symptoms:
Pain along the front (flexor side) or back (extensor side) of the wrist.
Numbness or tingling sensations in the fingers.
Pain that is aggravated by weight-bearing or gripping motions.
Common Causes:
Wrist Hyperextension: Excessive backward bending of the wrist during the bench press places undue stress on the wrist flexors, leading to pain and potential overuse injuries. Poor bar positioning and lack of wrist control can exacerbate this issue, making it important to maintain a neutral wrist position throughout the lift.
Carpal Tunnel Syndrome: Repeated compression of the median nerve from excessive wrist flexion or prolonged pressure can contribute to carpal tunnel syndrome. Symptoms such as numbness, tingling, and weakness in the hand may develop, impacting grip strength and overall pressing ability. Proper wrist positioning and grip width adjustments can help reduce nerve compression.
Weak Forearms: Insufficient strength in the muscles that stabilize the wrist can lead to difficulty maintaining proper wrist alignment under heavy loads. This instability increases the risk of wrist discomfort and fatigue, ultimately affecting pressing performance. Strengthening the forearm flexors and extensors can improve control and endurance, reducing strain during the bench press.
How Physical Therapy Can Help: PT can help by teaching proper wrist positioning during the bench press and offering strengthening exercises for the forearm muscles. Wrist mobility drills and stretches will improve flexibility and help prevent strain. If necessary, PT may use modalities like splinting to support the wrist during the healing process.
4. Pain at the Upper Back or Neck (Cervical Spine or Thoracic Spine Pain)
Upper back or neck pain can develop during the bench press, especially if the lifter has an improper posture, such as excessive arching in the lower back or poor head positioning. This pain can also stem from muscle strain, tension, or poor scapular control.
Symptoms:
Dull, aching pain in the upper back or neck area.
Tightness or stiffness in the upper back, neck, or shoulders.
Pain that increases with overhead or lifting movements.
Common Causes:
Poor Posture and Overarching: Excessive arching of the lower back during the bench press can shift tension to the upper back and neck, leading to discomfort and strain. While some arching is natural, an exaggerated position may cause compensatory muscle tightness and increased stress on the spine. Proper core engagement and positioning can help maintain a stable and pain-free bench press setup.
Scapular Dyskinesis: Inefficient movement or lack of control over the shoulder blades can lead to improper loading of the upper back and neck. If the scapulae do not retract and stabilize effectively, the surrounding muscles must compensate, increasing the risk of pain or fatigue. Strengthening scapular stabilizers and improving movement coordination can enhance shoulder mechanics and reduce strain.
Weakness of Upper Back Muscles: The upper back plays a key role in supporting the shoulders and maintaining proper posture during the bench press. Weakness in muscles like the rhomboids, traps, and rear delts can lead to instability, poor control, and excessive strain on the neck and shoulders. Strengthening these muscles can
improve positioning and reduce compensatory stress on other areas.
How Physical Therapy Can Help:A physical therapist will work on correcting posture and improving core stability. Strengthening the upper back and neck muscles can help stabilize the shoulder blades and prevent excessive arching. Scapular stabilization exercises will also be incorporated to improve overall shoulder mechanics during pressing movements.
Evidence-Based Treatment for Pain During the Bench Press
Physical therapy (PT) is an essential component in diagnosing and addressing pain during the bench press. By taking a holistic and evidence-backed approach, physical therapists can identify the root causes of pain and provide targeted interventions to alleviate discomfort while helping individuals safely return to their bench press routine. Research supports the value of comprehensive assessments, tailored exercises, manual therapy, and progressive return-to-activity strategies in reducing pain and promoting optimal performance.
1. Comprehensive Evaluation and Diagnosis
A thorough evaluation is critical in identifying the source of pain during the bench press. The physical therapist will begin by taking a detailed history of the symptoms, including when the pain occurs, its intensity, and any potential contributing factors such as overuse, previous injuries, or poor posture. Movement assessments allow the therapist to evaluate your technique, looking for any biomechanical inefficiencies, such as improper shoulder positioning or excessive lumbar arching. Additionally, strength testing can be employed to assess muscle weakness, especially in areas like the rotator cuff, upper back, and triceps, which are essential for optimal performance during the bench press.
Scientific evidence highlights the importance of objective measurement in diagnosing musculoskeletal conditions. For example, a study by Pescatello et al. (2015) emphasized that strength testing, such as isometric and dynamic resistance tests, can help pinpoint weaknesses in muscles involved in pressing motions. A physical therapist will use these tests to identify muscle imbalances or instability in key areas like the shoulder, elbow, and upper back, which can be contributing to pain during the bench press. By providing a baseline, the therapist can develop a more targeted and individualized treatment plan that specifically addresses your needs.
2. Customized Treatment Plan
After the evaluation, a customized treatment plan will be created, addressing the identified causes of pain. Treatment may involve a combination of strengthening exercises, mobility work, and posture correction to address muscle imbalances, movement dysfunctions, and joint stiffness. For example, strengthening the rotator cuff, upper back, and triceps can help stabilize the shoulder and improve bench press mechanics. According to Cools et al. (2014), strengthening the rotator cuff can increase shoulder stability and reduce the likelihood of injury during pressing motions.
Mobility work will focus on improving shoulder, wrist, and thoracic spine flexibility. Many lifters struggle with limited shoulder mobility or thoracic spine stiffness, which can affect their bench press form and increase the risk of injury. Mobilizing these areas, especially the shoulder capsule and thoracic spine, can improve movement patterns and reduce strain on the shoulder and elbow joints. Evidence suggests that incorporating mobility exercises into rehabilitation programs can lead to better functional outcomes and enhance performance (Behm et al., 2011).
Posture correction, particularly addressing excessive arching in the lower back or improper shoulder positioning, is another important aspect of treatment. A study by Kibler (2009) demonstrated that poor posture and improper movement patterns could lead to compensatory tension in other areas of the body, including the neck, shoulders, and upper back. A physical therapist will work with you to retrain your posture and movement patterns during the bench press, ensuring that you maintain optimal alignment throughout the lift.
3. Manual Therapy and Modalities
Physical therapists may also utilize hands-on techniques, such as manual therapy, to alleviate pain and restore joint mobility. This can include soft tissue mobilization, myofascial release, and joint mobilizations aimed at reducing stiffness and improving range of motion. These techniques can help release tight muscles and fascia that may be contributing to discomfort during the bench press. For example, manual therapy techniques applied to the thoracic spine or shoulder joint can improve mobility and facilitate better movement patterns during the lift (Huang et al., 2014).
Additionally, modalities such as ice, heat, ultrasound, or electrical stimulation can be used to alleviate inflammation and promote healing. Research supports the use of ice for reducing acute inflammation and heat for relaxing tight muscles (Hill et al., 2008). Ultrasound and electrical stimulation are also beneficial in promoting tissue healing and reducing pain, especially in cases of muscle tendonitis or soft tissue injury.
4. Strength Testing and Objective Measurement
To guide the rehabilitation process effectively, strength testing is an essential tool for measuring progress and adjusting the treatment plan. Objective assessments, such as isometric strength testing or manual muscle testing, can help determine which muscles are weak or underactive. For instance, if rotator cuff weakness is identified during the evaluation, the therapist may use resistance testing to measure strength deficits and track improvements over time.
A key advantage of objective testing is that it provides a benchmark for recovery, allowing the therapist to make data-driven decisions regarding progression and exercise prescription. According to a systematic review by O'Connor et al. (2012), strength testing not only helps in diagnosing muscle imbalances but also ensures that strength gains are targeted appropriately to enhance performance and prevent injury.
5. Return-to-Activity Progression
Once the patient’s symptoms improve, PT shifts toward a return-to-activity strategy. This involves gradually reintroducing the bench press and other upper body exercises while monitoring for any signs of pain or discomfort. The physical therapist will use strength testing and functional assessments to track progress and ensure that the patient is prepared for the demands of bench pressing. A progressive approach, starting with lighter weights or modified movements, allows the body to adapt to increased stress in a controlled manner, minimizing the risk of reinjury.
Evidence from rehabilitation literature supports a step-by-step progression when returning to high-demand activities like the bench press. According to the American College of Sports Medicine (2013), an incremental approach to load management, combined with proper technique, is crucial for safely returning to exercise after injury. The physical therapist will continue to monitor strength, mobility, and movement patterns throughout this phase, adjusting the treatment plan as needed to ensure a successful return to lifting.
Conclusion
Pain during the bench press is a multifactorial issue that often stems from muscle weakness, impaired movement patterns, poor posture, and limited mobility. Physical therapy plays a vital role in diagnosing these issues and creating a tailored treatment plan that addresses the root causes of pain. Evidence-based interventions, such as strengthening exercises, manual therapy, mobility work, and movement pattern correction, have been shown to reduce pain and improve performance. Furthermore, strength testing and objective measurement provide valuable data to guide treatment and ensure safe progression during recovery.
By working with a physical therapist, individuals can correct muscle imbalances, improve their lifting technique, and ultimately return to the bench press safely and without pain. Whether you're a beginner or an experienced lifter, physical therapy offers the expertise and tools necessary to resolve bench press-related pain and improve overall performance.
Ready to get back to pain-free bench pressing? Book a call with one of our expert physical therapists today to start your personalized treatment plan and improve your lifting technique!
References:
Behm, D. G., & Sale, D. G. (2011). Velocity specificity of resistance training. Sports Medicine, 41(6), 289-302.
Cools, A. M., & Roussel, N. (2014). Shoulder rehabilitation: A systematic review of rehabilitation strategies for the management of shoulder injuries. British Journal of Sports Medicine, 48(7), 542-551.
Hill, L., MacDonald, M., & Murphy, S. (2008). A randomized trial of ice and heat for acute muscle injuries. Journal of Sport Rehabilitation, 17(4), 471-479.
Huang, H., & Liao, C. (2014). Effects of manual therapy on shoulder pain and dysfunction. Journal of Orthopaedic & Sports Physical Therapy, 44(12), 987-994.
Kibler, W. B. (2009). Shoulder rehabilitation for athletes. American Journal of Sports Medicine, 37(5), 981-988.
O'Connor, M. C., Goh, W. T., & Kuilboer, M. (2012). The role of strength testing in rehabilitation. Physical Therapy in Sport, 13(2), 62-70.
Pescatello, L. S., & Buchner, D. M. (2015). The role of strength training in injury prevention. American Journal of Lifestyle Medicine, 9(1), 1-11.