Episode 65: Still Can’t Bench Without Shoulder Pain? Here’s Why (And What to Do About It)

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss a range of topics, starting with a humorous take on a recent Coldplay concert incident that sparked a conversation about public behavior. They then transition into a more serious discussion on shoulder pain related to bench pressing, exploring assessment techniques, the importance of movement quality, and how to modify exercises for better performance and pain management. The episode concludes with insights on the technical aspects of bench pressing and the significance of individualized coaching and adjustments.

Takeaways

• Coldplay incident highlights public behavior and consequences.
• Understanding shoulder pain is crucial for athletes.
• Assessing range of motion is key in treatment.
• Pain and movement are complex and interrelated.
• Bench press technique requires careful attention.
• Modifications can alleviate pain during exercises.
• Individualized coaching improves performance.
• Trial and error is essential in finding solutions.
• Movement tools are necessary for effective training.
• Strengthening the rotator cuff is vital for shoulder health.

Chapters

• 0:00 Intro
• 4:20 Understanding Shoulder Pain and Bench Pressing
• 10:35 Range of Motion and Strength Considerations For The Bench Press
• 15:42 Technique and Coaching For Bench Press
• 20:32 Final Thoughts on Pain Management and Training

Transcript

Joe Gambino (00:00.842)
Welcome back in to another episode of the Beyond Pain podcast. am one of your hosts, Joe Gambino, and I am here with our other host, Joe Lavaca. You can find us both on Instagram, myself at joegambinodbt and Lavaca over there at TrentonMotion underscore PT. This podcast is on Instagram, Beyond Pain podcast and on YouTube, cupsofjoe underscore PT. Welcome back, Joe boy.

Joe LaVacca (00:24.252)
It is good to be back and I almost forgot to bring up something I wanted to ask you about and this has got to be on everybody's mind because it's buzzing. What about that astronomer CEO and HR chief of staff at the Coldplay? They got cold played. I've heard a new verb when you're exposed at a concert or exposed at the least likely time you ever expected. You got cold played.

Joe Gambino (00:38.828)
you

Joe Gambino (00:43.276)
Joe LaVacca (00:52.606)
Um, so yeah, he came out and he was like, you know, sort of like almost like pushing back a little bit, like, yeah, I did something wrong, but Coldplay shouldn't be pushing or putting people up on the Jumbotron, which is like one of the reasons you go to a concert or a game. You want to go up on the Jumbotron. And I remember last year when Courtney, uh, Avery and Addison came out, we took them to a Met game, right? Cause I just

I like Citi Field more than I like Yankee Stadium. It's so much easier for me to get to being out of Long Island than it is to work my way up to the Bronx. Whatever. Dire Yankee fan prefer to go to Met Games. This is what it is. So Avery was like, it was June and Addison's going to be here. She's already off from school. And Avery was like, hey, can I stay home from school tomorrow? Because Addison's here. And I was like, there's no real reason. You have like a half day or something. It's a couple hours. Addison's probably going to be sleeping.

And she's like, oh, come on. Like we want to hang out. don't get to see each other. You know, she played the card and I was like, you know, I'll tell you what you get on the jumbotron and you can stay home tomorrow. wouldn't you know it her, Addison Courtney got on the jumbotron twice. And I think it was my sleeve that made it both times. was like, what the hell? Like, so, you know, they were all excited. They were jumping around dancing. So

What are your thoughts? Does he have a case? Should we be blasting people up, their lives out there on Jumbotron? Should we be assuming they're married couples?

Joe Gambino (02:20.428)
I think if you are doing something like that and you go to a public venue where you know that cameras are there, it's kind of on you at that point, like, you know, make better, better decisions, you know? Yeah, yeah, yeah. I don't know if it's worse, but when I'm watching that, seeing the reaction, like, I don't, like, I understand, like, you feel guilty in the moment, but like, it looks so much worse when, you're just like, oh, let me duck.

Joe LaVacca (02:25.41)
Yeah. Correct. Fret row in your box too.

Joe LaVacca (02:36.803)
Yeah

Joe LaVacca (02:43.086)
Yeah, yeah. Honestly, like if they would have just waved and been like, Oh my God, hey, no one would have asked who they were. Like the affair would have been like completely fine, right? It would have just been like, Oh, look at them. They're so cute. All they had to do is wait. But the fact that their faces melt and his face he just like looked down and sort of melting, you know,

Joe Gambino (02:47.253)
Yeah.

Joe Gambino (02:55.553)
Yeah.

Joe Gambino (03:03.572)
You're probably like crawled on the floor to get somewhere. I was like, man, you just make it look so bad.

Joe LaVacca (03:06.574)
But yeah, I know, know that it's so funny and like honestly like but like you said like you're literally on the rail in your box like you're not like hugging in the back or you know, whatever like you're like front row like for some reason it was like not even anybody around them which I would expect at a Coldplay concert to be honest you lots of seats if you know what I mean.

Joe Gambino (03:21.163)
Mm-hmm.

Joe LaVacca (03:35.552)
I'm just kidding Chris, don't put my life on blast at all. yeah, no, no, really, really, really interesting. People's behaviors are very fascinating. We've talked about behavior. So a little segue for us. There's nothing connected to what we're talking about though. Yeah.

Joe Gambino (03:39.754)
All the Coldplay fans are out now. That's it.

Joe Gambino (03:50.06)
Yeah, a little little bit through our topic on shoulder pain and bench pressing. Perfect.

Joe LaVacca (03:57.486)
Yeah, I I just popped into my mind. I know we didn't talk about it, but yeah. So today we're going to talk a little bit about shoulder pain and bench pressing. When you're working with any group of active athletes with shoulder pain, they are doing some sort of press, whether it's a push up, a bench press, you name it. So why don't we start at the top? We have someone come in to see us. What are...

your first couple of assessments or things that you want to look at with people virtually, especially, that we can kind of talk about and discuss to maybe kind of dig a little deeper into why their shoulder is hurting when it comes to the bench press or these pressing type motions.

Joe Gambino (04:43.788)
Yeah, I think there's a couple of things. think it really kind of depends on symptoms and stuff like that. But typically the main things that I'm starting to look at is like, what are the motions that happen at the penpress? And the big ones are, know, have some, you know, horizontal abduction there. You do get into some extension. There's internal rotation, right? So I want to break down those things and see how those things are from a mobility perspective. Do any of those things recreate the symptoms? And then what happens when we add some load to them? Same thing, right? How well can those tissues tolerate load?

Joe LaVacca (05:02.606)
Mm-hmm.

Joe Gambino (05:13.228)
If all those things are clear, then it's likely just going to be some overtraining, so to speak. So, you know, then I'm going to look at the movement or load them in different ways to see what else might recreate their pain. know, little things like that, test the joint, the AC joint, little stuff around there. But the big ones I'm going to initially look at are going to be those like how well can they extend? How well can they internally rotate with the arm at 90 degrees?

of abduction there, so straight out to the side and then can they, you know, like even just reach back and load that tissue overall and then I may look up at the neck due to thing on their symptoms and stuff like that.

Joe LaVacca (05:52.679)
Yeah, I like that. The extension one is interesting, right? Because there's been so many times by just looking at extension asymmetry that I've been able to help someone problem solve their shoulder pain with the bench. And it seems sort of like innocuous and it's not something that immediately comes up, but, you know, breaking down these little pieces and then going into your test and retest is sort of like the process that we have.

the best process that we have from assessment and treatment standpoint, right? It's like, hey, we know pain is complex, we know movement is complex, this seems a little off. What happens if we gave you a better shoulder in this capacity? Does that allow you to express yourself in something very complicated like a bench press? So I think that the range of motion discussion, much like our discussion when we mentioned about programming and peaking and the 10 % rule,

Joe Gambino (06:21.042)
and

Joe Gambino (06:36.237)
and

Joe LaVacca (06:49.102)
Is there a range of motion asymmetry that you're looking for or that you have a hard cut off? And I know you can't measure like, you know, degree for degree virtually, but are you when you're eyeballing, you know, keeping a 10 % rule in mind of a difference, a 20 % rule in mind? Is it just like pain or what's your screening process?

Joe Gambino (06:50.124)
you

Joe Gambino (07:07.493)
Yeah, I mean if there's no pain I mean I'm probably not going to really I mean like maybe if I'm saying like okay like this person doesn't have a lot of internal rotation we're just gonna work on those things because that just to build a healthier shoulder overall and get them better tools for bench press and stuff like that. But yeah if someone has pain and then I'm also seeing these things and I'm start to address whatever whatever is being found there and even if it's not like

I know. I never really put like off. It's more than a 10 % difference on the look at it. You know, and I think it comes out to pre-test post-testing and, what happens when we start to do things and what happens to how they feel afterwards. And does that change the move quality or how well they can do something. Then most things start to really make sense. well, we worked on internal rotation and we were strengthening their end range for this. And we worked on some repeated motions into extension. And then all of a sudden they were able to get at the bottom of their bench with

95 pounds way better than before, right? Like, okay, well that's really great. Then this tissue should continue to work down to some capacity because in those adaptations will happen and we'll allow them to get at least start to even use the bench as the, as a rehab. So maybe you can bench 200, but now we can start, you can do 95 pounds now. Let's load that tissue. Maybe we can do some like one and a half reps and spend some more time at the bottom of that position or partial reps and really just focus on that eccentric portion, right? So we can load those tissues and hit them stronger.

Joe LaVacca (08:15.118)
Yeah.

Joe Gambino (08:31.731)
So I think it depends. And then obviously if you're messing with the shoulder, nothing happens. I mean, you can get a full open from the neck, right? So then you're going to, I want to go up and clear the neck and see if there's any nerve tension to see what's kind of going on up there. If any, again, when you do something, love test post testing, you know, sometimes you can do it maybe too much where you get in the client's head. But I was, always doing these tests to see, oh, okay, these things make things worse. These things make things feel better.

Joe LaVacca (08:51.534)
you

Joe Gambino (08:57.995)
And that starts to allow me to figure out, this is going to be plan of action for the movements that are going to be put to this plan. How are we going to back off training? What modifications are we going to make? Little things like that.

Joe LaVacca (09:09.363)
Yeah, think, yeah, no hard set in terms of like ratio difference of range of motion. know having taken similar courses, following similar people, you know, the 10%, 10 degree, maybe just sort of like idea always pops up.

I think for me, it's going to be a little bit more of is it someone like you and I who is recreationally lifting? Well, yeah, if you have a 10 % difference in your range of motion, it's maybe not as big of a deal. If you're more in the professional level where you're doing this over and over again or a competition level, hey, then maybe I want to give you a little bit more of a framework where I want that to button up a little bit only because you're going to be asking your shoulder to do a lot more than you and I asked our shoulder to do or just sort of like

You know, a person who works a nine to five job has a family, you know, just doing a couple of sets of push-pull during the course of the week. So I think there's a sort of a frame or a screen that I'll think about there is how nitpicky do I want to get with this person? But I always kind of put it on our little whiteboard and with the explanation of, Hey, look, this is a difference we're seeing side to side. This is a difference that we're seeing on the side. That's painful, right? You know, this could be a protection behavior, but if we can start to train this and you know,

Joe Gambino (10:21.343)
Mm-hmm.

Joe LaVacca (10:23.982)
put on the shelf, put it on the idea, along with that test and retest sort of like, hmm, screening process that we go through with everyone, either during a session or week to week or month to month. As this improves, does your shoulder pain improve? As this improves, does your numbers on the bench go back up? But I also find that one of the other big,

screens that I've thrown in, especially since taking the dynamometer course, is just sort of like a quick screen of external rotation strength or posterior shoulder strength. And when we look at some of these EMG studies, not that I live and die by these EMG studies, but it is helpful to know on certain movements which muscles are taking a little bit more force. And with a pressing motion, the posterior aspect of your rotator cuff or posterior aspect of your shoulder girdle,

is working a little bit harder than some of the front muscles. So we have to create that nice stable platform back there so that way we can exert force. It's sort of like those cannons shooting off of a big ship, right? The ship maybe being a scapula. So if we can assess that, oftentimes I'll find that even kind of helping people work through some of their posterior shoulder strength, but making it real.

Joe Gambino (11:37.791)
Mm-hmm.

Joe LaVacca (11:39.822)
So the simplest test is usually a side lying external rotation test. know, hey, I'll take maybe 5 % of their body weight. You know, something's pretty light. Go to that non painful side. Hey, give me as many reps as you can with this, you know, and maybe 5 % even is too much for some people. And then they're really like, oh my God, you know, I benched for us 350 pounds and I can't, you know, do a side lying external rotation with three pounds even on my good side, you know, because those muscles get get fatigued pretty quickly. So I have to do it on the right side. And then with that same weight, all right.

let's go after the left side. And more often than not, people are burning up, they're fatiguing way sooner. So again, like not to say that if we just magically fix that, all their pain will go away, but it does create that kind of buy-in of like, wow, I didn't know that was there. And then I'll often do that with like a, maybe even like a rear delt fly too, you know, just one arm at a time, same thing, like two to 5 % of body weight. Hey, just give me as many as you can on this side, stop when you feel burning or fatigue.

Joe Gambino (12:14.891)
Mm-hmm.

Joe LaVacca (12:38.592)
and then we're going to chase that on the other side. So is that like any like, again, virtually, I know it's probably going to be a little bit different depending on where your client is, but do you have them do any plank tests, grip tests or anything like that as part of this screen?

Joe Gambino (12:53.419)
Not I don't do grip I mean I don't have a down on you know like a way to test those things But you know I have done you know like I look at like okay, you know yeah, I can see you know You know I'm gonna go for the you know more scapular stuff I'm gonna look at quality of movement as far as overhead movement goes when they're moving the shoulder I like is there scapula doing what we would expect it to do I will do you know the sideline you know how I'm do load external rotation see

someone who has a shoulder issue. It was exactly what you described where like, we're like, okay, let's on his, he had limited extra rotation on that side. On the impaired side, he had a hard time reaching across his body. He some pain within his golf swing. And then when we actually just try to like load extra rotation, like, I think he could only do like five or six reps with like three pounds before his like shoulder was like super fatigued, right?

Joe LaVacca (13:31.768)
side.

Joe LaVacca (13:44.332)
Yeah, it's crazy.

Joe Gambino (13:47.176)
Okay, well like you know we started working on those those things so you know it just comes down We look at mobility. I look at strength. I look at you know how the scapula kind of works I'll look at some of the joints around it and then based off of all that stuff It's you know whatever pops up, and then you know sound like a record here You know it just comes down to what kind of things make like when we were doing those tests And we started doing like I started working on extra rotation with that with that person

All of sudden like reaching across the body got better. Yes, and pain up here, and friction, like all of sudden that got better. Like so you're seeing those things. We're not just blindly saying, oh, because we saw this with one person, well, now it goes to everybody. like, I want to be able to see that when we do this, there's a change. And sometimes you do get these people where you do everything or you test everything and there are no changes. And I think those people who are slower responders, and then you just start with process and see how that kind of goes and let time kind of dictate a little bit.

Joe LaVacca (14:14.733)
Yeah.

Joe Gambino (14:41.035)
But more often than not, you should see some sort of change with something and then I lean into that very, very heavily.

Joe LaVacca (14:47.874)
Yeah, yeah, absolutely. I think that, you know, we've said this before too, that people usually are not necessarily starting their journey with you and I. You know, they've seen a few other people, you know, maybe they have been working on their internal rotation, maybe they have been working on this like external rotation. And then I'm always fascinated by this question because then I'll typically just ask them, well, has anybody watched you bench? No, because my other PT office didn't have a...

Joe Gambino (15:10.411)
Mm-hmm.

Joe LaVacca (15:14.752)
a barbell, they didn't have a bench, they didn't have enough weight, they only had these dumbbells and these kettlebells and these bands, so I couldn't show them. So I think like with something like a squat, deadlift, and a bench press, as we are conditioning tissues, and whatever that means, know, working on mobility, you know, working on conditioning endurance, conditioning strength to some degree, the cool thing is that we don't necessarily need one specific marker to help people with shoulder pain get better.

And a lot of times these markers don't improve, but their shoulder pain improves, which is kind of cool. So then I think it's sort of at that point, hey, what about technique? And how do you coach technique when it comes to the bench press to help people out?

Joe Gambino (15:53.387)
Mm-hmm.

Joe Gambino (16:00.012)
Yeah. And another thing that people don't actually realize is that the bench press is probably arguably more technical than squat or deadlift. Right. It's, it's, it's, you know, people are like, Oh, squat and deadlift, know, they would think it needs the least, right. But it requires the most amount of technical work. And the way I do, mean, I people who just send me videos, right. I want to be able to see it mostly from the side so I can see the wrist position. Is it over the elbow? Like, you know, where their bar path is looking like, right. Is it going like towards their feet or a little bit towards your head or straight up?

Joe LaVacca (16:23.342)
Mm-hmm.

Joe Gambino (16:29.643)
You know, what Are they actually like pulling their scapulas into retraction? Are they getting some good spine extension in there? Right because the whole setup there is meant to give you as much like passive support as possible So you can create the strength through through the motion Which is why some of these power lifters you'll see that if they have the mobility, right? They're gonna take these huge arcs and They're gonna shorten their range of motion and it's gonna give them a lot of lot of benefit when they're trying to actually, you know be strong

Joe LaVacca (16:29.838)
you

Joe LaVacca (16:50.55)
Yep.

Joe Gambino (16:57.259)
So I'll take those things and then I talked about this and the episode we talked about technology But then I will have their video on my screen. I will have a Zoom recording going and I will have their video there and I'm gonna be walking them through This is what I'm seeing here. This is this is what we need to make change I only one or two changes every time I'm coaching somebody because if I gave somebody ten different cues there and this is the same thing in person They're not gonna be able to process it all. So I take the one that I feel is the biggest

Joe LaVacca (17:08.032)
I mean...

Joe LaVacca (17:16.238)
That's it? Yeah.

Joe Gambino (17:26.123)
We're going to work through that one and then make that change. So I definitely think getting your eyes on technique can make a big difference. And then also modifications. mean, like what happened a lot of times with people who struggle with the rotation, if you incline them, it's going to be easier on their shoulders. What happens when you bring up the dumbbells barbell and you're not in such a fixed path? That stuff will also give you information as far as like, okay, you can bring this stuff now or work through this stuff. So go get your training response.

Joe LaVacca (17:41.752)
Mm-hmm.

Joe Gambino (17:53.804)
And then we can start working on how can we start to kind of build it up and get you back to bench. And sometimes it's just playing around with grip. mean, like for me, for a while, bench press was bothering my neck and went to slightly wider grip and it felt like ridiculously better. Um, like, Oh, this is great. Um, so I think sometimes same thing with like the squat, right? Like we always talk about foot position, the same thing with bench, same thing with deadlifts. Like you can make these minor changes to, where your hand positions are and see how that feels as well to help you out.

Joe LaVacca (18:07.0)
Yeah.

Joe LaVacca (18:22.542)
Yeah, I think you definitely hit on a couple things there. people I think are always really fascinated by like, again, that like, shrap retracted spinal extended position, you know, because they're, you know, kind of thinking, I want to be flat, and I want to reach my way, you know, through my bench press. And I'm like, well, that's not going to really be a pretty powerful position for you or a position where you have a lot of leverage when you're putting that much weight on yourself. So there's a lot of aha moments when we go through technique.

Joe Gambino (18:34.879)
Mm-hmm.

Joe LaVacca (18:49.806)
risk position is always one of them too, because people are like always trying to keep their risks in neutral rather than letting them extend just a little bit. So we take all these ideas from other places that we're taught, especially in PT, and then we're trying to apply them in all of these joints and all these different positions, and they just don't work like that. So, you know, this is where I think having some of that knowledge in the powerlifting space that, hey, look, if you want to go wider, you can, you could also have one.

narrow one wider if your shoulder again feels more comfortable that way and we're talking about limitations and know extension or internal rotation right so yeah play with that and that's another thing people are like oh i thought my hands had to be in the same position i thought my feet had to be in the same position i thought this had to be in the same position i'm like no so you know you just give them permission to move and what feels more comfortable with those one or two techniques and if you don't get the result you're looking for then just go to the next one

Or what I've kind of done is just ask people of like, look, if we're seeing these couple of opportunities, which one do you makes the most sense? Which one do you think that you can easily correct? And then we'll just start from there. And whatever the client, know, well, I can definitely just open up my grip a little bit. Cool. Then you don't do everything exactly the same that you just did. Just open up your grip, see if that helps. And then if they're still struggling, that's when I'll say, all right, cool. You picked all these couple of things.

Joe Gambino (20:07.659)
Mm-hmm.

Joe LaVacca (20:14.094)
What I would have picked number one would probably have been that spinal position or that wrist position. So what if we come back and we just think about that one thing now, does that make a difference? And then maybe it's just trial and error, maybe it's just some more repetitions, but yeah, we can definitely obviously change the way force is moving through tissue. If we can change that, maybe we change some perception, we can lower some pain, and then that kind of starts these muscles coordinating again a little bit more. And that's really what we're looking for to then.

Joe Gambino (20:27.611)
Mm-hmm.

Joe Gambino (20:43.423)
Yeah.

Joe LaVacca (20:44.236)
You know, build them back.

Joe Gambino (20:45.955)
I think you know when we're looking you know we're both not very biomechanical, but we're looking at like Bench, squat, deadlift and performance right like biomechanics really matter because you want the path of least resistance you want to be able to to use forces appropriately and if you bring the bar too low or too high or the bar isn't going in that like J shape on the way up well then you're going to be working harder than you have to and that's going to limit the amount of weight that's actually going be put on the bar right so it becomes a very that's why it becomes very technical

Joe LaVacca (20:56.824)
Totally.

Joe Gambino (21:15.475)
right? but otherwise, you know, that's why we do this retracted position and we have the spine extended. Sure. It's not the most functional, right? But when your goal is that a bigger bench or to have no pain in the bench and, and move efficiently, we're not training for functioning, right? We're trying to be better at this exercise, right? And think those are two very, very different things. then you use your accessory work and your other training in your program to create that, right? Like, okay, well, we need to work on protraction. So with rows, that's a common place where I'll stick that.

is at the bottom of your row you're gonna let your shoulder get all the way into protraction so you can work through a full range of motion. I'm not gonna do that on the bench press, so to speak. So a couple nuances there.

Joe LaVacca (21:55.586)
Yeah, for sure, for sure. Well, I think that's a lot to take in, right? I mean, we talked about range of motion asymmetry. We talked about posterior shoulder work. We're talking about skill now. We have a couple of like really good guests, I think, coming up for the podcast that I think can maybe even lend more of an ear here in the coming weeks. So everyone stay tuned for that. We're pretty pumped about these guests.

Joe Gambino (22:11.829)
Mm-hmm.

Joe LaVacca (22:23.094)
Anything else that you think is a pearl of wisdom for people experiencing pain with the bench press, Mr. Gambino?

Joe Gambino (22:29.321)
No, I think we recapped it well and I think it just comes down to making sure that you have the movement tool to be able to do so, that you are working on the rotator cuff strength and making sure scapula has mobility as well and stability and that you're also making sure that you're modifying accordingly to make sure that you're not just constantly pissing off the tissue just because you want to be able to bench. I found a lot of success by just pulling something out and plugging something in this place that's not painful.

Joe LaVacca (22:54.606)
So.

Joe Gambino (22:56.573)
working on a couple of other things and then slowly reintegrating the movement you want to get back in. mean, that's, that's honestly what I think like 90 % of people miss. It's like that, that simple.

Joe LaVacca (23:05.174)
Yes, exactly man. Amen, amen. And then, you know, I always like to tell people if you're striking out and you can't press, just pull a little bit more and that's how I'll leave it. Any other things Mr. Gambino? All right, all right. Well, everyone, thank you again for joining us for another episode. Joe, we love you. Listeners, we love you. And don't forget to tune in next week where we keep pressing forward.

Joe Gambino (23:21.02)
Nope, take us home.

Joe LaVacca (23:35.191)
on the BeyondPaint podcast.

Joe Gambino (23:36.5)
I see what you did there, Joe.