Activity modification for lifters with upper limb pain

One of the most common complaints among weightlifters and gym-goers is pain in the upper limb, particularly the shoulder. However, it’s important to recognize that pain can also arise in the elbow and wrist, affecting performance and comfort during training. In this blog, we’ll break down common upper limb injuries in lifters, how to manage them, and exercise modifications that can help you continue training with reduced discomfort.

Shoulder Pain in Lifters

The shoulder is a complex joint and prone to various injuries, especially during pressing exercises like bench press, shoulder press, and dips. Some of the most frequent shoulder conditions seen in weightlifters include:

• Rotator Cuff Injuries: Often caused by overuse acute tears during high force movement.

• Bicep Tendinopathy: Pain along the upper arm, often related to pulling movements.

• AC Joint Pain: Common with overhead exercises.

• Pec Tendinopathy: Usually linked to pressing exercises like the bench press or chest flys.

• Osteoarthritis (AC or Glenohumeral Joint): This can develop over time and is often exacerbated by heavy lifting.

Problematic Exercises and Modifications: Exercises that typically irritate shoulder discomfort include bench presses, push-ups, dips, and front/side raises and overhead press. A few modifications that may help include:

• Replacing straight bar squats with safety bar squats or using machines like the leg press.

• Floor press instead of bench of barbell press.

• Adjusting the grip for shoulder raises, shifting to a thumbs-up position.

• Focusing on low rows rather than high rows such as face-pulls to limit ROM used by the shoulder.

• Perform neutral overhead press

• Perform banded or landmine overhead press to reduce ROM needed.

Elbow Pain in Lifters

Elbow pain in lifters often manifests as lateral or medial epicondalgia, more commonly known as tennis or golfer’s elbow. This pain can stem from repetitive movements during heavy lifting or can be referred pain from the neck or shoulder.

Problematic Exercises and Modifications: Exercises like triceps extensions and skull crushers can exacerbate elbow pain, especially if performed early in a workout. It’s also important to pay attention to how heavy pressing and barbell squatting can overload the elbow joint. Here are some tips:

• Perform triceps exercises later in the workout to warm up the muscles first.

• Switch to cable exercises or resistance tubing to reduce strain on the elbows.

• Perform front/ lateral raises using a cuff or band around the forearm to take the load off of the wrist extensors.

• Focus on mobility, particularly in the chest and thoracic spine, to alleviate pressure on the elbows during squats.

Wrist Pain in Lifters

Wrist pain is less common but can be an issue, particularly in Olympic lifting, CrossFit, or during front squats and pushups. This discomfort is often due to excessive wrist extension or poor wrist positioning during weight-bearing exercises.

Problematic Exercises and Modifications: For those experiencing wrist pain, exercises such as pushups and front squats may be particularly uncomfortable. Some alternatives include:

• Substituting barbell bench press with dumbbells or using a hex bar for a neutral grip.

• Performing pushes using pushup bars or hex dumbbells to allow for a more neutral wrist position.

• Use a cross arm technique for front squat instead of the front rack position

Key Takeaways

Upper limb pain doesn’t mean you need to stop lifting altogether. By making the appropriate modifications to your workout, you can continue training while managing pain. Always listen to your body and work with a physiotherapist to develop a tailored program that addresses your specific needs.

If you’re looking for more in-depth guidance on upper limb conditions and exercises, check out resources like the Sporting Hand and Wrist Masterclass by Ian Gatt, which provides valuable insight into the management of hand and wrist pain in athletes.

With the right adjustments and knowledge, you can stay active and healthy despite occasional upper limb pain. Remember that pain management, mobility work, and proper exercise technique are key to long-term success in your fitness journey!