yogabook / pathology / bench press shoulder

Definition of

Bench-press shoulder is an insertion stenopathy of the insertion tendon of the pectoralis minor and is most common in men aged around 30 who do sports such as weight training or bodybuilding. The coracoid process then tends to be painful on the medial side. Both the bench press and other exercises that demand strength from the muscle trigger the familiar pain. Bench presses target a variety of muscles, especially the frontal adductor and transverse adductor muscles:

1. Pectoralis major
2. Deltoid pars clavicularis
3. Coracobrachialis
4. Biceps brachii
5. Muscles of the rotator cuff
6. Muscles in the kinetic chain such as the triceps

If the bench press is performed intensively with high loads over a long period of time, several disorders can occur that are relevant to the differential diagnosis:

1. Tear of the rotator cuff
2. Subacromial impingement
3. AC-joint distortion (sprain: overstretching of the capsule/ligaments)
4. Distal clavicle osteolysis
5. Biceps tendinitis
6. Strain of the pectoralis major
7. Strain of the coracobrachialis
8. Labral tear (SLAP lesion)

In one study, tearing of the pectoralis major was the most common injury. Cases of triceps tears were mostly associated with previous use of anabolic steroids.

The actual bench press shoulder described above can be caused by technical errors when performing the bench press, for example if the force required to move the barbell back up is generated proportionally from the protraction of the shoulder blade, in which the pectoralis minor is involved. This is not least due to an insufficiently retracted shoulder blade, which would normally be held in position by the weight applied. As there are two other muscles attached to the coracoid process, the coracobrachialis and the biceps with its short head, these must be excluded as causes of pain by clinical testing, i.e. tests must be carried out for pain on extension in retroversion of the arm with(coracobrachialis) and without(biceps) a flexed arm and for pain on exertion in frontal abduction (biceps and coracobrachialis) and flexion of the elbow joint (biceps).

Tests for pain on extension during elevation of the scapula and pain on exertion during forceful depression of the scapula confirm the suspicion of an insertional tendinopathy of the pectoralis minor attachment tendon.

Cause

1. Overuse and technical faults: rudimentary protraction of the shoulder blade, swinging movements, especially lower swing reversal

Predisposing

– Musculoskeletal system

1. Scapular dyskinesia

Diagnosis

1. clinically with the above symptoms
2. Sono/MRI

Symptoms

1. Pain in the coracoid process during bench presses and other transverse adductions of the arm
2. Stretching pain on elevation of the shoulder blade
3. Strain pain with powerful depression of the shoulder blade
4. Pressure pain of the coracoid process

Complications

1. Chronification
2. Tendon rupture

Therapy

1. Elimination of the above-mentioned faults in technique, Omitting the reverse bounce
2. If necessary: reduce the training intensity

Asana practice and movement therapy

The predominant cause of bench press shoulder is probably the incorrect execution of the bench press, in which the shoulder blade is protracted when the barbell is pressed against gravity instead of remaining in the starting position. The protraction can overstrain one of the muscles involved, the pectoralis minor, which does not receive many training stimuli in most people’s everyday lives and is therefore unlikely to be very robust, as its most important movement dimension, the depression of the shoulder blade, is rarely subjected to strengthening activities in everyday life. Even in many sports, the depressors of the shoulder blades lack training stimuli. If this muscle is now to be used in its second dimension of movement, in which it generates a significantly lower moment, If the patient’s brain is used in a way that does not generate a lot of insertion tendopathy, it often becomes structurally overwhelmed in the long term and develops an approach-related insertion tendopathy. As a rule, this disorder is hardly inflammatory in nature but overuse-related degenerative, so that above all a restorative strengthening training is required, as well as the discontinuation of triggering stimuli, and no healing of an inflammation must be waited for. The most important measure in this case is to perform the exercise bench press correctly, so that the shoulder blades remain largely retracted and mainly the transverse adductor muscles such as the pectoralis major and the pars clavicularis of the deltoid do the work. This is usually enough to allow the disorder to heal on its own. This can be supplemented by rehabilitative strengthening training in the direction of protraction of the shoulder blades, in which the pectoralis minor is trained together with its more powerful synergist, the seratus anterior. As is typical for insertional tendinopathies, rehabilitative training can result in pain sensation at the insertion up to NRS 3 or even 5 equivalent can be accepted under the conditions that these pain sensations do not increase over the exercise sessions and have subsided by the next day. A insertional tendopathy at the origins of the pectoralis minor is not known from practice not . Rehabilitative training can include other synergistic muscles and similar exercises and should be performed using heavy slow repetition technique .