Why Does My Shoulder Hurt When I Bench or Press?

Shoulder & Elbow7 min read  ·  Dr. Nevin Saju, PT, DPT

“There's clicking and popping in my shoulder every time I press.”

That's usually how it starts. Bench feels off. Overhead press gets pinchy near the top. Push ups and dips start to bother it too. Some people tell me about a knot in their shoulder blade that never seems to go away.

Others come in with more history. “I've had rotator cuff surgery before, and I'm nervous.” They've been told it's impingement, or a tear, or just “your rotator cuff,” and now every rep feels like a gamble.

The fear underneath all of it is the same. Am I going to lose pressing for good? Almost always, no. But the plan needs to change.

Why does my shoulder hurt when I bench or press overhead?

Usually because your shoulder is being asked to handle more load than it can tolerate right now. Research points to rotator cuff related pain as the most common cause of shoulder pain in both adults and athletes, and it behaves like a load problem, not a broken part.

Your rotator cuff's main job during pressing is to keep the ball of your shoulder centered in the socket. When those muscles can't produce enough of that compressive force, the ball drifts upward and the space at the top of the shoulder gets tighter. That's where the pinch comes from.

But the shoulder doesn't work alone. Your shoulder blade is the base it presses from. When the serratus anterior (the muscle wrapping your ribs under the shoulder blade) isn't doing its share and the upper trap is overworking, the shoulder blade tilts forward and the space narrows even more. Rib cage and upper back position change shoulder range too.

That's why I tell people that pain shows up where the body is overworking to compensate. The shoulder often pays for what the shoulder blade, upper back, or rib cage isn't doing. That knot in your shoulder blade is frequently part of the same story.

What about posture? Research reviews show static posture is poorly linked to shoulder pain. There's no single perfect posture to fix. Your body does better with more movement options, not a rigid position.

Training plays a big role. Rotator cuff pain is an overuse condition, and volume spikes beyond what the tendon can recover from are a common trigger. Heavy pressing at the extremes, like a deep stretched position at the bottom of a bench, also loads the front of the shoulder hard. That area includes the biceps tendon, the joint at the top of the shoulder, and the pec, all of which can be irritated by heavy pressing.

If you've been through rehab already and it didn't stick, there's a decent chance you were given the same light band exercises as an 80 year old with shoulder pain. That's not a knock on the therapist. It's a system problem, and I wrote about it in what to do when physical therapy didn’t work.

Your body isn't broken. It just can't handle what you're asking of it yet.

The shoulder often pays for what the shoulder blade and upper back aren't doing.

Is it impingement, is the clicking bad, and do I need an MRI?

“Impingement” is a broad label, not a diagnosis of something pinched and broken. Clicking on its own isn't damage, and imaging findings often don't match pain. Here's how to think about each.

Impingement

Research now treats impingement as an umbrella term that covers bursitis, rotator cuff tendinopathy, and partial or full rotator cuff tears. It's driven largely by how the cuff and shoulder blade control the joint, not just bone shape. Clinicians can often change symptoms on the spot by adjusting shoulder blade position, upper back position, or cuff activation, which tells you this is a movement and load problem you can work on. Trials comparing decompression surgery to placebo surgery found no added benefit from the real procedure, and a structured exercise program significantly reduces the need for surgery. Surgeons absolutely have a role in shoulder care. For most impingement, though, exercise comes first.

Clicking and popping

Noise isn't damage on its own. Clicking without pain, weakness, or a feeling of the shoulder slipping isn't a sign of structural failure. Clicking alongside a painful arc around shoulder height, especially if you're over 39, is one of the clues that points toward an irritated cuff tendon. That's a clue, not a verdict. A sudden loud pop during a heavy bench with immediate severe weakness is a completely different situation. See the red flags below.

The MRI

Research shows that what imaging finds doesn't line up neatly with how much pain you have or how well your shoulder works. Changes in the tendon can stick around on a scan even after the pain is gone. Just because it's torn doesn't mean surgery. Imaging has its place, especially after real trauma or with significant weakness, but a scan alone rarely changes the plan for pressing pain that came on gradually.

What should you change in your training this week?

Keep pressing, but change how. Lower the stress on the irritated tissue while you build the muscles that protect it.

If you want this mapped out around your actual program, that's what shoulder pain physical therapy and physical therapy for lifters look like here, and you can read what other lifters have said about getting back to pressing.

Written by

Dr. Nevin Saju, PT, DPT

Founder of Revenant Physical Therapy in Farmers Branch. Three open-heart surgeries taught him what it takes to trust your body again. Now he helps runners, lifters and active adults do the same. More about Nevin →