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Common Injury Sites and Clever Workarounds: Part I – The Upper Body

joint pain

By Eric Bach and Travis Pollen

Peruse many an online fitness publication, and you’re likely to encounter a whole lot of one-size-fits-all training programs.

We get it: when writing for the masses, it’s just easier to deal in terms of absolutes and generalizations.

You need to squat wide, with your feet externally rotated to maximum glute engagement, minimize range of motion, and get the most weight on the bar. 

Plus, you better deadlift. From the floor. Every damn time. No excuses. 

Sound familiar?

The thing is, by attempting to appeal to everyone, these cookie-cutter are a blind shot in the dark, failing to optimally apply to anyone.

The reason?

We’re all unique, with anatomical differences that require an individual approach to training. For example, Travis and I can’t blindly train with the same squat technique, that opens a pandoras box of issues ready to kick both of us square in the teeth. 

When we blindly train with cookie-cutter techniques, then needless injuries, aches, and pains creep in.

Maybe it’s an old football injury that acts up when you bench or SI joint pain when you deadlift. Whatever it is, we can relate: Just about everyone battles chronic aches and pains.

Personal Trainers Have limitations

 

As personal trainers, diagnosing and treating pain is outside of our scope of practice. But that doesn’t mean we can’t train our clients. It just means we have to get creative to work around problem areas.

The good news is that often simply by getting stronger and stabler in non-provocative movements, we often find issues resolving themselves.

In this two-part series, we’re breaking down ten common injuries sites, exercises that tend to provoke pain, and our go-to workarounds. Just remember, there are no absolutes in fitness. What works for one person might not work for another, so don’t be afraid to get a little clever.

[FYI: Travis recently released a new e-book, 50 Fit Tips (available for free HERE), in which he advocates for creative problem-solving and individualized fitness in order to help readers look, feel, and move better.]

50 fitness tips travis pollen

Let’s begin with Part I – The Upper Body. Eric’s answers are in black, whereas Travis’ are all listed in blue. 

Pain Site: Hand

Provocative: Heavy dumbbell row

Replace with: Straps

Whether you smashed a finger between dumbbells or sliced your finger cleaning a razor (guilty as charged), hand pain is brutal to work around. Without a full-strength grip, you’ll be severely limited in pulling strength on exercises like deadlifts, rows, and chin-ups.

I’m rarely a fan of straps, but in the case of hand injury, the trade-off is worth a pair of lifting straps.

 

Provocative: Lat pull-down

Replace with: Ab sling pull-down

Just about everyone has jammed a finger at least once or twice. The black and blue and swelling is not fun. What’s more, it can take an awfully long time to heal fully.

During the healing process, gripping can be a big problem — especially when the jammed finger is your middle one, and it looks like you’re giving people the finger whenever you pick something up!

As such, finger pain (or pain anywhere else in the hand) can be a serious barrier to training. Nobody wants to do legs all the time, but when you can’t grab onto anything without searing pain shooting up your finger, how many options does that leave in the gym?

As it turns out, there are actually quite a few ways to train the upper body that don’t involve grabbing onto anything at all. One example is the ab sling pull-down, in which you place your elbows inside ab slings attached to a pulley system overhead for lat pull-downs, thereby eliminating the need to grip anything.

Pain Site: Shoulder

Provocative: Bench press

Replace with: Floor press

You’d be hard-pressed to find an ex-athlete or lifter without some degree of shoulder dysfunction and pain. Most athletes flare their elbows in pressing movements, fixing the humerus into internal rotation. To accommodate this position the scapula rotates up and out, forcing scapular stabilizers to work overtime while rubbing on the supraspinatus ligament.

This creates a marked decrease in sub-acromial space which can increase impingement in the shoulder. The floor press reduces the range of motion of the shoulder and subsequent injury risk while still training a massive press.

Credit to Bret Contreras for this overview:

 

Provocative: Overhead press

Replace with: Lateral raises

“Pinching” pain in the front of the shoulder is ubiquitous among older trainees. Many will push through it for a while — until it becomes so excruciating that they can no longer lift their arm overhead and they’re forced to take time off.

The good news is that there’s a safer way to work the deltoids that doesn’t involve going overhead. You might even be familiar with it already. It’s called the lateral raise.

Sure, lateral raises are an old-school bodybuilder move and thus slightly less “functional” than the overhead press. But if your shoulder is bothering you on a given day, it’s best to steer clear of going overhead until the pain subsides.

In the lateral raise, the shoulder still moves into abduction, which will strengthen the front and middle delts just like the overhead press, only without provoking the problem range of motion (above 90° of abduction).

 

Pain Site: Elbow

Provocative: Repetitive heavy elbow flexion and extension. Push press, split jerk, big bad biceps curls in the squat rack. 

Replace with: De-loaded pulling movements and fat Gripz

Elbows are one of the most common injury sites, especially in men. More often than not, explosive exercises like the push press and split jerk coupled with a heavy dose of chin ups and curls aggravate the elbows and cause chronic pain. This answer isn’t sexy, but rest from repetitive flexion and explosive movements is important for recovery. De-load pulling movements and use Fat Gripz. Fat Gripz will introduce your grip strength as the limiting factor in provocative exercises, preventing you from over-doing it.  

Provocative: Skull crushers

Replace with: Close-grip bench press, push-ups with elbows in

Strong triceps are an integral component of lifting big weight in the bench press and overhead press. Moreover, they’re the key to filling out the sleeves of a t-shirt when you’ve maxed out on bicep development.

One of the best ways to work the triceps is with skull crushers. Unfortunately, as any lifter who’s been in the game for long enough knows, isolation exercises like skull crushers can wreak havoc on the elbows if they’re performed too frequently or with too much weight.

If your elbows are talking back from too many sets of heavy skull crushers, redirect your focus to compound exercises that emphasize the triceps such as close-grip bench press and push-ups with the elbows tracking in towards the sides.

Although these exercises are classically for the chest, the position of the hands and elbows places the pecs at a mechanical disadvantage and forces the front delts and triceps to bear the brunt of the load, which is exactly what we’re looking for.

 

Pain Site: Wrist

Provocative: Bench press (lack of rigidity through wrist)

Replace with: Better technique

The wrist is a complex joint. Should there be any wonder that wrist pain is common on the bench press?

The wrist is composed of the distal ends of the radius and ulna, 8 carpal bones, and the proximal portions of the 5 metacarpal bones.

With this many joint articulations, it’s essential the joint is kept rigid and supported during bench presses. Instead of letting the wrist cock backward, imagine the straight alignment of the wrist when throwing a punch. If you’ve ever thrown a punch without proper alignment, you’ve surely felt the repercussions later on.

The same thing happens on your pressing exercise, albeit to a lesser extent.  Sit bar in the heel of your hand, rather than high up. 

bench-press-low-grip

Photo credit: Stronglifts.com

This position allows a more rigid wrist, decreasing joint pain and keeping the forearm and wrist rigid for better pressing power.

Provocative: Conventional Push-ups

Replace with: Neutral grip push-ups on hexagonal dumbbells

Wrist pain is another one of those nagging upper body injuries. Land on your wrist hard just once, and you’re toast every time you go to bend it for the next month.

As an amputee, I fall on an outstretched hand more regularly than I’d like to admit, so I know exactly how annoying this pain can be. Whenever it happens, regular push-ups with a bent back wrist are a big no-no.

Luckily — since I love push-ups — there’s a simple fix: neutral grip push-ups atop hexagonal (flat-edged) dumbbells, which allow you to maintain a strong, stacked wrist position.

 

Pain Site: Upper back, posterior shoulder

Provocative: Overhead press

Replace with: Half-kneeling landmine press

The overhead press can be an excellent exercise, but due to poor thoracic mobility, trunk stability, and differing types of bony shoulder anatomy, it’s an exercise some of us should avoid.

Before writing this suggestion off as sacrilege, let’s dive into the anatomy. The glenohumeral joint of the shoulder acts as a ball-and-socket joint, giving it the most range of motion of any joint in the body. This also makes it much less stable, especially when coupled with our chronically internally rotated, caveman posture.Psst, check your posture ;).  

Now, when you raise your arm, the humeral head can crash into the acromion space, compressing the area of bones, and ligaments within the socket. If you’ve had the feeling someone is stabbing your shoulder with an icepick, this could be why. 
When this happens with heavy weight overhead, the muscles of the rotator cuff become irritated, leading further impingement.

To avoid this, I move clients with poor overhead mobility to half-kneeling landmine presses. The half-kneeling position trains the trunk to prevent flexion, while the landmine allows you to press at an angle to minimize crowding in the acromion process, while still overloading your deltoids and triceps.
Botta bing, botta boom. Landmines are the way to go.

Video Credit to the shoulder god himself Eric Cressey:

Provocative: Back squat

Replace with: Safety bar squat

The back squat. The king of all exercises. Everyone must do it, right? Not so fast. Sure, the back squat is great and all, but not if it causes pain.

The amount of thoracic spine extension and shoulder external rotation required to perform a good back squat isn’t always within everyone’s wheelhouse. To avoid going into painful ranges of motion at the shoulder and spine when squatting, simply opt for the safety bar squat instead.

The lower body stimulus the safety bar squat provides is nearly indistinguishable from that of the back squat, only it does so without contorting the upper body into a sometimes uncomfortable or even painful position. Instead, the bar rests around the shoulders and upper traps with the handles neutrally aligned in front of the body.

Be sure to check back with Eric and Travis next week for the link to Common Injury Sites and Clever Workarounds: Part II – The LOWER Body.

And Don’t Forget….

 Travis recently released a new e-book, 50 Fit Tips, FO FREE. In this ebook, he’ll show you how to individualize your training with his custom problem-solving strategies to look, feel, and move better. Get it here before it’s gone forever!]

50 fitness tips travis pollen

 

About the Guest Co-author

Travis Pollen is an NPTI certified personal trainer and American record-holding Paralympic swimmer. He recently completed his master’s degree in Biomechanics and Movement Science at the University of Delaware. He maintains his own blog and is always posting fitness tips and videos of his “feats of strength” on Facebook, Instagram, and Twitter.
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Copyright: lightwise / 123RF Stock Photo

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