Updated: Aug 11, 2019
You’re reasonably fit & know your way around the gym. And you would like to keep working out but shoulder pain after workouts can get so intense that surgery starts to become a welcome option. Are the only options surgery or inactivity?
First: Slow down & take a deep breath.
The sooner you address the issue, the less likely you’ll need surgery to get you back to normal. The general idea is the longer the pain sticks around without rehab, the tougher it is to get rid of. So serious attention is better sooner rather than later.
Realize that getting rid of gym shoulder pain (almost always caused by impingements) involves a change in the way you think & structure your workouts.
Read through to see if you can find ways to modify your workout and/or program design to stay in the gym without that nagging shoulder pain that keep showing up.
Balance your program:
Chest press, Lat Pulldowns & Overhead shoulder press do not make a balanced upper body program. The problem with only using these exercises is that they don’t take into account internal to external rotation ratios. Because of the attachments of the Lats and Pects on the humerus, training these motions in exclusion causes excessive shoulder internal rotation, seen with ROM deficits in people who tend towards stiffness, or joint instability in people who are more mobile. Overhead pressing doesn’t alter rotation ratios, but it is a big challenge to the rotator cuff- the stabilizing muscles that need to be strong & fast (and definitely not already irritated) to avoid pain pressing overhead. If you are having shoulder pain, I recommend holding off on these three exercises until you improve the quality of your strength ratios & range of motion. While you're "resting", rebalance the shoulder strength ratios by adding pain-free external rotation strengthening and delt work below shoulder height. Respect these exercises! They should become part of your program for life, even after you can return to your three faves.
Pull back to Push ahead:
Pull back on intensity & rev up on consistency. I know work & child concerns make consistency more difficult in your 40s, but if you take some time off (even just a week) don’t jump back at the same intensity the next time you hit the gym. And don’t try to make up for lost gym time with extra work. The body responds to small increments of change & reacts to large ones.* So you’re asking for pain if you swing from one extreme (inactivity) to the other (intensity or volume). Previous joint wear, slightly slower recovery times & quicker fatigue can literally make this painfully obvious in your 40s, so you might have to accept that you can only focus on maintenance until your commitments lighten up.
Remember what you’re working:
Most times it’s better to concentrate just on effort. But as reps or pounds increase, don’t forget to check in where you’re FEELING the effort once in awhile. You don’t have to chase soreness, but never feeling the effort & fatigue in your prime movers can be an indication of poor activation patterns & future irritation. This holds especially true when working your back musculature. The biceps, a persistent overachiever in the upper body, seems to always take over with Lat and Scapular work. Learn to recognize if you're feeling the effort only in your biceps so you change form to feel the effort in the right place. Pushing down slightly on the handles when a performing Pulley row seems to help re-focus the effort in your back; and pulling the bar apart can work with Lat pulldowns, but there are many more out there.
Realize you may be deconditioned:
Yes, you are shooting for only half of your college PRs, but that still may be not enough of a regression (sorry!) for your current strength level. You may have been able to bust out 20 pull-ups in college, but even one pull-up at this point may aggravate your shoulders, so try regressing to pull downs, assisted pull-ups, or as a last resort only rebalancing exercises for awhile if this is an irritating exercise.
Talk to a gym-based Physical Therapist:
Sometimes, just a chat with someone who you respect can give you more direction about what to focus on in the early stages of shoulder pain. Don't be shy to reach out and gather more information.
Is the pain sticking around for too long? Maybe it’s time to delve into a rehab plan. Look for part 2: Adding Rehab to Your Gym Program.
* First said by one of my incredible teachers, Brian Hoke PT