Shoulder pain at the gym: what to keep, what to change.

You've been back at the gym for three weeks, and on your second set of bench press, shoulder pain kicks in. You grit your teeth and finish. That evening, getting your jacket on is a struggle.

There seem to be two options: ignore it or pack it all in. Neither works. I see it often in people coming back after years at a desk. Diagnosis is your doctor's job. Your part is changing how you train.

How it shows up

There's usually no knock and no fall. The discomfort builds slowly, sometimes under the bar, sometimes as shoulder pain after the gym, that evening or the next morning.

• Halfway up. As your arm passes shoulder height, and often more on the way down.
• In certain exercises. Lateral raises, overhead presses, bench press.
• Day to day. The seatbelt, the top shelf.

Why your shoulder hurts at the gym

The shoulder is the most mobile joint in the body, and it pays for that in stability. The top of the arm bone rests in a socket that only partly holds it, like a ball on a saucer. Four small muscles and their tendons keep it centred.

Not much room. Those tendons run through a narrow passage under the bony roof of the shoulder. If your shoulders creep up towards your ears as you press, the passage narrows. Do it often enough and it can take its toll on those tendons.

Lots of pushing, little pulling. A bench-heavy routine neglects the muscles that hold your shoulder blades. Days hunched over a screen do the rest, along with stress, which hikes your shoulders up.

Can I train with shoulder pain?

Yes, if it's mild, only shows up in certain movements and you have none of the warning signs above. Train what doesn't hurt and change the movement that sets it off. Never train through pain, because pushing on can make what's behind it worse.

Take weight off, then range. Use only a load that doesn't hurt. If that's not enough, shorten the movement and stop short of the painful point. If it still hurts, drop that exercise until a doctor has seen you.

Elbows below your shoulders. While the shoulder is sore, leave out anything where your elbow reaches shoulder height or higher, or the bar goes behind your head. That leaves exercises with your arm close to your body: rows, and presses with your elbows low.

Shoulder blades back and down. Before every press, draw them together and down to open up that passage. And if you can't feel your chest working on the bench, your shoulder is doing the job instead. Drop the weight.

One pull for every push. Match them set for set. That strengthens the muscles steadying your shoulder blades. They barely move, but they keep the shoulder where it belongs.

Warm up first, and train the rest. Shoulder tendons have a poor blood supply, and going straight to the bench loads them cold. Start with a few minutes of movement and some light sets. Then legs, core and your good arm. Training the healthy side helps the other keep its strength.

Start with the warm-up, and with less weight where it hurts. If the ache hasn't eased within a few weeks, get it looked at. Knowing what it is beats training by guesswork.