March 26, 2025 • 2 min read
Understanding Anterior Shoulder Pain
Anterior shoulder pain is a common and often stubborn complaint among weightlifters and CrossFit athletes, frequently becoming noticeable during movements like the bench press, overhead press, or snatches. This discomfort is often attributed to a variety of factors, but one prevalent issue underlying persistent pain is weakness in the shoulder external rotators. In fact, many athletes experiencing anterior shoulder discomfort tend to have external rotator strength in the lower 50% when compared to age-related norms. This deficit is exacerbated by the tendency of lifters to heavily train the chest and lats, creating an internal rotation dominance. This muscular imbalance can lead to improper shoulder mechanics and increased, undue stress on the anterior structures of the shoulder joint, particularly the labrum.
The Role of Shoulder External Rotators
The shoulder external rotators, primarily the infraspinatus and teres minor, play a crucial role in stabilizing the humeral head (the ball) deep within the glenoid socket (the cup). When these muscles are weak, the humeral head can shift forward (anterior glide), leading to poor joint centering. This lack of centralized stability creates a “wobble” and excessive strain on the anterior components of the shoulder capsule, ligament, and labrum—a critical cartilage structure that provides stability and cushioning. Ignoring this dynamic instability is what truly perpetuates the pain cycle.
Biceps Tendonitis: A Common Misdiagnosis
Due to the close proximity of the biceps tendon to the labrum, Anterior Shoulder Pain is often misdiagnosed as simple biceps tendonitis. The long head of the biceps tendon attaches directly to the superior portion of the labrum, making it a common secondary source of pain. However, in many cases, the labrum itself is the primary pain generator, with biceps tendonitis being a secondary, compounding condition arising from underlying labral pathology and mechanical issues.
Self-Assessment for Biceps Tendonitis
If you have been diagnosed with biceps tendonitis, there is a simple test you can try to help identify whether your pain is truly coming from the biceps tendon or if the underlying cause may be labral-related. Perform a very heavy bicep curl; if this movement does not exacerbate your pain, it is likely that the biceps tendon is not the primary issue. Instead, the labrum and poor, forward-biased shoulder mechanics may be the root cause of your discomfort.
Addressing the Root Cause with Targeted Rehab
To effectively manage and prevent chronic Anterior Shoulder Pain, addressing the root cause—external rotator weakness and poor dynamic stability—is crucial. Incorporating specific strengthening exercises such as:
• External rotation with resistance bands: Low-load, high-volume work to build endurance.
• Face pulls: To engage the entire posterior chain, including the rotator cuff and scapular stabilizers.
• Wall walks: To emphasize sustained rotator cuff and scapular stability under load.
• Isometric holds: To improve endurance and stability at key positions of overhead lifting.
Additionally, focusing on better technique, proper warm-ups, and ensuring controlled eccentric phases during overhead lifts, pressing movements, and Olympic lifts can help significantly reduce strain on the anterior shoulder structures.
Conclusion: Don’t Guess, Get Assessed
Anterior shoulder pain that persists through rest is a clear signal of underlying mechanical dysfunction. While biceps tendonitis is frequently diagnosed, it may mask the true problem of poor stability and rotator weakness. By aggressively strengthening the external rotators and optimizing overall shoulder mechanics, athletes can not only mitigate pain but dramatically improve their lifting capacity. If you’re dealing with persistent shoulder pain, stop guessing and start assessing. Seek guidance from the barbell rehab experts and performance therapists at PhysioFit for a tailored, evidence-based rehab approach that gets you back to training stronger and safer today. Your full return to pain-free performance is achievable.