The Bad Bencher

Ok I have a fun hypothetical here and I'd actually love to get opinions from every other coach if possible.
Male 39 265lbs 1 year training and has an issue with the Bench Press.
The facts:
Benched 325x5x1 and 375x1x5 early this year.
Presses high 200s
History of rotator cuff injury (rim rent tear supra and infraspinatus; injury has been imaged but not repaired
Injury is old 5-7 years

Everytime the client benches he has pain in the distal bicep tendon during descent and there is severe discomfort in the proximal bicep tendon after the set.
For 2-3 days post bench there is pain in the rhomboid/trap as well as knots and pain around the scapula at distal attachments of the rotator cuff muscles (see pic for clarification as I may be wrong in the anatomical description)
Bench also causes progressively worse inflammation and pain in the anterior shoulder which leads to further inflammation and pain in the bicep ect ect ect

He has tried deload of bench (even just the bar hurts)
He has tried Pin Bench, Tempo Bench, and Floor Press as well as the Sling Shot and Closer Grips all have worked to varying degrees for a short time but increased intensity just circles back to the injury
He isn't particularly interested in Bench, but a 405 would be nice
Press is progressing very well without the bench

Ok I think that's all the background I can think of that matters before the real question.

What would you suggest for this client? Would you suggest they put Bench back in the program and keep hitting these walls? Would you suggest they just keep Pressing and let Bench just be a thing they ignore? Would you insert a modified Bench type and what would you use?

I am going to post this everywhere I can because I would love all the feedback I can find

How recent is the imaging?

My shoulders were messed up from benching. A lot of what you've described plus numbness in arms and hands when sleeping.

I would suggest a break from flat benching with a bar.

What worked for me is doing incline benching (say 45 degree angle) with dumbbells. Your bench numbers were close to mine. I did 55-10, 65-10, 75-10, 85-10 and recently 95-10. The dumbbells allow for a more natural grip angle which relieves some of the stress on the shoulder joint The hardest part is curling the weights in to position for pressing.

Once I achieved sets of 10 I added 1 rep to each set making all sets 11, 12, 13, and so on. The lighter sets tire you out for the heavier sets so the weight never gets too heavy to cause shoulder joint stress.

I did this for a few months and just recently returned to pain-free flat benching. I just did a single at 325 and a couple sling shots singles up to 358 with no issues, so while I lost some strength for sure I didn't lose a whole lot. Especially considering shoulder pain prevented me from doing any heavy benching prior to this change.

I plan on flat benching with a bar 1 day a week, and doing inclines with dumbbells 1 day per week, so a total of two pressing days. I also over-head press on the flat bench day too. I'm keeping volume down on my flat benching to hopefully avoid a flare up.

This may or may not work for you, but did help my shoulders.

Quote:

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Originally Posted by skid

Once I achieved sets of 10 I added 1 rep to each set making all sets 11, 12, 13, and so on. The lighter sets tire you out for the heavier sets so the weight never gets too heavy to cause shoulder joint stress.

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Unless the fatigue puts you in a disadvantageous mechanical position to control the dumbbells. Dumbbells are half as stable as a barbell -- one side can get out of line without being stabilized by the tie-in to the other side. You can adjust your grip width and elbow position with the bar to replicate the "natural grip angle" the dumbbells allegedly provide.

Quote:

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Originally Posted by Mark Rippetoe

Unless the fatigue puts you in a disadvantageous mechanical position to control the dumbbells. Dumbbells are half as stable as a barbell -- one side can get out of line without being stabilized by the tie-in to the other side. You can adjust your grip width and elbow position with the bar to replicate the "natural grip angle" the dumbbells allegedly provide.

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Dumbbells allow more freedom of movement as well as the ability to position your hands at angles other than a straight line like a barbell forces you to. The instability of the DB's also forces you to use much lighter weights. That said a barbell or swiss bar could be used as well as I did both. Just use lighter weights and not to go to near failure or grind until your shoulder has recovered. Probably the biggest impact is the change from benching flat to benching at an incline.

I've also noticed that EZ curl bar pullovers seemed beneficial to my shoulders too. My shoulders were quite tight and there was a bit of pain initially but after a couple workouts this movement loosened up my shoulders considerably and became pain free.

Anyways, this routine worked for me and I'm back to normal benching again.

I have almost the same issue. One scapula is genetically lower than the other scapula, strains and makes the shoulder on the same side hurt. Bench presses are the very shit in this situation. The press (with a very tight grip) and the chin up make the soulder feel better. And the only way to bench without suffering is doing a very close grip and wearing tight elbow and wrist wraps (I guess it's because they tighten the tendons well, I don´t know, it´s just something empirical; but it works).