Reoccurring tendinitis in shoulder when benching

[Yonason Herschlag]

Hi Coach!
I’ve searched your site on this subject, and found that in one instance you recommended giving the bench a rest and just doing standing overhead presses until the shoulder problem resolves.

I’d like to know if you have anything to add for my particular case. When I started lifting in 2013 at age 49 I totally over-trained the bench-press, being oblivious to my age and decades outside the gym. The radiologist doctor examined me with ultrasound found inflammation both in the pectoral and bicep tendons connecting to both shoulders. He diagnosed it as tendonitis.

For a period of three years it came and went. I would always down the weight after a flare up, and cautiously build back up over weeks with baby steps until the next flare up. Eventually the flare ups seemed to have ended, and I got my bench up to 120kgX3 exactly one year ago.

For whatever reason, I got another flare up a few months ago; attempting to just work through only made matters worse, so I gave regular benching a rest, and took anti-inflammatory-meds for a couple weeks. I found that the least irritable press is an inclined bench at 45 degrees with a standing press like grip (narrower than the regular bench) and elbows forward (like a standing press) and elbows closer to torso than the regular bench. The inclined bench feels great now – no irritation at low weights and high reps, but when I try regular benching with just a 20kg empty bar, I still feel irritation.

Is there any way to work through this faster?

PS After getting up to about 25% body-fat, I’ve been on a calorie deficit diet the past six months and have reduced body-weight by 5.5kg of which I estimate half of that is body fat, bringing it about one percent down. The point being, that I’m doing light workouts to minimize muscle loss as with the calorie deficit diet I have no chance at recovery from heavy workouts at age 55. So I’m not looking at the moment at matching or beating my PR, but rather just healing up the shoulder so I can get back to benching and be ready to lift heavy again whenever I get tired of cutting.

I’d greatly appreciate feedback from you and your team which has been my sole source of guidance ever since I began lifting in 2013. Many thanks.

In case my form is part of the problem, I’m including this clip of my PR from exactly a year ago.


PPS I'm curious for an explanation why flat benching irritates my shoulder, but doing flies on a machine is okay. I've been using the machine to keep my pecs active, as I feel the inclined press with close grip is targeting mainly my deltoids and triceps but missing the lower pecs.

[Yonason Herschlag]

Hi coach! I found your video here extremely enlightening. It gave me a deeper understanding of the anatomy and the function of the rotator cuff muscles, as well as the basic principals towards recovery, by not only gradually increasing weight, but also range of motion, with concrete practical examples.

You mention that the standard treatment that is often prescribed of light weights doing internal and external rotation has no practical application, and I did get how you explained the main function of the rotator cuff to be stabilization via isometric contraction. I'm just curious to know if arm wrestling does rely on the strength of internal rotation, and if backhand tennis movements incorporate external rotation. Also, is it possible that the high rep low weight of the internal/external rotation could have an advantage in healing by getting more circulation to the injured area via greater movement of the injured muscles?

In the mean-time I hope to incorporate some of your advice (from this video) in my workout today. But I'm looking forward to getting more of your enlightening insights and practical advice.

[Will Morris]

Hi Coach!
I’ve searched your site on this subject, and found that in one instance you recommended giving the bench a rest and just doing standing overhead presses until the shoulder problem resolves.

I’d like to know if you have anything to add for my particular case. When I started lifting in 2013 at age 49 I totally over-trained the bench-press, being oblivious to my age and decades outside the gym. The radiologist doctor examined me with ultrasound found inflammation both in the pectoral and bicep tendons connecting to both shoulders. He diagnosed it as tendonitis.

For a period of three years it came and went. I would always down the weight after a flare up, and cautiously build back up over weeks with baby steps until the next flare up. Eventually the flare ups seemed to have ended, and I got my bench up to 120kgX3 exactly one year ago.

For whatever reason, I got another flare up a few months ago; attempting to just work through only made matters worse, so I gave regular benching a rest, and took anti-inflammatory-meds for a couple weeks. I found that the least irritable press is an inclined bench at 45 degrees with a standing press like grip (narrower than the regular bench) and elbows forward (like a standing press) and elbows closer to torso than the regular bench. The inclined bench feels great now – no irritation at low weights and high reps, but when I try regular benching with just a 20kg empty bar, I still feel irritation.

Is there any way to work through this faster?

PS After getting up to about 25% body-fat, I’ve been on a calorie deficit diet the past six months and have reduced body-weight by 5.5kg of which I estimate half of that is body fat, bringing it about one percent down. The point being, that I’m doing light workouts to minimize muscle loss as with the calorie deficit diet I have no chance at recovery from heavy workouts at age 55. So I’m not looking at the moment at matching or beating my PR, but rather just healing up the shoulder so I can get back to benching and be ready to lift heavy again whenever I get tired of cutting.

I’d greatly appreciate feedback from you and your team which has been my sole source of guidance ever since I began lifting in 2013. Many thanks.

In case my form is part of the problem, I’m including this clip of my PR from exactly a year ago.


PPS I'm curious for an explanation why flat benching irritates my shoulder, but doing flies on a machine is okay. I've been using the machine to keep my pecs active, as I feel the inclined press with close grip is targeting mainly my deltoids and triceps but missing the lower pecs.

There is a lot to unpackage here, as the length of this post borders on being the length required of a personal consultation. This is especially true when you add the second post to this first post.

Succinctly, yes, there is a way to work through tendinosis (long-standing tendinitis) faster than what you are doing. Low weight - high repetition is not the preferred treatment for tendinosis at all. If you consider, tendinitis is an "over-use" injury, subjecting the diseased tendon to isolated work at low load and extremely high repetitions....in a manner it is not generally used for, you can easily see how this goes against any face validity to the treatment. The most promising work in treatment of tendinosis in the last two-three years has been calling for the shift from eccentric only loading to heavy, slow resistance training. The previous decade has been spent utilizing heavy eccentric training for tendinosis / tendinopathy, however, it was only shown to reliably decrease pain but does not seem to increase function. When heavy concentric loading was tested, it was shown reliably to increase function with no real change in pain. So, what do you do? You combine heavy slow eccentric with heavy, slow concentric and you get better outcomes. Pain goes down, function goes up, and it seems to really help with the kinesiophobia that sets in when someone has tendon pain. You simply control the tempo of the lifts and slow them down, while maintaining heavy loads.

It is certainly no surprise that you consistently feel that flat bench irritates your shoulders. While I commend you for training hard, heavy, and being very dedicated, your technique leaves a lot to be desired.

[Jr_Geezer]

No comment on form or rehab ideas, just that you might want to get a slightly more attentive spotter in the future. Also, lock your elbows when taking the bar off the hooks so things are a bit more secure when the bar is passing over your face. (That’s what the spotter is supposed to be helping you with, for example. )

[Yonason Herschlag]

Succinctly, yes, there is a way to work through tendinosis (long-standing tendinitis) faster than what you are doing. Low weight - high repetition is not the preferred treatment for tendinosis at all. So, what do you do? You combine heavy slow eccentric with heavy, slow concentric and you get better outcomes. Pain goes down, function goes up, and it seems to really help with the kinesiophobia that sets in when someone has tendon pain. You simply control the tempo of the lifts and slow them down, while maintaining heavy loads.

It is certainly no surprise that you consistently feel that flat bench irritates your shoulders. While I commend you for training hard, heavy, and being very dedicated, your technique leaves a lot to be desired.

Thanks Will. I will try slowing down the bench-press; and perhaps all my presses. When you say "heavy", would that be like 60%-70% of 1RM? And would you recommend 3X5 reps?

[Will Morris]

Thanks Will. I will try slowing down the bench-press; and perhaps all my presses. When you say "heavy", would that be like 60%-70% of 1RM? And would you recommend 3X5 reps?

I don't typically consider 60-70% 1RM being "heavy". I would tend to think more along the lines 85-90% being the target loads here.

[Yonason Herschlag]

I don't typically consider 60-70% 1RM being "heavy". I would tend to think more along the lines 85-90% being the target loads here.

First of all, thanks for your helpful advice. Since every time (since the flare-up a few months ago) I tried warming up benches with an empty bar I felt the tendinitis getting irritated, I hadn't benched in months other than 40kg 45degree inclined benches.

Applying your advice for the first time, I felt secure working up to 40kg with slow reps on the regular bench, and the slowing down made it feel much better. My second session I got up to 50kg 3x5. But clearly in my second set by the last rep I felt I was on the edge of harming myself (I really hate set backs, especially at my age - 55).

Considering that a few months ago before the flare up my work sets were sometimes 100kg, and sometimes 110kg, are you suggesting that I try to do slow reps with 90kg in my next session?!!!

And any critical tips on my form (or lack of it)?

[Will Morris]

And any critical tips on my form (or lack of it)?

# 1 - Treat weightlifting like it is a precision-dependent activity....much like marksmanship. Each and every rep should look as close to the other reps as possible.
# 2 - Actually get set prior to attempting the first rep. Taking if off the pins immediately down into the first rep is one of the best ways to crush your face there is.
# 3 - tendons, especially angry tendons, do not like rotation when loaded. There is a fair amount of elbow movement into internal and external rotation throughout the rep. Your forearms kind of flounder back and forth the entire rep. Get tight, stay tight, and reduce the amount of extraneous movement in the upper extremity to as close to zero as you can get.

[Yonason Herschlag]

# 1 - Treat weightlifting like it is a precision-dependent activity....much like marksmanship. Each and every rep should look as close to the other reps as possible.
# 2 - Actually get set prior to attempting the first rep. Taking if off the pins immediately down into the first rep is one of the best ways to crush your face there is.
# 3 - tendons, especially angry tendons, do not like rotation when loaded. There is a fair amount of elbow movement into internal and external rotation throughout the rep. Your forearms kind of flounder back and forth the entire rep. Get tight, stay tight, and reduce the amount of extraneous movement in the upper extremity to as close to zero as you can get.

Will - I am deeply indebted to you for your lazar insights and brilliant explanation helping me understand how to get on track.
I was flying to Johannesburg when you posted this; hence my delayed response.
Many thanks!!!

[Will Morris]

Will - I am deeply indebted to you for your lazar insights and brilliant explanation helping me understand how to get on track.
I was flying to Johannesburg when you posted this; hence my delayed response.
Many thanks!!!

You are certainly welcome, sir. Please keep us updated with your progress.