If you press heavy and press often, your risk of developing overhead press shoulder pain is much higher than that of the average gym-goer. That’s not bad luck. It’s a predictable result of how strength sports are programmed and how they develop certain muscles over time.
The good news is that understanding why it happens can help you fix it. In most cases, you don’t need to stop training.
The Pressing Imbalance That Builds Up Over Years
Powerlifting and bodybuilding involve a large amount of pressing volume. Bench press, incline press, and dumbbell press variations all place heavy demands on the pectoralis minor over time.
The pectoralis minor is a small muscle that connects the shoulder blade to the ribs. Its job is to pull the shoulder blade forward and downward into a position called anterior tilt, while the lower trapezius helps balance this force and keep the shoulder blade stable against the ribcage. Problems develop when pressing volume greatly exceeds pulling volume. Over time, the pectoralis minor can become dominant and begin pulling the shoulder blade out of position.
The result is a posture many experienced lifters recognize: rounded shoulders, a shoulder blade that tips outward, and reduced contact between the blade and the ribcage. This is more than a cosmetic issue. Every overhead movement now starts from a less efficient position, increasing stress on the tissues inside the shoulder joint with every repetition.
What Happens Inside the Joint
The rotator cuff and subacromial bursa sit in a small space at the top of the shoulder. When the shoulder blade rotates upward correctly during overhead movement, this space opens and allows the rotator cuff to function efficiently. When that rotation is limited, the space becomes smaller, and the tendons and bursa can become compressed during each repetition.
This is commonly called impingement. With enough training volume, the area can become irritated and painful. The upper trapezius often tries to compensate when the serratus anterior is not functioning well, lifting the shoulder blade upward instead of rotating it. While this strategy gets the arm overhead, it also increases compression at the top of the shoulder and can place additional stress on the rotator cuff over time.
If your shoulder rises toward your ear during overhead pressing, this compensation may be contributing to your symptoms.
The Rhomboid Problem Nobody Talks About
A second imbalance often develops alongside pec minor tightness, and it involves the rhomboids. These muscles connect the shoulder blade to the spine and help pull the shoulder blade toward the middle of the back.
Strong rhomboids are helpful, but excessively stiff rhomboids can create a different problem. They can limit the upward rotation needed for comfortable overhead pressing. For the shoulder blade to rotate upward, the serratus anterior must pull the blade around the ribcage while the rhomboids lengthen enough to allow that movement.
When the rhomboids become too stiff, they act like a short leash and restrict shoulder blade movement, no matter how hard the serratus works. This is why treatment should not focus only on strengthening weak muscles. In many cases, the rhomboids also need to be released and lengthened.
The Specific Fix for Strength Athletes
For powerlifters and bodybuilders, the solution must address both sides of the imbalance. First, reduce tension in the pec minor and rhomboids. Next, restore normal shoulder blade mobility. Finally, strengthen the shoulder through its improved movement pattern.
The landmine press is one of the best tools for this process because it allows meaningful loading while encouraging proper shoulder blade movement.
A few coaching cues can help:
• Start with the hand slightly in front of and outside the shoulder.
• Drive your body through the bar rather than simply pushing the bar away.
• Add a small torso rotation away from the bar at the top of the movement.
• Allow the shoulder blade to fully rotate upward as you finish the press.
Programming Considerations
Corrective exercises help, but long-term success often requires programming changes. Many lifters accumulate far more pressing volume than pulling volume, reinforcing the same imbalances that contributed to the problem in the first place.
Adding more rows, face pulls, and upper-back work can help maintain healthier shoulder mechanics. These exercises also help counteract chronic pec minor tightness and support the lower trapezius. Addressing shoulder pain requires more than treating symptoms. Combining corrective exercise with smarter programming is what creates lasting results.
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Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.