AC Joint Pain: Understanding, Exercises to Avoid, and Safe Alternatives

What exercises should I avoid with AC joint pain?

When dealing with Acromioclavicular (AC) joint pain, it's crucial to avoid exercises that compress, shear, or excessively stretch the joint, particularly those involving overhead movements, deep horizontal adduction, or direct impact on the shoulder.

Understanding AC Joint Pain

The AC joint is located at the top of the shoulder, where the collarbone (clavicle) meets the highest part of the shoulder blade (acromion). It's a relatively small joint, but crucial for shoulder movement and stability, especially during arm elevation. Pain in this joint often stems from two primary causes:

• AC Joint Sprain/Separation: An injury to the ligaments supporting the joint, typically from a direct blow to the shoulder or a fall onto an outstretched arm. Severity ranges from mild (Grade I) to severe (Grade III and above).
• AC Joint Osteoarthritis: Degenerative changes in the joint cartilage, common with aging or repetitive stress, leading to pain and stiffness.

Regardless of the cause, the goal is to reduce stress on the compromised joint, allowing it to heal or preventing further irritation.

General Principles for Exercise Avoidance with AC Joint Pain

When experiencing AC joint pain, your body will provide crucial feedback. Heed these general principles:

• Pain is Your Guide: Any exercise that elicits pain, sharp or dull, at the AC joint should be immediately stopped or significantly modified. Pushing through pain can exacerbate the injury.
• Avoid End-Range Movements: Movements that push the shoulder into its extreme limits of motion, especially overhead flexion (raising arm straight up) and horizontal adduction (bringing arm across the body), tend to stress the AC joint most.
• Minimize Direct Pressure and Impact: Exercises that place direct compressive forces or impact on the top of the shoulder should be avoided.
• Prioritize Controlled Motion: Focus on movements within a pain-free range, emphasizing stability and proper scapular mechanics.

Specific Exercises to Avoid or Modify

Based on biomechanical principles and common clinical experience, the following exercises frequently aggravate AC joint pain and should be avoided or significantly modified:

• Overhead Pressing Movements:
  • Barbell Overhead Press (Shoulder Press): Places significant compression and shear forces on the AC joint, especially at the top of the movement.
  • Dumbbell Overhead Press: Similar to barbell, but dumbbells allow for slight variations in hand position which may offer minimal relief, but still generally ill-advised.
  • Machine Shoulder Press: While potentially more stable, it still involves overhead compression.
  • Push Press/Jerks: High-impact, explosive overhead movements that are highly detrimental.
• Overhead Pulling Movements:
  • Pull-ups / Chin-ups (especially wide grip): While primarily targeting the lats, the overhead position and potential for scapular upward rotation and depression under load can stress the AC joint. Wide grips increase this stress.
  • Lat Pulldowns (especially wide grip): Similar mechanics to pull-ups, with wide grips increasing the stress.
• Horizontal Adduction and Deep Chest Exercises:
  • Dumbbell Pec Flyes (Flat, Incline, Decline): The deep stretch and horizontal adduction at the end-range can excessively stress the AC joint ligaments.
  • Cable Crossovers: Similar to dumbbell flyes, emphasizing horizontal adduction.
  • Barbell Bench Press (especially wide grip and deep range of motion): While a staple for chest, the bottom of the movement (deep horizontal adduction) and the compressive forces can irritate the AC joint. A narrower grip or reduced range of motion might be tolerated, but often best avoided initially.
  • Push-ups (deep range of motion): Similar to bench press, going too deep can stress the joint.
• Direct Loading and Scapular Depression/Protraction Under Load:
  • Dips (Parallel Bar Dips): This exercise places significant compressive and shearing forces on the AC joint, particularly at the bottom of the movement where the shoulder is depressed and extended.
  • Upright Rows: This exercise combines shoulder abduction and internal rotation, which can create impingement in the subacromial space and place direct stress on the AC joint.
  • Shrugs (especially heavy): While targeting the traps, heavy shrugs can cause excessive compression through the AC joint.
• High-Impact Activities:
  • Plyometric Push-ups or Box Jumps (if involving upper body impact): Any activity that involves sudden, high-force impact through the shoulder joint.
  • Contact Sports: Activities like football, rugby, or wrestling, which involve direct blows to the shoulder.

Why These Exercises Aggravate the AC Joint

Understanding the "why" helps you make informed decisions:

• Overhead Movements: When the arm elevates overhead, the acromion and clavicle naturally move relative to each other. If the joint is inflamed or the ligaments are compromised, this movement, especially under load, causes compression and shearing forces that exacerbate pain.
• Horizontal Adduction (Arm Across Body): Bringing the arm across the chest, as in flyes or the bottom of a bench press, stretches the AC joint capsule and ligaments. If these are already injured or inflamed, this stretch causes pain.
• Direct Axial Loading/Compression: Exercises like dips or heavy overhead pressing put direct downward pressure through the clavicle onto the acromion, directly compressing the joint surfaces.
• Scapular Dysfunction: Poor scapular control or excessive depression/protraction under load can alter the mechanics of the AC joint, leading to increased stress.

Safe Alternatives and Considerations

While avoiding aggravating exercises, it's crucial to maintain overall fitness and support shoulder health. Focus on:

• Pain-Free Range of Motion: Perform exercises within a range where you experience no pain. This might mean partial repetitions or reduced loads.
• Scapular Stability Exercises: Strengthening the muscles that stabilize the shoulder blade (rhomboids, lower trapezius, serratus anterior) is vital. Examples include:
  • Rows (Cable, Dumbbell, Machine): Performed with good scapular retraction.
  • Face Pulls: Excellent for rear deltoids and scapular retractors.
  • Band Pull-Aparts: Gentle and effective for upper back and rear deltoids.
  • Prone Y, T, W Raises: Targets different parts of the trapezius and rhomboids.
• Rotator Cuff Strengthening: Light resistance exercises for the rotator cuff (e.g., external and internal rotations with light dumbbells or resistance bands) can improve shoulder stability without directly stressing the AC joint.
• Lower Body and Core Training: Continue to train your lower body and core vigorously, as these areas do not directly stress the AC joint.
• Professional Guidance: Always consult with a qualified healthcare professional, such as a physical therapist, sports medicine physician, or orthopedic specialist. They can accurately diagnose the cause and severity of your AC joint pain and provide a tailored rehabilitation plan.
• Gradual Return to Activity: As pain subsides and strength improves, gradually reintroduce exercises, starting with light loads and limited ranges of motion, carefully monitoring your symptoms.

When to Seek Professional Guidance

It's imperative to seek professional medical advice if your AC joint pain:

• Is severe or worsening.
• Limits your ability to perform daily activities.
• Is accompanied by significant swelling, bruising, or deformity.
• Does not improve with rest and avoidance of aggravating activities.

A proper diagnosis is the first step toward effective management and a safe return to your fitness routine.