AC Joint Pain: Movements, Activities, and Habits to Avoid

What to Avoid with AC Joint Pain?

For individuals experiencing pain in the acromioclavicular (AC) joint, avoiding specific movements and activities is crucial to prevent further irritation, promote healing, and manage discomfort. This typically involves limiting overhead actions, cross-body movements, and heavy loading that directly stress the joint.

Understanding the AC Joint and Its Pain

The acromioclavicular (AC) joint is a critical articulation in the shoulder complex, connecting the acromion process of the scapula (shoulder blade) to the clavicle (collarbone). While it offers relatively little motion compared to the glenohumeral joint, its stability is paramount for overall shoulder function, facilitating scapular movement and arm elevation.

Pain in the AC joint commonly arises from two primary sources:

• AC Joint Sprains (Separations): These are acute injuries, often resulting from a direct fall onto the shoulder or a forceful impact. The severity ranges from mild ligamentous stretch (Grade I) to complete dislocation of the joint with significant ligamentous tearing (Grade III and higher).
• AC Joint Osteoarthritis: This is a degenerative condition where the cartilage within the joint wears down over time, leading to bone-on-bone friction, inflammation, and pain, especially with movement. It's common in older adults and athletes who place repetitive stress on the joint (e.g., weightlifters, overhead athletes).
• Distal Clavicle Osteolysis (Weightlifter's Shoulder): A less common condition, often seen in individuals performing repetitive heavy pressing movements, where microscopic fractures and reabsorption of the bone occur at the end of the clavicle.

Regardless of the cause, managing AC joint pain necessitates a strategic approach to activity modification.

Immediate Actions to Avoid After AC Joint Injury

In the acute phase following an AC joint injury, the primary goal is to minimize stress and promote initial healing.

• Avoid all painful movements: This is paramount. Any movement that elicits or exacerbates pain should be immediately ceased.
• Avoid direct pressure on the joint: Do not sleep on the affected side, and be mindful of seatbelts or backpack straps that may press directly on the joint.
• Refrain from lifting the arm overhead: Even light, unresisted overhead movements can compress the healing joint.
• Do not carry heavy objects: Especially on the affected side, as this can pull down on the shoulder and strain the AC joint.
• Resist the urge to "test" the joint: Repeatedly moving the arm to check for pain can disrupt healing.

Movements and Exercises to Avoid

For both acute injuries and chronic AC joint pain, certain movements and exercise types place undue stress on the joint and should be avoided or significantly modified.

• Overhead Movements:

  • Shoulder Presses (Dumbbell, Barbell, Machine): These exercises directly compress the AC joint, especially at the top of the movement, and can exacerbate pain and inflammation.
  • Overhead Squats, Snatches, Jerks: These Olympic lifts involve significant overhead stability and dynamic movement, placing immense stress on the AC joint.
  • Pull-ups and Lat Pulldowns (Wide Grip): While primarily targeting the lats, the overhead arm position and scapular mechanics can irritate the AC joint, particularly with a wide grip that increases shoulder abduction.
  • Overhead Triceps Extensions: Maintaining the arm in an overhead position can be problematic.
  • Any reaching or throwing motion above shoulder height: This includes sports-specific movements like throwing a baseball, serving in tennis, or spiking in volleyball.

• Cross-Body Adduction Movements:

  • Pec Deck Flys and Cable Crossovers: These exercises involve bringing the arm across the body, which can cause shearing forces on the AC joint, especially if the elbows are kept straight.
  • Hugging or Reaching Across the Body: Simple daily activities like putting on a seatbelt or reaching for an object on the opposite side can be painful.

• Heavy Horizontal Pressing:

  • Bench Press (Barbell, Dumbbell, Incline): While not purely overhead, heavy bench pressing, especially with a wide grip or deep range of motion, can place substantial stress on the AC joint due to scapular protraction and the leverage created.
  • Push-ups: Similar to the bench press, the loading through the shoulder girdle can aggravate the AC joint.

• Direct Shoulder Impingement Exercises:

  • Upright Rows: This exercise combines shoulder internal rotation and elevation, which is a classic position for impingement, directly stressing the AC joint and surrounding structures.

• Heavy Shrugs:

  • While shrugs primarily target the trapezius, heavy loading can directly compress the AC joint, especially if there's pre-existing inflammation or arthritis.

• Impact and Jarring Activities:

  • Running, Jumping, Plyometrics: The repetitive impact can transmit shock waves up the kinetic chain to the shoulder, jarring the AC joint.
  • Contact Sports: Activities like football, rugby, or martial arts carry a high risk of direct impact to the shoulder, which is the primary mechanism for acute AC joint separation.

Lifestyle and Activity Modifications

Beyond structured exercise, daily habits can significantly impact AC joint pain.

• Avoid Sleeping on the Affected Side: This places direct pressure on the joint, leading to pain and inflammation, and can disrupt healing.
• Modify Carrying Habits: Avoid carrying heavy backpacks with straps that dig into the shoulder, or heavy bags on the affected side. Consider cross-body bags or rolling luggage.
• Be Mindful of Posture: Slouching or rounded shoulders can alter scapular mechanics, potentially increasing stress on the AC joint. Maintain an upright posture with shoulders relaxed and back.
• Limit Repetitive Overhead Tasks: This includes occupational tasks like painting ceilings, stocking high shelves, or prolonged reaching.
• Do Not Ignore Pain: Pushing through pain is counterproductive and can worsen the condition, prolonging recovery. Pain is your body's signal to stop.

When to Seek Professional Guidance

While avoiding aggravating movements is critical, it's equally important to understand when professional medical and rehabilitative guidance is necessary.

• Persistent or Worsening Pain: If pain does not improve with rest and activity modification, or if it worsens, seek medical attention.
• Significant Swelling or Deformity: These are signs of a more severe injury, such as a higher-grade AC joint separation.
• Loss of Range of Motion or Strength: Inability to move the arm normally or significant weakness warrants professional assessment.
• Clicking or Grinding Sensations: While not always indicative of severe pathology, these can suggest joint surface irregularities or instability.

A healthcare professional (e.g., orthopedic surgeon, sports medicine physician) can accurately diagnose the cause and severity of AC joint pain. Following diagnosis, a physical therapist can design a personalized rehabilitation program focusing on pain management, restoring range of motion, improving scapular stability, and progressive strengthening of the rotator cuff and surrounding musculature, guiding a safe return to activity.

The Path to Recovery: What to Focus On

While this article emphasizes what to avoid, it's important to remember that recovery is an active process. Beyond avoidance, focus on:

• Rest and Ice: Especially in acute phases, to reduce inflammation and pain.
• Physical Therapy: A structured program is essential for restoring function, improving scapular control, strengthening supporting musculature (rotator cuff, periscapular muscles), and gradually reintroducing movement.
• Pain Management: As advised by a healthcare professional, which may include NSAIDs or other modalities.
• Gradual Progression: Once pain subsides and stability improves, a slow, controlled return to activities and exercises, guided by a professional, is key to sustainable recovery and preventing recurrence.