Barbell Squat: Causes, Prevention, and Treatment of Shoulder Pain

Why do my shoulders hurt when I barbell squat?

Shoulder pain during barbell squats is a common complaint, often stemming from a combination of improper bar placement, inadequate shoulder and thoracic mobility, poor grip mechanics, and underlying musculoskeletal imbalances or injuries that are exacerbated by the demands of the squat rack position.

Understanding the Barbell Squat Shoulder Position

The barbell squat requires the upper back and shoulders to create a stable shelf for the barbell. This position places significant demands on the shoulder joint's range of motion, particularly external rotation, extension, and abduction, as well as the mobility of the thoracic spine. Depending on whether you perform a high-bar or low-bar squat, the specific stresses on the shoulders will vary, but both positions necessitate a degree of shoulder flexibility and stability.

Common Biomechanical Contributors to Shoulder Pain

Several technical and anatomical factors can contribute to shoulder discomfort during barbell squats:

• Improper Bar Placement:
  • High Bar: If the bar is placed too high on the neck (instead of resting on the traps), it can compress cervical nerves or force the shoulders into an excessively internally rotated and extended position.
  • Low Bar: If the bar is placed too low on the posterior deltoids, it demands an extreme degree of shoulder external rotation and extension, which many individuals lack, leading to impingement or strain.
• Excessive Grip Width:
  • Grip Too Narrow: A very narrow grip forces the shoulders into maximal external rotation and extension, which can be highly restrictive and painful if mobility is limited, potentially impinging structures within the shoulder joint.
  • Grip Too Wide: While seemingly less stressful, a grip that is too wide can make it difficult to create a stable shelf, leading to excessive forward lean and increased stress on the anterior shoulder from resisting the bar's tendency to roll.
• Limited Shoulder Mobility:
  • Restricted External Rotation: A primary culprit, as the squat rack position requires significant external rotation of the humerus.
  • Limited Shoulder Extension: Inability to bring the arms back sufficiently can force the shoulder into an uncomfortable and unstable position.
  • Tight Pectoralis Minor/Major: Can pull the shoulders forward, limiting scapular retraction and external rotation.
  • Tight Latissimus Dorsi: This large back muscle can restrict shoulder flexion and external rotation, pulling the humerus into internal rotation.
• Restricted Thoracic Spine Mobility: A stiff upper back (thoracic spine) can prevent proper extension, forcing the shoulders to compensate by over-extending or internally rotating, leading to discomfort and an unstable bar path.
• Poor Scapular Stability: Weak or dysfunctional periscapular muscles (e.g., rhomboids, lower trapezius, serratus anterior) can lead to poor scapular positioning (e.g., protracted or elevated scapulae), compromising the stability of the glenohumeral joint and increasing impingement risk.
• Compensatory Elbow/Wrist Positioning: Flared elbows or hyperextended wrists often indicate a lack of shoulder or thoracic mobility, placing undue stress on the shoulder joint as it tries to achieve the necessary position.

Underlying Anatomical Considerations

When biomechanical issues are present, they can exacerbate or reveal underlying anatomical vulnerabilities:

• Rotator Cuff Tendinopathy/Strain: The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) are crucial for shoulder stability and rotation. The squat position can strain these tendons, especially if they are already inflamed or weakened.
• Bicipital Tendinopathy: Inflammation or irritation of the long head of the biceps tendon, which runs through the shoulder joint, can be aggravated by the extended and externally rotated position of the arm.
• AC Joint Irritation: The acromioclavicular (AC) joint, where the collarbone meets the shoulder blade, can become irritated if the bar presses directly on it or if excessive stress is placed on the joint due to poor positioning.
• Shoulder Impingement Syndrome: This occurs when tendons or bursa in the shoulder are compressed as the arm is lifted. The squat rack position can mimic this action, leading to pain, especially if pre-existing impingement is present.

Strategies for Alleviating and Preventing Shoulder Pain

Addressing shoulder pain during barbell squats requires a multi-faceted approach focusing on technique, mobility, and strength:

• Optimize Bar Placement:
  • High Bar: Ensure the bar rests firmly on the upper traps, not directly on the cervical spine. Actively squeeze the shoulder blades together to create a stable shelf.
  • Low Bar: The bar should rest on the posterior deltoids, with the shoulder blades squeezed back and down to form a stable platform.
• Adjust Grip Width: Experiment with different grip widths. The goal is to find the narrowest grip that allows you to maintain a neutral wrist position and keep your elbows relatively under the bar without excessive shoulder strain. For most, this means hands just outside shoulder width.
• Improve Shoulder and Thoracic Mobility:
  • Daily Mobility Drills: Incorporate exercises like "shoulder dislocations" (with a PVC pipe or resistance band), pec minor stretches, lat stretches, and thoracic spine extensions (e.g., foam rolling, cat-cow variations).
  • Dynamic Warm-up: Prioritize dynamic stretches for the shoulders and upper back before squatting.
• Strengthen Scapular Stabilizers and Rotator Cuff:
  • Include exercises like face pulls, band pull-aparts, band external rotations, YTWLs, and prone scapular retractions to build strength and endurance in the muscles that support the shoulder blade and rotator cuff.
• Maintain Proper Elbow and Wrist Positioning:
  • Keep elbows pointed down or slightly back, not excessively flared.
  • Maintain neutral wrists; avoid hyperextension. The bar should sit in the "meat" of the hand, not directly on the wrist joint.
• Consider Alternative Squat Variations:
  • If pain persists, temporarily switch to front squats (which demand less shoulder extension), safety bar squats, or goblet squats to continue training the lower body while allowing the shoulders to recover and mobility to improve.
• Progressive Overload and Deloads: Ensure you're not increasing weight too quickly. Incorporate deload weeks to allow for recovery and adaptation.

When to Seek Professional Help

While many cases of squat-related shoulder pain can be resolved with technique adjustments and mobility work, it's crucial to seek professional medical advice if you experience:

• Persistent pain that does not improve with rest or adjustments.
• Sharp, shooting, or radiating pain.
• Numbness or tingling in the arm or hand.
• Significant weakness in the shoulder or arm.
• Audible clicking, popping, or grinding sounds with pain.

A qualified physiotherapist, sports physician, or experienced strength coach can provide a thorough assessment, diagnose the underlying cause, and develop a tailored rehabilitation and training plan.