Dips: Causes of Pain, Prevention, and Alternatives

Why do dips hurt?

Dips, a highly effective compound exercise for the upper body, can unfortunately cause pain, most commonly in the shoulders and elbows. This discomfort often stems from improper form, inadequate joint mobility or stability, insufficient strength, or pre-existing musculoskeletal conditions, necessitating careful attention to technique and progressive loading.

Understanding the Dip: A Biomechanical Breakdown

The dip is a closed-chain compound exercise primarily targeting the triceps brachii, pectoralis major (lower fibers), and anterior deltoids. It involves significant movement at two major joints: the shoulder and the elbow.

• Shoulder Joint: Experiences extension and adduction. The glenohumeral joint (ball-and-socket) is placed under considerable stress, especially at the bottom of the movement, due to the combination of leverage and body weight. The scapulae should ideally depress and retract to provide a stable base.
• Elbow Joint: Undergoes flexion and extension. The triceps are the primary movers here, extending the elbow to lift the body.

The dynamic nature of the dip, suspending the entire body weight through these joints, makes it demanding and unforgiving of poor mechanics or underlying issues.

Common Causes of Shoulder Pain During Dips

The shoulder joint is a frequent site of pain during dips due to its complex structure and the stresses placed upon it.

• Excessive Depth or Range of Motion: Going too deep, where the shoulders drop significantly below the elbows, can place the glenohumeral joint in an overly extended and internally rotated position. This stretches the anterior capsule and impinges structures in the subacromial space (e.g., rotator cuff tendons, bursa).
• Poor Scapular Control: Failing to depress and retract the shoulder blades properly can lead to:
  • Shoulder Shrugging: Elevating the shoulders towards the ears, which reduces subacromial space.
  • Anterior Glenohumeral Glide: The humerus shifting too far forward in the socket, stressing the anterior capsule and potentially impinging the biceps tendon.
• Elbow Flare: Allowing the elbows to track wide to the sides shifts the stress more onto the anterior deltoids and pectorals, but also increases the internal rotation moment at the shoulder, potentially leading to impingement.
• Pre-existing Shoulder Conditions:
  • Rotator Cuff Impingement or Tendinopathy: Compression or irritation of the rotator cuff tendons (supraspinatus, infraspinatus, teres minor, subscapularis) is a common cause of pain, particularly with overhead or deep pressing movements.
  • AC Joint (Acromioclavicular Joint) Sprain/Irritation: The AC joint, where the collarbone meets the shoulder blade, can become painful due to direct compression or shear forces during the dip, especially if the shoulders are excessively protracted.
  • Labral Tears: Tears in the cartilage rim of the shoulder socket can cause clicking, catching, and deep-seated pain.
  • Shoulder Instability: Weakness in the stabilizing muscles or ligaments can lead to excessive movement of the humeral head, causing pain and a sense of apprehension.
• Inadequate Mobility: Limited thoracic spine extension or shoulder external rotation can force compensatory movements at the glenohumeral joint, increasing strain.
• Insufficient Strength: If the triceps, pectorals, or shoulder stabilizers are not strong enough to control the eccentric (lowering) phase, the body may collapse into a compromised position, leading to injury.

Common Causes of Elbow Pain During Dips

Elbow pain, while less common than shoulder pain, can be sharp and debilitating during dips.

• Hyperextension at the Top: Forcefully locking out the elbows at the top of the movement can create high impact stress on the joint, potentially irritating the joint capsule or leading to bone-on-bone compression over time.
• Triceps Tendinopathy: Overuse or excessive loading of the triceps tendon (where it attaches to the elbow) can lead to inflammation and pain, particularly during the eccentric phase or at the bottom of the dip. This is often exacerbated by rapid increases in volume or added weight.
• Poor Wrist Alignment: If the wrists are excessively extended or flexed, it can create an unfavorable kinetic chain, transferring undue stress up to the elbow.

Other Potential Pain Points

While less frequent, other areas can also experience discomfort during dips.

• Wrist Pain: Can occur if the wrists are not kept neutral and stacked directly over the hands, or if there's insufficient wrist mobility or strength to support the body weight.
• Sternum/Chest Pain: Sometimes experienced as a deep, central chest pain. This can be due to overstretching of the sternum or costochondral junctions (where ribs meet cartilage), especially with excessive depth and an anterior pelvic tilt.

Strategies to Prevent and Alleviate Dip Pain

Addressing dip pain requires a multi-faceted approach focusing on form, progression, and joint health.

• Prioritize Impeccable Form:
  • Control Depth: Lower yourself until your shoulders are no lower than your elbows. This generally keeps the shoulder in a safer, less impingement-prone position.
  • Elbow Position: Keep your elbows relatively tucked (not excessively flared) and tracking mostly backward.
  • Scapular Stability: Actively depress and retract your shoulder blades throughout the movement. Imagine "putting your shoulder blades in your back pockets."
  • Core Engagement: Maintain a neutral spine and engaged core to prevent excessive arching or rounding.
  • Controlled Movement: Avoid bouncing or using momentum. Perform both the eccentric and concentric phases with control.
• Progressive Overload and Scaling:
  • Start with Assisted Dips: Use an assisted dip machine or resistance bands to reduce the load and allow you to practice perfect form.
  • Build Foundational Strength: Ensure adequate strength in your triceps, pectorals, and shoulder stabilizers before attempting full bodyweight dips or adding external weight.
  • Gradual Progression: Only increase repetitions, sets, or add weight incrementally. Avoid sudden jumps in training volume.
• Thorough Warm-up and Mobility Drills:
  • Dynamic Shoulder Mobility: Include arm circles, band pull-aparts, and thoracic spine rotations.
  • Scapular Activation: Perform exercises like face pulls, band rows, and YTWLs to awaken the scapular stabilizers.
  • Elbow and Wrist Preparation: Gentle wrist circles and elbow flexion/extension movements.
• Strengthen Supporting Muscles:
  • Rotator Cuff Exercises: Internal and external rotations with light weights or bands.
  • Scapular Stabilizers: Rows, pull-aparts, and overhead presses to develop strength around the shoulder blade.
  • Triceps and Chest Isolation: Incorporate exercises like triceps pushdowns, overhead triceps extensions, and dumbbell presses to build specific strength.
• Listen to Your Body: Differentiate between muscle fatigue and sharp, acute joint pain. If you experience pain, stop the exercise immediately.
• Seek Professional Guidance: If pain persists despite modifying your technique and training, consult a physical therapist, sports medicine doctor, or a certified strength and conditioning specialist. They can diagnose underlying issues and provide a tailored rehabilitation plan.

When to Modify or Avoid Dips

It's crucial to know when to back off or opt for alternative exercises.

• Acute Pain: If you experience sharp, sudden pain during a dip, cease the exercise immediately.
• Diagnosed Joint Conditions: Individuals with pre-existing shoulder impingement, rotator cuff tears, AC joint issues, or elbow tendinopathy may need to avoid or significantly modify dips.
• Significant Mobility Limitations: If you cannot achieve a safe range of motion without compensation, dips may not be appropriate until mobility is improved.

Consider alternatives such as close-grip push-ups, triceps pushdowns, dumbbell bench presses, or landmine presses, which offer similar benefits with potentially less joint stress.

Conclusion

Dips are an incredibly effective exercise for building upper body strength and muscle, but they demand respect for proper biomechanics and individual limitations. Most pain associated with dips can be traced back to incorrect form, insufficient preparation, or pushing too hard too soon. By prioritizing proper technique, progressively overloading, incorporating comprehensive warm-ups and accessory work, and listening to your body, you can harness the benefits of dips while minimizing the risk of pain and injury. If pain persists, professional evaluation is always recommended to ensure long-term joint health.