What is AC joint pain and what causes it?

The AC (acromioclavicular) joint is at the top of the shoulder; pain typically results from sprains or separations caused by direct trauma, repetitive stress from overhead activities, or degenerative changes like osteoarthritis.

When should I absolutely avoid working out with AC joint pain?

You should immediately stop exercising and consult a medical professional if you experience severe acute pain, significant swelling or deformity, inability to move your arm, numbness, worsening pain, or suspect a fracture or high-grade tear.

What types of exercises are generally safe with AC joint pain?

Generally safe exercises include lower body workouts (e.g., squats, lunges), core exercises (e.g., planks, dead bugs), and modified upper body movements like horizontal rows, face pulls, and external rotations, provided they are performed within a pain-free range.

Which exercises should be strictly avoided if I have AC joint pain?

Strictly avoid exercises that put direct stress on the AC joint, such as overhead presses, bench presses, push-ups, dips, lateral/front raises (especially with heavy weights), and upright rows.

Why is professional guidance important for managing AC joint pain?

Professional assessment by a physical therapist or sports medicine physician is crucial for accurate diagnosis, tailored rehabilitation, and guidance on safely returning to activity while preventing re-injury.

Can I workout with AC joint pain?

Working out with AC joint pain is often possible, but it critically depends on the severity of the injury, the specific exercises, and your ability to perform movements without exacerbating pain or causing further damage.

Understanding AC Joint Pain

The acromioclavicular (AC) joint is a small but crucial joint located at the top of the shoulder, connecting the acromion (part of the shoulder blade) to the clavicle (collarbone). It plays a vital role in shoulder and arm movement, especially during overhead activities. Pain in this joint typically arises from an AC joint sprain or separation, which is a stretch or tear of the ligaments that hold the joint together.

Common Causes:

Direct trauma: Falls directly onto the shoulder (e.g., cycling accidents, sports collisions).
Repetitive stress: Overuse from activities involving overhead arm movements (e.g., weightlifting, throwing sports).
Degenerative changes: Osteoarthritis of the AC joint, common with aging.

Symptoms:

Localized pain at the top of the shoulder.
Swelling and tenderness over the joint.
Pain with overhead movements, cross-body arm movements, or sleeping on the affected side.
A visible bump or deformity (in more severe separations).

Grades of AC Joint Injury: AC joint injuries are typically graded based on the severity of ligament damage and displacement:

Grade I: Mild sprain, ligaments stretched but not torn, no significant displacement.
Grade II: Partial tear of the AC ligament, some displacement.
Grade III: Complete tear of both AC and coracoclavicular (CC) ligaments, significant displacement.
Grades IV-VI: More severe injuries involving greater displacement and often muscle involvement, requiring surgical intervention.

The "Can I Workout?" Answer: A Nuanced Perspective

For Grade I and mild Grade II AC joint injuries, working out is often possible with careful modification and adherence to pain-free movement. The goal is to maintain fitness without aggravating the injury. For more severe Grade II, Grade III, or higher-grade injuries, a period of rest, immobilization, and professional medical assessment is absolutely necessary before considering any exercise.

When to Absolutely AVOID Working Out

You should immediately cease all exercise and consult a medical professional (doctor, physiotherapist) if you experience:

Acute onset of severe pain after a fall or impact.
Significant swelling, bruising, or deformity around the shoulder.
Inability to move your arm through its normal range of motion without intense pain.
Numbness or tingling in your arm or hand.
Pain that worsens significantly during or after light activity.
Any suspicion of a fracture or high-grade ligament tear.

Safe Movement Principles with AC Joint Pain

If your pain is mild and a professional has cleared you for exercise, adhere to these principles:

Listen to Your Body: Pain is your body's alarm system. Never push through AC joint pain. If an exercise causes discomfort, stop immediately.
Pain-Free Range of Motion: Only move your arm and shoulder within ranges that are completely pain-free.
Controlled Movements: Avoid jerky, ballistic, or rapid movements. Focus on slow, controlled execution.
Load Management: Start with very light weights or bodyweight, gradually increasing resistance only if pain-free.
Prioritize Scapular Stability: Focus on exercises that strengthen the muscles around the shoulder blade (rhomboids, serratus anterior, lower trapezius) to provide better support for the AC joint.
Maintain Good Posture: Slouching can put additional stress on the AC joint.
Warm-Up Adequately: Gentle, pain-free mobility exercises for the shoulder and upper back.

Recommended Exercises and Modifications

When cleared, focus on exercises that minimize direct stress on the AC joint while maintaining overall fitness.

Lower Body:
- Squats (Goblet, Front, Back): Ensure the bar position for back squats does not press directly on the AC joint. Goblet or front squats may be more comfortable.
- Lunges (Forward, Reverse, Lateral): Excellent for leg strength without shoulder involvement.
- Deadlifts (Conventional, Sumo, Romanian): Can be performed as long as the initial setup and grip don't strain the shoulder. Use a trap bar if a conventional bar causes discomfort.
- Leg Press, Leg Extensions, Hamstring Curls, Calf Raises: All are safe options.
Core:
- Planks (Forearm Plank): Avoid high planks on hands if wrist extension or shoulder stabilization causes pain.
- Side Planks: Good for oblique strength.
- Dead Bugs: Excellent for core stability without upper body loading.
- Bird-Dog: Focus on controlled movement and spinal stability.
- Abdominal Crunches/Leg Raises: As long as there's no shoulder involvement or pulling on the neck.
Upper Body (Modified and Cautious):
- Horizontal Rows (Machine, Cable, Dumbbell): Focus on pulling movements where the elbows stay below shoulder height. Ensure scapular retraction, not just arm pulling.
- Face Pulls: Excellent for rear deltoids and upper back, promoting external rotation and scapular retraction. Use light resistance.
- External Rotations (Band, Cable, Light Dumbbell): Crucial for rotator cuff health and stability. Keep elbow tucked.
- Scapular Retractions/Depressions: Simple exercises like "W" raises or prone scapular squeezes to activate the muscles stabilizing the shoulder blade.
- Bicep Curls: Generally safe, but be mindful of any pain during the curl or initial lift.
- Tricep Pushdowns (Cable): Keep elbows close to the body. Overhead tricep extensions should be avoided.

Exercises to Strictly AVOID or Modify Heavily

These exercises place direct stress on the AC joint and should be avoided or approached with extreme caution and professional guidance.

Overhead Presses (Dumbbell, Barbell, Machine): The most common aggravator due to direct compression and shear forces on the AC joint.
Bench Press (Barbell, Dumbbell, Incline): Especially the bottom portion where the humerus is maximally extended, causing shear forces. Decline bench press might be less stressful but still risky.
Push-ups: Similar to bench press, can place significant stress on the AC joint. Elevated push-ups or kneeling push-ups might be possible if pain-free.
Dips: High risk due to the extreme shoulder extension and internal rotation at the bottom.
Lateral Raises and Front Raises (Especially with heavy weights): These movements directly load the deltoid and can impinge or stress the AC joint, particularly at the top of the movement.
Upright Rows: High risk due to internal rotation and abduction, leading to impingement and AC joint stress.
Pull-ups/Lat Pulldowns (Wide Grip): Overhead pulling can be problematic, especially with wider grips. Neutral grip or closer grip variations might be less painful if done very carefully.

The Role of Rehabilitation and Professional Guidance

For any AC joint pain, a comprehensive assessment by a physical therapist or sports medicine physician is highly recommended. They can:

Accurately diagnose the grade of injury.
Provide specific pain management strategies (e.g., RICE – Rest, Ice, Compression, Elevation).
Develop a tailored rehabilitation program focusing on restoring range of motion, strength, and stability.
Guide your return to activity, ensuring a safe and progressive approach.
Teach proper exercise technique to prevent re-injury.

Long-Term Management and Prevention

To prevent recurrence and maintain shoulder health:

Prioritize Scapular Stability: Continuously incorporate exercises that strengthen the muscles around the shoulder blade.
Improve Posture: Be mindful of rounded shoulders and forward head posture, which can contribute to AC joint stress.
Gradual Progression: When increasing weight or intensity, do so slowly and incrementally.
Proper Form Over Weight: Always prioritize correct biomechanics over lifting heavy.
Listen to Early Warning Signs: Address minor aches or stiffness before they escalate into full-blown pain.
Cross-Training: Vary your workouts to avoid overuse injuries in specific joints.

Conclusion

While the desire to maintain fitness is strong, exercising with AC joint pain requires a cautious, informed, and often professionally guided approach. For mild injuries, careful modification of exercises, strict adherence to pain-free movement, and a focus on core and lower body strength can allow for continued activity. However, for more severe injuries or persistent pain, rest and professional medical intervention are paramount. Prioritizing the health and long-term function of your AC joint will ultimately lead to more sustainable and pain-free training.

AC Joint Pain: Understanding, Safe Workouts, and Recovery