For anyone dealing with a history of shoulder pain, getting a solid upper body workout can feel like a minefield. Bench presses, overhead presses, pull-ups—many of the staple movements in strength training can feel off-limits when your shoulder isn’t moving or functioning the way it should.
But here’s the good news: physical therapy can help you get back to doing what you love in the gym—safely and effectively.
Why Overhead Movements Hurt
Many overhead exercises require a full range of motion at the shoulder. But for that to happen, the shoulder joint isn’t working alone. It relies on a coordinated effort between your shoulder blade (scapula) and your rib cage to allow your arm to move overhead without pain or compensation.
What often gets overlooked is that the rib cage needs to move 360 degrees—expanding and compressing both in the front (anterior) and back (posterior). If it can’t, your scapula can’t rotate properly, and your shoulder joint gets stuck—leading to stiffness, discomfort, or pain.
The Role of the Rib Cage in Shoulder Mobility
When you raise your arm overhead, your scapula upwardly rotates around your rib cage. But if your rib cage lacks the ability to expand and compress, especially in the upper back or chest wall, that scapular movement becomes restricted. Over time, this restriction limits your range of motion and contributes to shoulder issues.
At our physical therapy clinic, one of the first things we assess in patients with shoulder pain is how well their rib cage moves. If we find restrictions, we often start with targeted breathing and mobility drills.
Two Foundational Drills We Recommend
Here are two exercises we commonly use with patients:
1. Hooklying Overhead Reach with Breathing
This drill helps facilitate sternal movement—the rise and fall of your chest bone—which is essential for true overhead mobility. By combining this position with focused breathing, you can restore motion in the front of the rib cage.
2. Quadruped or Seated Upper Back Expansion Drills
These are designed to open up the posterior rib cage. Again, breathing is key. You’re forcing air into the areas that need more movement to help your scapula glide the way it should when you lift your arm overhead.
These exercises don’t just improve mobility—they create the preconditions for strength. Here is one example!
Build Strength in End Ranges
It’s not enough to just be mobile—you also need to be strong in those new positions. That’s one thing many people overlook. We rarely train in end-range positions, yet we expect to perform demanding lifts like pull-ups or overhead presses from those same angles.
Once mobility is restored, a good physical therapy plan includes strengthening drills that target those vulnerable ranges. This helps ensure that your body is prepared to handle the loads you’re placing on it.
Smart Modifications You Can Make in the Gym
Sometimes, even with mobility and strength gains, certain movements might still feel sketchy. That’s where smart exercise modifications come into play.
Here are two of our go-to adjustments:
1. Recline Your Bench for Overhead Pressing
Instead of pressing from a fully upright 90-degree position, try adjusting your bench to 70 degrees. This slight incline reduces the mobility demands on your shoulder but still gives you the same strength-building benefits.
2. Modify Your Pull-Up Angle
If you find yourself arching your back or “rowing” yourself to the bar during pull-ups, you’re likely compensating for a lack of mobility. Use bands, assist machines, or change your grip and angle to allow for vertical pulling without strain.
Physical Therapy: More Than Just Rehab
The beauty of physical therapy is that it’s not just for injury recovery—it’s also about performance optimization. Whether you’re a recreational lifter or a competitive athlete, working with a physical therapist can help you:
- Identify the root cause of pain or restriction
- Restore movement and strength
- Learn smarter ways to train around limitations
- Get back to enjoying your workouts without setbacks
Final Thoughts
Shoulder pain doesn’t have to be the end of your upper body training. By addressing rib cage mobility, strengthening in end ranges, and applying smart gym modifications, you can continue progressing—even with a history of pain.
If you’re tired of missing workouts or avoiding the exercises you love, consider reaching out to a physical therapy professional who understands performance. We’d love to help you move better, feel stronger, and train pain-free.
Interested in working with us?
Contact us today to schedule a performance-based physical therapy evaluation and start building a body that’s ready for anything—pain-free.
