Home Baseball Content Getting Geeky with AC Joints: Part 2

Getting Geeky with AC Joints: Part 2

Written on September 9, 2009 at 6:29 am, by Eric Cressey

Getting Geeky with AC Joints: Part 2

In my last newsletter, I went into great detail on the types of acromioclavicular (AC) joint injuries we see, and some of the common inefficiencies that cause some folks to become symptomatic.  I also outlined some corrective exercise strategies to expedite recovery time.  This week, though, I discuss a very important – yet often-overlooked – piece of the puzzle: how to maintain a training effect in spite of these injuries.

Ask anyone who has ever had an AC joint injury, and they’ll tell you three things to avoid if you don’t want to irritate it:

1. Avoid direct pressure to the area (particularly because it has very little muscle mass to cushion it)

2. Avoid reaching across the body (horizontal adduction)

3. Avoid reaching behind the body (full extension)

We can use these three guidelines to get moving in the right direction with respect to maintaining a training effect in spite of the AC joint injury.

With respect to #1 from above, front squats are an absolute no-no.  The pressure on the bar across the shoulder girdle can really take an upset AC joint and make it markedly worse.  And, since this is in many cases an injury that we’re just “waiting out,” simply training through it will only makes things worse long-term.  So, deadlift variations, single-leg variations, and back squats (assuming no other related problems) are likely better bets.  That said, we generally use the safety squat bar and giant cambered bar exclusively with those who present with AC joint problems.

Another important consideration in this regard is overhead pressing.  Believe it or not, many individuals with AC joint problems will actually tolerate overhead pressing quite well, as direct trauma to the AC joint won’t really compromise scapulohumeral rhythm very much.  However, you have to consider two things.

First, as I mentioned in my previous newsletter, some folks might have developed the AC joint issue over time due to a scapular anterior tilt causing the acromion and clavicle to sit differently.  This dyskinesis would also make overhead work less safe – so the individual would actually be training through a faulty movement pattern, and potentially injuring the rotator cuff, biceps tendon, bursa, and labrum.

Second, if the individual is okay to overhead press from a movement standpoint, one needs to make sure that the bar, dumbbell, or kettlebell does not come down directly on the AC joint in the bottom position.

With respect to #2 from above, obviously, dumbbell flyes and cable crossovers are out (not sure why they’d be “in” in the first place, but that’s a whole different newsletter).  However, close-grip bench pressing variations will generally cause pain as well.  You also have to be careful with cable and medicine ball variations that may position the arm across the body.

Moving on to #3, full extension of the humerus will light up an AC joint pretty quickly.  So, dips are out – and, honestly, I generally tell folks they’re out for good after one has experienced any kind of AC joint issue.  Full range-of-motion (ROM) bench pressing and push-ups are generally issues as well, so I tend to start folks with more partial ROM work.  Examples would include dumbbell and barbell floor presses and board presses.  Here’s a 3-board press:

As the shoulder starts to feel better, one can move down to 2-board, 1-board, and eventually full ROM bench press.  Remember, a medium or wide grip will generally be tolerated better than a close grip.

I also really like push-up iso holds at a pain-free ROM for these individuals because closed-chain exercises are always going to be a bit more shoulder friendly than open-chain variations.  This is really quite simple: set up as if you are going to do a push-up, and go down as far as you can with no pain.  When you reach your pain-free end-range, hold there while bracing the core, locking the shoulder blades down and back, and tightening the glutes; do not let the elbows flare out or hips sag!  We’ll hold for anywhere from 10-60s, depending on fitness levels.  Over the course of time, increase the ROM as your symptoms reduce.

There you have it: acromioclavicular joints – from onset to corrective exercise – in a nutshell.  Obviously, make sure you seek out a qualified professional if you think you may have these issues, but keep this progression in mind as you return to (or just try to stay in) the iron game.

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15 Responses to “Getting Geeky with AC Joints: Part 2”

  1. P. J. Striet Says:


    It’s ironic you devoted two newsletters to AC joint injuries because I’ve been dealing with some AC aggravation for the last 6 weeks or so. Question: while it has been well established one should bench press with a retracted and depressed scapulae, is is fair to say this position is potentially aggravating to the AC joint? I can dumbbell or barbell bench with a “neutral” scapulae (for lack of a better term) and have absolutely no pain (not that I do this on a regular basis but I was just doing some trial and error), but, when I bench with what would be considered a proper set-up (depressed and retracted), my right AC joint begins to hurt. Any thoughts on this? Also, yes, I can overhead press with absolutely no problem but dips flare things up (not that I do dips anymore…just going from past experience). Thanks.

  2. Kirk Kemp Says:

    I am currently one week away from finishing the Neanderthal no more series and purchased your book maximum strength to continue my training. However I feel like this book is still predominantly anterior while I am still in need of more posterior dominant training due to six plus years of bodybuilding type exercise. Am I wrong? Do you offer something that fits my predicament if so how much and where can I get it? Also I did lots of weighted pull ups with excessive weights of 100 plus pounds for 2 of those years. Thanks you cause my shoulders were really messed up from the pull ups and already feeling better from the Neanderthal no more series.

  3. Jerry Gershon Says:

    Excellent timing for me too! I’ve also go an AC joint sprain and have started Maximum Strength. I was wondering what kind of exercises I could use to maximize training effect during my injury. Any other suggestions for exercises I could do in the absence of benching variations, front squats and overhead lifts while training using your Max. Strength program?

  4. Eric Cressey Says:

    PJ – My hunch would be that you may be elevating the scaps a bit too much as you retract – possibly using upper traps too much. Tough to say w/out seeing you.

    Kirk – There’s actually markedly more pulling than pushing, especially when you consider the favorable effects of deadlifting on the postural muscles of the upper back. The pre-exercise mobility work will also help tremendously.

    Jerry – That was the basic idea of the newsletter! Go to back squats if you’re able; if not, use single-leg work. Substitute limited ROM stuff on the bench (or omit altogether, if it’s still painful). Plug in some pressdowns or push-up variations if overhead lifting is out.

  5. Chris Says:

    Separated acj 2-yr ago froma fall, had it pinned and, pin removed and rehab. Was told to lay off db lateral raises, front raises, upright rows and have since learnt not to do pronated grip pull ups.

    I’m ok with close grip benching but I actually prefer close grip floor pressing. Is it ok progress with the weight on this and any other exercise in due course as fear my limiter.

    I also train upper body twice/week and was wondering, as I have time October to March if it’s fine to get a third upper work out in per week doing a few row variations as I read somewhere the more rowing the better. Thanks

  6. John Says:

    I sprained my AC Joint like 2 months ago and it still kinda hurts here and there. If i apply direct pressure to it feels very uncomfortable and I cant sleep on it. reaching across my body and beind my head definately hurts, and looking in the mirror i can see a noticable difference between both of my shoulders. What should I do?

  7. Eric Cressey Says:

    John – Definitely get it checked out by a doctor/physical therapist in your area.

  8. Don W. Says:

    Hi Eric,

    In 2009, after returning from a pec minor tear, my shoulder dislocated on the same side tearing my AC joint.

    Things have healed with a nice bump, and I have returned to dumbbell benching with a neutral grip and slight incline. Things are going well.

    I have used face pulls in the 20-30 rep range to help stabilize my shoulder, but I am having problems re-developing my upper traps. With the barbell, my shoulder gets pulled too far forward irritating the AC, and with dumbbells I have a tendency to go too low, rasing/overstretching the joint.

    Any advice on upper traps after an AC injury?

    Thank you,

  9. Eric Cressey Says:

    Don – try some overhead shrugging variations; they work like a charm.

  10. Patrick Roy-V., Kin. Says:

    Hi Mr. Cressey,

    1. I would like to invite a re-examination of the commonly given advice of adducting the scapulae prior to bench pressing. I find that it increases tension on the AC joint. This is something I’ve experienced myself, having had an AC joint injury. As I had almost recovered fully, I began experimenting a lot and found that light-to-moderate scapula retraction is fine (and helps arm horizontal abduction), but anything more and the tension on the AC joint will be too high. So I feel the advice of strongly bringing the scapulae back and down is wrong.

    I see this echoes some of “P.J.” observations and so I read your response to his comment. I must specify that I did not elevate the scaps; moreso, adding depression to the retraction seemed to slightly further *increase* the pain/discomfort.

    2. There seems to be a fundamental issue with the bench: Due to its width, the glenohumeral joint is outside, while only the medial part of the scapula rests on the bench. The weight drives the lateral part of the scapula into the bench, which the cushioning allows, thereby rotating the scapulae outwards, and this pulls on the AC joint. This is a hypothesis a physio collegue and myself have emitted as the cause of injury. It is difficult for me to explain via text; I hope you can understand what I mean.

    I would enjoy reading your thoughts about these two points.

    Thank you for your newsletter and giving us the opportunity to discuss !

  11. Greg H. Says:

    Hi Eric,

    I was diagnosed recently with AC joint shoulder impingement syndrome and the X-ray shows arthritis only in the AC joint. I’m currently in physical therapy, stretching the pec minor and doing shoulder horn and lite full ROM front laterals 3 x week on top of my three days of lifting. Should I stop bench pressing and dumbell Millitary press? I’m able to comfortably front squat with bar rolled a little forward and off AC joint. Also heavy deadlifts, wide grip upright rows, shrugs and shoulder flys feel fine. I realize I have a muscle imbalance and devote one day of lifting on upper back seratus interior, rear delts, rhomboids. Is one set of bench or incline press per week ok (1×10 80% of max) or will an arthritic AC joint collapse?


  12. Eric Cressey Says:


    I’d encourage you to discuss these questions with your physical therapist, as he/she has evaluated you in person and can do a much better job of answering them, as I haven’t been able to see you and get a feel for how you move.

  13. Serena Says:

    Eric, my AC bumps are pretty severe but not caused by anything drastic. Probably from a couple auto accidents and natural thinness.

    My physical therapist said no overhead pressing but I have no pain in the AC joints (unless I sleep on the right side) and it’s not difficult for me. Still think it’s a bad idea? I can’t help cover the bumps if I can’t overhead press! Or can I?!

    Ps, my right AC joint area never stuck out until one day after bench pressing I noticed it and then it’s come out fully. I hate boney shoulders!!


  14. Eric Cressey Says:

    Hi Serena,

    I’d not really my place to “overrule” your physical therapist, as I haven’t seen you in person. I’d talk with him/her about it and see if you can come up with a plan TOGETHER.

  15. bastien Says:

    Hello Eric, First of all thank you for this article, I will try soon
    your advices but I have one question regarding a particular exercise
    which I’m not sure if it’s good for me to continue practicing it in my
    working out routine : Pull-up. Will it hurt my ac joint ? I though It
    will be better to use a neutral grip. What are your thoughts on it ?

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