The traditional barbell squat is generally considered to be rather safe if performed with correct form and the proper amount of weight, but certain health conditions or training inadequacies can cause the exerciser to experience significant pain in the shoulder muscles and the underlying joint itself during this particular exercise.
While a moderately common problem, the actual reason why the exerciser encounters this shoulder pain can be due to a multitude of reasons that may be difficult to pin down without being personally assessed by a physical therapist or similar trained professional.
Nonetheless, the majority of cases wherein an individual experiences shoulder pain while squatting are not of serious consequence or risk, and as such may be remedied with subsequent changes in the training routine of the exerciser, or with additional rehabilitative methods that correct any possible shoulder issues.
With the barbell squat and its related variations all being used primarily to train the lower body, the role of the shoulder in such an exercise is of little to no importance, and is generally used to stabilize the barbell atop the exerciser’s back and trapezius so as to prevent injury or dropping of the weight.
However, this places the shoulder joint in a certain position that can cause significant stress and pressure upon it, presenting one if not the main cause of shoulder pain during most cases of pain from a barbell squat.
This, of course, must be further explored so as to correct the underlying reasons behind such connective tissue stress - with a variety of other reasons also possibly being a culprit behind the shoulder pain.
Due to the flexion and extension of the ball and socket joint that is the shoulder, the positioning of the barbell along the exerciser’s back, any muscle groups related to the shoulder’s subsequent contraction, the exerciser’s grip width, and even their own bodily proportions can all also result in shoulder pain during the barbell squat.
The shoulders primarily act as minor stabilizer muscles throughout the entirety of the squat exercise, usually resulting in isometric type contraction wherein the muscle group (the three deltoid heads) are activated while remaining largely immobile.
This, of course, is also in relation to the rotator cuff muscles, which act as not only the primary support to the shoulder joint and the deltoids, but also as a primary mover during any movement involving that particular area of the body.
As such, it can stand to reason that any injury or fatigue of the rotator cuff muscles will also result in subsequent pain in the general shoulder area itself.
On rare occasions, pain may even be present along the back of the shoulder, wherein the rear or posterior head of the deltoid muscle group that makes up the shoulders is stressed or otherwise damaged from the positioning of the barbell atop the exerciser’s back, or even due to their own posture.
The most common reason an exerciser may experience pain after or during the performance of a barbell squat is a lack of shoulder joint mobility, either due to injury, excessive usage or a lack of tissue flexibility.
This is most noticeable in exerciser’s of rather wide grip width along the barbell or those who are performing the exerciser with improper form mechanics wherein their chest is leaning too far forward during the eccentric portion of the movement.
Generally, if this is the case, simple rehabilitative exercises that may improve the mobility of the exerciser’s shoulder are all that is required, with the particular type of rehabilitative exercise depending on the severity and nature of the exerciser’s reduced shoulder mobility.
Though reduced shoulder mobility is the primary reason behind shoulder pain during squats in the majority of cases, certain other aspects relating to the barbell squat such as the total weight being used or the exerciser’s own shoulder positioning can also cause such symptoms.
As such, it is generally a good idea for the exerciser or their coach to assess the following issues in their training or physical health in order to ensure that they are not the direct cause of their shoulder pain experienced during squatting, or simply their shoulder pain in general.
Being utilized as a minor stabilizer muscle during the barbell squat, the shoulders in such a position are not meant to withstand excessive amounts of weight as doing so can easily overload the muscle while it is placed in such a manner that significantly weakens its structural integrity.
This is primarily done on accident by the exerciser placing the barbell too high up on their back or by the exerciser spreading their grip too wide, forcing the shoulders to hold up the weight of their extended arms alongside the weight of the barbell itself.
Excessive loading of the stabilizer muscles can also occur in the event that the exerciser possesses a muscular imbalance that forces the shoulders to take a more dynamic role during the squat exercise - either from a weakened rotator cuff muscle or a weakened lower back muscle group, shifting some amount of the resistance to the shoulder muscles instead.
More of a general postural issue than one directly related to the performance of the barbell squat exercise itself, an internally or externally rotated shoulder or shoulders can be easily worsened by the added weight of the barbell on the exerciser’s back.
This can have the internal effect of grinding or pulling the ball of the shoulder against its socket, resulting in damage to the meniscus or labrum of the joint or a minor dislocation as the distal head of the humerus bone is pulled away from the socket.
Much like in the case of excessive weight being placed on the stabilizer muscles of the squat, improper form or a misuse of form mechanics throughout the exercise can also result in significant shoulder pain.
Such pain is primarily because of the shoulders or its related musculature being forced to take on more resistance than they should during the exercise, resulting in minute amounts of damage occurring throughout the connective tissue and - in the worst case scenario - to the bones themselves.
In order to avoid this, the exerciser should utilize proper form in a manner that is most comfortable to their unique bodily proportions, taking into account the various form cues that ensure the barbell squat does not induce injury when followed.
Occasionally, the particular reason behind shoulder pain when squatting is not in fact related to the squat exercise itself, and is instead either from other exercises performed during the exerciser’s workout routine or from a history of injuries in the shoulder area itself - with sharp, intense pain being an indicator that the exerciser must see a medical professional as soon as possible.
Certain exercises that place significant stress and pressure on the shoulder’s musculature and connective tissue such as upright rows, excessively high lateral raises or the bench press with an unretracted scapula can all lead to shoulder pain that is not immediately noticeable after the exercise itself has been completed.
If such issues are found to be the main cause of the exerciser’s shoulder pain, altering their training routine and making use of various recovery procedures should be more than sufficient enough to remedy the situation - save for serious cases that require out-patient medical attention.
Apart from this, individuals with a history of shoulder injuries or those at high risk of such injuries such as sufferers of certain genetic conditions or those of elderly age should all consult a physician prior to performing heavy compound exercises such as the squat, regardless of the severity of their shoulder pain.
A rather minor issue in comparison to other causes of shoulder pain while performing the squat exercise, pain in the back of the shoulders, along the trapezius or even at the back of the neck are generally caused by improper placement of the barbell or excessive weight being loaded onto the barbell itself.
This can also result from the knurling or rough section of the barbell being too sharp or otherwise abrasive, scraping the skin in these particular areas.
The best and quickest way to remedy such an issue is to simply place a towel or specialized barbell cushion along the center of the barbell so as to protect the exerciser from the rough and hard surface of the metal, as well as to force them to rest the barbell on their shoulder shelf properly.
The best way to remedy shoulder pain when squatting is to consult a professional athletic coach or physician, depending on the particular source of the problem itself.
This, however, is not always economical, or is otherwise excessive in comparison to the magnitude of the issue itself, and as such the exerciser may instead choose to simply perform remedial exercises or alter their squat form mechanics in order to treat the shoulder pain.
If the primary cause of this shoulder pain is due to stiff, inflexible, or otherwise inexperienced shoulder tissue such as in the case of low shoulder mobility or shoulder muscles that have yet to be warmed up appropriately, simply performing a stretching routine and warm-up routine prior to the squats should be sufficient.
In cases of overloading or excessive pressure being placed on the shoulder joint, reducing the total amount of weight used during the exercise, or altering the position of the barbell so as to shift the weight away from the shoulders and onto the posterior chain instead should result in near immediate relief.
For more serious situations such as muscular imbalances, excessive damage to the labrum, and nearby tissues or even a history of severe shoulder injuries, a period of recovery is required, alongside professionally prescribed remedial exercises that are targeted to repair or fix whatever tissue damage is causing the pain.
Otherwise, subsequent mobility work and alterations to the training environment and routine of the exerciser should present a more than sufficient enough response to the shoulder pain in the capacity of remedial action.
If the exerciser is unsure of what particular cause is behind their shoulder pain when squatting, or has discovered that it is in fact a combination of multiple factors all resulting in a complex mess of issues, they are best off consulting both a medical and athletic professional, both of which may work together to create a physical rehabilitation plan for said exerciser.
In certain situations, completely avoiding the barbell squat is the best possible response, as the issues of the exerciser may be impossible or difficult to fix, and as such a far easier remedy would be to simply alternate out the barbell squat with an exercise of similar training stimulus.
This is most important in individuals of rather advanced age, those suffering from chronic conditions that directly affect their connective, muscular or osseous health, or those with injuries of the shoulder area so severe that they cannot fully recover despite medical intervention.
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2. 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels Ariane Schwank, Paul Blazey, Martin Asker, Merete Møller, Martin Hägglund, Suzanne Gard, Christopher Skazalski, Stig Haugsbø Andersson, Ian Horsley, Rod Whiteley, Ann M. Cools, Mario Bizzini, and Clare L. Ardern Journal of Orthopaedic & Sports Physical Therapy 2022 52:1, 11-28
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