Push-ups: Risks, Common Injuries, and Safe Practice

What are the risks of push-ups?

While push-ups are a highly effective and foundational bodyweight exercise, they carry potential risks, primarily stemming from improper form, overtraining, and pre-existing conditions, which can lead to joint strain, overuse injuries, and exacerbate underlying musculoskeletal issues.

Introduction to Push-up Risks

The push-up is a cornerstone exercise for developing upper body pushing strength, core stability, and overall muscular endurance. Engaging the chest (pectorals), shoulders (deltoids), and triceps, it's a versatile movement adaptable to various fitness levels. However, like any exercise, when performed incorrectly, excessively, or without consideration for individual limitations, push-ups can lead to discomfort, pain, and even injury. Understanding these risks is crucial for safe and effective training.

Common Risk Factors for Push-up Injuries

Several factors contribute to the potential for injury during push-up execution:

• Improper Form and Technique: This is by far the leading cause of push-up related injuries. Deviations from proper biomechanics place undue stress on joints and tissues.
  • Sagging Hips/Arched Lower Back: Indicates weak core engagement, leading to lumbar spine compression or strain.
  • Elevated Shoulders/Shrugging: Places excessive strain on the neck and trapezius muscles, potentially contributing to shoulder impingement.
  • Flared Elbows: When elbows point directly out to the sides at 90 degrees, it puts the shoulder joint in a vulnerable position, increasing the risk of impingement and rotator cuff strain.
  • Forward Head Posture: Strains the cervical spine and can lead to neck pain.
  • Lack of Full Range of Motion: Not lowering sufficiently or not fully extending can lead to imbalances or limit muscle development, but going too deep without control can also be problematic.
• Overtraining and Insufficient Recovery: Performing too many repetitions, too frequently, or without adequate rest can lead to overuse injuries, muscle fatigue, and chronic inflammation. Tissues need time to repair and adapt.
• Pre-existing Conditions or Injuries: Individuals with prior shoulder issues (e.g., rotator cuff tears, impingement, instability), wrist pain (e.g., carpal tunnel syndrome, tendinitis), elbow issues (e.g., tennis elbow, golfer's elbow), or lower back problems may find push-ups exacerbate their symptoms.
• Inadequate Warm-up: Starting a push-up routine with cold muscles and joints increases the risk of strains and sprains. A proper warm-up prepares the body for activity.
• Lack of Foundational Strength: Attempting full push-ups without sufficient strength in the chest, shoulders, triceps, and core can lead to compensatory movements and poor form.

Specific Joint and Muscle Risks

Push-ups primarily stress the upper body and core, making these areas susceptible to specific injuries:

• Shoulder Injuries:
  • Shoulder Impingement: Often caused by excessive internal rotation of the humerus (flared elbows) or poor scapular control, where tendons (like the rotator cuff) are pinched in the subacromial space.
  • Rotator Cuff Strain/Tear: Overuse or sudden forceful movements, especially with poor form, can strain or tear the muscles stabilizing the shoulder joint.
  • AC Joint Sprain: Less common, but can occur with falls or awkward landings during push-ups, or excessive stress on the acromioclavicular joint.
• Wrist Pain:
  • Hyperextension Strain: The traditional push-up position places the wrists in significant extension, which can compress nerves and tendons, leading to pain or even carpal tunnel syndrome symptoms, especially for those with limited wrist mobility.
  • Tendinitis: Inflammation of the tendons around the wrist due to repetitive strain.
• Elbow Pain:
  • Tendinitis (Golfer's/Tennis Elbow): Inflammation of the tendons on the inside (medial epicondylitis or golfer's elbow) or outside (lateral epicondylitis or tennis elbow) of the elbow. This can result from overuse, improper grip, or imbalances.
• Lower Back Strain:
  • When the core muscles (abdominals, obliques, glutes) are not adequately engaged, the lower back can hyperextend (sag), placing excessive compressive forces on the lumbar spine and potentially leading to strain or pain.
• Neck Strain:
  • Allowing the head to drop or hyperextend (looking straight ahead or up) during the movement places undue stress on the cervical spine, leading to neck stiffness or pain.

Mitigating Risks: Safe Push-up Practice

To maximize the benefits of push-ups while minimizing risks, adhere to the following principles:

• Master Proper Form:
  • Full Body Alignment: Maintain a straight line from head to heels. Engage your glutes and brace your core as if preparing for a punch to prevent hip sagging or excessive arching.
  • Elbow Position: Tuck your elbows to approximately a 45-degree angle relative to your torso, rather than flaring them out to 90 degrees. This optimizes shoulder mechanics.
  • Shoulder Stability: Keep your shoulders packed down and away from your ears throughout the movement.
  • Head Neutral: Keep your neck in line with your spine, looking slightly ahead or down.
• Progressive Overload and Regression:
  • Start with Regressions: If full push-ups are too challenging, begin with modified versions such as wall push-ups, incline push-ups (hands on a sturdy elevated surface), or knee push-ups. Progress gradually as strength improves.
  • Controlled Progression: Only increase repetitions, sets, or move to more challenging variations (e.g., decline push-ups, weighted push-ups) when perfect form can be maintained.
• Listen to Your Body:
  • Pain is a Warning: Never push through sharp or persistent pain. Differentiate between muscle fatigue/burn and joint pain.
  • Rest and Recovery: Allow adequate rest days between intense push-up sessions for muscle repair and growth.
• Adequate Warm-up and Cool-down:
  • Warm-up: Include dynamic stretches for the shoulders, wrists, and thoracic spine, along with light cardio, before starting push-ups.
  • Cool-down: Perform static stretches for the chest, shoulders, and triceps after your workout.
• Vary Hand Positions and Equipment:
  • Wrist Health: If wrist pain is an issue, consider using push-up handles, dumbbells, or making a fist to keep wrists neutral.
  • Muscle Emphasis: Varying hand width can shift emphasis (e.g., wider for chest, narrower for triceps) and distribute stress differently across joints.
• Address Muscular Imbalances:
  • Ensure balanced strength development by incorporating pulling exercises (e.g., rows, pull-ups) to counteract the pushing dominance of push-ups and promote shoulder health.
  • Strengthen your core independently to support spinal stability during the movement.

When to Seek Professional Advice

If you experience persistent pain, numbness, tingling, or a significant decrease in range of motion while performing push-ups or in daily activities, consult a healthcare professional, such as a physical therapist, sports medicine doctor, or certified exercise physiologist. They can diagnose the issue and provide tailored guidance for recovery and safe exercise modification.

Conclusion

Push-ups are an incredibly effective and accessible exercise for building strength and endurance. However, their benefits are fully realized only when performed with meticulous attention to form, appropriate progression, and respect for individual physical limitations. By understanding and actively mitigating the associated risks, you can safely integrate push-ups into your fitness regimen, fostering long-term strength and joint health.