Pushup Pain: Causes, Locations, and Pain-Free Strategies

Why do my pushups hurt?

Pain during pushups often signals an underlying issue with form, muscle imbalances, overuse, or pre-existing conditions. Addressing the root cause, whether it's poor technique or a specific injury, is crucial for pain-free and effective training.

Common Causes of Pushup Pain

Understanding the potential sources of discomfort is the first step toward resolving it. Pain during pushups can stem from a combination of biomechanical errors, physiological stressors, and structural limitations.

• Improper Form and Technique: This is arguably the most frequent culprit.
  • Elbow Flare: Allowing elbows to point directly out to the sides (90 degrees to the body) places excessive stress on the shoulder joint, especially the anterior capsule and rotator cuff.
  • Hand Placement: Hands placed too wide or too far forward/backward can alter the leverage and strain specific joints or muscles. Too wide emphasizes the shoulder; too narrow (diamond pushups) can strain wrists and elbows.
  • Lack of Scapular Control: "Winging" of the shoulder blades (scapular protraction without control) or shrugging the shoulders towards the ears can indicate weak serratus anterior or lower trapezius, leading to shoulder instability and pain.
  • Spinal Alignment: Arching the lower back (lumbar hyperextension) or sagging the hips indicates a weak core, shifting stress to the spine and potentially causing back pain.
  • Neck Position: Looking up or letting the head drop can strain the cervical spine.
• Overuse and Insufficient Recovery:
  • Excessive Volume or Frequency: Performing too many repetitions, sets, or doing pushups too frequently without adequate rest can lead to cumulative microtrauma, resulting in tendinopathy (e.g., shoulder, elbow) or muscle strains.
  • Rapid Progression: Increasing the difficulty (e.g., adding weight, progressing to one-arm pushups) too quickly before the body has adapted can overload tissues.
• Muscle Weakness or Imbalance:
  • Weak Stabilizer Muscles: Weakness in the rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis) or scapular stabilizers (serratus anterior, rhomboids, trapezius) can lead to joint instability and compensatory movements.
  • Weak Core: A weak core compromises spinal stability, forcing other muscles to compensate and potentially leading to back or shoulder pain.
  • Pectoral or Triceps Weakness: If the primary movers are not strong enough, other structures (joints, connective tissue) may bear excessive load.
• Mobility Restrictions:
  • Shoulder Joint Stiffness: Limited range of motion in shoulder flexion, extension, or rotation can force compensatory movements during a pushup, leading to impingement or strain.
  • Thoracic Spine Immobility: A stiff upper back can prevent proper scapular movement and force the shoulders into a compromised position.
  • Wrist Extension Limitation: Insufficient wrist mobility can put excessive pressure on the wrist joint and its associated tendons.
• Pre-existing Injuries or Conditions:
  • Shoulder Issues: Impingement syndrome, rotator cuff tendinopathy or tear, AC joint sprain/arthritis, labral tears, or shoulder instability.
  • Elbow Issues: Medial or lateral epicondylitis ("golfer's elbow" or "tennis elbow"), triceps tendinopathy.
  • Wrist Issues: Carpal tunnel syndrome, tendinopathy (e.g., De Quervain's tenosynovitis), ganglion cysts, or previous sprains/fractures.
  • Pectoral Strain: A tear or strain in the chest muscle.
  • Nerve Impingement: Pain radiating from the neck or upper back due to compressed nerves (e.g., cervical radiculopathy).

Where Does It Hurt? Pinpointing the Pain

The location of your pain can provide significant clues about the underlying issue.

• Shoulder Pain: Often indicates issues with rotator cuff tendons (impingement, tendinitis), AC joint stress, or instability. Pain at the front of the shoulder can be bicipital tendinopathy. Pain deep within the joint may suggest labral issues.
• Elbow Pain: Pain on the outside of the elbow is often lateral epicondylitis (tennis elbow), while pain on the inside is medial epicondylitis (golfer's elbow). Pain at the back of the elbow can be triceps tendinopathy.
• Wrist Pain: Commonly due to excessive wrist extension, leading to compression of nerves or tendons, or inflammation of the wrist joint itself.
• Chest Pain: A sharp, localized pain may indicate a pectoral muscle strain or a costochondral (rib-sternum joint) issue.
• Neck or Upper Back Pain: Often a result of poor head and neck alignment, lack of core stability, or inadequate scapular control, leading to compensatory strain on the upper traps or levator scapulae.

Strategies for Pain-Free Pushups

Once the potential cause is identified, a structured approach can help alleviate pain and improve performance.

• Master Proper Form: This is paramount.
  • Hand Position: Place hands slightly wider than shoulder-width, with fingers pointing forward.
  • Elbow Angle: As you descend, tuck your elbows back at about a 45-degree angle relative to your torso. Avoid flaring them out to 90 degrees.
  • Body Alignment: Maintain a straight line from head to heels. Engage your core (brace your abdominals as if preparing for a punch) and glutes to prevent hip sagging or arching of the lower back.
  • Scapular Control: As you descend, allow your shoulder blades to retract and slightly depress. As you push up, protract them (imagine pushing the floor away). Avoid shrugging your shoulders.
  • Neck Neutrality: Keep your head in line with your spine, looking slightly forward or down.
• Modify and Progress Gradually: Do not force a full pushup if it causes pain.
  • Elevated Pushups: Perform pushups with your hands on an elevated surface (wall, sturdy bench, box). The higher the elevation, the easier the movement, reducing stress on joints. Gradually lower the elevation as strength improves.
  • Knee Pushups: If elevated pushups are still too challenging, perform them from your knees, maintaining the same upper body and core alignment.
  • Eccentric Focus: Perform only the lowering (eccentric) phase of the pushup slowly and with control, then reset. This builds strength safely.
  • Reduced Range of Motion: Start by performing pushups only to a comfortable depth, gradually increasing the range as pain subsides and strength increases.
• Address Weaknesses & Imbalances: Incorporate targeted exercises.
  • Scapular Stability: Exercises like YTWLs, face pulls, band pull-aparts, and serratus punches strengthen the muscles that stabilize the shoulder blade.
  • Rotator Cuff Strengthening: External and internal rotation exercises with light weights or resistance bands.
  • Core Strengthening: Planks, bird-dogs, dead bugs, and anti-rotation exercises to improve spinal stability.
  • Antagonist Training: Balance pushups (pushing muscles) with pulling exercises (rows, pull-aparts) to prevent muscle imbalances.
• Improve Mobility:
  • Thoracic Mobility: Cat-cow stretches, foam rolling the upper back, and thoracic rotations.
  • Shoulder Mobility: Arm circles, shoulder dislocates with a stick, and pec stretches.
  • Wrist Mobility: Wrist circles, prayer stretches, and wrist extensions/flexions.
• Prioritize Recovery:
  • Adequate Rest: Allow muscles and joints sufficient time to recover and adapt between training sessions.
  • Nutrition and Hydration: Support tissue repair and overall health.
  • Sleep: Essential for physiological recovery and repair.
• Listen to Your Body: Differentiate between muscle fatigue and joint pain. If a movement causes sharp, persistent, or worsening pain, stop immediately.

When to Seek Professional Help

While many pushup-related pains can be resolved with technique correction and progressive overload, certain symptoms warrant professional medical or rehabilitative attention.

• Persistent Pain: Pain that does not improve with rest, modifications, or self-care within a few days to a week.
• Sharp, Sudden Pain: Especially if accompanied by a "pop" or "snap" sound, which could indicate an acute tear or injury.
• Pain Accompanied by Other Symptoms: Swelling, bruising, numbness, tingling, weakness, or significant loss of range of motion.
• Pain that Worsens: If pain increases in intensity or frequency over time, even with reduced activity.
• Inability to Perform Daily Activities: If the pain impacts your ability to perform routine tasks outside of exercise.

Consulting a physical therapist, sports medicine physician, or other qualified healthcare professional can help accurately diagnose the issue and provide a tailored treatment and rehabilitation plan.