The push-up is one of the most common and effective bodyweight exercises, targeting the chest, shoulders, and triceps without requiring any equipment. Despite its simplicity, many people express concern about the exercise causing shoulder pain, particularly affecting the rotator cuff. These concerns often stem from the shoulder joint’s inherent mobility, which makes it vulnerable to stress under load. Whether a push-up is safe or detrimental depends almost entirely on the precision of its execution, rather than the movement itself.
The Role of the Rotator Cuff in Push-ups
The shoulder is a ball-and-socket joint, often described as being similar to a golf ball sitting on a tee due to the small socket relative to the size of the upper arm bone. This anatomy allows for a wide range of motion but requires a complex system of muscles to maintain stability. The rotator cuff is a group of four small muscles and their tendons that surround the shoulder joint, acting as dynamic stabilizers.
During a push-up, these muscles work continuously to keep the upper arm centered within the shoulder socket as the body moves. This constant stabilization is necessary to handle the compressive forces and control the movement. If the rotator cuff muscles are weak or fail to engage correctly, the joint can become unstable, leading to tendons rubbing against bone and potentially causing injury.
Common Form Mistakes That Cause Injury
The primary error that places undue stress on the rotator cuff is excessive elbow flare, where the arms move out to the side, creating a 90-degree angle between the torso and the upper arm. This wide position narrows the space where the supraspinatus tendon of the rotator cuff passes, causing it to rub against bony structures, which can lead to a painful condition called impingement syndrome.
Another common issue is the failure to control the shoulder blades, allowing them to “wing” or collapse toward the spine as the body lowers. This lack of scapular stability is often due to weak serratus anterior muscles, which are important for keeping the shoulder blade flat against the rib cage. When the shoulder girdle loses its stable base, the rotator cuff is forced to overcompensate. Performing the exercise with too much volume or intensity also quickly compromises form and increases the risk of strain or overuse injury.
Safe Push-up Technique for Shoulder Health
Protecting the rotator cuff requires conscious attention to the angle of the arms and the position of the shoulder blades. The most important adjustment is to tuck the elbows closer to the body, aiming for an arm angle between 45 and 60 degrees relative to the torso. This semi-tucked position effectively reduces shear forces on the shoulder joint and shifts the emphasis to the chest and triceps.
Hand placement should be approximately shoulder-width apart, with the hands stacked directly beneath the shoulders to ensure optimal joint alignment. To actively stabilize the shoulder, “pack” the shoulders by pulling the shoulder blades down and back, away from the ears. Engaging the latissimus dorsi muscles by gripping the floor and attempting to pull the hands toward the feet helps maintain this stable foundation. A straight body line must be maintained from head to heel by squeezing the glutes and bracing the core, which prevents the lower back from sagging and ensures proper alignment under load.
When to Modify or Stop Push-ups
If you experience sharp pain, clicking, or grinding in the shoulder during a push-up, immediately stop the exercise. Lingering pain that persists for more than a few days, or pain that occurs during simple daily movements, suggests a possible injury that requires professional attention. Pushing through this type of discomfort will only aggravate the underlying issue.
To continue working the pushing muscles while reducing stress on the joint, modifications are available that decrease the amount of body weight being lifted. Performing the push-up with hands elevated on a stable surface, such as a bench, box, or even a wall, is an excellent way to reduce the load. Another option is to perform a bent-knee push-up, which reduces the leverage and overall force requirement. If pain persists even with these modifications, substituting the movement with exercises like cable chest presses or various rowing movements can maintain strength until the shoulder is fully healed.