Shoulder pain, often from shoulder impingement, can impact daily activities and exercise. Understanding this condition and how exercises like push-ups affect it is key to managing symptoms and staying active. The safety of push-ups with impingement often depends on proper modification and body awareness.
What is Shoulder Impingement?
Shoulder impingement occurs when tendons, particularly those of the rotator cuff, or a fluid-filled sac called a bursa, become compressed or “pinched” within the shoulder joint. This pinching happens in the subacromial space, a narrow area beneath the acromion, which is part of the shoulder blade. The rotator cuff is a group of four muscles that stabilize the shoulder and enable arm movement, especially overhead motions. When these tissues swell or are irritated, they can rub against the surrounding bones, causing pain.
Common causes for this compression include repetitive overhead activities, frequently seen in athletes or individuals with certain occupations. Poor posture, muscle imbalances around the shoulder blade, or the development of bone spurs can also reduce the subacromial space, leading to impingement. Individuals with shoulder impingement experience pain at the top and outside of the shoulder, often worsening with overhead arm movements or when reaching behind the back. Other symptoms can include weakness, stiffness, or a clicking sensation in the shoulder.
How Push-ups Affect Impingement
A standard push-up involves a complex series of movements in the shoulder joint that can potentially aggravate existing impingement. During the downward phase, the shoulder moves into extension, and the humerus (upper arm bone) undergoes internal rotation and adduction. This combination of movements can reduce the space within the subacromial area, leading to increased compression of the rotator cuff tendons and bursa. Flaring the elbows out wide during a push-up can further increase this stress on the shoulder joint.
Improper form, such as a lack of controlled scapular movement or an arched lower back, can also contribute to impingement during push-ups. When the shoulder blade does not move optimally—specifically, if it lacks sufficient upward rotation and posterior tilt—the subacromial space remains constricted. This restricted movement can cause the soft tissues to be repeatedly pinched, exacerbating pain and inflammation. The significant compressive forces placed on the shoulder joint during a push-up can also contribute to pain.
Adapting Exercise for Shoulder Health
Modifying push-ups can allow individuals with shoulder impingement to continue strengthening their chest, shoulders, and triceps without aggravating their condition. Incline push-ups, performed against a wall or an elevated surface like a countertop or bench, reduce the amount of body weight supported by the arms, thereby decreasing stress on the shoulders. Gradually decreasing the incline over time can help rebuild strength safely. Another modification involves reducing the range of motion, stopping the downward movement before pain occurs and maintaining a fist-width distance between the chest and the ground.
Focusing on proper scapular stability and form is important; keeping the elbows tucked closer to the body, ideally at about a 45-degree angle, can help maintain a more open subacromial space. Incorporating “scapular push-ups,” where only the shoulder blades move to protract and retract while the arms remain straight, can strengthen the serratus anterior and improve shoulder blade control. Alternative exercises can target similar muscle groups without direct compressive stress on the shoulder. These include dumbbell chest presses (performed on the floor to limit range of motion), various rowing exercises for back and shoulder stability, and rotator cuff strengthening movements like resistance band rotations.
When to Consult a Professional
Seeking professional guidance is important if shoulder pain persists or worsens, especially if it interferes with daily activities or sleep. A healthcare provider, such as a doctor, physical therapist, or sports medicine specialist, can provide an accurate diagnosis and develop a personalized treatment plan. They will conduct a thorough physical examination, assessing range of motion, strength, and specific movements that elicit pain. Imaging tests, such as X-rays, MRI, or ultrasound, may be used to identify underlying issues like bone spurs, inflammation, or tendon damage.
Treatment for shoulder impingement often begins with conservative measures like rest, activity modification, and anti-inflammatory medications. Physical therapy is effective, focusing on strengthening rotator cuff and scapular muscles, improving flexibility, and correcting postural imbalances. Manual therapy may also improve joint mobility. Corticosteroid injections can provide temporary pain relief, used sparingly. Surgery is typically considered only if conservative treatments fail.