The pushup is a highly effective compound bodyweight exercise that builds strength across the chest, shoulders, triceps, and core. Pushups can cause back pain, but this is almost always a result of poor execution rather than an inherent flaw in the exercise. The movement requires the body to maintain a rigid plank position against gravity, which demands significant stability from the entire spinal column. When this full-body tension fails, the spine compensates, placing undue stress on sensitive structures. Most back pain associated with this exercise can be prevented by focusing on the quality of the movement over the quantity of repetitions.
Lumbar Spine Instability: The Primary Cause of Lower Back Pain
The most frequent cause of lower back pain during pushups is the mechanical failure of the lumbar spine to maintain a neutral position. This instability usually manifests in one of two distinct forms as the core muscles fatigue or are not properly engaged. The first error is “sagging,” where the hips drop below the line of the body, causing the lower back to hyperextend into an excessive arch, a position known as hyperlordosis.
This excessive arch places compressive forces on the facet joints and intervertebral discs. Since the abdominal muscles are lengthened, they are mechanically disadvantaged and cannot generate the necessary force to support the spine. The second common error is “piking,” where the hips lift too high in the air, creating a V-shape with the body.
While piking may seem safer, it shifts the load away from the chest and core, reducing the effectiveness of the exercise and placing inappropriate stress on the shoulders. Both sagging and piking break the straight line the body should form from head to heels, indicating core muscle failure to stabilize the spine. Correcting these errors is entirely dependent on learning how to brace the midsection effectively.
Thoracic and Cervical Alignment Errors
Beyond the lower back, poor form can also affect the thoracic (mid-back) and cervical (neck) regions of the spine. A common error in the mid-back is “rounding,” or thoracic flexion, where the upper back hunches. This compromises the kinetic chain, reducing the efficiency of force transfer to the chest and arms and making the pushup unnecessarily difficult. Hunching the upper back also prevents the shoulder blades from moving correctly, impairing proper shoulder function.
The neck is also susceptible to two distinct errors: dropping the head toward the floor or cranking the head up to look forward. Dropping the head, known as cervical flexion, causes the head to touch the ground before the chest, which limits the range of motion and makes the exercise less effective. Conversely, forcefully extending the neck to look forward places undue stress on the small stabilizing muscles of the cervical spine, increasing the risk of chronic neck pain and headaches. Maintaining a neutral neck position involves keeping the gaze fixed on a spot on the floor about a foot in front of the hands.
Establishing and Maintaining a Neutral Spine
Achieving a neutral spine prevents alignment errors and is accomplished by creating full-body tension, turning the body into a rigid plank. The neutral spine is a position where the natural curves of the spine are preserved, forming a straight line from the head through the hips to the heels. This alignment is established and maintained through the conscious, simultaneous engagement of the core and glutes.
A powerful cue for engaging the core is to brace the abdominal muscles as if anticipating a punch, pulling the ribs down toward the pelvis. Simultaneously, the gluteal muscles must be strongly squeezed, which helps to slightly tuck the pelvis under and prevent the hips from sagging. This combined tension locks the lumbar spine in place, ensuring the back does not arch or round during the movement. Proper hand placement also supports a neutral spine; the hands should be positioned slightly wider than shoulder-width, with the elbows tracking back at roughly a 45-degree angle to the torso.
Safer Alternatives to the Standard Pushup
For individuals who experience pain or cannot yet maintain the full-body tension required for a standard floor pushup, several modifications can build the necessary strength and stability. The most accessible alternative is the incline pushup, which involves elevating the hands on a stable surface like a bench, box, or wall. This modification reduces the percentage of body weight being pressed, making it easier to maintain the neutral spine alignment from head to heels.
Another modification is the knee pushup, where the knees remain on the floor, shortening the body’s lever arm. While effective, the incline variation often provides a better training effect because it maintains the straight-body alignment that is transferable to the full pushup. A resistance band looped around the hips and anchored to a rack can also provide assistance, supporting the midsection where sagging is most likely to occur. These alternatives are tools to build the foundational strength needed before progressing to the floor.