Push-ups are a common exercise, but they often raise concerns about shoulder health, particularly regarding the rotator cuff. The exercise itself does not inherently damage the shoulder; instead, strain or pain usually results from improper execution or a pre-existing weakness. The rotator cuff stabilizes the shoulder joint, and when this function is compromised by poor form, the joint becomes vulnerable to injury. Understanding proper shoulder function during this movement is the first step toward performing push-ups safely.
Function of the Rotator Cuff in Shoulder Stability
The shoulder is a ball-and-socket joint characterized by a wide range of motion and inherent instability. Because of this high mobility, the joint relies heavily on surrounding soft tissues for support. The rotator cuff is a group of four muscles—the supraspinatus, infraspinatus, teres minor, and subscapularis—that form a dynamic cuff around the joint.
The collective action of these muscles centers the head of the humerus within the socket. Without this stabilizing force, powerful chest and shoulder muscles would cause the humeral head to ride up and potentially pinch the soft tissues above it during movement. The rotator cuff ensures that as you press your body up and down, the joint remains properly aligned, preventing excessive friction and strain on the tendons. This dynamic stabilization is important during a closed-chain exercise like the push-up, where the hands are fixed to the ground and the body moves around the shoulder.
Identifying Push-Up Techniques That Cause Strain
The most common mechanical error that places excessive stress on the rotator cuff is allowing the elbows to flare out to the side excessively. When the elbows move out past a 45-degree angle from the torso, the shoulder approaches an abducted “T” position at the bottom of the movement, which mechanically narrows the space in the shoulder joint. This narrowing can pinch the rotator cuff tendons and bursa, leading to subacromial impingement syndrome and anterior shoulder pain.
Another frequent issue is failing to maintain proper scapular stability throughout the push-up. The shoulder blade, or scapula, must remain connected to the rib cage, requiring engagement of stabilizing muscles like the serratus anterior. When these muscles are weak or inactive, the shoulder blades can “wing” off the back. This creates an unstable base that compromises the cuff’s ability to center the humeral head, increasing strain on the joint.
Hand positioning also plays a role in creating strain. Placing the hands too far forward, rather than directly underneath the shoulders, significantly increases the demand on the anterior shoulder capsule and biceps tendon. A grip that is too wide also forces the elbows to flare out, placing the shoulder in a vulnerable position at the bottom of the repetition and increasing the likelihood of tendon irritation. These technical deviations compound mechanical stress, often leading to pain even when the rotator cuff muscles are healthy.
Adjusting Push-Up Form to Protect the Shoulder
Protecting the shoulder during push-ups begins by controlling the angle of the elbows relative to the torso. The ideal position is often referred to as the “arrow” position, where the elbows are tucked in to form an angle of approximately 20 to 45 degrees away from the body. This simple adjustment keeps the shoulder joint in a more natural and less impingement-prone alignment, reducing strain on the anterior structures.
Hand placement should be directly under the shoulders or only slightly wider, with the fingers pointed straight ahead or gently rotated outward. This slight external rotation of the hands can help cue appropriate muscular engagement and improve joint alignment as you press up.
Focusing on the movement of the shoulder blades is important for maximizing stability. At the top of the push-up, consciously push the ground away to protract the shoulder blades. This action creates a slight rounding of the upper back and fully engages the serratus anterior muscle.
If maintaining perfect form is not possible, the exercise must be modified to reduce the load on the rotator cuff.
Incline Modifications
Incline push-ups performed against a wall or a bench decrease the body weight being pressed. This allows the user to practice good form without excessive strain.
Knee Push-Ups
Performing the push-up from the knees reduces the load. This is an effective way to build necessary strength before progressing to the full plank position.
Controlled Tempo
Moving through each repetition with a slow and controlled tempo, rather than rushing, ensures that the stabilizing muscles have time to engage. This further minimizes the risk of injury.