The push-up is a foundational exercise, widely used for building upper body and core strength with no equipment required. Despite its popularity, shoulder pain is a frequent side effect that can quickly halt progress. This discomfort often stems from errors in movement mechanics, which place undue stress on the shoulder joint. Understanding these causes and making targeted adjustments is the direct path to performing this exercise without pain.
Identifying the Mechanical Causes of Pain
Shoulder pain during push-ups commonly results from three main mechanical faults that compromise the stability of the glenohumeral joint. The most frequent issue is excessive elbow flare, where the elbows travel out to the sides at a 90-degree angle to the torso. This T-shape position internally rotates the shoulder and pinches soft tissues, potentially leading to impingement or overuse injury of the rotator cuff tendons.
Another cause is a lack of scapular control, meaning the shoulder blades either wing out or collapse toward the spine without muscular support. The scapula acts as the base for the upper arm bone, and its instability forces the shoulder joint to compensate, causing strain in the front shoulder region. Finally, anterior glide, where the head of the humerus glides forward in the shoulder socket, can irritate the joint capsule and surrounding tendons. This often occurs when the elbows move too far behind the body at the bottom of the movement, overloading the front of the joint.
Immediate Actions to Stop the Pain
If you experience sharp or intense pain in the shoulder during a push-up, stop the exercise immediately. Continuing to push through the pain risks escalating a minor irritation into a more significant injury, such as a tendon strain or tear.
For acute pain or inflammation, applying the Rest, Ice, Compression, and Elevation (RICE) principle can help manage symptoms. Rest the shoulder by avoiding all pressing and overhead activities for a few days to allow irritated tissues to calm down. Applying ice for 15 to 20 minutes several times a day can help reduce swelling and discomfort. Pain that persists for more than three days, lingers during everyday movements, or prevents sleep warrants a consultation with a healthcare professional for a proper diagnosis and treatment plan.
Adjusting Push-up Technique for Prevention
Preventing pain requires a precise shift in how the push-up is executed, starting with hand placement. Position your hands slightly wider than shoulder-width apart, with the fingers pointed mostly forward or slightly inward. This setup encourages a more natural and stable shoulder position throughout the movement.
The most impactful change involves the elbow angle, which should travel backward at a 45-degree angle relative to the torso, forming an “arrow” shape instead of a “T.” This tucked position reduces internal rotation of the shoulder, decreasing stress on the rotator cuff and minimizing impingement risk. As you lower your body, focus on controlled retraction of the shoulder blades, pulling them back and down toward your hips. On the way up, actively push the floor away to achieve scapular protraction, moving the shoulder blades slightly away from the spine. This controlled scapular movement maintains a stable foundation for the arm bone.
Maintaining a straight line from the head to the heels, achieved by engaging the core and glutes, is essential. This full-body tension prevents the hips from sagging or the lower back from arching, which leads to compensatory movement in the shoulders. If performing a full push-up is too challenging, modify the exercise by elevating your hands on a stable surface, such as a bench or box. This reduces the percentage of body weight being lifted, allowing you to practice the corrected form under a lower load.
Strengthening Supporting Muscles for Stability
Long-term shoulder health depends on strengthening the muscles that stabilize the shoulder joint, which are often overlooked in traditional training. The rotator cuff muscles, particularly the external rotators, prevent the head of the humerus from sliding forward during pressing motions. Incorporating exercises like resistance band external rotations helps to balance strength across the joint.
The serratus anterior muscle, often called the “boxer’s muscle,” is crucial for holding the shoulder blade flat against the rib cage. Weakness here can lead to poor scapular control and subsequent pain. Scapular push-ups, where only the shoulder blades move to protract and retract the shoulders in a plank position, are an excellent way to isolate and strengthen this muscle.
To counteract the dominance of the chest and front shoulder muscles, which can pull the shoulders into a rounded posture, focus on strengthening the upper back. Face pulls or reverse flyes target the rear deltoids and mid-back muscles, promoting better posture. Consistent work on these accessory exercises provides the foundation for a strong, stable, and pain-free push-up.