Shoulder pain during a pushup is a common experience, often interrupting a basic and effective full-body exercise. The shoulder joint, known as the glenohumeral joint, is the most mobile joint in the body, which unfortunately makes it inherently unstable and susceptible to stress when under load, such as during a pushup. This compound movement places immense compressive forces on the shoulder, and any underlying weakness or mechanical error can quickly lead to discomfort or injury. Understanding the specific reasons your shoulder hurts is the first step toward pain-free pushups and long-term joint health.
Improper Movement Mechanics
The most immediate cause of shoulder pain during a pushup is often simply incorrect technique. Many people flare their elbows excessively outward, positioning them perpendicular to the torso, which stresses the anterior (front) capsule of the shoulder. Instead, the elbows should be tucked to about a 45-degree angle relative to the body to better engage the chest and triceps while protecting the joint. This flared position narrows the space where tendons and muscles pass, increasing the risk of compression and irritation.
Hand placement also affects shoulder stress. Placing the hands too wide or too far forward puts undue strain on the front of the shoulder. Ideally, hands should be positioned directly beneath or only slightly wider than the shoulders, with fingers pointing forward or slightly outward. Maintaining a straight line from head to heels, like a rigid plank, is necessary; allowing the back to sag or arch changes the shoulder’s position and can lead to pain.
A lack of proper scapular control often allows the shoulder blades to collapse or “wing” away from the rib cage at the bottom of the movement. The scapula must remain stable against the back, as its movement dictates the position of the upper arm bone (humerus). When the shoulder blades collapse, the subacromial space—the area where the rotator cuff tendons pass—is compressed, causing irritation.
Underlying Muscle Weakness and Instability
Improper mechanics often stem from underlying muscular deficiencies that compromise stability under load. The rotator cuff, a group of four small muscles and their tendons, is primarily responsible for stabilizing the head of the humerus within the shoulder socket. Weakness in these muscles, particularly the external rotators, allows the humerus to glide forward during the pressing motion, creating anterior shoulder pain.
The serratus anterior muscle is a key contributor to shoulder stability, holding the shoulder blade flat against the rib cage. When this muscle is weak or inactive, it leads to the poor scapular control and “winging” seen during pushups. This instability forces the shoulder complex to compensate, leading to excessive loading and potential injury.
Instability lower down the kinetic chain can transfer undue stress to the shoulders. Disengagement of the core and gluteal muscles can cause the lower back to sag or arch, altering the entire body’s alignment. For the shoulder to be stable, the entire body must act as a single, rigid unit. Weakness in the trunk forces the shoulders to overcompensate for the lack of stability.
Common Structural Injuries Aggravated by Pushups
Sometimes, pain is not just a mechanical issue but the aggravation of a pre-existing condition. Shoulder impingement syndrome occurs when soft tissues, such as tendons or bursae, are pinched between the bones of the shoulder, specifically under the acromion. The pushup motion, which involves horizontal adduction and internal rotation, can narrow this space, causing pain localized under the bony “roof” of the shoulder.
Biceps tendinitis, inflammation of the long head of the biceps tendon, is often felt as pain at the front of the shoulder. The pushup movement, particularly at the bottom when the shoulder is in extension, puts a stretch and compressive load on this tendon. Any sudden increase in pushup volume can cause irritation, and this condition is often misdiagnosed as a rotator cuff injury due to the proximity of the structures.
Pain localized directly on the top of the shoulder, often sharp, may indicate an Acromioclavicular (AC) joint strain. The AC joint connects the collarbone (clavicle) to the shoulder blade (acromion). Although pushups are not an overhead movement, the compression and shear forces placed on the joint can strain the surrounding ligaments. The pain is highly localized to the joint itself and often worsens with pressing movements.
Modifying Pushups and When to Seek Medical Advice
Simple modifications can reduce stress on the joint. Performing pushups on an incline, such as against a wall or an elevated surface, reduces the amount of body weight the shoulders must support. This allows the user to practice correct form and build stability. Reducing the range of motion, such as stopping a fist-width distance above the floor, can also prevent the shoulder from reaching a painful end-range position.
Using dumbbells or performing the exercise on your fists can help keep the wrists in a more neutral position, which often translates to better shoulder alignment. If the pain is sharp, radiating, or accompanied by a clicking or popping sound, stop the exercise immediately. If pain persists for more than one to two weeks, even after modification, or if discomfort affects daily activities like sleeping or reaching, consult a healthcare provider. A physical therapist can provide a precise diagnosis and guide a rehabilitation program focused on strengthening the stabilizing muscles.