The push-up is widely regarded as a foundational full-body exercise, engaging the chest, shoulders, triceps, and core simultaneously. While simple and requiring no equipment, the movement places significant compressive and sheer forces on the upper body joints. When pain occurs during this exercise, it is a signal that the body’s load tolerance has been exceeded, either through mechanical error or tissue overload. Identifying the precise source of this discomfort is the first step toward correcting the issue and making the exercise a beneficial part of a fitness routine.
Pain Caused By Improper Form
Most pain experienced during push-ups stems from mechanical errors that place undue strain on vulnerable joints. The most common error is allowing the elbows to “flare” out, moving perpendicular to the torso. This position forces the large head of the humerus into the subacromial space, compressing soft tissues and potentially leading to shoulder impingement syndrome. To correct this, the elbows should stay tucked closer to the body, ideally forming a 45-degree angle with the torso to keep the shoulder joint aligned.
Another frequent mechanical issue is the hyperextension of the wrist, where the hand is flat on the floor. This position forces the wrist into a near 90-degree angle, placing immense pressure on the small carpal bones and ligaments. This compression can cause pain on the back of the wrist or exacerbate conditions like Carpal Tunnel Syndrome. Modifying the exercise by using dumbbells or specialized push-up bars keeps the wrist in a neutral, straight line, greatly reducing this joint stress.
The push-up also relies heavily on the core to maintain a rigid plank position, and a failure here often results in lower back pain. If the hips sag toward the floor, the lumbar spine arches excessively, placing stress on the facet joints and spinal discs. Conversely, if the hips pike upward, the exercise shifts the load away from the chest and core. A straight line from the head through the hips to the heels must be maintained by bracing the abdominal and gluteal muscles.
Wrist, Elbow, and Shoulder Stress
Pain originating directly from the joints often involves inflammation of the tendons or compression of nerves. In the shoulder, persistent elbow flare can lead to rotator cuff strain or shoulder impingement, where the repeated pinching causes inflammation of the tendons and bursa beneath the acromion. This structural irritation is distinct from muscle soreness and often presents as pain deep within the joint during the lowering phase of the push-up.
Elbow pain is frequently diagnosed as triceps tendinitis. This condition involves damage and irritation to the triceps tendon where it attaches to the olecranon, the bony point at the back of the elbow. It is caused by repetitive, high-volume pushing movements, especially if the triceps lack the strength to tolerate the load. The result is a localized ache or sharp pain at the back of the elbow, particularly when straightening the arm against resistance.
For the wrist, the hyperextended position can lead to carpal tunnel stress due to the compression of the median nerve as it passes through the narrow carpal tunnel. Symptoms include pain, tingling, or numbness that may radiate into the thumb and first two fingers. Separately, the repetitive force can also cause chronic ligament strain or tendinopathy, such as DeQuervain’s Tenosynovitis, resulting in pain focused on the thumb side of the wrist due to tendon sheath irritation.
Muscle Fatigue and Acute Strain
Pain focused within the belly of the muscle tissue can signal either a normal adaptation process or a more acute injury. Delayed Onset Muscle Soreness, or DOMS, is the widespread, dull ache that begins 24 to 72 hours following an unaccustomed workout. This sensation is caused by microscopic damage (micro-trauma) to the muscle fibers during eccentric contractions, such as when lowering the body toward the floor. DOMS is a temporary response that indicates the body is repairing the tissue to build strength.
A true acute muscle strain, however, is a serious and immediate injury that occurs during the exercise itself. This involves a more significant tear of the muscle fibers, most commonly in the pectorals, anterior deltoids, or triceps. Acute strain is characterized by a sudden, sharp, and localized pain that forces an immediate stop to the movement. This type of pain is distinct from DOMS and often presents with tenderness, bruising, or swelling in the muscle.
Push-up pain can also be a consequence of cumulative overload due to inadequate rest. Muscle tissues require sufficient time to repair the micro-trauma from a workout; performing high-volume push-ups on consecutive days prevents this necessary recovery. This lack of rest leads to cumulative fatigue, resulting in chronic muscle tightness, reduced performance, and an increased susceptibility to acute strain. The body needs a cycle of stress followed by recovery to adapt and grow stronger.
When To Seek Medical Advice
While most push-up pain is manageable through form correction and rest, certain symptoms are red flags that warrant medical consultation. Pain that persists for more than 7 to 10 days despite rest, ice, and activity modification suggests a deeper issue beyond simple muscle soreness. Any pain severe enough to consistently interrupt sleep also requires medical evaluation. A sudden, sharp “pop” or tearing sensation felt during the movement should be taken seriously, as it may indicate a ligament tear, tendon rupture, or a significant muscle strain.
Swelling or bruising that appears rapidly and is localized around a joint, such as the elbow or shoulder, is another sign of acute tissue damage. Any radiating numbness, tingling, or weakness extending down the arm or into the hand suggests possible nerve involvement, such as Carpal Tunnel Syndrome or a pinched nerve in the neck or shoulder.