Strength Training Programs: A Quick Fix for Painful Push-ups
Written on July 28, 2009 at 6:48 pm, by Eric Cressey
Q: I’ve read a lot from you, Robertson, and Hartman about including push-up variations in strength training programs is really important for shoulder health. Unfortunately, whenever I do them, I have pain in my bum shoulder. Any ideas what to do?
A: Well, obviously, there are two things we need to rule out:
1. You may simply have a really irritated shoulder, which (in most cases) means that any sort of approximation or protraction movement could get it angrier, even if it is a closed-chain movement like the push-up that is normally pretty shoulder-friendly. Likewise, if you have a significant acromioclavicular joint injury, the extension range-of-motion at the bottom of a push-up could exacerbate your symptoms. So, obviously, the first step is to rule out if something is structurally wrong with your shoulder, and if so, if the push-up even belongs in your strength training program.
2. Your technique might just be atrocious. If the elbows are flared out, hips are sagging, and/or you’re in a forward head posture, simply changing your technique may very well alleviate those symptoms. In a good push-up, the elbows should be tucked to a 45-degree angle to the body, with the hips, torso, neck, and head in a straight line. The muscles of the upper back should essentially “pull” you down into the bottom position:
Once you’ve ruled out those two issues and still have some annoying issues, there is one more thing you can try: simply elevate the feet. Looking to the research, Lear and Gross found that performing push-ups with the feet elevated significantly increased activation of the serratus anterior (SA).
If we can get more SA recruitment and less pectoralis minor contribution, it keeps us out of a position of scapular anterior tilt, which mechanically decreases the subacromial space through which the rotator cuff tendons pass. In the picture below, think of the area just below the word “acromion” being smaller, and then picture what would happen to the tendons that pass through that region; they get impinged. Serratus anterior (along with lower trapezius) can help prevent that.
That said, I’ve seen quite a few folks with persistent shoulder pain with bench pressing variations (barbell and DBs) and regular push-ups who were able to do the feet-elevated versions completely pain free in their strength training programs. Obviously, begin with just body weight and see how it goes, but over time, you can start to add resistance and use the single-leg version.
EQI’s at various levels have helped my clients progress toward the execution of a conventional push-up. We’ve also used band deloaded (same as band deloaded (up) bench press) with good results.
I like the tips, especially the bit about serratus anterior activation to alleviate pec minor symptoms. What about if I am experiencing pain in the sternoclavicular area with any type of weighted push-up/benching exercise?
I have had similar situations where I couldn’t load in any form of pressing variation but with the elevated push up, the athlete had absolutely no issues.
This is great for motivation as I’ve had guys (and girls) frustrated when they couldn’t do any challenging pressing movements and we’d load up th elevated push up and let tehm go to work.
When I get a shoulder flare up, usually from overhead lifting/heavy bag work and/or shadow boxing, I find push ups painfull. Yet strangly enough I’m able to get upside down and perform (read attempt!) Handstand Pushups pain free.
For the next while I’m experimenting with the Handstand push up, see how it affects me long term.
It is somewhat ironic that incline pressing is often irritating to the shoulder and yet the decline push-up is more shoulder-friendly on account of increased SA activity.
I’m curious about the 1-leg version. Is it just meant to provide an additional core stability challenge?
I’ve done feet-elevated pushups with my feet together or even stacked and have not noticed any additional effort in pushing/shoulder stability. Am I missing something?
I do pushups with my feet on a box and using homemade blaststrap/rings. Now that I’ve done them this way a couple of years benching again hurts too much. I don’t miss benching anyway.
Great point Eric, In the Army we obviously do pushups a lot. I’ve been doing eleveated pushups since I was a young Private. They really feel better on the shoulder as you stated. Often times I find I would rather do pushups elevated…just for the added difficulty with my feet just above parrell.
As a veteran of lots of nagging rotator cuff injuries, the other thing that might help is a slight outward rotation of the hands… i had never tried the elevated feet, but i will now. thanks!
Excellent point, I like to get some of my clients working on scap protraction/retraction in a quadruped position and then take them into a push-up. However I still have some clients who complain about shoulder pain so I will definitely try adding some elevation to their feet.
Fantastic tip Eric. I’d been unable to do any significant push movements (either bench or push up) for over a year without irritating my right shoulder and causing pain. My Doctor said there isn’t enough damage to the joint to warrant surgery (UK NHS……). With this I feel like I can actually work out again.
Thank you!! For about a year and a half, I’ve been looking for an answer to my ongoing left anterior should pain and I’d just about given up. I’ve been unable to do P90X because it relies so heavily on pushups and my level of fitness has suffered greatly. I tried elevating my feet with a small footstool this morning. While my reps are probably lower due to the elevation, who cares? My shoulder is PAIN FREE!!!
July 28th, 2009 at 7:06 pm
Great push-up tip Eric.
EQI’s at various levels have helped my clients progress toward the execution of a conventional push-up. We’ve also used band deloaded (same as band deloaded (up) bench press) with good results.
July 28th, 2009 at 8:34 pm
I like the tips, especially the bit about serratus anterior activation to alleviate pec minor symptoms. What about if I am experiencing pain in the sternoclavicular area with any type of weighted push-up/benching exercise?
July 29th, 2009 at 12:39 am
EC,
Great insight into a problem that I’m sure we’ve each seen or experienced first-hand at some point.
I’ve got friends heading into town here in SoCal this weekend and will not be in attendance at PB.
However, if you and anyone else get the chance to sneak away for a bit, you should come check out the 6-man volleyball tourney.
Here’s a vid of years past…
http://www.youtube.com/watch?v=95IFeVvZDgw
In health,
Boh
David Bohmiller
July 29th, 2009 at 2:04 am
Good tips Eric and Smitty.
I have had similar situations where I couldn’t load in any form of pressing variation but with the elevated push up, the athlete had absolutely no issues.
This is great for motivation as I’ve had guys (and girls) frustrated when they couldn’t do any challenging pressing movements and we’d load up th elevated push up and let tehm go to work.
Luka
July 29th, 2009 at 2:54 am
Do you load in the press up before returning to barbell or dumbbell presses or just mix it up depending on the case?
July 29th, 2009 at 3:04 am
When I get a shoulder flare up, usually from overhead lifting/heavy bag work and/or shadow boxing, I find push ups painfull. Yet strangly enough I’m able to get upside down and perform (read attempt!) Handstand Pushups pain free.
For the next while I’m experimenting with the Handstand push up, see how it affects me long term.
July 29th, 2009 at 7:31 am
It is somewhat ironic that incline pressing is often irritating to the shoulder and yet the decline push-up is more shoulder-friendly on account of increased SA activity.
Very interesting!
July 29th, 2009 at 7:33 am
Hi Eric,
I’m curious about the 1-leg version. Is it just meant to provide an additional core stability challenge?
I’ve done feet-elevated pushups with my feet together or even stacked and have not noticed any additional effort in pushing/shoulder stability. Am I missing something?
July 29th, 2009 at 2:50 pm
I do pushups with my feet on a box and using homemade blaststrap/rings. Now that I’ve done them this way a couple of years benching again hurts too much. I don’t miss benching anyway.
July 29th, 2009 at 4:23 pm
Great point Eric, In the Army we obviously do pushups a lot. I’ve been doing eleveated pushups since I was a young Private. They really feel better on the shoulder as you stated. Often times I find I would rather do pushups elevated…just for the added difficulty with my feet just above parrell.
August 2nd, 2009 at 8:22 am
As a veteran of lots of nagging rotator cuff injuries, the other thing that might help is a slight outward rotation of the hands… i had never tried the elevated feet, but i will now. thanks!
May 14th, 2012 at 10:37 am
Eric,
Excellent point, I like to get some of my clients working on scap protraction/retraction in a quadruped position and then take them into a push-up. However I still have some clients who complain about shoulder pain so I will definitely try adding some elevation to their feet.
May 14th, 2012 at 12:04 pm
Great tip Eric! I’ve had two partial seperations in my shoulders and this exercise was one that I noticed didn’t cause any irritation. Thanks
April 15th, 2014 at 8:34 am
Fantastic tip Eric. I’d been unable to do any significant push movements (either bench or push up) for over a year without irritating my right shoulder and causing pain. My Doctor said there isn’t enough damage to the joint to warrant surgery (UK NHS……). With this I feel like I can actually work out again.
May 19th, 2014 at 9:18 am
Thank you!! For about a year and a half, I’ve been looking for an answer to my ongoing left anterior should pain and I’d just about given up. I’ve been unable to do P90X because it relies so heavily on pushups and my level of fitness has suffered greatly. I tried elevating my feet with a small footstool this morning. While my reps are probably lower due to the elevation, who cares? My shoulder is PAIN FREE!!!
December 8th, 2016 at 5:21 am
Wanted to say thanks as well…just tried this elevated technique and am able to do push ups pain free. Not sure why it works…but its great.