I love the push-up. It is a versatile exercise that can be utilized in many ways, when it is done correctly. The push-up, however can easily be done wrong and can have adverse effects, especially on shoulder health. Push-ups aren’t meant to be easy, in fact a perfect push-ups is hard and can be a full body exercise. A correct push-up is not just a upper body horizontal press exercise, it is also a great anterior core and glute activation exercise.
What is happening when we perform a push-up? The joint movements in the push phase include horizontal adduction at the shoulder (bringing your arms to the midline of the body), elbow extension(straightening your arm), and scapular protraction (your shoulder blades move toward the outside of the body). The muscles involved in horizontal adduction are pec major, anterior deltoid, and coracobrachialis. The tricep causes elbow extension and the serratus anterior and pec minor are contracted during scapular protraction. During the lowering phase the opposite occurs horizontal abduction occurs at the shoulder, flexion at the elbow, and retraction of the scapula. The above muscles have to eccentrically contract during the lowering phase to resist gravity and prevent your body from falling to the ground. While all of this is going on at our upperbody we must simultaneously engage our anterior core and glutes, this will keep a proper alignment of our spine and keep the body moving as one unit.
Before I talk about how to do a perfect push-up, I want to touch on the most common errors I’ve noticed:
1.) Arm flair out: This is when are elbows and shoulders are almost in a 90/90 position. This is an unsafe place for our shoulders, we are predisposing our shoulders to an anterior humeral glide which adds unwanted stress to the anterior components of the shoulder, mainly the anterior capsule and biceps tendon (long head). I’m really not sure why our physical education programs are teaching our youth to do push-ups like this. We need to start teaching our youth better movement patterns and the push-up is a great way to start.
I don’t believe there is only one way to do a push-up but, I do believe there is one way not to do a push-up, and that is in 90 degrees of shoulder horizontal abduction.
2.) Wide hand placement: With a wider hand placement we increase our lever arm and are already at a mechanical disadvantage. Wider hand placement usually leads to elbow flair due to lack of strength. If the hands are turned in (internally rotated) it’s even worse, because it adds more stress to the shoulder and elbow.
3.) Not going through the full ROM of the push-up. This occurs in a couple ways, the first is trying to do a full push-up with the arms flaired out or wide hand placement, these positions make it really hard to go through the full ROM of a push-up. The second way a decrease in movement occurs, is by leading with your head. Clients and athletes will drop their head with the thought that if their head hits the ground they are doing a full push-up. But, they are in fact not and this leads to a faulty movement pattern.
*Elbows flaired out, wide hand placement, and half the movement is completed. Sorry ladies, but this is not the proper way to perform a push-up. Ellen is actually going through more of the ROM than the first lady. (push-ups start at 0:49 secs)
4.) Lumbar hyperextension: Many people are stuck in an Anterior Pelvic Tilt, which brings the hips forward and allows the lower back to sag. This is harmful to the hips and low back.
5.) Not moving the body as one unit. In some cases, I will witness clients or athletes press their upper body up first and then the lower body follows. This occurs because of a lack of strength and core activation. Moving the body separately decreases the effectiveness of the this full body exercise.
5.) Upper trap/pec minor compensation. This occurs when we are unable to set our scapulas in a down and back position. The upper trap will fire and elevate the scapula and the pec minor will pull the scapula into an anterior tilt, rounding the shoulders forward.
6.) Squeezing your scapulae(shoulder blades) through the entire push up. Maintaining a retracted position throughout the movement does not allow the scapula to go through necessary movements on the rib cage and can be detrimental to shoulder health.
Keys To Performing a Correct Push-up:
1.) Hands or wrists under shoulders: By placing the hands closer to our body and under our shoulders we are increasing our mechanical advantage. Which sets up for a better press. Another note on hand placement is finger position. I like to keep the fingers pointed forward or slightly out. If our hands are turned in we are placing our shoulders in internal rotation.
2.) Elbows at no more than a 45 degree angle. As noted earlier, when we allow our elbows to flair out we put our shoulders in a bad position. So it’s best to keep our elbows closer to our torso, this decreases the lever arm and increases leverage. Decreasing the angle also allows us to easily get our shoulders into external rotation. External rotation, is not only a safe place for our shoulders, but it creates more torque and we can do more work. And if you notice, for anyone that benches, this is the same position we bench press in. Not only is the push-up a great body weight strength exercise, but it is also a movement prep exercise for the bench press.
A simple way to remember hand placement and elbow angle is by forming an arrow with our arms not a T.
3. ) Keep elbow crease forward. To piggy back off the last key, I like to cue my athletes and clients to keep their crease of their elbow forward, without moving their hands. This allows us to stay in external rotation and creates a better pressing surface.
4.) Vertical forearm: Keep your elbows over your wrist through the movement. At the bottom of the push-up your forearm should be in a vertical position. This decreases stress on the elbow joint. We do not want our forearms to translate forward or backwards while lowering into the bottom position.
5.) Set your shoulders back and down. Protract at the top and retract at the bottom: Think about putting your shoulder blades in your back pocket. At the top of the position, with your shoulder blades in your back pocket, protract (push your shoulder blades away from each) and at the bottom of the push-up retract (squeeze your shoulder blades together.) This allows the scapular to move freely along the rib cage creating a better scapulohumeral rhythm.
6.) Squeeze your glutes. Before starting to descend think about squeezing a credit card between you butt cheeks. This will activate your glutes and bring your hips out of a Anterior Pelvic Tilt. Squeezing your glutes will also help with core stabilization and help the body move together.
7.) Move the body as one unit. With the hands, elbows, shoulders, and glutes set we lower down as one unit, do not lead with the head, the chest should hit the floor first. Now, at the bottom we reverse the motion keeping the body moving together. With this the push-up becomes an upper body push, core stabilization, and glute activation exercise.
Quick Recap: Hands under shoulders, fingers forward or out, elbows at a 45 degree angle or closer to the body think ↑ not Τ, vertical forearm, set your shoulder blades down and back, protract at the top retract at bottom, squeeze your glutes and move everything together. Notice the video below.
Tips to Modifying a Push-up for beginners:
1.) Start at an Incline(Hands raised on bench or smith machine): Forget the kneeling push-up progression. The best way to get better at push-ups are to do more push-ups and the kneeling position does not incorporate full body tension like an incline push up, and places unwanted stress on the anterior structures of our shoulders and our elbows. With an incline push-up you can go through the full ROM of a regular push-up without using your whole body weight, which teaches a primary movement pattern and makes the client feel better about doing a modified push-up.
2.) Band Assisted Push-ups: Place the band under the hips to assist out of the bottom position. Again, this teaches a correct movement pattern by allowing full range of motion.
3.) Eccentric Push-ups: Lowering into the bottom position slowly will increase your eccentric strength and continue to teach the movement pattern.
Once you perfect your push-up there are many ways to progress them and make them more difficult. However, I can not stress enough how important it is to make sure the movement pattern is correct before adding complexity or load.
Questions, comments, suggestions, ideas are welcomed below…