The push-up is arguably the most convenient, versatile, and effective pressing movement for the upper body. However, pain can often limit individuals from performing or progressing the exercise. This blog will walk you through how to easily modify the push-up if you’re experiencing pain without having to sacrifice your gains at the same time.
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Anecdotally, discomfort at the wrist is one of the most common complaints as it relates to push-ups. Push-ups require a certain amount of wrist extension that is somewhat dependent on how you perform the movement. For example, if you shift your bodyweight up toward your head, that’s going to require more wrist extension than if you were to shift your weight toward your feet. Generally, you want to be somewhere in the middle. If you’re experiencing pain because of this loaded wrist extension, there are 3 simple modifications you can start with.
Push-ups using dumbbells, kettlebells, parallettes, etc. as they allow your wrists to maintain neutral in the sagittal plane.
However, if you also experience pain with radial or ulnar deviation, you might need to be mindful of your wrist position in the frontal plane as well.
Push-ups on your fists. If this is uncomfortable, you can place your knuckles on a soft surface, alter your grip, or hold onto an object like a towel (socks in picture).
Placing a towel under your hand to change the relative degree of wrist extension. Therefore, you can fold the towel up as much as you need to make the push-up comfortable for you. And actually, you can work backwards if you want to slowly build up your tolerance to wrist extension.
The shoulder is another common area for people to report musculoskeletal pain, but prior to my two suggestions, I do want to state that for most individuals, you should just let your shoulder blades move naturally during a push-up. Let them retract at the bottom, and protract at the top without giving it too much thought other than a few external cues like “push the floor away from you” or “don’t crush an egg under your sternum.”
The first mistake that people with shoulder pain might do is utilize a really wide grip. There’s nothing inherently wrong with this position, but it places a high demand on the shoulder and if you’re already experiencing discomfort here, you’ll likely want to switch to a narrower hand placement to help offload some of those sensitize structures.
The other issue that individuals tend to run into, especially if they have pain right in the front of the shoulder, is allowing their shoulders to dump forward at the bottom of the movement which puts a lot of load on that area. We can try to redistribute that load throughout the upper extremities by modifying the technique a bit, but in reality, just changing the difficulty or range of motion of the push-up is likelier an easier solution (see regressions and other options below).
The elbow is kind of the opposite of the shoulder. A narrower hand position where the elbows are really tucked in to your side, like a diamond push-up, is probably going to be less comfortable if you’re experiencing elbow pain so you might want to just take a slightly wider grip.
A push-up does require extension of the big toe and if you have very limited range of motion, a recent injury, or something else going on, it can be painful to be in that position. If you need to, just lay your feet flat on the floor or a towel, and you’re good to go.
If your low back is sensitive to extension, or arching, and you allow your hips to sag during a push-up, it might be helpful to think about balancing a glass of water on your low back or actually balancing an object on your low back like a foam roller. You can also come back to that cue of trying to touch an egg with your sternum without crushing it.
For the neck, I’m not trying to dichotomize the positions as good or bad, but they might be less advantageous for the task and can be worth modifying if you have neck pain.
So number 1, if you have your shoulders shrugged up to your ears the entire time, see if you can just let them relax as the scapular elevators aren’t the prime movers in a push-up.
And number 2, if you let your neck hang and this is recreating your symptoms, think about a string pulling your head back toward the ceiling.
The two easiest ways to regress a standard push-up are to elevate your hands or perform the movement on your knees, and since they both reduce the overall demand, they can help minimize symptoms at all of the previously mentioned areas.
I prefer elevating your hands since the technique will mimic a standard push-up and you can adjust the difficulty by using objects of varying heights. The higher you go, the easier the movement and you can gradually work your way down as you build up strength.
Other Options to Reduce Pain During the Push-up
Three of my other favorite options include isometric push-ups, eccentric push-ups, and push-ups with a reduced range of motion.
Isometric push-ups allow you to focus on technique and strength where you need it most, while keeping the movement comfortable. Slowly increase hold times or range of motion as needed.
Eccentric push-ups also help you work on technique and strength throughout the entire range of motion. Just don’t rush the movement. Go slow and controlled and repeat as tolerated.
Push-ups with a reduced range of motion can be done with no object or an object under your chest for standardization. The lower you go in a push-up, the more demand on most of the musculature involved. Pick a tolerable starting point and gradually work your way down.
The last thing I want to mention is load management. Not all pain with push-ups need a specific intervention. I’ve worked with clients who have gone from being completely inactive to joining a push-up competition at work where they do as many push-ups as possible every day for a month straight. This is unlikely to be a technique or joint issue. This is an issue of you doing too much, too quickly. If you want push-ups to be a regular part of your fitness routine, aim for a sustainable goal. Slow and steady wins the race.