Shoulder impingement is a common concern for active individuals, especially those who engage in strength training and pressing movements. This condition can make simple exercises, like the push-up, a source of sharp discomfort. Many people wonder if they must completely abandon the push-up during recovery. The answer depends heavily on the severity of the impingement and the willingness to make precise modifications to the exercise form.
Understanding Shoulder Impingement
Shoulder impingement syndrome occurs when soft tissues within the shoulder are compressed as the arm moves. The shoulder joint features a narrow passageway known as the subacromial space, located beneath the acromion (the bony roof of the shoulder). This space contains the tendons of the rotator cuff muscles, particularly the supraspinatus, and the subacromial bursa.
When the arm is raised, this space naturally narrows. Impingement pain results when the tendons or bursa become inflamed or pinched between the humerus (upper arm bone) and the acromion. This pinching is often exacerbated by movements that involve lifting the arm forward. The condition is frequently linked to repetitive microtrauma or muscle weakness that allows the humeral head to shift upward during movement.
Assessing the Safety of Push-ups
The traditional push-up requires shoulder flexion, adduction, and internal rotation, a pattern that inherently reduces the size of the subacromial space. For someone experiencing acute impingement, performing a full-depth push-up can maximize compression on the irritated tendons and bursa. This repetitive pinching action intensifies inflammation and delays healing.
Continuing to push through a sharp, stabbing sensation during any exercise should be avoided, as this indicates direct tissue irritation. Pain functions as the body’s warning signal, and ignoring it risks exacerbating the existing pathology, potentially leading to chronic pain or a rotator cuff tear. While a mild, dull ache that subsides immediately after the exercise may be manageable, any sharp pain warrants an immediate stop. The goal during recovery is to maintain strength without aggravating the joint.
Adjusting Form for Shoulder Comfort
If you are in a mild recovery phase or determined to attempt a push-up, several modifications can reduce the impingement risk.
Hand Placement Adjustment
Adjusting your hand placement is an effective strategy to create more space in the shoulder joint. Instead of a standard grip, rotate your hands so your fingers point slightly outward. This encourages external rotation of the shoulder and helps open the subacromial space.
Limiting Range of Motion
Another modification involves limiting the range of motion significantly to avoid the painful end ranges of the movement. Instead of lowering your chest all the way to the floor, stop the descent when your elbows reach approximately a 45-degree angle or when you feel the first hint of discomfort. This partial repetition still engages the chest and triceps while protecting the compressed structures.
Using an Elevated Surface
To decrease the overall load on the shoulder, utilize an elevated surface for your hands, such as a sturdy bench, box, or wall. Elevating the upper body reduces the percentage of body weight you are pressing, decreasing the force transmitted through the joint. This incline also naturally decreases the angle of shoulder flexion, which minimizes the narrowing of the subacromial space.
Alternative Strength Exercises
When push-ups must be avoided entirely, shoulder-friendly alternatives can still effectively target the chest, triceps, and anterior shoulder muscles.
Pressing Alternatives
The following exercises target pressing muscles while minimizing impingement risk:
- Dumbbell Floor Press: The floor restricts the range of motion, preventing the arm from traveling too far backward into the stretched position. Lying on your back stabilizes the shoulder joint and allows for a comfortable neutral grip.
- Landmine Press: This option targets pressing muscles by moving the weight in an arc, which is more forgiving than a straight vertical press. This exercise naturally limits overhead movement, keeping the shoulder in a safer position.
Posterior Muscle Strengthening
Incorporating exercises that strengthen the posterior muscles is paramount for long-term shoulder health. Banded exercises, such as face pulls or band pull-aparts, strengthen the external rotators and scapular retractors. These muscles help stabilize the shoulder blade and counteract the forward shoulder posture common in impingement. By focusing on these alternatives, you can continue to build upper body strength without compromising recovery.