Shoulder pain during push-ups is a frequent complaint, often signaling a mechanical issue with the movement itself. This exercise demands significant stability from the shoulder joint while subjecting it to compressive forces against the floor. When stability is compromised, the delicate structures within the shoulder can become irritated or injured. Understanding the source of this discomfort is the first step toward correcting the problem and safely continuing strength training.
Common Anatomical Sources of Pain
The shoulder’s ball-and-socket joint sacrifices bony stability for an extensive range of motion, making it highly dependent on surrounding soft tissues. One of the most common sources of pain is shoulder impingement, which occurs when tendons or the bursa are pinched between the bones of the shoulder joint during movement. Specifically, the supraspinatus tendon often becomes compressed beneath the acromion, the bony roof of the shoulder, leading to sharp or aching pain.
Another frequent issue is strain or inflammation of the rotator cuff tendons, a group of four muscles responsible for stabilizing the shoulder. The push-up is a closed-chain movement that requires high levels of rotator cuff activation to keep the humeral head centered in the socket. When these muscles are fatigued or subjected to poor mechanics, they can develop tendinitis, resulting in pain and tenderness, often felt at the front or side of the shoulder.
Technique Errors That Strain the Shoulder
The position of your elbows is a major factor in determining shoulder health during the push-up motion. Excessive elbow flare, where the elbows point straight out to the sides, is a common error that places undue stress on the shoulder capsule. This wide angle reduces the space for the rotator cuff tendons, increasing the likelihood of impingement as the body lowers. A safer alignment involves tucking the elbows so they form roughly a 45-degree angle relative to your torso at the bottom of the movement.
Poor control of the scapula, or shoulder blade, also contributes to shoulder strain, particularly if the blades are held rigid or allowed to “shrug” toward the ears. The shoulder blades should be allowed to retract (pinch together) slightly as you descend and protract (move away from the spine) as you push up. Failing to maintain this dynamic control can lead to muscle imbalances and a loss of stability. Additionally, placing the hands too far forward or too wide disrupts optimal alignment, forcing the shoulder to work from a mechanically disadvantaged position.
Immediate Adjustments and Safe Alternatives
If you experience pain, the immediate adjustment is to stop the exercise and apply the RICE principle: Rest and Ice. Applying ice to the affected area for 15 to 20 minutes several times a day helps reduce acute inflammation and pain. For continued training, you must immediately regress the exercise to reduce the load on the joint while maintaining proper form.
One of the most effective modifications is the elevated push-up, which involves placing your hands on an elevated surface like a bench or a wall. This incline position decreases the percentage of body weight pressed, significantly reducing stress on the anterior shoulder. You can also switch to a knee push-up, which similarly reduces the load while allowing you to practice correct elbow and scapular mechanics. Alternatives that work the same muscle groups without closed-chain compression include the dumbbell chest press, which permits a neutral grip and a more joint-friendly range of motion.
Knowing When to Seek Medical Consultation
While many cases of push-up pain can be managed through technique correction and modification, certain signs indicate the need for professional medical evaluation. You should seek an appointment with a physical therapist or orthopedist if the pain persists for more than a few days or continues to worsen despite rest and modifications. Pain that is sharp, intense, or radiates down the arm suggests a significant nerve or tendon issue requiring diagnosis.
A loss of function, such as an inability to lift your arm overhead or sudden weakness in the joint, is a serious sign requiring prompt attention. Any audible popping, clicking, or snapping sound accompanied by a sudden onset of pain should be evaluated immediately to rule out a tendon tear or other acute injury. Ignoring these symptoms can lead to prolonged recovery and the potential for a chronic condition.