Struggling with Shoulder Pain During Push-Ups? Here's What You Need to Know

Push-ups are a classic exercise, lauded for their ability to strengthen the upper body, particularly the chest, shoulders, and arms. However, if you’ve ever experienced shoulder pain after doing push-ups, you’re not alone. Many people struggle with this issue, and it can be frustrating, especially when you're trying to maintain a consistent workout routine. Understanding the root causes of shoulder pain during or after push-ups is crucial to preventing injury and ensuring that you can continue to perform this fundamental exercise effectively.

In this comprehensive guide, we'll explore the various reasons why your shoulders might hurt after push-ups, how to prevent it, and what steps you can take to alleviate the discomfort. Whether you're a fitness enthusiast, a beginner, or a seasoned athlete, this article will provide you with the insights needed to tackle shoulder pain and keep your workouts pain-free.

1. Improper Form: The Primary Culprit

One of the most common reasons for shoulder pain during or after push-ups is improper form. Even though push-ups seem simple, they require precise movements to be performed correctly. When the form is compromised, undue stress is placed on the shoulder joint, leading to pain and potential injury.

a. Elbow Positioning

A common mistake is flaring the elbows out to the sides at a 90-degree angle from the body. This position puts excessive strain on the shoulders, especially the rotator cuff muscles, which are small muscles that stabilize the shoulder joint. Instead, the elbows should be kept at about a 45-degree angle to the body. This position allows for better muscle engagement from the chest and triceps while reducing the load on the shoulders.

b. Hand Placement

Another crucial aspect of push-up form is hand placement. Placing your hands too far forward can lead to an imbalance in muscle engagement, causing your shoulders to bear more weight than they should. Ideally, your hands should be positioned directly under your shoulders when you're in the starting position of a push-up. This alignment helps distribute the weight evenly across your upper body, minimizing the risk of shoulder pain.

c. Core Stability

Core stability plays a significant role in maintaining proper push-up form. A weak core can cause your hips to sag or your back to arch, both of which can lead to improper shoulder positioning. Ensuring that your core is engaged throughout the exercise will help keep your body in a straight line from head to toe, reducing unnecessary strain on your shoulders.

2. Overuse and Muscle Imbalance

Overuse is another common cause of shoulder pain after push-ups, particularly if you're doing high volumes of this exercise without adequate rest or variation in your routine. Over time, the repetitive motion can lead to inflammation and irritation in the shoulder joints, particularly in the tendons.

a. Muscle Imbalance

Push-ups primarily target the pectoral muscles (chest), triceps, and anterior deltoids (front shoulder muscles). However, if these muscles become disproportionately stronger than the muscles on the opposite side of the body, such as the posterior deltoids (rear shoulder muscles) and upper back muscles, it can create a muscle imbalance. This imbalance can pull the shoulder joint out of alignment, leading to pain and discomfort.

To prevent muscle imbalance, it’s essential to incorporate exercises that target the opposing muscle groups, such as rows, face pulls, and reverse flyes. Strengthening the muscles of the upper back and rear shoulders will help maintain proper shoulder alignment and reduce the risk of pain during push-ups.

b. Rotator Cuff Overuse

The rotator cuff is a group of four muscles that surround the shoulder joint, providing stability and allowing for a wide range of motion. Because these muscles are relatively small and delicate, they can become easily fatigued, especially if overused without sufficient recovery time. Push-ups, particularly if performed in large volumes, can overtax the rotator cuff, leading to inflammation, tendinitis, or even a rotator cuff tear.

To avoid overuse injuries, it's essential to vary your workouts, allowing time for recovery between push-up sessions. Additionally, incorporating rotator cuff strengthening exercises, such as external rotations and YTWLs (a series of movements that engage the rotator cuff), can help improve the resilience of these muscles.

3. Pre-existing Shoulder Conditions

If you experience shoulder pain after push-ups, it might be due to a pre-existing shoulder condition that is exacerbated by the exercise. These conditions may not necessarily be caused by push-ups but can be aggravated by the motion and load placed on the shoulders during the exercise.

a. Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when the tendons of the rotator cuff are pinched between the bones in the shoulder joint, leading to pain and inflammation. This condition is often characterized by pain when lifting the arm overhead or reaching behind the back. Push-ups can exacerbate impingement due to the pressure they place on the front of the shoulder joint.

If you suspect you have shoulder impingement, it's important to address it with a healthcare professional. Treatment typically involves physical therapy to strengthen the rotator cuff and improve shoulder mechanics, as well as modifying exercises to avoid aggravating the condition.

b. Labral Tears

The labrum is a ring of cartilage that surrounds the shoulder socket, providing stability to the joint. A labral tear can occur due to trauma or repetitive motion, leading to pain, instability, and a sensation of catching or clicking in the shoulder. Push-ups can worsen symptoms of a labral tear, particularly if performed with improper form.

In cases of a suspected labral tear, a thorough evaluation by a medical professional is necessary. Treatment may involve physical therapy, and in some cases, surgery may be required to repair the tear.

c. Bursitis

Bursitis is the inflammation of the bursae, small fluid-filled sacs that cushion the bones, tendons, and muscles near joints. In the shoulder, bursitis can cause pain and tenderness, especially when performing activities that involve lifting the arm. Push-ups, due to the repetitive motion and pressure on the shoulder joint, can trigger or worsen bursitis.

Managing bursitis typically involves rest, anti-inflammatory medications, and physical therapy to address the underlying causes. Modifying exercises to reduce strain on the shoulder joint is also crucial.

4. Lack of Warm-Up and Mobility Work

A lack of proper warm-up and mobility work can significantly contribute to shoulder pain during and after push-ups. Jumping straight into a workout without adequately preparing the muscles and joints can lead to stiffness and reduced range of motion, increasing the risk of injury.

a. The Importance of Warm-Up

Warming up before performing push-ups is essential to increase blood flow to the muscles, improve flexibility, and prepare the joints for the upcoming activity. A proper warm-up should include dynamic stretches that target the shoulders, chest, and upper back, such as arm circles, shoulder rolls, and wall slides.

b. Mobility Work

In addition to a warm-up, incorporating shoulder mobility exercises into your routine can help improve the range of motion and reduce the risk of pain. Exercises like shoulder dislocations using a resistance band, thoracic spine rotations, and scapular push-ups are excellent for enhancing shoulder mobility.

Improving shoulder mobility can also help you achieve better form during push-ups, ensuring that the shoulder joint moves smoothly through its full range of motion without compensation from other muscles or joints.

5. Weak Stabilizer Muscles

The shoulder joint is a ball-and-socket joint, which allows for a wide range of motion. However, this also means that the shoulder relies heavily on stabilizer muscles to maintain its position and prevent injury. Weak stabilizer muscles, particularly those in the scapular (shoulder blade) region, can lead to shoulder pain during push-ups.

a. Scapular Stability

The scapula, or shoulder blade, plays a critical role in shoulder stability. If the muscles that control the scapula are weak or not functioning properly, it can lead to poor shoulder mechanics and pain during push-ups. Scapular stability exercises, such as scapular push-ups, scapular retractions, and wall slides, can help strengthen these muscles and improve overall shoulder stability.

b. The Role of the Serratus Anterior

The serratus anterior is a muscle located on the side of the ribcage that plays a key role in stabilizing the scapula. Weakness in this muscle can lead to a condition known as winged scapula, where the shoulder blade protrudes outward, compromising shoulder function and increasing the risk of pain. Incorporating exercises that target the serratus anterior, such as push-ups plus (where you add a scapular protraction at the top of a push-up), can help strengthen this muscle and reduce shoulder pain.

6. Push-Up Variations and Modifications

If shoulder pain persists despite addressing form, muscle imbalances, and mobility, it may be beneficial to explore push-up variations or modifications that place less strain on the shoulder joint.

a. Incline Push-Ups

Incline push-ups, where your hands are elevated on a bench or step, reduce the load on the shoulders while still allowing you to perform the exercise effectively. This variation is especially useful for those who are recovering from shoulder pain or who are new to push-ups.

b. Knee Push-Ups

Knee push-ups, where you perform the exercise with your knees on the ground, also reduce the load on the shoulders and can be a helpful modification if you’re experiencing pain. This variation allows you to build strength gradually while minimizing the risk of further injury.

c. Shoulder-Friendly Alternatives

If push-ups continue to cause shoulder pain, consider incorporating shoulder-friendly alternatives into your workout routine. Exercises like chest presses, floor presses, and resistance band chest presses can effectively target the same muscle groups without placing as much strain on the shoulder joint.

7. Recovery and Rehabilitation

If you’ve already developed shoulder pain from push-ups, taking steps to recover and rehabilitate the shoulder is crucial to preventing further injury.

a. Rest and Ice

In the initial stages of shoulder pain, rest is essential to allow the inflamed tissues to heal. Applying ice to the affected area can help reduce inflammation and alleviate pain.

b. Physical Therapy

Physical therapy is often recommended for those experiencing chronic shoulder pain. A physical therapist can assess your shoulder mechanics, identify areas of weakness, and develop a customized rehabilitation program to address the underlying causes of your pain.

c. Gradual Return to Exercise

Once your shoulder pain has subsided, it’s important to return to push-ups gradually, starting with modified versions and focusing on maintaining proper form. As you regain strength and stability, you can progress to full push-ups while continuing to monitor for any signs of pain.

Conclusion

Shoulder pain after push-ups is a common issue that can result from various factors, including improper form, overuse, muscle imbalances, pre-existing shoulder conditions, and inadequate warm-up and mobility work. By understanding the root causes of your pain and taking steps to address them, you can prevent injury and continue to enjoy the benefits of push-ups in your workout routine. Remember, if pain persists, it’s important to seek professional medical advice to ensure you’re taking the right steps for your shoulder health.