Wrist, elbow and shoulder pain during push-ups

Wrists hurt during push-ups mainly because of the angle. With your palms flat on the floor and your shoulders stacked over your hands, the wrist sits near the end of its extension range, close to 90 degrees, while carrying a large share of your bodyweight. That combination of end-range position and load is what most people are feeling.

This is not just theory. Cadaveric work published in the Journal of Hand Surgery measured joint pressure in push-up positions and found that a push-up performed with the wrist in extension significantly increased pressure in the radioscaphoid fossa, the thumb-side compartment of the wrist, compared with a less extended position. Separate research in the Journal of Hand Therapy has specifically compared force transmission through the wrist during push-ups on a hyperextended versus a neutral wrist, which tells you the neutral-versus-extended distinction is a real biomechanical variable and not a gym myth.

Three other contributors are worth checking. Load ramped too fast, so the wrists get the volume before the tissue is ready. Hands placed too far forward of the shoulders, which increases the extension angle. And a hard floor with no mat, which concentrates pressure at the heel of the hand.

The single most effective change for wrist pain during push-ups is getting the wrist out of extension. If the forearm and the back of the hand form a straight line, the joint is no longer being asked to work at its end range under load. Work down this list in order and change one thing at a time.

1. 1

   Use handles, parallettes or dumbbells

   Gripping push-up handles, parallettes or a pair of hex dumbbells keeps the wrist neutral, in a handshake position, while you press. This is the highest-value change available and it costs almost nothing. Hex dumbbells must be genuinely stable on the floor; round ones are not.

2. 2

   Try fist push-ups on a mat

   Push-ups on the fists, knuckles down on a folded towel or mat, achieve the same neutral wrist without equipment. Keep the wrist straight rather than letting it bend sideways, and build up slowly, because the knuckles need time to tolerate the contact.

3. 3

   Regress to an incline

   Hands on a bench, a table or a kitchen counter reduces both the load through the wrist and the extension angle at the same time. It is a legitimate training position, not a consolation prize. Push-up progression for beginners explains how to walk the incline back down over weeks.

4. 4

   Fix hand placement

   Hands under the shoulders or very slightly wider, not out in front of your head. Spread the fingers and grip the floor lightly so pressure spreads across the whole hand instead of pooling in the heel. Turning the hands out 10 to 20 degrees is comfortable for many people.

5. 5

   Warm the wrists up first

   A minute of gentle wrist circles, and slowly rocking forward and back on the hands in a quadruped position, prepares the joint before you load it. Warm-up is not a fix for a painful wrist, but it does make a tolerable one more tolerable.

6. 6

   Cut volume for a couple of weeks

   If pain has already set in, reduce the number of hard sets rather than trying to push through. Persistent wrist pain that is not improving after around two weeks of self-care is a reason to speak to a doctor or physiotherapist.

Elbow pain during push-ups is commonly reported on the inner or outer point of the elbow, and it usually shows up after a jump in volume rather than after a single session. The forearm muscles that control the wrist attach around those bony points, and a push-up asks them to work hard to stabilise a loaded, extended wrist. Change the wrist and you often change the elbow.

• Take the wrist to neutral. Handles or dumbbells reduce the stabilising demand on the forearm muscles that attach around the elbow, which is why wrist and elbow complaints often resolve together.
• Narrow the flare. Elbows drifting out toward 90 degrees from the torso stresses both elbow and shoulder. Keep them tucked to roughly 45 degrees, arrowhead shape rather than a T.
• Do not slam into lockout. Straightening the arm hard and fast at the top jams the joint. Finish the rep with the elbows straight but not snapped.
• Look at the volume curve, not the session. Elbow pain is typically a too-much-too-soon signal. Cutting weekly hard sets by a third for two weeks is a reasonable self-managed step, and how to increase push-ups covers how to rebuild volume without repeating the jump.

Persistent pain on the outside of the elbow, weak grip, or pain that is provoked by everyday gripping and lifting are things a clinician should look at. The American Academy of Orthopaedic Surgeons notes that lateral elbow problems often develop gradually from repetitive forearm use rather than from one identifiable injury, which is precisely how push-up volume creeps up on people.

Shoulder pain during push-ups is most often associated with two habits: letting the elbows flare wide, and letting the shoulders shrug up toward the ears as you descend. Both narrow the space the rotator cuff tendons pass through and put the joint into a position it is not well set up to press from.

What to change, in order of return: tuck the elbows to around 45 degrees from the torso; pull the shoulders down and slightly back so the shoulder blades set before you descend; and stop the descent at a depth you can control rather than collapsing onto the floor. A deep push-up is not automatically a better push-up if the bottom position is one you cannot hold. Push-up form has the full checklist.

Regressing to an incline is also the right call here, and it is a real training position rather than a demotion; push-up variations shows where it sits on the ladder. Higher hands reduce the load and the range at the same time, which lets you rebuild volume in a position that does not provoke symptoms. The AAOS advises seeking medical care as soon as possible for an acute injury causing intense shoulder pain, and seeing a doctor if less severe symptoms persist after a few days of rest.

Lower back discomfort during push-ups is usually a bracing issue rather than a back problem. As the arms fatigue, the hips sag toward the floor, the pelvis tips forward and the lumbar spine extends under load. The back is being asked to hold a position the trunk stopped supporting somewhere around rep eight.

• Squeeze the glutes and brace before you descend. A push-up is a moving plank. Set the trunk first, then bend the elbows.
• Tuck the ribs down toward the hips. Flared ribs and an arched lower back travel together. Think of shortening the front of your torso slightly.
• End the set when the hips drop. The rep where your midsection quits is the last rep of that set, regardless of what your arms could still do.
• Build the plank separately. If you cannot hold a solid front plank for 30 to 45 seconds, that is the limiting factor and worth training on its own.

Back pain that radiates into a leg, comes with numbness or tingling, or affects bladder or bowel control is not a form issue and needs prompt medical attention rather than a technique tweak.

Neck discomfort during push-ups usually comes from craning the head forward to touch the floor with the chin, or from watching your hands throughout the set. Both hold the neck in extension while the shoulders work, and the small muscles at the base of the skull end up doing static work for the length of the set.

The correction is simple: keep the head in line with the spine and let the eyes fall on a spot on the floor roughly a foot in front of your hands. Your chest reaches the floor, not your chin. If you are using a phone counter, position it so you do not have to lift your head to check the screen; a phone at floor level to your side, as described in counting push-ups with your phone camera, keeps your neck out of it.

Stop and get assessed if push-up pain is severe, if it followed a snap, grinding or popping sensation, if you cannot move or load the joint normally, if the area is hot, red and swollen, or if you have numbness, tingling or loss of feeling. Those are not training problems to work around.

For less dramatic aches, the NHS guidance on wrist pain gives a workable threshold for the whole body: see a GP or physiotherapist if the pain is stopping you doing normal activities, if it is getting worse or keeps coming back, or if it has not improved after about two weeks of treating it at home. The AAOS uses a similar rule for the shoulder, advising prompt care for acute intense pain and a doctor's visit if milder symptoms persist.

In the meantime, sensible self-care is unglamorous: reduce the aggravating volume rather than stopping all movement, keep the joint moving gently through pain-free range, and give it a fortnight of consistent, easier training. Training around a symptom is reasonable. Training through a worsening one is not.

Any discomfort that does not improve with a period of rest is a reason to see a specialist rather than a reason to add volume.

Paraphrasing standard orthopaedic guidance on persistent joint pain