Push up pain is discomfort or sharp sensation in the wrists, shoulders, elbows, back, chest, or neck that occurs during or after push ups. It usually signals a form issue, a mobility limitation, or an underlying condition, not a reason to stop doing push ups altogether.
Push ups are one of my favourite exercises for building upper body strength and supporting bone health. They load the wrists, forearms, shoulders, and they support the spine, all areas that matter when you’re managing osteoporosis or osteopenia. I prescribe them to nearly every client I work with.
Push Up Pain
You should not experience push up pain and push ups should never hurt or cause discomfort. If you feel pain during a push up, your body is telling you something needs to change. It might be your hand position. It might be your range of motion. It might be the variation you’re using. And in some cases, it might mean you need to see a professional before continuing.
In this guide, I’ll walk through the most common areas where my clients experience pain with push-ups, explain what’s likely causing it, and give you specific strategies to fix it. I’ve organized these sections by how frequently I see each problem, starting with wrist pain, which is by far the most common complaint.
Wrist Pain During Push Ups
Wrist pain is the single most common complaint I hear from clients when they start doing push ups. It’s also the easiest to fix.
Why Your Wrists Hurt During Push Ups
A standard push up forces your wrist into roughly 90 degrees of extension, meaning the back of your hand is angled sharply toward your forearm. For many people, especially those over 50, this is simply too much extension under load.
The most common causes of wrist pain during push ups include:
- Excessive wrist extension. The standard flat-hand push up position puts your wrist near its end range. Under bodyweight, this creates compression on the small bones and ligaments of the wrist.
- Weakness in the wrist extensors. If the muscles on the back of your forearm are not strong enough to stabilize the wrist under load, the joint takes the strain instead.
- Pre-existing conditions. Carpal tunnel syndrome, ganglion cysts, de Quervain’s tenosynovitis, and osteoarthritis of the wrist can all be aggravated by the push up position.
- Hypermobility. If your joints are naturally very flexible, your wrists may collapse past neutral under bodyweight, creating pain and instability. (A hypermobility test will help you determine your level of hypermobility.)
How to Fix Wrist Pain During Push Ups
- Change the angle of your wrist. This is the single most effective fix. Instead of placing your palms flat on the floor, use push up bars (see more detail below on push up bars), a pair of dumbbells, or make fists. All three options keep your wrist in a neutral, straight position and eliminate the excessive extension that causes most wrist pain.
- Reduce the load. Wall push ups and incline push ups (hands on a counter or sturdy bench) significantly reduce the amount of bodyweight passing through your wrists. If flat-on-the-floor push ups hurt, move to an incline and work your way down over weeks.
- Warm up your wrists before loading. Before your push up set, spend 30 seconds doing gentle wrist circles, prayer stretches (pressing your palms together and gently pushing your wrists down), and controlled flexion-extension movements. This prepares the joint for the load to come.
- Strengthen your wrists over time. Wrist curls (both palm-up and palm-down), grip exercises, and forearm rotations build the strength your wrists need to handle push up loads comfortably. These can be done with a light dumbbell or even a can of soup.
When to See a Professional About Wrist Pain
If your wrist pain persists after making the adjustments above, or if you notice swelling, numbness, or tingling in your fingers, it’s time to see a physiotherapist or hand specialist. These symptoms can indicate conditions that need specific treatment beyond exercise modification.
In my practice, wrist pain is the issue I address most often with new clients. In the vast majority of cases, switching to push up bars or moving to an incline push up solves the problem within the first session. I almost always start clients with both, an incline position and a neutral wrist grip, and progress from there.
Push Up Bars for Wrist Pain
If you decide to try push up bars, look for a few things.
- First, the grip should be padded and comfortable, you’ll be putting your full bodyweight through it.
- Second, the base needs to be wide and stable enough that it won’t tip or slide on your floor surface; rubber or non-slip feet are worth checking for.
- Third, choose a bar where the handles sit at a slight angle rather than perfectly straight across, a mild inward angle follows the natural position of the wrists and can feel more comfortable. You don’t need anything expensive or complicated. A simple, sturdy pair that keeps your wrists in a neutral position is all you’re looking for.
Shoulder Pain from Push Ups
Shoulder pain during push ups is the second most common problem I see. Unlike wrist pain, which is usually a straightforward position issue, shoulder pain can come from several different sources, and getting the right diagnosis matters.
Why Your Shoulders Hurt During Push Ups
The shoulder is a complex joint with a wide range of motion, which also makes it vulnerable to irritation when loaded incorrectly. Here are the most common causes:
- Elbow flare (the T position). When your elbows point straight out to the sides during a push up, your upper arms form a “T” shape with your torso. (See illustration below). This position narrows the subacromial space in your shoulder and can pinch the rotator cuff tendons and bursa. It’s the most common form error I correct.
- Poor scapular control. If your shoulder blades don’t move properly during the push up, specifically, if they don’t protract (spread apart) as you push up and retract (squeeze together) as you lower, the ball of the upper arm bone can shift forward in the socket. This creates anterior shoulder pain.
- Rotator cuff weakness or tendinopathy. The four small muscles of the rotator cuff stabilize the head of the humerus in the socket. If these muscles are weak or irritated, the shoulder joint becomes unstable under the load of a push up, leading to pain.
- Going too deep. Lowering your chest too far past your hands forces the shoulder into excessive extension. This can strain the anterior capsule and aggravate the biceps tendon.
- Scapular winging. If your shoulder blades poke out from your ribcage during push ups, it typically means your serratus anterior muscle is weak. This compromises the entire shoulder mechanics chain.
- Pre-existing conditions. Rotator cuff tears, labral tears, frozen shoulder (adhesive capsulitis), and AC joint arthritis can all cause pain during push ups.
How to Fix Shoulder Pain from Push Ups
- Tuck your elbows to a 30–45 degree angle. This is the single most important correction for shoulder pain. Instead of a T shape, your arms should form an arrow shape when viewed from above. This opens up the subacromial space and reduces impingement. In my programs, this arm position is non-negotiable.
- Reduce your range of motion. You don’t need to touch your chest to the floor. Stop the push up before you reach the point of pain and build depth gradually as your shoulder strengthens and mobility improves.
- Use wall push ups or incline push ups. Reducing the load gives your shoulder a chance to work through the movement pattern without being overwhelmed. Start with a wall push up and progress to a counter, then a bench, then the floor.
- Add scapular push ups to your routine. From a plank or push up position, keep your arms straight and let your shoulder blades squeeze together (retract), then push them apart (protract). This trains the serratus anterior, which is critical for scapular stability during push ups.
- Strengthen your rotator cuff. Banded external rotation exercises and side-lying external rotation with a light weight can help build the stability your shoulder needs. These are best done as a warm-up before push ups, not as an afterthought.
- Try self-massage for tight muscles. Trigger point work on the pec minor, upper trapezius, and infraspinatus can relieve muscular tension that contributes to poor shoulder mechanics during push ups.
When to See a Professional About Shoulder Pain
See a physiotherapist or sports medicine doctor if your shoulder pain doesn’t improve with the modifications above, if you experience clicking or catching sensations, if you have pain that wakes you at night, or if you notice weakness when reaching overhead. These can be signs of a structural issue that needs targeted rehabilitation.
In my practice, I teach every client to “pack” their shoulders before starting a push up. That means drawing the shoulder blades slightly down and back, think of tucking your shoulder blades into your back pockets. This sets the shoulder joint in a stable position before you add load. Combined with the arrow elbow position, this eliminates shoulder pain for the majority of my clients.
Elbow Pain When Doing Push Ups
Elbow pain during push ups often gets overlooked, but it’s more common than many people realize. The elbow is a hinge joint caught between the shoulder and wrist, and problems in either of those areas can show up as elbow pain.
Why Your Elbows Hurt During Push Ups
- Medial epicondylitis (golfer’s elbow). Pain on the inside of the elbow, caused by overload on the wrist flexor and pronator muscles where they attach to the inner elbow. This is common when you grip the floor hard during push ups.
- Lateral epicondylitis (tennis elbow). Pain on the outside of the elbow, caused by overload on the wrist extensor muscles. This can be aggravated by a wide hand position during push ups.
- Elbow hyperextension. Locking your elbows out fully at the top of each rep puts compressive stress on the joint. Over time, this can irritate the cartilage and ligaments.
- Triceps tendinopathy. Pain at the back of the elbow, right where the triceps tendon attaches. This tends to flare during the pressing (upward) phase of the push up.
- Ulnar nerve irritation. If you feel tingling or numbness in your ring finger and pinky finger during push ups, the ulnar nerve may be getting compressed at the elbow.
How to Fix Elbow Pain During Push Ups
- Don’t lock out at the top. Keep a slight bend in your elbows at the top of each push up. This removes the compressive stress of full lockout and keeps the muscles engaged rather than transferring load to the joint.
- Reduce the load. Move to incline or wall push ups to give the tendons a chance to adapt. Tendons recover more slowly than muscles, so patience matters here.
- Check your hand width. If your hands are too narrow, you’re overloading the triceps and the medial (inner) elbow. If they’re too wide, you’re overloading the lateral (outer) elbow. Aim for hands slightly wider than shoulder-width.
- Add eccentric strengthening. For lateral epicondylitis, a Tyler Twist exercise with a rubber bar is well-supported by research. For medial epicondylitis, slow wrist curls with a light weight can help. These exercises strengthen the tendon through its range of motion.
- Massage your forearms. Use a lacrosse ball or foam roller to work the muscles of the forearm. Tension in these muscles pulls directly on the elbow tendons.
When to See a Professional About Elbow Pain
If you notice grip weakness, if your elbow pain persists beyond two to three weeks despite modifications, or if you experience tingling into your fingers, see a physiotherapist. Elbow tendinopathies respond well to structured rehabilitation, but they need the right loading program.
In my practice, elbow pain during push ups often co-exists with wrist pain. The forearm muscles that control the wrist attach at the elbow, so if someone comes to me with elbow pain during push ups, I always assess the wrist as well. Addressing both together tends to resolve the problem faster than treating either one in isolation.
Back Pain from Push Ups
Back pain during push ups typically falls into two categories: upper back pain between the shoulder blades, and lower back pain. Each has different causes and different solutions.
Upper Back Pain During Push Ups
Pain between the shoulder blades during push ups usually comes from one of two issues:
- Thoracic kyphosis. An excessively rounded upper back, common in people with osteoporosis, can create strain in the muscles between the shoulder blades as they work overtime to stabilize the torso in the push up position.
- Rhomboid and mid-trapezius overload. When the serratus anterior muscle is weak, the rhomboids and middle trapezius muscles have to compensate to control the shoulder blades. This creates fatigue and eventually pain.
Fixes: Focus on thoracic extension mobility through exercises such as the cow part or cat/cow and thoracic extensions while on your stomach (spinal extension stretch in my Exercise for Better Bones) before your push up set. Shoulder blade push ups will strengthen the serratus anterior and take the load off the muscles between your shoulder blades.
Lower Back Pain During Push Ups
Lower back pain during push ups is almost always a core control issue. The most common causes:
- Sagging hips. When the core and glutes aren’t strong enough to maintain a straight body line, the hips drop toward the floor, creating hyperextension (excessive arch) in the lumbar spine. This compresses the facet joints and can strain the lower back muscles.
- Breath-holding or poor bracing. Holding your breath during a push up can spike intra-abdominal pressure and contribute to low back strain.
The fix is straightforward but important: before you attempt floor push ups, you need to be able to hold a solid plank for at least 30 seconds with a neutral spine. If you can’t, your core is not yet ready to stabilize your lower back during a push up. Start with incline push ups to reduce the core demand, and cue yourself with “ribs down, lower tummy tight” throughout the movement.
In my practice, I often start clients with wall push ups and progress through incline before floor for this exact reason. Many people want to jump straight to floor push ups, but if the core isn’t ready, the lower back pays the price. The progression takes patience, but it’s worth it.
Chest Pain from Push Ups: When to Worry
Chest pain during or after push ups can range from a minor muscular strain to a symptom that needs urgent medical attention. It’s important to understand the difference.
Musculoskeletal Causes of Chest Pain During Push Ups
Most chest pain from push ups is musculoskeletal, meaning it comes from the muscles, cartilage, or joints of the chest wall, not the heart. Common causes include:
- Pectoralis muscle strain. Overstretching the pec muscles at the bottom of the push up, especially if you’re returning to exercise after a break or going deeper than your muscles are prepared for.
- Costochondritis. Inflammation of the cartilage that connects your ribs to your sternum (breastbone). This produces a sharp, localized pain that you can often reproduce by pressing on the affected area.
- Sternoclavicular joint irritation. The joint where your collarbone meets your sternum can become irritated under repeated push up loading.
How to Fix Musculoskeletal Chest Pain
Reduce the depth of your push ups to avoid overstretching the pectorals. Move to an incline position to decrease the load. Warm up your chest with gentle dynamic stretching and light band reverse fly’s or pull-aparts before your push up set. If you suspect costochondritis, rest from push ups for a few days, apply ice to the area, and see a physiotherapist for a diagnosis.
Important: When Chest Pain Needs Urgent Attention
Chest pain during any form of exertion can be cardiac in origin. Stop exercising immediately and seek emergency medical attention if your chest pain is accompanied by:
- Shortness of breath
- Pain radiating into your jaw, neck, or left arm
- Dizziness or lightheadedness
- Nausea or cold sweats
- A feeling of pressure or tightness (rather than sharp, localized pain)
This is especially important for older adults and anyone with cardiovascular risk factors including high blood pressure, high cholesterol, diabetes, or a family history of heart disease. When in doubt, get it checked.
In my practice, I always ask new clients about their cardiac history before prescribing push ups or any upper body loading exercise. It’s a question that takes five seconds and could save a life. If you have any cardiac risk factors, please discuss push ups with your doctor before starting.
Neck Pain During Push Ups
Neck pain during push ups is less common than wrist or shoulder pain, but I see it regularly — particularly in clients who spend a lot of time at a desk.
Why Your Neck Hurts During Push Ups
- Looking up. Craning your neck to look forward or upward during a push up puts your cervical spine into hyperextension. Under the sustained load of a push up, this compresses the facet joints at the back of the neck and can strain the neck extensors.
- Your upper trapezius muscles are working more than they should. If you’re shrugging your shoulders up toward your ears during push ups, which many people do unconsciously, the upper trapezius muscles become overworked and fatigued. This produces a dull ache in the base of the neck and across the tops of the shoulders.
- Pre-existing cervical issues. Disc problems, cervical stenosis, and forward head posture can all be aggravated by the push up position.
- Poor tongue position. See the tongue to roof of mouth video below.
How to Fix Neck Pain During Push Ups
- Anchor your tongue to your upper pallet.
- Gently tuck your chin as though you were holding an orange to your breast bone.Your eyes should look about six inches higher than your fingertips, think long through the back of your neck. This positions your cervical spine in neutral and eliminates the hyperextension that causes most push up neck pain.
- Relax your upper traps. Before each rep, consciously draw your shoulders away from your ears. A useful cue is to think of creating “space between your ears and your shoulders.”
- Move to a wall or incline position. If neck pain persists, the upright position of a wall push up reduces the effect of gravity on your head and neck, making it much easier to maintain good cervical alignment.
- Self-massage. Targeted massage of the upper trapezius and suboccipital muscles (the small muscles at the base of your skull) can provide significant relief.
In my practice, neck pain during push ups shows up most often in people who already have a forward head posture from prolonged desk work or device use. The push up position puts extra demand on a cervical spine that’s already under strain. Correcting the head position during push ups is important, but so is addressing the underlying posture habits throughout the day.
Push Ups and Osteoporosis Exercise
Sign up below for my free seven day email course on osteoporosis and exercise. You will learn the fundamentals of safe and effective exercise if you have osteoporosis or osteopenia.
Free Email Course
How to Do a Push Up Without Pain: My Checklist
Now that we’ve covered what can go wrong, let me pull together the key form cues that keep push ups safe and pain-free. I use this checklist with every client.
- Hands slightly wider than shoulder-width, fingers spread. This distributes the load evenly through your hands and wrists.
- Elbows at 45 to 60 degrees from your torso. Arrow position, not T position. This protects your shoulders.
- Wrists neutral or slightly extended. Use push up bars or dumbbells if flat-palm position causes pain.
- Chin gently tucked, eyes on the floor ahead of your hands. Anchor your tongue to your upper pallet.
- Ribs down, gluts engaged lower abdominals engaged. No sagging through the hips. Your body should form a straight line from head to heels.
- Shoulders “packed.” Draw your shoulder blades slightly down and back before you begin. Let them move naturally away from each other as you push go into the push phase, also known as protraction.
- Stop before pain. If a certain depth hurts, don’t go that deep. Reduce your range of motion or increase the incline.
- Breathe. Inhale as you lower, exhale as you press up. Never hold your breath.
Push Up Variations: From Wall to Floor
One of the most powerful tools for managing push up pain is progression. Rather than attempting a full floor push up and dealing with pain, start at a level your body can handle comfortably and build from there.
Here is the progression I use with my clients:
- Wall push up. Hands on the wall at shoulder height. This is the lowest-load option and the best starting point if you’re dealing with active pain in any area. It’s also an excellent warm-up for more advanced variations.
- High incline push up. Hands on a kitchen counter or sturdy table. Moderate load increase from the wall, with a position that’s easy to control.
- Low incline push up. Hands on a bench, step, or the arm of a sofa. This gets closer to the load of a floor push up while still reducing the demand on your wrists, shoulders, and core.
- Full push up. Hands on the floor, full bodyweight. Only progress here when you can do the low incline version with good form and no pain.
- Decline push up. Feet elevated on a bench or step. This is an advanced variation that increases the load on the upper body. Not necessary for most people and not recommended if you have active pain.
Why I prefer incline progressions over knee push ups: Many people are taught to do push ups from their knees as a “beginner” option. While knee push ups reduce the load, they also change the kinetic chain, your core isn’t working the same way, and the movement pattern doesn’t transfer as cleanly to a full push up. Incline push ups keep the full-body plank position intact while simply adjusting the load. I find that clients who progress through inclines reach a confident, pain-free floor push up faster.
When to See a Professional for Push Up Pain
Most push up pain responds well to the form corrections and modifications I’ve described in this guide. However, there are situations where professional assessment is important:
- Pain that persists despite form corrections and load reduction
- Pain that wakes you at night
- Numbness or tingling in your fingers, hands, or arms
- Sudden weakness in your grip or ability to push
- Any chest pain with cardiac symptoms (shortness of breath, radiating pain, dizziness, nausea)
A qualified physiotherapist can assess your movement, identify the specific source of your pain, and design a rehabilitation program that gets you back to pain-free push ups. Don’t push through pain that isn’t resolving on its own.
Push Up Pain FAQs
Margaret Martin
Further Readings
Comments