Push-Up Techniques Affect Elbows and Shoulders: How Should They Be Used?

Background Push-ups are performed ubiquitously as a means of strengthening/training and evaluating the upper extremity. However, push-ups performed on the hands with the wrist extended can cause wrist, elbow and shoulder injuries, which may result in disability. Conversely, individuals with a prior wrist or elbow injury are unable to perform push-ups. Our purpose was to evaluate movement patterns in two push-up styles (neutral and extended wrist) at the elbow and shoulder joints. We hypothesized that force-transfer will differ between the two styles, allowing the adjustment of training protocols according to athletic and physiologic needs.

Patients and Methods Fourteen healthy right-handed male volunteers performed push-ups on a neutral wrist and a hyperextended wrist in the gait analysis laboratory. Skin markers were applied over fixed points in the upper extremity. A Vicon motion capture system was used to follow the kinematics. Force vectors were measured using force plates.

Results The movement and transfer of forces through the shoulder and elbow differ between the push-up styles. The shoulder moves more, in general, in a circular direction, when a push-up is performed on a neutral wrist compared to a push-up performed on an extended wrist. The shoulder is exposed to more load when the push-up is performed on a neutral wrist. The elbow moves less in general, and less in the medial and lateral planes, when the push-up is performed on a neutral wrist. The elbow is exposed to less load when the push-up is performed on a neutral wrist. The direction of forces through the joints differs between the two styles and the amount of force traversing the joints is inverse between the two styles.

Conclusions The movement through the elbow and shoulder is distributed differently during different styles of push-ups. The wrist and elbow can be relatively protected from ligament injury when push-ups are performed on a neutral wrist.

Conclusions Understanding the kinematics during different patterns of loading of the upper extremity can enable a tailored approach to strengthening training, treatment, and rehabilitation of the upper extremity. Specifically, differential strengthening and loading certain areas may be used for training protocols for a specific athletic task (such as throwing).