Push-ups: good for your shoulders…or not

Following on from my previous post on push-ups, I’d like to dig a little deeper into this foundational exercise. In particular, this post will be dedicated to discussing the initial body position used for your push-ups. This post was motivated by the fact that I keep seeing people starting in a position that may not be the most shoulder-friendly.

As I’ve already said, I think the push-up gets underestimated in terms of what you can get out of them. Obviously, they represent a way to strengthen the horizontal pushing pattern, but there’s more. How you hold the rest of your body provides you with additional opportunities to train the following:

• scapular stability—since you’re actively preventing your torso from drooping down between your shoulder blades;
• core engagement—an isometric co-contraction of muscles such as the transverse abdominus, internal and external obliques and your rectus abdominus;
• core control—in this case, by resisting extension of your low back to maintain your neutral spinal position;
• glute engagement from a neutral pelvic position—because of course you’re squeezing your glutes;
• leg intention—because your legs aren’t just straight, they’re intentionally straight; and
• adductor engagement—because you’re not just keeping your legs straight, you’re also squeezing them together.

This is an important body shape to train.

What I have been seeing is folks starting their push-ups ina hollow.

Potentially contentious opinion #2:

I think you should train your push-ups and planks in the strong neutral position above before you train them in a hollow. In fact, I might even go so far as to say I would prioritize training push-ups and planks in a strong, neutral spinal position over training in a hollow.

Please note: I am not suggesting you discard training the hollow. There are valid reasons why training the hollow body is useful. I just think training neutral is more important.

So perhaps I should explain:

The hollow body is an interesting animal. It often seems to end up involving a quite a bit of thoracic flexion. This isn’t such a big deal when you’re doing a hollow body hold or rock. In fact, in this context, it might even be useful.

What’s the issue?

When you set up for a push-up with a lot of thoracic flexion, the scapulae tend to end up protracted and anteriorly tilted. The issue that I’ve been encountering is that this position translates into (usually even more) anterior tilt of the scapula at the bottom of the push-up.

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(Admittedly, I don’t train push-ups in a hollow, so demonstrating for these photos, I kept sticking my butt out. Please ignore that for now and focus instead on the tilt of my shoulder blades.)

This appear to happen because of one or both of thefollowing:

• Starting in a hollow with more thoracic flexion than is necessary (which starts the scapula the aforementioned sub-optimal position
• Not allowing the scapula to move as you press up and down (which keeps the scapula in that sub-optimal position)

Why is this problematic?

There are a few things about this anterior tilting of the scapula that make it potentially problematic in the long run:

The anterior tilt of the scapula changes the ball-and-socket congruency and encourages/results in anterior translation of the humerus within the glenoid. That means the ‘ball’ shifts forward in the ‘socket’.

The concern is that this means more stress on anterior structures (anterior labrum or anterior capsule) …which, over time can mean more wear and tear on the labrum and/or the anterior capsule can get stretched out, leading to less stability in the joint. Both of these factors increase the likelihood of pain and injury.

• A brief tangential thought: hopefully we all know that, over time and especially with the rigors of circus training, it’s likely that some amount of wear and tear will happen within your shoulder joint. A combination of balanced strength and solid movement mechanics will likely lessen the amount of wear and tear, but over time, it’s still likely.
• And, hopefully we all also know that wear and tear or joint micro-instability don’t always result in pain. Learning about the presence of these sorts of things can freak people out and it doesn’t always need to. If you happen to get an MRI (or some other imaging) as part of the process of figuring out some pain, you might learn about what’s going on inside your joint and you might not like hearing about it. Remember though: your MRI findings are not your ultimate outcome. In many cases, dedicated physical therapy followed by strength and conditioning work can make your shoulder not only pain-free, but stronger than before. There are, of course, instances where it’s more than just wear, it’s actually a bad tear and those cases often mean time away from circus. And they may—or may not—require surgical intervention.
• Ultimately, we circle back to the same things: optimize joint mechanics and make it all really strong.
• #youarenotyourMRI

Getting back on track: the main thinking here is that if we aim to optimize how your body moves by working to achieve the best possible joint positions as you train, we minimize the role that bad mechanics can play in increasing the potential for future injury.

Also, moving into this position—with the anterior tilt—might just make your rotator cuff less effective. Have you ever seen the demonstration where the PT tests the strength of your external rotators and then asks you to slouch and then suddenly, your external rotation strength drops? This is essentially the same position.

So, what do we do about it?

Well, my first recommendation is to train your push-ups (and therefore, planks) with a more neutral spinal position.

And how do we do that?

I’m glad you asked!

Finding Neutral

Let’s start standing up. Your push-up and plank position should look the same as your standing posture.

Now, because aerialists spend so much time working overhead, they tend to be more likely to have developed a rather straight thoracic spine. There’s a chance that the more neutral position we’re talking about does involve some thoracic flexion.

One way to find it: stand up straight. Straight, straight, straight. And tall. Take a breath in through your nose. Exhale and allow your chest to drop ever so slightly…yes, it’s like slouching and it’s ok.

(I tried taking pictures of me doing this and it really doesn’t make for compelling imagery. From straight/extended thoracic spine to slightly flexed is subtle, yet it does make for a nicer platform, if you will, for your scapulae to sit upon.)

On the other hand, if you start (standing or in your push-up position) in your really-flexed hollow-type position, then I would say ‘stand up straighter’ …and that would bring you into a more neutral position.

Of course, your mileage may vary and you may need to play with this a bit to find the best position for you.

Now, do this in your push-up position.

Simply improving where you start moving from is likely to have a big impact on where you finish moving. If you’re really in the habit of being in a hollow when you do your push-ups or planks, then positioning yourself in a more neutral spinal alignment is going to feel weird at first.

Your shoulder blades are supposed to move!

The other thing is that we need to make sure your shoulder blades are, in fact, moving as you move to the bottom of your push-up (and as you push up).

Actually, if you were watch this cool video from the Muscleand Motion, you will probably end up wanting to dance.

More to the point, I have a couple of notes:

1. This is a great illustration of how your shoulder blades have to protract and retract as you do your push-ups.
2. I found the bit where all of the push-ups are done on knuckles instead of palms a bit weird…
3. In the animation where they show a push-up from the knees, you can see how rectus femoris pulls on the pelvis and breaks the nice line of the body. In the grand scheme of things, not such a big deal, but if rectus femoris pulls the pelvis into an anterior tilt like that, it may compromise core engagement. And it sticks your butt out. Again, not necessarily bad (there is a time and a place for sticking your butt out), but in this case,it means your glutes aren’t involved. This is just another way of stating my previous stance about elevating your torso rather than bending your knees when training push-ups.

So just make sure to move your shoulder blades!

Put another way, a part of the ‘fix’ here is mindfulness: if you suspect that your scapula is moving into an anterior tilt when you do your push-ups, then stop doing that.

How’s that for brilliant coaching? Just stop doing it that way. There. Fixed. I’m awesome. You’re awesome. Let’s go to Chipotle.

Seriously though, a part of this could just be that you’ve developed a bad habit, but you have the strength and mobility to move differently…so you’ll just need to be more deliberate about positioning when you do push-ups.

Wait, so why are we doing this again?

There may be good reasons why someone would want to train push-ups exclusively in a hollow. It’s also totally possible to do a push-up in a hollow and not anteriorly tilt your scapulae. However, there are two main reasons why I’m still not a fan of doing them only this way:

1. From a risk vs. reward standpoint, the more you hollow through your thoracic spine, the more you ‘risk’ moving into this not-so-good position. The benefits of training your push-up from a hollow position don’t seem to outweigh the risks of training with poor mechanics.
2. You’re just not always going to be in a hollow-type position when you want to exert a horizontal pushing force.

Now, that being said, remember that push-ups exist as a part of the spectrum of options for developing horizontal pushing strength. If/when you arrive at a point where you become interested in training planches or things like Maltese push-ups, obviously how you hold your body will change. It remains important, however, to strive for optimal mechanics and to minimize anterior tilt of the scapula. My main point here is that it is beneficial for just about everyone to build a solid foundation of pushing strength—from a more neutral position—prior to training more advanced skills.

So, there you go…

The latest in my deep thoughts about the push-up. Good for your shoulders—as long as you make sure you start and finish in a good position and maintain that good position throughout—and good for training a bunch of other things (see above)!

Until next time…

And this is, of course, just one piece of the larger puzzle that is your whole-body strength and conditioning plan. Circus arts require a foundation of whole-body, general strength upon which to build the specific-strength needed for all of the cool tricks and skills you want to do.

Need some help figuring out just what to do? Drop me a line. (Do people even say that anymore? Am I dating myself?) I’d be more than happy to help you with some ideas.

Or maybe you’d like me to do the thinking for you so that you can just get down to the business of getting stronger…well, we have things for that, too.