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

Abstract

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).