Push-up

Posted by Hans Lindgren DC on 16 October 2014 | 0 Comments

Tags: Exercise, Functional

The push-up is an exercise that probably has been around since the beginning of time. It is a very good exercise providing it is performed correctly. Many sports-coaches tell their youngsters to “Drop down and give me 10”. The problem with this is that if the stabilization of the shoulder-blades is not sufficient the benefit of the exercise is negated by the over-load put onto the shoulders. The key to this exercise is to pay close attention and not allow any deviations from perfect form.

Another issue often seen is that to make the exercise more interesting trainers have their clients performing it on dumbbells or kettle bells, adding a clap or other wacky variation.

If the client cannot even perform one repetition properly in the easiest possible position, why make it harder?

The main issue with the push-up exercise is that most individuals do not have enough shoulder-blade stability to perform it correctly. The majority of people would benefit from working on exercises to activate proper scapular stabilization before attempting push-ups.  Performing the DNS scapular stabilization test gives good information about the quality of the stabilization. The shoulder-blades should almost appear to be adhered to the ribcage - without “winging” or any excessive movement. A common error is that the shoulder-blades move in towards the spine to almost meet at the middle. The shoulder-blades should be anchored and positioned so that the inner border is parallel to the spine. The actual push-up movement occurs in the shoulder-joint and not between the shoulder-blade and the ribcage. The shoulder-blades are stabilized in that position by an important muscle chain consisting of Serratus Anterior, the diaphragm and the Oblique Abdominal muscles.  

Here are some key points for the set-up and execution of the push-up:

The spine should be kept in a neutral position all through the exercise. Common mistakes are hyper-extension of the neck and hyper-lordosis of the lumbar spine. Placing a broom-stick along the spine is a good teaching tool for proper spinal alignment.

The hand support is another very important point. There should be an even distribution of loading along the hand. Most often is the “little finger” side overloaded and there is very little weight-bearing on the thumb side. Correct hand support enhances good stabilization of the shoulder-blades. (See blog about the “Short Hand”)

A slight external rotation of the arm will help to facilitate better scapular stabilization. Instead of keeping the elbows pointing straight out sideways bring them a few degrees towards the foot end. The position of the arms should make up an arrow not a T.

The pelvis is another point of interest. Often the pelvis will drop forward into ante-version. Proper Intra-abdominal Pressure (IAP) and activity of the abdominal and gluteal muscles stabilizes the pelvis. The activation of the gluteal muscles will increase by turning the legs very slightly outwards.

To get the maximum effect out of a push-up a proper breathing pattern is vital.  When breathing in there should be an expansion of the lower rib cage sideways. To practice proper core-stabilization from the inside out, maintain an increased IAP while still breathing normally.

Push-up progression

1. Test for scapular stabilization- if there are signs of insufficient stabilization give push-ups a miss for the time being and concentrate on exercises that will improve your stabilization. Performing the exercise without proper stabilization of the joints will never improve the pattern - it will only lead to injuries.
2. Positioning- maintain a neutral spine, ensure even loading on your hands, and add a slight external rotation in the shoulder joint.   
3. Start at a level where you can maintain proper scapular stabilization – sometimes individuals have to start performing the exercise in a standing position and pushing against a wall, or with support on the knees instead of with straight legs.
4. As soon as you feel fatigue is compromising your stabilization, stop the exercise and allow a few minutes recovery time.  Pushing your body to continue at this point will not be of any benefit at all, and may lead to a pointless injury.