Push-ups may be one the best and most under-rated exercise in the gym. There are many variations, and with weighted vests or resistance bands, it's possible to seriously increase the difficulty. Not only that, it may be a much better exercise for those of us whose shoulders scream whenever we do flat bench presses.
This excellent article offers research, physiology, technique and other pointers - a one-stop resource for all you need to know to do this exercise well and safely.
by Bret Contreras and Elsbeth Vaino – 6/22/2011
Push-ups get no respect.
While other bodyweight exercises like chin-ups and dips boast devoted fans from all corners of the industry, the lowly push-up is the veritable red-headed step-child of the strength and conditioning world.
At the risk of going all Freudian, perhaps it has something to do with childhood?
Come across the word "push-up" in an otherwise blasé strength training program and suddenly you're a pimple-faced 7th grader again, desperately trying to avoid attention while an overly-caffeinated Mr. Hartmann doles out punishing sets of push-ups for the slightest of offences.
"Class started 17 seconds ago you slimy scumbag! Get on your face and give me 25!"
So rather than re-live that humiliation every time we strap on our Chucks, we label the push-up as "biomechanically inferior," or a "pussy exercise," and strike it from our programs, and our psyche.
But we're here to tell you that's just not fair, and there's much ado about the push-up that warrants your attention.
For example, if they're such a walk in the park, ever wonder why most novices do what they do when first attempting push-ups?
Why do rookies flare their elbows and place their hands high and wide? Why do they tend to sag in the core region, or limit the range of motion and perform "partial reps?"
And why do men just seem to "catch on" much quicker than women?
In this article, we're going to review the literature pertinent to push-ups, discuss common technique errors, offer some corrective exercises to assist in proper push-up performance, and provide a push-up progression list.
Literature Summary
Despite the notable absence of glutes and ass references, this is still a Bret Contreras co-production, which means one thing: research. Here's a brief summary of just some of what the literature says about push-ups.
The abdominal muscles are king when it comes to spinal stability during push-ups. The rectus abdominis is the primary stabilizer for preventing hip sagging, while the obliques do most of the work to prevent lateral shifting and twisting. The transversus abdominis, multifidus, and erector spinae are only minimal contributors to spinal stability during the push-up exercise.
Push-ups are also about arms and chest, with 73-109% maximum voluntary contraction (MVC) of the triceps, and 95-105% MVC of the pec major. The back is also involved, with serratus anterior as the top back muscle with 75% MVC compared to 27% for the mid traps and 36% for the lower traps.
Hand position plays an important role. A narrow base push-up position significantly increases stress on the elbow joint, but also involves higher muscle activation in the triceps and pecs. Internally rotated hand positions were also shown to produce greater and potentially injurious forces on the elbow joints.
Depending on your goal, you'll want to do different push-up progressions. Push-ups with alternating hands on a ball provided the greatest rectus abdominis and oblique challenge; one arm push-ups hit the lats, anterior deltoid, and erector spinae the hardest; and clapping push-ups were the toughest for the pec major, triceps, and biceps.
Cogley et al. (2005) found that narrow base push-ups led to higher EMG values in the triceps brachii and pectoralis major than wide base push-ups. Popular belief indicates that wide base push-ups activate more pec fibers, but this study showed otherwise.
An et al. (1992) found that peak axial forces on the elbow joint during push-ups averaged around 45% of bodyweight. This increases to 75% in the case of narrow base push-ups. This means that narrow base push-ups (with your hands closer together) increases stress on the elbow joint.
Beach et al. (2008) showed that suspended push-ups activated more core musculature than regular push-ups. Based on this finding you can use blast straps or a TRX to increase the efficacy of the push-ups exercise.
Lehman et al. found in 2008 that elevating the feet above the hands had a greater influence on scapulothoracic stabilizing musculature than placing the hands on a Swiss ball. This means that it's more challenging for the shoulder girdle stabilizers to do push-ups with your feet elevated onto a bench – with your hands on the ground – than to perform push-ups with your hands on a Swiss ball and your feet on the ground.
But don't dump the unstable equipment just yet. Lehman et al. also found in 2006 that as long as you kept the torso angle constant, it would be more effective to perform exercises such as Swiss ball and Bosu push-ups in comparison to bodyweight push-ups – provided you place the hands on the unstable piece of equipment rather than the feet.
Lou et al. (2001) showed that internal rotation of the hand position or full pronation of the forearm during push-ups led to greater posterior and varus forces on the elbow joints that could produce injurious shear forces. Considering this finding, it's recommended that internally rotated hand positions should be avoided for optimal elbow health.
Sandhu et al. (2008) found that push-ups with the hands placed on a Swiss ball significantly increased triceps and pectoralis major activity compared to normal push-ups, but only during the eccentric phase.
Youdas et al (2010) found that depending on the hand position, the push up activated between 73-109% MVC of the triceps brachii, 95-105% MVC of the pectoralis major, 67-87% MVC of the serratus anterior, and 11-21% MVC of the posterior deltoid musculature. The researchers also found that the narrow base position was the most effective position for increasing triceps contribution, and that the Perfect Push up™ device did not enhance muscular recruitment.
Common Biomechanical Errors
Think performing a push-up should come as natural as peeing your name in the fresh fallen snow? Think again.
There are three common push-up performance errors.
T-Set Up
First, when performing push-ups, people often set up with their hand position high and wide. If you took a snapshot from above as in an aerial view, their set up would look like the letter T. People do this to make the exercise easier.
Why is this position easier?
- The alignment of the pec fibers is better suited to produce force from this position.
- This position requires less muscle activation (as measured by EMG) in the pecs and the triceps.
- Shoulder horizontal abduction flexibility is limited, so the structures limiting flexibility will contribute much needed passive force in the bottom position.
Caterpillaring
Second is caterpillaring, or allowing the hips to sag resulting in anterior pelvic tilting and lumbar hyperextension. Here's why this occurs.
- They lack the core strength to stabilize their lumbopelvic region and simply allow their core to gain stability by "hanging" on the structures that limit this motion – namely the hip flexors and lumbar vertebrae. Basically, the hip flexors lengthen and contribute passive tension, and the neural arches of the vertebrae get closer together (aka approximation). This places the posterior elements of the spine at risk.
- People are stuck in anterior pelvic tilt due to tight hip flexors and erector spinae and don't have the muscular strength in the rectus abdominis and gluteus maximus to override this tightness during the push-up.
- By keeping the hips low and hinging at the lumbar spine, a lower percentage of bodyweight is being lifted since much of the body is hanging toward the floor, thereby making the exercise easier.
- People aren't strong in deeper ranges so they sag to "pretend" they're going deeper since their hips will bottom out before their chest, creating the illusion that they're using full ROM.
Stopping Short
Third, people cut the movement short and perform half-reps. Here's typically why this occurs.
- People lack end-range shoulder strength and stability.
- The bottom position of the push-ups involves a higher percentage of bodyweight than the top position, which makes the bottom more difficult. This makes the push-up the opposite of "accommodating resistance" since the loading increases as the push-up is lowered to the ground.
- People want to fool themselves into thinking that they're in better shape than they really are. The ego can handle doing ten half-rep push-ups, but it's tough for a typical person to admit that he or she isn't in good enough shape to perform a single legitimate, full-range push-up.
PPT: To Tilt or Not to Tilt
The push-up naturally encourages anterior pelvic tilt (APT) and lumbar extension due to the posteroanterior forces on the body induced by gravity. Contraction of the rectus abdominis is required to prevent pelvic and lumbar deformation and keep the lumbopelvic region in neutral, but further contraction of the glutes and abs will take you into posterior pelvic tilt (PPT). Whether you should enter into PPT, and the optimal amount of PPT, is up for debate.
Most coaches would agree that doing push-ups in APT is unwise. As long as you can keep a neutral posture, then all is well. However, some coaches believe that the push-up should be performed with a maximal glute and lower ab contraction to facilitate a strong PPT.
The PPT push-ups have three distinct advantages over the traditional push-up.
- Since it requires a strong glute and lower ab contraction to create the tilt, it serves as a static glute activation exercise. This allows you to kill two birds with one stone by improving the neural drive to the glutes while working the upper body. Take it from the Glute Guy, everyone can benefit from some extra glute activation!
- By shifting the pelvis forward with your glutes, you're no longer "hanging" on your hip flexors and lumbar vertebrae for stability. This will now require a stronger abdominal contraction as now you're using active muscles to keep you stable rather than passive muscles and ligaments. Theextra muscle force from the rectus abdominis and gluteus maximus makes it a more effective core exercise and makes the push-up a "total body exercise."
- Third, it"locks you in" so there's really no chance of losing core stability. In other words, you maintain a straight line from your shoulders to ankles while you perform push-ups. Now your hips won't begin to sag as the set ensues, which spares the posterior elements of the lumbar spine.
However, there's one drawback of performing the PPT push-ups.
Pelvic positioning is linked to lumbar and thoracic spine positioning. Specifically, a PPT is associated with increased thoracic kyphosis. Performing push-ups with a hyperkyphotic curve will affect scapulohumeral rhythm and could increase the risk of impingement and rotator cuff issues. While this might not cause any problems initially, it might present problems down the road.
Now, it is important to take a step back and note that you don't need a posterior pelvic tilt in your push-ups; what you need is to avoid anterior pelvic tilt push-ups. If you tend to produce an anterior pelvic tilt when you do push-ups, then encouraging PPT as you work on improving your push-ups is a great approach, but once you're able to maintain a neutral pelvic alignment, you may wish to eliminate the posterior tilt focus. For this reason, our corrections and progressions will be shown using a PPT.
Sex Differences: Men versus Women
Three different factors could explain why women struggle more with push-ups than men.
First, strength levels are different between men and women. When measured as a percentage of lean body mass, the differences are dramatically reduced, especially in the lower body. But upper body strength in men is greater than in women, and because upper body strength is a big part of a push-up (requiring moving around 66% of body weight), it's not a simple task for beginners, especially beginner women.
Second, most women possess a higher proportion of lower body muscle mass relative to upper body muscle mass compared to men. If you want to see how this feels, put yourself in a plank position and have someone place some weight above your chest and see how much of an added challenge that is. Then try this again but have the weight placed above your pelvis. Your core will need to work much more to support the weight at your pelvis than at the chest. For this reason women could find the push-ups more challenging for the core.
Third, push-ups are considered the gold standard for strength in young males. Teenage boys likely attempt far more push-ups than teenage females. The "manliness" factor of push-ups provides an incentive for males to try harder and master the push-up.
You're off on holiday: the neighbors are watering the plants; the in-laws are looking after the dog. But who will look after your pecs? How will they survive all those weeks without bench presses? You can't take benches, barbells or weights with you. But according to sports scientists at the University of Valencia in Spain you can work on your chest muscles without doing bench presses. If you use an elastic band, push-ups are just as effective as bench presses.
