The Push-Up is a highly accessibly bodyweight exercise with many variations that is likely relevant in the middle phases of rehabilitation as it places a relatively significant load on the upper body. Given the movement pattern and involved Muscle s, the Push-Up may be a viable part of treatment for pathologies such as Glenohumeral Instability , Rotator Cuff pathology, Scapular Dyskinesis , Lateral Epicondylitis , Medial Epicondylitis and back Pain .
Starting Position:
Patient lies prone on the ground with hands placed on either side of the torso, roughly inline with the Chest
Body is kept rigid from head to toe through the conscious activation of the major muscle groups
The Push-Up is then performed by straightening both arms and consequently pushing the body away from the ground. Compensation patterns such as excessive Lumbar Spine Lordosis , Forward Head Posture or Hip - Flexion should be avoided.
Feet Elevated Push-Up- greater activation of the Infraspinatus and Pectoralis Major (SOURCE-1)
Push-Up Plus - emphasises the Upper Subscapularis (SOURCE-1)
Plyometrics Push-Up- an explosive variation that entails a high-intensity eccentric Muscle Contraction , immediately followed by a fast/ powerful concentric component
One Arm Push-Up- more than two-fold the engagement of the Infraspinatus and Posterior Deltoid and ~ 50% greater engagement of the Pectoralis Major and Anterior Deltoid (SOURCE-1)
Handstand Push-Up - Vertical Push variation that utilises entire bodyweight through large overhead range
A Push-Up variation can be used for the Nine Test Screening Battery . Fingers are orientated cranially with hands lateral of the shoulders. A dowel or stick can be placed behind the patient to ensure alignment of the head and Lumbar Spine . Graded accordingly:
Patient experiences Pain during movement
Body is not pushed up as a unified segment
Body is pushed up as a unified segment, however, dowel does not remain in contact
Body is pushed up as a unified segment and contact with the dowel remains
The following exercises can be used as a regression if Push-Ups exceed the capacity of the patient:
Banded Horizontal Adduction - low load isotonic horizontal adduction exercise
Isometric Chest Squeezes - isometric exercise that isolates Chest
Bottoms-Up Kettlebell Walk - isometric push/ stability exercise with or without perturbation
Chest Press Machine - rudimentary horizontal push machine
Pallof Press - low load horizontal push exercise that emphasises anti-rotation of Core
The following exercises can be used as a progression to Push-Ups once exercise proficiency is achieved:
Bench Press - isotonic horizontal push exercise with capacity for high loads
Incline DB Bench Press - unilaterally loaded Bench variation on variable incline
Dips - bodyweight isotonic push exercise with large GH Joint - Extension range
Half DB Bench Press - unilateral isotonic horizontal pressing motion that emphasises the Anterior Sling
Kneeling Landmine Press - wholebody, explosive vertical pressing exercise with large overhead range
Medicine Ball Chest Press - plyometric horizontal pressing motion, often sports relevant
Escamilla, R. F., Yamashiro, K., Paulos, L., & Andrews, J. R. (2009). Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Medicine, 39(8), 663–685.
Gioftsos, G., Arvanitidis, M., Tsimouris, D., Kanellopoulos, A., Paras, G., Trigkas, P., & Sakellari, V. (2016). EMG activity of the serratus anterior and trapezius muscles during the different phases of the push-up plus exercise on different support surfaces and different hand positions. Journal of Physical Therapy Science, 28(7), 2114–2118. https://doi.org/10.1589/jpts.28.2114