Shoulder pain during push-ups is one of the most common training complaints, and it is also one of the most mismanaged — because the term covers multiple different problems that require different solutions. Shoulder impingement is not the same as AC joint pain, which is not the same as rotator cuff tendinopathy, which is not the same as labral irritation. Each has a different mechanism, a different location, and a different appropriate response.
This guide covers the most common causes of push-up shoulder pain, how to identify which is most likely from the location and behaviour of the pain, the specific technique corrections that address the most common causes, and the clear criteria for when professional assessment is the appropriate next step rather than self-management.
Important note: Shoulder pain that is severe, follows a specific injury, is accompanied by weakness, clicking with pain, or radiation into the arm should be assessed by a physiotherapist or doctor before attempting any exercise modification. This guide is appropriate for mild to moderate push-up shoulder discomfort of gradual onset in otherwise healthy individuals.
Why Push-Ups Commonly Cause Shoulder Pain
The shoulder joint is the most mobile joint in the body. This mobility comes at the cost of stability: the bony contact between the humeral head (upper arm bone) and the glenoid (shoulder socket) is minimal, and the joint relies heavily on the rotator cuff muscles, the labrum, and the surrounding ligaments for dynamic stability.
The push-up loads the shoulder in a specific way:
- The anterior deltoid produces shoulder flexion against body weight
- The rotator cuff (particularly the subscapularis) stabilises the humeral head in the socket throughout the movement
- The pectoralis major produces horizontal adduction
- The serratus anterior controls scapular protraction
When any of these systems is overloaded, impaired, or working in a mechanically compromised position (from poor technique), pain results.
The Main Causes of Push-Up Shoulder Pain
Cause 1: Subacromial Impingement (Most Common)
What it is: The subacromial space is the gap between the top of the humeral head and the underside of the acromion (the bony roof of the shoulder). The supraspinatus tendon and the subacromial bursa occupy this space. When this space is narrowed during the push-up — either from shoulder positioning, rotator cuff weakness, or scapular position — these structures are pinched (impinged) between the bones.
Location of pain: The anterior or lateral shoulder (front or outer shoulder), often described as a deep ache or a pinching sensation. Pain typically occurs in a specific arc of shoulder movement rather than throughout the full range.
When it hurts during push-ups: Most commonly at the bottom of the push-up (maximum shoulder flexion and elbow bend) where the subacromial space is smallest.
The technique connection:
- Elbows fully flared (90 degrees from the torso): A fully flared elbow position internally rotates the shoulder and narrows the subacromial space significantly. This is the single most common technique error causing push-up impingement.
- Hands too wide: Encourages the fully flared elbow position
- Forward head and rounded shoulders: A rounded upper back tilts the scapula downward, narrowing the subacromial space from above
Technique corrections for impingement:
- Bring the elbows to 45 degrees from the torso: The single most effective technique change. Narrowing the elbow angle from fully flared to 45 degrees typically eliminates or significantly reduces impingement pain immediately.
- Retract and depress the shoulder blades slightly before the first rep: A small amount of scapular retraction (shoulder blades together) and depression (shoulder blades down) opens the subacromial space before the movement begins.
- Narrow the hand position slightly: Moving from a wide grip to standard width reduces the tendency for the elbows to flare.
Cause 2: AC Joint Pain (Acromioclavicular Joint)
What it is: The AC joint is where the acromion (outer top of the shoulder blade) meets the clavicle (collarbone). It is located at the top of the shoulder and is directly compressed during certain shoulder positions.
Location of pain: The top of the shoulder, at a specific bony prominence. Often described as a sharp pain directly at the top of the shoulder rather than a diffuse aching.
When it hurts during push-ups: Typically at the deepest part of the push-up (when the shoulder is in maximum horizontal adduction and forward flexion), where compression on the AC joint is greatest.
The technique connection:
The AC joint is compressed when the push-up is performed with the hands too close together (diamond or very narrow grip) and when the chest is pressed deeply through the range. Wide or standard grip push-ups are typically better tolerated than narrow grip variations for people with AC joint pain.
Technique corrections for AC joint pain:
- Widen the hand position: Moving from narrow to standard or slightly wider than standard hand position reduces the AC joint compression at the bottom of the push-up.
- Reduce the range at the bottom: Not lowering quite as deeply (stopping 2 to 3 centimetres above the floor rather than touching) reduces the end-range compression on the AC joint.
- Avoid the narrow grip and diamond push-up variations: As covered in the close grip push up and diamond push-up articles on this site, these variations specifically increase AC joint compression and should be avoided during AC joint recovery.
Cause 3: Rotator Cuff Tendinopathy
What it is: Tendinopathy of one or more of the rotator cuff tendons (most commonly the supraspinatus) from overuse. The tendon develops a reactive or degenerative response to loading, producing pain with specific movements.
Location of pain: The lateral shoulder (outer side of the shoulder), sometimes extending into the upper arm. Typically a dull ache that persists after the push-up session and may be worse the following morning.
When it hurts during push-ups: Throughout the movement but particularly with repetitive high-volume push-up training. The pain tends to worsen with increasing volume and then settle with rest, following the classic tendinopathy pattern.
The technique connection:
Rotator cuff tendinopathy in the push-up context is most commonly a volume and load management issue rather than a pure technique issue. The tendon’s loading capacity has been exceeded by the training volume or intensity.
Management approach:
As covered in the stretches for achilles tendonitis article on this site in the context of tendinopathy management generally, the primary treatment for tendinopathy is progressive loading rather than rest. For the rotator cuff specifically:
- Reduce push-up volume temporarily: Allow the reactive phase to settle by reducing the number of sets and reps for 1 to 2 weeks.
- Maintain loading within pain limits: Completely resting typically worsens tendinopathy. Keep some push-up training within a pain level of 3 to 4 out of 10 during the session.
- Add rotator cuff strengthening: External rotation exercises (resistance band external rotation, side-lying external rotation) develop the rotator cuff’s capacity for the demands of push-up training.
- Progress volume gradually: When returning to full push-up training, increase volume by no more than 10 to 15 percent per week.
Cause 4: Biceps Tendinopathy or SLAP Lesion
What it is: The long head of the biceps tendon attaches to the top of the glenoid socket and the superior labrum. Overloading this structure (biceps long head tendinopathy) or injuring the labrum at the attachment point (SLAP — superior labrum anterior to posterior — lesion) produces anterior shoulder pain with specific movement patterns.
Location of pain: The anterior (front) shoulder, specifically in the bicipital groove (a groove on the front of the upper arm where the biceps tendon runs) or deep in the front of the shoulder.
When it hurts during push-ups: Typically at the bottom of the push-up where the shoulder is in combined forward flexion and external rotation, which loads the biceps long head tendon.
Why this requires assessment:
Biceps long head tendinopathy and SLAP lesions can look similar clinically and both can be mimicked by other conditions. Self-management of this specific cause is less appropriate than for the more common causes above. A physiotherapy assessment is recommended for persistent anterior shoulder pain that is not improved by the technique corrections described in this article.
Cause 5: Pectoralis Minor and Coracoid Impingement
What it is: The coracoid process is a bony projection at the front of the shoulder blade. The pectoralis minor tendon attaches to it. In some people, the space between the coracoid and the humeral head is narrowed, producing coracoid impingement. Tight pectoralis minor can also tilt the scapula and indirectly narrow the subacromial space.
Location of pain: Deep anterior shoulder, medial to the standard anterior deltoid pain of subacromial impingement.
Technique connection:
Excessively rounded shoulders (the head of the humerus rolling forward) and a forward-tilted scapula (from tight pectoralis minor) both narrow the coracohumeral space.
Management approach:
Pectoralis minor stretching (doorway stretch, sleeper stretch) alongside the scapular retraction technique correction described under Cause 1.
The Elbow Angle Rule: The Single Most Important Correction
Across multiple causes of push-up shoulder pain, the single most important and most effective technique correction is the elbow angle. The research on push-up technique and shoulder joint loading consistently finds that:
- Elbows at 90 degrees (fully flared): Highest subacromial and glenohumeral compressive loading. Most likely to cause pain.
- Elbows at 45 degrees from torso: Optimal loading for the shoulder — maximises the muscle contribution of the pectoralis major while minimising the impingement risk.
- Elbows at 0 to 30 degrees (fully tucked): Shifts load heavily to triceps, reduces chest activation.
For most people with push-up shoulder pain, changing the elbow angle from fully flared toward 45 degrees resolves or significantly reduces the pain before any other change is made. This should be the first correction attempted.
Technique Self-Assessment
Before assuming a pathological cause, perform this technique self-check:
- Elbow angle: Are the elbows at 45 degrees from the torso or closer to 90 degrees? If 90 degrees, correct this first.
- Hand width: Are the hands wider than shoulder width? Consider narrowing to standard width.
- Head position: Is the head forward of the shoulders? Tuck the chin slightly to bring the head in line with the spine.
- Shoulder blade position: Are the shoulders rounded forward at the start? Add a small retraction before the first rep.
- Wrist position: Are the wrists in significant extension or deviation? Ensure the wrists are neutral and positioned directly under the shoulders.
Correcting these five points resolves the majority of technique-related push-up shoulder pain within 2 to 4 sessions.
Exercise Modifications While Managing Shoulder Pain
When push-up shoulder pain prevents standard push-up training, these modifications allow continued upper body training while the underlying cause is addressed:
Incline push-up: As covered in the elevated push ups article on this site, elevating the hands reduces the shoulder loading and changes the movement angle. Many shoulder pain presentations that prevent standard push-ups are comfortable with hands elevated at 45 to 60 centimetres.
Narrow grip push-up (if AC joint is not the cause): The close grip push-up reduces the shoulder impingement risk by bringing the elbows closer to the torso.
Push-up plus (scapular push-up): As described in the planche push up article on this site in the context of scapular protraction, the push-up plus (performing a standard push-up then pushing the shoulder blades apart at the top) specifically develops the serratus anterior and scapular stability that is often insufficient in people with push-up shoulder pain.
Resistance band pressing: Horizontal pressing with a resistance band from a standing position changes the loading pattern and is often pain-free when floor push-ups are not.
Red Flags: When to Stop and Seek Assessment
Stop push-up training and seek physiotherapy or medical assessment if:
- Pain is sharp rather than a dull ache: Sharp pain during push-ups indicates acute structural loading that should not be pushed through
- Pain persists for more than 24 to 48 hours after a session: Post-exercise soreness that settles within 24 hours is normal; pain persisting beyond 48 hours indicates the training load is too high
- Pain is worsening week on week despite technique corrections: Progressive worsening despite correction indicates an underlying pathology requiring assessment
- Weakness accompanies the pain: Weakness alongside shoulder pain (difficulty lifting the arm, loss of push-up strength beyond what the pain would explain) suggests rotator cuff involvement that requires assessment
- Clicking or clunking with pain during push-ups: A painless click is common and benign; clicking that is accompanied by pain suggests possible labral or structural involvement
- Pain radiates down the arm or is accompanied by tingling or numbness: These neurological symptoms suggest nerve involvement (possibly from the cervical spine) that requires medical assessment
- Pain follows a specific injury (fall, collision, forceful movement): Acute injuries to the shoulder require assessment before resuming training
Frequently Asked Questions
Should I stop doing push-ups if my shoulder hurts?
Not necessarily immediately, but the answer depends on the type and severity of pain. Mild discomfort (2 to 3 out of 10) that does not worsen during the session and settles within 24 hours can be managed by applying the technique corrections in this article and monitoring the response. Pain above 4 to 5 out of 10, pain that worsens during the session, or pain that persists more than 48 hours after training warrants reducing or stopping push-ups while the cause is identified.
Can push-ups cause a rotator cuff tear?
Push-ups alone are unlikely to cause a full-thickness rotator cuff tear in an otherwise healthy shoulder. The rotator cuff tears most commonly associated with training are partial-thickness tears from repetitive overloading, and full tears typically involve either a specific traumatic event or significant degenerative change in the tendon over time. However, training through significant rotator cuff pain without assessment can worsen an existing partial tear. Any shoulder pain with significant weakness should be assessed.
Is it normal for shoulders to ache after push-up training?
Mild muscle soreness (DOMS) in the anterior deltoid and chest after high-volume push-up training is normal and expected. Joint pain (in the shoulder joint itself, particularly at the front or top of the shoulder) is not normal and is a signal that the joint structures are being overloaded. Distinguishing between muscle soreness (in the muscle belly, onset 24 to 48 hours after training, resolves within 72 hours) and joint pain (in or around the joint, immediate or early onset, may not follow the DOMS timeline) is the practical first step.
Does grip width affect shoulder pain during push-ups?
Yes. As described in this article, very wide grips encourage the elbows to flare (increasing subacromial impingement risk) and very narrow grips increase AC joint compression. Standard shoulder-width grip with elbows at 45 degrees is the most shoulder-friendly general push-up position. Individual anatomy means some people naturally find slightly wider or narrower positions more comfortable within this general principle.