Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton and Bruno Serra  

Introduction[edit | edit source]

Traditional push-ups.

Push-ups are an exercise in which a person, keeping a prone position, with the hands palms down under the shoulders, the balls of the feet on the ground, and the back straight, pushes the body up and lets it down by an alternate straightening and bending of the arms[1].

Traditional push-ups are beneficial for building upper body strength. They work the triceps, pectoral muscles, and shoulders. Using proper form, they can also strengthen the lower back and core by engaging (pulling in) the abdominal muscles. Push-ups are a fast and effective exercise for building strength. They can be done from virtually anywhere and don’t require any equipment[2].

Muscles Involved[edit | edit source]

Animation of a person doing push-ups.
  • The agonist (prime mover muscle): pectoralis major. As you lower yourself toward the floor, the pecs lengthen and control the speed of your descent. As you push back up again, they shorten. The lowering and lengthening phase of the exercise is called an eccentric contraction, while the lifting and shortening phase is called a concentric contraction.
  • Antagonists (the muscle which opposes the agonist): the main ones are the middle fibers of the trapezius muscle, the posterior deltoids and the rhomboids (all on the opposite side of the torso in relation to your pecs).
  • Synergists (helper muscles): Although not the target muscle of the exercise, these muscles are important as they assist the agonist. The main synergists in the push-up are the triceps and the anterior deltoids. They assist with elbow extension and shoulder flexion, respectively.
  • Fixators: rotator cuff (keep the head of your humerus firmly located within the glenohumeral joint), the upper traps help with upward rotation of the scapulae, and core muscles (hold the spine straight). Other fixators include latissimus dorsi muscles (aid in shoulder stability) and quadriceps, which work to keep your legs straight and rigid[3].

Physiotherapy[edit | edit source]

Push‐up exercises are commonly used in shoulder rehabilitation, for facilitation of proprioceptive feedback mechanisms, muscle co‐contraction, and dynamic joint stability training.

One reason for their common use is due to the relative ease of learning the movement, no equipment is necessary for the movement and the exercise can be modified for greater or lesser difficulty depending on the level of physical fitness of the patient.

This adaptability is represented by variations that can be used to modify the basic exercise in order to alter the difficulty of the conventional exercise that requires that the hands be placed in a natural position under the shoulder, the back straight, head up, and lower limb straight using the toes as the pivotal point.

If the patient lacks upper body strength, they may find it frustrating that they are unable to perform push-ups with good form. In such cases, it is recommended that the patient follow a program of exercise progression with push-up variations, as exemplified in this video:

For those seeking to treat patients with shoulder dysfunctions or pathologies, it is recommended to perform push-up plus exercises rather than focusing solely on building strength. As opposed to a typical push up where one is supported on both hands and toes on the floor, and lowers their body to the ground before returning, the push up plus is done with the arms extended from the same starting position as a push up. However, instead of lowering to the floor, the participant protracts their scapula.

Variations[edit | edit source]

A one-armed pushup.
One-armed push-up.

Variations include:

  • Knee push-ups (great for beginners).
  • Wall push-ups
  • Incline push-ups; This is a slightly tougher push-up variant compared to knee and wall push-ups. Incline push-ups are performed with the hands positioned higher than the feet.
  • Decline push-ups: require you to keep your legs on a higher plane and hands on the floor. You can use a bench, a box, or any piece of furniture to do this push-up.
  • One-arm push-up: fantastic challenge to face. Once you have built your core and upper body strength and endurance by practicing the above 9 types of push-ups, you may try the one-arm push-up. It works on the core, shoulders, chest, biceps, triceps, and forearm muscles[4].
  • Push-ups plus or serratus anterior push up: Start at the tip of a push-up position and move the scapula only into protraction/retraction[5].
Bruno Serra
A person effectively doing push-ups with just his hands.

Research on muscle activation[edit | edit source]

Recently, adding an unstable surface while performing the push-up has been suggested in order to increase muscular activity. But research shows that the addition of unstable surfaces in push-up training does not provide greater improvement in muscular strength and endurance than push up training performed on a stable surface in young men[6].

Other research suggests that, if a goal is to induce greater muscle activation during exercise, then push-ups should be performed with hands in a narrow base position compared with a wide base position[7].

On the other hand, a study that looked at the force generated by six different types of push-ups performed by 23 fit people found that push-ups with the feet elevated produced the most force, while push-ups with the hands elevated or done from the knees produced less force. Gender and height didn't seem to affect the force produced by the different push-up variations[8].

According to a 2020 study[9] on shoulder electromyography activity during push-up variations, the triceps and pectoralis major muscles had the highest electromyography amplitude during unstable push-ups, suspension push-ups, incline push-ups with hands on a ball, and standard push-ups. The study also found that the serratus anterior muscle had the highest electromyography amplitude during push-up plus and incline push-ups. The greatest global electromyography amplitude was observed during unstable surface push-ups.

References[edit | edit source]

  1. dictionary.com Pushups Available:https://www.dictionary.com/browse/push-up (accessed 16.12.2021)
  2. Healthline Benefits of pushups Available:https://www.healthline.com/health/fitness-exercise/pushups-everyday (accessed 16.12.2021)
  3. AZ central Anatomy pushup Available:https://healthyliving.azcentral.com/anatomy-push-up-15456.html (accessed 16.12.2021)
  4. Stylecraze Pushups Available: https://www.stylecraze.com/articles/pushups-for-women-and-their-benefits/(accessed 16.12.2021)
  5. Therapeutic associates The push up plus Available:https://www.therapeuticassociates.com/the-push-up-plus-your-exercise-for-naturally-amazing-posture/ (accessed 9.1.2022)
  6. Chulvi‐Medrano I, Martínez‐Ballester E, Masiá‐Tortosa L. Comparison of the Effects of an Eight‐Week Push‐Up Program Using Stable Versus Unstable Surfaces. International journal of sports physical therapy. 2012 Dec;7(6):586.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537455/ (accessed 16.11.2021)
  7. Cogley RM, Archambault TA, Fibeger JF, Koverman MM. Comparison of muscle activation using various hand positions during the push-up exercise. Journal of strength and conditioning research. 2005 Aug 1;19(3):628. Available:https://pubmed.ncbi.nlm.nih.gov/16095413/ (accessed 16.12.2021)
  8. Ebben, W. P., Wurm, B., VanderZanden, T. L., Spadavecchia, M. L., Durocher, J. J., Bickham, C. T., & Petushek, E. J. (2011). Kinetic analysis of several variations of push-ups. The Journal of Strength & Conditioning Research, 25(10), 2891-2894. Available at https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00806213/full?highlightAbstract=ups%7Cup%7Cshoulder%7Cpush
  9. Kowalski, K. L., Connelly, D. M., Jakobi, J. M., & Sadi, J. (2022). Shoulder electromyography activity during push-up variations: a scoping review. Shoulder & Elbow, 14(3), 325-339. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9121296/pdf/10.1177_17585732211019373.pdf