Movement errors and transferability part 2 - Do you even.... Push up brah?
The push up is a fascinating movement. It gives away so much information about the person performing it. Can you organise and maintain your spine while gravity is trying collapse it? Do you understand rotation and it's effect on a stable shoulder position? Do you have the mobility and stability to move and maintain scapular positioning? Do you know how to sequence movement to optimise position, joint loading, and prevent injury?
The push up is generally one of those 'just do it' movements. All too often it seems that getting work done at whatever cost becomes the priority, and is even rewarded, while the way it's performed takes a back seat.
Most of the common errors look something like
- Unorganised spine (overextended back, thighs/hips contacting the floor)
- Unorganised shoulder (elbows abducted to 90 degrees or more, no rotation into the ground, no scapular control)
- Dysfunctional sequencing of movement (loading the elbows before the shoulders)
I think these errors happen for a few reasons
- Not viewing the push up as a skill
- Not having a transferable unstanding of how to organise and move the hips and shoulders
- Neglecting movement quaility as a metric, and having a task completition mentality
- Not having a suitable progressive and regressive system for teaching and performing the push up
- Not knowing any better
Some of these things come down to the teacher, some come down to the mover.
Push up principles (how to perfom it)
Fundamentals of the push up that should be prioritised
1) Midline stabilisation
The spine comes first, always. Trying to apply force to an object through the shoulders or hips with an unorganised and unstable spine is just dumb.
You have two options when it comes to organising the spine for a push up. A neutral spine, or a hollow body position.
Set up in the top of a push up, squeeze your butt, then draw your pelvis towards your ribs. The same principal as before in the hip hinge. You will be a straight line from your head to your toes.
When in a prone position (face down) gravitiy is trying to collapse and overextend your spine. You can combat this by doing the opposite, creating a globally flexed position (hollow body). To make sense of this think about an arched shaped bridge.
To do so start with a neutral spine, then close the angle between your head and toes. Your hips will be higher than your head and feet, but you will still maintain tension throughout the front and back of your body from head to toe, your body is one smooth bow shape with no kinks.
2) Organised shoulder
There are two parts to this principle as well. Number one is the position of your shoulder blades. In the same way that that gravity is challenging the integrity of your spine, your scapular position is also being challenged. In the top of the push up, push the floor away from you just enough to resist your shoulder blades retracting and collapsing together. This push is buffering the force of gravity and is holding you up. Number two is the rotational component (torque). With you spine and shoulder blades set in a stable position, screw your hands into the ground (fingers facing forward). The rotation caused by this cue removes the slack within the shoulder system, making it stable.
3) Movement dynamics
Movement dynamics relates to the way movement is applied to the push up.
In the same way the hip hinge was initiated by pulling the hips backward behind the knees, the push up is initiated by moving the shoulders forward and in front of the elbows. This means the shoulders are prioritised over the elbows as the prime mover. The shoulder is a lot larger system than the elbow, so it makes sense to let it take the majority of the load. Moving the shoulders forward and keeping the forearm vertical removes the risk of exposing the elbow to any shearing forces.
Application (hand position)
The width of your hand stance will determine the amount of shoulder abduction (how close or far your elbows are to your body). Normal function as a human means you should be able to apply the push up principles through a variety of different stances. Think about it in real life terms, sometimes you have to push odd shaped wide objects such as a fridge, sometimes you have to push narrower objects such as a lawnmower. As long as you have a stable spine and understand how to create stability at the shoulder, you should be able to push from a variety of different positions.
The issue comes when the elbows end up being as high, or higher than the shoulders. The shoulders start to internally rotate (the opposite of what you're doing when you screw them into the ground), and come into a sub optimal position for applying force and resisting injury.
My interpretation is that people find push ups easier from this sub optimal position for a couple of reason. Having the hands inline with the shoulders shortens the length of the moment arm (distance between the elbow and shoulder) decreasing the amount of torque acting on the shoulder, and reduces the range of motion of the movement. However this creates a false sense of security as the musculature surrounding the shoulders is off tension and doesn't get loaded properly, the risk of inpingment increases, the shoulder blades move through a reduced range of motion and don't develope the motor control and strength required to progress and translate to more difficult iterations of the push up.
Range of Motion
Full range of motion for the push up would be starting the movement with straight arms and moving to a position where the shoulders are lower than the elbows. I'm not a fan of cueing full ROM with the push up by saying 'chest to the floor'. This cue compares the push up to the bench press, which it's not in the context of range of motion. The object moving in the bench press is the bar, which doesn't obstruct or violate the spinal position at end range, because it only ever comes in contact with the chest. If you flip yourself upside down into the push up and try to lower your chest till its touching the floor, unless you raise your head and overextend your back, you physically won't be able to do so. Performing a push up in a hollow body position will further increase the gap between the floor and your chest, but your shoulders will still be lower than the elbows.
Scaling the Push up
When scaling the push up there are a few things that govern the 'best practices' of the scaling option.
Spinal and shoulder mechanics
Make sure you're always in a position where you can set and maintain a neutral spine, and keep your shoulders in a good position. If your scalling option violates this and manipulates you into a compromised position then you're going to get caught out further down the track.
Transferable movement patterns
The way you move when scaling a movement needs to replicate the way you'd move throughout the full movement. Other than just being specific and allowing you to progress within the push up, this also means that you're reenforcing good movement patternts that translate. Don't confuse your brain with unnessessary and sub optimal movement patterns!
Full range of motion
Some people make the push up easier by minimising the range of motion being used. However by doing this you're stopping yourself from getting stronger in the bottom of the push up. This will prevent you from building strength and motor control in that portion of the movement, and will prevent you from progressing to a full push up. Prioritise full ROM from the start and make the push up easier with other methods.
How to scale
In my opinion, if you prioritise these principles the only way to really scale the push up and progress in a fast and effective manner is to elevate the level of the floor. My favourite way of doing this is to use a barbell set on a squat rack. This allows you to keep your wrists neutral if you have wrist issues, gives you an object that makes creating torque easy, and gives you a multitude of progressions right down to the floor. If you don't have a bar and rack, use a box or some steps.
Knowing how to organise the spine, shoulders, and apply force to an object with the push up carries over to not just pushing but also pulling movements. Exercises such as dips, bench presses, overhead presses, turkish get ups, pull ups, and rows all employ the same principles that are established with the push up.
Why does this even matter?
Given that the context of this blog is directed at somebody's quality of life, a persons ability to do the above is a pretty good indication of their shoulder health. It's uncommon to see somebody that knows how to organise their spine and shoulders and perform quality push ups, but still have shoulder issues, rotator cuff injuries etc. It's one thing to treat injuries, but if you don't look at movement first you'll constantly be chasing a moving target.
Movement never lies