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TONY AMBLER-WRIGHT

If you were able to try out the standard push-up stated in our first article of this series and found it to be more challenging than what you’ve been doing, this is excellent news! Most often, when the push-up is done correctly, we find it to be more challenging mentally and physically because of the targeted and increased recruitment of muscle fibres.

When focused on the multiple muscle groups involved in the push-up, this will require multiple systems to work, such as the neuromuscular and cardiovascular systems. The following article will not only help you to continue to improve your push-up, but it will also help you to identify and fix common compensations that you may be experiencing while trying to do them correctly.

While continuing to focus on keeping your alignment within the five kinetic chain checkpoints during the push-up, you may notice the following compensations:

1. Low Back Arch
2. Scapular Winging and Elevation
3. Forward Head

LOW BACK ARCH

If you or your client feels discomfort in your low back while either holding or lowering into the push-up, this is NOT normal. This is considered a “low back arch compensation.” The muscles in the Lumbopelvic-hip-complex (LPHC) are not all working together, resulting in muscular imbalances that can lead to discomfort and/or injury.

In this compensation, the client more than likely presents an anterior pelvic tilt (APT.) A Low Back Arch/APT presented during a movement assessment identifies the available range of motion in the LPHC. It is vital to modify and cue the push-up exercise correctly to stabilize the spine and correct movement patterns.

Muscles to consider that are overcompensating (overactive) are:

1. Hip Flexor Complex
2. Erector Spinae
3. Lattisismus Dorsi

The overactive muscles should be lengthened. The National Academy of Sports Medicine suggests we perform self-myofascial techniques and flexibility exercises to the overactive muscles. If you are not trained or unfamiliar with the muscle and, in some cases, not licensed (in the case of the Hip Flexor Complex), it is suggested to seek professional help and instruction for lengthening techniques.

After that, it is important to identify the underactive muscles (the muscles that need to be activated to ensure muscular balance within the LPHC).

Muscles to consider that are underactive are:

1. Intrinsic core stabilizer (anterior core)
2. Gluteus maximus
3. Hamstrings

The muscles stated above that are underactive should be “activated.” The National Academy of Sports Medicine suggests choosing exercises to target the underactive muscles and lengthen them directly. Choosing exercises for yourself or your client can get complicated as there are several different exercises, modifications, progressions, and styles. Below are a few examples of exercises with important cues to activate these underactive muscles.

1. Iso Prone Ab is also known as a plank.

This may not be your ordinary plank or a plank that you are used to. Again, in NASM fashion, we are very detail-oriented and want to make sure you are activating all of the correct areas to ensure efficiency and neuromuscular control. Planks are often done wrong and focused on how much time an individual can hold themselves up.

The NASM approach aims to stabilize the core while activating the glutes and intrinsic core stabilizers while keeping alignment in the five kinetic chain checkpoints. It is suggested to start the plank in the same manner as how you would start the push-up, but on your elbows instead of on your hands. Modifications may be needed while addressing a client that has presented a low back arch. Performing a knee plank is often used to ensure activation of the anterior core and glutes.

Coaching cue- Make sure to continuously address the five kinetic chain checkpoints and check in with your client and ask:

Which part of the body do you mostly feel this exercise?

a. Answers should include- in my midsection/core.

b. Answers should NOT include- in my low back or my shoulders. If a client feels the plank in their low back, this points to moderate to severe core instability and weakness. If a client feels it predominately in their shoulders, re-check their elbow placement, making sure it is placed in alignment with the shoulders and not in the “tripod” position.

2. Floor Bridge

Floor bridges are also an example of an exercise that will target the low back arch’s compensation. It is important here to address that this exercise activates the glutes and alignment in the spine in the supine position and not “how high” the hips can rise. This exercise is performed in the supine position with the knees bent, feet, and arms on the floor.

Coaching cue- Make sure to continuously address the 5 KC Checkpoints and check in with your client and ask:

Where in your body do you most feel this exercise?

a. Answers should and can include: glutes, stretching in the hip flexor, and sometimes a little in the hamstrings.

b. Answers should NOT include low back or “all” in the hamstrings.

Should your client feel the floor bridge exercise in the low back, try to re-coach and cue the client using auditory, tactical, or visual cues to lower their hips until they predominately feel their glutes activating. An individual will often try to go for more range of motion performing an incorrect movement pattern rather than focus on the primary muscle group that they are trying to gain neuromuscular control over.

If the client “only” feels the hamstring dominate the exercise, try adjusting the feet, moving either away or closer to their glutes. When this happens, this is called synergistic dominance. The hamstring is responsible for “helping” in this exercise. However, with a low back arch compensation, the hamstrings may have learned to dominate because the glutes have a hard time activating.

          Hip Flexors Gluteus Maximus
            Low Back Arches         Erector Spinae Hamstring Complex
      Latissimus Dorsi       Intrinsic Core Stabilizers

 

SCAPULAR WINGING

While performing a push-up or during your dynamic movement assessment by an NASM certified personal trainer, you must pay attention and identify if you or your client show scapular winging. This is often presented when the thoracic spine muscles (i.e., pectoral and posterior shoulder) have an imbalance. Specifically, when scapular winging is presented, the following muscles are affected:

Overactive muscles:

1. Pectoralis major

The National Academy of Sports Medicine suggests inhibiting and lengthening the pectoralis major by using a pin a release technique, often seen using a foam roller followed by a pectoralis stretch.

Underactive muscles

1. Serratus Anterior
2. Mid and Lower Trapezius

Following the inhibiting and lengthening series, exercises are specifically chosen to activate the serratus anterior and mid and lower trapezius. Make sure the exercise chosen is appropriately modified or progressed, taking into consideration the client’s available range of motion as well as their goal.

SHOULDERS ELEVATE

While performing a push-up or during your dynamic movement assessment by a NASM certified personal trainer, you may present scapular elevation. This is often presented with a client who has a muscular imbalance within the muscles of the upper thoracic spine and mid-spine. Specifically, when scapular elevation is presented, the following muscles are affected:

Overactive muscles:

1. Upper trapezius
2. Levator scapulae
3. Sternocleidomastoid

The National Academy of Sports Medicine suggests inhibiting and lengthening these muscles by using a pin a release technique, often seen using a foam roller followed by exercises for each stretch. When it comes to the Sternocleidomastoid (SCM), we would highly suggest hiring a licensed manual therapist to help inhibit this sensitive area in the neck.

Underactive muscles

1. Mid and Lower Trapezius

Following the inhibiting and lengthening series, exercises are specifically chosen to activate the mid and lower trapezius. Make sure the exercise chosen is appropriately modified or progressed, taking into consideration the clients’ available range of motion as well as their goal.

FORWARD HEAD

While performing a push-up or during your dynamic movement assessment by a NASM certified personal trainer, you may have identified the compensation of having your head move forward and out of alignment within the five KC’s. This is often presented with a client who has a muscular imbalance within the muscles of the upper thoracic spine and cervical spine. Specifically, when the forward head is presented, the following muscles are affected:

Overactive muscles:

4. Upper trapezius
5. Levator scapulae
6. Sternocleidomastoid

The National Academy of Sports Medicine suggests inhibiting and lengthening these muscles by using a pin a release technique, often seen using a foam roller followed by exercises for each stretch. When it comes to the Sternocleidomastoid (SCM), we would highly suggest hiring a licensed manual therapist to help inhibit this sensitive area in the neck.

Underactive muscles

2. Deep Cervical Flexors

Following the inhibiting and lengthening series, exercises are specifically chosen to activate the deep cervical flexors. Make sure the exercise chosen is appropriately modified or progressed, taking into consideration the client’s available range of motion as well as their goal.

An example of a great exercise (not limited to) for scapular winging, scapular elevation, and forward head posture while still keeping in mind the five kinetic chain checkpoints and the goal of a correct push-up is as follows:

NASM FLOOR COBRA

While performing a NASM floor cobra, keep in mind this is quite different from a traditional cobra taught in yoga. The floor cobra’s purpose is to continue to work toward spine stability while working on lengthening the pectoralis major and activating mid & low trapezius and serratus anterior.

This is often taught as a scapular retraction (mid-low trapezius) and scapular depression (serratus anterior.) The exercise is performed prone while the head and chest hover near the floor and always consider the five kinetic chain checkpoints.

-Coaching cue- Make sure to continuously scan the five kinetic chain checkpoints and check in with your client and ask:

Where in your body do you most feel this exercise?

a. Answers should include- mid/low trapezius (mid-back muscles)

b. Answers should NOT include- in my triceps, low back, or neck. If a client feels the cobra is in these areas, this points to moderately to severe core and spine instability and limited range of motion in the shoulder. If a client feels it predominately in their triceps, try widening their arms or guiding them toward a T position with their arms to allow refocusing on scapular retraction.

Suppose a client feels it more in their low back or neck, re-coach limiting extension within the spine. Often the client will present moderate to severe extension in their spine to compensate for limited retraction of the scapula (shoulder blades.)

If you’re feeling confident that the client is receptive to your coaching, cueing and is kinetically aware and ready to perform a push-up with limited to no compensation in the spine. In that case, you may also want to try a push-up plus.

PUSH-UP PLUS

While performing a push-up plus, the standard cueing of a push-up applies in addition to “pushing through” the scapula as the end position. This “push through” focuses specifically on the mid and lower trapezius as well as intrinsic core stabilizers. Keep in mind the five KC’s and that the thoracic spine stays neutral while the client performs the “push through.”

Remember that there are several other exercises, modifications, and progressions when it comes to correcting the compensation of scapular winging, elevation, and forward head posture. Performing an exercise for each compensation to further detail or address each segment of the compensation can also help you or your client obtain neuromuscular control in those areas. Correcting these compensations are key to performing a correct push-up in the long run.

Now that the compensations are addressed, we get to focus on how to challenge the push-up continuously. Specifically, addressing modifications and progressions of the push-up to make it either doable and/or more intense for yourself or your client.

While considering modifications and progressions of the push-up, The National Academy of Sports Medicine will often refer, teach and use the neural continuum to choose what type of push-up is appropriately challenging for the individual. See chart below. <——–

While addressing the neural continuum, it is also important to consider changing the body position relative to gravity. The closer to the floor the exercise is performed, the harder it gets. Let alone changing the stability of it by adding, taking away limbs, or providing an unstable surface.

Some individuals can not fathom doing a push-up, let alone getting on the floor to do it because it’s either been historically hard or they haven’t seen the benefit in it. Giving your client an attainable push-up exercise and allowing them to perform a modified push can be a great way to empower your client to start to incorporate push-ups into their fitness routine.

EXAMPLES OF MODIFICATIONS OF PUSH-UPS

1. Wall push-up progressed to Single leg wall push-up
2. Countertop push-ups progressed to single leg countertop push-ups
3. Push-ups on a low step progressed to single-leg push-ups on a low step. (leg on step)
4. Knee push-ups progressed to Single leg extension push-ups
5. Push-ups on the floor progressed to single-leg push-ups on the floor
6. Hands-on an unstable surface push-up progressed to single-leg push-up with hand on an unstable surface.

There are so many ways to use the neural continuum to help your client never plateau with push-ups. Don’t forget that you can also use different modalities such as hands or feet in suspension trainers, hands or feet on medicine balls, and any other stable or unstable surfaces. As long as the integrity of the push-up is not compromised and the client is able to complete the push-up without compensation and keep the f5ive KC’s in check.

As you can see, there are several ways you can make a push-up interesting, fun, and challenging. The real question is where and when these should apply. Starting with a beginner push-up program to correct compensations may be a great start prior to progressing into a full program addressing stabilization endurance, strength endurance, hypertrophy, maximal strength, and/or power.

         Muscles             Sets         Durations     Coaching Cue
     Inhibit-SMT,              Percussion                Therapy  Pectoralis Major      1 30 sec
 Lattisimus Dorsi      1 30 sec       Scan 5 KC’s
  Lengthen-Static  Chest (Pectorals)      1 30 sec
   Stretch or NMS   Stretch on wall

Lat Stretch on ball

     1 30 sec

 

  Exercise        Sets        Reps      Tempo        Rest   Coaching             Cue
   Activation-         Isolated   Mid and          Low          Trapezius         1-2        10-15        4/2/2       0 sec  Floor Cobra       (prone)
Strengthening   Intrinsic          Core         1-2        10-15       4/2/2       0 sec Floor Bridge       (supine)
   Integrated           Dynamic         Movement   Push-ups         1-2        10-15      4/2/2       0 sec If the client is not initially capable of performing the push-up, they may need to modify to a more suitable exercise

 

*2-5 days a week. It can also be used as a warm-up and movement preparation.

As the push-up gets easier and there is minimal to no compensation presented in the entire kinetic chain, congratulate yourself and/or your client for a job well done. Making sure there is minimal to no compensation is key to progressing your client to reach their optimum performance and goal. Make sure to always re-visit the neural continuum prior to moving on to another style of push-up if you ever feel bored, stuck, or not challenged.

In the next articles to come, we will specifically address each phase of NASM’s OPT model and how we can incorporate push-ups into each program according to the fitness goal. We will dive deeper into each phase, set, reps, exact exercises and why each phase is important, and when it may apply. Start practising those push-ups!