What a push-up asks of the elbow, and what no study has countedEmerging evidence
In a push-up your hands carry about two-thirds of your body weight (about 64% in a lab study of 23 young adults, and 66% in another of 8 men), your elbows bend to about a right angle or more at the bottom, and your triceps straighten them again. In a lab study of 9 men, the force along the forearm peaked at about 45% of body weight, and at normal hand width the triceps worked at 56% of their maximum strength.
No study counts how often push-ups cause elbow pain: the only report naming push-ups as the trigger is a single case, an army recruit with a snapping triceps and a slipping ulnar nerve. In a survey of 181 Dutch calisthenics (bodyweight street workout) athletes, the elbow was named in 10% of the injury reports over a year, behind the shoulder (32%) and the wrist (15%), though the abstract doesn't say whether these are shares of injuries or of athletes. In powerlifting, elbow and upper arm injuries made up 8.0%, and the weight-training sports have low injury rates next to team sports. So the map on this page is built from what each condition is known to do, push-up lab studies and health-service pages.
Sources 1, 2, 3, 4, 5, 6, 7
The back of the elbow: the triceps tendon, a pinch in the joint and the bursaEmerging evidence
An ache at the point of the elbow or just above it, worse pushing and straightening against resistance, is the pattern of triceps tendon pain, which a review calls "the rarest of the tendinopathies around the elbow". Strength is usually kept, and it is thought to settle without surgery, though no treatment trial exists. A jamming pain only as the elbow snaps fully straight fits a pinch at the back of the joint (posterior impingement), described in throwers, in boxers after over-straightening injuries, and in 4 weightlifters among 36 athletes treated with keyhole surgery. No study has looked at it in push-ups.
A soft, squashy swelling on the point of the elbow is olecranon bursitis, often after leaning on it. Knee and elbow bursitis together affect at least 10 in 100,000 people a year, mostly men aged 40 to 60. About a third of knee and elbow bursitis is infected, one review says, as were 24% of cases in 2,692 soldiers with elbow bursitis, and a fever comes with up to 77% of infected cases. Unlike an infected joint, the elbow still moves.
Sources 8, 9, 10, 11, 12, 13, 14
A torn triceps tendon is rare, and easily missedEmerging evidence
Triceps tendon tears are rare: 0.5% of the tendon tears seen in US emergency departments, with men affected about 12 times as often as women. They usually come from a heavy push or a fall onto an outstretched hand. Steroid injections, anabolic steroids, kidney disease and diabetes raise the risk: of 262 people who had surgery, 10% had kidney disease, 7% used anabolic steroids and 5% had had a steroid injection. The signs are a pop, swelling, bruising, a gap above the point of the elbow and weakness straightening the arm, especially overhead.
Tears are often missed while the elbow is swollen: 10 of 23 in one surgical series were misdiagnosed at first, and one case report describes a tear drained three times as bursitis. A full tear in an active person is usually repaired, and in that series of 22 people, repairing the tendon directly was always possible within 3 weeks.
Sources 15, 16, 17, 18, 19
The outer and inner elbow, and a loose elbowEmerging evidence
Tennis elbow, on the outer bump, is the commonest elbow tendon problem, and golfer's elbow, on the inner bump, is up to 6 times less common. Both are brought on by gripping, lifting, wrist movement and twisting. No NHS page or study names push-ups or weight through the hands as a cause, so gripping push-up handles or dumbbells tightly is the likelier trigger (our reading).
Rarely, the outer elbow is loose (posterolateral rotatory instability), usually after a dislocation and, rarely, after repeated steroid injections for tennis elbow. It shows as a clunk, a feeling of giving way or a fear that it will when pushing up from a chair or doing a push-up with the palms turned up: in 8 people whose looseness was confirmed at surgery, each of those two tests was positive in 7. In another series, 12 of 92 people operated on for stubborn tennis elbow had a mildly loose elbow, all after repeated injections. The evidence is a few small case series, so the warning line about it is our suggestion.
Sources 20, 21, 8, 22, 23, 24
The ulnar nerve, and why tingling shows at the bottomEmerging evidence
The ulnar nerve runs in a groove behind the inner bump, and bending the elbow squeezes and stretches it: in 20 cadaver arms, bending from straight to about 135 degrees narrowed the tunnel by 30% to 41% and the nerve by 33% to 50%, and in 10 others the nerve stretched by 15% or more. So tingling in the ring and little fingers at the bottom of a push-up, or when you lean on the elbow, points to the nerve, while an ache at the point of the elbow that builds as you push up points to the triceps tendon. That is our reading: no study has measured it in push-ups.
Painless clicks are common. The ulnar nerve slipped over the inner bump without symptoms in 51% of 153 older volunteers and in 15.8% of the nerves of 38 healthy adults. A click with tingling, or a painful snap over the inner bump, sometimes with part of the triceps slipping too (a snapping triceps), needs assessing.
Sources 25, 26, 27, 28, 29, 30
Less common causes, and the heartEmerging evidence
Less often, elbow pain with push-ups comes from elbow arthritis (typically in middle-aged men who have done heavy manual work), gout, rheumatoid or psoriatic arthritis, or a nerve in the neck: NHS inform says problems felt in your elbow can occasionally come from your neck. Rarely, it is an infection, a fracture after a fall, or a tumour, and tumours at the elbow are mostly harmless; in 37 people with a tumour near the elbow, 57% had pain and 54% swelling.
The heart can show up as arm pain. The NHS sends arm pain that comes on suddenly with pressure, heaviness or squeezing across your chest to 999, and its heart attack page adds chest pain that spreads to the arms, neck or jaw. That is why an arm that aches with effort and settles with rest is in the warning signs: especially an ache in the whole arm, or one with chest, jaw or neck discomfort, rather than one sore spot at the elbow.
Sources 64, 61, 60, 37, 65, 62, 58, 63
"It hurts at the top, when I lock out"Emerging evidence
No study has measured elbow load or pain with a locked or over-straightened elbow in a push-up. A jam right at the end of straightening fits a pinch at the back of the joint, which is described after over-straightening injuries, and the NHS advises people with hypermobile joints: "do not overextend your joints just because you can". So while it hurts, straighten smoothly without snapping into the lockout (our suggestion). There's no reason to avoid straightening for good.
Sources 3, 9, 10, 31
What a scan shows, and what it doesn'tStrong evidence
Elbow tendon pain is diagnosed by examination: NHS Lothian says imaging is "rarely required, particularly if there has not been a fall or an injury". After a fall, an X-ray matters if you can't fully straighten the elbow. In 2,127 people with an elbow injury, 98.4% of adults and 95.8% of children who could fully straighten it had no fracture, while nearly half of those who couldn't had one. An X-ray can also show a fleck of bone pulled off with a torn triceps tendon (in 61% to 88% of tears that were operated on).
An ultrasound or magnetic resonance imaging (MRI) scan confirms and sizes a suspected triceps tear, though a normal MRI doesn't rule out a loose elbow, which shows only when it moves. Nerve conduction tests are for unclear or worsening nerve symptoms: in one trial, 76% of people with typical mild ulnar nerve symptoms had normal tests.
Sources 32, 33, 16, 17, 23, 34, 35
How it usually goesEmerging evidence
No study follows elbow pain from push-ups. For tennis elbow, the commonest elbow tendon problem, 89% of people in the untreated groups of 24 trials had improved by a year, however long they had had it. NHS inform expects new elbow pain to begin to settle within 6 weeks. No study follows triceps tendon pain; a review calls it self-limiting. Mild or moderate ulnar nerve symptoms improved in 89.5% of 70 people by 6 months with advice, and the NHS says bursitis usually gets better in a few weeks. No one can promise a date.
Sources 36, 37, 8, 35, 38
