Sports Biomechanics

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Kinetic analysis of push-up exercises: a systematic

review with practical recommendations

Wissem Dhahbi, Helmi Chaabene, Anis Chaouachi, Johnny Padulo, David G

Behm, Jodie Cochrane, Angus Burnett & Karim Chamari

To cite this article: Wissem Dhahbi, Helmi Chaabene, Anis Chaouachi, Johnny Padulo, David
G Behm, Jodie Cochrane, Angus Burnett & Karim Chamari (2022) Kinetic analysis of push-up
exercises: a systematic review with practical recommendations, Sports Biomechanics, 21:1,
1-40, DOI: 10.1080/14763141.2018.1512149

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SPORTS BIOMECHANICS
2022, VOL. 21, NO. 1, 1–40
https://doi.org/10.1080/14763141.2018.1512149

Kinetic analysis of push-up exercises: a systematic review

with practical recommendations
Wissem Dhahbia,b,c, Helmi Chaabened, Anis Chaouachia,e,f, Johnny Padulo g,h
,
David G Behmi, Jodie Cochranej, Angus Burnettj,k and Karim Chamarik
a
Tunisian Research Laboratory, Sport Performance Optimization, National Center of Medicine and Science
in Sports, Tunis, Tunisia; bTraining Department, Qatar Police College, Doha, Qatar; cSport Science Program,
College of Arts and Sciences, University of Qatar, Doha, Qatar; dDivision of Training and Movement
Sciences, Research Focus Cognition Sciences, University of Potsdam, Germany; eSports Performance
Research Institute, AUT University, Auckland, New Zealand; fPVF Football Academy, Hang Yen, Vietnam;
g
Sport Performance Laboratory, Faculty of Kinesiology, University of Split, Split, Croatia; hDepartment of
Psychology, University of eCampus, Novedate, Italy; iSchool of Human Kinetics and Recreation, Memorial
University of Newfoundland, Newfoundland, Canada; jCentre for Exercise and Sport Science Research,
School of Medical and Health Sciences, Joondalup Campus, Edith Cowan University, Perth, Australia;
k
Athlete Health and Performance Research Centre, Aspetar, QATAR Orthopaedic and Sports Medicine
Hospital, Doha, Qatar

ABSTRACT ARTICLE HISTORY

Push-ups represent one of the simplest and most popular strength- Received 10 January 2018
ening exercise. The aim of this study was to systematically review Accepted 9 August 2018
and critically appraise the literature on the kinetics-related charac- KEYWORDS
teristics of different types of push-ups, with the objective of opti- Biomechanics; closed kinetic
mising training prescription and exercise-related load. A systematic chain exercise; ground
search was conducted in the electronic databases PubMed, Google reaction force; joint load;
Scholar and Science Direct up to April 2018. Studies that reported upper body
kinetic data (e.g. initial and peak-force supported by the upper-
limbs, impact-force, peak-flexion-moment of the elbow-joint, rate
of propulsive- and impact-, and vertebral-joint compressive-forces)
related to push-ups and included trained, recreational and
untrained participants, were considered. The risk of bias in the
included studies was assessed using the Critical Appraisal Skills
Programme scale. From 5290 articles retrieved in the initial search,
only 26 studies were included in this review. Kinetic data for 46
push-up variants were assessed. A limitation of the current review is
that the relationship between our findings and actual clinical or
practical consequences is not statistically proven but can only be
inferred from our critical descriptive approach. Overall, this review
provides detailed data on specific characteristics and intensities of
push-up variations, in order to optimise exercise prescription for
training and rehabilitation purposes.

Introduction
Push-up exercises are widely used either for upper-extremity strengthening or for
rehabilitation purposes (Faigenbaum et al., 2015; Ludewig, Hoff, Osowski, Meschke, &
Rundquist, 2004; Moseley, Jobe, Pink, Perry, & Tibone, 1992). The popularity of push-up

CONTACT Wissem Dhahbi [email protected]

© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 W. DHAHBI ET AL.

exercises may be attributed to the fact that they have several technical variations and can
be performed with little or no equipment. Additionally, the skills needed to perform
push-ups are simple to master and the exercise intensity can easily be adjusted (Cogley
et al., 2005) and adapted to various difficulty levels (Gouvali & Boudolos, 2005; Lou, Lin,
Chou, Chou, & Su, 2001; Mier, Amasay, Capehart, & Garner, 2014). Push-ups are
commonly used for dynamic warm-up, as an alternative to traditional weight training
(Ubinger, Prentice, & Guskiewicz, 1999; Vossen, Kramer, Burke, & Vossen, 2000). In
addition, push-ups are commonly used to rehabilitate the muscles of the upper extremi-
ties, particularly the shoulders (Ludewig et al., 2004). Moreover, push-up-based exercises
can be used in performance assessments of strength endurance (ACSM, 2013) for school-
age children (Loyd, Bishop, Walker, Sharp, & Richardson, 2003), military recruits
(Dhahbi et al., 2017a; Dhahbi, Chaouachi, Padulo, Behm, & Chamari, 2015; Knapik
et al., 2006) and elite athletes (Baker & Newton, 2006; Roe et al., 2015).
Recent studies have shown that a short-term (i.e. eight weeks) push-ups-based training
programme improves upper-limb maximum dynamic strength in college baseball players
(Carter, Kaminski, Douex, Knight, & Richards, 2007) and muscle-power performance in
healthy college-aged participants (Schulte-Edelmann, Davies, Kernozek, & Gerberding,
2005). In the same context, practising push-up exercises has been shown to improve
sport-specific performance (Klnç, 2008). For instance, Klnç (2008) reported significant
shooting performance improvement after 10 weeks of a push-ups-based training pro-
gramme in women basketball players aged 20 years. The same authors attributed this
improvement to strength and power performance enhancement following the push-ups-
based training programme. Additionally, it has been demonstrated that six weeks of push-
ups practice decreases shear forces, improves proprioception and dynamic stability (Swanik
et al., 2002) and enhances co-contraction and muscle recruitment (Rogol, Ernst, & Perrin,
1998; Ubinger et al., 1999). In terms of acute effects (i.e. post-activation potentiation),
previous studies have proved that push-up exercises improve neuromuscular coordination
(Ludewig et al., 2004) and increase joint compressive forces and stability (Calatayud,
Borreani, Colado, Martin, & Rogers, 2014).
Several studies have analysed muscles’ level of activation during different types of push-
ups, to distinguish their respective intensities (Beach, Howarth, & Callaghan, 2008;
Freeman, Karpowicz, Gray, & McGill, 2006; Gouvali & Boudolos, 2005). However, studies
concerning the kinetics-based quantification of push-up exercises are scarce. The standard
push-up (i.e. hands underneath shoulders, straight legs and body in a straight line) is the
most popular exercise (Suprak, Dawes, & Stephenson, 2011). It includes many variations
through simple changes in hand and/or leg positions. These variations affect the upper-
body muscle activation (McGill, Cannon, & Andersen, 2014). Thus, it could be feasible to
design a whole strength-training programme for the upper body using the different push-
up variations (Ubinger et al., 1999; Vossen et al., 2000). Despite the popularity of push-
ups, there is no previous study that reviews the literature on the kinetic characteristics of
various push-up exercises. Therefore, a summary and critical review of the literature on
the kinetic data for push-ups is needed, to improve our understanding and assist in
determining and adjusting the exercise load.
The kinetic parameters of push-ups have been obtained using two distinct estimation
methods: (i) ground reaction forces (GRFs) using a force platform to directly quantify the
load applied on the arms (Dhahbi et al., 2017a; Dumas, Cheze, & Frossard, 2009) and (ii)
 SPORTS BIOMECHANICS 3

inverse dynamics (Bisseling & Hof, 2006). The inverse dynamics method calculates joint
kinetics, (i.e. forces, moments and power) using direct measurement of the GRFs from
force platforms or force transducers and calculates joint position data from motion analysis
(Dumas et al., 2009). By estimating the mass and inertial properties of a segment, the joint
kinetics can be determined (Bisseling & Hof, 2006). An, Korinek, Kilpela, and Edis (1990)
and Donkers, An, Chao, and Morrey (1993) were the first researchers to analyse the kinetic
and kinematic characteristics of different push-up exercises. They developed and proposed
a method for collecting kinematic and kinetic data of the elbow joint during push-up
exercises. The same authors provided information on elbow-joint loading patterns (An
et al., 1990; Donkers et al., 1993).
Push-ups are an effective strength exercise that can be easily used and integrated
into a training programme without any extra tools (Cogley et al., 2005; Dhahbi
et al., 2017a). Therefore, the aim of this study was to comprehensively review and
critically appraise previous research on the kinetic analysis of push-up exercises.
Such a study may allow coaches to better understand the kinetic characteristics of
the various types of push-up exercise and to make informed decisions regarding
their training prescriptions.

Methods
Search strategy
The present systematic review of the published literature was conducted based on the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide-
lines (Moher, Liberati, Tetzlaff, & Altman, 2010). A comprehensive literature search
of original manuscripts was systematically performed on PubMed (MEDLINE),
Google Scholar, and Science Direct. The search was limited to manuscripts published
up to April 2018. A Boolean search strategy was applied using the operators ‘AND’
and ‘OR’. According to the main topic of the present study, different combinations
of the following terms were included in our search syntax: [(‘push-up’ OR ‘pushup’)
AND (‘kinetic analysis’ OR ‘dynamic analysis’) AND (‘ground reaction force’ OR
‘inverse dynamic’) AND (‘joint loading’ OR ‘reaction force’ OR ‘joint compressive
force’ OR ‘body weight’ OR ‘body mass’ OR ‘pressure’) AND (‘intensity’ OR ‘load’)].
Additionally, the snowballing technique was applied to the reference lists of retrieved
full-text articles to identify further articles that were not included in the initial
electronic search. Only full-text sources were included. Thus, abstracts and confer-
ence papers from annual meetings were excluded from the analysis.

Eligibility criteria
The criteria for the inclusion of retrieved articles were that they: (i) were written in
English, (ii) were published in peer-reviewed journals, (iii) addressed one or more push-
up exercise types (iv) considered a targeted population which contained non-pathological
participants (i.e. trained, recreational and untrained), (v) used a kinetic analysis approach
and (vi) reported at least one aspect of either intensity and supported load or joint
compressive load assessment.
4 W. DHAHBI ET AL.

Data extraction
Relevant articles identified through the searching process were independently evaluated
and assessed by three reviewers (i.e. WD, DB and JC) who screened the titles, the
abstracts and the full texts to reach a final decision on the study’s eligibility. In case of
uncertainty or disagreement, a fourth expert was consulted.
For each eligible study, data were extracted and examined by two independent
reviewers (WD and JC) who performed the data extraction following a predefined
template. The template included cohort size, demographic information including sex,
age and training background/expertise, push-up variation name and the objective and
design of the study. After completion of data extraction, the two independent reviewers
cross-checked the accuracy of the data. Any conflicting results between reviewers
resulted in a re-evaluation of the paper in question until a consensus was reached.

Assessment of study quality

The critical appraisal skills programme (CASP) score criteria of the Oxford Centre for
Evidence-based Medicine were used for methodological assessment of the quality of the
included cohort studies (Zeng et al., 2015). The quality evaluation of included studies
was performed by two investigators. Any disagreement in study selection or quality
assessment was resolved by further discussion.

Results
The preliminary systematic search resulted in 5290 hits. After careful examination of
titles and abstracts, 407 articles remained and were subsequently reviewed for eligibility.
The full texts of these 407 articles were screened with regard to the previously defined
inclusion/exclusion criteria. Finally, 26 articles were retained and included in this study
(Figure 1). The CASP scores for assessing the methodological quality of the 26 cohort
studies are shown in Table 1. Table 2 illustrates the main characteristics of the included
studies in terms of kinetic data for the respective push-up exercise, measured outcomes
and the number and sex of participants, as well as their training background.
Publication years ranged from 1990 (An et al., 1990) to 2018 (Giancotti, Fusco,
Varalda, Capranica, & Cortis, 2018). There are many variations of push-ups, as they can
vary according to factors such as starting position, the range of motion (ROM) and
movement speed. In total, we were able to identify46 push-up variations, which were
then grouped into subsets. The main push-up types addressed in the included studies
were standard push-ups (14 studies), flexed-knee push-ups, inter-hand-width push-ups
or depth/ROM push-ups, hands- or feet-elevated push-ups and plyometric push-ups
(seven studies each) and pushing speed (one study) (Table 2).
Our literature review showed that studies were based on the following kinetic indices
for characterising and analysing push-up exercises: initial force supported by upper-
limbs, peak force supported by upper-limbs, peak flexion moment of elbow joint,
impact force, rate of force development (e.g. propulsive and impact) and vertebral-
joint compressive forces. The kinetic indices were quantified using two distinct estima-
tion methods, that is direct measurement of GRFs and inverse dynamics. The main
findings of the analysed studies showed that irrespective of the push-up variant, the
 SPORTS BIOMECHANICS 5

Figure 1. Flow of information through the different phases of the systematic review.

load supported by the arms with the elbows flexed is significantly greater (8–21%) than
when the elbows are extended (Giancotti et al., 2018; Gulmez, 2016; Mier et al., 2014;
San Juan, Suprak, Roach, & Lyda, 2015; Suprak et al., 2011). The force supported by
both extended limbs, measured directly, ranged from 19% of body weight (BW) for
suspended (e.g. TRX) 45° push-ups (Gulmez, 2016) to 73% BW for posterior/inferior
push-ups (Gouvali & Boudolos, 2005) (Table 4). The force supported by the extended
dominant limb, measured directly, ranged from 6% BW for ‘prayer’ push-ups (Uhl,
Carver, Mattacola, Mair, & Nitz, 2003) to 60% BW for one-arm push-ups (Uhl et al.,
2003) (Table 4). The initial axial force on the elbow for extended dominant-limb
variants ranged from 21% BW for ‘fast’ push-ups (Chou et al., 2011) to 41% BW for
standard push-ups (An et al., 1990) (Table 4). The peak GRF for both limbs ranged
from 29% BW for anterior push-ups (Gouvali & Boudolos, 2005) to 131% BW for
standard countermovement push-ups (Hogarth, Deakin, & Sinclair, 2013) (Table 5).
The peak GRF for dominant-limb variants ranged from 67% BW for 3.8-cm ‘box-drop’
push-ups (Koch, Riemann, & Davies, 2012) to 78% BW for ‘clap’ push-ups (Moore,
Tankovich, Riemann, & Davies, 2012) (Table 5). The peak axial force on the elbow for
dominant-limb variants ranged from 33% BW for internal-hand-position push-ups
(Lou et al., 2001) to 46% BW for arms-together (i.e. adducted arms) push-ups
(Donkers et al., 1993) (Table 5). For plyometric push-ups, the impact force for both
6 W. DHAHBI ET AL.

Table 1. The critical appraisal skill program (CASP) score for assessing the methodological quality for
the 26 enrolled clinical cohort studies.
CASP CASP CASP CASP CASP CASP CASP CASP CASP CASP CASP CASP
Authors 1 2 3 4 5 6 7 8 9 10 11 12
Hinshaw et al. (2018) + + + + + + + + + + + +
Giancotti et al. (2018) + + + + + + + + + + + +
Polovinets et al. (2017) + + + + ? + + + + + + +
Wang et al. (2017) + + + + + + + + + + + +
Dhahbi et al. (2017a) + + + + + + + + + + + +
Gulmez (2016) + + + + ? + + + + + + +
San Juan et al. (2015) + + + + + + + + + + + +
McGill et al. (2014) + + + + + + + + + + + +
Mier et al. (2014) + + + + + + + + + + + +
Hogarth et al. (2013) + + + + + + + + + + + +
Koch et al. (2012) + + + + + + + + + + + +
Moore et al. (2012) + + + + + + + + + + + +
Garcia-Masso et al. + + + + + + + + + + + +
(2011)
Suprak et al. (2011) + + + + + + + + + + + +
Ebben et al. (2011) + + + + + + + + + + + +
Chou et al. (2011) + + + + ? + + + + + ? +
Chuckpaiwong and + + + + + + + + + + + +
Harnroongroj (2009)
Beach et al. (2008) + + + + - + + + + + + +
Chou et al. (2008) + + + + - + + + + + ? +
Gouvali and Boudolos + + + + + + + + + + + +
(2005)
Uhl et al. (2003) + + + + + + + + + + + +
Lou et al. (2001) + + + + + + + + + + ? +
Hrysomallis and Kidgell + + + + + - + + + + + ?
(2001)
Donkers et al. (1993) + + + + + ? + + + + + +
An et al. (1992) + + + + + ? ? + + + + +
An et al. (1990) + + + + + + + + + + ? +
The eligibility criteria has to be excluded for scoring of the CASP score; ‘+’ = indicates a ‘yes’ score; ‘–’ = indicates a ‘no’
score; ‘?’ = indicates a ‘can’t tell’ score.

limbs ranged from 65% BW for ‘jump’ push-ups (Garcia-Masso et al., 2011) to 192%
BW for standard squat push-ups (Dhahbi et al., 2017a). The propulsion rate force for
both limbs ranged from 0.32 BW/s for kneeling squat push-ups (Dhahbi et al., 2017a) to
8 BW/s for standard countermovement push-ups (Hogarth et al., 2013). The propulsion
rate force for dominant limb variants ranged from 2.9 BW/s for 3.8-cm box-drop push-
ups (Koch et al., 2012) to 3.3 BW/s for clap push-ups (Koch et al., 2012). The rate of
impact force for both limbs ranged from 17 BW/s for jump push-ups (Garcia-Masso
et al., 2011) to 49 BW/s for standard countermovement push-ups (Dhahbi et al., 2017a).
The rate of impact force for dominant-limb variants ranged from 4 BW/s for 3.8-c m
box-drop push-ups(Koch et al., 2012) to 7 BW/s for clap push-ups (Koch et al., 2012).
The peak flexion moment for dominant-limb variants ranged from 12 Nm for ‘apart’
variants (Donkers et al., 1993) to 29 Nm for ‘together’ variants (Donkers et al., 1993)
(Figure 2). The vertebral joint compressive forces ranged from 1233 N for standard
push-ups (McGill et al., 2014) to 3400 N for suspended push-ups (Beach et al., 2008).
Additionally, there is a controversy about the dominant/non-dominant effects on push-
up kinetic parameters. Regardless of push-up style, the initial force supported by the
upper-limbs (F0) (Polovinets, Wolf, & Wollstein, 2017) and the lateral and medial
elbow-joint force in the ‘up’ position, are greater on the dominant limb than on the
Table 2. Variations of push-up exercise.
Cited by Variation Figure
Standard push-ups
An et al. (1990); An et al. (1992); Beach et al. (2008); Chou Standard: The participant’s hand placement is defined as
et al. (2008); Chuckpaiwong and Harnroongroj (2009); the width equal to the distance between contralateral
Ebben et al. (2011); Gouvali and Boudolos (2005); acromion processes, measured from the inside border of
Donkers et al. (1993); Hogarth et al. (2013); Lou et al. each hand, with hands placed under the shoulders in the
(2001); Mier et al. (2014); San Juan et al. (2015); Uhl et al. beginning position, which is characterised by full elbow
(2003) extension.

Pushing speed
Chou et al. (2011) Fast-speed push-up:7 push-ups/10s.
Regular-speed push-up:5 push-ups/10s.
Slow-speed push-up:4 push-ups/10s.
Push-up: The participant keeps the elbow joints in full
extension and position their hands, with a forearm in an
axially non-rotated posture. The hand width is set to 1.5
times of the shoulder width and the feet are shoulder-
width apart in the initial posture.
Knee angle
Gouvali and Boudolos (2005); Ebben et al. (2011); Mier Flexed knee (knees down): The participant kneels on the
et al. (2014); San Juan et al. (2015); Suprak et al. (2011) floor on hands and knees, then walks the hands forward
until they can drop the hips. They stop when the body is
in a straight line from the shoulders to the knees. Wrists
are lined up beneath your shoulders. The participant
crosses the ankles, with their feet in the air. Knee push-
ups are performed in the same manner as the standard
push-up except they are on their knees instead of their
feet.
Uhl et al. (2003) Prayer: The participant kneels with weight shifted
primarily over the ankles and leans forward. The prayer
position is illustrated to represent a standing upper
extremity weight-bearing exercise in which minimal
weight is placed through the upper extremities. Note
that the participant places their middle fingers along
two taped lines on the scales; these are used to
SPORTS BIOMECHANICS

standardise hand position based on individual

biacromial widths.
(Continued)
7
 8

Table 2. (Continued).
Cited by Variation Figure
Uhl et al. (2003) Quadruped: The participant is positioned with hands and
knees on the ground with the shoulder flexed to 90°.
W. DHAHBI ET AL.

Variation of hand position (width) push-ups

An et al. (1992); Chou et al. (2008); Donkers et al. (1993); Shoulder abduction: Two marks for the position of the
Gouvali and Boudolos (2005) hands at the abducted variant, at a distance of ~150% of
the shoulder width.

An et al. (1992); Donkers et al. (1993); Chou et al. (2008); Shoulder adduction: Two marks for the position of the
Gouvali and Boudolos (2005) hands at the adducted variant, at a distance of ~50% of
the shoulder width.

Chuckpaiwong and Harnroongroj (2009) Push-up -10 (P-10): Hand interval~10 cm narrower than
the shoulder width on each side.

(Continued)
Table 2. (Continued).
Cited by Variation Figure
Chuckpaiwong and Harnroongroj (2009) Push-up + 10, + 20, or + 30 (P + 10, P + 20 or P + 30):
Hand interval -10, 20 or 30 cm wider than the shoulder
width on each side.

Depth/ROM push-ups
Lou et al. (2001) Internal position: Starting from the standard push-up
position, with arms at the participant’s sides, and palms
facing forward as a neutral reference position. The hands
are internally rotated at 90°.

Lou et al. (2001) External position: Starting from the standard push-up
position, with arms at the participant’s sides, and palms
facing forward as a neutral reference position. The hands
are externally rotated at 90°.
SPORTS BIOMECHANICS

(Continued)
9
 10

Table 2. (Continued).
Cited by Variation Figure
Polovinets et al. (2017) Neutral wrist: Starting from the standard push-up
position, but with neutral rotation of the wrist and
forearm, thus the knuckles were placed along the body
of the participant.
W. DHAHBI ET AL.

Gouvali and Boudolos (2005) PV: Two marks for the position of the feet at the anterior
variant, at a distance of + 30% of the arm-forearm
length, relative to the marks of the feet in the normal
position.

Gouvali and Boudolos (2005) AV: Two marks for the position of the feet at the posterior
variant, at a distance of −30% of the arm-forearm
length, relative to the marks of the feet in the normal
position.

An et al. (1992); Chou et al. (2008); Donkers et al. (1993) Superior: The hands are placed 15 cm in the cephalad
direction from the standard push-up position.

(Continued)
Table 2. (Continued).
Cited by Variation Figure
An et al. (1992); Chou et al. (2008); Donkers et al. (1993) Inferior: The hands are placed 15 cm in the caudal
direction from the standard push-up position

Hand or feet-elevated push-ups

Ebben et al. (2011); Lehman et al. (2006); Uhl et al. (2003) Push-up position with feet elevated on a 30, 45 or
61 cm box (FE30, FE61or FE45):Push-up feet elevated.
The participant maintains a push-up position with feet
elevated at . . . cm, with elbows in full extension and the
shoulder flexed to 90°.
Ebben et al. (2011); Lehman et al. (2006); Uhl et al. (2003) Hands elevated on a 30 or 61 cm box (HE30 or HE61):
Push-up hands elevated. The participant maintains a
push-up position with hands elevated at . . . cm, with
elbows in full extension and the shoulder flexed to 90°.

Gulmez (2016); McGill et al. (2014); Snarr and Esco (2013) TRX® push-up-with the TRX straps hanging vertically. The
participant adopts a push-up position with a handle in
either hand. They perform a push-up in the same
manner and at the same pace as the standard push-up.

Plyometric push-ups
Koch et al. (2012); Moore et al. (2012) Clap push-ups: The participant lowers their chest down
towards the force plates, while maintaining a straight
line with their body. After this phase, they forcefully and
explosively push-up in order to obtain an upper body
SPORTS BIOMECHANICS

take-off. While in the air, they clap their hands together

before landing back onto the force plates (or ground).
11

(Continued)
 12

Table 2. (Continued).
Cited by Variation Figure
Koch et al. (2012); Moore et al. (2012) Box-drop plyometric push-ups3.8, 7.6 or 11.4 cm
(3.8BD, 7.6BD or 11.4BD): This position is similar to the
clap push-ups. The participant lowers their chest down
towards the force plates, while maintaining their body in
a straight line. Once peak depth is obtained, they
explosively push up and, while in the air, manoeuvre
W. DHAHBI ET AL.

their hands, such that they land on the blocks

simultaneously. Upon contact with the blocks, the
participant immediately and explosively performs
another push-up off the blocks, landing with their hands
in the starting position (on the force plates) to perform a
subsequent repetition.
Garcia-Masso et al. (2011); Hrysomallis and Kidgell (2001) Countermovement push-up/explosive push-up: This is a
push-up performed with a maximum speed of
movement.
From the starting position (standard position), the
participant descends by flexing their elbows and
extending their arms until the sternum is approximately
3 cm from the floor. They immediately extend their
elbows and flex their arms to return to the starting
position.
Garcia-Masso et al. (2011) Jump push-up: This is similar to a clap push-up but
without the clap. From the starting position (standard
position), the participant descends by flexing their
elbows and extending their arms until the sternum is
approximately 3 cm from the floor. They immediately
extend their arms by taking advantage of the inertia
generated to take their hands off the floor. They are told
not to flex their elbows during the flight phase. Upon
landing, the participant must reduce the impact as much
as possible and continue the movement, thereby
carrying out another complete push-up with a flight
phase and landing. During the measurement, the
participant must carry out two complete repetitions of
the exercise (i.e. eccentric phase, concentric phase, flight
phase and landing phase) performed at maximal speed.
(Continued)
Table 2. (Continued).
Cited by Variation Figure
Garcia-Masso et al. (2011) Fall push-up:
Starting position: The participant kneels with bent arms
(90°), extended elbows and palms facing forward.
Execution: The participant lets himself/herself fall forward
and, at the moment of impact, tries to minimise the
impact-force as much as possible. They must place their
hands on the pre-set marks. They lower their bodies
until the sternum is approximately 3 cm from the floor.
They then extend their elbows and flex their arms,
thereby taking advantage of the inertia generated by
these movements, so as to take their hands off the floor
and attempt to return to the starting position.
Dhahbi et al. (2017a) Standard countermovement push-up (SCPU): From the
‘up’ standard position, the participant descends by
flexing their elbows until the elbows are flexed at
approximately 90°. They immediately extend their arms
to propel the upper body as high as possible. They are
requested not to flex their elbows during the flight
phase. Upon landing, the participant is requested to
reduce the impact as much as possible and resume the
starting position.
Dhahbi et al. (2017a) Standard squat push-up (SSPU): From the ‘up’ standard
position, the participant descends by flexing their
elbows until the elbows are at an angle of approximately
90°, and they maintain this position for about 1 s. When
their body is completely stabilised in this motionless
position, they then propel their upper body as high as
possible without performing a countermovement.
Dhahbi et al. (2017a) Kneeling countermovement push-up (KCPU): The KCPU
is performed in the same manner as the SCPU, except
with support from the knees instead of the feet (i.e.
kneeling position).
SPORTS BIOMECHANICS

(Continued)
13
 14

Table 2. (Continued).
Cited by Variation Figure
Dhahbi et al. (2017a) Kneeling squat push-up (KSPU): The KSPU is performed
in the same manner as the SSPU, except with support
from the knees instead of the feet.

Dhahbi et al. (2017a) Drop-fall push-up: The participant kneels with shoulders
W. DHAHBI ET AL.

in antepulsion (90°), with elbows extended and palms

facing forward. The participant then lets himself/herself
fall forward (under the effect of gravity). They lower their
body until the elbows are flexed at approximately 90°.
They immediately extend their arms in the same manner
as the KCPU.

Various types
Donkers et al. (1993); Uhl et al. (2003) One-arm push-up: The participant maintains a one-arm
push-up position with the elbow in full extension, the
dominant shoulder flexed to 90° and the non-dominant
hand placed behind the back during testing. The
participant is also asked to perform a one-handed push-
up if able to do so.
Uhl et al. (2003) Tripod: The participant remains in the quadruped position,
then flexes the non-performing shoulder to 180°

Uhl et al. (2003) Pointer: The participant maintains the same position as
the tripod position and extends the contralateral hip to
0°.
 SPORTS BIOMECHANICS 15

non-dominant limb (Lou et al., 2001). When performing plyometric push-ups, the
dominant upper-limb side demonstrated significantly greater peak forces and rate of
impact force (1.5% and 37% respectively) compared to the non-dominant side (Koch
et al., 2012). For all suspended push-up variations, no difference in F0 was found
between dominant and non-dominant arms (Gulmez, 2016). Moreover, there is a
controversy about the sex effects on push-up kinetic parameters. Mier et al. (2014)
found that F0 on the flexed elbow, (i.e. the ‘down’ position) as well as the peak force
supported by the upper-limbs (PF) are significantly greater for men than for women. In
the same context, Hinshaw, Stephenson, Sha, and Dai (2018) also found a significant
effect of sex on F0 and PF. However, the same authors did not establish pairwise
comparisons between men and women. Conversely, for both flexed-knee and standard
push-ups, Mier et al. (2014) did not find any significant difference between men and
women with regard to F0 during the extended elbow (i.e. up) position. Similarly, Ebben
et al. (2011) did not report any effect of sex on PF when performing different push-up
variations (i.e. standard, flexed-knee, feet-elevated and hands-elevated push-ups). Note
that regardless of push-up type, the neutral hand has been shown to be at the less-
stressful position for wrist and elbow joints (Chuckpaiwong & Harnroongroj, 2009; Lou
et al., 2001; Polovinets et al., 2017).

Discussion
Standard push-ups
The standard push-up is the most extensively studied (An, Chao, Morrey, & Donkers,
1992; An et al., 1990; Beach et al., 2008; Chou et al., 2008; Chuckpaiwong &
Harnroongroj, 2009; Donkers et al., 1993; Ebben et al., 2011; Gouvali & Boudolos,
2005; Hogarth et al., 2013; Lou et al., 2001; Mier et al., 2014; Polovinets et al., 2017; San
Juan et al., 2015; Uhl et al., 2003) (Table 2).

Initial force as a percentage of body weight supported by upper-limbs via direct

measurement (F0)
The load supported by the arms in the course of the push-up, is largely determined by the
participant’s BW and how it is supported on the ground (Mier et al., 2014) (Table 4).
Some authors have only assessed the dominant limb (the one used for writing (Polovinets
et al., 2017)) for kicking (Garcia-Masso et al., 2011) or for throwing (Uhl et al., 2003)),
while others have evaluated both limbs together (Dhahbi et al., 2017a; Gouvali &
Boudolos, 2005; Hogarth et al., 2013; Mier et al., 2014; San Juan et al., 2015; Suprak
et al., 2011) or have used both methods (Gulmez, 2016). Gouvali and Boudolos (2005)
recorded the force patterns during six different push-ups and found that a clear distinc-
tion does exist in GRF between the different postures adopted for each push-up type.
Overall, 75% BW was supported by the upper-limbs during a standard push-up when
the elbows were in flexion (Mier et al., 2014), while GRFs reached 69% BW when the
elbows were extended during the standard push-up (Freeman et al., 2006; Gouvali &
Boudolos, 2005; Mier et al., 2014; Suprak et al., 2011). However, Gouvali and Boudolos
(2005) demonstrated that the posterior push-up had the highest level of GRF supported
by both arms (i.e. 73% BW). This information can help coaches to choose an
16 W. DHAHBI ET AL.

appropriate intensity-related type of push-up when developing and guiding training

programmes.

Initial elbow joint axial force (as a percentage of BW, estimated with inverse
dynamics—F0ʹ)
Many researchers have assessed the initial joint axial forces (as a percentage of BW) on
the elbow (i.e. F0ʹ). These forces are observed to be heterogeneous for different push-up
variations, but they are similar across studies on the same variant, with the exception of
studies by Chou et al. (2011) and Lou et al. (2001). The latter studies reported lower
values for a standard push-up, with an axial joint force on the elbow of 28% BW, with
other results showing values from 37% to 41% BW (An et al., 1992, 1990; Donkers et al.,
1993). This may be explained by the mesomorphic body type and the lower distribution
of mass in the upper body of the Taiwanese cohort included in the Chou et al. (2011)
and Lou et al. (2001) studies (Table 3). It may also be related to the calculation models
used in different laboratories. According to Lou et al. (2001), the heterogeneity in the
anthropometric data for tested participants (e.g. mass and inertia of segments) could
result in a 5% difference in the force calculations.
The three-segment model used in Lou et al. (2001) assumed that the hand and
forearm behaved as two different rigid bodies. In contrast, Donkers’ model (Donkers
et al., 1993) assumed the hand and forearm to be one rigid body. This difference may
contribute to differences in force and moment calculations. The greater the number of
segments in the model, the greater the measurement error rate (Dumas et al., 2009; Lou
et al., 2001). Observing Table 4, it can be concluded that the F0ʹ values were approxi-
mately similar to the results from the direct measurement method for the same push-up
variation. It is important to consider the elbow-joint forces when designing a training
programme. However, it should be acknowledged that the elbow-joint force varies,
depending on the body positioning and elbow angle, which affect the moment arm and
torques.

Peak force relative to BW supported by upper-limbs (PF)

The present review of the literature revealed that for the standard push-up, the values of
the PF for both arms exhibited some variation ranging from 41% to 98% BW. This large
range of values may be due to the different measurement approaches used in different
investigations. For instance, Gouvali and Boudolos (2005) zeroed the force plate when
the participant’s hands were on the force plate (initial position of push-up) and found a
PF of41% BW, whilst other researchers, such as Mier et al. (2014), zeroed the force plate
when it was free of any weight and reported a PF of 98% BW. Additionally, it has been
shown that the performing velocity of push-ups can affect results (e.g. PF and PF’)
(Chou et al., 2011; Mier et al., 2014). In this regard, Mier et al. (2014)instructed
participants to perform one push-up in two seconds, whereas in the study of Gouvali
and Boudolos (2005), push-ups were performed at the participant’s own pace.

Peak elbow-joint axial forces (as a percentage of BW, estimated with inverse
dynamics—PF’)
Four studies (An et al., 1990; Chou et al., 2011; Donkers et al., 1993; Lou et al., 2001) have
examined the standard push-up and measured the PF’ of the dominant limb. The
Table 3. Kinetic studies of push-up variations.
Participants (N, age, BW,
Study height) Push-ups tests Significant findings (p < 0.05)
Hinshaw et al. -18 male and 17 female - Modified plyometric push-up on the knees (MP) - Force Applied to Hands at Starting Position (BW): For men and women:
(2018) physically active - Plyometric push-up without external loading (PP) MP< PP< PP5%< PP10%
- 21.9 ± 3.5 y - Plyometric push-up with an external load of 5% body - Force Applied to Feet at Starting Position (BW): For men and women:
- 70.2 ± 13.5 kg weight (PP5%) PP< PP5%< PP10%< MP
- 1.74 ± 0.10 m - Plyometric push-up with an external load of 10% body - Peak Force Applied to Hands during Push-up (BW):
weight (PP10%) For men: MP< PP and PP5%< PP10%
For women: MP< PP< PP5%< PP10%
- Peak Upper Body Power during Push-up (watt/BW): For men and women:
MP< PP,PP5% and PP10%
- Peak Velocity during Push-up (m/s):
For men: MP< PP10%< PP5%< PP
For women: MP< PP5% and PP10%< PP
- Force at Peak Power during Push-up (BW): For men and women:
MP< PP< PP5%< PP10%
- Velocity at Peak Power during push-up (m/s):
For men: MP< PP10%< PP5%< PP
For women: MP< PP5% and PP10%< PP
Giancotti et al. 17 male and 8 female Suspension push-up at different length of suspension For the cell load measurement: ICC: 0.91–0.96
(2018) physically active training device 178 For the force plate measurement: ICC: 0.97–0.98
- 28.1 ± 5.2 y cm (P1), 188 cm (P2), 198 cm (P3), 208 cm (P4), 218 cm - Load supported by hands (BW): for both flex and extend elbow positions;
- 69.4 ± 14.3 kg (P5), 228 cm (P6) and 238 cm (P7) P1< P2< P3< P4< P5< P6< P7
- 171.6 ± 11.3 cm - Load supported by feet (BW): for both flex and extend elbow positions;
P7< P6< P5< P4< P3< P2< P1
Polovinets et al. -14 healthy male - Hyperextended wrist push-up (HW) - All calculations of ICC showed good agreement between tests (ICC:0.69–0.96)
(2017) - 24.86 ± 0.95 y - Neutral wrist push-up (NW) - The total GRF measured did not differ between the 2 patterns of push-ups.
- 176.09 ± 3.06 cm, - The upper-limbs were loaded with an average of 70% of total body weight
- 22.94 ± 1.42 kg· m−2 during the experience.
- The applied GRF on the dominant hand was higher regardless of push-up
style.
- When performing NW, the GRF vector was more uniform throughout the
push-up in the vertical direction.
- The horizontal distance between the capitate bone location and the GRF
SPORTS BIOMECHANICS

origin was smaller in hyperextension.

- The forces travelled more dorsally over a wider area and more ulnarly in the
hyperextended wrist.
(Continued)
17
Table 3. (Continued).
18

Participants (N, age, BW,

Study height) Push-ups tests Significant findings (p < 0.05)
Wang et al. -60 recreationally active Ballistic push-up (i.e. Standard countermovement push- Peak Force (N): ICC: 0.971; SEM: 45
(2017) men up) Mean Force (N): ICC: 0.989; SEM: 21
- 24.5 ± 4.3 y Peak RFD (N/s): ICC: 0.849; SEM: 1059
- 1.75 ± 0.07 m Mean RFD (N/s): ICC: 0.867; SEM: 469
- 80.8 ± 13.5 kg Net Impulse (N· s): ICC: 0.956; SEM: 5.9
Peak Velocity (m/s): ICC: 0.863; SEM: 0.12
Flight Time (s): ICC: 0.750; SEM: 0.05
W. DHAHBI ET AL.

Peak Power (W): ICC: 0.936; SEM: 123

Mean Power (W): ICC: 0.934; SEM: 66
Dhahbi et al. -37 commandos physically - Standard countermovement push-up (SCPU) - Initial force supported (BW) and impact-force (BW): SCMJ-PU and SSJ-
(2017a) active and used to - Standard squat push-up (SSPU) PU> KCMJ-PU, KSJ-PU and DJF-PU
doing push-ups - Kneeling countermovement push-up (KCPU) - Peak ground reaction force take-off (BW): SCMJ-PU> DJF-PU> SSJ-PU and
- 23.3 ± 1.5 y - Kneeling squat push-up (KSPU) KCMJ-PU> KSJ-PU
- 78.7 ± 9.7 kg - Drop-fall push-up (DFPU) - Rate of force development during take-off (BW/s): SCMJ-PU and DJF-
- 1.80 ± 0.04 m PU> KCMJ-PU> SSJ-PU and KSJ-PU
- Flight time (s): DJF-PU> KCMJ-PU and KSJ-PU> SCMJ-PU and SSJ-PU
- Rate of force development impact (BW/s):No difference
Gulmez (2016) -28 physically healthy - TRX push-up angle 45° (P1) - Load applied to the TRX straps (kg):
males - TRX push-up angle 30° (P2) *P4> P3> P2> P1
- 24.1 ± 2.9 y - TRX push-up angle 15° (P3) *For all variations, elbow flexion> elbow extension
- 78.8 ± 9.8 kg - TRX push-up angle 0°(P4) *For all variations, no difference between dominant and non-dominant arms
- 179.4 ± 8.0 m
San Juan et al. - Total of 18 males and 4 - Traditional push-up plus (TPUP) - Vertical GRF (%BW):
(2015) females - Modified push-up plus (MPUP) *TPUP (+ 17% BW)> modified PUP
- 28.4 ± 10.1 y *TPUP at 90° of elbow flexion (75.99%BW)
- 75.3 ± 10.3 kg *TPUP at 20° of elbow flexion (70.18%BW)
- 176.9 ± 7.9 cm *MPUP at 90° of elbow flexion (52.95% BW)> MPUP at 20° of elbow flexion
(57.95%BW)
*Vertical GRF displayed a significant linear decrease across the ROM for both
variants
McGill et al. -40 physically healthy - Standard push-up - Mean spine (L4/L5) compression at the P-phase of each exercise:
(2014) males - TRX push-up TRX push-angle3> TRX push-up> TRX push-angle 2> stable shoulder
- 21.1 ± 2.0 y - TRX push-angle 1 protraction (coached)> TRX scapula push-up> TRX shoulder protraction
- 74.6 ± 7.8 kg, - TRX push-angle 2 (coached)> TRX push-angle 1> standard push-up> TRX shoulder protraction
- 1.77 ± 0.06 m. - TRX push-angle3 (not coached)> stable shoulder protraction (not coached)
- Stable shoulder protraction (coached) -Mean spine (L4/L5) shear forces at the P-phase of each exercise:
- TRX scapula push-up Standard push-up; TRX push-up> TRX push-angle 2> TRX push-angle3> TRX
- TRX shoulder protraction (coached) push-angle 1
- TRX shoulder protraction (not coached)
- Stable shoulder protraction (not coached)
(Continued)
Table 3. (Continued).
Participants (N, age, BW,
Study height) Push-ups tests Significant findings (p < 0.05)
Mier et al. (2014) 19 physically active men: - Dynamic standard push-up (DSP) - Maximal load supported during DSP and DMP (BW): Men> women
- 25 ± 7 y - Dynamic modified push-up (DMP) - Load supported in the static ‘down’ position (BW): Men> women
- 78.6 ± 10.7 kg - Static standard push-up ‘up’ - Load supported in the static ‘up’ position (BW): No difference was
- 1.77 ± 0.08 cm - Static standard push-up ‘down’ observed between men and women
18 physically active - Static modified push-up ‘up’ - Load supported in the static position (BW): Standard push-up> modified
women: - Static modified push-up ‘down’ push-up
- 22 ± 3 y
- 64.1 ± 6.8 kg
- 166 ± 6 cm
Hogarth et al. -14 men physically active - Plyometric push-up (i.e. SCPU) - Peak force (N), mean force (N), rate of force development during take-
(2013) and used to doing off (N/s), time to peak force (ms), flight time (ms), impulse (N· s) and
push-ups initial mass supported (N):
- 19 ± 1y, Moderate to high relative reliability (ICC = 0.8–0.96) and high absolute
- 92.6 ± 14.6 kg reliability (CV = 4.3–7.6%), except for rate of force development during take-
- 1.83 ± 0.07 m off (CV = 11%)
Koch et al. - 22 men physically active - Clap push-up (CPU) - Peak GRF (BW):
(2012) - 25.9 ± 1.3 y - 3.8 cm box-drop push-up (3.8BD) *Dominant limb> non-dominant limb
- 87.6 ± 12 kg - 7.6 cm box-drop push-up (7.6BD) *No significant difference between variations in push-ups
- 1.80 ± 0.08 m - 11.4 cm box-drop push-up (11.4BD) - Impact rate (BW/s):
*Dominant limb> non-dominant limb
*Within dominant limb, CPU> 11.4BD> 7.6 BD> 3.8 BD
- Propulsion rate (BW/s): CPU> 3.8 BD, 7.6BD, 11.4BD
Moore et al. - 21 recreationally active - Clap push-up (CPU) - Peak GRF (%BW): CPU> 3.8 BD, 7.6BD, 11.4BD
(2012) adult males - 3.8 cm box-drop push-up (3.8BD)
- 24.5 ± 3.7 y - 7.6 cm box-drop push-up (7.6BD)
- 83.2 ± 11.7 kg - 11.4 cm box-drop push-up (11.4BD)
- 1.82 ± 0.05 m
Garcia-Masso - 27 men physically active - Countermovement push-up (CMPU) - Maximum force (N): CMPU> FPU
et al. (2011) and used to doing - Jump push-up (JPU) - Rate of force development (N/s): CMPU> JPU
push-ups - Fall push-up (FPU) - Impact-force (N):FPU> JPU
- 22.44 ± 0.31 y - Rate of impact-force development (N/s): FPU> JPU
- 76.34 ± 0.97 kg
- 1.79 ± 0.01 m
Suprak et al. - 28 highly strength - Standard push-up ‘up’ (RU) - Percentage of body mass supported (%BW): RD> RU> FKD> FKU
(2011) trained men - Percentage change in body weight supported from up to down position
SPORTS BIOMECHANICS

- Standard push-up ‘down’ (RD)

- 33.6 ± 6.59 y - Push-up flexed knee ‘up’ (FKU) in traditional and modified push-ups (%BW):
- 84.66 ± 11.65 kg - Push-up flexed knee ‘down’ (FKD) - Push-up flexed knee> standard push-up
- 178.98 ± 5.76 cm
19

(Continued)
Table 3. (Continued).
20

Participants (N, age, BW,

Study height) Push-ups tests Significant findings (p < 0.05)
Ebben et al. - 14 men: - Push-up with feet elevated on a 30.48/60.96 cm box - Peak GRF expressed as a coefficient of total body mass:
(2011) - 22.5 ± 3.6 y - Push-up with hands elevated on a 30.48/60.96 cm box *FE 60.96> FE 30.48 > R> HE 30.48> HE 60.96> FK
- 83.70 ± 11.28 kg, - Push-up with flexed knee (FK) - Peak GRF (N):
179.81 ± 10.89 cm - Standard push-up (R) *FE 60.96, FE 30.48 > R, HE 30.48, HE 60.96, FK
- 9 women: *No difference between men and women
- 21.1 ± 1.6 y
- 69.34 ± 7.90 kg
W. DHAHBI ET AL.

- 173.43 ± 9.37 cm
Chou et al. -11 physically healthy - Fast-speed push-up: 7 push-ups/10s (F) - Joint forces of elbow at the examined push-up speeds:
(2011) males - Regular-speed push-up: 5 push-ups/10s (R) *Anterior/posterior force ‘up’ (%BW): RS> FS
- 24.54 ± 1.44 y - Slow-speed push-up: 4 push-ups/10s (S) *Anterior/posterior force ‘down’ (%BW): SS> FS
- 65.9 ± 7.17 kg *Lateral/medial force ‘up’ (%BW):SS,FS> RS
- 168.9 ± 5.32 cm *Lateral/medial force ‘down’ (%BW):SS,RS> FS
*Lateral/medial force ‘peak’ (%BW):RS,SS> FS
*Axial force ‘up’, ‘down’ and ‘peak’ (%BW): RS,SS> FS
- Joint moments of elbow at the examined push-up speeds:
- Frontal plane ‘peak’ (N· m): RS,SS> FS
- Sagittal plane ‘down’ and ‘peak’ (N· m): RS,SS> FS
- Transverse plane ‘down’ and ‘peak’ (N· m): SS> FS
Chuckpaiwong 10 physically active men - Push-up -10:Hand interval 10 cm narrower than the - Distribution of the mean peak pressure (N· cm−2):
and (20 hands) shoulder width on each side (P-10) Lunate and hypothenar are as> thenar, metacarpal and finger are as in both
Harnroongroj - 22.10 ± 0.7 y - Standard push-up (R) ‘up’ and ‘down’ positions (descriptive data)
(2009) - 65.80 ± 7.5 kg - Push-up + 10, + 20, or + 30: Hand interval -10, 20 or - Mean palmar peak pressure in lunate area during push-up in ‘up’ phase
- 1.73 ± 5.6 m 30 cm wider than the shoulder width on each side (N· cm−2): P + 30, P + 20 > P-10, R, P + 10
(P + 10, P + 20 or P + 30) - Mean palmar peak pressure in lunate area during push-up in ‘down’
phase (N· cm−2): P + 30 > P-10, R, P + 10, P + 20
- Mean palmar peak pressure in hypothenar area during push-up in
‘down’ phase (N· cm−2): P-10, R > P + 10, P + 20, P + 30
Beach et al. - 11 recreationally trained - Standard push-up (R) - Mean and peak L4/L5 intervertebral joint compressive forces (N):
(2008) men - Suspended push-up (SP) S ‘up’> SP ‘down’> R ‘up’> R ‘down’
- 27.4 ± 0.8 y - Mean and peak L4/L5 intervertebral joint anterior/posterior shear
- 89.4 ± 3.3 kg forces (N):
- 1.83 ± 0.02 m R ‘up’, SP ‘up’> R ‘down’, SP ‘down’
Chou et al. - 10 healthy male - Standard push-up (R) - Maximum axial force (%BW): R > S,A
(2008) students - Apart push-up (A) - Maximum flexion moment (N· m): AD> R > A
- Shoulders’ adduction push-up [50% shoulders’ width]
(AD)
- Superior push-up (S)
- Inferior push-up (I)
(Continued)
Table 3. (Continued).
Participants (N, age, BW,
Study height) Push-ups tests Significant findings (p < 0.05)
Gouvali and - 8 recreationally active - Standard push-up (R) - Significant differences existed for most vertical force variables (VGRF initial,
Boudolos adult males - Shoulders’ abduction [150% shoulders’ width] (AB) VGRF initial/BW, VGRF max., VGRF max./BW, VGRF min., VGRF min./BW, VGRF
(2005) - 20.5 ± 0.4 y - Shoulders’ adduction [50% shoulders’ width] (AD) integral during descending and VGRF range), but without presenting the
- 74.4 ± 5 kg - + 30% of arm-forearm length posteriorly to initial hand results of post hoc tests
- 176.8 ± 2.3 cm position (PV) - Not significant differences for anteroposterior force
- −30% of arm-forearm length anteriorly to initial hand - Initial load relative to body weight (%BW):
position (AV) PV> R, AB, AD, AV> FK
- Push-up flexed knee (FK)
Uhl et al. (2003) - 18 healthy participants - Prayer (P) - Percentage of body mass supported during ‘up’ position (%BW):
- 22 ± 3 y - Quadruped (Q) OA> T, Po, R, FE45 > Q > P
- 73 ± 17 kg - Tripod (T)
- 175 ± 10 cm - Pointer (Po)
- Standard push-up (R)
- Push-up with feet elevated on a 45 cm (FE45)
- One-arm push-up (OA)
Lou et al. (2001) - 10 physically healthy - Standard push-up (R) - Joint force of elbow at specific push-up events (%BW):
male - Internal position push-up (IR) *Anterior/posterior force ‘up’: R,ER> IR
- 26.1 ± 2.6 y - External position (ER) *Anterior/posterior force ‘peak’: R> ER,IR
- 69.3 ± 9.2 kg *Lateral/medial force ‘up’: R,ER> IR (dominant hand), ER> R> IR (non-dominant
-171.7 ± 5.2 cm hand)
*Lateral/medial force ‘peak’: R,ER> IR
*Axial force ‘up’: R,ER> IR (dominant hand)
*Axial force ‘down’: R,ER> IR (non-dominant hand)
*Axial force ‘peak’: R> ER,IR
- Joint force of elbow at specific push-up events (N· m):
*Frontal plane ‘up’: IR> ER> R (dominant hand), IR,ER> R (non-dominant hand)
*Frontal plane ‘down’: IR,ER> R (non-dominant hand)
*Sagittal plane ‘up’: R,ER> IR (dominant hand)
Hrysomallis and - 12 physically active men - Explosive push-up - No significant differences for any of the vertical force variables (impulse,
Kidgell (2001) - 22.8 ± 3.0 y maximum rate of force development, average force, peak force and initial
- 81.9 ± 9.2 kg mass on force plate) when the explosive push-ups were preceded by a set of
SPORTS BIOMECHANICS

- 181.3 ± 8.2 cm 5RM bench press exercises

(Continued)
21
 22

Table 3. (Continued).
W. DHAHBI ET AL.

Participants (N, age, BW,

Study height) Push-ups tests Significant findings (p < 0.05)
Donkers et al. - 9 healthy male - Standard push-up (R) - Description of typical pattern of force and moment of push-up exercise.
(1993) participant - Repeated standard push-up (RR) - Static axial force ‘up’ (%BW): I > R> AD,S
- 25 [20–30] y - Apart push-up (A) - Maximum axial force (%BW): R > A, S
- 78 [65–90] kg - Shoulders’ adduction push-up [50% shoulders’ width] - Maximum anterior-posterior force (%BW): S > R > A
- 178 [167–187] cm (AD) - Maximum flexion moment (N.cm): AD> R> RR,A
- Superior push-up (S) - Maximum valgus moment (N.cm): S > R
- Inferior push-up (I)
- One-handed push-up (OH)
An et al. (1992) - 9 healthy male - Standard push-up (R) - Description of typical pattern of force and moment of push-up exercise
participants - Repeated standard push-up (RR) - Maximum axial force (%BW): R > A
- 25 [20–30] y. - Apart push-up (A) - Maximum flexion moment (N cm): AD> R> RR,A
- Shoulders’ adduction push-up [50% shoulders’ width]
(AD)
- Superior push-up (S)
- Inferior push-up (I)
- One-handed push-up (OH)
An et al. (1990) - 1 male participant - Standard push-up (R) - 3D description of joint forces and moment of elbow
- 170 lbs≃77.11 kg, - Presentation of typical pattern of 3D force and moment of push-up exercise
- 6 ft≃182.88 cm
BW = body weight; GRF = ground reaction force; ROM = range of motion
Table 4. Initial load relative to body weight.
Ratio of body weight supported by both limbs, with Ratio of body weight supported by dominant limb, Initial axial force on elbow, relative to BW, for
direct measurement with direct measurement dominant limb
Push-up group Variations Studies Values SD Variations Studies Values SD Variations Studies Values SD
Standard push-up Standard Suprak et al. 0.69 0.02 Standard Uhl et al. 0.34 0.03 Standard Chou et al. 0.28 0.04
(2011) (2003) (2011)
Standard Gouvali and 0.66 0.02 Standard Donkers et al. 0.37
Boudolos (1993)
(2005)
Standard Mier et al. (2014) 0.67 0.04 Standard An et al. 0.41
for men (1990)
Standard Mier et al. (2014) 0.65 0.03 Standard An et al. 0.37
for women (1990)
Standard Dhahbi et al. 0.68 0.04 Standard Lou et al. 0.28 0.02
(2017a) (2001)
Standard Hogarth et al. 0.61 0.1 Standard Polovinets 0.35 0.02
(2013) et al.
Standard for men Hinshaw et al. 0.67 0.03 (2017)
(2018)
Standard for Hinshaw et al. 0.64 0.04
women (2018)
Standard San Juan et al. 0.76 Neutral Polovinets 0.35 0.03
(2015) wrist et al.
(2017)
Pushing speed Fast Chou et al. 0.21 0.03
(2011)
Slow Chou et al. 0.29 0.04
(2011)
Knee angle Flexed knee Suprak et al. 0.53 0.04 Prayer Uhl et al. 0.06 0.03
(2011) (2003)
Flexed knee Gouvali and 0.53 0.03 Quadruped Uhl et al. 0.19 0.02
Boudolos (2003)
(2005)
Flexed knee Mier et al. (2014) 0.53 0.04
for men
Flexed knee Mier et al. (2014) 0.52 0.03
for women
Flexed knee Dhahbi et al. 0.46 0.04
SPORTS BIOMECHANICS

(2017a)
Flexed knee for Hinshaw et al. 0.52 0.05
men (2018)
Flexed knee for Hinshaw et al. 0.48 0.05
23

women (2018)
Flexed knee San Juan et al. 0.53
(2015)
(Continued)
Table 4. (Continued).
Ratio of body weight supported by both limbs, with Ratio of body weight supported by dominant limb, Initial axial force on elbow, relative to BW, for
24

direct measurement with direct measurement dominant limb

Push-up group Variations Studies Values SD Variations Studies Values SD Variations Studies Values SD
Inter-hand width, Apart/shoulder Gouvali and 0.63 0.03 Apart Donkers et al. 0.37
position and direction abduction Boudolos (1993)
(2005)
Together/ Gouvali and 0.65 0.02 Adduction Donkers et al. 0.35
shoulder Boudolos (1993)
adduction (2005)
W. DHAHBI ET AL.

Posterior/inferior Gouvali and 0.73 0.03 Inferior Donkers et al. 0.39

variation Boudolos (1993)
(2005)
Anterior/superior Gouvali and 0.61 0.03 Superior Donkers et al. 0.35
variation Boudolos (1993)
(2005)
Internal Lou et al. 0.27 0.03
position (2001)
External Lou et al. 0.29 0.03
position (2001)
Feet elevated/hands TRX 178 cm Giancotti et al. 0.19 0.03 Push-up feet Uhl et al. 0.39 0.05
elevated (2018) elevated at (2003)
TRX 188 cm Giancotti et al. 0.23 0.03 45 cm
(2018)
TRX 198 cm Giancotti et al. 0.27 0.03 TRX 45° Gulmez 0.07
(2018) (2016)
TRX 208 cm Giancotti et al. 0.32 0.03 TRX 30° Gulmez 0.12
(2018) (2016)
TRX 218 cm Giancotti et al. 0.37 0.03 TRX 15° Gulmez 0.18
(2018) (2016)
TRX 228 cm Giancotti et al. 0.40 0.02 TRX 0° Gulmez 0.27
(2018) (2016)
TRX 238 cm Giancotti et al. 0.44 0.02
(2018)
TRX 45° Gulmez (2016) 0.13
TRX 30° Gulmez (2016) 0.24
TRX 15° Gulmez (2016) 0.37
TRX 0° Gulmez (2016) 0.54
Various stationary Tripod Uhl et al. 0.32 0.03
positions (2003)
Pointer Uhl et al. 0.34 0.04
(2003)
One-arm push-up Uhl et al. 0.60 0.06
(2003)
BW = bodyweight; SD = standard deviation
 SPORTS BIOMECHANICS 25

outcomes of these studies ranged from 36% to 45% BW (see Table 5). The results relative
to the standard push-up PF established by An et al. (1990) and Donkers et al. (1993) seem
to be high (45% of BW) compared to other studies (33% to 43% BW) (Chou et al., 2008;
Lou et al., 2001). Donkers et al. (1993) found that a simple change of hand width can affect
PF’ by around 4% BW. Lou et al. (2001) showed that the standard position (i.e. hands
facing forward as a neutral reference position) generated a significantly greater PF’ than
the ‘internal’ (i.e. hands internally rotated at 90°) and ‘external’ (i.e. hands externally
rotated at 90°) hand positions.

Peak flexion moment of elbow joint (PFM)

Similar PFM outcomes have been observed (An et al., 1990; Chou et al., 2011; Donkers
et al., 1993; Lou et al., 2001). The mean PFM value for the studies was around 23 Nm
for the standard push-up (Figure 2).

Speed of push-up
Our literature search found that there was little information on the kinetic analysis of
pushing speed on push-ups. Only Chou et al. (2011) investigated the kinetic implica-
tions (e.g. joint forces and moments) of performing push-ups at different speeds by
performing seven push-ups in 10 s as a fast push-up, five push-ups in 10s as a regular-
speed push-up and four push-ups in 10s as a ‘slow’ push-up.

F0 and PF’
Following the analysis of Chou et al. (2011), the velocity of the push-up execution did
not affect F0ʹ (see Table 4). However, the push-up speed did influence PF’, with a fast
push-up producing a greater force by a factor of 1.2 than a slower push-up, at 43% and
35% of BW respectively (Chou et al., 2011) (Table 5). Additionally, it was observed by
Chou et al. (2011) that performing push-ups at a slower speed reduces elbow-joint

Figure 2. Peak flexion moment of joint elbow as an absolute value. *Values displayed with ± SD are
in line with the availability in the literature.
Table 5. Peak force relative to body weight.
Peak GRF, relative to Peak axial force on elbow, relative to
body weight, body weight, for
26

Peak GRF, relative to body weight, for both limbs for dominant limb dominant limb
Push-up group Variations Studies Values SD Variations Studies Values SD Variations Studies Values SD
Standard push-up Standard Ebben et al. (2011) 0.64 0.04 Standard Chou et al. (2011) 0.38 0.05
Standard Mier et al. (2014) 0.98 0.08 Standard Donkers et al. (1993) 0.45
for men
Standard Mier et al. (2014) 0.80 0.04 Standard An et al. (1990) 0.45
for women
Standard Gouvali and 0.41 0.13 Standard Lou et al. (2001) 0.36 0.04
Boudolos (2005)
W. DHAHBI ET AL.

Pushing speed Fast Chou et al. (2011) 0.43 0.06

Slow Chou et al. (2011) 0.35 0.05
Knee angle Flexed knee Ebben et al. (2011) 0.49 0.05
Flexed knee Mier et al. (2014) 0.80 0.07
for men
Flexed knee Mier et al. (2014) 0.68 0.03
for women
Flexed knee Gouvali and 0.35 0.01
Boudolos (2005)
Inter-hand width, Shoulder abduction Gouvali and 0.38 0.12 Apart Chou et al. (2008) 0.43
position and direction Boudolos (2005)
Shoulder adduction Gouvali and 0.30 0.09 Apart Donkers et al. (1993) 0.45
Boudolos (2005)
Posterior variation Gouvali and 0.34 0.08 Together Donkers et al. (1993) 0.46
Boudolos (2005)
Anterior variation Gouvali and 0.29 0.07 Inferior Donkers et al. (1993) 0.46
Boudolos (2005) variation
Superior Chou et al. (2008) 0.44
variation
Superior Donkers et al. (1993) 0.42
variation
Internal Lou et al. (2001) 0.33 0.03
position
External Lou et al. (2001) 0.34 0.04
position
Plyometric push-up Explosive push-up Hrysomallis and 0.67 0.18 Clap Koch et al. 0.69 0.02
Kidgell (2001) (2012)
Explosive push-up Garcia-Masso et al. 0.68 0.02 Clap Moore et al. 0.78 0.15
(2011) (2012)
Standard squat push- Dhahbi et al. 1.04 0.10 3.8 cm Koch et al. 0.67 0.02
up (2017a) box- (2012)
drop
Kneelings quat push- Dhahbi et al. 0.82 0.10 3.8 cm Moore et al. 0.69 0.11
up (2017a) box- (2012)
drop
(Continued)
Table 5. (Continued).
Peak GRF, relative to Peak axial force on elbow, relative to
body weight, body weight, for
Peak GRF, relative to body weight, for both limbs for dominant limb dominant limb
Push-up group Variations Studies Values SD Variations Studies Values SD Variations Studies Values SD
Standard Dhahbi et al. 1.26 0.15 7.6 cm Koch et al. 0.70 0.02
countermovement (2017a) box- (2012)
push-up drop
Standard Wang et al. (2017) 1.21 0.24 7.6 cm Moore et al. 0.71 0.12
countermovement box- (2012)
push-up drop
Standard Hinshaw et al. 1.29 0.16 11.4 cm Koch et al. 0.69 0.02
countermovement (2018) box- (2012)
push-up drop
for men
Standard Hinshaw et al. 0.94 0.13 11.4 cm Moore et al. 0.71 0.12
countermovement (2018) box- (2012)
push-up drop
For women
Standard Hogarth et al. 1.31 0.23
countermovement (2013)
push-up
Kneeling Dhahbi et al. 0.99 0.14
countermovement (2017a)
push-up
Kneeling Hinshaw et al. 1.07 0.16
countermovement (2018)
push-up
for men
Kneeling Hinshaw et al. 0.79 0.12
countermovement (2018)
push-up
for women
Kneeling Garcia-Masso et al. 0.69 0.02
countermovement (2011)
push-up
Drop-fall push-up Dhahbi et al. 1.12 0.11
(2017a)
Fall (kneeling) Garcia-Masso et al. 0.65 0.02
(2011)
SPORTS BIOMECHANICS

Feet elevated/hands Feet elevated at Ebben et al. (2011) 0.74 0.02

elevated 60.96 cm
Feet elevated at Ebben et al. (2011) 0.70 0.02
30.48 cm
27

Hands elevated at Ebben et al. (2011) 0.55 0.05

30.48 cm
Hands elevated at Ebben et al. (2011) 0.41 0.06
60.96 cm
BW = bodyweight; GRF = ground reaction force; SD = standard deviation
28 W. DHAHBI ET AL.

loading. Therefore, to lighten the load, performing a slow push-up may be

recommended.

PFM
The fast and together variants are seen to be more stressful at the level of the elbow joint
(with values higher than 27 Nm), whereas the apart (Donkers et al., 1993) variant produces
the lowest intensity (12.11 Nm). Chou et al. (2011) showed that the PFM, the peak valgus
moment and the pronation moment at fast push-up speeds are 1.6, 1.3 and 1.4 times
greater respectively than at slow speeds. However, at lower speeds there is greater activa-
tion in the upper-limb and chest muscles. These observations indicate that performing
low-speed push-ups is preferred for greater muscle activation and therefore a slow muscle
contraction with sub-maximal resistance can substitute for stimulation with high-intensity
resistance. For example, if the overall resistance is low relative to the strength potential of
the athlete (such as a strong trainee who cannot access extra resistance and is performing
standard body-weight push-ups), low-speed push-ups may increase muscle activation and
therefore be more effective than faster contractions. In addition, performing low-speed
push-ups seems to be ideal from an injury prevention perspective due to the fact that there
is less torque on the elbow joints (Chou et al., 2011).

Flexed-knees push-up
F0
The F0 for the flexed-knee push-up was consistent across almost all studies (52–53% of
BW) (Gouvali & Boudolos, 2005; Mier et al., 2014; San Juan et al., 2015; Suprak et al.,
2011), except for one study which reported a slightly lower value of 46% BW (Dhahbi
et al., 2017a). During the static kneeling push-up position, Suprak et al. (2011) observed
a load of 53% of BW in the up (i.e. elbow extended) position compared to 62% of BW in
the down (i.e. elbow flexed) position. Mier et al. (2014) investigated the effects of push-
up variation (standard vs. kneeling) and sex on F0. They demonstrated that the relative
load did not differ between men and women in the static up position (Mier et al., 2014),
whereas the relative load was higher in men than in women during the static down
position (i.e. flexed elbow joint). These data demonstrated sex-related differences in the
relative loads that resulted from the push-ups (Gouvali & Boudolos, 2005; Suprak et al.,
2011). Women hold a slightly lower proportion of their skeletal muscle mass in the
upper body (Janssen, Heymsfield, Wang, & Ross, 2000), as well as generally having a
narrower chest and shoulder girth compared to men. This could contribute to a shorter
moment arm in women and influence the torque and hence the loading and intensity of
the push-up.

PF
Ebben et al. (2011) assessed the PF of push-up variations, including the standard push-
up and those performed with a flexed knee. Push-ups from the flexed-knee position
produced a lower PF than most push-up variations, with no sex-related differences
(Table 5). Previous studies reported lower PF for kneeling than for standard push-ups.
The three studies (Ebben et al., 2011; Gouvali & Boudolos, 2005; Mier et al., 2014) that
measured PF in standard and kneeling push-ups showed a lower PF in the latter push-
 SPORTS BIOMECHANICS 29

up type. Specifically, the PF for the kneeling push-ups has been shown to be between
35% and 80% BW. On the other hand, the PF for the standard push-ups ranged from
41% to 98% BW (Ebben et al., 2011; Gouvali & Boudolos, 2005; Mier et al., 2014).
Therefore, as the flexed-knee push-up showed a lower upper-body load, this would be
an effective alternative for individuals who are unable to perform a standard push-up or
who need a lighter load for any reason. This form of push-up is often chosen in order to
promote optimal scapulothoracic stability in the early phases of weight-bearing
shoulder rehabilitation standards (Suprak et al., 2011).

Inter-hand width (apart/shoulder abduction, together/shoulder adduction)

F0 and F0ʹ
The initial force in inter-hand-width variations ranged from 61% to 73% BW (Dhahbi
et al., 2017a; Ebben et al., 2011; Gouvali & Boudolos, 2005; San Juan et al., 2015; Suprak
et al., 2011) for F0 and from 35% to 39% BW for F0ʹ (An et al., 1992, 1990; Chou et al.,
2001, 2008; Donkers et al., 1993; Lou et al., 2001). These outcomes are similar to those
for the standard push-up within the same study (Donkers et al., 1993; Gouvali &
Boudolos, 2005) (see Table 4). It has been demonstrated that bearing a heavy weight
on a hyper-extended wrist (HW) can cause early development of wrist pain and
associated carpal tunnel syndrome (Gellman, Sie, & Waters, 1988). Polovinets et al.
(2017) compared in vivo GRF load vectors during a neutral wrist (NW) push-up with
those for push-ups performed on an HW. The main finding of his study showed that
when push-ups are performed with the wrist and forearm in neutral positions, forces
are transferred through the volar wrist and onto the broad articular surface of the distal
radius through the radioscaphoid and radiolunate joints, therefore with less joint stress.
Finally, Polovinets et al. (2017) recommended performing push-ups on an NW to
prevent wrist ligament injury or pain.

Pf
The narrower hand position exhibited lower PF or axial elbow-joint force compared to the
wider hand position (Donkers et al., 1993; Gouvali & Boudolos, 2005). The study of
Chuckpaiwong and Harnroongroj (2009) revealed that a wider hand position generates a
higher peak pressure on the medial side of the palm, whereas a narrower hand position
induces a higher peak pressure on the lateral side of the palm. Therefore, a wider hand position
may be the best choice when performing push-ups to prevent hypothenar pain, while a
narrower hand position may be appropriate to prevent thenar or lunate pain (Table 5).

PFM
The together variants are more stressful at the level of the elbow joint (with values
higher than 27 Nm), whereas the apart (Donkers et al., 1993) variant produces the
lowest intensity (12.11 Nm). Donkers et al. (1993) showed that a considerably greater
reduction in flexion torque resulted from hands being apart, while there was an increase
in the PFM in the apart position when initiating the set of push-ups. Greater PFM
torque existed throughout the cycle with hands together compared with the standard
hand position.
30 W. DHAHBI ET AL.

Depth/range of motion (‘posterior/inferior’ variation, ‘superior/anterior’

variation, internally rotated hand position and externally rotated hand position)
F0ʹ
Lou et al. (2001) evaluated the elbow-joint forces during push-up exercises at
various forearm rotations. These authors revealed that push-ups involving an
internally rotated position should be avoided, in order to prevent excessive shear
forces. Lou et al. (2001) also found that the externally rotated hand position and
standard push-up position had significantly greater (although small) initial (up)
axial force than the internally rotated position. Donkers et al. (1993) investigated
the effects of five push-up variations (i.e. standard, apart, together, superior and
inferior) on elbow-joint loading (Table 4).

PF’
The fast, apart, together, superior and inferior push-up variants displayed similar
values. Moreover, these are the push-ups with the most intense peak axial force on
the elbow (PF’ > 43% BW), in comparison with other variants, such as internal
position, external position and slow, where the force was lower (Table 5). Donkers
et al. (1993) found that the maximum axial force decreased from the value for the
standard position (45% BW) when hands were apart or superior, to 42.7% BW and
41.9% BW respectively. Lou et al. (2001) found that the standard position resulted
in significantly greater forces than the internal and external variants. In general, the
posterior/inferior variation imposed greater forces than the superior/anterior varia-
tion, and also greater forces than the standard push-up. Furthermore, the external
position resulted in greater forces than the internal position, though they were
similar to the standard push-up forces (Table 5).

Pfm
Significant differences in elbow-joint torques have been observed in studies for
push-ups with varying hand positions. Donkers et al. (1993) found that the
maximum valgus torque was significantly greater in a superior-hand-position
push-up compared to the standard push-up. The principal findings of Lou et al.
(2001) concern the frontal plane, with the valgus moment of the up-position event
(i.e. extended elbow joint) during the standard push-up being greater than in the
internal and external push-up variations. In addition, on the sagittal plane, the
PFM of the up-position event was greatest in the internal position. Therefore, it
would be logical to avoid a 90° internal rotation hand position in order to
minimise mechanical stress on the elbow joint. Morrey, Tanaka, and An (1991)
reported that the medial-collateral ligament is the major constraint for the elbow
joint in resisting valgus stress, while the lateral-collateral ligament helps the elbow
joint resist varus stress. These increases in joint loading increase the risk of injury
to the medial and lateral stabilising structures of the elbow, putting the medial-
collateral ligament, lateral-collateral ligament and flexor-pronator muscle group at
potential risk of injury.
 SPORTS BIOMECHANICS 31

Hands- or feet-elevated push-ups

F0
The elevated-hands exercise, as used by Ebben et al. (2011), involving the 61-cm box, is
similar to the exercise described by Gulmez (2016). Ebben et al. (2011) showed that, for
this position, where the elbows were in extension, the performer had an exercise load of
41% BW. The exercise load analysed by Gulmez (2016) for the same position was found
to be 23% BW higher than that established by Ebben et al. (2011). This could be due to
the unstable surface for TRX push-ups. Indeed, the values reported by Ebben et al.
(2011) (relative loads of 64% BW and 49% BW for standard and kneeling push-ups
respectively) were close to previous values (Gouvali & Boudolos, 2005; Mier et al., 2014;
Suprak et al., 2011) observed for a static push-up position (Table 4).

Pf
Ebben et al. (2011) assessed the PF of push-up variations, including the standard push-up
and those performed with a flexed knee, with feet elevated on a 30.48-cm box and a 60.96-
cm box and with hands elevated on a 30.48-cm box and a 60.96-cm box. The main
outcomes of this study proved that push-ups with the feet elevated produced a higher PF
than all other push-up variations (Ebben et al., 2011). Furthermore, push-ups with hands
elevated and push-ups from the flexed-knee position produced a lower PF than all other
push-up variations, with no sex-related differences in these push-up variations (Ebben
et al., 2011) (Table 5).

Plyometric push-ups
Pf
Dhahbi et al., (2017a) examined differences between GRF-based parameters collected
from five types of plyometric push-up: standard countermovement push-up, standard
squat push-up, kneeling countermovement push-up, kneeling squat push-up and ‘drop-
fall’ push-up. They revealed that the PF during take-off was higher for standard
countermovement push-ups compared to drop-fall push-ups, while the latter resulted
in a higher PF than other exercises. These findings are in agreement with the findings of
Garcia-Masso et al. (2011), who showed that PF during take-off of the countermove-
ment push-up was higher than in the ‘fall’ push-up. This difference in PF may be due to
the absence of a concentric phase during the descending movement. This suggests that
the PFs of the performed countermovement push-up exercises are achieved at the start
of the concentric phase of the propulsive phase. However, to confirm this hypothesis,
future studies will have to use synchronised kinematic and kinetic analyses to dissociate
concentric/eccentric contraction during the propulsion phase (Dhahbi et al., 2017a).
Based on the study by Koch et al. (2012), the clap and box-drop push-ups from 3.8 cm
(box-drop push-ups1), 7.6 cm (box-drop push-ups2) and 11.4 cm (box-drop push-
ups3) variants are more intense compared to the other analysed push-up variations.
Push-ups from kneeling positions and with elevated hands were less intense compared
to the other analysed push-up variations (Table 5). Moore et al. (2012) examined the
kinetic data related to box-drop push-ups1, box-drop push-ups2, box-drop push-ups3
and clap push-ups. The PF was significantly greater for the clap push-ups than for all
32 W. DHAHBI ET AL.

other variations (Garcia-Masso et al., 2011). However,Hinshaw et al. (2018) quantified

the changes in peak force, peak power and peak velocity for a modified plyometric
push-up on the knees and for plyometric push-ups with or without external loading
(5% or 10% of BW) in physically active young adults. The main finding of his study
revealed that the peak force and the force at peak velocity were higher for the push-up
without external loading compared to the two types of push-ups with external loading.
The same authors (Hinshaw et al., 2018) suggested that push-ups without external
loading may be more beneficial when a high movement speed is desirable and push-ups
with external loading may be preferable when greater force production is required. The
latter results were also supported by Wang et al. (2017), who investigated ground
reaction force patterns during ballistic push-ups (i.e. countermovement push-ups) in
60 recreationally active men, and found peak forces ranging from 120% to 121% BW.
It is not surprising that the forces associated with plyometric push-ups were lower
than for plyometric exercises involving the lower limbs, since the latter involves the
entire BW, while the upper-limbs only support part of the BW. The plyometric push-
ups impose a load of about three-quarters of the BW (Dhahbi et al., 2017a; Koch et al.,
2012). Thus, it is imperative that strength and conditioning coaches understand that the
PF in relation to the musculoskeletal system of each upper extremity was 0.7 times that
of the BW (a total of 1.4 times that of the BW across both extremities) (Dhahbi et al.,
2017a; Koch et al., 2012). This finding can be used when calculating the total loading
athletes have to withstand during a workout, in order to ensure sufficient stimulus for
adaptation while avoiding overloading risk (Dhahbi et al., 2017a; Koch et al., 2012).

Impact force
The studies conducted by Lo, McCabe, DeGoede, Okuizumi, and Ashton-Miller
(2003) and Garcia-Masso et al. (2011) indicate impact-force values of approximately
700 N (i.e. 100% BW) when performing plyometric push-ups. Dhahbi et al. (2017a)
revealed that the Impact force was higher in standard countermovement push-ups
and standard squat push-ups, compared to the other exercises. For standard counter-
movement push-up and standard squat push-up positions, the unsupported body
mass is greater, therefore the resulting force application is greater. Moreover, the
impact-force values ranged from 136% to 192% BW for all exercises. Several authors
(Garcia-Masso et al., 2011; Koch et al., 2012; Moore et al., 2012; Schulte-Edelmann
et al., 2005) demonstrated that the Impact force was influenced not only by the
height of fall but also by the neuromuscular strategy applied during the landing
phase. To this extent, it seems that the impact-force intensities must be taken into
consideration because they are influential and could be adapted to any situation in
order to increase or avoid overload. So far, the jump push-up and fall push-up
exercises are not considered inadvisable for young people. Therefore, young people
can use these two push-up variants to achieve greater training-related intensity.
Compared to other plyometric push-up exercises, the fall push-up exercises may
have a greater effect on the musculoskeletal and nervous systems (i.e. the upper-limb
adaptation to the fall and the damping reflex on impact) (Garcia-Masso et al., 2011).
Therefore, this form of exercise should be used with individuals who possess greater
physical fitness. Alternatively, for participants who aim to develop power through a
plyometric method without undergoing a large Impact force, the drop-fall push-up is
 SPORTS BIOMECHANICS 33

recommended. During these stages, lower-intensity loads should be applied with the
purpose of adequately preparing the musculoskeletal system for subsequent stress
(Garcia-Masso et al., 2011). Koch et al. (2012) highlighted an observed asymmetry
between the upper-limbs while performing push-ups. During the impact, the dominant
limb undergoes/produces the highest Impact forces. Future research could reveal the
underlying aetiology of this asymmetry.
Following the law of free fall, a fall from a greater height would result in greater
impact forces. In addition, the Impact forces are absorbed by the passive structures of
the musculoskeletal system (Chou et al., 2001; Kim & Ashton-Miller, 2003), which may
lead to osteogenic adaptations or potential injury (Burgess, Connick, Graham-Smith, &
Pearson, 2007; Daly, Rich, Klein, & Bass, 1999; Ebben, Fauth, Kaufmann, & Petushek,
2010). The results obtained by Moore et al. (2012) confirm the importance of quantify-
ing Impact forces while carrying out plyometric exercises involving the upper-limbs. It
is noteworthy that an impact-force intensity equal to twice that of the BW would be
considered low for lower-extremity plyometric activities, whereas for the upper-limbs
the same intensity could be considered medium to high (Nigg, Cole, & Brüggemann,
1995; Santos-Rocha, Veloso, & Machado, 2009).

The rate of force development (RFD)

To our knowledge, only five studies (Dhahbi et al., 2017a; Garcia-Masso et al., 2011;
Hogarth et al., 2013; Hrysomallis & Kidgell, 2001; Koch et al., 2012) have investigated
the RFD in the kinetic analysis of push-ups. Hogarth et al. (2013) examined the test–
retest reliability of GRF-based parameters collected from standard countermovement
push-ups. Hrysomallis and Kidgell (2001) used the positive maximum RFD, derived
from an explosive push-up, as a power index of the upper-limbs (Table 6). Dhahbi et al.
(2017a) similarly found that the propulsion RFD values are larger in countermovement
push-up exercises at 2.28 BW/s, compared to squat push-up exercises at 0.57 BW/s. In
addition, Wang et al. (2017) also examined the propulsion RFD of ballistic push-ups
and reported values of 5.89–5.99 BW/s. The authors (Dhahbi et al., 2017a; Wang et al.,
2017) explained these results by noting that the technique of the countermovement
push-up uses the stretch-shortening cycle to store and release elastic energy, which may
produce a force more quickly (Duchateau & Baudry, 2014; Earp et al., 2011) rather than
just using a concentric-type muscle contraction (e.g. squat push-ups). Meanwhile, as no
significant differences were found between all exercises for the RFD of impact, these
findings disagree with the results of Garcia-Masso et al. (2011), who found that the RFD
of impact was larger in fall push-ups than in jump push-ups. They (Dhahbi et al.,
2017a) attributed this observation to altered landing strategies adopted by the partici-
pants (Koch et al., 2012). Koch et al. (2012) compared the RFD of impact between the
dominant and non-dominant upper-limb in four plyometric push-up variations (clap
push-up, 3.8-cm box-drop push-up, 7.6-cm box-drop push-up and 11.4-cm box-drop
push-up). These authors reported a higher RFD of impact in the dominant limb than in
the non-dominant limb in all four push-up variations. Furthermore, for both limbs, the
clap RFD of impact was significantly greater than that for box-drop push-ups1, box-
drop push-ups2 and box-drop push-ups3. The clap form of push-ups demonstrated the
highest RFD of impact, indicating that force is applied more quickly than inbox-drop
push-ups1, box-drop push-ups2 and box-drop push-ups3, with little difference
34 W. DHAHBI ET AL.

Table 6. Push-up rate of ground reaction forces expressed as a coefficient of total body mass ground
reaction force per second.
Rate of impact force (BW/s) Propulsion rate force (BW/s)
Fall push-ups (Garcia-Masso et al., 2011) 27.79 ± 3.08 1.80 ± 0.10
Jump push-ups (Garcia-Masso et al., 2011) 16.82 ± 1.79 1.53 ± 0.14
Countermovement push-ups (Garcia-Masso et al., 2011) - 2.08 ± 0.13
Clap push-up (Koch et al., 2012) 7.26 ± 0.20* -3.32 ± 0.14*
3.8cm box-drop push-up (Koch et al., 2012) 4.22 ± 0.24* -2.87 ± 0.12*
7.6cm box-drop push-up (Koch et al., 2012) 4.92 ± 0.28* -2.99 ± 0.11*
11.4cm box-drop push-up (Koch et al., 2012) 6.27 ± 0.42* -2.87 ± 0.12*
Explosive push-up (Hrysomallis & Kidgell, 2001) - 5.88 ± 1.23
Standard countermovement push-up (Wang et al., 2017) - 5.99 ± 2.35
Standard countermovement push-up (Dhahbi et al. 2017a) 48.51 ± 38.72 2.28 ± 0.84
Standard countermovement push-up (Hogarth et al., 2013) - 7.65 ± 2.23
Standard squat push-up (Dhahbi et al. 2017a) 57.37 ± 66.79 0.57 ± 0.59
Kneeling countermovement push-up (Dhahbi et al. 2017a) 36.46 ± 26.33 1.55 ± 0.59
Kneelingsquat push-up (Dhahbi et al. 2017a) 39.45 ± 32.27 0.32 ± 0.16
Drop-fall push-up (Dhahbi et al. 2017a) 41.47 ± 32.54 3.02 ± 1.50
*Dominant limb; BW = body weight

observed between the PFs in these push-ups. Based on the significantly higher propul-
sion RFD, it appears that the clap push-up is the most intense form of push-up.
Furthermore, Koch et al. (2012) recommended that the increase in the height of box-
drop push-ups is an adequate stimulus for progressively increasing exercise demands.

Suspended push-ups
F0
The study by Gulmez (Gulmez, 2016) determined and compared the loads at four
different angles during TRX push-ups (which consist of push-ups holding TRX straps
which hang vertically). This research revealed that by decreasing the TRX angle and/or
when the elbows were in flexion, the elbow loading steadily increased. Gulmez (2016)
further reported that when the TRX angle was set at 0° and the elbows were extended,
50.4% BW was recorded. However, when the elbows were at maximum flexion, 75.3%
BW was supported on the straps. There was a more than four-fold increase in the
loading on the upper extremities when the TRX angle was changed from 45° to 0°.
These results agree with a recent study (Giancotti et al., 2018) which showed that when
the length of the TRX device increased, the body inclination decreased, while the
ground reaction force at the feet decreased and the load supported by the arms
increased. Moreover, when the participant moved from extension to flexion of the
elbow, the load on the TRX device increased. Based on this finding, the TRX angle may
be reduced to facilitate progression of training intensity. Furthermore, the instability of
the TRX push-up must also be taken into account as a factor affecting the relative load
at various angles.

Vertebral-joint compressive forces/loads

The proper performance of push-ups requires the performer to maintain a static and
standard lumbar spine posture while maintaining a balance of musculoskeletal and joint
systems against the force of gravity (Beach et al., 2008). The osteoligamentous struc-
tures of the spine are less resistant to bending movements from the standard back
 SPORTS BIOMECHANICS 35

posture (Panjabi, 1992). McGill et al. (2014) and Beach et al. (2008) kinetically analysed
the differences between stable and suspended push-up exercises, evaluating the spine
compressive loads. They showed (Beach et al., 2008; McGill et al., 2014) that there were
different levels of spine load for each push-up variation. In addition, there was greater
muscle activity associated with labile surface exercises to maintain the correct position
of the body compared to exercises on stable surfaces (Beach et al., 2008). However,
suspended push-ups resulted in more intense spine loads than push-ups on a stable
surface (Beach et al., 2008). Therefore, the decision to use suspended push-ups should
take into consideration the history of spine injury, training targets and the fitness level
of the performer (Beach et al., 2008; McGill et al., 2014). Labile push-ups elicit
significantly greater L4/L5 compression (Beach et al., 2008; McGill et al., 2014). All
pushing exercises analysed in the study by McGill et al. (2014) produced spine com-
pressions of less than 2 kN. On the other hand, in the study of Beach et al. (2008), some
suspended push-up variations (e.g. TRX) produced peak L4/L5 intervertebral-joint
compressive force loads of around 3.4 kN, exceeding the reference limit value estab-
lished by the National Institute of Occupational Safety and Health (NIOSH, 1981). The
NIOSH limit value was fixed to ensure the safety of the spine. Another study (Genaidy,
Waly, Khalil, & Hidalgo, 1993) suggested that the spine osteoligamentous structures of
boys can resist compressive loads of more than 17 kN without any injury risk.

Limitations
The first limitation of the current review is the fact that we were unable to evaluate the
reliability, validity and sensitivity of each kinetic parameter used in the included studies.
In addition, some studies tended to calculate the mechanical power outputs of explosive
push-ups, and their results (Hinshaw et al., 2018; Speranza et al., 2018; Wang et al.,
2017) should be regarded with caution, as the calculation methods used to find
mechanical power outputs are open to criticism (Dhahbi, Chaouachi, Cochrane,
Chèze, and Chamari 2017b; Wang et al., 2017). Thus, assessing the validity of the
method of estimating power output when performing push-ups, remains a point in
need of future attention.

Conclusions
In the current review, specific kinetic details are gathered for each push-up variation.
Based on the reviewed studies, the F0 with the elbows flexed is significantly greater (8–
20% BW) than that with the elbows extended. The load supported by one limb ranged
from 6% BW for prayer push-ups to 60% BW for one-arm push-ups. Regarding the PF
parameter, the clap push-up imposed the highest exercise intensity. Plyometric push-
ups achieved a higher propulsion rate force without causing very high impact forces (i.e.
they did not exceed forces of twice the body weight). Fast push-ups and push-ups with
the shoulder adducted resulted in the highest peak elbow flexion moments. Suspended
push-ups resulted in the highest vertebral-joint compressive forces. Except for sus-
pended push-up variations, the lateral and medial elbow-joint force, the peak force and
rate of impact force are greater on the dominant limb than on the non-dominant limb.
Moreover, outcomes on the effects of sex on push-up kinetic parameters are conflicting.
36 W. DHAHBI ET AL.

The push-ups with less wrist and elbow-joint stress are the ones that adopt a neutral
hand position.
The kinetic data detailed in this review for the various push-up exercises could be
used to individualise training load as a percentage of BW in an upper-body resistance-
training programme (Dhahbi et al., 2017a). The current review showed that the
intensity of push-up exercises can be adjusted by altering the starting position (e.g.
feet or knees, hand position, feet and/or hand height) and by altering the execution
speed, the surface type and the ROM. It is imperative to determine the client’s or
athlete’s fitness level, the goals of the training and the appropriate training load
stimulus, in order to select the appropriate push-up exercise.

Acknowledgements
The authors wish to express their sincere gratitude to Dr Del Wong, Prof Laurence Chèze and
Mr Yossef Labidi for their advice and cooperation.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial
or not-for-profit sectors.

ORCID
Johnny Padulo http://orcid.org/0000-0002-4254-3105

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