Why Do My Wrists Hurt When I Do Push-Ups? A Surgeon Explains

Nothing else in an ordinary workout asks the wrist to do what a push-up does. The hand is flat on the floor, the wrist is bent back as far as it will go, and most of your body weight is stacked on top of it — and then it moves. Planks, burpees, yoga flows through downward dog and the bottom of a bench press ask for something similar. So it is not surprising that the wrist is often the first thing to complain, long before the chest or the arms have had enough.

Most of the time that complaint is about position and load, and it eases when the hand position changes. But the same exercises are also the ones that expose a wrist problem that was already there — a ligament that is not holding, a piece of cartilage that has torn, a cyst on the back of the wrist, or a fracture from a fall that was written off as a sprain. The difference matters, because one gets better with an adjustment and the other does not.

Robert W. Wysocki, MD, a hand, wrist and elbow surgeon at Midwest Orthopaedics at Rush, explains why push-ups load the wrist the way they do, the signs that separate a form problem from a structural one, the conditions a hand specialist is thinking about when someone describes pain with push-ups or twisting, and when it is time to have the wrist examined.

Why Push-Ups Load the Wrist the Way They Do

The wrist is not a single hinge. It is a joint between the two forearm bones and eight small carpal bones arranged in two rows, held together by a dense web of ligaments and cushioned on the pinky side by a disc of cartilage. That arrangement gives the hand a remarkable range of motion, and it relies on ligaments — not bony shape — for its stability.

In a push-up, the wrist is pushed to the end of that range in one direction, extension, and held there. At the limit of extension, the back of the wrist joint is compressed and the front is stretched, and the load runs through the heels of the hands into the carpal bones rather than through the length of the forearm as it does when you hold a dumbbell. Any wrist that is short on extension — from stiffness, a previous injury or simply never having been asked to bend that far under load — will feel it at the back of the joint, usually in both wrists, usually at the top or bottom of the movement, and usually with relief as soon as the set ends.

That is the ordinary story, and it is the one behind most of the advice about hand position, push-up handles and building up gradually. It is the one to suspect when the pain is symmetric, has no clear starting event, and improves when the wrist is asked to bend a little less.

Is It Your Form or Your Wrist?

The wrist that hurts because of position behaves in a recognizable way. The wrist that hurts because something inside it is injured behaves differently, and the differences are what a surgeon listens for.

Pain in one wrist only, when both are doing the same push-up, points away from position and toward that wrist. Pain that started with a fall onto the hand, a hard twist, or a specific rep that "went" is a mechanical injury until proven otherwise. A click, pop or clunk that comes with pain — especially one you can feel under load or when you push up out of a chair — suggests a ligament or the cartilage disc rather than a stiff capsule. A lump on the back of the wrist that appears or grows with activity and shrinks with rest is a cyst. Pain that is pinpoint — you can put a fingertip on it — is more often a specific structure than a general overload. And pain that persists at rest, wakes you at night, or has lasted more than a few weeks despite changing how you do the exercise is no longer a form problem, whatever it started as.

Where on the wrist the pain sits is the other clue, and it organizes everything that follows. The back of the wrist in the middle, the pinky side, and the thumb side each have their own usual suspects.

Pain at the Back of the Wrist at the Top of a Push-Up: Dorsal Wrist Impingement

A common structural pattern in people who load the wrist in extension — push-ups, planks, handstands, gymnastics, yoga — is pain at the back of the wrist, in the middle, that appears at the very top of the extension and is gone as soon as the wrist comes out of it. The joint has a lining, called the capsule, and at the extreme of extension the fold of capsule at the back of the wrist can be pinched between the wrist bones. Repeated pinching leaves it thickened and inflamed, and after that push-ups tend to catch the same spot. Hand surgeons describe this as dorsal wrist impingement.

It tends to be tender at one point on the back of the wrist, roughly in line with the middle finger, and it is provoked by pushing the wrist into full extension under load — the push-up position exactly. It is often what people mean when they describe wrist pain when bending back, and it is the condition most easily confused with an ordinary positional ache, because it is one. The difference is that it does not settle with a few weeks of adjustment, and it can travel with a small ganglion cyst at the same spot.

A Bump on the Back of the Wrist: Ganglion Cyst

A ganglion cyst is the most common lump in the hand and wrist. It grows out of a joint or tendon sheath like a balloon on a stalk, filled with the same thick fluid that lubricates the joint, and the back of the wrist is its favorite place. It is not cancerous and in most cases is harmless. Many people notice it only as a bump that changes size — larger with activity, smaller with rest — which is why it is often noticed by someone who has recently taken up push-ups or yoga.

Many ganglion cysts cause no symptoms beyond the lump. Activity can make a cyst larger and put pressure on the structures around it, which is when it hurts; if a cyst presses on a nerve crossing the joint it can cause pain, tingling or weakness. A cyst can also be too small to see or feel and still cause pain at the back of the wrist — a hidden, or occult, ganglion is one of the things a surgeon considers when someone has dorsal wrist pain with push-ups and nothing visible to explain it. Ganglion cysts are common in people between 15 and 40, more common in women, and common among gymnasts, who load the wrist the same way.

Pain on the Pinky Side With Twisting and Weight-Bearing: TFCC Tear

On the pinky side of the wrist, between the end of the ulna and the small wrist bones, sits a disc of cartilage and ligaments called the triangular fibrocartilage complex, or TFCC. It cushions the joint and stabilizes the wrist during gripping and rotation. A TFCC tear can follow a fall on an outstretched hand, a twisting injury or a direct blow, or can develop over time from repetitive rotation and heavy lifting, particularly in people whose ulna is slightly longer than their radius. It is a familiar injury in tennis, golf and gymnastics.

The pattern is ulnar-sided wrist pain — the pinky side — that is worst with twisting and with weight-bearing on the wrist. Push-ups qualify on both counts: the wrist bears weight, and the turned-out hand position many people use to spare the back of the wrist adds a twist. There is often swelling and tenderness over the pinky side of the wrist, a clicking, popping or grinding sensation with rotation, and a sense that the wrist is weak or will not hold. Turning a doorknob, wringing a towel and pushing up from a chair are the everyday equivalents.

Pain on the Thumb Side After a Fall, With a Click: Scapholunate Ligament Injury

Between the thumb side and the center of the wrist, two of the most important carpal bones — the scaphoid and the lunate — are held together by a short, strong ligament called the scapholunate ligament. It keeps those two bones moving as a unit. A fall onto the outstretched hand is the classic way to injure it, though repetitive strain in athletes and manual workers and gradual wear can weaken it as well. A scapholunate ligament injury ranges from a mild sprain to a complete tear, and a complete tear lets the two bones drift apart.

What people notice is pain and swelling on the thumb side of the wrist, difficulty gripping or lifting, a clicking, popping or snapping sensation with wrist movement, weakness or a feeling of instability, and reduced motion. In a push-up the wrist is loaded exactly where those two bones meet, so this is the injury that turns a set of push-ups from uncomfortable to impossible — and the one that most often carries the story of a fall a few weeks earlier that "seemed like a sprain." It matters because an untreated scapholunate injury can progress to a pattern of arthritis in the wrist known as scapholunate advanced collapse, and the longer a complete tear goes untreated, the more the choice shifts from repairing the ligament toward salvaging the joint.

The Fall You Shrugged Off: Wrist Sprain or Hidden Scaphoid Fracture

Not every wrist injured in a fall has torn its scapholunate ligament, but every wrist injured in a fall that still hurts with push-ups deserves a closer look. A wrist sprain — a stretched or partly torn ligament — is the most common result of a fall onto the outstretched hand. It is painful, swollen, bruised and tender to touch, sometimes with a feeling of popping or tearing at the moment of injury. Mild sprains are typically managed at first with rest, ice, compression and elevation; pain and swelling that persist beyond about two days are the reason to be examined, because a wrist injury that looks mild can still involve a torn ligament.

The other reason is the scaphoid. A scaphoid fracture — a break in the small boat-shaped bone on the thumb side of the wrist — happens in the same fall, is often mistaken for a sprain because the pain can be modest and the wrist is not deformed, and does not always show on the first X-ray. Its signature is tenderness in the hollow at the base of the thumb, the "anatomic snuffbox," with pain that is worse on pinching, grasping, pushing and pulling. Because part of the scaphoid has a poor blood supply, a fracture that goes unrecognized can fail to heal or lead to the bone losing its blood supply altogether, which is why surgeons take wrist pain that has not settled within a day or two of a fall seriously, and why a splint and a repeat X-ray a couple of weeks later are sometimes the right answer to a normal first film. A more obvious break at the end of the forearm bone, a distal radius fracture, is the other fall injury in this group; treatment of a distal radius fracture depends on how the bone has broken and shifted.

Two Less Common Causes Worth Knowing

Two conditions are rarer but belong on the list because push-ups bring them out. Kienböck's disease is a loss of blood supply to the lunate, the carpal bone at the center of the wrist. Its cause is not known, but one recognized contributor is a difference in length between the two forearm bones, which puts extra pressure on the lunate when the wrist is loaded — the AAOS names doing a push-up as an example. It produces pain, swelling, stiffness, weakened grip and tenderness directly over the middle of the back of the wrist, and it progresses slowly enough that many people assume they have a sprain that will not heal.

The other is wrist arthritis. Worn cartilage in the wrist joint — from age, from a long-ago fracture or ligament injury, or from an inflammatory condition — hurts with weight-bearing and extremes of motion, and a push-up delivers both. Stiffness and swelling that are present in the morning and not just during exercise, and a wrist that has been getting gradually less mobile for years, point this way rather than toward a recent injury.

Push-Up Wrist Pain Side by Side

What the Clicking or Popping Means

Wrist popping is a common worry, and most of it is nothing. Tendons slipping over bone, a joint releasing gas, a wrist that has always clicked on rotation without pain — none of these need a surgeon. The clicks that do are the ones that come with pain, that appeared after an injury, that are felt as a clunk under load rather than a pop with free movement, or that are accompanied by a sense that the wrist is giving way. A painful clunk on the thumb side suggests the scapholunate ligament; a painful click on the pinky side with rotation suggests the TFCC; a catch at the back of the wrist at full extension suggests impingement. A surgeon will want to reproduce the click in the office, because where and when it happens is most of the diagnosis.

What People Commonly Try First

For push-up wrist pain that is symmetric, gradual and without a story, the measures a hand surgeon or hand therapist usually suggests first are about taking the wrist out of the extreme of extension and reducing the load until it has adapted. Push-up handles, dumbbells held as handles, or fists keep the wrist closer to neutral so the joint is not compressed at its limit. Raising the hands onto a bench or step reduces the share of body weight the wrists carry. Turning the hands slightly outward changes the angle at which the load meets the joint, though it adds a twist that a pinky-side wrist may not like. Reducing volume for a few weeks and building back gradually gives a stiff capsule time to settle. A therapist can assess how much extension the wrist actually has and, if it is limited, work on that directly — which is a better route than stretching aggressively into a joint that is already inflamed.

For pain that is more than positional, the same measures may make the exercise tolerable without addressing the cause, and that is the trap: a handle that takes the pressure off a ganglion or a torn TFCC does not treat either. For a wrist that has simply been overloaded, a surgeon or therapist may suggest a short period away from weight-bearing, a brace or splint that limits extension, and ice after activity, and may discuss over-the-counter anti-inflammatory medication if it is appropriate for your health history. Pain that outlasts that period, or that came from a fall in the first place, is the signal to stop adjusting and get examined.

When to See a Hand Specialist

Push-up wrist pain that eases when the hand position changes and disappears between sessions rarely needs an appointment. The following patterns do:

• Pain in one wrist that does not match the other, with the same exercise
• Any wrist pain that began with a fall, a twist or a specific rep, especially if it has not settled within a day or two
• Tenderness in the hollow at the base of the thumb after a fall, even if an X-ray was normal
• A click, pop or clunk that comes with pain, or a wrist that feels unstable or gives way
• A lump on the back of the wrist, or one that is growing, painful or affecting motion
• Swelling that persists, or pain at rest or at night
• Numbness, tingling or weakness in the hand
• Pain that has lasted more than a few weeks despite changing hand position and reducing load

Injuries are the ones a surgeon most wants to see early. A ligament that has torn, or a scaphoid that has broken, has a window in which repair is straightforward and a longer period in which it is not.

How a Specialist Finds the Cause

The examination starts with the story: which wrist, where exactly, what movements bring it on, whether there was a fall, how long it has been going on, what the wrist is asked to do in training and at work. The surgeon then locates the tenderness precisely — the back of the wrist in line with the middle finger, the pinky side over the TFCC, the thumb side over the scapholunate interval or in the snuffbox — and checks motion, grip and the wrist's stability. Provocative tests are part of it: pushing the wrist into loaded extension to reproduce impingement, loading and rotating the pinky side to test the TFCC, and shifting the scaphoid under the surgeon's thumb to feel for the clunk of a scapholunate injury. A lump is examined and, if it is a cyst, a light shone through it will usually confirm that it is filled with fluid.

X-rays are usually next. They show a fracture, a gap or misalignment between the scaphoid and lunate that gives away a ligament injury, the relative lengths of the forearm bones, and the changes of arthritis or Kienböck's disease. They do not show ligaments, cartilage or cysts directly, so when the picture is still unclear the surgeon may order an MRI — sometimes with dye injected into the joint first, an arthrogram, so the ligaments and the TFCC show up more clearly — or an ultrasound for a suspected hidden ganglion, or a CT scan for the bones. When the cause of wrist pain is still uncertain after examination and imaging, or when pain continues for months despite nonsurgical treatment, wrist arthroscopy — a camera the width of a pencil placed into the joint through a small incision — lets the surgeon look directly at the ligaments, cartilage and lining, and often treat what is found in the same procedure.

Treatment follows the diagnosis. Positional overload and mild impingement are usually managed with activity changes, a period of reduced or modified loading, and therapy. A ganglion that is not troublesome can be left alone — more than half disappear on their own — and one that hurts can be drained with a needle or removed, with the understanding that cysts often return. A TFCC tear is often treated first with a splint, activity modification and therapy, and with arthroscopic repair or debridement if it does not settle. A scapholunate injury is treated according to its severity and how long it has been present, from splinting for a partial injury to ligament repair or reconstruction for a complete one. A sprain is rested and splinted; a scaphoid fracture is casted or, depending on its location and displacement, fixed with a screw. Which of these applies, and whether any procedure is warranted, is a decision made with the surgeon after the examination and imaging.

Frequently Asked Questions

Is it normal for wrists to hurt during push-ups?

Some aching at the back of both wrists is common when the wrist is new to being loaded in full extension, and it usually improves as the wrist adapts and the hand position is adjusted. Pain that is one-sided, sharp, pinpoint, accompanied by clicking or a lump, or that began with a fall is not the normal version and should be examined.

Why does my wrist hurt when I bend it back?

The back of the wrist is compressed at the limit of extension. In a wrist that is stiff, that is a diffuse ache; in a wrist with dorsal impingement, a ganglion cyst, arthritis or Kienböck's disease, it is a more specific pain at a specific spot. Bending the wrist back is also the position that loads an injured scapholunate ligament, so pain on the thumb side with extension after a fall points there.

Do push-up bars fix wrist pain?

They reduce how far the wrist has to extend, which relieves positional pain and takes pressure off the back of the joint. They do not treat a torn ligament, a TFCC injury or a cyst; they can make those tolerable enough to keep training on, which delays the diagnosis. If handles resolve the pain completely, position was probably the problem. If pain persists on one side, or with twisting, it was probably not.

Should I keep doing push-ups with wrist pain?

Pain that is mild, symmetric and improving with adjustment can usually be trained around by reducing load and extension. Pain in one wrist, pain after an injury, pain with a click or clunk, or pain that is getting worse is a reason to stop loading the wrist and have it examined before continuing.

Can a TFCC tear heal on its own?

Some TFCC tears settle with a period of splinting, activity modification and therapy. Tears that do not respond, or that are severe enough to leave the wrist unstable, are treated surgically, usually arthroscopically. An examination and imaging are how a surgeon tells which is which.

Why does my wrist click when I do push-ups?

A painless click that has always been there is usually a tendon or joint noise and not a concern. A click that hurts, that started after an injury, or that feels like a clunk under load points to the scapholunate ligament on the thumb side or the TFCC on the pinky side, and is worth an evaluation.

Wrist pain that shows up in push-ups, planks and yoga is often the wrist telling you it has run out of extension under load, and it usually answers to a change in hand position and a little patience. When it does not — when it is one-sided, follows a fall, clicks, or comes with a lump — it is telling you something more specific, and the hand and wrist specialists who see these injuries every week can usually name it after an examination and an X-ray. As with the thumb that hurts when gripping, the spot and the trigger do most of the work; the exam finishes it.

This article is for general information and is not a substitute for medical advice. Please consult a physician about your individual situation.

Header illustration: "3D Medical Animation Human Wrist" by Scientific Animations, via Wikimedia Commons, CC BY-SA 4.0.

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