How to prevent a push up fitness restriction Published March 28, 2016 By Mykenzie Garrett, student physical therapist 628th Medical Group JOINT BASE CHARLESTON, S.C. -- Having a fitness restriction is seen as a Scarlet Letter in the military. One of the most common complaints physical therapists receive from patients requiring a fitness restriction is wrist pain or clicking with pushups and burpees. The standard push up form can lead to injuries as it combines extreme wrist range of motion with heavy load and multiple repetitions. In order to decrease the likelihood of wrist injuries or level of pain if you already have some, here are a few tips about form and technique in order to prevent wrist pain with weight-bearing exercises: Proper Pushup Form 1. Keep your wrist in a neutral position by performing them with push up handle bars. The Fitness Test can be taken with wrist in the punch position. Train throughout the year with the handle bars and use the punch position for six weeks before your test to acclimate the body to the difference. 2. Wrist should be directly under your shoulders. Placing your hands wider, narrower, in front, or behind the shoulder will increase pressure on your wrists. 3. Your elbows should be back at an angle (around 45 degrees), and not flared out beside you, otherwise this can create uneven stress on your joints. Useful Tip for Burpees 1. If you're at the gym use lightweight hexagonal dumbbells or push up handles. This keeps your wrist in a neutral position and adds a little more weight for more of a challenge. No dumbbells? No problem. You can still utilize the knuckle pushup technique in the grass to decrease the stress on your wrists. In order to understand what causes wrist pain, it's important to understand the structure and function of the hand. Most of the movement occurs at the junction between the two forearm bones; the radius (thumb side), and ulna (pinky side) and the eight carpal bones structured in two rows. The stability of the wrist joint is made up of a complex configuration of ligaments that connects each of these bones to one another. These structures allow the wrist to point up, down, left, right and rotate. The ligaments that hold the bones together become stretched out like a rubber band when the wrist is locked in extension like in a standard push up. The body weight being applied through these stretched ligaments with pushups causes them to loosen over time leading to instability and pain. Whatever the status of your wrists--currently painful, in recovery or problem-free, it is important to utilize the tips above especially when push-ups and burpees are considered a way of life for the military. The body's way of sending up a red flag is pain; it's time to start listening.