I'm a 78kg male and I'm having difficulty performing normal push-ups, could I have a condition affecting my musculoskeletal or neurological systems that's preventing me from doing them?

Difficulty Performing Push-Ups: Assessment and Approach

Your difficulty with push-ups is most likely due to deconditioning, inadequate muscle strength, or improper technique rather than a specific medical condition affecting your ability to "remember" or "train" the movement. The body doesn't "forget" how to do exercises, but muscles do decondition rapidly without regular use, and motor patterns require consistent practice to maintain 1.

Understanding Exercise Intolerance and Muscle Function

Deconditioning is a primary cause of exercise intolerance and manifests as reduced muscle strength, endurance, and coordination 1. When muscles aren't regularly challenged, they lose both mass and functional capacity, which directly impacts your ability to perform exercises like push-ups 1.

Key Factors to Consider

• Muscle strength and mass are critical determinants of physical work capacity, and patients with reduced muscle mass experience loss of both endurance and strength 1
• Peripheral muscle dysfunction and deconditioning are increasingly recognized as important contributors to exercise limitation, even in otherwise healthy individuals 1
• Habitual physical activity level significantly influences exercise capacity, and sedentary individuals have substantially lower functional capacity than active ones 1

When to Seek Medical Evaluation

Before attributing your difficulty solely to deconditioning, certain red flags warrant medical assessment:

• Chest discomfort, dizziness, or shortness of breath during or after attempting push-ups suggests possible cardiovascular or pulmonary issues requiring evaluation 1
• Joint pain, swelling, or significant orthopedic limitations may indicate musculoskeletal pathology 1
• Neurological symptoms such as weakness, numbness, or coordination problems affecting one side of the body could indicate neurological conditions 1
• Unexplained fatigue or exercise intolerance that seems disproportionate to your activity level may warrant cardiopulmonary exercise testing 1

Specific Medical Conditions to Rule Out

While uncommon, certain conditions can affect push-up performance:

• Functional neurological disorders can present with limb weakness and altered movement patterns, though these typically involve more obvious neurological signs 1
• Acute nerve injuries from exercise are rare but documented; one case report describes median nerve neuritis from push-ups, though this presented with acute pain and numbness 2
• Cervical spine pathology in older individuals performing push-ups has been reported, though this is extremely rare and typically presents with neurological symptoms 3

Recommended Approach to Regaining Push-Up Ability

Start with a structured resistance training program following evidence-based guidelines rather than attempting full push-ups immediately 1, 4.

Progressive Training Protocol

• Training frequency: Exercise major muscle groups (chest, shoulders, triceps, core) 2-3 days per week with at least 48 hours rest between sessions 1, 4
• Initial intensity: For beginners or deconditioned individuals, start at 40-50% of your one-repetition maximum (1RM), which feels "very light to light" 1, 4
• Repetition range: Perform 10-15 repetitions per set initially 1, 4
• Sets: Begin with 1-2 sets per exercise, progressing to 2-4 sets as strength improves 1, 4
• Rest intervals: Allow 2-3 minutes between sets 1, 4

Exercise Progression Strategy

Begin with modified push-up variations and progressively increase difficulty 1:

1. Wall push-ups: Start in a standing position pushing against a wall (note: be cautious with the "plus" phase as it may increase shoulder impingement risk) 5
2. Incline push-ups: Use an elevated surface like a bench or countertop
3. Knee push-ups: Perform push-ups from your knees on the floor
4. Eccentric-only push-ups: Lower yourself slowly from a full plank position
5. Full push-ups: Progress to standard push-ups once you can perform 15-20 repetitions of the previous variation

Progressive Overload Principles

• Systematically increase resistance when you can perform 1-2 repetitions over your target number on two consecutive sessions 4
• Without progressive overload, strength gains plateau, so consistent advancement is essential 4
• Gradual progression by adjusting duration, frequency, or intensity enhances adherence and reduces injury risk 1

Important Caveats and Safety Considerations

• Musculoskeletal injuries are common with exercise, particularly with high-impact or improper technique; low-impact modifications reduce this risk 1
• Proper form is critical: Focus on controlled movement with good alignment rather than maximum repetitions 1
• Avoid breath-holding during push-ups, as this increases cardiovascular stress 1
• Stop immediately if you experience chest pain, severe shortness of breath, dizziness, or joint pain 1

Age and Risk Factor Considerations

At 78kg body weight, if you are a male over 45 years with diabetes or 2+ cardiovascular risk factors planning vigorous exercise, medical evaluation including an exercise stress test is recommended before beginning an intensive program 1. However, for low-to-moderate intensity progressive resistance training starting with modified push-ups, formal medical screening is generally not required unless you have symptoms 1.

Expected Timeline for Improvement

• Neuromuscular adaptations occur within 2-4 weeks of consistent training, improving coordination and motor control 4
• Measurable strength gains typically appear within 4-8 weeks of proper resistance training 1
• Functional capacity improvements continue with consistent training over 8-12 weeks 1

The key is consistent, progressive training rather than attempting full push-ups before your muscles are adequately prepared 1, 4. Your body hasn't "forgotten" how to do push-ups—it simply needs systematic reconditioning through appropriate progressive resistance training.