Well Being: A push-up enthusiast is warned to lay off

My approach to exercise is strictly Thoreauvian - simplify, simplify! That's why I'm a big fan of body-weight exercise - push-ups, pull-ups, sit-ups, etc. Because resistance is supplied by your body weight, no fancy equipment is necessary, and the exercises can be performed just about any time, any place.

When I go on long road trips, I always drop for 50 push-ups when I stop to get gas or a meal. At work, I keep push-up stands handy. Several times a day, I'll pump fresh blood into my weary brain by knocking out a set of 25. Push-up stands keep your hands clean and enable you to drop deep and thoroughly expand and tax the muscles of your chest and shoulders.

Despite several severe shoulder injuries, I've been able to continue my push-up regimen (I do 50 before I retire at night) with no negative consequences, even though I'm 62 years old. But John Fenlin believes I'm foolish and courting disaster. To put it more bluntly, he thinks I'm crazy.

Fenlin, 75, is an orthopedic surgeon with the Rothman Institute of Thomas Jefferson University. His specialty is the shoulder. He repairs about eight rotator-cuff tears a week and performs about 40 shoulder replacements a year for those whose shoulders are beyond salvaging through natural means.

Fenlin and I have a history. Back in the late '90s, when I ripped up my left rotator cuff in a series of stupid accidents, Fenlin recommended strongly that I undergo surgery. One of my tendons was torn, he said, and like a snapped rubber band it was not going to mend itself. Over time, it would retract and atrophy and down the road I'd likely succumb to "cuff-tear arthropathy."

Macho bozo that I am, I disregarded his advice and was able to rehabilitate my shoulder through careful graduated weight training. When I saw Fenlin the other day, he was impressed by how well my shoulder had healed and functions. I had enlisted ancillary muscles to compensate for the torn tendon, he said, but he warned that though my shoulder is asymptomatic now, it might begin troubling me as I age.

Push-ups, he said, are not going to help. In fact, Fenlin recommends that all men over 40 stop doing push-ups, as well as other body-weight exercises such as pull-ups and dips.

"A push-up is a complex movement for the shoulder joint," Fenlin says. "It involves multiple muscle groups simultaneously. The shoulder is in an awkward position, and because you're working against your body weight, which is static, you can't control or vary the resistance."

If you're a high school or college athlete or a Marine recruit, with young healthy shoulders, push-ups aren't a problem, Fenlin says. But in middle age, while our muscles stay reasonably strong, the tendons that attach them to bone weaken, becoming less elastic and more prone to tears. This tendency can be aggravated by impingements and bone spurs, which abrade tendons, irritating and inflaming them, fraying them like a rope tugged repeatedly back and forth over a sharp edge, weakening them even more.

The other problem with push-ups is their macho allure. Push-ups invite competition. Tell a couple of young bucks to drop for 25 and before you know it they're competing to see who can do the most, a contest often encouraged by football coaches and drill sergeants.

Again, this is relatively harmless for fit guys in their 20s. It's another story for a couple of former wrestlers or rugby players, who meet at their 25th college reunion and, fortified by several beers, decide to prove who's the most manly by seeing who can knock out the most push-ups. These are the blokes likely to show up at Fenlin's office the following week with ripped-up rotator cuffs, torn biceps, or stretched labrums.

Bodybuilders are especially prone to such excess. So much of their ego revolves around their strength that it's difficult for them to concede the limitations of aging. Fenlin once performed surgery on a bodybuilder in his 50s who had rotator cuff tears in both shoulders, he told me. Normally, such an operation requires six months of healing. Six weeks after surgery, the bodybuilder was back in the gym, pumping iron. He wrecked his shoulders again and required a second operation. Says Fenlin: "He was addicted. He just couldn't stop. These guys refuse to back off from what they used to do and they'll do it till they die."

What does Fenlin recommend for more normal folks of a certain age?

Again, quit body-weight exercises - push-ups, pull-ups, dips - after age 40.

Don't perform an exercise to failure. In doing so, your body is likely to become misaligned and unstable, which can lead to injury.

Don't compete with a friend. "Macho is cool," Fenlin says, "but be smart."

Don't let a personal trainer push you beyond what's comfortable.

When it comes to the shoulder, flexibility is far more important than strength. Stretching is better than resistance training for the health of the shoulder, especially the rotator cuff, because as we age we become not only weaker but also stiffer.

Work out with free weights and machines so you can control the resistance and stay in alignment.

Use low weight and perform high reps.

"I recommend 20 reps in perfect form," Fenlin says. "You'll never grow muscle or bulk up. You'll never be a power lifter or bodybuilder, but you can be fit and toned, and chances are, you won't have to see me.

"Once you reach age 40, you should never work to failure. You should strive instead for perfect form."