Top 5 Fridays! 5 Ways to Get the Most Out of Your Prone Press Up for Low Back Pain

with baby overpressure

The prone press up, or repeated extension in lying is one of the best exercises to both prevent and treat uncomplicated low back pain.

However, like any movement and/or exercise, there are ways to get more out of it by making it more efficient. Here are 5 Ways to Improve Your Prone Press Up for Low Back Pain

1) Straighten out your arms all the way

when asked, should you keep your hips on the table/floor or straighten your arms out all the way, most patients and clinicians believe keeping the hips down is more important
however, the goal is to get to end range lumbar extension, and in cases where the spine and/or hips are lacking extension, you most likely are not getting to end range unless you let the hips rise, then sag with relaxation and gravity

2) Make it passive extension

The prone press up is not a segmental yoga cobra, to be performed using active lumbar erectors
this often limits extension unless you have very good motor control and have no perceived threat to this movement
I cue patients to use only their arms and chest and to relax their back, gluts, and hamstrings
passive extension gets to end range, which works better for the neurophysiologic reset, remember, end range is where the magic happens

3) Tilt the head and neck back at the end of the movement

many patients start extending the head and neck immediately
this often has the effect of firing the spinal extensors, plus gives them a false sense of how far back they are extending
the full arm elbow extension and spinal extension should occur first, then they can actively tilt their head and neck back to get a little more end range and slack the posterior chain

4) Sag modifications

a progression to the standard press up is to "sag" or exhale and let your body relax after each rep
I find holding the pressup and performing 3-5 diaphragmatic breaths, with full exhalation and holding the end of the exhale for 3 seconds or so before the next inhale works to decrease excessive tone/threat and gets to end range faster and more comfortably rather than doing one "sag" per rep

5) start in quadruped first, then let the hips drop

sometimes a patient cannot to a prone press up due to perceived threat to extension, pain during the motion they are unable to press through, or maybe even a lack of upper body strength
starting in quadruped first, lock the elbows and let the hips drop passively then tilt the head neck back at the end
this is one of my favorites to do after a few sets of kettlebell swings, deadlifts, or squats, just in case I had any butt wink
this is also my go to when gardening, cleaning or any other repetitive ADL that requires lumbar unloading
it's the perfect way to introduce variability to a lumbar spine that is unloaded more than loaded