Top 5 Fridays! 5 Considerations for the Prone Press Up

Today's Top 5 Friday topic is 5 Considerations for the Prone Press Up Exercise.

The simplicity and effectiveness of this exercise is often negated by incorrect prescription and performance. Here are keys to proper form, which leads to better outcomes. Do not abandon this exercise when extension is the directional preference just because it does not seem to be working!

1) Elbow fully extended or keep the hips on the table?

The answer is.... make sure the patient extends the elbows fully
in case of tight hip flexors, lumbar extension may be limited
if the key to derangement reduction or stretching dysfunction is end range, end range, end range, the patient is not reaching end range by keeping the hips down
elbows in full extension allows for slight hip sagging, which allows gravity to take the hips/pelvis into a slightly more sagged position, thus getting a bit more extension

I have seen arguments for hips on the table, but this is the way I was trained in fellowship by my mentor, and I stick to it also because it gets more results.

2) Make sure the patient is passively extending the lumbar spine

patients often use their erectors to assist this motion
the cue is only use your arms and chest muscles
passive extension leads to greater ROM and increases the derangement reduction force
this occasionally also makes the motion more comfortable if there was PDM

3) The patient should also be relaxing their LEs - easily seen if the seesaw on the way back down - LEs lift as the body lowers

this can also limit extension by firing the lumbar extensors with the hip extensors
if they are contracting their gluts or hamstrings, you can passively internally rotate the hips to prevent contration

4) Extend the cervical spine at the end of the press-up

this also promotes further extension, are you seeing a pattern?

5) Pain

if it hurts during the motion, it's ok as long as it does not REMAIN worse
patients often stop during mid range if it hurts
you do not know how the motion will affect the symptoms unless you push to end range (in the presence of severe dysfunction, they may need significant OMPT)
pain that increases proximally is ok, as long as it decreases distally

i.e. patient reports lumbar pain increasing, but calf pain is gone - that is centralization and a good prognosticator of positive outcomes

all centralization, improvements in motion, and decrease in Sx should remain when loaded (WB) if the exercise is effective
occasionally self mobilization, or repeated extension in lying/standing is needed hourly for days for permanent effect
don't beat a dead horse!

this exercise works or it doesn't
you can come back to it after some hip IASTM, functional release, thoracic STM and mobilization to see if it is more effective