Clinical Pearl: Getting to End Range for Extension in Standing

Where The Manual Therapist happens daily!

Patients often find the extension in standing exercise less effective than extension in lying for lower back pain. This is most likely because the extension in lying is easier for them to achieve end range.

Benefits of EIS vs EIL

• can perform it anywhere, so it is done more frequently
• is WB and thus more conducive to function
• arm strength not required

EIS Cons

• may be more threatening if patient has more pain with WB
• may be unsafe for patient's with balance or vestibular issues

neutral

Starting in anterior pelvic tilt for hypermobile

Some patients have difficulty getting to end range in EIS because they are hypermobile. If this is true, just have them start with an anterior pelvic tilt prior to performing the extension in standing. Many patients also often "cheat" by flexing their knees and bringing their hips forward, thus not getting to end range lumbar extension. If this is the case, have them perform it with either the front of their thighs (my preferred modification) or the back of their thighs against a table or other stationary object. This really helps a patient attain end range in standing, thus helping to reduce the derangement/reset the area.

Keeping it Eclectic...