Clinical Pearl: A Novel Way to Regain Prone Extension for Lower Back Pain

There is no doubt that the prone press-up is a great exercise to relieve lumbar pain and centralize radiating leg pain.

Why it works is of course some debate, it may or may not reduce a disc protrusion, but this post is not to rehash that. Some patients will have fear of this motion, since it is probably something they have never done, or an uninformed clinician told them extension was "bad" for their back.

If your patient has a painful block, there is no need to have them keep hammering away at the perceived barrier. A little OMPT can help

light IASTM to the paraspinals
some P/A mobs in a slow grade 3 on various levels of the lumbar spine

However, some patients will be touch adverse, or in the past, not responded well to an overly aggressive pair of hands or instruments. This Clinical Pearl is for those patients.

Patient Position:

prone: flat or on elbows

Therapist Position

standing over the patient on either side of the table

Technique

place on hand on a posterior scapula and the other on the contralateral thigh

i.e. left posterior scapula, right posterior thigh

apply light graded pressure to both areas and have the patient resist into a diagonal extension pattern
hold each pressure on/pressure off 3-4 reps, 3-5 seconds each
repeat on the opposite side
have the patient re-test the prone press-up and see if they regain more pain free extension and are able to get over that perceive barrier

Try it the next time your patient has a painful block to extension, and has fear avoidance to direct treatment anywhere around the lumbar spine. This way, you get to use PNF for hands on facilitation of movement, but stay away from any perceived threat to the area being protected.