Top 5 Fridays! 5 Considerations for the Prone Press Up | Modern Manual Therapy Blog

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


13 comments:

  1. Good post, definitely useful info! What are your thoughts on breathing out at end range and do you hold for a period of time?

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  2. I definitely progress to "sags" within at least 1-2 visits, especially if Sx are better, but not abolished and they have hit a plateau with self treatment. Sags typically are held for 2-3 seconds at the end range.

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  3. Finally, Dr. E, a post I already had some knowledge on! I have learned so many new things from your blog, it's nice to feel a little "in the know" with this one!

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  4. Finally, Dr. E, a post I already had some knowledge on! I have learned so many new things from your blog, it's nice to feel a little "in the know" with this one!

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  5. Wish I could. You covered what I knew and more! Loved the tip about passive IR at the hips to relax the gluts. That was always hard to cue verbally.

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  6. I wonder why to do the press up? if we know that it can't "milk the disc forward" and can't reduce the bulge or extrusion

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  7. You should review your research! Some radiology studies show a minor disc protrusion can be reduced with this passively. Also, even if that is ever completely debunked, the movement and system itself are very well proven effective for acute and chronic lower back pain conditions.

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  8. Erson,
    I hope you could open/see the picture that i attach to this comment.
    Do you recognize the paper and/or author?
    What you think about his thoughts?

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  9. Erson,
    I hope you could open/see the picture that i attach to this comment.
    Do you recognize the paper and/or author?
    What you think about his thoughts?

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  10. Yes, I've of course seen those, again, regardless of the mechanism, the MOVEMENTs are helpful, it is most likely neurologic more than mechanical. However, the study that proved were minor disc protrusions by Charles April, a radiologist. Forget the mechanism and use the movement as a treatment and assessment. It's so easy, why wouldn't you do it? It also promotes centralization and increase of an osteokinematic motion that is often lost in many lower back pain patients.

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  11. I take The picture in my previous comment from a lecture/paper of Stanely Paris. (That the reason i ask you if you know the paper/author).
    I attach link for the paper, the pages that linked to our conversation are 15-17.
    The paper is very interesting.

    http://www.aaompt.org/education/conference11/handouts/distinguished_lecture_paris.pdf

    Waiting to hear your proffesional opinion

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  12. Yeah, I knew it was Paris, I went to his school! The funny thing is, he doesn't like the disc theory, and that's fine. That doesn't stop him from actually prescribing pressups as an exercise. He just thinks it's from a different mechanism. Paris also thinks specificity is still needed for manipulation. It's not.

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