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