Top 5 Fridays! 5 Prone Pressup Variations | Modern Manual Therapy Blog

Top 5 Fridays! 5 Prone Pressup Variations

There is nothing like a simple prone pressup to help with central, bilateral, or not far lateral lumbar derangements! Here are 5 variations.

before (I use fists because it's easier on my wrists)


1) The standard pressup

  • have to make sure you're doing the first correctly before you vary it!
  • the patient should be instructed to only use the arm and chest muscles to initiate the movement 
  • no lumbar erectors, hamstrings, or gluts should be activated
  • if so, turn the feet inward to inhibit the gluts
  • make sure the hips stay relaxed, but if it's between straightening the elbows, or keeping the hips down, go for straight elbows (gets to end range better)
  • at the end of the motion, extend the head and neck to further relax the back and go into more extension
    • extending the head first makes a patient feel like they're going into more extension than they really are and tends to kick in the extensors
"Roadkill" for right lower quarter 

2) The "Roadkill"
  • nicknamed by an MDT Diplomat's patient who stated lying like they were roadkill centralized and abolished their lumbar complaints
  • for unilateral complaints
  • the leg that is up is the
    • side they are more limited in sidegliding TOWARD
    • the side of the more distal complaints, i.e. LE pain bilaterally, but right leg is below the knee, left leg is into the thigh, so the leg that is biased is the right side
  • perform the rest as above, but naturally the hips will raise off of the mat/bed, plinth more due to the unilateral loading

after, the prone on elbows "walk over"

3) "roadkill" elbow walks
  • this is a regression if they cannot centralize or remain better with the above, or tolerate full pressup
  • have them start prone with involved LE in roadkill
  • wait for 3-5 minutes, possibly with moist heat on the lower back
  • then progress to prone on elbows in roadkill
    • to further reduce the derangement, have them walk their upper body toward loading the involved side
    • they can get to end range, then walk on and off or sway their trunk, pressure on/pressure off to help with derangement reduction
before, is it a cat-camel?

nope, it's a repeated extension in lying!

4) quadruped hip drops
  • this is my gardening, floor cleaner's low back pain prevention strategy
  • this also works for people who do not have enough upper body strength to perform a pressup
  • start in quadruped, arms straight elbows locked, and drop the hips forward
  • this works great with a few diaphragmatic breaths to help you relax into end range
partial WB repeated extensions

5) partial WB, hands on a table or chair repeated extension
  • if prone pressup is not quite reducing it, but the patient is not able to tolerate full load, try this in between regression from REIS
  • have the patient place their hands on a table/plinth and they rock their hips forward similar to #4 hip drops
  • make sure they are keeping their scapula in neutral
  • another advantage is a patient can perform it anywhere, unlike the prone pressup at work
  • this gets the benefit of being in a partially WB position and enables good transition to repeated extension in standing, where you want the patient to eventually go as it's a WB loading/unloading strategy and thus easier to perform more regularly
Staying Eclectic and ready to rock my hometown of Pittsburgh for the Pitt-Marquette Challenge!


  1. Do you still use extension in lying with hips offset (versus "roadkill")? "Roadkill" as progression?

  2. Anders, very rarely. I found patients have difficulty getting into the position correctly, and often shift/rotate or do not get to end range, so it was not as effective at reducing the derangement.

  3. The therapists at Orthopaedics Plus in Burlington, MA helped me so much with stretching and motion after I hurt my back and knee in an accident last year. Check out their site at