Using Low Threshold Strategy to Improve Multisegmental Extension | Modern Manual Therapy Blog

Using Low Threshold Strategy to Improve Multisegmental Extension

How do you know someone should have a rapid response in any movement? A good indication is when actively, the movement is limited and/or painful, but passively it is significantly better and/or pain free.

This would indicate a motor control/stability issue, not issues in the tissues. Stop stretching and prescribe some stability!

All kinds of movement reeducation work here from

  • scapula stability for upper quarter
  • pattern assisted active straight leg raise for lower quarter 
  • rolling patterns for overall diagonal motor control anteriorly and posteriorly
Here is a quick case of a low threshold strategy to improve MSE.

MSE DP prior to adductor squeeze

MSE much improved, and now DN after adductor squeeze
When you think stability don't always go high threshold planks, that may be appropriate in some cases, but often not when the patient is in pain. Low threshold strategies are much less threatening, often easier to perform and cue. In this case, using an airex pad in between the knees, the patient was instructed to squeeze lightly and to engage her pelvic floor as if she was stopping the flow of urine. Her MSE motion improved significantly and was no longer painful. This was also instructed for HEP.

The next time an active movement is painful, possibly repeated extension in standing, sidegliding in standing, and the patient is hesitant to perform the reset, try a light adductor squeeze and pelvic floor engagement. Elimination of pain during a movement increases compliance which of course greatly enhances outcomes!

Keeping it Eclectic....


  1. Cool..looks like Toe Touch Pattern getting better with adductor is the opposite actually. Thank you

  2. It can be either pattern, it's just a cue for the adductors, which in turn may facilitate pelvic floor and thus enhance mobility through proximal stability.