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.
- prone: flat or on elbows
- standing over the patient on either side of the table
- 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.
Keeping it Eclectic...